A comparison of medical litigation filed against obstetrics and gynecology, internal medicine, and surgery departments

Defensive medicine through the lens of the managerial perspective: a literature review

PURPOSE

Several studies have been carried out on defensive medicine, but research from the managerial viewpoint is still scarce. Therefore, the aim of the present study is to conduct a literature review to better understand defensive medicine from a managerial perspective.

DESIGN/METHODOLOGY/APPROACH

A literature review was conducted of studies focusing on the organisational (meso) level of healthcare providers and managerial practices. A final sample of 28 studies was processed.

FINDINGS

Defensive medicine has mainly been studied in the USA, and scholars have principally used quantitative surveys. High-risk specialities have been a critical field of investigation, and a large portion of the papers are published in journals that cover medicine, health policy, education and law fields. The analysis showed that operations and the organisation of staffing were the most discussed managerial practices. No study considered planning and budgeting aspects.

ORIGINALITY/VALUE

The review confirmed that the managerial aspect of defensive medicine has not been fully addressed. Stimulated by this gap, this study analyses the managerial background of the defensive medicine phenomenon and shows which managerial practices have been most analysed. This paper also contributes to developing the literature on defensive medicine from the managerial side. Areas for future research include qualitative studies to investigate the behaviour of managers of healthcare companies to give a different perspective on defensive medicine and organisations' decision-making.

RESEARCH LIMITATIONS/IMPLICATIONS

Some important publications might have been missed in this work because of the choice of only two databases. A further limit could be imposed by the use of the English language as an inclusion criterion.

Artificial intelligence and the future of midwifery: What do midwives think about artificial intelligence? A qualitative study

The evidence on how AI will make a revolution is insufficient. Our aim was to investigate opinions of midwives on the future of AI and midwifery. Semi-structured interviews were done with 18 midwives in Turkey. Themes were identified: expectations included the advantages and conditional acceptance of robotic technology, prejudices reflected perceived shortcomings, lack of human competencies, and trust issues. Concerns included midwifery care and concerns about her future. Midwives were overwhelmingly skeptical about the replacement of human capabilities by AI and found the technology's potential limited.

Five-year results of no-fault compensation related to childbirth injuries in Taiwan

OBJECTIVE

Increasing obstetric medical litigations had great impacts in health care system resulted in lower recruitment of residents and higher medical cost of defensive medicine in Taiwan. In order to reduce medical litigation, the "Childbirth Accident Emergency Relief Act" was implemented in June 2016. This study presented five-year results of a novel childbirth accident compensation system.

MATERIALS AND METHODS

The purpose of the Relief Act was to establish a national relief system to ensure timely relief, reduce medical disputes, promote the partnership between patient and medical personnel. The compensations included maximal 2 million NTD for maternal death, maximal 0.3 million NTD for neonatal and fetal deaths, and 3, 2, and 1.5 million NTD for maternal or neonatal profound, severe, and moderate disabilities, respectively. Puerperal hysterectomy was included with maximal 0.8 million NTD compensation.

RESULTS

Since June 30, 2016 to June 30, 2021, there were 1340 applications reviewed by Committee and 1258 were approved with total relief of 744.7 million NTD (26.6 million USD) with approve rate of 93.9%. It took an average of 109.8 days to start application from childbirth and 102.4 days to get compensation from application. 66.1% of accident victims agreed this system can restore doctor-patient relationship by immediate care and assistance from medical institutions.

CONCLUSION

The Relief Act is the first government leading compensation system to establish a national relief system. It was enacted to reduce medical disputes, promote the partnership between patient and medical personnel, and enhance health and safety of women during childbirth. A no-fault compensation would be an efficient alternative disputes resolution to childbirth accidents.

Medical Malpractice Litigation in Non-Mesh-Related Pelvic Organ Prolapse Surgery: An Analysis of 91 Cases

INTRODUCTION

Malpractice litigations have significant implications for patients and physicians. Studies have investigated mesh litigations in female pelvic reconstructive surgery, but none on nonmesh pelvic organ prolapse (POP) surgery. Our purpose is to determine the reasons for and outcomes of medical malpractice after nonmesh POP surgery.

METHODS

Westlaw (Thompson Reuters, New York, New York) is a legal research database of US court records. We identified completed POP litigations from 1987 to 2018 using the following: "pelvic organ prolapse," "enterocele," "rectocele," "cystocele," "uterine prolapse," and "vaginal wall prolapse." Mesh-related cases were excluded. Outcomes included reasons for litigation, verdict, injury, and payments. Statistical analysis was performed with nonparametric tests and χ2 independence test.

RESULTS

Ninety-one litigations were included. The median plaintiff age was 53 years (range, 36-85 years). The leading allegation was negligence of surgery (n = 59; 65%). The jury sided with the defendant physician in 67% of cases (n = 61). There was no association between case verdict and patient age (P = 0.781), geographic region (P = 0.824), or allegation (P = 0.904). The primary complications were urinary tract injury (n = 24; 26%), need for additional surgery (n = 22; 24%), and new postoperative urinary symptoms (n = 22; 24%). The median payout was $280,000 (interquartile range, $137,250-$1,300,000), with no difference between plaintiff awards or settlements (P = 0.659).

CONCLUSION

The leading allegation of malpractice litigations for nonmesh POP surgery is negligence of surgery, whereas the most common complication was urinary tract injury. A verdict in favor of the physician defendant was the most likely outcome. Plaintiff awards and settlements were not statistically different with no variation by region or time.

Dentists' Legal Liability and Duty of Explanation in Dental Malpractice Litigation in Japan

Introduction

Dental litigation accounts for approximately 10% of medical cases in Japan. This study sought to identify factors related to dentists’ legal liability in Japan, including their duty to explain procedures and treatments to their patients.

Methods

We analysed court decisions in 166 dental malpractice cases litigated in Japan between 1978 and 2017. To identify factors related to the legal liability of dentists, an analysis was performed to evaluate the associations among patient characteristics, dentist characteristics, litigation, and dentists’ explanatory behaviour.

Results

Of the 36 cases related to dentist liability, the study identified 23 cases (63.9%) of litigation in which the dentists were found to be in violation of their duty to provide an explanation. Regarding the severity of injury, the ratio of death and permanent disability was significantly higher in decisions in which the purpose of the explanation was something other than obtaining the patient's consent compared with decisions to obtain the patient's consent (P = .014).

Conclusions

In cases in which the dentist was found legally responsible, the proportion of cases involving procedural negligence with the explanation of medical guidance was significantly higher. Dentists should pay careful attention not only to the patient's consent but also to their explanations, including “medical guidance.” Moreover, they should recognise that inappropriate explanations correlate with serious errors.

Debunking the myth that the majority of medical errors are attributed to communication

CONTEXT

Many articles, book chapters and presentations begin with a declaration that the majority of medical errors are attributed to communication. However, this statement may not be supported by the research reported in the literature.

OBJECTIVES

The purpose of this systematic review is to identify where errors are reported in the research literature.

METHODS

A systematised review was conducted of research articles over the last 20 years (1998-2018) indexed in PubMed/MEDLINE and the Cumulative Index to Nursing and Allied Health (CINAHL) using term combinations: medical errors, research and communication. Inclusion was based on reported generalised primary research of medical error and the reported causes.

RESULTS

This systematised review resulted in 2881 research articles, which produced 42 that met the inclusion criteria. Although there was some overlap, three categories of errors were dominant in this research: errors of commission (20 articles; 47.6%), errors of omission (six articles; 14.2%) and errors through communication (four articles; 9.5%). There were 12 (28.5%) articles in which all three categories together significantly contributed to error. Of these 12 articles, errors of commission or omission were dominant in nine articles (21.4%) and errors of communication were prevalent in only three articles (7%).

CONCLUSIONS

The assertion that the majority of medical errors can be attributed to miscommunication is not supported by this systematic review. Overwhelmingly, most reported errors are attributed to errors of omission or commission. Intentionally or unintentionally providing misinformation may mislead patient safety initiatives, and research and funding agency priorities.

Challenges in providing maternity care in remote areas and islands for primary care physicians in Japan: a qualitative study

Background

Maintaining a maternity care system is one of the biggest issues in Japan due to the decreasing number of obstetricians, especially in remote areas and islands. The aim of this qualitative study was to explore the challenges in women’s health and maternity care in remote areas and islands for primary care physicians and obstetricians in order to provide an insight necessary to develop a better health care system.

Methods

We conducted semi-structured interviews with 13 primary care physicians and 4 obstetricians practicing maternity care at clinics/hospitals in remote areas and islands across Japan. Interview data were analyzed, using the modified Grounded Theory Approach, to elucidate the challenges primary care physicians faced in their practice.

Results

Primary care physicians who engaged in maternity care recognized the following challenges: low awareness of primary care, lack of training opportunities, unclear goal of the training, lack of certification system, lack of consultation system, and lack of obstetricians to offer support. These six challenges along with the specialty’s factors such as sudden changes of patients’ condition were considered to result to the provider’s hesitation and anxiety to engage in the practice.

Conclusions

This study found six environmental/systemic factors and three specialty’s factors as the main challenges for primary care physicians in providing maternity care in remote areas and islands for primary care physicians in Japan. Increasing the awareness of primary care and developing a maternity care training program to certify primary care physicians may enable more primary care physicians to engage in and provide women’s health and maternity care in remote areas and islands.

An Ethogram to Quantify Operating Room Behavior

BACKGROUND

The operating room (OR) is a highly social and hierarchical setting where interprofessional team members must work interdependently under pressure. Due primarily to methodological challenges, the social and behavioral sciences have had trouble offering insight into OR dynamics.

PURPOSE

We adopted a method from the field of ethology for observing and quantifying the interpersonal interactions of OR team members.

METHODS

We created and refined an ethogram, a catalog of all our subjects' observable social behaviors. The ethogram was then assessed for its feasibility and interobserver reliability.

RESULTS

It was feasible to use an ethogram to gather data in the OR. The high interobserver reliability (Cohen's Kappa coefficients of 81 % and higher) indicates its utility for yielding largely objective, descriptive, quantitative data on OR behavior.

CONCLUSIONS

The method we propose has potential for social research conducted in healthcare settings as complex as the OR.

Litigations in Obstetric and Gynecological Practice: Can it be prevented? A Probability to Possibility

BACKGROUND

Litigation in medical practice is becoming a global problem. So it is necessary to know what constitutes negligence and what is required to prove it and how far it is preventable.

OBJECTIVES

To analyze the prevalence and reasons for litigations in Obstetrics and Gynaecology for medical negligence and deficiency in service. To analyze on what grounds negligence was proved and to know whether it was preventable.

MATERIALS AND METHODS

It is a retrospective analysis of the judgments obtained from all the District Consumer Courts of South India and was specifically analyzed for reasons in filing the case, nature of settlement, and factors considered in deciding negligence especially in the field of obstetrics and gynecology.

RESULTS

Totally 1317 cases were found on medical negligence and deficiency in service, with 347 (26.34 %) cases on Obstetrics and Gynecology (OBG) topping the list. Out of 347 cases on OBG 312 (89.91 %) cases were settled in the Courts. Negligence was proved in 98 (31.41 %) cases and 214 (68.59 %) cases were dismissed without compensation. 77 (24.68 %) cases on gynecology were filed with common reasons for litigation being Post-op complications, intraop complications (11.68 %), extension of surgery beyond consent (2.6 %) and out of 235 (75.32 %) cases on Obstetrics, tubectomy failure (23.82 %), birth asphyxia (10.21 %), traumatic injury to new born (5.96 %) were the common reasons for litigations. Inadequate documentation and improper consent were the main factors considered in deciding negligence on part of the doctors.

CONCLUSION

With reasonable skill and care in diagnosis and treatment, proper documentation and legally valid consent it is not probable but possible to prevent litigations.