Josep Benet-Travé

Analysis of obstetrics and gynecology professional liability claims in Catalonia, Spain (1986-2010).

OBJECTIVE To identify relevant factors involved in obstetrics and gynecology (OG) professional liability claims to help archive better management of risks. STUDY DESIGN Analysis of 885 OG claims opened between 1986 and 2010, with the identification of the most common events leading to a claim, the economical and juridical characteristics of the claims, as well as the relevant trends over the study period. RESULTS Most claims related to obstetrics. Labor, delivery and its complications accounted for 33.1% of the claims; 12.77% related specifically to cesarean. Oncological diseases, fetus death during labor and delivery, neurologically impaired infant and histerectomy-related problems were the most frequently claimed events. Most cases ended up without an indemnity payment and 37.7% of closed files were solved by an out-of-court procedure. Average payment was higher for the obstetric procedures than for those concerning gynecology cases. The proportion of claims relating to obstetrics increased during the study period, as well as the average payment. CONCLUSION OG is at high-risk for malpractice claims, but compensation awards are not frequent. However, particular events, such as retained foreign objects, tubal ligation, ultrasound diagnosis or neurologically impaired newborns, deserve special attention regarding medico-legal issues.

Catastrophic Medical Malpractice Payouts in Spain

Abstract:Patient safety and professional liability are major concerns worldwide. Despite the pervasive influence of catastrophic malpractice payouts, little is known about the specific characteristics and the overall relevance and characteristics of these payouts, especially outside U.S. borders. Five hundred fifty claims led to a payout among 2,236 claims from January 1, 2004 to December 31, 2010, in Catalonia (Spain). We analyzed data on patient, provider, and claim characteristics. Accordingly to our sample, Spanish catastrophic payouts (SCP) were defined as payouts over &OV0556;200,000, which was found in 32 cases (5.8%). Diagnostic errors and patient death were not as relevant as previously reported. However, it is remarkable that the literature emanating from different countries shows similar trends besides contextual differences: patients suffering minor injuries are not likely to receive a catastrophic payout, catastrophic payouts are associated with patient age less than one; SCP are most associated with anesthesiology and resuscitation, general surgery, and obstetrics and gynecology; and SCP were more likely to occur when a case went to trial compared to when a case was settled out of court. Studies, such as this, provide a wider picture of the medical liability worldwide reality and helps avoiding isolated discourses.

Professional Liability Claims in Vascular Surgery Practice

BACKGROUND Patient safety is a major concern worldwide, but particularly high rates of adverse events are reported in the surgery setting. Angiology and vascular surgery is of special interest due to the complexity of the pathologies involved and the esthetic component of some of its procedures. In this study we identified the most frequent factors that apply to vascular surgery claims to determine areas of special risk in vascular surgery, with an aim to improve patient safety. METHODS We performed a retrospective and descriptive study of the claims pertaining to vascular surgery from the database of the Service of Professional Liability (SRP) of the Official College of Physicians of Barcelona. The time frame of data collection was from 1986 to 2009. We analyzed both the clinical and legal characteristics of the cases. RESULTS Of the total of 6952 registered claims during the 23-year period, 91 (1.3%) were related to the practice of vascular surgery. Of these, 53.8% were related to venous pathology and 46.1% to arterial pathology. Neurologic damage was the main motive for claims (15.3%), followed by thromboembolic disease (14.2%), burns as a result of cosmetic treatment (12%), and amputation (10.9%). The neurologic damage in relation to vein pathology registered the greatest proportion of cases with professional liability (30.8%), followed by burns (19.2%), forgotten gauze (11.5%), and amputations (11.5%). CONCLUSIONS Angiology and vascular surgery does not seem to be a specialty with a high risk for claims, but complications, such as thromboembolic disease and neurologic damage after varicose vein intervention, do occur and deserve special attention so improvements can be made to patient safety.

Procedimientos quirúrgicos objeto de reclamación por presunto defecto de praxis

Resumen La responsabilidad profesional medica y los episodios adversos en la asistencia sanitaria son preocupaciones de primer orden en el ambito internacional y el analisis de las reclamaciones por presunto defecto de praxis supone una potencial fuente de conocimiento. Se han descrito tasas especificamente elevadas de episodios adversos y reclamaciones en los procedimientos quirurgicos. El presente articulo analiza las reclamaciones interpuestas ante el Consejo de Colegios de Medicos de Cataluna entre los anos 1986 y 2012, mediante la exploracion de los procedimientos quirurgicos reclamados mediante codificacion CIE-9-MC, asi como el resultado final de la reclamacion. Entre los 5.419 expedientes identificados sobre procedimientos quirurgicos destacaron, por su elevada frecuencia, las intervenciones del sistema musculoesqueletico y de piel y tegumentos. Las intervenciones correspondientes a la medicina “no curativa” destacaron por sus elevadas tasas de procedimientos que finalizaron mediante acuerdo transaccional o condena, que resulto significativamente mayor para las mastopexias. Los resultados obtenidos subrayan la importancia del area quirurgica en responsabilidad profesional medica y el riesgo elevado de condena de los procedimientos pertenecientes a la denominada “medicina satisfactiva o no curativa”.

Surgical procedures involved in claims for alleged defects in praxis

Resumen La responsabilidad profesional medica y los episodios adversos en la asistencia sanitaria son preocupaciones de primer orden en el ambito internacional y el analisis de las reclamaciones por presunto defecto de praxis supone una potencial fuente de conocimiento. Se han descrito tasas especificamente elevadas de episodios adversos y reclamaciones en los procedimientos quirurgicos. El presente articulo analiza las reclamaciones interpuestas ante el Consejo de Colegios de Medicos de Cataluna entre los anos 1986 y 2012, mediante la exploracion de los procedimientos quirurgicos reclamados mediante codificacion CIE-9-MC, asi como el resultado final de la reclamacion. Entre los 5.419 expedientes identificados sobre procedimientos quirurgicos destacaron, por su elevada frecuencia, las intervenciones del sistema musculoesqueletico y de piel y tegumentos. Las intervenciones correspondientes a la medicina “no curativa” destacaron por sus elevadas tasas de procedimientos que finalizaron mediante acuerdo transaccional o condena, que resulto significativamente mayor para las mastopexias. Los resultados obtenidos subrayan la importancia del area quirurgica en responsabilidad profesional medica y el riesgo elevado de condena de los procedimientos pertenecientes a la denominada “medicina satisfactiva o no curativa”.

Procedimientos quirúrgicos objeto de reclamación por presunto defecto de praxisSurgical procedures involved in claims for alleged defects in praxis

Resumen La responsabilidad profesional medica y los episodios adversos en la asistencia sanitaria son preocupaciones de primer orden en el ambito internacional y el analisis de las reclamaciones por presunto defecto de praxis supone una potencial fuente de conocimiento. Se han descrito tasas especificamente elevadas de episodios adversos y reclamaciones en los procedimientos quirurgicos. El presente articulo analiza las reclamaciones interpuestas ante el Consejo de Colegios de Medicos de Cataluna entre los anos 1986 y 2012, mediante la exploracion de los procedimientos quirurgicos reclamados mediante codificacion CIE-9-MC, asi como el resultado final de la reclamacion. Entre los 5.419 expedientes identificados sobre procedimientos quirurgicos destacaron, por su elevada frecuencia, las intervenciones del sistema musculoesqueletico y de piel y tegumentos. Las intervenciones correspondientes a la medicina “no curativa” destacaron por sus elevadas tasas de procedimientos que finalizaron mediante acuerdo transaccional o condena, que resulto significativamente mayor para las mastopexias. Los resultados obtenidos subrayan la importancia del area quirurgica en responsabilidad profesional medica y el riesgo elevado de condena de los procedimientos pertenecientes a la denominada “medicina satisfactiva o no curativa”.