Financial compensation for radiotherapy-related adverse events in a judicial system where proof of medical negligence is not required

Purpose: To examine the frequency of adverse events related to radiation th erapy that lead to financial compensation in a judicial system that is not based on litigation in court but on statutory insurance where proof of medi cal negligence is not required for obtaining compensation. Methods and Materials: In Finland, an injured patient does not sue through the courts, but submits an insurance claim to the Patient Insurance Associa tion. Proof of medical negligence is not required for obtaining compensatio n. We reviewed all filed claims associated with radiotherapy presented to t he Patient Insurance Association from May 1987 to January 1999. During this time period, 1,732,000 patient visits to radiation therapy units were made , and the estimated number of radiotherapy treatments was 86,600. The data collected included descriptions of the adverse events, examination of the r adiation therapy procedures followed, assessment of the causal relation of the event to radiotherapy by the therapists involved and by independent rev iewers, and the sums used for compensation. Results: Only 102 patients (about 0.1%) had filed a claim for financial com pensation, and in 18 (0.02%) cases the claim led to compensation. The mean national annual expenditure used for compensation was $35,200, and the sums paid in single cases ranged from $310 to $287,430 (median, $1,970). The ex penditure used for compensating adverse radiation events was about $4 per t reated patient, which is about 0.3% of all radiation therapy costs. Conclusions: The frequency of radiation therapy injuries that are financial ly compensated can remain low in an insurance-based judicial system where n o litigation or attorneys are involved. (C) 2001 Elsevier Science Inc.