FORENSIC MEDICAL AND LEGAL ASPECTS OF THE PROVISION OF MEDICAL CARE IN OBSTETRICS AND GYNECOLOGY

Abstract

Relevance. Sometimes statistics on medical errors are hushed up, and information about individual incidents becomes known thanks to the media.
 Objective: to identify the most common obstetric-gynecological profile defects and their causes by analyzing the data of the State Statistics Service on maternal and infant mortality during pregnancy, childbirth, and the postpartum period and compare it with the forensic analysis of obstetric-gynecological profile medical care.
 Materials and methods. 625 cases were analyzed according to the State Statistics Service on maternal and infant mortality during pregnancy, childbirth and the postpartum period, court sentences in criminal cases under Articles 139 and 140 of the Criminal Code of Ukraine, according to the Unified State Register of Court Decisions of Ukraine since 2009 in 2019, as well as data from forensic medical examination commissions on “medicinal matters” for 2013-2019 performed by the State Institution “Main Bureau of Forensic Medical Examination of the Ministry of Health of Ukraine”, including cases of previous departmental audits by the commissions of the Health Administration. The data obtained were subjected to statistical processing by standard methods of descriptive statistics.
 Results. In these 255 examinations, defects in the provision of medical care were found by expert commissions in 186 cases, which amounted to 72.9%. Moreover, of these "defective cases", 62.9% (117 cases) were in a direct causal relationship with an unfavorable outcome; 35.5% (6 cases) - in some deficiencies that did not have a causal relationship with the onset of fetal death. In 3 cases of examinations in gynecology, there were contradictions in the entries in the medical documentation, they did not allow assessing the quality of medical care and the relationship with the consequences. At the pre-hospital stage (in the clinic), defects were allowed in 65.5%, and at the hospital - in 72.8%. In the presence of departmental inspections in 23%, there was a complete coincidence of the results of the conclusions of the commissions of the bureau of forensic medical examination and medical examination, and only in cases of significant defects in direct causal connection with the consequences. At the same time, when analyzing 53 court sentences according to the register of court decisions, it turned out that 13 of them related to the obstetric and gynecological profile, and 12 of them were indictment. In all cases, the source of evidence in cases was exclusively the “Expert Conclusions”.
 Conclusions. It was found that forensic medical examinations for the provision of obstetric and gynecological medical care occupy a leading place in the overall structure of commission examinations in “medical matters”, in the vast majority of examinations, defects in the provision of medical care were found that were in direct causal connection with an unfavorable outcome.