Medical Lawsuits Research Articles

Criminal responsibilities of nurses in Turkish criminal law and determining the awareness levels of senior nursing students regarding this responsibility

BackgroundIt is noteworthy that there is an increase in medical lawsuits filed against nurses in Turkey and in the rest of the world. The purpose of this article is to examine nurses’ criminal liability and senior nursing students’ awareness of these responsibilities.MethodsAll senior students (n = 309) of the Faculty of Nursing who were studying in the 2020–2021 academic year of the university constituted the population of the research. The study was completed with 300 students who were studying between the dates of the research and who agreed to participate in the research. Data was collected online via Google Forms. The data obtained from the research was analyzed with the program SPSS 20. Numbers and percentages, averages, and chi-square tests were used to evaluate the data.ResultsThis article provides an overview of nurses’ criminal liability and senior nursing students’ awareness of these responsibilities. The article offers striking implications regarding the awareness of trainee nurses who have not yet started their careers regarding the criminal liability of nurses.ConclusionThe result of our research clearly revealed that the majority of senior nursing students have insufficient knowledge about professional criminal responsibilities, that they are not aware of their duties, powers, and criminal responsibilities as defined in legislation, and that they do not know the types of criminal responsibilities.

Estimating the Effect of Disclosure of Patient Safety Incidents in Diagnosis-Related Patient Safety Incidents: A Cross-sectional Study Using Hypothetical Cases.

Disclosure of patient safety incidents (DPSIs) is a strategic measure to reduce the problems of patient safety incidents (PSIs). However, there are currently limited studies on the effects of DPSIs on resolving diagnosis-related PSIs. Therefore, this study aimed to estimate the effects of DPSIs using hypothetical cases, particularly in diagnosis-related PSIs. A survey using 2 hypothetical cases of diagnosis-related PSIs was conducted in 5 districts of Ulsan Metropolitan City, Korea, from March 18 to 21, 2021. The survey used a multistage stratified quota sampling method to recruit participants. Multiple logistic regression and linear regression analyses were performed to determine the effectiveness of DPSIs in hypothetical cases. The outcomes were the judgment of a situation as a medical error, willingness to revisit and recommend the hypothetical physician, intention to file a medical lawsuit and commence criminal proceedings against the physicians, trust score of the involved physicians, and expected amount of compensation. In total, 620 respondents, recruited based on age, sex, and region, completed the survey. The mean age was 47.6 (standard deviation, ±15.1) years. Multiple logistic regression showed that DPSIs significantly decreased the judgment of a situation as a medical error (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.79), intention to file a lawsuit (OR, 0.53; 95% CI, 0.42-0.66), and commence criminal proceedings (OR, 0.43; 95% CI, 0.34-0.55). It also increased the willingness to revisit (OR, 3.28; 95% CI, 2.37-4.55) and recommend the physician (OR, 8.21; 95% CI, 4.05-16.66). Meanwhile, the multiple linear regression demonstrated that DPSIs had a significantly positive association with the trust score of the physician (unstandardized coefficient, 1.22; 95% CI, 1.03-1.41) and a significantly negative association with the expected amount of compensation (unstandardized coefficient, -0.18; 95% CI, -0.29 to -0.06). DPSIs reduces the possibility of judging the hypothetical case as a medical error, increases the willingness to revisit and recommend the physician involved in the case, and decreases the intent to file a lawsuit and commence a criminal proceeding. Although this study implemented hypothetical cases, the results are expected to serve as empirical evidence to apply DPSIs extensively in the clinical field.

Changes in the Cesarean Section Rate Following the Implementation of Guidelines Concerning Cesarean Section on Maternal Request

Traditionally, cesarean delivery on maternal request (CDMR) has been defined as a cesarean section performed at the request of the pregnant woman rather than for medical necessity. It was thought to provide minimal benefits to both the pregnant woman and the fetus and was seen as an inefficient use of healthcare resources. However, the recent rise in the choice and use of cesarean sections is influenced not only by obstetrical factors but also by psychological and socio-cultural factors of the mother, the desire among medical providers to avoid uncertainty, and the pursuit of time and economic convenience, among other complex factors. In particular, there is a growing trend among medical professionals who prefer cesarean sections to avoid costly medical lawsuits. However, if a pregnant woman opts for an elective cesarean section due to the convenience of medical professionals or fear of litigation, even if she prefers a vaginal delivery, it would be considered an unnecessary cesarean section. When a pregnant woman desires CDMR, medical professionals should thoroughly explain the advantages and disadvantages of both attempting vaginal delivery and CDMR so that she can make an informed decision. Nevertheless, if a pregnant woman still chooses a cesarean section after being fully informed, her autonomy should be respected. In such cases, it is recommended that medical practitioners use a minimally invasive surgical method, along with appropriate preoperative and postoperative care, to reduce the morbidity of both the mother and infant and to support a rapid recovery.

A Review on the Use of Artificial Intelligence in Fracture Detection.

Artificial intelligence (AI) simulates intelligent behavior using computers with minimum human intervention.Recent advances in AI, especially deep learning, have made significant progress in perceptual operations, enabling computers to convey and comprehend complicated input more accurately. Worldwide, fractures affect people of all ages and in all regions of the planet. One of the most prevalent causes of inaccurate diagnosis and medical lawsuits is overlooked fractures on radiographs taken in the emergency room, which can range from 2% to 9%. The workforce will soon be under a great deal of strain due to the growing demand for fracture detection on multiple imaging modalities. A dearth of radiologists worsens this rise in demand as a result of a delay in hiring and a significant percentage of radiologists close to retirement. Additionally, the process of interpreting diagnostic images can sometimes be challenging and tedious. Integrating orthopedic radio-diagnosis with AI presents a promising solution to these problems. There has recently been a noticeable rise in the application of deep learning techniques, namely convolutional neural networks (CNNs), in medical imaging. In the field of orthopedic trauma, CNNs are being documented to operate at the proficiency of expert orthopedic surgeons and radiologists in the identification and categorization of fractures. CNNs can analyze vast amounts of data at a rate that surpasses that of human observations. In this review, we discuss the use of deep learning methods in fracture detection and classification, the integration of AI with various imaging modalities, and the benefits and disadvantages of integrating AI with radio-diagnostics.

Medical Malpractice and Diagnostic Errors in Japanese Emergency Departments.

Emergency departments (ED) are unpredictable and prone to diagnostic errors. In addition, non-emergency specialists often provide emergency care in Japan due to a lack of certified emergency specialists, making diagnostic errors and associated medical malpractice more likely. While several studies have investigated the medical malpractice related to diagnostic errors in EDs, only a few have focused on the conditions in Japan. This study examines diagnostic error-related medical malpractice lawsuits in Japanese EDs to understand how various factors contribute to diagnostic errors. We retrospectively examined data on medical lawsuits from 1961-2017 to identify types of diagnostic errors and initial and final diagnoses from non-trauma and trauma cases. We evaluated 108 cases, of which 74 (68.5%) were diagnostic error cases. Twenty-eight of the diagnostic errors were trauma-related (37.8%). In 86.5% of these diagnostic error cases, the relevant errors were categorized as either missed or diagnosed incorrectly; the others were attributable to diagnostic delay. Cognitive factors (including faulty perception, cognitive biases, and failed heuristics) were associated with 91.7% of errors. Intracranial hemorrhage was the most common final diagnosis of trauma-related errors (42.9%), and the most common initial diagnoses of non-trauma-related errors were upper respiratory tract infection (21.7%), non-bleeding digestive tract disease (15.2%), and primary headache (10.9%). In this study, the first to examine medical malpractice errors in Japanese EDs, we found that such claims are often developed from initial diagnoses of common diseases, such as upper respiratory tract infection, non-hemorrhagic gastrointestinal diseases, and headaches.

An intrauterine fetal death alleged as medical negligence: an autopsy-based case report

Adverse events during the pregnancy deter the mother’s health and raise questions regarding the country’sexistent healthcare. India is among the few nations responsible for two-thirds of all intrauterine fatalitiesworldwide. Intrauterine deaths risk medical negligence lawsuits by the aggrieved family members againstthe treating doctors and the hospital authorities. Fetal autopsy forms a valuable audit of clinical care, enableslearning about such adverse pregnancy outcomes, and assists in administering justice in medical lawsuits. Wediscuss a case of a 30-year-old pregnant female at 38 weeks +1 day of gestation. She was reported to a hospitalwith lower abdominal pain. Per abdomen examination, fetal heart sound was reported to be present, and shewas sent home. She presented with complaints of lower abdominal pain, rupture of membrane, and loss offetal movements the next day and was diagnosed as intrauterine fetal death. The family members alleged it asmedical negligence, and the fetus was sent for a medicolegal autopsy. During the autopsy, skin desquamation ofabout 75% of the total body surface area was present. The umbilical cord stump was dark reddish brown colored.Overriding of the cranial bones was noted. The diaphragm was present at the level of the 4th rib. The lungs werenon-crepitant and had liver-like consistency. Hydrostatic and stomach-bowel tests were negative. Cut sectionsof the lower end of the femur, the upper end of the tibia, and the body of the sternum, calcaneum, and talusshowed the appearance of the ossification centers. Medicolegal autopsy helped answer the investigating officer’squestions and establish fetal age, time since intrauterine death, and whether the fetus was live or dead born.

Current Endoscopy Training in Korea and Future Aspects

The training of trainees to perform endoscopies is challenging. There is no standardized training program in Korea. Trainees usually learn to perform endoscopies under the supervision of an educator, an expert endoscopist. However, most of educators have never received formal training. For high quality and effecting training, formal training program for educators is needed. Also, specific assessment tools measuring performance and improving training are required. The use of simulators for acquiring, maintaining, and assessing skills in endoscopy has grown over the past decade. Many data suggest that simulation training may accelerate the acquisition of specific technical skills in endoscopy early in training. If we include education using simulators in basic endoscopy education, it will be of great help to shorten the endoscopy training time and improve the endoscopy training environment. A significant portion of medical lawsuits against gastroenterologists in Korea are related to complications related to sedation. Therefore, endoscopy education should include contents related to sedation education. Also, systematic and thorough education program along with assessment tool measuring true competence of sedation in endoscopy is needed. Changes should be made at all levels to improve our endoscopy training system.

Impact of Shorter Trial Periods in Medical Litigation

Abstract This study examined the reasons for the decline in the plaintiff win rate in medical lawsuits in Japan since 1999. The results suggest that the decline in the plaintiff win rate is likely due to the overall shortening of trial periods. In particular, if the trial period is shortened by one month, the plaintiff win rate decreases by 1.63%. After indicating the correlation between a decrease in plaintiffs’ winning rate and a shortened trial period, this study examines the causal relationship from five perspectives and the substantive factors.

의료소송의 책임제한의 경우 진료비 지급의무에 대한 검토

In the case of medical malpractice litigations, even if the hospital's negligence is admitted, in most cases restriction on liability is admitted. Since the medical expenses are in return for medical practice, the hospital can claim it when the medical practice is performed according to the contents delegated. In the event of a medical malpractice, if the hospital is not negligent, or if it is completely responsible, it is clear whether the mandate has been fulfilled. But in case of restriction on liability, it is not clear whether or not a medical fee can be claimed. In many cases, courts judge that there is no obligation to pay the total medical expenses regardless of the liability limit rate, while in most cases, medical expenses are calculated by reflecting the liability limit rate. If the obligation to pay medical expenses is judged differently depending on whether it is a claim for damages or a medical expense lawsuit, an unreasonable situation may occur in which the obligation to pay medical expenses is judged differently depending on the timing of payment of medical expenses. If the patient's negligence contributes, the ratio of negligence should be reflected in the medical expenses according to the law of comparative negligence. If the risk of the disease itself is high or the patient's constitutional predisposition limits liability, the proportion of the factor's contribution in terms of fair and reasonable sharing of damages should be reflected in the claim.

Paralysis Following Spinal Surgery: The Principle of Distribution of Burdon of Proof and its Adjustment in Respect of Civil Medical Lawsuits

Paralysis Following Spinal Surgery: The Principle of Distribution of Burdon of Proof and its Adjustment in Respect of Civil Medical Lawsuits

Suture localization of scalp biopsy sites

Common methods in dermatology, alone or in combination, for surgical site identification are HIPAA-compliant biopsy site photography, descriptive triangulation with anatomic landmarks, diagrams, and patient or caregiver site identification.1 Inability to accurately identify the surgical site is often multifactorial and can result in delays in care, wrong-site surgery, and medical lawsuits. Specifically, surgical sites on the scalp pose a significant risk of misidentification due to lack of specific, fixed anatomic landmarks, difficulty producing high-quality photographs on a dense hair-bearing scalp, and limited or absent patient visualization.

Assessing Interpersonal and Communication Skills.

Assessing Interpersonal and Communication Skills.

Obstetricians\u2019 perspectives on trial of labor after cesarean (TOLAC) under the two-child policy in China: a cross-sectional study

BackgroundAs the birth policy has been adjusted from one-child-one-couple to universal two-child-one-couple in China, there is an increasing number of women undergoing a second pregnancy after a previous cesarean section (CS). Undertaking an elective repeat CS (ERCS) has been taken for granted and has thus become a major contributor to the increasing CS rate in China. Promoting trial of labor after CS (TOLAC) can reduce the CS rate without compromising delivery outcomes. This study aimed to investigate Chinese obstetricians’ perspectives regarding TOLAC, and the factors associated with their decision-making regarding recommending TOLAC to pregnant women with a history of CS under the two-child policy.MethodsA cross-sectional survey was carried out between May and July 2018. Binary logistic regression was used to determine the factors associated with the obstetricians’ intention to recommend TOLAC to pregnant women with a history of CS. The independent variables included sociodemographic factors and perceptions regarding TOLAC (selection criteria for TOLAC, basis underlying the selection criteria for TOLAC, and perceived challenges regarding promoting TOLAC).ResultsA total of 426 obstetricians were surveyed, with a response rate of ≥83%. The results showed that 31.0% of the obstetricians had no intention to recommend TOLAC to pregnant women with a history of CS. Their decisions were associated with the perceived lack of confidence regarding undergoing TOLAC among pregnant women with a history of CS and their families (odds ratio [OR] = 2.31; 95% CI: 1.38–1.38); obstetricians’ uncertainty about the safety of TOLAC for pregnant women with a history of CS (OR = 0.49; 95% CI: 0.27–0.96), and worries about medical lawsuits due to adverse delivery outcomes (OR = 0.14; 95% CI: 0.07–0.31). The main reported challenges regarding performing TOLAC were lack of clear guidelines for predicting or avoiding the risks associated with TOLAC (83.4%), obstetricians’ uncertainty about the safety of TOLAC for women with a history of CS (81.2%), pregnant women’s unwillingness to accept the risks associated with TOLAC (81.0%) or demand for ERCS (80.7%), and the perceived lack of confidence (77.5%) or understanding (69.7%) regarding undergoing TOLAC among pregnant women and their families.ConclusionA proportion of Chinese obstetricians did not intend to recommend TOLAC to pregnant women with a history of CS. This phenomenon was closely associated with obstetricians’ concerns about TOLAC safety and perceived attitudes of the pregnant women and their families regarding TOLAC. Effective measures are needed to help obstetricians predict and reduce the risks associated with TOLAC, clearly specify the indications for TOLAC, improve labor management, and popularize TOLAC in China. Additionally, public health education on TOLAC is necessary to improve the understanding of TOLAC among pregnant women with a history of CS and their families, and to improve their interactions with their obstetricians regarding shared decision making.

Complications Versus Lawsuits !

Not every medical claim or lawsuit is necessarily result of a complication or a malpractice. This is especially true in Plastic surgery practice. It was interesting to compare serious surgical complications and mortality risk in various specialties. Gastric bypass surgery, a very popular bariatric procedure designed to treat obesity carries a mortality risk of 0.3% within a month (1:333 cases). Laparoscopic cholecystectomy carries a mortality risk of 0.15% or (1:666) within a month of the surgery as well. Whereas Liposuction as a sole procedure (probably the most common aesthetic operation globally) carries a mortality risk of 1:5000 based on one of the most critical reviews on this issue (Grazer et al. PRS 2000; 105:436-66).

Experiences of neurological surgeons with malpractice lawsuits.

As a specialty that treats acute pathology and refractory pain, neurosurgery is at risk for high liability, making the practice of defensive medicine quite common. The extent to which the practice of defensive medicine is linked to experience with malpractice lawsuits remains unclear. The aims of this study were to clarify this by surveying neurosurgeons about the frequency of experiencing medical lawsuits and to show how neurosurgeons reflect on facing such lawsuits. A survey consisting of 24 questions was distributed among members of the Congress of Neurological Surgeons. The survey consisted of four parts: 1) demographics of participants; 2) the way malpractice lawsuits affect the way respondents practice medicine; 3) experiences with medical malpractice lawsuits; and 4) the effect of the medical malpractice environment on one's own practice of medicine. There were a total of 490 survey respondents, 83.5% of whom were employed in the US. Of the respondents, 39.5% stated they were frequently or always concerned about being sued, and 77.4% stated their fear had led to a change in how they practice medicine. For 58.4%, this change led to the practice of defensive medicine, while for others it led to more extensive documentation (14.3%) and/or to referring or dropping complex cases (12.4%).Among the respondents, 80.9% at some time were named in a medical malpractice lawsuit and 12.3% more than 10 times. The main concerns expressed about being sued included losing confidence and practicing defensive medicine (17.8%), personal assets being at risk (16.9%), and being named in the National Practitioner Data Bank (15.6%). Given the medical malpractice environment, 58.7% of respondents considered referring complex patient cases, whereas 36.5% considered leaving the practice of medicine. The fear of being sued (OR 4.06, 95% CI 2.53-6.51) and the consideration of limiting the scope of practice (OR 3.08, 1.80-5.20) were both independently associated with higher odds of considering leaving the practice of medicine. The current medicolegal landscape has a profound impact on neurosurgical practice. The fear of being sued, the financial aspects of practicing defensive medicine, and the proportion of neurosurgeons who are considering leaving the practice of medicine emphasize the need for a shift in the medicolegal landscape to a system in which fear of being sued does not play a dominant role and the interests of patients are protected.

Perception Gaps of Disclosure of Patient Safety Incidents Between Nurses and the General Public in Korea.

ObjectivesThis study aimed to explore nurses’ perceptions regarding disclosure of patient safety incidents.MethodsAn anonymous online survey was conducted, and results were compared with those of the general public using the same questionnaire in a previous study.ResultsAmong 689 nurses, 96.8% of nurses felt major errors should be disclosed to patients or their caregivers, but only 67.5% felt disclosure of medical errors should be mandatory. In addition, 58.5% of nurses were concerned that disclose will increase the incidence of medical lawsuits. More than two-thirds of nurses felt such discloses will reduce feelings of guilt associated with a patient safety incident. Only 51.1% of nurses, but 93.3% of the public, felt near misses should be disclosed to patients.ConclusionsNurses generally had a positive attitude toward disclosure of patient safety incidents, but they preferred it less than the general public. To reduce this gap, legal and nonlegal measures will need to be implemented. Furthermore, it is necessary to continue monitoring the gap by regularly assessing perceptions of disclosure of patient safety incidents among health care professionals and the general public.

L’expertise médicale au temps des pandémies : l’exemple des cancers

Medical law suits were interrupted during the COVID-19 pandemia and judicial process will come shortly back to the normal. Pandemia induced delays in the cancer diagnosis and treatment. These modifications were validated by expert consensus from the medical societies. However in the coming years it is highly possible that patients think they were victims of a “loss of chance” and ask for a compensation. The various situations in which physicians can be involved are described and recommendations for the management of medical charts are discussed.

Requirements of Health Data Management Systems for Biomedical Care and Research: Scoping Review.

BackgroundOver the last century, disruptive incidents in the fields of clinical and biomedical research have yielded a tremendous change in health data management systems. This is due to a number of breakthroughs in the medical field and the need for big data analytics and the Internet of Things (IoT) to be incorporated in a real-time smart health information management system. In addition, the requirements of patient care have evolved over time, allowing for more accurate prognoses and diagnoses. In this paper, we discuss the temporal evolution of health data management systems and capture the requirements that led to the development of a given system over a certain period of time. Consequently, we provide insights into those systems and give suggestions and research directions on how they can be improved for a better health care system.ObjectiveThis study aimed to show that there is a need for a secure and efficient health data management system that will allow physicians and patients to update decentralized medical records and to analyze the medical data for supporting more precise diagnoses, prognoses, and public insights. Limitations of existing health data management systems were analyzed.MethodsTo study the evolution and requirements of health data management systems over the years, a search was conducted to obtain research articles and information on medical lawsuits, health regulations, and acts. These materials were obtained from the Institute of Electrical and Electronics Engineers, the Association for Computing Machinery, Elsevier, MEDLINE, PubMed, Scopus, and Web of Science databases.ResultsHealth data management systems have undergone a disruptive transformation over the years from paper to computer, web, cloud, IoT, big data analytics, and finally to blockchain. The requirements of a health data management system revealed from the evolving definitions of medical records and their management are (1) medical record data, (2) real-time data access, (3) patient participation, (4) data sharing, (5) data security, (6) patient identity privacy, and (7) public insights. This paper reviewed health data management systems based on these 7 requirements across studies conducted over the years. To our knowledge, this is the first analysis of the temporal evolution of health data management systems giving insights into the system requirements for better health care.ConclusionsThere is a need for a comprehensive real-time health data management system that allows physicians, patients, and external users to input their medical and lifestyle data into the system. The incorporation of big data analytics will aid in better prognosis or diagnosis of the diseases and the prediction of diseases. The prediction results will help in the development of an effective prevention plan.

Medical Malpractice in Neurological Diseases

The results of medical lawsuits in Japan can affect actual clinical settings, and it might be useful to analyze medical lawsuits in order to understand medical issues. Some diseases such as subarachnoid hemorrhage, cerebral infarction treated with thrombolytic therapy and treatable encephalitis could cause problems, which in turn may lead to lawsuits, when the results of treatment for those situations are fatal. In addition, there are cases in which other neurological diseases are related to litigation. Therefore, I scrutinized such cases and suggested useful tips for establishing good relationships between doctors and patients and preventing troubles that could lead to medical lawsuits.

A restricted view on the identification of litigation cases of traditional Chinese medicine in the Republic of China: a case study of Yan Yulin

Medical appraisal is one of the important means to determine whether there are faults in medical behavior and to deal with medical disputes. The issue of whether the medical lawsuit of traditional Chinese medicine should be submitted to traditional Chinese medicine, western medicine or forensic identification began to be debated since the Republic of China. With the efforts of the traditional Chinese medicine community, the Prescription Appraisal Committee of the National Medical Center of the Republic of China was established, which obtained the peer appraisal right for the lawsuit of traditional Chinese medicine. This paper takes the case of Yan Yulin's negligence causing death, which was sent by Shandong High Court to the National Medical Center in 1937, as an example, to explore the general situation of the identification system of the traditional Chinese medicine litigation in the period of the Republic of China, in order to provide reference for the establishment of the judicial identification system of medical damage in traditional Chinese medicine.