title: Forensic evaluation of medical liability cases in general surgery.
abstract: Although medical liability (disciplinary, civil and criminal) is increasingly becoming an issue, few studies exist, particularly from the perspective of forensic science, which demonstrate the extent to which medical malpractice occurs, or when it does, the reasons for it. Our aims were to evaluate the current situation concerning medical liability in general surgery (GS) in Portugal, the reasons for claims, and the forensic evaluations and conclusions, as well as the association between these issues and the judicial outcomes. We analysed the Medico-Legal Council (CML) reports of the National Institute of Legal Medicine and Forensic Sciences of Portugal related to GS during 2001-2010. The judicial outcomes of each case were requested from the Public Prosecutor Office (PPO) and the court. Alleged cases of medical liability in GS represented 11.2% of the total cases analysed by the CML. We estimated that in Portugal, 4:100,000 surgeries are subject to litigation. The majority of complaints were due to the patient's death (75.4%), with laparoscopic cholecystectomy surgeries representing 55.2% of cases. In 76.1% of the cases, the CML believed that there was no violation of legesartis and in 55.2% of cases, no causal nexus was found between the medical practice and the alleged harm. The PPO prosecuted physicians in 6.4% of the cases and resulted in one conviction. Finally, the importance of the CML reports as a relevant technical-scientific tool for judicial decision was evident because these reports significantly (p < 0.05) influenced the prosecutor's decision, whether to prosecute or not.
authors.affiliation: Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: H
authors.initials: H
authors.lastname: Moreira
authors.affiliation: Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, University of Porto, Porto, Portugal National Institute of Legal Medicine and Forensic Sciences, North Branch, Portugal Biomedical Sciences Institute "Abel Salazar", University of Porto, Porto, Portugal Center of Forensic Sciences (CENCIFOR), Portugal.
authors.forename: T
authors.initials: T
authors.lastname: Magalhães
authors.affiliation: Department of Legal Medicine and Forensic Sciences, Faculty of Medicine, University of Porto, Porto, Portugal Center of Forensic Sciences (CENCIFOR), Portugal IINFACTS - Institute of Research and Advanced Training in Health Sciences and Technologies, Department of Sciences, Advanced Institute of Health Sciences - North, CESPU, CRL, Gandra, Portugal REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal.
authors.forename: Rj
authors.initials: R
authors.lastname: Dinis-Oliveira
authors.affiliation: Center of Forensic Sciences (CENCIFOR), Portugal Surgery Department, Faculty of Medicine, University of Porto, Porto, Portugal São João Hospital Center, Porto, Portugal ataveira@med.up.pt.
authors.forename: A
authors.initials: A
authors.lastname: Taveira-Gomes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D005554:Forensic Medicine; D013502:General Surgery / Q000331:legislation & jurisprudence*; D006801:Humans; D016365:Liability, Legal; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D011174:Portugal; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data; D055815:Young Adult
keywords: forensic evaluation; general surgery; leges artis; malpractice; medical liability