Analysis of medical malpractice in modern conditions (according to the materials of commissional forensic medical examinations)

Abstract

Professional occupation of a doctor is quite often followed by different imperfections, which end up negatively for the patients. Every case of inadequate medical care becomes an object of investigation which can’t be implemented without the conclusion of commissional forensic medical examination. This problem is not enough studied in contemporary Ukrainian forensic medicine. That’s why the research on structure, occurrence and peculiarities of medical malpractice become the goal of the research.
 Materials and methods. The study analyzes archival materials (reports of forensic medical commission examinations) handled in Ternopil regional Bureau of forensic medical examination during 2007-2014 years. The research results are summarized and processed with general statistical methods.
 Results of the research. It is defi that during studied period 112 examinations concerned to medical malpractice were imple- mented which was 9,05% from the general quantity of all commissional examinations. Different medical mistakes were defi in 82,1%. Among of them physicians’ malpractice at providing emergency medical care equaled (74,1%), in hospital department (19,6%). Medical malpractice was administered almost with the same frequency on pre-hospital and hospital levels (45,5% against 49,1%). The bigger half of this malpractice on hospital level was revealed during patients approach to the polyclinic (56,9%).
 According to physician specialties, medical errors are present in: anesthesiologists (39,3 % of all cases), therapist (21,4 %), obstetri- cians and gynecologists (18,7 %), pediatricians (17,8 %), surgeons (14,3 %).
 The most frequent medical errors were diagnostic ones, what is confi in 61,1% of cases, errors in medical records – 46,4%, treatment errors – 40,2%, organizational – 27,7%, deontological – 21,4%. Wrong actions of physicians were rarely unitary and had as- sociation with each other.
 The diagnostic errors were insuffi clinical, laboratory and instrumental examination of a patient; underestimation of clinical features of the disease, baselessness of clinical diagnosis, absence of needed special methods of diagnostics and examination.
 Treatment defects were associated with mistakes in drug prescription, particularly: excessive dosage, insuffi or excessive infusion volume, unreasonable prescription of big amount of drugs at the same time (polypragmasy).
 Among other wrong actions there were the absences of indications for surgery, absences of patients monitoring data, underestimation of patient condition, no predictions of following complications and incorrect prognosis.
 Among organizational errors there were the absences of concilium, incorrect hospitalization, violations of rules of patients’ hospitalization, absences or equipment malfunction, insuffi control of diagnostic and treatment process.
 The errors among medical records were the absence of rate of pulse, respiratory rate, temperature, absence or insuffi
 of additional methods of clinical examination, absence of informed consent, inappropriate diagnosis which didn’t correspond with International Classifi of Diseases.
 Among the deontological errors was the incorrect behavior of medical staff with patients or relatives and concealment of anamnesis data by patient.
 In one fourth of all cases, the defects were a combination of insuffi and late medical care.
 Among the objective reasons of medical errors it was defi the following: the severity of patients status and presence of comor- bidities (32,1% of cases); late appeal for medical care or fast course of the disease (21,4%); diffi of diagnostics or atypical course of the disease (13,4%); patients’ or relatives’ refusal for admission to hospital department (8,0%); patients’ non-adherence of treatment (2,7%). The subjective reasons included incorrect professional actions of medical personnel (9,8%) and its poor quality. The violations were followed by severe consequences such as: the death of a patient (70,6%); severe injuries (2,2%); moderate injuries (8,7%).
 Direct or indirect connection between incorrect actions of medical staff and negative consequences was found in 9,8% of cases. Generally, medical errors were combined, specifi during the diagnostics, treatment and keeping medical records. The majority of cases (80%) of medical malpractice was caused by the objective reasons.