The evolution of informed consent in gastroenterology.

With medical litigation on the rise, physicians require a nuanced understanding of the legalities of consenting patients to reduce their liability while practising evidence-based medicine. This study aims to a) clarify the legal duties of gastroenterologists in the UK and USA when gaining informed consent and b) provide recommendations at the international and physician level to improve the consent process and reduce liability.A bibliometric analysis of the Web of Science database with the MeSH terms "gastroenterology" and "informed consent" yielded 383 articles, of which 228 were excluded due to not meeting the inclusion criteria. Of the top 50 articles, 48% were from American institutions and 16% were from the UK. Thematic analysis showed 72% of the articles discussed informed consent in relation to diagnostic procedures, 14% regarding treatment, and 14% regarding research participation.Both the USA and the UK have progressed from previously paternalistic Natanson case (1960) and Bolam test (1957), respectively, where physicians were held to the standard of a "reasonable and prudent medical doctor". The American Canterbury case (1972) and the British Montgomery case (2015) radically shifted the standard of disclosure during the consent process by requiring physicians to explain all information pertinent to a "reasonable patient".It is our recommendation that a two-pronged approach be taken; a) creation of international guidelines for consenting patients for invasive procedures in gastroenterology, and b) development of internationally standardised endoscopy consent forms containing all the details pertinent to a "reasonable patient".

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.

Five-year results of no-fault compensation related to childbirth injuries in Taiwan.

OBJECTIVE: Increasing obstetric medical litigations had great impacts in health care system resulted in lower recruitment of residents and higher medical cost of defensive medicine in Taiwan. In order to reduce medical litigation, the "Childbirth Accident Emergency Relief Act" was implemented in June 2016. This study presented five-year results of a novel childbirth accident compensation system. MATERIALS AND METHODS: The purpose of the Relief Act was to establish a national relief system to ensure timely relief, reduce medical disputes, promote the partnership between patient and medical personnel. The compensations included maximal 2 million NTD for maternal death, maximal 0.3 million NTD for neonatal and fetal deaths, and 3, 2, and 1.5 million NTD for maternal or neonatal profound, severe, and moderate disabilities, respectively. Puerperal hysterectomy was included with maximal 0.8 million NTD compensation. RESULTS: Since June 30, 2016 to June 30, 2021, there were 1340 applications reviewed by Committee and 1258 were approved with total relief of 744.7 million NTD (26.6 million USD) with approve rate of 93.9%. It took an average of 109.8 days to start application from childbirth and 102.4 days to get compensation from application. 66.1% of accident victims agreed this system can restore doctor-patient relationship by immediate care and assistance from medical institutions. CONCLUSION: The Relief Act is the first government leading compensation system to establish a national relief system. It was enacted to reduce medical disputes, promote the partnership between patient and medical personnel, and enhance health and safety of women during childbirth. A no-fault compensation would be an efficient alternative disputes resolution to childbirth accidents.

Third trimester intrauterine fetal death: proposal for the assessment of the chronology of umbilical cord and placental thrombosis.

The timing of umbilical cord and placental thrombosis in the third trimester intrauterine fetal death (TT-IUFD) may be fundamental for medico-legal purposes, when it undergoes medical litigation due to the absence of risk factors. Authors apply to human TT-IUFD cases a protocol, which includes histochemistry and immunohistochemistry (IHC) for the assessment of thrombi's chronology. A total of 35 thrombi of umbilical cord and/or placenta were assessed: 2 in umbilical artery, 6 in umbilical vein, 15 in insertion, 10 in chorionic vessels, 1 in fetal renal vein, 1 in fetal brachiocephalic vein. Thrombi's features were evaluated with hematoxylin-eosin, Picro-Mallory, Von Kossa, Perls, and immunohistochemistry for CD15, CD68, CD31, CD61, and Smooth Muscle Actin. The estimation of the age of the thrombi was established by applying neutrophils/macrophages ratio taking into consideration, according to literature, the presence of hemosiderophagi, calcium deposition, and angiogenesis. To estimate an approximate age of fresh thrombi (< 1 day), a non-linear regression model was tested. Results were compared to maternal risk factors, fetal time of death estimated at autopsy, mechanism, and cause of death. Our study confirms that the maternal risk factors for fetal intrauterine death and the pathologies of the cord, followed by those of the placental parenchyma, are the conditions that are most frequently associated with the presence of thrombi. Results obtained with histological stainings document that the neutrophile/macrophage ratio is a useful tool for determining placental thrombi's age. Age estimation of thrombi on the first day is very challenging; therefore, the study presented suggests the N/M ratio as a parameter to be used, together with others, i.e., hemosiderophagi, calcium deposition, and angiogenesis, for thrombi's age determination, and hypothesizes that its usefulness regards particularly the first days when all other parameters are negative.

Inferior alveolar nerve injury following dental implant placement: A medicolegal analysis of French liability lawsuits.

AIMS: This study thus aimed to review and analyze liability lawsuits resulting from implant surgery-related inferior alveolar nerve (IAN) injury over a twenty-year period in France. MATERIALS AND METHODS: A retrospective descriptive study was performed to analyze judicial decisions pertaining to IAN injury from a legal database between 2000 and 2020. Inclusion criteria comprised all closed malpractice cases that involved an oral and maxillofacial surgeon or a dentist who performed a mandibular implant surgery resulting in IAN injury. The following data were recorded: judicial decision reference (including jurisdiction and date of final court ruling), timing between the incident and final court ruling, number of involved practitioners, patient's age and gender, practitioner's age and gender, implant type, number of implants, location of iatrogenic implant(s), allegation of IAN injury, alleged cause of injury, justification(s) for conviction, compensation amount and legal costs. RESULTS: Twelve judicial decisions from high civil courts relating to ten closed cases of liability lawsuits were included and analyzed. All of involved practitioners were dentists or oral surgeons, working in the private sector. Eventually, 85% of them were convicted. Mean indemnification was 17,340€ and highest indemnification was 42,828€ (inflation-adjusted in 2020 euros). Mean interval between the incident and final ruling was 87,1 ± 34,2 months. CONCLUSIONS: Permanent nerve injury following dental implant placement can result in legal action. In the event of lawsuit, the risk of being convicted is high. Practitioners performing oral implantology procedures should practice effective risk management to avoid time-consuming unwanted litigations and administrative proceedings.

National trends and cost of litigation in UK National Health Service (NHS): a specialty-specific analysis from the past decade.

BACKGROUND AND AIMS: Medical litigation claim and costs in UK are rising. This study aims to analyse the 10-year trend in litigation costs for individual clinical specialties in the UK from 2009/10 to 2018/19. METHODS: Data were procured from National Health Service (NHS) Resolution. Number of claims, total litigation costs and cost per claim were ascertained for each financial year. The data collected also includes the number of claims and average amount per claim per speciality during the years 2009-2019 (2009/2010 to 2018/2019 financial years). RESULTS: The total annual cost of NHS litigation is currently £3.6 billion(2018/2019). Damages make up the greatest proportion of costs(£1.5 billion). Surgical specialties have the greatest number of claims annually(2847) but Obstetrics has the greatest total litigation(£1.9 billion) and cost per claim(£2.6 million). Number of claims, total costs and cost per claim are significantly greater in 2018/2019 than in 2009/2010. CONCLUSIONS: Addressing the issue of litigations is complex. Medically there are speciality specific issues that require attention, whilst some general measures are common to all: effective communication, setting realistic targets and maintaining a motivated, adequately staffed workforce. These, alongside legal reforms, may reduce the financial burden of increasing litigation on the NHS.

When Doves Cry: Some Perspectives on Medical Litigations in Nigeria.

Medical litigation is one branch of litigation that is attracting a lot of interest in Nigeria in recent years. Apart from the very common cases of negligence in medical practices other causes of action are arising as a result of doctor-patient relationships with the doctor's responsibility to act in the best interest of his patient being often rewarded with stressful and expensive litigation. This paper specifically focuses only on litigation against medical doctors in the discharge of their duties to their patient whist highlighting the possible causes of action that may arise against doctors under the extant laws applicable in Nigeria. The paper also considers situations where doctors are caught in-between the need to preserve overall public health interests and the rights or interests of patients. The paper concludes that the plight and dilemma of doctors should not be perceived negatively but rather positively bearing in mind the humane and humanitarian calling of their profession.

Le contentieux médical est une branche du contentieux qui suscite beaucoup d'intérêt au Nigeria ces dernières années. Outre les cas très courants de négligence dans les pratiques médicales, d'autres causes d'action surviennent à la suite de relations médecin-patient, la responsabilité du médecin d'agir dans le meilleur intérêt de son patient étant souvent récompensée par des litiges stressants et coûteux. Ce document se concentre spécifiquement uniquement sur les litiges contre les médecins dans l'exercice de leurs fonctions envers leur patient tout en soulignant les causes d'action possibles qui peuvent survenir contre les médecins en vertu des lois en vigueur applicables au Nigeria. Le document examine également les situations dans lesquelles les médecins sont pris entre la nécessité de préserver les intérêts généraux de santé publique et les droits ou intérêts des patients. L'article conclut que la situation critique et le dilemme des médecins ne doivent pas être perçus négativement mais plutôt positivement en gardant à l'esprit la vocation humaine et humanitaire de leur profession Mots-clés: Pratique médicale, contentieux médical, droits du patient, intérêt public.

Medical malpractice in Norway: frequency and distribution of disciplinary actions for medical doctors 2011-2018.

BACKGROUND: Physicians who perform unsafe practices and harm patients may be disciplined. In Norway, there are five types of disciplinary action, ranging from a warning for the least serious examples of malpractice to loss of licence for the most serious ones. Disciplinary actions always involve medical malpractice. The aims of this study were to investigate the frequency and distribution of disciplinary actions by the Norwegian Board of Health Supervision for doctors in Norway and to uncover nation-wide patient safety issues. METHODS: We retrospectively investigated all 953 disciplinary actions for doctors given by the Board between 2011 and 2018. We categorized these according to type of action, recipient's profession, organizational factors and geographical location of the recipient. Frequencies, cross tables, rates and linear regression were used for statistical analysis. RESULTS: Rural general practitioners received the most disciplinary actions of all doctors and had their licence revoked or restricted 2.1 times more frequently than urban general practitioners. General practitioners and private specialists received respectively 98.7 and 91.0 disciplinary actions per 1000 doctors. Senior consultants and junior doctors working in hospitals received respectively 17.0 and 6.4 disciplinary actions per 1000 doctors. Eight times more actions were received by primary care doctors than secondary care doctors. Doctors working in primary care were given a warning 10.6 times more often and had their licence revoked or restricted 4.6 times more often than those in secondary care. CONCLUSION: The distribution and frequency of disciplinary actions by the Norwegian Board of Health Supervision clearly varied according to type of health care facility. Private specialists and general practitioners, especially those working in rural clinics, received the most disciplinary actions. These results deserve attention from health policy-makers and warrant further studies to determine the factors that influence medical malpractice. Moreover, the supervisory authorities should assess whether their procedures for reacting to malpractice are efficient and adequate for all types of physicians working in Norway.

Responsabilidad Médica en Chile: Fallos de la Corte Suprema de Justicia 2017 / Medical Malpractice in Chile: Rulings of the Supreme Court of Justice 2017

RESUMEN: El objetivo de este trabajo fue analizar los datos epidemiológicos y jurídicos de los casos por responsabilidad médica fallados por la Corte Suprema de Justicia chilena (CSJ) el año 2017, para relevar los escenarios de alto riesgo, aportando a su prevención. Se realizó un estudio retrospectivo, revisando los fallos de la CSJ en la base de datos electrónica del Poder Judicial chileno. Se seleccionaron y analizaron los fallos por responsabilidad médica. Se detectó un total de 61 casos por responsabilidad médica que alcanzaron la CSJ en 2017. Todos correspondieron a causas civiles. La duración promedio de los juicios fue 41,9 meses. La especialidad más demandada y condenada fue ginecología. La mayoría de las demandas y condenas afectó al Sistema Público de salud. Los casos que dan origen a las demandas son, en su mayoría, de atención de urgencias por sobre las programadas, y de tratamiento por sobre procedimientos quirúrgicos. El 54,8 % de los casos resultaron en la muerte del paciente. La mitad de los fallos condenatorios involucraba el fallecimiento del usuario afectado. Se deben investigar los factores de riesgo no sólo de la ocurrencia de mal-praxis, si no de la judicialización de los conflictos médico-paciente, especialmente en el área gineco-obstétrica, incluyendo los casos de instancias anteriores a la CSJ. Se debe investigar así mismo los factores de riesgo para la mayor propensión de los profesionales de sexo masculino de ser demandados y condenados por malpraxis médica.

ABSTRACT: The objective of the present study is to characterize the epidemiologic and juridical data for medical malpractice cases ruled by the Chilean Supreme Court (CSC) in 2017, to highlight the high risk scenarios, as a contribution to their prevention. A search of the CSC electronic database was conducted to identify and analyze CSC rulings for medical malpractice cases. In this study 61 malpractice cases ruled by CSC were identified. The CSC received only civil cases of medical malpractices during the studied period. The average duration of the trial was 41.9 months. Gynecologists faced suits and received sentences more frequently than any other type of specialist. The majority of prosecuted cases and convictions were associated with the public health system. A greater number of claims were related to emergency care than with scheduled procedures. Likewise, more claims were associated with non-surgical treatment than with surgical procedures. 54.8 % of all cases resulted in the patient's death. Half of the cases that lead to conviction, were related to the death of a patient. Risk factors should be investigated, not only of the occurrence of malpractice, but also of the judicial process of doctor-patient conflicts, especially in the obstetrics and gynecology area, including the analysis of cases of prior judicial instances. The risk factors for the higher propensity of male professionals to be prosecuted and convicted for medical malpractice should also be investigated.

Informed consent in plastic surgery, evaluation of its effectiveness for mutual satisfaction of patient and doctor: Comparison of methods.

BACKGROUND: The acquisition of signed informed consent is not always enough to ensure adequate medical protection. Particularly, in plastic surgery, improving the doctor-patient relationship by understanding the patient's emotions and expectations becomes a determining factor when choosing the best therapeutic strategy for the subject in question, which may also include nonsurgical eligibility. METHODS: Ninety patients with various plastic surgery disabilities were recruited and randomly divided into three groups: Patients in the first group underwent the ``traditional'' clinical interview, those in the second underwent the clinical approach called Shared Decision Making (SDM), and those in the third group received both the SDM and a questionnaire evaluating patient expectations (Expectation Questionnaire-Pgm). At the end of each interview, a specialist physician in Plastic, Reconstructive and Aesthetic Surgery was asked to fill in a questionnaire regarding his/her satisfaction with the method used. Likewise, the patient filled in a questionnaire on his/her satisfaction with the interview. RESULTS: For the doctors, the third method was superior in investigating patient expectations, emotions, and personal preferences. For the patients, the third method scored significantly higher than the first one for overall satisfaction and ability to evaluate personal preferences and needs and higher than the first and second methods in assessing expectations. CONCLUSIONS: For doctors, the SDM coupled with the Expectation Questionnaire-Pgm proved to be the most useful tool to understand patient expectations and emotions and thus improve the medical-patient relationship through shared decision-making. The third method therefore aims for better patient coverage and improved informed consent, thereby reducing the likelihood of litigation and better assessing nonfitness for operation.

Medical litigation experience of the victim of medical accident: a qualitative case study.

This study aims to demonstrate a comprehensive understanding of the life experience of victims of medical accidents after medical accidents and medical litigations. A single victim of a medical accident participated in the study. Six upper categories were derived as the results: "frustration and anger toward medical accident occurrence," "desolated struggle for medical litigation," "distrust of medical litigation related legal profession," "accepting myself with a disability caused by a medical accident," "a life with far more unexpected challenges as an athlete with disabilities," and "find new meaning after the medical accident." The participant was experiencing physical and psychological distress in the process of accepting the medical accident and the disability. In addition, the participant was exposed to the secondary psychological distress from the medical profession, lawyer, and legal profession in the peculiar situation of medical litigation, and to the third psychological distress in life living as a disabled person.

Experiences and responses of second victims of patient safety incidents in Korea: a qualitative study.

BACKGROUND: Healthcare professionals who experience trauma due to patient safety incidents can be considered second victims, and they also suffer from various difficulties. In order to support second victims, it is necessary to determine the circumstances of the incidents in question, along with the symptoms that the victims are experiencing and the support they require. A qualitative study on healthcare professionals of various occupations, such as physicians and nurses working in Korea, was conducted, and the experiences and response methods and processes of second victims were examined. METHODS: In-depth interviews were conducted with 16 healthcare professionals (six physicians, eight nurses, and two pharmacists) who had experienced a patient safety incident. All interviews were recorded and transcribed, and the data analysis was conducted in accordance with Strauss and Corbin's grounded theory. Both open coding and axial coding were performed. Consolidated criteria for reporting qualitative research (COREQ) were applied in this study. RESULTS: The results of the open coding demonstrated that the experiences of second victims can be categorized into "the reactions of the first victim and surrounding people after the incident," "Influence of factors aside from the incident," "the initial complex responses of the participants to the incident," "open discussion of the incident," "the culture in medical institutions regarding early-stage incident response," "the coping responses of the participants after incidents," and "living with the incident." Then, the seven categories in the open coding stage were rearranged according to the paradigm model, and the reaction process of the second victims was analyzed through process analysis, being divided into the "entanglement stage," "agitating stage," "struggling stage," "managing stage," and "indurating stage." CONCLUSIONS: This research is significant because it provides a comprehensive understanding of second victims' experiences in the eastern region of Korea, by obtaining data using a qualitative research method. The findings of the study also highlight the five stages of the second victim response process, and can be used to design a specialized second victim support program in Korea.

Justice Is Blind but Expert Witnesses in Medical Imaging Are All Seeing: The Potential For "Blind Reads" to Mitigate Bias in Expert Evidence.

Expert evidence in medical imaging claims has the potential for well-recognised biases. Informational biases occur from the distorted context when an expert witness knows which specific finding is present and the severity of the injury sustained as a result of the undiagnosed finding. Systemic litigation biases occur from the selection and undersampling of opinions and issues with compensation and affiliation between the expert and parties to litigation. Blinding the expert witness to outcomes holds potential for mitigating these biases and may act as a screening tool to evaluate civil claims. The more complex strategies of blinding the expert to both the legal case and the commissioning legal party, by providing a "library of imaging" for review to imitate a normal day's work, are unlikely to be practical for Australian legal practice. The persuasiveness of blinded expert evidence in mediation, concurrent evidence and court decisions in Australia is still uncertain.

Official definitions for undesirable medical events : Are they correctly applied in medicine?

BACKGROUND: In Austria, elaborate definitions exist for the undesirable medical events side effect, adverse event, complication and medical malpractice. We aimed at investigating whether the official definitions for the abovementioned terms can be understood by a sample population representing a cross-section of the Austrian population. METHODS: In this study 1021 Austrian citizens were interviewed. Demographic parameters (age, gender, occupation, level of education, monthly income, number of inhabitants at place of residence) were assessed. Participants were told the official definitions for complication, side effect, adverse event and medical malpractice and asked to select the correct definition for "complication". The impact of sample characteristics on the ability to identify the correct definition was investigated. RESULTS: Of the participants 315 (31%) identified the correct definition of a complication. Almost the same number (n = 302, 30%; χ2 for single samples: p = 0.087) falsely selected the definition for side effect. Significantly fewer (both p < 0.001) chose the definitions for adverse event (n = 220, 22%) and medical malpractice (n = 155, 15%). Only the respective state of origin showed significant influence on the probability of choosing the correct definition out of the four. The probability was highest in Vorarlberg (0.400) and lowest in Upper Austria (0.216, p < 0.001). CONCLUSION: For the majority the present official definitions for undesirable medical events are too complex to understand. Simple definitions for undesirable medical events should be included into patient education.

A comparative analysis of the discrimination conclusions for medical litigation cases of a hospital / 中华医院管理杂志

Objective To compare the differences found between the proportion of responsibility between in-house experts of the hospital and that of judicial appraisals for 52 cases of medical disputes of a hospital in recent years.Methods A total of 52 cases of disputes were selected, which were evaluated by the in-house experts screening meeting at a tertiary hospital in Beijing from 2015 to 2018.According to the causes of these disputes, these cases were divided into seven categories, calculating respectively the mean value of the proportion of judicial appraisal responsibility and that of in-house experts for all cases of the same category.The paired t test was used to compare the consistency of the above two methods.Results The overall level of judicial appraisal responsibility(35.00% ) was significantly higher than the in-house expert screening(20.96% ).Among them, the cases of improper selection of treatment plan, improper operation of surgery or insufficient evaluation of surgical difficulty risk, and medical disputes caused by complications, the degree of responsibility of the judicial appraisal institutions was quite different from that of in-house experts of the hospital.Conclusions Because the judicial appraisal agencies have certain difficulties in the identification of complex medical technology problems, it is recommended to establish a library of judicial appraisal experts as soon as possible to encourage the experts to participate in the trial of disputes.

The reform of legal system on the construction and reflection of the logic of actions of all parties in the medical litigation:An empirical study of 404 cases about 6 three-A hospitals in D city / 中国卫生政策研究

Taking the judicial reference information of 404 cases of medical litigation from the 6 three-A hospi-tals from 2009 to 2014 in D city as the sample,it was found that in the reform of the legal system represented by the implementation of the Tort Liability Act increased the number of medical tort litigations obviously;Decline in apprais-al rate,more summary procedure and mediation apply and its high success rate in claim for compensation, serious mediating tendency and decreased hospital's attention to medical litigation have conflicted with the authoritative,effi-cient,fair and reasonable goals that institutional changes are intended to achieve. This is related to the harmonization of the legal pattern of medical damage litigations as it lessens the dispute resolution before litigation and changes liti-gation expectations of the litigants aggravate the burden of evidence from applicants,especially the cost of applying of appraisal,increases the discretion of courts,but failing to improve its professional trial capacity in a timely manner. Based on the investigation of the influence of institutional changes to the logic of operations,the role of the third-party pre-statement dispute resolution mechanism in medical disputes should be further addressed in the future to balance the burden of evidence-relieving methods with the burden of doctor-patient evidence in the form of ease of proof and to improve the procedural diversion mechanism for conciliation and the diversion should be improved to strengthen dama-ges to make the compensation procedure more scientific.

Learning from an analysis of closed malpractice litigation involving myocardial infarction.

OBJECTIVE: To examine the epidemiologic data, identify the pattern of dispute, and determine clinical litigious errors by analyzing closed malpractice claims involving myocardial infarction (MI) in Taiwanese courts. METHODS: A retrospective descriptive study was performed to analyze the verdicts pertaining to MI from the population-based database of the Taiwan judicial system between 2002 and 2013. The results of adjudication, involved specialists, primary dispute leading to lawsuits, and litigious errors were recorded. RESULTS: A total of 36 closed malpractice claims involving MI were included. The mean interval between the incident and litigation closure was 65.5 ± 28.3 months. Nearly 20% of the cases were judged against clinicians and the mean payment was $100639 ± 49617, while the mean imprisonment sentence was 4.3 ± 1.8 months. Cardiologists and emergency physicians were involved in 56.3% of cases, but won 92.6% of lawsuits, while other specialists lost nearly 25% of lawsuits. The most common dispute was misdiagnosis (38.9%), but this dispute had the lowest percentage of loss (7.1%). Disputes regarding delayed diagnosis were judged against the defendants in 50% of claims. Clinicians lost the lawsuit in the following conditions: 1) misdiagnosis of MI in patients with typical chest pain and known coronary artery risk factors; 2) failure to perform thoughtful evaluation and series investigations in patients suspicious of ischemic heart disease; 3) failure to perform indicated treatment to avoid disease progression. CONCLUSIONS: Medical practitioners should keep a high index of MI suspicion, especially if the diagnosis and treatment of MI are beyond their daily practice. Prudent patient reevaluation, serial ECG and cardiac enzyme testing, and early consultation are suggested to reduce malpractice liability.

The removal of an implant beneath the optic canal by modified endoscopic-assisted sinus surgery.

Displacement of dental implants into the maxillary sinus is one of the rare complications during the implant surgery. However, it is always possible that clinicians confront with this unexpected result and patients should be informed ahead of maxillary implant surgery. For clinicians, it is important to be aware of how to deal with the complication, because the migrated implant must be removed as early as possible. There have been several classical ways to approach the maxillary sinus, such as the Caldwell-Luc procedure and endoscopic sinus surgery and these methods still have been chosen by many surgeons although quite a lot of complications exist. In this study, the author introduced a new sinus approach technique, modified endoscopic-assisted sinus surgery (MESS) as an efficient, easy and less complication-inducing sinus approach. A clinical case was described where a displaced dental implant beneath the optic nerve was successfully removed by MESS. Furthermore, essential considerations to avoid medical litigation and maintain close rapport with the patients were discussed when dealing with the case of displaced implant in the maxillary sinus.

Medicolegal implications of radial and femoral access for coronary angiography and intervention in 2016: Focus on retroperitoneal hemorrhage.

BACKGROUND AND OBJECTIVES: Retroperitoneal hemorrhage is a rare but serious complication of transfemoral approach (TFA) and TFA percutaneous coronary intervention (PCI). Radial approach for coronary angiography and intervention (transradial approach, TRA) is associated with lower access site complications and reduced blood transfusion rates. Retroperitoneal bleeding has not been described with TRA. This study sought to evaluate the relationship between femoral access for coronary angiography (TFA) and PCI-induced retroperitoneal hemorrhage and the resulting medical litigation in the United States. METHODS: From 342 lawsuit claim records identified in LexisNexis database search, 17 cases of TFA and TFAPCI-related retroperitoneal hemorrhage decided between 1995 and 2015 were included in the study. Claims were thoroughly reviewed and information about the date the case was decided, patient outcome, the plaintiff, the defendant, the claim, and the trial outcome were extracted. RESULTS: The most common filled claim was medical malpractice (53% of the cases), followed by wrongful death (18%) and review of the Commissioner's decision to deny the application for supplemental security income (12%). Forty-seven percent of the cases were won by the defense, 29% by the plaintiff, and 24% were remanded for a new trial. In 82% of the cases, physicians were sued, but only 14% of the cases were won by the plaintiff. In 59% of the claims, the patient died; however, 70% of those cases were decided in favor of the defending physician and hospital. CONCLUSION: Retroperitoneal hemorrhage is an uncommon complication of TFA and TFA PCI and is associated with high mortality rates. Physicians should able to identify this complication early and address it in a timely manner based on the applicable standard of care. TRA and TRA PCI is a reliable alternative and may potentially reduce medicolegal liability related to access site choice.