scholarly journals Medical Liability of Residents in Taiwan Criminal Court: An Analysis of Closed Malpractice Cases

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Kuan-Han Wu ◽  
Po-Chun Chuang ◽  
Chih-Min Su ◽  
Fu-Jen Cheng ◽  
Chien-Hung Wu ◽  
...  
Keyword(s):  
Diagnostic Errors ◽  
Criminal Court ◽  
Medical Liability ◽  
National Database ◽  
Common Disease ◽  
Resident Physicians ◽  
Malpractice Claims ◽  
Operation Procedure ◽  
Performance Errors ◽  
Performance Error

Objective. By analyzing closed criminal malpractice claims involving resident physicians, we aimed to clarify the characteristics of litigations and examine the litigious errors leading to guilty verdicts. Design. A retrospective descriptive study. Setting/Study Participants. The verdicts pertaining to physicians recorded on the national database of the Taiwan justice system were reviewed. Main Outcome Measures. The characteristics of litigations were documented. Negligence and guilty verdicts were further analyzed to identify litigious errors. Results. Between January 1, 2000, and December 31, 2014, from a total of 436 closed criminal malpractice cases, 40 included resident physicians. Five (12.5%) cases received guilty verdicts with mean imprisonment sentences of 5.4 ± 4.1 months. An average of 77.2 months was required for the final adjudication, and surgery residents were involved most frequently (38.9%). Attending physicians were codefendants in 82.5% of cases and were declared guilty in 60% of them. Sepsis (37.5%) was the most common disease in the 40 cases examined, followed by operation/procedure complications (25%). Performance errors (70%) were more than twice as common than diagnostic errors (30%), but the percentage of guilty verdicts in performance error cases was much lower (7.1% vs. 25%). Four negligence cases received nonguilty verdicts, which were mostly due to lack of causation. Conclusion. Closed criminal malpractice cases involving residents took on average 6.22 years to conclude. Performance errors accounted for 70% of cases, with treatment of sepsis and operation/procedure complications predominant. To reduce medicolegal risk, residents should learn experiences from analyzing malpractice cases to avoid similar litigious pitfalls.

scholarly journals Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation

2021 ◽  
pp. bmjqs-2020-011593
Author(s):  
Traber D Giardina ◽  
Saritha Korukonda ◽  
Umber Shahid ◽  
Viralkumar Vaghani ◽  
Divvy K Upadhyay ◽  
...  
Keyword(s):  
Medical Record ◽  
Clinical Care ◽  
Diagnostic Testing ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Diagnostic Process ◽  
Healthcare Organisation ◽  
Safety Concerns ◽  
Patient Complaints ◽  
Malpractice Claims

BackgroundPatient complaints are associated with adverse events and malpractice claims but underused in patient safety improvement.ObjectiveTo systematically evaluate the use of patient complaint data to identify safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement.MethodsWe reviewed patient complaints submitted to Geisinger, a large healthcare organisation in the USA, from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). We selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. Investigators reviewed all complaint summaries and identified cases as ‘concerning’ for diagnostic error using the National Academy of Medicine’s definition of diagnostic error. For all ‘concerning’ cases, a clinician-reviewer evaluated the associated investigation report and the patient’s medical record to identify any missed opportunities in making a correct or timely diagnosis. In cohort 2, we selected a 10% sample of ‘concerning’ cases to test this smaller pragmatic sample as a proof of concept for future organisational monitoring.ResultsIn cohort 1, we reviewed 1865 complaint summaries and identified 177 (9.5%) concerning reports. Review and analysis identified 39 diagnostic errors. Most were categorised as ‘Clinical Care issues’ (27, 69.2%), defined as concerns/questions related to the care that is provided by clinicians in any setting. In cohort 2, we reviewed 2423 patient complaint summaries and identified 310 (12.8%) concerning reports. The 10% sample (n=31 cases) contained five diagnostic errors. Qualitative analysis of cohort 1 cases identified concerns about return visits for persistent and/or worsening symptoms, interpersonal issues and diagnostic testing.ConclusionsAnalysis of patient complaint data and corresponding medical record review identifies patterns of failures in the diagnostic process reported by patients and families. Health systems could systematically analyse available data on patient complaints to monitor diagnostic safety concerns and identify opportunities for learning and improvement.

scholarly journals Characteristics of Paid Malpractice Claims Among Resident Physicians From 2001 to 2015 in the United States

2020 ◽  
Vol 95 (2) ◽  
pp. 255-262 ◽  
Author(s):  
McKinley Glover ◽  
Glen W. McGee ◽  
Derek S. Wilkinson ◽  
Harnam Singh ◽  
Alexis Bolick ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Resident Physicians ◽  
Malpractice Claims

scholarly journals Serious misdiagnosis-related harms in malpractice claims: The “Big Three” – vascular events, infections, and cancers

Diagnosis ◽  
2019 ◽  
Vol 6 (3) ◽  
pp. 227-240 ◽  
Author(s):  
David E. Newman-Toker ◽  
Adam C. Schaffer ◽  
C. Winnie Yu-Moe ◽  
Najlla Nassery ◽  
Ali S. Saber Tehrani ◽  
...  
Keyword(s):  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Healthcare Research ◽  
Insurance Company ◽  
Vascular Events ◽  
Cross Sectional ◽  
Permanent Disability ◽  
High Severity ◽  
Malpractice Claims ◽  
Severity Of Injury

Abstract Background Diagnostic errors cause substantial preventable harm, but national estimates vary widely from 40,000 to 4 million annually. This cross-sectional analysis of a large medical malpractice claims database was the first phase of a three-phase project to estimate the US burden of serious misdiagnosis-related harms. Methods We sought to identify diseases accounting for the majority of serious misdiagnosis-related harms (morbidity/mortality). Diagnostic error cases were identified from Controlled Risk Insurance Company (CRICO)’s Comparative Benchmarking System (CBS) database (2006–2015), representing 28.7% of all US malpractice claims. Diseases were grouped according to the Agency for Healthcare Research and Quality (AHRQ) Clinical Classifications Software (CCS) that aggregates the International Classification of Diseases diagnostic codes into clinically sensible groupings. We analyzed vascular events, infections, and cancers (the “Big Three”), including frequency, severity, and settings. High-severity (serious) harms were defined by scores of 6–9 (serious, permanent disability, or death) on the National Association of Insurance Commissioners (NAIC) Severity of Injury Scale. Results From 55,377 closed claims, we analyzed 11,592 diagnostic error cases [median age 49, interquartile range (IQR) 36–60; 51.7% female]. These included 7379 with high-severity harms (53.0% death). The Big Three diseases accounted for 74.1% of high-severity cases (vascular events 22.8%, infections 13.5%, and cancers 37.8%). In aggregate, the top five from each category (n = 15 diseases) accounted for 47.1% of high-severity cases. The most frequent disease in each category, respectively, was stroke, sepsis, and lung cancer. Causes were disproportionately clinical judgment factors (85.7%) across categories (range 82.0–88.8%). Conclusions The Big Three diseases account for about three-fourths of serious misdiagnosis-related harms. Initial efforts to improve diagnosis should focus on vascular events, infections, and cancers.

25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank

2013 ◽  
Vol 22 (8) ◽  
pp. 672-680 ◽  
Author(s):  
Ali S Saber Tehrani ◽  
HeeWon Lee ◽  
Simon C Mathews ◽  
Andrew Shore ◽  
Martin A Makary ◽  
...  
Keyword(s):  
Diagnostic Errors ◽  
Data Bank ◽  
Malpractice Claims ◽  
National Practitioner Data Bank

scholarly journals Factors and impact of physicians’ diagnostic errors in malpractice claims in Japan

PLoS ONE ◽  
2020 ◽  
Vol 15 (8) ◽  
pp. e0237145
Author(s):  
Takashi Watari ◽  
Yasuharu Tokuda ◽  
Shohei Mitsuhashi ◽  
Kazuya Otuki ◽  
Kaori Kono ◽  
...  
Keyword(s):  
Diagnostic Errors ◽  
Malpractice Claims

1139: AN EPIDEMIOLOGIC STUDY OF ICU MALPRACTICE CLAIMS IN A NATIONAL DATABASE OF MALPRACTICE INSURERS

2016 ◽  
Vol 44 (12) ◽  
pp. 360-360 ◽  
Author(s):  
Sheri Berg ◽  
Lisa Heard ◽  
Ellen Song ◽  
Richard Pino ◽  
Edward Bittner
Keyword(s):  
Epidemiologic Study ◽  
National Database ◽  
Malpractice Claims

Malpractice claims related to diagnostic errors in the hospital

2017 ◽  
Vol 27 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Ashwin Gupta ◽  
Ashley Snyder ◽  
Allen Kachalia ◽  
Scott Flanders ◽  
Sanjay Saint ◽  
...  
Keyword(s):  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Trend Test ◽  
Inpatient Setting ◽  
Risk Of Death ◽  
Provider Characteristics ◽  
Hospitalised Patients ◽  
Malpractice Claims ◽  
Male Patients ◽  
Paid Claims

BackgroundLittle is known about the incidence or significance of diagnostic error in the inpatient setting. We used a malpractice claims database to examine incidence, predictors and consequences of diagnosis-related paid malpractice claims in hospitalised patients.MethodsThe US National Practitioner Database was used to identify paid malpractice claims occurring between 1 January 1999 and 31 December 2011. Patient and provider characteristics associated with paid claims were analysed using descriptive statistics. Differences between diagnosis-related paid claims and other paid claim types (eg, surgical, anaesthesia, medication) were assessed using Wilcoxon rank-sum and χ2 tests. Multivariable logistic regression was used to identify patient and provider factors associated with diagnosis-related paid claims. Trends for incidence of diagnosis-related paid claims and median annual payment were assessed using the Cochran-Armitage and non-parametric trend test.Results13 682 of 62 966 paid malpractice claims (22%) were diagnosis-related. Compared with other paid claim types, characteristics significantly associated with diagnosis-related paid claims were as follows: male patients, patient aged >50 years, provider aged <50 years and providers in the northeast region. Compared with other paid claim types, diagnosis-related paid claims were associated with 1.83 times more risk of disability (95% CI 1.75 to 1.91; p<0.001) and 2.33 times more risk of death (95% CI 2.23 to 2.43; p<0.001) than minor injury, after adjusting for patient and provider characteristics. Inpatient diagnostic error accounted for $5.7 billion in payments over the study period, and median diagnosis-related payments increased at a rate disproportionate to other types.ConclusionInpatient diagnosis-related malpractice payments are common and more often associated with disability and death than other claim types. Research focused on understanding and mitigating diagnostic errors in hospital settings is necessary.

Psychiatric trainees facing their medical liability: Results from the 2014 nationwide AFFEP survey

2014 ◽  
Vol 29 (S3) ◽  
pp. 634-634
Author(s):  
A. Lepetit
Keyword(s):  
Risk Assessment ◽  
Medical Practice ◽  
Decision Process ◽  
Online Survey ◽  
Criminal Court ◽  
Health Care Facilities ◽  
Medical Decision ◽  
Medical Liability ◽  
Legal Action ◽  
Legal Risk

IntroductionIn the past two years in France, four psychiatrists were charged or condemned for manslaughter relating to their practice with dangerous psychiatric patients escaping mental health care facilities. Facing this increasing litigation of psychiatry, the French federation of psychiatric trainees (AFFEP) set up a survey in order to assess the concern of its members of being sued, the consequences of this apprehension on their medical practice and their theoretical instruction on law and legal action risk.MethodsAn online survey was submitted by email to all the AFFEP members nationwide between the 2nd April and the 31st October 2014.ResultsEight hundred and thirteen responses were obtained (65% response rate). Regarding the concern of being sued for their medical practice, 85% of psychiatric trainees dread legal pursuits. This apprehension is significantly higher amongst female trainees (P = 0.004). Legal risk assessment is involved in the medical decision process of 89% of psychiatric trainees. This trend is significantly lower amongst trainees with previous legal teaching during their residency (P = 0.02). Concerning theoretical instruction, 62% of psychiatric trainees rates it insufficient and 28% non-existent during their academic training; 96% of psychiatric trainees want to make this theoretical instruction mandatory.DiscussionThe fear of legal pursuit is well known in psychiatry [1,2] but this study reveals that it begins as early as residency. In France, one explanation can be that psychiatry is the second most sued medical specialty in criminal court [3]. Specific theoretical training in law seems to be a solution in order to decrease the toll taken by legal risk assessment in daily practice.ConclusionConcern about legal action is very high amongst psychiatric trainees and the consequences of this fear impact their day-to-day medical decision process.

scholarly journals The medicolegal impact of misplaced pedicle and lateral mass screws on spine surgery in the United States

2020 ◽  
Vol 49 (5) ◽  
pp. E20
Author(s):  
Eric W. Sankey ◽  
Vikram A. Mehta ◽  
Timothy Y. Wang ◽  
Tracey T. Than ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
United States ◽  
Spine Surgery ◽  
Pedicle Screws ◽  
Potential Method ◽  
The United States ◽  
Medical Liability ◽  
Lateral Mass ◽  
Malpractice Claims ◽  
Procedural Error ◽  
Case Closure

Spine surgery has been disproportionately impacted by medical liability and malpractice litigation, with the majority of claims and payouts related to procedural error. One common area for the potential avoidance of malpractice claims and subsequent payouts involves misplaced pedicle and/or lateral mass instrumentation. However, the medicolegal impact of misplaced screws on spine surgery has not been directly reported in the literature. The authors of the current study aimed to describe this impact in the United States, as well as to suggest a potential method for mitigating the problem.This retrospective analysis of 68 closed medicolegal cases related to misplaced screws in spine surgery showed that neurosurgeons and orthopedic spine surgeons were equally named as the defendant (n = 32 and 31, respectively), and cases were most commonly due to misplaced lumbar pedicle screws (n = 41, 60.3%). Litigation resulted in average payouts of $1,204,422 ± $753,832 between 1995 and 2019, when adjusted for inflation. The median time to case closure was 56.3 (35.2–67.2) months when ruled in favor of the plaintiff (i.e., patient) compared to 61.5 (51.4–77.2) months for defendant (surgeon) verdicts (p = 0.117).

scholarly journals Does state malpractice environment affect outcomes following spinal fusions? A robust statistical and machine learning analysis of 549,775 discharges following spinal fusion surgery in the United States

2020 ◽  
Vol 49 (5) ◽  
pp. E18
Author(s):  
Andrew K. Chan ◽  
Michele Santacatterina ◽  
Brenton Pennicooke ◽  
Shane Shahrestani ◽  
Alexander M. Ballatori ◽  
...  
Keyword(s):  
Machine Learning ◽  
Spinal Fusion ◽  
Medical Malpractice ◽  
Medical Liability ◽  
Learning Models ◽  
Malpractice Claim ◽  
Discharge Disposition ◽  
Medical Malpractice Claim ◽  
Malpractice Claims ◽  
Machine Learning Models

OBJECTIVESpine surgery is especially susceptible to malpractice claims. Critics of the US medical liability system argue that it drives up costs, whereas proponents argue it deters negligence. Here, the authors study the relationship between malpractice claim density and outcomes.METHODSThe following methods were used: 1) the National Practitioner Data Bank was used to determine the number of malpractice claims per 100 physicians, by state, between 2005 and 2010; 2) the Nationwide Inpatient Sample was queried for spinal fusion patients; and 3) the Area Resource File was queried to determine the density of physicians, by state. States were categorized into 4 quartiles regarding the frequency of malpractice claims per 100 physicians. To evaluate the association between malpractice claims and death, discharge disposition, length of stay (LOS), and total costs, an inverse-probability-weighted regression-adjustment estimator was used. The authors controlled for patient and hospital characteristics. Covariates were used to train machine learning models to predict death, discharge disposition not to home, LOS, and total costs.RESULTSOverall, 549,775 discharges following spinal fusions were identified, with 495,640 yielding state-level information about medical malpractice claim frequency per 100 physicians. Of these, 124,425 (25.1%), 132,613 (26.8%), 130,929 (26.4%), and 107,673 (21.7%) were from the lowest, second-lowest, second-highest, and highest quartile states, respectively, for malpractice claims per 100 physicians. Compared to the states with the fewest claims (lowest quartile), surgeries in states with the most claims (highest quartile) showed a statistically significantly higher odds of a nonhome discharge (OR 1.169, 95% CI 1.139–1.200), longer LOS (mean difference 0.304, 95% CI 0.256–0.352), and higher total charges (mean difference [log scale] 0.288, 95% CI 0.281–0.295) with no significant associations for mortality. For the machine learning models—which included medical malpractice claim density as a covariate—the areas under the curve for death and discharge disposition were 0.94 and 0.87, and the R2 values for LOS and total charge were 0.55 and 0.60, respectively.CONCLUSIONSSpinal fusion procedures from states with a higher frequency of malpractice claims were associated with an increased odds of nonhome discharge, longer LOS, and higher total charges. This suggests that medicolegal climate may potentially alter practice patterns for a given spine surgeon and may have important implications for medical liability reform. Machine learning models that included medical malpractice claim density as a feature were satisfactory in prediction and may be helpful for patients, surgeons, hospitals, and payers.

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