Kaplan Jonathan L, Hammert Warren C, Zin James E
Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Can J Plast Surg. 2007 Fall;15(3):155-7. doi: 10.1177/229255030701500309.
Physicians continue to practice in a very litigious environment. Some physicians try to mitigate their exposure to lawsuits by avoiding geographical locations known for their high incidence of medical malpractice claims. Not only are certain areas of the United States known to have a higher incidence of litigation, but it is also assumed that certain areas of the hospital incur a greater liability. There seems to be a medicolegal dogma suggesting a higher percentage of malpractice claims coming from patients seen in the emergency room (ER), as well as higher settlements for ER claims.
To determine if there is any validity to the dogma that a higher percentage of malpractice claims arise from the ER.
An analysis of common plastic surgery consults that result in malpractice claims was performed. The location where the basis for the lawsuit arose - the ER, office (clinic) or the operating room (OR) - was evaluated. The value of the indemnity paid and whether its value increased or decreased based on the location of the misadventure was evaluated.
According to the data, which represented 60% of American physicians, there was a larger absolute number of malpractice claims arising from the OR, not the ER. However, the highest average indemnity was paid for cases involving amputations when the misadventure originated in the ER.
The dogma that a greater percentage of lawsuits come from incidents arising in the ER is not supported. However, depending on the patient's injury and diagnosis, a lawsuit from the ER can be more costly than one from the OR.
医生仍在一个诉讼频发的环境中执业。一些医生试图通过避开医疗事故索赔高发的地理位置来减少面临诉讼的风险。美国不仅某些地区的诉讼发生率较高，而且医院的某些区域也被认为承担着更大的责任。似乎存在一种法医学教条，认为来自急诊室（ER）就诊患者的医疗事故索赔比例更高，并且急诊室索赔的和解金额也更高。
确定急诊室产生更高比例医疗事故索赔这一教条是否有任何依据。
对导致医疗事故索赔的常见整形手术会诊进行分析。评估诉讼依据产生的地点——急诊室、办公室（诊所）还是手术室（OR）。评估支付的赔偿金数额以及根据事故发生地点其价值是增加还是减少。
根据代表60%美国医生的数据，医疗事故索赔的绝对数量更多来自手术室，而非急诊室。然而，当事故发生在急诊室时，涉及截肢案件的平均赔偿金最高。
急诊室产生更高比例诉讼这一教条没有依据。然而，根据患者的损伤和诊断情况，来自急诊室的诉讼可能比来自手术室的诉讼成本更高。
