Retrospective Analysis of 291 Cases of Medical Malpractice Involving Death / 法医学杂志

Objective To study the medical malpractice cases involving death, and discuss the identification ideas and methods of medical malpractice cases. Methods A total of 291 medical malpractice cases involving death accepted and settled from January 2012 to December 2017 at the Judicial Appraisal Center of Southern Medical University were collected. Based on the age, gender, hospital level, clinical department, whether or not autopsy was performed, cause of death, cause of medical mistakes, causality and causative potency of the appraised person, statistical analysis was made. Results There were more males than females in medical malpractice cases involving death. Mostly young adults or children were involved in these cases. The number of cases involving tertiary hospitals was the highest; among the clinical departments, the internal medicine department had the largest number of cases, followed by surgery, obstetrics and gynecology, pediatrics, etc. Autopsy rate has a trend of increasing year by year. Most patients die from the natural outcomes of their disease or ineffective treatment. Most hospitals have certain medical mistakes, and have an indirect correlation with the patient's death, mainly slight factors. Conclusion Judicial appraisal of medical malpractice should follow the principle of "one-effect and multi-cause", and comprehensively consider various factors such as, the diseases and constitution of the patient, natural outcomes of the diseases, the current medical technology and the level of diagnosis and treatment of the hospital, etc.

El arbitraje médico y las quejas concluidas relacionadas con la población de menores de 15 años durante el periodo 2011-2015 / Medical arbitration and claims for malpractice related to health service users under 15 years of age during 2011-2015

Resumen: Introducción: Las quejas constituyen un indicador negativo en la calidad de la atención médica. El conocimiento de los problemas que las originan y sus consecuencias constituyen elementos fundamentales para las estrategias de mejora de la calidad. En este estudio se dan a conocer los resultados del análisis de laudos concluidos, emitidos por la Comisión Nacional de Arbitraje Médico durante el periodo 2011-2015, que corresponden a la población usuaria menor de 15 años. Métodos: Estudio transversal descriptivo. Se analizó información extraída de los laudos concluidos en los últimos 5 años en los que la población afectada tuviera menos de 15 años, independientemente del servicio involucrado. Resultados: Se detectaron 40 laudos, la mayoría involucrados con servicios de pediatría, encontrándose una distribución homogénea por edad y sexo. Los porcentajes más altos se encontraron en las edades extremas de la población estudiada: menores de 1 año (32%) y de 10 a 14 años (30%). La principal causa de la queja fueron los problemas con los auxiliares de diagnóstico (45%). Se detectó un promedio de 8.7 eventos adversos por caso, la mayoría relacionados con procedimientos. Entre los daños destacan 12 defunciones y 9 discapacidades permanentes. Se encontró evidencia de mala práctica en el 65% de los casos y hubo una sentencia condenatoria en el 60% de los laudos. Conclusiones: Se obtuvieron resultados en cuatro grandes apartados: características sociodemográficas, descripción de la atención médica, eventos adversos y sus repercusiones en los daños a la salud, y la evaluación del acto médico y conclusiones del laudo.

Abstract: Background: Claims by health services users are a negative indicator of the care quality. To know the situations that originate them, and their consequences are key issues to consider in order to design strategies to improve the quality of health services. This study analyses the cases submitted to the National Medical Arbitration Commission with a final arbitration decision during the period 2011-2015, related to health service users younger than 15 years old. Methods: Cross-sectional descriptive study. We analyzed information extracted from the reports with a final arbitration decision in the last 5 years, selecting those where the affected users were younger than 15 years old. Results: A total of 40 cases arbitral award were found, most of them involving pediatric services, with a similar number of male and female users and a similar proportion in the extreme age groups, <1 year (32%) and 10-14 years (30%). The main cause of the complaint was related to diagnostic procedures (45%). An average of 8.7 adverse events per case were identified, most of them associated with procedures. Among the damages, there were 12 deaths and 9 permanent disabilities. There was evidence of malpractice in 65% of the cases and in 60% of the cases, the sentence was condemnatory. Conclusions: This manuscript shows information in four main sections: sociodemographic characteristics, description of medical care, adverse events and their repercussions on health damages, evaluation of the medical act and conclusions of the arbitration process.

Forensic Analysis on 52 Medical Malpractice Cases of Cardiac Death / 法医学杂志

OBJECTIVES@#To synthetically analyse the medical malpractice cases of cardiac death in forensic identification, and to explore the generality and characteristic of cause of death, medical malpractice and assessment of participation degree.@*METHODS@#Totally 52 medical malpractice cases of cardiac death examined in the Xiaoshan Branch Office, Hangzhou Minghao Forensic Judical Appraisal Institute, from January 2015 to April 2018 were collected. The general information of cases, medical institutions and situations of hospital stay, cause of death, medical malpractice and assessment of participation degree were retrospectively analysed.@*RESULTS@#In 52 cases, the male to female ratio was 2.25:1, and most subjects aged >50-60. Cardiac death caused by hypertensive heart disease or coronary heart disease was most common （67.3%）, followed by viral myocarditis and cardiomyopathy （13.5%）. There were 24 cases involved surgery, and the survival time after surgery was from 1 h to 118 d with a 7 d medium value. There were 63 medical institutes involved in these medical malpractices. Medical malpractice presented in most hospitals more or less, and the participation degree was >20%-30%.@*CONCLUSIONS@#Forensic appraisal contributes to determine causes of death, which not only provides scientific evidence for medical malpractice identification, but also improves diagnosis and treatment levels of medical institutions.

Maus-tratos e discriminação na assistência ao aborto provocado: a percepção das mulheres em Teresina, Piauí, Brasil / Maltreatment and discrimination in induced abortion care: perception of women in Teresina, State of Piauí, Brazil

Resumo O tratamento das complicações do aborto provocado pode ser dificultado por atitudes de discriminação praticadas por profissionais de saúde nos hospitais e serviços de aborto. Este artigo recuperou histórias de violência institucional entre mulheres que provocaram o aborto em condições ilegais e inseguras. Foram entrevistadas 78 mulheres internadas em um hospital público de referência em Teresina por complicações do aborto provocado. Utilizou-se roteiro semiestruturado com perguntas sobre práticas e itinerários de aborto e violência institucional durante a internação. Práticas discriminatórias e de maus-tratos durante a assistência foram relatadas por 26 mulheres, principalmente entre aquelas que confessaram a indução do aborto. Julgamento moral, ameaças de denúncia à polícia, negligência no controle da dor, longa espera pela curetagem uterina e internação conjunta com puérperas foram os principais tipos de violência institucional narrados. As práticas de violência institucional na assistência ao aborto provocado violam o dever de acolhimento do serviço de saúde e impedem que as mulheres tenham suas necessidades de saúde atendidas.

Abstract Treatment of complications resulting from induced abortion may be hampered by discriminatory attitudes manifested by healthcare professionals in hospitals and abortion services. This article retrieved stories of institutional abuse directed at women who had an induced abortion in illegal and unsafe conditions. Seventy-eight women admitted to a public hospital in Teresina for complications after an induced abortion were interviewed. A semi-structured script was used with questions about practices and itineraries of abortion and institutional violence during hospitalization. Discriminatory practices and maltreatment during care were reported by 26 women, especially among those who confessed to induction of the abortion. Moral judgement, threat of filing a complaint to the police, negligence in the control of pain, long wait for uterine curettage, and hospitalization with mothers who have recently given birth were the main types of institutional violence reported by women. Cases of institutional violence in the care of induced abortion violates the duty of the healthcare service and prevents women from receiving the necessary health care.

Institutional violence and quality of service in obstetrics are associated with postpartum depression

ABSTRACT OBJECTIVE To investigate the association between institutional violence in obstetrics and postpartum depression (PP depression) and the potential effect of race, age, and educational level in this outcome. METHODS This is a cross-sectional study about the health care conditions for the maternal and child population of the Federal District, Brazil, carried out in 2011. The study has used a probabilistic sample of 432 women, whose children were aged up to three months, stratified by clusters. Indicators of institutional violence and demographic characteristics have been used in a logistic regression model to estimate the probability of occurrence of postpartum depression. RESULTS The model has identified a high prevalence of postpartum depression, being it higher among non-white women and adolescent females, besides having a strong positive association between the several indicators of obstetric violence and postpartum depression. Positive interactions on a multiplicative scale have also been observed between: violence by negligence by health care professionals and race and age; physical violence from health care professionals and age; and, verbal violence from health care professionals and race. CONCLUSIONS The indicators adopted to reflect institutional violence in obstetric care are positively associated with postpartum depression, which calls for a reflection on the need to make the health care protocols adequate to the precepts of the Brazilian humanization of childbirth care policies and changes in the obstetric care model.

Adverse events in the intensive care unit: impact on mortality and length of stay in a prospective study / Eventos adversos en una unidad de cuidados intensivos: impacto en la mortalidad y en el tiempo de internamiento en un estudio prospectivo / Eventos adversos na unidade de terapia intensiva: impacto na mortalidade e no tempo de internação em um estudo prospectivo

Abstract: This study sought to evaluate the occurrence of adverse events and their impacts on length of stay and mortality in an intensive care unit (ICU). This is a prospective study carried out in a teaching hospital in Rio de Janeiro, Brazil. The cohort included 355 patients over 18 years of age admitted to the ICU between August 1, 2011 and July 31, 2012. The process we used to identify adverse events was adapted from the method proposed by the Institute for Healthcare Improvement. We used a logistical regression to analyze the association between adverse event occurrence and death, adjusted by case severity. We confirmed 324 adverse events in 115 patients admitted over the year we followed. The incidence rate was 9.3 adverse events per 100 patients-day and adverse event occurrence impacted on an increase in length of stay (19 days) and in mortality (OR = 2.047; 95%CI: 1.172-3.570). This study highlights the serious problem of adverse events in intensive care and the risk factors associated with adverse event incidence.

Resumen: Este estudio tuvo como objetivo evaluar la ocurrencia de eventos adversos y el impacto de los mismos sobre el tiempo de permanencia y mortalidad en una unidad de cuidados intensivos (UCI). Se trata de un estudio prospectivo, desarrollado en un hospital universitario de Río de Janeiro, Brasil. La cohorte estaba formada por 355 pacientes mayores de 18 años admitidos en la UCI, durante el período del 1º agosto de 2011 al 31 de julio de 2012. El proceso de identificación de eventos adversos se basó en una adaptación del método propuesto por el Institute for Healthcare Improvement. La regresión logística fue utilizada para analizar la asociación entre la ocurrencia de evento adverso y el óbito, ajustado por la gravedad del paciente. Se confirmaron 324 eventos adversos en 115 pacientes internados a lo largo de un año de seguimiento. La tasa de incidencia fue de 9,3 eventos adversos por 100 pacientes-día y la ocurrencia de evento adverso impactó en el aumento del tiempo de internamiento (19 días) y en la mortalidad (OR = 2,047; IC95%: 1,172-3,570). Este estudio destaca el serio problema de los eventos adversos en la asistencia a la salud prestada en cuidados intensivos y los factores de riesgo asociados a la incidencia de eventos.

Resumo: Este estudo teve como objetivo avaliar a ocorrência de eventos adversos e o impacto deles sobre o tempo de permanência e a mortalidade na unidade de terapia intensiva (UTI). Trata-se de um estudo prospectivo desenvolvido em um hospital de ensino do Rio de Janeiro, Brasil. A coorte foi formada por 355 pacientes maiores de 18 anos, admitidos na UTI, no período de 1º de agosto de 2011 a 31 de julho de 2012. O processo de identificação de eventos adversos baseou-se em uma adaptação do método proposto pelo Institute for Healthcare Improvement. A regressão logística foi utilizada para analisar a associação entre a ocorrência de evento adverso e o óbito, ajustado pela gravidade do paciente. Confirmados 324 eventos adversos em 115 pacientes internados ao longo de um ano de seguimento. A taxa de incidência foi de 9,3 eventos adversos por 100 pacientes-dia, e a ocorrência de evento adverso impactou no aumento do tempo de internação (19 dias) e na mortalidade (OR = 2,047; IC95%: 1,172-3,570). Este estudo destaca o sério problema dos eventos adversos na assistência à saúde prestada na terapia intensiva e os fatores de risco associados à incidência de eventos.

Análisis de 7 años de la queja en gineco-obstetricia por la Comisión Estatal de Arbitraje Médico en Oaxaca, México / 7-year analysis of the complaint in gynecology-obstetrics by the State Commission of Medical Arbitration in Oaxaca, Mexico

ANTECEDENTES: Se realizó la revisión de 7 años del Sistema de Quejas Médicas en la Comisión Estatal de Arbitraje Médico del Estado de Oaxaca, México, entidad autónoma y calificada para dirimir el proceso de inconformidad durante el fenómeno de la atención médica. Se analizaron todas las quejas, formas de resolución y en especial se identifico la queja en gineco-obstetricia. OBJETIVO: Caracterizar la inconformidad en la queja del usuario en la especialidad de gineco-obstetricia. MÉTODO: Investigación documental, descriptiva, transversal, retrospectiva y sin implicaciones éticas, efectuada mediante el análisis de bases de datos del SAQMEDO de enero de 2008 a abril de 2015. Se seleccionaron todos los expedientes de quejas médicas de la especialidad, entre todas las presentadas. RESULTADOS: El Instituto Mexicano del Seguro Social fue la entidad más frecuente en quejas médicas seguida por la medicina privada. Por octavo año consecutivo la ginecología y obstetricia prevalece como líder en quejas de los usuarios, sumando en el actual análisis 100 de 438 quejas. El origen de las quejas resulta de la deficiencia en la otorgación del servicio institucional y privado que contabilizó el 69% de los casos. CONCLUSIONES: La falta en el proceso de la evaluación del desempeño ha sido fundamental en la repetición de la queja en gineco-obstetricia. A lo largo de 8 años se ha repetido el modelo vicioso, sin que las instituciones hagan algo a cambio. De continuar ignorando el problema de manera local conseguiremos que éste ciclo se perpetúe.

BACKGROUND: It has been made a complete analysis of 7 years in the State Commission of Medical Arbitration in Oaxaca, one of the southern states in México. This Commission is the legal entity to judge the process of malpractice. The study was aim to identify the obstetrics and gynecology complains. OBJECTIVE: Characterize the medical complain in the obstetrics and gynecology specialty. METHOD: It was conducted a documentary research, descriptive, transversal, retrospective and without ethical implications, through analysis of databases of the State Commission of Medical Arbitration of Oaxaca, corresponding to 2008 -2015 activity report; we selected records were medical complaints in the specialty of gynecology-obstetrics. RESULTS: The Mexican Institute of Social Security Services became the most demanded medical provider closely followed by the private practice. Obstetrics and gynecology was the most demanded medical specialty for 8th uninterrupted years. From 438 claims 100 accounted to this specialty. The failure to give or perform the service was the origin of the complains. CONCLUSION: Absence of risk assessment and supervision of competence in the performance of the medical process were the most forthcoming issues when malpractice were continue to identified. Eight in a row years of failure to amended these vicious process speaks for itself. Lots of hard work are to be consider as a reliability strategy.

Medical legal dispute in hospitals of different grades: a retrospective study on 206 cases / 法医学杂志

OBJECTIVE@#To analyze the characteristics of medical malpractice from different grades of hospitals and to explore forensic investigation strategies in assessing medical dispute.@*METHODS@#A total of 206 cases of medical dispute from 2009 to 2010 investigated by the Department of Forensic Medicine in Nanjing Medical University were selected and analyzed according to fault incidence, fault-prone part, and degree of causality in the treatment.@*RESULTS@#Among the 206 cases analyzed, tertiary hospitals, secondary hospitals and primary hospitals showed medium, high and low error rate, respectively. A majority of medical malpractice cases were distributed in the departments of surgery, medicine and gynecology.@*CONCLUSION@#The frequency and severity of medical malpractice in primary hospitals were high, which were gradually reduced in tertiary and secondary hospitals.

Estudio de las denuncias penales por responsabilidad profesional médica en el Instituto de Medicina Legal de Lima, Perú / Criminal claims about medical professional liability in the Instituto de Medicina Legal of Lima, Peru

Objetivos. Determinar las características de las denuncias penales por responsabilidad profesional médica, a partir de los informes periciales emitidos en la División Clínico Forense de Lima, Perú. Materiales y métodos. Se realizó un estudio transversal donde se incluyeron todos los informes periciales emitidos del 2005 al 2010, en la División Clínico Forense de Lima, Perú. Se realizó el análisis descriptivo de cada una de las variables. Resultados. El 60,3% (495/821) de las denuncias penales por responsabilidad profesional médica fueron valoradas como acuerdo a la lex artis; el 16,8% (138/821) no acuerdo a la lex artis; en 13% (107/821) de los casos no se pudo emitir conclusiones, y en 9,9% (81/821) las conclusiones del informe pericial no incluyen una valoración del acto médico. Los casos donde la lesión se atribuyó al propio proceso de la enfermedad correspondieron al 80,9% (502/620), y los que se consideraron resultado de la asistencia sanitaria al 19,0% (118/620). La distribución de la causa de la lesión según el cumplimiento de la lex artis mostró diferencias significativas. Conclusiones. En nuestro país, las denuncias por presunta responsabilidad médica se encuentran en aumento, predominantemente en las especialidades quirúrgicas, donde la probabilidad de ser considerado como un acto médico no adecuado a la lex artis es mayor. Asimismo en un porcentaje importante de casos no se llegan a emitir conclusiones valorativas sobre el acto médico.

Objectives.To determine the characteristics of the criminal complaints claining medical professional liability, based on the expert reports issued by the Forensic Examination Division of Lima, Peru. Materials and methods. A cross-sectional study was carried out, which included all the expert reports issued between 2005 and 2010 at the Forensic Examination Division of Lima, Peru. A descriptive analysis of each of the variables was performed. Results. 60.3% (495/821) of the criminal complaints for medical professional liability were valued as being in accordance with the lex artis while16.8% (138/821) were not in accordance with the lex artis. In 13% (107/821) of the cases, conclusions could not be drawn;in 9.9% (81/821) of the cases, the conclusions in the expert report did not include an valuations of the medical act.The cases in which the injury was attributed to the process of the disease itself accounted for 80.9% (502/620), and those in which in the injury was considered a result of the health care received were 19.0% (118/620). The distribution of the cause of the injury based on accordance with the lex artis showed significant differences. Conclusions. In our country, the number of claims for claimed medical liability is increasing, predominantly in relation to surgical specialties, where a medical act is more likely to be considered not in accordance with the lex artis. In addition, in a significant percentage of cases, no conclusions are drawn about the medical act.

Medical negligence in surgery: 112 cases retrospective analysis / 法医学杂志

OBJECTIVE@#To explore the general characteristics of medical negligence in surgery in order to provide the reference for forensic practices.@*METHODS@#One hundred and twelve cases of medical negligence in surgical department were retrospectively analyzed in Fada Institute of Forensic Medicine and Science from 2008 to 2010.@*RESULTS@#The common types of medical negligence cases in the surgery were improper operation procedure (28.57%), failure of consent (26.79%), and inadequate monitoring (22.32%). The results of complications included disability or functional impairment (61.61%), death (31.25%) and transient impairment with no obvious adverse reactions (7.14%). The most common roles played by the medical negligence cases were minor role (26.79%), equal role (19.64%), and slight role (14.29%).@*CONCLUSION@#Significant attention should be paid to the operation procedure, consent, and monitoring. It should be cautious to not make assessment on involvement degree of medical negligence.

Un estudio de reclamos hospitalarios: el rol de la relación médico-paciente / A study of hospital complaints and the role of the doctor-patient communication

Background: Medical practice in Chile has changed dramatically over the last few years. Patients have raised their expectations and there is a growing number of complaints, and malpractice lawsuits. The doctor-patient relationship plays a fundamental role in patient satisfaction and has also been identified as an issue in most medical lawsuits. Aim: To analyze the importance of doctor-patient communication in the complaints received in a university hospital in Chile. Material and Methods: Review ofall complaints received at the office for quality of care at a university hospital. Complaints classified in delay, manners and information categories were selected for further analysis. Results: Of a total of8931 complaints registered between 2001 and 2008, 635 (19 percent) involved a doctor. Fifty one per cent of the latter, were related to the doctor-patient relationship. Of these, 146 cases (45 percent) were further classified as "Dysfunctional delivery of Information", 74 cases (23 percent) as "Not understanding the patient/'family's perspective", 54 cases (17 percent) as "Discrediting the patient or family's views" and 49 cases (15 percent) as "Lack of communication". Conclusions: The percentage of complaints related to communication with the doctor is high, though lower than cited in other studies. The most common complaint is the dysfunctional delivery of information.

Analysis of 12 cases of fetal malformation in forensic medical malpractice / 法医学杂志

OBJECTIVE@#To explore the main reasons of medical malpractice of fetal abnormalities and to analyze the key points and the ideas in judicial appraisal.@*METHODS@#According to the related laws, regulations and clinical practice guidelines, the medical faults and the contribution degree in 12 medical malpractice cases about fetal abnormalities were analyzed.@*RESULTS@#There were medical faults in five cases. Among them, the doctors did not fulfill the duty of inform in 2 cases, did not analyze the abnormal results comprehensively in 2 cases, did not have qualified medical conditions and normative reports in 1 case. The hospitals needed to take the minor responsibility in 2 cases and slight responsibility in 2 cases.@*CONCLUSION@#The key points in the judicial appraisal are whether the doctors abide by the related laws, regulations and clinical practice guidelines in prenatal examination, screen and diagnosis, and whether the doctors realize the limitations of ultrasonic testing and fulfill the obligation of inform.

Processos judiciais em oftalmologia: análise de possíveis fatores desencadeantes / Litigation in ophthalmology: analysis of possible triggers

Objetivo: Analisar os possíveis fatores de desencadeamento de processos judiciais na área de oftalmologia. Método: Estudo retrospectivo de 70 casos de processos judiciais cíveis em oftalmologia. Foram avaliados em cada processo, a anamnese, o exame oftalmológico, os dados do paciente no momento do incidente, sexo, idade, diagnóstico inicial e diagnóstico da causa do processo, número de consultas antes e após o fato desencadeante, a realização de exames pré-operatórios mínimos de acordo com os protocolos da Cooperativa Estadual de Serviços Administrativos em Oftalmologia - COOESO, termo de consentimento informado, as folhas de descrição do procedimento, de enfermagem, de materiais e medicamentos do centro cirúrgico, do anestesista, da alta hospitalar e o valor da indenização. Resultados: Dos 70 casos analisados, com relação à acuidade visual final, 45 (64,3 por cento) apresentavam amaurose. Quanto às condições prévias ao tratamento, os diagnósticos foram: catarata 46 (65,7 por cento), ametropias 12 (17,1 por cento), trauma ocular 8 (11,4 por cento), glaucoma 3 (4,3 por cento) e descolamento de retina 1 (1,4 por cento). Com relação às principais complicações secundárias ao tratamento efetuado que deram motivação à lide, os diagnósticos foram: descolamento de retina 37 (52,8 por cento), acuidade visual insatisfatória pós cirurgia de catarata 12 (17,1 por cento), irregularidades corneanas após cirurgia refrativa 8 (11,4 por cento), endoftalmites 4 (5,7 por cento), desconforto com óculos prescritos 4 (5,7 por cento) e atrofia bulbar 4 (5,7 por cento). O número de consultas antes do início do processo foi de até duas em 67,1 por cento dos casos. Os processos decorrentes de cirurgia representaram 94,3 por cento da amostra. Termo de consentimento informado não foi utilizado em 63 por cento do total de casos cirúrgicos. Os valores de indenização pagos foram menores do que 50 mil reais em 72,7 por cento. Conclusões: Foram fatores importantes relacionados aos processos judiciais oftalmológicos: amaurose, tratamento cirúrgico, descolamento de retina, número reduzido de consultas pré-operatórias e ausência de termo de consentimento.

Purpose: To analyze the possible predisposing factors of lawsuits involving ophthalmologists. Methods: Retrospective study of 70 lawsuits involving the practice of Ophthalmology. The patient's gender, age, medical and ophthalmic history were reviewed. The eye disorder that generated the prosecution, the pre-existing ophthalmic diagnosis, the preoperative exams and the operating room data were also analyzed. The informed consent form, the outcome of the litigation and the value of compensation were recorded. Results: Blindness was reported in 45 (64.3 percent) of the 70 lawsuits and was the principal eye disorder related to litigation. The pre-existing eye diseases associated with legal claims were: cataracts in 46 (65.7 percent) lawsuits, refractive errors in 12 (17.1 percent), ocular trauma in 8 (11.4 percent), glaucoma in 3 (4.3 percent) and retinal detachment in 1 (1.4 percent) lawsuit. The major surgical complications that possibly motivated the patient to sue the ophthalmologist were retinal detachment in 37 (52.8 percent) lawsuits, poor visual acuity after cataract surgery in 12 (17.1 percent), corneal disorders following refractive surgery in 8 (11.4 percent), endophthalmitis in 4 (5.7 percent), discomfort with refractive prescriptions in 4 (5.7 percent) and ocular atrophy in 4 (5.7 percent) lawsuits. Ophthalmic surgery was involved in 94.3 percent of the 70 prosecutions analyzed. Two or less visits to the ophthalmologist preceding the surgical or refractive event leading to legal dispute were recorded in 67.1 percent of the lawsuits. A pre-surgical Informed consent form was not used in 63 percent of the 66 surgical procedures leading to litigation. 62.9 percent of the lawsuits were unfavorable to the Ophthalmologist and the amount of compensation was less than R$ 50,000 in 72.7 percent of these legal claims. Conclusions: Blindness, surgery, retinal detachment, few pre-operative ophthalmic visits and the lack of informed consent forms were possible risk factors associated with lawsuits in the field of Ophthalmology.

Epidemiologia da sífilis gestacional em Fortaleza, Ceará, Brasil: um agravo sem controle / Epidemiology of gestational syphilis in Fortaleza, Ceará State, Brazil: an uncontrolled disease

O objetivo deste estudo transversal foi conhecer o perfil epidemiológico das gestantes com VDRL reagente, em Fortaleza, Ceará, Brasil, no ano de 2008. Foi verificado o percentual das gestantes com sífilis que foram consideradas inadequadamente tratadas e os motivos da inadequação, de acordo com as normas do Ministério da Saúde. Foram entrevistadas 58 gestantes no pós-parto imediato, internadas em cinco maternidades públicas do município, e consultadas as informações do prontuário e do cartão das gestantes. Foram avaliados dados sociodemográficos, obstétricos e variáveis relacionadas ao diagnóstico e tratamento da gestante e do parceiro. Apenas três (5,2 por cento; IC95 por cento: 1,8 por cento-14,1 por cento) gestantes foram consideradas adequadamente tratadas. O principal motivo da inadequação do tratamento foi a falta ou inadequação do tratamento do parceiro (88 por cento dos casos; IC95 por cento: 76,2 por cento-94,4 por cento). Foi possível constatar a necessidade de um segundo VDRL no terceiro trimestre de gestação. Os dados evidenciaram que o atendimento recebido pela gestante não foi suficiente para garantir o controle da sífilis congênita.

This cross-sectional study investigated the epidemiological profile of pregnant women with positive VDRL in Fortaleza, Ceará State, Brazil, in 2008. The study verified the proportion of pregnant women with syphilis that was classified as treated incorrectly according to Brazilian Ministry of Health guidelines, and assessed the reasons for inadequate treatment. Fifty-eight women who had given birth at five public maternity hospitals were interviewed consecutively following delivery. Data were also recovered from medical files and pregnancy cards. Sociodemographic and obstetric data and information related to the diagnosis and treatment of syphilis in both pregnant women and their partners were analyzed. Only three (5.2 percent; 95 percentCI: 1.8 percent-14.1 percent) pregnant women had received adequate treatment. The main reason for inadequate treatment was lack of partner treatment (88 percent of cases; 95 percentCI: 76.2 percent-94.4 percent). Medical care as currently provided does not guarantee the control of gestational syphilis in this sample.

Forensic analysis of 74 tumor related medical malpractice cases / 法医学杂志

OBJECTIVE@#To analyze the causes of medical malpractice in patients with tumor, to determine the medical responsibility, and to recommend the related preventions.@*METHODS@#Seventy four medical malpractice cases, which were involved in tumor and collected from 2000 to 2009 in medicolegal expertise center of west China, were analyzed retrospectively.@*RESULTS@#The medical malpractice cases in the patients with tumor showed an increasing tendency in recent years. The main causes are missed diagnosis, misdiagnosis, improper chemotherapy and neglect of complications. The causes of medical malpractice were different in the different levels of medical services. The occurrence of medical malpractice in surgery and OB-GYN showed more frequent than the others.@*CONCLUSION@#Forensic pathology autopsy is important to resolve medical malpractice of tumor patients by finding out the cause of death and clarifying the medical responsibility. The occurrence of medical malpractice could be reduced by the clinical doctors through improving serve consciousness, obtaining the patients' trust, improving the medical treatment, following related laws and rules, fulfiling duty of medical careness.

Perfil epidemiológico general de las quejas médicas atendidas en la Comisión Nacional de Arbitraje Médico: 1996-2007 / Epidemiological general profile of complaints treated at the National Medical Arbitration Commission: 1996-2007

OBJECTIVE: To analyze medical complaints over a period of 11 years, for making recommendations for prevention and improving planning for responding. MATERIAL AND METHODS: We studied the medical complaints at the National Medical Arbitration Commission (Conamed, per its acronym in Spanish) between 1996 and 2007 using descriptive statistics to identify their general profile in relation to the variables of time, place and person. We also studied the frequency of evident medical malpractice as well as the severity of the damage it produces. RESULTS: The request for responses to medical complaints increased between 1996 and 2007 and there was less demand between July and December. Two states in the country account for 69.7 percent of the complaints and 74.0 percent are from public institutions. Fifty-eight percent come from women and the 25-34 and 65+ age groups have the highest percentage. We found in 27.0 percent of the complaints there is evidence of medical malpractice and obstetrics and gynecology have the highest percentage of complaints, physical harm and severity of injury. Complaints about treatment are nearly four times more than diagnosis. CONCLUSIONS: It is necessary to improve the quality of diagnosis and treatment and identify cost-effective measures to reduce medical malpractice and the severity of physical damage in patients.

OBJETIVO: Analizar las quejas médicas atendidas en un periodo de 11 años con el fin de formular recomendaciones para prevenirlas y mejorar la planeación para su atención. MATERIAL Y MÉTODOS: Se estudiaron las quejas de la Comisión Nacional de Arbitraje Médico (Conamed) recibidas entre 1996 y 2007 y se utilizaron medidas de estadística descriptiva para conocer su perfil general en relación con las variables de tiempo, lugar y persona. También se determinó la frecuencia de mala práctica médica evidente, así como la gravedad del daño que producen. RESULTADOS: La solicitud de atención de quejas se incrementó entre 1996 y 2007, y existió menor demanda de atención en julio y diciembre. Dos estados del país concentran 69.7 por ciento de las quejas y 74 por ciento proviene de instituciones públicas. El 58 por ciento son de mujeres y los grupos de 25 a 34, y de 65 y más años tienen el mayor porcentaje. En 27 por ciento de las quejas atendidas hay evidencia de mala práctica médica y ginecología y obstetricia presenta el mayor porcentaje de quejas, daño físico y gravedad del daño. Las quejas por tratamiento son casi cuatro veces más que las de diagnóstico. CONCLUSIONES: Es necesario mejorar la calidad del diagnóstico y el tratamiento e identificar medidas efectivas para el costo que reduzcan la mala práctica médica y la gravedad del daño físico en los pacientes.

Retrospective study on forty cases of medical legal dispute / 法医学杂志

OBJECTIVE@#To analyze the main causes of medical dispute and the main types of medical malpractice. The related problems were discussed in forensic expertise.@*METHODS@#Forty cases of medical dispute from 2006 to 2008 in our institute were analyzed retrospectively.@*RESULTS@#In 40 cases of medical dispute, city-level hospitals, county-level hospitals, town-level hospitals and private clinics were 11 (27.5%), 24 (60.0%), 2 (5.0%) and 3 (7.5%) cases respectively. The internal medicine departments, surgical departments, gynaecological and obstetric departments, pediatric departments and outpatient center were 16 (40.0%),10 (25.0%), 9 (22.5%), 2 (5.0%) and 3 (7.5%) cases, respectively. The amount of cases from city-level hospitals, county-level hospitals diagnosed by the medical experts as the medical malpractice showed less than that from town-level hospitals and private clinics.@*CONCLUSION@#The amount of cases of medical dispute from city-level and county-level hospitals were more than that of town-level hospitals. But the amount of cases diagnosed by the medical experts as medical malpractice from city-level and county-level hospitals were less than that of town-level hospital and private clinics.

Analysis of 82 forensic expertise cases on medical disputes in obstetrics and gynecology / 法医学杂志

OBJECTIVE@#To study the rules of forensic expertise on medical disputes in obstetrics and gynecology, and the characteristics of medical faults in order to provide theoretical supports for forensic expertise.@*METHODS@#Eighty two cases of forensic expertise on medical disputes in obstetrics and gynecology were respectively analyzed, which were performed in Forensic Science Center of West China from 2002 to 2008.@*RESULTS@#It has been found that cases of forensic expertise on medical disputes in obstetrics and gynecology were increasing year by year, with more dispute cases from municipal (district) and county hospitals than other hospitals. More disputes involved in childbearing and surgery cases. The main reasons of the medical faults were due to defects of medical techniques and managements.@*CONCLUSION@#The forensic expertise of medical dispute must focus on the corresponding clinical regulations and whether the doctor fulfill their obligations. Meanwhile, whether there are physician negligence, technique faults and management defects should be investigated.