Search Results (26)

Background/Objectives: Orthopedic surgery is among the most frequently litigated medical specialties worldwide. However, high-court malpractice decisions involving orthopedic specialists in Türkiye remain underexplored. This study aims to identify the patterns, causes, and outcomes of malpractice cases involving orthopedists by analyzing Turkish Supreme Court decisions over the past 15 years. Methods: A retrospective review of orthopedic malpractice cases adjudicated by the Turkish Court of Cassation between January 2010 and November 2025 was conducted. Variables included type of alleged offense, clinical context, primary/secondary liability, initial court outcomes, high-court decisions, and fault attribution. Findings were compared with international literature to contextualize national patterns. Results: A total of 71 decisions were analyzed. Negligent injury was the most common allegation. Initial acquittal and conviction rates were 50.7% and 49.3%, respectively. The Supreme Court affirmed 53.5% of decisions and overturned 46.5%. Fault was attributed to orthopedic specialists in 29.6% of cases, while 40.8% were found faultless; the remaining cases required additional expert evaluation. Litigation themes included diagnostic delay, postoperative complications, inadequate monitoring, and documentation deficiencies. Comparative analysis revealed substantial alignment between Turkish and international malpractice patterns. Conclusions: Orthopedic malpractice litigation in Türkiye mirrors global trends, with most claims stemming from trauma-related care and diagnostic errors. Although many cases undergo prolonged appeals, ultimate conviction rates remain low. Strengthened documentation, improved communication, and enhanced clinical guideline adherence may reduce litigation risk and improve patient safety. Full article

Italian Court of Cassation Ruling Decree 30032 of 30 October 2023 discusses a medical malpractice case concerning the diagnosis of dermatofibrosarcoma protuberans and the alleged diagnostic and therapeutic delay. By examining how the ruling frames the role of histopathology in proving pathology benignity, authors prompt to reflect on diagnostic path, the allocation of the burden of proof, and the role of dermatologist’s expertise in professional liability issues. Over a four-year period, five health professionals were involved in a claim concerning an initial diagnosis of an epidermoid cyst and a subsequent diagnosis of dermatofibrosarcoma protuberans. The plaintiff questioned the delay in diagnosis, and the Court of Cassation found two physicians liable because they could not prove that the treated pathology was initially benign. We argue that equating diagnostic correctness exclusively with histological confirmation is unnecessary, both clinically and legally, in typical cases, if the reasoning and findings are adequately documented. Additionally, we examine the value of dermatologists’ experience and the scope of professional competence as measures of liability. Finally, we outline the minimum standards of clinical documentation necessary to make the diagnostic pathway traceable and verifiable. The diagnostic process is a discretionary effort that integrates multiple sources of information, both instrumental and experiential, to reach the most reasonable hypothesis. While histopathology is a crucial tool, it is not the sole gateway to a correct diagnosis of every cutaneous alteration. Adequate disclosure and structured documentation of the diagnostic reasoning are fundamental to the care process and fair assessment of professional responsibility. Full article

Introduction: Orthodontic practice, though often considered low-risk compared with other dental specialties, is increasingly exposed to medico-legal challenges shaped by the volatile, uncertain, complex, and ambiguous (VUCA) environment of modern healthcare. The aim of this review was to identify the underlying causes and typologies of malpractice claims in orthodontics. Methods: This narrative review synthesizes evidence from 2010–2024 on malpractice allegations and risk management strategies in orthodontics, with attention to the clinical, ethical, and legal dimensions. Results: The analysis of the included articles identified the most common types of malpractice allegations and the share of malpractice allegations of orthodontists in relation to other specialties; the main risks of orthodontic practice were identified, as well as risk management strategies in orthodontics. The findings highlight that most malpractice allegations are not related to medical/clinical errors, but to ethical–legislative, behavioral/relational, and perceptual/aesthetic vulnerabilities. Conclusions: This review highlights the need for physicians to focus on the acquisition of transversal skills, to have the ability to understand, adapt and respond to the rational and emotional needs of patients. This is essential in an ever-changing world, supporting healthcare professionals in maintaining professional safety. This review opens a relevant research direction on the role and impact of digital technology in the orthodontist–patient relationship, having the ability to influence the dynamics of this therapeutic relationship and the perception of the treatment outcome. Full article

Background: Given the expansiveness of diagnostic and therapeutic hysteroscopy, promptly recognizing complications and intervening as necessary to prevent adverse outcomes and minimize legal risk is imperative. We aim to describe the litigious trends in hysteroscopic procedures across the United States; Methods: Publicly available lawsuits published on a well-known legal database, Westlaw, were reviewed. The search term “’hysteroscop!’” was used to filter cases for court opinions containing words with this prefix, including “hysteroscopy”, “hysteroscopies”, and “hysteroscopic.” Adverse events, procedural outcomes, post-procedural surgery urgency, and resultant disabilities were extracted for themes; Results: The primary complication resulting in legal action was uterine perforation (52.9%), followed by claimed technical mistakes (23.5%) and damage to surrounding structures (11.8%). The most common outcome was the need for future corrective surgery (70.6%), and a number of cases resulted in permanent brain damage or death (23.6%). Of the patients that required subsequent corrective surgery (n = 12), 91.7% of them required emergent surgery. Patients sought damages most commonly from individual attending providers (41.2%), attending physician and practice groups/hospitals collectively (41.2%), and additional entities, including resident physicians in training and manufacturers. Awards ranged from $322,308 to $9,387,109; Conclusions: Medical malpractice litigation is challenging to patients and providers alike, often leading to financial, emotional, and professional burden. Our evaluation highlights the variability in adverse events from hysteroscopy which prompt litigation, financial burden of lawsuits, and legal risk of individual providers, in an attempt to improve safety of future procedures. Full article

Labor management remains a critical issue in obstetrics, with dystocic labor presenting significant challenges in both management and outcomes. Recent advancements in intrapartum ultrasound have facilitated substantial progress in monitoring labor progression. This paper explores the integration of artificial intelligence (AI) into obstetric care, focusing on the Artificial Intelligence Dystocia Algorithm (AIDA) for assessing spatial dystocia during labor. The AIDA utilizes intrapartum ultrasonography to measure four geometric parameters: the angle of progression, the degree of asynclitism, the head–symphysis distance, and the midline angle. These measurements are analyzed using machine learning techniques to predict delivery outcomes and stratify risk. The AIDA classification system categorizes labor events into five classes, providing a nuanced assessment of labor progression. This approach offers several potential advantages, including objective assessment of fetal position, earlier detection of malpositions, and improved risk stratification, placing labor events within a broader context of labor dystocia and obstetric care and discussing their potential impact on clinical practice. This paper serves as a more comprehensive overview and discussion of the AIDA approach, its implications, perspectives, and future directions. However, challenges such as the technological requirements, training needs, and integration with clinical workflows are also addressed. This study emphasizes the necessity for additional validation across diverse populations and careful consideration of its ethical implications. The AIDA represents a significant advancement in applying AI to intrapartum care, potentially enhancing clinical decision-making and improving outcomes in cases of suspected dystocia. This paper explicates the key methodological approaches underpinning the AIDA, illustrating the integration of artificial intelligence and clinical expertise. The innovative framework presented offers a paradigm for similar endeavors in other medical specialties, potentially catalyzing advancements in AI-assisted healthcare beyond obstetrics. Full article

This work provides an economic exploration of the multifaceted world of medical malpractice risk. Third party liability insurance plays a central role in protecting healthcare providers and public care institutions from the financial consequences of medical malpractice claims, although in recent years, the industry landscape has been characterised by periods of distress for this type of protection, with rising litigations and reimbursement costs, resulting in a peculiarly complex market. For the Italian context, the study focuses on the financial repercussions for healthcare institutions of the growing trend towards risk retention practises, legally empowered by the introduction of Law No. 24/2017. The analysis employs Generalised Linear Models for the regressive approach to incorporate the structural and organisational characteristics of hospitals and uses quantitative simulations to explore different scenarios at a regional aggregate level. Due to the limited existing literature and data on the topic, this research aims to provide new methods for effectively understanding and managing this type of risk, thereby supporting decision-making processes in the healthcare sector. Full article

Background: Plastic surgery is one of the medical specialties with the highest risk of recurrent medical malpractice claims. The frequency of civil lawsuits represents an issue for the micro- and macro-economy of practitioners of these health treatments. This paper aims to discuss the medico-legal aspects and claim path in a case of a cosmetic blepharoplasty complicated by lagophthalmos wrongly related to the procedure but due to missed hyperthyroidism. Case Description and Literature Review: A 48-year-old woman who underwent cosmetic blepharoplasty with undiagnosed hyperthyroidism claimed that the lagophthalmos that occurred some months after the procedure was due to medical malpractice, due to an over-resection of the exuberant lower eyelid tissue. The review question was, “Are thyroid disfunctions usually considered contraindications to be communicated to patients who undergo blepharoplasty?”, and the databases MEDLINE via PubMed, Embase, Scopus, Ovid, ISI Web of Science, Cochrane, and Google Scholar were used. Results and Discussion: There were 21 eligible papers. The case highlights the importance and complexity of causal inference (such as unknown thyroid dysfunctions), related informed consent involving information on possible complications unrelated to malpractice, and guidelines recommending endocrinological consultation for cosmetic/functional blepharoplasty in patients at risk (e.g., female patients with a known history of thyroid disease). Full article

One of the challenges in the healthcare sector is making accurate forecasts across insurance years for claims reserve. Healthcare claims present huge variability and heterogeneity influenced by random decisions of the courts and intrinsic characteristics of the damaged parties, which makes traditional methods for estimating reserves inadequate. We propose a new methodology to estimate claim reserves in the healthcare insurance system based on generalized linear models using the Overdispersed Poisson distribution function. In this context, we developed a method to estimate the parameters of the quasi-likelihood function using a Gauss–Newton algorithm optimized through a genetic algorithm. The genetic algorithm plays a crucial role in glimpsing the position of the global minimum to ensure a correct convergence of the Gauss–Newton method, where the choice of the initial guess is fundamental. This methodology is applied as a case study to the healthcare system of the Tuscany region. The results were validated by comparing them with state-of-the-art measurement of the confidence intervals of the Overdispersed Poisson distribution parameters with better outcomes. Hence, local healthcare authorities could use the proposed and improved methodology to allocate resources dedicated to healthcare and global management. Full article

Background: Orthopedic surgery is a specialty at risk for medical malpractice claims. We aimed to assess the frequency of alleged malpractice cases related to orthopedic surgery in the Netherlands from the last 15 years. Methods: We systematically searched the database of the Dutch Medical Disciplinary Court for verdicts related to orthopedic surgery between January 2009 and July 2023 and extracted case data and data on allegations and outcomes. Results: We identified 158 verdicts (mean of 10.5 per year), of which 151 (96%) were filed against specialists and 7 (4%) against residents. Cases were most frequently classified as incorrect treatment/diagnosis (n = 107, 67.7%). Cases were related to the subspecialties of knee (n = 34, 21.5%), hip (n = 31, 19.6%), ankle (n = 25, 15.8%), spine (n = 22, 13.9%), and shoulder (n = 19, 12.0%). A total of 32 cases (20.3%) were judged as partially founded and 9 (6%) as founded. The Dutch Medical Disciplinary Court imposed 28 warnings, 10 reprimands, and 3 temporary suspensions. A total of 68 appeals were submitted, of which 95% were rejected for filing patients. In three instances, unfounded verdicts were changed to two warnings and a reprimand. In four appeals by an orthopedic surgeon, a warning and reprimand were dismissed, and two reprimands were changed to warnings. Conclusions: The amount of malpractice cases against orthopedic surgeons in the Netherlands is relatively low. The cases in our study may improve our understanding of allegations against physicians and improve the quality of patient care. Full article

Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75–7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50–3.46, p < 0.001). Prioritizing protection from professional liability over patients’ actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a ‘risk management culture’ and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine. Full article

(1) Background: Identifying hospital-related critical, and excellent, areas represents the main goal of this paper, in both a national and local setting. Information was collected and organized for an internal company’s reports, regarding civil litigation that has been affecting the hospital, to relate the obtained results with the phenomenon of medical malpractice on a national scale. This is for the development of targeted improvement strategies, and for investing available resources in a proficient way. (2) Methods: In the present study, data from claims management in Umberto I General Hospital, Agostino Gemelli University Hospital Foundation and Campus Bio-Medico University Hospital Foundation, from 2013 to 2020 were collected. A total of 2098 files were examined, and a set of 13 outcome indicators in the assessment of “quality of care” was proposed. (3) Results: From the total number, only 779 records (37.1%) were attributable to the categories indexable for the present analysis. This data highlights how, following a correct and rigorous categorization of hospital events, it is possible to analyze these medico-legal aspects using a small number of indicators. Furthermore, it is important to consider how a consistent percentage of remaining events was difficult to index, and was also of poor scientific interest. (4) Conclusions: The proposed indicators do not require standards to be compared to, but provide a useful instrument for comparative purposes. In fact, in addition to comparative assessment between different business realities distributed throughout the territory, the use of outcome indicators allows for a longitudinal analysis evaluating the performance of an individual structure over time. Full article

Criminal trials and claims against physicians for malpractice-related damages have increased dramatically in recent years, and, with Obstetrics and Gynecology being one of the medical specialties that is at the highest risk, we carried out a retrospective analysis aimed at examining all Obstetrics- and Gynecology-related medical professional liability prosecutions within the General Register of Criminal Records of the Rome Public Prosecutor’s Office between the years 2000 and 2014. The number of prosecutions increased steadily in the years 2000–2005, with varying trends in the following years. A total of 727 healthcare professionals were involved in criminal charges, and most prosecuted crimes were related to Articles 590 and 589 of the Italian Penal Code, followed by violations of Article 17 of Law 194/78. In most cases, filing was requested and granted without opposition. In 95 cases, an expert witness was appointed by the Court, and in 68 cases, the technical consultants of the State Prosecutor found culpable conduct. Public hospitals, private nursing homes and outpatient clinics, or private practices were mostly involved; in 45% of the cases, the physicians were hospital employees. In this setting, Italy is prepared to introduce new measures and regulations to address the issues posed by defensive medicine and charges of professional liability for healthcare providers. Full article

Fetal inflammatory response syndrome (FIRS) represents the fetal inflammatory reaction to intrauterine infection or injury, potentially leading to multiorgan impairment, neonatal mortality, and morbidity. Infections induce FIRS after chorioamnionitis (CA), defined as acute maternal inflammatory response to amniotic fluid infection, acute funisitis and chorionic vasculitis. FIRS involves many molecules, i.e., cytokines and/or chemokines, able to directly or indirectly damage fetal organs. Therefore, due to FIRS being a condition with a complex etiopathogenesis and multiple organ dysfunction, especially brain injury, medical liability is frequently claimed. In medical malpractice, reconstruction of the pathological pathways is paramount. However, in cases of FIRS, ideal medical conduct is hard to delineate, due to uncertainty in diagnosis, treatment, and prognosis of this highly complex condition. This narrative review revises the current knowledge of FIRS caused by infections, maternal and neonatal diagnosis and treatments, the main consequences of the disease and their prognoses, and discusses the medico-legal implications. Full article

In this study, we developed a similar text retrieval system using Sentence-BERT (SBERT) for our database of closed medical malpractice claims and investigated its retrieval accuracy. We assigned each case in the database a short Japanese summary of the accident as well as two labels: the category was classified as a hospital department mainly, and the process indicated a failed medical procedure. We evaluated the accuracies of a similar text retrieval system with the two labels using three different multilabel evaluation metrics. For the encoders of SBERT, we employed two pretrained BERT models, UTH-BERT and NICT-BERT, that were trained on huge Japanese corpora, and we performed iterative optimization to train the SBERTs. The accuracies of the similar text retrieval systems using the trained SBERTs were more than 15 points higher than those of the Okapi BM25 system and the pretrained SBERT system. Full article

Thyroid surgeries can often lead to operative complications, sometimes with consequences on the patient’s health. This often leads to claims for compensation but the assessments of consultants and judges are not always objective. Based on these considerations, the authors analyzed forty-seven sentences issued between 2013 and 2022 regarding claims of alleged medical malpractice. This analysis aims to examine the cases presented in the sentences and the evaluations proposed by the judges to offer ideas for objective evaluation by the legislation in force in Italy. Full article