A 12-year analysis of closed medical malpractice claims of the Taiwan civil court: A retrospective study

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.

The influence of emergency department crowding on the efficiency of care for acute stroke patients

Objective

To investigate the impact of emergency department (ED) crowding (number of ED patients) and number of ED staff on the efficiency of the ED care process for acute stroke patients.

Design

Retrospective cohort study conducted from 1 May 2008 to 31 December 2013.

Setting

Largest primary stroke center (3000-bed tertiary academic hospital) in southern Taiwan.

Participants

Patients aged 18-80 years presenting to the ED with acute stroke symptoms ≤3 h from symptom onset (n = 1142).

Main Outcome Measures

Door-to-assessment time (DTA), door-to-computed tomography completion time (DTCT) and door-to-needle time (DTN).

Results

Of the 785 patients with ischemic stroke, 90 (11.46%) received thrombolysis. In the multivariate regression analysis, the number of ED patients and the number of attending physicians were significantly associated with delayed DTA and DTCT but not DTN. Initial assessment by a resident was also associated with delayed DTA and DTCT. The number of nurses was associated with delayed DTCT and DTN.

Conclusions

Although ED crowding was not associated with delayed DTN, it predicted delayed DTA and DTCT in thrombolysis-eligible stroke patients. The number of attending physicians affected initial assessment and DTCTs, whereas the number of nurses impacted thrombolytic administration times.

An analysis of causative factors in closed criminal medical malpractice cases of the Taiwan Supreme Court: 2000-2014

Most medical malpractice in Taiwan leads to criminal prosecution. This study examined the epidemiologic factors and clinical errors that led to medical malpractice convictions in Taiwanese criminal prosecutions. A retrospective, 15-year population-based review of criminal Supreme Court judgments pertaining to medical malpractice against physicians and nurses was conducted. Eighty-four cases were reviewed, yielding data that included the number and specialty involved, accused hospitals, the diagnosis, the time interval between incidents to closure, result of adjudication, the origin of cases (private vs. public prosecution), the result of medical appraisal, and the primary error. Overall, the cases averaged 7.6years to achieve final adjudication. Seventy-five percent were settled in favor of the clinician; twenty-three physicians and three nurses were found guilty, but all of these avoided imprisonment via probation or replacement with forfeit. The single most risky specialty was emergency medicine (22.6% of the cases), with 36.8% of those resulting in guilty verdicts. The most common diagnosis groups were infectious diseases (23.8%), intracranial hemorrhages (10.7%), and acute coronary syndrome (9.5%). Public prosecutions had a 41.2% conviction rate; no guilty verdicts resulted from private prosecution. Nineteen (22.6%) cases were commuted, and 73.7% of those had a controversial appraisal result. The characteristics of criminal malpractice prosecution in Taiwan that could be improved to relieve the stress of frivolous lawsuits on the judicial process include lengthy jurisdiction process; low public-prosecution conviction rate; frequent commuted jurisdiction related to a controversial appraisal; and zero imprisonment rate for clinicians.

An analysis of closed medical litigations against the obstetrics departments in Taiwan from 2003 to 2012†

OBJECTIVE

To examine the epidemiologic data of closed medical claims from Taiwanese civil courts against obstetric departments and identify high-risk diseases.

DESIGN

A retrospective descriptive study.

SETTING/STUDY PARTICIPANTS

The verdicts from the national database of the Taiwan judicial system that pertained to obstetric departments were reviewed. Between 2003 and 2012, a total of 79 closed medical claims were included.

MAIN OUTCOME MEASURES

The epidemiologic data of litigations including the results of adjudication and the disease and outcome of the alleged injury.

RESULTS

A majority of the disputes (65.9%) were fetus-related. Four disease categories accounted for 78.5% of all claims including (i) perinatal maternal complications (25.3%); (ii) errors in antenatal screening or ultrasound diagnoses (21.5%); (iii) fetal hypoxemic-ischemia encephalopathy (16.5%); and (iv) brachial plexus injury (15.2%). Six cases (7.6%) resulted in an indemnity payment with a mean amount of $109 205. Fifty-one cases (64.6%) were closed in the district court. The mean incident-to-litigation closure time was 52.9 ± 29.3 months. All cases with indemnity payments were deemed negligent or were at least determined to be controversial by a medical appraisal, while all defendants whose care was judged as appropriate by a medical appraisal won their lawsuits.

CONCLUSIONS

Almost 93% of clinicians win their cases but spend 4.5 years waiting for final adjudication. The court ruled against the clinician only if there was no appropriate response during a complication or if there was no follow-up or further testing for potential critical diseases.

Factors associated with delayed recognition of pulmonary tuberculosis in emergency departments in Taiwan

OBJECTIVE

To identify and evaluate factors associated with delayed recognition of pulmonary tuberculosis (TB) in the emergency department (ED).

BACKGROUND

Delayed recognition of pulmonary TB in ED may precipitate mortality and morbidity.

METHODS

Medical records of newly diagnosed TB patients admitted to four hospitals in Taiwan were retrospectively reviewed. Patients were divided into two groups based on ED physicians' recognition or not of TB and statistically compared to identify differences in their characteristics.

RESULTS

310 newly diagnosed TB patients were identified; 150 were unrecognized in the ED. Cough, chest tightness, general malaise, and body weight loss were more common for those with recognized TB. Older age (≥65 yrs, P = 0.035) and chronic renal insufficiency (P = 0.005) were associated with delayed TB recognition.

CONCLUSION

Older age and chronic renal insufficiency are risk factors for delayed TB while in the ED. Typical symptoms should heighten alertness for recognizing TB.

Predicting resistance and managing susceptibility to cyromazine in the Australian sheep blowfly Lucilia cuprina

Four cyromazine-resistant variants of Lucilia cuprina were selected after ethyl methanesulfonate mutagenesis and screening above the concentration of cyromazine lethal to susceptibles. Resistance is controlled by a single gene in each variant. Two resistance loci have been identified, one (Cyr 4) closely linked to the marker 'reduced eyes' on chromosome IV, the other (Cyr 5) closely linked to the 'stubby bristles' marker on chromosome V. Concentration-mortality line analysis shows resistance ratios are low (1.5-3x). One variant [Cyr 4(2)] is viable as a homozygote, the others are lethal [Cyr 4(1)] or, at best subvital [Cyr 5(1) and Cyr 5(2)]. Competition experiments between resistant heterozygotes and susceptibles show that resistance to cyromazine is selected for over a limited range of concentrations. The capacity of laboratory studies to predict likely resistance mechanisms before they evolve in the field is discussed. The use of genetic, toxicological and relative fitness data arising from these studies to devise the most effective strategies of insecticide usage while minimising the evolution of resistance is emphasised.