title: [No-fault medical accidents: review of two years' activity of the regional commission for the compensation of medical accidents of the Provence-Alpes-Côtes d'Azur region (PACA)].
abstract: Compensation for victims of medical accidents identified as no-fault medical accidents (NFMA) will be financed by national solidarity: this is a major and innovative feature of the Law of March 4, 2002 relative to Patients' Rights. In this review, we analyse the decisions of the regional commission on compensation of medical accidents in the Provence-Alpes-Côtes d'Azur (PACA) region of France in 2004 and 2005, and we attempt to identify the prevalence of certain surgical procedures liable to result in NFMA and to define the concept of "unintended consequences" in the context of state of health of the patient and the predictable course of the malady. We hope to improve the medical information given to the patient and thereby the overall quality of management. NFMA was acknowledged in 57 claims, about 10% of all those received by the commission during this period. Nearly half of the claims were within the competence of the commission because of the existence of serious sequelae (Permanent Partial Disability) in 47%. No typical profile of age or gender emerged in the patients with NFMA. The majority of cases occurred after surgical procedures, in particular gastrointestinal surgery and orthopaedic surgery; 91% were planned procedures. We did not identify increased risk related to any given type of surgery, particular disease condition, or precise anatomic region. Complications were those usually observed such as neurological complications in vascular surgery or perforations in gastrointestinal surgery. The interpretation of NFMA has undergone an evolution during this two-year period. In 2004, previous poor health status precluded acknowledgment of a medical accident, the argument being that there was a predisposition to the complication which occurred. In 2005, compensation was based on a reduced Partial Permanent Disability score compared to the patient's previous health status. This became a means of measuring the impact of the medical complication on an already predictably unfavorable clinical course without medical intervention, and the legal aspect of the "ineluctable nature" of this course.
authors.affiliation: Service de médecine légale et droit de la santé, faculté de médecine CHU Timone - Marseille.
authors.forename: M-D
authors.initials: MD
authors.lastname: Piercecchi-Marti
authors.forename: B
authors.initials: B
authors.lastname: Sastre
authors.forename: S
authors.initials: S
authors.lastname: Zuck
authors.forename: A
authors.initials: A
authors.lastname: François
authors.forename: C
authors.initials: C
authors.lastname: Genety
authors.forename: C
authors.initials: C
authors.lastname: Bartoli
authors.forename: G
authors.initials: G
authors.lastname: Leonetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D035881:Compensation and Redress; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005602:France; D005767:Gastrointestinal Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D016365:Liability, Legal; D008297:Male; D019300:Medical Errors / Q000191:economics* / Q000331:legislation & jurisprudence; D008499:Medical Records; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications / Q000601:surgery; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D028701:Patient Rights; D012189:Retrospective Studies