Risk management and provider liabilities in infantile cerebral palsy based on malpractice litigation cases
Risk management and provider liabilities in infantile cerebral palsy based on malpractice litigation cases
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基于医疗事故诉讼案例的小儿脑瘫风险管理和提供者责任
DOI：
10.1016/j.jflm.2018.11.010
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发表时间：
2019-02-01
影响因子：
1.5
通讯作者：
Li, Guohong
中科院分区：
文献类型：
--
作者：
Zhou, Leyin;Li, Heng;Li, Guohong
目的：婴儿脑性瘫痪（CP）严重影响婴儿的生存和生活质量。CP通常由多种因素引起，导致医疗差错在CP中的作用存在因果不确定性，导致医疗纠纷频发。方法：回顾性分析1999年6月18日至2017年11月23日中国裁判文书网收录的400件CP医疗事故诉讼案例，内容包括基本案情、CP风险因素、医疗差错、医疗事故责任认定、赔偿等。新生儿窒息占63.5%，其次为缺氧缺血性脑病（63.3%）、新生儿感染（52.3%）和颅内出血（36.0%）。89.1%的民事判决结果为医疗差错责任，最终责任比例最高。最常见的三种医疗差错是未能及时完成分娩（30.2%）、产程检测评估不完整（28.8%）和病历不规范（25.3%）。平均每个病例涉及2.5个医疗差错。早产儿和足月儿CP医疗差错的分布无显著性差异（P > 0.05）。91.4%的索赔获得了损害赔偿，平均赔偿金额为73506美元。家庭实际总损失的平均值为128，198美元。解读：医疗事故CP诉讼案件中医患矛盾突出，2017年中国新增CP案件造成的总损失为39.7亿美元。窒息是最常见的危险因素CP，因为它可能很容易引起患者家属的注意。医疗服务提供者不重视早产儿的风险管理。应重视胎儿监护和规范病历书写的重要性。
Aim: Infantile cerebral palsy (CP) severely affects the survival and quality of life of infants. CP is typically caused by multiple factors, leading to causal uncertainty of the role of medical errors in CP and resulting in frequent medical disputes. No relevant research exists on risk management and malpractice liabilities in CP, including in China.Method: A retrospective analysis of 400 CP malpractice litigation cases from 18th June 1999 to 23rd November 2017, collected from China Judgments Online, included basic case information, CP risk factors, medical errors, medical malpractice liability determination, and compensation.Results: Up to 63.5% of infants with CP were affected by asphyxia, followed by hypoxic-ischemic encephalopathy (63.3%), neonatal infection (52.3%) and intracranial hemorrhage (36.0%). Most (89.1%) of civil judgments resulted in liability for medical errors, with the highest proportion of ultimate liability. The three most frequent medical errors were failure of completing delivery in time (30.2%), incomplete assessment of birth process detection (28.8%), and nonstandard medical records (25.3%). Each case involved 2.5 medical errors on average. No difference in the distribution of medical errors between premature and full-term CP infants (P > 0.05) was found. Compensation for damage was awarded in 91.4% of claims, and the mean value of compensation was $73,506. The mean value of the total actual loss of the family was $128,198.Interpretation: Contradictions between the doctors and patients were prominent in malpractice CP litigation cases, with a total loss of $3.97 billion attributable to new CP cases in China in 2017. Asphyxia was the most frequent risk factor for CP since it may easily draw the attention of the sufferer's family. Medical service providers did not pay attention to risk management in preterm infants. The importance of fetal monitoring and standardized medical record writing should be emphasized.