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      Characterization of medical malpractice claims against obstetricians affiliated to FEPASDE in Colombia 1999-2014: historic cohort Translated title: Caracterización de los procesos de responsabilidad médica contra obstetras afiliados al Fepasde en Colombia, en el periodo 1999-2014. Cohorte Histórica

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          Abstract

          Abstract Introduction: Medical malpractice claims have been increasing at a constant rate worldwide, resulting in a burden for practitioners as well as for the health system. In obstetrics, the problem is even greater considering that it is one of the medical specialties with the largest number of medical malpractice suits. Objective: To characterize medical malpractice claims in the area of obstetrics in Colombia from the perspectives of the physician, the patient, the institution, the medical care provided, and the legal proceeding. Materials and methods: Historical descriptive cohort of closed medical malpractice cases between 1999 and 2014 filed against obstetricians affiliated to a special solidarity fund for support in lawsuit cases. Simple random sampling (n = 279) in a universe of 982 proceedings. Variables related to the proceeding, the obstetrician, the institution, medical care, and the patient were measured. Results: The most frequent lawsuits were related to ethics (44.4%). The proportion of unfavorable rulings was 7.7%, more frequently in civil cases (31.8%). The prevalence of lawsuits was higher in private institutions (60%). The majority of the cases were related to patients in the second half of the gestation period (86%). In 74.7% of the cases, legal action was initiated as a result of events occurring during childbirth. The most frequent cause was neonatal compromise (38.9%), followed by fetal compromise (24.7%). Conclusion: Care during childbirth, fetal, and neonatal demise are critical sources of medical malpractice claims.

          Translated abstract

          Resumen Introducción: Los procesos de responsabilidad médica han tenido un aumento sostenido en el mundo, representando una carga para el profesional y el sistema de salud. En obstetricia el problema es aún mayor dada que es una de las especialidades con más acciones médico legales. Objetivo: Caracterizar los procesos de responsabilidad médica en obstetricia en Colombia, desde las dimensiones del médico, la paciente, la institución, la atención médica provista y el proceso legal. Materiales y métodos: Cohorte histórica descriptiva de procesos médico legales cerrados entre 1999 y 2014 contra obstetras asociados a un fondo solidario especial para auxilio en caso de demandas. Muestreo aleatorio simple (n = 279) de un universo de 982 procesos. Se midieron variables del proceso, obstetra, la institución, la atención médica y la paciente. Resultados: Los procesos más frecuentes fueron éticos (44,4%). La proporción de procesos desfavorables fue del 7.7%, con mayor frecuencia en procesos civiles (31,8%). Hubo mayor prevalencia de procesos en instituciones privadas (60%). La mayoría de los procesos ocurrió en pacientes en la segunda mitad de la gestación (86%). La acción judicial estuvo relacionada a hechos acaecidos durante la atención del parto en un 74,7% de las pacientes. La causa más frecuente de la acción legal, fue el compromiso del recién nacido (38,9%) seguido por el compromiso del feto (24,7%). Conclusiones: La atención del parto, la mortalidad fetal y del recién nacido son áreas críticas en la generación de procesos médico legales.

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          Malpractice risk according to physician specialty.

          Data are lacking on the proportion of physicians who face malpractice claims in a year, the size of those claims, and the cumulative career malpractice risk according to specialty. We analyzed malpractice data from 1991 through 2005 for all physicians who were covered by a large professional liability insurer with a nationwide client base (40,916 physicians and 233,738 physician-years of coverage). For 25 specialties, we reported the proportion of physicians who had malpractice claims in a year, the proportion of claims leading to an indemnity payment (compensation paid to a plaintiff), and the size of indemnity payments. We estimated the cumulative risk of ever being sued among physicians in high- and low-risk specialties. Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic-cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics. It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties. There is substantial variation in the likelihood of malpractice suits and the size of indemnity payments across specialties. The cumulative risk of facing a malpractice claim is high in all specialties, although most claims do not lead to payments to plaintiffs. (Funded by the RAND Institute for Civil Justice and the National Institute on Aging.).
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            Consequences of defensive medicine, second victims, and clinical-judicial syndrome on surgeons' medical practice and on health service.

            Increased knowledge in disease causes and progression, along with technological and technical advancements in their diagnosis and treatment, have led to increased expectations from physicians by patients and their relatives. The condition of "second victim" is known to affect caregivers that commit an error, and seriously impairs private life and subsequent practice. Besides, a condition has been described, the clinical-judicial syndrome, affecting caregivers at any moment during a medical litigation. In this scenario, physicians have started to practice "defensive medicine", aimed at protect themselves from liability rather than actually advancing care of patients. This paper represents the first review on defensive medicine with specific focus on surgery in an Italian setting. We reviewed the literature on the topic, with particular focus on surgeons and Italian current status, and provide the readers with a snapshot on these relevant issues, proposing strategies to prevent and reduce the practice of defensive medicine, and to support patients and physicians suffering from medical errors.
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              The medical liability climate and prospects for reform.

              For many physicians, the prospect of being sued for medical malpractice is a singularly disturbing aspect of modern clinical practice. State legislatures have enacted tort reforms, such as caps on damages, in an effort to reduce the volume and costs of malpractice litigation. Attempts to introduce similar traditional reform measures at the federal level have so far failed. Much less prominent, but potentially more important, are proposed alternative approaches for resolving medical injuries; a number of these efforts are currently being tested in federally sponsored demonstration projects. These nontraditional reforms have considerable promise for addressing some of the system's most challenging issues, including high costs and barriers to accessing compensation. In this Special Communication, we review recent national trends in medical liability claims and costs, which indicate a sharp reduction in the rate of paid claims and flat or declining levels in compensation payments and liability insurance costs over the last 7 to 10 years. We discuss a number of nontraditional reform approaches--communication-and-resolution programs, presuit notification and apology laws, safe harbor legislation, judge-directed negotiation, and administrative compensation systems--and we conclude by describing several forces likely to shape change in the medical liability environment over the next decade.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rca
                Revista Colombiana de Anestesiología
                Rev. colomb. anestesiol.
                SCARE-Sociedad Colombiana de Anestesiología y Reanimación (Bogotá, Cundinamarca, Colombia )
                0120-3347
                June 2018
                : 46
                : 2
                : 112-118
                Affiliations
                [3] Bogotá orgnameFundación Universitaria de Ciencias de la Salud Colombia
                [5] Bogotá Arauca orgnameUniversidad Nacional de Colombia Colombia
                [4] Bogotá orgnameSociedad Colombiana de Anestesiología y Reanimación Colombia
                [2] Bogotá orgnameSociedad Colombiana de Anestesiología y Reanimación Colombia
                [1] Bogotá orgnameUniversidad Nacional de Colombia orgdiv1School of Medicine Colombia
                Article
                S0120-33472018000200112
                10.1097/cj9.0000000000000022
                51ed9005-f69a-4950-ab62-01026bdfbf83

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 7
                Product

                SciELO Colombia


                Forensic Medicine,Liability,Legal,Administrative Claims,Healthcare,Legal Process,Obstetricia,Medicina Legal,Responsabilidad Legal,Reclamos Administrativos en el Cuidado de la Salud,Proceso Legal,Obstetrics

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