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2.
J Surg Res ; 245: 212-216, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421365

RESUMO

BACKGROUND: Pulmonary embolism and deep vein thrombosis are common clinical entities, and the related malpractice suits affect all medical subspecialties. Claims from malpractice litigation were analyzed to understand the demographics of these lawsuits and the common reasons for pursuing litigation. METHODS: Cases entered into the Westlaw database from March 5, 1987, to May 31, 2018, were reviewed. Search terms included "pulmonary embolism" and "deep vein thrombosis." RESULTS: A total of 277 cases were identified. The most frequently identified defendant was an internist (including family practitioner; 33%), followed by an emergency physician (18%), an orthopedic surgeon (16%), and an obstetrician/gynecologist (9%). The most common etiology for pulmonary embolism was prior surgery (41%). The most common allegation was "failure to diagnose and treat" in 62%. Other negligence included the failure to administer prophylactic anticoagulation while in the hospital (18%), failure to prescribe anticoagulation on discharge (8%), failure to administer anticoagulation after diagnosis (8%), and premature discontinuation of anticoagulation (2%). The most frequently claimed injury was death in 222 cases (80%). Verdicts were found for the defendant in 57% of cases and for the plaintiff in 27% and settled in 16%. CONCLUSIONS: The most frequently cited negligent act was the failure to give prophylactic anticoagulation, even after discharge. The trends noted in this study may potentially be addressed and therefore prevented by systems-based practice changes. The most common allegation, "failure to diagnose and treat," suggests that first-contact doctors such as emergency physicians and primary care practitioners must maintain a high index of suspicion for deep vein thrombosis/pulmonary embolism.


Assuntos
Falha da Terapia de Resgate/estatística & dados numéricos , Imperícia/estatística & dados numéricos , Médicos/estatística & dados numéricos , Embolia Pulmonar/terapia , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Bases de Dados Factuais/estatística & dados numéricos , Diagnóstico Tardio/economia , Diagnóstico Tardio/legislação & jurisprudência , Diagnóstico Tardio/estatística & dados numéricos , Falha da Terapia de Resgate/economia , Falha da Terapia de Resgate/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Consentimento Livre e Esclarecido/estatística & dados numéricos , Imperícia/economia , Médicos/economia , Médicos/legislação & jurisprudência , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Embolia Pulmonar/mortalidade , Estados Unidos/epidemiologia , Trombose Venosa/diagnóstico , Trombose Venosa/etiologia , Trombose Venosa/mortalidade
3.
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
4.
S Afr Med J ; 109(10): 743-744, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635570

RESUMO

This article deals with what doctors in the private sector should do if relatives of deceased patients refuse to consent to medicolegal autopsies and demand that the bodies be handed over to them. The law does not require consent by relatives for medicolegal autopsies, because the State has a compelling interest in ensuring that such deaths are properly investigated. Relatives of patients who have died an unnatural death may be criminally prosecuted if they attempt to obstruct doctors from carrying out their duties under the Inquests Act 58 of 1959 and the regulations regarding the rendering of forensic pathology services.


Assuntos
Autopsia , Patologia Legal/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Médicos/legislação & jurisprudência , Setor Privado , Causas de Morte , Família , Humanos
5.
Wiad Lek ; 72(9 cz 2): 1839-1843, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622276

RESUMO

OBJECTIVE: Introduction: It was identified that one of the priorities of medical reform in Ukraine is the establishment of an effective system of legal regulation of professional physician's obligations that meets European standards. However, the legal regulation of relations between actors in the field of health care lags behind the practice of their development. The aim to find out the status of legal regulation of the professional obligations of health workers, to identify the gaps in this regulation, to formulate proposals for improving the legal framework for the issue under investigation. PATIENTS AND METHODS: Materials and methods: Legislation of Ukraine and certain European countries, international declarations and conventions, scientific works, 28 judgments of the European Court of Human Rights, 96 sentences of the practice of the national courts of Ukraine. CONCLUSION: Conclusions: During the study, the stages of determining the professional physician's obligations were singled out, which would optimize the legislative process of regulation of obligations. One of the problems is the incorrect translation of protocols, which is assigned to a medical care institution. It was proposed to solve this problem by introducing a unified system of protocols and standards, the duty of translation and adaptation of which is entrusted to the central body of executive power in the field of health care. It is relevant to consolidate the duty of medical records management at the level of law, which will serve as a guarantee of ensuring the proper performance by the physician of a professional obligation to treat and diagnose a particular patient. In order to avoid cases of judgments, based on the results of the сommission's assessment of the actions of a physician and to eliminate the number of cases of unjustified attraction of physicians to liability, it is necessary to consolidate a clear list of general professional physician's obligations in a single regulatory act.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Médicos/legislação & jurisprudência , Direitos Humanos , Humanos , Papel Profissional , Ucrânia
6.
Wiad Lek ; 72(9 cz 2): 1844-1850, 2019.
Artigo em Polonês | MEDLINE | ID: mdl-31622277

RESUMO

Infectious diseases are a serious social problem. For several years, there has been an increase in syphilis in Poland. It is an infectious disease and as such is subject to legal regulations. Common (such as all infectious diseases) and detailed statutory regulations apply to syphilis. The subject of the article is the presentation of Polish legal regulations on syphilis as an infectious disease. The specific objective of the article is to present and analyze the doctor's duties regarding the diagnosis (suspicion) of syphilis.


Assuntos
Doenças Transmissíveis/diagnóstico , Notificação de Abuso , Médicos/legislação & jurisprudência , Papel Profissional , Sífilis/diagnóstico , Humanos , Polônia
7.
Schmerz ; 33(5): 443-448, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31478141

RESUMO

BACKGROUND: Since March 2017 the law amending narcotics and other legal regulations has made it possible for doctors to prescribe cannabis and cannabis-derived medicines. The introduction of § 31 para 6 of the Social Code Book V (SGB V) allows that patients can be treated with cannabis-derived medicines at the expense of the statutory health insurance if they have a severe illness. COURT DECISIONS: The law requires the approval of a prescription of cannabis for medical purposes by the health insurance before the granting of benefits. Due to denied permission, numerous cases are pending before the social tribunals. The article presents which legal issues are decided and why there is still no case law from the Federal Social Court on the essential questions. OUTLOOK: The possibility of prescribing cannabis as medicine at the expense of the health insurance is an important advance in social law. The § 31 para 6 SGB V should be evaluated as soon as possible. The provisions of SGB V for the reimbursement of off-label treatment should be harmonized with § 31 para 6 SGB V.


Assuntos
Cannabis , Seguro Saúde , Médicos , Prescrições , Assistência à Saúde/legislação & jurisprudência , Alemanha , Humanos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Médicos/legislação & jurisprudência , Prescrições/estatística & dados numéricos
8.
S Afr Med J ; 109(8): 552-554, 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31456546

RESUMO

The Court of Arbitration for Sport recently confirmed that the decision by the International Association of Athletics Federations to require hyperandrogenic female athletes such as Caster Semenya to reduce their testosterone levels to compete in certain races has been widely condemned. The World Medical Association has warned doctors not to assist in implementing the decision, as it would be unethical. The same would apply in terms of the Health Professions Council of South Africa's rules of professional conduct. Such treatment is 'futile' in medical terms, and does not serve the purpose of providing healthcare. Therefore, doctors may lawfully refuse to prescribe it. The decision is a violation of Semenya's constitutional rights and would be regarded as unethical should doctors comply with it. However, the prescription of such drugs would not be unlawful if Semenya gave informed consent to taking them. Such consent would not be a defence to a disciplinary hearing on unprofessional conduct, but would be a good defence to any legal action arising from unpleasant side-effects - provided they were explained to her.


Assuntos
Antagonistas de Androgênios/administração & dosagem , Atletas , Hiperandrogenismo/tratamento farmacológico , Futilidade Médica/ética , Futilidade Médica/legislação & jurisprudência , Médicos/legislação & jurisprudência , Feminino , Humanos , Recusa do Médico a Tratar/legislação & jurisprudência , Medicina Esportiva/legislação & jurisprudência
9.
Tex Med ; 115(8): 38-40, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369131

RESUMO

Eight years ago, when he experienced a rare patient death, McAllen family physician Ruben Aleman, MD, signed the death certificate the way Texas physicians had been doing it for years, and the only way he knew how: using pen and paper. That resulted in the Texas Medical Board (TMB) not only coming after him, but accusing him of "unprofessional or dishonorable conduct that is likely to deceive or defraud the public" - words found in the state Medical Practice Act. The Texas Supreme Court recently decided that was an overreach for a physician who simply hadn't signed up on the state's electronic death registration system, which at the time was relatively new.


Assuntos
Atestado de Óbito/legislação & jurisprudência , Sistemas On-Line/legislação & jurisprudência , Médicos/legislação & jurisprudência , Humanos , Texas
10.
Tex Med ; 115(7): 32-37, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31334826

RESUMO

Physicians can encounter a web of confusion and unfairness when it comes to navigating the Texas Medical Board (TMB). A Travis County district court has given Texas physicians clarity and hope when it comes to certain medical board investigations. The court's decision, if it holds up, establishes an important precedent for when physicians are required to register their facility as a pain management clinic.


Assuntos
Clínicas de Dor/legislação & jurisprudência , Médicos/legislação & jurisprudência , Humanos , Texas
11.
Australas Psychiatry ; 27(5): 441-443, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31179722

RESUMO

OBJECTIVE: In inpatient forensic settings, a psychiatrist is expected to wear 'Two Hats', as a treating physician and as an expert to provide risk assessments and expert advice to the judicial authorities for leave and release decisions. Although dual roles have long been accepted as an inevitable part of independent forensic practice, there are additional ethical challenges for the treating psychiatrist to provide an expert opinion. This paper examines the specific ethical ambiguities for a treating psychiatrist at the interface of legal process related to leave and release decisions in the treatment of forensic patients. CONCLUSIONS: While respect for justice is the prevailing ethical paradigm for court-related forensic work, the medical paradigm should remain the key ethical framework for psychiatrists in treatment settings. Thus, psychiatrist should be aware of possible adverse consequences in acting as forensic experts for their patients. A conscientious adherence to clinical facts and awareness of the 'Two Hats' ethical pitfall can serve as important reference points in framing the psychiatric evidence in the decision-making process and safeguard treating psychiatrist's role.


Assuntos
Psiquiatria Legal/ética , Psiquiatria Legal/legislação & jurisprudência , Transtornos Mentais/terapia , Pessoas Mentalmente Doentes/legislação & jurisprudência , Médicos/ética , Médicos/legislação & jurisprudência , Humanos , Medição de Risco/legislação & jurisprudência
12.
Schmerz ; 33(5): 378-383, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31243538

RESUMO

The law on the amendment of the narcotics law and other regulations, which was accepted by consensus by the German Parliament, significantly expanded the options for the use of cannabis-based medicinal products. In individual cases, already approved cannabis-based medicinal products can also be prescribed outside the approved indication at the expense of the statutory health insurance funds (GKV). The cost of treatment with cannabis flowers and extracts as well as dronabinol, which are not approved under the drug law, will also be covered by the GKV upon application. Physicians must advise their patients on the options of treatment with cannabis-based medicinal products and support them in applying for reimbursement. The prescription of unauthorized medical cannabis products poses particular challenges, as there is no summary of product characteristics that is mandatory for authorized finished products. In addition, physicians are obliged to participate in an accompanying survey. To this end, they must send data to the Federal Institute for Drugs and Medical Devices providing information about treatment with cannabis-based medicinal products. When prescribing medical cannabis products as defined in the Act of 6 March 2017 amending the law on narcotic drugs and other regulations, physicians assume a special responsibility that goes far beyond the responsibility for the use of authorized finished medicinal products.


Assuntos
Cannabis , Legislação de Medicamentos , Maconha Medicinal , Médicos , Alemanha , Humanos , Médicos/legislação & jurisprudência , Inquéritos e Questionários
13.
Phys Med Rehabil Clin N Am ; 30(3): 649-655, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31227139

RESUMO

Any physician who has authored an Independent Medical Evaluation or medical record review can and should anticipate being called as an expert witness (EW). Litigants rely on EW testimony in most civil cases. The most common areas in which EWs participate and provide opinions and testimony are workers' compensation, personal injury, and medical malpractice. This report will become part of the discovery process, the process by which a party to a lawsuit can obtain information from another party or other entities involved in the lawsuit.


Assuntos
Prova Pericial/legislação & jurisprudência , Médicos/legislação & jurisprudência , Conflito de Interesses/legislação & jurisprudência , Prova Pericial/ética , Humanos , Papel do Médico , Médicos/ética , Profissionalismo/legislação & jurisprudência
15.
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
17.
Int J Law Psychiatry ; 64: 142-149, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31122624

RESUMO

BACKGROUND: Involuntary admission (IA) for psychiatric treatment is a massive restriction of human rights. Therefore, its execution is regulated by law. During executing IAs referring physicians find themselves in a dual role: support of patients in the recovery process but also safe-keeper of society. In Zurich, Switzerland the law stipulates that physicians regardless of their medical specialization may admit patients who suffer from a mental disorder, mental disability or severe neglect involuntarily if care cannot be provided otherwise, regardless of their decision-making capacity. The referring physician is obliged to examine the patients, hear their views on the IA, inform them about the following steps and about their right of appeal at the civil court. We aimed to assess whether referring physicians can comply with those legal requirements for an IA. Additionally, we examined whether legal considerations differed according to the physicians` professional backgrounds and attitudes towards coercion in general. METHODS: We invited physicians from different in- and outpatient settings who executed IAs to the University Hospital of Psychiatry Zurich to participate in a newly developed online survey. We used correlation analysis, chi-square and t-tests to analyze the responses of 43 psychiatrists with those of 64 other physicians. RESULTS: In about 1/3 of the IAs referring physicians were not able to hear the patients' views on the IA, to inform the patients about the following steps and about their right of appeal. Psychiatrists felt more certain with the legal basis of IA compared to physicians other than psychiatrists. Nevertheless, the latter stated that the assessment of the risk for suicide and danger should not be restricted only to psychiatrists. Both groups differed in their attitudes towards coercion with psychiatrists being more critical. CONCLUSIONS: Interventions should be developed to facilitate a compliance with legal requirements during IA. Physicians who execute IAs must have a thorough knowledge of the clinical and legal basis for their actions. We recommend specialized consultation teams for the assessment of PES and regular training including ethical discussions, especially for physicians other than psychiatrists.


Assuntos
/legislação & jurisprudência , Transtornos Mentais/terapia , Médicos/legislação & jurisprudência , Encaminhamento e Consulta/legislação & jurisprudência , Adulto , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Psiquiatria/legislação & jurisprudência , Suíça
18.
Int J Law Psychiatry ; 64: 150-161, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31122625

RESUMO

BACKGROUND: Since Belgium legalised euthanasia, the number of performed euthanasia cases for psychological suffering in psychiatric patients has significantly increased, as well as the number of media reports on controversial cases. This has prompted several healthcare organisations and committees to develop policies on the management of these requests. METHOD: Five recent initiatives that offer guidance on euthanasia requests by psychiatric patients in Flanders were analysed: the protocol of Ghent University Hospital and advisory texts of the Flemish Federation of Psychiatry, the Brothers of Charity, the Belgian Advisory Committee on Bioethics, and Zorgnet-Icuro. These were examined via critical point-by-point reflection, focusing on all legal due care criteria in order to identify: 1) proposed measures to operationalise the evaluation of the legal criteria; 2) suggestions of additional safeguards going beyond these criteria; and 3) remaining fields of tension. RESULTS: The initiatives are well in keeping with the legal requirements but are often more stringent. Additional safeguards that are formulated include the need for at least two positive advices from at least two psychiatrists; an a priori evaluation system; and a two-track approach, focusing simultaneously on the assessment of the patient's euthanasia request and on that person's continuing treatment. Although the initiatives are similar in intent, some differences in approach were found, reflecting different ethical stances towards euthanasia and an emphasis on practical clinical assessment versus broad ethical reflection. CONCLUSIONS: All initiatives offer useful guidance for the management of euthanasia requests by psychiatric patients. By providing information on, and proper operationalisations of, the legal due care criteria, these initiatives are important instruments to prevent potential abuses. Apart from the additional safeguards suggested, the importance of a decision-making policy that includes many actors (e.g. the patient's relatives and other care providers) and of good aftercare for the bereaved are rightly stressed. Shortcomings of the initiatives relate to the aftercare of patients whose euthanasia request is rejected, and to uncertainty regarding the way in which attending physicians should manage negative or conflicting advices, or patients' suicide threats in case of refusal. Given the scarcity of data on how thoroughly and uniformly requests are handled in practice, it is unclear to what extent the recommendations made in these guidelines are currently being implemented.


Assuntos
Tomada de Decisões/ética , Eutanásia Ativa Voluntária/legislação & jurisprudência , Transtornos Mentais/psicologia , Fatores Etários , Bélgica , Eutanásia Ativa Voluntária/ética , Eutanásia Ativa Voluntária/psicologia , Família , Humanos , Competência Mental/legislação & jurisprudência , Transtornos Mentais/diagnóstico , Médicos/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Estresse Psicológico/diagnóstico , Estresse Psicológico/psicologia
19.
J Law Health ; 32(1): 110-134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31087832

RESUMO

On May 31, 2017, Ohio Attorney General Mike DeWine took a step in fighting Ohio's opioid epidemic, bringing the first of many lawsuits against five top pharmaceutical companies. However, under Federal and State law, there is an exception called the Learned Intermediary Doctrine, which can absolve drug manufacturers of liability from any misconduct that might be found and transfer that liability to a treating physician. This exception is the way many drug manufacturers were able to avoid being held responsible in the past. This Note proposes that with the current pending lawsuit in the State of Ohio, an exception to the Learned Intermediary Doctrine should be introduced. This Note begins with a discussion of opioids and how these drugs have become such an aggressive problem in a very short amount of time in Ohio. Part II talks about the role the government can play and the drug manufacturers have played and continue to play in the availability of opioids. It discusses the effect these pharmaceutical companies have had on this problem and in increasing this problem. Part II also discusses why this is a problem and why this problem matters. Further, it talks about the steps that have already been taken by the Ohio Legislature to combat the opioid problems. Finally, it delves into a discussion of what this current lawsuit means for fighting and decreasing the opioid problem and how it will directly affect the heroin epidemic in Ohio.


Assuntos
Responsabilidade Legal , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Indústria Farmacêutica/legislação & jurisprudência , Heroína/administração & dosagem , Humanos , Legislação como Assunto , Ohio/epidemiologia , Médicos/legislação & jurisprudência , Formulação de Políticas , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência
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