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Medical negligence in drug associated deaths

Burkhard Madea1, Frank Musshoff, Johanna Preuss

  • 1Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, 53111 Bonn, Germany. b.madea@uni-bonn.de

Forensic Science International
|June 30, 2009
PubMed

Insights

Medication errors causing death are underreported in medical malpractice claims. Even when adverse drug events (ADEs) are suspected, proving a causal link to death is legally challenging for physicians and expert witnesses.

Area of Science:

  • Medical Law
  • Pharmacovigilance
  • Clinical Toxicology

Background:

  • Adverse drug events (ADEs) are common and serious medical complications.
  • Despite their frequency, medication errors leading to malpractice claims are infrequent.
  • Lethal outcomes from drug-related issues present diagnostic and legal challenges.

Purpose of the Study:

  • To evaluate the frequency and nature of medication errors in medical malpractice cases with lethal outcomes.
  • To compare the incidence of ADEs in epidemiological studies with their recognition in legal malpractice claims.
  • To identify prevalent types of medication errors and reasons for underreporting.

Main Methods:

  • Retrospective multicenter study of 4450 medical malpractice cases with lethal outcomes.
  • Focused analysis on 575 drug-related cases.
  • Inclusion of autopsy findings and expert witness evaluations to establish causal connections.

Main Results:

  • In 50% of drug-related cases, no causal link between drug therapy and death was found post-autopsy.
  • A causal link was approved in 232 cases (e.g., drug allergies, overdose, wrong application).
  • Legally, only 70 cases involved approved medication errors, with 42 deemed causal for death. Common errors included contraindicated drugs, incorrect application, and overdose in renal insufficiency.

Conclusions:

  • Medication errors are significantly underreported in medical malpractice data compared to epidemiological ADE data.
  • Physicians and expert witnesses face difficulties in recognizing ADEs and establishing a legal causal link to death.
  • Legal recognition of medication errors as a cause of death is substantially lower than their actual occurrence.

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