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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 1  |  Issue : 1  |  Page : 21-25

Analyses of Medical Malpractice in Judicial Appraisal: 505 Cases


Center of Cooperative Innovation for Judicial Civilization; Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing, China

Date of Web Publication29-May-2015

Correspondence Address:
Tiantong Yang
Collaborative Innovation Center of Judicial Civilization, Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, 26 Houtun North Road, Qinghe, Haidian District, Beijing, PRC, 100192
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5014.157906

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  Abstract 

The purpose of this paper is to investigate and analyze the current situation of medical malpractice and make suggestions for preventative measures from a judicial appraisal standpoint. From 2002 to 2011, we conducted and analyzed 505 medicolegal malpractice experiments at the Fada Institute of Forensic Medicine and Science (FIFMS) in Beijing, People's Republic of China (PRC). We found that the occurrence of medical disputes in surgical and obstetrical/gynecological cases seemed more frequent. The main causes of medical disputes included issues regarding medical ethics, poor quality of the medical staff, equipment malfunctions, and dereliction of duty by the medical personnel. The reasons for dissatisfaction varied among the different levels of medical service. Basic medical services garnered the most complaints. If we can work to improve the moral and professional standards of the medical staff members, intensify their ethics, and foster good relationships between patients and medical professionals, the quality of medical care would improve and the number of disputes regarding medical services would be reduced.

Keywords: Judicial appraisal, medical dispute, medical malpractice


How to cite this article:
You M, Wang X, Lu D, Zhang H, Di S, Zhang F, Guo Z, Yuan L, Chang L, Xiang J, Yu L, Yang Y, Yang T. Analyses of Medical Malpractice in Judicial Appraisal: 505 Cases. J Forensic Sci Med 2015;1:21-5

How to cite this URL:
You M, Wang X, Lu D, Zhang H, Di S, Zhang F, Guo Z, Yuan L, Chang L, Xiang J, Yu L, Yang Y, Yang T. Analyses of Medical Malpractice in Judicial Appraisal: 505 Cases. J Forensic Sci Med [serial online] 2015 [cited 2020 Aug 9];1:21-5. Available from: http://www.jfsmonline.com/text.asp?2015/1/1/21/157906


  Introduction Top


On April 1, 2002, the Supreme People's Court promulgated the Provisions of the Supreme People's Court on Evidence in Civil Proceedings. That same year, the State Council adopted the Regulations on the Handling of Medical Accidents. It was the first time that two legal documents confirmed the principle of "reverse onus," one of the most important public rules for maintaining the social public interest and balancing the rights and interests of both parties. However, instead of easing the doctor-patient relationship, these documents made it increasingly complex and serious. In 2007, Gao Qiang, the erstwhile minister and party secretary of the Ministry of Health of the People's Republic of China (PRC) stated at a national health-work meeting that the PRC's national medical and health services were facing "nervous doctor-patient relationships, an increase in medical malpractice, violence, and other malignant events." [1]

The related data showed that 80-90% of the cases of the petition received by the Department of Public Health were related to medical malpractice. [2] In July 2010, the implementation of the Tort Liability Law (TLL) improved the laws of the civil and commercial systems as well as created a special law for civil torts, thereby safeguarding the citizens' lawful rights and interests more easily. At the same time, the TLL reinterpreted the standards for medical malpractice liability and put forward new methods for judicial authentication of medical damages. Although the PRC has made such laws and regulations to adjust the doctor-patient relationship, it is foreseeable that the health and medical conditions will not be improved in the short term. Thus, the number of lawsuits involving damages for medical malpractice will not decrease immediately, making the judicial authentication of medical damages extremely challenging. In order to properly solve medical disputes and put forward reasonable suggestions and opinions, this study collected 505 cases involving medical malpractice in our institute from 2002 to 2011 in order to analyze the distribution, ratio of fault, informed consent, and other factors through a retrospective study. Hopefully, the study results will also provide suggestions for necessary changes in the PRC's policies and legislations involving medical malpractice.


  Materials and Methods Top


Material source

All the files issued by the Fada Institute of Forensic Medicine and Science (FIFMS) were investigated from 2002 to 2011, and 505 cases with medical malpractice claims were included in the study. Each file included opinions of both sides in the lawsuit, medical records, relevant test records, autopsy records, histopathology inspection records, consultation records, and identifying documentations.

Statistical analysis

The data were analyzed using the SPSS 17.0 statistical software (South Wacker Drive, 11 th Floor, Chicago, IL).


  Results Top


Evaluation of medical malpractice cases

The study covered the years 2002 to 2011. We investigated 505 cases for medical malpractice in the FIFMS. The number of cases ranged from a low of 33 in both 2004 and 2006 to a high of 72 in 2009. There was a jump in the number of cases between 2006 and 2007, resulting in an 87.88% increase from 1 year to the next [Table 1].
Table 1: Evaluation of medical malpractice cases


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Distribution of medical malpractice

We determined that 315 (or 62.38%) of the cases studied did, in fact, deal with medical malpractice issues. Some 182 of the cases (or 36%) were deemed to be unrelated to medical malpractice, while the remaining eight cases could not be identified for various reasons. The degrees of malpractice were B (n = 70, 13.86%), C (n = 97, 19.21%), D (n = 77, 15.25%), E (n = 60, 11.88%), and F (n = 11, 2.18%), respectively, [Table 2].
Table 2: Distribution of medical malpractice


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Distribution of clinical sections

The 505 cases studied involved 31 clinical departments. The departments with the highest malpractice rates were Obstetrics (95 cases-18.81%), Orthopedics (66 cases-13.07%), and General Surgery (58 cases-11.48%). The number of cases in the departments of Hematology, Orthopedic Surgery, Otorhinolaryngology, Dermatology, Anorectal, Anesthesiology, and Radiology were each less than 10 [Figure 1].
Figure 1: Distribution of clinical sections.

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Sex and age composition of medical malpractice

Of the 505 cases we studied, 228 (45.15%) involved male patients and 277 (54.85%) centered around female patients. The following age ranges had more than 70 cases each: 21-30 years (15.25%), 41-50 years (14.65%), 51-60 years (14.26%), and 61-70 years (13.86%). Although there were just 29 cases in the age group of 71-80 years, or less than 6%, it contained 23 cases of malpractice, accounting for 79.31% of the cases in this age group. The age group of 90+ years had both the least number of cases and the lowest percentage of malpractice cases [Table 3], [Figure 2].
Figure 2: Bar chart for age distribution of medical malpractice.

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Table 3: Rate of age distribution of medical malpractice


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Malpractice rate by type of hospital

Tertiary hospitals had a medical malpractice case rate of about 62.3%, more than the 59.44% in secondary hospitals and the 60% in primary hospitals. In proprietary hospitals, the figure, at 93.75%, was much higher. Although the overall number of primary hospitals is low, it had greater volatility every year [Table 4], [Figure 3].
Figure 3: Line chart for distribution of hospital degree and malpractice rates.

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Table 4: Malpractice rate by type of hospital


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Informed consent cases

There were 103 cases involving informed consent, accounting for 20.39% of all the cases. The lowest figure was 4.34% in 2003, while the highest figure was 29.17% in 2009. It climbed steeply from 9.09% to 23.52% in 2005 [Table 5], [Figure 4].
Figure 4: Line chart for distribution of disputes of informed consent.

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Table 5: Cases of informed consent


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  Discussion Top


Fault distribution of participation

The level C of medical malpractice accounted for 19.21% of cases. However, level D was 15.25% and level E was 11.88%, which still illustrates that most of the cases between them add up to a substantial a number. In addition, there were 11 level F cases and it was determined that the degree of responsibility was 100%. Six of the level F cases had very serious outcomes. Two examples of this include one case where the right kidney was mistakenly removed, and another in which a retrobulbar injection of gentamycin was made into the eye. The other five level F cases did not have serious results, including the one in which an error was made in a pathological diagnosis, but the patient obtained a second consultation in another hospital in time to confirm that the tumor was malignant; so, the tumor was removed at last.

Additionally, there was a total of 315 cases identified as medical mistakes, but the other 182 cases were correct, which consisted of 36.04% of all the cases. In other words, at least one-third of the cases involve invalid litigation, which will waste a lot of health care resources. We summarize three main reasons to explain. First, "factors of the patients" such as the lack of medical knowledge, avoidance of costs, sky-high compensation, and so on. All these can cause medical disputes. The patients often lack the consciousness of medical risks. They often have high expectations, judge the service quality only from the diagnosis and the treatment effect or the result of the treatment, think that the diagnosis is misdiagnosed if it is not clear, and believe that complications will appear if there is an error in diagnosis. Once their illness worsens, they put all responsibility on the medical staff, which can cause a lawsuit. Second, "factors of the media." The standpoints of the media are obviously misleading. An increasing number of reports give publicity to the principle of reverse onus, medical accident treatments, and the huge compensation. The media always report on the hospital's responsibility and predict huge damages, which can lead to protracted disputes. Third, "factors of the medical staff." With the doubt of the current measures of diagnosis and treatment, the patients often seek confirmation from other medical staff. Without understanding the whole process of diagnosis or treatment, other medical staff members often make comments because of competition or self-service. This can also cause disputes. If disputes occur, the patients will pester the original medical staff, not giving up, because they believe that they hold "professional medical evidence." The patients end up distrusting their original medical providers, even though definite appraisal opinions have been given. Therefore, the devastating opinions from the subsequent medical staff are very irresponsible.

Distribution of clinical sections

The Obstetrics department is the most frequently accused of the clinical units; however, the Orthopedics and General Surgery departments are the primary branches against which malpractice claims are filed. Since the short course of neonatal disease that is 1 h-2 days, and the fast transition, parents often vent their anger on the medical staff without the acceptance of any bad result. It is thought that maternity patients are a healthy group, and that being pregnant is a very common thing. In fact, this is a completely wrong attitude. Due to the lack of understanding regarding the complexity of the birth process and modern medical limitations, any deaths during pregnancy or delivery can result in a medical damage compensation lawsuit. [3],[4],[5]

The appraised individual's age composition

Because of the change of lifestyle, the age of onset tends to be lower. In the age ranges 21-30 years, 41-50 years, and 51-60 years, the patients are mature. If they were lead to death or deformity due to illness, disputes must be triggered. So, the number of these cases is the greatest. What is worth noting, though, is the age group of 71-80 years, in which although the number of cases was only 29 (5.74% of all cases), 23 of them were incorrect. Although the absolute number of identification is less, the ratio of fault is quite high. The patients in that age group have multiple, complex diseases, which make it difficult to diagnose clearly or treat dialectically. At the same time, the patients and their relatives still have the expectation that the disease will be cured. If the effect of treatment tends to be serious, disputes can result easily. Similarly, those patients who are more than 80 years old as well as their families will not get entangled in disputes even if death occurs. In the age group of 81-90 years, only four cases were wrong, which is one-fourth. There were no incorrect cases in the age group of 90+ years.

The age groups of 0-1 years (11.29%) and 11-20 years (57.89%) were similar to that of the 71-80 years age goup, and the rates of fault were 6.14% and 67.74%, respectively. It can be suggested that the staff pays more attention because medical damages occur easily when treating patients in the age groups of 0-1 years, 11-20 years, and 71-80 years.

The fault distribution form

Out of the total 505 cases, there were 315 wrong cases and the average ratio of fault was 62.38%. Among them, the tertiary hospital's was 62.3% the secondary hospital's was 59.44%. Though the vast majority of medical resources concentrated in the first-level and the secondary hospitals, most of the difficult patients were centered in them, too. These hospitals undertake most of the existing medical tasks in our country. In other words, they also bear most of the existing compensation claims of medical damage.

Although the ratio of fault was 60% in the first-level hospitals, which is lower than the average, there are great differences from year to year. The ratio was 33.33% in 2003, but 100% in 2005, 2008, 2009, and 2010. The ratio of fault was up to 93.5% in private medical institutions. Poor equipment, poor technical conditions, less knowledge of the illness, and economic interests will drive them to blindly treat the patients, so the misdiagnosis of serious consequences will occur easily in those medical institutions. It is vital that the supervision at these hospitals is increased in order to reduce the occurrence of medical malpractice. [6],[7]

One-fifth of all the cases relate to the problem of informed consent. The average ratio was 20.39%. Disputes over informed consent increased from 9.09% in 2004 to 23.52% in 2005. The ratio subsequently remained high, which shows that patients value the right of informed consent and that there are many instances of infringement on that right by medical staff. Medical personnel are legally obligated to fully inform the patients of their rights, pursuant to informed consent. How to define the right of informed consent and how to determine the causal relationship of damage consequences are two of the important research subjects of the judicial appraiser. [8]


  Conclusion Top


Although China has greatly improved its health and medical system, the contradiction between arduous medical tasks and insufficient health resources has not been fundamentally resolved. This contradiction raises a large number of legal issues in the medical field. In recent years, medical malpractice appraisement cases have increased in China. Frequently occurring medical disputes and the unharmonious doctor-patient relationship have become hot social issues. High quality information has an important impact on improving the hospital's efficiency and patient's satisfaction as well as resolving patient disputes. With the development of our society, we should work harder to make it more and more harmonious.


  Acknowledgement Top


This study was supported by the Key Projects in the National Science and Technology Pillar Program during the Eleventh Five-Year Plan Period (2012BAK16B02), Scientific Research Foundation for the Returned Overseas Chinese Scholars, State Education Ministry (No. (2013)1792), Training Programmers Foundation for the Beijing Talents (2013D002023000002), Beijing Planning Project of Philosophy and Social Science (13FXC032), and Project of Young Teachers' Academic Innovation Team by China University of Political Science and Law (2014CXTD04).

 
  References Top

1.
Qiang G. http://www.moh.gov.cn/newshtml/17574.htm. [Last accessed on 2007 Jan 08].  Back to cited text no. 1
    
2.
Zhang T. Reasons for medical malpractice. Chinese Journal of Hospital Administration 2005;21:537-9.  Back to cited text no. 2
    
3.
Jiangfan Y, Qisheng Q. Primary study for medical malpractice relate to infant. The Journal of Law and Medicine 2004;11:89-91.  Back to cited text no. 3
    
4.
Youmin W, Wenjun W, Qinchu Z. Retrospective analysis on Medical Malpractice in Judicial Appraisal: 45 Cases. Journal of Chinese Physician 2005;33:61-3.  Back to cited text no. 4
    
5.
Turillazzi E, Bello S, Bonsignore A, Neri M, Riezzo I, Fineschi V. Retrospective analysis of anaesthesia-related deaths during a 12-year period: Looking at the data from a forensic point of view. Med Sci Law 2012;52:112-5.  Back to cited text no. 5
    
6.
Sun Y, Jia K, Yu X. Analysis for misdiagnosis in medical malpractice. J Diffic and Compl Cas 2005;6:179-80.  Back to cited text no. 6
    
7.
Wang L, Guo Y, Chen X. Medical malpractice in judicial appraisal: 288 cases. West China Medical Journal 2008;23:15-6.  Back to cited text no. 7
    
8.
Wang X. Research for Medical Malpractice in Judicial Appraisal. Beijing: PHCPPSU; 2009. p. 97.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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