ISSN 2413-6077. IJMMR 2016 Vol. 2 Issue 234 ISSN 2413-6077. IJMMR 2016 Vol. 2 Issue 2

doI 10.11603/IJMMR.2413-6077.2016.2.7029

mEdIcAL ERRORs IN cLINIcAL PRAcTIcE Of PhYsIcIANs  
IN TERNOPIL REgION (UKRAINE)

V. V. Franchuk
I. HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY, TERNOPIL, UKRAINE

Background. The professional occupation of a doctor quite often meets different imperfections, which have 
negative outcome for patients. 

Objective. The study was aimed to investigate the expert characteristics of improper performance of the 
professional duties by medical staff on the example of a particular region of Ukraine.

Methods. In the study the archival materials (commission forensic medical examinations) held in Ternopil 
Regional Bureau of Forensic Medical Examination in 2007–2014 years were analysed. The research results are 
summarized and processed with the use of general statistical methods.

Results. it is defined that during this period 112 examinations concerning medical malpractice were imple-
mented (9.05% of all commission examinations). 

Conclusions. Medical errors were combined, specifically during the diagnostics, treatment and in medical 
records. The majority of cases (82.1%) of medical malpractice were caused by the objective reasons.

KEY WORDS: medical malpractice, medical errors, forensic medical examinations, dereliction of 
duty by medical personnel, negligence.

Introduction
The professional occupation of a doctor 

quite often meets different imperfections, 
which have negative outcome for patients. 
After the implementation of Criminal Code of 
Ukraine in 2001, especially Article 140 “Unjus-
tifiable dereliction of duty by the medical or 
pharmaceutical practitioner”, the number of 
criminal proceedings on the so-called “medical 
cases” significantly increased. This article be-
came very important for forensic medical ex-
amination and for law in general, because of 
unintended events during medical care delivery 
and their legal correct qualification were fore-
seen in Ukrainian law for the first time. The 
experts of the World Health Organization con-
sider that near 6–7 patients die every day in 
Ukraine as a result of medical errors. The Jour-
nal of Patient Safety released a new study in 
2013 that estimated number of preventable 
medical errors above 440,000 annually [1].

every case of inadequate medical care 
becomes an object of investigation which can’t 

be implemented without the conclusion of the 
commission on forensic medical examination. 
This problem is not  st udied enough in 
contemporary Ukrainian forensic medicine. 
That is why the study of structure, occurrence 
and peculiarities of medical malpractice is the 
aim of the research.

Material and Methods
In the study archival materials (commission 

forensic medical examinations) handled in 
Ternopil Regional Bureau of Forensic Medical 
examination (TRBFMe) in 2007–2014 years were 
analysed. The research results are summarized 
and processed by general statistical methods.

Results and Discussion
During the studied period 112 examinations 

were conducted in TRBFMe for “medical mat-
ters” (9.05% of all commission examinations). 
Improper medical care was revealed in major-
ity of the cases (92 (82.1%)) when dereliction of 
duty by medical personnel occurred. The notion 
improper medical care or medical malpractice 
covers all unintended and wilful failures, omis-
sions and defects of medical care delivery, 
treatment and intervention. Due to Anglo-
Saxon system of law all failures in the doctors 

International Journal of Medicine and Medical Research 
2016, volume 2, Issue 2, p. 34–36
copyright © 2016, TSMU, All Rights Reserved

Corresponding author: Valentyn Franchuk, Department of 
Pathological anatomy with Forensic Medicine course, І. Hor-
bachevsky Ternopil State Medical University, 12 Ruska Street, 
Ternopil, Ukraine, 46001
Phone number: +380679835870 
E-mail: franchukv@tdmu.edu.ua

V. V. Franchuk



ISSN 2413-6077. IJMMR 2016 Vol. 2 Issue 2 35

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conduct are divided into two types: medical 
negligence and professional misconduct [2]. 
From the point of Ukrainian legislation all cases 
of unintentional medical intervention or lack of 
such can by classified into three main groups: 
medical maloccurrence, professional crimes of 
medical practitioners and medical errors. The 
term maloccurrence is the same both Anglo-
Saxon and Slavonic law systems: inspite of good 
medical attention and care, an individual fails 
to respond properly or may suffer from adverse 
reactions of the drug [3]. The definition “profes-
sional crimes of medical staff” means inade-
quate medical care or medical intervention that 
foresees criminal liability of defendant. Gross 
breach of the standards of medical care occurs 
in those cases the severe consequences de-
velop for a patient. This is similar to the term 
“criminal negligence” in Anglo-Saxon law sys-
tem. Other cases of unsuccessful medical care 
are usually qualified in Ukrainian law as “med-
ical errors” (similar to “civil negligence”).

Totally, 19 cases (20.6%) met unjustifiable 
medical care and were determined as crimes 
in medical sphere. Medical errors (civil negli-
gence) were recognized by the forensic medical 
expert commissions in 73 cases (79.4% of all). 
The majority of such deviations were committed 
by hospital doctors and were performed during 
emergency medical care delivery [4]. The pro-
portion of physicians facing an unintentional 
medical intervention or lack of such [5] ranged 
from 39.3% in anaesthesiology, 21.4% in inter-

nal medicine, 18.7% in obstetrics and gynaecol-
ogy, 17.8% in paediatrics, 14.3% in general 
surgery and 4.5% in family medicine, ophthal-
mology, neurosurgery, 3.6% in neurology, 2.7% 
in oncology and 1.8% in psychiatry (Table 1).

The following mistakes were diagnosed by 
forensic medical examination: misjudgement 
of diagnostics (61.1% of cases), mistakes in me-
dical records (46.4%); mistakes during invasive 
procedures or medical treatment including 
medication errors (40.2%), institutional defects 
(27.7%), failures in the doctors conduct which 
impinge upon their professional relationships 
(deontological) were determined in 21.4% of 
cases. As a rule, forensic medical expert com -
mis sions established the presence of two diffe-
rent types of the mistakes (23.2%) simulta-
neously, if for example misjudgement of clinical 
symptoms was combined with medication 
errors. The presence of 4 different types of 
mistakes were ascertained in 16.7% of “medical 
cases”; 3 defects (14.3%); all kinds of defects 
(3.6%). The following failures in the diagnostics 
were normally revealed: insufficient or incom­
plete general-clinical, laboratory and instru-
mental examinations; misjudgement of clinical 
symptoms; inadequacy of the clinical diagnosis; 
unskilful implementation of conventional 
special diagnostic methods and procedures. 
Mistakes during medical treatment including 
medication errors took place: the excess doses 
of medication, insufficient or excess amount of 
infusion, unjustified prescription of many the­

Table. 1. The prevalence of malpractice among medical practitioners 

Specialty of a physician
The number of cases in which  

deficiencies of paramedics of certain  
specialties were established (n=112)

The percentage  
on total amount  

of research cases (%)
Anaesthesiologists 44 39,3%
Therapists 24 21,4%
Obstetricians 21 18,7%
Paediatricians 20 17,8%
Surgeons 16 14,3%
Traumatologists 15 13,4%
Іnfectiologists 14 12,2%
emergency doctors 10 8,9%
Family doctors 5 4,5%
Ophthalmologists 5 4,5%
Neurosurgeons 5 4,5%
Radiologists and clinicians ultrasound 5 4,5%
Neurologists 4 3,6%
Oncologists 3 2,7%
Psychiatrists 2 1,8%

Note: digital values exceed the total number of cases due to (in one case) deficiency assumptions on medical professionals 
of different specialties.

V. V. Franchuk



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rapeutic agents concurrently. Besides of these, 
the breach of care delivery standards, lack of 
monitoring data about a patient, omission of 
patient’s condition, unforeseen complications 
etc. were detected too. The following institu-
tional defects seemed more frequent: equip­
ment malfunctions, absence of consultations; 
incorrect admission of a patient; inadequate 
monitoring of hospital administration about 
medical care. Numerous mistakes in medical 
records were found: the absence of hemo­
dynamic parameters; superficial and incorrect 
description of objective state, lack of informed 
consent of a patient, inadequate clinical diag-
nosis, incomplete epicrisis etc. All deontological 
errors were commonly conducted with a poor 
qualification of medical staff, negative rela­
tionships between a patient and doctor, doctor 
and patient’s relatives [6]. Approximately 30% 
of all studied cases faced the breach of medical 
care standards. 

Forensic medical examination confirmed 
the objective reasons for medical malpractice 
in almost 80% of cases. They were: the severity 
of patient’s condition or the presence of comor-
bidity (32.1% of cases); rapid duration of pa-
thological process (21.4%); difficulties in diag­
nostics or atypical manifestations of disease 

(13.4%). The subjective reasons (i.e., due to poor 
qualification of medical personnel) were 
detected in 9.8% of cases. All these cases were 
qualified as criminal negligence. Dereliction of 
duty by medical staff as a rule was accompanied 
by severe consequences for patients (fatality, 
grievous degree of severity, prolongation of 
illness, moderate degree of severity).

Conclusions
Dereliction of duty by medical personnel is 

confirmed more than 80% of “medical cases” 
in the conclusions of the commission forensic 
medical examinations.

The occurrence of unintentional medical 
intervention or lack of such in anaesthesiology, 
therapeutic, obstetrical/gynaecological, paedi-
atric and surgical cases was more frequent. 
Unintended medical incidents were associated 
with and occurred during diagnostics, treat-
ment, medical care, medication and in medical 
records. Considered inadequate medical care 
was usually insufficient and combined with 
breach of care standards. 

The majority of medical errors happened 
due to different objective reasons. Criminal 
negligence was identified in about 20% of 
medical malpractice cases.

References
1. James, John T. A New, evidence-based estimate 

of Patient Harms Associated with Hospital Care. 
Journal of Patient Safety 2013; 9(3): 122–128.

2. Shepherd R. Medical malpractice (in). Simp-
son’s Forensic medicine. london. Arnold publi sher; 
2003: 15–26.

3. Narayan Reddy K.S. Professional negligence 
(malpraxis) (in). The essentials of Forensic Medicine 
and Toxicology. Hyderabad. K. Suguna Devi publi-
sher; 2006: 30–45.

4. Sorensen B, lynnerup N. Fatal outcome after 
unintended events following medical intervention: 
a forensic pathological case survey. RRFMS 2014; 4: 
11–17.

5. Anupam B. Jena, Seth Seabury, Darius 
lakdawalla, Amitabh Chandra. Malpractice Risk 
According to Physician Specialty. N engl J Med 2011; 
365 : 629–636.

6. Meng You, Xu Wang, Di lu, Haidong Zhang, 
Shengli Di, Fengqin Zhang et al. Analyses of Medical 
Malpractice in Judicial Appraisal: 505 Cases. Forensic 
Sci Med 2015; 1: 21–25.

Received: 2016-12-09

V. V. Franchuk