OBJECTIVES: To analyze the cases of medical damage after misdiagnosis of tubal pregnancy, to explore the causes of medical damage, the causal relationship between medical malpractice and the damage consequences, as well as the causative potency, in order to provide evaluation ideas for forensic identification of such cases. METHODS: Eighteen cases of forensic identification of tubal pregnancy related medical damage were collected and retrospectively analyzed from the aspects of age, maternity history, fertility requirements, risk factors, diagnosis and treatment, medical malpractice, damage consequences, and causative potency. RESULTS: All 18 cases were tubal pregnancy, of which 17 cases had medical malpractice, resulting in 14 cases of affected tubal resection, 2 cases of hemorrhagic shock death, 1 case of intrauterine fetal death and affected tubal resection. The other case had the consequence of affected tubal resection, but there was no malpractice in the treatment. CONCLUSIONS Correct diagnosis is helpful to make appropriate treatment plan, prevent disease progression and reduce serious adverse consequences and the occurrence of medical disputes. Scientific and reasonable analysis of the causal relationship between medical malpractice and damage consequences and the causative potency is of great significance to the successful settlement of medical disputes.
Pregnancy ; Female ; Humans ; Retrospective Studies ; Pregnancy, Tubal/surgery* ; Salpingectomy/methods* ; Fertility ; Malpractice

At present, medical disputes are still widely-concerned social problems and occasionally evolve into severe social events. In the dispute settlement mechanism, forensic identification opinion is the important technical support. Due to the high professionalism and complexity of medicine, the identification of medical malpractice has become major and difficult problem in the identification. This paper systematically analyze the concept of medical malpractice and five legal theories of malpractice determination, pointing out that China's forensic identification of medical damage should be led by the theory of "medical standards", supplemented by "prudent patient" standard and strengthen "peer review" in form. At the same time, seven main identification principles should be followed in practice: (1) take "obligation of diagnosis and treatment" as the basic principle of medical malpractice identification; (2) take whether to fulfill the obligation of diagnosis and treatment corresponding to current medical level as the specific principle; (3) take diagnosis and treatment routine, norms and guidelines as the main basis; (4) the principle of "peer review"; (5) the principle of "the generality of medical emergency action"; (6) the principle of "notification-informed-consent"; (7) the principle of "review of complications". This paper also puts forward the corresponding identification ideas in view of the above principles, hoping this helps standardize medical damage forensic identification activities.
Dissent and Disputes ; Forensic Medicine ; Humans ; Informed Consent ; Malpractice

On the basis of retaining the technical identification system of medical negligence, the Medical Association Identification Rules of Medical Damage mainly provides technical services for various types of conciliation work about doctor-patient dispute. Its identification work is still influenced by the thinking of medical negligence technical identification and has certain administrative color. Guidance for Judicial Expertise of Medical Malpractice is mainly reflected that the trial of civil cases and pre-trial mediation of courts need service. Its procedures and evidence review are strictly required by the litigation rules and has the characteristics of public legal services provided as a third-party neutral institution. Technical identification of medical damage, whether organized by the Medical Association or the forensic identification institutions, is carried out under the background of the current Regulations on the Prevention and Treatment of Medical Disputes and the Civil Code of the People's Republic of China; both have a corresponding positive role in regulating the medical damage identification activities, and have also laid a certain foundation for the establishment of a unified identification system in the future in China. To understand the different characteristics of the medical damage identification rules issued by the Chinese Medical Association and the Ministry of Justice, and to improve the understanding of the standardization of the forensic identification of medical damage, a comparative study was conducted on Medical Association Identification Rules of Medical Damage and Guidance for Judicial Expertise of Medical Malpractice from seven aspects: Concept and legal status, entrust of identification, identification acceptance, identification procedures, identification presentation meeting, theory of medical malpractice evaluation, consequences and causality of medical damage. The subject of evaluation, the function of evidence review, the role of consulting experts, the technical standard system of malpractice evaluation and other contents were emphatically analyzed.
China ; Forensic Medicine ; Humans ; Malpractice

There has been an exponential increase in plastic surgery cases over the last 20 years, surging from 2.8 million to 17.5 million cases per year. Seventy-two percent of these cases are being performed in the office-based or ambulatory setting. There are certain advantages to performing aesthetic procedures in the office, but several widely publicized fatalities and malpractice claims has put the spotlight on patient safety and the lack of uniform regulation of office-based practices. While 33 states currently have legislation for office-based surgery and anesthesia, 17 states have no mandate to report patient deaths or adverse outcomes. The literature on office-base surgery and anesthesia has demonstrated significant improvements in patient safety over the last 20 years. In the following review of the proceedings from the PRS Korea 2018 meeting, we discuss several key concepts regarding safe anesthesia for officebased cosmetic surgery. These include the safe delivery of oxygen, appropriate local anesthetic usage and the avoidance of local anesthetic toxicity, the implementation of Enhanced Recovery after Surgery protocols, multimodal analgesic techniques with less reliance on narcotic pain medications, the use of surgical safety checklists, and incorporating “the patient” into the surgical decision-making process through decision aids.
Anesthesia ; Checklist ; Clothing ; Decision Support Techniques ; Humans ; Korea ; Malpractice ; Oxygen ; Patient Safety ; Plastics ; Seoul ; Surgery, Plastic

Hospice and palliative care can help terminal patients and their family members to face the natural end of life more comfortably, by providing them with an environment to address psychosocial and spiritual problems, as well as physical symptoms. However, most patients and their caregivers have the misconception that hospice care means the withdrawal of all treatments. Many physicians also consider hospice care to be a form of terminal care after all treatments are finished. Laws regulating the withdrawal of life-prolonging treatment came into effect in Korea in 2018, and these regulations also apply to most terminal stages of benign diseases. The withdrawal of futile life-prolonging treatment is quite different from euthanasia or negligence. At the last stage of disease, treatment aimed at alleviating various symptoms can make critically ill patients more comfortable and thereby help them to die with dignity. Patients with a terminal illness should receive hospice and palliative care, instead of futile life-prolonging treatment. Therefore, education and training programs to promote a proper understanding of hospice and palliative care should be considered mandatory.
Caregivers ; Critical Illness ; Education ; Euthanasia ; Hospice Care ; Hospices ; Humans ; Jurisprudence ; Korea ; Malpractice ; Palliative Care ; Social Control, Formal ; Terminal Care ; Withholding Treatment

This study aimed to suggest the justification for a self-regulatory body for medical licenses in Korea by reviewing recent cases of physician arrests for medical accidents in Korea. A number of recent cases of medical mistakes have been criminalized by courts in Korea, leading to widespread concern and fear throughout the healthcare community. Without a profession-led self-regulation system ever having been introduced in Korea, there is no alternative method for disciplining doctors other than through criminal tort law. It is expected that the volume of malpractice lawsuits will increase rapidly in Korea as the government ambitiously expands its plans for universal health coverage. Instead of facing criminal charges, however, doctors must put forth an effort to introduce a contemporary form of medical regulation, with more advanced disciplinary measures against substandard practice. The Korean Medical Association has undertaken the challenging mandate of establishing a new professional regulatory body to provide a tribunal and disciplinary system for the medical profession. It has proven difficult to persuade doctors of its purpose and value, as the majority do not yet fully grasp the very foreign concept of self-regulation. Moving forward, however, it will eventually become the responsibility of doctors to persuade society, lawmakers, government, and patient interest groups of the necessity and viability of self-regulation, which may also prove challenging. Despite these predictable challenges, it is imperative that Korean doctors solve the issue of creating a new, modern regulatory body capable of effective self-regulation and acceptable disciplinary measures, within the near future.
Criminals ; Delivery of Health Care ; Hand Strength ; Humans ; Jurisprudence ; Korea ; Liability, Legal ; Licensure ; Malpractice ; Medical Errors ; Methods ; Public Opinion ; Self-Control

Iatrogenic calcinosis cutis is due to the intravenous administration of calcium gluconate or calcium chloride to treat hypocalcemia. The arthors report three cases of calcinosis cutis with calcifications involving the upper or lower extremities in neonates following the extravasation of calcium gluconate. Three neonates, a 2-week-old girl, 4-week-old boy, and a 4-week-old girl, were consulted for indurated nodules after the intravenous administration of calcium gluconate at the intensive care unit. Complete remission of palpable nodule and calcification was observed on the radiograph at three weeks, four weeks and six months after the initial presentation in each. All three neonates with iatrogenic calcinosis curtis were resolved spontaneously without functional and cosmetic complications. According to enhancement of the patient's cognition about benign disease, a suitable explanation of the disease and avoiding unnecessary treatment through an early diagnosis of iatrogenic calcinosis cutis will reduce a number of potential medical malpractice disputes.
Administration, Intravenous ; Calcinosis ; Calcium Chloride ; Calcium Gluconate ; Calcium ; Cognition ; Dissent and Disputes ; Early Diagnosis ; Female ; Humans ; Hypocalcemia ; Infant, Newborn ; Intensive Care Units ; Lower Extremity ; Male ; Malpractice

OBJECTIVE: Among emergency department patient complaints, complaints related to medical malpractice can often lead to lawsuits. This study examined the reasons for medical malpractice complaints and find ways to improve the medical process and patient satisfaction in an emergency department. METHODS: This study analyzed 269 official complaints of emergency department patients between January 1, 2007, and December 31, 2016. From these complaints, 100 complaints of medical malpractice were analyzed and the complaints of the non-medical process, such as unkindness, cost, facilities and the others, were excluded. The patients' age, sex, relationship between the patient and complainer, insurance state and visiting hour were analyzed. Details of the medical malpractice complaints were assessed and classified into four reasons: diagnosis, examination, treatment, and explanation. This study attempted to analyze the hospital's response to the complaints made during the medical process. RESULTS: Among the 100 medical malpractice complaints, 75 occurred at night duty; 40 were related to treatment, 32 to diagnosis, 22 to examination, and six to explanation. Among the treatment, wound problems were the most frequent reason for 23 cases. The hospital made financial compensation to 16 of its patients. CONCLUSION: The medical malpractice complaints occurred mainly at night. Treatment, especially wound problems, was the most frequent reason for the complaints. The rate of monetary compensation was higher than that of the other studies.
Compensation and Redress ; Diagnosis ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Humans ; Insurance ; Malpractice ; Patient Satisfaction ; Retrospective Studies ; Wounds and Injuries

BACKGROUND: To identify trends in injuries and substandard care associated with anesthesia, we analyzed the Korean Society of Anesthesiologists database for anesthesia-related case files from July 2009 to June 2018. METHODS: Case characteristics, injuries, and outcomes were compared between the first part (July 2009–June 2014, n = 105) and the second part (July 2014–June 2018, n = 92) of the analyzed time period. RESULTS: Overall, 132 cases resulted in death. The proportion of fatal cases for sedation was similar to general anesthesia (66.2% vs. 76.3%). The proportion of cases with permanent injury or death decreased significantly in the second part of the period compared with the first part (76.1% vs. 93.3%, P = 0.002). With a growing trend in the proportion of sedation cases, a similar number of sedation and general anesthesia cases were referred during the overall period (77 and 76 cases, respectively). Propofol-based regimens remained the dominant sedation method (89.7% in the first part vs. 78.9% in the second part). The most common adverse event in cases of permanent injury or death was identified as being respiratory in origin (98/182, 53.8%). Permanent injuries or deaths were related to local anesthetic systemic toxicity (LAST) and beach-chair positioning for shoulder surgery, in 8 and 5 cases, respectively. CONCLUSIONS: Despite the decreasing trend in injury severity with time, several characteristic injury profiles were identified: lack of vigilance in propofol-based sedation, neurological injuries related to the beach-chair position, and LAST occurring during tumescent anesthesia or brachial plexus block.
Anesthesia ; Anesthesia, General ; Brachial Plexus Block ; Dissent and Disputes ; Malpractice ; Methods ; Shoulder

These days, medical practice tends to be highly specialized and divided into qualified medical personnel, including nurses. Recent amendments of medical law show the change of the nurse's role in medical practice. Traditionally, nursing has been an aid work to doctor's practices and is one of the core parts of medical practices. Nurses are a skilled occupational group and individuals are trained and licensed as professionals during their educational courses under government supervision. Because all of the nursing practices cannot be directed or recognized by doctors and nurses are building their own expertise as healthcare providers, they can be held accountable in medical malpractice. In the past, from the perspective of legal responsibility, the nurse was only regarded as an assistant to a doctor; hence, a nurse's malpractice was concluded as a supervising doctor's liability. In the case of medical malpractice caused by nurses, the range of responsibility will be different, depending on the scope of the work carried out by nurse and whether it was supervised by a doctor. Therefore, further discussion is needed regarding the scope of independent nursing practice in order to distribute the legal liability. The authors reviewed ten cases of precedents of medical dispute, examined the events in-depth, and analyzed the court rulings determining the legal responsibility of a doctor or nurse.
Dissent and Disputes ; Health Personnel ; Humans ; Jurisprudence ; Liability, Legal ; Malpractice ; Nurse's Role ; Nursing ; Occupational Groups ; Organization and Administration