Perrotti Michael, Badger William, Prader Susan, Moran Michael E
Urology Service, St. Peter's Cancer Care Center and Department of Surgery, Albany Medical College, Albany, New York 12208, USA.
J Urol. 2006 Nov;176(5):2154-7; discussion 2157. doi: 10.1016/j.juro.2006.07.024.
Malpractice premiums have increased by up to 57% for urologists in the last 3 years, for which the reasons are not clearly reported. We sought to better understand factors contributing to the current medical malpractice crisis in urology.
Working with the Medical Liability Mutual Insurance Company of New York State we evaluated malpractice claims in urology that were closed with indemnity payment between 1985 and 2004. Individual claims were assessed for the purported negligent act, the procedure when applicable and the expense incurred. We also evaluated the impact of new technologies, eg laparoscopic nephrectomy, on reported claims.
A total of 469 urology malpractice claims were closed with indemnity payment during the period evaluated for a total loss indemnity of Dollars 99,335,431. The number of files closed with indemnity payment yearly remained relatively constant at an average of 22 claims. The average indemnity payment increased each year and after correcting for inflation a 191% increase was observed for the period evaluated. The greatest number of claims was related to postoperative events (total of 101), followed by intraoperative events (96), failure to diagnose a given condition (60), medication administration error (21) and a foreign body left following surgery (20). In the area of new technologies laparoscopic surgery accounted for 4 claims and transurethral needle ablation accounted for 1. Vasectomy accounted for 8 claims.
In the current study surgical procedures were the greatest generator of claims with the most common being oncological. Emerging and new technologies, eg laparoscopy and robotics, did not account for the increase in indemnity payments observed to date. Only further investigation will determine whether this is secondary to a lag time in the closure of suits related to these emerging technologies or to a lack of such suits. The actual number of claims closed with indemnity payment yearly remained relatively constant. However, the indemnity payment per claim far outpaced that expected for inflation. The observed increase in indemnity payment per claim would appear to be a significant contributing factor to the current malpractice crisis in urology.
在过去3年中，泌尿科医生的医疗事故保险费增长了高达57%，但其原因尚无明确报道。我们试图更好地了解导致当前泌尿科医疗事故危机的因素。
与纽约州医疗责任互助保险公司合作，我们评估了1985年至2004年间以赔偿结案的泌尿科医疗事故索赔。对每一项索赔评估其所谓的过失行为、适用的手术以及所产生的费用。我们还评估了新技术（如腹腔镜肾切除术）对报告索赔的影响。
在评估期间，共有469起泌尿科医疗事故索赔以赔偿结案，总损失赔偿额为99335431美元。每年以赔偿结案的档案数量相对稳定，平均每年22起索赔。平均赔偿金额逐年增加，经通货膨胀校正后，在评估期间增长了191%。索赔数量最多的与术后事件相关（共101起），其次是术中事件（96起）、未能诊断特定病情（60起）、用药错误（21起）以及手术后遗留异物（20起）。在新技术领域，腹腔镜手术有4起索赔，经尿道针状电极消融术有1起索赔。输精管切除术有8起索赔。
在当前研究中，手术操作是索赔的最大来源，最常见的是肿瘤手术。新兴技术（如腹腔镜和机器人技术）迄今并未导致观察到的赔偿金额增加。只有进一步调查才能确定这是由于与这些新兴技术相关的诉讼结案存在滞后时间，还是由于此类诉讼数量不足。每年以赔偿结案的实际索赔数量相对稳定。然而，每项索赔的赔偿金额远远超过通货膨胀预期。观察到的每项索赔赔偿金额的增加似乎是当前泌尿科医疗事故危机的一个重要促成因素。
