Medical malpractice claims involving children

Bladder exstrophy-epispadias complex related litigation: A legal database review

OBJECTIVE

To review the nature and extent of bladder exstrophy-epispadias related malpractice litigation in the United States.

METHODS

Two legal databases (Nexis Uni, WestLaw) were reviewed for state and federal cases using the terms "bladder exstrophy", "cloacal exstrophy", "epispadias", in combination with "medical malpractice", or "negligence", or "medical error", or "complication", or "malpractice", or "tort". Databases were queried from 1948 to 2022 and reviewed for medical and legal details.

RESULTS

Our search yielded 16 unique legal cases with 6 fitting established criteria for analysis. Urology and paediatric urologists were named in 50% of cases as were community medical systems. Cause for lawsuit included negligence in surgical performance (50%), primary closure of exstrophy (33%), and post-operative care (50%). Settlement agreement was reached in one case (17%). Outcomes favoured the physician in 60% of trials. Lawsuits alleging negligent surgical performance and/or post-operative care exclusively named urologists with outcomes favouring the surgeon in 66% of cases. The settlement payment (n = 1) was $500,000 and monetary damages (n = 1) equated to $1.3 million.

CONCLUSIONS

Malpractice litigation related to BEEC treatment is rare. Trial outcomes favour the medical provider. Cases that resulted in financial liability successfully alleged avoidable negligence resulting in irreversible physical damage. The authors recommend families with BEEC seek board-certified paediatric urologists experienced in treating this complex and/or Bladder Exstrophy Centers of Excellence. Further, we recommend surgeons treating BEEC properly educate patients and families on the severity of this major birth defect including its lifelong implications and need for surgical revisions.

Medical Malpractice in Turkey: Pediatric Cases Resulting in Death

Background:

Malpractice in medicine refers to the failure of a physician to meet a standard of diagnosis and treatment, damages/injuries caused by reprehensible ignorance, or negligence of a doctor.

Methods:

Allegedly malpractice cases of pediatricians and the cases in which causal link between malpractice and death was confirmed by the decision of the First Board of Specialization of the Council of Forensic Medicine between the dates of Januray 1, 2012 and December 31, 2014 were analyzed retrospectively.

Results:

The study revealed that in the majority of 286 cases, the infants were 0-28 days old (n = 115; 40.2%) and were hospitalized due to respiratory problems (n = 111; 38.8%). The allegations of malpractice cases were most frequently seen in private hospitals (n = 120; 42%). Malpractice was found in 17.5% of the cases (n = 50), in which the majority of cased were proved to be diagnostic errors (n = 24; 48%). The most common diagnostic error was the misdiagnosis of “healthy child” in medical malpractice cases (n = 11, 22%).

Conclusions:

In conclusion, it is considered to be important for the pediatricians to maintain proper communication with the relatives of the patients while monitoring their health condition, and pediatricians are expected to be more careful—especially in the diagnostic phase—in the cases involving 0-1 age group as children are most likely to be diagnosed as healthy in this age group.

A detailed analysis of pediatric surgical malpractice claims in Germany: what is the probability of a pediatric surgeon to be accused or convicted?

AIM OF THE STUDY

Pediatric surgeons treat a vulnerable population in which unfavorable outcome can lead to substantial long-term costs, placing them at risk for malpractice claims. This study aims to characterize the frequency and circumstances in which malpractice claims were successfully brought against pediatric surgeons in Germany over the last 5 years.

MATERIALS AND METHODS

Anonymous data on medical treatment errors and payments were acquired from the Federal Chamber of Physicians from 2014 through 2018 and analyzed for most frequent diagnoses and circumstances that resulted in accusation or conviction. Those claims that were successfully rebutted were compared to as controls. Lifetime risk for being involved in litigation and its outcome was calculated.

RESULTS

There were 129 medical malpractice claims over the 5-year observation period. Medical error was confirmed in 56 cases (43%); the rest were successfully appealed. The risk of the prototypical German pediatric surgeon to be accused was 5.24% and to be convicted 2.27% per year in practice. The most common reasons for conviction (alone or in combination) were surgical-technical errors (23%), treatment delay (21%), insufficient workup (17%), incorrect diagnosis (17%), and incomplete consent (16%).The most frequent circumstances leading to a conviction were trauma (27%), inguinal hernia (7%), circumcision (7%), testicular torsion (7%), acute abdomen (7%), and appendicitis (5%).

CONCLUSION

Over a 40-year career, pediatric surgeons in Germany face an average calculated risk of 2.1 to be accused and 0.9 to be convicted of malpractice claims. Certain circumstances pose higher risks for litigation than others. Knowledge of these patterns may help practitioners avoid medicolegal confrontation.

Mistrial or Misdiagnosis: The Importance of Autopsy and Histopathological Examination in Cases of Sudden Infant Bronchiolitis-Related Death

Pediatrics, among all the branches of medicine, is a sector not particularly affected by a high number of claims. Nevertheless, the economic value of the compensation is significantly high, for example, in cases of children who suffered multiple disabilities following perinatal lesions with a long life expectancy. In Italy, most of the claims for compensation concern surgical pathologies and infections. Among these latter, the dominant role is taken by respiratory tract infections. In this context, the purpose of this manuscript is to present a case series of infant deaths in different emergency-related facilities (ambulances, emergency rooms) denounced by relatives. Following these complaints, the autopsy was performed, and subsequent histological examinations revealed the presence of typical and pathognomonic histological findings of acute viral bronchiolitis, whose morphological appearance is poorly reported in the literature. The analysis of these cases made it possible to highlight the following conclusions: the main problems in diagnosing sudden death causes, especially in childhood, are the rapidity of death and the scarce correlation between the preexistent diseases and of the cause of death itself. For all these reasons, the autopsy, either clinical or medicolegal, is mandatory in cases of sudden unexpected infant death to manage claim requests because only the histological examinations performed on samples collected during the autopsy can reveal the real cause of death.

Awareness of professional rules among Iranian nurses: a cross-sectional study

Background

One of the main responsibilities of professional nurses is protecting themselves against legal complications. Hence, they have to be sufficiently aware of the professional rules. This study examines the Iranian nurses’ awareness of professional rules.

Methods

A total of 260 nurses were randomly selected from among the nurses working at various wards and included in this cross-sectional descriptive analytical study. Data were collected using a researcher-made questionnaire. The collected data were then analyzed using descriptive (mean and frequency percentage) and inferential (Kolmogorov-Smirnov, Mann-Whitney U, and Kruskal-Wallis) statistics.

Results

The nurses’ mean awareness of professional rules was 28.3 ± 4.0 out of 37. There was a significant relationship between the mean awareness of the nurses and ward (p = 0.001). However, this relationship was not significant regarding demographic variables age, sex, marital status, job title, working experience, education and history of participation in retraining courses on professional rules.

Conclusion

A significant number of nurses were not adequately aware of professional rules, which can put them and their working organization at serious risks. Some measures such as holding web-based or in-person training courses and providing educational booklets and pamphlets can be helpful in this regard.

Infections in a Children's Hospital autopsy population

We reviewed our Children's Hospital autopsies (1986-2009, 3-8 year groups) to determine the contribution of infections/inflammation to death and trends over time. Infections were categorized as (1) underlying cause of death, (2) mechanism of death complicating another underlying cause of death, (3) contributing (4) agonal or (5) incidental. Of 608 autopsies (44% of deaths), 401 had 691 infections (66%, 1.72 infections/infected child). In categories 1-5, there were 85 (12.3%), 237(34.3%), 231 (33.4%), 82 (11.9%) and 56(8.1%) infections. Leading infections include bronchopneumonia (188), sepsis (144- Enterococcus most common with 22), meningitis (35- Streptococcus pneumoniae most common with 10), pneumonitis (33), peritonitis (29). Sepsis declined in 2002-2009, attributed to fluid resuscitation standardization. Meningitis declined after 1993, and may be partially attributed to vaccines (Hemophilus influenza, Streptococcus pneumoniae). Despite advances in anti-microbial therapy, 66% of pediatric autopsies had inflammatory lesions, predominately as the mechanism or contributing factor rather than the underlying cause of death.