Medical Negligence Research Articles

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.

Medical Negligence in Nigeria; The Legal Remedies

Medical Negligence in Nigeria; The Legal Remedies

Medical Negligence and Its Litigation in Nigeria

Medical Negligence and Its Litigation in Nigeria

Criminal and Civil Aspects Of Healthcare Worker Liability For Medical Malpractice in Croatia

A healthcare worker's liability for damage caused to patients can be criminal, civil, misdemeanour, and disciplinary, with the necessary precondition that the damage was caused as a result of medical malpractice or negligence, and not as a result of the regular course of the disease. The paper analyzes the criminal law and civil law aspects of the healthcare worker's responsibility for damage caused by medical malpractice through the provision of medical care. The imprecise definition of the legal nature of the healthcare worker's responsibility, the obligations that the law imposes on doctors, the definition of malpractice in medical treatment, as well as the legal basis of responsibility, indicate the existence of many legal dilemmas that require additional analysis to which we would like to contribute with this paper. Because of a broad concept of issues in healthcare worker's liability, this paper aims to explain the material assumptions of criminal (duty to act) and civil (negligence) liability and discusses the legal position of a medical expert in both types of proceedings.

Assessment of Knowledge and Awareness in Handling theMedicolegal Cases among the Interns in a Tertiary Care Hospital - A Questionnaire based study

In the near past, doctors are considered God by the patients but, in this era, doctors are threatened by patients by increasing trends of complaints & litigations against doctors. The doctors should have knowledge and awareness in handling medicolegal cases to minimize faults & litigations. Hence it is necessary to evaluate knowledge and awareness in handling medicolegal cases among budding doctors. The present study was conducted to assess the knowledge and awareness in handling Medicolegal cases among the Interns. Methods: This was a questionnaire based study carried out at Jawaharlal Nehru Medical College, Kaher. A predesigned self-structured multiple-choice questionnaire containing 21 questions was framed based on knowledge and awareness and was prepared in Google forms and sent to 116 Interns who were posted in various departments after obtaining informed consent. The results obtained in the study showed that the interns had enough knowledge about consent, inquest, and MCCD and also had enough awareness of the Consumer protection act, 2019 and issuing injury certificates but the interns lagged some knowledge in certain IPC sections, lagged awareness in maintaining MLC records and also lagged confidence in handling the medicolegal cases independently. Overall knowledge of medicolegal cases among our interns is better compared to peers but needs to be enhanced to promote knowledge and to avoid medical negligence in their future practice.

Managing Complications

Complications are neither entirely predictable nor preventable in the practice of spinal surgery. Communications, particularly the pre-operative consent, play an important role in the management of complications. Patient dissatisfaction leading to complaints and legal proceedings are common and expected sequelae to complications. This article is an overview of important aspects of doctor–patient communication and the relevant legal issues including the principles followed by the judicial system in India while adjudicating on alleged medical negligence.

Professional indemnity/medical malpractice insurance—Awareness among medical students and consultants of India: An online survey study

Abstract Introduction: Professional indemnity (PI) or medical malpractice insurance (MMI) has been a hot topic considering the increasing number of medical negligence cases rising worldwide. However, there is a palpable difference in understanding and usage of this tool in developed countries and regions such as India. Aim: This study aimed to analyze the general understanding of resident doctors and consultants about MMI and knowledge about its technical jargon. Materials and Methods: We distributed short Google Form questionnaires about various aspects of MMI. We recorded the data from 141 resident doctors and 42 consultants in the Navi Mumbai area of India. As it was a survey, we required no ethical review. Results: As consultants’ experience grew, so did their understanding of medical indemnity. Approximately 90%, 64%, and 22% of consultants with 10 years, 5–10 years, and 5 years of experience had acquired PI. The AOY:AOT (any one year:anyone time) ratio was known to just 35% of these specialists. About half of the resident doctors were aware of PI and the effects of medical specialization on PI. Around a fifth of the individuals had only acquired the PI. Conclusion: There needs to be more clarity between the need and knowledge of MMI in India. This needs to be addressed by teaching medical postgraduates about it during training. “There should be special emphasis on medical indemnity in terms of its need, clauses, and cost during postgraduate medical training.”

Responsible Practice or Restricted Practice? An Empirical Study of the Use of Clinical Guidelines in Medical Negligence Litigation (I)

Responsible Practice or Restricted Practice? An Empirical Study of the Use of Clinical Guidelines in Medical Negligence Litigation (I)

Serious complications related to regional anaesthesia: Study ofGreek Courts' Decisions.

Regional anaesthesia and analgesia present many advantages. Related complications are few and have been fully described. Information on regional anaesthesia malpractice is lacking in Greece. The objectives of the analysis were to highlight areas of high litigation risk and report the financial impact of claims. Published judicial decisions of criminal, civil, administrative and disciplinary content, from 1995 to 2020, were searched in the legal information banks. The court decisions were analysed by an expert in collaboration with the lawyers of the investigation. A total of 26 court decisions related to complications from regional anaesthesia were found involving 10 cases, which comprised: 8 convictions, 1 referral of the case for a new expert opinion and 1 acquittal. In 6 cases the medical negligence involved complications after epidural anaesthesia and in 2 after subarachnoid anaesthesia. In 1 case there was collective liability of the anaesthesiologist and the obstetrician for negligent homicide and in 7 cases liability of the anaesthesiologist for bodily injuries. The duration of the litigation was 5-16 years. Analysis of court cases made it possible to identify the causes that led to complications during regional anaesthesia. Informed consent, non-traumatic technique, careful patient selection, adherence to safety rules, and early diagnosis and treatment of complications are essential to avoid permanent injury.

Особенности специального субъекта и объективной стороны в составе неоказания помощи больному, повлекшего по неосторожности смерть больного или причинение тяжкого вреда его здоровью

The importance of the presented topic is explained by the high social risk expressed in the occurrence of medical negligence’s adverse consequences, especially when it entails serious harm to the patient’s health or his death. The aim is to establish the revealing proper crime subject peculiarities of non-assistance to patient, which caused by negligence the death or serious harm to health infliction and the causal link between his act and the adverse consequences. The study of the signs of a special subject in the considered corpus delicti, objective side’s conditions and containment identification, as well as the criminal cases consideration practice analysis and the criminal record status under part 2 of article 124 of the Criminal Code of the Russian Federation are defined as tasks. The empirical basis is provided by statistical data on the criminal record for the studied crime, as well as judicial practice materials, in which the author conducted a content analysis. According to the research results it is noted that the key criterion distinguishing the crimes committed under part 2 of article 124 of the Criminal Code of the Russian Federation from crimes under part 2 of article 109 and part 2 of article 118 of the Criminal Code of the Russian Federation is professional-destructive (bona fide) medical defect expressed in the criminal legislation as special subject omission without valid reasons.

Who judges medical practice?

Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship.

Medical negligence in Bangladesh: A quest for feasible reform

The term "Medical Negligence" is an issue of grave human rights apprehension that directly affects the "right to life and right to health care" which also the concern for all parties involved in medical care facilities. Most State-sponsored have passed Acts and established courts to fortify health care laws. Though there are no precise and inclusive laws to stop "medical negligence" in Bangladesh, various legal mechanisms are still in place under different laws that are not specifically codified. As a result, the possibility of medical-based legal consequences remains out of the orbits of courts, and leads to violence, which invites many complications. However, hospital malpractices cause sufferings and unnecessary deaths for numerous people. There is no denying fact that people suffer and occasionally die due to reckless medical treatment in our country. This article will describe the legal sphere of medical negligence, evaluate the present laws on "medical negligence" in Bangladesh, and emphasize the quest for feasible reform to elevate this unaddressed legal pitch for the benefit of the people. IIUC Studies Vol.18, December 2021: 157-172

Quality improvement & ethical issues in laboratory medicine

The principal guidelines of healthcare ethics is first & foremost is that the patient’s welfare is paramount. Personnel working in clinical and/or research laboratories or engaged in biomedical sciences or research should be aware of their ethical responsibilities & comply with the ethical code of conduct all laboratories follow quality guidelines & maintain proper documentation. Corrective and Preventive Action(CAPA) is the key to maintain quality of testing & to prevent any medical negligence & report descrepancies. Henceforth, Clinical/Research laboratories should try to avoid circumstances or situations that give rise to a conflict of interest & unlawful act.

DEFENSIVE MEDICINE AND MEDICAL MALPRACTICES IN INDIA: AN ECONOMIC ANALYSIS

Medical science claims to have developed several ways of controlling health risks, increasing safety standards and protocols related to medical practices and procedures but it cannot claim that it has eliminated all other kinds of risks associated with it. The recent spurt in the litigation against medical professionals for medical negligence and the claim for redressal or compensation has shaken the confidentiality and patient-doctor relationship to a new high level. The increasing cost of medical malpractice litigation has increased the practice of defensive medicine. It is a medical practice that can be said as an act of economic security against potential allegations of negligence. The present study on economic analysis of medical malpractices and practice of defensive medicine focuses on a pre-existing market relationship between medical negligence and the resultant defensive practices adversely affecting many aspects of human life. The present research is divided into five sections. The first section deals with the nature of the existing market and the economic analysis of the relationship between medical negligence liability and its potential impact on the practice of defensive medicine. The aforesaid market relationship is much more pronounced in the western countries. It is based on the understanding of cost of litigation, the expectation of liability in excess to actual damages and the benefits accruing out of practicing defensive medicine in response to the above situation. However, in the context of India the relationship is not that simple. Particularly, when medical malpractice litigations are not very common practice by the victims and the so-called existing healthcare industry is already running at kickbacks for referring patients, inflating bills and thereby promoting defensive medical practices. In order to promote efficient transactions, exchanges and economic efficiency in the above market, role of legal means cannot be denied. The second part of the study examines the role of the insurance industry in dealing with medical claims. In an inefficient insurance market, insured medical claims remain low and out-of-pocket medical expenditure remains very high. This unethical socio-economic malpractice is economically inefficient and thereby inducing loss of socio-economic welfare of the people. The third section delves upon the unintended socio-economic impacts of the medical malpractices and defensive practice. Particularly in a welfare state like India, it neither results in an activity reinforcing excellence in the medical profession nor helps in achieving the constitutional mandate of ‘Right to Health’. An individual’s sense of wellbeing is incomplete in the absence of his physical as well as mental wellbeing and both of them are responsible for country’s economic and social development. The fourth part examines the relationship of law with defensive medicine. The role of law in regulating the market and thereby reducing healthcare costs is very important. Although it is very difficult to have correct estimates of medical liability costs and various components of it, the growing concerns related to increasing practice of defensive medicine has to be adequately addressed by law. The fifth and the last section discusses the conclusions and recommendations. Today, when the entire world is going through a phase of health crisis, the concerted effort of citizens and government becomes indispensable. In a country like India accessibility and affordability of medical facilities and insurance has to be ensured. With the continuous increase in health care costs the very objective of fair distribution of available healthcare facilities has become a difficult and unachievable task. In order to deal with the above complex and perplexing problem we need greater involvement of economics, law and suitable public policies. India’s fragmented health infrastructure may result in economic inefficiency, reduction in social and economic welfare, wastage of scarce medical resources and high-cost treatment.

When Science Races: the Standard of Care and Medical Negligence in the Times of Covid-19

Abstract When a new disease emerges, there are at first no specific medicinal products to treat it. This has also been the case in the Covid-19 pandemic. Scientists and health professionals have been trying to establish the best treatments possible using the already-existing medicines that are normally used for different indications. The off-label use of medicinal products is a standard part of medical practice. If it meets certain criteria, it is not contradictory to the standard of care. Nevertheless, the urgency of the pandemic situation brings about new issues. What amount of data on efficacy and safety should be considered sufficient to scientifically justify the off-label use of a particular medicine? How should health professionals reflect the rapid scientific developments and high levels of uncertainty in their clinical practice? How can be these factors influenced by the politicisation of medicine? The paper deals with the outlined questions in order to analyse and concretise the criteria for off-label use of medicinal product in the specific context of the Covid-19 pandemic.

The History of Medical Ethics in India

The History of Medical Ethics in India

Safety of acupuncture by Korean Medicine Doctors: a prospective, practice-based survey of 37,490 consultations

BackgroundTo evaluate safety of acupuncture treatment by Korean Medicine Doctors (KMDs), a prospective, practice-based survey on adverse events (AEs) associated with acupuncture was conducted.MethodsFrom July 2016 to October 2017, KMDs were invited to participate in an online survey. Frequency was calculated as the number of AEs per 10,000 treatments; severity was assessed with the Common Terminology Criteria for Adverse Events Grading (Severity) Scale; and causality was evaluated using the World Health Organisation-Uppsala Monitoring Centre system for standardised case causality assessment. Associations between AE occurrence and KMDs’ type of practice/clinical experience and patient age/gender/current medication(s) were analysed.ResultsData on 37,490 acupuncture treatments were collected from 222 KMDs. At least one AE was reported from 4,518 acupuncture treatments, giving a frequency rate of 1,205 per 10,000 acupuncture treatments; this increased to 4,768 treatments when administrative problems related to defective devices or medical negligence were added, for a rate of 1,272 per 10,000 acupuncture treatments. Commonly reported AEs were bleeding, needle site pain, and bruising. Approximately 72.9% of AEs/administrative problems were assessed as they certainly occurred by acupuncture treatment in causality assessment. Most AEs/administrative problems were considered mild in severity and two life-threatening AEs were resolved with no sequelae. Compared to males, female patients were more likely to experience AEs and KMDs’ clinical experience was not associated with reported AE occurrence.ConclusionsAlthough acupuncture-associated AEs occur commonly, they are largely transient and mild. Acupuncture performed by qualified KMDs may serve as a reliable medical treatment with acceptable safety profiles.

What can be done to improve diagnosis of aortic dissection?

Aortic dissection (AD) is rare. Missed AD is a common reason for coronial investigations and civil claims for medical negligence. Recommendations include improved education, supervision and information transfer, reminders in chest pain pathways and higher rates of investigation for AD. Higher investigation rates pose risks to patients and the health system which may not be in balance with the likelihood of AD. The appropriate diagnostic yield of investigation to balance risk and benefit has not been defined. The AD detection risk score pathway has been proposed as a useful diagnostic tool but concerns about its derivation, validation and utility remain. In this paper, we try to draw together published literature and local audit data to develop recommendations about what might be done to reduce the number of missed AD cases in EDs and what the impact of higher investigation rates might be.

Evaluation of the law relating to medical negligence in Sri Lanka

The KDU Journal of Multidisciplinary Studies (KJMS) is published biannually, by the Faculty of Graduate Studies, General Sir John Kotelawala Defence University, Sri Lanka. KJMS is an international open access and peer reviewed journal which publishes high quality original research papers from multi-disciplinary and interdisciplinary approaches.

Taking action against medical accidents: A brief history of AvMA and clinical risk management in the NHS.

Established in 1982, Action against Medical Accidents (AvMA)-originally named Action for Victims of Medical Accidents-was effectively the first charity in Britain dedicated to 'patient safety'. This article provides a historical analysis of the origins and work of AvMA, situating its background in the medical negligence 'crisis' of the 1970s and 1980s, growing consumerism in healthcare, and the significant barriers to justice patients confronted following a clinical incident. It also explores AvMA's impacts on evolving attitudes towards patient harm and safety in the NHS. The article asserts that in addition to supporting patients and campaigning for changes in legal procedures, AvMA played an instrumental role in raising the political profile of adverse health events ('medical accidents'). By supporting claimant solicitors and increasing their chances of legal success, AvMA contributed to the rising tide of negligence claims, which incentivised NHS trusts and health authorities to introduce clinical risk management (CRM). By 2000, CRM was being framed as part of a broader mission to improve quality and safety in healthcare, and AvMA was recognised as a key stakeholder in the new patient safety agenda.