关于卫生监督医疗纠纷类图书归类探析

指出第四版《中图法》中有关卫生监督、医疗事故、医疗纠纷等类目中存在的一些问题和不足,并提出具体改进措施和分类建议。     

日本的医疗纠纷处理与防范机制及其对我国的启示

日本的医疗纠纷一直较少,但近几年有增加的趋势.文章对日本医疗纠纷的处理及防范机制进行了详尽的汇总,日本的医疗纠纷处理机制有3种:当事人对话协商、法院诉讼和日本医学协会(JMA)的处理程序.其中的JMA责任保险处理程序很有特色.近几年,日本学者对如何防范医疗纠纷的发生提出了许多实用的观点.在思考、借鉴日本的经验基础上,提出了几点对我国有益的政策建议.     

Impact of the medical care act amendment on the medical malpractice litigation in Taiwan

Medical malpractice leads to medical criminal liability and claims. The national data of medical criminal liabilities across various specializations, before and after the Medical Care Act amendment, was lacking in Taiwan. The aim of this study is to clarify the impact of the law amendment. A comprehensive retrospective analysis of medical crimes was conducted from January 2001 to December 2020 in Taiwan. The number of medical criminal litigation, defendants, people who plead guilty, conviction rate, and punishment sentences were analyzed. Additionally, the number of practicing physicians in the year was used as the baseline to determine the rate of the accused and guilty rate per 10,000 physician-years, respectively. From 2001 to 2020, there were 249 criminal litigations of medical professionals, which gave rise to 335 defendants. The proportion of defendants by specialization was 19.1% in internal medicine, 26.3% in surgery and orthopedics, 11.9% in obstetrics and gynecology, 3.3% in pediatrics, 25.7% in physicians (who were not related to the aforementioned 4 specializations), and 13.7% in non-physician staff. After the amendment to the Medical Care Act in 2017, the accused rates per 10,000 physician-years decreased significantly in aggregate and by specialization between 2016 and 2020; the guilty rate per 10,000 physician-years during 2016 to 2020 was the minimum, compared to the past. The amendment to the Medical Care Act in 2017 reduced the number of vexatious criminal proceedings. The amendment also reduced criminal liabilities by reducing the guilty rate during 2016 to 2020, compared to the previous period.     

Disclosure,Apology, and Offer Programs: Stakeholders’ Views of Barriers to and Strategies for Broad Implementation

Context: The Disclosure, Apology, and Offer (DA&O) model, a response to patient injuries caused by medical care, is an innovative approach receiving national attention for its early success as an alternative to the existing inherently adversarial, inefficient, and inequitable medical liability system. Examples of DA&O programs, however, are few. Methods: Through key informant interviews, we investigated the potential for more widespread implementation of this model by provider organizations and liability insurers, defining barriers to implementation and strategies for overcoming them. Our study focused on Massachusetts, but we also explored themes that are broadly generalizable to other states. Findings: We found strong support for the DA&O model among key stakeholders, who cited its benefits for both the liability system and patient safety. The respondents did not perceive any insurmountable barriers to broad implementation, and they identified strategies that could be pursued relatively quickly. Such solutions would permit a range of organizations to implement the model without legislative hurdles. Conclusions: Although more data are needed about the outcomes of DA&O programs, the model holds considerable promise for transforming the current approach to medical liability and patient safety.     

Medico-legal considerations in the context of neonatal encephalopathy and therapeutic hypothermia

Neonatal encephalopathy (NE) is a significant complication of the peripartum period. It can lead to lifelong neurologic disabilities, including cerebral palsy, cognitive impairments, developmental delays, and epilepsy. Induced hypothermia is the first therapy, which has shown promise in improving the outcomes for neonates with moderate to severe NE following a presumed intrapartum insult.NE is also a frequent source of medical malpractice litigation. In this paper, we will review salient features of the American Tort System as it pertains to medical malpractice. We will discuss the obstetric medico-legal implications of therapeutic hypothermia and suggest a five-step approach to analyzing neonatal cases for causation, etiology, timing of occurrence, responsibility, and liability. We will close with three illustrative clinical cases.     

When Artificial Intelligence Models Surpass Physician Performance: Medical Malpractice Liability in an Era of Advanced Artificial Intelligence

It seems inevitable that diagnostic and recommender artificial intelligence models will ultimately reach a point when they outperform human clinicians. Just as antibiotics displaced a host of medicinals for treating infections, the superior performance of such models will force their adoption. This article contemplates certain ethical and legal implications bearing on that adoption, especially because they involve a clinician’s exposure to allegations of malpractice. The article discusses four relevant considerations: (1) the imperative of using explainable artificial intelligence models in clinical care, (2) specific strategies for diminishing liability when a clinician agrees or disagrees with a model’s findings or recommendations but the patient nevertheless experiences a poor outcome, (3) relieving liability through legislation or regulation, and (4) comprehending such models as “persons” and therefore as potential defendants in legal proceedings. We conclude with observations on clinician–vendor relationships and argue that, although advanced artificial intelligence models have not yet arrived, clinicians must begin considering their implications now.     

The Claims Management Committees trial: Experience of an Italian Hospital of the National Health System

Introduction: In Italy, health care is mainly financed by earmarked central and regional taxes, with regions receiving their allocated share of resources from the National Health Fund. The Council of the Tuscany Region in 2009 began an experimentation aimed to enforce the extrajudicial conciliation. The Council established the Claims Management Committees (CMC) for civil liability in the Tuscan Health Service. The CMC trial provides that the damages are compensated directly by the hospital, removing the cost of liability insurance. The aim of this study is to collect and compare the liability-insurance-period and the CMC trial-period. Materials and methods: Data were derived from the management claims database of the Health Directorate of the Careggi Hospital in Florence between 2006 and 2012. Two main periods are considered for the comparison of data: 2006–2007–2008 during the insurance management and 2010–2011–2012 during the CMC trial. Results: During the insurance management period, the total expenditure was equal to the €14,846,334.44 paid in the 3-year period. The total expenditure during the CMC trial 3-years period was equal to €7.076.370,75. Under the CMC management, we observed a marked decrease in the recourse to legal action in the face of a substantial maintenance of the number of claims opened for each year. The CMC trial showed a greater speed in setting claims for damages. Discussion and conclusions: Under CMC management, a greater and more diligent efficiency is matched by a lower economic outlay. The use of the direct management of damage compensation may be an important tool for risk management, thus guaranteeing the recourse to targeted and appropriate interventions.