Korean J Pain.  2015 Oct;28(4):254-264. 10.3344/kjp.2015.28.4.254.

Review of Medical Dispute Cases in the Pain Management in Korea: A Medical Malpractice Liability Insurance Database Study

• Kim YD
• Moon HS

• KMID: 2151668
• DOI: http://doi.org/10.3344/kjp.2015.28.4.254

Abstract

BACKGROUND
Pain medicine often requires medico-legal involvement, even though diagnosis and treatments have improved considerably. Multiple guidelines for pain physicians contain many recommendations regarding interventional treatment. Unfortunately, no definite treatment guidelines exist because there is no complete consensus among individual guidelines. Pain intervention procedures are widely practiced and highly associated with adverse events and complications. However, a comprehensive, systemic review of medical-dispute cases (MDCs) in Korea has not yet been reported. The purpose of this article is to analyze the frequency and type of medical dispute activity undertaken by pain specialists in Korea.
METHODS
Data on medical disputes cases were collected through the Korea Medical Association mutual aid and through a private medical malpractice liability insurance company. Data regarding the frequency and type of MDCs, along with brief case descriptions, were obtained.
RESULTS
Pain in the lumbar region made up a major proportion of MDCs and compensation costs. Infection, nerve injury, and diagnosis related cases were the most major contents of MDCs. Only a small proportion of cases involved patient death or unconsciousness, but compensation costs were the highest.
CONCLUSIONS
More systemic guidelines and recommendations on interventional pain management are needed, especially those focused on medico-legal cases. Complications arising from pain management procedures and treatments may be avoided by physicians who have the required knowledge and expertise regarding anatomy and pain intervention procedures and know how to recognize procedural aberrations as soon as they occur.

Keyword

Complication; Forensic medicine; Informed consent; Medication errors; Nerve block; Pain clinic

MeSH Terms

Compensation and Redress
Consensus
Diagnosis
Dissent and Disputes*
Forensic Medicine
Humans
Informed Consent
Insurance, Liability*
Korea*
Lumbosacral Region
Malpractice*
Medication Errors
Nerve Block
Pain Clinics
Pain Management*
Specialization
Unconsciousness

Figure

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  Fig. 1 Total number of registered anesthesiology and pain medicine doctors in Korea. Data obtained for 2012 thru 2014.

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  Fig. 2 Total number of Korean Association of Anesthesia & Pain Management Specialist (KAPS) members between 2012 and 2014.

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  Fig. 3 Classification of medical dispute cases according to body parts from 2010 to 2014.

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  Fig. 4 Classification of medical dispute cases by content and severity from 2010 to 2014. Data shown for cases involving death and/or unconsciousness (a), mild (b) and severe (c) procedure-related infection, body injury (including nerve damage, muscle weakness, and pneumothorax; (d), bleeding or hematoma (e), procedure-related fracture (f), post-procedure headache (g), treatment-related skin burn (h), complications related to other medical departments (i), drug allergy (j), and diagnosis issues (k).

• 

  Fig. 5 The frequency of medical dispute cases in each body part from 2010 to 2014. Data shown for cases involving death or unconsciousness (a), mild (b) and severe (c) procedure-related infection, body injury (including nerve damage, muscle weakness, and pneumothorax; (d), bleeding or hematoma (e), procedure-related fracture (f), post-procedure headache (g), treatment-related skin burn (h), complications related to other medical departments (i), drug allergy (j), and diagnosis issues (k).

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  Fig. 6 Average compensation costs by the body part from 2010 to 2014. Costs presented in units of Korean "won".

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  Fig. 7 Average compensation costs by medical dispute case content from 2010 to 2014. Costs presented in Korean "won". Data shown for cases involving death and/or unconsciousness (a), mild (b) and severe (c) procedurerelated infection, body injury (including nerve damage, muscle weakness, and pneumothorax; (d), bleeding or hematoma (e), procedure-related fracture (f), post-procedure headache (g), treatment-related skin burn (h), complications related to other medical departments (i), drug allergy (j), and diagnosis issues (k).

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