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

Abstract

BackgroundPain 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.MethodsData 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.ResultsPain 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.ConclusionsMore 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.

Analysis of medical disputes regarding chronic pain management in the 2009–2016 period using the Korean Society of Anesthesiologists database

“…Similar results were obtained in a previous domestic analysis of pain management-related medical disputes, in which case files were collected through the Korean Medical Association's Mutual Aid and a private medical malpractice liability insurance company [2]. …”

“…The active involvement of anesthesiologists in chronic pain management has been paralleled by an increase in the number of related medical dispute cases [2]. Clearly, given that many different medical specialties are involved in chronic pain management in Korea and elsewhere, medical disputes are not limited to the anesthesiology community.…”

Analysis of judicial precedent cases regarding epidural injection in chronic pain management in Republic of Korea

“…Inadequate sterile technique was recognized as a cause for malpractice in five of these cases. Infection, a potentially serious complication of inadequate sterile technique, has been reported in previous studies 14–16. Several practice advisories of epidural injection emphasize the importance of aseptic technique during the procedure 20 21.…”

“…The most common alleged injuring event was non-sterile technique (n=17), and the most common contributing factors to injury were perceived deficits in technical skill, followed by poor clinical judgement. In an analysis of 335 medical disputes regarding pain management in Korea from 2010 to 2015, the most common type of complication was infection 16…”

State of education regarding ultrasound-guided interventions during pain fellowships in Korea: a survey of recent fellows

“…As spinal pain represents the most common disease entity in Korea [ 15 ], further training regarding spinal procedures should be provided during the fellowship program to ensure appropriate application, and reduce the risk of complications due to operator error. Furthermore, as new US-guided interventional techniques are introduced into clinical practice, fellowship programs should ensure that physicians have been properly trained to implement these techniques safely and effectively.…”