Abstract
Patients seek more and more actively compensation for treatment injuries, accidents, infections, and even because of unsatisfied results. Injuries or mistreatment are quite frequently seen in orthopaedic surgery, because operations are increasing and unsatisfactory results can be easily recognised from radiographic documentation.
Compensation can be theoretically sought by three main routes: directly from the orthopaedic surgeon or his insurance company, secondly, from the institution where he is working (or its insurance company) and thirdly, from a statutory system if there is one available. The first two direct compensation mechanisms are based on direct link between the patient and the physician involved. A statutory system can be universal and act more as a no fault compensation system.
Statutory patient insurance was introduced in1987 in Finland (Patient Insurance Act). This act covers all medical treatment, both public and private care in Finland including examination, surgical and nonoperative treatment, inpatient ward treatment, physiotherapy, rehabilitation as well as patient transportation.
All hospitals and companies dealing with medical care need to be insured. The institutions or companies responsible of the medical work owe the policyholder status. Therefore workers in the medical field need not to make their own insurance agreements nor pay any insurance fees to the companies.
The Finnish Patient Insurance Centre handles all claims in Finland, about 7.000 cases yearly, of which about 2.000 will give compensation to the patients. An independent Patient Injury Board stated by the Ministry of Health supervises the Centre.
So far, orthopaedics and traumatology has been the leading speciality in producing injuries. The injuries are divided into six subgroups: 1) treatment injury, 2) infection, 3) equipment-related injury, 4) accident related injury, 5) wrong delivery of pharmaceuticals and 6) unreasonable injury (severe complication with permanent disability after accurate treatment).
The evaluation of patient injury is concentrated on the case itself. The personnel involved to the treatment will not be accused or sued whenever a patient injury has been recognised. This no-guilt principle has been adopted well in Finland.
In the treatment injuries the level of acceptable care is determined by standard of an experienced professional of that speciality he/she represents. That means that an orthopaedic operative or diagnostic procedure will be evaluated compared to the level, which a graduated and experienced orthopaedic surgeon could have normally reached. Infection injuries are considered acceptable and do not lead to compensation when being superficial, or if a deep infection heels within a couple of weeks or months with adequate treatment and without any permanent disability. Traumatic accidents are quite rare as well as breakage of medical equipment and error of delivery of pharmaceuticals in pharmacies. Unreasonable injuries are seen a few yearly.
The prerequisite for compensation is that there has to be an objectively recognised harm to the patient due to a diagnostic or treatment procedure. Patient insurance covers the following costs: 1) medical treatment expenses, 2) other necessary expenses caused by the injury, 3) loss of income on maintenance, 4) pain and suffering, 5) permanent functional defect, and 6) permanent cosmetic injuries.
In 2004 the total costs of compensation paid was 24.2 million e (public health care 88% and private health care12%).
The yearly claim and compensation data is used for comparative analysis between the hospital districts and given also to the medical and surgical societies in order to enhance medical knowledge and skills and prevention of similar injuries in the future.
Patients owe still the possibility to sue the hospital or doctors involved. However, these cases will be normally handled by the Patient Insurance Centre and not by the medical personnel individually. In fact, the amount of trials against medical units or personnel has diminished dramatically after adoption of the Patient Insurance Act in Finland.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
