Descriptive Analysis of Epidemiological Profile from Authors of Civil Claims Due to Supposed Medical Malpractice Against Neurosurgeons in Brazil

Introduction The neurosurgical practice often involves situations that require rapid and immediate decisionmaking, and a very lowmargin for error may eventually lead to an unsatisfactory clinical outcome. Thus, neurosurgery is considered as a medical specialty with high risk for the occurrence of litigation for supposed malpractice. The main objective of the present study was to identify the most prevalent epidemiological profile of the authors of civil claims for alleged malpractice against neurosurgeons, as well as to identify the legal strategies most commonly employed in this type of lawsuit. Methods This is a descriptive, retrospective and quantitative study, with review of the initials/exordials of all civil actions motivated by alleged malpractice against neurosurgeons, defended by an office specialized in Medical Law, from 2008 to 2018. Data were collected relative to the author of the action; the disease that led to the outbreak of the action; and some legal information of interest for the outcome of the litigation. Results During the period studied, 16 compensation/eviction claims were identified as being motivated by supposed neurosurgical malpractice. The average age of the authors was 51 years old; with a high school or undergraduate level of education in 75% of the cases, and especially from the Class B social extract (43%). Degenerative affections of the lumbar spine (12 cases, 75%) were the most common diseases that motivated the litigation, followed by brain tumors (2 cases, 12.5%), 1 case of carpal tunnel syndrome, and 1 case of chronic pain due to inflammatory radiculitis. The average value of the sponsored claim was 649,000.00 reais. Justice gratuity was granted in 80% of the cases and the reversal of the burden of proof by 30%. The main documentary evidence was medical reports ­ from third parties or the surgeon him/herself, and medical records.

Avaliação de sentenças e jurisprudências relacionadas a ações judiciais envolvendo cirurgias plásticas estéticas / Evaluating judgments and decisions related to lawsuits involving aesthetic plastic surgery

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

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

Professional Practice and Neurosurgery: What Every Neurosurgeon Should Know about Malpractice

Introduction The objective of the present study was to review the epidemiological aspects of malpractice in neurosurgery and to identify preventive measures regarding malpractice for neurosurgeons. Methods The following terms (alone or in combination) were searched in the PubMed and Biblioteca Virtual em Saúde databases: neurosurgery (neurocirurgia), lawsuits (ações judiciais), malpractice (erro médico), and litigation (litígio) and identifying studies on these topics published from 2000 to April 2018. Literature Review In Brazil, 6.9% of the physicians are sued per year. The most common type of malpractice alleged in litigation is negligence. According to the literature, the neurosurgical disease that has sparked the most litigation is spinal disease. The outcomes of these cases vary: sometimes the neurosurgeon prevails, and at other times the plaintiff prevails. To prevent or reduce malpractice claims, the neurosurgeon should take the following precautions: 1. follow medical protocols; 2. perform surgeries in an environment consistent with good medical practice; 3. evaluate and monitor antibiotic prophylaxis; 4. develop a good relationship with the patient based on ethics, good faith and transparency; 5. request the presence of the patient and of his or her family when there is a problem in order to didactically explain the case; 6. keep good medical records to document all of the actions performed (informed consent and description of the surgery and of the pre and postoperative); 7. always seek technical improvement (continuing education/professional development); 8. in the case of attending physicians, monitor patients, treating any postoperative complications; and 9. conduct multidisciplinary team meetings to optimize treatment decisions and to share responsibility for making difficult decisions.

Criminal liability of medical professionals in the São Paulo State Court of Appeals / Responsabilização penal do médico no Tribunal de Justiça do Estado de São Paulo

ABSTRACT Objective To collect criminal justice data involving medical professionals in the São Paulo State Court of Appeals and to establish the number of criminal proceedings involving said professionals, the content of the accusations and the conviction rate per specialty. Methods A keyword search was carried out in the State Appellate Court case law website with the term "medical error" for decisions rendered from January 1st, 2011 to December 31st, 2016, and the subject "criminal law" was selected. Results A total of 34 cases met the inclusion criteria and were analyzed. Lower court's convictions accounted to 73.5% of the cases, with a slight tendency towards increase over the years. The number of cases per medical specialty was ten cases of clinical emergency, eight of obstetrics, seven of surgery, three of pediatrics (one case was related to pediatrics and obstetrics), two of orthopedic surgery, two of clinical director, one anesthesiologist and one nonemergency internal medicine physician. Among these cases, 6 were related to bodily injury, 26 to homicide and 2 criminal contempt. Conclusion The physicians most exposed to medical error were from surgical specialties, probably due to the higher rate of complications associated with the procedures, and emergency physicians, professionals who need greater qualification.

RESUMO Objetivo Realizar um levantamento de dados na esfera penal envolvendo médicos no Tribunal de Justiça do Estado de São Paulo e estabelecer o número de processos penais que os envolveu, verificando o teor das acusações e a frequência das condenações, levando-se em consideração as especialidades em que eles atuavam. Métodos Foi realizada pesquisa por palavra-chave na área de jurisprudência do site do Tribunal de Justiça do Estado de São Paulo com o termo "medical error" para as decisões proferidas de 1° de janeiro de 2011 até 31 de dezembro de 2016, sendo selecionado o assunto "direito penal". Resultados Foram encontrados e analisados 34 processos que corresponderam ao critério de inclusão. Houve 73,5% de condenação em primeira instância, observando-se discreta tendência de aumento no decorrer dos anos. O número de processos, de acordo com a especialidade médica, foi dez casos de emergência clínica, oito de obstetrícia, sete de cirurgia, três de pediatria (sendo que em um caso se referia a pediatria junto de obstetrícia), dois de ortopedia, dois de diretor clínico, um de anestesista e um de clínico não emergencista. Dentre estes casos, 6 se referiam à lesão corporal, 26 a homicídio e 2 a crime de desobediência. Conclusão Os médicos mais expostos a erros médicos foram os das especialidades cirúrgicas, provavelmente devido ao maior índice de complicações associadas ao procedimento, e os emergencistas, necessitando de uma maior capacitação destes profissionais.

Entendimento do Tribunal de Justiça do Pará sobre o erro médico na esfera penal / Understanding of the Court of Justice of Pará on medical error in the criminal sphere

INTRODUÇÃO: O processo por erro médico costuma ter impacto profundo tanto na vida profissional como na vida pessoal do médico. Entretanto, como a judicialização da medicina é recente, carece de estudos com análise dos fatos a partir da dupla perspectiva da Medicina e do Direito. OBJETIVO: Analisar os processos da esfera penal do Tribunal de Justiça do Pará. MÉTODOS: Foi realizada uma pesquisa por palavra-chave no site do Tribunal de Justiça do Estado do Pará (TJPA) com o termo de pesquisa: "erro médico". RESULTADOS: Foram encontrados 42 julgados jurisprudenciais. Desses, 24 foram excluídos, pois: 4 eram repetições; 19 eram crimes não cometidos por médicos e 1 por tratar de difamação. Ocorreu uma prescrição e três processos ainda não haviam sido julgados na primeira instância. Dos 14 processos julgados, houve 6 condenações e 8 absolvições. A distribuição por especialidades se deu da seguinte maneira: 8 na ginecologia-obstetrícia (GO); 4 na emergência clínica; 2 na cirurgia geral; 1 em anestesiologia/cirurgia plástica; 1 em oftalmologia; 1 em ortopedia; e 1 em radiologia. CONCLUSÃO: Os casos de acusação de supostos erros cometidos por médicos no exercício de suas especialidades ainda são raros no panorama geral do Pará. As especialidades ligadas à cirurgia e às situações de emergência, principalmente GO, foram as principais envolvidas nesse tipo de processo.

INTRODUCTION: The medical error process usually has a profound impact on both professional and personal life of the doctor.However, since the judicialization of medicine is recent, there is a need to study the facts from the dual perspective of medicine and law. OBJECTIVE: To analyze the criminal proceedings of the Pará Court of Justice. METHODS: A keyword search was performed on the website of the Court of Justice of the State of Pará (TJPA) with the search term: "medical error". RESULTS: Forty-two sentences were found. Of these, 24 were excluded because: four were repetitions; 19 were crimes not committed by doctors and one was defamation. In addition, one prescription occurred and three cases had not yet been tried at first instance.Of the 14 lawsuits judged, there were six convictions and eight acquittals. The distribution by specialties was as follows: eight cases in obstetrics/gynechology (Ob-Gyn); four in clinical emergency; two in general surgery; one in anesthesiology/plastic surgery; one in ophthalmology; one in orthopedics; and one in radiology. CONCLUSION: The cases of accusation of alleged errors committed by doctors in the exercise of their specialties are still rare in the state of Pará. Specialties related to surgery and emergency situations, especially Ob-Gyn, seem to be the main ones involved in this type of process.

Civil liability of the ophthalmologist in the São Paulo Court of Appeals / Responsabilidade civil do médico oftalmologista no Tribunal de Justiça do Estado de São Paulo

ABSTRACT Objective To conduct a data survey on the subject of medical claims involving civil liability in ophthalmology at the São Paulo Court of Appeals. Methods A case law research was carried out on the São Paulo Court of Appeals website searching for the keyword “ophthalmologist” for all years until 2016. Results Of the 65 cases found, 29 were selected. There has been an increase in the number of claims in ophthalmology, especially in surgical procedures on the anterior chamber of the eye. Most lower court judgments were for defendant. Conclusion The study suggested the need for specialists to exercise the required amount of care when treating the patients, so that they may understand the risks inherent to the procedure. Despite the increase in claims, most decisions were favorable for the physician.

RESUMO Objetivo Realizar um levantamento de dados sobre a temática dos processos envolvendo responsabilidade civil em sede da Oftalmologia no Tribunal de Justiça do Estado de São Paulo. Métodos Foi realizada uma pesquisa jurisprudencial por palavra-chave no site do Tribunal de Justiça do Estado de São Paulo com o seguinte termo de pesquisa “oftalmologista” para todos os anos até 2016. Resultados Foram encontrados 65 processos, dos quais 29 foram selecionados. Observou-se tendência ao aumento de processos na área, e predominância de processos em procedimentos oftalmológicos cirúrgicos em câmara anterior do olho. A maioria das sentenças de primeira instância foi improcedente. Conclusão O estudo aponta para a necessidade de atenção dos especialistas para com o paciente, no sentido de que ele compreenda os riscos inerentes ao procedimento. Apesar do aumento de processos, a maioria permanece favorável ao médico.

O Erro médico sob o olhar do Judiciário: uma investigação no Tribunal de Justiça do Distrito Federal e Territórios / The medical error under the eyes of the Judiciary: an investigation at the Court of Justice of Federal District and Territories / La mala praxis bajo la mirada del poder judicial: una investigación ante el Tribunal de Justicia del Distrito Federal y Territorios

Objetivo: A atividade do profissional da área médica pode suscitar em morte do paciente ou o comprometimento de sua integridade física ou de sua saúde, por conduta culposa (negligência, imperícia ou imprudência). Esses atos geram ações de responsabilidade civil levando-o a ressarcir os danos produzidos ao paciente ou ações de responsabilidade penal trazendo consequências criminais agente. Método acórdãos em segunda instância disponível no site do TJDFT no período de 2013 a 2015, utilizando os termos "erro médico" no campo disponibilizado para pesquisa resultando um total de 204 processos. Resultados: Desta analise 97% dos processos foram julgados pela justiça comum e 3% por juizados especiais; 1% tratavam de dano material, 46% sobre danos morais e 53% relacionados a danos morais e materiais; as especialidades de menor participação nos pleitos de erro médico foram endocrinologia, dermatologia, fisioterapia, pneumologia, proctologia e erros provenientes da farmácia enquanto as com maior número de processos foram gineco-obstetrícia, cirurgia geral e plástica; encontramos ações cujo o réu foi o setor privado em 51%, o setor público 44% e individual em 5% dos processos analisados; as sentenças foram improcedentes em 57%, procedentes em 22% parcialmente procedentes em 19% e extintos em 2% dos processos analisados. Conclusão: A influência jurídica dentro da prática médica vem a moldar as atitudes e as práticas de saúde nos serviços motivado pelas repercussões legais e também pelas consequências econômicas para a gestão sendo um reflexo de uma sociedade em que a afirmação de direitos e a ideia de ter sofrido uma lesão compensável é entendida como a responsabilidade de um bom profissional ou de um bom serviço de saúde. O médico não deve ser considerado o único responsável e causador do dano pois é necessário que todas as partes envolvidas estejam engajadas nas mudanças sugeridas pela Organização Mundial de Saúde e que merecem ser implementadas. Palavras-chave: Judicialização. Erro médico. Direito à Saúde. Saúde Pública.

Objective: Actions related to health professionals can end in death of the patient or impairment of his or her physical integrity and health, through misconduct (negligence, malpractice or recklessness). These actions can lead to civil liability towards compensating damages towards the patient or criminal liability actions towards criminal charges. Methods: This article performed a jurisprudential research with data collected from second instance judgments available on the TJDFT website throughout 2013 to 2015, using the terms "medical error" in the research field involving 204 cases. Results: From this analysis 97% of the cases were judged by the common justice and 3% by special courts; 1% dealt with material damage, 46% about moral damages and 53% on moral and material damages. Specialties with fewer participation in medical error lawsuits were endocrinology, dermatology, physiotherapy, pneumology, proctology and errors from the pharmacy, whereas lawsuits with most cases were gynecological-obstetrics, general and plastic surgery. We found actions whose defendant was the private sector in 51%, the public sector in 44% and individual in 5% of the analyzed cases. The sentences were dismissed in 57%, ruled in favor of the plaintiff 22% partially in favor 19% and extinguished in 2% of the lawsuits analyzed. Conclusion: The legal influence within medical practice shapes health attitudes and practices in medical services motivated by the legal repercussions and also by the economic management consequences as a reflection of a society in which rights affirmation and the idea of undergoing an indemnable injury is understood as the responsibility of a good professional or a good health service. Physicians should not be considered the sole responsible of the harmful event and all parties related should be involved in the changes that deserve to be performed and were once suggested by the world health organization.

Objective: El campo de la medicina de la actividad profesional puede aumentar las tasas de muerte del paciente o el compromiso de su integridad física o su salud, por conducta culposa. Estas acciones generan acciones de responsabilidad que lo llevó a compensar el daño causado a las demandas de los pacientes o de responsabilidad penal que traen consecuencias criminales. Métodos: En este artículo se llevó a una investigación judicial de la recolección de datos de los juicios en apelación disponibles en el sitio TJDFT 2013-2015, utilizando los términos "error médico" en el campo correspondiente para la investigación que resulta en un total de 204 casos. Resultados: Este análisis el 97% de los casos fueron juzgados por los tribunales ordinarios y 3% por los tribunales especiales; 1% tratada daños materiales, el 46% de daño moral y el 53% en relación con los daños morales y materiales; las especialidades de menor participación en demandas por negligencia médica eran endocrinología, dermatología, fisioterapia, neumología, proctología y los errores de la farmacia, mientras que el mayor número de casos fueron ginecológica y obstetricia, cirugía general y plástica; encontrar acciones que el acusado era el sector privado en un 51%, el sector público 44% e individual 5% de los casos analizados; las frases fueron rechazadas por el 57%, llegando en el 22% parcialmente procedentes en un 19% y se disolvieron en 2% de los casos analizados. Conclusión: La influencia jurídica en el ejercicio de la medicina viene a dar forma a las actitudes y las prácticas de salud en los servicios motivados por las repercusiones legales y también las consecuencias económicas para la gestión como un reflejo de una sociedad en que las afirmaciones de los derechos y de la idea de haber sido objeto de una lesión compensable se entiende como la responsabilidad de un buen profesional y un buen servicio de salud. El médico no debe ser considerado el único responsable de causar el daño y es necesario que todas las partes están involucradas en los cambios que merecen ser hecho y que en sugeridos por la Organización Mundial de la Salud.

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.

Professional misconduct or criminal negligence: when does the balance tilt.

On September 13, 2013, the Supreme Court absolved Dr Praful Desai, an oncologist, of conviction on the charge of criminal medical negligence in the treatment of one of his patients. This article examines the judgment of the Supreme Court in the light of medical negligence and criminal jurisprudence.

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.

Gravidez prolongada: subsídios da literatura médica para uma defesa / Prolonged pregnancy: medical literature support for a defense

A conduta para o atendimento de gestantes com gravidez prolongada sofre variações conforme o serviço pesquisado. Trabalhos de meta-análise mostram que o atendimento ideal da gravidez com mais de 41 semanas ainda requer mais estudos, alguns mostrando vantagens na indução do trabalho de parto e outros não. Por outro lado, observa-se, cada vez mais, processos judiciais contra médicos nas áreas de Ginecologia e Obstetricia, em decorrência de negligência, imperícia e imprudência, muitas vezes de difícil caracterização, no atendimento dessas pacientes. A gestação prolongada, que ocorre, aproximadamente, em torno de 10% das gestações, pode causar acometimentos irreversíveis tanto maternos quanto fetais, aumentando a morbimortalidade de ambos, além de ser um dos motivos de denúncia de erro médico. Este trabalho teve como objetivo buscar evidências científicas na literatura que ofereçam diretrizes para o melhor atendimento dessas pacientes, na tentativa de se evitar danos maternos e fetais e ainda oferecer subsídios para uma defesa profissional, caso o médico sofra denuncia por má pratica quando do atendimento de uma gestante nessa condição

Procedures for the care of pregnant women with prolonged pregnancy can vary according to the service. Meta-analysis show that the ideal treatment of pregnancy over 41 weeks still demands more studies, some of them showing advantages in the induction of delivery and others not. On the other hand, it can be increasingly observed lawsuits against doctors in Obstetrics and Gynecology as a result of negligence, malpractice and imprudent acts - which are difficult to characterize - in the care of these patients.The prolonged gestation, which occurs roughly in around 10% of pregnancies, can cause irreversible maternal and fetal attacks, increasing morbidity and mortality of both. It is also one of the reasons for denunciation of medical error. This work had the purpose of seek evidence in the scientific literature that provide guidelines to ensure a better management of these patients, in an attempt to prevent maternal and fetal damage and give subsidies for a professional defense if the doctor is accused of malpractice in the treatment of a woman in this condition

Distocia de ombro: erro médico? Subsídios da literatura médica para uma defesa / Shoulder dystocia: medical error? Subsidies of medical literature for a defense

Cada vez mais os médicos e, principalmente, os obstetras são responsabilizados por eventos desfavoráveis ocorridos durante sua atividade profissional. Muitos advogados aproveitam esta ocorrência para denunciá-los com o intuito de ganhar causas milionárias. A distocia de ombros é um evento obstétrico incidental, imprevisível em muitos casos e que, na maioria das vezes, causa tocotraumatismo, principalmente no feto, levando muitos advogados a pedirem indenização reparatória, às vezes por toda a vida da criança afetada, o que implica um desgaste moral, profissional e patrimonial do obstetra, o qual não é o responsável por tal ocorrência. Este trabalho teve por finalidade colher dados da literatura e da medicina baseada em evidências para dar subsídios científicos para formar a defesa do profissional, que sofrer tal incidente.

Each new day, doctors and, mainly, obstetricians are responsible by occurred favorable events during its professional activity. Many lawyers try to take advantage of this occurrence, denouncing them with the intention of gaining millionaire causes. The shoulders' dystocia is an incidental and unexpected delivery event in many cases, that most of the time causes traumatic delivery, mainly fetal trauma, which leads many lawyers to ask for ensuing litigation indemnity, to the times for all the life of the child affected and that it implies in a moral consuming, professional and patrimonial of obstetrician, who is not the responsible for such occurrence. This paper has as a purpose to collect literature and medicine based on evidences data to give scientific subsidies to form the defense of the professional, who suffers such incident.

Error médico y eventos adversos / Medical errors and adverse events: new paradigms?

The literature is reviewed about the perception and attitude of physicians and patients in relation to medical errors, specially in the context of public health service. The actual tendency is to consider them as part of the medical process with a systemic approach, where monitoring and prompt recognition is important in enhancing the quality and security of the hospitalized patients. In ethics, the new paradigm is to inform medical errors. Even though legally it is not clear, there have been international advances in this topic. Some recommendations are described to confront these situations with patients and understand their reactions. In the future, more transparency is expected

Objetivo: Revisar la literatura en relación a la actitud y la percepción del equipo de salud y los pacientes en relación a error médico y eventos adversos en sistemas de salud, especialmente en el contexto hospitalario de los sistemas públicos de salud. La tendencia actual descrita en la literatura es considerar los errores como parte del proceso médico, con un enfoque sistémico, cuya vigilancia y reconocimiento es fundamental en la mejoría de la calidad y la seguridad del paciente hospitalizado. Desde la ética, el nuevo paradigma de informar errores está muy establecido pero el marco legal no es tan claro, aunque internacionalmente hay cambios al respecto. Se describen algunas recomendaciones para asumir la situación frente a los pacientes y entender sus reacciones. Se espera una mayor transparencia en la información a futuro

Role of informed consent.

These days, complete information with regard to surgery is required to be given to the patient so that the patient becomes aware of the procedure which is sought to be followed by the Surgeon. It should not be presumed that a patient may not / need not know the procedure or is incapable of understanding the medical terms and, therefore, there is no use in explaining them. There cannot be a presumption that all patients are ignorant about their anatomy or the adverse effects or benefits of surgery, and, in any case, those days are over. Hence, properly informed written consent before operation is the necessity. It is difficult for the Court to accept contention of the doctor that because the general consent is taken, he can perform the operation in the way he likes. General consent is – while operating if some difficulty or any contemplated difficulty arises, then he can adopt such further or alternative operative measures or treatment to save the life of the patient or for patient’s benefit. But, that would not give surgeon any discretion to do whatever surgeon chooses. This would also be against the medical ethics, and the purpose for which express consent is obtained. If oral consent was obtained before two days of the operation, at least some notes would have been made and that is not produced on record.