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Compassionally reserved for inoperable patients in 2002, Transcatheter Aortic Valve Implantation has now a place almost equivalent to surgical valve replacement. The pioneering teams first succeeded in demonstrating a benefit on the mortality of extremely serious patients, while managing a learning curve that seemed unreachable without a strong partnership with cardiac surgeons. This win/win challenge enabled cardiologists to surpass the limits they did not dare to brave (management of large arterial approach, annular rupture and tamponade) and surgeons to appropriate the endovascular's culture. The technological contribution, the maturity of the teams and the expansion to less severe populations have reduced the perioperative mortality of TAVI to less than 3%. At this stage, it seemed interesting to take stock of forensic developments around this technique. After a review of the studies and the healthcare requirements, we reported and analyzed the claims received from one of the leaders of the medical insurance in France. From this feedback, attempts will be made to identify ways of improving the prevention and subsequent treatment of complications, which will undoubtedly limit the risk of subsequent complaints., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: Presentation of data collected on urology claims from the register of a French insurance company., Material and Method: Compensation claims involving urologists covering the period 2009-2018 were identified and analyzed., Results: A total of 37 files were found. Oncological and functional surgical interventions accounts for 78% of repair claims. Postoperative complications represent 76% of the cases. The most represented acts are total prostatectomy (5) and promonto-fixation (4). The average time of complaint is 28.6 months [1-144 months], the average duration of a procedure (opening-closing) is 32.8 months [12-72 months]. The Conciliation and Compensation Commissions (CCC) and the High Court Courts (HCC) were solicited respectively in 51% and 33% of the proceedings. An amicable agreement is found in 16% of cases. There was no criminal or disciplinary proceedings. The average cost of a closed urology file is 7836 € [0-31,120 €]. In total, 64.8% of the expertises confirm practices in the respect of the rules of the art., Conclusion: This series presents the first forensic analysis of a portfolio of urologists on a period of 9 years in French urology. There is a rate of responsibility retained against the practitioner in only 27% of cases. The low rate of faulty files, the absence of a conviction for breach of the duty to provide information and in connection with antibiotic prophylaxis seem to confirm that the practice of urology in France is of good quality, a further study on a longer period of time and on a larger cohort of urologists would allow a finer medico-legal approach., Level of Evidence: 3., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

The purpose of this work is to better understand the reasons for post-surgical instability and what makes up the bed of medico-legal complications. Beyond technical competence, it is essential to observe a very high degree of rigor in listening to the real motivations in order to give the most accurate possible surgical indications and in particular to know to detect and never to operate certain patients who, whatever we do, will always be dissatisfied. The quality of information is one of the essential elements of prevention: information is part of the care and there is no therapeutic success without a successful relationship between a caregiver and a carereceiver. Before the surgery, it is essential to pre-establish written proof of the proper delivery of the information by signing a receipt and an informed consent document. However, the information does not stop at the time of the operative gesture and it is necessary to be able to provide complete and timely information about any post-surgical complications. Furthermore, aesthetic medicine is well understood and rigorously implemented, contributes to the prevention of surgical and medico-legal complications, reducing the heaviness of certain surgical gestures. The question of e-reputation should in no way be neglected. From this point of view, prevention consists in controlling as much as possible the Internet environment. Indeed, where, in the past, in the presence of a dissatisfied patient awaited us, the fear of word-of-mouth or trial is added to the risk of harm E-reputation whose implications can be very damaging. At a time when the intensive use of the Internet allows anyone to get out of anonymity, we must also control these tools at the risk of sacrificing our expertise at the coronation of amateurs., (Copyright © 2017. Published by Elsevier Masson SAS.)

Background: In France little is known about either the characteristics of people who take legal action because they believe themselves to be victims of harm caused by medical activity, or about their complaint trajectory. The law of 4th March 2002 created an out-of-court settlement mechanism which aims to reduce inequitable access to compensation experienced by victims faced with legal procedures that are both lengthy and costly. This mechanism now occupies a central position among the avenues of recourse available to patients and their families., Methods: The study relates to the exhaustive database of 18,258 requests for compensation filed with the out-of-court settlement mechanism between 2003 and 2009. It takes 4 series of variables into account: (1) the characteristics of the people concerned by the request, (2) the recourse practices, (3) the result of the requests, (4) the characteristics of the commissions with whom they dealt. Univariate and multivariate analyses were performed, in particular to find factors relating to the different responses given to the requests., Results: Of the requests filed with the out-of-court settlement mechanism, 34.5% led to compensation being awarded, 30.7% were deemed inadmissible and 34.8% were rejected on the basis of expert opinions. The risk of inadmissibility was greater when the victim was a woman, undeceased, or a minor aged between 1 and 17; it bore no relation to standard of living. Recourse to a lawyer (24%) depended on various characteristics, in particular the age and vital status of the victim. It is associated to the decrease of the risk of inadmissibility and to the increase of the chances of receiving compensation. There were significant differences in the ways requests were processed (depending on where they were filed), in the time it took to examine the case, and in the tendency to reject requests before or after expert medical opinion., Conclusion: This study offers the first ever description of the population of patients and families who accessed the out-of-court settlement mechanism for medical claims in France. It looks at how, within the mechanism, the diversity of practices impacts inequity and experiences during the compensation process., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

The concept of medical error in responsibility litigation was based until the past last years on a necessary direct and definite causal link between fault and injury. In France, since the 1960s and increasingly during the last decade, the idea of loss of chance arose, considered as a new and genuine prejudice (practically, a fixable damage); it became the subject of several legal precedents from the Cour de cassation and the Conseil d'État. Thus, plaintiffs may currently demand a compensation for a loss of chance even though a doubt exists on the causal link between the fault and the observed damage. The most frequent litigation circumstances implying a loss of chance are lack of information, lack or delay in diagnosis, delay in action, and default in medical assessment. Based on practical cases, the author presents the most propitious situations where litigation for loss of chance may occur and discusses possible preventive measures., (Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Objective: The aim of this study was to analyze the medicolegal claims related to obstetrics in French hospitals., Material and Methods: We did retrospective study on insurance claims provided by Sham insurances and which has been settled by a court over a 3-year period (2004-2006)., Results: We analyzed 66 closed claims that occurred between 1983 and 2005 in French hospitals (54 general hospitals and 12 academic). The average time between the declaration of the claim and the court conviction was 6 years. The average amount of compensation per claim was 500,000 €. The damage occurred during vaginal delivery (n=44), planned (n=5) or unplanned (n=4) cesarean. The more often claims are fetal asphyxia (n=24) or shoulder dystocia (n=8). The consequences are very important: cerebral palsy (16), death of the newborn (12), death of the mother (2) or brachial plexus injuries (6)., Conclusion: The causes identified by the expert are always multifactorial with generally a misdiagnosis (n=27), a decision making error (n=36), a care error by the midwife (n=21) and/or a delay in medical care (n=13). These data should help strengthen the quality approach in obstetrics., (Copyright © 2015. Published by Elsevier Masson SAS.)

In the absence of any proven medical fault by a plastic surgeon, the patient could not obtain compensation through national solidarity (as stipulated by the Law of March 4th 2002). Indeed ONIAM (France's National Office for Medical Accidents' Compensation) has always rejected any claims on the grounds that cosmetic surgery differs from medical care. Through its judgment of February 5th 2014, France's final Court of Appeals settled the question and considered cosmetic surgery as medical care; in case of serious injuries following unforeseeable medical complications, the patient may be compensated by ONIAM, as with any other medical act. This jurisprudence will certainly result in medical liability insurers be no longer those only responsible for compensation of injuries following cosmetic surgery. Plastic surgeons' insurance premiums should logically become cheaper., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

In rhinoplasty, satisfying the patient both aesthetically and functionally can be complex. In aesthetic surgery, the rhinoplastician has a reinforced obligation of means. In our experience, the functional outcome of the patient is closely linked to the morphological result. When a rhinoplasty provides the patient with full aesthetic satisfaction, even if he/she has breathing difficulties, there will be very few disputes. In primary rhinoplasty, unsatisfactory results occur in 15%-30% of the cases. While orally informing the patient is paramount, the practitioner must also have written proof of the information via documents given or sent to the various players including the patient. The taking of pre- and postoperative photographs is essential and the surgeon must keep them on file for support in case of conflict., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Of the 1603 civil liability cases filed between 2002 and 2012 related to upper-limb surgery, we found 20 proceedings (11 in court and 9 in front of the French CCI [commission for medical accidents]) that involved a total of 24 physicians: three proceedings involved multiple parties for a single patient and implicated two physicians in two cases and three physicians in one case. The grounds for liability being invoked varied greatly, but a good many of these cases concerned outcomes that were deemed unsatisfactory or insufficient in light of the initial injury. Information is always difficult to convey in an emergency setting, but is not generally disputed. However, the information process must be completed during the postoperative period and the patient informed of the injury assessment, expected results, potential complications and the possibility of surgical revision in the medium term. An expert found grounds for physician liability and breach of best practices in only three cases. In summary, this study shows that trauma-related flexor tendon injuries are rarely grounds for indictment of physicians before courts of civil jurisdiction (12 per 1000) and findings of liability for breach of best practices are even more rare (2 per 1000)., (Copyright © 2014. Published by Elsevier SAS.)

In 2002, a new law significantly modified the legal treatment of medical accidents in France, encouraging dialogue and conciliation rather than litigation. Specific structures were created to settle disputes without recourse to the judiciary system. A mechanismfor national solidarity was also created in order to indemnfy some victims. More than ten years later the number of court cases has diminished but vigilance is still required, notably because of the increasingly large sums awarded to victims of medical accidents.

Trust is essential in all forms of medical care. It first appears when the patient chooses the professional, then when the latter suggests a treatment. This medical contract can be broken by both parties, if this trust disappears. The ultimate situation is the occurrence of complications, which can lead to a real distrust of the professional with a complaint made against him or her.

It is in this atmosphere fuelled by the recent scandal of the PIP implants that the final court of appeal has given a judgment on July 12, 2012 which reorients the debate. While patients seeked a shared responsibility between the provider of the implants and the surgeon, in this case of faulty testicular implants, the final court of appeal just ruled out the responsibility of the surgeon. But this jurisprudence can only be applied to private law, i.e. for private healthcare whereas lawsuits filed against public hospitals depend on a different legal liability system., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Objectives: To analyse the nature of medico-legal claims in a high-risk speciality., Materials and Methods: Retrospective review of the causes of medico-legal disputes at the department of Obstetrics and Gynaecology of the North University Hospital of Marseilles between November 1997 and December 2010. Disputes were defined by complaints, judicial or conciliatory claims and intentional declaration of potential medico-legal case by physicians., Results: Fifty-nine controversial medico-legal cases were identified within this 13-year period. Ninety percent (n=53) of cases concerned obstetrics and 10% (n=6) gynaecology. The rate of litigations tripled in a decade. Half of the litigations led to judicial or conciliatory expertise. The average rate of malpractice litigations was 2.4 per physician. Uterine rupture was the most common cause of complaints., Conclusion: Increased awareness of the nature of litigations may help elaborate risk reduction management programs in order to reduce professional liability on the long run., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Claims in anesthesia and intensive care remains high, despite the reduction of morbidity and mortality associated with this activity. The absence of a national register makes it difficult to quantify. The Medical Committee of MACSF-Sou Medical Group, professional liability insurer of more than half of French physicians, provided us support. The amount of compensation paid is growing and the scope of compensated damage is expanded by the Dintilhac mission. The Act of March 4, 2002 has fully confirmed the principle of medical liability for misconduct. Generally, compensation for bodily injury is based on the demonstration of a causal link between a wrongful event and injury. The proof of fault lies with the applicant. Information accountable to patients and nosocomial infection are a particular setting. The Act of March 4, 2002 has also defined the concept of therapeutic risk. With the establishment of the Regional Commissions of Conciliation and Compensation (RCCI) and the National Office for Compensation of Medical Accident (Oniam), it is now possible for a patient to be compensated for an injury resulting from an accident Medical non-offending, while acknowledging the lack of accountability of the practitioner. The expertise conducted by an RCCI is adversarial. For the practitioner called to the cause, it is important to prepare for both substance and form, with the assistance of the medical board's insurance company., (Copyright © 2012 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Liability, from a legal point of view, is a person's obligation to answer for their actions or inactions and the resulting consequences. This can lead, if there is fault and injury resulting from this fault, to the need for financial compensation or a prison sentence.

Purpose: The fast modifications in French medical legislation, the increasing number of litigations and the professional consequences for the practitioner warrant the necessity to recall the "how to manage" a claim for medical error., Patients and Methods: Four cases of legal action against oncologists are presented., Results and Discussion: The importance of quality and traceability of the given information, the essential pieces of the medical file, the description of the different process steps and of the contradictory meeting are presented and discussed., Conclusion: Beyond the control of medical and technical risks, the practitioners in general and the radiation oncologist in particular should learn on the daily management of the risk related to medical claim., (Copyright © 2012 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.)

Settlement of medical malpractice claims was radically changed by the Kouchner Law that set up a rapid, effective system of indemnification. Victims can choose between conventional court proceedings and a non-judicial conciliation procedure. Choice between the two processes depends on the circumstances of the case.

The Court of cassation is the highest court in the French judiciary. In a recent decision on June 3, 2010, the supreme jurisdiction quashed partially a court of appeal judgement. A patient developed erectile dysfunction following open prostatectomy for benign prostatic hyperplasia. The patient was not informed of this risk before the surgery. The judges recall that failure to provide information, including very exceptional risks, asserts in itself the physician's responsibility and allows financial reparation for patients. In accordance with this decision, a new jurisprudence in medical responsibility is born., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Objectives: The law of March2002 was introducing a new concept of liability in the field of prenatal diagnosis, survey and investigations. For wrongful birth, medical physicians are responsible for newborn infants with congenital or hereditary disorder only in a case of characterized malpractices., Materials and Methods: We performed a study about decisions that awarded or refused monetary damages specifically to the parents in the light of this new law. This research was performed by using official court rulings website, crossed in the search engine two expression-keys that were characterized: fault and antenatal diagnosis. Fifteen rulings were reviewed and studied. The matter of our research is to understand how the judges characterize the medical malpractice and insist upon the qualification "Blatant" in the field of prenatal medical liability?, Results: In fact, judicial decisions explicit more what it is not a characterized fault than what it is. Such judicial rejections stated that the medical practices were based on to established medical references and so couldn't be characterized. The taking care, the survey and the biological and radiological investigations of the pregnancy were evaluated in accordance to the knowledge of science although they didn't diagnose fetal malformations. Only four rulings accepted this kind of medical fault, focused the notion of medical neglect accompanied with hurriedness for some judges when physicians performed in particular antenatal echography. In these circumstances, the physician performed quickly and without interest the medical investigations which missed to detect fetal malformations. Two rulings of them categorized the malpractice by the inversion of results, and by the no information about unusual margin of error for cellular culture. The judge argued that negligence of health-care-providers denied to the parents the psychological preparation of hosting disabilities newborn. In this point of view, the judges want to damage parent's injuries., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Background: The authors studied a cohort of 154 patients with unilateral vocal cord paresis following thyroidectomy, analyzing the pathogenesis, symptomatology, spontaneous evolution, and management of this complication., Objective: This retrospective study distinguished between vocal cord paresis due to recurrent laryngeal nerve injury or due to injury of the cricoarytenoid articulation. We assessed the influence multiple variables on therapeutic management. The results and complications of currently-employed surgical techniques to remedy unilateral vocal cord paresis were defined., Patients and Methods: Injury to the recurrent laryngeal nerve was the cause of vocal cord paresis in 98% of cases; injury to the cricoarytenoid articulation accounted for only 2% of cases. When the recurrent laryngeal nerve had not been actually transected, spontaneous recovery of vocal cord function occurred in 36% of cases. No spontaneous recovery was noted when the nerve had been divided. The interval to recovery of cord function ranged from 2 to 15 months (median: 4 months). Spontaneous recovery of vocal cord function had occurred in 90% of these patients by the 9th postoperative month. Three factors significantly influenced the decision to perform a median transposition of the injured vocal cord: known transection of the recurrent laryngeal nerve, the interval to consultation with an ENT specialist, and the severity of dysphonia. Medial transposition of the injured vocal cord resulted in an immediate improvement in the quality of voice and speech with no major complications., Conclusion: Unilateral vocal cord paresis occurring after thyroidectomy is not always symptomatic and is not uniformly due to injury of the recurrent laryngeal nerve. Management does not always require surgical reintervention. The practical and medico-legal consequences of these injuries are discussed.

Surgeons, like other doctors, practice their profession within a framework of contractual liability defined by statute in 1936. This established that the doctor was subject to a contractual obligation to provide appropriate and diligent care. Care and technical acts should conform to those which would have been provided by a prudent doctor within the standards of knowledge and practice of his field; care which deviates from this standard would be considered medical error or fault. This standard of care is referred to as "sound professional conduct". However, while not calling this basic principle into question, civil jurisdictions have progressively held surgeons liable whenever injury has occurred following surgical acts, without considering whether care deviates from sound professional conduct. Since 2000, judges have begun to attribute a requirement for absolute safety of results in cases where the surgeon had injured an organ unrelated to the planned operation. However it seems that the rare judgments given on this topic in the last 2-3 years have become less frequent. The creation of a compensation regime for medical accidents, via the law dated March 4, 2002, has contributed to this evolution. It is to be hoped that the flaws described in this system do not encourage jurisdictions to reconsider previous case law decisions.

Whether you are an aficionado or completely uninitiated, everyone has an opinion on bull-fighting. The bull-fighter is in constant risk of injury. A medical team made up of surgeons, anesthetists, emergency physicians and nurses remains present throughout the show. For the anaesthetist and surgeon, a wounded bullfighter is an emergency because the vital and functional prognosis are engaged. The team must act in conformity with normal practice and the Code of Medical Ethics because any lack of coordination between the practitioners is punishable by law in the same way as technical fault. Several specific aspects of this type of medical procedure should be highlighted: firstly, the legal restrictions within the corrida, and secondly, the nature of the medical team, which may be comprised of doctors normally based within a public health institution and others who practice in a private health establishment. The particularity of the situation reveals differences in the system of liability, and civil liability must be distinguished from administrative liability: both of these allow the victim to obtain compensation for harm caused, but the consequences of each are different according to doctor status. The fact that the anaesthetists frequently work on a voluntary and benevolent basis does not exonerate them from liability. Lastly, a question frequently addressed is whether or not the doctor is covered by his professional insurance when he is on ringside duty.

A thorough discussion of the risks and benefits of proposed surgery is a legal obligation stemming from the code of the health service. A multidisciplinary discussion assembling all involved services best serves to balance the risks of a procedure against the hoped for benefit. A written précis should document this discussion in the patient's chart, both as a part of the patient record and also to refer to in case of eventual medico-legal dispute. While a personal oral discussion should take place with the patient, it should be fully documented. A copy of this informed consent can be sent to referring colleagues or to the patient. This document, by summarizing the elements of the risk/benefit discussion is a supplementary means to assure that the information was given and understood. The primary physician can refer back to it in ongoing discussions with his patient to be sure that the patient has full understanding and has opportunity to have his questions answered. This may require a supplementary office visit. If the referring physician cannot answer these questions, he may need to refer back to the surgeon.

The Law of 4 March, 2002, established regional commissions of conciliation and indemnification (CRCI) to enable the swift and amicable resolution of demands for damages due to medical care (including prevention and diagnosis) by private practitioners, private clinics, and public hospitals. The commission may decide that: (1) the physician or healthcare facility is liable (generally, indemnification by the insurance company), or (2) that indemnification is due in the name of 'national solidarity' (indemnification by a national organism called ONIAM), or (3) no damages are due. There are two important restrictions: For the CRCI to have jurisdiction to determine indemnification, it is imperative that at least one of the severity criteria be met. The 4 severity criteria are: (1) a permanent disability greater than 24%, (2) temporary disability for at least 6 months during a one-year period, or (3) permanent inability to perform the previous occupation, or (4) rarely, especially severe problems (for example, economic) in living conditions that result from the medical care. The procedure applies only to care provided since 5 September 2001. From the request for indemnification by 'ONIAM or the insurer, the process must last no longer than one year.