The Study of Causes and Types of Medical Malpractice from Patient’s Perspective -- Based on Decisions of the Courts in Taiwan

• Main Authors: Che-Chen Wu, 吳澤誠
• Other Authors: 鍾國彪
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/40149697262173113139

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 94 === The final decisions of the arguments of the medical malpractices are at the justice hand of the Courts. The purpose of this study is based on the decisions of the Courts, including the preliminary information, medical treatment, and the results of medical judgments, to analyze the contents of the decisions and to investigate the trends and types of medical malpractice, and the ratio of the determined negligence in medical judgments. Furthermore, it analyzes the differences of the above data between the individual department of different level of hospitals in North, Middle and South Districts in Taiwan. This study uses five characteristic index including medical malpractice, medical error, medical negligence, medical injury and medical damage to surf all the decisions related to medical malpractice of the civil sues in District Courts from Aug. 1, 1999 to Sept. 30, 2005 and select 162 decisions which are decisions of pure medical malpractices screened from among decisions of non-malpractices or duplicated malpractices. The method of the study is by means of the “content analysis” to get three databases: preliminary information, medical treatment and medical judgments and to analyze the differences between these three databases. The results are as follows: 1. The trend of medical malpractice in Taiwan is not mounting. From the analysis of 162 civil decisions, the apex of the trend is in 2001 (30 cases) and it goes down rather than up thereafter. 2. Most of malpractices occur in the medicine and surgery departments, and in medical centers. There are 63.3% and 32.7%, respectively. 3. The major types to evoke sue are the procedures of surgery, pre-treatment notification, diagnosis, medical management and prescription. Theses five types are the major types of negligence and account for 61.1% (162/817 practices). 4. The types of omission errors are medical examinations, transfers, laboratory examinations and inspections. The omission errors are the types of negligence that the executives of hospitals or care-givers can’t notice by themselves. In regard of no actual misdoings, it is naturally difficult to give appropriate judgment for correction or management. In this study, there are totally 173 practices, accounting for 24.1% (173/817 practices). 5. There is relatively high rate that the Courts request for professional medical consultations and relatively low rates both of win for patients and the decisive judgment for medical negligence. There are total 343 professional consultations in 162 cases with average 2.12 times each case and the rate of negligence is 13.4%. The rate of win for patients is 22.2%. Among “judgment model” there is 1.7 times each case asked for judgment and the rate of decisive judgment for negligence is only 15.2%. Too low rate of recognition for negligence will increase the frequency for medical judgments and the main reason for this phenomenon is that the patients doubt the result and request for repeated judgments. 6. The rate of win for patients in malpractice decisions is higher in southern hospitals, in surgery department and in clinic level and there is a reverse relationship between the level of hospitals and the rates of the decisions for negligence and win. The rate of win for patients in southern hospitals is 27.3% in 162 cases and 26.1% in surgery department and 34.4 % in clinic level and they are much higher than the average rate 22.2% in Taiwan. According to the severity of diseases, the hospitals are separated into two categories: medical centers and district hospitals versus local hospitals and clinics. The rate of win and rate of decisions for negligence are 17.3% versus 29.0% and 13.3% versus 43.5%, respectively. There shows significant difference. According to the results, we propose three suggestions: 1. For future study In Harvard study, there are in-between relationships of the rates of total number of patients versus medical adverse events, versus medical malpractice , versus sue, and versus compensation: 3.7%, 27.6%, 13.2% and 50%, respectively. Although there are 162 cases analyzed in this study, the actual details of medical adverse events need further investigation. 2. For executives of hospitals Omission errors reflect the aggressive demand for the care-receivers to the care-givers and they often occur due to the negligence of executives or care-givers. Because there is no actual mistreatment, it is unable to be inspected along the whole medical treatment and, therefore, is difficult to evaluate and control. Hence, the executives can make more effort on inspection and control of the proposed types of omission errors, rates, specific field and treatment to promote the quality of medical care. 3. For faculty of medical judgment institution The relatively high rate of repeated judgments reflects the unbelief to the professional institute. The relatively low rate of negligence worsens the doubt and raises the rate of repeated judgments. The issues that how to convince the people medical judgment the professional institute made, how to provide adequate profession and how to represent its undoubted independence and justice need thorough considerations.