Litigations following spinal neurosurgery in France: 'out-of-court system,' therapeutic hazard, and welfare state
| Autor: | Bertrand Debono, Nicolas Lonjon, Lynda Lettat-Ouatah, Carole Gerson, Renaud Bougeard, Thierry Houselstein |
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| Přispěvatelé: | Centre Francilien du Dos, Clinique du Val d'Ouest, Service de Neurochirurgie [Montpellier], CHU Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Mécanismes moléculaires dans les démences neurodégénératives (MMDN), Université de Montpellier (UM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École pratique des hautes études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL) |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
PDR = permanent disability rate
Neurosurgery Medical malpractice Commission Conciliation [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery 030218 nuclear medicine & medical imaging 03 medical and health sciences spine surgery 0302 clinical medicine Malpractice NI = nosocomial infection out-of-court system Medicine Humans MACSF = Mutuelle d’Assurances du Corps de Santé Français PRL = Patients’ Rights Law Retrospective Studies therapeutic hazard ACDF = anterior cervical discectomy and fusion business.industry ONIAM = National Compensation Office for Medical Accidents Medical record Compensation (psychology) no-fault system litigation malpractice Welfare state ALIF = anterior lumbar interbody fusion General Medicine medicine.disease Hazard Spine 3. Good health Compensation and Redress Surgery [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] Neurology (clinical) Medical emergency France CCI = Commission for Conciliation and Compensation business 030217 neurology & neurosurgery |
| Zdroj: | Neurosurgical Focus Neurosurgical Focus, American Association of Neurological Surgeons, 2020, 49 (5), pp.E11. ⟨10.3171/2020.8.FOCUS20582⟩ |
| ISSN: | 1092-0684 |
| DOI: | 10.3171/2020.8.FOCUS20582⟩ |
| Popis: | OBJECTIVESpinal surgeries carry risks of malpractice litigation due to the random nature of their functional results, which may not meet patient expectations, and the hazards associated with these complex procedures. Claims are frequent and costly. In France, since 2002, a new law, the Patients’ Rights Law of March 4, 2002, has created an alternative, out-of-court scheme, which established a simplified, rapid, free-of-charge procedure (Commission for Conciliation and Compensation [CCI]). Moreover, this law has optimized the compensation provided to patients for therapeutic hazards by use of a national solidarity fund. The authors analyzed the consequences of this alternative route in the case of claims against private neurosurgeons in France.METHODSFrom the data bank of the insurer Mutuelle d’Assurances du Corps de Santé Français (MACSF), the main insurance company for private neurosurgeons in France, the authors retrospectively analyzed 193 files covering the period 2015–2019. These computerized files comprised the anonymized medical records of the patients, the reports of the independent experts, and the final judgments of the CCI and the entities supporting the compensation, if any.RESULTSDuring the 5-year study period (2015–2019), the insurance company recorded 494 complaints involving private neurosurgeons for spinal surgery procedures, of which 126 (25.5%) were in civil court, 123 (24.9%) were under amicable procedure, and 245 (49.6%) were in the out-of-court scheme administered by the CCI. Out of these 245 cases, only 193 were closed due to delays. The conclusions of the commission were rejection/incompetence decisions in 47.2% of the cases, therapeutic hazards in 21.2%, nosocomial infections in 17.6%, and practitioner fault in 13.5%. National solidarity compensated for 48 complaints (24.8%). The final decision of the CCI is not always consistent with the conclusions of the experts mandated by it, illustrating the difficulty in defining the concept of hazards. The authors found that the therapeutic hazards retained and compensated by the national solidarity included decompensated spondylotic myelopathies (15% of the 40 cases) and cauda equina syndromes (30%). As allowed by law, 11.5% of the patients who were not satisfied triggered a classical procedure in a court.CONCLUSIONSIn the French out-of-court system, trial decisions resulting in rulings of proven medical malpractice are rare, but patients can start a new procedure in the classical courts. The therapeutic hazard remains a subtle definition, which may be problematic and require further discussion between experts and magistrates. In spite of the imperfections, this out-of-court system proposes a major evolution to move patients and medical providers from legal battles to reconciliations. |
| Databáze: | OpenAIRE |
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