The application of graph theoretical analysis to complex networks in medical malpractice: Lessons learned from China (Preprint)

2021 ◽  
Author(s):  
Shengjie Dong ◽  
Chenshu Shi ◽  
Zhiying Jia ◽  
Minye Dong ◽  
Yuyin Xiao ◽  
...  
Keyword(s):  
Informed Consent ◽  
Medical Malpractice ◽  
Semantic Network ◽  
Lessons Learned ◽  
World Health ◽  
Complex Network Theory ◽  
Scale Free ◽  
Interactive Behavior ◽  
Technical Errors ◽  
Malpractice Claims

BACKGROUND Studies have shown that hospitals or physicians with multiple malpractice claims are more likely to be involved in new claims; this finding indicates that medical malpractice may be clustered by institutions. OBJECTIVE We aimed to identify common factors that contribute to developing interventions to reduce future claims and patient harm. METHODS This study implemented a null hypothesis whereby malpractice claims are random events—attributable to bad luck with random frequency. As medical malpractice is a complex issue, thus, this study applied the complex network theory, which provided the methodological support for understanding interactive behavior in medical malpractice. Specifically, this study extracted the semantic network in 6610 medical litigation records (unstructured data) obtained from a public judicial database in China; they represented the most serious cases of malpractice in the country. The medical malpractice network of China (MMNC) was presented as a knowledge graph; it employs the International Classification of Patient Safety from the World Health Organization as a reference. RESULTS We found that the MMNC was a scale-free network: the occurrence of medical malpractice in litigation cases was not random, but traceable. The results of the hub nodes revealed that orthopedics, obstetrics and gynecology, and emergency department were the three most frequent specialties that incurred malpractice; inadequate informed consent work constituted the most errors. Non-technical errors (e.g. inadequate informed consent) showed a higher centrality than technical errors. CONCLUSIONS Hospitals and medical boards could apply our approach to detect hub nodes that are likely to benefit from interventions; doing so could effectively control medical risks. CLINICALTRIAL Not applicable

scholarly journals A detailed analysis of pediatric surgical malpractice claims in Germany: what is the probability of a pediatric surgeon to be accused or convicted?

2021 ◽  
Author(s):  
Sara Mahler ◽  
Emilio Gianicolo ◽  
Oliver J. Muensterer
Keyword(s):  
Medical Malpractice ◽  
Pediatric Surgeon ◽  
Technical Errors ◽  
Surgical Technical ◽  
Malpractice Claims ◽  
Incorrect Diagnosis ◽  
Calculated Risk ◽  
Medical Malpractice Claims ◽  
Observation Period

Abstract Aim of the study Pediatric surgeons treat a vulnerable population in which unfavorable outcome can lead to substantial long-term costs, placing them at risk for malpractice claims. This study aims to characterize the frequency and circumstances in which malpractice claims were successfully brought against pediatric surgeons in Germany over the last 5 years. Materials and methods Anonymous data on medical treatment errors and payments were acquired from the Federal Chamber of Physicians from 2014 through 2018 and analyzed for most frequent diagnoses and circumstances that resulted in accusation or conviction. Those claims that were successfully rebutted were compared to as controls. Lifetime risk for being involved in litigation and its outcome was calculated. Results There were 129 medical malpractice claims over the 5-year observation period. Medical error was confirmed in 56 cases (43%); the rest were successfully appealed. The risk of the prototypical German pediatric surgeon to be accused was 5.24% and to be convicted 2.27% per year in practice. The most common reasons for conviction (alone or in combination) were surgical-technical errors (23%), treatment delay (21%), insufficient workup (17%), incorrect diagnosis (17%), and incomplete consent (16%).The most frequent circumstances leading to a conviction were trauma (27%), inguinal hernia (7%), circumcision (7%), testicular torsion (7%), acute abdomen (7%), and appendicitis (5%). Conclusion Over a 40-year career, pediatric surgeons in Germany face an average calculated risk of 2.1 to be accused and 0.9 to be convicted of malpractice claims. Certain circumstances pose higher risks for litigation than others. Knowledge of these patterns may help practitioners avoid medicolegal confrontation.

Minimizing Vulnerability to Malpractice Claims

2017 ◽  
Author(s):  
William R Berry
Keyword(s):  
Informed Consent ◽  
Medical Malpractice ◽  
Interpersonal Skills ◽  
Informed Consent Process ◽  
Consent Process ◽  
Malpractice Claims

This review provides strategies for avoiding lawsuits and advice for dealing with a lawsuit if one is ever filed. Medical malpractice is explained as are the personal issues for the defendant physician. Strategies for preventing malpractice suits are presented, including those relative to communication and interpersonal skills, the informed consent process, and documentation. Advice is provided for what surgeons should do if sued or if threatened with a lawsuit, including measures for assisting in the defense and settling claims versus trying a case. Preparing for a deposition is discussed. How a surgeon should act when a defendants or witness in a courtroom trial is presented. This review contains 13 references.

Minimizing Vulnerability to Malpractice Claims

2017 ◽  
Author(s):  
William R Berry ◽  
Janaka Lagoo
Keyword(s):  
Informed Consent ◽  
Key Words ◽  
Medical Records ◽  
Medical Malpractice ◽  
Interpersonal Skills ◽  
Informed Consent Process ◽  
Consent Process ◽  
Malpractice Claims

This review provides strategies for avoiding lawsuits and advice for dealing with a lawsuit if one is ever filed. Medical malpractice is explained, as are the personal issues for the defendant physician. Strategies for preventing malpractice suits are presented, including those relative to communication and interpersonal skills, the informed consent process, and documentation. Advice is provided for what surgeons should do if sued or threatened with a lawsuit, including measures for assisting in the defense and settling claims versus trying a case. Preparing for a deposition is discussed. How a surgeon should act when serving as a defendant or witness in a courtroom trial is presented. This review contains 5 tables, and 23 references. Key words: claim, communication, defendant, informed consent, lawsuit, malpractice, medical records, negligence, suit

Minimizing Vulnerability to Malpractice Claims

2017 ◽  
Author(s):  
William R Berry ◽  
Janaka Lagoo
Keyword(s):  
Informed Consent ◽  
Key Words ◽  
Medical Records ◽  
Medical Malpractice ◽  
Interpersonal Skills ◽  
Informed Consent Process ◽  
Consent Process ◽  
Malpractice Claims

This review provides strategies for avoiding lawsuits and advice for dealing with a lawsuit if one is ever filed. Medical malpractice is explained, as are the personal issues for the defendant physician. Strategies for preventing malpractice suits are presented, including those relative to communication and interpersonal skills, the informed consent process, and documentation. Advice is provided for what surgeons should do if sued or threatened with a lawsuit, including measures for assisting in the defense and settling claims versus trying a case. Preparing for a deposition is discussed. How a surgeon should act when serving as a defendant or witness in a courtroom trial is presented. This review contains 5 tables, and 23 references. Key words: claim, communication, defendant, informed consent, lawsuit, malpractice, medical records, negligence, suit

Lessons Learned From Medical Malpractice Claims Involving Critical Care Nurses

2020 ◽  
Vol 29 (3) ◽  
pp. 174-181
Author(s):  
Laura C. Myers ◽  
Lisa Heard ◽  
Elizabeth Mort
Keyword(s):  
Emergency Department ◽  
Operating Room ◽  
Medical Malpractice ◽  
Odds Ratio ◽  
Improve Patient Safety ◽  
Lessons Learned ◽  
National Database ◽  
Malpractice Claims ◽  
Common Diagnosis ◽  
Multivariable Regression

Background Medical malpractice data can be used to improve patient safety. Objective To describe the types of harm events involving nurses that lead to malpractice claims and to compare claims among intensive care units (ICUs), emergency departments, and operating rooms. Methods Malpractice claims closed between 2007 and 2016 were extracted from a national database. Claims with a nurse as the primary provider were identified and then compared by location of the harm event: ICU, emergency department, or operating room. Multivariable regression was used to determine predictors of claims payment. Results Of 54 699 claims, 314 involved ICU nurses as the primary provider. The majority (59%) of claims involving ICU nurses resulted in death or permanent injury. The most common allegation of claims involving ICU nurses was failure to monitor (47%), which was higher than among claims against nurses in the emergency department (9%) or the operating room (4%) (P < .001). The most common diagnosis in claims involving ICU nurses was decubitus ulcers (26%). Despite equivalent numbers of defendants per claim, the median indemnity for paid claims involving ICU nurses was higher ($125 000) than that paid for claims originating in the emergency department ($56 799) or operating room ($43 910) (P < .001). In multivariable regression, 2 variables increased the risk of claim payment: ICU location (odds ratio, 1.79 [95% CI, 1.29-2.48]) and permanent injury (odds ratio, 1.50 [95% CI, 1.07-2.09]). Conclusions Malpractice claims involving ICU nurses were distinct from claims in comparably fast-paced settings. Focusing harm-prevention efforts in the ICU on skin integrity and monitoring of patients would most likely mitigate many highly severe harms involving ICU nurses, which would benefit both patients and nurses.

scholarly journals Allegations of Failure to Obtain Informed Consent in Spinal Surgery Medical Malpractice Claims

JAMA Surgery ◽  
2017 ◽  
Vol 152 (6) ◽  
pp. e170544 ◽  
Author(s):  
Jennifer Grauberger ◽  
Panagiotis Kerezoudis ◽  
Asad J. Choudhry ◽  
Mohammed Ali Alvi ◽  
Ahmad Nassr ◽  
...  
Keyword(s):  
Informed Consent ◽  
Spinal Surgery ◽  
Medical Malpractice ◽  
Malpractice Claims ◽  
Medical Malpractice Claims

319 Determining the Role of Informed Consent Allegations in Spinal Surgery Medical Malpractice

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 269-269
Author(s):  
Jennifer Grauberger ◽  
Panagiotis Kerezoudis ◽  
Asad Choudhry ◽  
Mohammed Ali Alvi ◽  
Sandy Goncalves ◽  
...  
Keyword(s):  
Informed Consent ◽  
Spinal Surgery ◽  
Medical Malpractice ◽  
Bivariate Analysis ◽  
Control Group ◽  
Malpractice Litigation ◽  
Additional Surgery ◽  
Increased Risk ◽  
Malpractice Claims ◽  
Severity Of Injury

Abstract INTRODUCTION Predictive factors associated with increased risk of medical malpractice litigation have been identified including severity of injury, physician sex and error in diagnosis. However, there is a paucity of literature investigating informed consent in spinal surgery malpractice. Our objective was to highlight the failure to obtain informed consent as an allegation in medical malpractice claims for patients undergoing spine-surgery. METHODS This was a retrospective case-control study using a national medico-legal database westlaw next. We identified a total of 233 patients (80 with no informed consent allegation, 153 who cited lack of informed consent) who underwent spinal surgery and filed a malpractice claim were studied. RESULTS >The most common informed consent allegations were failure to explain risks/side effects of surgery (30.4%) and failure to explain alternative treatment options (9.9%). In bivariate analysis, patients in the control group were more likely to require additional surgery (56.3% vs 34.6%, P = 0.002) and suffer from more permanent injuries compared to the informed consent group (P = 0.033). On multivariable regression analysis, permanent injuries were more often associated with indemnity payment following a plaintiff verdict (OR 3.12, 95% CI 1.46 - 6.65, P = 0.003) or a settlement (OR 6.26, 95% CI 1.06 - 36.70, P = 0.042). Informed consent allegations were significantly associated with less severe (temporary/emotional) injury (OR 0.52, 95% CI 0.28 - 0.97, P = 0.043). Additionally, allegations of informed consent were found to be predictive of a defense verdict versus a plaintiff ruling (OR 0.41, 95% CI 0.17 - 0.98, P = 0.046) or settlement (OR 0.01, 95% CI 0.001 - 0.15, P < 0.001). CONCLUSION Lack of informed consent is an important cause for medical malpractice litigation. Although associated with a lower rate of indemnity payments, malpractice lawsuits including informed consent allegations still present a time, money, and reputation toll for physicians

Minimizing Vulnerability to Malpractice Claims

2017 ◽  
Author(s):  
William R Berry ◽  
Janaka Lagoo
Keyword(s):  
Informed Consent ◽  
Key Words ◽  
Medical Records ◽  
Medical Malpractice ◽  
Interpersonal Skills ◽  
Informed Consent Process ◽  
Consent Process ◽  
Malpractice Claims

This review provides strategies for avoiding lawsuits and advice for dealing with a lawsuit if one is ever filed. Medical malpractice is explained, as are the personal issues for the defendant physician. Strategies for preventing malpractice suits are presented, including those relative to communication and interpersonal skills, the informed consent process, and documentation. Advice is provided for what surgeons should do if sued or threatened with a lawsuit, including measures for assisting in the defense and settling claims versus trying a case. Preparing for a deposition is discussed. How a surgeon should act when serving as a defendant or witness in a courtroom trial is presented. This review contains 5 tables, and 23 references. Key words: claim, communication, defendant, informed consent, lawsuit, malpractice, medical records, negligence, suit

Characterization of Medical Malpractice Litigation after Rhinoplasty in the United States

2020 ◽  
Author(s):  
Adrian A Ong ◽  
Andrew Kelly ◽  
Geroline A Castillo ◽  
Michele M Carr ◽  
David A Sherris
Keyword(s):  
United States ◽  
Patient Satisfaction ◽  
Informed Consent ◽  
Medical Malpractice ◽  
The United States ◽  
Medication Administration ◽  
Ocular Injury ◽  
Contributing Factors ◽  
Malpractice Litigation ◽  
Malpractice Claims

Abstract Background Rhinoplasty is one of the most common operations performed with favorable results and high patient satisfaction. However, when complications occur or when the desired outcome is not achieved, patients may seek litigation on the premise that there was a violation in the standard of care. Knowledge of malpractice claims can inform rhinoplasty surgeons on how to minimize risk of future litigation as well as improve patient satisfaction. Objectives 1) To identify motives for seeking medical malpractice litigation after rhinoplasty; 2) To examine outcomes of malpractice litigation after rhinoplasty in the United States. Methods The Westlaw legal database was reviewed for all available court decisions related to malpractice after rhinoplasty. Data collected and analyzed included plaintiff gender, location, specialty of defendant(s), plaintiff allegation, and adjudicated case outcomes. Results Twenty-three cases were identified between 1960 and 2018, located in 12 states in the United States. Plaintiffs were 70% female. Otolaryngologists were cited in 11 cases while 12 cases involved a plastic surgeon. All cases alleged negligence. Cases involved “technical” errors (69.6%), “unsatisfactory” outcomes (39.1%), inadequate follow-up or aftercare (30.4%), issues with the informed consent process (21.7%), unexpectedly extensive surgery (8.7%), improper medication administration (4.3%), and failure to recognize symptoms (4.3%). Twenty of the 23 adjudicated cases (86.9%) were ruled in favor of the surgeon. Contributing factors in cases alleging malpractice included poor aesthetic outcome/disfigurement (60.7%), new (post-surgical) onset/persistent nasal symptoms (30.4%), postoperative pain (21.7%), orbital/ocular injury (17.4%), burns (4%), nerve damage (4%), and issues with sleep (4%). Conclusions Malpractice litigation after rhinoplasty favored the surgeon in the majority of the adjudicated cases reviewed. The most common reason for litigating was dissatisfaction with aesthetic outcomes. Rhinoplasty surgeons may mitigate possible litigation by developing a positive doctor-patient relationship, clearly understanding the patient’s surgical expectations, obtaining detailed informed consent while maintaining frequent and caring communication with the patient.

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