An analysis of forensic examinations in civil medical “malpractice” cases

Introduction. Currently, in Russia there is an annual increase in the number of criminal and especially civil cases brought in connection with the professional activities of healthcare workers, which is associated with the growth in the number of lawyers, the emergence of the institution of independent examination and insurance companies trying to lay the compensation payments on physicians or healthcare facilities. Aim. An analysis of forensic examinations in civil medical “malpractice” cases in order to identify defects in medical care providing. Materials and methods. An analysis of the materials of 23 forensic examinations in civil medical “malpractice” cases was performed. All forensic examinations were carried out by expert panels; for their performing, along with forensic medicine experts, qualified physicians were involved in accordance with the specialization of the clinical situation being examined (obstetricians-gynecologists, surgeons, traumatologists, etc.). The forensic examinations were carried out by an expert organization established by the Novosibirsk Regional Association of Physicians and having the appropriate authorization for the implementation of activities to evaluate the quality of medical care (license, etc.). Results. In most of the cases analyzed, the examinations were performed due to the plaintiffs’ claims regarding untimely or inadequate diagnostics and treatment, as well as the lack of reliable information provided to relatives about the patient’s condition. In all 23 cases, the court was satisfied with the interpretation and scientific validity of the expert opinions, which served as the basis for making judicial decisions. When considering the performed examinations, the courts did not have any misunderstandings or disagreements with the content of the conclusions; not a single point was called into question. In 96% of the cases considered, the plaintiffs’ claims were partially satisfied by the court; in 4% (one case), the parties came to a voluntary settlement. In 18% of cases, appeals were filed against the court decisions by both the plaintiffs and the defendants; however, only in one case out of four was the decision of the first-instance court changed in terms of recovery in favor of the plaintiff. In one case, the decision of the first-instance court was overturned in terms of imposing fines on a healthcare facility. One claim was considered by the cassation court, the decision of the first-instance court was left unchanged. Conclusion. Based on the analysis of materials of civil forensic examinations and the literature, it can be concluded that there is no unified approach to working out a number of problems at the intersection of medicine and jurisprudence. To settle these problems, it is necessary to develop new methodological approaches. The issue of personal injury due to defects in the provision of medical care can only be resolved if there is a direct cause-and-effect relationship between the physician’s actions and adverse outcome for a patient.