Nagashima Hisashi, Wada Yoshitaka, Hongo Kazuhiro
Clinical Safety and Quality Management Section, University of Toyama Hospital.
Institute of Comparative Law, Waseda University.
Neurol Med Chir (Tokyo). 2017 Aug 15;57(8):426-432. doi: 10.2176/nmc.oa.2017-0049. Epub 2017 Jun 30.
Following the modern raising of public awareness, the numbers of malpractice litigation are increasing in the health care delivery system in Japan despite the extensive efforts of physicians. Authors reviewed the issues of litigation and the reasons for court decision from the healthcare-related negligence lawsuits in the past 15 years in Japan and investigated the cautionary points for reducing potential litigation. Healthcare-related negligence lawsuits between January 2001 and December 2015 were retrieved and sorted in each clinical field from the database in Courts in Japan and investigated on the proportional factors of the claims and court decisions in the neurosurgical field. During the period, 446 of healthcare-related court decisions including 41 against neurosurgeons (9.2%) were retrieved. Three of 41 decisions retrieved were decisions to retries for lower court decisions. In 38 claims against the neurosurgeons, 26 identified the negligence and 12 dismissed. In 26 decisions in favor of the plaintiffs, identified negligence in diagnosis in 4, clinical judgment in 3, technical skills in 5, clinical management in 7 and process of informed consent in 7. Five out of 18 decisions after 2006 were identified as negligence in an informed consent process, and additional one, who was mainly identified in inadequate technical skills also identified existing an inadequate informed consent process as a fundamental cause of litigation. Neurosurgeons are a higher risk group for malpractice litigation in Japan and adequate informed consent is important to reduce the risk of litigation.
随着公众意识在现代的提高，尽管医生们付出了巨大努力，但日本医疗保健系统中的医疗事故诉讼数量仍在增加。作者回顾了过去15年日本医疗相关过失诉讼中的诉讼问题和法院判决原因，并调查了减少潜在诉讼的注意事项。从日本法院的数据库中检索了2001年1月至2015年12月期间的医疗相关过失诉讼，并按每个临床领域进行分类，同时调查了神经外科领域索赔和法院判决的比例因素。在此期间，共检索到446项医疗相关法院判决，其中41项针对神经外科医生（9.2%）。检索到的41项判决中有3项是对下级法院判决进行重审的决定。在针对神经外科医生的38项索赔中，26项认定存在过失，12项被驳回。在26项支持原告的判决中，4项认定诊断存在过失，3项认定临床判断存在过失，5项认定技术技能存在过失，7项认定临床管理存在过失，7项认定知情同意过程存在过失。2006年之后的18项判决中有5项被认定在知情同意过程中存在过失，另外1项主要认定技术技能不足，但也认定存在知情同意过程不充分是诉讼的根本原因。在日本，神经外科医生是医疗事故诉讼的高风险群体，充分的知情同意对于降低诉讼风险很重要。
