Kim Min Ji, Shin Su Hwan, Park Ji Yong
Department of Medical Law and Ethics, Graduate School, Yonsei University, Seoul, Korea.
Korea Medical Dispute Mediation and Arbitration Agency, Seoul, Korea.
Ann Surg Treat Res. 2020 Sep;99(3):131-137. doi: 10.4174/astr.2020.99.3.131. Epub 2020 Aug 27.
Necrotizing fasciitis (NF) is one of the most severe healthcare-associated infections. Early diagnosis of NF is difficult because of nonspecific signs and symptoms in the early stage. NF often presents with risks of medicolegal disputes. This study aimed to provide baseline data on the general characteristics of medical accidents involving NF, features of NF, and typical court opinions regarding medical malpractice in Korea.
In this study, 25 cases of medical malpractice litigation involving NF sentenced between 1998 and 2018 were analyzed with respect to 3 variables: medical accident, NF, and breach of duty.
The department of colorectal surgery was most frequently involved in litigation cases (40.0%), and colorectal surgery was the most frequent procedure before the diagnosis of NF (40.0%). The most common sites were the upper and lower extremities. The courts agreed that there was typically improper monitoring after treatment, frequently related to NF.
These litigation cases imply that physicians cannot be blamed for the failure to prevent NF. The timely recognition and management of NF might be considered as one of the main factors for deciding malpractice in court. Therefore, surgeons, especially in the department of colorectal surgery, should pay attention to changes in the patient's status after surgery. Surgeons need to learn from medical accidents, as it is important for risk management, preventing the occurrence of similar cases, and improving the quality of healthcare services. We report the medicolegal implications from medical lawsuits involving NF.
坏死性筋膜炎（NF）是最严重的医疗相关感染之一。由于早期症状和体征不具特异性，NF的早期诊断较为困难。NF常引发医疗法律纠纷风险。本研究旨在提供有关韩国涉及NF的医疗事故一般特征、NF的特点以及关于医疗过失的典型法庭意见的基线数据。
在本研究中，对1998年至2018年间判决的25起涉及NF的医疗过失诉讼案件，就医疗事故、NF和失职这三个变量进行了分析。
结直肠外科最常卷入诉讼案件（40.0%），在NF诊断前最常进行的手术是结直肠手术（40.0%）。最常见的部位是上肢和下肢。法院一致认为，治疗后通常存在监测不当的情况，这常与NF相关。
这些诉讼案件表明，不能因未能预防NF而指责医生。NF的及时识别和处理可能被视为法庭判定医疗过失的主要因素之一。因此，外科医生，尤其是结直肠外科的医生，应关注术后患者状况的变化。外科医生需要从医疗事故中吸取教训，因为这对于风险管理、预防类似病例的发生以及提高医疗服务质量都很重要。我们报告了涉及NF的医疗诉讼的法医学意义。
