Malpractice claims related to musculoskeletal imaging. Incidence and anatomical location of lesions.

PURPOSE: Failure to detect lesions of the musculoskeletal system is a frequent cause of malpractice claims against radiologists. MATERIALS AND METHODS: We examined all the malpractice claims related to alleged errors in musculoskeletal imaging filed against Italian radiologists over a period of 14 years (1993-2006). RESULTS: During the period considered, a total of 416 claims for alleged diagnostic errors relating to the musculoskeletal system were filed against radiologists; of these, 389 (93.5%) concerned failure to report fractures, and 15 (3.6%) failure to diagnose a tumour. CONCLUSIONS: Incorrect interpretation of bone pathology is among the most common causes of litigation against radiologists; alone, it accounts for 36.4% of all malpractice claims filed during the observation period. Awareness of this risk should encourage extreme caution and diligence.

[Analysis of violence against health care workers through medical surveillance at the workplace in a 8-yr period]. / Analisi della violenza contro i lavoratori della Sanità durante la sorveglianza sanitaria in un periodo di 8 anni.

Physical and moral violence against the workers of a local public health unit is perspectively studied in the period 2005-2011. Data were collected during periodic medical surveillance of all workers exposed to risk and with more than one year of seniority. The prevalence of the phenomenon is constant in the period under review. On average, each year a worker in ten is physically assaulted, and one in five is subjected to verbal abuse. The professional groups most exposed to violence are nurses (OR 2.67 IC95% 1.63-4.39) and doctors (OR 2.44 IC95% 1.34-4.46). The areas at greatest risk are the psychiatric care (OR 25.7, IC95% 11.1-59.6) and emergency and first aid (OR 8.8, CI95% 3.8-20.5). The workplace violence against health workers requires urgent preventive interventions.

Radiologic malpractice litigation risk in Italy: an observational study over a 14-year period.

OBJECTIVE: The purpose of this study is to assess the risk of medical malpractice litigation for Italian radiologists, compared with the corresponding data in the literature. MATERIALS AND METHODS: The insurance claims of Italian radiologists over the 1993-2006 period were anonymously assessed and classified according to the cause of the claim. RESULTS: A total of 1,424 claims were filed during the examined period, with most claims being filed at a considerable time interval after the event (up to 10 years). The resulting incidence may be estimated as 44.2 cases per 1,000, meaning that 44% of Italian radiologists have received, or will receive, summons regarding their professional activity during the past 10 years. CONCLUSION: The risk of medical malpractice litigation for Italian radiologists is by now comparable to that for American radiologists. Comparison with previous data concerning the same study population shows that the diagnostic errors category has surpassed all other error categories (nondiagnostic errors) and that, within the diagnostic errors category, claims for allegedly missed cancer have surpassed claims for allegedly missed bone abnormalities. Among missed diagnosis claims, the maximum increase concerned mammograms. Strict adherence to radiologic standards and radiotherapy protocols may be a means of reducing the risk of legal action and obviating litigation.

[Workers with alcohol and drug addiction problems. Consensus Document of the Study Group on Hazardous Workers]. / Lavoratori con problemi di alcol e dipendenze. Documento di Consenso del gruppo La.R.A. (Lavoratori Rischiosi per gli Altri).

BACKGROUND: Italian Law 81/08 (so-called "Unified Text of Laws on Health and Safety at Work"), came into force on 15 May 2008 and incorporates provisions related to medical surveillance of drug and alcohol dependency at the workplace. OBJECTIVES: Occupational health traditionally addresses the issue of protection of worker from occupational hazards. The issue of protection of third parties from behaviour of workers resulting from drug and alcohol dependency implies an original methodological approach, involving full cooperation of employer, employees, and health and safety consultants. METHODS: A consensus development meeting was organized under the leadership of the Italian Study Group on Hazardous Workers (La.R.A. group). The meeting brought together physicians of different specialties, legal experts and bioethicists, labour and management policy-makers, to discuss the issue and define the research data available, the standards that were appropriate, and which policies were fair. RESULTS: The efficacy of medical surveillance, including workplace drug-testing, relies on a comprehensive policy, including written and verbal information on the use of alcohol and drugs on the job, training for supervisors and management, employee education, and employee assistance structures. Sample collection and testing should be carried out in accordance with standardized and tested procedures. Small businesses will need assistance, including development of model policies, setting up consortia for testing services and if necessary request for National Insurance benefits to reduce costs. CONCLUSIONS: The recently introduced Italian legislation on occupational safety and health closely resembles Finnish law since it consists of a "double channel" for workplace drug testing. At recruitment, the employer is entitled to ask a job applicant for a certificate of "Job fitness", including drug tests, that can be issued only by a public health institution, where the job applicant works on a well-defined set of tasks which require accuracy, trustworthiness, independent judgement or a very good reaction capacity. The employer may also refer the employee to the public health institution to obtain a certificate in the course of an employment contract when there is a legitimate suspicion that the employee is working while under the effects of drugs or alcohol or that the employee is a drug addict. After recruitment, the physician responsible for medical surveillance of workers (the so-called "Competent Physician") is entitled to perform drug tests on employees. The need for a test is decided by the health care professional, not by the employer, and only a general report on the health of the employee ("fit", fit with restrictions" or "unfit") may be given to the employer. Workers positive for drug tests will be referred to a public health institution for re-testing and treatment.

[Critical aspects of the management of "hazardous" health care workers. Consensus document]. / Aspetti critici della gestione dei "lavoratori rischiosi" nei servizi sanitari. Documento di consenso.

BACKGROUND: A worker is considered to be hazardous to others when, in the course of performing a specific work task, his/her health problems (e.g., substance dependence, emotional disorders, physical disability, transmissible diseases) pose a risk for other workers' or the public's health and safety, or begins to interfere with ability to function in profession life. The presence of certain illnesses or the fact that a health care worker is impaired because of them do not necessarily imply that he, or she, is hazardous for others. Working in health care increases the probability that an impaired worker being hazardous for others. Management of hazardous workers requires new techniques and procedures, and specific policies. OBJECTIVE AND METHODS: An interdisciplinary group of experts from medical, bioethical, legal and administrative disciplines, together with trade union and employers' representatives, is currently attempting to define a way to put prevention measures into practice in accordance with state laws and individual rights. RESULTS: A consensus document is presented, covering critical aspects such as: social responsibility of the employer, risk management, informed consent, non compliance, confidentiality, responsibility of workers, disclosure of risk to patients, non-discrimination, counselling and recovery of impaired workers, effectiveness of international guidelines. CONCLUSIONS: Occupational health professionals are obliged to adhere to ethical principles in the management of "hazardous" workers; the assessment of ethical costs and benefits for the stakeholders is the basis for appropriate decisions.