Methodology of Ascertainment in Medical Malpractice in Living Persons

In recent decades, increasing significance has been placed on medical responsibility and liability. Progress in modern medicine has raised expectations that any health problem can be treated by specialists in any field of medicine. Nevertheless, depending on the circumstances and complications surrounding each particular case, a suspicion of medical malpractice can arise if the outcome is not as expected. The role played by legal medical experts has taken on increasing importance in judicial investigations. It is against this background that the first “Consensus Guidelines Document” dedicated to the evaluation process in cases of suspected medical malpractice was developed by the ECLM working group on medical malpractice in 2012. Once the qualification of the expert has been established as a prerequisite for the procedure, the methods of ascertainment can be determined. These include collecting all clinical data from the admission authorization to reports on post-surgical treatment and release from hospital. An analysis of the clinical documents may reveal a necessity to contact specialists of other fields to ensure a better definition of the case in question. A subsequent clinical examination is required to establish the clinical condition of the patient. Furthermore, the relationship between the current situation and previous medical actions must be verified. Other diagnostic procedures may be performed to ascertain the possibility of medical malpractice as a possible cause of impaired health. A clinical synthesis should summarize the main, central facts. The final evaluation begins with a comparison of data, followed by the identification of pathological features, damage or incapacities that constitute either temporary or permanent impairment, and the reconstruction of pathophysiological pathways. This evaluation should be based on scientific sources such as guidelines, consensus documents and established operational procedures. It may then be possible to determine real error, pseudo-error, conscious error or non-observance of required rules. This may also comprise a discussion of the direct relationship between error and damage, including the degree of probability of the relationship. All of these steps are described in detail in the ECLM consensus document. This can be seen as an example of harmonization of juridical-legislative medical malpractice procedures in European states.