case study on medico legal cases

Overview of Medico-legal Issues

• First Online: 01 January 2011

Cite this chapter

• I. W. Fong 2  

Part of the book series: Emerging Infectious Diseases of the 21st Century ((EIDC))

560 Accesses

Medical malpractice litigation is usually the result of an unexpected and undesirable outcome in our customers (patients) and when the affected individual or family perceives the outcome as being due to carelessness or poor clinical care. In the present era of modern medicine, the management of any given patient involves many layers of physicians and health care professionals from encounter to completion of care, for any specific condition. With this complexity of medical care, there is an increased risk of some error along the route towards the end result of cure or achieving relief and patient satisfaction. As a result, each health professional owes a separate duty to the patient within his or her area of practice. Although an individual health professional is not directly liable for the mistakes of others, in complex cases with multiple encounters by several health professionals, it is often difficult to determine the individual responsible for the outcome. However, in many of the cases, despite checks along the way involving multiple layers of health care workers, errors are often overlooked and missed by several health professionals.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info
• Durable hardcover edition

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Schiff GD, Kim S, Abrams R, Cosby K, Lambert B, Elstein AS, Hasler S, Krosnjar N, Odwazny R, Wisniewski MF, McNutt RA (2003). Diagnosing diagnostic errors: lessons in patient safety: From Research to Implementation, vol. 2. Rockville, MD. Agency for Health Care Research and Quality p255–278. AHRQ Publication No. 050021.

Google Scholar  

Golodner L (2004). How the public perceives patient safety. Newsletter of the National Patient Safety Foundation. 1997:1–6.

Shojania KG, Burton EC, McDonald KM, Goldman L (2003). Changes in rates of autopsy-detected diagnostic errors over time. A systematic review. JAMA 289:2849–2856.

Article   PubMed   Google Scholar  

Sato L (2001). Evidence-based patient safety and risk management technology. J Qual Improv 27:435.

Phillips R, Bartholomew L, Dovey S, Fryer GE Jr, Miyoshi TJ, Green LA (2004). Learning from malpractice claims about negligent adverse events in primary care in the United States. Qual Saf Health Care 13:121–126.

Graber ML, Franklin N, Gordon R (2005). Diagnostic error in internal medicine. Arch Intern Med 165:1493–1499.

You Gov Survey of Medical Misdiagnosis (2005). Isabel Healthcare – Clinical Decision Support System. Available at: http://www.isabel-healthcare.com

Burroughs TE, Waterman AD, Gallagher TH, Waterman B, Adams D, Jeffe DB, Dunagan WC, Garbutt J, Cohen MM, Cira J, Inguanzo J, Fraser VJ (2005). Patient concern about medical errors in emergency departments. Acad Emerg Med 23:57–64.

Article   Google Scholar  

Elstein AS (1995). Clinical reasoning in medicine. IN: Higgs JJM (ed). Clinical reasoning in the Health Professions. Butterworth-Heineman Ltd, Oxford, England, p49–59.

Berner ES, Graber ML (2008). Overconfidence as a cause of diagnostic error in medicine. Am J Med 121: S21–S23.

Croskerry P (2003). Cognitive forcing strategies in clinical decision making. Ann Emerg Med 142:110–120.

Redelmeier DA (2005). The cognitive psychology of missed diagnosis. Ann Intern Med 142:115–120.

PubMed   Google Scholar  

Brennan TA, Leape LL, Laird NM, Herbert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH, (1991). Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 324:370–376.

Article   PubMed   CAS   Google Scholar  

Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, Etchells E, Ghali WA, Hėbert P, Majumdar SR, O’Beirne M, Palacios-Derflingher L, Reid RJ, Sheps S, Tamblyn R (2004). The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 170:1678–1686.

Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD (1995). The quality in Australian Health Care Study. Med J Aust 163:458–471.

PubMed   CAS   Google Scholar  

Davis P, Lay-Yee R, Briant R, Ali W, Scott A, Schug S (2002). Adverse events in New Zealand public hospitals 1: occurrence and impact. N Z Med J 115:U271 (1167).

Vincent C, Neale G, Woloshynowych M (2001). Adverse events in British Hospitals: preliminary retrospective chart review. BMJ 322:517–519.

Schiǿler, T, Lipczak H, Pedersen BL, Mogensen, TS, Bech RB, Stockmarr A, Svenning AR, Frolich A (2001). Danish Adverse Event Study. Incidence of adverse events in hospitals. A retrospective study of medical records. Ugeskr Laeger 163:5370–5378.

Thomas EJ, Brennan TA (2000). Incidence and types of preventable adverse events in elderly patients: population based review of medical records. BMJ 320:741–744.

Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, William EJ, Howard KM, Weiler PC, Brennan TA (2000). Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 38:261–271.

Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubucher JR, Wilbur K, Wiens MO, Samoy LJ, Lacaria K, Pursell RA (2008). Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ 178:1563–1569.

Leape L, Brennan TA, Laird N, Lawthers AG, Localio R, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H (1991). The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 324:377–384.

Fisher G, Fetters MD, Munro AP, Goldman EB (1997). Adverse events in primary care identified from a risk-management database. J Fam Pract 45:40–46.

Wilson T, Sheikh A (2002). Enhancing public safety in primary care. BMJ 324:584–587.

Elder NC, Dovey SM (2002). Classification of medical errors and preventable adverse events in primary care: a synthesis of the literature. J Fam Pract 51:927–932.

Flynn EA, Barker KN (2007). Research on errors in dispensing and medication administration. IN: Cohen MR (ed). Medication Errors, 2 nd Edition, American Pharmacists Association: Washington DC, p15–41.

Leape LL (2007). Systems analysis and redesign: the foundation of medical error prevention. IN: Cohen MR (ed). Medication Errors, 2 nd Edition, American Pharmacists Association: Washington DC, p3–14.

Cohen MR (2007). Causes of medication errors. IN: Cohen MR (ed). Medication Errors, 2 nd Edition, American Pharmacists Association: Washington DC, p55–66.

Kohn LT, Corrigan JM, Donalson MS (eds) (2000). To Err is Human: Building a Safer Health System. National Academics Press, Washington DC.

Teagarden JR (2007). The clinical bioethics of safe medication practice. IN: Cohen MR (ed). Medication Errors, 2 nd Edition, American Pharmacists Association: Washington DC, p587–604.

Hepler CD, Strand LM (1990). Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 47:533–543.

Bartlett G, Blais R, Tamblyn R, Clermont RJ, MacGibbon B (2008). Impact of patient communication problems on the risk of preventable adverse events in acute care settings. CMAJ 198:1555–1562.

WHO (1972). International drug monitoring: the role of national centers. Tech Rep Ser. WHO no. 498.

Edwards IR, Aronson JK (2000). Adverse drug reactions: definition, diagnosis and management. Lancet 356:1255–1259.

Lazarou J, Pomeranz BH, Corey PN (1998). Incidence of adverse drug reactions in hospitalized patients. JAMA 279:1200–1205.

Khong TK, Singer DRJ (2002). Adverse drug reactions: current issues and strategies for prevention and management. Expert Opin Pharmacother 3:1289–1300.

Wasserfallen J, Livio F, Buclin T, Tillet L, Yersin B, Biolaz J (2001). Rate, type and cost of adverse drug reactions in emergency department admissions. Eur J Int Med 12:442–447.

Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, Small SD, Sweitzer BJ, Leape LL (1997). The costs of adverse drug events in hospitalized patients. JAMA 277:307–311.

Classen DC, Pestotnik S, Evans RS, Lloyd JF, Burke JP (1997). Adverse drug events in hospitalized patients . Excess length of stay, extra costs, and attributable mortality. JAMA 277:301–306.

Poon EG, Keohane CA, Yoon CS, Ditmore M, Bane A, Levtzion-Korach O, Moniz T, Rothschild JM, Kachalia AB, Hayes J, Churchill WW, Lipsitz S, Whittemore AD, Bates DW, Gandhi TK (2010). Effect of bar-code technology on the safety of medication administration. N Engl J Med 362:1698–1707.

Gallaher TH, Studdert DM, Levinson W (2007). Disclosing harmful medical errors to patients. N Engl J Med 356:2713–2719.

Kraman SS, Hamm G (1999). Risk management: extreme honesty may be the best policy. Ann Intern Med 131:963–987.

Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldman DA, Sharek PJ (2010). Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 363:2124–2134.

Kachalia A, Kaufman SR, Boothman R, Anderson S, Welch K, Saint S, Rogers MA (2010). Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med 153:213–221.

Download references

Author information

Authors and affiliations.

St. Michael’s Hospital, University of Toronto, Room 4179 CC 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to I. W. Fong .

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Fong, I.W. (2011). Overview of Medico-legal Issues. In: Medico-Legal Issues in Infectious Diseases. Emerging Infectious Diseases of the 21st Century. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-8053-3_14

Download citation

DOI : https://doi.org/10.1007/978-1-4419-8053-3_14

Published : 20 January 2011

Publisher Name : Springer, New York, NY

Print ISBN : 978-1-4419-8052-6

Online ISBN : 978-1-4419-8053-3

eBook Packages : Medicine Medicine (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Study of handling of medico-legal cases in governmental hospitals in Cairo

Affiliations.

• 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
• 2 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: [email protected].
• 3 Public Health Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
• PMID: 30216826
• DOI: 10.1016/j.jflm.2018.09.001

Medico-legal case (MLC) represents an integral part of medical practice in the emergency departments and causalities. Therefore, the physicians should have the sufficient knowledge of their roles and responsibilities while handling these cases to aid legal justice. This study on the physicians working in governmental hospitals in Cairo aimed to assess physicians' knowledge, practice and attitude regarding handling of MLCs. The study included 452 physicians working in 7 governmental hospitals in Cairo. There were non-significant differences in physicians' knowledge, practice and attitude scores according to their age groups, gender, job titles or duration of work experience. Physicians working in the day surgery centre had the lowest knowledge and attitude scores. Daily rate of confrontation with MLCs was reported by 42% the participants (190 physicians) and weekly rate was reported by 21.7% (98 physicians). Writing ML report was found as the most frequently encountered difficulty faced the participants during handling of MLCs (67.1%), followed by dealing with the patients' relatives. In conclusion, this study revealed absence of a well defined protocol for recognition and handling of MLCs in all included governmental hospitals in Cairo.

Keywords: Cairo; Handling; Hospital; Medico-legal case.

Copyright © 2018 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

• Attitude of Health Personnel*
• Clinical Competence*
• Documentation
• Forensic Medicine*
• Hospitals, Public
• Middle Aged
• Physician's Role*
• Professional-Family Relations
• Sampling Studies
• Surveys and Questionnaires

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Indian J Radiol Imaging
• v.18(2); 2008 May

Radiology medico-legal cases

From medical law cases - for doctors, vol 1: 1; pgs 34, 35, case 1: medical literature in aid to justify medical action.

Editor's note: The article has been modified from the original to protect the identities of those concerned.

Dr. A and Ors versus Patient Z; Judgment in favor of: Doctor.

Facts of the case

The patient underwent a USG examination of the abdomen, performed by the sonologist (Opposite Party - OP) and the report read, “gall bladder …. contains multiple echogenic shadows of stones accompanied by P-A shadowing in the neck region.” Relying on the report, the patient was operated for removal of stones but no stones were found.

Patient's allegation/s of medical negligence

The allegation was that a wrong report was given by the sonologist (OP) and relying on the same, the patient underwent surgery. It was alleged that it was unconvincing that stones could have disappeared within a period of 18 days of the USG, i.e., when the surgery done.

Doctor's Defense

• The doctor in his defense produced medical literature wherein it was categorically stated, “Finally small gallstones are occasionally seen to disappear…. This can happen at any time and is not necessarily accompanied by symptoms.”
• Further, the operational notes of surgeon recorded, “Gall bladder had few adhesions with omentum and the cut surface showed thickened mucosa with few tiny whitish spots? Calcareous deposits, but did not contain any calculi” were also pointed out in defense.

Findings of the Court

• The court in view of the medical literature, the operating surgeon's statement in court and findings recorded in the operation notes, held that it was possible for stones to disappear within 18 days.
• Hence, the sonologist (OP) was not found to be negligent.

Detailed Discussion

• The appellants were the opposite parties before the State Commission, where the respondent/complainant, patient Z had filed a complaint alleging a case of medical negligence against the appellants.

“The gall bladder is normal in size and shape. Its wall thickness is 3 mm. It contains multiple echogenic shadows of stones accompanied by P-A shadowing in the neck region. No mass seen. No perifocal edema seen. No stone seen in the CBD or cystic duct.”

• Because this report showed multiple shadows of stones, the complainant got herself admitted for removal of stones and operation was carried on, on 11.6.1996 by one Dr. B, but in reality, no stones were found. Thus, alleging a case of medical negligence, a case was filed before the State Commission, who after hearing the parties allowed the complaint and directed the appellants to refund Rs. 400 charged for the examination along with cost of Rs. 1,000. Aggrieved by this order, this appeal has been filed before us.
• Despite service of notice, none appears for the respondent/complainant, hence proceeded ex parte . We heard the appellant Dr. C on behalf of the appellants.
• After hearing appellant and perusal of material on record as well as the medical literature brought on record, we find that the State Commission has held the appellants guilty of medical negligence on account of the fact that while the USG test carried out on 24.5.1996 by the appellants showed multiple echogenic shadows of stones in gall bladder by P-A shadowing in the neck region, the State Commission found it unconvincing that it could have disappeared within a period of 18 days, i.e., when the surgery done by Dr. B on 11.6.1996, the stones were not seen.

“Finally small gallstones are occasionally seen to disappear. This is usually due to their passage into b the common duct where they mayor may not be retained. This can happen at any time [Figure 37.6] and is not necessarily accompanied by symptoms. This is one of the main justifications for operative choledochography.”

“Gall bladder had few adhesions with omentum and the cut surface showed thickened mucosa with few tiny whitish spots? Calcareous deposits, but did not contain any calculi. Liver and other adjacent viscera normal. CBD normal. Gall bladder sent for HPE (Histopathological examination).”

• We have also seen the cross-examination of the concerned surgeon, wherein he has clearly admitted, “…if the stone is of very small size or few in number, there could be its passing out during the period between 24.5.96 and 11.6.1996.”
• In view of the medical literature brought on record cited above and what the operating surgeon stated in his cross-examination, along with his findings referred to in the operation notes, we are of the view that in the light of this material, the order passed by the State Commission cannot be sustained. There is neither any other expert evidence nor material brought on record by the respondent/complainant in support of the allegations of medical negligence on the part of the appellants. Only, deemed to be expert, Dr. B has admitted that these stones could have passed out during this period. In view of this, according to us, the State Commission could not have held the statement of the appellants “not at all convincing”.
• In the aforementioned circumstances, we are unable to sustain the order passed by the State Commission, which is set aside. The appeal is allowed and the complaint stands dismissed.
• No order as to costs.
• Appeal allowed.

Source of Support: Nil

Conflict of Interest: None declared.