Medical Malpractice:A Comparative Perspective Between China and the United States

At the beginning of the 1970s,the United States turned onto the winding road of medical malpractice compensation.With the goal of properly dealing with this issue,the United States embarked on a process of continuous reform.In recent years,the number of disputes over medical malpractice liabilities in China has increased considerably.However,dealing with these disputes in accordance with the provisions of the current law is not going smoothly,and maybe we can learn from the experiences of the United States.The relevant measures for the solutions to medical malpractice in the United States and China will be analyzed from a comparative perspective.These include enactments of medical malpractice,the classification of medical malpractice,the doctrine of liability fixation,the burden of proof,the criterion of judging negligence,the liability subject,the authentication system,expert witnesses,standards of compensation,and suggested reforms in the system of the medical malpractice liability,including stipulating the medical malpractice liability of administration in the Civil Code,optimizing the criteria of recognizing negligence,applying organizational fault liability,establishing pilot projects of no-fault medical liability,developing an open mechanism for medical malpractice disclosures and improving the capacity to deal with medical chaos.

Malpractice claims for endoscopy

AIM: To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. METHODS: We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time. RESULTS: There were 1901 endoscopy-related closed claims against all providers from 1985 to 2008. The specialties include: internal medicine (n = 766), gastroenterology (n = 562), general surgery (n = 231), general and family practice (n = 101), colorectal surgery (n = 87), other specialties (n = 132), and unknown (n = 22). Colonoscopy represented the highest frequen-cies of closed claims (n = 788) and the highest total indemnities ($54 093 000). In terms of mean claims payment, endoscopic retrograde cholangiopancreatography (ERCP) ranked the highest ($374 794) per claim. Internists had the highest number of total claims (n = 766) and total claim payment ($70 730 101). Only total claim payments for colonoscopy and ERCP seem to have increased over time. Indeed, there was an average increase of 15.5% per year for colonoscopy and 21.9% per year for ERCP after adjusting for inflation. CONCLUSION: There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation.

Mediation for medical malpractice actions: an efficient approach to the law and veterinary care

Veterinarians today face an increased risk for malpractice claims in view of increased client awareness of the benefits of the human-animal bond and advances in preventive and specialized veterinary medicine.An important problem with medical malpractice litigation is the manner in which malpractice claims are resolved. In several countries, thousands of claims have been successfully resolved via Alternative Dispute Resolution processes such as mediation, conciliation and arbitration.In medical media-tion, health care providers, patients/animal owners, families, clergy and attorneys partici-pate directly in an informal, usually voluntary, dispute resolution process that can lead to for unique and promising approaches to resolving conflicts.Recently in Italy framework legislation addressing mediation has been introduced and it is also used to resolve medical malpractice disputes.Given that in Italy medical mediation is formally a new concept and is still evolving, an examination is made. The importance of “mediation” for veterinarians’ civil liability will be evaluated, underlining how it could become an important instrument in speeding up the resolution of court actions concerning medical mal-practice.

Prevention of Malpractice in the Field of Health, as the Other Type of Prevention

Background: So far, five types of prevention including: primordial, primary, secondary, tertiary and quaternary prevention levels have been defined in literatures. Aim: In this study, we have proposed “prevention of malpractice” as the other level of prevention. Methods: Qualitative comparison of the data, obtained from the review of conducted studies by using of scientific literatures, registered in PubMed, Google Scholar and Scopus sites. Results: Bringing dozens of examples of “malpractice” in the five areas of prevention. Conclusion: We concluded that, “malpractice” may be occurred at all levels of prevention and preventing it can be considered as the other level of prevention.

Medical malpractice litigation involving otolaryngology residents and fellows:A case-based 30-year review

BACKGROUND Errors,misdiagnoses,and complications can occur while trainees are involved in patient care.Analysis of such events could reveal areas for improvement by residency and fellowship programs.AIM To examine lawsuits tried at the state and federal level involving otolaryngology trainees.METHODS The LexisNexis database,an online legal research database containing state and federal case records from across the United States,was retrospectively reviewed for malpractice cases involving otolaryngology residents or fellows from January 1,1990 to December 31,2020.Case data collected:Plaintiff/trainee/defendant characteristics,allegations,medical outcomes,and legal outcomes.RESULTS Over the study period,20 malpractice lawsuits involving otolaryngology trainees were identified.Plaintiffs raised numerous allegations including procedural error(n=12,25.5%),incorrect diagnosis and/or treatment(n=8,17.0%),and lack of knowledge of trainee involvement(n=6,12.8%).Nine cases(45%)had verdicts in favor of the plaintiff,whereas 5 cases(25%)had verdicts in favor of the defense.Six cases(30%)ended in a settlement.Awards to plaintiffs were heterogenous,with a median of$617,500(range$32K-17M)for settled cases and verdicts favoring plaintiffs.CONCLUSION The findings enclosed herein represent the first published analysis of trainee involvement in otolaryngology malpractice cases held at the state/federal level.Otolaryngology trainees can be involved in lawsuits for both procedural and nonprocedural events.This study highlights the importance of education specifically in the domains of procedural errors,informed consent,proper diagnosis/management,and clear communication within patient care teams.Training programs should incorporate these study findings into effective simulation courses and didactic sessions.Educating trainees about common pitfalls holds the promise of decreasing healthcare systems costs,reducing trainee burnout,and,most importantly,benefiting patients.

Evaluation of Medical Malpractice Litigations in China, 2002–2011

In the past 10 years,medical malpractice litigations have become a serious public health and social issues in China.This study aims to evaluate the medical malpractice litigations in Beijing.A retrospective study was conducted using the database from the Key Laboratory of Evidence Science(KLES)at China University of Political Science and Law(CUPL)to demonstrate the extent and characteristics of the alleged medical malpractice cases and the conclusions of forensic evaluation from 2002 to 2011 in Beijing.A total of 1515 alleged medical malpractice cases were investigated by forensic medical experts at KLES‑CUPL during the study period.Of the 1515 cases,45.2%were male patients and 54.8%were female patients.The age of the patients ranged from newborn to 90 years,with average age of 44 years.The alleged medical malpractice cases involved 11.3%of newborns.From 2002 to 2006,the average number of medical malpractice litigations was 123 cases per year,while from 2007 to 2011,the average number of medical malpractice litigations was 180 per year,a 46%increase.Of the 1515 cases,588(38.8%)litigations were due to the patients’death.Clinical departments involved in claims most often were obstetrics(18.9%),followed by orthopedics(15.1%)and general surgery(11.5%).Medical error was found in 945(62.4%)cases.Of the 945 confirmed medical malpractice cases,the top medical misadventures were diagnostic errors(36.5%),improper performance of procedures(36.4%),and medication error(12.6%).Although tertiary hospitals were more likely to be sued than the secondary and primary hospitals(63.6%vs.36.4%),there was no significant difference between tertiary and secondary hospitals in the percentage of confirmed malpractice cases(62.3%vs.59.4%).The primary hospitals had the highest confirmed malpractice cases(73.2%).

Analyses of Medical Malpractice in Judicial Appraisal: 505 Cases

The purpose of this paper is to investigate and analyze the current situation of medical malpractice and make suggestions for preventative measures from a judicial appraisal standpoint.From 2002 to 2011,we conducted and analyzed 505 medicolegal malpractice experiments at the Fada Institute of Forensic Medicine and Science(FIFMS)in Beijing,People’s Republic of China(PRC).We found that the occurrence of medical disputes in surgical and obstetrical/gynecological cases seemed more frequent.The main causes of medical disputes included issues regarding medical ethics,poor quality of the medical staff,equipment malfunctions,and dereliction of duty by the medical personnel.The reasons for dissatisfaction varied among the different levels of medical service.Basic medical services garnered the most complaints.If we can work to improve the moral and professional standards of the medical staff members,intensify their ethics,and foster good relationships between patients and medical professionals,the quality of medical care would improve and the number of disputes regarding medical services would be reduced.

Clinical peer review in the United States: History, legal development and subsequent abuse

The Joint Commission on Accreditation requires hospitals to conduct peer review to retain accreditation.Despite the intended purpose of improving quality medical care,the peer review process has suffered several setbacks throughout its tenure.In the 1980s,abuse of peer review for personal economic interest led to a highly publicized multimillion-dollar verdict by the United States Supreme Court against the perpetrating physicians and hospital.The verdict led to decreased physician participation for fear of possible litigation.Believing that peer review was critical to quality medical care,Congress subsequently enacted the Health Care Quality Improvement Act(HCQIA)granting comprehensive legal immunity for peer reviewers to increase participation.While serving its intended goal,HCQIA has also granted peer reviewers significant immunity likely emboldening abuses resulting in Sham Peer Reviews.While legal reform of HCQIA is necessary to reduce sham peer reviews,further measures including the need for standardization of the peer review process alongside external organizational monitoring are critical to improving peer review and reducing the prevalence of sham peer reviews.

Two case reports of novel syndrome of bizarre performance of gastrointestinal endoscopy due to toxic encephalopathy of endoscopists among 181767 endoscopies in a 13-year-university hospital review: Endoscopists, first do no harm!

BACKGROUND Although deficient procedures performed by impaired physicians have been reported for many specialists,such as surgeons and anesthesiologists,systematic literature review failed to reveal any reported cases of deficient endoscopies performed by gastroenterologists due to toxic encephalopathy.Yet gastroenterologists,like any individual,can rarely suffer acute-changes-inmental-status from medical disorders,and these disorders may first manifest while performing gastrointestinal endoscopy because endoscopy comprises so much of their workday.CASE SUMMARIES Among 181767 endoscopies performed by gastroenterologists at William-Beaumont-Hospital at Royal-Oak,two endoscopies were performed by normally highly qualified endoscopists who manifested bizarre endoscopic interpretation and technique during these endoscopies due to toxic encephalopathy.Case-1-endoscopist repeatedly insisted that gastric polyps were colonic polyps,and absurdly“pressed”endoscopic steering dials to“take”endoscopic photographs;Case-2-endoscopist repeatedly insisted that had intubated duodenum when intubating antrum,and wildly turned steering dials and bumped endoscopic tip forcefully against antral wall.Endoscopy nurses recognized endoscopists as impaired and informed endoscopy-unit-nurse-manager.She called Chief-of-Gastroenterology who advised endoscopists to terminate their esophagogastroduodenoscopies(fulfilling ethical imperative of“physician,firstdo-no-harm”),and go to emergency room for medical evaluation.Both endoscopists complied.In-hospital-work-up revealed toxic encephalopathy in both from:case-1-urosepsis and left-ureteral-impacted-nephrolithiasis;and case-2-dehydration and accidental ingestion of suspected illicit drug given by unidentified stranger.Endoscopists rapidly recovered with medical therapy.CONCLUSION This rare syndrome(0.0011%of endoscopies)may manifest abruptly as bizarre endoscopic interpretation and technique due to impairment of endoscopists by toxic encephalopathy.Recommended management(followed in both cases):1-recognize incident as medical emergency demanding immediate action to prevent iatrogenic patient injury;2-inform Chief-of-Gastroenterology;and 3-immediately intervene to abort endoscopy to protect patient.Syndromic features require further study.

Assessment of Diarrheal Disease Management Practice in Under-Five-Year Children According to WHO Guideline in Health Facilities of Hawassa City, SNNPR, Ethiopia

Objective: To explore the practice of management of diarrhea in under-5-year children at health facilities found in Hawassa town, and associated factors with malpractice in comparison. Methodology: Cross Sectional study was conducted in 2 hospitals, 2 health centers and 2 private clinics that are found in Hawassa city which is found in Southern Nations, Nationalities and peoples (SNNP), 275 KM to south from Addis Ababa, capital city of Ethiopia from august 2017-October 2017. Structured checklist was used to retrieve the required information from the patients on arrival and stay in pediatrics OPDs and wards. The data analysis carried out using SPSS version 20.0. Logistic regression was carried out to analyze the association between the independent and dependent variables. Statistically significant associations were declared at p-values of less than or equal to 0.05. Results: Out of 420, about 397 (94.5%) children with diarrheal disease between the ages of 3 - 59 months were studied. The study subjects were from governmental hospitals (35.5%), health centers (34.5%) and private clinics (30%) that are found in Hawassa City. Sign of dehydration was 66 (17%) of which majority 59 (83%) of them were rehydrated. As to Zink supplementation, only 180 (45%) received it;antibiotics were the commonly (59.1%) prescribed drugs. Only 43.3% of children were appropriately managed. Hospitals had higher odds of inappropriate management of diarrhea with AOR = 1.61 (95% CI: 1.04 - 2.5) and children one year or younger were more inappropriately managed for diarrhea at the health facilities with AOR of 2.3 (95% CI: 1.57 - 4.41). Conclusions: In the current study the management of diarrhea at the health facilities is unsatisfactory as only less than half of children with diarrhea were properly managed. Treatment of diarrhea at hospital level and the patient’s age being less than 1 year were found to significantly affect the level of mismanagement of the diarrheal disease. Therefore, orientation and trainings for health care providers especially GPs and Residents should be given to adhere to recommended zinc therapy, Oral Rehydration Salts (ORS) replacement therapy and rational antibiotics prescription.

Anesthesia Related Closed Claims and Litigations at the Detroit Medical Center: Analysis, Lessons Learned, and Conclusions

The analysis of closed claims and litigations can provide an invaluable tool to improve patient safety by minimizing adverse anesthesia-related outcomes. Analysis of collective data describing such claims is integral to develop new guidelines aimed to reduce adverse anesthesia-related events. In this study, we give a descriptive analysis of anesthesia-related claims at the Detroit Medical Center, Detroit, MI, USA. The study analyzed different components in anesthesia-related closed claims and litigations such as medical, demographic and socio-economic factors. From 67,000 procedures in anesthesiology care provider, related cases claims were made in 0.057% (38/67,000) of all cases. The majority of claims involved procedures involving Caucasian females aged 51-55 years. The highest risk periods involved early shift times during Monday and Tuesday, particularly of procedures performed during August. About 33% of all cases in which death occurred involved patients who received an Obstetrics/Gynecology or an Orthopedic procedure under general anesthesia. The majority of closed claims and litigations cases were distributed between procedures treating nerves injuries and anoxic encephalopathy. The OR and PACU at urban hospitals had the highest claim rates. MD anesthesiologists constituted the lowest proportion of all anesthesia providers involved in closed claims incidents. The average compensation paid was predominately in the range of $200,000-$250,000. In addition to reporting anesthesia related factors involved in closed claims and litigations this study also includes a series of recommendations which may work as a framework for improving anesthesia practices.

The Emerging Importance of Professional Liability Insurance Coverage for Pharmacists

As the responsibilities for clinical pharmacists have increased in recent years, the pharmacy practitioner finds the need for professional liability insurance. This report describes the practice changes under way and describes the malpractice insurance options available to current pharmacy practitioners.

Multidimensional Approach to Suicide Prevention in Jails and Prisons: The Best Defense against Liability Lawsuits

Inmates in jails and prisons are a high-risk group for suicide. Often, legal claims of medical negligence and §1983 based on deliberate indifference by the correctional officials follow. Unique stable and dynamic factors and circumstances and their interaction explain most suicides. A systematic suicide screening using a well-designed suicide screening questionnaire that captures known risk factors will identify most inmates at risk if adequately used. Identification and subsequent mental health assessment set the stage for preventive intervention, monitoring, and treatment of the inmates. A multidimensional suicide prevention program saves not only lives but also the best defense against a liability lawsuit.

A Rare Complication:Perioral Burn Related to Electrocautery Use during Adenotonsillectomy

Electrocautery is frequently used for incisions and bleeding control during adenotonsillectomy which is one of the most commonly performed pediatric surgical procedures. Although cases of perioral burn related to electrocautery use are rarely reported complications in literature, they account for a significant portion of malpractice lawsuits. The use of insulated surgical tools and lip protective equipment, careful surgery, and the frequent control of surgical equipment may decrease the number of this complication. This study examines whether a rarely reported complication related to perioral burn is indeed rarely seen or whether there are problems in reporting the real rates because it is evaluated to be a case of malpractice, and the protective factors that will prevent this problem. Consequently, it is underlined that this complication, which is more frequently seen than it is reported, should be a part of preoperative information process and the consent form.

Evolution of health law in Turkey

Turkey has always been one of the leading countries in the field of health and fundamental rights.Though Turkey is a member of many international organizations and a candidate state for the European Union,had some regulations on fundamental rights,patients rights and right to health,even before the international papers,such as the Universal Declaration of Human Rights,did not come into force.Turkey always follows closely to the new developments in health care technologies,that is why Turkey continues to be one of the most chosen countries in international health tourism.These improvements in health care drive Turkey to adjust its regulations related to patients'fundamental rights and right to access to health.In the 2000s,health law postgraduate programs were founded in some universities in Turkey.With these programs,research in health law has been accelerated.Turkey will be one of the leading countries in health law too in the next few years.In this study,we started with the fundamental sources of the right to health in Turkey;then we continued with current objects at issue in Turkish health law;then we gave place to the current problems of Turkish health law such as reproductive rights,problems related to organ and tissue transplantations,increasing numbers of legal cases against health care professionals,their possible solutions and the future expectations.

医疗事故中的因果关系初探

医疗事故中的因果关系初探刘新社，刘明俊，唐承汉，张秦初Ａｆｅｗｗｏｒｄｓａｂｏｕｔｔｈｅｃａｕｓａｔｉｏｎｏｆｍａｌｐｒａｃｔｉｃｅ￥ＬｉｕＸｉｎｇｓｈｅ（ＦｕｃｕｌｔｙｏｆＦｏｒｅｎｓｉｃＭｅｄｉｃｉｎｅ，ＸｉａｎＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ...

Origin and Prevention of Workplace Violence in Health Care in China： Legal and Ethical Considerations

WORKPLACE VIOLENCE IN HEALTH CARE：A CONTINUOUS GLOBAL PROBLEM AND ITS CHARACTERISTICS IN CHINA Workplace violence is a persistent problem in health care worldwide. The victims are usually nurses and workers in the emergency department. The academic debate, as it develops overtime, would allow us to gain an integral insight about this problem. The author searched the related research and debate articles in English in PubMed （www.pubmed.conl） dated from 1990 to 2016 [Figure 1 ]. In total, 1899 items with the keywords of＂workplace violence,＂ 600 items with ＂workplace violence healthcare,＂ 786 items with ＂＇workplace violence nursing,＂ and 279 items with ＂workplace violence emergency＂ （there is some overlap between these four groups） have been published.

Confrontation and Integration: The Present and Future of Forensic Examinations on Medical Damage in China

In China,two administrative regulations and judicial interpretations related to forensic examinations of medical damage were issued from March 2017 to June 2018.In chronological order,they were interpretation of the supreme people’s court on several questions concerning the application of law in the trial of disputes over liability for medical damage and regulations on the prevention and handling of medical disputes.Those two laws,especially the regulation,have had a fundamental impact on the pattern of forensic examinations on medical damage.This paper systematically reviews the current status and existing problems with forensic examinations on medical damage following implementation of the law of tort liability;it discusses new concepts of procedures,institutional arrangements,and the selection of examiners for forensic examinations on medical damage.We believe that through the regulation,the dualistic confrontation status of forensic examinations on medical damage will gradually change toward integration.We consider that forensic examinations of medical damage will face three challenges in the future:(1)enhancing the establishment of standards;(2)undertaking theoretical research into forensic examinations onmedical damage;and(3)promoting the development ofinterdisciplinary identification specialistsmajoring in both medicine and law.Only in this way will it be possible to rectify the current dilemma with forensic examinations on medical damage in China.