Submitted by Leonardo Simões Agapito (leoagapito@gmail.com) on 2018-06-18T14:19:15Z No. of bitstreams: 1 impressão.final.pdf: 690488 bytes, checksum: 2dd44cf2aedc15d4a1498228fd8dde23 (MD5) / Approved for entry into archive by Jacqueline de Almeida null (jacquie@franca.unesp.br) on 2018-06-18T18:53:18Z (GMT) No. of bitstreams: 1 Agapito_LS_me_fran.pdf: 690488 bytes, checksum: 2dd44cf2aedc15d4a1498228fd8dde23 (MD5) / Made available in DSpace on 2018-06-18T18:53:18Z (GMT). No. of bitstreams: 1 Agapito_LS_me_fran.pdf: 690488 bytes, checksum: 2dd44cf2aedc15d4a1498228fd8dde23 (MD5) Previous issue date: 2018-05-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O presente trabalho tem como objetivo analisar a responsabilidade penal decorrente da omissão médica, particularmente por instrumentos dogmáticos e, por estes, obter maior segurança jurídica para médicos, pacientes e profissionais. Partindo dos métodos indutivo e sistemático, o trabalho analisa os critérios postos pelo código penal brasileiro para a omissão penalmente relevante – dever agir, poder agir e a especial posição de garante – relacionando com elementos próprios da imputação penal – injusto, culpabilidade e autoria – e externos, que configuram o próprio ambiente em que opera a tutela – deveres administrativos, gestão de risco e semiótica. Para tanto, utiliza-se como referencial teórico o pensamento funcional normativista, com especial atenção aos estudos de Günther Jakobs. Ao final, é possível, pelo método indutivo, depreender-se a própria opção político criminal brasileira, bem como, pelo método sistemático, demonstrar os caminhos necessários não apenas para o aprofundamento da questão, mas para a própria intervenção penal nos casos em que for chamado a atuar. / The presente study persuits to analise criminal responsability for medical default, particularly by dogmatic instruments and, by them, obtain more legal security for health professionals, patients and legal professionals. By indutiv and sistematic methods, the current study analyse brasilian penal code criteria for criminal relevant default – duty, permission and special position of garantor – conecting this with criminal responsability criteria – wrongful, culpability and authorship – and external elements that set up medical context – administrative duties, risk management and semiotic. Thereunto, the study uses as theoritc reference a normativist perspective, specialy Günther Jakobs’s studies. At the end, it’s possible, by indutiv analyses, understand the criminal policy option in Brazil, as well as, by sistemic analyses, demonstrate necessary ways for further studies, but also to righteous criminal justice intervention.

This paper utilizes data on physician malpractice insurance premiums and state tort law to analyze how physicians in various medical specialties are differentially affected by caps on noneconomic damages. As higher premiums put pressure on legislators to enact damage caps, I instrument caps on noneconomic damages with enactment of tort reform measures that do not affect malpractice premiums to uncover the effect of caps on noneconomic damages on such premiums. I find evidence to support that, in terms of dollars saved, physicians in high risk specialties benefit more from noneconomic damage caps than physicians in low risk specialties. However, in percentage terms, I find that physicians in all specialties essentially benefit equally from caps on noneconomic damages.

The present thesis investigates the possible effects of limiting the compensations victims can obtain in medical malpractice cases through schedules of noneconomic damages. While economic damages are rather simple to calculate, problems arise with respect to the assessment of noneconomic damages. To reduce both the variability in the compensations granted to victims and the perception of a high level of arbitrariness in determining noneconomic losses, many countries have adopted different types of ceilings to limit the nonmonetary component of malpractice compensations. While flat and tiered caps have been widely studied in the related literature, the effects of schedules are still debated due to the scarce available evidence. Using Italy as a case study, I investigated the likely impact of schedules on noneconomic damages on a number of key outcomes showing that this policy can affect patients´ behavior and the filing of malpractice claims. Schedules are associated to a lower number of claims as well as of claims not decided on the merit. These results seem to be due to a drop in the number of frivolous claims. In addition, under schedules, average compensation and trial duration results to be higher. This is consistent with the expectation that under schedules there is a higher frequency of claims involving serious injuries. Hence, results could be further explored and used also in Czech Republic policy.

Public opinion in recent years has been seemingly manipulated by superfluous stories, bad press, and negative commentaries regarding the perceived "Medical Malpractice Crisis." It has initiated a political attack on Florida's tort system which has resulted in making valid medical malpractice claims even more so difficult for victimized plaintiffs to pursue. After months of diligent research, and with the loyal aid of my university advisors and the dedicated law librarians I've had the honor to work with, I have thoroughly analyzed Florida's past and present medical malpractice tort reforms and governing procedural laws; in addition to arguing, by virtue of this thesis, why these reforms were truly enacted, how traditional tort reforms have egregiously compromised public interests, why Florida's future--with regard to legislative change--is grim, and how new, innovative tort reforms--such as those established overseas--could genuinely benefit Floridians. The premise of the conclusion reached in this research is partially iterated in a quote by the critically acclaimed "Insurance Law Expert," Tom Baker: "...the medical malpractice myth. Built on a foundation of urban legend mixed with the occasional true story, supported by selective references to academic studies, and repeated so often that even the mythmakers forget the exaggeration, half truth, and outright misinformation employed in the service of their greater good, the medical malpractice myth has filled doctors, patients, legislators, and voters with the kind of fear that short circuits critical thinking." --Baker, T. (2005). The medical malpractice myth. Chicago: University of Chicago Press.

The Florida Birth-Related Neurological Injury Compensation Act has been the subject of intense scrutiny regarding its efficacy, constitutionality, and ethical implications, specifically as it relates to the widespread practice of patients agreeing to its terms prior to providing them with prenatal care. This research investigates the potential unconstitutionality of the Neurological Injury Compensation Association (NICA) as an exclusive remedy, questioning the legality of the bill under the Fourteenth Amendment due to potential violations of patient rights to litigation. Through a comprehensive analysis of relevant case and statutory laws as well as secondary sources, this paper addresses the ethical and legal dilemmas posed by NICA's imposition on patients and providers alike. Additionally, it addresses the widely debated relevance and necessity of NICA, given the ineffectiveness in achieving intended objectives and the mounting backlog of claims, raising fundamental questions about governmental delegation of power to non-governmental entities, and the erosion of patients' rights to seek recourse for medical malpractice. This research also examines the issue of informed consent within NICA, highlighting that many expectant mothers are pressured into accepting the program without a clear understanding of its ramifications. Healthcare providers often fail to adequately inform patients about their legal rights and the restrictions that NICA imposes, which fundamentally undermines ethical medical practice and patient autonomy. This lack of transparency raises questions about whether healthcare systems prioritize administrative efficiency and legal protections for providers over the welfare of patients. Furthermore, the study investigates how NICA disproportionately affects vulnerable populations, who may lack the resources or legal knowledge necessary to effectively navigate the system. This paper contends that the structural flaws in NICA have implications that extend beyond its exclusivity, impacting overall healthcare accountability. By eliminating the possibility of pursuing traditional malpractice claims, NICA diminishes the deterrent against negligent medical practices, allowing providers to evade full responsibility for their actions. The research proposes reforms that would transform NICA from an exclusive remedy into an optional alternative, thereby granting families the choice to pursue the legal avenues that best meet their needs while ensuring accountability in healthcare. These suggested changes aim to align the program with constitutional standards, protect patient rights, and establish a more equitable and effective system for addressing birth-related injuries.

Cette étude se référera au caractère contractuel de la responsabilité civile médicale en droit chilien comparé avec le droit français. Je commencerai donc par une analyse historique de la privatisation de la santé et du phénomène de la contractualisation de l’activité sanitaire au Chili. Le principal problème a été que les demandeurs ont échappé au caractère contractuel de la responsabilité et ce principalement à cause du problème du cumul des responsabilités. Ce problème présent en droit chilien peut être résolu à travers une étude approfondie du contrat médical, de ses conditions d'existence et de validité, de ses principales caractéristiques et des différentes théories qui ont tenté d'expliquer sa nature juridique. Nous analyserons également les cas où la relation médicale initiale n'a pas pour source le contrat médical, bien qu’il ait de toute façon été considéré par la jurisprudence et la doctrine comme ayant un caractère contractuel. Nous étudierons dans le même temps les différentes théories qui ont eu comme finalité de contractualiser la responsabilité des centres hospitaliers, tant publics que privés, par le fait de leurs salariés, pour ainsi éviter que la responsabilité de ces centres devienne effective conformément aux normes de la responsabilité extracontractuelle. / The contractual nature of the medical liability had no the same interest in chilean law that french law. However, the increasing privatization of health and the phenomenon of contracting activity for Chilean takes us a deal to make a further study to determinate the contours from the French law. The main problem was that the applicants have escaped the contractual liability and mainly because of the problem of overlapping responsibilities. This problem present in chilean law can be resolved through a thorough study of the medical contract, the conditions of its existence and validity of its main characteristics and different theories have attempted to explain its legal nature and it provide a legal regime that atypical contracts. On the other hand we have to deal with all cases where the initial medical relationship does not source the medical contract, although it has been considered anyway by courts and commentators as having a contractual, and why try to analyze the different theories that have had the purpose of contractualize responsibility for private and public hospitals,, by the fact of their employees, to avoid the responsibility of these centers become effective in accordance with standards of tort.

Obligation to compensate for personal injury in connection with provision of health care This dissertation is focused on the obligation to compensate for personal injury in connection with the provision of health care. The aim of the dissertation is to analyse relevant general elements of the obligation to compensate for personal injury as well as relevant special elements of such obligation. The dissertation surveys the interpretation of conceptual changes related to the recodification of Czech private law in the area of tort law in connection with the provision of health care. Legal basis of the doctor-patient relationship will also be analysed because such analysis is crucial for determination which elements of the obligation to compensate for personal injury will regularly be applied in this field. Therefore, the first chapter is devoted to the legal nature of the doctor-patient relationship. The second chapter deals with the obligation to compensate for personal injury caused by the provision of health care, i.e. with the definition and analysis of relevant elements of such obligation in this field. The third chapter is focused on the wrongfulness as one of the significant elements of the obligation to compensate for personal injury; substantial attention of this chapter is aimed at the...

It has been estimated that in the United States, between 44,000 to 98,000 patients succumb to medical errors each year. Due to a shortage of graduates of domestic medical schools, many graduates of foreign medical schools are practicing in the United States. The medical education received in foreign medical schools may not be equivalent to the medical education received in domestic medical schools, which are schools located in the United States, Puerto Rico and Canada. Differences due to the educational backgrounds of the foreign-schooled physicians may contribute to an increase in medical board disciplining. Furthermore, graduates of medical schools where the instruction is not conducted in the English language may receive increased medical board disciplining when compared to the graduates of medical schools where English is the language of instruction. Finally, domestic medical schools that are ranked low according to The Gourman Report, 8th Edition may provide a substandard medical education, causing their graduates to have increased rates of discipline when compared to peers who have graduated from higher ranked medical schools. This study examines the effects of undergoing foreign medical training as opposed to domestic medical training and receiving medical school instruction in the English language or another language, on the frequency and severity of disciplinary action taken by the Florida Board of Medicine against medical doctors licensed in Florida since 1952 (N = 39,559). Also examined are the effects of attending domestic medical schools that are ranked lower than other domestic medical schools on the frequency and severity of disciplinary action taken by the Florida Board of Medicine against medical doctors licensed in Florida since 1952 (n = 25,479). Control variables used in this logistic regression analysis include whether the medical doctor is specialty board certified or not, the specialty practiced and the medical doctor's race and gender. Archival data from the Florida Department of Health were used for this study. This study found that the graduates of medical schools where the instruction is not in the English language are more likely to receive discipline and are more likely to receive more severe types of discipline than graduates of medical schools where the instruction is in the English language. It was also found that medical doctors who are ABMS certified, are practicing either a surgical specialty, obstetrics, gynecology, psychiatry, emergency medicine, family medicine or diagnostic radiology, or are male have increased odds of being disciplined by the Florida Board of Medicine.

Introdução: o aumento da cobertura vacinal reduziu a incidência das doenças imunopreveníveis, elevando os casos de Evento Adverso Pós-Vacinação e Erro de imunização. Objetivo: analisar os erros de imunização e a percepção de vacinadores sobre os fatores que contribuem para a sua ocorrência. Método: abordagem mista, desenvolvida em duas fases: primeira, quantitativa, descritiva, documental, retrospectiva, no período de 2003 a 2013. Utilizados dados secundários do Brasil e primários e secundários do Paraná Sistema de Informação de Eventos Adversos Pós-Vacinação e relatório de erros de imunização do Programa de Imunização. A segunda, qualitativa, exploratória, prospectiva, tendo como referencial a Teoria do Erro Humano, realizada com vacinadores da Região Metropolitana de Curitiba que notificaram erro de imunização em 2013. Classificação do erro de imunização: com evento adverso e sem evento adverso. Para o cálculo das taxas de incidência de erro e diagrama de dispersão, foi utilizado o software SPSS versão 23.0 ajustados pelo Modelo de Regressão Linear Simples. Na fase II, os dados foram coletados por meio de entrevistas e observação não participante, analisados segundo Bardin, utilizando o Web Qualitative Data Analysis WebQDA. Resultados: de 2003 a 2013, no Brasil e no Paraná, o abscesso subcutâneo quente foi o erro de imunização com evento adverso mais frequente. Os menores de um ano foram os mais atingidos pelos erros e a BCG teve taxa de incidência mais elevada. A incidência do erro de imunização com evento adverso aumentou ao longo do período, enquanto o sem evento adverso, elevou-se expressivamente em 2012. A análise da tendência no Paraná de 2003 a 2018, revelou crescimento anual, com elevação contínua da incidência, para ambos, mostrando ainda que a elevação dos percentuais e taxas ocorreu nas campanhas de vacinação, introdução de novas vacinas e mudanças no Calendário Nacional de Vacinação. Nas observações das 26 salas de vacinação, identificou-se: refrigerador não exclusivo, falhas na higienização das mãos (78%), não abordagem sobre possíveis contraindicações ou adiamento da vacinação. Foram entrevistados 115 vacinadores, 96% mulheres, 42% entre 30 a 39 anos, 54% com nível médio de escolaridade e 53% formados há cinco anos ou mais. Atuavam na sala de vacinação entre 3 a 11 anos, 71% realizavam atividades concomitantes em outros setores e 76% não tinham outro emprego. A entrevista revelou que 47% dos vacinadores tinham conhecimento de erro de imunização no seu trabalho, 8,7% estiveram envolvidos em erros e 1,7% referiram haver subnotificação. Dos discursos dos vacinadores emergiram três categorias analíticas: fatores humanos (57,3%), institucionais/organizacionais (34%) e ambientais (8,7%). Das categorias empíricas, destacou-se fatores psicológicos (43,2%) e das subcategorias: distração (21,4%) e estresse (20,9%). Conclusões: o erro de imunização é causado pela interação de múltiplos fatores. Mantendo-se os cenários, as incidências de erro de imunização, com ou sem evento adverso, tendem a continuar ascendentes até 2018. Campanhas, novas vacinas e mudanças no calendário de vacinação aumentam o risco de erro de imunização. Na visão dos vacinadores, a ocorrência de erro de imunização está relacionada, principalmente, a fatores psicológicos e gestão de pessoas. A maioria dos erros de imunização é potencialmente prevenível, desde que a sua ocorrência e causas sejam identificadas. / Introduction: the increase in vaccination coverage reduced the incidence of vaccine-preventable diseases, increasing the number of cases of Adverse Events Following Vaccination and Immunization Error. Objective: to analyze the immunization errors and the perception of vaccinators on the factors that contribute to their occurrence. Method: mixed approach, developed in two phases: the first being quantitative, descriptive, documentary, retrospective, in the period from 2003 to 2013. Secondary data from Brazil and primary data from Paraná were used Surveillance System of Adverse Events Following Vaccination and immunization error reports of the Immunization Program. The second, qualitative, exploratory, prospective phase had as reference the Theory of Human Error, performed with vaccinators of the Metropolitan Region of Curitiba who reported immunization errors in 2013. Classification of immunization error: with and without adverse event. For the calculation of the incidence rates of error and dispersion diagram, the SPSS software version 23.0 was used, adjusted through the Simple Linear Regression Model. In phase II, the data were collected through interviews and non-participant observation, analyzed according to Bardin, using the Web Qualitative Data Analysis WebQDA software. Results: from 2003 to 2013, in Brazil and Paraná, warm subcutaneous abscess was the most frequent immunization error with adverse event. Children under one year old were the most affected by the errors and BCG had higher incidence rate. The incidence of immunization error with adverse event increased over the period, while its incidence without adverse event increased significantly in 2012. The analysis of the trend in Paraná from 2003 to 2018 showed annual growth, with continuous increase in incidence, for both, also showing that the increase of the percentages and rates occurred during the vaccination campaigns, introduction of new vaccines and changes in the National Vaccination Calendar. During the observation of the 26 vaccination rooms, the following were identified: non-exclusive cooler, failures in the sanitation of hands (78%), no addressing of the possible contraindications or postponement of vaccination. 115 vaccinators were interviewed, 96% women, 42% between 30 and 39 years of age, 54% with average level of education and 53% graduated for five years or more. They had been working in the vaccination room for 3 to 11 years, 71% performed concomitant activities in other sectors and 76% did not have another job. The interview revealed that 47% of vaccinators were aware of immunization errors in their work, 8.7% were involved in errors and 1.7% declared there being underreporting. The speeches of the vaccinators resulted in three analytical categories: human (57.3%), institutional/organizational (34%) and environmental (8.7%) factors. Those which stood out, of the empirical categories, were the psychological factors (43.2%), and of the subcategories, distraction (21.4%) and stress (20.9%). Immunization error is caused by the interaction between multiple factors. Conclusions: if kept constant, the scenarios and incidence of immunization errors, with or without adverse event, tend to continue increasing up to 2018. Campaigns, new vaccines and changes in the vaccination calendar increase the risk of immunization error. For the vaccinators, the occurrence of immunization error is related mainly to psychological factors and people management. Most immunization errors are potentially preventable, provided their occurrence and causes are identified.

A presente pesquisa tem como objetivo analisar a responsabilidade do médico dentro do contexto doutrinário e jurisprudencial da atualidade e demonstrar, a partir da análise de ações judiciais por alegado erro médico, propostas perante o Poder Judiciário, que os direitos atribuídos ao consumidor pelo Código de Defesa do Consumidor, bem como as prerrogativas de facilitação do acesso ao judiciário atualmente são aplicados pelos profissionais do Direito ao exercício da atividade médica de forma generalizada, ou seja, tanto em relação às sociedades empresárias hospitais, clínicas e planos de saúde, quanto aos profissionais liberais, sem considerar que o §4º do artigo 14 do Código de Defesa do Consumidor, ao estabelecer como requisito para a responsabilidade do profissional liberal a comprovação de culpa (imprudência, negligência e imperícia), determina, a contrario sensu, a aplicação das normas do Código Civil, de forma que, também as prerrogativas de facilitação de acesso ao judiciário, exclusivas da legislação de consumo, não poderiam ser aplicadas ao exercício da atividade pelo profissional liberal. / This study aims at analyzing physicians responsibilities at both the doctrinal and jurisprudential levels to date. Thus, it also aims to show, from an analysis of alleged medical malpractice suits filed in the judiciary power, that the consumers rights guaranteed by the Code of Consumers Defense, as well as the privileges of access to the judiciary power, are currently applied by law professionals for the medical practice in a general way, meaning that both business corporations, hospitals, clinics and health insurance companies, as well as liberal professionals, not mentioning the fourth paragraph of clause 14 from the Code of Consumers Defense, which regulates liberal professionals responsibilities to establish guilt of imprudence, negligence or malpractice, it is, however, guided by the application of the rules from the Civil Code, in a sense that the privileges of access to the judiciary power could not be applied to the liberal Professionals medical practice, either.