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小儿眼科的医疗事故诉讼

Engelhard SB, Collins M, Shah C, et al.

期刊名称:JAMA Ophthalmology

卷期:2016年第134卷第11期

项道满 项道满,医学博士、主任医师、硕士研究生导师。 现任中山大学附属广州妇儿童医院、广州医科大学附属广州市妇女儿童医疗中心、广州市儿童医院眼科主任。 任中华医学会眼科分会斜视与小儿眼科学组委员、 中华医学会儿科分会眼科学组副组长, 中国医师协会眼科分会斜视与儿童眼科专业委员会委员, 中国妇幼保健协会儿童眼保健专业委员会副主任委员兼秘书长 、 中华预防医学会儿童保健分会视听学组委员, 广东省妇幼保健协会儿童眼保健专业委员会主任委员、 广东省视光学会学会斜视弱视专业委员会副主任委员、 广州市医学会眼科分会副主任委

儿童眼科是一个新兴的学科。对儿科眼科医疗事故诉讼的认识,能够让眼科医生更好地理解如何给予患者最好的照顾和如何如何防止这样的诉讼。作者调查发现,儿童眼科医疗事故被诉讼的常见的临床情况包括:外伤性眼损害(15 22.1%),早产儿视网膜病变(12 例占 17.6%),和眼内炎(6 例,占8.8% )。与早产儿视网膜病变相关的诉讼,原告获得了最高的补偿金。相对于成人患者,涉及儿童眼科患者的医疗纠纷诉讼,比成人诉讼解决,但结局可能是原告得到更高的赔偿金。

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摘要

重要性:了解儿科医疗事故诉讼的结果让医生了解如何最好的照顾病人,防止这样的诉讼。目的:报告和分析涉及18岁以下患者的眼科医疗事故诉讼的原因和结果。设计、设置和参与者:综述了WestLaw数据库201541日至30日眼科相关的诉讼案件,包括193011日至20141231日美国的定居点和审判裁决。检索条目包括检索到的文档中任意处的眼科或眼科医生和医疗事故。案件包括原告在煽动时间中不足18岁。比较儿科病例和成人病例。主要结果和措施:儿科医疗事故案件结果和结算金额。结果:本研究包括68例原告不足18岁的眼科医疗事故案件。55例(51.5%)经审判解决。与584例成年案件中168例相比,其中35例中,17例判决支持原告(差异,33%95%可信区间,-24%64%P=0.1)。17例支持原告的裁决意味着陪审团奖金4815693美元(平均883281美元;范围147765-42061690美元)。68例中有9例(13.2%)导致结算,意味着调整赔偿1912738美元(平均1377689美元;范围92070-8493086美元)。剩下的24例(35.3%)涉及上诉裁决,预审和后审判救援裁决,1例判决。和成人案件相比,儿童案件评委会奖更高(差异3422134美元;95%可信区间-34221348731916美元;P=0.003)。法律上涉及失明的案件更有可能导致判决支持原告(差异60.5%95%可信区间-1%62%P=0.3)。常见的临床诉讼场景是创伤性眼部损伤(15 [22.1%]),视网膜病变的早期(12 [17.6%])和眼内炎(6 [8.8%])。结论和相关性:涉及儿科患者的医疗事故诉讼更有可能支持原告,解决时比成人诉讼需要更高的货币补偿。涉及视网膜早期病变的案件导致给予原告最高支付赔偿,失明和/或眼内炎案件的解决更有可能支持原告。这些信息可能会让小儿眼科医生了解常见的导致诉讼的情况。

Importance:Understanding outcomes of pediatric malpractice litigation allows ophthalmologists to gain insight into how to best care for patients and prevent such litigation.Objectives:To report and analyze the causes and outcomes of ophthalmology medical malpractice litigation involving patients younger than 18 years.Design, Setting, and Participants:The WestLaw database was reviewed from April 1 to 30, 2015, for ophthalmology-related lawsuits, including settlements and trial verdicts, in the United States from January 1, 1930, to December 31, 2014. Search terms included ophthalmology or ophthalmologist and malpractice anywhere in the retrieved documents. Cases in which the plaintiffs were younger than 18 years at the time of the inciting event were included. Pediatric cases were compared with adult cases.Main Outcomes and Measures:Pediatric malpractice case outcomes and settlement amounts.Results:Sixty-eight ophthalmology malpractice cases involving plaintiffs younger than 18 years were included in the study. Thirty-five cases (51.5%) were resolved via jury trial. Of these 35 cases, verdicts in favor of the plaintiff were issued in 17 pediatric cases (48.6%), compared with 168 of 584 adult cases (28.8%) (difference, 33%; 95% CI, -24% to 64%; P=.01). The 17 cases that resulted in verdicts in favor of the pediatric plaintiff had a mean jury award of $4815693 (median, $883281; range, $147765-$42061690). Nine of the total 68 cases (13.2%) resulted in a settlement, with mean adjusted indemnities of $1912738 (median, $1377689; range, $92070-$8493086). The remaining 24 cases (35.3%) involved appellate rulings, pretrial and posttrial relief rulings, and 1 bench verdict. Jury awards were higher in pediatric vs adult cases (difference, $3422134; 95% CI, -$3422134 to $8731916; P=.002), as were indemnity payments (difference, $1186757; 95% CI, -$69074 to $3342588; P=.003). Cases involving legal blindness were more likely to result in verdicts in favor of the plaintiff (difference, 60.5%; 95% CI, -1% to 62%; P=.30). Common clinical scenarios in cases of litigation were traumatic ocular injury (15 [22.1%]), retinopathy of prematurity (12 [17.6%]), and endophthalmitis (6 [8.8%]).Conclusions and Relevance:Malpractice litigation involving pediatric patients was more likely to be resolved in favor of the plaintiff and was associated with higher monetary awards than was adult litigation. Cases involving retinopathy of prematurity resulted in the highest payments to plaintiffs, and cases involving legal blindness and/or endophthalmitis were more likely to be resolved in favor of the plaintiff. This information may give pediatric ophthalmologists insight into the situations and conditions that commonly lead to litigation.


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