A 12-year analysis of closed medical malpractice claims of the Taiwan civil court: A retrospective study.
A 12-year analysis of closed medical malpractice claims of the Taiwan civil court: A retrospective study.
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DOI：
10.1097/md.0000000000010237
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发表时间：
2018-03
期刊：
影响因子：
1.6
通讯作者：
Wu KH
中科院分区：
文献类型：
--
作者：
Hwang CY;Wu CH;Cheng FC;Yen YL;Wu KH
医疗事故诉讼增加了医生的压力，降低了职业满意度，这可能导致防御性医疗以避免诉讼。因此，从以往的医疗事故索赔中吸取经验是很重要的。摘要本研究旨在透过分析台湾民事法院已了结的医疗事故理赔个案，探讨与医疗事故理赔相关的流行病学因素，找出医疗事故理赔的高风险专科，并判断临床上哪些错误容易导致医疗事故诉讼。目前的分析通过使用基于人口的数据库进行回顾性研究，审查了台湾司法系统的判决，重点关注2002年至2013年期间的946起已了结的医疗索赔。在这些医疗事故索赔中，只有14.1%的判决是针对临床医生的，平均赔偿金额为83,350美元。最常见的单一专科是产科（10.7%），而手术组约占40%。总共有46.3%的患者在索赔中死亡或严重受伤。与对死亡患者的75,632美元的赔偿相比，对严重后果的原告的平均赔偿金额约为4.5倍。医疗事故诉讼的高危诊断人群为感染性疾病（7.3%）、恶性肿瘤（7.2%）和肢体骨折（4.9%）。未确诊的先天性畸形（4.5%）和传染病（5.8%）组的索赔成功率相对较低。手术纠纷是民事医疗事故索赔中最常见的争议（38.8%），其次是诊断错误（19.3%）。在打赢官司的被告中，有85.9%是由临床医生代理的，但他们平均要花4.7年的时间才能做出最终裁决。为了减少无谓的诉讼，应该加强预防患者不切实际的期望的教育。还需要进一步调查以改善冗长的司法程序，以减轻医疗事故索赔对临床医生和从业人员以及司法系统和合法索赔人的压力。
Malpractices lawsuits cause increased physician stress and decreased career satisfaction, which might result in defensive medicine for avoiding litigation. It is, consequently, important to learn experiences from previous malpractice claims. The aim of this study was to examine the epidemiologic factors related to medical malpractice claims, identify specialties at high risk of such claims, and determine clinical which errors tend to lead to medical malpractice lawsuits, by analyzing closed malpractice claims in the civil courts of Taiwan. The current analysis reviewed the verdicts of the Taiwan judicial system from a retrospective study using the population-based databank, focusing on 946 closed medical claims between 2002 and 2013. Among these medical malpractice claims, only 14.1% of the verdicts were against clinicians, with a mean indemnity payment of $83,350. The most common single specialty involved was obstetrics (10.7%), while the surgery group accounted for approximately 40% of the cases. In total, 46.3% of the patients named in the claims had either died or been gravely injured. Compared to the $75,632 indemnity for deceased patients, the mean indemnity payment for plaintiffs with grave outcomes was approximately 4.5 times higher. The diagnosis groups at high risk of malpractice litigation were infectious diseases (7.3%), malignancies (7.2%), and limb fractures (4.9%). A relatively low success rate was found in claims concerning undiagnosed congenital anomalies (4.5%) and infectious diseases (5.8%) group. A surgery dispute was the most frequent argument in civil malpractice claims (38.8%), followed by diagnosis error (19.3%). Clinicians represent 85.9% of the defendants who won their cases, but they spent an average of 4.7 years to reach final adjudication. Increased public education to prevent unrealistic expectations among patients is recommended to decrease frivolous lawsuits. Further investigation to improve the lengthy judicial process is also necessary to relieve the stress of medical malpractice claims on clinicians and practitioners, as well as on the judicial system and rightful claimants.