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Healthcare
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Update on Malpractice and Medical Liability
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Update on Malpractice and Medical Liability

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Healthcare Quality and Patient Safety".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 19359

Special Issue Editor

Prof. Dr. Nunzio R. Di Nunno

E-Mail Website
Guest Editor
Department of Sperimental Medicine, School of Medicine, Salento University, 73100 Lecce, Italy
Interests: forensic sciences; medical negligence; medical malpractice; medical liability

Special Issue Information

Dear Colleagues,

When a medical provider’s actions or inaction fail to meet the medical standard of care, their behavior constitutes medical negligence. If their medical negligence causes their patient to suffer an injury, it becomes medical malpractice. When the patient can prove the various legal elements that add up to medical malpractice, they can take legal action against the negligent medical provider to recover compensation for their injury. The idea that doctors never make professional mistakes has gradually changed in the past twenty years, as can easily be understood from the medical literature on the subject, since it has become recognized that a medical (iatrogenic) mistake is always possible bearing in mind the difficulties inherent to the profession itself. It is often the final link in a chain of factors, so the last figure called upon to act is not necessarily the one responsible or, at any rate, not the only one responsible for the adverse or terminal event.

This change in attitude is due to the fact that, increasingly often, the patient is cared for not by a single doctor but by a whole team that belongs, moreover, in its turn to a health facility that must possess certain quality and efficiency features. Moreover, the COVID-19 pandemic has substantially impacted malpractice lawsuits, both in fatal SARS-CoV-2 infections and during the vaccination program.

The purpose of this Special Issue is to collect the different experiences worldwide in the forensic field regarding medical liability, including original investigations, case series, case reports, and reviews. This will help the reader to understand which practices and procedures are most involved in medical malpractice, and the tools we have available to verify the conduct of the healthcare professionals involved.

Dr. Nunzio Di Nunno
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • medical negligence
  • medical malpractice
  • medical liability
  • forensic sciences

Published Papers (9 papers)

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Research

Jump to: Review, Other

10 pages, 586 KiB  
Article
Requests for Compensation in Cases Involving Patients’ Falls in Healthcare Settings: A Retrospective Analysis
by Federica Mele, Mirko Leonardelli, Stefano Duma, Carlo Angeletti, Gerardo Cazzato, Carmelo Lupo, Ettore Gorini, Cristoforo Pomara, Alessandro Dell’Erba and Maricla Marrone
Healthcare 2023, 11(9), 1290; https://doi.org/10.3390/healthcare11091290 - 30 Apr 2023
Cited by 2 | Viewed by 2008
Abstract
Falls are the most frequent adverse events recorded in healthcare facilities. By employing a multifaceted strategy to ensure prevention interventions that are specific to the patient type and environmental risk management, risk factor evaluation may help to reduce falls in the hospital setting. [...] Read more.
Falls are the most frequent adverse events recorded in healthcare facilities. By employing a multifaceted strategy to ensure prevention interventions that are specific to the patient type and environmental risk management, risk factor evaluation may help to reduce falls in the hospital setting. Patient falls are one of the main causes of lawsuits against hospitals, which has led to the development of validated instruments that are beneficial in treating the patient after the incident and effective in minimizing the frequency of falls. The aim of our study is to evaluate compensation claims asserting healthcare culpability in situations where a patient fell in a hospital setting. The collected data relate to judgments issued in Italy until December 2022 regarding 30 episodes of falls that occurred between 2003 and 2018. Our research revealed that approximately 50% of Italian healthcare organizations lose the case in court when a patient falls in a hospital setting and dies or is injured. In half of these cases, the failure of the medical staff to use protective equipment against falls is what led to the court’s acceptance of the compensation claim. In order to improve the quality of healthcare services, fall prevention techniques must continue to be implemented. Full article
(This article belongs to the Special Issue Update on Malpractice and Medical Liability)
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17 pages, 4295 KiB  
Article
Collateral Victims of Defensive Medical Practice
by Ana Cernega, Marina Meleșcanu Imre, Alexandra Ripszky Totan, Andreea Letiția Arsene, Bogdan Dimitriu, Delia Radoi, Marina-Ionela Ilie and Silviu-Mirel Pițuru
Healthcare 2023, 11(7), 1007; https://doi.org/10.3390/healthcare11071007 - 01 Apr 2023
Cited by 1 | Viewed by 1557
Abstract
This paper analyzes the phenomenon of defensive medical practice, starting from the doctor–patient relationship, and the behavioral and professional factors that can influence the proper functioning of this relationship and the healthcare system. We analyze medical malpractice, given the increase in the number [...] Read more.
This paper analyzes the phenomenon of defensive medical practice, starting from the doctor–patient relationship, and the behavioral and professional factors that can influence the proper functioning of this relationship and the healthcare system. We analyze medical malpractice, given the increase in the number of accusations, as an essential factor in triggering the defensive behavior of doctors, together with other complementary factors that emphasize the need for protection and safety of doctors. The possible consequences for the doctor–patient relationship that defensive practice can generate are presented and identified by analyzing the determining role of the type of health system (fault and no-fault). At the same time, we investigate the context in which overspecialization of medical personnel can generate a form of defensive practice as a result of the limiting effect on the performance of a certain category of operations and procedures. The increase in the number of malpractice accusations impacts the medical community—“the stress syndrome induced by medical malpractice”—turning doctors into collateral victims who, under the pressure of diminishing their reputational safety, practice defensively to protect themselves from future accusations. This type of defensive behavior puts pressure on the entire healthcare system by continuously increasing costs and unresolved cases, which impact patients by limiting access to medical services in the public and private sectors. Full article
(This article belongs to the Special Issue Update on Malpractice and Medical Liability)
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16 pages, 376 KiB  
Article
Healthcare Liability and Thyroidectomy: When Is the Surgeon Wrong?
by Maricla Marrone, Carlo Angeletti, Mirko Leonardelli, Stefano Duma, Gerardo Cazzato, Ettore Gorini, Alessandro Dell'Erba and Cristoforo Pomara
Healthcare 2023, 11(4), 577; https://doi.org/10.3390/healthcare11040577 - 15 Feb 2023
Cited by 1 | Viewed by 1132
Abstract
Thyroid surgeries can often lead to operative complications, sometimes with consequences on the patient’s health. This often leads to claims for compensation but the assessments of consultants and judges are not always objective. Based on these considerations, the authors analyzed forty-seven sentences issued [...] Read more.
Thyroid surgeries can often lead to operative complications, sometimes with consequences on the patient’s health. This often leads to claims for compensation but the assessments of consultants and judges are not always objective. Based on these considerations, the authors analyzed forty-seven sentences issued between 2013 and 2022 regarding claims of alleged medical malpractice. This analysis aims to examine the cases presented in the sentences and the evaluations proposed by the judges to offer ideas for objective evaluation by the legislation in force in Italy. Full article
(This article belongs to the Special Issue Update on Malpractice and Medical Liability)
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8 pages, 241 KiB  
Article
Geographic and Specialty-Specific Disparities in Physicians’ Legal Compliance: A National-Scale Assessment of Romanian Medical Practice
by Codrut Andrei Nanu, Maria Cristina Plaiasu and Antoine Edu
Healthcare 2023, 11(4), 499; https://doi.org/10.3390/healthcare11040499 - 08 Feb 2023
Cited by 2 | Viewed by 1261
Abstract
Background: Physicians must respect their patients’ rights to informed consent, privacy, access to medical records, non-discrimination, treatment by a qualified doctor, and a second medical opinion. Compliance with patients’ rights is mandatory, and legal breaches are considered medical malpractice under Romanian law. This [...] Read more.
Background: Physicians must respect their patients’ rights to informed consent, privacy, access to medical records, non-discrimination, treatment by a qualified doctor, and a second medical opinion. Compliance with patients’ rights is mandatory, and legal breaches are considered medical malpractice under Romanian law. This is the first study to assess physicians’ practices nationally and create a geographical map of legal compliance. Results: We examined survey responses of 2978 physicians, including 1587 general practitioners and 1391 attending physicians from high-risk specialties. According to the findings, 46.67% of physicians’ practices adhered to the law. Physicians’ practices were homogenous across the country’s regions. General practitioners were significantly more legally compliant than attending physicians were. Additionally, 94.02% of the physicians acknowledged malpractice anxiety, whereas only 17.67% had been accused of malpractice. Conclusions: Our findings emphasize the need for further research and to voice issues about Romanian physicians’ low level of legal compliance. This study provides a starting point for future studies to evaluate the benefits of interventional strategies in this field. Healthcare facilities should provide physicians with easily available resources when they are unsure about their legal obligations, and establish an observer organization that can detect unlawful conduct. Interventions should concentrate on education programs and expert guidance. Full article
(This article belongs to the Special Issue Update on Malpractice and Medical Liability)

Review

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11 pages, 867 KiB  
Review
Consent and Complications in Health Care: The Italian Context
by Maricla Marrone, Enrica Macorano, Giuseppe Lippolis, Pierluigi Caricato, Gerardo Cazzato, Antonio Oliva and Benedetta Pia De Luca
Healthcare 2023, 11(3), 360; https://doi.org/10.3390/healthcare11030360 - 27 Jan 2023
Cited by 2 | Viewed by 1686
Abstract
Informed consent is the manifestation of the will that a patient freely expresses toward a medical treatment. The physician is responsible for acquiring informed consent for both medical and nursing procedures. Informed consent represents a juridical–deontological tool that allows therapeutic choices to be [...] Read more.
Informed consent is the manifestation of the will that a patient freely expresses toward a medical treatment. The physician is responsible for acquiring informed consent for both medical and nursing procedures. Informed consent represents a juridical–deontological tool that allows therapeutic choices to be shared with the user after having exhaustively explained the risks and benefits of the procedure itself. In fact, the physician has an obligation to provide the patient with clear and comprehensible information about the type of service, the methods of delivery, the benefits, the risks, even unforeseeable ones, and the complications. According to Italian legal guidelines, in cases of presumed health responsibility, the health professional accused of negligence will have to demonstrate that any complication that has arisen, although foreseeable, was not preventable. Through the analysis of a clinical case relating to the procedure of insertion of a bladder catheter performed by a nurse and a review of the literature, the authors explain the importance of the information that must be provided to the patient before carrying out any invasive procedure, even if not performed by the doctor. The authors describe the problem in the Italian context and propose a possible solution. Full article
(This article belongs to the Special Issue Update on Malpractice and Medical Liability)
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10 pages, 1184 KiB  
Review
Pressure Ulcers from the Medico-Legal Perspective: A Case Report and Literature Review
by Filippo Gibelli, Paolo Bailo, Ascanio Sirignano and Giovanna Ricci
Healthcare 2022, 10(8), 1426; https://doi.org/10.3390/healthcare10081426 - 29 Jul 2022
Cited by 3 | Viewed by 2899
Abstract
Introduction: The identification of professional liability profiles related to the development of pressure injuries is a very thorny issue from a medico-legal perspective. This is because no matter how strict the applied prevention protocols applied may be, the development of such injuries is [...] Read more.
Introduction: The identification of professional liability profiles related to the development of pressure injuries is a very thorny issue from a medico-legal perspective. This is because no matter how strict the applied prevention protocols applied may be, the development of such injuries is largely dependent on endogenous factors. This paper aims to investigate the medico-legal issues related to this topic through the exposition of one case of medico-legal litigation and a traditional review of the literature. Methods: We performed a literature search using three databases (Pubmed, Scopus, and Web Of Science), restricting the search to the period between 2001 and 2021. We used “pressure ulcers” and “jurisprudence” as the main keywords. From an initial library of 236 articles, our selection resulted in 12 articles, which were included in the review. Results: We identified the ever-increasing expectations of patients and the concept of automatic attribution of responsibility when a pressure ulcer develops as the primary reasons for the increase in litigation over the past 20 years. The related corrective measures are numerous: a strict adherence to guidelines, an adequate documentation of preventive measures, a risk assessment, family involvement, and a successful collaboration between physicians and government institutions. Conclusions: The biological complexity of the pathogenetic development of pressure ulcers makes the subject very delicate from the medico-legal point of view. In principle, it is possible to state that a very large proportion of such injuries are preventable, but that there remains a percentage of them that cannot be prevented. In such cases, only a proper documentary demonstration of the adequacy of preventive measures can exclude liability profiles. Full article
(This article belongs to the Special Issue Update on Malpractice and Medical Liability)
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10 pages, 508 KiB  
Review
Medical Malpractice Lawsuits Involving Trainees in Obstetrics and Gynecology in the USA
by Summer Ghaith, Ronna L. Campbell, Jordan R. Pollock, Vanessa E. Torbenson and Rachel A. Lindor
Healthcare 2022, 10(7), 1328; https://doi.org/10.3390/healthcare10071328 - 17 Jul 2022
Cited by 6 | Viewed by 2408
Abstract
Background: While the liability risks for obstetrics and gynecology (ob/gyn) physicians are widely recognized, little is known about how trainees have been involved in ob/gyn lawsuits. Objectives: To characterize involvement of trainees in malpractice lawsuits related to ob/gyn. Methods: The legal database Westlaw [...] Read more.
Background: While the liability risks for obstetrics and gynecology (ob/gyn) physicians are widely recognized, little is known about how trainees have been involved in ob/gyn lawsuits. Objectives: To characterize involvement of trainees in malpractice lawsuits related to ob/gyn. Methods: The legal database Westlaw was utilized to collect ob/gyn-related malpractice lawsuits involving trainees reported from 1986 to 2020 in the USA. Outcome: Forty-six malpractice cases involving ob/gyn trainees were identified, including 34 cases related to obstetrics and 12 to gynecology. There were 11 cases alleging lack of informed consent, including 7 cases alleging lack of consent for trainee involvement. Of the 34 obstetrics cases, 27 related to procedural complications, 17 to treatment, 13 to diagnosis, and 4 to informed consent. Of these, 17 were decided in favor of the physician, 6 resulted in findings of negligence, 9 had unknown outcomes, and 3 ended in settlement. For the 6 cases ending in a finding of negligence, the mean award was $2,174,472 compared to $685,000 for those that were settled. Of the 12 gynecology cases, 8 related to procedural complications, 7 to informed consent, 3 to diagnosis, and 2 to treatment. Of these, 6 were decided in favor of the physician, 3 resulted in findings of negligence, and 3 had unknown outcomes. For the cases ending in a finding of negligence, the mean award was $465,000. Conclusions and Outlook: This review of malpractice cases highlights types of situations in which trainees are sued and reveals the importance of designing curriculum around faculty training and supervision regarding trainee involvement in patient care. Full article
(This article belongs to the Special Issue Update on Malpractice and Medical Liability)
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Other

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9 pages, 1267 KiB  
Commentary
Failure in Medical Practice: Human Error, System Failure, or Case Severity?
by Mihai Dan Roman, Sorin Radu Fleacă, Adrian Gheorghe Boicean, Cosmin Ioan Mohor, Silviu Morar, Horatiu Dura, Adrian Nicolae Cristian, Dan Bratu, Ciprian Tanasescu, Adrian Teodoru, Radu Necula and Octav Russu
Healthcare 2022, 10(12), 2495; https://doi.org/10.3390/healthcare10122495 - 09 Dec 2022
Cited by 3 | Viewed by 2051
Abstract
The success rate in medical practice will probably never reach 100%. Success rates depend on many factors. Defining the success rate is both a technical and a philosophical issue. In opposition to the concept of success, medical failure should also be discussed. Its [...] Read more.
The success rate in medical practice will probably never reach 100%. Success rates depend on many factors. Defining the success rate is both a technical and a philosophical issue. In opposition to the concept of success, medical failure should also be discussed. Its causality is multifactorial and extremely complex. Its actual rate and its real impact are unknown. In medical practice, failure depends not only on the human factor but also on the medical system and has at its center a very important variable—the patient. To combat errors, capturing, tracking, and analyzing them at an institutional level are important. Barriers such as the fear of consequences or a specific work climate or culture can affect this process. Although important data regarding medical errors and their consequences can be extracted by analyzing patient outcomes or using quality indicators, patient stories (clinical cases) seem to have the greatest impact on our subconscious as medical doctors and nurses and these may generate the corresponding and necessary reactions. Every clinical case has its own story. In this study, three different cases are presented to illustrate how human error, the limits of the system, and the particularities of the patient’s condition (severity of the disease), alone or in combination, may lead to tragic outcomes There is a need to talk openly and in a balanced way about failure, regardless of its cause, to look at things as they are, without hiding the inconvenient truth. The common goal is not to find culprits but to find solutions and create a culture of safety. Full article
(This article belongs to the Special Issue Update on Malpractice and Medical Liability)
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4 pages, 1432 KiB  
Case Report
Broken Needle Embedded in the Body during Vascular Puncture
by Hye Sook Choi
Healthcare 2022, 10(8), 1436; https://doi.org/10.3390/healthcare10081436 - 31 Jul 2022
Viewed by 3257
Abstract
The use of needles is essential in most medical procedures and surgery; however, needle breakage is not known to happen very frequently. Even if it does, it is most likely to occur during dental procedures, sutures, aspiration, biopsy, anesthesia, and drug abuse. To [...] Read more.
The use of needles is essential in most medical procedures and surgery; however, needle breakage is not known to happen very frequently. Even if it does, it is most likely to occur during dental procedures, sutures, aspiration, biopsy, anesthesia, and drug abuse. To our knowledge, this is the first report about needle detachment from the syringe during a vascular puncture for blood collection. In this case, an 87-year-old obese woman with generalized edema had repeated vascular punctures to the femoral artery for arterial blood gas analysis (ABGA). After blood collection at this instance, when the syringe was pulled out, the needle was detached from it. Radiography revealed that the broken needle was lodged in the groin. A surgical incision with the fluoroscopic radiography located the embedded needle in the soft tissue and allowed the retrieval of its fragments from the groin soft tissue. Obesity and repeated punctures may increase the risk of needle breakage and prior inspection of needles for such procedures may be necessary. Full article
(This article belongs to the Special Issue Update on Malpractice and Medical Liability)
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