Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-18T01:25:52.589Z Has data issue: false hasContentIssue false
  • English
  • Français

Malpractice issues in modern anaesthesiology

Published online by Cambridge University Press:  01 November 2007

A. Mavroforou ,
G. Stamatiou ,
S. Koutsias ,
E. Michalodimitrakis ,
G. Vretzakis  and
A. D. Giannoukas
A. Mavroforou*
Affiliation:
University of Thessaly Medical School, Department of Medical Law and Ethics, Larissa, Greece University of Crete Medical School, Forensic Sciences Department, Heraklion, Crete, Greece
G. Stamatiou
Affiliation:
University of Thessaly Medical School, Department of Anaesthesiology, Larissa, Greece
S. Koutsias
Affiliation:
University of Thessaly Medical School, Department of Vascular Surgery, Larissa, Greece
E. Michalodimitrakis
Affiliation:
University of Crete Medical School, Forensic Sciences Department, Heraklion, Crete, Greece
G. Vretzakis
Affiliation:
University of Thessaly Medical School, Department of Anaesthesiology, Larissa, Greece
A. D. Giannoukas
Affiliation:
University of Thessaly Medical School, Department of Vascular Surgery, Larissa, Greece
*
Correspondence to: Anna Mavroforou, 13 Ath. Agorogianni Street, 41335 Larissa, Greece. E-mail: amavroforou@hotmail.com; Tel: +30 2410 627600; Fax: +30 2410 627645
Get access

Summary

Medical malpractice has been raised as an important problem in daily practice, while the media and public remain unforgiving to those perceived to have harmed the patients’ life. This article highlights important legal issues related to medical malpractice and summarizes the sources and the nature of potential errors in anaesthesiology practice.

Keywords

LIABILITY LEGALINFORMED CONSENTANAESTHESIOLOGYMALPRACTICE
Type
Review
Information
European Journal of Anaesthesiology , Volume 24 , Issue 11 , November 2007 , pp. 903 - 911
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Fenn, P, Hermans, D, Dingwall, R. Estimating the cost of compensating victims of medical negligence. BMJ 1994; 309: 389.CrossRefGoogle ScholarPubMed
2.Beckmann, LA. The influence of the current medicolegal climate on New South Wales anaesthetic practice. Anaesth Intensive Care 2005; 33: 762–767.CrossRefGoogle ScholarPubMed
3.B-Lynch, C, Coker, A, Dua, JA. A clinical analysis of 50 medico-legal claims evaluating the causes and assessing the potential benefit of alternative dispute resolution. Br J Obstet Gynaecol 1996; 103: 1236–1242.CrossRefGoogle Scholar
4.Samarkandi, A. Medico-legal liabilities of anesthesia practice in Saudi Arabia. Middle East J Anesthesiol 2006; 18: 693–706.Google ScholarPubMed
5.Ozdemir, MH, Cekin, N, Can, IO, Hilal, A. Malpractice and system of expertise in anesthetic procedures in Turkey. Forensic Sci Int 2005; 153: 161–167.CrossRefGoogle ScholarPubMed
6.Blendon, RJ, DesRoches, CM, Brodie, M et al. . Views of practicing physicians and the public on medical errors. N Engl J Med 2002; 347: 1933–1940.Google Scholar
7.Sa Rego, MM, Watcha, MF, White, PF. The changing role of monitored anesthesia care in the ambulatory setting. Anesth Analg 1997; 85: 1020–1036.CrossRefGoogle ScholarPubMed
8.Brazier, M. Medical negligence. In: Brazier, M, ed. Medicine, Patients and the Law. England: Penguin Books, 1992: 112–139.Google Scholar
9. UK Government Statement, Hansard, 24 March 1998, cols 165–166.Google Scholar
10.Gann, R. The therapeutic partnership: legal and ethical aspects of consumer health information. Health Libr Rev 1995; 12: 83–90.CrossRefGoogle ScholarPubMed
11.Mavroforou, A, Giannoukas, AD, Katsamouris, A, Michalodimitrakis, E. The importance of communication between physicians and patients: special considerations in the era of endovascular therapy. Int Angiol 2002; 21: 99–102.Google Scholar
12.Mavroforou, A, Giannoukas, AD, Mavrophoros, D, Michalodimitrakis, E. Physician’s liability in interventional radiology and endovascular therapy. Eur J Radiol 2003; 46: 240–243.CrossRefGoogle ScholarPubMed
13Kraushar, MF. Recognizing and managing the litigious patient. Surv Ophthalmol 1992; 37: 54–56.Google Scholar
14.Yoshida, A. The importance of informed consent in the field of ophthalmology. Hokkaido Igaku Zasshi 1998; 73: 15–20.Google Scholar
15.Byrne, DJ, Napier, A, Cuschieri, A. How informed is signed consent? Br Med J (Clin Res Ed) 1988; 296 6625: 839–840.Google Scholar
16. UK Family Reform Act 1969 in Section 8(1).Google Scholar
17. Gillick v West Norfolk and Wisbech Area Health Authority [1985] 3 All ER 402.Google Scholar
18.Buchanan, AE, Brock, DW. Deciding for Others. The Ethics of Surrogate Decision Making. Cambridge MA: Cambridge University Press, 1989.Google Scholar
19.Alderson, P. Choosing for Children. Parents’ Consent to Surgery. Oxford, UK: Oxford University Press, 1990.Google Scholar
20.Henry, F. Uterine artery embolization for symptomatic uterine fibromas. Informed consent of the patient. J Radiol 2001; 82: 111–115.Google Scholar
[21.Vincent, JL. Information in the ICU: are we being honest with our patients? The results of a European questionnaire. Intensive Care Med 1998; 24: 1251–1256.CrossRefGoogle Scholar
22.Aitkenhead, AR. Informing and consenting for anaesthesia. Best Pract Res Clin Anaesthesiol 2006; 20: 507–524.CrossRefGoogle ScholarPubMed
23.White, SM, Baldwin, TJ. Consent for anaesthesia. Anaesthesia 2003; 58: 760–774.CrossRefGoogle ScholarPubMed
24.Rosique, I, Perez-Carceles, MD, Romero-Martin, M, Osuna, E, Luna, A. The use and usefulness for patients undergoing anaesthesia. Med Law 2006; 25: 715–727.Google Scholar
25.Osuna, E, Perez-Carceles, MD, Perez-Moreno, JA, Luna, A. Informed consent. Evaluation of the information provided to patients before anaesthesia and surgery. Med Law 1998; 17: 511–518.Google ScholarPubMed
26.Flanagan, JC. The critical incident technique. Psychol Bull 1954; 51: 327–358.Google Scholar
27.Cooper, JB, Newbower, RS, Long, CD, McPeek, B. Preventable anesthesia mishaps: a study of human factors. Anesthesiology 1978; 49: 399–406.CrossRefGoogle ScholarPubMed
28.Reason, J. Human Error. Cambridge: Cambridge University Press, 1990.CrossRefGoogle Scholar
29.Wheeler, SJ, Wheeler, DW. Medication errors in anaesthesia and critical care. Anaesthesia 2005; 60: 257–273.Google Scholar
30.Taylor, G, Larson, CP, Prestwich, R. Unexpected cardiac arrest during anesthesia and surgery. JAMA 1976; 236: 2758–2760.Google Scholar
31.Craig, J, Wilson, ME. A survey of anaesthetic misadventures. Anaesthesia 1981; 36: 933–936.Google Scholar
32.Gaba, DMAuthMaxwell, M, DeAnda, A. Anesthetic mishaps: breaking the chain of accident evolution. Anesthesiology 1987; 66: 670–676.Google Scholar
33.Cooper, JB, Newbower, RS, Kitz, RJ. An analysis of major errors and equipment failures in anesthesia management: considerations for prevention and detection. Anesthesiology 1984; 60: 34–42.CrossRefGoogle ScholarPubMed
34.ASHP guidelines on preventing medication errors in hospitals. Am J Hosp Pharm 1993; 50: 305–314.Google Scholar
35.Anonymous. Suggested definitions and relationships among medication misadventures, medication errors, adverse drug events, and adverse drug reactions. Am J Health Syst Pharm 1998; 55: 165–166.CrossRefGoogle Scholar
36.Webb, RK, Russell, WJ, Klepper, I, Runciman, WB. The Australian Incident Monitoring Study. Equipment failure. An analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21: 673–677.CrossRefGoogle ScholarPubMed
37.Currie, M, Mackay, P, Morgan, C et al. . The Australian Incident Monitoring Study. The ‘wrong drug’ problem in anaesthesia: an analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21: 596–601.Google Scholar
38.Webster, CS, Merry, AF, Larsson, L, McGrath, KA, Weller, J. The frequency and nature of drug administration error during anaesthesia. Anaesth Intensive Care 2001; 29: 494–500.Google Scholar
39.ASHP guidelines on preventing medication errors in hospitals. Am J Hosp Pharm 1993; 50: 305–314.Google Scholar
40.Leape, LL, Bates, DW, Cullen, DJ et al. . Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA 1995; 274: 35–43.Google Scholar
41.Bates, DW, Cullen, DJ, Laird, N et al. . Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995; 274: 29–34.Google Scholar
42.Ludbrook, GL, Webb, RK, Fox, MA, Singleton, RJ, The Australian Incident Monitoring Study. Problems before induction of anaesthesia. An analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21: 593–595.CrossRefGoogle ScholarPubMed
43.Raju, TN, Kecskes, S, Thornton, JP, Perry, M, Feldman, S. Medication errors in neonatal and paediatric intensive-care units. Lancet 1989; 2: 374–376.CrossRefGoogle ScholarPubMed
44.Bordun, LA, Butt, W. Drug errors in intensive-care. J Paediatr Child Health 1992; 28: 309–311.Google Scholar
45.Vincer, MJ, Murray, JM, Yuill, A et al. . Drug errors and incidents in a neonatal intensive care unit. A quality assurance activity. Am J Dis Children 1989; 143: 737–740.Google Scholar
46.Wilson, DG, McArtney, RG, Newcombe, RG et al. . Medication errors in paediatric practice: insights from a continuous quality improvement approach. Eur J Pediatr 1998; 157: 769–774.Google Scholar
47.Dean, B, Schachter, M, Vincent, C, Barber, N. Prescribing errors in hospital inpatients: their incidence and clinical significance. Qual Saf Health Care 2002; 11: 340–344.Google Scholar
48.Wagner, MM, Hogan, WR. The accuracy of medication data in an outpatient electronic medical record. J Am Med Inform Assoc 1996; 3: 234–244.Google Scholar
49.Black, R, Woolman, P, Kinsella, J. Variation in the transcription of laboratory data in an intensive care unit. Anaesthesia 2004; 59: 767–769.Google Scholar
50.Bates, DW, Leape, LL, Cullen, DJ et al. . Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280: 1311–1316.Google Scholar
51.Wilson, DG, McArtney, RG, Newcombe, RG et al. . Medication errors in paediatric practice: insights from a continuous quality improvement approach. Eur J Pediatr 1998; 157: 769–774.CrossRefGoogle ScholarPubMed
52.Dean, B, Schachter, M, Vincent, C, Barber, N. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet 2002; 359: 1373–1378.Google Scholar
53.Arrowsmith, JB, Gerstman, BB, Fleischer, DE, Benjamin, SB. Results from the American Society for Gastrointestinal Endoscopy/US Food and Drug Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy. Gastrointest Endosc 1991; 37: 421–427.Google Scholar
54.Iber, FL, Livak, A, Kruss, DM. Apnea and cardiopulmonary arrest during and after endoscopy. J Clin Gastroenterol 1992; 14: 109–113.Google Scholar
55.Cote, CJ, Notterman, DA, Karl, HW, Weinberg, JA, McCloskey, C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000; 105: 805–814.Google Scholar
56.Cote, CJ, Karl, HW, Notterman, DA, Weinberg, JA, McCloskey, C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics 2000; 106: 633–644.CrossRefGoogle Scholar
57.Cote, CJ, Notterman, DA, Karl, HW, Weinberg, JA, McCloskey, C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000; 105: 805–814.Google Scholar
58.Bhananker, SMM, Posner, KL, Cheney, FW, Caplan, RA, Lee, LA, Domino, KB. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology 2006; 104: 228–234.Google Scholar
59.JrHug, CC. MAC should stand for maximum anesthesia caution, not minimal anesthesiology care. Anesthesiology 2006; 104: 235–239.Google Scholar
60.Cheney, F. The American Society of Anesthesiologists Closed Claims Project: what have we learned, how has it affected practice, and how will it affect practice in the future? Anesthesiology 1999; 91: 552–556.Google Scholar
61.Domino, KB, Posner, KL, Caplan, RA, Cheney, FW. Airway injury during anesthesia: a closed claim analysis. Anesthesiology 1999; 91: 1703–1711.Google Scholar
62.Cheney, FW, Posner, KL, Caplan, RA. Adverse respiratory events infrequently leading to malpractice suits. A closed claim analysis. Anesthesiology 1992; 75: 932–939.Google Scholar
63.Cheney, FW, Domino, KB, Caplan, RA, Posner, KL. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology 1999; 90: 1062–1069.Google Scholar
64.Cheney, FW, Domino, KB, Caplan, RA, Posner, KL. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology 1999; 90: 1062–1069.Google Scholar
65.Chadwick, HS, Posner, K, Caplan, RA, Ward, RJ, Cheney, FW. A comparison of obstetric and non-obstetric anesthesia malpractice claims. Anesthesiology 1991; 74: 242–249.CrossRefGoogle Scholar
66.Domino, KB, Bowdle, TA, Posner, KL, Spitellie, PH, Lee, LA, Cheney, FW. Injuries and liability related to central vascular catheters: a closed claims analysis. Anesthesiology 2004; 100: 1411–1418.Google Scholar
67.Kain, ZN. The National Practitioner Data Bank and anesthesia malpractice payments. Anesth Analg 2006; 103: 646–649.CrossRefGoogle ScholarPubMed
68.Orser, BA, Chen, RJ, Yee, DA. Medication errors in anesthetic practice: a survey of 687 practitioners. Can J Anaesth 2001; 48: 139–146.Google Scholar
69.Hubler, M, Mollemann, A, Eberlein-Gonska, M, Regner, M, Koch, T. Anonymous critical incident reporting system in anaesthesiology. Results after 18 months. Anaesthesist 2006; 55: 133–141.Google Scholar
70.Reason, JT. Human error: models and management. BMJ 2000; 320: 768–770.Google Scholar
71.Edbril, S, Lagasse, RS. Relationship between malpractice litigation and human errors. Anesthesiology 1999; 91: 609–611.Google Scholar
72.Bhananker, SM, Posner, KL, Cheney, FW, Caplan, RA, Lee, LA, Domino, KB. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology 2006; 104: 228–234.Google Scholar
73.Lacalio, AR, Lawthers, AG, Brennan, TA et al. . Relation between malpractice claims and adverse events due to negligence: Results of the Harvard Medical Practice Study III. N Engl J Med 1991; 325: 245–251.Google Scholar
74.Donchin, Y, Gopher, D, Olin, M et al. . A look into the nature and causes of human errors in the intensive care unit. Crit Care Med 1995; 23: 294–300.Google Scholar
75.Wu, AW, Folkman, S, McPhee, SJ, Lo, B. Do house officers learn from their mistakes? JAMA 1991; 265: 2089–2094.Google Scholar
76.Taxis, K, Barber, N. Causes of intravenous medication errors: an ethnographic study. Qual Saf Health Care 2003; 12: 343–347.Google Scholar
77.Mach, E. Knowledge and Error. Dordrecht: Reidel Publishing Co., 1905 (English translation, 1976).Google Scholar
78.Webb, RK, Russell, WJ, Klepper, I, Runciman, WB, The Australian Incident Monitoring Study. Equipment failure. An analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21: 673–677.CrossRefGoogle ScholarPubMed
79.Frey, B, Kehrer, B, Losa, M et al. . Comprehensive critical incident monitoring in a neonatal–pediatric intensive care unit: experience with the system approach. Intensive Care Med 2000; 26: 69–74.Google Scholar
80.James, RH. 1000 anaesthetic incidents: experience to date. Anaesthesia 2003; 58: 856–863.Google Scholar
81.Brown, SL, Bogner, MS, Parmentier, CM, Taylor, JB. Human error and patient-controlled analgesia pumps. J Intraven Nurs 1997; 20: 311–316.Google Scholar
82.Brown, SL, Morrison, AE, Parmentier, CM, Woo, EK, Vishnuvajjala, RL. Infusion pump adverse events: experience from medical device reports. J Intraven Nurs 1997; 20: 41–49.Google ScholarPubMed
83.Carlisle, D, Upton, D, Cousins, D. Infusion confusion. Nurs Times 1996; 92: 48–49.Google Scholar
84.Lin, L, Isla, R, Doniz, K et al. . Applying human factors to the design of medical equipment: patient-controlled analgesia. J Clin Monit Comput 1998; 14: 253–263.Google Scholar
85.Vicente, KJ, Kada-Bekhaled, K, Hillel, G, Cassano, A, Orser, BA. Programming errors contribute to death from patient-controlled analgesia. Case report and estimate of probability. Can J Anaesth 2003; 50: 328–332.CrossRefGoogle ScholarPubMed