The Present Legal Status Regarding the Utilization of Mechanical or Pharmacological Restraints in Psychiatric and Social-Health Settings.

No abstract present.

Clinical Safety Recommendations for Testicular Torsion: Analysis of 101 Claims Settled with Compensation in Spain and France.

INTRODUCTION: The study aimed to analyze testicular torsion (TT) claims settled with compensation to have data available as the basis for making recommendations to decrease clinical risk and prevent claims. TT is a urological emergency with a high rate of orchiectomy, representing one of the main reasons for urological claims. METHODS: Data were analyzed from personal majority policy and from the public sector of Catalonia (Spain), as well as data from the main medical civil liability insurance firm at healthcare centers in France in the period from January 1, 2000 to December 31, 2018. RESULTS: Fifty Spanish and 51 French cases were analyzed. Statistical differences were logged in the two settings analyzed in performing ultrasounds, in the area where primary care was provided and with regard to settlement amounts. Diagnosis was late in 76.2% of cases. DISCUSSION: The medical action time from the onset of symptoms and Doppler testicular ultrasound in cases of questionable differential diagnoses is key to prognoses to save the testicles. Properly filling out the emergency report and the rest of medical records are essential for receiving correct medical care and defending possible claims.

Paediatricians' Practice About SUDDEN Infant Death Syndrome in Catalonia, Spain.

Background SIDS is the major cause of death among healthy born infants in developed countries. Its causes are still unclear, but its risk can be reduced by implementing some simple active interventions. In Spain, limited attention was given to SIDS by the national healthcare system, and actual data on healthcare professionals' practice on this topic was not available. This study explored for the first time paediatricians' knowledge and practice about SIDS. Methods A cross-sectional survey was carried out between November 2012 and April 2013 in Catalonia, and reached 1202 paediatricians. The response rate was 46%. Results 94% of respondents perceived themselves as qualified for giving advice and recommendations about SIDS to parents, but only 58% recognized the supine position as the safest position and recommended the supine position exclusively to parents. Seniority and 'having received a specific training about SIDS' were detrimental to paediatricians' knowledge. Discussion Efforts should be made in order to improve paediatricians' knowledge and practice about SIDS. Specific refresher trainings are highly recommended, and should especially target paediatricians with higher seniority. These trainings could be provided as optional modules, as we could see that the paediatricians who would most benefit from them are already aware of the need to refresh their knowledge.

Medical Professional Liability in Psychiatry.

INTRODUCTION: The safety of patients and the risk of malpractice claims are overriding concerns in medicine and psychiatry. MATERIAL AND METHODS: Claims for alleged malpractice in psychiatry managed by the Council of Colleges of Physicians of Catalonia between 1986 and 2009 were analyzed to evaluate their clinical and legal characteristics. RESULTS: Ninety-four malpractice claims were found in a 23-year period, mainly claims related to diagnosis (63.83%, including assessment of suicide risk) and the legal figure of serious professional negligence resulting in death (46.8%). Most claims were for hospital (62.77%), emergency (52.5%), and team (53.75%) care. The possible affected party was male (51.58%) with a mean age of 36.6 years. In one-half of the cases, the harm claimed was death. The cases involved 139 specialists, predominantly male (69.57%), with a mean age of 41 years, and of Spanish nationality (91.4%). The time between the medical act and the respective claim was 1.28 years and the time to resolution was 2.68 years. Most of the cases (77.66%) were processed through the courts. The outcome of the cases was filing or dismissal in 91 (95.77%), conviction in 2 (2.81%), and settlement in 1 (1.41%). CONCLUSIONS: The cumulative incidence of 0.013 claims (1.35%) in 23 years suggests that there is a very low risk of lawsuits in psychiatry, with a similarly low rate of sentences of professional liability and awards for financial compensation. Specific actions could improve clinical safety, particularly in suicide risk assessment.

Professional liability claims in vascular surgery practice.

BACKGROUND: Patient safety is a major concern worldwide, but particularly high rates of adverse events are reported in the surgery setting. Angiology and vascular surgery is of special interest due to the complexity of the pathologies involved and the esthetic component of some of its procedures. In this study we identified the most frequent factors that apply to vascular surgery claims to determine areas of special risk in vascular surgery, with an aim to improve patient safety. METHODS: We performed a retrospective and descriptive study of the claims pertaining to vascular surgery from the database of the Service of Professional Liability (SRP) of the Official College of Physicians of Barcelona. The time frame of data collection was from 1986 to 2009. We analyzed both the clinical and legal characteristics of the cases. RESULTS: Of the total of 6952 registered claims during the 23-year period, 91 (1.3%) were related to the practice of vascular surgery. Of these, 53.8% were related to venous pathology and 46.1% to arterial pathology. Neurologic damage was the main motive for claims (15.3%), followed by thromboembolic disease (14.2%), burns as a result of cosmetic treatment (12%), and amputation (10.9%). The neurologic damage in relation to vein pathology registered the greatest proportion of cases with professional liability (30.8%), followed by burns (19.2%), forgotten gauze (11.5%), and amputations (11.5%). CONCLUSIONS: Angiology and vascular surgery does not seem to be a specialty with a high risk for claims, but complications, such as thromboembolic disease and neurologic damage after varicose vein intervention, do occur and deserve special attention so improvements can be made to patient safety.

Physical restraints in nursing homes: A qualitative study with multiple stakeholders.

AIM: This study aims to understand the perceptions regarding physical restraints of the elder-care professional's stakeholders. DESIGN: A qualitative methodology was employed. METHODS: Semi-structured interviews were conducted with a convenient sample of 19 participants, which included nursing homes' managers, nurses and physicians; law, ethics, quality or patient rights' protection experts in care and public servers with responsibilities in the field. The data were collected, recorded and verbatim transcribed. A thematic analysis approach was used to analyse the data. RESULTS: Three main themes emerged: the use of restraints, organizational issues and regulation. Although professionals involved in nursing care agree that improvements have been made, they highlight the negative impact of restraints and the need for a change in culture about their use. Yet, they have concerns about the 'zero restraints' feasibility, with divergent views on the need for a stronger regulatory framework.

Professional Liability in Plastic Surgery: A Change of Scenario in Medical Professional Liability in Spain.

The epidemic of complaints and/or litigation, both in and out of court, for cases of alleged malpractice has increased dramatically. In Spain, claims related to plastic surgery are gaining more and more interest. Methods: The Council of Medical Associations of Catalonia database was used to analyze claims related to plastic surgery from 1986 to 2021. Results: 1039 claims (9.8% over 10,567 total claims) were studied. Both the total number of claims (P = 0.016; R2=0.16) and the number of claims for plastic surgery (P < 0.0005; R2=0.732) showed an upward trend during the period of study. In the period from 2000 to 2021, the behavior was different; while the number of total claims stabilized (P = 0.352; R2 = 0.043), plastic surgery claims continued to show a time-related tendency to increase (P < 0.0005; R2=0.484). The distribution was 50.12% out of court. Ten unique procedures accounted for 84.5% of the total number of claims. Liability was observed in 21.46% of the closed claims, with differences between civil (20.34%), criminal (6.89%), and out-of-court (25.53%) procedures. Regarding compensation amounts, out-of-court cases had an average of 33,169.44 euros paid; civil cases, 29,153.37 euros; and criminal cases, 37,186.88 euros. Conclusions: The increase in the number of cases can only be related to an increase in the activity carried out by plastic surgeons. There has been a change in Spain in terms of the most sought-after medical specialty, with plastic surgery having displaced the perennially most sought-after specialty, orthopedic surgery and traumatology.

The Impact of Malpractice Claims on Physicians' Well-Being and Practice.

OBJECTIVES: Malpractice litigation causes extreme stress. We examine the psychological impact of malpractice claims on physicians' well-being and the consequences on patient care. METHODS: A confidential telephone survey, administered to physicians with both open and closed claims from the previous year, explored symptoms, well-being changes, needs, impairments, and practice changes. RESULTS: Of the 282 respondents, more than half (56.38%) reported a notable psychological reaction to the malpractice claim, with no differences between the open and closed claims (P = 0.2477) or between closed claims with and without a payout (P = 1). Physicians facing criminal proceedings were more likely to experience a notable psychological impact (P = 0.0206). Almost half of the respondents (45.39%) acknowledged practice changes: viewing patients as potential plaintiffs (45.39%), paying more attention to recordkeeping (42.19%), obtaining medicolegal training (37.94%), ordering more tests (36.17%), and avoiding specific kinds of patients (21.63%) or procedures (19.85%). Acknowledging a psychological impact was positively and significantly associated with professional practice changes (P < 0.0001), and the mean number of symptoms was significantly higher among those who acknowledged practice changes (P = 0.0001). CONCLUSIONS: Our results confirm the psychological impact of a malpractice claim and that impacted physicians are more likely to change their care practices, involving defensive medicine practices. Therefore, care for physicians facing malpractice claims needs to be considered under the umbrella of health care quality. Timely mental health referral paths could help mitigate the psychological impact and avoid the pernicious effects of negative practice changes.

[Medico-legal aspects and professional liability of telemedicine in urology.] / Aspectos médico-legales y responsabilidad profesional médica de la telemedicina en urología.

Recientemente, Carrión et al. (1) publicaban un acertado análisis sobre el uso de la telemedicina (TM) en urología en el contexto de la pandemia por COVID-19. El escenario de emergencia durante la pandemia debida al SARS-CoV-2 ha propiciado un uso exponencial de la TM que ha permitido mantener el acceso y la continuidad de la atención a los pacientes y apoyar a los profesionales de primera línea, optimizando los servicios presenciales y minimizando las infecciones por transmisión del COVID-19 (2).

Recientemente, Carrión et al. (1) publicaban un acertado análisis sobre el uso de la telemedicina (TM) en urología en el contexto de la pandemia por COVID-19. El escenario de emergencia durante la pandemia debida al SARS-CoV-2 ha propiciado un uso exponencial de la TM que ha permitido mantener el acceso y la continuidad de la atención a los pacientes y apoyar a los profesionales de primera línea, optimizando los servicios presenciales y minimizando las infecciones por transmisión del COVID-19 (2).

Twenty four years of oral and maxillofacial surgery malpractice claims in Spain: patient safety lessons to learn.

PURPOSE: Oral and maxillofacial surgery (OMS) malpractice risk is of special interest due to both the aesthetic component of some procedures and the complexity of the pathologies involved. This study aims to identify relevant factors involved in OMS professional liability (PL) claims to help achive better management of risks and improve patient safety. METHODS: We performed a retrospective analysis of 315 OMS claims opened between 1990 and 2014 from the database of the PL Department of the Catalonian Council of Medical Colleges, and identified their clinical, economical and juridical characteristics. RESULTS: OMS showed a high rate of compensation (33.8%). Dental implant surgery, third molar surgery and rhinoplasty presented the greatest exposure to claims, and in these cases, lack of osteointegration of dental implants, neurologic injury of inferior dentoalveolar/lingual nerves and a poor aesthetic result were the most frequently compensated sequelae. Statistically, significant association was found between this perioperative complications group and the presence of PL. Poorly documented patient information (informed consent document) was also significantly related with PL outcome. CONCLUSIONS: OMS is a specialty of medium risk for claims, especially oral surgery cases. Surgical complications, such as neurologic damage after oral/head and neck procedures and poor aesthetic results, do occur and deserve special attention to improve patient safety, as well as patient-information procedure.

Clinical judicial syndrome: The impact of judicial proceedings on physician. / El síndrome clínico judicial: el impacto de los procedimientos judiciales en los médicos.

Complaints of alleged malpractice are a concern for doctors, however the impact these complaints have on them receives little attention. We present a systematic review of the scientific literature by searching the MEDLINE database, without no time limit, of manuscripts on doctors' reaction to a malpractice claim, carried out in Spanish, English and French. Their methodological quality was evaluated, and the results were analysed. The search identified a total of 18 articles, mostly without empirical sample analysis, which described the clinical judicial syndrome construct, its symptomatology, prevalence, etiopathogenesis and issues of prevention and approach. The literature on this subject is very scarce and has poor empirical foundation. However, the available data underscored the relevance of the impact that these complaints have on doctors and highlight the need to establish preventive measures and approaches to the so-called clinical judicial syndrome.