DeLuke Dean M
J Oral Maxillofac Surg. 2006 May;64(5):838-42. doi: 10.1016/j.joms.2006.01.020.
Under tort law, injured parties have the basic right to seek indemnity for wrongful injury, including injury from medical malpractice. Unfortunately, the present system is associated with many undesirable secondary effects, including problems of patient access to care, excessive testing or overtreatment, and undertreatment due to doctors' fear of malpractice. Nationwide, there are innumerable cases of doctors abandoning obstetrical or other high risk practices, or migrating away from states with less friendly tort laws. The California MICRA legislation of 1976 is often cited as a model for tort reform, but even this model legislation may be insufficient to restore a beleaguered trust between medical providers and their patients. Several key research studies suggest that the jury system fails to fairly and reliably compensate injured patients, and fails to deter or discipline errant doctors. To adequately meet the common needs of patients and health care providers, there must be an appropriate emphasis on aggressive risk management, quality improvement, patient safety, professional oversight, and responsible insurance underwriting. Moreover, there must be a systemic improvement of the current tort system as it pertains to medical malpractice. Although incremental reforms at the state level are slowly occurring and should certainly be supported, a greater reward may ultimately stem from more radical restructuring to a system of medical tribunals.
根据侵权法,受害方有权就不法伤害寻求赔偿,包括医疗事故造成的伤害。不幸的是,现行制度伴随着许多不良的次生影响,包括患者获得医疗服务的问题、过度检查或过度治疗,以及由于医生担心医疗事故而导致的治疗不足。在全国范围内,有无数医生放弃产科或其他高风险业务,或从侵权法不太友好的州迁移出去的案例。1976年加利福尼亚州的《医疗损害赔偿改革法案》(MICRA)常被引为侵权法改革的典范,但即使是这一典范性立法,可能也不足以恢复医疗服务提供者与其患者之间陷入困境的信任。几项关键研究表明,陪审团制度未能公平、可靠地赔偿受害患者,也未能威慑或惩戒犯错的医生。为了充分满足患者和医疗服务提供者的共同需求,必须适当强调积极的风险管理、质量改进、患者安全、专业监督和负责任的保险承保。此外,必须对现行侵权制度中与医疗事故相关的部分进行系统性改进。虽然州一级的渐进式改革正在缓慢进行,当然应该得到支持,但更大的成效最终可能源于对医疗法庭制度进行更彻底的重组。