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In previous studies, surgical specialties accounted for most malpractice claims. The objective of the present study was to determine the risk for malpractice claims for physicians working in hospitals. A retrospective observational study using anonymized closed malpractice claims between 2007 up to 2021 from two Dutch insurers was carried out. Main outcomes involved claim volume & outcome, and the estimated annual risk (EAR) for a claim per year for the individual physician from all specialties. Sustained or settled claims were considered unfavorable for the physician (UOP). Surgical specialists, involving surgical specialties and specialties with surgical characteristics accounted for 77% (14,330/18,649) of the claims closed. Liability was denied in 51% of the claims (n = 9,487). The remaining claims were sustained (granted) (n = 4,600; 25%), settled (n = 3,444; 18%) or closed without decision (n = 1118; 6%). Surgeons faced an average EAR of 21.6% (range 6.5 − 28%) which was higher compared to colleagues from specialties with surgical characteristics (EAR 7.3%; range 2.9 − 10.1%) and non-surgical specialties (EAR 2.5%; range 0.9 − 4.4%). Surgical specialists received more claims than their non-surgical colleagues. Relative to specialty size, surgeons faced a higher risk for a claim in general, as well as for a claim with an unfavorable outcome. [ABSTRACT FROM AUTHOR]

Copyright of Angle Health Law Review is the property of Angle Publishing Co., Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract In previous studies, surgical specialties accounted for most malpractice claims. The objective of the present study was to determine the risk for malpractice claims for physicians working in hospitals. A retrospective observational study using anonymized closed malpractice claims between 2007 up to 2021 from two Dutch insurers was carried out. Main outcomes involved claim volume & outcome, and the estimated annual risk (EAR) for a claim per year for the individual physician from all specialties. Sustained or settled claims were considered unfavorable for the physician (UOP). Surgical specialists, involving surgical specialties and specialties with surgical characteristics accounted for 77% (14,330/18,649) of the claims closed. Liability was denied in 51% of the claims (n = 9,487). The remaining claims were sustained (granted) (n = 4,600; 25%), settled (n = 3,444; 18%) or closed without decision (n = 1118; 6%). Surgeons faced an average EAR of 21.6% (range 6.5 − 28%) which was higher compared to colleagues from specialties with surgical characteristics (EAR 7.3%; range 2.9 − 10.1%) and non-surgical specialties (EAR 2.5%; range 0.9 − 4.4%). Surgical specialists received more claims than their non-surgical colleagues. Relative to specialty size, surgeons faced a higher risk for a claim in general, as well as for a claim with an unfavorable outcome.

We study the potential impact of the legal vulnerability created by ubiquitous information technology (IT) and provide insights into its unintended consequences in a typical healthcare screening context. Screening policies determine the level of care provision (i.e., whether to conduct a test) based on patient risk information. If IT shares risk information with physicians in the testing stage, follow-up decisions may be more accurate. Yet, physicians may also face heightened legal risk from increased information visibility. In this context, we examine the socially optimal screening (based on risk information) and follow-up policies (based on risk and test information). Litigation is generally associated with the overutilization of health care because of physicians' defensive medicine practices. In contrast, we find that the strategic underprovisioning of health care through screening policies could be a consequence of information sharing in the presence of litigation concerns. The underprovisioning of health care is aggravated if the precision of risk information relative to that of the medical test increases or the physician becomes more self-interested and less patient oriented. However, limits on malpractice damages can alleviate the underprovisioning of health care. [ABSTRACT FROM AUTHOR]

With medical litigation on the rise, physicians require a nuanced understanding of the legalities of consenting patients to reduce their liability while practising evidence-based medicine. This study aims to a) clarify the legal duties of gastroenterologists in the UK and USA when gaining informed consent and b) provide recommendations at the international and physician level to improve the consent process and reduce liability. A bibliometric analysis of the Web of Science database with the MeSH terms "gastroenterology" and "informed consent" yielded 383 articles, of which 228 were excluded due to not meeting the inclusion criteria. Of the top 50 articles, 48% were from American institutions and 16% were from the UK. Thematic analysis showed 72% of the articles discussed informed consent in relation to diagnostic procedures, 14% regarding treatment, and 14% regarding research participation. Both the USA and the UK have progressed from previously paternalistic Natanson case (1960) and Bolam test (1957), respectively, where physicians were held to the standard of a "reasonable and prudent medical doctor". The American Canterbury case (1972) and the British Montgomery case (2015) radically shifted the standard of disclosure during the consent process by requiring physicians to explain all information pertinent to a "reasonable patient". It is our recommendation that a two-pronged approach be taken; a) creation of international guidelines for consenting patients for invasive procedures in gastroenterology, and b) development of internationally standardised endoscopy consent forms containing all the details pertinent to a "reasonable patient". [ABSTRACT FROM AUTHOR]

Background/Aims As the number of lower gastrointestinal endoscopies and high-risk examinees increases, the incidence of adverse events related to lower gastrointestinal endoscopy is also increasing. In addition, medical dispute and lawsuits related to the adverse events are also rapidly increasing. Methods Medical disputes related to lower gastrointestinal endoscopy that had been filed in Korea Medical Dispute Mediation and Arbitration Agency (K-medi) between April 2012 and August 2020 were evaluated with the corresponding medical records and written appraisal. Facility, patient, procedure, adverse events, and outcome-related variables related to the medical disputes were analyzed. Results As the number of cases of lower gastrointestinal endoscopy in Korea increases each year, the number of medical disputes related to lower gastrointestinal endoscopy appraised by K-medi also increased every year during the same period. Among a total of 121 cases analyzed, 86 cases (71.1%) were to conciliation, and 35 cases (28.9%) were consigned by the prosecution. Perforation cases accounted for the largest proportion (90 cases, 76.9%). Most of the cases 119, 98.3%) were performed non-emergent procedure and only 10 cases (8.3%) were performed with therapeutic purpose. About a fifth (25 cases, 20.7%) were cases of deceased patients. Conclusion Medical disputes related to lower gastrointestinal endoscopies are increasing, and in order to prevent them in the future, it is important to review data on existing cases and establish specific response guidelines. [ABSTRACT FROM AUTHOR]

Copyright of Angle Health Law Review is the property of Angle Publishing Co., Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Clinical innovation is essential in the development and improvement of interventions used to treat medical conditions. In Australia, the States and Territories have statutorily reintroduced the Bolam principle in a modified form which provides a defence for medical practitioners who have practised in a manner that, at the time, was widely accepted in Australia by peer professional opinion as competent professional practice. This article explores whether the standard could be successfully pleaded as a defence by experimental practitioners. In doing so, the obstacles to an experimental practitioner's ability to rely on the statutory defence are analysed. It finds that the standard effectively entrenches established practices without sheltering legitimate efforts to advance medicine. [ABSTRACT FROM AUTHOR]

The health profession is considered to be one of the noblest professions in the world. While Indian medical infrastructure is being noticed and praised on the global map, on the contrary, the doctor-patient relationship is deteriorating, our internal medical setup is facing extensive problems with consumer cases/medical litigation fast becoming one of the most serious of all issues. The number of cases against ophthalmologists for malpractice is increasing. While very few cases may be legitimate and based on clinical negligence exercised by the doctors, most medical professionals are wrongfully accused because of the lack of public understanding. The eye care professionals must communicate empathetically, emphasize diligent service delivery and also maintain proper records about the patient history, examination, consent, treatment and follow-up, and referral. Eye camp surgery should be done only in the operation theater of the hospital set up and the permissible number of cataract-IOL surgery can be done following all checklist/protocols and precautions. Lawsuits for medical negligence in ophthalmic practice can be minimized or avoided by following surgical checklists, protocols, proper documentation (maintaining medical records), taking informed consent, communication about the cost and outcome of the procedure or treatment, timely referral of the patient (in case of any complication), and obtaining adequate professional liability insurance.

Objective: Increasing obstetric medical litigations had great impacts in health care system resulted in lower recruitment of residents and higher medical cost of defensive medicine in Taiwan. In order to reduce medical litigation, the “Childbirth Accident Emergency Relief Act” was implemented in June 2016. This study presented five-year results of a novel childbirth accident compensation system. Materials and methods: The purpose of the Relief Act was to establish a national relief system to ensure timely relief, reduce medical disputes, promote the partnership between patient and medical personnel. The compensations included maximal 2 million NTD for maternal death, maximal 0.3 million NTD for neonatal and fetal deaths, and 3, 2, and 1.5 million NTD for maternal or neonatal profound, severe, and moderate disabilities, respectively. Puerperal hysterectomy was included with maximal 0.8 million NTD compensation. Results: Since June 30, 2016 to June 30, 2021, there were 1340 applications reviewed by Committee and 1258 were approved with total relief of 744.7 million NTD (26.6 million USD) with approve rate of 93.9%. It took an average of 109.8 days to start application from childbirth and 102.4 days to get compensation from application. 66.1% of accident victims agreed this system can restore doctor–patient relationship by immediate care and assistance from medical institutions. Conclusion: The Relief Act is the first government leading compensation system to establish a national relief system. It was enacted to reduce medical disputes, promote the partnership between patient and medical personnel, and enhance health and safety of women during childbirth. A no-fault compensation would be an efficient alternative disputes resolution to childbirth accidents.

The timing of umbilical cord and placental thrombosis in the third trimester intrauterine fetal death (TT-IUFD) may be fundamental for medico-legal purposes, when it undergoes medical litigation due to the absence of risk factors. Authors apply to human TT-IUFD cases a protocol, which includes histochemistry and immunohistochemistry (IHC) for the assessment of thrombi's chronology. A total of 35 thrombi of umbilical cord and/or placenta were assessed: 2 in umbilical artery, 6 in umbilical vein, 15 in insertion, 10 in chorionic vessels, 1 in fetal renal vein, 1 in fetal brachiocephalic vein. Thrombi's features were evaluated with hematoxylin–eosin, Picro-Mallory, Von Kossa, Perls, and immunohistochemistry for CD15, CD68, CD31, CD61, and Smooth Muscle Actin. The estimation of the age of the thrombi was established by applying neutrophils/macrophages ratio taking into consideration, according to literature, the presence of hemosiderophagi, calcium deposition, and angiogenesis. To estimate an approximate age of fresh thrombi (< 1 day), a non-linear regression model was tested. Results were compared to maternal risk factors, fetal time of death estimated at autopsy, mechanism, and cause of death. Our study confirms that the maternal risk factors for fetal intrauterine death and the pathologies of the cord, followed by those of the placental parenchyma, are the conditions that are most frequently associated with the presence of thrombi. Results obtained with histological stainings document that the neutrophile/macrophage ratio is a useful tool for determining placental thrombi's age. Age estimation of thrombi on the first day is very challenging; therefore, the study presented suggests the N/M ratio as a parameter to be used, together with others, i.e., hemosiderophagi, calcium deposition, and angiogenesis, for thrombi's age determination, and hypothesizes that its usefulness regards particularly the first days when all other parameters are negative. [ABSTRACT FROM AUTHOR]

Abstract Background Healthcare professionals who experience trauma due to patient safety incidents can be considered second victims, and they also suffer from various difficulties. In order to support second victims, it is necessary to determine the circumstances of the incidents in question, along with the symptoms that the victims are experiencing and the support they require. A qualitative study on healthcare professionals of various occupations, such as physicians and nurses working in Korea, was conducted, and the experiences and response methods and processes of second victims were examined. Methods In-depth interviews were conducted with 16 healthcare professionals (six physicians, eight nurses, and two pharmacists) who had experienced a patient safety incident. All interviews were recorded and transcribed, and the data analysis was conducted in accordance with Strauss and Corbin’s grounded theory. Both open coding and axial coding were performed. Consolidated criteria for reporting qualitative research (COREQ) were applied in this study. Results The results of the open coding demonstrated that the experiences of second victims can be categorized into “the reactions of the first victim and surrounding people after the incident,” “Influence of factors aside from the incident,” “the initial complex responses of the participants to the incident,” “open discussion of the incident,” “the culture in medical institutions regarding early-stage incident response,” “the coping responses of the participants after incidents,” and “living with the incident.” Then, the seven categories in the open coding stage were rearranged according to the paradigm model, and the reaction process of the second victims was analyzed through process analysis, being divided into the “entanglement stage,” “agitating stage,” “struggling stage,” “managing stage,” and “indurating stage.” Conclusions This research is significant because it provides a comprehensive understanding of second victims’ experiences in the eastern region of Korea, by obtaining data using a qualitative research method. The findings of the study also highlight the five stages of the second victim response process, and can be used to design a specialized second victim support program in Korea.

This study aims to demonstrate a comprehensive understanding of the life experience of victims of medical accidents after medical accidents and medical litigations. A single victim of a medical accident participated in the study. Six upper categories were derived as the results: “frustration and anger toward medical accident occurrence,” “desolated struggle for medical litigation,” “distrust of medical litigation related legal profession,” “accepting myself with a disability caused by a medical accident,” “a life with far more unexpected challenges as an athlete with disabilities,” and “find new meaning after the medical accident.” The participant was experiencing physical and psychological distress in the process of accepting the medical accident and the disability. In addition, the participant was exposed to the secondary psychological distress from the medical profession, lawyer, and legal profession in the peculiar situation of medical litigation, and to the third psychological distress in life living as a disabled person.

This study aims to demonstrate a comprehensive understanding of the life experience of victims of medical accidents after medical accidents and medical litigations. A single victim of a medical accident participated in the study. Six upper categories were derived as the results: "frustration and anger toward medical accident occurrence," "desolated struggle for medical litigation," "distrust of medical litigation related legal profession," "accepting myself with a disability caused by a medical accident," "a life with far more unexpected challenges as an athlete with disabilities," and "find new meaning after the medical accident." The participant was experiencing physical and psychological distress in the process of accepting the medical accident and the disability. In addition, the participant was exposed to the secondary psychological distress from the medical profession, lawyer, and legal profession in the peculiar situation of medical litigation, and to the third psychological distress in life living as a disabled person. [ABSTRACT FROM AUTHOR]

The acquisition of signed informed consent is not always enough to ensure adequate medical protection. Particularly, in plastic surgery, improving the doctor–patient relationship by understanding the patient's emotions and expectations becomes a determining factor when choosing the best therapeutic strategy for the subject in question, which may also include nonsurgical eligibility. Ninety patients with various plastic surgery disabilities were recruited and randomly divided into three groups: Patients in the first group underwent the ''traditional'' clinical interview, those in the second underwent the clinical approach called Shared Decision Making (SDM), and those in the third group received both the SDM and a questionnaire evaluating patient expectations (Expectation Questionnaire-Pgm). At the end of each interview, a specialist physician in Plastic, Reconstructive and Aesthetic Surgery was asked to fill in a questionnaire regarding his/her satisfaction with the method used. Likewise, the patient filled in a questionnaire on his/her satisfaction with the interview. For the doctors, the third method was superior in investigating patient expectations, emotions, and personal preferences. For the patients, the third method scored significantly higher than the first one for overall satisfaction and ability to evaluate personal preferences and needs and higher than the first and second methods in assessing expectations. For doctors, the SDM coupled with the Expectation Questionnaire-Pgm proved to be the most useful tool to understand patient expectations and emotions and thus improve the medical-patient relationship through shared decision-making. The third method therefore aims for better patient coverage and improved informed consent, thereby reducing the likelihood of litigation and better assessing nonfitness for operation. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals who experience trauma due to patient safety incidents can be considered second victims, and they also suffer from various difficulties. In order to support second victims, it is necessary to determine the circumstances of the incidents in question, along with the symptoms that the victims are experiencing and the support they require. A qualitative study on healthcare professionals of various occupations, such as physicians and nurses working in Korea, was conducted, and the experiences and response methods and processes of second victims were examined.Methods: In-depth interviews were conducted with 16 healthcare professionals (six physicians, eight nurses, and two pharmacists) who had experienced a patient safety incident. All interviews were recorded and transcribed, and the data analysis was conducted in accordance with Strauss and Corbin's grounded theory. Both open coding and axial coding were performed. Consolidated criteria for reporting qualitative research (COREQ) were applied in this study.Results: The results of the open coding demonstrated that the experiences of second victims can be categorized into "the reactions of the first victim and surrounding people after the incident," "Influence of factors aside from the incident," "the initial complex responses of the participants to the incident," "open discussion of the incident," "the culture in medical institutions regarding early-stage incident response," "the coping responses of the participants after incidents," and "living with the incident." Then, the seven categories in the open coding stage were rearranged according to the paradigm model, and the reaction process of the second victims was analyzed through process analysis, being divided into the "entanglement stage," "agitating stage," "struggling stage," "managing stage," and "indurating stage."Conclusions: This research is significant because it provides a comprehensive understanding of second victims' experiences in the eastern region of Korea, by obtaining data using a qualitative research method. The findings of the study also highlight the five stages of the second victim response process, and can be used to design a specialized second victim support program in Korea. [ABSTRACT FROM AUTHOR]

Background: In Austria, elaborate definitions exist for the undesirable medical events side effect, adverse event, complication and medical malpractice. We aimed at investigating whether the official definitions for the abovementioned terms can be understood by a sample population representing a cross-section of the Austrian population.Methods: In this study 1021 Austrian citizens were interviewed. Demographic parameters (age, gender, occupation, level of education, monthly income, number of inhabitants at place of residence) were assessed. Participants were told the official definitions for complication, side effect, adverse event and medical malpractice and asked to select the correct definition for "complication". The impact of sample characteristics on the ability to identify the correct definition was investigated.Results: Of the participants 315 (31%) identified the correct definition of a complication. Almost the same number (n = 302, 30%; χ2 for single samples: p = 0.087) falsely selected the definition for side effect. Significantly fewer (both p < 0.001) chose the definitions for adverse event (n = 220, 22%) and medical malpractice (n = 155, 15%). Only the respective state of origin showed significant influence on the probability of choosing the correct definition out of the four. The probability was highest in Vorarlberg (0.400) and lowest in Upper Austria (0.216, p < 0.001).Conclusion: For the majority the present official definitions for undesirable medical events are too complex to understand. Simple definitions for undesirable medical events should be included into patient education. [ABSTRACT FROM AUTHOR]

In the past 10 years, medical malpractice litigations have become a serious public health and social issues in China. This study aims to evaluate the medical malpractice litigations in Beijing. A retrospective study was conducted using the database from the Key Laboratory of Evidence Science (KLES) at China University of Political Science and Law (CUPL) to demonstrate the extent and characteristics of the alleged medical malpractice cases and the conclusions of forensic evaluation from 2002 to 2011 in Beijing. A total of 1515 alleged medical malpractice cases were investigated by forensic medical experts at KLES-CUPL during the study period. Of the 1515 cases, 45.2% were male patients and 54.8% were female patients. The age of the patients ranged from newborn to 90 years, with average age of 44 years. The alleged medical malpractice cases involved 11.3% of newborns. From 2002 to 2006, the average number of medical malpractice litigations was 123 cases per year, while from 2007 to 2011, the average number of medical malpractice litigations was 180 per year, a 46% increase. Of the 1515 cases, 588 (38.8%) litigations were due to the patients' death. Clinical departments involved in claims most often were obstetrics (18.9%), followed by orthopedics (15.1%) and general surgery (11.5%). Medical error was found in 945 (62.4%) cases. Of the 945 confirmed medical malpractice cases, the top medical misadventures were diagnostic errors (36.5%), improper performance of procedures (36.4%), and medication error (12.6%). Although tertiary hospitals were more likely to be sued than the secondary and primary hospitals (63.6% vs. 36.4%), there was no significant difference between tertiary and secondary hospitals in the percentage of confirmed malpractice cases (62.3% vs. 59.4%). The primary hospitals had the highest confirmed malpractice cases (73.2%).

Aims: The aim of the review is to understand the concept of abuse in health care in general and its various forms. It includes-review of what is meant by healthcare and health care abuse; identify its various forms and to recognize who may be the most potential victims; find out the reasons of abuse by health care providers; and, know the role of ethical guidelines and institutional policy in confronting abuse in health care. Methods: Literatures and publications on the subject were searched in order to identify research studies investigating abuse in health care that were studied, analyzed and presented. Results: Abuse in health care today is an emerging concept in need of a clear analysis and definition. At the same time, boundaries to the related concepts are not demarcated. Medical professionals and institutions are being targeted worldwide today for negligence and the medical litigation has become a huge challenge. Throughout history, health care professionals have been trusted because of their competency and caring abilities. However, the disturbing reality is that physical and psychological maltreatment of patients do occur in the health care settings throughout the world. The abuse can vary from treating someone with disrespect in a way which significantly affects the person's qualify of life, to causing actual physical suffering. Differently able and dependent people are more susceptible to such abuse. Work overload, staff burnout, lack of information and instructions were also indicated to underlie instances of abuse in health care. Conclusions: We, in the healthcare facility, should first accept that abuse in health care does occur and causes distress. This change needs to occur at individual, cultural and structural level. Next step will be for the staffs to be aware of abuse in health care when it happens and recognize it as such. It is always better to create a situation where we could prevent abuse from happening at health centers. Hospital personnel must implement a change in workplace culture to stop abusive behaviors wherever they occur. Each and every health care facility should be client friendly and respecting their rights. Effective ethical guidelines were needed to minimize abuse as existing ethical codes were found to be ineffective and above all there was a lack of awareness of the contents of the relevant ethical documents. [ABSTRACT FROM AUTHOR]

Objective: To examine the epidemiologic data, identify the pattern of dispute, and determine clinical litigious errors by analyzing closed malpractice claims involving myocardial infarction (MI) in Taiwanese courts.Methods: A retrospective descriptive study was performed to analyze the verdicts pertaining to MI from the population-based database of the Taiwan judicial system between 2002 and 2013. The results of adjudication, involved specialists, primary dispute leading to lawsuits, and litigious errors were recorded.Results: A total of 36 closed malpractice claims involving MI were included. The mean interval between the incident and litigation closure was 65.5 ± 28.3 months. Nearly 20% of the cases were judged against clinicians and the mean payment was $100639 ± 49617, while the mean imprisonment sentence was 4.3 ± 1.8 months. Cardiologists and emergency physicians were involved in 56.3% of cases, but won 92.6% of lawsuits, while other specialists lost nearly 25% of lawsuits. The most common dispute was misdiagnosis (38.9%), but this dispute had the lowest percentage of loss (7.1%). Disputes regarding delayed diagnosis were judged against the defendants in 50% of claims. Clinicians lost the lawsuit in the following conditions: 1) misdiagnosis of MI in patients with typical chest pain and known coronary artery risk factors; 2) failure to perform thoughtful evaluation and series investigations in patients suspicious of ischemic heart disease; 3) failure to perform indicated treatment to avoid disease progression.Conclusions: Medical practitioners should keep a high index of MI suspicion, especially if the diagnosis and treatment of MI are beyond their daily practice. Prudent patient reevaluation, serial ECG and cardiac enzyme testing, and early consultation are suggested to reduce malpractice liability. [ABSTRACT FROM AUTHOR]

Displacement of dental implants into the maxillary sinus is one of the rare complications during the implant surgery. However, it is always possible that clinicians confront with this unexpected result and patients should be informed ahead of maxillary implant surgery. For clinicians, it is important to be aware of how to deal with the complication, because the migrated implant must be removed as early as possible. There have been several classical ways to approach the maxillary sinus, such as the Caldwell-Luc procedure and endoscopic sinus surgery and these methods still have been chosen by many surgeons although quite a lot of complications exist. In this study, the author introduced a new sinus approach technique, modified endoscopic-assisted sinus surgery (MESS) as an efficient, easy and less complication-inducing sinus approach. A clinical case was described where a displaced dental implant beneath the optic nerve was successfully removed by MESS. Furthermore, essential considerations to avoid medical litigation and maintain close rapport with the patients were discussed when dealing with the case of displaced implant in the maxillary sinus. [ABSTRACT FROM AUTHOR]

Background: The author analyzed the anesthesia medical malpractice closed claims that were referred to the Legal Health Organization (LHO) in order to evaluate the magnitude and underlying factors of the problem in Saudi Arabia. Materials and Methods: Annual reports covering the period from 1420H-1429H (1999-2008) were statistically analyzed to give mean figures and percentages in each annual report, and then demonstrated all together to run the differential analysis together with the trend along the studied period. Results: Data analysis showed an escalating trend for the total number of claims over the study period being started with 440 cases on 1420H and ended with 1356 cases by the year 1429H. The annual percentage of the final verdicts of accusation to the total number of claims presented to all committees ranges between 45.5%−60.2% with a mean value of 49.9%. Distribution of final verdicts among different clinical specialities showed that obstetrics takes the lead with a mean percentage of 25.5% along the studied period (1420H-1429H), followed by the practice of general surgery with a mean percentage of 13.8%. The sector of health care service showed a significant variation in relation to the mean number of final verdicts with accusation along the studied period, being the highest in the Ministry of Health sector with a mean number of 216.8 claims, followed by the private sector with a mean number of 197.3 claims. Conclusion: Adherence to the standards of medical practice is by far to the best approach to avoid and reduce the incidence of litigation.

Objective: To examine the epidemiologic data of closed medical claims from Taiwanese civil courts against obstetric departments and identify high-risk diseases.Design: A retrospective descriptive study.Setting/study Participants: The verdicts from the national database of the Taiwan judicial system that pertained to obstetric departments were reviewed. Between 2003 and 2012, a total of 79 closed medical claims were included.Main Outcome Measures: The epidemiologic data of litigations including the results of adjudication and the disease and outcome of the alleged injury.Results: A majority of the disputes (65.9%) were fetus-related. Four disease categories accounted for 78.5% of all claims including (i) perinatal maternal complications (25.3%); (ii) errors in antenatal screening or ultrasound diagnoses (21.5%); (iii) fetal hypoxemic-ischemia encephalopathy (16.5%); and (iv) brachial plexus injury (15.2%). Six cases (7.6%) resulted in an indemnity payment with a mean amount of $109 205. Fifty-one cases (64.6%) were closed in the district court. The mean incident-to-litigation closure time was 52.9 ± 29.3 months. All cases with indemnity payments were deemed negligent or were at least determined to be controversial by a medical appraisal, while all defendants whose care was judged as appropriate by a medical appraisal won their lawsuits.Conclusions: Almost 93% of clinicians win their cases but spend 4.5 years waiting for final adjudication. The court ruled against the clinician only if there was no appropriate response during a complication or if there was no follow-up or further testing for potential critical diseases. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to review the typical factors related to physician's liability in obstetrics and gynecology departments, as compared to those in internal medicine and surgery, regarding a breach of the duty to explain.Methods: This study involved analyzing 366 medical litigation case reports from 1990 through 2008 where the duty to explain was disputed. We examined relationships between patients, physicians, variables related to physician's explanations, and physician's breach of the duty to explain by comparing mean values and percentages in obstetrics and gynecology, internal medicine, and surgical departments with the t-test and χ(2) test.Results: When we compared the reasons for decisions in cases where the patient won, we found that the percentage of cases in which the patient's claim was recognized was the highest for both physician negligence, including errors of judgment and procedural mistakes, and breach of the duty to explain, in obstetrics and gynecology departments; breach of the duty to explain alone in internal medicine departments; and mistakes in medical procedures alone in surgical departments (p = 0.008). When comparing patients, the rate of death was significantly higher than that of other outcomes in precedents where a breach of the duty to explain was acknowledged (p = 0.046). The proportion of cases involving obstetrics and gynecology departments, in which care was claimed to be substandard at the time of treatment, and that were not argued as breach of a duty to explain, was significantly higher than those of other evaluated departments (p <0.001). However, internal medicine and surgical departments were very similar in this context. In obstetrics and gynecology departments, the proportion of cases in which it had been conceded that the duty to explain had been breached when seeking patient approval (or not) was significantly higher than in other departments (p = 0.002).Conclusion: It is important for physicians working in obstetrics and gynecology departments to carefully explain the risk of death associated with any planned procedure, and to obtain genuinely informed patient consent. [ABSTRACT FROM AUTHOR]

Medical malpractice stress syndrome can cause a range of emotions and exacerbate physical disorders. The feeling of lost personal integrity cannot be appeased only by exoneration of those acquitted of charges, but the emotional toll of litigation stress can be mitigated by education in the legal process, developing trustful relationships with the legal team, using support teams or life coaches, and participating in regular physical activity. Sharing a personal story with other defendant nurses, learning effective ways of communicating, and developing healthy coping skills allow the nurse to heal emotionally and come to terms with the lawsuit as a learning experience as discussed in this article. [ABSTRACT FROM AUTHOR]

Purpose: Recently, legal disputes resulting from medical accidents have been increasing annually. The purpose of this study is to determine the causes and characteristics of medical disputes brought as a result of neonatal accidents and to suggest measures to reduce the number of medical malpractice suits. Methods: Twenty-eight medical malpractice lawsuits brought as a result of neonatal accidents between 2005 and 2009 were analyzed. Results: The average time taken to resolve these lawsuits was approximately 4.4 years. The average gestational age and birth weight of the newborns in these cases were 35.3 ±4.2 weeks and 2,668±931 g, respectively. Twelve cases (42.9%) were concluded partially in favor of the plaintiffs, while in 10 (35.7%) cases the plaintiffs lost. In 11 of the 12 cases that were concluded partially in favor of the plaintiffs, the defendants were found guilty of violating their duty of care. Medical accidents resulted in death in 10 cases and physical disability in 18 cases, and cerebral palsy and blindness were the most common physical disabilities. The average compensation amount ordered as damages was KRW 161,389,291±12,636,454. Conclusion: In medical litigation, the standard of judgment is whether appropriate medical practices were performed based on the patient's symptoms. Thus, to comply with the medical treatment rules is paramount in securing patients' safety and protecting doctors themselves. Individual effort is necessary, but not sufficient to prevent medical accidents; multilateral, systemic reform is also required if the number of neonatal medical accidents is to be reduced. [ABSTRACT FROM AUTHOR]

Background: Although China experienced great improvement in their health system, disputes between patients and doctors have increasingly intensified, reaching an unprecedented level. Retrospective analysis of medical malpractice litigation can discover the characteristics and fundamental cause of these disagreements. Methods: We analyzed medical malpractice litigation data from 1998 to 2011 for characteristics of claims via a litigation database within a nationwide database of cases (1086 cases) in China, including claims, liabilities, injures, and compensation payments. Results: Among the cases analyzed, 76 percent of claims received compensation in civil judgment (640 out of 841), while 93 percent were fault liability in paid judgment (597 out of 640). The average time span between the occurrence of the injury dispute and closure of claims was 3 years. Twenty-two percent of claims (183 of 841) were caused by injury, poisoning, and other external causes. Seventy-nine percent of claims (472 of 597) were contributed to by errors in medical technology. The median damage compensation payment for death was significantly lower than for serious injuries (P < 0.001; death, $13270 [IQR, $7617–$23181]; serious injury, $23721 [IQR, $10367–$57058]). Finally, there was no statistically significant difference in the median mental compensation between minor injury, serious injury, and death (P = 0.836). Conclusion: The social reasons for the conflict and high payment were catastrophic out-of-pocket health-care expense in addition to the high expectations for treatment in China. There were no distinguishing features between China and other countries with respect to time of suits, facilities, and specialties in these claims. The compensation for damages indifferent medical injuries was unfair in China. [ABSTRACT FROM AUTHOR]

Consent is defined as the "voluntary agreement to or acquiescence in what another person proposes or desires". In the context of medical practice it is now universally accepted that every human being of adult years and of sound mind has the right to determine what shall be done with his or her own body. Informed consent is now a central part of medical ethics and medical law. There has been a change in the public's expectations of their role in medical decision making. The paternalistic approach by doctors is no longer acceptable. Today the patient has the right to receive and the doctor the obligation to give sufficient and appropriate information so that the patient can make an informed decision to accept or refuse a treatment option. This has led to higher standards of practice in the process of informed consent taking. Consent taking is both a legal and moral requirement. Failure to comply with standards of practice can result in criminal prosecution, civil litigation or disciplinary action by the relevant professional authority. Consent taking is a process and not merely a one-off affixation of the patient's signature on a consent form. It involves a continuous discussion to reflect the evolving nature of treatment from before the treatment is given to the post-operative or discharge period. The regulatory authorities in many countries have established standards for consent taking which would include the capacity of the patient, the person who should seek consent, the information to be provided and the necessary documentation. [ABSTRACT FROM AUTHOR]

Aim: This article aims to highlight issues related to malpractice in plastic surgery and to point out the importance of good understanding of the law and the value of a patient's written informed consent as measures of professional protection. Methods and Material: Search of relevant literature from PubMed. Results: The demand for cosmetic plastic surgery increases despite the increasing cost, in contrast to other traditional goods for which demand typically declines as price increases. Cosmetic plastic surgery has moved beyond the stage of being an exclusive privilege of the rich and famous. Nevertheless, cosmetic plastic surgery is one of the medical specialties exposed to a substantially high risk of malpractice claims. Most malpractice claims in cosmetic plastic surgery are not consequences of technical faults but because of inadequate patient selection criteria and lack of adequate communication between patient and surgeon. Proven efficient training, careful utilization of computer imaging techniques in association with the adoption of simple precautions and guidelines and adequate communication along with a completed patient's consent form are important essentials in case of medical litigation. Conclusions: In today's litigious society, maintenance of high standards in daily practice with continuous training and appropriate documentation of every procedure are all a sufficient defense of the plastic surgeon in case of medical litigation. Written patient's informed consent remains an integral part of the communication between physicians and patients, and importantly is facilitating professional protection. [ABSTRACT FROM AUTHOR]

There is increasing evidence that effective communication is a critical means by which surgeons can assist their patients to achieve the best outcomes. This paper examines the processes and outcomes of effective communication by surgeons in cancer teams, and includes: (i) strategies that promote collaborative relationships with patients and lead to more effective treatment; (ii) strategies to improve multidisciplinary team performance; and (iii) methods to minimize the risk of error and litigation. The experience of a cancer diagnosis involves radical changes in patients’ lives, somewhat akin to suddenly finding yourself in the middle of a rugby scrum for the first time. The analogy of rugby throws fresh light on such critical factors in communication as prematch preparation, orientation to the game and the team, a good kick off, sizing up the opposition, creative plays and optimizing teamwork to promote quality of life and survival. [ABSTRACT FROM AUTHOR]

Introduction/objective: Modern practice in Radiology has rapidly changed over the last decades incorporating invasive techniques. Additionally, litigation in medical practice has arisen as an important issue. This article aims to highlight issues related to malpractice in interventional radiology and endovascular therapy in order to point out the importance of the written informed consent. Methods and material: Search of relevant literature from the Pubmed. Results: The role of radiologist has been greatly transformed over the last decades. He is not only entitled to participate in the diagnosis but also he undertakes therapeutic procedures, either alone or as a member of a team. Thus the radiologist is now more exposed to actions that maximize litigation risk. Adequate communication and a written consent form seem to be mandatory before any invasive radiological procedure. Patient should know in detail the benefits and the risks of the scheduled procedure and whether the proposed therapy is a new form of treatment or part of a randomized trial. Discussions and conclusion: Interventional radiologist or physician is exposed to high litigation risk. This certainly requires an urgent adaptation of his practice and attitude to the new reality. Written patient''s informed consent remains an integral part of the communication between physicians and patients, and importantly is offering professional protection along these lines. [Copyright &y& Elsevier]

Aims: This study thus aimed to review and analyze liability lawsuits resulting from implant surgery-related inferior alveolar nerve (IAN) injury over a twenty-year period in France., Materials and Methods: A retrospective descriptive study was performed to analyze judicial decisions pertaining to IAN injury from a legal database between 2000 and 2020. Inclusion criteria comprised all closed malpractice cases that involved an oral and maxillofacial surgeon or a dentist who performed a mandibular implant surgery resulting in IAN injury. The following data were recorded: judicial decision reference (including jurisdiction and date of final court ruling), timing between the incident and final court ruling, number of involved practitioners, patient's age and gender, practitioner's age and gender, implant type, number of implants, location of iatrogenic implant(s), allegation of IAN injury, alleged cause of injury, justification(s) for conviction, compensation amount and legal costs., Results: Twelve judicial decisions from high civil courts relating to ten closed cases of liability lawsuits were included and analyzed. All of involved practitioners were dentists or oral surgeons, working in the private sector. Eventually, 85% of them were convicted. Mean indemnification was 17,340€ and highest indemnification was 42,828€ (inflation-adjusted in 2020 euros). Mean interval between the incident and final ruling was 87,1 ± 34,2 months., Conclusions: Permanent nerve injury following dental implant placement can result in legal action. In the event of lawsuit, the risk of being convicted is high. Practitioners performing oral implantology procedures should practice effective risk management to avoid time-consuming unwanted litigations and administrative proceedings., Competing Interests: Declarations of Competing Interest None., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Objective: Increasing obstetric medical litigations had great impacts in health care system resulted in lower recruitment of residents and higher medical cost of defensive medicine in Taiwan. In order to reduce medical litigation, the "Childbirth Accident Emergency Relief Act" was implemented in June 2016. This study presented five-year results of a novel childbirth accident compensation system., Materials and Methods: The purpose of the Relief Act was to establish a national relief system to ensure timely relief, reduce medical disputes, promote the partnership between patient and medical personnel. The compensations included maximal 2 million NTD for maternal death, maximal 0.3 million NTD for neonatal and fetal deaths, and 3, 2, and 1.5 million NTD for maternal or neonatal profound, severe, and moderate disabilities, respectively. Puerperal hysterectomy was included with maximal 0.8 million NTD compensation., Results: Since June 30, 2016 to June 30, 2021, there were 1340 applications reviewed by Committee and 1258 were approved with total relief of 744.7 million NTD (26.6 million USD) with approve rate of 93.9%. It took an average of 109.8 days to start application from childbirth and 102.4 days to get compensation from application. 66.1% of accident victims agreed this system can restore doctor-patient relationship by immediate care and assistance from medical institutions., Conclusion: The Relief Act is the first government leading compensation system to establish a national relief system. It was enacted to reduce medical disputes, promote the partnership between patient and medical personnel, and enhance health and safety of women during childbirth. A no-fault compensation would be an efficient alternative disputes resolution to childbirth accidents., (Copyright © 2021. Published by Elsevier B.V.)

Medical litigation is one branch of litigation that is attracting a lot of interest in Nigeria in recent years. Apart from the very common cases of negligence in medical practices other causes of action are arising as a result of doctor-patient relationships with the doctor's responsibility to act in the best interest of his patient being often rewarded with stressful and expensive litigation. This paper specifically focuses only on litigation against medical doctors in the discharge of their duties to their patient whist highlighting the possible causes of action that may arise against doctors under the extant laws applicable in Nigeria. The paper also considers situations where doctors are caught in-between the need to preserve overall public health interests and the rights or interests of patients. The paper concludes that the plight and dilemma of doctors should not be perceived negatively but rather positively bearing in mind the humane and humanitarian calling of their profession., Competing Interests: The authors certifies that there is no conflict of interest in connection with the submitted article., (Copyright © 2021 by West African Journal of Medicine.)

Abstract: The aim of this study was to investigate all the lawsuits related to oral surgery practice over a period of three years, and to analyze the different causes of litigation. Inclusion criteria involved all the closed cases that proved malpractice against an oral and maxillofacial surgeon or involved a dentist who performed an oral and maxillofacial surgical procedure. The most common causes of litigation were oro-antral communication, neurological deficit, and bleeding. The study presented the lessons learned from 20 cases, and concluded that most of the lawsuits in oral surgery practice can be prevented either through preoperative measures or by dealing with the impact of the surgical error through good patient rapport and communication [Copyright &y& Elsevier]