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Background An increased interest in medical liability claims has been noticed. Nevertheless, detailed data on subject of claims and possible factors that contribute to litigation and indemnity payments are scarce and relatively dated. Insight into these data may provide valuable information to prevent both incidents and malpractice claims. Objective To analyse the subject, outcome and costs of malpractice claims related to gynaecological care and their connection with treatment indications and treatment phases. Design A retrospective analysis of malpractice claims related to gynaecology. Setting All claims related to gynaecology, filed and closed by Netherlands’ largest liability insurance company, Centramed between 2005 and 2022. Sample N  = 382. Methods An in-depth analysis of claim files was performed. Results A total of 68.6% of the claims were related to perioperative incidents. A total of 88.0% of all claims were related to treatments with a benign indication and only 12.0% were related to malignancies. The share of malignant treatment indications was high for claims related to diagnostic incidents (37.9%), compared to 7.3% for claims related to surgical treatment. Liability was accepted in 22.5% of all claims. The total costs of all claims amount €6,6mlj. Besides the indication for treatment, deficient expectation management (a lack of informed consent) contributes to dissatisfaction and increases the risk of malpractice claims. Finally, an inadequate medical file compromises legal defence and influences the judgement and settlement of malpractice claims. Conclusions There is a connection between treatment indications and treatment phases and the risk of malpractice claims and their outcome.

BACKGROUNDThere is widespread agreement that the full potential of health information technology (health IT) has not yet been realized and of particular concern are the examples of unintended consequences of health IT that detract from the safety of health care or from the use of health IT itself. The goal of this project was to obtain additional information on these health IT–related problems, using a mixed methods (qualitative and quantitative) analysis of electronic health record–related harm in cases submitted to a large database of malpractice suits and claims. METHODSCases submitted to the CRICO claims database and coded during 2012 and 2013 were analyzed. A total of 248 cases (<1%) involving health IT were identified and coded using a proprietary taxonomy that identifies user- and system-related sociotechnical factors. Ambulatory care accounted for most of the cases (146 cases). Cases were most typically filed as a result of an error involving medications (31%), diagnosis (28%), or a complication of treatment (31%). More than 80% of cases involved moderate or severe harm, although lethal cases were less likely in cases from ambulatory settings. Etiologic factors spanned all of the sociotechnical dimensions, and many recurring patterns of error were identified. CONCLUSIONSAdverse events associated with health IT vulnerabilities can cause extensive harm and are encountered across the continuum of health care settings and sociotechnical factors. The recurring patterns provide valuable lessons that both practicing clinicians and health IT developers could use to reduce the risk of harm in the future. The likelihood of harm seems to relate more to a patientʼs particular situation than to any one class of error.

Incident reporting is an important method to identify risks because learning from the reports is crucial in developing and implementing effective improvements. A medical malpractice claims analysis is an important tool in any case. Both incident reports and claims show cases of damage caused to patients, despite incident reporting comprising near misses, cases where no event occurred and no-harm events. We therefore compare the two worlds to assess whether they are similar or definitively different. From 1 January 2014 to 31 December 2021, the claims database of Policlinico Universitario A. Gemelli IRCCS collected 843 claims. From 1 January 2020 to 31 December 2021, the incident-reporting database collected 1919 events. In order to compare the two, we used IBNR calculation, usually adopted by the insurance industry to determine loss to a company and to evaluate the real number of adverse events that occurred. Indeed, the number of reported adverse events almost overlapped with the total number of events, which is indicative that incurred-but-not-reported events are practically irrelevant. The distribution of damage events reported as claims in the period from 1 January 2020 to 31 December 2021 and related to incidents that occurred in the months of the same period, grouped by quarter, was then compared with the distribution of damage events reported as adverse events and sentinel events in the same period, grouped by quarter. The analysis of the claims database showed that the claims trend is slightly decreasing. However, the analysis of the reports database showed that, in the period 2020–2021, the reports trend was increasing. In our study, the comparison of the two, malpractice claims and incident reporting, documented many differences and weak areas of overlap. Nevertheless, this contribution represents the first attempt to compare the two and new studies focusing on single types of adverse events are, therefore, desirable.

BackgroundThe complication rate of modern antireflux surgery or paraesophageal hernia repair is unknown, and previous estimates have been extrapolated from institutional cohorts.MethodsA population-based retrospective cohort study of patient injury cases involving antireflux surgery and paraesophageal hernia repair from the Finnish National Patient Injury Centre (PIC) register between Jan 2010 and Dec 2020. Additionally, the baseline data of all the patients who underwent antireflux and paraesophageal hernia operations between Jan 2010 and Dec 2018 were collected from the Finnish national care register.ResultsDuring the study period, 5734 operations were performed, and the mean age of the patients was 54.9 ± 14.7 years, with 59.3% (n = 3402) being women. Out of all operations, 341 (5.9%) were revision antireflux or paraesophageal hernia repair procedures. Antireflux surgery was the primary operation for 79.9% (n = 4384) of patients, and paraesophageal hernia repair was the primary operation for 20.1% (n = 1101) of patients. A total of 92.5% (5302) of all the operations were laparoscopic. From 2010 to 2020, 60 patient injury claims were identified, with half (50.0%) of the claims being related to paraesophageal hernia repair. One of the claims was made due to an injury that resulted in a patient's death (1.7%). The mean Comprehensive Complication Index scores were 35.9 (± 20.7) and 47.6 (± 20.8) (p = 0.033) for antireflux surgery and paraesophageal hernia repair, respectively. Eleven (18.3%) of the claims pertained to redo surgery.ConclusionsThe rate of antireflux surgery has diminished and the rate of paraesophageal hernia repair has risen in Finland during the era of minimally invasive surgery. Claims to the PIC remain rare, but claims regarding paraesophageal hernia repairs and redo surgery are overrepresented. Additionally, paraesophageal hernia repair is associated with more serious complications.

Shared decision-making (SDM) is considered the preferred communication model, yet its applicability in the diagnostic process is understudied. To identify clinical situations in the diagnostic process that could benefit from SDM. An observational study of closed malpractice claims against general practitioners (2012-2020) related to problems of diagnosis, obtained from a liability insurance company in the Netherlands. We established SDM-selection criteria, specified for the diagnostic process (i.e. diagnostic uncertainty, multiple options and clinical equipoise). Phase 1: We selected and categorised eligible cases, using summarised information from a claim database. Phase 2: We analysed 90 fully documented claims and extracted information from GPs and patients related to the diagnostic process. Using this data, we conducted an inductive thematic analysis. Phase 1: 261 out of 1477 claims (18%) met the SDM-selection criteria. The main reason for complaints was (omitted) test-ordering (155 claims, 59.4%). The most frequent final diagnoses were: fracture (49%), malignancy (10%), infection (9%), tendon rupture (8%) and cardiovascular disease (4%). Phase 2: Six types of diagnostic considerations emerged from the data: diagnostic uncertainty, using time as a diagnostic tool, management consequences, information about test indication or procedure, indications for re-evaluation and individual patient context. Contradictory statements from GPs and patients demonstrated a lack of shared understanding. The diagnostic process could benefit from SDM in several areas, including discussing diagnostic options, test conditions (e.g. timing and procedure) and follow-up. SDM training programs should be tailored to encourage clinicians to apply SDM in diagnostic decisions.

The Surgical Patient Safety System (SURPASS) has been proven to improve patient outcomes. However, few studies have evaluated the details of litigation and its prevention in terms of systemic and diagnostic errors as potentially preventable problems. The present study explored factors associated with accepted claims (surgeon-loss). We retrospectively searched the national Japanese malpractice claims database between 1961 and 2017. Using multivariable logistic regression models, we assessed the association between medical malpractice variables (systemic and diagnostic errors, facility size, time, place, and clinical outcomes) and litigation outcomes (acceptance). We evaluated whether or not the factors associated with litigation could have been prevented with the SURPASS checklist. We identified 339 malpractice claims made against general surgeons. There were 159 (56.3%) accepted claims, and the median compensation paid was 164,381 USD. In multivariable analyses, system (odds ratio, 27.2 95% confidence interval 13.8–53.5) and diagnostic errors (odds ratio 5.3, 95% confidence interval 2.7–10.5) had a significant statistical association with accepted claims. The SURPASS checklist may have prevented 7% and 10% of the accepted claims and systemic errors, respectively. It is unclear what proportion of accepted claims indicated that general surgeon loses should be prevented from performing surgery if the SURPASS checklist were used. In conclusion, systemic and diagnostic errors were associated with accepted claims. Surgical teams should adhere to the SURPASS checklist to enhance patient safety and reduce surgeon risk.

BackgroundMedicolegal expertise concerning bariatric surgery has greatly evolved, both quantitatively and qualitatively, but unfortunately, the jurisprudence is poor on the subject.ObjectivesThe aim of this article is to propose a global and practical approach to medical liability in bariatric surgery.SettingUniversity Hospital, FranceMethodsThis is a retrospective study which deals with an analysis of cases of surgical malpractice litigation between 2009 and 2011. Only the malpractice claims taken to the High Court and the Regional Commission of Reconciliation and Compensation have been taken into account in this study.ResultsDuring this period, there were 426 cases of visceral and digestive surgical malpractice litigation, 81 of which involved bariatric surgery (19%). Fistula was the most common complication leading to a malpractice claim (43.67%). The period of time between the allegations and the procedure was 2 years on average, with a range of 1 to 6 years. There were seven fistulas reported with gastric bypass GB (18.5%) and 31 with sleeve gastrectomy SG (81.5%) leading to malpractice claims. In the majority of cases, only the surgeon was implicated. Sometimes the anaesthetist or the surgical staff were implicated separately or “in solidum” with the surgeon. Every surgical technique was examined.ConclusionPatients do not spontaneously differentiate between recovery from a complication and the result of an alleged error. Attention must be paid to the implications and discourteous remarks. Surgical complications are often unpredictable events and are not synonymous with medical mistakes.

Background Medical malpractice presents a significant challenge to the healthcare system in Egypt and other countries, inflicting both physical and psychological harm on patients. Furthermore, it imposes a financial burden on both patients and physicians. This study aimed to analyze the medicolegal aspects of malpractice claims associated with aesthetic interventions. The study also aims to establish explicit criteria for identifying and differentiating positive cases from negative ones. This study is a retrospective descriptive observational analysis of medical malpractice claims related to aesthetic interventions. The data was obtained from the records of the Cairo Medicolegal Area between 2016 and 2020, encompassing a total of 98 cases in the study. Results The majority of cases were females (89.8%). The age group most significantly affected was between 26 to 35 years old. Plastic surgery accounted for the highest percentage (51%) of alleged cases among medical specialties. Consultants were the most frequently accused physicians (32.7%). Liposuction was the most frequent procedure (31.6%). Most of the malpractices occurred in private hospitals (45.9%). The outcome indicated that permanent infirmity accounted for 10.2%, while mortality constituted 3.1%. Conclusions The current study demonstrated that women constitute the predominant demographic in the examined malpractice cases, with plastic surgery being the most common area for alleged claims. The main complaints include disfigurement, dissatisfaction with results, and burn injuries. Aesthetic malpractice is more frequent in private hospitals than in general hospitals, frequently necessitating further treatment due to complications.

Background: Examining medico-legal cases within hospitals aids in identifying care-related problems, facilitating necessary corrections and emphasizing successful preventive measures. The case of Meyer Children’s Hospital is particularly noteworthy as it offers insights into the evolution of litigation in regard to a tertiary pediatric hospital. Methods: The study sample comprised 158 malpractice claims received by Meyer Children’s Hospital from 1 January 2010 to 31 December 2023, which were managed by the Claims Management Committee (CMC) responsible for civil liability within the hospital. In this observational retrospective study, the following variables were analyzed: (1) The characteristics of the patients (age–sex) and the manner in which they interacted with the hospital, ultimately resulting in the compensation claim (method of access, area of specialty, outcomes based on the International Classification of Patient Safety (ICPS)). (2) Medico-legal factors: the details of the compensation claim, the significant issues noted in various cases, and the findings of the medico-legal inquiry conducted by the CMC. In cases of ADR (Alternative Dispute Resolution), we evaluated the nature of the procedure, the results, and the amount of compensation awarded. Results: We conducted a descriptive statistical analysis to delineate the trend of claims and identify specific deficiencies within structures or departments over time. Invasive procedures and surgical operations were identified as the leading causes of accidents, resulting in heightened mortality rates and serious injuries. The most common errors observed were diagnostic and therapeutic. Conclusions: The data that emerged highlighted a low rate of claims (11.28/year) and a low claim/service ratio (0.0002%), suggesting a high level of safety of patient care at the hospital. The acceptance rate (32%), the percentage of rejected cases (48/158~30% of total, or 48/99~49% of resolved claims), the average compensation (EUR 68,312), and the percentage of cases (92%) with judicial opinions consistent with those of the CMC indicate a tendency to pursue exploratory compensation requests and the effectiveness of CMC’s activity. Meanwhile, the predominant error types (surgical and diagnostic) are in accordance with national and international data. Finally, the scarcity of disputes concerning informed consent reflects the impressive effectiveness of the communication strategies utilized by the pediatricians at this center.

In the last few years, the trends of malpractice claims have escalated worldwide. In many judicial systems, forensic medical examiners manage malpractice lawsuits because of their experience in medical, legal, and ethical aspects of healthcare. They analyze medical records to objectively investigate consent-related issues and verify any neglect or deviations from standard medical care. Then, the extent of harm is evaluated in the surviving cases by determining the degree of resulting infirmity. Judicial penalty and compensation depend on the infirmity's percentage. In cases involving patient death, comprehensive post-mortem examinations are performed to explore potential medical errors death causes, and causal relations between error and the occurrence of death. It is essential to consider that evaluating technical errors necessitates the expert opinions of consultants from the same specialties as the accused physicians. The legal obligation for all forensic medicine experts is to provide objective, unbiased, evidence-based medicolegal reports. The ethical commitments include preserving the confidentiality of data of both patients and accused healthcare providers. Also, forensic medical examiners could actively participate in healthcare education to protect medical staff against future malpractice accusations.