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1.
J Surg Res ; 244: 599-603, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31536845

RESUMO

BACKGROUND: Section 6002 of the Affordable Care Act, commonly referred to as "The Sunshine Act," is legislation designed to provide transparency to the relationship between physicians and industry. Since 2013, medical product and pharmaceutical manufacturers were required to report any payments made to physicians to the Centers for Medicare and Medicaid Services (CMS). We predicted that most clinical faculty at our institution would be found on the Open Payments website. We elected to investigate payments in relationship to divisions within the department of surgery and the level of professorship. METHODS: All clinical faculty (n = 86) within the department of surgery at our institution were searched within the database: https://openpaymentsdata.cms.gov/. The total amount of payments, number of payments, and the nature of payments (food and beverage, travel and lodging, consulting, education, speaking, entertainment, gifts and honoraria) were recorded for 2017. Comparison by unpaired t-test (or ANOVA) where applicable, significance defined as P < 0.05. RESULTS: Of the 86 faculty studied, 75% were found within the CMS Open Payments database in 2017. The mean amount of payment was $4024 (range $13-152,215). Median amount of payment was $434.90 (range $12.75-152,214.70). Faculty receiving outside compensation varied significantly by division and academic rank (P < 0.05). Plastic surgery had the highest percentage of people receiving any form of payment ($143-$1912) and GI surgery had the largest payments associated with device management ($0-$152,215). The variation seen by rank was driven by a small number of faculty with receipt of large payments at the associate professor level. The median amount of payment was $428.53 (range $13.97-2306.05) for assistant professors, $5328.03 (range $28.30-152,214.70) for Associate Professors, and $753.82 (range $12.75-17,708.65) for full professors. CONCLUSIONS: Reporting of open payments to CMS provides transparency between physicians and industry. The significant relationship of division and rank with open payments database is driven by relatively few faculty. The majority (94%) received either no payments or less than $10,000.


Assuntos
Centros Médicos Acadêmicos , Conflito de Interesses/economia , Revelação/estatística & dados numéricos , Indústria Farmacêutica , Docentes de Medicina/economia , Cirurgiões/economia , Alabama , Conflito de Interesses/legislação & jurisprudência , Bases de Dados Factuais , Revelação/legislação & jurisprudência , Indústria Farmacêutica/economia , Indústria Farmacêutica/legislação & jurisprudência , Docentes de Medicina/ética , Docentes de Medicina/legislação & jurisprudência , Docentes de Medicina/estatística & dados numéricos , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/legislação & jurisprudência , Humanos , Patient Protection and Affordable Care Act , Cirurgiões/ética , Cirurgiões/legislação & jurisprudência , Cirurgiões/estatística & dados numéricos , Estados Unidos
2.
J Card Surg ; 34(5): 323-328, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30905069

RESUMO

BACKGROUND AND AIM: The feared prospect of involvement in malpractice litigation ultimately becomes a reality for many physicians in high-risk specialties such as cardiothoracic surgery. This study systematically analyzes malpractice claims by procedure type and alleged injury mechanism. METHODS: An extensive nation-wide database of medical malpractice claims was searched, and 140 involving cardiac procedures were identified. The primary reason for the lawsuit was classified as a periprocedural injury, postoperative mismanagement, failure to operate in a timely manner or at all, performing an unnecessary procedure, performing a procedure too soon, lack of informed consent, or patient abandonment. RESULTS: Cardiac surgeons were defendants in 47.8% of cases and cardiologists in 56.4%. Forty percent of cases involved coronary artery bypass grafting, valvular surgery, or both; 50% of these received defendant verdicts. The most common reason for the lawsuit was periprocedural injury, most frequently due to poor prosthetic valve fit/securement (23.1%) or surgical site infection (15.4%). For congenital cases, most lawsuits alleged periprocedural injury, with perfusion-related issues (cooling during circulatory arrest, failure to inform surgeon about poor oxygenation) cited in 37.5%. Cardiologists and cardiothoracic or vascular surgeons were codefendants in 14.3% of cases, most commonly coronary artery bypass grafting (40%) or cardiac catheterizations (25%). In all catheterization cases, the allegation against the surgeon was a failure to diagnose/treat the complication in a proper or timely manner. In postoperative mismanagement cases, bleeding/tamponade was the most common allegation category (31.8%). CONCLUSIONS: A careful review of cardiac surgical malpractice litigation can identify common contributory factors to adverse patient outcomes and catalyze practice improvement.


Assuntos
Procedimentos Cirúrgicos Cardíacos/legislação & jurisprudência , Jurisprudência , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Cirurgiões/legislação & jurisprudência , Idoso , Cateterismo Cardíaco , Ponte de Artéria Coronária/legislação & jurisprudência , Feminino , Valvas Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/legislação & jurisprudência , Hemorragia Pós-Operatória
3.
Tex Med ; 115(1): 44-45, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30811557

RESUMO

Miguel Gomez, MD's well-publicized legal fight isn't over yet. In its latest turn, the Texas Medical Association is still standing behind the surgeon as he fights to uphold a verdict against one of the state's largest nonprofit hospital systems for defaming him.


Assuntos
Difamação/legislação & jurisprudência , Hospitais Filantrópicos/legislação & jurisprudência , Cirurgiões/legislação & jurisprudência , Humanos , Texas
4.
J Pediatr Surg ; 54(5): 891-894, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30782439

RESUMO

The following is a summary of the fourth Ein Panel Debate Session from the 50th Annual Meeting of the Canadian Association of Pediatric Surgeons (CAPS) held in Toronto, ON, from September 26-29, 2018. The session focused on surgeon well-being at different stages of career: role of mentorship at the start of career, second victim syndrome, litigation stress syndrome, and retirement. Using Maslach Burnout Inventory Survey, CAPS members were presented their wellness scores as a group compared to other health care providers. The power of surgical culture in influencing decision making and judgment was explored. A culture shift toward vulnerability and transparency is possible and more suitable to expert practice and surgeon wellness.


Assuntos
Esgotamento Profissional/etiologia , Pediatria , Sociedades Médicas , Especialidades Cirúrgicas , Cirurgiões/psicologia , Canadá , Humanos , Tutoria , Pediatria/educação , Pediatria/legislação & jurisprudência , Escalas de Graduação Psiquiátrica , Aposentadoria , Especialidades Cirúrgicas/educação , Especialidades Cirúrgicas/legislação & jurisprudência , Cirurgiões/legislação & jurisprudência , Inquéritos e Questionários
6.
Biosci Trends ; 12(6): 560-568, 2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30606978

RESUMO

Since serious problematic cases regarding the technical safety of technically demanding operations were reported in Japan, the Ministry of Health, Labor and Welfare issued new regulations on June 10, 2016 requiring each hospital to check the status of informed consent, skill of surgery team and governance system of the surgical unit, when the highly difficult new medical technologies were introduced to a hospital. In order to firmly establish this new system for highly difficult new medical technologies, it is very important and informative to survey the current situation for guidelines and consensus regarding introduction of medical technology with special skills in Japan and overseas. Based on the survey of questionnaires, document retrieval, and expert interviews, we found that documentation related to the introduction process of highly difficult medical technologies is very rare, and the regulations were mainly issued by academic societies. Moreover, even if such documentation existed, the quality of the regulations is poor and not sufficient enough to perform surgical practice safely. Therefore, for medical practitioners, comprehensive and concrete regulations should be issued by the government or ministry to legally follow in regard to technically demanding operations. A new practice guideline was proposed by our special research group to regulate the introduction process of highly difficult new medical technologies in hospitals in Japan. This guideline, gained understanding from relevant academic societies, provided a comprehensive view on the interpretation of "high difficulty new medical technology" prescribed by the law and show the basic idea at a preliminary examination from the viewpoints of "Surgeon's requirement", "Guidance system", "Medical safety" , and "Informed consent". These efforts will contribute to the improvement of the quality of guidelines regarding "highly difficult new medical technology".


Assuntos
Tecnologia Biomédica/normas , Assistência à Saúde/normas , Difusão de Inovações , Hospitais/normas , Tecnologia Biomédica/legislação & jurisprudência , Competência Clínica , Assistência à Saúde/organização & administração , Administração Hospitalar/legislação & jurisprudência , Administração Hospitalar/normas , Hospitais/estatística & dados numéricos , Humanos , Consentimento Livre e Esclarecido/normas , Japão , Legislação Hospitalar/normas , Legislação Hospitalar/estatística & dados numéricos , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Cirurgiões/legislação & jurisprudência , Cirurgiões/normas , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/legislação & jurisprudência , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas , Inquéritos e Questionários/estatística & dados numéricos
7.
Ann Surg ; 270(1): 84-90, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-29578910

RESUMO

OBJECTIVE: We merged direct, multisource, and systematic assessments of surgeon behavior with malpractice claims, to analyze the relationship between surgeon 360-degree reviews and malpractice history. BACKGROUND: Previous work suggests that malpractice claims are associated with a poor physician-patient relationship, which is likely related to behaviors captured by 360-degree review. We hypothesize that 360-degree review results are associated with malpractice claims. METHODS: Surgeons from 4 academic medical centers covered by a common malpractice carrier underwent 360-degree review in 2012 to 2013 (n = 385). Matched, de-identified reviews and malpractice claims data were available for 264 surgeons from 2000 to 2015. We analyzed 23 questions, highlighting positive and negative behaviors within the domains of education, excellence, humility, openness, respect, service, and teamwork. Regression analysis with robust standard error was used to assess the potential association between 360-degree review results and malpractice claims. RESULTS: The range of claims among the 264 surgeons was 0 to 8, with 48.1% of surgeons having at least 1 claim. Multiple positive and negative behaviors were significantly associated with the risk of having malpractice claims (P < 0.05). Surgeons in the bottom decile for several items had an increased likelihood of having at least 1 claim. CONCLUSION: Surgeon behavior, as assessed by 360-degree review, is associated with malpractice claims. These findings highlight the importance of teamwork and communication in exposure to malpractice. Although the nature of malpractice claims is complex and multifactorial, the identification and modification of negative physician behaviors may mitigate malpractice risk and ultimately result in the improved quality of patient care.


Assuntos
Relações Interprofissionais , Imperícia/estatística & dados numéricos , Relações Médico-Paciente , Comportamento Social , Cirurgiões/legislação & jurisprudência , Cirurgiões/psicologia , Competência Clínica , Cirurgia Geral , Humanos , Massachusetts , Procedimentos Ortopédicos , Satisfação do Paciente , Revisão dos Cuidados de Saúde por Pares , Gestão de Riscos , Cirurgiões/ética
8.
J Med Biogr ; 27(1): 37-45, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27566233

RESUMO

The London surgeon and anaesthetist, Joseph Thomas Clover (1825-1882), and the Birmingham surgeon, Joseph Sampson Gamgee (1828-1886), are well known figures in the history of medicine. Draft letters among the surviving papers of Joseph Clover have been transcribed and reveal new information about their friendship, their financial affairs and Clover's motivation to become a full-time anaesthetist. They have also led to the discovery that Gamgee was briefly imprisoned in Warwick County Goal for debt in 1859.


Assuntos
Correspondência como Assunto/história , Cirurgiões/história , Cirurgiões/legislação & jurisprudência , Anestesistas , Inglaterra , História do Século XIX , Londres
12.
Ann Surg Oncol ; 25(10): 2939-2947, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29956091

RESUMO

BACKGROUND: Approximately 15% of general surgeons practicing in the United States face a medical malpractice lawsuit each year. This study aimed to determine the reasons for litigation for breast cancer care during the past 17 years by reviewing a public legal database. METHODS: The LexisNexis legal database was queried using a comprehensive list of terms related to breast cancer, identifying all cases from 2000 to 2017. Data were abstracted, and descriptive analyses were performed. RESULTS: The study identified 264 cases of litigation pertaining to breast cancer care. Delay in breast cancer diagnosis was the most common reason for litigation (n = 156, 59.1%), followed by improperly performed procedures (n = 26, 9.8%). The medical specialties most frequently named in lawsuits as primary defendants were radiology (n = 76, 28.8%), general surgery (n = 74, 28%), and primary care (n = 52, 19.7%). The verdict favored the defendant in 145 cases (54.9%) and the plantiff in 60 cases (22.7%). In 59 cases (22.3%), a settlement was reached out of court. The median plaintiff verdict payouts ($1,485,000) were greater than the settlement payouts ($862,500) (p = 0.04). CONCLUSION: Failure to diagnose breast cancer in a timely manner was the most common reason for litigation related to breast cancer care in the United States. General surgery was the second most common specialty named in the malpractice cases studied. Most cases were decided in favor of the defendant, but when the plaintiff received a payout, the amount often was substantial. Identifying the most common reasons for litigation may help decrease this rate and improve the patient experience.


Assuntos
Neoplasias da Mama/cirurgia , Diagnóstico Tardio/legislação & jurisprudência , Imperícia/história , Imperícia/legislação & jurisprudência , Cirurgiões/legislação & jurisprudência , Neoplasias da Mama/patologia , Bases de Dados Factuais , Feminino , História do Século XXI , Humanos , Consentimento Livre e Esclarecido , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
13.
J Vasc Surg Venous Lymphat Disord ; 6(4): 541-544, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29909860

RESUMO

OBJECTIVE: Placement of inferior vena cava (IVC) filters is a controversial focus of medical malpractice. Clinicians currently have little information to guide them regarding key issues and outcomes in litigation. In this retrospective legal case review, we analyzed the factors associated with malpractice actions involving IVC filters. METHODS: The legal databases LexisNexis and Westlaw were searched from 1967 to 2016 for all published legal cases in the United States involving placement of IVC filters. Keywords included "IVC," "inferior vena cava," "filter," and "malpractice." Social Security Disability claims, product liability actions, and hospital employment contract disputes were excluded. RESULTS: There were 310 search results eligible for initial review. After application of exclusion criteria, 29 cases involving medical malpractice were included in final analysis. The majority of excluded cases were insurance disputes and tax revenue cases. Overall, private practitioners were most often sued (11/29 [37.9%]), whereas 24.1% of defendants were academic hospitals (7/29), 20.7% were prisons (6/29), and 17.2% were community hospitals (5/29). The most common specialty named was vascular surgery (8/29), whereas interventional radiologists were named only twice. The most common indications for IVC filter placement were hypercoagulable state (8/29 [29.6%]), recurrent pulmonary embolism (PE; 6/29 [22.2%]), and trauma (5/29 [18.5%]). The most common underlying allegations involved failure to insert IVC filter when indicated (14/29 [48.3%]), intraprocedural negligence (5/29 [17.2%]), and failure to timely remove device (5/29 [17.2%]). Common complications included failure to prevent occurrence of PE (14/29 [48.3%]), device migration (4/29 [13.8%]), and perforation of organs or vasculature (3/29 [10.3%]). Death of the patient occurred in 41.4% of total cases (12/29). In cases in which the patient died, the most common indications for filter placement were trauma (4/12 [33.3%]) and deep venous thrombosis (3/12 [25.0%]), and the most common complication in those patients who died was the failure to prevent a subsequent PE (9/12 [75.0%]). Available verdicts favored defendants (13/14 [92.9%]). In cases with defense verdicts, the most common indications for filter placement similarly were trauma (4/13 [30.8%]) and deep venous thrombosis (3/13 [23.1%)], and the most common complication was failure to prevent PE (9/14 [64.3%]). CONCLUSIONS: Analysis of malpractice cases involving IVC filters revealed key factors associated with litigation. Overall, verdicts favored defendants. Private practitioners were most commonly sued, and the most common reasons for bringing suit were failure to insert filter, intraprocedural complications, and failure to remove filter. Deeper awareness of issues related to malpractice litigation can inform clinical practice and improve patient care and safety.


Assuntos
Remoção de Dispositivo/legislação & jurisprudência , Seguro de Responsabilidade Civil/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Implantação de Prótese/legislação & jurisprudência , Procedimentos Cirúrgicos Vasculares/legislação & jurisprudência , Filtros de Veia Cava , Centros Médicos Acadêmicos/legislação & jurisprudência , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/instrumentação , Hospitais Comunitários/legislação & jurisprudência , Humanos , Erros Médicos/efeitos adversos , Prisões/legislação & jurisprudência , Prática Privada/legislação & jurisprudência , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/mortalidade , Radiologistas/legislação & jurisprudência , Radiologia Intervencionista/legislação & jurisprudência , Medição de Risco , Fatores de Risco , Cirurgiões/legislação & jurisprudência , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/instrumentação , Procedimentos Cirúrgicos Vasculares/mortalidade , Filtros de Veia Cava/efeitos adversos
14.
Bone Joint J ; 100-B(6): 687-692, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29855237

RESUMO

Our aim in this paper was to investigate the guidelines and laws governing informed consent in the English-speaking world. We noted a recent divergence from medical paternalism within the United Kingdom, highlighted by the Montgomery v Lanarkshire Health Board ruling of 2015. We investigated the situation in the United Kingdom, Australia, New Zealand, Canada, and the United States of America. We read the national guidance regarding obtaining consent for surgical intervention for each country. We used the references from this guidance to identify the laws that helped inform the guidance, and reviewed the court documents for each case. There has been a trend towards a more patient-focused approach in consent in each country. Surgeons should be aware of the guidance and legal cases so that they can inform patients fully, and prevent legal problems if outdated practices are followed. Cite this article: Bone Joint J 2018;100-B:687-92.


Assuntos
Política de Saúde/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Assistência Centrada no Paciente/legislação & jurisprudência , Austrália , Canadá , Cirurgia Geral/legislação & jurisprudência , Guias como Assunto , Humanos , Responsabilidade Legal , Nova Zelândia , Relações Médico-Paciente , Cirurgiões/legislação & jurisprudência , Reino Unido , Estados Unidos
15.
Ann Vasc Surg ; 51: 25-29, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29758323

RESUMO

BACKGROUND: The objective of the study was to analyze causes and outcomes of malpractice claims against vascular surgeons in the United States. METHODS: Cases entered into the Westlaw database from January 1, 1999 to December 31, 2014 were reviewed. Search terms "vascular" and "surgeon" were used. Data were compiled on the allegation, subject matter, and outcome of each case. Additional data including demographics of the defendant were obtained from the U.S. News Health reports on practicing physicians. RESULTS: Of a total of 785 cases identified from the Westlaw database using the search terms "vascular" and "surgeon", 485 (61.8%) were identified where a vascular surgeon was the defendant or expert witness. Of these, 135 (27.8%) had a vascular surgeon identified as a defendant. Among these 135 cases, 88 (65.2%) were found for the defendant with 31 (23%) and 15 (11.1%) being found for the plaintiff or settled, respectively. Of the 31 cases found for the plaintiff, the median award was $750,000 and mean award was $1,830,000. Mean time from incident to verdict was 4.8 years. The most common procedures which led to litigation were open or endovascular peripheral revascularization (PR) (14.8%), carotid interventions (CIs) (11.85%), aortic interventions (AI) (11.1%), vascular trauma (9.63%), dialysis access (8.15%), and venous surgery (5.93%). The most common allegation was "failure to diagnose and treat" (48.9%), followed by complication of open surgery (31.85%) and negligent procedure (25.19%). The most common injuries reported were death (31.85%), major amputation (23.7%), neurovascular injury (14.8%), and bleeding (5.9%). CONCLUSIONS: Analysis of vascular surgery malpractice litigation in the Westlaw database revealed details regarding the subject matter and outcomes of these cases. Through this closed claims analysis, the most common procedures leading to litigation were found to be PR, CI, and AI and not thoracic outlet syndrome procedures as commonly believed. Furthermore, the most common allegations were a "failure to diagnose and treat" and "open surgical complication". Analysis of the salient features and outcomes in these cases can provide a framework for heightened awareness of issues which lead to malpractice claims and can ultimately improve patient care and safety.


Assuntos
Compensação e Reparação/legislação & jurisprudência , Seguro de Responsabilidade Civil/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Cirurgiões/legislação & jurisprudência , Procedimentos Cirúrgicos Vasculares/legislação & jurisprudência , Bases de Dados Factuais , Humanos , Seguro de Responsabilidade Civil/economia , Imperícia/economia , Erros Médicos/economia , Segurança do Paciente/legislação & jurisprudência , Medição de Risco , Cirurgiões/economia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/economia , Procedimentos Cirúrgicos Vasculares/mortalidade
16.
ANZ J Surg ; 88(10): 956-958, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29761606

RESUMO

Surgeons play a significant role in the treatment of patients with many types of cancer, including the management of advanced and recurrent disease after long periods of apparent remission. The recently introduced Victorian Voluntary Assisted Dying (VAD) Act represents a shift in paradigm in Australian medical practice. To be eligible for VAD, the new legislation requires patient assessment by a physician with at least 5 years post-fellowship experience and relevant expertise in the patient's condition. Given many specialist surgeons' experience in managing advanced and often incurable malignancy, it is likely that many will receive referrals for assessment for VAD. It is foreseeable that other states and territories in Australia will follow suit with similar legislation. It is imperative that surgeons receiving referrals to assess patients seeking access to VAD are familiar with the legislation and assessment process. This article summarizes the current regulation of VAD in Australia, including the patient application and assessment process, briefly reviews world-wide assisted dying practices and discusses the relevance to surgeons practicing in Australia.


Assuntos
Eutanásia/legislação & jurisprudência , Suicídio Assistido/legislação & jurisprudência , Cirurgiões/legislação & jurisprudência , Austrália/epidemiologia , Definição da Elegibilidade , Humanos , Legislação Médica , Cloreto de Potássio/administração & dosagem , Autoadministração/métodos
17.
Ann Thorac Surg ; 106(3): 691-695, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29723534

RESUMO

BACKGROUND: Cardiothoracic surgery is one of the more highly litigated medical specialties. The incidence and outcomes of federal cases related to cardiac surgery have not been previously explored. METHODS: A legal research service was queried for cardiac surgery-related terms. Citations and related documents were reviewed for relevance and case details. Inclusion criteria were federal district court cases involving cardiac operations. Exclusion criteria were rulings on solely procedural matters. Associations were explored using the Fisher exact test. RESULTS: Of 354 unique citations from 1956 to 2017, 19.2% (n = 68) met criteria. The highest number of cases (25% [n = 17]) were litigated in the Third Circuit. Operations involved coronary artery bypass grafting in 33.8% (n = 23), valves in 32.4% (n = 22), and congenital operations in 19.1% (n = 13). Litigation was prompted by media reporting in 10.3% (n = 7) and involved neurologic injury in 17.6% (n = 12), death in 33.8% (n = 23), and informed consent issues in 29.4% (n = 20). Findings were summary judgment for the defendant in 45.6% (n = 31), partial summary judgment in 17.6% (n = 12), dismissal in 27.9% (n = 19), and ruling for the plaintiff in 7.4% (n = 5). Of the rulings for the plaintiffs, damages had a median dollar amount of $591,300 (interquartile range, $214,2673.50 to $5,807,687.00]. In Fisher's exact test analysis, neurologic injury was significantly associated with ruling for the plaintiff (p < 0.01); death, surgeon defendant, surgical decision-making/conduct, and adult cardiac case type were not associated. CONCLUSIONS: Federal cardiac malpractice court cases are rare. Rulings in favor of the plaintiff, although also rare, are associated with neurologic injury. A comprehensive picture of cardiac surgery-related litigation will require advances in data abstraction techniques and codification.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/legislação & jurisprudência , Função Jurisdicional , Imperícia/legislação & jurisprudência , Doenças do Sistema Nervoso/etiologia , Cirurgiões/legislação & jurisprudência , Distinções e Prêmios , Procedimentos Cirúrgicos Cardíacos/métodos , Estudos de Coortes , Bases de Dados Factuais , Governo Federal , Feminino , Humanos , Masculino , Imperícia/estatística & dados numéricos , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Estados Unidos
18.
Ann Ital Chir ; 89: 1-19, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29629884

RESUMO

È pleonastico ricordare che ogni individuo raziocinante delle essere responsabile delle sue azioni: deve agire con la coscienza degli scopi che si propone evitando possibili conseguenze negative dei suoi atti. In ambito medico questo tipo di responsabilità è codificata con le norme della "deontologia". Per secoli l'arte terapeutica è stata praticata da individui dotati di una particolare vocazione ed una particolare cultura acquisita da Maestri dell'arte ancor prima che dalla propria esperienza, con nozioni di erboristeria e di elementari conoscenze anatomiche e di fisiologia, circondati da un'aura sacerdotale e da un rispetto derivante dal timore e dall'ammirazione per il coraggio e auspicabilmente dai successi, e facendo riferimento nell'occidente mediterraneo alle regole operative fissate nel Giuramento di Ippocrate, di significato tra il sacro ed il deontologico. Lo sviluppo delle tecniche anestesiologiche a partire dalla seconda metà dell'800 ha determinato l'ampliamento delle iniziative chirurgiche di tipo elettivo, a fianco con gli storici interventi in emergenza per la cura di lesioni traumatiche, ancor prima delle acquisizioni riguardanti le infezioni. Con l'espansione del campo di azione della chirurgia, le possibili complicanze ed i possibili insuccessi hanno fatto da contrappeso ai sentimenti di rispetto e di fiducia nei confronti dei chirurghi, giungendo a far assimilare in tali casi la loro opera quale causa all'origine di danni, provocati rientrando quindi nella categoria dei reati sottoposti alla Legge penale. Così, al termine deontologico di "responsabilità" valido per ogni iniziativa ed ogni professione, per i medici è venuto ad associarsi la qualifica di "professionale", con un significato di presunta colpevolezza. Da una parte le regole deontologiche si sono ampliate, ed hanno coinvolto direttamente il paziente nella fase decisionale delle terapie chirurgiche, formalizzate programmaticamente in moderni codici deontologici ed operativamente nel documento del "consenso informato". Per altro verso le leggi innovative del Codice Civile definito nel 1942, che al posto delle pene del codice penale introduceva il criterio della risarcibilità economica del danno in caso di riconosciuta "responsabilità professionale", ha determinato il coinvolgimento di altre figura professionali, e cioè di avvocati e di medici legali, oltre che delle organizzazioni assicurative, con detrimento alla serenità nell'espletamento delle professioni sanitarie e con l'insorgenza per reazione della cosidetta "medicina difensiva". La concretezza di queste problematiche hanno richiesto l'interessamento attivo della Giurisprudenza con una serie di sentenze, ed una formulazione di decreti e nuove leggi parlamentari, ancora in pieno assestamento nel corso del 2017, lasciano in qualche modo ancora irrisolti alcuni nodi.


Assuntos
Cirurgia Geral/legislação & jurisprudência , Cirurgia Geral/ética , Cirurgia Geral/história , Juramento Hipocrático , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Consentimento Livre e Esclarecido , Itália , Responsabilidade Legal/história , Imperícia/história , Imperícia/legislação & jurisprudência , Obrigações Morais , Papel do Médico , Responsabilidade Social , Cirurgiões/ética , Cirurgiões/história , Cirurgiões/legislação & jurisprudência
19.
J Vasc Surg ; 68(1): 219-224, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29402665

RESUMO

OBJECTIVE: The standard of care in the treatment of vascular disease continues to evolve as endovascular therapies develop. Currently, it is unclear how medical malpractice litigation has adapted to the "endovascular era." This retrospective case review is the most comprehensive analysis to date of malpractice actions involving endovascular procedures performed by vascular surgeons (VSs), interventional radiologists (IRs), interventional cardiologists (ICs), and cardiothoracic surgeons (CTSs). METHODS: The legal databases LexisNexis and Westlaw were searched for all published legal cases in the United States involving endovascular procedures. The search was limited to state and federal cases up to and including the year 2016. Keywords included "malpractice," "vascular," "endovascular," "catheter," "catheterization," "stent," "angiogram," "angiography," and "surgery." Cases involving tax revenue, insurance disputes, Social Security Disability, and hospital employment contract disputes were excluded. Data were analyzed using χ2 test. RESULTS: There were 2115 initial search results identified, and 369 cases were included in final analysis. The rate of endovascular procedure-related lawsuits (per 1000 active physicians in the specialty) was highest for ICs (105.56), whereas rates for VSs and IRs were comparable (18.47 and 16.85, respectively); 93% of the IC cases were related to coronary interventions. Overall, 55% (148/271 classifiable cases) of actions were related to elective procedures. For VSs specifically, 46% (25/54) of cases arose from diagnostic angiography and inferior vena cava filter placement, two relatively minor procedure types. Overall, 83% (176/211 finalized cases) of verdicts favored defendants, with no significant differences across the specialties; 43% (157/368) of total cases involved death of the patient. Among the four specialties, there was a significant (P = .0004) difference in the primary allegation (informed consent, preprocedure negligence, intraprocedure complications, or postprocedure complications) underlying the litigation. For CTSs and VSs, there was a predominance of informed consent and preprocedure negligence allegations (70% [7/10] and 52% [28/54], respectively). Intraprocedure negligence was the most common allegation for IRs (59% [23/39]), whereas allegations were more evenly distributed among ICs. CONCLUSIONS: Key issues were identified regarding malpractice litigation involving the specialties that commonly perform endovascular procedures. Despite the increasing number of ICs doing peripheral interventions, a large majority of IC cases were related to coronary treatments. A surprisingly large percentage of VS cases were related to seemingly minor cases. There were significant interspecialty differences in the primary underlying allegations. As the scope of endovascular procedures broadens and deepens, it is important for clinicians to be aware of legal considerations relevant to their practice.


Assuntos
Competência Clínica/legislação & jurisprudência , Procedimentos Endovasculares/legislação & jurisprudência , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Radiologistas/legislação & jurisprudência , Cirurgiões/legislação & jurisprudência , Procedimentos Cirúrgicos Cardíacos/legislação & jurisprudência , Causas de Morte , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Procedimentos Endovasculares/tendências , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Imperícia/tendências , Erros Médicos/efeitos adversos , Erros Médicos/tendências , Radiografia Intervencionista , Radiologistas/tendências , Estudos Retrospectivos , Especialização/legislação & jurisprudência , Cirurgiões/tendências , Fatores de Tempo , Estados Unidos
20.
J Arthroplasty ; 33(5): 1520-1523, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29398260

RESUMO

BACKGROUND: A prior survey of members of the American Association of Hip and Knee Surgeons revealed that 78% of responding surgeons were named as a defendant in at least 1 lawsuit, and 69% of these lawsuits were dismissed or settled out of court. The most common sources of litigation were nerve injury, limb-length discrepancy, and infection. This study examined common reasons for lawsuits after total joint arthroplasty (TJA) in a single metropolitan area. METHODS: A retrospective review of lawsuits filed between 2009 and 2015 in a 5-county metropolitan area was performed, including 30 hospitals and 113 TJA surgeons. Complaints underwent a manual review to determine the number of lawsuits and the specific allegations filed against each surgeon. RESULTS: Thirty-one (27.4%) surgeons were named as a defendant in at least 1 lawsuit. Eighty-three total lawsuits were filed during the period, 50 of which were dismissed or settled outside of court. Top reasons for lawsuits were, in descending order, infection, nerve injury, chronic pain, vascular injury, periprosthetic fracture, retention of foreign body, dislocation, limb-length discrepancy, venous thromboembolism, loosening, compartment syndrome, and other medical complaints. CONCLUSION: Infection appears to be the basis of most lawsuits after TJA. Surgeons should be aware of the potential for a lawsuit for complications and should strive to better communicate with patients regarding preoperative informed consent and disclosure after adverse events. Surgeons should minimize performing surgery in patients at high risk of complications, such as patients with a higher likelihood of developing postoperative infection or patients on chronic pain medications.


Assuntos
Artroplastia de Quadril/legislação & jurisprudência , Artroplastia do Joelho/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Infecções Relacionadas à Prótese/etiologia , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Cidades , Hospitais , Humanos , Consentimento Livre e Esclarecido , Articulação do Joelho , New England , Fraturas Periprotéticas/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgiões/legislação & jurisprudência
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