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.

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.

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.

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.

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.