Legal analysis of South Korean cosmetic filler litigations for safer medical practices.

Cosmetic filler injections have gained popularity in recent years, but the rise in complications has led to an increase in legal disputes. This study analyzes civil court rulings related to cosmetic filler injection lawsuits in South Korea from 2007 to 2023. A retrospective case analysis was performed using a systematic database search, and a mixed-methods approach was employed for data analysis. The study examined 27 cases, revealing a high rate of liability findings against medical practitioners. Skin necrosis and blindness were the most common complications, and intravascular filler injection was recognized as negligence. Violation of informed consent was found in most cases, with mean compensation awards of ￦193,019,107 KRW ($142,831 USD) for first instance cases and ￦81,845,052 KRW ($60,564 USD) for second instance cases. The findings emphasize the importance of practitioner awareness, adherence to precautionary measures, and proactive prevention and management of complications. Collaboration among stakeholders is crucial for developing strategies that prioritize patient safety and minimize legal disputes in the aesthetic medicine industry. This study provides valuable insights for enhancing medical practices and safeguarding patient well-being in the field of cosmetic filler injections.

Patients' and doctors' views and experiences of the patient safety trajectory of breast cancer care.

INTRODUCTION: Successful breast cancer outcomes can be jeopardised by adverse events. Understanding and integrating patients' and doctors' perspectives into care trajectories could improve patient safety. This study assessed their views on, and experiences of, medical error and patient safety. METHODS: A cross-sectional, quantitative 20-40 item questionnaire for patients attending Cork University Hospital Cancer Centre and breast cancer doctors in the Republic of Ireland was developed. Domains included demographics, medical error experience, patient safety opinions and concerns. RESULTS: 184 patients and 116 doctors completed the survey. Of the doctors, 41.4% felt patient safety had deteriorated over the previous five years and 54.3% felt patient safety measures were inadequate compared to 13.0% and 27.7% of patients respectively. Of the 30 patients who experienced medical errors/negligence claims, 18 reported permanent or long-term physical and emotional effects. Forty-two of 48 (87.5%) doctors who experienced medical errors/negligence claims reported emotional health impacts. Almost half of doctors involved in negligence claims considered early retirement. Forty-four patients and 154 doctors didn't experience errors but reported their patient safety concerns. Doctors were more concerned about communication and administrative errors, staffing and organisational factors compared to patients. Multiple barriers to error reporting were highlighted. CONCLUSION: This is the first study to assess patients' and doctors' patient safety views and medical error/negligence claims experiences in breast cancer care in Ireland. Experience of medical error/negligence claims had long-lasting implications for both groups. Doctors were concerned about a multitude of errors and causative factors. Failure to embed these findings is a missed opportunity to improve safety.

Balancing the scales of safety: the criminal law's impact on patient safety and error reduction.

The chance of death from medical error within the hospital setting is 33,000 times greater than dying in an aircraft crash. Despite patient safety being central to healthcare delivery across the world, medical errors and patient harm remain prevalent. This review evaluates the role of the criminal law in regulating healthcare across England and Wales, using prior legal case studies, and focussing on the offence of gross negligence manslaughter (GNM). It further examines the extent to which the law promotes patient safety and minimises fatal errors in healthcare. Medical negligence resulting in a patient's death invokes the more punitive criminal law. In the context of the legal framework in England and Wales, individuals, including medical professionals, who are found to have caused a fatality due to 'gross negligence' may potentially be subject to manslaughter charges. Healthcare delivery is complex as it involves working in high-risk environments, invariably as part of a team. When things go wrong, it is rarely the result of an individual's error but rather a systemic failure. Human factors that may contribute to GNM include organisational influences such as trust targets and pressures to deliver results, unsafe supervision, or inadequate staffing, and preconditions for unsafe acts whereby clinicians are fatigued whilst performing multiple roles simultaneously. A more just culture is warranted in response to the criminalisation of cases of healthcare malpractice, in particular those involving GNM, in which healthcare professionals would be able to learn without fear of retribution.

Antipsychotic-induced weight gain: exploring the role of psychiatrists in managing patients' physical health - challenges, current options and direction for future care.

Antipsychotics and severe mental illness (SMI) are associated with weight gain, and obesity increases the risks of cardiometabolic disease and premature death. These present management and liability issues for psychiatrists. Physical healthcare for people with SMI is poor, and this may partly be owing to training limitations and lack of proactiveness by psychiatrists. Ethically and legally, psychiatrists have a duty to avoid unnecessary harm and to maintain an acceptable standard of care. This would apply particularly to patients receiving compulsory treatment for their SMI owing to their vulnerability. Discrepancy between psychiatric and non-psychiatric approaches to pharmacological treatment creates ambiguity, and weight gain could demotivate antipsychotic adherence. This article explores how the Mental Health Act could be used to address these issues, and the ethical considerations, and proposes how long-acting glucagon-like peptide-1 receptor agonists could be introduced into existing psychiatric practice as a treatment option for antipsychotic-induced weight gain and obesity in SMI.

The role of the right to life in respect of deaths caused by negligence in the healthcare context.

This article investigates the question of whether a death caused by negligence in the healthcare context is capable of violating the right to life under Article 2 of the European Convention on Human Rights. This provision imposes extensive positive obligations upon Contracting States, including an operational duty to take reasonable steps to save a life that they know, or ought to know, is at risk. This article addresses the question of exactly when such an operational duty arises, with particular focus on the healthcare context in which deaths caused by medical negligence have not traditionally been regarded as amounting to violations of the right to life. This article argues that two key factors in determining the existence of an operational duty to save life are the assumption of responsibility and nature of risk. It also argues for the need to take surrounding circumstances into account and for an increased use of the right to life in holding public bodies to account for deaths caused by negligence in the healthcare context.

Complications in Neurosurgery: General Ethical Principles for Minimizing Them and Subsequent Legal Action.

Medicine and surgery carry inherent risks of inadvertent and unintended harm to the patient. Training, experience, and skill help ensure smooth recovery in most cases. However, there are circumstances beyond the control of the neurosurgeon that may predispose to complications. This review discusses steps that may help to diminish risks to the patient and can be taken before their admission to hospital, in the operating theater, and after surgery. When a complication does occur despite all care, it is essential to maintain total transparency with the patient and his or her family. It is important that they are active witnesses to the care and treatment being lavished on the individual to minimize the harm from the mishap. Should legal action follow despite such efforts, the neurosurgeon must be prepared to defend with the help of a wise, experienced lawyer and to provide evidence of his or her professional competence and the appropriateness of care offered to the patient. In any case, it is counterproductive to view every patient as a potential legal threat or indulge in defensive medical practice.

The conundrums of the reasonable patient standard in English medical law.

BACKGROUND: In its 2015 decision in Montgomery v. Lanarkshire Health Board, the Supreme Court of the United Kingdom overruled the long-standing, paternalistic prudent doctor standard of care in favour of a new reasonable patient standard which obligates doctors to make their patients aware of all material risks of the recommended treatment and of any reasonable alternative treatment. This landmark judgment has been of interest to the rest of the common law world. A judicial trend of invoking Montgomery to impose more stringent requirements on doctors is discernible in subsequent decisions since then. MAIN BODY: In this narrative review, without questioning the idea that properly informed patients should play a more active role in procedures affecting their own health in furtherance of their autonomy, safety, and consumer rights, we identify and analyse, with the aid of realistic clinical thought experiments, three practical conundrums that the Montgomery standard may inflict on the daily work of doctors, unfairly exposing them to arbitrary legal risks. CONCLUSIONS: These conundrums pertain to the ascertainment of the risks that must be disclosed to the patient under the test of 'materiality'; the legal uncertainty as to the scope of the exceptions; and the actual ability of doctors to cope with the pressures of time. These conundrums offer ripe opportunities to rethink the proper role of judicially developed medical law in modern health care practice.

Plaintiff aims in medical negligence disputes: limitations of an adversarial system.

The adversarial nature of medical negligence litigation is subject to frequent criticism by the media, patient advocates, and scholars. In Ireland, reform of the medical negligence dynamic is often mooted, particularly in response to the high financial costs of this type of litigation; however, change in this area has been slow. Recently, the Irish courts have dealt with a number of high-profile, medical negligence disputes, including claims for those affected by the CervicalCheck controversy, which involved the failure to disclose the results of a retrospective audit to women who had developed cervical cancer. These cases have again highlighted the shortcomings of an adversarial system. This article explores the limitations of the tort system in the context of plaintiff aims in medical negligence disputes, drawing on empirical findings (qualitative interviews with patient support groups and barristers), and the literature. In doing so, the article argues that while financial compensation is necessary and appropriate in cases of medical negligence, the current system fails to recognise the often emotional nature of these claims, and the wider needs and aims of litigants involved in these disputes.

The Statutory Standard of Care in Australia and its Application to Experimental Medical Practice.

Clinical innovation is essential in the development and improvement of interventions used to treat medical conditions. In Australia, the States and Territories have statutorily reintroduced the Bolam principle in a modified form which provides a defence for medical practitioners who have practised in a manner that, at the time, was widely accepted in Australia by peer professional opinion as competent professional practice. This article explores whether the standard could be successfully pleaded as a defence by experimental practitioners. In doing so, the obstacles to an experimental practitioner's ability to rely on the statutory defence are analysed. It finds that the standard effectively entrenches established practices without sheltering legitimate efforts to advance medicine.

Consumers or Patients? Medical Device Recipients under Australian Law Straddle Two Worlds.

This article analyses the status of medical device recipients under Australian law. The 2021 Gill v Ethicon Sàrl litigation in the Federal Court of Australia has brought the issue to the fore. Moving from the Court's findings, the article dissects the specific vulnerability of medical device recipients and explores the under-researched distinction between patients and consumers under Australian law. The analysis spans the regulatory landscape for medical devices prior to marketing approval, the statutory protections and causes of actions available to consumers under the Australian Consumer Law, and the safeguards for patients developed under medical law (particularly medical negligence). In addition to doctrinal clarifications, the article provides a discussion of key policy considerations that frame the various regimes. Patients and consumers share characteristics, but their legal protections differ in terms of focus and objectives. Medical device recipients straddle both worlds, requiring the highest levels of care and disclosure.

Who judges medical practice?

Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship.

Las demandas judiciales por la percepción del paciente de una actuación médica inadecuada son una realidad creciente en la práctica médica, la cual entraña una preocupación extendida en el gremio médico. Las demandas judiciales frecuentemente conllevan circunstancias adicionales a la primaria preocupación de prevenir o sancionar actos de negligencia médica. CETREMI emite algunas recomendaciones a los profesionales jurídicos y médicos para mejorar esta situación y evitar daños en la relación médico-paciente.

Reforming clinical negligence in England: lessons about patients' and providers' values from medical injury resolution in New Zealand and the United States of America.

England's current review of clinical negligence and consideration of alternatives (such as no-fault compensation) should be welcomed. Valuing what patients and families want, and need, after harm in healthcare necessitates a system that enables their needs to be met. Medical negligence litigation is misaligned with patients' needs after harm events. By contrast, alternatives (such as no-fault and communication-and-resolution programmes) offer opportunities to place patients', families' and providers' values at the forefront of resolution efforts. This article offers empirical insights and lessons from two alternative systems for resolving medical injuries: New Zealand's (NZ's) administrative compensation scheme, and the US communication-and-resolution programmes (CRPs). The review in England presents an exciting opportunity to design a system for responding to medical injuries that harnesses the strengths of alternative approaches for resolving medical injuries, while also improving on the challenges with treatment injury in NZ.

The doctrine of "Reasonable Doctor" in medical negligence: Need to be more reasonable.

The model of a 'reasonable doctor' has been quite successfully used to deliver justice in disputes involving medical negligence. However, many a times a doctor is held guilty of negligence when viewed through the narrow lens of an ideal 'reasonable doctor' and without looking into the circumstances under which he was working which could have actually led to the alleged act of negligence. This short write-up highlights the importance of applying this doctrine more reasonably in the best interest of all stake holders and the drawbacks of the doctrine of 'reasonable doctor' in adjudicating medical negligence cases with few international case laws.

¿Quién juzga la actuación médica? / Who judges medical practice?

Resumen Las demandas judiciales por la percepción del paciente de una actuación médica inadecuada son una realidad creciente en la práctica médica, la cual entraña una preocupación extendida en el gremio médico. Las demandas judiciales frecuentemente conllevan circunstancias adicionales a la primaria preocupación de prevenir o sancionar actos de negligencia médica. CETREMI emite algunas recomendaciones a los profesionales jurídicos y médicos para mejorar esta situación y evitar daños en la relación médico-paciente.

Abstract Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship.

Sufficient informed consent to medical treatment of adults: legal and ethical perspectives from Malawi.

This special communication discusses the current legal and ethical requirements for informed consent to medical treatment of adults in Malawi. It analyzes the scope of the laws and code of ethics on professional discipline, including criminal privilege for surgeries and clarifies when insufficient disclosures entitle patients to compensation under civil law. Inconsistencies and uncertainties in the law are made apparent. It evaluates to which degree disclosure standards of other Commonwealth jurisdictions (e.g. the case of Montgomery) would be suitable for the health care setting of a country like Malawi that is characterized by shortages of resources, high illiteracy rates and a communitarian cultural context. Doctor-patient communication is not alien to African culture and part of sufficient informed consent. In order to balance the need for efficiency in health care delivery, accountability for quality care, fairness and effective patient-doctor communication the authors suggest to adopt the reasonable patient test only, if a defence of heavy workload on case-to-case basis is introduced at the same time. This does not dispense the need for organisational diligence on part of the institutional health care provider within its capacity.

Medicolegal Priorities for a Neurosurgeon/Neurologist in the COVID Era.

Vulnerable moments, panic, and uncertainties are the hallmarks of pandemic outbreaks. Medicolegal challenges add further injury to the public health chaos. Although containing the pandemic is of prime concern, medicolegal and ethical uncertainties further complicate ideal standards of medical care. Constraints in the provision of medical care, resource limitations, infectivity risks, burgeoning costs, and pandemic control laws, create extremely precarious medicolegal situations. Ethics and medical negligence laws may, at times, be trampled upon by the overwhelming urgencies of the pandemic. Hence, we attempt to review basic ethical and medicolegal principles that are put to test by pandemic urgencies. We aim to study these vulnerable medicolegal moments in neurosurgeons'/neurologists' clinical and research practices during the COVID-19 times from our own practice and contemporary literature on COVID practices, medicolegal sciences, and pandemic healthcare directives. We also review supportive measures and safeguards to brace these vulnerable moments effectively. We compile medicolegally sound and ideal practice parameters, including the basic principles for a restructured informed surgical consent ensuring a medicolegally and ethically sound practice. Several ethical and medicolegal exigencies are part of medical practice during a pandemic. Special care should be taken to avoid violations of medicolegal and ethical proprieties during the urgencies of medical care and research. Restructuring of contracts like the informed consent would also count as an ideal practice modification in a pandemic.

Bile Duct Injuries as a Result of Cholecystectomy: An Australian Perspective.

Cholecystectomy remains the mainstay treatment for symptomatic gallstones. Despite the evolution of surgical techniques and approaches, bile duct injury represents a significant complication, even in experienced hands. It is associated with significant postoperative morbidity, resource utilisation and costs. Compared to the international data, there is a paucity of data on malpractice cases involving bile duct injuries (BDIs) proceeding to definitive judgment and defence. This article examines the surgical literature and the case law in Australia as it relates to BDIs following cholecystectomy. This article aims to discuss the issues surrounding major bile duct injury litigation and compares the Australian perspective with international experience.

Medical Error Litigation in Nigeria: A Proposal for Change.

Negligence actions are the most important and dynamic of all torts because they are the principal means of compensating victims of accidents, including medical errors. Unfortunately, victims of medical error in Nigeria have not historically been able to enjoy the relief available through negligence suits. This article explores the Nigerian legal and regulatory framework for addressing medical errors and offers suggestions that could help improve such medical error response.

Clinical negligence cases in the English NHS: uncertainty in evidence as a driver of settlement costs and societal outcomes.

The cost of clinical negligence claims continues to rise, despite efforts to reduce this now ageing burden to the National Health Service (NHS) in England. From a welfarist perspective, reforms are needed to reduce avoidable harm to patients and to settle claims fairly for both claimants and society. Uncertainty in the estimation of quanta of damages, better known as financial settlements, is an important yet poorly characterised driver of societal outcomes. This reflects wider limitations to evidence informing clinical negligence policy, which has been discussed in recent literature. There is an acute need for practicable, evidence-based solutions that address clinical negligence issues, and these should complement long-standing efforts to improve patient safety. Using 15 claim cases from one NHS Trust between 2004 and 2016, the quality of evidence informing claims was appraised using methods from evidence-based medicine. Most of the evidence informing clinical negligence claims was found to be the lowest quality possible (expert opinion). The extent to which the quality of evidence represents a normative deviance from scientific standards is discussed. To address concerns about the level of uncertainty involved in deriving quanta, we provide five recommendations for medico-legal stakeholders that are designed to reduce avoidable bias and correct potential market failures.