Descriptive Analysis of State and Federal Spine Surgery Malpractice Litigation in the United States.

STUDY DESIGN: A retrospective review. OBJECTIVE: This study aimed to determine the factors associated with malpractice litigation in cases involving spine surgery in the United States. SUMMARY OF BACKGROUND DATA: Medical malpractice is of substantial interest to the medical community due to concerns of increased health care costs and medical decision-making for the sole purpose of reducing legal liability. METHODS: The Westlaw online legal database (Thomson Reuters, New York, NY) was searched for verdict and settlement reports pertaining to spine surgery from 2010 to 2015. Data were collected regarding type of procedure, patient age and gender, defendant specialty, outcome, award, alleged cause of malpractice, and factors involved in the plaintiff's decision to file. Initial search queried 187 cases, after which exclusion criteria were applied to eliminate duplicates and cases unrelated to spine surgery, yielding a total of 98 cases for analysis. RESULTS: The verdict was in favor of the defendant in 62 cases (63.3%). Neurosurgeons and orthopedic surgeons were the most common defendants in 29 (17.3%) and 40 (23.8%) of the cases, respectively. A perceived lack of informed consent was noted as a factor in 24 (24.4%) of the cases. A failure to diagnose or a failure to treat was noted in 31 (31.6%) and 32 (32.7%) cases, respectively. Median payments for plaintiff verdicts were nearly double those of settlements ($2,525,000 vs. $1,300,000). A greater incidence of plaintiff verdicts was noted in cases in which a failure to treat (P < 0.05) was cited, a patient death occurred (P < 0.05), or an emergent surgery had been performed (P < 0.01). CONCLUSION: Overall, physicians were not found liable in the majority of spine surgery malpractice cases queried. LEVEL OF EVIDENCE: 4.

[New trends in the regulation of medical practice in the context of health care reform: the Mexico case]. / Nuevas tendencias en la regulación de la profesión médica en el contexto de la reforma del sector salud: el caso de México.

The recent panorama of medical practice regulation in Mexico is exposed. The dynamics of regulation changes is observed in different areas, with particular intensity in the labor market. Changes seem to be moving towards the constitution of a new regulatory model. A full state regulation for the last 50 years, is being substituted by a model where private and professional corporations are increasing their influence through informal mechanisms of regulation. In the constitution of this new model, the presence of a wide variety of actors claiming regulatory authority is notorious. Three of these new actors are analyzed: The National Commission for Medical Arbitrage, managed care models of medical services, and Specialists Certification Councils. The changes that have occurred in the process of regulation and its future transformation have an intimate link with the reform of the Mexican health care system.

[Teenage law offenders in Rio de Janeiro and institutions that "rehabilitate" them. The perpetuation of negligence]. / Os adolescentes infratores do Rio de Janeiro e as instituições que os "ressocializam". A perpetuação do descaso.

This article presents data from juvenile delinquents in the Rio de Janeiro Minors Court. It is an exploratory study with qualitative and quantitative approaches, conducted in 1994 in three schools (Padre Severino Institute, João Luiz Alves School, and Santos Dumont School) in Greater Metropolitan Rio de Janeiro and responsible for the legal custody of juvenile delinquents. Social and demographic aspects of the adolescents and families are shown, and the daily routines of employees, adolescents, and researchers are reported. This paper stresses the damaging effects on the lives of these youngsters by their families, society, and judiciary and legal custody institutions. It also suggests approaches and positive ways of reorienting the issue.