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1.
Vet Rec ; 187(4): 140-141, 2020 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-32826370

RESUMO

In this article exploring some of the key recommendations from the RCVS Legislation Working Party (LWP), RCVS registrar and director of legal services Eleanor Ferguson discusses disciplinary reform.


Assuntos
Técnicos em Manejo de Animais/legislação & jurisprudência , Legislação Veterinária/organização & administração , Má Conduta Profissional/legislação & jurisprudência , Sociedades Veterinárias , Médicos Veterinários/legislação & jurisprudência , Humanos , Reino Unido
2.
Pain Physician ; 23(3): E297-E304, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32517406

RESUMO

BACKGROUND: Prescribing opioids has become a challenge. The US Drug Enforcement Agency (DEA) and Centers for Disease Control and Prevention (CDC) have become more involved, culminating in the March 2016 release of the CDC's "Guidelines for Prescribing Opioids for Chronic Pain." OBJECTIVES: Given the new guidelines, we wanted to see if there have been any changes in the numbers, demographics, physician risk factors, charges, and sanctions involving the DEA against physicians who prescribe opioids, when compared to a previous DEA database review from 1998 to 2006. STUDY DESIGN: This study involved an analysis of the DEA database from 2004 to 2017. SETTING: The review was conducted at the Henry Ford Health System Division of Pain Medicine. METHOD: After institutional review board approval at Henry Ford Health System, an analysis of the DEA database of criminal prosecutions of physician registrants from 2004-2017 was performed. The database was reviewed for demographic information such as age, gender, type of degree (doctor of medicine [MD] or doctor of osteopathic medicine [DO]), years of practice, state, charges, and outcome of prosecution (probation, sentencing, and length of sentencing). An internet-based search was performed on each registrant to obtain demographic data on specialty, years of practice, type of medical school (US vs foreign), board certification, and type of employment (private vs employed). RESULTS: Between 2004 and 2017, Pain Medicine (PM) had the highest percentage of in-specialty action at 0.11% (n = 5). There was an average of 18 prosecutions per year vs 14 in the previous review. Demographic risk factors for prosecution demonstrated the significance of the type of degree (MD vs. DO), gender, type of employment (private vs. employed), and board certification status for rates of prosecution. Having a DO degree and being male were associated with significantly higher risk as well as being in private practice and not having board certification (P < .001). In terms of type of criminal charges as a percent of cases, possession with intent to distribute (n = 90) was most prevalent, representing 52.3% of charges, with new charges being prescribing without medical purpose outside the usual course of practice (n = 71) representing 41.3% of charges. Comparison of US graduates (MD/DO) vs. foreign graduates showed higher rates of DEA action for foreign graduates but this was of borderline significance (P = .072). LIMITATIONS: State-by-state comparisons could not be made. Specialty type was sometimes self-reported, and information on all opioid prosecutions could not be obtained. The previous study by Goldenbaum et al included data beyond DEA prosecution, so direct comparisons may be limited. CONCLUSION: The overall risk of DEA action as a percentage of total physicians is small but not insignificant. The overall rates of DEA prosecution have increased. New risk factors include type of degree (DO vs. MD) and being in private practice with a subtle trend toward foreign graduates at higher risk. With the trend toward less prescribing by previously high-risk specialties such as Family Medicine, there has been an increase in the relative risk of DEA action for specialties treating patients with pain such as PM, Physical Medicine and Rehabilitation, neurology, and neurosurgery bearing the brunt of prosecutions. New, more subtle charges have been added involving interpretation of the medical purpose of opioids and standard of care for their use. KEY WORDS: Certification, CDC, criminal, DEA, opioid, prescribing, prosecution, sanctions.


Assuntos
Analgésicos Opioides/uso terapêutico , Médicos/legislação & jurisprudência , Padrões de Prática Médica/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Adulto , Prescrições de Medicamentos , Disciplina no Trabalho/estatística & dados numéricos , Feminino , Órgãos Governamentais/legislação & jurisprudência , Regulamentação Governamental , Fidelidade a Diretrizes , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
3.
Med Leg J ; 88(1_suppl): 35-37, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32519568

RESUMO

The Covid-19 pandemic caused a marked increase in admissions to intensive care units. The critically ill patients' condition from the infection resulted in their deaths. The healthcare facilities have got into trouble because of the pandemic. In fact, they had to create additional beds in a very short time and to protect health workers with personal protective equipment. Healthcare professionals fear that there will be an increase in complaints and medico-legal malpractice claims and hence they have urged politicians to discuss this. The Italian Parliament recently debated the topic of medical liability and passed the Decree-Law no. 18 of 17 March 2020 (DL - so called Cura Italia) by which they want to extend the concept of "gross negligence" to healthcare facilities. Several Extended Care Units have suffered from outbreaks of Covid-19, so the Prosecutor's Office of several cities initiated investigations against them. This situation has reached Sicily, where the Prosecutor's Office of Palermo has opened an inquiry against an Extended Care Unit. Simultaneously, the Covid-19 pandemic may change patients' attitudes towards healthcare professionals, who are risking their lives daily. So the Italian medico-legal community is debating these questions, with one last pending question remaining: is the number of medico-legal claims likely to increase or trend down?


Assuntos
Betacoronavirus , Pessoal de Saúde/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Pandemias/legislação & jurisprudência , Administração da Prática Médica/legislação & jurisprudência , Infecções por Coronavirus/terapia , Erros de Diagnóstico/legislação & jurisprudência , Humanos , Legislação Hospitalar/estatística & dados numéricos , Responsabilidade Legal , Imperícia/estatística & dados numéricos , Pneumonia Viral/terapia , Má Conduta Profissional/legislação & jurisprudência , Sicília
4.
Rev. esp. med. legal ; 46(2): 56-65, abr.-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193991

RESUMO

En los últimos años ha habido un incremento de reclamaciones contra médicos por presunta mala praxis. Nuestro objetivo ha sido analizar retrospectivamente las denuncias por responsabilidad médica en los juzgados de Barcelona durante los años 2004-2009, evaluadas en el Instituto de Medicina Legal y Ciencias Forenses de Cataluña. MATERIAL Y MÉTODO: Se realizó a partir de 3 bases de datos: la primera, las 283 periciales elaboradas por los médicos forenses durante estos años; la segunda, el programa informático judicial TEMIS-2; y la tercera, revisión de sentencias judiciales. RESULTADOS: En 257 casos (90,81%) la reclamación fue penal, 18 (6,36%) procedimientos contencioso-administrativos, 5 civiles (1,77%) y 3 de Fiscalía (1,06%). La edad media fue de 48,38 años (DE±19,39), en el 62,77% la perjudicada fue una mujer, siendo estas las que sufrieron más secuelas. En el 88,34% la reclamación era contra un médico, siendo la más habitual el mal resultado terapéutico (32,86%). Las especialidades más denunciadas fueron la traumatología, obstetricia y ginecología y cirugía general. Hubo más reclamaciones en la sanidad privada. En el 72,41% de los casos que llegaron a juicio la sentencia fue absolutoria y de los 8 que fueron condenados, solo en uno hubo prisión. La mediana del tiempo hasta la sentencia fue de 1.602 días. CONCLUSIONES: La vía penal es la más frecuente. Las mujeres reclaman más y sufren más secuelas. Las especialidades quirúrgicas son las más denunciadas. En el 27,59% de los casos que llegaron a juicio hubo sentencias condenatorias y solo en uno privación de libertad


In recent years there has been an increase in claims against doctors for alleged malpractice. Our objective was to retrospectively analyze complaints of medical liability in the courts of Barcelona between 2004-2009, evaluated at the Institute of Legal Medicine and Forensic Sciences of Catalonia. MATERIAL AND METHOD: We used 3 databases: the first, the 283 forensic reports prepared by forensic doctors during those years; the second, the judicial computer programme TEMIS-2; and the third, a review of judicial sentences. RESULTS: In 257 cases (90.81%) the claim was criminal, 18 (6.36%) contentious-administrative proceedings, 5 civil (1.77%) and 3 Prosecutor's Office claims (1.06%). The average age was 48.38 years (SD±19.39), in 62.77% the injured party was a woman, and they suffered more sequelae. In 88.34% the claim was against a doctor, a poor therapeutic outcome being the most common (32.86%). The most reported specialties were traumatology, obstetrics and gynaecology, and general surgery. There were more complaints in private healthcare. In 72.41% of the cases that came to trial the sentence was acquittal, and of the 8 convictions, only one was imprisoned. The median time to sentencing was 1,602 days. CONCLUSIONS: The criminal route is the most frequent. Women claim more and suffer more consequences. Surgical specialties are the most reported. In 27.59% of the cases that came to trial there were convictions, and only one resulted in deprivation of liberty


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Imperícia/legislação & jurisprudência , Seguro de Responsabilidade Civil/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Segurança do Paciente/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Responsabilidade Legal , Gestão da Segurança/organização & administração
5.
N Z Med J ; 132(1488): 49-54, 2019 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851661

RESUMO

AIM: To describe disciplinary cases for inappropriate prescribing of drugs of dependence by doctors in New Zealand, 1997-2016. METHODS: A retrospective analysis of disciplinary decisions to describe characteristics of cases (setting, drugs, outcome) and doctors (sex, specialty, years since qualification). RESULTS: There were 25 disciplinary decisions involving 24 doctors. Disciplined doctors were mostly male (19;76%), working in general practice (19;76%), and older (mean 24 years in practice). Pharmacists were the most common source of notification to the authorities (6;24%); medical colleagues reported only four (16%). The alleged misconduct often involved behaviour in addition to inappropriate prescribing. In all cases the doctor was found guilty of professional misconduct. Penalties were severe: six doctors were removed from practice, 11 were suspended, and of the remainder all but one had restrictions on practice imposed. In many decisions there was no patient harm documented. CONCLUSION: Disciplinary cases for inappropriate prescribing of drugs of dependence by doctors in New Zealand are not common, but the consequences can be dire. The role of discipline in doctors with drug dependence is unclear.


Assuntos
Prescrição Inadequada , Médicos/legislação & jurisprudência , Padrões de Prática Médica/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Feminino , Humanos , Prescrição Inadequada/economia , Prescrição Inadequada/legislação & jurisprudência , Masculino , Nova Zelândia/epidemiologia , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias
6.
Br J Nurs ; 28(14): 955, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31348710

RESUMO

Sam Foster, Chief Nurse, Oxford University Hospitals, reflects on the responsibility employers have to ensure that disciplinary procedures and processes are fit for purpose.


Assuntos
Disciplina no Trabalho/normas , Enfermeiras e Enfermeiros/legislação & jurisprudência , Medicina Estatal/organização & administração , Competência Clínica/legislação & jurisprudência , Humanos , Má Conduta Profissional/legislação & jurisprudência , Sociedades de Enfermagem , Reino Unido
7.
Rev. derecho genoma hum ; (50): 161-201, ene.-jun. 2019.
Artigo em Espanhol | IBECS | ID: ibc-191222

RESUMO

El presente estudio tiene por objeto examinar el Convenio sobre la falsificación de productos médicos y delitos similares que supongan una amenaza para la salud pública (Medicrime). Los estados miembros, conscientes de la amenaza que representa para la salud pública el comercio internacional de medicamentos falsificados, han aprobado diversos instrumentos para controlar la elaboración, distribución y venta de medicamentos para el consumo humano en la Unión Europea, entre los que se destaca el aprobado por el Consejo de Europa, esto es, el Convenio Medicrime, hecho en Moscú el 28 de octubre de 2011, y que entró en vigor a partir del 1 de enero de 2016. Este instrumento ha contado, desde entonces, con la firma de más de 23 países de Europa, África y Asia para quienes supone un recurso indispensable en materia penal para los estados miembros que les permitirá proteger en mejor medida la salud pública de los ciudadanos de la venta ilegal de medicamentos


The purpose of this study is to examine the Convention on Counterfeiting of Medical Products and Similar Crimes Which pose a Threat to Public Health (Medicrime). The member states, aware of the threat to public health posed by the international trade in counterfeit medicines, have adopted various instruments to control the manufacture, distribution and sale of medicines for human consumption in the European Union, including the one approved by the Council of Europe, i.e. the Medicrime Convention, done in Moscow on 28 October 2011, which entered into force on 1 January 2016. This instrument has since been signed by more than 23 countries in Europe, Africa and Asia, for which it is an indispensable resource in criminal matters for member states that will allow them to better protect the public health of citizens from the illegal sale of medicines


Assuntos
Humanos , Fraude/legislação & jurisprudência , Medicamentos Falsificados , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Acordos de Cooperação Científica e Tecnológica , Má Conduta Profissional/legislação & jurisprudência , Crime/legislação & jurisprudência , Tráfico de Drogas/legislação & jurisprudência , Retirada de Medicamento Baseada em Segurança/legislação & jurisprudência
9.
J Gen Intern Med ; 34(7): 1330-1333, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31044409

RESUMO

Despite the strict prohibition against all forms of sexual relations between physicians and their patients, some physicians cross this bright line and abuse their patients sexually. The true extent of sexual abuse of patients by physicians in the U.S. health care system is unknown. An analysis of National Practitioner Data Bank reports of adverse disciplinary actions taken by state medical boards, peer-review sanctions by institutions, and malpractice payments shows that a very small number of physicians have faced "reportable" consequences for this unethical behavior. However, physician self-reported data suggest that the problem occurs at a higher rate. We discuss the factors that can explain why such sexual abuse of patients is a persistent problem in the U.S. health care system. We implore the medical community to begin a candid discussion of this problem and call for an explicit zero-tolerance standard against sexual abuse of patients by physicians. This standard must be coupled with regulatory, institutional, and cultural changes to realize its promise. We propose initial recommendations toward that end.


Assuntos
Imperícia/legislação & jurisprudência , National Practitioner Data Bank/legislação & jurisprudência , Relações Médico-Paciente , Médicos/legislação & jurisprudência , Delitos Sexuais/legislação & jurisprudência , Feminino , Humanos , Masculino , Médicos/normas , Má Conduta Profissional/legislação & jurisprudência , Delitos Sexuais/prevenção & controle , Estados Unidos/epidemiologia
10.
J Leg Med ; 39(1): 15-34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31141457

RESUMO

Medical regulators have a responsibility to protect, promote, and maintain the health and safety of patients. Here, we compare and contrast the processes for addressing concerns about doctors in four countries with legal systems based on English common law: the UK, Australia, the United States, and Canada. The legal provisions underpinning each jurisdiction's disciplinary processes depict distinctive outlooks from the different authorities as each works toward the same goal. The initial stages of the investigation process are broadly similar in all of the jurisdictions examined. Each process, however, has subtle differences with regard to its comparators. Factors include how matters of discipline are framed, the constitution of disciplinary panels, and how the perceived independence of these panels all philosophically affect the public safety remit of each regulator. This work constitutes the first comparison of international regulatory frameworks for the profession of medicine.


Assuntos
Disciplina no Trabalho/legislação & jurisprudência , Médicos/legislação & jurisprudência , Médicos/normas , Garantia da Qualidade dos Cuidados de Saúde/legislação & jurisprudência , Garantia da Qualidade dos Cuidados de Saúde/normas , Austrália , Canadá , Humanos , Internacionalidade , Jurisprudência , New York , Segurança do Paciente , Inabilitação do Médico/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Responsabilidade Social , Reino Unido
11.
J Forensic Leg Med ; 65: 1-4, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31009838

RESUMO

Article 2 of the European Convention of Human Rights (ECHR) protects the Right to Life that is invoked in an inquest where the diseased has expired in circumstances of custody or control by an agency of state. The High Court in 2012 ordered the second inquest in the Hillsborough case where the correct directions to the jury were read as to when there is a breach of such a duty. The inquest findings resulted in criminal charges being brought against two former senior police officers, who were indicted linked to the disaster. This paper examines the inquest process where there is a jury and considers the framework of the Coroners Court in the context of Article 2 where death has occurred under circumstances of duress.


Assuntos
Médicos Legistas/legislação & jurisprudência , Polícia/legislação & jurisprudência , Lesões por Esmagamento/mortalidade , Desastres , Direitos Humanos/legislação & jurisprudência , Humanos , Má Conduta Profissional/legislação & jurisprudência , Futebol , Reino Unido
16.
Am J Bioeth ; 19(1): 16-34, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30676904

RESUMO

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.


Assuntos
Análise Ética , Ética Médica , Prescrição Inadequada/estatística & dados numéricos , Licenciamento em Medicina/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Médicos/legislação & jurisprudência , Má Conduta Profissional/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Disciplina no Trabalho , Humanos , Prescrição Inadequada/ética , Prescrição Inadequada/legislação & jurisprudência , Licenciamento em Medicina/ética , Licenciamento em Medicina/estatística & dados numéricos , Imperícia/legislação & jurisprudência , Médicos/ética , Má Conduta Profissional/ética , Má Conduta Profissional/legislação & jurisprudência , Delitos Sexuais/ética , Delitos Sexuais/legislação & jurisprudência , Estados Unidos
18.
Ann Ital Chir ; 90: 485-490, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31929172

RESUMO

Judgement no. 8770 released on February 22, 2018 by the joint criminal divisions of the Supreme Court of Cassazione innovatively established that emergency medical conditions represent "problem of special complexity" and, therefore, it is mandatory to apply art. 2236 of the Italian Civil Code. This article provides that health care professional may be convicted only in case of willful misconduct or gross negligence. The authors analyze the jurisprudential evolution of all those elements that are fundamental to assess health care professional liability: a) special complexity of the performance b) relation between imprudence and carelessness c) conditions that may make the healthcare liability gross. The principles approved by the joint criminal division within the above mentioned judgment significantly expand special complexity cases' range and, therefore, the corresponding liability's limitation range is extended. Due to the solidity of the reasons on which it is based, this sentence could permanently influence the orientation of the Courts and, therefore, dramatically diminish the risk of professional liability for healthcare staff. There is, however, a lack of clarity in the practical applications of the distinction between unskillfulness, on the one hand, and imprudence and negligence on the other. This event risks to nullify the usefulness of the joint criminal divisions' intervention. In fact, if the Court considers the health care professional behavior to be imprudent or negligent (rather than unskilled), no limitation of liability can be applied. KEY WORDS: Carelessness, Criminal and civil medical liability limitation, Emergency medical treatments, Gross negligence, Problems of special complexity, Unskillfulness, imprudence.


Assuntos
Serviços Médicos de Emergência/legislação & jurisprudência , Pessoal de Saúde/legislação & jurisprudência , Responsabilidade Legal , Competência Clínica , Crime/legislação & jurisprudência , Humanos , Itália , Imperícia/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência
19.
Res Social Adm Pharm ; 15(10): 1195-1203, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30529012

RESUMO

In many countries with legal systems based on English common law, pharmacy regulators have a responsibility to protect, promote and maintain the health and safety of patients. Where there is a potential risk to patient safety, or where the public's confidence in pharmacy could be adversely affected by the actions of a pharmacist, these regulators have a statutory duty to investigate concerns. The legal provisions underpinning each jurisdiction's disciplinary processes depict distinctive outlooks from the different authorities, as each works towards the same goal. Legal statues, regulations, rules, and guidance affecting the disciplinary process in Great Britain, Australia, New York and New Brunswick were collated, and the processes they describe were attached to a common process flow diagram for step-by-step evaluation of their respective legal provisions. The initial stages of the respective investigation process are broadly similar in all the jurisdictions examined; however, each process has subtle differences that afford some level of advantage or disadvantage over its comparators. Factors including: how matters of discipline are framed; the existence of a separate process for minor and uncontested violations; the ability to effect an interim suspension of a practitioner's license; threshold criteria for escalation of complaints; the membership of disciplinary panels; and the perceived independence of these panels all philosophically affect the public safety remit of each regulator. This work constitutes the first comparison of international regulatory frameworks for the profession of pharmacy. Of the four jurisdictions examined, Great Britain most clearly acts in the interest of the public and the profession - rather than the respondent pharmacist - at every step of its process.


Assuntos
Assistência Farmacêutica/legislação & jurisprudência , Farmacêuticos/legislação & jurisprudência , Má Conduta Profissional/legislação & jurisprudência , Humanos , Legislação Farmacêutica , Segurança do Paciente
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