目的:本研究旨在描述这些特征,损伤结果,并支付产科医疗事故诉讼,以更好地了解产科的法医学负担,并使用国家卫生服务诉讼机构编码分类法对产科医疗事故诉讼的原因进行分类,以进一步提高产科护理的质量。
方法:我们回顾并检索了2013年至2021年期间来自中国判决在线的法律审判法庭记录的关键信息。
结果:本研究综述了3441起成功提起的产科医疗事故诉讼,赔偿总额为139,875,375美元。在2017年达到顶峰之后,产科医疗事故索赔的数量开始下降。在被起诉的2424家医院中,8.3%(201/2424)被称为“重复被告”,因为他们参与了多项诉讼。死亡和伤害是53.4%和46.6%的病例的结果,分别。最常见的结局类型是新生儿死亡,占所有病例的29.8%。死亡赔偿金的中位数高于伤害(P<0.05)。就详细的伤害结果而言,重大新生儿损伤的赔偿金额中位数高于新生儿死亡和胎儿死亡(P<0.05)。主要孕产妇受伤的赔偿金额中位数高于孕产妇死亡的赔偿金额(P<0.05)。产科医疗事故的主要原因是分娩并发症和不良事件的管理(23.3%),劳动管理(14.4%),职业决策(13.7%),胎儿监测(11.0%),和剖宫产管理(9.5%)。8.7%的病例的原因是高额支付(≥100,000美元)。正如多变量分析的结果表明,中国中部地区的医院(优势比[OR],0.476;95%置信区间[CI],0.348-0.651),中国西部的医院(或者,0.523;95%CI,0.357-0.767),和二级医院(或者,0.587;95%CI,0.356-0.967)具有较低的高支付风险。承担最终责任的医院(或,9.695;95%CI,4.072-23.803),全部责任(或,16.442;95%CI,6.231-43.391),新生儿重大损伤(或,12.326;95%CI,5.836-26.033),主要产妇伤害(或,20.885;95%CI,7.929-55.011),孕产妇死亡(或,18.783;95%CI,8.887-39.697),孕产妇死亡儿童受伤(或,54.682;95%CI,10.900-274.319),产妇伤害与儿童死亡(或,6.935;95%CI,2.773-17.344),以及母亲和孩子的死亡(或,12.770;95%CI,5.136-31.754)具有较高的支付风险。在因果域中,只有麻醉药有较高的支付风险(或,5.605;95%CI,1.347-23.320),但与麻醉相关的诉讼仅占所有案件的1.4%。
结论:由于产科医疗事故诉讼,医疗保健系统不得不支付大量费用。需要做出更大的努力来最大程度地减少严重的伤害结果并提高危险领域的产科质量。
This study aimed to depict the characteristics, injury outcomes, and payment of obstetric malpractice lawsuits to better understand the medicolegal burden in obstetrics and categorize the causes of obstetric malpractice lawsuits using The National Health Service Litigation Authority coding taxonomy for further quality improvement in maternity care.
We reviewed and retrieved key information on court records of legal trials from
China Judgment Online between 2013 and 2021.
A total of 3441 obstetric malpractice lawsuits successfully claimed were reviewed in this study, with a total indemnity payment of $139,875,375. After peaking in 2017, the number of obstetric malpractice claims begins to decline. Of the 2424 hospitals that were sued, 8.3% (201/2424) were referred to as \"repeat defendant\" because they were involved in multiple lawsuits. Death and injury were the outcomes in 53.4% and 46.6% of the cases, respectively. The most common outcome type was neonatal death, which made up 29.8% of all cases. The median indemnity payment for death was higher compared with injury ( P < 0.05). In terms of detailed injury outcomes, the major neonatal injury had higher median indemnity payments than neonatal death and fetal death ( P < 0.05). The median indemnity payment of the major maternal injury was higher than that of maternal death ( P < 0.05). The leading causes of obstetric malpractice were the management of birth complications and adverse events (23.3%), management of labor (14.4%), career decision making (13.7%), fetal surveillance (11.0%), and cesarean section management (9.5%). The cause for 8.7% of cases was high payment (≥$100, 000). As indicated by the results of the multivariate analysis, the hospitals in the midland of
China (odds ratio [OR], 0.476; 95% confidence interval [CI], 0.348-0.651), the hospitals in the west of
China (OR, 0.523; 95% CI, 0.357-0.767), and the secondary hospitals (OR, 0.587; 95% CI, 0.356-0.967) had lower risks of high payment. Hospitals with ultimate liability (OR, 9.695; 95% CI, 4.072-23.803), full liability (OR, 16.442; 95% CI, 6.231-43.391), major neonatal injury (OR, 12.326; 95% CI, 5.836-26.033), major maternal injury (OR, 20.885; 95% CI, 7.929-55.011), maternal death (OR, 18.783; 95% CI, 8.887-39.697), maternal death with child injury (OR, 54.682; 95% CI, 10.900-274.319), maternal injury with child death (OR, 6.935; 95% CI, 2.773-17.344), and deaths of both mother and child (OR, 12.770; 95% CI, 5.136-31.754) had higher risks of high payment. In the causative domain, only anesthetics had a higher risk of high payment (OR, 5.605; 95% CI, 1.347-23.320), but anesthetic-related lawsuits made up just 1.4% of all cases.
The healthcare systems had to pay a significant amount as a result of obstetric malpractice lawsuits. Greater efforts are required to minimize serious injury outcomes and improve obstetric quality in the risky domains.