Dong yup Lee MD MPH Pyeongchang Health Center amp County Hospital Email ped83dyleegmailcom Increasing medical disputes Data from the Korea Medical Dispute Mediation and Arbitration Agency ID: 1045167
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1. Medical Litigation and the Care of NewbornsDong yup Lee, MD, MPH Pyeongchang Health Center & County HospitalE-mail: ped83dylee@gmail.com
2. Increasing medical disputesData from the Korea Medical Dispute Mediation and Arbitration AgencyData from the Judicial YearbookData from the Korea Consumer AgencyCases of Medial LitigationCases of Medial Disputes
3. Process of medical disputes▶Medical service useMedical accidents Medical disputes ▶Disputes mediation organizationMutual agreementMedical litigation
4. Effect of increased medical litigationIf medical ligationDefensive medicine Excessive diagnostictest and treatmentHealth care costs Patient's financial burden Avoiding a department withfrequent medical disputesShortage of medical professionals in particular departmentMedical approachability Negative impacts on patients
5. Purpose of studyNewborn?The first 4weeks after birthMany physiological changes occurVery vulnerable and unstable2/3 of infants death hereHigh risk pregnancy ↑Preterm birthLow birth weight babyChromosomal anomalyCongenital malformationPotential risk factor for medical accidentsIf this trend continues? Medical disputes will increasePurpose of this study?To identify the causes and characteristics of medical litigation through the analysis of precedents in neonatal areaTo propose measures in order to reduce medical malpractice
6. Definition of termsMedical accidentsMedical malpracticeMedical disputesUnexpected results in medical actA value neural termMedical accident caused by negligence of doctorsA legal termConflicts between doctors and patients due to medical accidentDuty of careObligation of the medical personnel to make efforts to prevent patients’ physical or mental harm 2. To take action for avoiding a bad outcomeDuty of explanationObligation to explain all the means of treatment, the risks, diagnosis and prognosisMedical malpracticeMedical accidents1. To recognize the outcome in advanceTo satisfy the patient’s right to know
7. 01Duration of the medical litigation02Birth weight and gestational age03Final court resultVariablesTypes of violation of duty05Amount of compensation for damage06Disease classification07Outcome of medical accident0428 cases of precedents2005-2009, for 5 yearsInterval from the time of the incident to the end of the litigation1.Plaintiffs win (including partial win)2.Plaintiffs lost3.Reconciliation1.Death 2.Disability3.Recovery1.Violation of the duty of care2.Violation of the duty of explanationCategorized based on the main symptoms
8. ResultsDuration of the medical litigation?4.4 yearGestational age Average gestational ageAll newborn in study 35.3weeks Preterm baby in study (9 cases) 31.9weeksBirth weight Average birth weightAll newborn in study 2.7kgLow birth weight baby in study (8 cases) 1.6kgLow birth weight infant rate28.6% 4.9% VS32.1% 5.7%Preterm infant rateVSfrom Lee et al. Neonatal Med 2015 February;22(1):1-7.
9. Final court results10 Violation of the duty of care11Types of violation of duty11Violation of the duty of care and explanationViolation of the duty of explanationOutcomes of medical accidentsResultsAmount of compensation for damageKRW161,389,291≒$136,000 Death outcome cases KRW 86,772,582Disability outcome casesKRW 208,872,650
10. Total 28cases6cases(21.4%)5cases(17.9%)4cases(14.3%)4cases(14.3%)5cases(17.9%)Results1cases(3.6%)Gastrointestinal diseasesNeurological diseasesPulmonary diseasesOphthalmic diseasesAspiration accidentsDrug associated accident2cases(7.1%)Infectious diseases1cases(3.6%)Otorhinolaryngologic diseases
11. Group1 Gastrointestinal diseasesTotal 6 casesNecrotizing enterocolitis (4 cases)Severe dehydration due to diarrhea, vomiting and bloody stool (2 cases)FeaturesNo Symptom or mild symptoms Weight, intake, excretion and basic vital signs must be measuredWarning sign : weight loss beyond the degree of postnatal physiological weight loss (less than 10%)- IUP 36weeks, 2.9kg, 7th day- Due to diarrhea, bloody stool- Transferred to a university hospital Died of sepsis, 2.34kg 0.56kg(19.3%) weight loss- Vital signs, weight and I/O not checked- After 2days, symptoms got worseReal caseFrom 2005 to 2009, among 28 cases
12. Group2 Neurological diseasesTotal 5casesNuclear jaundice due to hemolytic disease of newborns(2cases)Hypoxic ischemic brain injury, Convulsion (3cases)Real case From 2005 to 2009, among 28 casesIt should be considered to transfer patients if facilities are not adequate for the best treatmentFeaturesStandard of judgment?Whether doctors made efforts to control convulsions and prevent it from recurringTwo cases of nuclear jaundiceNewborn hemolytic disease[Treatment]1. Exchange transfusion2. Intensive phototherapyTotal bilirubin levels ↑↑- Case 1: 19mg/dl at 1st day- Case 2: 61mg/dl at 3rd day Patients were not transferred immediatelyExchange transfusion timing was delayed
13. Group3 Pulmonary diseasesFeaturesNo case plaintiffs wonRespiratory distress symptoms were aggravated shortly after birth or within hours- Disease severity Immaturity of newborn lung Weight, agePatient factors Treatment methods (medicine, nutrition etc.) Treatment equipments Doctor’s decision makingOther factorsFrom 2005 to 2009, among 28 casesTotal 4casesHyaline membrane disease(2cases)Pneumothorax (1case)Meconium aspiration(1case)
14. Group4 Ophthalmic diseasesTotal 4 casesRetinopathy of prematurity(ROP)From 2005 to 2009, among 28 casesRisk factorControllabilityHow to deal with ROPGestational age↓Birth weight ↓→ Immaturity of retina UncontrollableCheck up regularly to see if it is going to ROPLong term, high density oxygen therapyControllableUse only as little as oxygen needs
15. Group5 Aspiration accidentsTotal 5 casesInvasive procedure immediately after feeding (3cases)Insufficient belching (2cases)From 2005 to 2009, among 28 casesFeaturesRegurgitation easily happen in neonate Avoid invasive procedure after feedingCheck the last feeding time before procedure Belch after feedingTo ensure enough time has passed for the stomach contents to be emptied.Aspiration of stomach contents by vomiting or reflux
16. OthersFrom 2005 to 2009, among 28 casesInfectious diseases (2cases) 1 plaintiffs won 1 plaintiffs lostDrug associated accident (1case) plaintiffs lostOtorhinolaryngologic disease (1case) plaintiffs lostMeningitis, sepsis by Group B streptococcus infectionMyocarditis, encephalitis by enterovirus infectionSkin necrosis due to extravasation of calciumSensory hearing loss after use ototoxic antibiotics
17. The yardstick of judgmentACBNobody can blame a doctor why he didn’t choose treatment AOption A, BReasonable choices based on current medical standard of careOption CUnreasonable choiceBad resultsOptionOutcomeProcessJudgmentBUnwanted Results Reasonable choiceMedical accident. Responsibility (X)CUnreasonable choiceMedical malpractice. Responsibility (O)ProcessOutcome
18. 020301LimitationsImpossible to analyze the contents not in the written judgmentDecisions from a non-specialist in the medical fieldFrequent cases in medical litigation → Not represent cases in real medical field→ Possible to miss important cluesOnly for the part requested by the patient
19. Inadequate facilities for treatment0204Treatment in accordance with the clinical practice guidelines Fulfill duty of care and explanation01To prevent medical malpracticeTake home messageBest way to protect patients and defend doctors themselves from medical accidentsConsider transfer patients to a higher level hospital Uncontrollable diseases03Regularly check patients to detect worsening of diseases
20. Questions & AnswersThank you for your attention.Dong yup Lee, MD, MPH Pyeongchang Health Center & County HospitalE-mail: ped83dylee@gmail.com