Subject(s)
Cardiac Surgical Procedures/economics , Centers for Medicare and Medicaid Services, U.S./economics , Fee Schedules/economics , Insurance, Health, Reimbursement/economics , International Classification of Diseases/economics , Medicare/economics , Postoperative Care/economics , Surgeons/economics , Budgets , Cardiac Surgical Procedures/legislation & jurisprudence , Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Fee Schedules/legislation & jurisprudence , Health Care Reform/economics , Health Expenditures , Hospital Charges , Hospital Costs , Humans , Insurance, Health, Reimbursement/legislation & jurisprudence , Medicare/legislation & jurisprudence , Policy Making , Postoperative Care/legislation & jurisprudence , Relative Value Scales , Surgeons/legislation & jurisprudence , United StatesABSTRACT
Women who experience complications from abortion, whether unlawful or lawful, induced or spontaneous, need immediate post-abortion care. Delay in providing care might cause women's avoidable disability, lost childbearing capacity, or death. Rendering care is not an abortion procedure nor illegal, and does not justify conscientious objection. Harm reduction strategies to reduce effects of unsafe abortion may legitimately inform women who might consider resort to abortifacient interventions of their rights to professional post-abortion care. Healthcare practitioners' refusal or failure to provide available care might constitute ethical misconduct and attract legal liability, for instance for negligence. States are responsible to ensure healthcare practitioners' and facilities' provision of post-abortion care, including both medical care and psychological support, delivered with compassion and respect for dignity, and to suppress stigmatization of patients and/or caregivers. Mandatory reporting of patients suspected of criminal abortion violates professional confidentiality. States' failures of indicated care might constitute human rights violations.
Subject(s)
Abortion, Induced/adverse effects , Postoperative Care , Abortion, Induced/ethics , Abortion, Induced/legislation & jurisprudence , Female , Humans , Postoperative Care/ethics , Postoperative Care/legislation & jurisprudence , Pregnancy , Refusal to Treat/ethics , Refusal to Treat/legislation & jurisprudence , Reproductive Health/ethics , Reproductive Health/standards , Women's HealthABSTRACT
Concerns still exist regarding the role of early routine upper gastrointestinal contrast study (UGI) after bariatric procedures for detection of early complications. We reviewed our database to identify patients who underwent laparoscopic primary or redo surgery (previously placement of adjustable gastric banding), between January 2012 and December 2017. All the patients underwent UGI within 48 h after surgery. Among 1094 patients, early UGI was abnormal in 5 patients: in 4 cases a leak (one false positive) and in one case stenosis (one true positive) were suspected. In this clinical setting, five leaks were observed and required surgical re-exploration: 3 correctly identified and 2 not detected at UGI. Overall, 3 patients developed anastomotic stenosis. Our data suggest that early routine UGI after bariatric procedures has limited utility.
Subject(s)
Bariatric Surgery , Diagnostic Techniques, Digestive System , Obesity, Morbid/surgery , Postoperative Care/methods , Postoperative Complications/diagnosis , Upper Gastrointestinal Tract/diagnostic imaging , Adult , Aged , Bariatric Surgery/rehabilitation , Constriction, Pathologic/diagnosis , Constriction, Pathologic/surgery , Contrast Media/therapeutic use , Diagnostic Tests, Routine , Early Diagnosis , Female , Humans , Jurisprudence , Laparoscopy/methods , Laparoscopy/rehabilitation , Male , Medical Futility/legislation & jurisprudence , Middle Aged , Obesity, Morbid/diagnosis , Postoperative Care/legislation & jurisprudence , Predictive Value of Tests , Retrospective Studies , Treatment Outcome , Upper Gastrointestinal Tract/surgery , Young AdultABSTRACT
BACKGROUND AND AIM: The feared prospect of involvement in malpractice litigation ultimately becomes a reality for many physicians in high-risk specialties such as cardiothoracic surgery. This study systematically analyzes malpractice claims by procedure type and alleged injury mechanism. METHODS: An extensive nation-wide database of medical malpractice claims was searched, and 140 involving cardiac procedures were identified. The primary reason for the lawsuit was classified as a periprocedural injury, postoperative mismanagement, failure to operate in a timely manner or at all, performing an unnecessary procedure, performing a procedure too soon, lack of informed consent, or patient abandonment. RESULTS: Cardiac surgeons were defendants in 47.8% of cases and cardiologists in 56.4%. Forty percent of cases involved coronary artery bypass grafting, valvular surgery, or both; 50% of these received defendant verdicts. The most common reason for the lawsuit was periprocedural injury, most frequently due to poor prosthetic valve fit/securement (23.1%) or surgical site infection (15.4%). For congenital cases, most lawsuits alleged periprocedural injury, with perfusion-related issues (cooling during circulatory arrest, failure to inform surgeon about poor oxygenation) cited in 37.5%. Cardiologists and cardiothoracic or vascular surgeons were codefendants in 14.3% of cases, most commonly coronary artery bypass grafting (40%) or cardiac catheterizations (25%). In all catheterization cases, the allegation against the surgeon was a failure to diagnose/treat the complication in a proper or timely manner. In postoperative mismanagement cases, bleeding/tamponade was the most common allegation category (31.8%). CONCLUSIONS: A careful review of cardiac surgical malpractice litigation can identify common contributory factors to adverse patient outcomes and catalyze practice improvement.
Subject(s)
Cardiac Surgical Procedures/legislation & jurisprudence , Jurisprudence , Malpractice/legislation & jurisprudence , Malpractice/statistics & numerical data , Surgeons/legislation & jurisprudence , Aged , Cardiac Catheterization , Coronary Artery Bypass/legislation & jurisprudence , Female , Heart Valves/surgery , Humans , Male , Middle Aged , Postoperative Care/legislation & jurisprudence , Postoperative HemorrhageABSTRACT
Thyroid surgery has the potential for significant life-changing postoperative complications. Since 1995, the NHS Litigation Authority has handled litigation claims in England. This article reviews all thyroid surgery litigation claims between 1995 and 2012 and looks at potential strategies to minimize future claims.
Subject(s)
Iatrogenic Disease , Malpractice/legislation & jurisprudence , Postoperative Complications , Thyroidectomy/legislation & jurisprudence , Burns , Delayed Diagnosis/legislation & jurisprudence , Diagnostic Errors/legislation & jurisprudence , England , Humans , Informed Consent/legislation & jurisprudence , Intraoperative Awareness , Jurisprudence , Liability, Legal , Postoperative Care/legislation & jurisprudence , Recurrent Laryngeal Nerve Injuries , Retrospective Studies , State MedicineSubject(s)
Ambulatory Surgical Procedures/legislation & jurisprudence , Cooperative Behavior , General Practice/legislation & jurisprudence , Interdisciplinary Communication , Preoperative Care/legislation & jurisprudence , Reimbursement Mechanisms/legislation & jurisprudence , Germany , Humans , Postoperative Care/legislation & jurisprudenceABSTRACT
Cases of death related to simple routine outpatient surgery are repeatedly reported. Minimum standards of staff and medical equipment for postoperative surveillance are deliberately ignored for economic reasons. Using two case studies this article identifies classical types of medical malpractice and organizational fault. Recommendations for criminal investigation in this type of cases are outlined for the competent authorities.
Subject(s)
Ambulatory Surgical Procedures/legislation & jurisprudence , Brain Death/diagnosis , Death, Sudden/etiology , Malpractice/legislation & jurisprudence , Postoperative Complications/etiology , Recovery Room/legislation & jurisprudence , Anesthesia, General , Brain/pathology , Brain Death/pathology , Child , Compensation and Redress/legislation & jurisprudence , Death, Sudden/pathology , Female , Germany , Humans , Hypoxia, Brain/etiology , Hypoxia, Brain/pathology , Male , Nasal Obstruction/surgery , Postoperative Care/legislation & jurisprudence , Postoperative Complications/pathology , Tooth ExtractionABSTRACT
In 2001, the German Protection against Infection Act came into force, implementing a variety of new regulations. For the first time, obligatory infection control visits of the public health departments in surgical ambulatory practices were implemented, as well as optional infection control visits in all medical, dental and paramedical practices using invasive methods. Based on the data of the public health department of the city of Frankfurt am Main, Germany, an evaluation of this new regulation is given in this paper. First, prioritization of these new tasks was mandatory. First priority was given to the obligatory visits in surgical practices, second priority to the hygiene visits in practices performing endoscopy in gastroenterology as well as in urology and in practices of traditional healers, and third priority was given to all other doctors' practices. After receiving preliminary information and further training of the doctors etc., the control visits were performed by members of the public health department, using a checklist based on the guidelines of the German Commission on Hospital Infection Prevention ("Kommission für Krankenhaushygiene und Infektionsprävention"). Since 2001, more than 1100 infection control visits in medical practices in Frankfurt am Main were documented. Not only in surgical, but also in gastroenterological and urological practices great improvement could be achieved, regarding not only hand hygiene and reprocessing surface areas, but especially in reprocessing medical devices. In practices for internal medicine and those of general practitioners, errors in hand hygiene, skin antiseptic and surface disinfection also decreased. According to our results, especially regarding the improved quality of structure as well as quality of process and with regard to the public discussion on this hygiene topic, our evaluation is absolutely positive. The new regulation proved worthwhile.
Subject(s)
Ambulatory Care/legislation & jurisprudence , Ambulatory Care/statistics & numerical data , House Calls/statistics & numerical data , Infection Control/legislation & jurisprudence , Infection Control/statistics & numerical data , Surgical Wound Infection/epidemiology , Surgical Wound Infection/prevention & control , Female , Germany/epidemiology , Humans , Incidence , Male , Postoperative Care/legislation & jurisprudence , Postoperative Care/statistics & numerical data , Program Evaluation , Risk Factors , Treatment OutcomeSubject(s)
Ambulatory Care/economics , Ambulatory Care/legislation & jurisprudence , Contract Services/economics , Contract Services/legislation & jurisprudence , Cooperative Behavior , Interdisciplinary Communication , National Health Programs/economics , National Health Programs/legislation & jurisprudence , Patient Care Team/economics , Patient Care Team/legislation & jurisprudence , Postoperative Care/legislation & jurisprudence , Reimbursement Mechanisms/economics , Reimbursement Mechanisms/legislation & jurisprudence , Dissent and Disputes/economics , Dissent and Disputes/legislation & jurisprudence , Fraud/economics , Fraud/legislation & jurisprudence , Germany , Humans , Negotiating , Postoperative Care/economicsABSTRACT
Bariatric and metabolic surgery is experiencing a noteworthy increase worldwide in recent years, but protocols and consensus published in the past decade have not yet established clear evidence-based clinical recommendations. The Endocrine Society, with the participation of the European Society of Endocrinology, has promoted the creation of an expert panel to propose a clinical practice guideline for postoperative management of patients, candidates to bariatric surgery, that places a particular emphasis on evidence-based medical aspects. The main arguments reflected in those recommendations are set out in this article and are subject to analysis and discussion from the specific viewpoint of the current European experience.