Absence Of Negligence Research Articles

Penolakan Pasien Dalam Keadaan Darurat Karena Belum Divaksin

Introduction: Criminal liability arises when the damage caused by the negligence of the hospital's medical staff meets three factors: The three factors are the presence or absence of negligence, wrongdoing, and other relevant sanctions. In addition, under the criminal justice system, if a company commits a crime, its owner can be jailed or fined.Purposes of the Research: This study aims to analyze and explain the refusal of patients in an emergency situation because they have not been vaccinated against the Health Law Number 36 of 2009 and to analyze and explain the legal policy mechanism taken for patients in an emergency situation because they have not been vaccinated who are referred to the hospital.Methods of the Research: The type of research used is normative, which is focused on providing explanations that explain a particular category. Approach the problem of the statute approach (statute approach) and the conceptual approach (conceptual approach). The collection of legal materials through primary legal materials is then free from secondary legal materials. The processing and analysis of legal materials is described in a qualitative way with the aim of describing the findings in the field.Results of the Research: The refusal of patients in an emergency situation because they have not been vaccinated is contrary to the Health Law No. 36 of 2009. In which the Law of the Republic of Indonesia No. 36 of 2009 concerning Health has regulated the refusal of health services by hospitals. The legal policy mechanism that is taken for emergency patients because they have not been vaccinated is that they still pay attention to the existing legal rules for both patients and for the hospital, by prioritizing patient safety first, all patients are entitled to outpatient medical services, inpatient care, or emergency department at a health facility. This is regulated in the Law of the Republic of Indonesia number 29 of 2004 concerning medical practice, Law of the Republic of Indonesia number 36 of 2009 concerning health. The refusal to take care of the patient's health is ignored by medical institutions, because it can worsen the patient's condition.

CRIMINAL LIABILITY OF MEDICAL RESPONSIBILITY IN HANDLING OF PATIENTS WITH GASTROINTESTINAL DISORDERS

Errors that can occur in medical actions from medical personnel include gastrointestinal handling. Gastrointestinal is commonly found in the intensive care unit (ICU). Errors or omissions are an essential element to determine whether or not a person can be sentenced to a crime, as well as in medical malpractice actions, it is largely determined by the presence or absence of negligence or errors of medical personnel in carrying out medical actions against patients, both professionally and legally. The purpose of the study was to analyze “Criminal Liability of Medical Personnel who are Negligent in Handling Patients with Gastrointestinal Disorders”. The results of the study obtained: 1) Criminal provisions against medical personnel who are negligent in handling patients with gastrointestinal disorders are regulated in Article 51 of the Republic of Indonesia Law Number: 29 of 2004 concerning medical practice, where a medical worker is obliged to provide assistance on a humanitarian basis. Looking at these provisions, it can be seen that the medical profession requires special competence and authority because the actions taken contain considerable risks. Medical personnel in carrying out medical procedures already have service standards that serve as guidelines and guidelines that apply to all medical personnel. If the standard is not implemented or implemented but is not in accordance with the required average standard, in the sense of ignoring the obligations stipulated by the applicable laws and regulations and the code of ethics of the medical profession, then it can be said as an error in the form of culpa or negligence. 2) Criminal liability of medical personnel for negligence in handling patients with gastrointestinal disorders is a criminal act by which, of course, can be subject to criminal provisions or sanctions. Criminal provisions that can be applied to medical personnel who are negligent in providing treatment to patients with gastrointestinal disorders are regulated in the general criminal provisions of Articles 267, 299, 304, 322, 344, 346, 347, 348 and Article 349 of the Criminal Code, which includes acts of a deliberate nature. As for what includes negligence, it is stated in Article 359, Article 360, and Article 361 of the Criminal Code, 3) The rights of health workers to the demands of patients with gastrointestinal disorders have been regulated through laws and regulations, namely Article 11 paragraph (1) of the Republic of Indonesia Law Number: 36 of 2014 concerning Health Workers and Article 50 of the Republic of Indonesia Law: Number 29 of 2004 concerning Medical Practice.

Ethics and Law.

Ethics and Law.

The development of intention-based morality: The influence of intention salience and recency, negligence, and outcome on children's and adults' judgments.

Two experiments were conducted to investigate the influences on 4-8 year-olds' and adults' moral judgments. In both, participants were told stories from previous studies that had indicated that children's judgments are largely outcome-based. Building on recent research in which one change to these studies' methods resulted in substantially more intention-based judgment, in Experiment 1 (N = 75) the salience and recency of intention information were increased, and in Experiment 2 (N = 99) carefulness information (i.e., the absence of negligence) was also added. In both experiments even the youngest children's judgments were primarily intention-based, and in Experiment 2 punishment judgments were similar to adults' from 5-6 years. Comparisons of data across studies and experiments indicated that both changes increased the proportion of intention-based punishment judgments-but not acceptability judgments-across age-groups. These findings challenge and help to explain those of much previous research, according to which children's judgments are primarily outcome-based. However, younger participants continued to judge according to outcome more than older participants. This might indicate that young children are more influenced by outcomes than are adults, but other possible explanations are discussed. (PsycINFO Database Record

Approximate Methods for Analysing the Effects of Creeping and Shrinkage of Reinforced and Prestressed Concrete Constructions

́Precisé procedures of analysis of so - called slow deformations, based on absence of negligence, are not suitable for practical calculations, due to its characteristic to be in demand of sufficient analyses. For that reason, there is the need for applying the approximative procedures and methods of analyses which give acceptable results, and they are still based on simplified mathematical relations. There are three procedures of that kind included in the exposition: method of simplified differential equation, modified Trost procedure and method of the idealistic modulus of elasticity, as well as their applicability on the exact example of the reinforced and prestressed concrete element.

Perceived Negligence: Why Patients Sue?

Let me share with you my thoughts on why patients sue despite rendering your best professional care to them. My past 10 years in law practice, dealing mainly with medical malpractice cases, have been a professional journey for me both as a lawyer and a physician. The opportunity to hear first hand patients and family members alike articulate their opinions, observations and feelings as to why they are filing a complaint or has filed a complaint has heightened my awareness on the unique nature of medical practice. I am pretty sure that as actively practicing physicians, and for an alleged medical negligence, you have already confronted peer reviews, disciplinary proceedings, complaints and actual medical malpractice suits. Perhaps, it is true that complaints are badges of burgeoning practice – more patients, more complaints. In my experience one observation remains the same and certain; if you commit negligence you will be sued. If the patient or family members did not sue, then your case is the exception. Do not take comfort that you did not intend to harm a patient or commit negligence. Understand that it is the very nature of negligence, there is no malice or intent involved; otherwise it is no longer negligence but physical injuries or homicide or maybe murder. What I want to address specifically is why do patients sue in the absence of negligence? Why did the patient or family member perceive your conduct as negligent in the absence of actual negligence? Remember that majority of medical malpractice cases are based only on “perceived negligence” and eventually will be dismissed. However, what matters is not in winning cases but in avoiding cases based on perceived negligence. It is best to remember that once you are sued, you have already lost. It is useless to taste your victory because the public nature of the case and the protracted course of litigation have already robbed you of your appetite to celebrate not to mention the adverse financial impact of facing a lawsuit. The first question to ask is “Why was it perceived as negligence in the first place?” In the absence of good communications with the patient or family members, any sudden occurrence of adverse events or complications can be interpreted by some as “physician-made.” The unfair expectation “to guarantee good results” has further expose physicians as “fair game” for lawsuits once something bad happens to a patient. In this scenario, I believed that the main culprit is “failed communications.” The often cited maxim “Physician’s communication skills are as important as clinical skills” should always be underscored every time a physician attends to a patient. All the more that this maxim gains significance if you are dealing with in-patients (admitted patients). Take note that majority of medical negligence cases are filed by in-patients. Ask yourself – Do I spend enough time, in a 24-hour period, explaining all aspects of the disease to a patient? Do I have the patience to answer every question my patient asks, no matter how trivial the question is? Do I appear genuinely interested? If your answer to these questions is “No”, then it is time to learn the art of good communication. It does not matter how good you are, it is the face to face encounter your patient remembers. Your chart rounds, continuing updates and review of previous cases will never be recalled by your patients for obvious reason – such activities are not seen by your patients. Such activities are not plus points. Often times, the line of good communications can be jeopardized by an adverse event. In this instance, the real strength of your resolve to maintain an open line of communication will be tested. Unfortunately, I often hear complainants saying, “We barely saw Dr. X after the incident” or “It was the resident who explained to us everything” or “Dr. X was vague in his explanations.” Comments like these are brought about by lack or poor communications. In some cases of perceived negligence, respondent physician can either explain the facts in front of the family or explain it in open court. Good communication skills can both neutralize the desire to file a lawsuit and defuse a confrontational situation. Communicating well with your patients can prevent an unfounded lawsuit. If your patient can hear you and likewise hear him too, then there is no reason why your patient should go to court to tell his complaint.

Closed claims from Switzerland: an important contribution to improving patient safety in anaesthesia

Studies based on closed claims are very important in our efforts to improve patient safety. For patients, complications of anaesthesia can be compared with ‘friendly fire’. Harm is done unintentionally by somebody whose aim was to help. Patients may be seriously injured or even die due to a complication of anaesthesia, and such events may also lead to serious psychological consequences for the responsible anaesthesiologist. Most patients are prepared to accept that surgery may not be entirely successful, or may be associated with a small incidence of complications, but they are often unwilling to acknowledge that any untoward consequence which they attribute to anaesthesia, or the anaesthetist, is acceptable. When a patient is having a surgical procedure, we can choose regional anaesthesia, general anaesthesia or a combination. In order to make our choice, we need to know the risks associated with the various procedures and relate these to the benefits. Furthermore, it is important, if possible, to know the warning signs that something is wrong before the actual complication occurs. An increased awareness of such signs and of potential contributors to harmful events can be obtained from observations in prospective studies or anecdotally from case reports, retrospective reviews and closed claim studies, as in this issue of the European Journal of Anaesthesiology. This type of analysis is still rare but is very important because considerable amounts of useful information on complications and potential approaches to their prevention can be learnt and applied in the future. In this issue of the European Journal of Anaesthesiology, closed claims from Switzerland are reviewed.1 That study retrospectively reviewed 171 patients with anaesthesia-related injuries in the period 1987–2008. It seems a very low number considering that there are 7 million citizens in Switzerland and that data from more than 20 years were analysed. However, it is important to recognise that the actual number of injuries may be as much as 30 times greater because of under-reporting.2 It is remarkable that the majority of the claims (54%) were related to regional anaesthesia, assuming that regional anaesthesia represents only about 30% of all anaesthetic procedures in Switzerland. There is no obvious explanation for this disproportionately high incidence of injuries related to regional anaesthesia. Is regional anaesthesia, in fact, associated with a higher incidence of complications or are confounding factors, including the small number of cases, an explanation? On the basis of their findings, Staender et al.1 developed the following preventive strategies: not to repeat injections nor administer unusually large amounts of local anaesthetics in the event of incomplete block; to ensure that the puncture site for spinal anaesthesia is below L2/3; not to proceed with the injection when the puncture is painful or induces twitching; and finally to remain alert to clinical signs of epidural haematoma. If a patient complains of persistent hoarseness after tracheal intubation, possible subluxation of the arytenoid cartilage must be excluded as a cause without delay. Great care must be taken when placing a central venous catheter and the correct position of the catheter tip must be verified. In Scandinavia, patients can seek financial compensation from systems which operate on a no-fault-no-blame basis. Payment is made for any injury even in the absence of negligence if specific criteria are fulfilled. As a result, the Scandinavian countries have more than 20 times more anaesthesia claims per anaesthetic given than Switzerland, England, Canada or the USA.3 Data from analysis of these closed claims have already resulted in several studies and recommendations. We hope that more such studies will follow in order to identify potential means to improve patient safety and prevent injuries.

Traumatic dental injuries during anaesthesia: part I: clinical evaluation

Dental injuries represent the most common claims against the anaesthesiologist. Dental lesions are frequent complications of oro-tracheal intubation and major causal factors are (i) poor dentition, (ii) aggressive laryngoscopy, (iii) insufficient anaesthesia and curarization, (iv) emergency interventions and (v) lack of experience by the anaesthesiologist. We conducted a retrospective analysis of 83 cases of dental lesions occurring during elective, emergent and urgent surgery requiring general anaesthesia with tracheal tube placement in the years between 2000 and 2008. Preoperative evaluation of dental status was obtained from the anaesthesiology chart, filled by an experienced anaesthesiologist during the preoperative visit. Anaesthesiological records were inspected by physicians of Legal Medicine Department with the aim to attribute responsibility for the damage and manage potential reimbursements. Costs related to the required dental repair were also noted. Eighty-three patients of a total of 60.000 surgical procedures (no day surgery) under general anaesthesia were affected by dental lesions (0.13%). Seventy-five per cent of lesions occurred during intubation manoeuvres for elective major surgery, 15% occurred at tracheal intubation for minor surgery and 10% were related to emergency surgery. Teeth avulsions accounted for 50% of lesions, followed by damage to crowns and bridges (14%), luxations and fractures (>15%). The overall incidence of dental injury in our retrospective study was 1.38 per 1000 anaesthetics, which is slightly higher than those reported by some and lower with respect to others. Avulsion of a permanent tooth occurred in patients who were affected by severe mobility of native teeth while undergoing surgery. Even though the majority of anaesthesiologists were trained enough in the use of airway devices and aware of the potential damage while using excessive forces, some unexpected difficulties may have led to lesions. It is known that damage to teeth can occur even in the absence of negligence.

Expansion of Liability under Public Nuisance

1 * Executive Director, Searle Center on Law, Regulation, and Economic Growth, Northwestern University. Phone: (312) 503-0290; Email: hbutler@law.northwestern .edu. ** Foundation Professor of Law, George Mason University School of Law. 3301 N. Fairfax Dr. Arlington, VA 22201Phone: 703-993-9484; Fax: 703-993-8088; Email: Tzywick2@gmu .edu; Web: http:// mason.gmu .edu/ ~tzywick2/ . Searle Center Public Nuisance Roundtable

Medical Malpractice and the Chest Physician

The US malpractice system is based on tort law, which holds physicians responsible for not harming patients intentionally or through negligence. Malpractice claims are brought against physicians from most medical disciplines in proportion to their numbers in practice and to the frequency with which they perform procedures. Claims against chest physicians most commonly allege injuries caused by the following: (1) errors in diagnosis, (2) improper performance of procedures, (3) failure to supervise or monitor care, (4) medication errors, and (5) failure to recognize the complications of treatment. Most of these injuries occur in hospitals, and many of the injured patients die. The social goals of the medical malpractice system include the following: (1) compensating patients injured through negligence, (2) exacting corrective justice, and (3) deterring unsafe practices by creating an economic incentive to take greater precautions. Some patients injured through negligence are compensated, but most are not. Claims are brought against some negligent physicians but also some who are not negligent, and being negligent does not guarantee that a claim will be brought. The deterrent effect of medical malpractice is unproven, and the malpractice system may prompt defensive medicine and increase health-care costs. And by stressing individual accountability, it conflicts with a systems-oriented approach to reducing medical errors.

Informed Consent and Its Central Role in Plastic and Cosmetic Surgery

Sir: Crockett et al. wrote an article,1 we should say both surgical and sociological, about the influence of plastic surgery “reality television” on cosmetic surgery patients’ expectations and decision making. The authors underline the fact that with these programs “come a host of potential concerns, ranging from the misrepresentation of surgical risks to increased unhealthy competition among surgeons to produce the best outcome,” and the level of deception can seriously preclude even the informed consent. We find all of the authors’ remarks very interesting. We would furthermore emphasize the tremendous importance of the informed consent in plastic and cosmetic surgery procedures. In Italy, the surgeon’s obligation toward patients, especially in cosmetic surgery, is of means; in fact, the surgeon is not responsible for the missed achievement of the result expected by the patient and is not obliged to ensure the result, in the absence of negligence or inexperience, as it is understood that the surgeon must realistically represent the chance to obtain the pursued result to the patient.2 It is the explanation of the subject of the procedure,3 at the moment of the consultation (it must be done also with a written report/model), that firms up both the information about the surgical procedure and the surgeon’s limit of responsibilities. The cosmetic surgery peculiarity is related mainly to the purpose of the procedure, not merely necessary to the health status but aimed at an aesthetic improvement. Although the definition of health by the World Health Organization embraces psychological satisfaction deriving from the acceptance of personal appearance, an almost unanimous chorus was raised4 affirming that informed consent should be, in the case of cosmetic procedures, more scrupulous, or at least “different.”5 Fortunately, since 1995, jurisprudence objected against this differentiation that does not find deontologic reasons to be sustained: in fact, does a patient who needs an open heart procedure have fewer rights to be carefully informed compared with the patient who asks for a breast augmentation?6 We believe that to avoid patient and surgeon misunderstandings and also medicolegal issues, a correct and complete informed consent should be delivered. This should be submitted well in advance of the operation to let the patient know correctly what he or she should expect by the procedure and what the possible risks and complications are. The above and the reasoned consideration of the informed consent to the surgical procedure are the two matters that define the surgeon’s work and the responsibility to the patient. If it is true that plastic surgery reality television plays a role in patient perceptions and decision making, only diligent information giving can avoid “unhealthy, unrealistic expectations” as, for example, in the simplest case, that a surgical procedure always leaves a scar. Andrea Armenio, M.D. Luigi Annacontini, M.D. Dimitrios Dionyssiou, M.D. Matteo D. E. Simone, M.D. Plastic and Reconstructive Surgery Department University of Bari Bari, Italy

The relationship between physician behaviors and blood gas values in the first hours of life--implications for "standards" of medical care for infants with respiratory distress.

It is standard practice for physicians to use blood gas (BG) evaluations when evaluating neonates with respiratory distress. In this study we addressed two questions: (1) What is the distribution of BG values in a population of infants receiving BG evaluation in the first 4 hours of life; and (2) How does the behavior of physicians correlate with BG values in these infants? We discuss the implications of our findings for claims about "standards" of medical care for newborn infants with respiratory distress. We reviewed medical records for 226 infants with birthweight > 2000 grams who were not intubated at the time of first BG determination. For 199 arterial samples, mean values were pH = 7.31 +/- 0.9 (SD); PaCO2 = 38.5 +/- 11.9 torr; PaO2 = 104 +/- 52 torr; and base excess (BE) = -6.5 +/- 3.8 mEq/L. These values did not differ significantly from previously published data for normal term infants without respiratory distress. However, the a/A ratio (0.45 +/- 0.19) for patients in our distressed population was significantly lower than reported for normal infants (0.65 +/- 0.10). For 186 infants admitted directly to our Newborn Intensive Care Unit, the elapsed time from birth to BG 1 was 1.07 +/- 0.64 hours. This value did not vary significantly as a function of severity of illness, assessed by pH, PaCO2, PaO2, a/A ratio, or BE. No blood gas parameter was simultaneously sensitive and specific for predicting subsequent mechanical ventilation. PaCo2 1 > 80 torr was associated with subsequent mechanical ventilation in 4 of 4 infants; however, the positive predictive value of PaCO2 1 was < 50% for levels below 80 torr, and only 4 of 22 infants eventually intubated were identified by a value of PaCO2 1 > 80 torr. The power of "abnormal" values of PaO2, a/A ratio, pH, or BE to predict subsequent intubation was even lower than PaCO2. Jurors in medical malpractice cases are instructed to define negligence as a deviation from the "skill and care ordinarily used in similar cases," and to determine the existence or absence of negligence guided by the testimony of "expert" witnesses. Recognizing that anecdotal recall of experience, even by "experts," may be inaccurate and is often systematically biased (the "Monday morning quarterback" phenomenon), we propose that the testimony of expert witnesses ought to conform, whenever possible, to a data-based description of medical care that actually is "ordinary used in similar circumstances". Our current observations suggest that (1) expert opinions of the "standard" to evaluate neonatal respiratory distress with a BG sample should reflect that the time scale is 1 to 2 hours, not 10 to 20 minutes; and (2) expert opinions that "abnormal" BG values either "require" or "preclude" intubation for most newborn infants with respiratory distress find little support in data. Clinical observation, not BG values, appears to be the most powerful "standard" by which physicians determine whether to initiate mechanical ventilation for newborn infants with respiratory distress.