de Reuver Philip R, Dijkgraaf Marcel G W, Gevers Sjef K M, Gouma Dirk J
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Ann Surg. 2008 Nov;248(5):815-20. doi: 10.1097/SLA.0b013e318186de35.
To determine the inter-rater agreement of expert witness testimonies in bile duct injury malpractice litigation.
Malpractice litigation is an increasing concern in modern surgical practice. As most of the lawyers are not educated in medicine, expert witnesses are asked to testify about negligence of care in most jurisdictions. Although expert witnesses greatly determine the outcome of a claim, the reliability of expert testimony may be arbitrary.
Surgical expert witnesses independently assessed whether negligence of care occurred by reviewing the complete medical history of closed litigation cases. All cases concerned iatrogenic bile duct injury, which occurred during laparoscopic cholecystectomy. The level of agreement was measured and case characteristics associated with negligence were determined.
Thirteen independent experts reviewed 10 closed litigation cases. In 1 of the 10 cases, full agreement was observed. In 7 of the 10 cases, the highest percentage of agreeing experts was 53% or less. Chance-corrected levels of agreement were in the slight to fair range (Kendall W coefficient of concordance = 0.16-0.25). Disease-related mortality was associated with judgments on negligence (P = 0.02). Judgments on negligence of care were not associated with delay in diagnosis or the severity of injury. Experts with more years of clinical experience agreed more about negligence. Experts working in an academic setting agreed less than experts working in a teaching hospital. Finally, 8 of the 13 experts plead for the assignment of more than 1 expert witness to review and comment in a surgical litigation case.
The reliability of expert witness testimonies in bile duct injury litigation is frail. Defendants, plaintiffs, experts, and lawyers should be aware of the drawbacks of expert witness testimonies. Raising consensus concerning the standards of surgical care may be required to improve agreement in judgments on negligence.
确定在胆管损伤医疗事故诉讼中专家证人证词的评分者间一致性。
医疗事故诉讼在现代外科实践中日益受到关注。由于大多数律师没有医学教育背景，在大多数司法管辖区，需要专家证人就医疗护理过失进行作证。尽管专家证人在很大程度上决定了索赔的结果，但专家证词的可靠性可能是随意的。
外科专家证人通过审查已结案诉讼案件的完整病史，独立评估是否存在医疗护理过失。所有病例均涉及腹腔镜胆囊切除术期间发生的医源性胆管损伤。测量一致性水平，并确定与过失相关的病例特征。
13名独立专家审查了10起已结案诉讼案件。在10起案件中的1起中，观察到完全一致。在10起案件中的7起中，同意的专家的最高百分比为53%或更低。经机会校正的一致性水平在轻微到中等范围（肯德尔W和谐系数=0.16 - 0.25）。疾病相关死亡率与关于过失的判断相关（P = 0.02）。关于医疗护理过失的判断与诊断延迟或损伤严重程度无关。临床经验更丰富的专家对过失的看法更一致。在学术环境中工作的专家比在教学医院工作的专家意见一致性更低。最后，13名专家中的8名主张在外科诉讼案件中指定多名专家证人进行审查和评论。
胆管损伤诉讼中专家证人证词的可靠性很脆弱。被告、原告、专家和律师应意识到专家证人证词的缺点。可能需要就外科护理标准达成共识，以提高对过失判断的一致性。
