Evaluación de las sentencias en vía civil contra obstetras y ginecólogos en España (1987-2013) / Evaluation of judgments in the civil right against obstetrics and gynecologists in Spain (1987-2013)

Objetivo: la Ginecología ocupa un papel destacado por el número de demandas judiciales. Los daños en los que el afectado es el feto o el recién nacido, suponen las situaciones más conflictivas en el ámbito de la responsabilidad de la especialidad. El objetivo de nuestro estudio es buscar si existe un perfil del condenado, mediante el estudio de sentencias en altas instancias judiciales. Material y Métodos: se analizaron las sentencias desde 1987 hasta 2013. Se utilizaron tablas de distribución de Fisher, de normalidad y el t-Test para comparación de diferencias entre grupos y la prueba no paramétrica de Mann-Withney para comparación de muestras independientes. Se realizó un estudio multivariante seguido de análisis de conglomerados para estimar las variables más influyentes. Resultados: globalmente el 54,3% de los casos terminaron en condena, entre ellos 107 (57%) de 182 eventos relacionados con daño o muerte fetal. El resultado condenatorio de la sentencia previa, el daño cerebral permanente y que el evento ocurriera en la sanidad pública, fueron las variables que más peso tuvieron en el resultado de la sentencia condenatoria. El tiempo medio desde el suceso demandado hasta la sentencia definitiva fue de 7,8 años. Conclusiones: los daños relacionados con el feto, aportan las situaciones de mayor riesgo legal en la especialidad de Obstetricia y Ginecología. Los tiempos medios de resolución de los procedimientos en sede judicial son elevados (AU)

Objective: Gynecology plays a prominent role in the number of lawsuits. The damages, in which the affected is the fetus or the newborn, are the most conflictive situations in the field of responsibility of the specialty. The objective of our study is to find out if there is a profile of the convicted, through the study of sentences in high judicial court. Material and Methods: we analyzed the sentences from 1987 to 2013. We used Fisher distribution tables, normality and t-Test for comparison of differences between groups and the non-parametric Mann-Withney test for comparison of independent samples. We performed a multivariate study followed by cluster analysis to estimate the most influential variables. Results: Overall, 54.3% of the cases ended in a conviction judgment, including 107 (57%) of 182 events related to fetal damage or fetal death. A previous conviction ruling, permanent brain damage and an event originated in the public health system, were the variables that had the greatest weight in the result of the conviction. The average time from the first complaint to the final sentence was 7.8 years. Conclusions: Damages related to the fetus, will be the main concern and represent the highest legal risk in Obstetrics and Gynecology. It takes a high average time to get a final sentence (AU)

Seguridad clínica y responsabilidad profesional en ginecología y obstetricia / Clinical safety and professional responsibility in gynaecology and obstetrics

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Análisis de reclamaciones judiciales contra obstetras y ginecólogos en España. Estudio específico de la vía penal (1987-2013) / Analysis of court claims filed against obstetricians and gynaecologists in Spain. Specific study of the criminal court system (1987-2013)

Objetivo. En España las reclamaciones judiciales contra ginecólogos resueltas por vía penal son escasas, menos del 3%. Esta vía conlleva sanción económica y penas de cárcel y de inhabilitación. El objetivo es estudiar las sentencias resueltas por vía penal, por ser de consecuencias más graves y obtener un perfil del condenado. Material y métodos. Análisis retrospectivo de las sentencias judiciales penales contra ginecólogos desde 1987 hasta 2013. Hemos utilizado tablas de distribución de Fisher, de normalidad y el t-Test para comparación de diferencias entre grupos y la prueba no paramétrica de Mann-Withney para comparación de muestras independientes. Para la caracterización de dos grandes grupos, el de «condenado» y «no condenado», realizamos estudio multivariante mediante análisis de correspondencias múltiples seguidas de análisis de conglomerados para agrupar. Resultados. De 85 casos el 54,6% de las reclamaciones judiciales procedían de actos médicos del sector público, aunque el mayor número de condenas, el 59,3%, lo fue por demandas sobre hechos ocurridos en el ámbito de la sanidad privada. La probabilidad de condena en sucesos relacionados con el parto fue del 36,6% (20 de 55) frente al 16,6% (5 de 30) de episodios de otro origen. En el 69,2% de los casos de procedimientos penales por daño neurológico (encefalopatía neonatal) la sentencia fue condenatoria y con las indemnizaciones más elevadas. El tiempo medio trascurrido entre el incidente y la condena fue de 5,7 años. Con una condena previa, la posibilidad de confirmación en instancias superiores fue del 71,9%. Una absolución se confirmó en el 96,2% de las ocasiones. Conclusiones. Aunque es elegida para iniciar el procedimiento pocas reclamaciones se resuelven en vía penal. La mayoría se deben a complicaciones durante el parto y en un tercio se condena. Lo más probable es que se confirme la sentencia previa cuando esta fue absolutoria (AU)

Introduction. Court claims against gynaecologists in the Spanish criminal court system are a rare occurrence (less than 3%). These can lead to financial penalties, imprisonment and disqualification. Our aim is to study the court sentences issued in such cases, as these involve the most serious convictions, and to obtain a profile of those convicted. Material and methods. A retrospective analysis of the sentences against gynaecologists during the period from 1987 to 2013. We used F-distribution tables, normal distribution tables and Student's t-test to compare differences between groups, and the Mann-Whitney nonparametric test for comparison of independent samples. In order to define two broad groups, those of 'convicted' and 'not convicted', we performed a multivariate study analysis followed by cluster analysis to determine similar sentences. Results. Of the 85 cases, 56.4% of complaints came from procedures in the public sector, but the highest rate of convictions (59.3%) was based on complaints originating in the private healthcare sector. The likelihood of conviction in events related to childbirth was 36.6% (20 out of 55) versus 16.6% (5 out of 30) in incidents of another origin. 69.2% of cases of criminal proceedings for permanent neurological damage (neonatal encephalopathy) concluded in a criminal conviction and had the highest financial compensation. The average time elapsed between the incident and the sentence was 5.7 years. With a prior conviction, the possibility of confirmation at higher levels was 71.9%. An acquittal was confirmed in 96.2% of cases. Conclusions. Of the court claims filed against gynaecologists based on their professional activity, very few are decided upon in the criminal courts. Most are due to complications during childbirth, and one-third ends with a conviction. A judgment of acquittal is most likely to be confirmed when this was the case with the previous one (AU)

Seguridad Clínica y responsabilidad profesional en ginecología y obstetricia / No disponible

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An analysis of closed medical litigations against the obstetrics departments in Taiwan from 2003 to 2012†.

OBJECTIVE: To examine the epidemiologic data of closed medical claims from Taiwanese civil courts against obstetric departments and identify high-risk diseases. DESIGN: A retrospective descriptive study. SETTING/STUDY PARTICIPANTS: The verdicts from the national database of the Taiwan judicial system that pertained to obstetric departments were reviewed. Between 2003 and 2012, a total of 79 closed medical claims were included. MAIN OUTCOME MEASURES: The epidemiologic data of litigations including the results of adjudication and the disease and outcome of the alleged injury. RESULTS: A majority of the disputes (65.9%) were fetus-related. Four disease categories accounted for 78.5% of all claims including (i) perinatal maternal complications (25.3%); (ii) errors in antenatal screening or ultrasound diagnoses (21.5%); (iii) fetal hypoxemic-ischemia encephalopathy (16.5%); and (iv) brachial plexus injury (15.2%). Six cases (7.6%) resulted in an indemnity payment with a mean amount of $109 205. Fifty-one cases (64.6%) were closed in the district court. The mean incident-to-litigation closure time was 52.9 ± 29.3 months. All cases with indemnity payments were deemed negligent or were at least determined to be controversial by a medical appraisal, while all defendants whose care was judged as appropriate by a medical appraisal won their lawsuits. CONCLUSIONS: Almost 93% of clinicians win their cases but spend 4.5 years waiting for final adjudication. The court ruled against the clinician only if there was no appropriate response during a complication or if there was no follow-up or further testing for potential critical diseases.

Business and Organizational Models of Obstetric and Gynecologic Hospitalist Groups.

The growth of obstetric and gynecologic (OB/GYN) hospitalists throughout the United States has led to different organizational approaches, depending on the perception of what an OB/GYN hospitalist is. There are advantages of OB/GYN hospitalist practices; however, practitioners who do this as just 1 piece of their practice are not fulfilling the promise of what this new specialty can deliver. Because those with office practices have their own business models, this article is devoted to the organizational and business models of OB/GYN hospitalists for physicians whose practice is devoted to inpatient obstetrics with or without emergency room and/or inpatient gynecology coverage.

A comprehensive obstetric patient safety program reduces liability claims and payments.

Begun in 2003, the Yale-New Haven Hospital comprehensive obstetric safety program consisted of measures to standardize care, improve teamwork and communication, and optimize oversight and quality review. Prior publications have demonstrated improvements in adverse outcomes and safety culture associated with this program. In this analysis, we aimed to assess the impact of this program on liability claims and payments at a single institution. We reviewed liability claims at a single, tertiary-care, teaching hospital for two 5-year periods (1998-2002 and 2003-2007), before and after implementing the safety program. Connecticut statute of limitations for professional malpractice is 36 months from injury. Claims/events were classified by event-year and payments were adjusted for inflation. We analyzed data for trends as well as differences between periods before and after implementation. Forty-four claims were filed during the 10-year study period. Annual cases per 1000 deliveries decreased significantly over the study period (P < .01). Claims (30 vs 14) and payments ($50.7 million vs $2.9 million) decreased in the 5-years after program inception. Compared with before program inception, median annual claims dropped from 1.31 to 0.64 (P = .02), and median annual payments per 1000 deliveries decreased from $1,141,638 to $63,470 (P < .01). Even estimating the monetary awards for the 2 remaining open cases using the median payments for the surrounding 5 years, a reduction in the median monetary amount per case resulting in payment to the claimant was also statistically significant ($632,262 vs $216,815, P = .046). In contrast, the Connecticut insurance market experienced a stable number of claims and markedly increased cost per claim during the same period. We conclude that an obstetric safety initiative can improve liability claims exposure and reduce liability payments.

Reflections on the Canadian MORE(OB) obstetrical risk management programme.

In, 2001, the Patient Safety Division of the Society of Obstetricians and Gynaecologists of Canada initiated and championed a new program to improve patient safety performance in Canadian hospital obstetric units. This new program was developed under the banner of Managing Obstetrical Risk Efficiently and called the MORE(OB) Programme The MORE(OB) Programme was first piloted in Canadian hospitals at the beginning of May 2002 and, by mid 2004, 33 pilot sites had been implemented. In autumn 2004, this program embarked on a national launch. In 2007, the Society of Obstetricians and Gynaecologists of Canada collaborated with the Healthcare Insurance Reciprocal of Canada to form Salus Global Corporation. The birth of this corporate entity embraced the support of rapid expansion of the program within and outside of Canada. This collaboration also enabled innovation and implementation of safety programs beyond the obstetric discipline.

A nationwide descriptive study of obstetric claims for compensation in Norway.

OBJECTIVE: To describe causes of substandard care in obstetric compensation claims. DESIGN AND SETTING: A nationwide descriptive study in Norway. POPULATION: All obstetric patients who believed themselves inflicted with injuries by the Health Service and applying for compensation. METHODS: Data were collected from 871 claims to The Norwegian System of Compensation to Patients during 1994-2008, of which 278 were awarded compensation. MAIN OUTCOME MEASURES: Type of injury and cause of substandard care. RESULTS: Of 871 cases, 278 (31.9%) resulted in compensation. Of those, asphyxia was the most common type of injury to the child (83.4%). Anal sphincter tear (29.9%) and infection (23.0%) were the most common types of injury to the mother. Human error, both by midwives (37.1% of all cases given compensation) and obstetricians (51.2%), was an important contributing factor in inadequate obstetric care. Neglecting signs of fetal distress (28.1%), more competent health workers not being called when appropriate (26.3%) and inadequate fetal monitoring (17.3%) were often observed. System errors such as time conflicts, neglecting written guidelines and poor organization of the department were infrequent causes of injury (8.3%). CONCLUSIONS: Fetal asphyxia is the most common reason for compensation, resulting in large financial expenses to society. Human error contributes to inadequate health care in 92% of obstetric compensation claims, although underlying system errors may also be present.

[Who limit vaginal birth for breech presentation: medical practice or Law? Discussion between a medical doctor, a lawyer and the head chief of an university hospital]. / Qui limite l'apprentissage obstétrical et la pratique de l'accouchement de la présentation du siège par voie basse : la médecine ou le droit? Discussion entre un praticien, un avocat et un responsable de service universitaire.

The mode of delivery of breech presentation still remains a debate in France. Despite the medical arguments, themselves in debate, exists a legal pressure felt by medical practitioners. Our study highlights the different opinions of medical practitioners, lawyers and medical teachers faced with breech presentation.