Prevention of medical malpractice and disputes through analysis of lawsuits related to coronary angiography and intervention

Cheol Won Hyeon,Won Lee,So Yoon Kim,Ji Yong Park,Su Hwan Shin 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.3

Background/Aims: Possible fatal complications arising from coronary angiography (CAG), percutaneous coronary intervention (PCI), and coronary artery disease itself, are likely to cause medical disputes. Presenting the current status and reasons for judgments given in lawsuits related to CAG/PCI, this study aimed to identify ways to prevent unnecessary disputes and medical malpractice suits related to CAG/PCI through lawsuit analysis. Methods: A total of 13 cases (20 judgments) found in the Supreme Court of Korea’s Written Judgment Management System from 1998 to 2017 were analyzed. Results: Coronary artery injury was the most common causative complication that led to lawsuits (n = 6, 46%). Six cases (46%) were ruled in favor of the plaintiff for violation of duty of care (n = 4) and duty of explanation (n = 2), respectively. Cases that violated duty of care included two errors in intra-procedure device manipulation, one in pre-procedure diagnosis, and one in management of post-procedure complication. Lack of explanation regarding the risk of complications was pointed out in both cases that violated duty of explanation. The average awarded amount for the damages was 114,436,064 Korean won. Conclusions: Physicians need not fear unfair judgments so long as they follow standard of care because the Court consistently looked at the probability, the foreseeability, and the evidence. Therefore, maintaining standard of care is important. Besides, specific, detailed, and comprehensible explanations, including the risk of complications in addition to the necessity of procedures, are important to ensure the patient clearly understands the possible risk of adverse outcomes.

국내 정형외과 의료소송 현황 파악

이원(Won Lee),이미진(Mi Jin Lee),김용민(Yong Min Kim),우찬명(Chan Myung Woo),김소윤(So Yoon Kim),김양수(Yang-Soo Kim) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.3

목적: 국내 정형외과 관련 의료소송 판결문의 분석을 통하여 정형외과 의료소송의 현황과 원인이 된 과정을 파악하고자 함이다. 대상 및 방법: 소송시작이 2005년부터 2010년인 정형외과 의료소송 판결문 341건을 대상으로 하여 빈도분석을 실시하였다. 결과: 사건 발생 시점에서 소송 종결 시점까지의 평균 소요기간은 4.22년이었다. 의료소송의 원인이 된 과정은 수술이 46.3%였고, 수술의 종류는 척추 수술이 가장 많았다. 사고의 결과는 장애가 가장 많았고, 최종심 결과는 원고일부승이 40.5%, 원고패(기각)가 34.3%였다. 감염은 전체 중 26.1%에서 발생하였고, 손해배상 청구금액은 평균 181,998,036원이었으며 인용금액은 평균 58,897,161원이었다. 결론: 정형외과 의료소송으로 이어진 의료사고의 주요 원인 과정은 수술이 가장 많았고, 그 중에서도 척추 수술이 가장 많았다. 추후 의료사고의 근본 원인분석을 통해 의료사고를 줄이고 재발을 방지하기 위한 후속 연구가 이루어져야 할 것이다. Purpose: Through the analysis of orthopedics lawsuit rulings, the purpose of this study is to understand the current trends of medical lawsuits in orthopedics in Korea. Materials and Methods: An analysis of medical lawsuits in orthopedics was conducted. As the study method, a quantitative analysis was performed on 341 cases. Results: The average period of lawsuits, from the occurrence of the medical accident to end of the ruling, took an average of 4.22 years. The most frequent procedure that was the main cause of the medical accidents was surgery, at 46.3%. When surgery is the main procedure that caused the medical accidents, the result of examining the types of surgeries showed that spine surgery had the highest percentage. For the outcome of the accident, the highest number of cases resulted in disability and for the final court outcome, 40.5% ruled partially in favor of the plaintiff (the patient) with acknowledgement of only the damage incurred due to medical error of the total sum claimed, and dismissal of the claim made by the plaintiff (patient) accounted for 34.3%; 26.1% of cases develop infection. For the amount of claim for damage, the average amount of claim was 181,998,036 won; in the judgement amount, the average amount of judgement was 58,897,161 won. Conclusion: The most frequent procedure in orthopedics was surgery and spine surgery comprised a large proportion of these surgeries. Future studies to determine root causes of medical accidents should be conducted to reduce medical lawsuits and to plan against the repeating of medical accidents.

Analysis of Judicial Precedents Cases Regarding Skin Cancer from 1997 to 2017 in Republic of Korea

( Su Hwan Shin ),( Won Lee ),( So Yoon Kim ),( Gwanghyun Jo ),( Je-ho Mun ),( Soo Ick Cho ) 대한피부과학회 2019 Annals of Dermatology Vol.31 No.3

Background: Both medical disputes and the incidence of skin cancer are increasing in Korea. Objective: The aim of this study was to figure out the medical litigation related to skin cancer and propose a method to prevent the medical disputes. Methods: Skin cancer-related judgments were searched by The Supreme Court of Korea’s Written Judgment Management System based on the keywords for skin cancer. The search system included sentenced cases at the Lower Courts, the Appellate Courts, and the Supreme Court from 1997 to 2017. Results: Seven cases were selected as the litigation cases related to skin cancer. Four cases (57.1%) presented malignant melanoma, while the rest presented squamous cell carcinoma, metastatic skin cancer, and peripheral T cell lymphoma (1 case in each). Four cases resulted in death from cancer metastasis, and 3 cases presented as sequelae. The legal issues related to the medical disputes could be categorized as follows: misdiagnosis, delayed diagnosis, performance error, and lack of informed consent. Delayed diagnosis and lack of informed consent were the most common issues (n=4) in the precedents. Five cases (71.4%) were sentenced the awarded amounts to the plaintiff, including 2 cases of settlement decision. The average awarded amount was 42,553,644±27,567,455 Korean won. Conclusion: Physicians should pay attention to the cases of the skin cancer to prevent medical malpractice and disputes. The practices pertaining to proper diagnosis, treatment plans, and obtaining an informed consent should be followed during the course of treating skin cancer. (Ann Dermatol 31(3) 300∼306, 2019)

Analysis of judicial precedents cases regarding skin cancer from 1997 to 2017 in Republic of Korea

( Gwanghyun Jo ),( Su Hwan Shin ),( Won Lee ),( So Yoon Kim ),( Je-ho Mun ),( Soo Ick Cho ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.2

Background: Both medical disputes and the incidence of skin cancer are increasing in Korea. Objectives: To figure out the medical litigation related to skin cancer and propose a method to prevent the medical disputes Methods: Skin cancer-related judgments were searched by The Supreme Court of Korea’s Written Judgment Management System based on the keywords for skin cancer. The search system included sentenced cases at the Lower Courts, the Appellate Courts, and the Supreme Court from 1997 to 2017 Results: Seven cases were selected as the litigation cases related to skin cancer. Four cases (57.1%) presented malignant melanoma, while the rest presented squamous cell carcinoma, metastatic skin cancer, and peripheral T cell lymphoma (1 case in each). Four cases resulted in death from cancer metastasis, and 3 cases presented as sequelae. The legal issues related to the medical disputes could be categorized as follows: misdiagnosis, delayed diagnosis, performance error, and lack of informed consent. Delayed diagnosis and lack of informed consent were the most common issues (n=4) in the precedents. Five cases (71.4%) were sentenced the awarded amounts to the plaintiff, including 2 cases of settlement decision. The average awarded amount was 42,553,644±27,567,455 Korean Won. Conclusion: Physicians should pay attention to the cases of the skin cancer to prevent medical malpractice and disputes.

Analysis of acne-related judicial precedents from 1997 to 2018 in South Korea

( Ji Hoon Yang ),( Soo Ick Cho ),( Su Hwan Shin ),( Won Lee ),( So Yoon Kim ),( Dae Hun Suh ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.2

Background: Medicolegal disputes are increasing in practical medicine. Acne is a common problem but is usually related to cosmetic problems such as acne scars. Medications or procedures related to acne could lead to medical malpractice. Objectives: To analyze medical litigation associated with acne or acne scar in South Korea. Methods: Acne-related judgements were searched using the Supreme Court of Korea’s Written Judgment Management System based on the keywords “acne” or “acne scar.” Results: Eleven cases were selected as litigated cases of acne or acne scar. Eight cases (72.7%) were related to acne scar and three (27.3%) were related to acne. Treatment modalities such as peeling (n = 6), laser treatment (n = 3), photodynamic therapy (n = 1), and antibiotic (n = 1) resulted in lawsuit. Claimed sequelae of the treatment were hyperpigmentation (n = 5), scar worsening (n = 5), erythema (n = 3), skin bumps (n = 1), and liver transplant (n = 1). Eight cases (72.7%) were awarded to the plaintiff, and the others were dismissed. The average awarded amount was 16,801,324± 24,452,486 (mean±standard deviation) Korean Won. Conclusion: Various treatments for acne or acne scar can cause medical disputes. Unnecessary litigation could be prevented if simple measures such as history taking, choosing proper procedure, and adequate management after the procedure along with sufficient informed consent were performed.

Immunomodulatory activity of <i>Lactobacillus</i> strains isolated from fermented vegetables and infant stool

Won, Tae Joon,Kim, Bongjoon,Oh, Eun Seul,Bang, Joon Seok,Lee, Yoon Jeong,Yoo, Jong-Sun,Yu, Hyunmin,Yoon, Joowon,Hyung, Kyeong Eun,Park, So-Young,Hwang, Kwang Woo Canadian Science Publishing 2011 Canadian journal of physiology and pharmacology Vol.89 No.6

<P> Four Lactobacillus strains - Lactobacillus plantarum CJLP133, L. plantarum CJLP243, L. plantarum CJNR26, and Lactobacillus gasseri CJMF3 - were isolated from Korean fermented food or healthy infant feces, and their capacity to modulate cellular and humoral immune responses was studied. Feeding of the tested lactobacilli for 8 weeks did not alter the weight of and cell numbers in the spleen of mice. However, CJLP133 and CJLP243 strains increased the T lymphocyte population in the spleen of mice, while CJNR26 and CJMF3 increased the B lymphocyte population. In splenocytes treated with concanavalin A, ingestion of CJLP133 and CJLP243 promoted T lymphocyte proliferation and secretion of T cell cytokines, whereas feeding of the CJNR26 and CJMF3 strains enhanced B lymphocyte proliferation in splenocytes treated with lipopolysaccharide and plaque formation. These results suggest that CJLP133 and CJLP243 have immunostimulating activity through the enhancement of T cell activation, while CJNR26 and CJMF3 exhibit immunopotentiation through the increment of B cell activation. </P>

Microbial Contamination Levels of Strawberries at Domestic Farms of South Korea

Won-Il Kim,A-Ra Jo,Se-Ri Kim,Song Hee Ryu,Ki-Woong Nam,Yohan Yoon,Deok-Hoon Yoon,So-Yong Oh,Myeong Hyeon Nam,Jae-Gee Ryu,Hwang-Yong Kim 한국토양비료학회 2014 한국토양비료학회지 Vol.47 No.6

Foodborne illness due to the consumption of contaminated raw strawberries is a continuing food safety concern. This study investigated and evaluated contamination levels of bacteria on strawberries at farms stage to evaluate potential hazards associated with fresh strawberries. A total of 315 samples, 105 samples from 5 sampling sites (A to E) of 21 farms and 210 samples from 1 sampling site of 6 farms, was collected every month for four months and analyzed to enumerate aerobic bacterial counts, Coliforms/E. coli, Bacillus cereus and Staphylococcus aureus. In addition, the prevalence study of five pathogens (S. aureus, E. coli, E. coli O157:H7, Salmonella spp. and Listeria monocytogenes) was performed on each sample. Aerobic bacterial counts ranged from 0.48 to 6.36 Log CFU/g, with the highest bacterial cell counts recorded for D and E sites. Coliforms were detected in 71 samples (22.5%) with a minimum of 0.48 cfu/g and a maximum of more than 4 Log CFU/g. B. cereus was detected in 98 samples (31.1%) among total samples analyzed. S. aureus was detected in 2 samples with a minimum of 0.48 Log CFU/g and a maximum of 1.38 Log CFU/g. E. coli, E. coli O157:H7, Salmonella spp. and L. monocytogenes were not isolated from any of the samples. The microbial contamination levels of strawberries determined in this study may be used as the fundamental data for microbiological risk assessment.

Case Report : A synchronous hepatocellular carcinoma and renal cell carcinoma treated with radio frequency ablation

( Yoon Serk Lee ),( Jeong Han Kim ),( Hyeon Young Yoon ),( Won Hyeok Choe ),( So Young Kwon ),( Chang Hong Lee ) 대한간학회 2014 Clinical and Molecular Hepatology(대한간학회지) Vol.20 No.3

Radio-frequency ablation (RFA) is a curative treatment for hepatocellular carcinoma (HCC). Percutaneous RFA has been shown to be beneficial for patients with small renal cell carcinoma (RCC) lacking indications for resection. We experienced the case of a 53-year-old male who had conditions that suggested HCC, RCC, and alcoholic liver cirrhosis. Abdominal contrast-enhanced computed tomography (CT) and magnetic resonance image showed liver cirrhosis with 2.8 cm ill-defined mass in segment 2 of the liver and 1.9 cm hypervascular mass in the left kidney. These findings were compatible with the double primary cancers of HCC and RCC. Transarterial chemoembolization (TACE) was performed to treat the HCC. After the TACE, a focal lipiodol uptake defect was noticed on a follow up CT images and loco-regional treatment was recommended. Therefore, we performed RFAs to treat HCC and RCC. There was no evidence of recurrence in the follow up image after 1 month. (Clin Mol Hepatol 2014;20:306-309)

Consideration of Discrepancy between Needle-Washout Thyroglobulin and Serum Thyroglobulin of Recurrent Papillary Thyroid Cancer

So Ra Kim,Mi-Kyung Kwak,Hye Ran Kang,Seug Yun Yoon,Seong Soon Kwon,Bo Young Kim,Hoo Nam Choi,Hye Jeong Kim,Jae Wook Kim,So-Young Jin,Hyeong Kyu Park,Dong Won Byun,Kyoil Suh,Myung-Hi Yoo 순천향대학교 순천향의학연구소 2014 Journal of Soonchunhyang Medical Science Vol.20 No.2

Although the prognosis of papillary thyroid cancer (PTC) is extremely good, locoregional recurrences after initial treatment occur. Thyroglobulin (Tg) is a reliable tumor marker to detect recurrence or persistence of PTC. However, occasionally serum Tg may miss the detection of a recurrence. We report a 54-year-old female presented with hoarseness due to cervical recurrence without concomitant elevation of serum Tg and anti-Tg antibody, in contrast to extremely increased needle-washout Tg, who had undergone a total thyroidectomy and radioiodine ablation as initial therapies for PTC. Several factors causing such discrepancy between needlewashout Tg and serum Tg can be suggested including site of recurrence, volume of tumor, interference by some kind of plasma antibodies other than anti-Tg antibody, and any conformational defect of Tg protein. Among them, the most convincing explanation is that any conformational defect of Tg may lead to impaired secretion of Tg to blood. We suggest that more studies are needed to find the cause for potential mechanisms involved in PTC recurrences without increased serum Tg.

Hospitalized Cases of Adolescent and Adult H1N1 Influenza in a University Hospital in Korea, September 2009-January 2010

Yoon, So Yoon,Ryu, Yon Ju,Kang, Hye Won,Baek, Doo Hyun,Kim, Soo Hyun,Choi, Min Young,Park, Hye Sung,Lee, Jin Hwa,Chun, Eun Mi,Chang, Jung Hyun,Cho, Young Joo,Jun, Yoon Hee,Shim, Sung Shine,Lee, Mi Ae 이화여자대학교 의과학연구소 2010 EMJ (Ewha medical journal) Vol.33 No.2

연구배경:2009년 4월 새로운 인플루엔자 A(H1N1) 바이러스에 의한 감염은 전세계적으로 대유행이 시작되었다. 본 연구에서는 대한민국의 한 대학병원에서 발생한 H1N1 인플루엔자 감염환자 중에서 청소년과 성인 입원 환자를 대상으로 임상적 특성과 예후에 대하여 2009년 9월부터 2010년 1월까지 조사하여 알아보고자 하였다. 방 법:대유행 H1N1 인플루엔자로 확진된 13세 이상의 환자의 의무기록을 후향적으로 분석하였으며 대유행 H1N1 인플루엔자는 real-time reverse transcriptase-polymerase chain reaction 시행하여 확진하였다. 결 과:43명의 대유행 인플루엔자 입원 환자 중에서 7명(16%)은 중환자실 치료를 받았으며 이중 1명(2%)은 사망하였다. 평균 연령은 45세였고 기저질환으로 천식, 당뇨, 허혈성 심장질환, 기관지 확장증, 암의 순서로 많은 빈도수를 보였다. 임상증상으로 발열이 가장 주된 증상이었으며 그 외에 기침, 호흡곤란, 콧물, 근육통 또는 관절통, 인후통을 호소하였다. 입원 시 42명 중 25명의 환자에서 흉부 방사선 검사 결과 폐렴을 동반하였고 만성호흡기 질환의 악화를 보인 경우가 11명의 환자에서 관찰 되었다. 또한 23명의 Fish환자에서 산소공급이 필요하였으며 이중 2명은 급성 호흡부전으로 인하여 기계 환기가 필요하였다. 중환자실 입원을 요한 7명의 환자들은 모두 기저질환을 가지고 있었으며 이중 5명은 천식, 3명은 허혈성 심장 질환이 있었고 임신 상태와 당뇨가 각각 1명으로 나타났다. 확진된 모든 환자들은 증상 발현으로부터 평균 2일 내에 항바이러스제를 처방 받았다. 결 론:천식은 입원치료를 요하는 대유행 인플루엔자 감염환자에서 가장 흔하게 동반된 내과적 질환이었으며 특히 허혈성 심장질환 동반하는 환자의 경우 중환자실 입원을 필요로 함을 알 수 있으며 연구 결과 대부분의 환자에서 항바이러스제 치료에 효과적인 것으로 나타났다.