Judicialización en cardiología y cirugía cardiovascular: estudio observacional transversal en materia de responsabilidad patrimonial en la sanidad pública española / Litigation in cardiology and cardiovascular surgery: A cross-sectional observational study of liability in the spanish public healthcare system

Introducción: la sobrestimación por los facultativos del riesgo a una demanda judicial tiene, entre otras consecuencias, la intensificación de la medicina defensiva. El objetivo del trabajo fue analizar las características de las sentencias sobre la responsabilidad médica en España en la asistencia sanitaria pública en las especialidades de cardiología y cirugía cardiovascular.Material y métodos: estudio observacional transversal cuyo objetivo fue analizar las sentencias dictadas en la jurisdicción contencioso-administrativa por los Tribunales Superiores de Justicia entre el período 2008-2020, en las especialidades de cardiología y cirugía cardiovascular. Las variables fueron administrativas, clínicas, judiciales e indemnizatorias.Resultados: se analizaron 1.015 sentencias, de las cuales 47 (4,63%) se refirieron a las especialidades de cardiología y cirugía cardiovascular. Ambas obtuvieron porcentajes de frecuencia similares, cardiología 22 (2,16%) y cirugía cardiovascular 25 (2,46%). El 74,1% de las sentencias fueron desestimatorias en primera instancia y el 75% en segunda instancia. Los 2 motivos de sentencia estimatoria más frecuentes fueron la pérdida de oportunidad 6 (42,85%) y la mala praxis diagnóstica y/o terapéutica 5 (35,71%). Los daños reclamados fueron: fallecimiento 21 (44,68%) y secuelas 26 (55,32%). La mediana de las indemnizaciones fue 30.000 euros.Conclusiones: la baja frecuencia de las demandas en cardiología y cirugía cardiovascular indica que se trata de especialidades de «bajo riesgo» de litigiosidad. La inmensa mayoría de las sentencias son, además, desestimatorias de la pretensión de los pacientes. Los datos contribuyen a estructurar el papel de las demandas judiciales y a aumentar el conocimiento de los profesionales en la dimensión médico-legal de la asistencia sanitaria. (AU)

Introduction: The overestimation by physicians of the risk of a lawsuit has, among other consequences, the stepped-up of defensive medicine. To analyze the characteristics of medical liability rulings in Spain in public health care in the specialties of cardiology and cardiovascular surgery.Materials and methods: Cross-sectional observational study analyzing the rulings handed down in the contentious-administrative jurisdiction by the High Courts of Justice in the period 2008-2020, in the specialties of cardiology and cardiovascular surgery. The variables were administrative, clinical, judicial, and compensatory.Results: A total of 1015 rulings were analyzed; 47 (4.63%) involved to the specialties of cardiology and cardiovascular surgery. Both obtained similar frequency percentages, cardiology 22 (2.2%) and cardiovascular surgery 25 (2.5 %). A total of 74.1 % of the rulings were dismissed in the first instance and 75% in the second instance. The two grounds for finding against the defendent were loss of chance 6 (42.85%) and diagnostic and/or therapeutic malpractice 5 (35.71%). Damages were usually claimed: death 21 (44.68%) and sequelae 26 (55.32%). The median award was 30,000 euros.Conclusions: The low frequency of claims in cardiology and cardiovascular surgery indicates that these are “low risk” specialties for litigation. The vast majority of the rulings are, moreover, dismissive of the patients' claims. The data help to structure the role of lawsuits and to increase professionals' knowledge of the medical-legal dimension of health care. (AU)

Evolution of Legislation and the Incidence of Elective Abortion in Spain: A Retrospective Observational Study (2011-2020).

BACKGROUND: According to the WHO, "unsafe abortion occurs when a pregnancy is terminated either by people lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both". AIM: To review the legislation that ensures access to elective abortion and the main indicators of elective abortion in Spain. METHODS: A retrospective observational study was conducted across all regions of Spain from 2011 to 2020. The regulations of each region on the creation of the clinical committee and the creation of the registry of conscientious objector professionals were identified. Data were collected on rates of elective abortions per 1000 women, type of health center where the intervention was performed, interval of weeks of gestation, and cause. RESULTS: After Law 2/2010 entered into force, the Spanish regions created a clinical committee; however, very few regions have a registry of conscientious objectors. During the study period, the average annual rate in Spain was 11.10 elective abortions per 1000 women between 15 and 44 years of age, showing a decreasing trend (annual percentage change of -1.92%). Only 10.67% of abortions were performed at public centers. In 90.18% of the cases, abortions were performed at the woman's request. CONCLUSION: Spain legislated late compared to most European Union countries. The current law is similar to that of other member states, allowing abortion at the woman's request in the first fourteen weeks and thereafter for medical reasons. Most abortions are performed at private centers, although many territorial inequalities are observed.

Patient deaths during the period of prolonged stay in cases of delayed discharge for nonclinical reasons at a university hospital: a cross sectional study.

Background: Delayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care. Methods: A descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007-2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student's T test and Pearson's chi-square test (χ 2) were used. Results: A total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital.

Cost of stay and characteristics of patients with stroke and delayed discharge for non-clinical reasons.

Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007-2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The median age was 79.7 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care.

Empirical analysis of medical malpractice litigation involving urgent-care settings in the Spanish national health service. / Análisis empírico de la litigiosidad judicial por responsabilidad médica en la asistencia sanitaria pública urgente en España.

OBJECTIVES: To analyze the characteristics of superior court decisions in litigation or administrative procedures for medical malpractice claims involving urgent care settings in the Spanish national health service. MATERIAL AND METHODS: Observational cross-sectional study of judicial rulings handed down between 2008 and 2020 in cases involving urgent care. We analyzed administrative, clinical, and judicial variables as well as the amounts of compensation awarded. RESULTS: A total of 1015 rulings were analyzed; 243 cases (23.9%) involved urgent medical care. Most cases (223 [91.8%]) involved elderly patients. The largest proportion of defendants (97 [39.9%]) were emergency physicians, and the most common setting was a hospital emergency department (211 [86.8%]). The grounds for finding against the defendant were most often diagnostic or therapeutic error (40 [46.0%] cases) and lost opportunity (35 [40.2%] cases). Damages were usually claimed for sequelae (122 [50.2%] cases) and death (112 [46.1%] cases). The median award was €46 000, the minimum was €1300, and the maximum was €974 849. CONCLUSION: In medical and other health-care malpractice cases, the majority of claims (about 64%) are dismissed. This finding, unreported until now, may help to contain the overestimation of risk of liability in urgent medical care. It also reinforces the need to provide medical practitioners with more training regarding the legal aspects of health care.

OBJETIVO: Analizar las características de las sentencias sobre responsabilidad médica en España en la asistencia sanitaria pública urgente, dictadas en la jurisdicción contencioso-administrativa por los Tribunales Superiores de Justicia. METODO: Estudio observacional transversal que analizó las sentencias entre 2008 y 2020 en la asistencia urgente. Se incluyeron variables administrativas, clínicas, judiciales y de cuantía indemnizatoria. RESULTADOS: Se analizaron 1.015 sentencias, de las que 243 (23,9%) se refirieron a una asistencia urgente. La mayoría se refería a pacientes mayores de edad, 223 (91,8%). La especialidad más implicada fue Medicina de Urgencias y Emergencias 97 (39,9%) y el ámbito más frecuente fue el hospitalario 211 (86,8%). El 64,6% de las sentencias fueron íntegramente desestimatorias. Los motivos de sentencia condenatoria más habituales fueron la mala praxis diagnóstica o terapéutica 40 (46,0%), y la pérdida de oportunidad 35 (40,2%). Los daños más reclamados fueron secuelas 122 (50,2%) y fallecimiento 112 (46,1%). La mediana de las indemnizaciones fue 46.000 euros, intervalo: 1.300-974.849. CONCLUSIONES: La mayoría de las sentencias recaídas en la resolución de reclamaciones profesionales médico-sanitarias son íntegramente desestimatorias. Este dato, que era desconocido hasta el momento en la medicina pública, puede contribuir a enmarcar la sobrestimación del riesgo legal en la asistencia urgente. Así mismo, refuerza la idea de la necesidad de aumentar la formación de los profesionales en los aspectos médico-legales de la asistencia sanitaria.

Análisis empírico de la litigiosidad judicial por responsabilidad médica en la asistencia sanitaria pública urgente en España / Empirical analysis of medical malpractice litigation involving urgent-care settings in the Spanish national health service

Objetivo. Analizar las características de las sentencias sobre responsabilidad médica en España en la asistencia sanita- ria pública urgente, dictadas en la jurisdicción contencioso-administrativa por los Tribunales Superiores de Justicia. Método. Estudio observacional transversal que analizó las sentencias entre 2008 y 2020 en la asistencia urgente. Se incluyeron variables administrativas, clínicas, judiciales y de cuantía indemnizatoria. Resultados. Se analizaron 1.015 sentencias, de las que 243 (23,9%) se refirieron a una asistencia urgente. La mayoría se refería a pacientes mayores de edad, 223 (91,8%). La especialidad más implicada fue Medicina de Urgencias y Emergencias 97 (39,9%) y el ámbito más frecuente fue el hospitalario 211 (86,8%). El 64,6% de las sentencias fueron íntegramente desestimatorias. Los motivos de sentencia condenatoria más habituales fueron la mala praxis diagnóstica o terapéutica 40 (46,0%), y la pérdida de oportunidad 35 (40,2%). Los daños más reclamados fueron secuelas 122 (50,2%) y fallecimiento 112 (46,1%). La mediana de las indemnizaciones fue 46.000 euros, intervalo: 1.300-974.849. Conclusiones. La mayoría de las sentencias recaídas en la resolución de reclamaciones profesionales médico-sanitarias son íntegramente desestimatorias. Este dato, que era desconocido hasta el momento en la medicina pública, puede con- tribuir a enmarcar la sobrestimación del riesgo legal en la asistencia urgente. Así mismo, refuerza la idea de la necesidad de aumentar la formación de los profesionales en los aspectos médico-legales de la asistencia sanitaria.

Background and objective. To analyze the characteristics of superior court decisions in litigation or administrative procedures for medical malpractice claims involving urgent care settings in the Spanish national health service. Methods. Observational cross-sectional study of judicial rulings handed down between 2008 and 2020 in cases involving urgent care. We analyzed administrative, clinical, and judicial variables as well as the amounts of compensation awarded. Results. A total of 1015 rulings were analyzed; 243 cases (23.9%) involved urgent medical care. Most cases (223 [91.8%]) involved elderly patients. The largest proportion of defendants (97 [39.9%]) were emergency physicians, and the most common setting was a hospital emergency department (211 [86.8%]). The grounds for finding against the defendant were most often diagnostic or therapeutic error (40 [46.0%] cases) and lost opportunity (35 [40.2%] cases). Damages were usually claimed for sequelae (122 [50.2%] cases) and death (112 [46.1%] cases). The median award was €46 000, the minimum was €1300, and the maximum was €974 849. Conclusions. In medical and other health-care malpractice cases, the majority of claims (about 64%) are dismissed. This finding, unreported until now, may help to contain the overestimation of risk of liability in urgent medical care. It also reinforces the need to provide medical practitioners with more training regarding the legal aspects of health care.

Evolution of Legislation and Crimes Based on Sexual Identity or Orientation in Spain: A Retrospective Observational Study (2011-2021).

Respect for different sexual options and orientations prevents the occurrence of hate crimes against lesbian, gay, bisexual, trans and intersex (LGTBI) persons for this reason. Our aim was to review the legislation that protects the rights of LGTBI people and to quantify the victimization rates of hate crimes based on sexual identity and orientation. A retrospective observational study was conducted across all regions of Spain from 2011-2021. The laws on LGTBI rights in each region were identified. Hate crime victimization data on sexual identity and orientation were collected in annual rates per 100,000 inhabitants, annual percentage change and average change during the study period to assess the trend. The regulatory development of laws against discrimination against LGTBI individuals is heterogeneous across regions. Overall, in Spain there is an upward trend in the number of hate crime victimizations motivated by sexual identity or orientation. The effectiveness of data collection, thanks to better training and awareness of police forces regarding hate crimes and the processes of data cleansing and consolidation contributes to a greater visibility of hate crimes against LGTBI people.

Delayed Discharge for Non-Clinical Reasons in Hip Procedures: Differential Characteristics and Opportunity Cost.

Delayed discharge for non-clinical reasons shares common characteristics with hip procedures. We sought to quantify the length of stay and related costs of hip procedures and compare these with other cases of delayed discharge. A cross-sectional study was conducted at a public hospital in Spain (2007-2015) including 306 patients with 6945 days of total stay and 2178 days of prolonged stay. The mean appropriate stay was 15.58 days, and the mean prolonged stay was 7.12 days. The cost of a prolonged stay was €641,002.09. The opportunity cost according to the value of the hospital complexity unit was €922,997.82. The mean diagnostic-related groups' weight was 3.40. Up to 85.29% of patients resided in an urban area near the hospital (p = 0.001), and 83.33% were referred to a long-stay facility for functional recovery (p = 0.001). The proportion of patients with hip procedures and delayed discharge was lower than previous reports; however, their length of stay was longer. The cost of prolonged stay could account for 21.17% of the total. Compared with the remaining cases of delayed discharge, the appropriate stay was shorter in hip procedures, with a profile of older women living in an urban area close to the hospital and referred to a long-stay center for functional recovery.

Differential characteristics of cases of patients diagnosed with pneumonia and delayed discharge for non-clinical reasons in Northern Spain.

BACKGROUND: Delayed discharge for non-clinical reasons is related to a failure to plan for discharge and a lack of availability of intermediate care resources as an alternative to acute hospitalisation. The literature concerning the relationship with pneumonia is scarce. At present, the coronavirus pandemic is a new cause of complicated pneumonias that can further affect the functionality of the most fragile patients. OBJECTIVE: The aim of this study was to understand what characteristics are typical of patients affected by pneumonia, compared with other cases of delayed discharge. METHODS: A cross-sectional study was conducted. All cases of delayed discharge were studied at the hospitalisation units of a general university hospital in Northern Spain from 2007 to 2015. In order to compare the differential characteristics of the groups of patients with pneumonia with the total Student's T-test and Pearson's chi-square test (χ²) were used. RESULTS: 170 patients were identified with a diagnosis of pneumonia and delayed discharge for non-clinical reasons during the study period. These cases accumulated a total of 4790 days of total stay, of which 1294 days corresponded to the prolonged stay. The mean age of the patients was 80.23 years. The mean DRG weight was 2.28 [SD 0.579], and 14.12% of patients with pneumonia and delayed discharge died. So, patients with pneumonia were older (P = .001), less complex (P = .001) and suffered greater deaths compared with the remaining patients (P = .001). CONCLUSIONS: The sum of these factors has to do with comorbidities and complications associated with ageing and the characteristics of conditions such as aspiration pneumonia.

Declared Reasons for Cessation of Breastfeeding during the First Year of Life: An Analysis Based on a Cohort Study in Northern Spain.

BACKGROUND: Breastfeeding is the gold standard of infant feeding due to the many advantages it offers to both the child and the mother. OBJECTIVE: To identity the main reasons for cessation of breastfeeding reported by mothers during the first year of life. DESIGN: A prospective cohort study was conducted, recruiting 970 infants from a university hospital in Spain. The main maternal variables studied were maternal age, parity, educational level, work occupation, smoking habit, weeks of gestation at birth, birth weight, feeding type, and duration of breastfeeding. All participants were followed for one year to determinate the duration of breastfeeding and to gather reasons for abandoning breastfeeding. RESULTS: At six months, the percentage of breastfeeding experienced a decline of 50%, and only 24.5% of these mothers maintained breastfeeding. Up to 15.8% of the mothers decided to give up exclusive breastfeeding by their own choice, whereas 15.4% did so because they suspected low milk production. Work-related causes represent the third reason of abandonment. CONCLUSIONS: Our results highlight the need to improve the health policies for the promotion, protection, and support for the initiation and maintenance of breastfeeding. In particular, our results highlight the importance of researching women's low milk production and work-related factors, with particular emphasis on improving conciliation measures.

Deseados pero abandonados: el incierto destino de los embriones criopreservados / Desired but abandoned: the uncertain fate of cryopreserved embryos

La reproducción asistida, de la mano de ciencias afines como la genómica y la criobiología, ha transformado de modo vertiginoso el abordaje de la fertilidad, no solamente por los avances científico-técnicos, sino por la coyuntura social contemporánea. Como es conocido, en la actualidad se ha elevado el porcentaje de mujeres y parejas que deben recurrir a estas técnicas biomédicas y, con ellas, se han diversificado las etiologías de la infertilidad. El continuo avance por superar los obstáculos biológicos y ofrecer nuevas opciones con las que solventar la infertilidad, lleva también asociados interrogantes y dilemas éticos y normativos. Entre esos dilemas nos encontramos los usos y destinos de los embriones criopreservados sobrantes de las técnicas de reproducción asistida (TRA). Tras más de cuatro décadas de fecundación in vitro (FIV), la problemática surgida a raíz de la criopreservación embrionaria y la incesante acumulación de embriones parece no haber alcanzado su fin. Así, las diferentes opciones contempladas por la normativa vigente no acaban de satisfacer a los pacientes y profesionales para poder responder a la situación existente de almacenamiento de un número importante de embriones criopreservados en los biobancos de los centros de reproducción asistida, sin destino definido (AU)

La reproducció assistida, de la mà de ciències afins com la genòmica i la criobiologia, ha transformat de manera vertiginosa l'abordatge de la fertilitat, no solament pels avanços cientificotècnics, sinó per la conjuntura social contemporània. Com és conegut, en l'actualitat s'ha elevat el percentatge de dones i parelles que han de recórrer a aquestes tècniques biomèdiques i, amb elles, s'han diversificat les etiologies de la infertilitat. El continu avanç per superar els obstacles biològics i oferir noves opcions amb les quals solucionar la infertilitat, porta també associats interrogants i dilemes ètics i normatius. Entre aquests dilemes ens trobem els usos i destinacions dels embrions criopreservats sobrants de les tècniques de reproducció assistida (TRA). Després de més de quatre dècades de fecundació in vitro (FIV), la problemàtica sorgida arran de la criopreservació embrionària i la incessant acumulació d'embrions sembla no haver aconseguit la seva fi. Així, les diferents opcions contemplades per la normativa vigent no acaben de satisfer als pacients i professionals per a poder respondre a la situació existent d'emmagatzematge d'un nombre important d'embrions criopreservats en els biobancs dels centres de reproducció assistida, sense destinació definida (AU)

Assisted reproduction, hand in hand with related sciences such as genomics and cryobiology, has vertiginously transformed the approach to fertility, not only because of scientific and technical advances, but also because of the contemporary social context. As is well known, a high percentage of women and couples who have to resort to this biotechnology and, with them, the aetiologies of infertility have diversified. The continuous progress in overcoming biological barriers and provide new therapeutic options to address infertility also raises ethical and regulatory questions and dilemmas. Among these dilemmas are the uses and purpose of cryopreserved embryos left over from assisted reproduction techniques. After more than four decades of in vitro fertilization (IVF), the concern arising from embryo cryopreservation and the incessant accumulation of embryos do not seem to have reached an end. Thus, the different options contemplated by the current regulations do not satisfy users and professionals to be able to respond to the existing situation of storage of a significant number of cryopreserved embryos in the biobanks of assisted reproduction clinics, with no defined destination (AU)

Factors Associated with Bed-Blocking at a University Hospital (Cantabria, Spain) between 2007 and 2015: A Retrospective Observational Study.

Current studies on bed-blocking or delayed discharge for non-medical reasons report important variations depending on the country or setting under study. Research on this subject is clearly important as the current system reveals major inefficiencies. Although there is some agreement on the patient-related factors that contribute to the phenomenon, such as older age or a lack of functional ability, there is greater variability regarding environmental or organizational factors. This study sought to quantify the number of cases and days inappropriately spent in hospital and identify patient characteristics and healthcare service use associated with the total length of stay. All cases of delayed discharge were studied at the hospitalization units of a general university hospital in Northern Spain between 2007 and 2015. According to regression estimates, the following characteristics were related to a longer stay: higher complexity through (Diagnosis-Related Group) DRG weight, a diagnosis that implied a lack of functional ability, surgical treatment, having to wait for a destination upon final discharge or return home. After an initial increase, a reduction in delayed discharge was observed, which was maintained for the duration of the study period. Multi-component interventions related with discharge planning can favor a reduced inefficiency with fewer unnecessary stays.

A place in the sun? Healthcare rights of retired UK citizens in Spain post-Brexit.

At least 100,000 retired UK citizens currently live in Spain. Under EU law, they are entitled to access the Spanish National Health Service (NHS) with minimum administrative difficulty. What will their legal position be under a 'no-deal Brexit'? This is a question of Spanish law. The worst case scenario is that they will have to reapply for their residence permits under the Spanish legislation applicable to non-EU/European Economic Area citizens, with all the administrative inconvenience and cost entailed. If they successfully reapply, their personal health care costs will be considerably higher than at present, should they choose to remain in Spain. Very obvious questions of capacity planning arise. The Spanish system will potentially need to gear up for a significant administrative effort. Given the distinct possibility of a 'no-deal Brexit', the UK NHS should prepare to welcome significant numbers of pensioners home.