Modelling Contributing Factors of Judicial Judgment in Medical Negligence Cases
Article Sidebar
Main Article Content
Abstract
Medical negligence litigation poses significant challenges for healthcare systems, justice institutions, and patient safety. Yet the specific criteria shaping judicial judgment in such cases — and the differential weight assigned to them by distinct professional actors — have not been empirically modelled. This study addresses this gap by examining the criteria that contribute to judicial judgment in medical negligence cases in Greece, with particular focus on their relative importance in determining liability outcomes and the amount of compensation awarded. Using a structured questionnaire administered to a convenience sample of 71 professionals — judges, lawyers, and medical experts — the study empirically assesses the significance attributed to 27 predefined adjudication criteria. The study analysed data using descriptive statistics, correlation coefficients, and multiple ordinary least squares (OLS) regression models, using participant characteristics such as profession, court type, and years of experience as explanatory variables. Results indicate that severity, permanence, and extent of harm, along with the existence of a causal link between the medical act and patient outcome, are consistently rated as paramount across all participant groups. The regression models exhibit limited explanatory power (R² = 7–35%), reflecting broad inter-professional consensus on criterion ranking. The study identifies cross-court inconsistency in adjudication and procedural barriers to access to justice as institutional deficiencies linked to SDG 3 (Good Health and Well-Being) and SDG 16 (Peace, Justice, and Strong Institutions). These failures carry direct implications for insurance markets, healthcare expenditure, and the practice of defensive medicine. To address them, the study advances two concrete reform proposals: introducing harmonised adjudication guidelines to standardise judicial decision-making across courts, and establishing a no-fault compensation mechanism for the Greek healthcare system.
Downloads
| Abstract views: 0 | PDF Downloads: 0 |
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Akachi, Y., & Kruk, M. E. (2017). Quality of care: Measuring a neglected driver of improved health. Bulletin of the World Health Organization, 95(6), 465–472. https://doi.org/10.2471/BLT.16.180190
Antoci, A., Fiori Maccioni, A., & Galeotti, M. (2019). Defensive medicine, liability insurance and malpractice litigation in an evolutionary model. Nonlinear Analysis: Real World Applications, 47, 414–435. https://doi.org/10.1016/j.nonrwa.2018.08.012
Arlen, J. (2013). Economic analysis of medical malpractice liability and its reform. In J. Arlen (Ed.), Research handbook on the economics of torts (pp. 51–66). Edward Elgar. https://doi.org/10.4337/9781781006177.00010
Bismark, M., & Dauer, E. A. (2006). Motivations for medico-legal action: Lessons from New Zealand. The Journal of Legal Medicine, 27, 55–70. https://doi.org/10.1080/01947640500533317
Bornstein, B. H. (2004). The impact of different types of expert scientific testimony on mock jurors' liability verdicts. Psychology, Crime & Law, 10(4), 429–446. https://doi.org/10.1080/1068316030001629292
Bovbjerg, R. R., & Raymond, B. (2003). Patient safety, just compensation and medical liability reform. Kaiser Permanente Institute for Health Policy.
Campbell, F., Sein, T. T., Htoo, T. S., Khine, W. Y. K., Howard, N., & Balabanova, D. (2023). Policy space and pro-health equity national policymaking: A case study of Myanmar during political transition (2006–16). Health Policy and Planning, 38(2), 170–180. https://doi.org/10.1093/heapol/czac076
Campbell, T. (2023). Promote peaceful and inclusive societies. In Oxford commentary on the SDGs. Oxford University Press. https://doi.org/10.1093/law/9780192885173.003.0017
Centre for Quality Improvement and Patient Safety. (2024). Centre for Quality Improvement and Patient Safety self-study (Academic Review 2020–2024). Temerty Faculty of Medicine, University of Toronto.
Chen, B. (2010). Defensive medicine under enterprise insurance [Working paper]. SSRN. https://doi.org/10.2139/ssrn.1640955
Chodos, J. E. (2015). Should there be specialty courts for medical malpractice litigation? Columbia Medical Review, 1(1), 10–22.
Clancy, C. M. (2009). Ten years after To Err Is Human. Journal of Patient Safety, 5(3), 199–200. https://doi.org/10.1177/1062860609349728
Coetzee, L. C., & Carstens, P. (2011). Medical malpractice and compensation in South Africa. Chicago-Kent Law Review, 86(3), 1263–1301.
Colivicchi, I., Fabbri, T., & Iannizzotto, A. (2024). Risk retention and management implications of medical malpractice in the Italian NHS. Risks, 12(10), Article 160. https://doi.org/10.3390/risks12100160
Crisp, D. H. (2017). Anatomy of medical errors: The patient in room 2: A nurse's story of surviving preventable medical errors and discovering the truth. Sigma Theta Tau International.
Deitschel, C. H., Buckley, J. M., Evans, G., & Fraser, J. J. (2002). Guidelines for expert witness testimony. Pediatrics, 109(5), 974–979. https://doi.org/10.1542/peds.109.5.974
Devine, D. J., Clayton, L. D., Dunford, B. B., Seying, R., & Pryce, J. (2001). Jury decision making: 45 years of empirical research on deliberating groups. Psychology, Public Policy, and Law, 7(3), 622–727. https://doi.org/10.1037/1076-8971.7.3.622
Edozien, L. C. (2001). Determining the appropriate standard of care. Clinical Risk, 7(1), 9–14. https://doi.org/10.1258/1356262011928211
Farrell, A.-M., Devaney, S., & Dar, A. (2010). No-fault compensation schemes for medical injury: A review (Interim Report). Scottish Government Social Research. http://dx.doi.org/10.2139/ssrn.2221836
Fenn, P., Gray, A., & Rickman, N. (2010). Enterprise liability, risk pooling and diagnostic care. Journal of Public Administration Research and Theory, 21(Suppl. 2), i85–i104. https://doi.org/10.1093/jopart/muq026
Ferrara, S. D., Baccino, E., Bajanowski, T., Boscolo-Berto, R., Castellano, M., De Angel, R., Pauliukevičius, A., Ricci, P., Vanezis, P., Vieira, D. N., Viel, G., Villanueva, E., & EALM Working Group on Medical Malpractice. (2013). Malpractice and medical liability: European guidelines on methods of ascertainment and criteria of evaluation. International Journal of Legal Medicine, 127(3), 545–557. https://doi.org/10.1007/s00414-013-0836-5
Ghartey, A. (2023). Systematic review of patient perspective on informed consent. University of Cape Coast Law Journal, 3(1). https://doi.org/10.47963/ucclj.v3i1.1250
Giesen, D. (1988). International medical malpractice law. Martinus Nijhoff.
Glassman, A. D. (2004). Federal caps in medical malpractice liability actions. Hamline Law Review, 27(3), 640–687. https://open.mitchellhamline.edu/cgi/viewcontent.cgi?article=1020&context=wmlr
Harris, J. E. (1987). Defensive medicine: It costs, but does it work? JAMA, 257(20), 2801–2802. https://doi.org/10.1001/jama.1987.03390200141032
Hugh, T. B., & Dekker, S. W. A. (2009). Hindsight bias and outcome bias in the social construction of medical negligence. Journal of Law and Medicine, 16(5), 846–857. https://research-repository.griffith.edu.au/server/api/core/bitstreams/2a2c1c32-5706-5007-bc87-4687cfbd4e32/content
Kachalia, A., Mello, M. M., Brennan, T. A., & Studdert, D. M. (2008). Beyond negligence. Social Science & Medicine, 66(2), 387–402. https://doi.org/10.1016/j.socscimed.2007.08.020
Kampra, A., & Vozikis, A. (2026). Judicial assessment of medical negligence liability in Greek case law: Empirical and jurisprudence analysis of 320 decisions. HAPSc Policy Briefs Series, 7(1), 8–27. https://doi.org/10.12681/hapscpbs.46250
Knowles, E. (2022). Calculating medical malpractice settlement damages. The Knowles Group.
Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., Adeyi, O., Barker, P., Daelmans, B., Doubova, S. V., English, M., García-Elorrio, E., Guanais, F., Gureje, O., Hirschhorn, L. R., Jiang, L., Kelley, E., Lemango, E. T., Liljestrand, J., . . . Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era: Time for a revolution. The Lancet Global Health, 6(11), e1196–e1252. https://doi.org/10.1016/S2214-109X(18)30386-3
Levin, N. (2017). Medical malpractice in Israel. Sociology and Anthropology, 5(3), 199–208. https://doi.org/10.13189/SA.2017.050305
Lungu, D. (2023). Patient safety: A systematic review. Texila International Journal of Academic Research, 10(2). https://doi.org/10.21522/tijar.2014.10.02.art003
Malito, D. V., Umbach, G., Savoia, A., & Hulme, D. (2020). Measuring governance to achieve sustainable development: Promises and challenges. World Development, 129, Article 104849. https://doi.org/10.1007/978-3-319-71066-2_32-1
McAbee, G. N., Brown, J. L., Donn, S. M., & Gonzalez, J. L. (2009). Expert witness participation. Pediatrics, 124(5), 1620–1625. https://doi.org/10.1542/peds.2009-1132
Mello, M. M. (2002, October 25). Does the tort system improve medical quality? [Presentation]. World Medical Leaders, New York, NY, United States.
Mello, M. M., Kelly, C. N., Studdert, D. M., & Brennan, T. A. (2003). Hospitals' behavior in a tort crisis. Health Affairs, 22(6), 225–233. https://doi.org/10.1377/hlthaff.22.6.225
Ng, I. K. (2024). Informed consent in clinical practice. Clinical Ethics. Advance online publication. https://doi.org/10.1177/14782715241247087
O'Connell, J., & Pohl, C. (1997–1998). How reliable is medical malpractice law? [Review of the book Medical malpractice and the American jury: Confronting the myths about jury incompetence, deep pockets, and outrageous damage awards, by N. Vidmar]. Journal of Law and Health, 12(2), 359–376.
Owusu-Dapaa, E. (2014). Medical malpractice and the complexity of healthcare litigation: Is there a case for a no-fault compensation regime in England and Wales? [Working paper]. SSRN. https://doi.org/10.2139/ssrn.2462511
Pace, N. M., Golinelli, D., & Zakaras, L. (2004). Capping non-economic awards in medical malpractice trials: California jury verdicts under MICRA. RAND Corporation.
Panagiotou, A. (2016). Medical liability in Europe at the dawn of cross-border health care: Time to reflect on the possibility of harmonizing the policies regarding medical liability? European Journal of Health Law, 23(4), 350–372. https://www.jstor.org/stable/48712273
Paul, S. R., & Narang, S. K. (2017). Expert witness participation. Pediatrics, 139(3), Article e20164122. https://doi.org/10.1542/peds.2016-4122
Pergolizzi, J. V., & LeQuang, J. A. (2024). Daubert standard and expert witnesses. Cureus, 16(10), Article e69346. https://doi.org/10.7759/cureus.69346
Quality Interagency Coordination Task Force. (2000). Doing what counts for patient safety: Federal actions to reduce medical errors and their impact (Report to the President).
Queudot, M., & Meurs, M.-J. (2018). Artificial intelligence and predictive justice: Limitations and perspectives. In M. Mouhoub, S. Sadaoui, O. Ait Mohamed, & M. Ali (Eds.), Recent trends and future technology in applied intelligence (Lecture Notes in Artificial Intelligence, Vol. 10868, pp. 889–897). Springer. https://doi.org/10.1007/978-3-319-92058-0_85
Quinlan, A., Krolikowski, F. J., Dunham, W. G., & Reuter, K. (1986). Risk management enhances quality care and protection from liability. The Pathologist, 40(6), 12–16.
Samanta, A., Mello, M. M., Foster, C., & Tingle, J. (2006). Role of clinical guidelines in medical negligence litigation. Medical Law Review, 14(3), 321–366. https://doi.org/10.1093/medlaw/fwl010
Sanbar, S. S., & Pataki, L. I. (1978). The expert witness in medical liability cases. Journal of Legal Medicine, 6(1), 9–15. https://doi.org/10.1111/j.1748-720X.1978.tb00234.x
Segal, J. B., & Sacopulos, M. J. (2009). A modified no-fault malpractice system can resolve multiple healthcare system deficiencies. Clinical Orthopaedics and Related Research, 467(2), 430–437. https://doi.org/10.1007/s11999-008-0577-9
Stauch, M. (2011). Medical malpractice and compensation in Germany. Chicago-Kent Law Review, 86(3), 1139–1168. https://scholarship.kentlaw.iit.edu/cklawreview/vol86/iss3/7/
Studdert, D. M., Mello, M. M., & Brennan, T. A. (2010). Defensive medicine and tort reform: A wide view. Journal of General Internal Medicine, 25(5), 380–381. https://doi.org/10.1007/s11606-010-1319-8
Thomas, E. J., & Petersen, L. A. (2003). Measuring errors and adverse events in health care. Journal of General Internal Medicine, 18(1), 61–67. https://doi.org/10.1046/j.1525-1497.2003.20147.x
United Nations. (2023a). Metadata for indicator 16.3.1: Proportion of victims of violence in the previous 12 months who reported their victimization to competent authorities. Inter-Agency and Expert Group on SDG Indicators. https://unstats.un.org/sdgs/metadata/files/Metadata-16-03-01.pdf
United Nations. (2023b). Metadata for indicator 16.3.2: Unsentenced detainees as a proportion of overall prison population. Inter-Agency and Expert Group on SDG Indicators. https://unstats.un.org/sdgs/metadata/files/Metadata-16-03-02.pdf
United Nations. (2023c). Metadata for indicator 16.3.3: Proportion of the population who have experienced a dispute in the past two years and who accessed a formal or informal dispute resolution mechanism. Inter-Agency and Expert Group on SDG Indicators. https://unstats.un.org/sdgs/metadata/files/Metadata-16-03-03.pdf
Uznadze, N. (2025). Patient's informed consent and physician's civil liability. Journal of Law, 2(1). https://doi.org/10.60131/jlaw.2.2025.10697
Vainieri, M., Vandelli, A., & Trinchese, D. (2024). Tricky choices between short or long-term financial sustainability: Cost allocation for medical malpractice claims in Italy. Cogent Business & Management, 11(1), Article 2423894. https://doi.org/10.1080/23311975.2024.2423894
Vanezis, P. (2013). Medical responsibility and liability in the United Kingdom. In Forensic medicine (pp. 139–156). Springer. https://doi.org/10.1007/978-3-642-35831-9_7
Vozikis, A., & Riga, M. (2012). Patterns of medical errors: A challenge for quality assurance in the Greek health system. In M. Savsar (Ed.), Quality assurance and management. InTech.
Watson, K., & Kottenhagen, R. (2017). Patients' rights, medical error and harmonisation of compensation mechanisms in Europe. European Journal of Health Law, 25, 1–23. https://doi.org/10.1163/15718093-12460348
Williams, J. (2007). No-fault medical malpractice compensation: Policy considerations for design of a demonstration project (Report No. 2007-06). AARP Public Policy Institute.
World Bank, Health, Nutrition and Population Unit. (2003). Medical malpractice systems around the globe: Examples from the US—tort liability system and the Sweden—no fault system (Working Paper No. 29011). World Bank. http://documents.worldbank.org/curated/en/421621468779085220
World Health Organization. (2025a). Universal health coverage (UHC), SDG Target 3.8. Global Health Observatory. https://www.who.int/data/gho/data/themes/universal-health-coverage
World Health Organization. (2025b). Coverage of essential health services (SDG 3.8.1): Metadata. Inter-Agency and Expert Group on SDG Indicators. https://unstats.un.org/sdgs/metadata/files/Metadata-03-08-01.pdf
Wright, W. L. (2021). Standards of care and expert testimony in jurisprudence. In Forensic neuropsychology (pp. 479–496). Springer. https://doi.org/10.1007/978-3-030-68570-6_31
Yamin, A. E., & Lander, F. (2015). Implementing a circle of accountability: A framework for judiciaries in enforcing health-related rights. Journal of Human Rights, 14(3), 312–331.