A theoretical justification and a new approach to the important problems of modern forensic medicine, including the establishment of peculiarities, causes and consequences of inappropriate medical care, were presented in the dissertation. Successful scientific results of the research were achieved for the first time in Ukraine on the basis of a comprehensive study of the data of forensic medical examinations in cases of medical malpractice, as well as on the basis of analysis of court decisions in cases of medical malpractice litigation.
It has been established that various disadvantages in the provision of medical care were confirmed by the forensic medical expert commissions in the documentation of 72,0 % of the criminal cases.
Such mistakes arise during the performance of diagnostic and therapeutic medical procedures, in cases of emergency medical care, at the hospital stage, at the various departments of hospitals.
Generally speaking, unskilful medical care due to its qualitative characteristics is inadequate and untimely in terms of delivery and is accompanied by severe consequences for patients (97,0 % of alleged medical malpractice cases). Majority of the disadvantages of medical care occur due to various objective reasons, but every one of five is caused by professional negligence of health care professionals.
Different defects of medical care in anaesthesiology, obstetrics, surgery, internal medicine in nursing are summarized, systematized and analyzed for the first time in Ukraine. It has been established that in addition to the disadvantages of diagnosis and treatment, the medical practitioners of the above-mentioned professional groups also assume institutional and deontological errors and cause a significant number of mistakes in medical records.
Almost half of malpractice claims against anaesthesiologists, obstetricians, gynaecologists and internists reveal various breaches of standards adopted in medical care. The causal relationship between the actions or inactivity of the medical practitioner and the negative consequences was confirmed by expert commissions among half of the medical malpractice cases alleged to surgeons and internists.
The method of decision tree construction, as one of the components of the technology of intelligent processing of the multivariate database (Data Mining), was used for anaesthetists and showed that the disadvantages in their professional activity were primarily caused by objective reasons. The prognostic criteria for the risk of defects in the practical activity of anaesthetists are rapid duration of pathological process and associated professional activity together with the internists. Provided treatment was mainly substandard in such cases and caused harm, injury or death to a patient.
Poor concordance between the polyclinic and the stationary levels of medical care is the prognostic criterion of adverse events in obstetrics.
Improper medical care in internal medicine is characterized by the following forensic medical expert peculiarities: the absence of a direct causal relations between the actions (inactivity) of internists and the harmful consequences (Р = 1,0), the absence of improper performance of procedures (Р = 0,93), a negative influence of such objective factor as comorbidity (Р = 0,91).
Mathematical calculation of information entropy revealed significantly strong correlation between dereliction of duties by surgeons and traumatologists, when their poor concordance with primary care practitioners, with the probability (P = 0,80), initiated various disadvantages in diagnostics and treatment that resulted in patients’ death or disability.
Dereliction of duties by nurses usually occurred at a pre-hospital level of care, in policlinics (attribute usage – 96,55 %) or inside ambulances (attribute usage – 62,93 %). Different institutional errors in functions of emergency departments were detected by expert commissions as serious preconditioned reason in cases of medical malpractice claims against nurses (the probability of harmful consequences is Р = 0,80).
The determination, summarizing and analysis of forensic features of unintended events in medical practice allowed us to formulate scientifically substantiated recommendations for eliminating the causes and conditions of inadequate medical care. Accepted and summarized data promoted the identification of risk factors for better prophylactics to avoid medical errors.
A scale of the assessment of the patient’s objective status (SAPOS) and an order of injury’ description allowed to optimize an expert assessment of the victim’s status in cases of inappropriate medical care.
Specific ways to optimize forensic medical expertise and to improve scientific substantiation of expert conclusions in cases of medical malpractice litigation are proposed in the research as well.
