FORENSIC MEDICAL AND LEGAL ASPECTS OF THE PROVISION OF MEDICAL CARE IN OBSTETRICS AND GYNECOLOGY
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Keywords

forensic medical examination, obstetrics, gynecology, defect, provision of medical care

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Pletenetska , A. (2020). FORENSIC MEDICAL AND LEGAL ASPECTS OF THE PROVISION OF MEDICAL CARE IN OBSTETRICS AND GYNECOLOGY. Medical Science of Ukraine (MSU), 16(2), 40-44. https://doi.org/10.32345/2664-4738.2.2020.7

Abstract

Relevance. Sometimes statistics on medical errors are hushed up, and information about individual incidents becomes known thanks to the media.

Objective: to identify the most common obstetric-gynecological profile defects and their causes by analyzing the data of the State Statistics Service on maternal and infant mortality during pregnancy, childbirth, and the postpartum period and compare it with the forensic analysis of obstetric-gynecological profile medical care.

Materials and methods. 625 cases were analyzed according to the State Statistics Service on maternal and infant mortality during pregnancy, childbirth and the postpartum period, court sentences in criminal cases under Articles 139 and 140 of the Criminal Code of Ukraine, according to the Unified State Register of Court Decisions of Ukraine since 2009 in 2019, as well as data from forensic medical examination commissions on “medicinal matters” for 2013-2019 performed by the State Institution “Main Bureau of Forensic Medical Examination of the Ministry of Health of Ukraine”, including cases of previous departmental audits by the commissions of the Health Administration. The data obtained were subjected to statistical processing by standard methods of descriptive statistics.

Results. In these 255 examinations, defects in the provision of medical care were found by expert commissions in 186 cases, which amounted to 72.9%. Moreover, of these "defective cases", 62.9% (117 cases) were in a direct causal relationship with an unfavorable outcome; 35.5% (6 cases) - in some deficiencies that did not have a causal relationship with the onset of fetal death. In 3 cases of examinations in gynecology, there were contradictions in the entries in the medical documentation, they did not allow assessing the quality of medical care and the relationship with the consequences. At the pre-hospital stage (in the clinic), defects were allowed in 65.5%, and at the hospital - in 72.8%. In the presence of departmental inspections in 23%, there was a complete coincidence of the results of the conclusions of the commissions of the bureau of forensic medical examination and medical examination, and only in cases of significant defects in direct causal connection with the consequences. At the same time, when analyzing 53 court sentences according to the register of court decisions, it turned out that 13 of them related to the obstetric and gynecological profile, and 12 of them were indictment. In all cases, the source of evidence in cases was exclusively the “Expert Conclusions”.

Conclusions. It was found that forensic medical examinations for the provision of obstetric and gynecological medical care occupy a leading place in the overall structure of commission examinations in “medical matters”, in the vast majority of examinations, defects in the provision of medical care were found that were in direct causal connection with an unfavorable outcome.

https://doi.org/10.32345/2664-4738.2.2020.7
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References

Kohn LT, Corrigan JM, Donaldson MS. To Err is Human: Building a Safer Health System // Institute of Medicine (US) Committee on Quality of Health Care in America. Washington (DC): National Academies Press (US). 2000, 1 (1). PMID: 25077248. DOI: https://www.ncbi.nlm.nih.gov/pubmed/25077248

Kathleen Sutcliffe. The Health Care Industry Needs to Be More Honest About Medical Errors // Time USA. 2019 Nov 05. URL: https://time.com/5717545/medical-errors/

[In the United States, medical errors have been cited as one of the leading causes of death] // Interfax. 2016. [in Russian]. URL: http://www.interfax.ru/world/506759

[Medical error: causes and consequences] // Medical and legal portal "103-

law.org.ua". 2012. [in Ukrainian]. URL: http://103-law.org.ua/Article.aspx?a=61

[In Ukraine there are no statistics of medical errors, - the expert] // Analytical online publication of Lviv "Zaxid.net". 2012. [in Ukrainian]. URL: https://zaxid.net/v_ukrayini_nema_statistiki_likarskih_pomilok__ekspert_n1266352

[Medical error and how to deal with it] // Agency of regional information and

analytics "galinfo.com.ua". 2013. [in Ukrainian]. URL: http://galinfo.com.ua/articles/likarska_pomylka_i_yak_z_neyu_borotysya_125439.html

Bushmeleva N.N. [Defects in the provision of medical care in cases of maternal

death at the regional level] // Electronic scientific journal "Social Aspects of Population Health". 2014. 3 (37). [in Russian]. URL: http://vestnik.mednet.ru/content/view/565/30/lang,ru/

Mateikovich EA, Shevlyukova TP, Kukarskaya EY, Galieva GD. [Medical errors in the provision of obstetric and gynecological care] // Modern problems of science and education. 2018. 5 (1). [in Russian]. URL: http://www.science-education.ru/ru/article/view?Id=27991

Steblyuk VV. [Legal and moral and ethical aspects of criminal offenses in the field of professional activity of medical workers] // Forensic examination. 2013. 2: 45-8. [in Ukrainian]. http://nbuv.gov.ua/UJRN/sme_2013_2_14

Dunaevskaya LG. [Investigation of crimes committed during the provision of

medical care]. Kyiv: UMCC Center; 2012. 168 p. [in Ukrainian]. ISBN 978-966-8287-34-3.

Criminal Procedure Code of Ukraine // Information of the Verkhovna Rada of

Ukraine (VVR). 2016. [in Ukrainian]. URL: http://zakon2.rada.gov.ua

Distribution of deaths by sex, age groups and causes of death (0,1) // Database of State Statistics of Ukraine. [in Ukrainian]. URL: http://database.ukrcensus.gov.ua/Mult/Dialog/Saveshow.asp

Unified State Register of Judgments of Ukraine. 2020. [in Ukrainian]. URL: http://www.reyestr.court.gov.ua/

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