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1.
Ann R Coll Surg Engl ; 102(2): 144-148, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31755728

RESUMO

INTRODUCTION: Statutory duty of candour was introduced in November 2014 for NHS bodies in England. Contained within the regulation were definitions regarding the threshold for what constitutes a notifiable patient safety incident. However, it can be difficult to determine when the process should be implemented. The aim of this survey was to evaluate the interpretation of these definitions by British neurosurgeons. MATERIALS AND METHODS: All full (consultant) members of the Society of British Neurological Surgeons were electronically invited to participate in an online survey. Surgeons were presented with 15 cases and asked to decide in the case of each one whether they would trigger the process of duty of candour. Cases were stratified according to their likelihood and severity. RESULTS: In all, 106/357 (29.7%) members participated in the survey. Responses varied widely, with almost no members triggering the process of duty of candour in cases where adverse events were common (greater than 10% likelihood) and required only outpatient follow-up (7/106; 6.6%), and almost all members doing so in cases where adverse events were rare (less than 0.1% likelihood) and resulted in death (102/106; 96.2%). However, there was clear equipoise in triggering the process of duty of candour in cases where adverse events were uncommon (0.1-10% likelihood) and resulted in moderate harm (38/106; 35.8%), severe harm (57/106; 53.8%) or death (49/106; 46.2%). CONCLUSION: There is considerable nationwide variation in the interpretation of definitions regarding the threshold for duty of candour. To this end, we propose a framework for the improved application of duty of candour in clinical practice.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Segurança do Paciente/legislação & jurisprudência , Qualidade da Assistência à Saúde/legislação & jurisprudência , Medicina Estatal/organização & administração , Estudos Transversais , Inglaterra , Implementação de Plano de Saúde , Humanos , Erros Médicos/legislação & jurisprudência , Erros Médicos/prevenção & controle , Neurocirurgiões/legislação & jurisprudência , Neurocirurgiões/estatística & dados numéricos , Neurocirurgia/legislação & jurisprudência , Neurocirurgia/organização & administração , Relações Médico-Paciente , Sociedades Médicas/legislação & jurisprudência , Sociedades Médicas/organização & administração , Medicina Estatal/legislação & jurisprudência , Inquéritos e Questionários/estatística & dados numéricos
2.
Rev. bras. cir. plást ; 34(4): 485-496, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047909

RESUMO

Introdução: É consenso no meio jurídico que os resultados referentes às atividades médicas sejam obrigação de meio, e não de resultado. Contudo, há grande discussão quando se trata de procedimentos estéticos. A Resolução nº 1621/2001, do Conselho Federal de Medicina, define que o objetivo do ato médico na cirurgia plástica também constitui obrigação de meio. O estudo avaliou, entre novembro de 2015 a novembro de 2017, 106 casos, para verificar se o entendimento do Judiciário se alinha à Resolução do CFM [Conselho Federal de Medicina]. Foram quantificados o número de processos e a porcentagem dos casos julgados como procedentes ou improcedentes, além de verificar as principais posições doutrinárias e jurisprudenciais que embasaram as sentenças admitidas como procedentes. Foi, ainda, quantificado o número de casos cuja decisão do magistrado foi relacionada com o posicionamento do laudo pericial médico. Métodos: Foi feita busca no banco de sentenças do site do Tribunal de Justiça do Estado de São Paulo (SP), por meio da palavra-chave "Cirurgia Plástica", de todos os processos de indenização relacionados a cirurgias plásticas estéticas. Resultados: Foram sentenciados como improcedentes 61 casos (58%). Foram sentenciados como procedentes 45 casos (42%). Em 96% dos casos (102) a sentença relacionou-se positivamente com a análise pericial. Conclusão: Foram 102 sentenças concordantes aos laudos periciais e apenas quatro casos cuja sentença divergiu do entendimento do laudo. Estes dados mostram a importância crucial da análise pericial para a definição das sentenças judiciais. Analisando todas as sentenças, observou-se que em nenhum caso os juízes levaram em conta a Resolução do CFM [Conselho Federal de Medicina].


Introduction: There is a legal consensus that the results of medical activities represent obligations of means, not results. However, there is ample discussion when it comes to aesthetic procedures. Resolution 1621/2001 of the Federal Council of Medicine also defines the objective of a medical act in plastic surgery as an obligation of means. This study evaluated 106 cases between November 2015 and November 2017 to verify whether the decisions of the Judicial Power agree with the Resolution of the Federal Council of Medicine. The number of lawsuits and the percentage of claims granted or denied were quantified, and the opinions of jurists and courts that supported the claims granted were verified. The number of cases in which the judge's decision was related to the opinion of a medical expert was also quantified. Methods: The authors searched the judgment database located on the website of the Court of Justice of the State of São Paulo (SP) for damage related to aesthetic plastic surgery, using the keyword "Plastic Surgery" for all actions. Results: A total of 61 claims (58%) were denied, and 45 (42%) were granted. In 96% of cases (102) the judgment was positively related to the expert report. Conclusion: There were 102 cases in which the judgment agreed with the expert reports and only four cases in which the judgment did not agree with the reports. These data show the crucial importance of experts' reports in defining judicial judgments. The analyses of all judgments showed that there were no cases in which the judge considered the Resolution of the Federal Council of Medicine.


Assuntos
Humanos , História do Século XXI , Administração em Saúde Pública , Cirurgia Plástica , Erros Médicos , Decisões Judiciais , Estética , Medicina Legal , Jurisprudência , Administração em Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/métodos , Administração em Saúde Pública/estatística & dados numéricos , Cirurgia Plástica/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Medicina Legal/estatística & dados numéricos
3.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 27(Special Issue): 710-714, 2019 Aug.
Artigo em Russo | MEDLINE | ID: mdl-31747166

RESUMO

The article examines the main types of medical errors and their causes. It systemizes typical iatrogenic diseases. The work defines leading directions for medical errors prevention, including the effective usage of simulation learning technologies. Authors analyze current regulatory acts and the main rule-making trends in the field of medical errors.


Assuntos
Doença Iatrogênica , Erros Médicos , Humanos , Erros Médicos/legislação & jurisprudência
4.
Br J Hosp Med (Lond) ; 80(7): 387-390, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31283388

RESUMO

The costs of litigation are large and increasing, to a level that places a drain on precious health-care resources and affects the way medicine is practised. This article examines whether a change to a no-fault legal system would lead to reduced costs and improved patient care.


Assuntos
Imperícia/economia , Imperícia/legislação & jurisprudência , Erros Médicos/economia , Erros Médicos/legislação & jurisprudência , Humanos , Responsabilidade Legal/economia , Procedimentos Ortopédicos/economia , Melhoria de Qualidade/organização & administração , Medicina Estatal/economia , Medicina Estatal/legislação & jurisprudência , Reino Unido , Ferimentos e Lesões/economia
6.
J Leg Med ; 39(1): 35-53, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141455

RESUMO

Negligent conduct by health care providers can result in medical malpractice injury sustained by parents denied their right to decide whether and when to have children. In this review of the international medicolegal literature, the authors present a comparative analysis of the law of medical negligence in this context and a discussion of the grounds for compensable injury resulting from medical error. The discussion is focused on the legal provisions for compensable injury awarded to the plaintiff (expectant mother, parents of the born child, and born child) and the types of injury various legal systems recognize in such cases. The aim of this article is to provide medical malpractice investigators and legal professionals with an overview of the birth cases.


Assuntos
Compensação e Reparação/legislação & jurisprudência , Legislação como Assunto , Responsabilidade Legal , Imperícia/legislação & jurisprudência , Direito de não Nascer , Austrália , Canadá , Chile , Europa (Continente) , Feminino , Pessoal de Saúde/legislação & jurisprudência , Humanos , Internacionalidade , Japão , Masculino , Erros Médicos/legislação & jurisprudência , Pais , Gravidez , Diagnóstico Pré-Natal , Estados Unidos
7.
Pediatr Emerg Care ; 35(6): 440-442, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31135686

RESUMO

Every pediatric emergency medicine provider will be involved in medical errors during their career and many will face the prospect of at least one malpractice lawsuit. These events can cause significant stress, including detrimental effects on providers' mental and physical health. This stress may also impact the provider's ability to care for future patients. In this installment of our series, "A Call to Restore Your Calling: Self-care of the Emergency Physician in the Face of Life-Changing Stress," we examine how medical errors and malpractice lawsuits may affect providers and how individuals and organizations can address these events.


Assuntos
Esgotamento Profissional/psicologia , Imperícia/legislação & jurisprudência , Erros Médicos/psicologia , Adaptação Psicológica , Esgotamento Profissional/complicações , Serviço Hospitalar de Emergência , Humanos , Imperícia/estatística & dados numéricos , Erros Médicos/legislação & jurisprudência , Erros Médicos/estatística & dados numéricos , Médicos/psicologia , Autocuidado/psicologia
8.
Wiad Lek ; 72(4): 697-701, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31055559

RESUMO

OBJECTIVE: Introduction: Health systems and health policies across the European Union are becoming more and more interconnected and also more complex. This increased interconnection raises many health policy issues, including health care quality. Mistakes in medical care can occur anywhere in the health care system - at hospitals, doctor's offices, nursing homes, pharmacies, or patients' homes - and in any part of the treatment process involving wrong medication, improper treatment, or incorrect or delayed test results. The aim of the article is to develop adequate theoretical and scientific-practical proposals for the modernization of the legal regulation to protect patients' rights aimed at observance of constitutional rights and freedoms. PATIENTS AND METHODS: Materials and methods: In order to obtain the results the analysis of medical, labor and civil law norms are investigated. The article uses analysis and synthesis methods, as well as a comparative legal method. RESULTS: Review: A number of proposals are given for improving legislation in the area of eliminating obstacles to provision of qualitative primary care / medical-preventive care, prevention of formal attitude towards the patient, the implementation of preventive protection measures which should notify in advance about the violation of the law in the medical sphere. CONCLUSION: Conclusions: Ukraine urgently needs a legal mechanism to protect the rights of patients; it will become a systemic phenomenon and will consist of legal means, forms, ways by which the restoration of violated patients' rights is provided, the support of protected interests by the law is maintained, legal disputes are resolved and other obstacles to realization of patients' rights are overcome.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Direitos do Paciente , União Europeia , Humanos , Ucrânia
9.
Obstet Gynecol Clin North Am ; 46(2): 215-225, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056124

RESUMO

Keeping patients safe while they receive medical care is essential. Yet current systems designed to ensure patient safety are not enough, because medical error is the third leading cause of preventable deaths in the United States. Clinicians can partner with the patient to enhance patient safety. Pulse Center for Patient Safety proposes patient- and family-driven processes designed to improve a patient's chances of avoiding harm. This article discusses highlights of the role of patient safety through a grassroots lens, summarizes the factors that influence the patient's role in patient safety and reviews recommendations on how clinicians can partner with patients.


Assuntos
Participação do Paciente , Segurança do Paciente , Adulto , Comunicação , Feminino , Ginecologia , Registros de Saúde Pessoal , Humanos , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Erros Médicos/mortalidade , Erros Médicos/prevenção & controle , Obstetrícia , Defesa do Paciente , Educação de Pacientes como Assunto , Assistência Centrada no Paciente/métodos , Relações Médico-Paciente , Qualidade da Assistência à Saúde , Fatores de Risco , Estados Unidos
10.
Obstet Gynecol Clin North Am ; 46(2): 239-245, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056126

RESUMO

Within health care, the Just Culture is model of workplace justice intended to create fairness for providers and create better outcome for patients. It is about creating a common language to evaluate provider conduct. A Just Culture helps create an open reporting culture. To create better patient safety outcomes, a Just Culture shifts the focus from errors and outcomes to system design and the facilitation of good behavioral choices.


Assuntos
Erros Médicos , Segurança do Paciente , Gestão da Segurança , Responsabilidade Social , Feminino , Ginecologia , Humanos , Imperícia , Erros Médicos/legislação & jurisprudência , Erros Médicos/prevenção & controle , Obstetrícia , Risco , Assunção de Riscos , Inquéritos e Questionários , Terminologia como Assunto , Resultado do Tratamento
11.
Obstet Gynecol Clin North Am ; 46(2): 247-255, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056127

RESUMO

Disclosure of medical errors and adverse outcomes is expected by regulatory agencies and society as a whole. Disclosure should occur in a systematic way that ensures honesty and transparency regarding the care that has been provided. It is often appropriate to seek professional help from Clinical Risk Management to assist with disclosure of any serious safety event that resulted in harm. Disclosure of medical errors facilitates efforts to prevent recurrence of safety events.


Assuntos
Erros Médicos , Revelação da Verdade , Atitude do Pessoal de Saúde , Empatia , Feminino , Ginecologia , Custos de Cuidados de Saúde/tendências , Humanos , Recém-Nascido , Sulfato de Magnésio/administração & dosagem , Imperícia/economia , Imperícia/legislação & jurisprudência , Erros Médicos/economia , Erros Médicos/legislação & jurisprudência , Obstetrícia , Pré-Eclâmpsia/terapia , Gravidez , Gestão de Riscos
12.
Br J Surg ; 106(11): 1433-1441, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31112294

RESUMO

BACKGROUND: A video and medical data recorder in the operating theatre is possible, but concerns over privacy, data use and litigation have limited widespread implementation. The literature on legal considerations and challenges to overcome, and guidelines related to use of data recording in the surgical environment, are presented in this narrative review. METHODS: A review of PubMed and Embase databases and Cochrane Library was undertaken. International jurisprudence on the topic was searched. Practice recommendations and legal perspectives were acquired based on experience with implementation and use of a video and medical data recorder in the operating theatre. RESULTS: After removing duplicates, 116 citations were retrieved and abstracts screened; 31 articles were assessed for eligibility and 20 papers were finally included. According to the European General Data Protection Regulation and US Health Insurance Portability and Accountability Act, researchers are required to make sure that personal data collected from patients and healthcare professionals are used fairly and lawfully, for limited and specifically stated purposes, in an adequate and relevant manner, kept safe and secure, and stored for no longer than is absolutely necessary. Data collected for the sole purpose of healthcare quality improvement are not required to be added to the patient's medical record. CONCLUSION: Transparency on the use and purpose of recorded data should be ensured to both staff and patients. The recorded video data do not need to be used as evidence in court if patient medical records are well maintained. Clear legislation on data responsibility is needed to use the medical recorder optimally for quality improvement initiatives.


Assuntos
Salas Cirúrgicas/legislação & jurisprudência , Procedimentos Cirúrgicos Operatórios/legislação & jurisprudência , Humanos , Erros Médicos/legislação & jurisprudência , Segurança do Paciente/legislação & jurisprudência , Privacidade , Gestão da Segurança/legislação & jurisprudência , Gravação em Vídeo/legislação & jurisprudência
13.
Am J Nurs ; 119(5): 12, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033534
14.
J Bone Joint Surg Am ; 101(7): e27, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30946201

RESUMO

BACKGROUND: Poor clinical outcomes and adverse events following orthopaedic trauma are common, which may lead to litigation. To our knowledge, factors associated with litigation following fracture care have not previously been evaluated. METHODS: A retrospective review of fracture-related malpractice lawsuits from 1988 to 2015 was completed utilizing VerdictSearch (ALM Media Properties), a medicolegal database. Defendant and plaintiff characteristics along with fracture type, allegations, litigation outcomes, and the association of case characteristics with outcomes were analyzed. RESULTS: A total of 561 cases were evaluated; 360 cases were excluded, resulting in a total of 201 cases that were analyzed in detail. The mean age of the plaintiff was 43.1 years (standard deviation [SD],19.4 years). Twenty-four fracture types were represented among the analyzed cases. The most common fractures were of the radius (44), the femur (32), the tibia (30), the ulna (29), the humerus (26), the spine (24), the hip (17), and the fibula (15). Overall, 129 (64.2%) cases resulted in a defense verdict, 41 (20.4%) cases resulted in a plaintiff verdict, and 31 (15.4%) cases resulted in a settlement. For plaintiff verdicts, the mean indemnity payment was $3,778,657 (median, $753,057; range, $89,943 to $27,926,311). For settlements, the mean indemnity payment was $1,097,439 (median, $547,935; range, $103,541 to $9,445,113). The mean indemnity for plaintiff verdicts was significantly greater than the mean indemnity for settlements (p = 0.03). The presence of a neurological deficit was associated with a significantly greater likelihood of a favorable outcome for the plaintiff (52.8% for plaintiffs with neurological deficit versus 32.1% for plaintiffs without neurological deficit; p = 0.019). CONCLUSIONS: This study examined malpractice litigation following traumatic orthopaedic injuries. In cases with decisions for the plaintiff, indemnity payments were on average more than $2.5 million larger than payments for settlements. In fracture cases with neurological deficit, malpractice cases were more likely to result in a favorable outcome for the plaintiff.


Assuntos
Fraturas Ósseas/cirurgia , Imperícia/economia , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Erros Médicos/economia , Complicações Pós-Operatórias/economia , Estados Unidos , Adulto Jovem
15.
Med Leg J ; 87(2): 83-84, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30942650

RESUMO

Medical error and the potential subsequent harm caused to patients, relatives and healthcare professionals have been identified as a serious public health concern. Non-technical error has been implicated as a contributing cause in a significant number of adverse events. Modern surgical training in the United Kingdom has evolved to include non-technical skills training to complement traditional technical training. The recognition of non-technical training as well as a renewed focus on legal learning outcomes during training may promote a culture of greater risk awareness and subsequent clinical risk reduction.


Assuntos
Cirurgia Geral/educação , Cirurgia Geral/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Competência Clínica/normas , Humanos , Erros Médicos/prevenção & controle , Erros Médicos/psicologia , Médicos/legislação & jurisprudência , Médicos/psicologia , Reino Unido
20.
Stanford Law Rev ; 71(2): 341-409, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30883076

RESUMO

Based on case studies indicating that apologies from physicians to patients can promote healing, understanding, and dispute resolution, thirty-nine states (and the District of Columbia) have sought to reduce litigation and medical malpractice liability by enacting apology laws. Apology laws facilitate apologies by making them inadmissible as evidence in subsequent malpractice trials. The underlying assumption of these laws is that after receiving an apology, patients will be less likely to pursue malpractice claims and will be more likely to settle claims that are filed. However, once a patient has been made aware that the physician has committed a medical error, the patient's incentive to pursue a claim may increase even though the apology itself cannot be introduced as evidence. Thus, apology laws could lead to either increases or decreases in overall medical malpractice liability risk. Despite apology laws' status as one of the most widespread tort reforms in the country, there is little evidence that they achieve their goal of reducing litigation. This Article provides critical new evidence on the role of apology laws by examining a dataset of malpractice claims obtained directly from a large national malpractice insurer. This dataset includes substantially more information than is publicly available, and thus presents a unique opportunity to understand the effect of apology laws on the entire litigation landscape in ways that are not possible using only publicly available data. Decomposing medical malpractice liability risk into the frequency of claims and the magnitude of those claims, we examine the malpractice claims against 90% of physicians in the country who practice within a particular specialty over an eight-year period.


Assuntos
Responsabilidade Legal , Imperícia/legislação & jurisprudência , Gestão de Riscos/legislação & jurisprudência , Humanos , Erros Médicos/legislação & jurisprudência , Governo Estadual , Estados Unidos
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