Discerning Why Patients Die: Legal and Political Controversies in Japan, the United States, and Taiwan
The processes of discerning the causes of medical injury, and sometimes attributing them to errors by medical professionals, are fraught with legal and political controversy. This short descriptive essay presents several key features of how Japan, the United States, and Taiwan address the discernment process through their respective legal systems. Statistical trends in civil, criminal, and administrative systems for fixing responsibility and determining compensation are set out, and areas of political controversy are identified. Of particular interest are the diminishing number of civil malpractice claims in the United States, the recent establishment of medical specialty courts and no-fault obstetrical injury compensation systems in Japan and Taiwan, the relative prominence in the 21st century (in terms of physician concern, if not in the absolute number of cases) of criminal prosecutions of medical personnel in Japan and especially in Taiwan, and legislative proposals now under consideration in Japan and Taiwan to channel medical disputes away from the criminal law system and to improve peer review, dispute resolution, and patient safety.
Criminal judgments to medical malpractice in Taiwan.
Our society is the only country that punishes physicians with medical malpractice by using criminal law as a routine, while most countries in this planet settle almost all medical disputes with civil action. In Taiwan, criminal suits account 79% of all medical malpractice law suits. The purpose of this trial is to investigate the reasons for the overruled criminal judgment by empirical approach. In this study, 15 overruled judgments out of 615 criminal prosecutions were collected from February 1st, 2002 to January 31st, 2005. The judgments of these cases are analyzed by using "the content analytic method". It is found that in these 15 criminal prosecutions, 16 doctors out of 18 defendants lost their trials, which indicates, statistically, one doctor was sentenced to be guilty per every 3 months. Out of these unlucky ones, two-thirds of the criminals were surgeons, one-fifth internists, and the rests are gynecologists and pediatricians. The average of the terms of imprisonment was 6.6months and, fortunately, all of them obtained probation or replacement with forfeit. In these cases, most of the doctors came from local hospitals or clinics, while only two were from the medical centers. Concerning the disputes, five cases were involved with delayed or missed diagnoses of the illness and the other ten in the surgical complications. In the first 4 years of the 21st century, there was one physician in Taiwan sentenced guilty per every 3 months, which is a unique phenomenon in the world. The criminal rate of physicians in Taiwan is the highest in all professionals in the world. Most of these criminal doctors were the laborious, mind-dependent, life-saving surgeons, internists, pediatricians, and gynecologists. According to the causes of the disputes, the difference between the expectation of the doctors and that of the patients should be treated by informed consent doctrine to avoid the very expensive defensive medicine.
Cryostat use and tissue processing in Mohs micrographic surgery.
Information of cryostat use and reliability was collected from 130 members of the American College of Mohs Micrographic Surgery and Cutaneous Oncology. The Damon IEC International cryostat was utilized by 38% of the survey participants, followed by the Reichert Histostat (18%) and the LabTek/TissueTek (13%). Data were also collected on methods of frozen-section embedding and technical training.