Original Article
Study of financial compensation in rulings against obstetricians and gynaecologists in Spain (1987–2013)
Estudio de las compensaciones económicas sobre sentencias contra obstetras y ginecólogos en España (1987-2013)
Read
2500
Timeswas read the article
527
Total PDF
1973
Total HTML
Share statistics
array:24 [ "pii" => "S244542491730016X" "issn" => "24454249" "doi" => "10.1016/j.remle.2017.04.001" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "194" "copyright" => "Asociación Nacional de Médicos Forenses" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Spanish Journal of Legal Medicine. 2017;43:64-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 751 "formatos" => array:2 [ "HTML" => 631 "PDF" => 120 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0377473216300736" "issn" => "03774732" "doi" => "10.1016/j.reml.2016.11.003" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "194" "copyright" => "Asociación Nacional de Médicos Forenses" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Med Legal. 2017;43:64-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 323 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 182 "PDF" => 130 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>" "titulo" => "Estudio de las compensaciones económicas sobre sentencias contra obstetras y ginecólogos en España (1987-2013)" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "64" "paginaFinal" => "69" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Study of financial compensation in rulings against obstetricians and gynaecologists in Spain (1987-2013)" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1311 "Ancho" => 1523 "Tamanyo" => 125614 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cantidades de las indemnizaciones según el motivo de la demanda.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nicolás García-Ruiz, Andrés Santiago-Sáez, María Elena Albarrán-Juan, Elena Labajo-González, Bernardo Perea-Pérez" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Nicolás" "apellidos" => "García-Ruiz" ] 1 => array:2 [ "nombre" => "Andrés" "apellidos" => "Santiago-Sáez" ] 2 => array:2 [ "nombre" => "María Elena" "apellidos" => "Albarrán-Juan" ] 3 => array:2 [ "nombre" => "Elena" "apellidos" => "Labajo-González" ] 4 => array:2 [ "nombre" => "Bernardo" "apellidos" => "Perea-Pérez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S244542491730016X" "doi" => "10.1016/j.remle.2017.04.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S244542491730016X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0377473216300736?idApp=UINPBA00004N" "url" => "/03774732/0000004300000002/v1_201704300025/S0377473216300736/v1_201704300025/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2445424917300171" "issn" => "24454249" "doi" => "10.1016/j.remle.2017.04.002" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "193" "copyright" => "Asociación Nacional de Médicos Forenses" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Spanish Journal of Legal Medicine. 2017;43:70-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 9090 "formatos" => array:2 [ "HTML" => 8776 "PDF" => 314 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "Deaths by firearm and intraoral gunshot: Medicolegal etiology" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "70" "paginaFinal" => "78" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Muertes por arma de fuego y disparo intraoral: etiología medicolegal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1186 "Ancho" => 1582 "Tamanyo" => 275685 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Anterior dental extrusion, lip contusions (case 4, suicide).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Enrique Dorado-Fernández, Eduardo Andreu-Tena, Concepción Magaña-Loarte, Elisa Ruiz-Tagle Fernández, David Cáceres-Monllor, José Luis Souto López-Mosquera, Andrés Santiago-Sáez" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Enrique" "apellidos" => "Dorado-Fernández" ] 1 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Andreu-Tena" ] 2 => array:2 [ "nombre" => "Concepción" "apellidos" => "Magaña-Loarte" ] 3 => array:2 [ "nombre" => "Elisa" "apellidos" => "Ruiz-Tagle Fernández" ] 4 => array:2 [ "nombre" => "David" "apellidos" => "Cáceres-Monllor" ] 5 => array:2 [ "nombre" => "José Luis" "apellidos" => "Souto López-Mosquera" ] 6 => array:2 [ "nombre" => "Andrés" "apellidos" => "Santiago-Sáez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0377473216300724" "doi" => "10.1016/j.reml.2016.11.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0377473216300724?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445424917300171?idApp=UINPBA00004N" "url" => "/24454249/0000004300000002/v1_201705270105/S2445424917300171/v1_201705270105/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2445424917300201" "issn" => "24454249" "doi" => "10.1016/j.remle.2017.04.005" "estado" => "S300" "fechaPublicacion" => "2017-04-01" "aid" => "191" "copyright" => "Asociación Nacional de Médicos Forenses" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Spanish Journal of Legal Medicine. 2017;43:58-63" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1405 "formatos" => array:2 [ "HTML" => 1173 "PDF" => 232 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Mental disorders and criminal responsibility in arsonists" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "58" "paginaFinal" => "63" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trastornos mentales y responsabilidad criminal en incendiarios" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1626 "Ancho" => 1503 "Tamanyo" => 83802 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Motivations behind arson.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rodrigo Dresdner Cid, Jorge Oscar Folino" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Rodrigo" "apellidos" => "Dresdner Cid" ] 1 => array:2 [ "nombre" => "Jorge Oscar" "apellidos" => "Folino" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0377473216300700" "doi" => "10.1016/j.reml.2016.10.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0377473216300700?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2445424917300201?idApp=UINPBA00004N" "url" => "/24454249/0000004300000002/v1_201705270105/S2445424917300201/v1_201705270105/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Study of financial compensation in rulings against obstetricians and gynaecologists in Spain (1987–2013)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "64" "paginaFinal" => "69" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Nicolás García-Ruiz, Andrés Santiago-Sáez, María Elena Albarrán-Juan, Elena Labajo-González, Bernardo Perea-Pérez" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Nicolás" "apellidos" => "García-Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Andrés" "apellidos" => "Santiago-Sáez" "email" => array:1 [ 0 => "ansantia@ucm.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "María Elena" "apellidos" => "Albarrán-Juan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Elena" "apellidos" => "Labajo-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Bernardo" "apellidos" => "Perea-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Obstetricia y Ginecología, Hospital El Escorial, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Escuela de Medicina Legal y Forense, Universidad Complutense de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Legal, Hospital Clínico San Carlos, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de las compensaciones económicas sobre sentencias contra obstetras y ginecólogos en España (1987-2013)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1320 "Ancho" => 1572 "Tamanyo" => 99235 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Amounts of compensation grouped by chronological intervals.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">To prevent malpractice claims it is best to know the causes and to learn by analysing all the factors involved in possible errors. It is clear that in Spain and Europe, in general, there is less interest in deepening the analysis of complaints than in the Anglo-Saxon world, even though this knowledge would help to improve quality of care and patient safety. This knowledge could also lead to a decrease in costs for individuals and for the health system itself.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Information on malpractice claims often comes from the media, which focus on claims with the highest compensation and most newsworthiness, and which, although caused by the most serious errors, represent a biased assessment, at times projecting insecurity about the system and thus contributing to an increase in health costs.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">3</span></a> Moreover, we are not aware of the real significance of the term “constant increase” in relation to “medical malpractice”, which can range from problems in the management of waiting lists to complaints about medical errors, often forgetting about the result of the final judgement regarding the latter.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In Spain, one of the first analyses dates back to 1993.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> After assessing the health and judicial systems, taking into account the decisions of the Supreme Court of Spain, the analysis already refers to an increase in the number of claims, although other authors also using court data state that few of these claims lead to compensation.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding the current accident rate in our health system, a Catalan group the Legal Medicine Unit of the Official Medical Association of Barcelona is one of the most active.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> Our group has also made contributions of interest using data from judicial decisions.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">7,8</span></a> Although a biased view can be given in any case, we believe that, in the absence of other more reliable sources, the study of judicial rulings helps to prevent terminological corruption and render the analysis of the amounts of compensation to be included in the rulings themselves more reliable, with the exception of the Catalan health system.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In claims for damages arising from their activity, in Spain the fields of obstetrics and gynaecology take centre stage.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">7,9,10</span></a> Although it is doubtful whether this can be transferred to other settings,<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a> when the interest is focused on studying extreme (or catastrophic, as coined by some authors) amounts of compensation,<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">9–13</span></a> it is customary to find this specialty in the top spot, irrespective of the country.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There seems to be a trend towards a progressive increase in compensation in our setting, excluding economic adjustments.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a> In fact, Spanish legislative projects are in the works for calculating compensation for healthcare damages which refer to special cases, such as incidents involving individuals who were previously not sick. If they come into effect, they are unlikely to improve the situation in the field of obstetrics and gynaecology, which often deals with healthy people in situations, childbirth, where only a perfect result is expected.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">14,15</span></a> This paper conducts a specific analysis in this specialty and in our setting, focusing on the amounts of financial compensation, the evolution thereof, and the adverse events that rise to them, grouped as previously referred to in other publications.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a> Decisions made by criminal courts have been excluded as we consider them a group with special connotations that have already been the object of a previous study.<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and method</span><p id="par0035" class="elsevierStylePara elsevierViewall">The paper mainly uses the Westlaw Aranzadi database of rulings, accessing the same from the School of Legal Medicine at the Complutense University of Madrid. All rulings in medical malpractice cases against gynaecologists have been collected across Spain, for medical procedures that occurred after 1987 with a ruling published before May 2013, and which reached at least a court of second instance or higher; i.e., Provincial Court, Superior Court of Justice, or Supreme Court. This database contains the full decisions. All were taken from civil and contentious-administrative procedures. The variables studied were the adverse effect of the claim, the year of the ruling and the final compensation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The claims were grouped into 2 large groups–obstetrics and gynaecology–each with its own differentiation by events.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using the SPSS 19.0 statistical software, Fisher's exact test, normal distribution test and Student's <span class="elsevierStyleItalic">t</span>-test were used to compare the differences between groups, and the non-parametric Mann–Whitney test was used to compare independent samples. Cases were grouped by periods and ranges according to the amounts used by insurance companies in civil liability coverage for health professionals.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The study includes 431 rulings, with 244 convictions and their corresponding compensation awards. In obstetrics the average award was €271,573, compared with €63,678 in gynaecology (<span class="elsevierStyleItalic">p</span>, 0.01), with a maximum of €1,627,213 and €850,000 and a median of €180,000 and €30,000, respectively.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the amounts grouped according to the most relevant and most common events. It can be seen that compensation for permanent brain damage is the most important in terms of maximum and average amounts, with up to €20,000,000 requested for compensation. Maximum compensation awarded was: €1,627,213 for permanent brain damage; €750,000 for errors in prenatal diagnosis; €300,000 for shoulder dystocia; €250,000 for foetal death; €850,000 for complications of hysterectomy; €250,000 for delays in diagnosing breast cancer; and €180,000 for curettage complications. The high compensation for complication of hysterectomy was due to pulmonary embolism, with cardiorespiratory arrest and recovery with brain damage.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the compensation awards according to the ranges used by many insurance companies to calculate premiums. Almost 80% were less than €300,000 and only 3.4% were more than €900,000.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Given the extensive period analysed, it has been divided into intervals to assess the evolution of compensation and to facilitate comparison with other publications studying shorter periods. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows that the trend is towards an increase in all parameters analysed: maximum compensation of €480,000 in the first period to €1,627,000 in the final one; an average of €106,712 in 1995–1999 to €257,932 in 2010–2013, and the same for medians of €51,500 to €185,000, respectively.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Replicating the design of other publications, data were collected from a similar range: 2004–2010. Of 104 compensation awards, 43 cases (41.34%) exceeded €200,000, which would be the starting amount for what has been termed “catastrophic compensation”. Of these, €200,000–€399,999 were awarded in 20 cases (46.52%); €400,000–€599,999 in 7 cases (16.27%), and over €600,000 in 16 cases (37.2%). There are no gynaecology cases above €300,000, except for the aforementioned hysterectomy. Overall, all compensation awards are related to obstetric events, more specifically with childbirth and foetal damage or with errors in prenatal diagnosis, with 3 (6.97%) cases exceeding €900,000.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">Complaints against physicians are the subject of widespread attention as they aim to reflect the safety and reliability of a health system, they have an impact on the behaviour of professionals towards what is known as defensive medicine, and they have impact on the media, among other issues.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The first point seems somewhat contradictory given that some authors believe that advances in therapeutics and technology and improved quality and safety standards have been accompanied by an increase in complaints against obstetricians and gynaecologists,<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> contrary to expectations. Regarding obstetrics and gynaecology in developed countries, despite low maternal and infant mortality rates and the fact that safety in specialty departments is considered excellent, complaints against gynaecologists continue to rise, especially when compared with other specialties.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">19</span></a> The most common grounds leading to these claims, however, are the same throughout the world: neonatal encephalopathy, errors in prenatal diagnosis, shoulder dystocia, and errors in the screening of certain diseases.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">16</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Another reason people focus on complaints against gynaecologists is their influence on changing attitudes in specific aspects of childbirth, which has led to an unjustified increase in the rate of Caesarean sections and low rates of assisted delivery.<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">20,21</span></a> Recent publications even link this increase to a rise in insurance premiums covering professional liability,<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">22</span></a> which would be justified by the increased number of claims and an increasing trend in the number of high, catastrophic (employing a term coined by other authors) compensation claims.<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">9,10</span></a> This situation could worsen if health-specific projects come to fruition,<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a> which may reduce compensation for medical errors relating to sick patients but differentiate those relating to healthy patients, such as mother and foetus, and others within this specialty. In addition, the highest compensation awards are correlated with injured individuals of under one year of age,<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">9,10</span></a> which is also the case here.</p><p id="par0090" class="elsevierStylePara elsevierViewall">A particularity of our paper, which would justify the importance of obstetrics, is that it only collects judicial rulings from courts of second instance and higher, where it is assumed that the most serious cases are dealt with. It is also said that compensation is higher when the case is resolved in court.<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">23,24</span></a> Our paper has not taken into account out-of-court settlements, about which we only have references from Catalonia, where the special features of medical insurance are resolved by out-of-court settlement in more than 70% of the cases in which physician responsibility is found, accounting for 25% of the total claims.<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">25,26</span></a> We do not know how acceptance of these settlements is affected by the injury being caused to a sick or a healthy individual, which has been mentioned as a particular aspect in obstetrics and gynaecology. In any case, promoting this course should become the norm, with some authors already having done so.<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">12,14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Compared with global data on the specialty, our paper aims for a more specific analysis, observing that diagnostic errors in some cancers are also important by frequency and by the amount of compensation, as has already been published.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> Despite the known heterogeneity in the causes of childhood cerebral palsy, and that few cases are exclusively related to severe hypoxia during childbirth,<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">28–30</span></a> it seems appropriate to repeat that there are events that occur only at the time of childbirth and whose complications may result in this crippling disease.<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">31,32</span></a> Claims that end in conviction for this latter complication include virtually all the “catastrophic” compensation awards and can be considered as a benchmark for the calculation of insurance premiums in obstetrics, which are among the highest.<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Extreme cases, which are the most high-profile ones,<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">3</span></a> can create uncertainty regarding the system's safety by relating them to negligent acts<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a>; however, these are rare cases and only account for a small number of medical errors.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a> Our system, like others in our setting, bases its operation on high quality standards. Although all our actions have the potential to injure others, it is widely considered that childbirth will never be an action whose risks are fully controlled.<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> Moreover, although scientific advances and improvements in medical care have led to a drastic decrease in risks, they are not correlated with a decreased number of claims generally against physicians, or against physicians in this specific specialty.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Physicians receive little training on the legal and judicial aspects of their professional practice. Perhaps they also receive little information. We would like this paper to be a stimulus for encouraging further studies in this area.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0110" class="elsevierStylePara elsevierViewall">This paper aims to provide figures for a well-known fact; i.e., that obstetrics involves the highest compensation awards for malpractice, especially for permanent damage related to the foetus, be it cerebral damage related to childbirth or errors in prenatal diagnosis. In gynaecology, claims for errors in diagnosing breast cancer, and rarely some other adverse event, are among the most numerous, include the highest compensation awards in case of conviction, and have gone all the way to the Supreme Court of Spain.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Limitations</span><p id="par0115" class="elsevierStylePara elsevierViewall">Owing to its design, this study excludes cases resolved in courts of first instance and out-of-court settlements; accordingly, there may be a bias towards obstetric events which, as already mentioned, include the most serious cases and involve the highest compensation awards. On the other hand, the analysis of these events could be considered the most interesting.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that there are no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres843881" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec838998" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres843882" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec838997" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Limitations" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-11-03" "fechaAceptado" => "2016-11-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec838998" "palabras" => array:6 [ 0 => "Compensation" 1 => "Gynaecologist convictions" 2 => "Claims" 3 => "Obstetrics litigation" 4 => "Medical liability" 5 => "Medical malpractice" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec838997" "palabras" => array:6 [ 0 => "Indemnizaciones" 1 => "Condenas a ginecólogos" 2 => "Demandas" 3 => "Judicialización en obstetricia" 4 => "Responsabilidad médica" 5 => "Negligencias médicas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Malpractice payouts occupy an important place in Obstetrics and Gynaecology. We analysed a long period (1987–2013) of court sentences focusing on compensation amount and the way compensation has changed. In Spain there are not many economic analyses on Obstetrics and Gynaecology, specifically on the main adverse events that lead to catastrophic payouts.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective analysis of a legal database on court sentences in civil and administrative litigation against obstetricians and gynaecologists during the study period was performed. The adverse event under examination, the year of the ruling, and the payouts for malpractice were the variables analysed. Statistical analysis was performed using SPSS Statistics 19.0, F-distribution and normal distribution tables as well as the Student's <span class="elsevierStyleItalic">t</span>-test to compare differences between groups.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We recovered 431 cases, 244 of which resulted in a conviction (56.6%). Obstetrics involved the highest payouts (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01) and a 57.5% chance of being convicted. The accusations with the highest payouts involved foetal death or foetal injury, which were the most common cause of payouts exceeding €300,000. Overall, 78.7% (193) of convictions involved a payout below €300,000 and the mean, median and maximum payouts increased steadily during the study period.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Obstetric claims and foetal-related injury involve the highest payouts, with an increasing trend. Catastrophic payouts are common.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En indemnizaciones por mala praxis, la obstetricia y la ginecología ocupa un lugar destacado. Analizamos las sentencias de un largo periodo (1987-2013) centrándonos en la cuantía de las indemnizaciones y su evolución. En España existen pocos análisis económicos de esta especialidad y específicamente que muestren aquellos eventos adversos que soportan las indemnizaciones más elevadas.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se trata de un análisis retrospectivo de las sentencias judiciales en las vías civil y contencioso-administrativa, contra obstetras y ginecólogos tomadas de bases de datos jurídicas en el periodo de estudio. Las variables consideradas han sido las indemnizaciones en los casos de condena, el evento adverso juzgado y el año de la sentencia. El software estadístico SPSS 19.0 permitió obtener tablas de distribución de Fisher, de normalidad y el t test para comparación de diferencias entre grupos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De 431 casos, 244 terminaron en condena (56,6%). La obstetricia soportó las indemnizaciones más elevadas (p, 0,01) y una probabilidad de ser condenado del 57.5%. Los eventos relacionados con daño o muerte foetal presentaron las indemnizaciones más elevadas y fueron la causa más común entre las indemnizaciones, superiores a 300.000 €. Globalmente, en el 78,7% (193) de los casos con condena, la cantidad fue inferior a 300.000 €. Los máximos, así como la media y la mediana de las indemnizaciones, fueron aumentando a lo largo del periodo de estudio.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las demandas en el entorno de la obstetricia y los daños relacionados con el feto soportan las indemnizaciones más elevadas, con tendencia a incrementarse. Las indemnizaciones extremas no son infrecuentes.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García-Ruiz N, Santiago-Sáez A, Albarrán-Juan ME, Labajo-González E, Perea-Pérez B. Estudio de las compensaciones económicas sobre sentencias contra obstetras y ginecólogos en España (1987–2013). Rev Esp Med Legal. 2017;43:64–69.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1311 "Ancho" => 1523 "Tamanyo" => 122019 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Amounts of compensation according to the grounds for the claim.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1320 "Ancho" => 1572 "Tamanyo" => 99235 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Amounts of compensation grouped by chronological intervals.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Compensation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Frequency \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cumulative \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><€300,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">193 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">€300,001–€600,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">91.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">€600,001–€900,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">€900,001–€1,200,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>€1,200,001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">244 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1425353.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Compensation grouped by category.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0185" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Liability for medical malpractice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.M. Danzon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Handbook of health economics" "paginaInicial" => "1339" "paginaFinal" => "1404" "serieFecha" => "2000" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0190" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Responsabilidad por una práctica médica inadecuada: una perspectiva económica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Carles" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "2003" "volumen" => "17" "paginaInicial" => "494" "paginaFinal" => "503" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14670257" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0195" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Noticias de prensa sobre errores clínicos y sensación de seguridad al acudir al hospital" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.J. Mira" 1 => "M. Guilabert" 2 => "I.M. OrtízL. Navarro" 3 => "M.V. Pérez-Jover" 4 => "J.M. Aranaz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaceta.2010.06.009" "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "2010" "volumen" => "24" "paginaInicial" => "33" "paginaFinal" => "39" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21094562" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0200" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Las reclamaciones judiciales por mala praxis médica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.J. Llovet" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Salud Públ" "fecha" => "1993" "volumen" => "67" "paginaInicial" => "315" "paginaFinal" => "323" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0205" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La medicina basada en la evidencia en el sistema judicial norteamericano" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Guillen" 1 => "I. Aguinaga" 2 => "F. Guillen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "An Sist Sanit Navar" "fecha" => "1998" "volumen" => "21" "paginaInicial" => "385" "paginaFinal" => "388" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12891397" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0210" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of obstetrics and gynecology profesional liability claims in Catalonia, Spain (1986–2010)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E.L. Gómez-Duran" 1 => "J.A. Lailla-Vicens" 2 => "J. Benet-Travé" 3 => "J. Arimany- Manso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jflm.2008.12.016" "Revista" => array:6 [ "tituloSerie" => "J Forensic Leg Med" "fecha" => "2009" "volumen" => "16" "paginaInicial" => "301" "paginaFinal" => "306" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19573837" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0215" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de las consecuencias médico-legales de las reclamaciones judiciales de pacientes. Estudio comparativo de los casos de traumatología, ginecología y obstetricia, anestesia y reanimación, y odontoestomatología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Perea Pérez" 1 => "A. Santiago Saez" 2 => "M.E. Labajo González" 3 => "M.I. Albarrán Juan" 4 => "J.A. Sánchez Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Trauma Fund Mafre" "fecha" => "2009" "volumen" => "20" "paginaInicial" => "264" "paginaFinal" => "268" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0220" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El médico ante los tribunales: análisis de las sentencias judiciales relacionadas con la responsabilidad profesional médica en España" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B. Perea-Pérez" 1 => "A. Santiago-Saéz" 2 => "M.E. Labajo-González" 3 => "M.E. Albarrán-Juan" 4 => "E. Dorado-Fernández" 5 => "A. García-Martín" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Med Legal" "fecha" => "2013" "volumen" => "39" "paginaInicial" => "130" "paginaFinal" => "134" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0225" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Epub ahead of print" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Catastrophic medical malpractice payouts in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Arimany-Manso" 1 => "E.L. Gómez-Durán" 2 => "E. Barbería-Marcalain" 3 => "J. Benet-Travé" 4 => "C. Martin-Fumadó" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jhq.12074" "Revista" => array:6 [ "tituloSerie" => "J Healthc Qual" "fecha" => "2015" "volumen" => "38" "paginaInicial" => "290" "paginaFinal" => "295" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25103285" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0230" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Catastrophic medical malpractice payouts in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.J. Bixenstine" 1 => "A.D. Shore" 2 => "W.T. Mehtsun" 3 => "A.M. Ibrahim" 4 => "J.A. Freischlag" 5 => "M.A. Makary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jhq.12011" "Revista" => array:6 [ "tituloSerie" => "J Healthc Qual" "fecha" => "2014" "volumen" => "36" "paginaInicial" => "43" "paginaFinal" => "53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23551334" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0235" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malpractice risk according to physician specialty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.B. Jena" 1 => "S. Seabury" 2 => "D. Lakdawalla" 3 => "A. Chandra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMsa1012370" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2011" "volumen" => "365" "paginaInicial" => "629" "paginaFinal" => "636" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21848463" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0240" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Las reclamaciones sobre responsabilidad profesional por especialidades en un escenario diferente al estadounidense" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Arimany-Manso" 1 => "E.L. Gómez-Durán" 2 => "J. Aubia-Marimon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaceta.2012.04.015" "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "89" "paginaFinal" => "93" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22698648" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0245" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Le risque des professions de santé en 2006 [Internet]. Decisions de justice. Rapport sur les décisions de justicerendues en 2006 (médecins sociétaires du Sou Médical-Groupe MACSF). Responsabilité, Revue de formation sur le risque médical [consulted Nov 2014]. Available in: <a href="http://www.cfef.org/archives/bricabrac/macsf2006.pdf">http://www.cfef.org/archives/bricabrac/macsf2006.pdf</a>" ] ] ] 13 => array:3 [ "identificador" => "bib0250" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Baremo para la determinación de indemnizaciones por daños derivados de actividades en el ámbito sanitario [Internet], Madrid, 28 June 2013 [consulted Dec 2015]. Available in: <a href="http://static.diariomedico.com/docs/documentos/baremo.pdf">http://static.diariomedico.com/docs/documentos/baremo.pdf</a>" ] ] ] 14 => array:3 [ "identificador" => "bib0255" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Litigation in obstetrics: a lesson learnt and a lesson to share" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.M. Chou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1028-4559(09)60183-2" "Revista" => array:6 [ "tituloSerie" => "Taiwan J Obstet Gynecol" "fecha" => "2006" "volumen" => "45" "paginaInicial" => "1" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17272201" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0260" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Litigations and the obstetrician in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Adinma" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/2141-9248.181847" "Revista" => array:6 [ "tituloSerie" => "Ann Med Health Sci Res" "fecha" => "2016" "volumen" => "6" "paginaInicial" => "74" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27213088" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0265" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis de reclamaciones judiciales contra obstetras y ginecólogos en España. Estudio específico de la vía penal (1987-2013)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. García-Ruiz" 1 => "A. Santiago-Sáez" 2 => "M.E. Albarrán-Juan" 3 => "E. Labajo-González" 4 => "B. Perea-Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Med Legal" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "136" "paginaFinal" => "141" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0270" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Practice patterns to decrease the risk of a malpractice suit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.G. Williams" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/GRF.0000000000000203" "Revista" => array:6 [ "tituloSerie" => "Clin Obstet Gynecol" "fecha" => "2016" "volumen" => "59" "paginaInicial" => "439" "paginaFinal" => "446" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27101242" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0275" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of medical litigation filed against obstetrics and gynecology, internal medicine, and surgery departments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Hamasaki" 1 => "A. Hagihara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12910-015-0065-1" "Revista" => array:5 [ "tituloSerie" => "BMC Med Ethics" "fecha" => "2015" "volumen" => "16" "paginaInicial" => "72" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26498823" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0280" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of malpractice claims on the use of caesarean section" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.S. Schifrin" 1 => "W.R. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.bpobgyn.2012.10.004" "Revista" => array:6 [ "tituloSerie" => "Best Pract Res Clin Obstet Gynaecol" "fecha" => "2013" "volumen" => "27" "paginaInicial" => "269" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23206669" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0285" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of cesarean delivery: the scope of the problem" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Boyle" 1 => "U.M. Reddy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.semperi.2012.04.012" "Revista" => array:6 [ "tituloSerie" => "Semin Perinatol" "fecha" => "2012" "volumen" => "36" "paginaInicial" => "308" "paginaFinal" => "314" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23009961" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0290" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Malpractice and obstetric practice: the correlation of malpractice premiums to rates of vaginal and cesarean delivery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.T. Johnson" 1 => "V. Choubey" 2 => "A. Satin" 3 => "E.F. Werner" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajog.2015.12.056" "Revista" => array:6 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "2016" "volumen" => "214" "paginaInicial" => "545" "paginaFinal" => "546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26767796" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0295" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Chandra A, Nundy S, Seabury SA. The growth of physician medical malpractice payments: evidence from the national practitioner data bank. Health Affairs, published online May 31, 2005." ] ] ] 23 => array:3 [ "identificador" => "bib0300" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Claims, errors, and compensation payments in medical malpractice litigation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.M. Studdert" 1 => "M.M. Mello" 2 => "A.A. Gawande" 3 => "T.K. Gandhi" 4 => "A. Kachalia" 5 => "C. Yoon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMsa054479" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2006" "volumen" => "354" "paginaInicial" => "2024" "paginaFinal" => "2033" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16687715" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0305" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Un modelo integral y de gestión directa del aseguramiento de la responsabilidad profesional médica en Cataluña" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Arimany-Manso" 1 => "E.L. Gómez-Durán" 2 => "M. Bruguera" 3 => "J. Aubia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2013" "volumen" => "141" "paginaInicial" => "300" "paginaFinal" => "304" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0310" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Arimany-Manso J, Esperanza L. Gómez-Durán Reclamaciones por presunto defecto de praxis [Internet]. Seguridad clínica. 2014 [consulted in 2016]. Available in: <a href="https://www.comb.cat/cat/professional/responsabilitat/pdf/2014LlibreSEGURIDADCLINICA.pdf">https://www.comb.cat/cat/professional/responsabilitat/pdf/2014LlibreSEGURIDADCLINICA.pdf</a>" ] ] ] 26 => array:3 [ "identificador" => "bib0315" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk management and medico-legal issues in breast cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.J. Ward" 1 => "V.L. Green" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/GRF.0000000000000203" "Revista" => array:6 [ "tituloSerie" => "Clin Obstet Gynecol" "fecha" => "2016" "volumen" => "59" "paginaInicial" => "439" "paginaFinal" => "446" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27101242" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0320" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A template for defining a causal relation between acute events and cerebral palsy: international consensus statement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.H. MacLennan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "1999" "volumen" => "319" "paginaInicial" => "1054" "paginaFinal" => "1059" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10521205" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0325" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.D.V. Hankins" 1 => "M. Speer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Obstet Gynecol" "fecha" => "2003" "volumen" => "102" "paginaInicial" => "628" "paginaFinal" => "636" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12962954" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0330" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cerebral palsy: causes, pathways, and the role of genetic variants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.H. MacLennan" 1 => "S.C. Thompson" 2 => "J. Gecz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajog.2015.05.034" "Revista" => array:6 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "2015" "volumen" => "213" "paginaInicial" => "779" "paginaFinal" => "788" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26003063" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0335" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "667.e1-8" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neonatal encephalopathy and the association to asphyxia in labor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Jonsson" 1 => "J. Agren" 2 => "S. Nordén-Lindeberg" 3 => "A. Ohlin" 4 => "U. Hanson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Am J Obstet Gynecol" "fecha" => "2014" "volumen" => "211" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0340" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relevant obstetric factors for cerebral palsy: from the nationwide obstetric compensation system in Japan" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Hasegawa" 1 => "S. Toyokawa" 2 => "T. Ikenoue" 3 => "Y. Asano" 4 => "S. Satoh" 5 => "T. Ikeda" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0148122" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2016" "volumen" => "11" "paginaInicial" => "e0148122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26821386" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0345" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstetric malpractice litigation and cerebral palsy in term infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.L. Johnson" 1 => "E. Blair" 2 => "F.J. Stanley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jflm.2010.12.002" "Revista" => array:6 [ "tituloSerie" => "J Forensic Leg Med" "fecha" => "2011" "volumen" => "18" "paginaInicial" => "97" "paginaFinal" => "100" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21420644" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0350" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Twenty years of evidence on the outcomes of malpractice claims" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.G. Peters Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11999-008-0631-7" "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2009" "volumen" => "467" "paginaInicial" => "352" "paginaFinal" => "357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19048355" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0355" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La responsabilidad profesional médica en Europa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Castellano Arroyo" 1 => "S.D. Ferrara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Med Legal" "fecha" => "2014" "volumen" => "40" "paginaInicial" => "161" "paginaFinal" => "166" ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0360" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increasing liability premiums in Obstetrics—analysis, effects and options" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Soergel" 1 => "O. Schöffski" 2 => "P. Hillemanns" 3 => "U. Hille-Betz" 4 => "S. Kundu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Geburtshife Frauenheilkd" "fecha" => "2015" "volumen" => "75" "paginaInicial" => "367" "paginaFinal" => "376" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24454249/0000004300000002/v1_201705270105/S244542491730016X/v1_201705270105/en/main.assets" "Apartado" => array:4 [ "identificador" => "58964" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24454249/0000004300000002/v1_201705270105/S244542491730016X/v1_201705270105/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S244542491730016X?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 16 | 3 | 19 |
| 2024 September | 38 | 6 | 44 |
| 2024 August | 16 | 6 | 22 |
| 2024 July | 18 | 4 | 22 |
| 2024 June | 18 | 4 | 22 |
| 2024 May | 13 | 9 | 22 |
| 2024 April | 22 | 4 | 26 |
| 2024 March | 28 | 5 | 33 |
| 2024 February | 33 | 4 | 37 |
| 2024 January | 10 | 4 | 14 |
| 2023 December | 12 | 5 | 17 |
| 2023 November | 17 | 3 | 20 |
| 2023 October | 27 | 3 | 30 |
| 2023 September | 13 | 2 | 15 |
| 2023 August | 14 | 1 | 15 |
| 2023 July | 13 | 4 | 17 |
| 2023 June | 22 | 1 | 23 |
| 2023 May | 46 | 3 | 49 |
| 2023 April | 47 | 3 | 50 |
| 2023 March | 26 | 2 | 28 |
| 2023 February | 25 | 8 | 33 |
| 2023 January | 35 | 3 | 38 |
| 2022 December | 42 | 7 | 49 |
| 2022 November | 23 | 9 | 32 |
| 2022 October | 19 | 10 | 29 |
| 2022 September | 17 | 12 | 29 |
| 2022 August | 16 | 6 | 22 |
| 2022 July | 17 | 9 | 26 |
| 2022 June | 11 | 20 | 31 |
| 2022 May | 26 | 7 | 33 |
| 2022 April | 16 | 14 | 30 |
| 2022 March | 22 | 11 | 33 |
| 2022 February | 20 | 8 | 28 |
| 2022 January | 56 | 9 | 65 |
| 2021 December | 56 | 8 | 64 |
| 2021 November | 39 | 6 | 45 |
| 2021 October | 54 | 18 | 72 |
| 2021 September | 19 | 14 | 33 |
| 2021 August | 17 | 5 | 22 |
| 2021 July | 13 | 8 | 21 |
| 2021 June | 35 | 6 | 41 |
| 2021 May | 20 | 11 | 31 |
| 2021 April | 33 | 20 | 53 |
| 2021 March | 9 | 6 | 15 |
| 2021 February | 18 | 8 | 26 |
| 2021 January | 15 | 17 | 32 |
| 2020 December | 12 | 8 | 20 |
| 2020 November | 15 | 6 | 21 |
| 2020 October | 15 | 8 | 23 |
| 2020 September | 13 | 10 | 23 |
| 2020 August | 19 | 7 | 26 |
| 2020 July | 62 | 1 | 63 |
| 2020 June | 16 | 9 | 25 |
| 2020 May | 15 | 10 | 25 |
| 2020 April | 27 | 3 | 30 |
| 2020 March | 19 | 3 | 22 |
| 2020 February | 19 | 12 | 31 |
| 2020 January | 10 | 5 | 15 |
| 2019 December | 23 | 6 | 29 |
| 2019 November | 9 | 7 | 16 |
| 2019 October | 24 | 12 | 36 |
| 2019 September | 12 | 8 | 20 |
| 2019 August | 7 | 0 | 7 |
| 2019 July | 24 | 9 | 33 |
| 2019 June | 32 | 15 | 47 |
| 2019 May | 83 | 9 | 92 |
| 2019 April | 49 | 1 | 50 |
| 2019 March | 10 | 4 | 14 |
| 2019 February | 16 | 5 | 21 |
| 2019 January | 15 | 2 | 17 |
| 2018 December | 9 | 1 | 10 |
| 2018 November | 13 | 1 | 14 |
| 2018 October | 18 | 4 | 22 |
| 2018 September | 18 | 5 | 23 |
| 2018 August | 25 | 1 | 26 |
| 2018 July | 15 | 5 | 20 |
| 2018 June | 18 | 2 | 20 |
| 2018 May | 15 | 1 | 16 |
| 2018 April | 15 | 1 | 16 |
| 2018 March | 102 | 1 | 103 |
| 2018 February | 2 | 3 | 5 |
| 2018 January | 5 | 1 | 6 |
| 2017 December | 12 | 1 | 13 |
| 2017 November | 12 | 2 | 14 |
| 2017 October | 10 | 1 | 11 |
| 2017 September | 15 | 1 | 16 |
| 2017 August | 1 | 0 | 1 |
Show all