[Analysis of claims for wrong-site surgery (1986-2017)]. / Reclamaciones por cirugía en sitio erróneo (1986- 2017).

BACKGROUND: Wrong site surgery (WSS) is a potentially preventable adverse event in healthcare. METHODS: We performed a retrospective analysis of the 9,129 claims managed by the Professional Liability Service of the Catalonian's Colleges of Physicians from 1986 to 2017. RESULTS: We identified 57 claims for WSS (1.78 per year), with an increase in the final ten years (0.92 to 3.83). One patient identification error corresponded to the anesthetic procedure; surgery involving fingers (17.5%), backbone (15.8%), knee (12.3%) and teeth (12.3%) was predominant. Orthopedic Surgery and Traumatology was the specialty most involved (54.4%), being tooth extraction, vertebral disc prolapsed surgery and finger bone resection the most frequent procedures with seven cases each (12.3%). Claims followed criminal (16 cases, 28.1%) or civil proceedings (9 cases, 15.8%), with two guilty verdicts on a civil basis. The frequency of claims leading to compensation was 59.6%, averaged 9,210.23 euros per claim, resolved through extrajudicial (65.6%) or judicial channels (50.0%). CONCLUSION: WSS events cannot be overlooked and shows high incidence of claims liability rates, which highlights the need to increase efforts to ensure patient safety in this area.

Malpractice risk at the physician level: Claim-prone physicians.

Professional liability and patient safety are worldwide concerns and efforts to identify claimed physicians' characteristics cross borders. Interventions with "at risk populations" would help to better address the underlying problems that lead to many claims. We analyzed physicians' characteristics of every paid claim between 2005 and 2014 in Catalonia region (Spain). We identified 808 physicians involved in 725 paid claims. A total of 12.38% physicians had at least two paid claims over the study period. Physicians' risk of future paid claims was increased if they had more than one previous paid claim (hazard ratio, 1.87; 95% confidence interval [CI], 1.67-2,1). More than half the claims were accounted for by physicians in four specialty groups: obstetrics and gynecology (20.4%), traumatology and orthopedic Surgery (17.5%), plastic surgery (10%) and general surgery (9.7%). The risk of recurrence was higher among surgery-related specialties than among non-surgery-related specialties. Specialty is a particularly strong determinant of claim incidence, so the risk issue may not be so individually determined, but conditioned by the kind of medicine or procedures we practice. Nevertheless, physicians' risk of future paid-claims increases after the second claim. Management systems should take advantage of this information, in order to prevent patient safety events and malpractice claims. Our results support both specialty-based interventions in high-risk specialties, such us Plastic Surgery, as well as interventions at a physician level in those physicians with more than one paid claim.

Clinical safety and professional liability claims in Ophthalmology. / Seguridad clínica y reclamaciones por responsabilidad profesional en Oftalmología.

INTRODUCTION: Patient safety is an international public health priority. Ophthalmology scientific societies and organisations have intensified their efforts in this field. As a tool to learn from errors, these efforts have been linked to the management of medical professional liability insurance through the analysis of claims. MATERIAL AND METHODS: A review is performed on the improvements in patient safety, as well as professional liability issues in Ophthalmology. RESULTS: There is a high frequency of claims and risk of economic reparation of damage in the event of a claim in Ophthalmology. Special complaints, such as wrong surgery or lack of information, have a high risk of financial compensation and need strong efforts to prevent these potentially avoidable events. Studies focused on pathologies or specific procedures provide information of special interest to sub-specialists. The specialist in Ophthalmology, like any other doctor, is subject to the current legal provisions and appropriate mandatory training in the medical-legal aspects of health care is essential. CONCLUSIONS: Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career, and help in increasing patient safety. The aim of this review is to contribute to this training, for the benefit of professionals and patients.

[Clinical safety and professional liability claims in Orthopaedic Surgery and Traumatology]. / Seguridad clínica y reclamaciones por responsabilidad profesional en Cirugía Ortopédica y Traumatología.

The specialist in orthopaedic and traumatological surgery, like any other doctor, is subject to the current legal provisions while exercising their profession. Mandatory training in the medical-legal aspects of health care is essential. Claims against doctors are a reality, and orthopaedic and traumatological surgery holds first place in terms of frequency of claims according to the data from the General Council of Official Colleges of Doctors of Catalonia. Professionals must be aware of the fundamental aspects of medical professional liability, as well as specific aspects, such as defensive medicine and clinical safety. The understanding of these medical-legal aspects in the routine clinical practice can help to pave the way towards a satisfactory and safe professional career. The aim of this review is to contribute to this training, for the benefit of professionals and patients.

Catastrophic Medical Malpractice Payouts in Spain.

Patient safety and professional liability are major concerns worldwide. Despite the pervasive influence of catastrophic malpractice payouts, little is known about the specific characteristics and the overall relevance and characteristics of these payouts, especially outside U.S. borders. Five hundred fifty claims led to a payout among 2,236 claims from January 1, 2004 to December 31, 2010, in Catalonia (Spain). We analyzed data on patient, provider, and claim characteristics. Accordingly to our sample, Spanish catastrophic payouts (SCP) were defined as payouts over &OV0556;200,000, which was found in 32 cases (5.8%). Diagnostic errors and patient death were not as relevant as previously reported. However, it is remarkable that the literature emanating from different countries shows similar trends besides contextual differences: patients suffering minor injuries are not likely to receive a catastrophic payout, catastrophic payouts are associated with patient age less than one; SCP are most associated with anesthesiology and resuscitation, general surgery, and obstetrics and gynecology; and SCP were more likely to occur when a case went to trial compared to when a case was settled out of court. Studies, such as this, provide a wider picture of the medical liability worldwide reality and helps avoiding isolated discourses.