1Centre Francilien du Dos, Neurosurgery Department, Paris.
2Neurosurgery Department, Private Hospital of Versailles-Ramsay Santé, Versailles.
Neurosurg Focus. 2020 Nov;49(5):E11. doi: 10.3171/2020.8.FOCUS20582.
Spinal surgeries carry risks of malpractice litigation due to the random nature of their functional results, which may not meet patient expectations, and the hazards associated with these complex procedures. Claims are frequent and costly. In France, since 2002, a new law, the Patients' Rights Law of March 4, 2002, has created an alternative, out-of-court scheme, which established a simplified, rapid, free-of-charge procedure (Commission for Conciliation and Compensation [CCI]). Moreover, this law has optimized the compensation provided to patients for therapeutic hazards by use of a national solidarity fund. The authors analyzed the consequences of this alternative route in the case of claims against private neurosurgeons in France.
From the data bank of the insurer Mutuelle d'Assurances du Corps de Santé Français (MACSF), the main insurance company for private neurosurgeons in France, the authors retrospectively analyzed 193 files covering the period 2015-2019. These computerized files comprised the anonymized medical records of the patients, the reports of the independent experts, and the final judgments of the CCI and the entities supporting the compensation, if any.
During the 5-year study period (2015-2019), the insurance company recorded 494 complaints involving private neurosurgeons for spinal surgery procedures, of which 126 (25.5%) were in civil court, 123 (24.9%) were under amicable procedure, and 245 (49.6%) were in the out-of-court scheme administered by the CCI. Out of these 245 cases, only 193 were closed due to delays. The conclusions of the commission were rejection/incompetence decisions in 47.2% of the cases, therapeutic hazards in 21.2%, nosocomial infections in 17.6%, and practitioner fault in 13.5%. National solidarity compensated for 48 complaints (24.8%). The final decision of the CCI is not always consistent with the conclusions of the experts mandated by it, illustrating the difficulty in defining the concept of hazards. The authors found that the therapeutic hazards retained and compensated by the national solidarity included decompensated spondylotic myelopathies (15% of the 40 cases) and cauda equina syndromes (30%). As allowed by law, 11.5% of the patients who were not satisfied triggered a classical procedure in a court.
In the French out-of-court system, trial decisions resulting in rulings of proven medical malpractice are rare, but patients can start a new procedure in the classical courts. The therapeutic hazard remains a subtle definition, which may be problematic and require further discussion between experts and magistrates. In spite of the imperfections, this out-of-court system proposes a major evolution to move patients and medical providers from legal battles to reconciliations.
由于脊柱手术的功能结果具有随机性，可能无法满足患者的期望，并且与这些复杂手术相关的风险，因此脊柱手术存在医疗事故诉讼的风险。此类诉讼索赔频繁且代价高昂。在法国，自 2002 年以来，一项新法律即 2002 年 3 月 4 日的《患者权利法》，创建了一种替代性的庭外方案，该方案建立了一种简化、快速、免费的程序（调解和赔偿委员会[CCI]）。此外，该法律通过使用国家团结基金，优化了为治疗风险向患者提供的赔偿。作者分析了这种替代途径在法国针对私人神经外科医生的索赔中的后果。
作者从法国私人神经外科医生的主要保险公司 Mutuelle d'Assurances du Corps de Santé Français（MACSF）的保险公司数据库中，回顾性分析了 2015-2019 年期间的 193 份文件。这些计算机化文件包括患者匿名医疗记录、独立专家的报告以及 CCI 和任何支持赔偿的实体的最终判决。
在 5 年的研究期间（2015-2019 年），保险公司记录了 494 起涉及私人神经外科医生的脊柱手术程序的投诉，其中 126 起（25.5%）在民事法庭，123 起（24.9%）在和解程序中，245 起（49.6%）在 CCI 管理的庭外方案中。在这 245 起案件中，只有 193 起因拖延而结案。委员会的结论是，47.2%的病例为拒绝/无能力决定，21.2%为治疗风险，17.6%为医院感染，13.5%为医生过错。国家团结基金赔偿了 48 起投诉（24.8%）。CCI 的最终决定并不总是与它授权的专家的结论一致，这说明了定义危害概念的难度。作者发现，国家团结基金保留并赔偿的治疗风险包括代偿性颈椎病性脊髓病（40 例中的 15%）和马尾综合征（30%）。根据法律规定，11.5%不满意的患者可以在经典法庭启动新程序。
在法国的庭外系统中，导致医疗事故裁决的审判裁决很少见，但患者可以在经典法庭启动新程序。治疗风险仍然是一个微妙的定义，可能存在问题，需要专家和法官之间进一步讨论。尽管存在缺陷，这种庭外系统还是提出了一个重大的变革，使患者和医疗服务提供者从法律斗争转向和解。
