RESUMO
The authors studied 175 severe medical complaints which ended in Arbitration veredicts or expert opinions, handled by and Alternative Disputes Resolution Institution (CONAMED) between June 1996 and December 1999. The study was focused on 25 cases with complete medical records. Belonged to Gynecology area, 8 cases (32%), and 17 cases (68%) to Obstetrics. The physicians involved were ob/gyn specialists in 14 cases. Health public institutions were involved in 14 cases (56%), and private practitioners, 11 cases (44%). The main sources of unsatisfaction were injuries or technical failures during surgical procedures in 24% (6 cases) or diagnostic failures in 6 cases (24%). The outcomes were: deaths 8 (32%), amputation or another sequelae in three cases (12%), and fetus or newborns deaths or injuries in two cases (6%). The claimers asked for monetary benefits in 15 cases (60%), disclosure of medical responsibility in 8 cases (24%), and to probe murder or injuries in 3 cases (12%). The CONAMED conclusions were medical malpractice in 14 cases (56%), administrative failures in 14 cases (56%), and patient responsibility in 4 cases (16%).
Assuntos
Ginecologia , Imperícia , Obstetrícia , Adulto , Feminino , Humanos , Responsabilidade Legal , México , Pessoa de Meia-IdadeRESUMO
The author studied 140 complex medical complaints handled by an Alternative Disputes Resolution Institution (CONAMED), between June 1996 and December 1999. There were 79 females and 61 males, cases originated in public hospitals 93 (66.4%) and private hospitals or practitioners 47 (33.6%). Several cases were treated sequentially in both types of institutions. The medical specialties involved were in frequency order: Neurosurgery, General Surgery, Gyn-Ob, Anesthesiology, Traumatology and Orthopedics, Oncology, Emergency, and 22 others. The causes of complaints were: Surgical treatment, Medical treatment, Diagnosis, Anesthesia, and mixed causes. There were 59 deaths, 43 anatomic or functional loses, disability or sequelae; and 34 recoveries. CONAMED delivered 27 arbitration verdicts, 94 expert opinions asked by prosecutors or human rights organizations, and 1 technical advice to medical authorities. Some resolutions included more than one case. More than half of physicians involved were found not guilty of malpractice. Even though the main CONAMED purpose is to improve the quality of Medical Care acting as The Health Ombudsman, its performance may be on behalf of medical practitioners.
Assuntos
Imperícia , Negociação , MéxicoAssuntos
Filosofia Médica , Política , México , Programas Nacionais de Saúde/tendências , SociologiaRESUMO
UNLABELLED: The object of this research was investigating the existence of programs, as well as the patient's and healthy worker's opinions, concerning the quality of Medical Attention in the representative medical institutions in Mexico City (Distrito Federal). Eighteen directors of medical institutions were interviewed; as well as fifty university graduates, one hundred out patients from health centers and three hundred patients treated at general hospitals. A poll was applied to two hundred and fifty physicians and two hundred and fifty nurses from health centers and general hospitals. RESULTS: The eighteen institutions studied had permanent programs for Supervision and assemend. Other activities were also detected: sixteen had Technical Committees, five had a Department for Complaints, three had Quality Circles, two had programs for Evaluation of Educational Needs, two had Patients Polls, two had Worker's Polls, one had a Shadow Study and two had Quality Control Programs. The 86% of university graduates belonged to the social security system. Among these, 36% attended public services, 36% of them did this selectively and 28% did not use social security. 30% felt that public medical services were good, 14% less than good and 56% bad. 36% felt that public services were better than private ones, 36% said both were equally good and 28% judged the public system as worse than the private ones. The main deficiency reported was a lack of personal warmth. The patients from both the general practice and hospitalization graded the opportunity, warmth and process of medical attention as variables with figures of 80% or more. The frequency of diverse "complications" was 66% in out patients and 36% in the hospitalized ones. The physicians and nurses graded the infrastructure, teaching, laboral motivation and satisfaction, and continuity of services as variables with percentages of 50% to 60%; whereas the variables of warmth, control and supervision with values of 60% to 80%. Hospital nurses were less satisfied. These results show patients to have an acceptable satisfaction whereas the health personnel was unmotivated. Practical actions are suggested to improve the quality of medical attention.