Category Archives: approfondimenti

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Claims to surgical error

Surgical error gives rise to a specific case where the responsibility is on the performing physician With this particular case of medical malpractice, responsibility for medical surgical error is applied when the operation, though not on purpose, does harm to the physical well being of the patient.
For the existence of liability it is necessary, therefore, that there is a an injury which can manifest itself as personal injury or the death of the patient – a case for culpable conduct by the doctor and a causal link between these two elements. For culpable behaviour, any behaviour by the surgeon which can be considered to be in breach of his or her duty of care, ie any conduct which is based on negligence, carelessness and inexperience veering away from the standard required for the exercise of the art of the medical profession.
The burden of proving the presence of an injury, of culpable behaviour and the causal link will be up to the patient, who will for this purpose need the advice of an expert, advice from another professional and a legal doctor.

Case studies in the field of surgical error is a particularly rich and diverse subset of medical malpractice. In our country the number of cases exceeds 300,000 a year, and more than 10% of those are concentrated in the area of ​​general surgery, to which more specific areas, such as cosmetic surgery have been added.
There are many negative consequences to surgery mishaps the most serious of which is of course the death of the patient during the course of the operation or during the postoperative hospital stay. But many, unfortunately take the form of disabilities, inflicted by accidental damage to nerves or blood vessels during surgery, rupturing of implants or teeth during the intubation of the patient, there are cases of sutures poorly executed or removed prematurely. There are also many cases of forceps, gauze pads tragically forgotten in the wound.
Inadequate assistance during the post operative phase will also be attributable to the same category of surgical error. The inadequacy or lack of careful anticoagulant therapy, for example, can cause severe thrombosis.
Equally remarkable is the variety of cases in cosmetic surgery, a field in which all the typical dangers of surgery present are joined by the specific risks of an undesired, and could even be disturbing, final aesthetic effect to the patients appearance.

The most recent case law tends to consider the responsibility of the physician in an instance of surgical error as a contractual liability. From this point of view it is up to the patient to prove the existence of such a contract, the injury caused and the causal link between that and the conduct of the surgeon. However, the honour of proving that the operation was conducted in manner befitting their code of practice falls to the latter party.
To be able to take legal action, pursuing surgical error damages, it would be advisable to collect all health care documentation necessary, keeping copies of reports, medical records and any kind of prescription obtained, which will be examined by counsel and by the expert party.


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Damage prostheses defective or infected

Damages prosthesis defective or infected – With the term prosthesis we mean all artificial devices which have the purpose of replacing any missing parts of the human body, or used to integrate damaged parts.
The production of prostheses can be either in series, as in the case of heart valves, or customized made in the case of orthopaedic prostheses and dental implants.
These elements are foreign to the body, which is why they result in rejection after the implantation has taken place, as well as cause infections and/ or more serious injury to the patient.
The law is still not very clear in the case of a claim by a patient who alleges to have suffered damage as a result of the application of a prosthesis.
It is the patient must prove that the damage suffered is as a result of the implementation of a prosthesis, and this must be supported by legal and forensic expertise to determine whether a case for damages can be applied to your hearing aid manufacturer or if the product liability can also be attributed to the doctor who has performed the procedure, or the health facility which facilitated the intervention.

The negative consequences for a patients health as a result of an intervention of this type, and for poor health care in general, is not quantifiable since health, taken to be understood as well being, it is not quantifiable. This is why it is more correct to speak in terms of a compensation equivalent irreparable in totality.
Individuals who have suffered harm due to defective prostheses orincorrectly installed devices, can and must rely on a firm which specialises in medical malpractice, which is supported by medical examiners who are themselves also specialized in and will versed in the practice of compensation.

As already outlined, the law in this area is not entirely comprehensive and use is made of experiences from the legal systems of other countries which have faced similar case problems, such as the United States, England and France.
High-profile cases exist where by some prosthesis have been proved to be harmful, these cases have been retold and amplified by the press to such a degree that they have become a public issue.
One of the most famous cases, which emerged in 2010, involves tn artificial hip joint, produced by the giant De Puy – Johnson & Johnson, which was deemed dangerous to the health of those who had had the prosthesis implanted. It was the same technicians from the US who warned of the dangers of blood poisoning known as metallosis. In essence it is the abnormal rubbing of metal parts in contact with eachother which results in the consequent release of harmful substances into the blood.

Despite the fact that these implants were considered to be the best on the market, the producers were inundated with claims by patients who had found abnormal blood values, and who were forced to undergo another surgery to remove the suspect implants and in so doing under going yet another ordeal of suffering.
Even more clamours is the case of the famous breast implants PIP, made with a gel which did not comply with safety standards, it was at risk of breaking and this in turn causes the risk of inflammation of the axillary lymph nodes, and even of breast cancer. In Europe, 400,000 women have had these implants put in. The anger and terror of these women took down Poly Implant Prothèse, leading to the arrest of the founder and the director of the company.


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Compensation for orthopaedic injury

Orthopaedic damages – The red card for serious injury caused by medical errors goes to orthopaedics, which, along with traumatology has an average of 16.5% of   the 90 daily cases.
Very often the cause can be found to be the   frantic work schedules, and the the most serious risk for the patient is often due to the “careless mistake” on the part of the doctor who, once the main injury has been taken care of   neglects to notice secondary injuries.
In the operating room surgical steps are often performed steps regardless of their correct sequence and the equipment can be insufficiently monitored, thus increasing a septic risk . In fact, as to reduce or eliminate the risk of infections, surgery operating rooms should be located in a separate block. The osseous system, not being vascularized, has almost nonexistent defenses against viruses and bacteria and, therefore, the observance of specific protocols for both the preparation of the patient and for those in the operating room, should be strictly observed. Each year there are 28,000 cases of bone infections, many of which are attributable to medical errors and misdiagnosis, especially in the South.

Orthopedic injury

There are many, various and by no means negligible, mistakes made on the ward too. A patient who has little or no possibility of movement often turns into a bedridden chronic case, due to the continuous pressure asserted on the body by the bed, the patient falls victim to the dangers of decubitus ulcers and the necessary assistance from the staff in cases where the patient needs to be manually handled several times throughout the day. This too is is frequently limited due to overcrowding of the wards.
Risk of post operative infection even for patients who have dealt with an operation following an trauma, and who follow the assisted period of convalescence with an external fixator who acts as a pivotal link between the external environment and the external one. A patient therefore who is not subject to the appropriate checks can then easily fall victim to sepsis.
It sounds like a joke but, unfortunately it’s a harsh reality, among the surgical errors in orthopedics we also have cases of incorrect amputation!
A separate chapter is taken up with spinal surgery where mishandling of the patient by staff can pose considerable risks to the patients health. The timing of meals, if not duly monitored, can turn into a tragedy, since the patient lying would have obvious difficulty swallowing and risks aspiration pneumonia caused by food entering the bronchial tubes.
Finally, far too often, the risk of thrombosis due to immobility could always be easily averted with continuous monitoring which would quickly identify early symptoms. Above all heparin should always be prescribed to patients with a plaster cast or rigid bandages and restrictive bandages, as it would easily protected then against this risk.
However, if it is true that a number of errors are attributable to the doctors and nurses, it should also be emphasized that work in crowded conditions and in poorly organized and chaotic departments increases exponentially the possibility for careless mistakes related to the exchange of medical records or prescriptions which can lead to the administration of the wrong drugs, at the wrong times and, above all, to the wrong patients.


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Compensation for oncological injury

Oncological injury – We are talking about 90 deaths per day attributable to medical errors and oncology, among other specialist departments guilty of harming their patients, they are responsible for13% of these errors, preceded only by the orthopaedics department.
This is according to the view of experts who have promised to organise a conference in an effort to put an end to the high percentage of errors occurring in the operating room (32%), closely followed by wards (28%), of those (22) in emergency and (18) in clinics.

Compensation for oncological injury
There are less detailed figures to be found for the most common errors in oncology (oncological injuries), even if there are still a high number of cases caused by mixing up drugs with similar names to one another, for example paraplatino, cisplatin and oxaliplatin.
Mixing up medical records, or charts written in an incomprehensible manner which leads to errors in diagnosis and treatment are often attributable to a chaotic work environment and poor organization, as well as confusion during prescribed examination, radiation treatments poorly conducted which cause burns, excessive use of X-rays which is often unnecessary, an incorrect dosage of anesthesia or a poor attention to informed consent procedures.
Prescription which go beyond their therapeutic indications or deficiency in the assessment of the states of patients can cause serious problems, especially during chemotherapy where data on vital signs, allergies and toxicity must always be taken with extreme precision and be constantly monitored.
The media have complained for example about the case of a cancer patient of advanced years who was urged to sign an informed consent form for a course of experimental chemotherapy unsuited to their physical condition and which immediately caused severe bleeding complications and the subsequent death of patient.
Also with regard to pharmaceuticals, which in the oncology department seems to cause more victims than road accidents, significant harm is attributable to the lack of compliance with the administration durations and incorrect storage, not protecting photosensitive drugs or temperature sensitive drugs from the elements .
Delaying the commencement of therapy can also result in misdiagnosis or a delay in the evaluation and treatment of   serious illness can cause grave problems.
Practically 50% of oncology errors come in the prescriptive stages due to a lack of knowledge of the patients medical history or non-existent histories and the non-prescription of an appropriate therapy. Transcription errors during therapy add up to around 14.5%. In this regard, and only referring to errors in the field of oncology, the Health authority recently issued a document with technical indications which puts the responsibility for the preparation of cancer drugs , even in cases of emergency, on the pharmacist alone and calls for computerization of the prescription processes.


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Injury due to osteomyelitis malpractice

Claim: damages due to osteomyelitis medical malpractice – Osteomyelitis is an osteoarticular infection which my have various degrees of severity and, is generally, as a result of a severe fracture, the transmission of blood or a due to medical error.

Injury due to osteomyelitis malpractice

Very often, and especially in recent years, this disease was caused by incompetence or by negligence on the part of a medical practitioner. The recent and numerous cases of osteomyelitis due to medical error is a genuine testimony to this, which has given way to a series of complaints and damage repayments designed to compensate patients who, in spite of their injuries, have had to overcome serious and persistent illness, depending obviously on the severity of their individual situations.

The infection in the bones and joints can cause some very dangerous conditions, and also, physical and injury and damage to moral, the patient may require professionals specializing in medical malpractice, and submit a claim which would usually be accepted after a thorough appraisal by a legal doctor (the terms lapse once a medical certificate is over 10 years old).

Unfortunately, there are multiple medical malpractice cases, which have also been reported by the media and in newspapers, where medical malpractice has been shown to be evident after a surgical intervention, were patients themselves have found forgotten objects such as bandages or pieces of surgical instruments used in the operating room still inside them.

The infective process of osteomyelitis affects both the bone that the bone marrow and involves the production of pus. The disease can be acute or chronic and is usually localized by laboratory examinations such as MRI, X-rays and bone scans.
The most common signs of osteomyelitis are sharp pains and decreased mobility of the hand, swelling, fever, redness, appearance of fistulas, tuberculosis and syphilis.

Osteomyelitis is often only diagnosed after a lengthy period. Depending on its severity and on the area affected the best therapy is based on a broad-spectrum of antibiotics combined with analgesic drugs which can reduce the perception of pain.
Once identified with certainty it is best to opt for a targeted treatment of antibiotic against the bacterial species which causes the infection, this should significantly shorten recovery time.

Severe cases of osteomyelitis, however, necessitate treated with surgery to remove the infected area. In cases where a cure or surgical removal is not performed in a timely manner a shortening of the bone may occur and deformities may appear.


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Compensation for damages as a result of facial nerve paralysis

Facial nerve paralysis damages – Facial nerve paralysis is a condition which affects one side of the face and more than 75% of patients make a complete recovery. The most frequent cause to facial paralysis is due to the presence of Herpes Simplex virus in patients, this is the same virus which causes extremely annoying cold sores on the face. It is a paralysis linked to an inflammatory process and, is usually only temporary.

Other causes which may result in the development of facial paralysis are congenital causes, tumours, or trauma. Finally there are iatrogenic causes, that is, causes arising as a direct result of surgery on, the middle or the inner ear, the parotid or the base of the skull.

Paralysis due to iatrogenic causes are particularly widespread in cases where the surgery is complex and extensively involving the facial nerve, resulting in functional, aesthetic and, consequently, also psychological problems. The muscles of the face are constantly altered and this involves a number of issues related to the formulation of emotions and facial expressions. Problems of a functional nature, especially affect the eye, which often can’t be adequately lubricated, as the eyelids gradually lose their firmness. Furthermore, the patient has difficulty with speech, related to the loss of tissue tone in the cheeks and difficulty breathing due to the collapse of the medial nasal passage.

Iatrogenic causes directly linked to the appearance of facial paralysis are mainly due to cutting injuries or direct damage, to the mechanisms of tension and pressure, surgery complications such as bruising or hematoma, and poor supervision during anaesthesia. We are therefore dealing with, perioperative injury, since the onset of the condition may occur before, during or after a visit to the operating room and may be the result of an error by one of the attending: paramedics, anaesthesiologists, surgeons, etc. …

Since this condition isn’t predictable, it is difficult to estimate, even approximately, the incidences of this phenomenon. The overall risk of peripheral nerve tracts damage in patients subject to surgery is around 0.1 or 0.2%. Some of the nerves damaged in iatrogenic injuries are: the superficial radial, the spinal accessory nerve, the common peroneal nerve and the median, these split into a series of nerve branches equally involved although lesser known.

The EMG is the diagnostic tool most suited to highlighting injuries of this type and, in cooperation with conduction studies, it is possible to assess in a rather precise manner the nature of the damage, highlighting the presence of the phenomena of re-innervation of muscle, well in advance of the neurological examination on an apparent muscle contraction .

Generally facial paralysis as a result of iatrogenic factors are diagnosed promptly, allowing for immediate action, and therefore a higher percentage of success. Early intervention avoids the need for additional surgery delays and limits the amount of time the affected muscles are denervated, exponentially increasing the chances of recovery, which would otherwise be rather slim. Sometimes, however, these findings only come about after a considerable delay, beyond the optimum time for an intervention.


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