[Estimation of medical protocol correctness in the light of opinions issued as ordered by the judiciary or prosecution authorities].
Medical personnel, most commonly physicians, are held responsible for situations in which in the course of medical treatment some adverse effects develop that endanger the patient's health and life. Such effects generally include death, a severe damage to patient's health as well as the exposing of patients to the danger of such effects developing in them. The effects of the kind result either from some medical malpractice or from medical personnel's negligence. The aim of the paper was to analyse medico-legal expertises issued as ordered by the Polish Judiciary and Prosecution Authorities in cases of alleged medical malpractice that had been issued by the Chair and Department of Forensic Medicine, Medical University of Gdańsk, and to compare the results with those from similar studies done by Chairs and Departments of Forensic Medicine at the Medical Universities of Katowice, Kraków, and Wrocław.


METHODS
Analysis was done of 372 medico-legal expertises issued in the years 1990-2004 by the Chair and Department of Forensic Medicine, Medical University of Gdańsk. The results obtained were compared with those from a similar analysis of medicolegal expertises issued in Gdarisk in the years 1968-1977 and also with those from studies presented by Departments of Forensic Medicine at the Medical Universities of Katowice, Kraków, and Wrocław.


RESULTS
Legal proceedings were generally conducted by the Public Prosecutor's Office, less frequently by the police, and only in 7.2% were such cases subject to the civil law procedure. Most frequently assessed health care facilities included hospitals (66.1%), clinics of medical universities (16.6%), and ambulance service (13.4%). Seldom were the charges of medical malpractice brought against basic health care facilities (9.4%) or private practices (3.5%). As revealed in the analyzed material, adverse health effects of a disease or injury included death--70.5%, a severe damage to patient's health--9.1%, and the endangering of patients with development of such effects--0.4%. In 60.8% of the cases analyzed, medical protocol implemented by medical personnel was assessed as proper. Medical malpractice were found in 18.5% of the cases, including diagnostic malpractice--1.8% therapeutic malpractice--2.7%, and those of logistic nature--4%. Similar results were obtained by the above mentioned Departments of Forensic Medicine. Negligence in the rendering of health care was found in 13.4 of the medico-legal expertises analyzed. Conclusions. In the material subjected to this analysis criminal cases are predominant. Medical personnel, including medical practitioners, are more and more frequently charged with exposing patients to the immediate danger of loss of life or a severe damage to their health (Art. 160 of the Polish Penal Code). There are more and more cases in which the adverse effects endangering patient's health or life result from negligence rather than from some medical malpractice.
Department of Forensic Medicine, Medical University of Gdańsk, Poland. dekape@amg.gda.pl
Dorota
D
Pieśniak
Zbigniew
Z
Jankowski
Stefan
S
Raszeja
D000046:Academic Medical Centers / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D002961:Civil Rights / Q000331:legislation & jurisprudence; D003951:Diagnostic Errors / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D004636:Emergency Service, Hospital / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005104:Expert Testimony / Q000331:legislation & jurisprudence / Q000592:standards*; D006801:Humans; D007603:Jurisprudence; D007882:Legislation, Hospital / Q000706:statistics & numerical data; D008318:Malpractice / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011044:Poland; D011216:Practice Management, Medical / Q000331:legislation & jurisprudence* / Q000592:standards; D028743:Professional Misconduct / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012189:Retrospective Studies