Medical errors: the “dark” side of medicine. Examples of the consequences of famous doctors' mistakes

The manifestations of diseases are so diverse and dissimilar that the most attentive and conscientious attitude sometimes leads to an incorrect diagnosis. Therefore, when making a decision, the court will take into account whether the specialist has taken all possible and available measures to prevent negative consequences. So, if the doctor carried out the necessary diagnostic measures, which should have shown the problem, but did not, then the likelihood of being held accountable for an erroneous diagnosis is minimal. In this case, the doctor most likely did everything in his power, and unless the contrary is proven, he will not be held legally responsible for an incorrect diagnosis.

Medical error

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Considering that the damaged eye needed to be removed, he mistakenly removed the boy’s absolutely healthy organ. We can only guess what kind of punishment doctors suffered for their mistakes more than a hundred years ago.

9. Radiation and treatment An even greater misfortune befell the patient suffering from tongue cancer. Jerome Parks - that was the name of the patient - for several days, mistakenly received radiation aimed at others healthy organs, in particular on the brain.

The consequence of this was the complete loss of hearing and vision of the patient. The unbearable torment of the unfortunate man was alleviated only by death.

10. Disinfected patient Also, the mistake of nurse Virginia Mason ended in a fatal outcome. She, having inattentively read the inscription on the package, gave the patient an injection of a disinfectant solution.
Mary McClinton, 69, did not survive such negligence. eleven.

Medical errors and liability for them

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Path: → Lectures (continued) →→ Medical errors An unfavorable treatment outcome associated with a doctor’s honest mistake is usually referred to as medical errors. The term “medical error” is used only in medical practice.

The variety of medical errors, their causes and conditions of occurrence has led to the fact that until now there is no single concept of medical error, which naturally complicates the medical and legal assessment of erroneous actions of medical workers. The main criterion for medical error is the doctor’s conscientious error arising from certain objective conditions without elements of negligence, negligence and professional ignorance.

Concept and statistics of medical errors in Russia First of all, the victim should understand that the law will be on his side, since medical error is a criminal offense. However, it has a number of features, many of which you need to know:

• Since often this error occurs accidentally and implies an act without bad intentions, the responsibility on the part of the doctor is mitigated.

  In order for the punishment to be serious, it will be necessary to prove that the error was malicious.

• The objective causes of medical error are negligence, inattention and lack of experience. They are taken into account to reduce the sentence.
• Subjective causes of medical error are negligence during examination and conduct medical actions, neglect of modern medical supplies etc.

What is medical error (concept and examples)?

Therefore, solving the problem at the legal level is very difficult. And yet, expert conclusions about the presence of a medical error (and it is better to appoint such an examination away from the region of the incident) can fail a particular medical worker under one or another criminal article.

Important

Then a court decision will probably follow on the ban on practicing medicine for certain period. And for the death of a patient, doctors can even be sentenced to imprisonment.

And even if no crime is found in the doctor’s actions based on the results of the investigation or trial, he may be subject to disciplinary liability. Bail does not always work and not everywhere. Somewhere, the administration of a hospital or clinic can independently punish an employee.

Compensation to a patient for harm resulting from a medical error Obviously, the consequences of a medical error can vary, and significantly.

Examples of medical errors

Part 3 of Art. is being considered. 123 CC.

• The patient contracted HIV infection due to the negligence of the doctor. Part 4 art. 122 of the Criminal Code provides for imprisonment for up to 5 years.
• If, as a result of illegally carried out medical or pharmaceutical activities, the patient suffered serious harm to health, the perpetrator is punishable by Part 1.

  1 tbsp. 235 CC. Fatal cases are considered under Part 2 of Art. 235 CC.

• If the patient was not provided with assistance, as a result of which he suffered moderate or light weight, the punishment is established by Art. 124 CC. If the harm is more significant or irreparable, then Part 2 of Art. 124 CC.
• If the fact of medical negligence is established, the result of which is the infliction of serious harm to human health or the death of the patient, then Part 2 of Art.

What is medical negligence, how to define it and bring criminals to justice?

Therefore, he has the right to present the amount he needs, but within reasonable limits.

• Criminal liability. It is established for harm caused to life and death due to medical error.

  
  In the event that the patient received poor-quality medical care, but no significant harm was caused to his health, criminal liability is impossible. A forensic examination is carried out to determine the extent of the damage.

Often, victims have to make certain efforts to receive moral harm, because usually doctors do not agree to admit the fact of a mistake and prove their own innocence by all means.

13 creepy examples of medical negligence

Subjective reasons are used in legal practice to aggravate the sentence. According to a statement by a representative of the Investigative Committee of the Russian Federation, the latest statistics on medical errors are as follows:

• In 2015, 712 people, including 317 children, suffered from medical errors and poor quality medical care.
• In 2016, 352 patients died as a result of medical errors, of which 142 were children. At the same time, the Investigative Committee received more than 2,500 reports of crimes related to medical negligence.

  Based on them, more than 400 criminal cases were opened.

To date, there is no precise definition of medical error. That is why the situation is quite difficult during the proceedings, because it is necessary to prove the fact of a medical error.

Medical errors: the “dark” side of medicine

“Medical error” refers to the actions or inaction of a doctor that led to a deterioration in the patient’s condition, and in the most tragic cases, to his death. It is often difficult to prove that a medical error occurred (this is due to the incompetence of interested parties, criminal corporate solidarity, and other factors), but nevertheless, citizens have such an opportunity at the legal level.

The child looked bad, was lethargic, drowsy, ate without appetite, and coughed. On January 29, 1998, at 1 p.m., Klava B., along with other children, was put to bed in the bedroom. The child slept peacefully and did not cry. When the children got up at 3 p.m., Klava B. showed no signs of life, but was still warm.

The nursery's older nurse immediately began performing artificial respiration on her, gave her two injections of caffeine, and the child's body was warmed up with heating pads. The arriving emergency doctor performed mouth-to-mouth artificial respiration and chest compressions.

However, it was not possible to revive the child. During a forensic medical examination of Klava B.’s corpse, the following were discovered: catarrhal bronchitis, widespread serous-catarrhal pneumonia, interstitial pneumonia, multiple foci of hemorrhages into the lung tissue, which was the cause of the child’s death.

When you go to doctors, you hope that they won’t make a mistake. Meanwhile, these are the most ordinary people who, like everyone else, make mistakes in their work. But the consequences are quite terrible and their price is much higher. A person may ultimately lose his health, or even his life.

Amputation of a healthy limb? Introduction of a foreign drug instead of a medicine? These are not horror stories and gossip at all, but real cases.

In medical practice, things happen that you might not immediately believe. At the same time, even the most highly qualified specialists in expensive and advanced clinics make mistakes. Let's talk about the most terrible medical errors.

Another leg. Few people can imagine that experienced doctor suddenly confuses left and right. But this is exactly what happened to a surgeon from Tampa, Florida. In 1995, during an operation he had to amputate right leg to his 52-year-old patient Willie King. When he woke up after anesthesia, he discovered that his sore limb was in place, but his left one was missing! They tried to console the patient with the fact that she, too, was unwell and would eventually be amputated anyway. King sued the hospital, won the case and received 900 thousand dollars in compensation from the clinic itself and 250 thousand from the inattentive doctor. In addition, the surgeon was deprived of his license for six months.

Wrong eye. This terrible doctor's mistake happened 120 years ago. In 1892, 10-year-old Thomas Stewart lost an eye in an accident. The boy accidentally stumbled upon a knife, which caused partial loss of vision. Doctor Alexander Proudfoot was called to help and quickly decided that the damaged eye needed to be urgently removed. Upon completion of this operation, the surgeon suddenly discovered that instead of a diseased eye, he had removed a healthy one.

Incorrect exposure. Radiation should not necessarily be considered harmful. Of course, it often harms health, leading to death. However, medicine also uses radiation to treat oncological diseases. But like any other medicine, it must be used extremely carefully and in the right doses. Patient Jerome Parks was unlucky with radiation. He was diagnosed with tongue cancer, but the computer gave the wrong direction for radiation. As a result, the patient's healthy neck and brain stem were irradiated. The “treatment” lasted three days. As a result, the patient quickly lost his vision, hearing, and ability to swallow. When the mistake was discovered, no one could save Jerome, and he soon died.

Disinfectant instead of medicine. This story is another reason to read the inscriptions on medicine labels. In one medical center Virginia Mason did not follow this rule as often as she did. As a result, patient Mary McClinton was injected not with medicine, but with a disinfectant for medical instruments. This caused the death of a 69-year-old woman, and the hospital became much stricter about the designation and sorting of medications.

Forgotten napkin. Stories of things forgotten in the womb of a patient, unfortunately, are not so rare for doctors. In 2007, Indian woman Sabnam Praveen experienced a joyful event - her son was born. The child was born as a result of caesarean section. However, the joy did not last long; the woman soon felt unwell. Sabnam began to complain of abdominal pain. Doctors for three whole years could not understand the cause of the patient’s illness. Eventually she ended up on the operating table at the Chattisgarh Institute of Medicine. It turned out that the surgeon who delivered the baby was very inattentive - he forgot a napkin in the patient’s stomach. It remains unclear in history whether the poor woman received any financial compensation. But Donald Church managed to earn 97 thousand dollars from the doctors’ mistake. A similar story happened to him. When he was operated on in 2000 at Washington Medical Center, his stomach was “forgotten.” surgical instrument 31 centimeters in length.

Food in the lungs. An elderly 79-year-old patient at a San Francisco clinic, Eugene Rigs, suffered from diverticular disease. He could not even imagine that he would die in hospital not because of this disease, but because of the monstrous negligence of the doctors. Eugene's illness prevented him from eating enough naturally. Doctors decided that food could be delivered to the patient’s stomach through a special tube. However, it was entered incorrectly. As a result, food began to flow not into the patient’s stomach, but into his lungs. The error was quickly discovered, but it was impossible to correct the consequences. A few months later, Rigs died due to complications. His wife sued the government, because according to US law, claims cannot be brought against hospitals and military doctors.

Wrong father. A married couple, Thomas and Nancy Andrews, could not conceive a second child naturally for a long time. That is why they turned to the Center reproductive medicine in NYC. There the couple was offered IVF, in vitro fertilization, which implies artificial conception in a test tube. Soon the long-awaited pregnancy really came. The couple were in seventh heaven. But when the child was born, the parents were quite surprised. The girl, named Jessica, had much darker skin and hair than her father and mother. It turned out that this phenomenon was not a whim of nature at all, but a mistake by doctors. This was confirmed by a DNA test, which showed that Thomas Andrews was not the biological father of the child, but some other man. His sperm was mistakenly used for artificial insemination.

Evil doctor. There is plenty of evidence that it is better not to anger doctors. Romanian Nel Radonescu was unlucky; he had to deal with a nervous doctor. A 36-year-old man was sent for surgery to correct abnormal testicular structure. And due to a medical error, he was left without a penis. At the same time, Dr. Naum Chomu did not confuse the penis with the testicles. It’s just that during the operation he accidentally touched the patient’s urethra, which drove him crazy. In a rage, the doctor cut off his patient's penis, and also cut it into small pieces. The unfortunate patient was forced to sue. The authorities decided to oblige Choma to pay for the patient's operation to restore his penis using skin from his arm. Moreover, the nervous doctor was deprived medical license and paid for the moral damages of his injured patient.

This article will discuss insurance issues, liability and punishment for medical errors. It is shown which article of the Criminal Code of the Russian Federation is provided for, i.e. What is the criminal liability for medical error?

Statistics and examples of medical errors are given. Recommended where to go and how to avoid medical errors. Examples are given from life during childbirth, dentistry, and surgery. How to prove a doctor's negligence.

Quite often, medical errors in Russia lead to serious and sometimes irreversible consequences. In judicial practice, the attitude towards such cases is ambiguous, and it is sometimes not possible to prove the fact of a medical error. The reasons, types and examples of doctors’ errors are very diverse, and unfortunately, the annual statistics of medical errors are not encouraging and each of us can face this problem.

As you know, “Forewarned is forearmed,” so we recommend that you carefully read this article in order to have an idea in what cases you can achieve the truth and hold doctors accountable for the medical errors they have made.

General information: causes, examples and types of medical errors

A medical or medical error is a non-malicious mistake made by a medical worker (doctor) in the process of carrying it out. professional activity in the case where dishonest performance of one’s duties, as well as negligent attitude towards them, are excluded.

Every person has the right to medical care. This fact is enshrined in the Constitution of the Russian Federation (Part 1, Article 41 of the Constitution of the Russian Federation).

The most important principle of health care in our country is the quality and accessibility of medical care.

High-quality medical care can only be called if it meets the following requirements:

1) Timely delivery.

2) The correct choice of preventive methods.

3) Correct choice of diagnosis, treatment and rehabilitation.

4) Achieving the result that was planned.
The above requirements are reflected in paragraph 21 of Article 2 of the Law “On the Fundamentals of the Protection of Citizens”.

Nevertheless, quite often we have to deal with medical errors arising from exposure to various circumstances. The consequence of such medical errors is harm to the health and lives of citizens.

A medical or medical error can be encountered both at the stage of diagnosis and during treatment or even surgical intervention.

Most common reasons medical errors are as follows:

1) Uncoordinated actions of doctors. Especially if the patient is being treated by several doctors.

2) Improper handling of medical equipment.

3) Disregard for established sanitary standards.

4) Inattentive assignment medicines. For example, if they were prescribed in the wrong dosage or do not correspond to the diagnosis.

Criminal liability for medical error, article of doctor's fault

The Criminal Code of the Russian Federation does not provide for medical error special composition crimes. Actions, as well as inaction of a doctor, as a result of which he may be brought to criminal liability are described in the Special Part of the Criminal Code of the Russian Federation.

Note: A medical malpractice lawyer can advise you. The form for contacting him is given at the end of the article.

In this case, the following conditions must be met:

1. Illegal behavior of a doctor.
2. Causing serious harm to health or death.
3. The presence of a cause-and-effect relationship between harm and the doctor’s unlawful behavior.
4. The doctor's fault.

At first glance, it may seem that bringing a doctor to criminal liability in the presence of the conditions described above is not difficult. But in reality, everything is not so simple. It is often quite difficult, and sometimes simply impossible, to prove the fact that illegal actions or inaction of a doctor took place.

Unlawful actions are those that violate the norms established by law regulating medical activities. Violations of customs and rules of medical practice in the process of conducting a complex of therapeutic, diagnostic and preventive measures. Moreover, they can exist not only in written form, but also in unwritten traditions of medical practice.

It is worth noting that the treatment process for each individual patient differs from all previous ones, even with a single diagnosis. In other words, the methodology for carrying out procedures (diagnostic and therapeutic), the treatment regimen and prescription of drugs, as well as monitoring the patient’s health status may be different in each individual case.

Simply put, if three patients have the same diagnosis, but the first one has an allergic reaction to certain medical supplies, the second has concomitant diseases, and the third is of advanced age, then individual treatment will be prescribed for each of them, taking into account all associated factors.

As a result of the situations described above, it is often not possible to objectively assess the illegality of a doctor’s actions in relation to a specific patient. The thing is that there are different approaches to treating the same disease.

It is also not easy to prove that the patient was harmed as a result of the doctor’s negligent behavior. This is explained by the fact that what is subject to punishment is not the fact that the doctor did not cure the patient, but the fact that in the process of treatment he significantly deviated from generally accepted norms, which led to a deterioration in the patient’s condition.

In case of a medical (medical) error, the doctor’s fault can exist solely in the form of negligence (negligence or frivolity).

A medical professional’s mistake in the form of frivolity occurs when he foresaw the possibility of undesirable consequences, but unreasonably expected that he had the power and competence to prevent them. In other words, he understood that his actions or inaction could harm the patient, but he thought that he could cope with the situation that arose, and in the end he did not have enough experience and knowledge.

Malpractice in the form of negligence occurs when a physician does not foresee the possibility of undesirable consequences as a result of his actions or inactions. Although if he had been more attentive and prudent to this situation, then such consequences could have been avoided.

Essentially, negligence is a significant discrepancy with generally accepted norms of action by medical workers with identical and similar education and experience, which led to harm to the health of the patient.

We also note that criminal liability in the event of a medical error is provided only in cases where the patient’s health has been seriously harmed. If the patient received medical care of inadequate quality and as a result his health suffered minor harm (mild to moderate), then the guilty doctor will not be held criminally liable. The severity of the harm is determined during the investigation based on the results of a forensic medical examination.

This is a prerequisite for conducting an investigation. After all, it is in the process of conducting a forensic medical examination of medical errors that it will be determined to what extent the nature of the treatment in relation to the patient complied with the standards. For example, if a doctor made a mistake during a surgical procedure, then the court will hear the opinion of an independent expert doctor regarding how and under what conditions this operation was performed.

Thus, resolving disputes regarding the medical cases described above is often quite difficult. This can be explained by the fact that each individual case is unique in its content, and it is not possible to reflect all standards at the legislative level.

As mentioned above, the Criminal Code of the Russian Federation does not provide for a separate crime for committing a medical error. If as a result of unlawful actions or inaction medical personnel If severe harm to the patient’s health was caused or death occurred, then criminal liability arises for certain elements of the crime that are provided for in the Special Part of the Criminal Code of Russia. The conditions under which this is possible were described above.

According to Part 2 of Article 109 of the Criminal Code of the Russian Federation, a medical error that led to the death of a patient can be punishable by imprisonment for up to three years with or without deprivation of the right to engage in medical activities for the same period.

If the patient’s health was seriously harmed as a result of improper performance of the doctor’s duties, then this doctor may be held criminally liable in the form of imprisonment for up to one year with or without deprivation of the right to engage in medical activities for the same period.

In addition to the above-mentioned crimes, there are the following types medical errors subject to criminal punishment:

1) Illegal abortion as a result of which the death of the patient occurred or serious harm was caused to her health. (Part 3 of Article 123 of the Criminal Code of the Russian Federation).

2) Infection of a patient with HIV infection as a result of improper performance of professional medical duties. (Part 4 of Article 122 of the Criminal Code of the Russian Federation). A sentence of up to 5 years in prison is provided.

3) Private lesson pharmaceutical activities or medical practice without a license for these types of activities in the case where this led to harm to health as a result of negligence. (Part 1 of Article 235 of the Criminal Code of the Russian Federation). If these types of activities led to the death of the patient, then the perpetrators will be punished in accordance with Part 2 of Article 235 of the Criminal Code of the Russian Federation.

4) Not helping the patient(Article 124 of the Criminal Code of the Russian Federation). In this case, it is enough to cause moderate harm to the patient’s health as a result of negligence. If, as a result of the doctor’s negligence, serious harm was caused to the patient’s health or even death occurs, then the doctor’s act will be considered a qualified one (Part 2 of Article 124 of the Criminal Code of the Russian Federation).

5) Negligence. It represents improper performance or complete failure to perform his duties by an official as a result of a careless and dishonest attitude towards his work. If the doctor’s negligence led to serious harm to health or death of the patient as a result of negligence, then it will be qualified in accordance with Part 2 of Article 293 of the Criminal Code of the Russian Federation.

Let us note that after a criminal case has been initiated and before the judicial investigation, the victim has the right to file a civil claim and demand compensation for property damage that was caused by the crime, as well as compensation for moral damage. These rights are noted in Article 44 of the Criminal Procedure Code of the Russian Federation.

If the patient does not exercise this right, then after the verdict against the doctor is passed, claims for compensation for harm and compensation for moral damage can be filed in civil proceedings. According to Part 2 of Article 306 of the Code of Criminal Procedure of the Russian Federation, if the doctor’s guilt is not recognized, the court will refuse to satisfy the civil claim.

Medical risk

According to Article 41 of the Criminal Code of the Russian Federation, justified medical risk can exclude criminal liability.

But in order for this risk to be recognized as legitimate, the following conditions must be met:

1) Medical risk should be aimed at preserving the health and life of the patient.

2) The goal specified in the previous paragraph cannot be achieved by other means that do not involve risk. If there is alternative method treatment that is less risky or is not associated with risk at all, then the doctor should give preference to it.

3) The doctor is obliged to take measures sufficient from a professional point of view in order to prevent possible harm as much as possible.

If harm to the patient’s health was caused within the conditions described above, then no crime will be found in the doctor’s actions. If these conditions were not met and, as a result, the health and life of the patient was harmed, then if the doctor is guilty, it will be possible to prosecute him criminally.

Nobody keeps official statistics on medical errors. According to calculations public organizations, medical errors claim the lives of 50 thousand people every year. According to the Center for Independent Medical and Legal Expertise, dentists take first place in professional errors. Death or injury of a mother in labor or a newborn in maternity hospital- In second place. Third place is occupied by surgeons of all specialties.

So we've covered some very important questions.

Medical malpractice in Russia. Judicial practice, types, classification, definition, concept, consequences and causes of medical error

The concept of medical error can be considered in several aspects. On the one hand, even the most conscientious specialist, who is responsible for his reputation and in no way wants to harm the patient, can make mistakes.

However, some doctors perform their functions poorly and show negligence and indifference to the patient. IN best case scenario this will not affect the patient in any way; at worst, it will lead to deterioration in health, or even death due to medical error. It is in such situations that the relatives of the victim wonder what responsibility the doctor bears, whether a medical error can be classified under an article of the Criminal Code of the Russian Federation (Criminal Code of the Russian Federation).

The definition of a medical error comes down to the fact that it is an unintentional or indirectly intended criminal act of a physician in relation to a patient.

Any crime entails criminal liability, therefore, in this case, criminal law clearly protects the interests of the injured party.

The question is how serious the punishment will be, and here it is necessary to understand the following points:

1. This crime in itself does not imply an intentional illegal act, so the sanction for careless behavior will be far from maximum. In order to punish the attacker on a grand scale, you will have to look for factual evidence of intent to cause harm.
2. There are also mitigating circumstances that the judge takes into account when sentencing. This is careless behavior or lack of practice and experience. These circumstances characterize the objective side of the offense.
3. At the same time, the subjective side is expressed in the criminal’s attitude towards his actions. Thus, negligence in the performance of duties means that a person understands the meaning of his actions, does not fully devote himself to work, may lead to negative consequences, and still acts in this way due to negligence. Of course, such circumstances are taken into account when deciding the fate of the offender and aggravate the situation of the defendant.

According to judicial practice, medical omissions occur about 700 times a year. Slightly less than half of the cases of poor-quality medical care concern the treatment of minors. The country's Investigative Committee recorded about 350 fatal cases, 150 of which involved children.

As is known, the state has a mandatory health insurance(OMS). If you have a policy, a citizen can contact the insurance company with an application or complaint about a medical institution or a specific specialist. The latter, in turn, conducts its own investigation and engages the competent authorities to prevent further violations and punish the perpetrators. So, statistics show that every year insurance companies receive about 2,500 complaints that the activities of doctors have signs of negligence and criminal features.

The concept of medical error has not been established legally. The main thing is that proving the fact of an offense falls on the shoulders of the victim, who must present maximum evidence to confirm this circumstance.

Depending on at what point in the treatment the error occurred, there are several types of mistakes by doctors.

So, the classification of medical errors is:

1. The most common errors occur in practice when diagnosing clients.
2. Which appear when there is insufficient provision of medical workers with equipment or medicines. This also includes the uncoordinated and disorganized work of medical staff.
3. After establishing an incorrect disease, the doctor automatically prescribes incorrect treatment (in the form of medications taken, method of taking medications, etc. health treatments). As a result, one error is superimposed on the second, which leads to unpredictable results.
4. The doctor’s next omission is of a psychological nature, and concerns the choice of the wrong tactics of behavior when communicating with the patient or his family members.
5. Often, with a large flow of documents, health workers record information about one person in medical documentation another: they confuse tests, medical histories, etc.
6. The last category concerns pharmaceutical errors, when a specialist incorrectly compared the effect of a drug with the client’s diagnosis or dispensed medications that are incompatible with each other.

Of course, these mistakes have completely different subjective and objective sides, so they will be assessed taking into account the details of the act. Equally important when choosing the type of criminal liability of the offender will be the damage caused by the error of the healthcare employee.

Dentist services most often cost the client a large sum, regardless of whether private clinic provides treatment or government. Of course, the price tags in paid medical institutions are higher, but the cost of the service will not insure against mistakes.

Claims against representatives of the dental medical industry vary depending on the object and subject of the appeal.

Thus, dishonesty may be on the part of a visitor who, through the court, tries to accuse the doctor of lack of qualifications and return the amount of an expensive procedure. In turn, some specialists have the habit of performing services poorly, thereby securing work for themselves in the future so that the client will come again.

The latter case is almost impossible to prove, and it hardly amounts to a criminal offense. But in the first situation, statistics are observed that a third of cases involving accusations against dentists remain without a solution satisfactory to the plaintiff due to lack of grounds.

However, the rest (and most) of the cases still confirm the fact that dentists make mistakes in practice.

In general, medical mistakes dental office boil down to this:

• incorrect diagnosis of dental or oral disease;
• poor choice of pain reliever;
• treating the wrong tooth, etc.

In order to minimize the risks of a client going to court, the doctor should carefully study the disease, clearly explain to the patient what the problem is, propose a treatment concept, coordinate and clarify all the nuances. If the patient needs thorough treatment, an agreement can be concluded with him, which spells out the conditions of treatment and gives the patient’s consent to carry it out.

The types of medical errors also affect the punishment of the employee. If errors in the work of a physician are identified within the work team, then disciplinary sanctions are applied to him in the form of a decrease in the level of skill, a reprimand. The perpetrator may also be sent to advanced training classes. The doctor may be demoted or even fired.

If the defect was noticed by patients and they came to complain about the doctor, then one of these types of liability may await him:

1. In accordance with civil law. This type liability is considered as part of a civil claim for damages. This often includes a moral damages clause. The victim chooses an amount that, in his opinion, would cover the costs of restoring health and mental suffering. Of course, the cost of the specified damage must be confirmed by evidence in the form of checks and receipts for payment for medicines and health procedures.
2. Sanctions provided for by criminal law. Apply if negligence caused harm to human life or health. Also, if the consequence of the defect was the death of the unfortunate person. The patient must understand that the irresponsibility, inaction and carelessness of the doctor is assessed as a crime only if the harm caused turns out to be significant. In order to determine how badly the patient’s health has been affected, an examination is carried out to identify medical indicators.

Separately, you need to think through the tactics of proving that a person has suffered morally. In general, the evidence base must be strong, since, most likely, the doctor will deny everything and not admit guilt.

So, if a medical error occurs, the article that should be applied is absent as such. Criminal law provides for certain crimes under which a physician can be punished for causing adverse consequences to a patient due to improper actions of medical personnel.

So, if the judge determined based on the results medical analysis that appearance fatal outcome directly related to the actions of a resuscitator, gynecologist or other specialist, the employee will face punishment under Part 2 of Art. 109 of the Criminal Code. According to the disposition of this norm, a sanction is applied in case of careless actions of an official that resulted in death.

Punishment can be in the form of restriction or deprivation of liberty for up to three years. It is possible to be held less liable if the claim relates to adverse consequences in the form of serious danger and grievous bodily harm. For such an offense, the perpetrator is punishable by up to 1 year in prison (Article 118 of the Criminal Code). Along with these sanctions, the doctor may be deprived of the right to work in the medical field.

1. Process in obstetrics and gynecology, if the legal process for performing an abortion was not followed or other cases when the patient was injured in the gynecological office, Art. 123 CC.
2. If the health worker did not comply with safety measures and his actions caused the person who applied to become infected with HIV infection. Punishment occurs in accordance with part four of Art. 122 of the Criminal Code and consists of imprisoning the perpetrator for 5 years.
3. If clinical measures, which were undertaken by a doctor or pharmaceutical employee and led to moderate or severe negative consequences for human health, then they are punishable under the first part of Art. 235. Under part two, the same acts are qualified if they caused death.
4. Art. 124 implies punishment for refusal to provide assistance by an employee who should and could have provided it. Here there is also a difference between parts one and two in terms of consequences from moderate harm to death.
5. The law separately spells out Article 293 of the Criminal Code, which establishes liability for the negligence of medical personnel. To be punished, persons under this article must severe consequences for health or death.

The classification of offenses depends on the specific elements of the crime: the objective and subjective side. That is why the legislator did not leave a single legal concept and rules stipulating responsibility for misconduct in treatment and prevention.

Along with a claim for a crime, the injured party has the right to file an application in which to demand that the defendant be forced to pay monetary compensation.

Where can you go and complain if what the doctor does goes beyond the boundaries of what is acceptable and harms clients:

1. To the management team of a medical institution. Even if the medical clinic is paid, it must have an employee who is responsible for his subordinates. In public hospitals this is the head structural unit organization or chief physician. The victim must write a statement or come to a personal appointment, explain the situation in detail, provide evidence of the doctor’s erroneous actions and show the result of the mistake. The head physician or manager analyzes the application and takes disciplinary action: making a decision on deprivation monetary reward subordinate, reprimand, imposition of penalties, raising the issue of reducing qualifications.
2. To the insurance company where the citizen received health insurance. A detailed statement is written here and evidence is included. Based on the submitted facts, the insurance company conducts an investigation, and if there is no fact of slander, the organization will face a fine.
3. To the court. To begin legal proceedings, you will need to draw up statement of claim indicating the circumstances, justification of legal requirements with legal point vision. Based on the testimony and evidence of the parties, the judge will decide whether the defendant should pay compensation and determine its amount.
4. To the prosecutor's office. The appeal to this authority must be based on the fact that the defendant is accused of a crime. Here the complainant needs to be careful as he will have to go through an unpleasant conversation if the allegations turn out to be untrue.

The function of supervision over the activities of medical organizations is also performed by the Ministry of Health and Roszdravnadzor, to which a citizen has the right to file a complaint.

When choosing a competent authority, a person should focus on the relationship between the violation and the consequences caused. Of course, for any charges, the person must have sufficient evidence of the offense and cause-and-effect relationships.

What is included in the evidence base

It is necessary to begin the explanation with the fact that the patient was treated in the clinic by a specific specialist.

Identification of the fact of the state in a relationship can be carried out on the basis of the following documents:

• documentation about the patient from the medical record;
• papers with survey results;
• payment documents confirming the fact of payment for the services of the medical institution;
• pharmacy receipts for the purchase of medicines;
• written prescriptions, etc.

Witness testimony may be used to support the victim's accusations. If a person decides to complain, he should take care of copies of the above papers; lawyers recommend keeping the originals.

Arbitrage practice

Medical errors examples from life:

1. Doctors' mistakes also happen in pediatrics; one of the cases caused the death of a little girl, which was caused by a severe lung disease. Pneumonia had no obvious symptoms, so the doctor considered the baby healthy. The pediatrician discharged a sick child whose body could not withstand the overload in kindergarten.
2. Another patient suffered after the operation. The medical staff violated technical standards, and a wound appeared, which became a source of infection, due to which the patient died.
3. In the field of pathology, about 21% of cases of incorrect examination results were found.
4. Citizens note that medical examinations in hospitals are carried out fictitiously. There are cases when a baby dies or becomes disabled when obstetricians pull him out of the birth canal.

Based on the reports of police officers and experts, it can be concluded that such consequences are caused by a lack of practice and knowledge among employees. To prevent and prevent such situations, employees should include professional development classes in their schedule and spend time on self-development.

1. Medical errors:

Ø insufficient examination;

Ø delayed diagnosis of severe PE;

Ø late hospitalization and too late delivery;

Ø Clinical and laboratory indicators indicate combined severe PE, stage III FGR.

Woman 22 years old. B-1. Pregnancy 34-35 weeks. Head presentation.

From the anamnesis: she was treated for ureaplasmosis, psoriasis, chronic disease. otitis, arthropathy knee joint. Blood pressure 120/80-135/85 mm Hg.

1st trimester – without complications.

From 23 weeks - deterioration in health (weakness, fatigue), sometimes blood pressure rises to 160/100 mm Hg, pathological weight gain (7 days up to 900 g). Next – swelling. She took diuretics and antihypertensive drugs (capoten, dopegit). The blood pressure returned to normal (120/80 – 130/75 mm Hg, but the swelling recurred. The state of health worsened. One day the blood pressure increased to 190/110 mm Hg, and a urine test showed proteinuria up to 3 g/day.

At 34-35 weeks she was hospitalized in the maternity hospital with the diagnosis: Pregnancy 35 weeks. Moderate gestosis. Conclusion: conduct an examination. “We are at risk of worsening gestosis.” Prescribed: dopegit for increased blood pressure, chimes 75 mg/day, phenozepam, papaverine. During the examination - FPN (lag of indicators by 3 weeks).

A day later, the condition worsened sharply. Appeared headache, lethargy, drowsiness. Blood pressure 180/120 mm Hg. Bradycardia 32-47 beats/min. Proteinuria 12 g/day. Creatinine 163 mmol/l. Severe hypoproteinemia (total blood protein 49 g/l), AST 591 units/l, ALT 275 units/l. Oliguria. Acute renal-hepatic and cerebral failure. Urgent consultation.

Emergency caesarean section, after which 6 hours later the condition sharply worsened: loss of consciousness. Convulsive syndrome (eclampsia). Anuria. Blood pressure 230/130 mm Hg. A cerebral hemorrhage was diagnosed. Decompression craniotomy was performed. On the first day - death.

Pathomorphological examination: Severe PE. Intracerebral hemorrhage. HELLP syndrome. DIC syndrome. Near the hemorrhage area there are extensive ischemic areas in the brain. Neurons are in a state of necrobiosis and acute necrosis. Pericellular, perivascular cerebral edema. Multiple scattered microthrombi in the vessels of the brain, liver, kidneys.

Final diagnosis: Pregnancy 35 weeks. Head presentation. Eclampsia. Intracerebral hemorrhage with areas of ischemia. HELLP syndrome. DIC syndrome. Decompression craniotomy.

Coincidence of clinical and pathomorphological diagnoses.

Main mistakes:

1. Insufficient examination of a patient with risk factors (young primigravida). 24-hour blood pressure monitoring was not performed, and hypertension was not diagnosed.

2. Early-onset PE (from 23 weeks). Normalization of blood pressure when prescribing antihypertensive drugs does not stop the progression of PE, distorts the clinical picture, and repeatedly worsens the prognosis.

3. Error in assessing the severity. There was not mild or moderate gestosis, but severe PE, apparently combined with pre-existing arterial hypertension of unspecified origin.

4. Too late hospitalization (the duration of PE is at least 13 weeks (!). Changes that occur with such a duration of endothelial dysfunction lead to irreversible changes (up to detachment of cerebral vascular endothelial cells) and the rapid progression of irreversible changes in the kidneys, liver, hemostatic system - “cannot live” - transition to an irreversible degree of PE/E.

5. Too late delivery, which worsened the condition and prognosis. Inadequate drug therapy.

6. Early onset (23 weeks), duration 13 weeks, high arterial hypertension, severe proteinuria, hypoproteinemia, thrombocytopenia, hyperenzymemia are classic signs severe complication and the need for early delivery (at 23 weeks, when blood pressure increased to 180/110-190/110 mm Hg, proteinuria 3 g/day).

The woman's death is preventable.

2. Medical errors:

Ø transferred from one hospital to another twice and the third after attacks of eclampsia to extreme in serious condition?!

Ø eclampsia in hospital.

The patient is 23 years old. B-1. The GI was observed from 30 weeks of pregnancy.

Recently (?) there has been a deterioration in health, swelling, and increased blood pressure (140/90-160/100 mm Hg).

Hospitalized at 35 weeks in the Central District Hospital.

Edema accepted general character; in each analysis, proteinuria is 0.66 - 1 g/l. Blood tests show signs of hemoconcentration, hypoproteinemia, and disseminated intravascular coagulation syndrome. Blood pressure increased to 180/120 mm Hg, despite antihypertensive, antispasmodic and “vasoactive” therapy for 5 days. “Unexpectedly” (?!) 3 attacks of eclampsia occurred in the hospital (in a row). Magnesium therapy, diazepam, antispasmodics (?) were prescribed. The pregnant woman was examined by the team of the DCC of the perinatal center in the conditions of the central district hospital. On examination she was “stunned”, her consciousness was confused. Blood pressure 140/90-150/100 mm Hg. The dynamics showed a progressive decrease in platelets, an hourly increase in high levels of AST, ALT, creatinine (140-180 mmol/l). The patient's condition is assessed as extremely serious. Diagnosis: Pregnancy 34-35 weeks. Eclampsia. HELLP syndrome. Multiple organ failure.

The patient was discussed consultatively. Conclusion: Considering the extremely serious condition of the patient, the lack of adequate care in the Central District Hospital (?), a decision was made to transfer to the perinatal center. In order to ensure transportation, the patient was transferred to mechanical ventilation.

She was delivered to the perinatal center by air (helicopter) in extremely serious condition on mechanical ventilation. Saturation 98%. Blood pressure 180/110 mm Hg. Oliguria. Subictericity. Diagnosis: Pregnancy 35 weeks. Eclampsia during pregnancy. HELLP syndrome. Acute hepatic-renal failure. DIC syndrome. Acute fibrinolysis. Brain swelling. Ventilation

Tests: proteinuria 4.6 g/l, free Hb more than 250 g/l, AST 316, ALT 124, direct bilirubin 64 µmol/l, creatinine 183 mmol/l, thrombocytopenia< 100х10 9 /л, фибриноген 5 г/л, агрегация тромбоцитов 24%, ПТИ 86%.

Due to the lack of possibility of emergency vaginal delivery, the patient was delivered by cesarean section with the administration of FFP, platelet concentrate, glucocorticoids, and fibrinolysis inhibitors. Blood loss 600 ml. IN postoperative period continued mechanical ventilation, syndromic therapy.

On the 2nd day after cesarean section, a decision was made to transfer the patient to Hospital No. 4, taking into account the need to use efferent treatment methods (increasing cerebral edema, coma). A multispiral tomography of the brain and an EEG were performed. Total cerebral ischemia, “stop-contrast picture,” was detected. A week later, brain death, biological death, was declared.

The autopsy showed a picture of total brain necrosis, which was a complication of eclampsia during pregnancy.

Death due to cerebral necrosis.

Main mistakes:

1. Underestimation of severe PE, an attempt (at 35 weeks) to prolong pregnancy, rapid progression of multiple organ failure, and a belated decision on the need for delivery by cesarean section led to status eclampticus (4 convulsive attacks, coma) in the obstetric institution.

2. Twice (?) transferred from the Central District Hospital to the OPC, from the OPC to the OAR. Conclusion: “...taking into account the extremely serious condition of the patient and the lack of adequate care in the Central District Hospital (?!),” a decision was made to transfer her to the air ambulance department.

3. Delayed delivery due to cerebral edema, acute hepatic-renal failure (after transfer to the outpatient department).

4. In the postoperative period (2nd day), the patient, who was in an extremely serious condition, was again transferred from the OPC to the OAR (motivation: the need to use efferent methods due to the increase in cerebral edema, total ischemia according to MSCT data. A week later - lethal Exodus.

5. Conclusion: insufficient examination, underestimation of the true severity of PE, delayed delivery, improper organization emergency care. Lack of magnesium therapy for the prevention of eclampsia, use of inadequate medications (no-spa, crystalloids), poor observation (one of the attacks of eclampsia in the absence of medical personnel).

3. Medical errors:

Ø not diagnosed serious disease kidney;

Ø not hospitalized in a timely manner;

Ø rupture of the liver capsule, eclampsia;

Ø late termination of pregnancy.

The patient is 16 years old. B-1. Almost healthy.

Registered with the LCD from 10 weeks of pregnancy. Visited 8 times. From 26-27 weeks of pregnancy, proteinuria (traces of protein in the urine), increased blood pressure 140/90 mm Hg. Diagnosis: Nephropathy. Antispasmodic (no-spa, papaverine) and antihypertensive therapy was prescribed.

At 33 weeks without apparent reason Blood pressure increased to 190/110 -200/120 mm Hg. Delivered to the maternity hospital by ambulance.

Upon admission against the background of high hypertension - a convulsive attack of eclampsia. Complications: HELLP syndrome. Brain swelling. Pulmonary edema. DIC syndrome.

Emergency caesarean section. A dead fetus was extracted, 1650 g, 41 cm.

3 hours after the operation the condition worsened. Signs of intra-abdominal bleeding. Acute anemia. Hypotension. Tachycardia.

Relaparotomy – revision of organs abdominal cavity. Spontaneous liver rupture was detected. Hemostasis. Resuscitation. Ventilation Blood transfusion.

She died on the 4th day of the postoperative period.

A pathological and anatomical study revealed damage to the liver tissue (centrilobular and periportal necrosis, hemorrhages, plasma impregnation of the liver and kidney tissues). Secondary wrinkled bud. Signs of DIC syndrome. Brain swelling.

Main mistakes:

1. The patient belonged to a high-risk group for the development of early PE (young age of the primigravida, indications of kidney disease in childhood).

2. Insufficient examination in the residential complex. There was no 24-hour blood pressure monitoring, dynamic determination of proteinuria, proteinemia, hemostasis, or ultrasound of the kidneys (!). A secondary wrinkled kidney was not diagnosed. The therapist's examination is unqualified.

3. Edema and arterial hypertension from 26-27 weeks of pregnancy were regarded not as early PE, but as “Hypertension in pregnant women”, “Edema in pregnant women”.

4. Late hospitalization at 33 weeks with signs of cerebral edema (eclampsia on admission), despite the fact that a week before, blood pressure increased once to 190/110 - 200/120 mm Hg. Antispasmodics that were not indicated (no-spa, papaverine) and tableted antihypertensive drugs were prescribed.

5. Severe PE due to kidney disease is indicated by liver rupture and cerebral edema.

4. Medical errors:

Ø discrepancy between clinical and pathological diagnoses;

Ø underestimation of the severity of PE;

Ø late delivery.

The patient is 29 years old. B-2. R-2. Gestation period is 31-32 weeks. Twins. Threat of premature birth.

History: from 23-24 weeks, recurrent edema appeared, blood pressure 140/90 - 150/100 mm Hg, traces of protein in the urine. He suffers from chronic bronchitis and sometimes has headaches (migraines?). After suffering from ARVI - cough, low-grade fever, pain behind the sternum and lower abdomen. She was examined in the hospital (MBUZ Central District Hospital). When measuring blood pressure during the day, 110/70 – 160/100 – 170/110 – 130/85 mm Hg. Proteinuria in isolated urine samples
3 g/l – 0.33 g/l – 1 g/l. Total blood protein 53-47 g/l, decreased platelet count (250-150 x 10 9 / l), anemia (Hb 97 g/l).

My health gradually worsened (insomnia, nausea, loss of appetite). Shortness of breath and tachycardia appeared (pulse 100-120 beats/min). The uterus is in a state of increased tone.

P.V. – cervical length 1.5 cm, cervical canal open by 2 cm. The presenting part of the fetus is not determined (the first fetus is obliquely located, the second is longitudinally located, the head is at the top).

Examination and observation by a therapist: suspicion of myocardial dystrophy, endomyocarditis. NDC. Acute respiratory failure. Right-sided pneumonia. Preeclampsia in the second half of pregnancy. Treatment for 5 days (antibiotics - amoxiclav, inhalation, ambroxol, berodual, dibazol, papaverine). The condition worsens: shortness of breath increases, repeated vomiting against the background of continuous coughing. Blood pressure 160/100 mm Hg. Pulse 120 beats/min. At 3 o'clock in the morning a consultation was held. Diagnosis: Pregnancy 32 weeks. Twins. Threat of premature birth. Transverse position of the first fetus. Preeclampsia I-II (mild - moderate degree). Acute bronchitis. Respiratory failure
0-1 tbsp. Myocardial dystrophy. Acute heart failure. Anemia II degree.

At 5 a.m., the patient was consulted by telephone via the air ambulance line with an infectious disease specialist, cardiologist, nephrologist, head. obstetric department OB-2. On the recommendation of specialists, additional examination should be carried out: ultrasound of the heart, change antibacterial therapy, transfer to the intensive care unit. Blood culture for sterility. Pulse-lowering therapy. Repeat laboratory examinations. Ultrasound of the kidneys. ECG, radiograph of the OGK again. Repeated consultation after the examination.

The woman was transferred to the intensive care unit. Repeated consultation examination. Diagnosis: Acute myocarditis of viral etiology (?) with dilatation of the heart cavities. Circulatory failure I. Pulmonary hypertension. Acute heart failure. Right-sided pneumonia. ODN II Art. OPN. Moderate gestosis in the second half of pregnancy.

An urgent laparotomy was performed. C-section. Dressing of internal iliac arteries on both sides and ascending branches of the uterine arteries (increased blood loss during surgery due to uterine hypotension and tissue bleeding). Fruit weight 1000 g and 960 g. ZRP – IIIst.

After the operation, the patient's condition quickly deteriorated. She died 16 hours after the operation, on the 7th day from the moment of admission to the hospital.

Pathological and anatomical changes using immunohistochemical research methods indicate severe PE, HELLP syndrome, hepato-renal insufficiency, pulmonary edema, distress during delivery, and the presence of combined damage to the mitral and tricuspid valves. Bilateral hydrothorax and disseminated intravascular coagulation syndrome were detected. Massive thrombosis of microcirculation vessels. Multiple hemorrhages in the mucous membranes of the stomach, mesentery, and intestines. Cortical necrosis of the kidneys and adrenal glands. Extensive liver necrosis. Right-sided pneumonia.

Main mistakes:

1. The following take place:

Discrepancy between clinical and pathological diagnoses; discrepancy in diagnosis according to the underlying disease, complication, concomitant disease;

Delayed diagnosis of the underlying disease and its severity;

Delayed diagnosis of complications of PE;

The case was not discussed at the pathological-anatomical conference.

2. GI and hospital doctors ignore the main clinical and laboratory indicators of severe PE: early start(24-26 weeks), blood pressure increases to 160/110 mm Hg. and higher, high proteinuria, severe hypoproteinemia, thrombocytopenia, anemia, which developed in the second half of pregnancy.

3. Attention and therapy are aimed at preventing premature birth and somatic diseases that aggravated the course of severe PE.

4. The diagnosis of severe PE has not been made. Instead, the vague term “preeclampsia of the second half of pregnancy” is used without assessing the severity.

5. Clinical picture PE was aggravated by concomitant somatic diseases(bronchitis, ARVI), the threat of premature birth, which required an in-depth examination, differential diagnosis, and a qualified examination by an obstetrician-gynecologist.

6. The therapist’s conclusion about suspicion of endomyocarditis, myocardial dystrophy and the presence of NCD is not substantiated. In the presence of severe (undiagnosed) PE, a course of antibiotic therapy only worsened the patient's condition. A consultative examination of a therapist raises doubts about his competence.

7. To clarify the diagnosis, you should call more qualified specialist“on yourself”, because multiple consultations with an infectious disease specialist, etc. without examining the patient, the uncertainty of the diagnosis increased.

8. Misdiagnosis, insufficient qualifications of doctors, delayed delivery, inadequate therapy are associated with insufficient knowledge of the problem of “preeclampsia”, modern capabilities preventing severe complications.