Science.gov

Sample records for malpractice

  1. Research Malpractice.

    ERIC Educational Resources Information Center

    Chubin, Daryl E.

    1985-01-01

    Discusses the issue of academic fraud in the form of science research malpractice. Topic areas considered include: malpractice studies; causes of misconduct; normal and deviant research behavior; and distinguished research characteristics in production, reporting, dissemination, and evaluation. Consequences of malpractice and…

  2. Information Practice and Malpractice.

    ERIC Educational Resources Information Center

    Mintz, Anne P.

    1985-01-01

    Discussion of extent of information malpractice highlights role of information broker, copyrights and fees, special library problems, protection against malpractice, contracts, ready reference risks, education against malpractice, continuing education, personal values, malpractice insurance, information producers, Dun and Bradstreet versus…

  3. [Autoptically confirmed malpractice cases].

    PubMed

    Madea, Burkhard

    2008-01-01

    Claims of lethal medical malpractice cases in penal law are mostly dealt with by experts in forensic medicine since in lethal cases the autopsy is crucial for determining the cause of death. Knowledge of the cause of death, in turn, is the necessary basis of an expert opinion on negligence and the causality between negligence and cause of death. Compared to civil lawsuits filed for malpractice and cases dealt with at the arbitration committees of the medical councils penal lawsuits with 1500 to 2000 cases per year are of minor importance. Our own retrospective multicentre study on lawsuits filed for lethal cases of medical malpractice (based on autopsy findings of 4450 cases) revealed an annual increase in autopsies due to medical negligence from 3 to 6 hundred. Hospital doctors are more frequently affected by medical malpractice claims than private-practice physicians. However, the rate of confirmed medical malpractice cases is much higher for doctors in private practice. Although surgeons are most frequently charged with medical malpractice the rate of confirmed medical malpractice cases is comparatively low in surgery. Medico-legal autopsies in cases of alleged medical malpractice are often ordered by the public prosecutor because the manner of death was classified as unnatural or undetermined. Therefore the often-heard reproach that doctors frequently make mistakes and do their very best to hide them is not true. Thus, it has to be recommended that in a case of unexpected death associated with medical treatment the doctor in his own interest should classify the manner of death as undetermined. PMID:19213446

  4. Five myths of medical malpractice.

    PubMed

    Hyman, David A; Silver, Charles

    2013-01-01

    We identify five myths of medical malpractice that have wide currency in medical circles. The myths are as follows: (1) Malpractice crises are caused by spikes in medical malpractice litigation (ie, sudden rises in payouts and claim frequency), (2) the tort system delivers "jackpot justice," (3) physicians are one malpractice verdict away from bankruptcy, (4) physicians move to states that adopt damages caps, and (5) tort reform will lower health-care spending dramatically. We test each assertion against the available empirical evidence on the subject and conclude by identifying various nonmythical problems with the medical malpractice system. PMID:23276845

  5. Educational Malpractice in Britain.

    ERIC Educational Resources Information Center

    Khan, Anwar

    1996-01-01

    The English Court of Appeal found it difficult to establish standards of teachers' duty of care to establish the new tort of educational malpractice. However, the Court recently decided that claims based in negligence and alleging a failure on the part of teachers to identify and respond to the needs of certain learning-disabled students were not…

  6. The Malpractice Feud

    PubMed Central

    Obayuwana, Alphonsus O.

    1981-01-01

    The propriety of an immediate resolution of the malpractice feud rests on the strong thesis that law and medicine cannot be mutually exclusive if both shall continue to remain true to their traditional pledges. The common need to serve, primarily, the human being and, secondarily, the client or patient is a sufficient basis for much compromise. It should always be remembered that if there were no life there would be no rights to defend; nor would life be worth its very name, if legal rights were nil. This paper assesses some of the basic differences between law and medicine, identifies the historical and recent events that precipitated the current malpractice feud, and offers some ameliorative measures for resolving the uneasy state. PMID:7218368

  7. Information Practice and Malpractice. . .Do We Need Malpractice Insurance?

    ERIC Educational Resources Information Center

    Mintz, Anne P.

    1984-01-01

    Relates interview responses of seven information brokers on proper practice of information and extent of malpractice (e.g., industrial espionage, breaches of client or source confidentiality). Types of protection against malpractice--contracts, good educational background for entry-level positions, continuing education, personal values,…

  8. Medical Malpractice in Wuhan, China

    PubMed Central

    He, Fanggang; Li, Liliang; Bynum, Jennifer; Meng, Xiangzhi; Yan, Ping; Li, Ling; Liu, Liang

    2015-01-01

    Abstract Medical disputes in China are historically poorly documented. In particular, autopsy-based evaluation and its impact on medical malpractice claims remain largely unstudied. This study aims to document autopsy findings and medical malpractice in one of the largest cities of China, Wuhan, located in Hubei Province. A total of 519 autopsies were performed by the Department of Forensic Medicine, Wuhan University School of Medicine, Wuhan, China, over a 10-year period between 2004 and 2013. Of these cases, 190 (36.6%) were associated with medical malpractice claims. Joint evaluation by forensic pathologists and clinicians confirmed that 97 (51.1%) of the 190 claims were approved medical malpractice cases. The percentage of approved malpractice cases increased with patient age and varied according to medical setting, physician specialty, and organ system. The clinico-pathological diagnostic discrepancy was significantly different among various physician specialties (P = 0.031) and organ systems (P = 0.000). Of those cases involved in malpractice claims, aortic dissection, coronary heart disease, and acute respiratory infection were most common. Association between incorrect diagnosis and malpractice was significant (P = 0.001). This is the first report on China's medical malpractice and findings at autopsy which reflects the current state of health care services in one of the biggest cities in China. PMID:26559306

  9. Isaac Ray, malpractice defendant.

    PubMed

    Weiss, Kenneth J

    2013-01-01

    Isaac Ray (1807-1881), founder of American forensic psychiatry, produced his classic Treatise on the Medical Jurisprudence of Insanity in 1838. He did not begin to practice asylum medicine, however, until 1841, when he became superintendent of the Maine Insane Hospital in Augusta. There, he treated a patient, Isaac Hunt, who later sued him for malpractice and then self-published a book, Astounding Disclosures! Three Years in a Mad House, detailing alleged abuses suffered at the doctor's hands. This article recalls the incident and tracks Ray's reactions to it, the public's perception of asylums, and the tension between paternalistic asylum medicine and an emerging consumer-rights movement. PMID:24051591

  10. The malpractice liability crisis.

    PubMed

    Brenner, R James; Smith, John J

    2004-01-01

    Most medical malpractice cases are tried under the civil tort of negligence and are often triggered by adverse outcomes. These proceedings are aimed primarily at determining whether the conduct of a health care provider was reasonable. Such legal actions have mostly been subject to state jurisdiction. Increasingly, a number of factors are converging that are threatening the continued practice of medicine in some states and hence patients' access to care. These include higher amounts of monetary damages awarded to successful plaintiffs, consequent rising malpractice premiums, and the threatened economic insolvency of medical liability insurance carriers as a result of the broader economic downturn. The result is a serious public health dilemma. The national scope of the problem has been considered a crisis, which has prompted unprecedented federal legislative proposals directed toward providing new and preemptive parameters for capitated noneconomic damages, restrictions on certain civil procedures affecting lawsuit outcomes, and methods for attorney compensation, which some states have either not previously addressed or found unconstitutional. A survey of different states' problems and common issues should assist the reader in understanding the nature of the crisis and proposed solutions. PMID:17411514

  11. Malpractice: a perspective for physiotherapists.

    PubMed

    Osborne, P H

    1983-01-01

    A malpractice action--one aspect of the application of legal principles known as the law of torts--is a means whereby an injured party may seek compensation for harm caused by another party. The primary function of the law of torts is to determine whether the injurer is under a legal obligation to provide compensation to the injured for some loss due to negligent or faulty conduct. A malpractice action against a physiotherapist involves a plaintiff patient who has been injured, a defendant physiotherapist who stands accused of having caused an injury, and a determination as to whether or not the physiotherapist should bear the loss. In order to establish the liability in negligence, a plaintiff must satisfy four requirements: duty of care, breach of standard of care, causation, and damage. In this paper, a case study of malpractice action against a physiotherapist is outlined as an example of the type of arguments used by both the plaintiff and the defendant. Malpractice actions are an important means of controlling the standards of all health professionals. Because increasingly complicated technology and increased pressures on health care professionals are unlikely to reduce the number of accidents, the malpractice action will continue to provide recourse for those patients injured by lapses from the requisite standards of a profession. The threat of a malpractice action alone, however, is not enough to ensure high professional and ethical standards. PMID:10262976

  12. The Welfare Effects of Medical Malpractice Liability

    PubMed Central

    Lakdawalla, Darius N.; Seabury, Seth A.

    2013-01-01

    We use variation in the generosity of local juries to identify the causal impact of medical malpractice liability on social welfare. Growth in malpractice payments contributed at most 5 percentage points to the 33% total real growth in medical expenditures from 1990-2003. On the other hand, malpractice leads to modest mortality reductions; the value of these more than likely exceeds the costs of malpractice liability. Therefore, reducing malpractice liability is unlikely to have a major impact on health care spending, and unlikely to be cost-effective over conventionally accepted values of a statistical life. PMID:23526860

  13. Malpractice--a plaintiff's perspective.

    PubMed

    Zinman, E J

    1997-01-01

    Evaluation of malpractice litigation considers any breach of the fiduciary responsibility of the dentist, violations of the standard of care, comparative patient negligence, possible defenses such as honest mistake and causation. Issues in determining damages and mitigation are also discussed and a series of questions is offered concerning evidence for various dental procedures. Emerging trends in litigation include disregard of manufacturers' precautionary instructions in using new materials. PMID:9270217

  14. Some thoughts on dental malpractice.

    PubMed

    Morris, W O

    1976-06-01

    Malpractice litigation is not new nor is it limited to the professions of medicine and dentistry. The number of dental malpractice claims is increasing in many countries though the percentage of cases in which the patient succeeds remains constant at about ten to twelve per cent. In successful cases however the monetary compensation awarded has increased substantially in the past few years. The increasing use of multi-chair dental offices and the employment of more auxiliary workers in dental practice may have contributed to the increase in litigation as has the widespread dissemination of knowledge of patients' rights by newspapers and television. It is unfair to blame the legal profession for this increase. There is evidence that the 'contingent fee' arrangement between plantiff and lawyer contributes to the number of cases brought. It has been suggested that the existence of malpractice insurance may make the dentist less careful to prevent untoward effects of dental treatment. In many states the law will not permit punitive damages to be paid by the insurance agency nor are fines imposed for criminal activities covered. It is important that the dentist should be fully informed about the details of the cover which his insurance does in fact provide. PMID:1067226

  15. [Postvaccinal complication and medical malpractice law].

    PubMed

    Posa, A; Zierz, S

    2016-06-01

    The case report involves a 38-year-old female patient with muscular atrophy, paresis and sensory deficits in the right upper limb following several vaccinations. A legal dispute ensued over whether medical malpractice could have caused the neurological deficits. Medical malpractice could not be confirmed. Even vaccinations administered correctly can lead to neurological impairment. PMID:27483686

  16. Reflections on Malpractice of Reference Librarians.

    ERIC Educational Resources Information Center

    Wan, Ronglin

    1994-01-01

    Explores the legal ramifications of malpractice among librarians and the possible impact on services due to fear of being sued. Topics include identification of potential malpractice areas; cooperative electronic reference services; use of reference standards; insurance; contract; disclaimer; updating library collections; using Internet resources;…

  17. Perspectives on medical malpractice self-insurance financial reporting.

    PubMed

    Frese, Richard C; Kitchen, Patrick J

    2012-11-01

    Financial reporting of medical malpractice self-insurance is evolving. The Financial Accounting Standards Board Accounting Standards Codification Section 954-450-25 provides guidance for accounting and financial reporting for medical malpractice. Discounting of medical malpractice liabilities has been reassessed in recent years. Malpractice litigation reform efforts continue in several states. Accountable care organizations could increase the frequency of medical malpractice claims because of patients' heightened expectations regarding quality of care. PMID:23173362

  18. American medical malpractice litigation in historical perspective.

    PubMed

    Mohr, J C

    2000-04-01

    Medical malpractice and the problems associated with it remain an important issue in the US medical community. Yet relatively little information regarding the long-term history of malpractice litigation can be found in the literature. This article addresses 2 questions: (1) when and why did medical malpractice litigation originate in the United States and (2) what historical factors best explain its subsequent perpetuation and growth? Medical malpractice litigation appeared in the United States around 1840 for reasons specific to that period. Those reasons are discussed in the context of marketplace professionalism, an environment that provided few quality controls over medical practitioners. Medical malpractice litigation has since been sustained for a century and a half by an interacting combination of 6 principal factors. Three of these factors are medical: the innovative pressures on American medicine, the spread of uniform standards, and the advent of medical malpractice liability insurance. Three are legal factors: contingent fees, citizen juries, and the nature of tort pleading in the United States. Knowledge of these historical factors may prove useful to those seeking to reform the current medical malpractice litigation system. PMID:10755500

  19. The unrealized potential of malpractice arbitration.

    PubMed

    Metzloff, T B

    1997-01-01

    Although the use of arbitration in the commercial arena has increased tremendously in recent years, there has been a reluctance to adopt arbitration of medical malpractice claims in place of litigation. After discussing the benefits of arbitration in medical malpractice cases, Professor Metzloff examines why the use of arbitration has not become predominant, discussing such factors as judicial hostility, failure of state statutes designed to encourage arbitration, and lack of hard evidence that arbitration works. Professor Metzloff then explores the future of arbitration in medical malpractice cases, citing examples from his own work experience with Duke Law School's Private Adjudication Center, and discusses attributes which would make malpractice arbitration successful in the future. PMID:10164669

  20. How profitable is medical malpractice insurance?

    PubMed

    Hassan, M

    1991-01-01

    High medical malpractice insurance premiums charged to physicians have created the perception of a crisis. Some researchers have expressed the concern that medical malpractice insurance companies are making excessive profits. In this paper I compute the actual and allowable normal underwriting profit rates in medical malpractice, as well as in other liability lines, for six large insurance companies. These allowable, normal profit rates are then compared with actual profit rates to evaluate the relative profitability of each line of insurance. Data from 1978 through 1986 show that medical malpractice insurance ranked medium in underwriting profitability compared with other lines of insurance, and during 1985-86 it was the least profitable insurance business. PMID:1826500

  1. THE CALIFORNIA MEDICAL MALPRACTICE PICTURE.

    PubMed

    RUBSAMEN, D S

    1963-11-01

    The California physician's steadily increasing risk of legal liability poses a basic question: Will he ultimately wind up a guarantor of results, carrying a great burden of malpractice insurance in order to pay for every untoward result of medical treatment? This alarming prospect is the result of many years of judicial (and therefore lay) speculation on the legal significance of the injury which brings the patient into court. Does it look as though this injury probably is associated with medical negligence? If so, let the doctor explain. And the explanation must be very complete. The legal instrument which thus reverses the traditional requirements of proof, permitting the patient-plaintiff to remain silent while the doctor-defendant must exculpate himself, is an evidentiary doctrine called res ipsa loquitur-the thing speaks for itself. The application of the doctrine relieves the patient-plaintiff of the necessity of producing an expert witness to point the finger and say, "The medical conduct that produced this injury was sub-standard." The increased use of the doctrine reflects a judicial conviction that in many parts of California physicians refuse to testify for the patient-plaintiff regardless of the merit to his case.A recent California Supreme Court decision suggests that the Court is not unaware of the adverse social consequences implicit in the irrational expansion of the physician's risk of legal liability. But a reversal of this trend would seem to be contingent on positive conduct from the medical profession in California-conduct demonstrating that no meritorious patient-plaintiff will fail in his malpractice lawsuit for lack of an expert medical witness. PMID:14081771

  2. Examination Management and Examination Malpractice: The Nexus

    ERIC Educational Resources Information Center

    Ogunji, James A.

    2011-01-01

    Examination malpractice or cheating has become a global phenomenon. In different countries of the world today, developed and developing, academic dishonesty especially cheating in examinations has heightened and taken frightening dimension. In many countries of the world this phenomenon has become a serious matter of concern that has left many…

  3. Medical Malpractice: The Experience in Italy

    PubMed Central

    2008-01-01

    At the present time, legal actions against physicians in Italy number about 15,000 per year, and hospitals spend over €10 billion (~US$15.5 billion) to compensate patients injured from therapeutic and diagnostic errors. In a survey summary issued by the Italian Court for the Rights of the Patient, between 1996 and 2000 orthopaedic surgery was the highest-ranked specialty for the number of complaints alleging medical malpractice. Today among European countries, Italy has the highest number of physicians subject to criminal proceedings related to medical malpractice, a fact that is profoundly changing physicians’ approach to medical practice. The national health system has paid increasingly higher insurance premiums and is having difficulty finding insurance companies willing to bear the risk of monetary claims alleging medical malpractice. Healthcare costs will likely worsen as Italian physicians increasingly practice defensive medicine, thereby overutilizing resources with the goal of documenting diligence, prudence, and skill as defenses against potential litigation, rather than aimed at any patient benefit. To reduce the practice of defensive medicine and healthcare costs, a possible solution could be the introduction of an extrajudicial litigation resolution, as in other civil law countries, and a reform of the Italian judicial system on matters of medical malpractice litigation. PMID:18985423

  4. [Aspects of communication regarding medical malpractice suits].

    PubMed

    Pilling, János; Erdélyi, Kamilla

    2016-04-24

    Due to problems experienced in health care, there is an increased amount of malpractice suits nowadays. Nevertheless, some physicians are more likely to be sued, or more frequently sued, than others. Numerous studies indicate that this phenomenon fundamentally results from a lack of interpersonal and communication skills on the part of the sued doctor, namely, deficiencies in questioning the patient, listening, conveying information, etc. Communication is of pivotal importance in patient care vis-à-vis medical errors as well. The majority of physicians aim to conceal the error, albeit this may lead to further deterioration of the patient's condition. In institutions where open communication regarding errors was introduced within the medical team and toward the patient and their family alike, the number of malpractice suits decreased. It is crucial to establish a means of support for doctors, and to promote communication trainings, as well as a supportive legal environment. PMID:27084438

  5. Medical malpractice arbitration: a primer for Texas physicians.

    PubMed

    Fraser, J J

    1997-01-01

    The medical malpractice crises and ensuing tort reform efforts, including methods of alternative dispute resolution (ADR), are generally reviewed. Arbitration in the context of medical malpractice is examined from the perspective of other states' experiences. Michigan has one of the nation's oldest medical malpractice arbitration programs, but it suffers from underutilization. California's experience derives from the use of arbitration in the managed care setting. While Texas has statutory provisions for medical malpractice arbitration, in light of public policy favoring ADR, the statute could be perceived as antipublic policy, resulting in underuse. The National Practitioner Data Bank also serves to discourage physician participation. Policy options are offered to address these concerns. PMID:9210844

  6. [Liability for medical malpractice: an economic approach].

    PubMed

    Carles, M

    2003-01-01

    In recent years, changes in the organization of healthcare institutions and the increased number of medical malpractice claims have revealed the need to study the concept of medical responsibility and the repercussion of these changes on healthcare provision. To date, discussion has focussed on legal aspects and economic implications have been largely ignored.The present article reviews studies that have performed an economic analysis the subject. Firstly, we examine studies that gradually introduce the concepts of uncertainty, risk aversion and moral hazard. Secondly, in the healthcare environment, we pay particular attention to models that include new arguments on professionals' objective duties or to bargaining models when there is asymmetric information. Finally, we consider the medical malpractice insurance market and investigate how reputation and the possibilities of exercising defensive medicine influence healthcare provision. Our analysis suggests that, due to the characteristics of the healthcare market, the models proposed by the economy of information are very useful for performing economic analyses of liability in medical malpractice. However, alternative hypotheses also need to be formulated so that these models can be adapted to the specific characteristics of different health systems. PMID:14670257

  7. Actuarial considerations of medical malpractice evaluations in M&As.

    PubMed

    Frese, Richard C

    2014-11-01

    To best project an actuarial estimate for medical malpractice exposure for a merger and acquisition, a organization's leaders should consider the following factors, among others: How to support an unbiased actuarial estimation. Experience of the actuary. The full picture of the organization's malpractice coverage. The potential for future loss development. Frequency and severity trends. PMID:25647911

  8. 45 CFR 60.7 - Reporting medical malpractice payments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... amount specified at 42 CFR 1003.103(c). (d) Interpretation of information. A payment in settlement of a... 45 Public Welfare 1 2014-10-01 2014-10-01 false Reporting medical malpractice payments. 60.7... PRACTITIONER DATA BANK Reporting of Information § 60.7 Reporting medical malpractice payments. (a) Who...

  9. 45 CFR 60.7 - Reporting medical malpractice payments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... amount specified at 42 CFR 1003.103(c). (d) Interpretation of information. A payment in settlement of a... 45 Public Welfare 1 2012-10-01 2012-10-01 false Reporting medical malpractice payments. 60.7... Information § 60.7 Reporting medical malpractice payments. (a) Who must report. Each entity, including...

  10. Medical Malpractice: A Framework for Action. Report to Congressional Requesters.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC. Div. of Human Resources.

    At the request of Senator John Heinz and Representative John Edward Porter, the General Accounting Office (GAO) assessed the nature of increases in the costs of medical malpractice insurance over the years, how various states have tried to deal with medical malpractice problems, and what federal and state actions may be warranted. This report…

  11. The Regulation of Medical Malpractice in Japan

    PubMed Central

    2008-01-01

    How Japanese legal and social institutions handle medical errors is little known outside Japan. For almost all of the 20th century, a paternalistic paradigm prevailed. Characteristics of the legal environment affecting Japanese medicine included few attorneys handling medical cases, low litigation rates, long delays, predictable damage awards, and low-cost malpractice insurance. However, transparency principles have gained traction and public concern over medical errors has intensified. Recent legal developments include courts’ adoption of a less deferential standard of informed consent; increases in the numbers of malpractice claims and of practicing attorneys; more efficient claims handling by specialist judges and speedier trials; and highly publicized criminal prosecutions of medical personnel. The health ministry is undertaking a noteworthy “model project” to enlist impartial specialists in investigation and analysis of possible iatrogenic hospital deaths to regain public trust in medicine’s capacity to assess its mistakes honestly and to improve patient safety and has proposed a nationwide peer review system based on the project’s methods. PMID:19002542

  12. Damages Caps in Medical Malpractice Cases

    PubMed Central

    Nelson, Leonard J; Morrisey, Michael A; Kilgore, Meredith L

    2007-01-01

    This article reviews the empirical literature on the effects of damages caps and concludes that the better-designed studies show that damages caps reduce liability insurance premiums. The effects of damages caps on defensive medicine, physicians’ location decisions, and the cost of health care to consumers are less clear. The only study of whether consumers benefit from lower health insurance premiums as a result of damages caps found no impact. Some state courts have based decisions declaring damages caps legislation unconstitutional on the lack of evidence of their effectiveness, thereby ignoring the findings of conflicting research studies or discounting their relevance. Although courts should be cautious in rejecting empirical evidence that caps are effective, legislators should consider whether they benefit consumers enough to justify limiting tort recoveries for those most seriously injured by malpractice. PMID:17517115

  13. The Expert Witness in Medical Malpractice Litigation

    PubMed Central

    2008-01-01

    Physicians may find serving as an expert witness to be interesting, intellectually stimulating, and financially beneficial. However, potential expert witnesses should be aware of the increased legal scrutiny being applied to expert witness testimony in medical malpractice litigation. In the past, expert witnesses received absolute immunity from civil litigation regarding their testimony. This is no longer the case. Expert witnesses may be subject to disciplinary sanctions from professional organizations and state medical boards. In addition, emerging case law is defining the legal duty owed by the expert witness to the litigating parties. Orthopaedic surgeons who serve as expert witnesses should be familiar with the relevant Standards of Professionalism issued by the American Academy of Orthopaedic Surgeons. PMID:19052827

  14. Malpractice claims analysis yields widely applicable principles.

    PubMed

    Waldman, J D; Spector, R A

    2003-01-01

    We received 50 claims of medical negligence in pediatric cardiology. From the analysis, patterns were identified and recommendations for improvement were found that apply generally to healthcare. Less than half (38%) of the claims were found to be medically meritorious. The impression of substandard care was often (7/50) created by an erroneous attribution of cause of death at autopsy. Both structured learning for caregivers and education of the public will reduce the frequency of malpractice forms-both valid and frivolous. Caregivers should document more effectively. The current tort system neither deters nor compensates as it was intended. The assignment of blame to a single individual is usually not in concert with the reality of modern medicine. Good health care is not a passive behavior; active participation by the public is required. PMID:12360392

  15. China's criminal penalty for medical malpractice: too lenient or not?

    PubMed

    Zhu, Sun; Li, Lei; Li, Yuanchao

    2011-05-01

    Although China had greatly improved its health and medical system, the contradiction between arduous medical tasks and insufficient health resources has not been fundamentally resolved. This contradiction raised a large number of legal issues in medical industry. Literatures about these issues are usually published in legal journal, and are not easy accessible to clinicians. We thus provide clinicians a brief introduction to the legal liability of medical malpractice, and describe the debate about the punishment setting of China's medical malpractice crime in detail. Considering the complexity and humanitarian nature of medical practice, legislators set a relative lenient punishment system for medical malpractice crime. But the "aggravating" supporter argued that, judging from criminal jurisprudence, only serious irresponsible medical personnel might face criminal penalty, so severe penalty was not conflict with the humanitarian nature of medical work. They also deemed that, too lenient penalties of this crime had broken the internal harmony of Criminal Law, and violated the basic principles of law. The opponents believed that: although the statutory penalty for medical malpractice crime seemed lenient, the declared sentence was more severe than surrounding areas. And, too severe penalties would not only aggravate the shortage of Chinese medical personnel, but also deteriorate the unbalanced physician-patient relationship. So, they did not agree enhancing the penalty of medical malpractice crime. We propose to add disqualification to the punishment setting of medical malpractice crime, reform the health system more thoroughly. We also hope Chinese governments could encourage medicolegal research. And, from the viewpoint of risk management in health care, we emphasize the role of Medical Professional Liability Insurance system as a powerful tool to prevent medical malpractice. PMID:21269864

  16. Malpractice aspects of medically prescribed exercise.

    PubMed

    Sagall, E L

    1975-01-01

    Stress exercise testing of suspected or known cardiacs and medical recommendations to patients to undertake physical fitness conditioning exercise programs constitute medical treatment in the eyes of the law and as such render the prescribing and supervising physicians legally responsible for harmful consequences to the patient to the same degree and under the same legal principles applicable for other medically prescribed diagnostic and therapeutic procedures. The physician who employs a stress exercise test or who recommends that a patient engage in exercise as part of a prophylactic, rehabilitative, or therapeutic program must be alert to those aspects of his recommendations which possess potential malpractice hazards. In particular, he should direct his attention to recognized indications and contraindications of exercise test and exercise programs. Furthermore, he should perform an adequate preexercise screening examination and he must make sure that the exercise is properly monitored; that it is immediately terminated upon onset of signs or symptoms of impending serious reactions; that adequate advance preparations have been made for the treatment of foreseeable emergencies, particularly those requiring cardiopulmonary resuscitation and advanced life support; and that such treatment is in full accord with generally accepted and proper medical standards. Finally, the physician must make certain that he adequately informs the patient of the potential risks and hazards associated with exercise stress testing and exercise programs so that the consent to such procedures can be classified legally as valid and "informed". PMID:1221239

  17. Preinduction activities: a closed malpractice claims perspective.

    PubMed

    Moody, M L; Kremer, M J

    2001-12-01

    The American Association of Nurse Anesthetists Foundation conducts an ongoing study of closed malpractice claims that involve nurse anesthetists. A team of 8 CRNA researchers has to date investigated 223 closed claim files from the St Paul Fire and Marine Insurance Company. Research findings have demonstrated that failure to provide appropriate anesthesia care relative to the Scope and Standards for Nurse Anesthesia Practice was significantly associated with adverse anesthetic outcomes. Claims that involved inadequate preinduction activities (n = 22) were analyzed in the context of their compliance with published standards of care. The largest group of claims in this analysis (59%) involved damaging respiratory events, 28% entailed damaging cardiovascular events, and the principal issue in 13% of these claims involved failure to seek available information such as laboratory studies on the medical record. The most prevalent occurrence with damaging respiratory events was undocumented airway assessment in 27% of the claims. In 55% of these claims, the medical history was not completely documented. The surgical procedure categories were general surgical (32%), obstetrical (27%), otolaryngogical (23%), orthopedic (14%), and gynecologic (5%). The involved standards of care are reviewed, and recommendations are made regarding consistent completion of preinduction activities. PMID:11837148

  18. [Radiological considerations of malpractice in dentistry].

    PubMed

    Bianchi, S D; Lojacono, A; Balma, E

    1996-11-01

    Several branches of competence are needed to evaluate malpractice in dentistry: first a complete case history, secondly careful clinical observation and finally a correct procedure of radiographic documentation. This latter is able to prove existence of the treatment and its evolution, moreover it shows the bone, the dental components underneath the surface and the treatment becomes appraisable by different observers. In restorative dentistry, radiological findings allow us to demonstrate overcontoured restorations in approximal sites and, if necessary, identify the biological width. In endodontics the insufficient filling or the overfilling of the root channel can be demonstrated along with the material used for the filling and the presence of fractured instruments inside the channel. In prosthodontics, on the other hand, the quality of the abutments, fractured roots and/or prosthesis, symptoms of inadequate charge on the bone and overcontours with the subsequent periodontal damage can be seen. In orthodontics one can assess the appearance of infrabone pockets, reabsorptions and horizontal recessions. In extractive surgery it is again possible to identify through radiographic documentation small root fragments in the maxillary sinus (possible sinusitis associated) and maxillary fractures as a consequence of extractions. In the field of implantology, damage to noble structures due to inadequate case planning can be highlighted. PMID:9026700

  19. Surgical malpractice in California: res judicata.

    PubMed

    Barthel, Erik R; Stabile, Bruce E; Plurad, David; Kim, Dennis; Neville, Angela; Bricker, Scott; Putnam, Brant; Bongard, Fred

    2014-10-01

    Medical negligence claims are of increasing concern to surgeons. Although noneconomic damage awards in California are limited by the Medical Injury Compensation Reform Act (MICRA) law to $250,000, the total amount of such settlements can increase significantly based on claims for economic damages. We reviewed negligence litigation involving California surgeons to determine outcomes and monetary awards through retrospective review of surgical malpractice cases published in a legal journal. This review was limited to actions involving general surgeons. Such litigation was voluntarily reported by either defense's or plaintiff's counsel at the conclusion of the litigation. Data reviewed included alleged damages incurred by the plaintiff; plaintiff's pretrial settlement demand, plaintiff or defense verdict, use of alternate means of resolution such as arbitration or mediation, and total monetary award to the plaintiff. A total of 69 cases were reported over a 20-month period: 32 (46%) were plaintiffs' verdicts, whereas 37 (54%) were in favor of the surgeon. Only 10 (31%) of the plaintiff verdicts were by jury trial, whereas the rest were settled by pretrial agreement, mediation, or arbitration. Of cases settled by alternate dispute resolution, the median settlement was $820,000 (n = 22) compared with a median jury trial award of $300,000 (n = 10). PMID:25264649

  20. Physician spending and subsequent risk of malpractice claims: observational study

    PubMed Central

    Schoemaker, Lena; Bhattacharya, Jay; Seabury, Seth A

    2015-01-01

    Study question Is a higher use of resources by physicians associated with a reduced risk of malpractice claims? Methods Using data on nearly all admissions to acute care hospitals in Florida during 2000-09 linked to malpractice history of the attending physician, this study investigated whether physicians in seven specialties with higher average hospital charges in a year were less likely to face an allegation of malpractice in the following year, adjusting for patient characteristics, comorbidities, and diagnosis. To provide clinical context, the study focused on obstetrics, where the choice of caesarean deliveries are suggested to be influenced by defensive medicine, and whether obstetricians with higher adjusted caesarean rates in a year had fewer alleged malpractice incidents the following year. Study answer and limitations The data included 24 637 physicians, 154 725 physician years, and 18 352 391 hospital admissions; 4342 malpractice claims were made against physicians (2.8% per physician year). Across specialties, greater average spending by physicians was associated with reduced risk of incurring a malpractice claim. For example, among internists, the probability of experiencing an alleged malpractice incident in the following year ranged from 1.5% (95% confidence interval 1.2% to 1.7%) in the bottom spending fifth ($19 725 (£12 800; €17 400) per hospital admission) to 0.3% (0.2% to 0.5%) in the top fifth ($39 379 per hospital admission). In six of the specialties, a greater use of resources was associated with statistically significantly lower subsequent rates of alleged malpractice incidents. A principal limitation of this study is that information on illness severity was lacking. It is also uncertain whether higher spending is defensively motivated. What this study adds Within specialty and after adjustment for patient characteristics, higher resource use by physicians is associated with fewer malpractice claims. Funding, competing

  1. Effects of Health Information Technology on Malpractice Insurance Premiums

    PubMed Central

    Kim, Hye Yeong

    2015-01-01

    Objectives The widespread adoption of health information technology (IT) will help contain health care costs by decreasing inefficiencies in healthcare delivery. Theoretically, health IT could lower hospitals' malpractice insurance premiums (MIPs) and improve the quality of care by reducing the number and size of malpractice. This study examines the relationship between health IT investment and MIP using California hospital data from 2006 to 2007. Methods To examine the effect of hospital IT on malpractice insurance expense, a generalized estimating equation (GEE) was employed. Results It was found that health IT investment was not negatively associated with MIP. Health IT was reported to reduce medical error and improve efficiency. Thus, it may reduce malpractice claims from patients, which will reduce malpractice insurance expenses for hospitals. However, health IT adoption could lead to increases in MIPs. For example, we expect increases in MIPs of about 1.2% and 1.5%, respectively, when health IT and labor increase by 10%. Conclusions This study examined the effect of health IT investment on MIPs controlling other hospital and market, and volume characteristics. Against our expectation, we found that health IT investment was not negatively associated with MIP. There may be some possible reasons that the real effect of health IT on MIPs was not observed; barriers including communication problems among health ITs, shorter sample period, lower IT investment, and lack of a quality of care measure as a moderating variable. PMID:25995964

  2. Medical Malpractice: Reform for Today's Patients and Clinicians.

    PubMed

    Stamm, Jason A; Korzick, Karen A; Beech, Kristen; Wood, Kenneth E

    2016-01-01

    The current system of medical malpractice does a poor job of serving the best interests of physicians or patients. Economic and societal forces are shifting the nature of health care from the individual physician to a system of health care professionals, characterized by accountable care organizations. In particular, more physicians are employed, quality and outcomes are routinely measured, and reimbursement is moving to value-based purchasing. Medical malpractice likewise needs to transition to a new model that is consistent with the modern era of patient-centered care. Collective accountability, the concept that patient care is the responsibility of all the members of the health care organization, requires malpractice reform that reflects a systems-based practice of medicine. Enterprise liability, coupled with medical error communication and resolution programs, provides the legal framework necessary for the patient-centered practice of medicine in today's environment. PMID:26391747

  3. A new resource for managing malpractice risks in managed care.

    PubMed

    Bursztajn, H; Brodsky, A

    1996-10-14

    The risk of malpractice liability faced by physicians is exacerbated by third-party intrusions such as those encountered in today's managed care environment. The likelihood that a malpractice action will be brought is increased by the interaction among patients, families, or physicians who are at high risk for litigation and situations (eg, denial of treatment benefits by the managed care organization) that create adversity. To prevent the ready translation of resource adversity into an adversarial physician-patient-family relationship, a forensic psychiatric consultation is recommended. PMID:8862097

  4. Malpractice in Radiology: What Should You Worry About?

    PubMed Central

    Cannavale, Alessandro; Santoni, Mariangela; Mancarella, Paola; Passariello, Roberto; Arbarello, Paolo

    2013-01-01

    Over recent years the professional role of the radiologist has been evolved due to the increasing involvement in the clinical management of the patient. Radiologists have thus been increasingly charged by new duties and liabilities, exposing them to higher risks of legal claims made against them. Malpractice lawsuits in radiology are commonly related to inappropriate medical care or to the poor physician-patient relationship. In the present paper, we provide overview of the basic principles of the medical malpractice law and the main legal issues and causes of legal actions against diagnostic and interventional radiologists. We also address some issues to help radiologists to reduce risks and consequences of malpractice lawsuits. These include (1) following the standard of care to the best of their ability, (2) cautious use of off-label devices, (3) better communication skills among healthcare workers and with the patient, and (4) ensuring being covered by adequate malpractice insurance. Lastly, we described definitions of some medicolegal terms and concepts that are thought to be useful for radiologists to know. PMID:23691316

  5. Let's make a deal: trading malpractice reform for health reform.

    PubMed

    Sage, William M; Hyman, David A

    2014-01-01

    Physician leadership is required to improve the efficiency and reliability of the US health care system, but many physicians remain lukewarm about the changes needed to attain these goals. Malpractice liability-a sore spot for decades-may exacerbate physician resistance. The politics of malpractice have become so lawyer-centric that recognizing the availability of broader gains from trade in tort reform is an important insight for health policy makers. To obtain relief from malpractice liability, physicians may be willing to accept other policy changes that more directly improve access to care and reduce costs. For example, the American Medical Association might broker an agreement between health reform proponents and physicians to enact federal legislation that limits malpractice liability and simultaneously restructures fee-for-service payment, heightens transparency regarding the quality and cost of health care services, and expands practice privileges for other health professionals. There are also reasons to believe that tort reform can make ongoing health care delivery reforms work better, in addition to buttressing health reform efforts that might otherwise fail politically. PMID:24395935

  6. Educational Malpractice: American Trends and Implications for Australian Schools.

    ERIC Educational Resources Information Center

    Whalley, P. W. F.

    1986-01-01

    Educational malpractice developments in America may affect legal accountability of Australian teachers and educational institutions. This paper discusses significant American cases and commentators' observations in the context of the Australian legal system. Teachers should embrace their widening legal responsibility in order to advance…

  7. Mainstreaming, Malpractice, and New Roles for the School Nurse.

    ERIC Educational Resources Information Center

    Jenkins, Ruth L.

    1983-01-01

    Mainstreaming of handicapped children who need unique nursing procedures, high caseloads, and decreasing numbers of school nurses have created an environment of potential harm to handicapped children. Educators without adequate training may assume treatment of these children, creating potential for malpractice lawsuits. Revised perceptions of…

  8. Malpractice reform in the 1990s: past disappointments, future success?

    PubMed

    Kinney, E D

    1995-01-01

    State governments, the federal government, interest groups, and researchers have proposed various approaches to reform the malpractice system. Malpractice reforms fall into two generations. First-generation reforms are those adopted by states beginning in the 1970s chiefly to reduce claim frequency and severity and thereby improve the malpractice system primarily from the perspective of providers and insurers. Scholars and interested constituencies developed second-generation reforms, such as use of medical practice guidelines to set the standard of care, various no-fault approaches, enterprise liability, mandated alternative dispute resolution, and scheduling damages, to streamline the adjudication and compensation system from the perspective of claimants and providers. Research indicates that first-generation reforms have not been very effective in achieving the compensation and deterrence goals of tort, whereas second-generation reforms hold greater promise of doing so. This analysis of state and federal legislation indicates that states, and more recently Congress, have been reluctant to adopt second-generation reforms but continue to promote and/or adopt first-generation reforms. The strength of the provider lobby, concerns of health care reformers about the relationship between defensive medicine and health system costs, and lack of an organized consumer force for second-generation malpractice reform are important explanations of why the states and Congress have not embraced second-generation reforms. Furthermore, federal and state legislative interest in second-generation reforms, although never high, is waning in the current health care reform debate. PMID:7738324

  9. Contingent fees in medical malpractice litigation - a qualitative assessment.

    PubMed

    Ottensmeyer, D J; Smith, H L; Porter, J

    1983-08-01

    The medical profession has experienced high liability insurance premiums accompanied by widespread use of contingent fees in medical malpractice litigation. It is worthwhile, therefore, to assess qualitatively the merits of contingent fees, the evidence suggesting that they are associated with unjustified litigation and their implications for the medical and legal professions. PMID:6636743

  10. [Current issues in legal cases of compensation for healthcare malpractice].

    PubMed

    Heiner, Tamás; Barzó, Tímea

    2014-09-21

    The number of medical malpractice lawsuits filed each year in Hungary has considerably increased since 1990. The judicial decisions and practices on determining and awarding wrongful damages recoverable for medical malpractices in the Hungarian civil law have been developing for decades. In the meantime, a new Hungarian Civil Code (Act V of 2013) has entered into force, which among others, necessitates the revaluation of assessment of damages recoverable for medical malpractices. There are two main areas where fundamental changes have been introduced, which may significantly affect the outcome of medical malpractice lawsuits in the future. In the early stage of medical malpractices it was unclear whether the courts had to consider either the contractual relationship between patients and healthcare providers (contractual liability) or general codal articles on damages arising from non-contractual liability/torts (delictual liability) in their judgement delivered in the cases. Both the theoretical and practical experience of the last ten years shows that healthcare services agreements are concluded between healthcare providers and patients with the aim and intention to provide appropriate professional healthcare services to patients, which meet patients' interests and wishes. The medical service is violated if it fails to meet patients' interests and wishes as well as the objectives of the agreement. Since the new legislation implies a stricter liability for damages in the case of breach of contract and stricter rules for exempting the party in breach from compensation obligations, the opportunities to exempt healthcare providers from these obligations have become limited compared to previous regulations. This modification, which was aimed at further integrating the established judicial practices into legislation, stipulates the application of the rules for liability for damages resulting from medical malpractice in non-contractual situations. This paper analyses

  11. Medical malpractice among physicians: who will be sued and who will pay?

    PubMed

    Weycker, D A; Jensen, G A

    2000-09-01

    This paper examines whether a physician's future claims of medical malpractice are predictable from information on the physician's recent claims history, training credentials, practice characteristics, and demographics. Data on the medical malpractice experience of 8,733 Michigan physicians between 1980 and 1989 is analyzed. We find strong evidence of repetition over time regarding who was sued and who paid claims. The worse a physician's malpractice litigation record during 1980-1984, the worse was his record during 1985-1989. Training credentials were also highly predictive of future malpractice experience. Physicians trained at lower ranked medical schools or who went through lower-ranked residency programs faced higher odds of developing adverse malpractice records, even after controlling for their previous litigation record. Growing internet access to information on these characteristics will help inform prospective patients if they wish to avoid physicians likely to be sued and likely to make payments in the future for malpractice. PMID:11105413

  12. An Introduction to Medical Malpractice in the United States

    PubMed Central

    2008-01-01

    Medical malpractice law in the United States is derived from English common law, and was developed by rulings in various state courts. Medical malpractice lawsuits are a relatively common occurrence in the United States. The legal system is designed to encourage extensive discovery and negotiations between adversarial parties with the goal of resolving the dispute without going to jury trial. The injured patient must show that the physician acted negligently in rendering care, and that such negligence resulted in injury. To do so, four legal elements must be proven: (1) a professional duty owed to the patient; (2) breach of such duty; (3) injury caused by the breach; and (4) resulting damages. Money damages, if awarded, typically take into account both actual economic loss and noneconomic loss, such as pain and suffering. PMID:19034593

  13. Clinical psychopharmacology and medical malpractice: the four Ds.

    PubMed

    Preskorn, Sheldon H

    2014-09-01

    The four Ds of medical malpractice are duty, dereliction (negligence or deviation from the standard of care), damages, and direct cause. Each of these four elements must be proved to have been present, based on a preponderance of the evidence, for malpractice to be found. The principles of psychopharmacology and the information in the package insert for a drug often play a central role in deciding whether dereliction and direct cause for damages were or were not applicable in a particular case. The author uses data from two cases in which patients were inadvertently fatally poisoned by medication to illustrate two ways in which such information can affect the outcome. In one case, the clinician should have known that he was giving a toxic dose to the patient, whereas that was not true in the other case. PMID:25226197

  14. Initiation of medical malpractice suits: a conceptualization and test.

    PubMed

    Penchansky, R; Macnee, C

    1994-08-01

    Despite the concern with medical malpractice suits and research about them, little is known about why some perceived injuries lead to claims of malpractice while other similar injuries do not. This paper presents a conceptualization and hypotheses regarding the determinants of an injury or perceived injury leading to suit. The conceptualization and hypotheses are tested using information collected from 113 medical malpractice plaintiffs' attorneys in three states. A series of proposed concepts prove useful in explaining patient willingness to pursue a suit as well as the plaintiff's success and award size. These are concepts of anger, reluctance to sue, patient and provider worthiness, affinity, economic burden and potential for compensation. Specific attributes of the injury, the patient, the provider, and the doctor-patient relationship relate to these concepts. Injury and doctor-patient relationship attributes prove more important than patient or provider attributes. However, the reported impact of the attributes of the patient and physician on plaintiff success and award is high and suggests that the impact of "non-relevant" variables in the medical malpractice process. Doctor-patient relationship variables hypothesized to reflect affinity are reported to be important in reducing patient willingness to pursue a case; and, certain populations, such as minorities, elderly, foreign-born, are perceived to have a reluctance to sue. The effect of specific characteristics of the patient, the doctor, the injury and the patient-doctor relationship on patient reaction and on disposition is reported, as well as evidence that relates to the validity of the overall conceptualization. PMID:8057697

  15. Absence of physician recourse in malpractice litigation--malicious prosecution.

    PubMed

    Spector, Richard A

    2002-01-01

    The courts are protective of the plaintiff's rights under law to seek redress in the court by placing the facts of their allegations before a judge or jury. Because the avenue to the court is through representation and advocacy, the courts equally are protective of the agent of that representation, the attorney. To date, no physician who has been sued for medical malpractice in Louisiana has brought a successful malicious prosecution claim against the plaintiff or his attorney. PMID:12014457

  16. Management of Re-Occurring Cases of Examination Malpractice in Plateau State Collage of Health Technology Pankshin, Nigeria

    ERIC Educational Resources Information Center

    Dusu, Paul Bot; Gotan, Anthony; Deshi, Jummai M.; Gambo, Barashe

    2016-01-01

    Nigeria's educational system is gradually degenerating, as the sanctity of education process has been affected by malpractice. The purpose of this paper was to assess re-occurring incidence of examination malpractice in Plateau State College of Health Technology Pankshin, Nigeria. It looked at cases of examination malpractice and students'…

  17. Students Perception of the Role of Parents in Academia and Continued Examination Malpractice

    ERIC Educational Resources Information Center

    Ofoegbu, Felicia I.

    2009-01-01

    The formal school system is bedeviled with many problems some of which have defied satisfactory solutions. One major problem plaguing the Nigerian education system is large scale examination malpractice. The aim of the study is to find out the role of parents in academia in perpetrating and perpetuating examination malpractice. The population of…

  18. Correlates of Examination Malpractice among Secondary School Students in Oyo State, Nigeria

    ERIC Educational Resources Information Center

    Animasahun, R. A.; Ogunniran, J. O.

    2014-01-01

    The purpose of this study is to investigate the correlates of examination malpractice among secondary school students in Oyo State, Nigeria. The instrument used for the study was tagged Predisposing Factors towards Examination Malpractice Questionnaire (PFTEMQ). The instrument was administered to 300 students randomly selected from 20 multi staged…

  19. Crisis? What crisis. Five states not experiencing crushing malpractice premium increases.

    PubMed

    Schneck, Lisa H

    2002-01-01

    Five states not experiencing crushing malpractice premium increases. As daily headlines across the nation advertise the plight of physicians, medical practices and hospitals struggling to cope with soaring medical malpractice costs, five states--California, Colorado, Indiana, New Mexico and Wisconsin--have established countermeasures that are keeping them on the sidelines of the crisis. PMID:12500748

  20. External Quality Assurance in Higher Education: How Can It Address Corruption and Other Malpractices?

    ERIC Educational Resources Information Center

    Martin, Michaela

    2016-01-01

    Corruption and malpractices in higher education are today a major concern in nearly all higher education systems worldwide. It is a multifaceted phenomenon and has become particularly visible in the academic domain. This paper represents an exploration of the possible role that quality assurance can play in addressing corruption and malpractices.…

  1. Factor Responsible for Examination Malpractices as Expressed by Undergraduates of Osun State University, Nigeria

    ERIC Educational Resources Information Center

    Yusuf; Adeoti, Florence; Olufunke, Yinusa Rasheedat; Ruth, Bamgbose Oluwayemisi

    2015-01-01

    The study investigated perception of undergraduates on factors responsible for examination malpractices. The study is a descriptive study; a sample of two hundred (200) undergraduates formed the participants for the study. A questionnaire titled: "Factor responsible for examination malpractices was used for data collection. Data collected…

  2. Medical Malpractice in Wuhan, China: A 10-Year Autopsy-Based Single-Center Study.

    PubMed

    He, Fanggang; Li, Liliang; Bynum, Jennifer; Meng, Xiangzhi; Yan, Ping; Li, Ling; Liu, Liang

    2015-11-01

    Medical disputes in China are historically poorly documented. In particular, autopsy-based evaluation and its impact on medical malpractice claims remain largely unstudied. This study aims to document autopsy findings and medical malpractice in one of the largest cities of China, Wuhan, located in Hubei Province. A total of 519 autopsies were performed by the Department of Forensic Medicine, Wuhan University School of Medicine, Wuhan, China, over a 10-year period between 2004 and 2013. Of these cases, 190 (36.6%) were associated with medical malpractice claims. Joint evaluation by forensic pathologists and clinicians confirmed that 97 (51.1%) of the 190 claims were approved medical malpractice cases. The percentage of approved malpractice cases increased with patient age and varied according to medical setting, physician specialty, and organ system. The clinico-pathological diagnostic discrepancy was significantly different among various physician specialties (P = 0.031) and organ systems (P = 0.000). Of those cases involved in malpractice claims, aortic dissection, coronary heart disease, and acute respiratory infection were most common. Association between incorrect diagnosis and malpractice was significant (P = 0.001). This is the first report on China's medical malpractice and findings at autopsy which reflects the current state of health care services in one of the biggest cities in China. PMID:26559306

  3. Instruction on health care malpractice issues in entry-level physical therapy curricula.

    PubMed

    Scott, R W

    1990-01-01

    In the face of an ongoing health care malpractice crisis, instruction on malpractice issues in entry-level health care professional education programs is vital for the legal well-being of prospective clinicians. A 1978 survey of US medical schools revealed that less than 40% required instruction in medical law. By 1989, 76% of US medical schools required medicolegal instruction. This article summarizes the results of a survey of entry-level physical therapy educational programs to determine whether a majority currently offer required malpractice instruction. The study found that the majority do offer such instruction. Half of the physical therapy programs with instruction in malpractice employ attorney instructors, essential for improving relations between health care and legal professionals. Graduate entry-level programs offer 11 or more hours of medicolegal instruction with greater frequency than undergraduate programs. Additional surveys of other allied health disciplines are recommended to ascertain other standards for entry-level malpractice-related instruction. PMID:2228781

  4. The effect of medical malpractice liability on rate of referrals received by specialist physicians.

    PubMed

    Xu, Xiao; Spurr, Stephen J; Nan, Bin; Fendrick, A Mark

    2013-10-01

    Using nationally representative data from the United States, this paper analyzed the effect of a state’s medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the United States during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state’s malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums and an indicator for whether the state had a cap on non-economic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on non-economic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state’s medical malpractice environment on physicians’ referral behavior. PMID:23527533

  5. Juries and Medical Malpractice Claims: Empirical Facts versus Myths

    PubMed Central

    2008-01-01

    Juries in medical malpractice trials are viewed as incompetent, antidoctor, irresponsible in awarding damages to patients, and casting a threatening shadow over the settlement process. Several decades of systematic empirical research yields little support for these claims. This article summarizes those findings. Doctors win about three cases of four that go to trial. Juries are skeptical about inflated claims. Jury verdicts on negligence are roughly similar to assessments made by medical experts and judges. Damage awards tend to correlate positively with the severity of injury. There are defensible reasons for large damage awards. Moreover, the largest awards are typically settled for much less than the verdicts. PMID:19002541

  6. Medical and peer review records in malpractice litigation.

    PubMed

    Florin, D; Murphy, J G

    1992-01-01

    Medical records and peer review documents are important items in assessing claims brought against physicians for malpractice. In the United States, the adequacy of these documents and the extent to which their production can be mandatory is a complex subject governed by the statutory and/or common law of the individual states. Spoliation of medical records is not frequently encountered and will probably remain an isolated phenomenon. There is, however, constant development in the law regarding the discovery of documents compiled by health care providers and the extent to which these can be considered to constitute privileged information. PMID:23511097

  7. Neurological Fallacies Leading to Malpractice: A Case Studies Approach.

    PubMed

    Johnston, James C; Wester, Knut; Sartwelle, Thomas P

    2016-08-01

    A young woman presents with an intracranial arachnoid cyst. Another is diagnosed with migraine headache. An elderly man awakens with a stroke. And a baby delivered vaginally after 2 hours of questionable electronic fetal monitoring patterns grows up to have cerebral palsy. These seemingly disparate cases share a common underlying theme: medical myths. Myths that may lead not only to misdiagnosis and treatment harms but to seemingly never-ending medical malpractice lawsuits, potentially culminating in a settlement or judgment against an unsuspecting neurologist. This article provides a case studies approach exposing the fallacies and highlighting proper management of these common neurologic presentations. PMID:27445252

  8. Juries and medical malpractice claims: empirical facts versus myths.

    PubMed

    Vidmar, Neil

    2009-02-01

    Juries in medical malpractice trials are viewed as incompetent, antidoctor, irresponsible in awarding damages to patients, and casting a threatening shadow over the settlement process. Several decades of systematic empirical research yields little support for these claims. This article summarizes those findings. Doctors win about three cases of four that go to trial. Juries are skeptical about inflated claims. Jury verdicts on negligence are roughly similar to assessments made by medical experts and judges. Damage awards tend to correlate positively with the severity of injury. There are defensible reasons for large damage awards. Moreover, the largest awards are typically settled for much less than the verdicts. PMID:19002541

  9. Burnout, Job Satisfaction, and Medical Malpractice among Physicians

    PubMed Central

    Chen, Kuan-Yu; Yang, Che-Ming; Lien, Che-Hui; Chiou, Hung-Yi; Lin, Mau-Roung; Chang, Hui-Ru; Chiu, Wen-Ta

    2013-01-01

    Objectives: Our objective was to estimate the incidence of recent burnout in a large sample of Taiwanese physicians and analyze associations with job related satisfaction and medical malpractice experience. Methods: We performed a cross-sectional survey. Physicians were asked to fill out a questionnaire that included demographic information, practice characteristics, burnout, medical malpractice experience, job satisfaction, and medical error experience. There are about 2% of total physicians. Physicians who were members of the Taiwan Society of Emergency Medicine, Taiwan Surgical Association, Taiwan Association of Obstetrics and Gynecology, The Taiwan Pediatric Association, and Taiwan Stroke Association, and physicians of two medical centers, three metropolitan hospitals, and two local community hospitals were recruited. Results: There is high incidence of burnout among Taiwan physicians. In our research, Visiting staff (VS) and residents were more likely to have higher level of burnout of the emotional exhaustion (EE) and depersonalization (DP), and personal accomplishment (PA). There was no difference in burnout types in gender. Married had higher-level burnout in EE. Physicians who were 20~30 years old had higher burnout levels in EE, those 31~40 years old had higher burnout levels in DP, and PA. Physicians who worked in medical centers had a higher rate in EE, DP, and who worked in metropolitan had higher burnout in PA. With specialty-in-training, physicians had higher-level burnout in EE and DP, but lower burnout in PA. Physicians who worked 13-17hr continuously had higher-level burnout in EE. Those with ≥41 times/week of being on call had higher-level burnout in EE and DP. Physicians who had medical malpractice experience had higher-level burnout in EE, DP, and PA. Physicians who were not satisfied with physician-patient relationships had higher-level burnout than those who were satisfied. Conclusion: Physicians in Taiwan face both burnout and a high risk

  10. Informed consent in dental malpractice claims. A retrospective study.

    PubMed

    Lopez-Nicolas, Manuel; Falcón, Maria; Perez-Carceles, Maria Dolores; Osuna, Eduardo; Luna, Aurelio

    2007-06-01

    With the introduction of informed consent in dental practice in Spain during the last ten years activity has been focused on avoiding complaints rather than on giving adequate information to the patient. However, in the eyes of many professionals the document by which patients accept the cost or estimated charge of treatment is the equivalent of informed consent. Although Spanish law permits verbal consent in some cases (low risk therapeutic activities), some dentists interpret this law in a very broad way. The aim of this paper was to study the fulfilment of informed consent in relation to professional malpractice claims presented to the College of Dentists of the province of Murcia, south east Spain (regional professional association) during the last twelve years (n=52). Evaluation of the complaints pointed to adequate professional behaviour in 14 cases and malpractice in 38 cases (in 29 of which the treatment applied was technically correct but with inadequate information provided during the process, while nine cases represented technical errors). The written document of informed consent was absent in 40 cases, although the verbal information supplied was considered adequate in 14 cases. When the document of informed consent was present (12 cases) it was considered unsuitable, although adequately complemented by oral information. PMID:17695737

  11. Medical malpractice as reflected by the forensic evaluation of 4450 autopsies.

    PubMed

    Madea, Burkhard; Preuss, Johanna

    2009-09-10

    A multicentre retrospective analysis of 4450 autopsies carried out due to suspicion of medical malpractice in 17 German institutes of forensic medicine from 1990 to 2000 was performed for the German Federal Ministry of Health. During the time period analysed an increase of cases could be mentioned. The main results of the study are: in the cooperating institutes the total number of autopsies due to suspected medical malpractice ranged from 1.4 to 20%. In more than 40% of the cases preliminary proceedings were started because the manner of death was certified as non-natural or not clarified. Hospital doctors were more affected by medical malpractice claims than doctors in private practice. However, the number of confirmed cases of medical malpractice was higher for doctors in private practice than for hospital doctors. Although surgery is still at the top of the disciplines involved in medical malpractice claims the number of confirmed surgical cases was below the average. Mistakes in care were confirmed to be above the average. Medico-legal autopsies are still a very sufficient method to evaluate cases of medical malpractice: 2863 cases could already be clarified by autopsy. Up to now there is no systematic registration of medical malpractice charges in Germany. A systematic registration should be initiated to build up and/or improve error reporting systems and, thus, to improve patient safety. Compared to other sources of medical malpractice claims (arbitration committees of the medical chambers, reference material of health and insurance companies, files of civil courts) the data of the present multicentre study are in so far unique as only lethal cases were evaluated and a complete autopsy report was available as basis of an expert opinion in alleged medical malpractice cases. PMID:19524380

  12. Is the malpractice crisis filtering down to family planning?

    PubMed

    1986-06-01

    Evidence now exists that the insurance industry is including contraceptive researchers and family planning clinics in its crackdown on malpractice and liability policies. Family planning practioners have been lumped together with private physicians under the category "Profit-buster" for most major insurers, and the effects are just beginning to show. The liability problems of family planning clinics overlap those of physicians and drug companies. Essentially, they, too, can be held responsible for the products they prescribe and dispense to their clients. When the family planning clinic of NEWCAP, Inc., a community action program in Wisconsin, was abruptly dropped by its insurer in November, the staff was puzzled. NEWCAP had a spotless record and had experienced no previous insurance problems. The insurance company justified its actions by explaining it was getting out of the malpractice field altogether. Although NEWCAP's dilemma seems to be unique at this time, family planning organizations are concerned about the future. The malpractice crackdown also is causing problems for contraceptive researchers. Over the past few years, research and development programs have suffered because of difficulty in obtaining product liability insurance. Due to insurance costs, the Popuation Council's US clinical trials of the promising NORPLANT contraceptive implant were pared down to the minimum number required for Food and Drug Administration approval. Family Planning International's clinical trials of the biodegradable contraceptive implant Capronor have been postponed because an insurer could not be found. Acquiring insurance does not put the researcher over the hurdle, according to Richard Lincoln, senior vice president of the Alan Guttmacher Institute. There are more problems ahead after the research is completed. Dr. Harold Nash, New York's Population Council, has some suggestions for alleviating what seems to be a growing problem. If interest rates increase and insurers

  13. [Briefing and accusation of medical malpractice--the second victim].

    PubMed

    Wienke, A

    2013-04-01

    In June 2012, the German Medical Association (Bundesärztekammer) published the statistics of medical malpractice for 2011 [1]. Still ENT-specific accusations of medical malpractice are by far the fewest in the field of hospitals and actually even in the outpatient context. Clearly most of the unforeseen incidents still occur in the disciplines of trauma surgery and orthopedics. In total, however, an increasing number of errors in treatment can be noticed on the multidisciplinary level: in 25.5% of the registered cases, an error in treatment was found to be the origin of damage to health justifying a claim for compensation of the patient. In the year before, it was only 24.7%. The reasons may be manifold, but the medical system itself certainly plays a major role in this context: the recent developments related to health policy lead to a continuous economisation of medical care. Rationing and limited remuneration more and more result in the fact that therapeutic decisions are not exclusively made for the benefit of the patient but that they are oriented at economic or bureaucratic aspects. Thus, in the long term, practising medicine undergoes a change. According to the §§ 1, 3 of the professional code of conduct for doctors (Musterberufsordnung für Ärzte; MBO-Ä) medical practice as liberal profession is principally incompatible with the pursuit of profit, however, even doctors have to earn money which more and more makes him play the role of a businessman. Lack of personnel and staff savings lead to excessive workloads of physicians, caregivers, and nurses, which also favour errors. The quality and even the confidential relationship between doctor and patient, which is important for the treatment success, are necessarily affected by the cost pressure. The victims in this context are not only the patients but also the physicians find themselves in the continuous conflict between ethical requirements of their profession and the actual requirements of the

  14. Medical malpractice in perspective. II--The implications for Britain.

    PubMed Central

    Quam, L; Fenn, P; Dingwall, R

    1987-01-01

    The "malpractice crisis" in the United States cannot be understood in isolation. Litigation is precipitated by features of the American health care and social security systems. Relative to the United Kingdom, there are fewer barriers of access to the courts, although the role of contingency fees has probably been exaggerated. Given the great institutional differences between the UK and the USA, the crisis seems unlikely to be replicated here unless there are further moves towards privatising both the costs of providing health care and the costs of its failures. It is concluded that a marginal change in the frequency or average cost of claims could have a serious impact on National Health Service resources, the medical defence societies, recruitment to specialties, and clinical practice. Debate over possible reforms is compromised by the dearth of good empirical data. Any changes, however, must address both the deterrence of bad practice and the compensation of injured patients. Images p1599-a PMID:3113546

  15. Legal aspects of cases of medical malpractice in Denmark.

    PubMed

    Segest, E

    1993-01-01

    A survey has been carried out of court rulings during the last decade in cases regarding patients' complaints about alleged medical malpractice. The character of the cases is described, both penal code/disciplinary cases and cases regarding compensation. A number of main themes is evaluated: the availability of case records to the patient; the possibility for patients to choose medical advisers; the lessening of the burden on patients to prove that physicians have been negligent; and the relaxation of the burden on patients to prove causality between the injury and the medical treatment given. These main themes are evaluated over time. The investigation should be seen in the light of the fact that Denmark has recently introduced a patient insurance scheme, and the study will be the starting point for a later evaluation of the importance of this scheme, with particular reference to an improvement in patients' rights. PMID:8183069

  16. The Ecology of Defensive Medicine and Malpractice Litigation

    PubMed Central

    2016-01-01

    Using an evolutionary game, we show that patients and physicians can interact with predator-prey relationships. Litigious patients who seek compensation are the ‘predators’ and physicians are their ‘prey’. Physicians can adapt to the risk of being sued by performing defensive medicine. We find that improvements in clinical safety can increase the share of litigious patients and leave unchanged the share of physicians who perform defensive medicine. This paradoxical result is consistent with increasing trends in malpractice claims in spite of safety improvements, observed for example in empirical studies on anesthesiologists. Perfect cooperation with neither defensive nor litigious behaviors can be the Pareto-optimal solution when it is not a Nash equilibrium, so maximizing social welfare may require government intervention. PMID:26982056

  17. Application of the locality rule and implications for malpractice actions against physical therapists.

    PubMed

    Fantaci, E S

    1982-05-01

    Physical therapists are becoming involved increasingly in malpractice actions. The number of such actions will likely increase as the profession moves towards specialized practice and practice without medical referral. This article is intended to clarify some of the major principles of negligence and malpractice law as they apply to physical therapists. There are few reported cases of malpractice involving physical therapists, but an abundance of cases involving physicians. The extent to which physicians and therapists have been treated alike in these past malpractice suits is examined. This article also discusses some of the potential legal implications of specialization and practice without referral and their effect on the physical therapist in general practice and the therapist practicing without referral. PMID:7071160

  18. A review of medical malpractice issues in Malaysia under tort litigation system.

    PubMed

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-07-01

    Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability. PMID:24999124

  19. Review of Medical Malpractice Issues in Malaysia under Tort Litigation System

    PubMed Central

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-01-01

    Medical malpractice cases are a matter of much concern in many countries including Malaysia where several cases caught the attention of the public and authorities. Although comprehensive annual statistics on medical negligence claims are not available in Malaysia since such data are not collected systematically in this country there are indications of an upward trend. Medical malpractice cases have been publicized by the media, academic researchers and in government annual reports prompting government policy makers, oversight agencies and the medical profession itself to take appropriate action. The increasing dissatisfaction with the current tort litigation system requires exploring alternatives and new approaches for handling medical malpractice cases. This study aims to examine the difficulties inherent in the tort system in Malaysia for solving medical malpractice claims and evaluates the structure of this system from the perspective of effectiveness, fairness, compensation, accessibility, and accountability. PMID:24999124

  20. The importance of negative defensive medicine in the effects of malpractice reform.

    PubMed

    Montanera, Daniel

    2016-04-01

    This article presents a model of physician and insurer behavior in which the practice of defensive medicine, both positive and negative, can arise. Accounting for negative defensive medicine, and insurers' reaction to it, leads to different predictions of the effects of changing malpractice pressure compared to past models. Rising malpractice pressure causes both health care spending and quality to increase up to a threshold, and decrease thereafter. This non-monotonicity implies that malpractice reform is not a "silver bullet" capable of achieving both cost reductions and quality improvements for all consumers. The results can further explain inconsistent findings in the empirical literature and suggest alternative specifications for estimating the effects of malpractice reform. PMID:25855557

  1. Medical malpractice and new devices: defining an elusive standard of care.

    PubMed

    Greenberg, Michael D

    2009-01-01

    Early adoption of a new medical device by a physician carries with it some degree of malpractice liability risk. The legal standard for malpractice varies from place to place, but generally requires an evaluation of the physician's conduct either against that of a hypothetical "reasonable physician," or else against professional custom. Where the use of a new device involves a significant departure from traditional modalities of care, and a bad clinical result follows, questions may arise about whether the legal standard for malpractice has been violated. We suggest that a liberal interpretation of the malpractice standard of care is appropriate, and even necessary to avoid the potential for perverse disincentives to technical innovation in medicine. PMID:19715141

  2. The Impact of Malpractice Burden on Michigan Obstetrician-Gynecologists’ Career Satisfaction

    PubMed Central

    Xu, Xiao; Siefert, Kristine A.; Jacobson, Peter D.; Lori, Jody R.; Ransom, Scott B.

    2008-01-01

    Background Medical services for pregnancy and childbirth are inherently risky and unpredictable. In many states, obstetrician-gynecologists (ob-gyns) who attend the majority of childbirths in the U.S. and provide the most clinically complex obstetric procedures are struggling with increasing malpractice insurance premiums and litigation risk. Despite its significant implications for patient care, the potential impact of malpractice burden on ob-gyn physicians’ career satisfaction has not been rigorously tested in previous research. Methods Drawing on data from a statewide survey of obstetric providers in Michigan, this paper examined the association between medical liability burden and ob-gyns’ career satisfaction. Malpractice insurance premiums and malpractice claims experience were used as two objective measures for medical liability burden. Descriptive statistics were calculated and multivariable logistic regressions estimated for data analysis. Results Although most respondents reported satisfaction with their overall career in medicine, 43.7% had become less satisfied over the last five years and 34.0% would not recommend obstetrics/gynecology to students seeking career advice. Multivariable regression analysis showed that compared to coverage through an employer, paying $50,000/year or more for liability insurance premium was associated with lower career satisfaction among ob-gyns (odds ratio = 0.35, 95% confidence interval: 0.13–0.93). We found no significant impact of malpractice claims experience, including both recent malpractice claims (during the last five years, i.e., 2001–2006) and earlier malpractice claims (more than five years ago), on overall career satisfaction. Conclusions The findings of this study suggest that high malpractice premiums negatively affect ob-gyn physicians’ career satisfaction. The impact of the current medical liability climate on quality of care for pregnant women warrants further investigation. PMID:18590881

  3. On average, physicians spend nearly 11 percent of their 40-year careers with an open, unresolved malpractice claim.

    PubMed

    Seabury, Seth A; Chandra, Amitabh; Lakdawalla, Darius N; Jena, Anupam B

    2013-01-01

    The US malpractice system is widely regarded as inefficient, in part because of the time required to resolve malpractice cases. Analyzing data from 40,916 physicians covered by a nationwide insurer, we found that the average physician spends 50.7 months-or almost 11 percent-of an assumed forty-year career with an unresolved, open malpractice claim. Although damages are a factor in how doctors perceive medical malpractice, even more distressing for the doctor and the patient may be the amount of time these claims take to be adjudicated. We conclude that this fact makes it important to assess malpractice reforms by how well they are able to reduce the time of malpractice litigation without undermining the needs of the affected patient. PMID:23297278

  4. The AANA Foundation Malpractice Closed Claims Study: A Descriptive Analysis.

    PubMed

    Jordan, Lorraine M; Quraishi, Jihan A

    2015-10-01

    The AANA Foundation Closed Claims Researchers evaluated 245 closed claims spanning from 2003-2012. The majority of claims comprised CRNA providers whom are mainly male, independent contractors, certified between 1980-1999, and with malpractice coverage limits of $1 million/$3 million. The median age for all claimants was 50 years old, and 63.7% of claimants were female. For those claims where race was known, 54% of claimants were Caucasian. Most adverse events occurred in a hospital with an outpatient admission status. The majority of adverse events were identified as intra-anesthesia. The top five surgical procedures associated with these claims were orthopedic general surgery, cosmetic, obstetric, and neurologic procedures. An adverse event leading to death occurred in 35.1% of claims. Regardless of severity of injury, reviewers determined that 45.5% of negative outcomes were preventable, 32.7% of the anesthesia treatment was inappropriate, and 29% of negative outcomes were caused by CRNAs' actions. Reviewers found that no AANA Standards were breached in 45.7% of claims; however, Standards 4, 5, and 3 were the most common standards breached. The most costly severity classification was major permanent injury (ie, paraplegia, blindness, loss of two limbs, or brain ddamage) with a median payment of $299,810. PMID:26638452

  5. Malpractice litigation for uninformed consent. Implications for physical therapists.

    PubMed

    Banja, J D; Wolf, S L

    1987-08-01

    Although physicians generally are expected to secure their patients' informed consent to medical treatment, an emerging body of legal opinion holds that in certain situations nurses and allied health care professionals may be found similarly responsible. Failure of a health care provider to protect a patient's right of informed consent might result in a lawsuit alleging that serious harm was sustained needlessly because the patient plaintiff was not informed of certain significant risks of or consequences that resulted from treatment. As a professional group that puts patients at risk of harm during treatment, physical therapists need to know about their legal duty to facilitate a patient's awareness of and consent to treatment. This article discusses the nature of that duty and how a patient plaintiff might try to prove negligence against a physical therapist who allegedly fails to secure a valid statement of informed consent. The article also provides recommendations so that physical therapists might protect themselves from malpractice suits alleging "uninformed" consent. PMID:3615592

  6. Court Decisions on Medical Malpractice in China After the New Tort Liability Law.

    PubMed

    Zhang, Kui; Li, Yuan; Fan, Fei; Liu, Xin; Deng, Zhen-Hua

    2016-09-01

    A new Tort Law of the People's Republic of China became effective on July 1, 2010. We undertook an analysis of medical malpractice lawsuits brought before regional courts in Beijing districts after this new Tort Liability Law went into effect. In total, 726 cases eventuating in a final verdict were collected from the Beijing district courts from 2011 to 2013 in this retrospective study; 83.7% of the 726 alleged instances of medical malpractice were confirmed to be malpractice by the final verdict. The disciplines most frequently involved with claims of medical malpractice were obstetrics and gynecology, the most frequent outcomes was death, and the most common types of case associated with malpractice was surgery related. The average length of time between the occurrence of the injury and closure of the claim was 9.2 months, and the average payment was ¥163,000. Since the introduction of the new Tort Liability Law, the average time to complete a litigation was shortened, but it has made little apparent difference otherwise. PMID:27281443

  7. Cost, correlates and effects of malpractice litigation in family practice residency programmes in the United States.

    PubMed

    Bowman, M A; Murray, J L

    1989-06-01

    A survey of family practice residency programme directors in the United States was undertaken to look at the impact of malpractice and malpractice insurance on residency education. Of 385 programmes 276 (71.7%) responded to the 20 question survey. The results indicated a mean rate of 0.043 claims per resident or faculty member in the previous year. One-fifth of the respondents did not report the type of malpractice insurance retained for residents and over half did not report the cost of insurance for residents. Current problems with liability were most often related to the region of the country, number of visits to the family practice centre, the number of residents, the number of faculty, the type of faculty employer and the type of resident employer. Programmes which anticipated future problems with liability were most likely to be those with current problems. The areas identified as most concerning to residents included: obstetrics, cost of malpractice insurance, difficulty obtaining coverage, and the general anxiety created by malpractice litigation. PMID:2744300

  8. Strategic risk management: reducing malpractice claims through more effective patient-doctor communication.

    PubMed

    Virshup, B B; Oppenberg, A A; Coleman, M M

    1999-01-01

    Many malpractice suits are brought not because of malpractice nor even because of complaints about the quality of medical care but as an expression of anger about some aspect of patient-doctor relationships and communications. The theory presented is that under the stress of anxiety and physical illness, some patients regress to childhood needs; physicians are not generally trained to fill such needs. Thus, these patients, angry because of this, express their anger in malpractice suits. This theory has been taught to physicians and medical students as part of a physician continuing medical education (CME) seminar on Loss Prevention/Risk Management through demonstration of active-listening techniques to seminar participants. Physicians who understand and can respond appropriately to the emotional needs of their patients are less likely to be sued. This may also translate into a more fulfilled practice of medicine by those physicians who are most aware of the importance of a positive relationship. PMID:10452132

  9. American Academy of Pediatrics: Technical report: Alternative dispute resolution in medical malpractice.

    PubMed

    Fraser, J J

    2001-03-01

    The purpose of this technical report is to provide pediatricians with an understanding of past crises within the professional liability insurance industry, the difficulties of the tort system, and alternative strategies for resolving malpractice disputes that have been applied to medical malpractice actions. Through this report, pediatricians will gain a technical understanding of common alternative dispute resolution (ADR) strategies. The report explains the distinctions between various ADR methods in terms of process and outcome, risks and benefits, appropriateness to the nature of the dispute, and long-term ramifications. By knowing these concepts, pediatricians faced with malpractice claims will be better-equipped to participate in the decision-making with legal counsel on whether to settle, litigate, or explore ADR options. PMID:11230609

  10. Strategies for reducing the risk of malpractice litigation in perinatal nursing.

    PubMed

    Koniak-Griffin, D

    1999-01-01

    Perinatal nurses are involved in malpractice litigation most often as employees of a hospital being sued. Contemporary case examples from malpractice claims provide the foundation for examining how perinatal nurses can become the focus of such litigation. Increasing demand for individual nurse accountability, cost containment strategies that require nurses to broaden their scope of practice and to supervise unlicensed assistive personnel, increasing use of medical technologies, and the reality of compromised newborns and unexplained outcomes place perinatal nurses at risk for continued malpractice vulnerability. Specific strategies for risk reduction can be used by the individual nurse and the institution in relation to hospital policies and procedures, application of the nursing process, documentation, birth videos, and delegation of tasks to unlicensed assistive personnel. PMID:10363541

  11. Special report on reimbursement. Medicare program abandons 1986 malpractice rule.

    PubMed

    Manning, M M

    1992-01-01

    Hospitals with claims "properly pending" before fiscal intermediaries or in the courts need do nothing in order to obtain corrected reimbursement for fiscal years so pending. However, to speed processing of corrected reimbursements for fiscal years pending in appeals before the PRRB, hospitals should request that the Board determine its jurisdiction and remand to the fiscal intermediary for payment as soon as possible. It will be helpful to include with any such request a copy of the notice of program reimbursement and the original appeal letter for each fiscal year under appeal. Despite the fact that HCFA Ruling 91-1 effectively concedes that HCFA has applied an invalid regulation to all fiscal years since May 1, 1986, HCFA counsel have stated that HCFA will not permit reopening of closed cost reports to correct the inappropriate apportionment of malpractice insurance costs. Nevertheless, hospitals that do not presently have a claim or appeal pending have several options. Under the Provider Reimbursement Manual, HIM-15, sections 2930-2931, fiscal intermediaries are required to reopen cost reports filed within the three-year reopening period to correct errors. Accordingly, should a fiscal intermediary deny a provider's reopening request, the provider should seriously consider taking an appeal to the PRRB. The PRRB's jurisdiction to review fiscal intermediary denials of requests to reopen cost reports was affirmed by the United States Court of Appeals for the Ninth Circuit, see State of Oregon v. Bowen, 854 F.2d 346 (9th Cir. 1988), a decision that is controlling in California, Oregon, Washington, Nevada, Arizona, Montana, Idaho, Hawaii, Alaska, Guam, and the Northern Mariana Islands.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10117365

  12. Psychiatry malpractice and administrative inquiries of alleged physician misconduct.

    PubMed

    Meyer, Donald J

    2006-09-01

    Practicing psychiatrists face a range of professional liability from malpractice litigation and from inquiries and hearings conducted by health care agencies. The causes of an action and the standards by which physician conduct is measured vary widely between these two processes. Many psychiatrists do not appreciate sufficiently the gravity of the risks they may face from an administrative sanction. Understanding the legal and administrative expectations of practicing psychiatrists serves practitioners' professional risk management. Those psychiatrists who choose to participate as expert witnesses for courts or administrative agencies need to familiarize themselves with the applicable legal standards and the respective roles of experts in these two different settings. The courts and administrative agencies have different social missions and correspondingly differing expectations of the expert opinions admitted.An expert's function as educator about the application of psychiatric knowledge and treatments to legal contexts is optimized when that expert clearly understands the function of the opinion that is sought. As educators about special knowledge to the adjudicating body, experts are advocates for their objectively generated and scientifically grounded opinion. Psychiatry is increasingly under the purview of regulations from multiple sources private and public. This article has reviewed medicolegal concepts and terms of psychiatrists' exposure to liability from a comparative point of view. Familiarity assists psychiatrists in navigating the complex legal arena in which they practice and provides a foundation for psychiatrists to work to change the multitude of laws and regulations when doing so is in the best interests of their patients and of their discipline of medicine. PMID:16904502

  13. Physicians and strikes: can a walkout over the malpractice crisis be ethically justified?

    PubMed

    Fiester, Autumn

    2004-01-01

    Malpractice insurance rates have created a crisis in American medicine. Rates are rising and reimbursements are not keeping pace. In response, physicians in the states hardest hit by this crisis are feeling compelled to take political action, and the current action of choice seems to be physician strikes. While the malpractice insurance crisis is acknowledged to be severe, does it justify the extreme action of a physician walkout? Should physicians engage in this type of collective action, and what are the costs to patients and the profession when such action is taken? I will offer three related arguments against physician strikes that constitute a prima facie prohibition against such action: first, strikes are intended to cause harm to patients; second, strikes are an affront to the physician-patient relationship; and, third, strikes risk decreasing the public's respect for the medical profession. As with any prima facie obligation, there are justifying conditions that may override the moral prohibition, but I will argue that the current malpractice crisis does not rise to the level of such a justifying condition. While the malpractice crisis demands and justifies a political response on the part of the nation's physicians, strikes and slow-downs are not an ethically justified means to the legitimate end of controlling insurance costs. PMID:15035924

  14. High physician concern about malpractice risk predicts more aggressive diagnostic testing in office-based practice.

    PubMed

    Carrier, Emily R; Reschovsky, James D; Katz, David A; Mello, Michelle M

    2013-08-01

    Despite widespread agreement that physicians who practice defensive medicine drive up health care costs, the extent to which defensive medicine increases costs is unclear. The differences in findings to date stem in part from the use of two distinct approaches for assessing physicians' perceived malpractice risk. In this study we used an alternative strategy: We linked physicians' responses regarding their levels of malpractice concern as reported in the 2008 Health Tracking Physician Survey to Medicare Parts A and B claims for the patients they treated during the study period, 2007-09. We found that physicians who reported a high level of malpractice concern were most likely to engage in practices that would be considered defensive when diagnosing patients who visited their offices with new complaints of chest pain, headache, or lower back pain. No consistent relationship was seen, however, when state-level indicators of malpractice risk replaced self-rated concern. Reducing defensive medicine may require approaches focused on physicians' perceptions of legal risk and the underlying factors driving those perceptions. PMID:23918482

  15. Insurance: Profitability of the Medical Malpractice and General Liability Lines. Report to Congressional Requesters.

    ERIC Educational Resources Information Center

    General Accounting Office, Washington, DC.

    This report on the profitability of the property/casualty insurance industry and in particular of the medical malpractice insurance line was prepared at the request of Representatives Henry A. Waxman and James J. Florio and Senators Paul Simon, Daniel K. Inouye, Albert Gore, Jr., and Jay D. Rockefeller. Four different estimates of medical…

  16. Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty

    PubMed Central

    Seabury, Seth A.; Helland, Eric; Jena, Anupam B.

    2014-01-01

    The impact of medical malpractice reforms on the average size of malpractice payments in specific physician specialties is unknown and subject to debate. We analyzed a national sample of 220,653 malpractice claims from 1985–2010 merged with information on state liability reforms. We estimated the impact of state noneconomic damage caps on average malpractice payment size for physicians overall and for 10 different specialties, and compared how the effects differed according to the restrictiveness of the cap ($250,000 vs. $500,000 cap). We found noneconomic damage caps reduced payments by $42,980 (15%; p<0.001), with a $250,000 cap reducuing average payments by $59,331 (20%; p<0.001), while a $500,000 cap had no significant effect. Effects varied according to specialty and were largest in specialties with high average payments, such as pediatrics. This suggests that the effect of noneconomic damage caps differs by specialty, and only more restrictive caps result in lower average payments. PMID:25339633

  17. Medical Malpractice Claims in Radiation Oncology: A Population-Based Study 1985-2012

    SciTech Connect

    Marshall, Deborah C.; Punglia, Rinaa S.; Fox, Dov; Recht, Abram; Hattangadi-Gluth, Jona A.

    2015-10-01

    Purpose: The purpose of this study was to determine trends in radiation oncology malpractice claims and expenses during the last 28 years and to compare radiation oncology malpractice claims to those of other specialties. Methods and Materials: We performed a retrospective analysis of closed malpractice claims filed from 1985 to 2012, collected by a nationwide medical liability insurance trade association. We analyzed characteristics and trends among closed claims, indemnity payments (payments to plaintiff), and litigation expenses. We also compared radiation oncology malpractice claims to those of 21 other medical specialties. Time series dollar amounts were adjusted for inflation (2012 was the index year). Results: There were 1517 closed claims involving radiation oncology, of which 342 (22.5%) were paid. Average and median indemnity payments were $276,792 and $122,500, respectively, ranking fifth and eighth, respectively, among the 22 specialty groups. Linear regression modeling of time trends showed decreasing total numbers of claims (β = −1.96 annually, P=.003), increasing average litigation expenses paid (β = +$1472 annually, P≤.001), and no significant changes in average indemnity payments (β = −$681, P=.89). Conclusions: Medical professional liability claims filed against radiation oncologists are not common and have declined in recent years. However, indemnity payments in radiation oncology are large relative to those of many other specialties. In recent years, the average indemnity payment has been stable, whereas litigation expenses have increased.

  18. Educators, Illegal Behavior, and Deterrence: A Resource Allocation Approach to Malpractice in Education.

    ERIC Educational Resources Information Center

    Nelson, F. Howard

    1982-01-01

    Views illegal behavior in education, from sexual discrimination to professional malpractice, as a problem in optimal resource allocation. Urges effective use of fines or their equivalent, so administrators can weigh the benefits of illegal activity against the costs of apprehension and punishment. (Author/RW)

  19. The malpractice crisis in obstetrics and gynecology: is there a solution?

    PubMed

    Barber, H R

    1991-01-01

    The malpractice ripoff began when the no-fault automobile accident law was passed. Many lawyers were in a panic at this time and turned to medical malpractice litigation to make a living. It became the conduit to quick wealth. The patient was the loser, the lawyer the winner, and the physician often devastated by the patient's ingratitude. For a patient-plaintiff to maintain a successful lawsuit for medical negligence against a physician, four elements must be alleged and proved in a court of law: duty, breach of duty, causation, and damages. Each must be proved by a patient to prevail against a physician. Since this is very difficult to do, the lawyers have subtly brought in a new approach called maloccurrence. This is defined as a bad outcome unrelated to the quality of care provided. The lawyers need not prove the four elements to win a malpractice case; many are won on deceit and in violation of the law by introducing the concept of maloccurrence. Not only are tort reforms needed but out of court alternatives must be mandated by law or our health care delivery system will be destroyed. Government interference and the malpractice ripoff has had a devastating effect on the talent attracted to medical school, and the number of applicants is falling rapidly. The medical malpractice crisis could soon be translated into a health delivery service crisis. Concerned citizens must join together with the medical profession and leaders of the legal profession to halt this monstrous injustice. The litigation milieu has not only paralyzed the health care industry but it has had a devastating effect across the board on the way Americans live and do business. It must be solved now for justice delayed is justice denied. PMID:2049569

  20. MALPRACTICE AND THE QUALITY OF CARE IN RETINOPATHY OF PREMATURITY (AN AMERICAN OPHTHALMOLOGICAL SOCIETY THESIS)

    PubMed Central

    Reynolds, James D.

    2007-01-01

    Purpose A review of retinopathy of prematurity (ROP) malpractice cases will identify specific, repetitive problems in the provision of care and the reasons underlying these problems. Opportunities to improve the quality of care provided to premature infants with ROP will result. Methods A retrospective review of a series of 13 ROP malpractice cases in which the author served as a paid consultant, as well as a review of the literature for additional cases, was conducted. The series of 13 involved a review of the entire medical record as well as testimony and depositions. The characteristics of each case are tabulated, including state, date, allegations, defendants, disposition, award, the medical facts and care issues involved, and the judgment of medical error. In addition, a merit review was performed on the care in each case, and an error assessment was performed. Results The quality of care issues included neonatology failure to refer or follow up in 8 of 13, failure to adequately supervise resident care in 2 of 13, ophthalmologic failure to follow up in 6 of 13, and failure to properly diagnose and manage in 9 of 13. The latter included 4 of 13 that hinged on zone III issues and the presence or absence of full nasal vascularization with or without previous zone II disease. Merit review found negligent error by at least one party in 12 of 13. Ophthalmology error was found in 6 of 13. Malpractice, ie, negligent error causing negligent harm, was judged to be present in 9 of 13. Conclusions Negligent errors are common in malpractice cases that proceed to disposition. There are a limited number of repetitive errors that produce malpractice. An explanation of how these errors occur, coupled with the pertinent pathophysiology, afford an excellent opportunity to improve patient care PMID:18427626

  1. Predicting risk for medical malpractice claims using quality-of-care characteristics.

    PubMed Central

    Charles, S C; Gibbons, R D; Frisch, P R; Pyskoty, C E; Hedeker, D; Singha, N K

    1992-01-01

    The current fault-based tort system assumes that claims made against physicians are inversely related to the quality of care they provide. In this study we identified physician characteristics associated with elements of medical care that make physicians vulnerable to malpractice claims. A sample of physicians (n = 248) thought to be at high or low risk for claims was surveyed on various personal and professional characteristics. Statistical analysis showed that 9 characteristics predicted risk group. High risk was associated with increased age, surgical specialty, emergency department coverage, increased days away from practice, and the feeling that the litigation climate was "unfair." Low risk was associated with scheduling enough time to talk with patients, answering patients' telephone calls directly, feeling "satisfied" with practice arrangements, and acknowledging greater emotional distress. Prediction was more accurate for physicians in practice 15 years or less. We conclude that a relationship exists between a history of malpractice claims and selected physician characteristics. PMID:1462538

  2. [Forensic assessment of suspected medical malpractice and outcome of preliminary proceedings against medical practitioners].

    PubMed

    Sandhop, Michael W; Birngruber, Christoph G; Dettmeyer, Reinhard B

    2014-01-01

    In a retrospective study, all autopsies performed at the Institute of Forensic Medicine of the Justus Liebig University of Giessen between 1968 and 2007 for suspected medical malpractice with fatal outcome were evaluated and analysed with regard to the reason for initiating preliminary investigations and the medical specialties involved. In 109 cases, the prosecution files could be inspected as to the outcome of the proceedings. As there are hardly any comparable studies in the German-speaking countries, the data were compared with the results of two older studies. In many cases, medical malpractice could be excluded directly at the end of the post-mortem examination. Most of the charges were dropped according to Section 170 subs. 2 Code of Criminal Procedure. PMID:25004618

  3. Limiting Exposure to Medical Malpractice Claims and Defamatory Cyber Postings via Patient Contracts

    PubMed Central

    Segal, Jeffrey J.

    2008-01-01

    The documents patients sign on admission to a medical practice can constitute a legal contract. Medical practices around the country are attempting to use these documents as a prospective defense against medical malpractice claims. Protective contractual provisions are often attacked on grounds that they are legally void as a result of unconscionability. Widespread use of arbitration clauses have been met with mixed success. Arbitration clauses that limit damages available in medical negligence cases have been stricken in some states as having provisions that impose excessive entry costs on a patient starting the arbitration process. Other provisions relating to prequalification requirements for expert witnesses are now being used with increasing frequency. Clauses have even been placed in patient contracts that address cyber postings of adverse claims against physicians. Prospective patient contracts may be an effective means to limit exposure to medical malpractice lawsuits and to minimize defamatory cyber postings. PMID:19057975

  4. Limiting exposure to medical malpractice claims and defamatory cyber postings via patient contracts.

    PubMed

    Sacopulos, Michael; Segal, Jeffrey J

    2009-02-01

    The documents patients sign on admission to a medical practice can constitute a legal contract. Medical practices around the country are attempting to use these documents as a prospective defense against medical malpractice claims. Protective contractual provisions are often attacked on grounds that they are legally void as a result of unconscionability. Widespread use of arbitration clauses have been met with mixed success. Arbitration clauses that limit damages available in medical negligence cases have been stricken in some states as having provisions that impose excessive entry costs on a patient starting the arbitration process. Other provisions relating to prequalification requirements for expert witnesses are now being used with increasing frequency. Clauses have even been placed in patient contracts that address cyber postings of adverse claims against physicians. Prospective patient contracts may be an effective means to limit exposure to medical malpractice lawsuits and to minimize defamatory cyber postings. PMID:19057975

  5. Widespread hyoscine hydrobromide toxicity due to contract manufacturer malpractice : the travacalm episode.

    PubMed

    McEwen, John; Thompson, Barry R; Purcell, Patrick M; Kelly, Larry F; Krauss, Adrian S

    2007-01-01

    An outbreak of hyoscine hydrobromide toxicity was detected through the Australian pharmacovigilance system. The unexpectedly wide variation in hyoscine hydrobromide content between individual tablets within single packets created difficulties in initially explaining the clinical experiences. Strict time requirements for review of incoming adverse drug reaction reports and close involvement of the highly skilled national drug regulatory laboratory resulted in early identification of the cause of the outbreak and led in turn to the identification of malpractice by the contract manufacturer. PMID:17472417

  6. Conditions that influence the impact of malpractice litigation risk on physicians’ behavior regarding patient safety

    PubMed Central

    2014-01-01

    Background Practicing safe behavior regarding patients is an intrinsic part of a physician’s ethical and professional standards. Despite this, physicians practice behaviors that run counter to patient safety, including practicing defensive medicine, failing to report incidents, and hesitating to disclose incidents to patients. Physicians’ risk of malpractice litigation seems to be a relevant factor affecting these behaviors. The objective of this study was to identify conditions that influence the relationship between malpractice litigation risk and physicians’ behaviors. Methods We carried out an exploratory field study, consisting of 22 in-depth interviews with stakeholders in the malpractice litigation process: five physicians, two hospital board members, five patient safety staff members from hospitals, three representatives from governmental healthcare bodies, three healthcare law specialists, two managing directors from insurance companies, one representative from a patient organization, and one representative from a physician organization. We analyzed the comments of the participants to find conditions that influence the relationship by developing codes and themes using a grounded approach. Results We identified four factors that could affect the relationship between malpractice litigation risk and physicians’ behaviors that run counter to patient safety: complexity of care, discussing incidents with colleagues, personalized responsibility, and hospitals’ response to physicians following incidents. Conclusion In complex care settings procedures should be put in place for how incidents will be discussed, reported and disclosed. The lack of such procedures can lead to the shift and off-loading of responsibilities, and the failure to report and disclose incidents. Hospital managers and healthcare professionals should take these implications of complexity into account, to create a supportive and blame-free environment. Physicians need to know that they

  7. A medical malpractice understanding to FASB ASU no. 2010-24.

    PubMed

    Frese, Richard C; Kitchen, Patrick J

    2011-10-01

    FASB ASU No.2010-24, Healthcare Entities (Topic 954): Presentation of Insurance Claims and Related Insurance Recoveries changes how healthcare entities present medical malpractice liabilities on financial statements. Healthcare CFOs may need the assistance of their auditors and actuaries to ensure that ASU 2010-24 is appropriately implemented. Actuaries need to estimate the recoverable asset, using methods such as historical loss experience, increased limits factor, and commercial premium. PMID:22053640

  8. A transdisciplinary team acting on evidence through analyses of moot malpractice cases.

    PubMed

    Constantino, Rose E

    2007-01-01

    A transdiciplinary team is crucial for healthcare systems to act based on evidence in responding to the global demand of the business of caring and patient safety. The purpose of this paper is to outline a transdisciplinary team led by nurses that examines linkages between moot malpractice cases filed against a healthcare system and to the quality of the healthcare system's ecology, caregiver, and patient safety outcomes. PMID:17577087

  9. Abraham Lincoln loses a medical malpractice case, debates Stephen A. Douglas, and secures two murder acquittals.

    PubMed

    Spiegel, Allen D; Kavaler, Florence

    2004-02-01

    An improperly healed fracture was the most common reason for the medical malpractice crisis between the 1830s and 1860s in the United States. As a practicing lawyer in Illinois, Abraham Lincoln defended physicians in medical malpractice law suits. One of these was Dr. Powers Ritchey, who was sued for malpractice in 1855. Lincoln agreed to represent Dr. Ritchey in 1858 as the case was appealed to the supreme court of Illinois. In the interim, Lincoln defended two indicted murderers and won acquittals for both. Between the two murder trials, Lincoln debated Stephen A. Douglas while running for U.S. Senator from Illinois. Lincoln believed that Ritchey's case was poorly represented in the lower court. Ritchey's prior attorneys did not file a bill of exceptions to the testimony of the plaintiff's expert medical witnesses. Lincoln attempted to rebut the allegation of a lack of reasonable medical care and diligence by Ritchey, and he sought to secure a new trial for his client. In its decision, the supreme court of Illinois did not find any error and affirmed the lower court's judgment. PMID:14768936

  10. Change in Oregon Maternity Care Workforce after Malpractice Premium Subsidy Implementation

    PubMed Central

    Smits, Ariel K; King, Valerie J; Rdesinski, Rebecca E; Dodson, Lisa G; Saultz, John W

    2009-01-01

    Objectives (1) To determine the proportion of maternity care providers who continue to deliver babies in Oregon; (2) to determine the important factors relating to the decision to discontinue maternity care services; and (3) to examine how the rural liability subsidy is affecting rural maternity care providers' ability to provide maternity care services. Study Design We surveyed all obstetrical care providers in Oregon in 2002 and 2006. Survey data, supplemented with state administrative data, were analyzed for changes in provision of maternity care, reasons for stopping maternity care, and effect of the malpractice premium subsidy on practice. Principal Findings Only 36.6% of responding clinicians qualified to deliver babies were actually providing maternity care in Oregon in 2006, significantly lower than the proportion (47.8%) found in 2002. Cost of malpractice premiums remains the most frequently cited reason for stopping maternity care, followed by lifestyle issues. Receipt of the malpractice subsidy was not associated with continuing any maternity services. Conclusions Oregon continues to lose maternity care providers. A state program subsidizing the liability premiums of rural maternity care providers does not appear effective at keeping rural providers delivering babies. Other policies to encourage continuation of maternity care need to be considered. PMID:19500166

  11. Malpractice Burden, Rural Location, and Discontinuation of Obstetric Care: A Study of Obstetric Providers in Michigan

    PubMed Central

    Xu, Xiao; Siefert, Kristine A.; Jacobson, Peter D.; Lori, Jody R.; Gueorguieva, Iana; Ransom, Scott B.

    2011-01-01

    Context It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. Purpose This study examined whether higher malpractice burden on obstetric providers was associated with an increased likelihood of discontinuing obstetric care and whether there were rural-urban differences in the relationship. Methods Data on 500 obstetrician-gynecologists and family physicians who had provided obstetric care at some point in their career (either currently or previously) were obtained from a statewide survey in Michigan. Statistical tests and multivariate regression analyses were performed to examine the interrelationship among malpractice burden, rural location, and discontinuation of obstetric care. Findings After adjusting for other factors that might influence a physician’s decision about whether to stop obstetric care, our results showed no significant impact of malpractice burden on physicians’ likelihood to discontinue obstetric care. Rural-urban location of the practice did not modify the nature of this relationship. However, family physicians in rural Michigan had a nearly four fold higher likelihood of withdrawing obstetric care when compared to urban family physicians. Conclusions The higher likelihood of rural family physicians to discontinue obstetric care should be carefully weighed in future interventions to preserve obstetric care supply. More research is needed to better understand the practice environment of rural family physicians and the reasons for their withdrawal from obstetric care. PMID:19166559

  12. High and low-risk specialties experience with the U.S. medical malpractice system

    PubMed Central

    2013-01-01

    Background “High-liability risk specialties” tend to be the focus of medical malpractice system research and debate, but concerns and fears are not limited to this group. The objective of this study was to examine whether “high-liability risk” medical specialties have a different experience with the malpractice system than “low-liability risk” specialties. Methods We reviewed claims data from the Physician Insurers Association of America’s Data Sharing Project between January 1985 and December 2008. We used linear regression, controlling for year, to determine how liability risk affected outcomes of interest. Results In high-liability risk specialties, 33% of claims result in indemnity payments compared to 28% for low-liability risk specialties (p < 0.001). The average indemnity payment for high-liability risk specialties was $315,314 compared to $267,146 for low-liability risk specialties (p = 0.25). Although only a small percentage of claims go to trial, low-liability risk specialties have significantly more claims that are ultimately dropped, withdrawn or dismissed, while high-liability risk specialties have significantly more claims that result in plaintiff settlement (p < 0.001). Conclusions Malpractice risk exists for all specialties. Variability in indemnity costs are found in both high- and low-liability risk specialties. Differences in the reasons for which claims are initiated for high- and low-liability risk specialties likely necessitate different risk management solutions. PMID:24192524

  13. Governmental studies on medical malpractice: the implications of rising premiums for healthcare and the allocation of health resources.

    PubMed

    Hoffman, A C

    2005-06-01

    The United States may or may not be facing a "malpractice crisis" which can result in a loss of quality of medical care in certain specialties by virtue of non-performance or the exiting of certain physicians from certain high-risk specialties due to increases in premiums. Various studies have been performed by various governmental agencies on a federal level in the United States. The Department of Legal Medicine, part of the Armed Forces Institute of Pathology, began collecting veteran's affairs medical malpractice claims data and extracting information from the analysis from medical records and associated documents. During the 1993 fiscal year, 801 medical malpractice claims were filed against the Department of Veteran's Affairs. The Department of Veteran's Affairs had approximately 125,000 hospital discharges and 26 million outpatient visits during the same time period. The rate of claims per hospital discharge was less than 1/ 1000 hospital patient discharges (.864/1000). Subsequent to that report, several other reports have been issued including a report on medical malpractice insurance generated by the General Accounting Office in 2003, some ten years later. More recently, a report of medical malpractice having implications on rising premiums on and access to health care generated by the General Accounting Office was released in August of 2003. This paper will demonstrate areas of concern with regard to the area of medical malpractice as well as incidence of medical malpractice and claims upon the insurance industry, medical specialties and the impact upon the community generally in the United States. PMID:16082866

  14. [Delayed appendectomy because of diagnostic malpractice: Experiences of the Arbitration Board of the North German Medical Associations].

    PubMed

    Vinz, Heinrich; von Bülow, Markward; Neu, Johann

    2015-01-01

    From 2000 to 2012, 447 panel proceedings concerning acute appendicitis were evaluated. 271 cases (57 %) were related to alleged diagnostic malpractice. This was confirmed in 176 cases (67 %). The following medical specialities were involved (m = quote of malpractice): general surgery 33 %, m = 51 %; paediatric surgery 3 %, m = 44 %; general practitioner and prehospital emergency services 24 %, m = 62 %; internal medicine 19 %, m = 70 %; paediatrics 13 %, m = 57 %; gynaecology 3 %, m = 91 %; urology 2 %, m = 17 %. The most frequent misdiagnosis was gastroenteritis (43 % in adults, 69 % in children), obviously based on the concomitant symptom of diarrhoea. Surgery revealed all stages of advanced appendicitis up to peritoneal sepsis, organic failure and death (n = 5). The evaluation of the files and the experts' reports of the 176 cases of diagnostic malpractice allowed to define the following basic failures, which led to unjustified delay of operation: careless history-taking, no or incomplete physical examination, no follow-up investigations, incorrect interpretation of the patient's complaints and clinical findings, no or incomplete documentation. Conducting a thorough investigation is essential to avoiding diagnostic malpractice. Internal analysis of failures or near failures may contribute to reducing the number of future cases of malpractice. PMID:26699259

  15. Delays in medical malpractice litigation in civil law jurisdictions: some evidence from the Italian Court of Cassation.

    PubMed

    Grembi, Veronica; Garoupa, Nuno

    2013-10-01

    Medical malpractice law and tort reform are contentious issues. In this paper, we focus on Italy as an example of a civil law jurisdiction. Italian medical malpractice law is essentially judge-made law. However, its effectiveness is likely to be curtailed by excessive delays in litigation. Several reforms have been enacted since the late 1980s to correct this situation. By making use of the decisions of the Italian Court of Cassation (which have shaped medical malpractice law) from 1970 to 2009, we show that these reforms had no general statistically significant impact on delays. Recent reduction of delays does not seem to be related to legal reforms but rather explained by other factors. PMID:23360807

  16. Ophthalmic Malpractice and Physician Gender: A Claims Data Analysis (An American Ophthalmological Society Thesis)

    PubMed Central

    Fountain, Tamara R.

    2014-01-01

    Purpose: To analyze and compare malpractice claims rates between male and female ophthalmologists and test the hypothesis that claims rates are equal between the two sexes. Methods: A retrospective, cohort study review was made of all claims reported to the Ophthalmic Mutual Insurance Company from January 1990 through December 2008 in which an expense (including indemnity and/or legal defense costs) was paid or reserved. A total of 2,251 claims were examined. Frequency (claims per physician) and severity (indemnity payment, associated expenses and reserves per claim) were analyzed for both male and female ophthalmologists. Frequency and severity data were further stratified by allegation, type of treatment, and injury severity category. Results: Men were sued 54% more often than females over the period studied (P<.001). Women had lower claims frequencies across all allegations and within the treatment areas of cataract, cornea, and retinal procedures (P<.7). Men had more claims associated with severe injury, including permanent major injury and death (P<.001). The average amount paid in indemnity and expenses was 7% higher for claims against women ($115,303 compared to $107,354 against men). Conclusions: Nearly 20 years of closed claim data reveal male ophthalmologists are significantly more likely than women to have reported malpractice activity. Claims against men were associated with more severe injury to the patient but were slightly less costly overall compared to claims against women. Further study is necessary to understand the reasons underlying gender disparities in malpractice claims rates and whether the observed past differences are predictive of future results. PMID:25411514

  17. Medical malpractice lawsuits and the value of skilled and diverse legal counsel.

    PubMed

    Lapuyade, Keith D; Sorkin, Alison C

    2013-12-01

    Medical malpractice claims against dermatologists and dermapathologists arise mostly out of claims for negligence--when a patient claims a provider owed a duty to a patient, breached that duty, and caused damages to the patient. When a health care provider files a claim with his or her insurance company, the insurance company will usually retain and pay an attorney for the health care provider. It is important to understand the role the attorney retained by the insurance company plays to evaluate whether a health care provider should seek the advice of independent or "personal" counsel. PMID:24800431

  18. An Analysis of the Number of Medical Malpractice Claims and Their Amounts

    PubMed Central

    Bonetti, Marco; Cirillo, Pasquale; Musile Tanzi, Paola; Trinchero, Elisabetta

    2016-01-01

    Starting from an extensive database, pooling 9 years of data from the top three insurance brokers in Italy, and containing 38125 reported claims due to alleged cases of medical malpractice, we use an inhomogeneous Poisson process to model the number of medical malpractice claims in Italy. The intensity of the process is allowed to vary over time, and it depends on a set of covariates, like the size of the hospital, the medical department and the complexity of the medical operations performed. We choose the combination medical department by hospital as the unit of analysis. Together with the number of claims, we also model the associated amounts paid by insurance companies, using a two-stage regression model. In particular, we use logistic regression for the probability that a claim is closed with a zero payment, whereas, conditionally on the fact that an amount is strictly positive, we make use of lognormal regression to model it as a function of several covariates. The model produces estimates and forecasts that are relevant to both insurance companies and hospitals, for quality assurance, service improvement and cost reduction. PMID:27077661

  19. An Analysis of the Number of Medical Malpractice Claims and Their Amounts.

    PubMed

    Bonetti, Marco; Cirillo, Pasquale; Musile Tanzi, Paola; Trinchero, Elisabetta

    2016-01-01

    Starting from an extensive database, pooling 9 years of data from the top three insurance brokers in Italy, and containing 38125 reported claims due to alleged cases of medical malpractice, we use an inhomogeneous Poisson process to model the number of medical malpractice claims in Italy. The intensity of the process is allowed to vary over time, and it depends on a set of covariates, like the size of the hospital, the medical department and the complexity of the medical operations performed. We choose the combination medical department by hospital as the unit of analysis. Together with the number of claims, we also model the associated amounts paid by insurance companies, using a two-stage regression model. In particular, we use logistic regression for the probability that a claim is closed with a zero payment, whereas, conditionally on the fact that an amount is strictly positive, we make use of lognormal regression to model it as a function of several covariates. The model produces estimates and forecasts that are relevant to both insurance companies and hospitals, for quality assurance, service improvement and cost reduction. PMID:27077661

  20. Educational Malpractice and Setting Damages for Ineffective Teaching: A Comparison of Legal Principles in the USA, England and Australia

    ERIC Educational Resources Information Center

    Mawdsley, Ralph D.; Cumming, J. Joy

    2008-01-01

    The extent to which educational institutions and their teachers in the USA, England, and Australia should bear legal responsibility in damages for ineffective classroom teaching is the subject of this article. At the heart of the controversy regarding educational malpractice is the issue of remedies. Federal and state courts in the USA have…

  1. Medical malpractice reform: noneconomic damages caps reduced payments 15 percent, with varied effects by specialty.

    PubMed

    Seabury, Seth A; Helland, Eric; Jena, Anupam B

    2014-11-01

    The impact of medical malpractice reforms on the average size of malpractice payments in specific physician specialties is unknown and subject to debate. We analyzed a national sample of malpractice claims for the period 1985-2010, merged with information on state liability reforms, to estimate the impact of state noneconomic damages caps on average malpractice payment size for physicians overall and for ten different specialty categories. We then compared how the effects differed according to the restrictiveness of the cap ($250,000 versus $500,000). We found that, overall, noneconomic damages caps reduced average payments by $42,980 (15 percent), compared to having no cap at all. A more restrictive $250,000 cap reduced average payments by $59,331 (20 percent), and a less restrictive $500,000 cap had no significant effect, compared to no cap at all. The effect of the caps overall varied according to specialty, with the largest impact being on claims involving pediatricians and the smallest on claims involving surgical subspecialties and ophthalmologists. PMID:25339633

  2. 20 CFR 30.609 - Is a settlement or judgment received as a result of allegations of medical malpractice in...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... result of allegations of medical malpractice in treating an illness covered by EEOICPA a recovery that... PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000,...

  3. 20 CFR 30.609 - Is a settlement or judgment received as a result of allegations of medical malpractice in...

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... result of allegations of medical malpractice in treating an illness covered by EEOICPA a recovery that... PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000,...

  4. 20 CFR 30.609 - Is a settlement or judgment received as a result of allegations of medical malpractice in...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... result of allegations of medical malpractice in treating an illness covered by EEOICPA a recovery that... PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000,...

  5. 20 CFR 30.609 - Is a settlement or judgment received as a result of allegations of medical malpractice in...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... result of allegations of medical malpractice in treating an illness covered by EEOICPA a recovery that... PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000,...

  6. 20 CFR 30.609 - Is a settlement or judgment received as a result of allegations of medical malpractice in...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... result of allegations of medical malpractice in treating an illness covered by EEOICPA a recovery that... PROGRAMS, DEPARTMENT OF LABOR ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000 CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000,...

  7. Comparing Canadian and American Legislation and Litigation in the Area of Medical Malpractice in Sport and Recreation.

    ERIC Educational Resources Information Center

    Toutant, Monique; And Others

    This paper analyzes sport and fitness malpractice suits in the United States and Canada, emphasizing the responsibility of doctors, along with some application to physiotherapists, trainers, or athletic therapists. The number of suits is felt to be limited but growing rapidly in both countries. The issues discussed include duty to patients…

  8. A Perception of Examination Malpractice and Pupil's Academic Performance in Primary Science in Cross River State, Nigeria

    ERIC Educational Resources Information Center

    Cornelius-Ukpepi, Bernedette Umali; Enukoha, Obinna I.

    2012-01-01

    The focus of this study was to determine perception of examination malpractice and academic performance in Primary Science among sixth grade in Cross River State, Nigeria. In order to achieve the set objectives of this study, three hypotheses were formulated and tested. Two instruments were used for data collection. They were perception of…

  9. [The frequency of medical malpractice: the results of the German Expert Panels and Arbitration Boards for Medical Liability].

    PubMed

    Schaffartzik, Walter; Neu, Johann

    2008-01-01

    The Gutachterkommissionen and Schlichtungsstellen in Germany (Expert Panels and Arbitration Boards for Medical Liability) were founded in the 1970s in order to serve as an institution other than the courts where suspected incidents of malpractice can be evaluated. The "Medical Error Reporting System" (MERS) was developed by the North German Schlichtungsstelle. The data it provides serve as the basis for the national statistics published by the Bundesärztekammer (German Medical Association). 7201 factual decisions were made. In 5074 proceedings no malpractice cases or risk disclosure problems were discovered, while in 2127 proceedings either of the two problems was noticed, and in 1,683 proceedings these problems were rated as being causative in the claimed harm and led to the recommendation to grant financial compensation to the patient. The MERS data reveal that most of the diagnoses which led patients to file a claim with the Gutachterkommissionen and Schlichtungsstellen referred to orthopaedics and traumatology and in the majority of cases reproaches were directed at surgical therapy. Doctors must strive to minimise malpractice and harm caused by medical treatment. With the help of the national statistics of the Bundesärztekammer derived from MERS the doctor can easily access information on cases of medical malpractice and harm in his or her discipline. This knowledge helps to foresee risks in a patient's treatment and to avoid errors. PMID:19213444

  10. Errors and pitfalls: Briefing and accusation of medical malpractice - the second victim.

    PubMed

    Wienke, Albrecht

    2013-01-01

    In June 2012, the German Medical Association (Bundesärztekammer) published the statistics of medical malpractice for 2011 (published at http://www.bundesaerztekammer.de). Still ENT-specific accusations of medical malpractice are by far the fewest in the field of hospitals and actually even in the outpatient context. Clearly most of the unforeseen incidents still occur in the disciplines of trauma surgery and orthopedics. In total, however, an increasing number of errors in treatment can be noticed on the multidisciplinary level: in 25.5% of the registered cases, an error in treatment was found to be the origin of damage to health justifying a claim for compensation of the patient. In the year before, it was only 24.7%. The reasons may be manifold, but the medical system itself certainly plays a major role in this context: the recent developments related to health policy lead to a continuous economisation of medical care. Rationing and limited remuneration more and more result in the fact that therapeutic decision are not exclusively made for the benefit of the patient but that they are oriented at economic or bureaucratic aspects. Thus, in the long term, practising medicine undergoes a change. According to the §§ 1, 3 of the professional code of conduct for doctors (Musterberufsordnung für Ärzte; MBO-Ä) medical practice as liberal profession is principally incompatible with the pursuit of profit, however, even doctors have to earn money which more and more makes him play the role of a businessman. Lack of personnel and staff savings lead to excessive workloads of physicians, caregivers, and nurses, which also favour errors. The quality and even the confidential relationship between doctor and patient, which is important for the treatment success, are necessarily affected by the cost pressure. The victims in this context are not only the patients but also the physicians find themselves in the continuous conflict between ethical requirements of their profession

  11. Errors and pitfalls: Briefing and accusation of medical malpractice – the second victim

    PubMed Central

    Wienke, Albrecht

    2013-01-01

    In June 2012, the German Medical Association (Bundesärztekammer) published the statistics of medical malpractice for 2011 (published at http://www.bundesaerztekammer.de). Still ENT-specific accusations of medical malpractice are by far the fewest in the field of hospitals and actually even in the outpatient context. Clearly most of the unforeseen incidents still occur in the disciplines of trauma surgery and orthopedics. In total, however, an increasing number of errors in treatment can be noticed on the multidisciplinary level: in 25.5% of the registered cases, an error in treatment was found to be the origin of damage to health justifying a claim for compensation of the patient. In the year before, it was only 24.7%. The reasons may be manifold, but the medical system itself certainly plays a major role in this context: the recent developments related to health policy lead to a continuous economisation of medical care. Rationing and limited remuneration more and more result in the fact that therapeutic decision are not exclusively made for the benefit of the patient but that they are oriented at economic or bureaucratic aspects. Thus, in the long term, practising medicine undergoes a change. According to the §§ 1, 3 of the professional code of conduct for doctors (Musterberufsordnung für Ärzte; MBO-Ä) medical practice as liberal profession is principally incompatible with the pursuit of profit, however, even doctors have to earn money which more and more makes him play the role of a businessman. Lack of personnel and staff savings lead to excessive workloads of physicians, caregivers, and nurses, which also favour errors. The quality and even the confidential relationship between doctor and patient, which is important for the treatment success, are necessarily affected by the cost pressure. The victims in this context are not only the patients but also the physicians find themselves in the continuous conflict between ethical requirements of their profession

  12. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology

    PubMed Central

    Windfuhr, Jochen P.

    2015-01-01

    Background: Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e. tonsillotomies) are increasingly performed. The aim of this study was to evaluate technical traps and pitfalls as well as alleged medical malpractice associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN). Methods: A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published trials and verdicts in Germany. Results: The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed nine cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including two children (5 and 8 years of age) and seven adults (aged 20 to 69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; four patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. Three Conciliation Boards submitted decicions associated with TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only three of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation

  13. [Abortion in the first trimester of pregnancy and the risk of malpractice].

    PubMed

    Soutoul, J H; Boog, G; Michaux, P; Lansac, J; Froge, E; Beaumont, E

    1983-01-01

    Although the legalization of abortion in France has led to a reduction in the grave complications generally associated with illegal abortion, abortion legislation has left open the possibility of malpractice complaints. A study of 81 trial records and communications from insurance compaines and the National Council of the Order of Physicians, as well as personal observations, forms the basis for a new classification of malpractice complaints. 39% of cases concerned 1 or more infractions of the abortion legislation, of which only failure to observe required conditions, such as performance by a physician, performance in a hospital or other approved facility, and limiting procedures to the allowable gestational age, can lead to penal sanctions. In 12% of the records (10 cases), maternal deaths from various causes were followed by civil suits. 2 cases were in process and 3 had led to penal sanctions. The conditions of anesthesia were involved in about 1/4 of the cases. In about 20% of cases, the complications were immediate and nonfatal, such as retention, hemorrhage, and perforation. Only 3 in 16 such cases were brought to trail and most of the others were settled by insurance compaines. 6% of cases resulted from medical errors without serious consequences, and 19 cases, or 22%, from unsuccessful abortions. Although parents of children born after unsuccessful abortions have not been awarded any indemnification, the existence of means for avoiding such a failure has been cited in 1 case and the treat of a fertility effect after unsuccessful abortion could possibly be admitted in French law in the future. Abortion practitioners should exercise the greatest prudence in following the law and in performing abortions. PMID:12266645

  14. Evaluating different types of malpractices in midwifery that were referred to the forensic medicine commission and the medical council between 2006 and 2011 in Isfahan province, 2013

    PubMed Central

    Beigi, Marjan; Asadi, Leila; Valiani, Mahbube; Mardani, Fardin

    2015-01-01

    Background: Medical malpractices in obstetrics are one of the main health concerns since in addition to the mortalities and morbidities caused for the two susceptible groups of mothers and neonates, they may lead to difficulties for the accused gynecologists and midwives in returning to their routine medical career and giving services to the patients. Hence, this study was conducted to evaluate different types of malpractices in midwifery that were referred to the legal medical commission and medical council in Isfahan province. Materials and Methods: In this cross-sectional descriptive study, we evaluated the data from all midwifery cases referred to the forensic medicine commission and medical council in Isfahan province between 2006 and 2011, with at least one lawsuit confirmed by the jury. Results: The results showed that in a total of 206 investigated cases at the medical council and forensic medicine commission in Isfahan, 66 cases of medical error sentences including 38 cases in medical council and 28 cases in forensic medicine commission were proved, which revealed 32% of malpractice in midwifery services in 2006–2011 in Isfahan. Negligence (39.2%), imprudence (23.5%), and disobedience of governmental regulations (19.6%) stood among the most commonly reported malpractices. Our findings also suggest that the most common malpractices happened in the postpartum period with a frequency of 44.7%; in addition, governmental hospitals were shown to have the most frequent malpractices with a frequency of 50%. Conclusions: Our results reveal that malpractices in midwifery services during and after delivery are so common, leading to irreversible complications to the mothers’ and neonates’ health in the society. On the other hand, considering the fact that most of these malpractices are preventable, related education, pertinent plans, and proper supervision sys. PMID:26257795

  15. [Revision of the medical malpractice law? Need for action and reform from the viewpoint of the physician].

    PubMed

    Bushe, K A

    1998-10-01

    With regard to the revision of the criminal code, the BJM has suggested two regulations concerning the lawsuit of medical malpractice. The text expounds the contence of section 229 E (wrongful treatment, personal injury) and section 230 E (unwillful negligence). It appears disturbing that constitutes for wrongful treatment in the context of assault upon the patient have been included in criminal law so the offence is now rated at the same level as (grievous) personal injury. The aim of the revision being further protection of personal rights and the right of self-determination. The proposed section 229 E and section 230 E are not able to guard the clinician against allegations of assault under criminal law prosecution. The code of civil law should suffice to balance most conditions of malpractice and assault upon the patient. Prosecution by criminal code should be held back for willful offences and wanton or reckless negligence. PMID:9885161

  16. Malpractice in dermatopathology: principles, risk mitigation, and opportunities for improved care for the histologic diagnosis of melanoma and pigmented lesions.

    PubMed

    High, Whitney A

    2008-06-01

    Melanoma represents a substantial source of risk within dermatology and dermatopathology. This article seeks to provide general pathologists, dermatologists and dermatopathologists with an overview of the basics principles of medical malpractice litigation, a review of the essentials of reporting and the importance of expert consultation for melanoma and pigmented lesions, and suggestions to improve quality care and reduce medicolegal risk associated with melanoma and pigmented lesions. PMID:18436070

  17. The Legal Doctrine on 'Limitation of Liability' in the Precedent Analysis on Plastic Surgery Medical Malpractice Lawsuits.

    PubMed

    Park, Bo Young; Pak, Ji-Hyun; Hong, Seung-Eun; Kang, So Ra

    2015-12-01

    This study intended to review the precedents on plastic surgery medical malpractice lawsuits in lower-court trials, classify the reasons of 'limitation of liability' by type, and suggest a standard in the acknowledgement of limitation of liability ratio. The 30 lower-court's rulings on the cases bearing the medical negligence of the defendants acknowledged the liability ratio of the defendants between 30% and 100%. Ten cases ruled that the defendants were wholly responsible for the negligence or malpractice, while 20 cases acknowledged the limitation of liability principle. In the determination of damage compensation amount, the court considered the cause of the victim side, which contributed in the occurrence of the damage. The court also believed that it is against the idea of fairness to have the assailant pay the whole compensation, even there is no victim-side cause such as previous illness or physical constitution of the patient, and applies the legal doctrine on limitation of liability, which is an independent damage compensation adjustment system. Most of the rulings also limited the ratio of responsibility to certain extent. When considering that the legal doctrine on limitation of liability which supports concrete validity for the fair sharing of damage, the tangible classification of causes of limitation of liability suggested in this study would be a useful tool in forecasting the ruling of a plastic surgery medical malpractice lawsuit. PMID:26713045

  18. The Legal Doctrine on 'Limitation of Liability' in the Precedent Analysis on Plastic Surgery Medical Malpractice Lawsuits

    PubMed Central

    Kang, So Ra

    2015-01-01

    This study intended to review the precedents on plastic surgery medical malpractice lawsuits in lower-court trials, classify the reasons of 'limitation of liability' by type, and suggest a standard in the acknowledgement of limitation of liability ratio. The 30 lower-court's rulings on the cases bearing the medical negligence of the defendants acknowledged the liability ratio of the defendants between 30% and 100%. Ten cases ruled that the defendants were wholly responsible for the negligence or malpractice, while 20 cases acknowledged the limitation of liability principle. In the determination of damage compensation amount, the court considered the cause of the victim side, which contributed in the occurrence of the damage. The court also believed that it is against the idea of fairness to have the assailant pay the whole compensation, even there is no victim-side cause such as previous illness or physical constitution of the patient, and applies the legal doctrine on limitation of liability, which is an independent damage compensation adjustment system. Most of the rulings also limited the ratio of responsibility to certain extent. When considering that the legal doctrine on limitation of liability which supports concrete validity for the fair sharing of damage, the tangible classification of causes of limitation of liability suggested in this study would be a useful tool in forecasting the ruling of a plastic surgery medical malpractice lawsuit. PMID:26713045

  19. Interpreting risk as evidence of causality: lessons learned from a legal case to determine medical malpractice.

    PubMed

    Mercuri, Mathew; Baigrie, Brian S

    2016-08-01

    Translating risk estimates derived from epidemiologic study into evidence of causality for a particular patient is problematic. The difficulty of this process is not unique to the medical context; rather, courts are also challenged with the task of using risk estimates to infer evidence of cause in particular cases. Thus, an examination of how this is done in a legal context might provide insight into when and how it is appropriate to use risk information as evidence of cause in a medical context. A careful study of the case of Goodman v. Viljoen, a medical malpractice suit litigated in the Ontario Superior Court of Justice in 2011, reveals different approaches to how risk information is used as or might be considered a substitute for evidence of causation, and the pitfalls associated with these approaches. Achieving statistical thresholds, specifically minimizing the probability of falsely rejecting the null hypothesis, and exceeding a relative risk of 2, plays a significant role in establishing causality of the particular in the legal setting. However, providing a reasonable explanation or establishing "biological plausibility" of the causal association also seems important, and (to some) may even take precedent over statistical thresholds for a given context. PMID:27305892

  20. Onset of complications following cervical manipulation due to malpractice in osteopathic treatment: a case report.

    PubMed

    Cicconi, Michela; Mangiulli, Tatiana; Bolino, Giorgio

    2014-10-01

    The aim of this study is to correlate cervical disc herniation with manipulation performed by a non-physician osteopath on a patient complaining of neck pain. The authors report a case in which a woman - treated with osteopathic spinal manipulation - developed cervical-brachial neuralgia following the cervical disc herniation. The patient then underwent surgery and was followed by physiotherapists. A clinical condition characterized by limitation of neck mobility, with pain and sensory deficit in the right arm and II-III fingers, still persists. The patient consulted the authors to establish whether cervical disc herniation could be attributed to manipulation. Adverse events or side effects of spinal manipulative therapy are relatively common and usually benign. Most of these side effects are mild or moderate, but sometimes they can be severe. Cervical manipulation can provoke complications less often than thoracic or lumbar manipulation. Furthermore, many diseases can be absolutely and relatively contraindicated to osteopathic treatment. Therefore, the knowledge of a patient's clinical conditions is essential before starting a manipulative treatment; otherwise the osteopath could be accused of malpractice. It is the authors' opinion that a cause-effect relationship exists between the manipulative treatment and the development of disc herniation. PMID:24402084

  1. [Incomplete paraplegia after delayed diagnostics of motor function deficits. Severe malpractice?].

    PubMed

    Regauer, M; Neu, J

    2013-03-01

    A 72-year-old female patient was transferred to a rehabilitation centre after surgical stabilization of a subtrochanteric femoral fracture. However, adequate mobilization was not possible there and 5 days after transfer deficits in the motor function of both lower extremities were documented for the first time and an initial paraplegia was diagnosed the following day by a neurologist. Magnetic resonance imaging (MRI) revealed the suspicion of an unstable fracture of the seventh thoracic vertebral body 8 days after the initial symptoms, which was confirmed by computed tomography after another 3 days. Surgical decompression and stabilization were performed at a department for neurosurgery 4 days later but incomplete paraplegia persisted permanently. The patient complained about insufficient diagnostic measures at the rehabilitation centre. The expert opinion concluded that it would have been mandatory to investigate the matter of the newly occurring neurological symptoms immediately but this had only been performed after undue delay, which had to be interpreted as a case of medical malpractice. The expert pointed out that it was not possible to provide clear evidence that emergent diagnosis and surgery would have enabled a significantly better outcome.The arbitration board ascertained a lack of examination and argued that prompt and adequate diagnostic measures would have revealed the relevant pathological finding and thus surgery would have been performed immediately. According to the reversal of evidence in favor of the patient it could be assumed that no permanent neurological damage existed when the first neurological symptoms occurred and that emergent surgery at least had the potential to prevent permanent paraplegia. This opinion of the arbitration board is supported by numerous references in the literature. PMID:23478903

  2. Expert witness blinding strategies to mitigate bias in radiology malpractice cases: a comprehensive review of the literature.

    PubMed

    Durand, Daniel J; Robertson, Christopher T; Agarwal, Gautam; Duszak, Richard; Krupinski, Elizabeth A; Itri, Jason N; Fotenos, Anthony; Savoie, Brent; Ding, Alexander; Lewin, Jonathan S

    2014-09-01

    Like all physicians, radiologists in the United States are subject to frequent and costly medical malpractice claims. Legal scholars and physicians concur that the US civil justice system is neither precise nor accurate in determining whether malpractice has truly occurred in cases in which claims are made. Sometimes, this inaccuracy is driven by biases inherent in medical expert-witness opinions. For example, expert-witness testimony involving "missed" radiology findings can be negatively affected by several cognitive biases, such as contextual bias, hindsight bias, and outcome bias. Biases inherent in the US legal system, such as selection bias, compensation bias, and affiliation bias, also play important roles. Fortunately, many of these biases can be significantly mitigated or eliminated through the use of appropriate blinding techniques. This paper reviews the major works on expert-witness blinding in the legal scholarship and the radiology professional literature. Its purpose is to acquaint the reader with the evidence that unblinded expert-witness testimony is tainted by multiple sources of bias and to examine proposed strategies for addressing these biases through blinding. PMID:25041992

  3. Guidelines for expert witness testimony in medical malpractice litigation. Committee on Medical Liability. American Academy of Pediatrics.

    PubMed

    2002-05-01

    The interests of the public and the medical profession are best served when scientifically sound and unbiased expert witness testimony is readily available to plaintiffs and defendants in medical negligence suits. As members of the physician community, as patient advocates, and as private citizens, pediatricians have ethical and professional obligations to assist in the administration of justice, particularly in matters concerning potential medical malpractice. The American Academy of Pediatrics believes that the adoption of the recommendations outlined in this statement will improve the quality of medical expert witness testimony in such proceedings and thereby increase the probability of achieving equitable outcomes. Strategies to enforce ethical guidelines should be monitored for efficacy before offering policy recommendations on disciplining physicians for providing biased, false, or unscientific medical expert witness testimony. PMID:11986466

  4. Review of Medical Dispute Cases in the Pain Management in Korea: A Medical Malpractice Liability Insurance Database Study

    PubMed Central

    Moon, Hyun Seog

    2015-01-01

    Background Pain medicine often requires medico-legal involvement, even though diagnosis and treatments have improved considerably. Multiple guidelines for pain physicians contain many recommendations regarding interventional treatment. Unfortunately, no definite treatment guidelines exist because there is no complete consensus among individual guidelines. Pain intervention procedures are widely practiced and highly associated with adverse events and complications. However, a comprehensive, systemic review of medical-dispute cases (MDCs) in Korea has not yet been reported. The purpose of this article is to analyze the frequency and type of medical dispute activity undertaken by pain specialists in Korea. Methods Data on medical disputes cases were collected through the Korea Medical Association mutual aid and through a private medical malpractice liability insurance company. Data regarding the frequency and type of MDCs, along with brief case descriptions, were obtained. Results Pain in the lumbar region made up a major proportion of MDCs and compensation costs. Infection, nerve injury, and diagnosis related cases were the most major contents of MDCs. Only a small proportion of cases involved patient death or unconsciousness, but compensation costs were the highest. Conclusions More systemic guidelines and recommendations on interventional pain management are needed, especially those focused on medico-legal cases. Complications arising from pain management procedures and treatments may be avoided by physicians who have the required knowledge and expertise regarding anatomy and pain intervention procedures and know how to recognize procedural aberrations as soon as they occur. PMID:26495080

  5. Professional liability insurance in Obstetrics and Gynaecology: estimate of the level of knowledge about malpractice insurance policies and definition of an informative tool for the management of the professional activity

    PubMed Central

    2011-01-01

    Background In recent years, due to the increasingly hostile environment in the medical malpractice field and related lawsuits in Italy, physicians began informing themselves regarding their comprehensive medical malpractice coverage. Methods In order to estimate the level of knowledge of medical professionals on liability insurance coverage for healthcare malpractice, a sample of 60 hospital health professionals of the obstetrics and gynaecology area of Messina (Sicily, Italy) were recluted. A survey was administered to evaluate their knowledge as to the meaning of professional liability insurance coverage but above all on the most frequent policy forms ("loss occurrence", "claims made" and "I-II risk"). Professionals were classified according to age and professional title and descriptive statistics were calculated for all the professional groups and answers. Results Most of the surveyed professionals were unaware or had very bad knowledge of the professional liability insurance coverage negotiated by the general manager, so most of the personnel believed it useful to subscribe individual "private" policies. Several subjects declared they were aware of the possibility of obtaining an extended coverage for gross negligence and substantially all the surveyed had never seen the loss occurrence and claims made form of the policy. Moreover, the sample was practically unaware of the related issues about insurance coverage for damages related to breaches on informed consent. The results revealed the relative lack of knowledge--among the operators in the field of obstetrics and gynaecology--of the effective coverage provided by the policies signed by the hospital managers for damages in medical malpractice. The authors thus proposed a useful information tool to help professionals working in obstetrics and gynaecology regarding aspects of insurance coverage provided on the basis of Italian civil law. Conclusion Italy must introduce a compulsory insurance system which could

  6. [Suicide and malpractice].

    PubMed

    Catanesi, Roberto; Carabellese, Felice

    2011-01-01

    Some recent statements on the subject of psychiatrists' responsibility for suicide committed by patients have provoked lively discussions about the welfare duties of public psychiatric services, causing a widespread climate of alarm among medical institutions. The discussion is primarily about the extent of the psychiatrist's "posizione della garanzia", in particular the duty of protection and surveillance in relation to the risk of self-destructive behavior, referring to convictions not only in TSO cases but also in cases of voluntary hospitalization and valid consensus on treatment. The subject of suicide inevitably reminds us of the predictability of self-destructive behavior and, above all, of its prevention. The authors compare data from scientific literature on this subject - the organizational model of territorial psychiatry - with the principles ordered by the convictions, in particular the request for "ulterior and more rigorous protective rules", thus highlighting their complicated synthesis. In the authors' opinion, a possible literal interpretation of the legal indications would risk a profound change in the quality of the relationship between psychiatrist and patient. The authors, striving to adopt the psychiatrists' point of view, want to finally provide some operational advice with the objective to delimit good practice according to a medico-legal view. PMID:21572467

  7. Malpractice in Counseling Neuropsychology.

    ERIC Educational Resources Information Center

    Woody, Robert Henley

    1992-01-01

    Responds to earlier four articles on integration of counseling psychology and neuropsychology by noting that neuropsychology occurs in settings with high risk of legal complaints. Contends that aspiration to press counseling psychology toward clinical neuropsychology should be filtered through consideration for legal risk. Explores legal…

  8. [Guideline to prevent claims due to medical malpractice, on how to act when they do occur and how to defend oneself through the courts].

    PubMed

    Bruguera, M; Arimany, J; Bruguera, R; Barberia, E; Ferrer, F; Sala, J; Pujol Robinat, A; Medallo Muñiz, J

    2012-04-01

    Claims due to presumed medical malpractice are increasing in all developed countries and many of them have no basis. To prevent legal complaints, the physicians should know the reasons why complaints are made by their patients and adopt the adequate preventive measures. In the case of a complaint, it is essential to follow the guidelines that allow for adequate legal defense and the action of the physician before the judge that inspires confidence and credibility. The risk of the claims can be reduced with adequate information to the patient, the following of the clinical guidelines, control of the risk factors and adoption of verification lists in each invasive procedure. In case of complication or serious adverse effect, explanations should be given to the patient and family and it should be reported to the facility where one works and to the insurance company. If the physician received a claim, he/she should report it to the insurance compare so that it can name a lawyer responsible for the legal defense who will advise the physician regarding the appearance in court before the judge. PMID:22397887

  9. How reason for surgery and patient weight affect verdicts and perceptions in medical malpractice trials: a comparison of students and jurors.

    PubMed

    Reichert, Jenny; Miller, Monica K; Bornstein, Brian H; Shelton, Hon Donald E

    2011-01-01

    Jurors' decision-making processes are often influenced by extra-legal factors, including judgments of defendants and plaintiffs. Two studies comparing the decisions of university students with those of community jurors sought to determine if extra-legal factors such as individual differences (including identity as a student or juror participant), the reason for surgery (medically necessary vs. elective), the type of surgery (e.g., gastric bypass, nasal reconstruction) or weight of the patient influenced jurors' decisions and perceptions in medical malpractice suits, such that participants would hold negative perceptions of overweight patients or patients who undergo elective surgeries. Results indicate that students and jurors differ in perceptions of the patient's injury and perceptions of risk, which explains some of the variance in liability verdicts. Students were more likely to find doctors liable, but also were more likely to assign responsibility to patients than were jurors. Patients who had undergone elective surgery were seen as more responsible for their situation - and their doctors were assigned less responsibility - than those who had undergone a medically necessary surgery. Tests of weight bias showed that jurors found overweight patients less responsible for their situation than patients of normal weight, but students showed the opposite pattern. Theoretical explanations are explored and implications discussed. PMID:21308752

  10. How do authors of systematic reviews deal with research malpractice and misconduct in original studies? A cross-sectional analysis of systematic reviews and survey of their authors

    PubMed Central

    Elia, Nadia; von Elm, Erik; Chatagner, Alexandra; Pöpping, Daniel M; Tramèr, Martin R

    2016-01-01

    Objectives To study whether systematic reviewers apply procedures to counter-balance some common forms of research malpractice such as not publishing completed research, duplicate publications, or selective reporting of outcomes, and to see whether they identify and report misconduct. Design Cross-sectional analysis of systematic reviews and survey of their authors. Participants 118 systematic reviews published in four journals (Ann Int Med, BMJ, JAMA, Lancet), and the Cochrane Library, in 2013. Main outcomes and measures Number (%) of reviews that applied procedures to reduce the impact of: (1) publication bias (through searching of unpublished trials), (2) selective outcome reporting (by contacting the authors of the original studies), (3) duplicate publications, (4) sponsors’ and (5) authors’ conflicts of interest, on the conclusions of the review, and (6) looked for ethical approval of the studies. Number (%) of reviewers who suspected misconduct are reported. The procedures applied were compared across journals. Results 80 (68%) reviewers confirmed their data. 59 (50%) reviews applied three or more procedures; 11 (9%) applied none. Unpublished trials were searched in 79 (66%) reviews. Authors of original studies were contacted in 73 (62%). Duplicate publications were searched in 81 (69%). 27 reviews (23%) reported sponsors of the included studies; 6 (5%) analysed their impact on the conclusions of the review. Five reviews (4%) looked at conflicts of interest of study authors; none of them analysed their impact. Three reviews (2.5%) looked at ethical approval of the studies. Seven reviews (6%) suspected misconduct; only 2 (2%) reported it explicitly. Procedures applied differed across the journals. Conclusions Only half of the systematic reviews applied three or more of the six procedures examined. Sponsors, conflicts of interest of authors and ethical approval remain overlooked. Research misconduct is sometimes identified, but rarely reported. Guidance on

  11. [Malpractice in health care teams].

    PubMed

    Pizarro, Carlos

    2011-05-01

    To be successful, modern medical acts require the participation of several professionals and assistants and, as such, there has been a steady trend from individual medicine to the collective practice of the profession. This format raises issues in determining when a medical professional or other practitioner is liable for the acts of a colleague. This thesis proposes to resolve the problems involved in the collective practice of medicine by restricting liability to a physician responsible for another practitioner, only to those cases where he/she has been willingly introduced into the medical act. PMID:22051720

  12. Swedish malpractice reports and convictions.

    PubMed

    Kriisa, M

    1990-01-01

    The Swedish system, with the Board of Health and Welfare as supervisor, and Medical Board of Responsibility gives both authorities and patients the opportunity to file reports demanding disciplinary action where an error is perceived to have been committed. A total of 184 primary care complaints, involving 230 staff of which 170 were physicians and 42 nurses, were reviewed. Complaints were made by patients or parents in 73% and by the Board of Health in 14%. Handling took up to 4 years. Erroneous or delayed diagnosis was the cause in 58%, erroneous medication in 11%, rudeness in 14%. Of the 230 staff reported, 23 received warnings and 19 reprimands. PMID:1983253

  13. Illiteracy: An Incurable Disease or Education Malpractice?

    ERIC Educational Resources Information Center

    United States Senate Republican Policy Committee, Washington, DC.

    The major theory examined in this paper is that the increasing problem of illiteracy in the United States may be due to a faulty method of teaching reading. The causes of the illiteracy problem and possible solutions are explored using evidence from reading research and classroom results. The following topics concerning the teaching of reading are…

  14. Marketing malpractice: the cause and the cure.

    PubMed

    Christensen, Clayton M; Cook, Scott; Hall, Taddy

    2005-12-01

    Ted Levitt used to tell his Harvard Business School students, "People don't want a quarter-inch drill--they want a quarter-inch hole." But 35 years later, marketers are still thinking in terms of products and ever-finer demographic segments. The structure of a market, as seen from customers' point of view, is very simple. When people need to get a job done, they hire a product or service to do it for them. The marketer's task is to understand what jobs periodically arise in customers' lives for which they might hire products the company could make. One job, the "I-need-to-send-this-from-here-to-there-with-perfect-certainty-as-fast-as-possible"job, has existed practically forever. Federal Express designed a service to do precisely that--and do it wonderfully again and again. The FedEx brand began popping into people's minds whenever they needed to get that job done. Most of today's great brands--Crest, Starbucks, Kleenex, eBay, and Kodak, to name a few-started out as just this kind of purpose brand. When a purpose brand is extended to products that target different jobs, it becomes an endorser brand. But, over time, the power of an endorser brand will surely erode unless the company creates a new purpose brand for each new job, even as it leverages the endorser brand as an overall marker of quality. Different jobs demand different purpose brands. New growth markets are created when an innovating company designs a product and then positions its brand on a job for which no optimal product yet exists. In fact, companies that historically have segmented and measured markets by product categories generally find that when they instead segment by job, their market is much larger (and their current share much smaller) than they had thought. This is great news for smart companies hungry for growth. PMID:16334583

  15. Hypertension and Cerebral Hemorrhage: A Malpractice Controversy

    PubMed Central

    Franklin, Stanley S.; Hunt, Marshall T.; Vogt, Thomas; Walsh, Gregory; Paglia, Donald E.

    1980-01-01

    The plaintiff alleged that failure of the attending physician to manage her husband's hypertension properly resulted in his death from intracerebral hemorrhage. Four lines of evidence supported the defendant: (1) In 1970 to 1971 there was uncertainty in the medical community whether mild hypertension should be treated with drugs; this uncertainty still existed at the time of the trial. (2) Severe hypertension and advanced age are the two most important predisposing factors leading to intracerebral hemorrhage; the deceased patient had neither. (3) Hemorrhage into the cerebral cortex and underlying white matter is not typical of hypertensive intracerebral bleeding; more likely, rupture of an arteriovenous malformation occurred. (4) A diagnosis of hypertensive intracerebral hemorrhage is not one of exclusion but requires objective evidence of vascular change in the brain, heart and kidney; these changes were not found in the deceased patient. In conclusion, an expert witness should testify objectively rather than be the advocate of a lawyer's theory of liability. ImagesFig. 6.Fig. 7.Fig. 9.Fig. 10. PMID:7233893

  16. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Data Bank, in accordance with regulations at 45 CFR part 60, subpart B, as applicable, regarding any...; (iv) Social Security number, if known, and if obtained in accordance with section 7 of the Privacy Act... care that led to the claim. These documents include the medical records of the patient whose care...

  17. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Data Bank, in accordance with regulations at 45 CFR part 60, subpart B, as applicable, regarding any...; (iv) Social Security number, if known, and if obtained in accordance with section 7 of the Privacy Act... care that led to the claim. These documents include the medical records of the patient whose care...

  18. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Data Bank, in accordance with regulations at 45 CFR part 60, subpart B, as applicable, regarding any...; (iv) Social Security number, if known, and if obtained in accordance with section 7 of the Privacy Act... care that led to the claim. These documents include the medical records of the patient whose care...

  19. Examination Malpractice in Nigeria: Causes and Effects on National Development

    ERIC Educational Resources Information Center

    Onyibe, C. O.; Uma, Uma U.; Ibina, Emmanuel

    2015-01-01

    Education, being a process of teaching and learning is evaluated through examination at the end of the learning period. Examination not only serves as a feedback for the trainer to ascertain the level of knowledge acquisition but also serves as a measure of knowledge retention by the trainee. Any misconduct or irregularity distorts this feedback…

  20. 400K British Pounds for Educational Malpractice by University Academics

    ERIC Educational Resources Information Center

    Palfreyman, David

    2006-01-01

    The Canadian Supreme Court in "Young v. Bella" has approved the award of C$840K to Ms Young against the Memorial University of Newfoundland and also two of its academics. In this article, the author comments on the "Young v. Bella" case. Ms Young was a distance-learning student studying social work and hoped to get on a professional course and so…

  1. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Data Bank, in accordance with regulations at 45 CFR part 60, subpart B, as applicable, regarding any payment for the benefit of a physician, dentist, or other licensed health care practitioner which was made... the physician, dentist, or other licensed health care practitioner for whose benefit the payment...

  2. 45 CFR 60.7 - Reporting medical malpractice payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... amount specified at 42 CFR 1003.103(c). (d) Interpretation of information. A payment in settlement of a... benefit of a physician, dentist or other health care practitioner in settlement of or in satisfaction in whole or in part of a claim or a judgment against such physician, dentist, or other health...

  3. 45 CFR 60.7 - Reporting medical malpractice payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... amount specified at 42 CFR 1003.103(c). (d) Interpretation of information. A payment in settlement of a... benefit of a physician, dentist or other health care practitioner in settlement of or in satisfaction in whole or in part of a claim or a judgment against such physician, dentist, or other health...

  4. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Data Bank, in accordance with regulations at 45 CFR part 60, subpart B, as applicable, regarding any payment for the benefit of a physician, dentist, or other licensed health care practitioner which was made... the physician, dentist, or other licensed health care practitioner for whose benefit the payment...

  5. Medical malpractice: a review of issues for providers.

    PubMed

    Ryan, Marsha

    2002-12-01

    The worlds of law and medicine meet in some very interesting and very important ways. Together, lawyers and physicians tackle such subjects as cloning, right to die, surrogate parenthood, and embryo preservation and implantation, to name a few. The most personal and painful nexus for physicians comes when a physician is sued and must then deal with the legal system as a defendant. The world of plaintiffs, experts, legal doctrines, state and federal law, and judicial application of law to the facts of the case can be intimidating. It is hoped that this overview has allowed the hematology-oncology practitioner to become more familiar with the theories and procedures involved in medical negligence actions. The physician, when comfortable with the basics, may better tolerate the apparent idiosyncrasies of the system and even may be able to protect him or herself from becoming involved in a lawsuit ab initio. PMID:12512170

  6. Malpractice and the Communication Consultant: A Proactive Approach.

    ERIC Educational Resources Information Center

    Montgomery, Daniel J.; And Others

    1995-01-01

    Provides communication practitioners with an overview of legal and ethical issues facing individuals who market themselves as professional communication consultants. Discusses the tort of negligence. Outlines court-supported practices that professional consultants might use to help protect clients and themselves. Argues that an understanding of…

  7. Scratching beneath the Surface of Communities of (Mal)practice

    ERIC Educational Resources Information Center

    Pemberton, Jon; Mavin, Sharon; Stalker, Brenda

    2007-01-01

    Purpose: This paper seeks to surface less positive aspects of communities of practice (CoPs), regardless of emergent or organisationally managed, grounded in political-power interactions. Examples are provided from the authors' experiences of a research-based CoP within UK higher education. Design/methodology/approach: The paper is primarily…

  8. Moral Intelligence: An Antidote to Examination Malpractices in Nigerian Schools

    ERIC Educational Resources Information Center

    Olusola, Olayiwola Idowu; Ajayi, Oluwagbemiga Samson

    2015-01-01

    Moral intelligence is the capacity to apply moral principles to one's own values, goals and actions (or the ability to see what is right and integrate it into one's life and actions) It is considered as the individual capacity to understand right from wrong, to have strong ethical convictions and to act on them to behave in the right and…

  9. [Examination of Medical Malpractice Allegations by Arbitration Boards].

    PubMed

    Horch, R E

    2016-04-01

    Commentary to the paper "What went wrong? Conciliatory proceedings of a German mediation center after breast reductions", Allert S., Flechtner C., Vogt P. M. et al. Handchir Mikrochir Plast Chir, DOI 10.1055/s-0042-103586. PMID:27096209

  10. Educational Malpractice and Academic Negligence in Private Schools: Legal Implications for School Administrators

    ERIC Educational Resources Information Center

    Hassan, Saman

    2009-01-01

    The current litigious climate in the United States has resulted in a notably high frequency of lawsuits being filed against the educational system. School administrators are routinely named in lawsuits filed by disgruntled parents and students against schools and their governing bodies. This dissertation reviewed litigious actions in both public…

  11. 76 FR 10825 - Federal Tort Claims Act (FTCA) Medical Malpractice Program Regulations: Clarification of FTCA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-28

    ... implementing Public Law 102-501 was published in the Federal Register (60 FR 22530) on May 8, 1995, and added a...), as further discussed in the September 1995 Notice (60 FR 49417). For those situations, the Department... September 1995 Notice immunization example to include events to immunize individuals against...

  12. 78 FR 58202 - Federal Tort Claims Act (FTCA) Medical Malpractice Program Regulations: Clarification of FTCA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-23

    ... rule implementing Public Law 102-501 was published in the Federal Register (60 FR 22530) on May 8, 1995... (60 FR 49417). For those situations, it was determined that the activities described in the September... September 1995 Notice immunization example to include events to immunize individuals against...

  13. Psychological Abuse of Children: Implications for Malpractice and Dismissals of Teachers.

    ERIC Educational Resources Information Center

    Lynch, Patrick D.

    This article defines psychological abuse of students in school settings and describes legal aspects of the problem, particularly with respect to possible action in negligence. The following four categories of psychological abuse are examined: verbal abuse, refusal to communicate, physical acts (and sexual abuse) that cause psychological damage,…

  14. Tales of the crypt for psychiatrists: mourning, melancholia, and mortuary malpractice.

    PubMed

    Eth, S; Leong, G B; Garrick, T R

    1996-01-01

    Death awaits all, leaving in its wake relatives and friends affected by the loss of a loved one. Immediately following death, the funeral process begins, resulting in permanent burial in a cemetery. This report investigates the dysfunctional interactions between grief-stricken relatives and mortuaries that are associated with civil litigation for negligence. Psychiatric evaluations of 25 bereaved plaintiffs from nine separate lawsuits were performed. In addition, medical records and legal pleadings were reviewed as sources of additional information. General themes from the clinical material are identified and illustrated by two cases. Surviving relatives are in an acute state of emotional turmoil, rendering them exquisitely sensitive to lapses in expected routine and perceived disrespect toward the decreased. These issues are intensified when the circumstances of the death were traumatic, when the relationship with the deceased was ambivalent, when specific cultural and religious factors are present, and when the influence of litigation is felt. If the burial process is disrupted, civil suits for negligence may be filed that exacerbate grief and challenge the psychiatrist's efforts to resolve diagnostic ambiguity in the face of emotionally charged cultural and religious practices. PMID:9001746

  15. Malpractice in the new millennium: better than today? Managed care, telemedicine, genetic tests create new liabilities.

    PubMed

    1996-01-01

    The practice of medicine is at a crossroads. Many physicians speak of early retirement and of discouraging their children from pursuing a medical career. Physicians-in-training, heeding warnings about a surplus of specialists, are entering primary care residencies in record numbers. Proposals in 1993 and 1994 to transform the nation's health care system fizzled or, as some charge, were euthanized by insurance interests and by politicians worried about a potential loss of campaign contributions. Managed care has emerged as the "new paradigm," enticing physicians and hospitals into fragile, ambivalent relationships. Despite their unrivaled position atop the national pedestal of admiration, many physicians still worry that every patient is a potential litigant. Americans love their doctors and believe that no country has a better health care system. Nevertheless, medical scientists have been productive, and report that a number of extraordinary diagnostic and treatment breakthroughs are within reach. But the excitement about their discoveries is tempered by mounting fears over the long-range legal and ethical consequences of medical research. PMID:8936700

  16. Malpractice Burden, Rural Location, and Discontinuation of Obstetric Care: A Study of Obstetric Providers in Michigan

    ERIC Educational Resources Information Center

    Xu, Xiao; Siefert, Kristine A.; Jacobson, Peter D.; Lori, Jody R.; Gueorguieva, Iana; Ransom, Scott B.

    2009-01-01

    Context: It has long been a concern that professional liability problems disproportionately affect the delivery of obstetrical services to women living in rural areas. Michigan, a state with a large number of rural communities, is considered to be at risk for a medical liability crisis. Purpose: This study examined whether higher malpractice…

  17. Educational Malpractice?: Higher Ed May Be Courting Trouble with Overpaid Execs and Restless Consumers

    ERIC Educational Resources Information Center

    Smith, Robert B.; Fleming, Dana L.

    2007-01-01

    The number and complexity of state and federal regulations governing U.S. colleges and universities is on the rise. Consumerism, soaring tuition costs, burgeoning student loan debt and the high expectations of parents are all converging to put higher education under increased scrutiny. Two related issues: students feeling like they do not get…

  18. Mandatory pre-suit mediation: local malpractice reform benefiting patients and healthcare providers.

    PubMed

    Jenkins, Randall C; Warren, Lindsay A; Gravenstein, Nikolaus

    2010-01-01

    The Florida Patient Safety and Pre-Suit Mediation Program (FLPSMP) was implemented as a pilot program to provide patients of healthcare providers and facilities associated with the University of Florida Health Science Center with timely and fair compensation when injured and to combat rising healthcare legal liability expenses. Prior to filing a formal lawsuit, participants of the FLPSMP join in a confidential and nonbinding pre-suit mediation conducted by a neutral third-party mediator. The process fosters confidential and candid communication between doctors and patients, saving thousands of dollars in legal expenses for both patients and providers. PMID:20979162

  19. Conflicts of Interest, Selective Inertia, and Research Malpractice in Randomized Clinical Trials: An Unholy Trinity

    PubMed Central

    Berger, Vance W.

    2014-01-01

    Recently a great deal of attention has been paid to conflicts of interest in medical research, and the Institute of Medicine has called for more research into this important area. One research question that has not received sufficient attention concerns the mechanisms of action by which conflicts of interest can result in biased and/or flawed research. What discretion do conflicted researchers have to sway the results one way or the other? We address this issue from the perspective of selective inertia, or an unnatural selection of research methods based on which are most likely to establish the preferred conclusions, rather than on which are most valid. In many cases it is abundantly clear that a method that is not being used in practice is superior to the one that is being used in practice, at least from the perspective of validity, and that it is only inertia, as opposed to any serious suggestion that the incumbent method is superior (or even comparable), that keeps the inferior procedure in use, to the exclusion of the superior one. By focusing on these flawed research methods we can go beyond statements of potential harm from real conflicts of interest, and can more directly assess actual (not potential) harm. PMID:25150846

  20. Use of the countersuit by pharmacists who have been groundlessly sued for malpractice.

    PubMed

    Brushwood, D B

    1982-01-01

    Attorneys for patients who have been injured by adverse reactions to drugs often name as defendants the prescribing physician, the drug manufacturer, and the pharmacist. In many jurisdictions neither the law of warranty nor the law of strict liability will support a cause of action against a pharmacist who has done nothing more than correctly dispense a drug which was correctly prescribed. If the lawsuit against the pharmacist can be shown to have been filed for no other reason than to coerce a nuisance settlement or just to be cautious, the pharmacist may have available a remedy in the form of a countersuit. Malicious prosecution is one cause of action which might be maintainable as a countersuit. The elements of the cause of action are: 1) the initiation of a lawsuit; 2) lack of probable cause; 3) malice; 4) termination in favor of the pharmacist; and 5) damages. Lack of probable cause and malice are interrelated and are the two most difficult elements to prove. Abuse of process is another possible cause of action. The elements are: 1) an illegal, improper, or perverted use of the process; 2) an ulterior motive or purpose; and 3) damages. Other causes of action which have been considered by attorneys for groundlessly sued health professionals are barratry, defamation, attorney negligence, prima facie tort, and violation of a disciplinary rule. PMID:10256916

  1. [Medical error--professional liability for malpractice in Bosnia and Herzegovina].

    PubMed

    Pranjić, Nurka

    2009-01-01

    Medical care is frequently compared to aviation, as many of the factors which lead to errors in both fields are similar. In this article we review the literature on such events and discuss the ethical, legal and practical aspects of civil liability in the case of medical error. Ethics, professional policy and the law, as well as the relevant empirical literature, suggest that timely and candid disclosure should be standard practice. In harmonization to ethical codex, the physician is obliged to inform the patient about the origin of medical error. Civil liability is one of the most important parts of law that regulates health care service. Medical chambers could be having a very important role in alternative methods of medical error disciplinary screening proceedings. Guidelines for disclosure of medical error to patients, and their families if necessary, are proposed. PMID:19769287

  2. 32 CFR 750.54 - Payment of costs, settlements, and judgments related to certain medical or legal malpractice claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... providing health care functions or legal services and within the scope of employment; and (2) Such personnel furnish prompt notification and delivery of all process served or received, and other...

  3. 32 CFR 536.80 - Payment of costs, settlements, and judgments related to certain medical malpractice claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... wrongful actions or omissions occurred during the performance of medical, dental, or related health care functions (including clinical studies and investigations) while the medical or health care employee was acting within the scope of employment. (2) Such personnel furnish prompt notification and delivery of...

  4. 32 CFR 536.80 - Payment of costs, settlements, and judgments related to certain medical malpractice claims.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... wrongful actions or omissions occurred during the performance of medical, dental, or related health care functions (including clinical studies and investigations) while the medical or health care employee was acting within the scope of employment. (2) Such personnel furnish prompt notification and delivery of...

  5. Complaint and disciplinary systems in dentistry in Sweden: a presentation and discussion of their efficacy in preventing malpractice.

    PubMed

    René, N; Westesson, P L; Owall, B

    1993-09-01

    The Swedish systems for complaints and supervision with many possibilities of claiming on different levels may lead to prevention of future problems in medical and dental care. The systems are corrective, preventive and compensatory, and are important in the process of quality assurance. However, some elements need improvement. The present paper gives as a background an overview of the Swedish systems and discusses a few cases. Comparisons with systems in other countries, especially the USA, are made, and new measures are discussed. There is a need for smooth, preventive measures as well as strong, punitive and corrective measures. Recidivist doctors/dentists must be stopped. PMID:8260637

  6. 20 CFR 10.717 - Is a settlement or judgment received as a result of allegations of medical malpractice in...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... that must be reported to OWCP or SOL? 10.717 Section 10.717 Employees' Benefits OFFICE OF WORKERS... injury covered by the FECA a gross recovery that must be reported to OWCP or SOL? Since an injury caused... reported to OWCP or SOL....

  7. Failure to Apply the Flynn Correction in Death Penalty Litigation: Standard Practice of Today Maybe, but Certainly Malpractice of Tomorrow

    ERIC Educational Resources Information Center

    Reynolds, Cecil R.; Niland, John; Wright, John E.; Rosenn, Michal

    2010-01-01

    The Flynn Effect is a well documented phenomenon demonstrating score increases on IQ measures over time that average about 0.3 points per year. Normative adjustments to scores derived from IQ measures normed more than a year or so prior to the time of testing an individual have become controversial in several settings but especially so in matters…

  8. Legal Implications of Models of Individual and Group Treatment by Professionals.

    ERIC Educational Resources Information Center

    Lynch, Patrick D.

    Although medical malpractice suits are based on a model of treatment of an individual by a professional, educational malpractice suits are based on a group treatment model. When the medical model and the teaching model are compared, the contrasts are so great that medical malpractice principles are not a reliable guide to the emerging law of…

  9. Applying Negligence Doctrine to the Teaching Profession.

    ERIC Educational Resources Information Center

    Collingsworth, Terrence P.

    1982-01-01

    The author first reviews the current cases on teacher negligence and attempts to isolate the reasoning behind the courts' refusal to recognize a cause of action for educational malpractice, then develops a hypothetical case to illustrate that ordinary principles of negligence can be applied to an educational malpractice case. (Author/MLF)

  10. [Injuries in anaesthesia. Results of the Hannover arbitration procedure 2001-2005].

    PubMed

    Schaffartzik, W; Neu, J

    2007-05-01

    The Schlichtungsstelle in Hannover (expert panel for arbitration), northern Germany, was founded in 1976 to settle disputes between patients and doctors. Furthermore, publications regarding the decisions of the Schlichtungsstelle serve as an important medium to prevent malpractice by increasing doctors' awareness of critical processes in their field. Between 2001 and 2005 the Schlichtungsstelle decided on 435 malpractice claims in anaesthesia. An accumulation of injuries was observed in anaesthetic procedures with respect to the airways (23.9%), injuries related to regional anaesthesia (18.2%), vasopuncture (13.1%) and positioning of the patients (9.9%). In 21.8%, the Schlichtungsstelle advised to seek a resolution without going to court by paying financial compensation in favour of the patient. In these cases the Schlichtungsstelle's evaluation had come to the conclusion that malpractice was the cause of the patient's injury. We would like to mention that 21 cases of intraoperative awareness were included in the claims, of which 52.4% (average 21.8%) were evaluated to be the result of malpractice and thus financial compensation was advised. The appropriate care for the patient, required from every doctor, calls the anaesthesiologists to avoid all possible malpractices, thus reducing patients' injury due to such malpractices to a minimum. But even injuries not caused by malpractice need to be examined closely and improvement should be sought. PMID:17377756

  11. Liabilities and risks of using cone beam computed tomography.

    PubMed

    Friedland, Bernard; Miles, Dale A

    2014-07-01

    The use of conebeam computed tomography (CBCT) carries with it medicolegal risks of which the practitioner should be aware. These include licensing and malpractice liability concerns. A practitioner who intends to take and/or use CBCT scans should seek advice from his malpractice carrier before doing so. All scans should be read by someone competent to interpret them. Using the services of an out-of-state radiologist to read scans poses its own set of risks. Consultation with a malpractice carrier and dental boards is advisable in this situation. PMID:24993928

  12. Expert witness reform.

    PubMed

    Horton, J Bauer; Reece, Edward; Janis, Jeffrey E; Broughton, George; Hollier, Larry; Thornton, James F; Kenkel, Jeffrey M; Rohrich, Rod J

    2007-12-01

    The legal system depends on the medical expert for evidence. Doctors readily complain about frivolous cases that go to trial, yet a lawyer cannot bring a frivolous claim to trial without a physician expert witness stating that the claim is not frivolous. An insurance company cannot raise premiums without medical expert witnesses servicing the increasing litigation against the insured. Physicians must look to themselves as a major contributor to rising malpractice insurance costs. For without the physician expert witness, no medical malpractice lawsuit can take place. It is the expert physician, not the attorneys or insurance companies, who defines "meritless" and "frivolous" and who ultimately controls the courts' medical malpractice caseload. PMID:18090781

  13. Building the business case for patient-centered care.

    PubMed

    Charmel, Patrick A; Frampton, Susan B

    2008-03-01

    Hospitals that provide patient-centered care reap a number of financial benefits, including: Reduced length of stay. Lower cost per case. Decreased adverse events. Higher employee retention rates. Reduced operating costs. Decreased malpractice claims. Increased market share. PMID:19097611

  14. Examining Tennessee's collateral source rule.

    PubMed

    Regan, Judith; Hadley, Edward; Regan, William M

    2008-11-01

    The common law collateral source rule was established to prevent the defendant from benefiting from their wrongful actions. Despite a trend in the United States to limit the effects of the collateral source rule, the rule remains in force in courts of the State of Tennessee. However, to assist with the malpractice crisis, the legislature prohibited this rule by statute in regards to the Medical Malpractice Act. Although this statutory prohibition of the collateral source rule worked to lessen verdicts in malpractice cases after passage, the availability of consortium damages resulting from Jordan v. Baptist Three Rivers Hospital in 1999 has worked to drive verdicts substantially higher. Regardless the Medical Malpractice Act has been held as constitutional and has been clarified through several recent Tennessee court decisions. PMID:19024250

  15. Legal and Ethical Issues in School Psychologists' Participation in Psychopharmacological Interventions with Children.

    ERIC Educational Resources Information Center

    DeMers, Stephen T.

    1994-01-01

    Discusses expanded role for psychologists and school psychologists ranging from increased knowledge about psychopharmacology to collaborative practice with prescribing physician to obtaining limited independent prescription privileges. Explores legal issues associated with such role expansion: credential concerns, malpractice liability, and record…

  16. Legal and Professional Standards in Program Evaluation.

    ERIC Educational Resources Information Center

    Thurston, Paul W.; And Others

    1984-01-01

    Four legal considerations involved in program evaluation are briefly described: defamation, contract, evaluation malpractice, and confidentiality of sources. Two hypothetical evaluation problems illustrate these legal issues. Suggestions for evaluation practice, based on these legal issues, are presented. (BW)

  17. Is liability possible for forensic psychiatrists?

    PubMed

    Weinstock, R; Garrick, T

    1995-01-01

    Forensic psychiatrists are not as vulnerable to liability as general psychiatrists. The absence of a traditional physician-patient relationship and judicial and quasijudicial immunity are all protective against malpractice actions. Although the absence of a doctor-patient relationship removes an essential element of malpractice, other types of liability such as defamation and ordinary negligence are possible and may not be covered by malpractice insurance. A model is proposed for forensic psychiatry of a partial secondary doctor-patient relationship out-weighted in most circumstances by duties to truth and/or the hiring attorney. Such a model seems most consistent with conflicting duties currently forced on all psychiatrists. This model has advantages of a duty, a violation of which is likely to be covered by malpractice insurance. Rather than deemphasizing partial secondary physician-patient responsibilities, it is advised to stress the important protection provided by judicial and quasijudicial immunity. PMID:8605402

  18. Labor law update--Part 2.

    PubMed

    Fiesta, J

    1997-02-01

    As a nurse moves away from the patient's bedside, the liability exposure for malpractice decreases. However, the nurse who moves into a management position faces another kind of liability-one regarding disciplinary actions such as employee terminations. PMID:9287737

  19. Assessing legal responsibility for implant failure.

    PubMed

    Palat, M

    1991-04-01

    The number of malpractice suits related to implants has recently increased significantly, with awards that are among the largest in dentistry. This article discusses the principles involved in assessing liability for implant failure and the various clinical situations that can affect liability in implant practice. The author also provides a list of the interrogatories required of defendants in malpractice suits related to implants. PMID:1893392

  20. Medico-legal autopsies as a source of information to improve patient safety.

    PubMed

    Madea, Burkhard

    2009-04-01

    Clear data on the epidemiology of medical malpractice are missing, at least for Germany. Especially data on the frequency of malpractice claims in penal and civil law are not available. However, from epidemiological and healthcare research some data on the frequency of adverse events (AE), preventable adverse events (PAE) and negligent adverse events (NAE) are available. According to a review of the German Alliance of Patient Safety adverse events can be expected in 5-10%, preventable adverse events in 2-4%, negligent adverse events in about 1% and lethal outcome in about 0.1% of hospitalized patients. However, these data are not compatible with figures from civil and penal law and there seems to be a great "litigation gap". Data on malpractice cases are available from the files of the arbitration committees on medical malpractice, files of liability insurance companies and files of the institutes of forensic medicine. However, these files are not complete and data sources may have some interferences. The arbitration committees are, however, mainly dealing with living patients. Lethal cases are a special subgroup and the best available data source are the files of the institutes of forensic medicine. This subgroup is of special importance since death is the most severe outcome of medical malpractice and the reproach to have caused the death of a patient by medical negligence is the most severe malpractice claim. From a retrospective multicentre study on autopsies performed in cases of medical malpractice claims (altogether 101.358 autopsies, 4450 due to medical malpractice claims) the most important data will be presented (disciplines concerned, cause of accusation, classification of accusation, causes of preliminary proceedings, occupational group and number of approved medical malpractice, outcome of medical malpractice proceedings). However, these data are not only of a descriptive value but have utmost importance also for risk analysis and to increase patient

  1. Controlling Legal Risk for Effective Hospital Management

    PubMed Central

    Park, Hyun Jun; Cho, Duk Young; Park, Yong Sug; Kim, Sun Wook; Park, Jae-Hong

    2016-01-01

    Purpose To analyze the types of medical malpractice, medical errors, and medical disputes in a university hospital for the proposal of countermeasures that maximize the efficiency of hospital management, medical departments, and healthcare providers. Materials and Methods This study retrospectively reviewed and analyzed 55 closed civil lawsuits among 64 medical lawsuit cases carried out in Pusan National University Hospital from January 2000 to April 2013 using medical records, petitions, briefs, and data from the Medical Dispute Mediation Committee. Results Of 55 civil lawsuits, men were the main plaintiffs in 31 cases (56.4%). The average period from medical malpractice to malpractice proceeding was 16.5 months (range, 1 month to 6.4 years), and the average period from malpractice proceeding to the disposition of a lawsuit was 21.7 months (range, 1 month to 4 years and 11 months). Conclusions Hospitals can effectively manage their legal risks by implementing a systematic medical system, eliminating risk factors in administrative service, educating all hospital employees on preventative strategies, and improving customer service. Furthermore, efforts should be made to establish standard coping strategies to manage medical disputes and malpractice lawsuits, operate alternative dispute resolution methods including the Medical Dispute Mediation Committee, create a compliance support center, deploy a specialized workforce including improved legal services for employees, and specialize the management-level tasks of the hospital. PMID:27169130

  2. The approach of Bayesian model indicates media awareness of medical errors

    NASA Astrophysics Data System (ADS)

    Ravichandran, K.; Arulchelvan, S.

    2016-06-01

    This research study brings out the factors behind the increase in medical malpractices in the Indian subcontinent in the present day environment and impacts of television media awareness towards it. Increased media reporting of medical malpractices and errors lead to hospitals taking corrective action and improve the quality of medical services that they provide. The model of Cultivation Theory can be used to measure the influence of media in creating awareness of medical errors. The patient's perceptions of various errors rendered by the medical industry from different parts of India were taken up for this study. Bayesian method was used for data analysis and it gives absolute values to indicate satisfaction of the recommended values. To find out the impact of maintaining medical records of a family online by the family doctor in reducing medical malpractices which creates the importance of service quality in medical industry through the ICT.

  3. Legal briefing: informed consent in the clinical context.

    PubMed

    Pope, Thaddeus Mason; Hexum, Melinda

    2014-01-01

    This issue's "Legal Briefing" column covers recent legal developments involving informed consent.1 We covered this topic in previous articles in The Journal of Clinical Ethics.2 But an updated discussion is warranted. First, informed consent remains a central and critically important issue in clinical ethics. Second, there have been numerous significant legal changes over the past year. We categorize recent legal developments into the following 13 categories: (1) Medical Malpractice Liability, (2) Medical Malpractice Liability in Wisconsin, (3) Medical Malpractice Liability in Novel Situations, (4) Enforcement by Criminal Prosecutors, (5) Enforcement by State Medical Boards, (6) Enforcement through Anti-Discrimination Laws, (7) Statutorily Mandated Disclosures Related to End-of-Life Counseling, (8) Statutorily Mandated Disclosures Related to Aid in Dying, (9) Statutorily Mandated Disclosures Related to Abortion, (10) Statutorily Mandated Disclosures Related to Telemedicine, (11) Statutorily Mandated Disclosures Related to Other Interventions, (12) Statutorily Mandated Gag and Censorship Laws, (13) Informed Consent in the Research Context. PMID:24972066

  4. Policies pertaining to complementary and alternative medical therapies in a random sample of 39 academic health centers.

    PubMed

    Cohen, Michael H; Sandler, Lynne; Hrbek, Andrea; Davis, Roger B; Eisenberg, David M

    2005-01-01

    This research documents policies in 39 randomly selected academic medical centers integrating complementary and alternative medical (CAM) services into conventional care. Twenty-three offered CAM services-most commonly, acupuncture, massage, dietary supplements, mind-body therapies, and music therapy. None had written policies concerning credentialing practices or malpractice liability. Only 10 reported a written policy governing use of dietary supplements, although three sold supplements in inpatient formularies, one in the psychiatry department, and five in outpatient pharmacies. Thus, few academic medical centers have sufficiently integrated CAM services into conventional care by developing consensus-written policies governing credentialing, malpractice liability, and dietary supplement use. PMID:15712764

  5. [Medical fault or professional negligence? Case studies in two recovery nutrition centers in Niger].

    PubMed

    Halidou Doudou, M; Manzo, M L; Guero, D

    2014-12-01

    In developing countries such as Niger, the risk of medical malpractice is ubiquitous in health, jeopardizing patient safety. The aim of this work was to contribute to patients' safety and respect of code of ethics and conduct in the exercise of the medical profession. The reported cases involved two children under 5 years who were admitted to nutrition rehabilitation centers, died as a result of medical malpractice. In Niger, there are no statistics on this phenomenon and a few cases found have always been considered "accident" or "fate." The establishment of an observatory collections of such information should improve their frequency, consequences and propose a prevention plan. PMID:25449444

  6. [Fetishistic practices in youth].

    PubMed

    Bach, H

    1975-11-01

    The author, after giving an outline of various theories of the genesis of sexual malpractices in general and so-called fetishistic practices in particular, tries to show, by reference to the behavior shown by several normally intelligent and socially fully integrated young persons, that juvenile fetishism cannot be considered a perversion in the proper sense of the word. Also, the results of observations made on these young persons show that biological factors play a minor role in the genesis of sexual malpractices. Disturbed social learning processes in the realm of interhuman relations are considered to be essential to the development of abnormal practices. PMID:1215443

  7. Risk Management and Medico-Legal Issues in Breast Cancer.

    PubMed

    Ward, Charles J; Green, Victoria L

    2016-06-01

    Breast cancer is a leading source of malpractice claims for radiologists and gynecologists. Delay in or failure to diagnosis was the second most common cause for allegations of malpractice and failure to diagnosis breast cancer accounted for the majority of these claims. The amount paid in indemnity for such claims was only second to claims paid for neurologically impaired newborns. Issues involved in documentation and communication are reviewed with a focus on specific medical legal cases. Obstetrician gynecologists must remain cognizant of the potential for liability. PMID:27101242

  8. Defensive psychiatry and the disruption of treatment boundaries.

    PubMed

    Simon, R I

    2000-01-01

    Defensive psychiatry refers to any act or omission that is performed not for the benefit of the patient but to avoid malpractice liability or to provide a legal defense against a malpractice claim. Defensive practices that produce deviant treatment boundaries usually take the form of clinically unnecessary prohibitions that disturb the therapist's position of neutrality. A distinction is drawn between boundary violations, boundary crossings and boundary issues. Typical clinical issues that provoke defensive treatment boundaries include managing patients with sexual transferences and potentially violent patients that may require the therapist to warn and protect endangered third parties. Defensive boundaries are usually created by unrecognized or uncorrected therapists' countertransferences. PMID:10994296

  9. Minimizing medical litigation, part 2.

    PubMed

    Harold, Tan Keng Boon

    2006-01-01

    Provider-patient disputes are inevitable in the healthcare sector. Healthcare providers and regulators should recognize this and plan opportunities to enforce alternative dispute resolution (ADR) a early as possible in the care delivery process. Negotiation is often the main dispute resolution method used by local healthcare providers, failing which litigation would usually follow. The role of mediation in resolving malpractice disputes has been minimal. Healthcare providers, administrators, and regulators should therefore look toward a post-event communication-cum-mediation framework as the key national strategy to resolving malpractice disputes. PMID:16711089

  10. Considerations for implementing pre-dispute arbitration agreements in provider contracts.

    PubMed

    Desmond, Joseph M

    2008-01-01

    Due in part to the historical increase in large compensatory awards and punitive damages in jury verdicts in medical malpractice/long-term care cases and the concomitant increase in the costs of defending these claims, healthcare providers have sought to reduce litigation costs and avoid exposure to runaway jury verdicts in medical malpractice trials by implementing arbitration agreements in healthcare admission contracts. Risk managers should be aware of the evolving law in this area and recognize that a successful arbitration program requires a commitment to ensuring that the program is administered in accordance with evolving laws. PMID:20200899

  11. [The notion and classification of expert errors].

    PubMed

    Klevno, V A

    2012-01-01

    The author presents the analysis of the legal and forensic medical literature concerning currently accepted concepts and classification of expert malpractice. He proposes a new easy-to-remember definition of the expert error and considers the classification of such mistakes. The analysis of the cases of erroneous application of the medical criteria for estimation of the harm to health made it possible to reveal and systematize the causes accounting for the cases of expert malpractice committed by forensic medical experts and health providers when determining the degree of harm to human health. PMID:22686055

  12. 42 CFR 414.26 - Determining the GAF.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...: (1) The geographic physicians' work adjustment factor for a service is the product of the proportion... geographic practice expense adjustment factor for a service is the product of the proportion of the total... geographic malpractice adjustment factor for a service is the product of the proportion of the total...

  13. Errors in cervical smears: minimizing the risk of medicolegal consequences.

    PubMed

    Greening, S E

    1997-01-01

    Cytologists need to critically evaluate their practices and practice settings to ensure that what they do and how they document what they do will withstand both regulatory and legal scrutiny. Any individual involved in cytology as a laboratory owner, operator, director, supervisor, technical or staff employee, independent agent, or customer representative is a potential target of cytology malpractice litigation. All of these individuals must participate in the risk management process. For the laboratory as a corporate entity, business and technical practices, including quality control and quality assurance procedures, must be contemporary, legitimate, and justifiable. Sound scientific evidence and well-subscribed standards of practice supporting an individual's or laboratory's conduct are the best defenses to malpractice claims. For the near future, litigation will continue to focus on false-negative Pap smears on a case-by-case basis. Laboratories and individuals can reduce the risk of malpractice liability by directing their attention to proactive quality control and quality assurance methods. But in the final analysis, consumer education about the benefits and limitations of the Pap test is key to limiting malpractice claims. PMID:9249818

  14. Decline in Medical-School Applications Seen Damaging Quality of Health Care.

    ERIC Educational Resources Information Center

    Mangan, Katherine S.

    1988-01-01

    Factors related to the decline in applications for medical school include costs of medical education, student's desire to begin earning money quickly, publicity about the high cost of malpractice insurance and the increasingly bureaucratic nature of the medical professions, and the perception that there is a continuing overabundance of doctors.…

  15. The Emerging Legal Issue of Competency Testing.

    ERIC Educational Resources Information Center

    Carter, David G.

    1979-01-01

    As more states adopt minimum competency testing (MCT) programs, MCT is becoming the subject of much debate among educators and in the courts. MCT has been attacked by those who claim it discriminates against Blacks and non-English-speaking minorities. Also raised in the MCT debate is the question of educational malpractice. (RLV)

  16. Ethics in Education: The Role of Teacher Codes. Canada and South Asia

    ERIC Educational Resources Information Center

    van Nuland, Shirley; Khandelwal, B. P.

    2006-01-01

    To curb malpractice in the education sector, various countries have developed professional codes of conduct. Given the importance of this issue, the International Institute for Educational Planning (IIEP) devoted this book to codes of conduct. This book includes three separate, though interrelated and complimentary parts. Section One of the report…

  17. A Quantitative Study of the Impact of an Empirically Validated Empathy Training Program on Pre-Med Students

    ERIC Educational Resources Information Center

    Nonnenkamp, Donna J.

    2013-01-01

    Medical educators recognize the need for empathetic physicians, and empathy has been considered to be extremely important in medical education. Research has shown that empathy can lead to positive patient outcomes, greater patient satisfaction, and compliance, lower malpractice litigation, reduced cost of care and fewer medical errors. The purpose…

  18. Negligence in Academic Advising and Abortion Counseling: Courts Rulings and Implications.

    ERIC Educational Resources Information Center

    Stone, Carolyn

    2002-01-01

    Presents two court cases to illuminate school counselors' legal responsibilities in academic advising and abortion counseling. The cases are presented to show how appellate court decisions can guide and inform future decision making in a variety of malpractice situations, and to equip professionals to exercise even greater care for their minor…

  19. Blanks on medical records may give payers denial ammo.

    PubMed

    Gardner, E

    1991-10-21

    Incomplete and inaccurate patient records have always left hospitals vulnerable to losing malpractice suits. But increasingly, good records mean hospitals are more likely to collect on bills that are scrutinized by utilization review firms, Medicare peer review organizations and other such bill examiners. That places a higher premium than ever on paying meticulous attention to a patient's medical record. PMID:10114223

  20. The Problem of Open Cheating and Invigilator Compliance in the Lebanese Brevet and Baccalaureat Examinations

    ERIC Educational Resources Information Center

    Vlaardingerbroek, Barend; Shehab, Saadeddine S.; Alameh, Sahar K.

    2011-01-01

    This paper describes a study on examination room cheating during Lebanese Brevet and Baccalaureat examinations with a focus on "open cheating"--malpractices which are aided and abetted by examination invigilators. Findings suggest that the problem is widespread and is largely attributable to the empathy invigilators feel with candidates. The…

  1. An Overview of Cyberbullying in Higher Education

    ERIC Educational Resources Information Center

    Washington, Edwina Thomas

    2015-01-01

    Bullying is a social problem. The proliferation of electronic technology has provided a new forum for bullies to harm victims. That is, bullies can transmit harmful text messages, photos, or video over the Internet and other digital communication devices to victims. This malpractice of technology-oriented phenomenon known as cyberbullying has…

  2. Crime and Crime Management in Nigeria Tertiary Institutions

    ERIC Educational Resources Information Center

    Adebanjo, Margaret Adewunmi

    2014-01-01

    This paper examines crime and its management in Nigerian tertiary institutions. Tertiary institutions today have become arenas for crime activities such as rape, cultism, murder, theft, internet fraud, drug abuse, and examination malpractices. This paper delves into what crime is, and its causes; and the positions of the law on crime management.…

  3. Helping Student Teachers Avoid Adverse Legal Actions.

    ERIC Educational Resources Information Center

    Peach, Larry; Reddick, Thomas L.

    1984-01-01

    Discusses five areas of the school environment lending themselves to the possibility of teacher and student teacher liability: negligence, malpractice, rights to privacy, field trips, and search of students and school property. Suggests specific guidelines for decreasing the possibility of adverse legal action. (NEC)

  4. Ethical Issues in Expert Opinions and Testimony.

    ERIC Educational Resources Information Center

    Weed, Roger O.

    2000-01-01

    This article provides an overview of ethical issues in private for-profit practice, with particular focus on expert testimony, using examples from a sample of claims filed with the National Association of Rehabilitation Professionals in the Private Sector and malpractice insurance companies. Complaints most frequently involve issues related to…

  5. Managing 'tail liability'.

    PubMed

    Frese, Richard C; Weber, Ryan J

    2013-11-01

    To reduce and control their level of tail liability, hospitals should: Utilize a self-insurance vehicle; Consider combined limits between the hospital and physicians; Communicate any program changes to the actuary, underwriter, and auditor; Continue risk management and safety practices; Ensure credit is given to the organization's own medical malpractice program. PMID:24340649

  6. Gender Differences in Forestalling Anti-Social Behaviours among Student Fitness Aspirants and Recreationists in Nigerian Universities

    ERIC Educational Resources Information Center

    Okunbor, A. O.; Agwubike, E. O.

    2009-01-01

    The purpose of the research was quadrupled. It investigated the prevalence of anti-social behaviours in campuses of Nigerian universities. Several student fitness aspirants and recreationists perceived examination malpractices (85%), stealing (83%), armed robbery (81%), prostitution (82%), drunkenness (80%), smoking (79%), hard drug consumption…

  7. 75 FR 12559 - Statement of Organization, Functions and Delegations of Authority

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-16

    ... Administration (HRSA) (60 FR 56605, as amended November 6, 1995; as last amended at 75 FR 7608-7610 dated... professional organizations to promote quality assurance efforts and deter fraud and abuse by administering the... trends in data, quality assurance, risk management, medical liability and malpractice; (5) conducts...

  8. The Role of Market Forces in the Delivery of Health Care: Issues for Research.

    ERIC Educational Resources Information Center

    National Center for Health Services Research and Health Care Technology Assessment (DHHS/PHS), Rockville, MD.

    This edition of the Role of Market Forces program note suggests empirical and descriptive analyses required to complement new areas of health policy emphasis and direction. Eight areas and related questions involving health economics are outlined: (1) rural health care; (2) medical malpractice and insurance; (3) supply, productivity, and…

  9. [Silent death in the recovery room--organizational fault with fatal consequences].

    PubMed

    Zinka, Bettina; Neelmeier, Tim

    2013-01-01

    Cases of death related to simple routine outpatient surgery are repeatedly reported. Minimum standards of staff and medical equipment for postoperative surveillance are deliberately ignored for economic reasons. Using two case studies this article identifies classical types of medical malpractice and organizational fault. Recommendations for criminal investigation in this type of cases are outlined for the competent authorities. PMID:24010383

  10. Torts.

    ERIC Educational Resources Information Center

    Thurston, Paul W.

    Chapter 5 of a book on school law, this chapter reports the cases decided during 1979 involving tort claims in the schools. The cases are organized according to headings including negligence (with an emphasis on student injuries), educational malpractice, negligence defenses (especially common law and statutory immunity), liability insurance,…

  11. School Psychological Services and Program Evaluation

    ERIC Educational Resources Information Center

    MacGregor, Mary Jo, Ed.

    1972-01-01

    A variety of court decisions and laws relevant to malpractice and liability of school psychologists are presented. Terms are defined and examples of faulty psychological testing, defamation, withholding information, and inferred imcompetence are provided. Suggestions regarding litigation and legal defenses are made and issues related to…

  12. Torts.

    ERIC Educational Resources Information Center

    McCarthy, Martha M.

    During 1978, cases pertaining to pupil injuries (mainly involving athletics) and employee injuries under workmen's compensation laws continued to dominate tort litigation in the educational sphere. Several noteworthy cases, however, were rendered in the emerging areas of educational malpractice and constitutional torts. The cases discussed are…

  13. Toward Ending Cultural and Cognitive Relativism in Special Education

    ERIC Educational Resources Information Center

    Kauffman, James M.; Sasso, Gary M.

    2006-01-01

    Postmodernism, by whatever label, is intellectually bankrupt. It cannot be reconciled with a scientific view. If taken seriously, it leads to catastrophic consequences for any field of study, including special education. It also leads to malpractice in special education. Whole language instruction, radical multicultural education, and facilitated…

  14. Major Health Issues for States: 1987.

    ERIC Educational Resources Information Center

    Landes, David

    Health care will continue to occupy a prominent place in state legislative deliberations, as indicated by the National Conference of State Legislatures' 1987 State Issues Survey. The survey addressed state actions in these health issue areas: (1) health care for the medically indigent; (2) medical malpractice; (3) certificate of need and health…

  15. Professional Satisfaction among California General Dentists.

    ERIC Educational Resources Information Center

    Shugars, Daniel A.; And Others

    1990-01-01

    This study assessed professional satisfaction among 558 California general dentists using the Dentist Satisfaction Survey. Among findings were that dentists were most dissatisfied with the threat of malpractice, level of income, demands of managing the practice, and amount of personal time. Findings have implications for counseling predoctoral…

  16. Great Minds Think Differently: Sustaining a System of Thinking

    ERIC Educational Resources Information Center

    Patton, Margaret Curette; Kritsonis, William Allan

    2007-01-01

    Should students only be exposed to basic content in schools? Of course not, an educator's job is to teach students how to become self-sufficient learners. In the medical profession, doctors lose their license for malpractice. In the legal profession, attorneys lose their ability to practice law for misconduct. Many times in the education…

  17. The Prevalence and Special Educational Requirements of Dyscompetent Physicians

    ERIC Educational Resources Information Center

    Williams, Betsy W.

    2006-01-01

    Underperformance among physicians is not well studied or defined; yet, the identification and remediation of physicians who are not performing up to acceptable standards is central to quality care and patient safety. Methods for estimating the prevalence of dyscompetence include evaluating available data on medical errors, malpractice claims,…

  18. Gerontology & Policies for Not Treating Terminally Ill Patients.

    ERIC Educational Resources Information Center

    Jarrett, William H.

    Proposals have been developed to clarify physician responsibility in withholding treatment to terminally ill patients. These proposals seek to provide a legal shield against malpractice proceedings and to reduce confusion over how to resolve high medical costs through standardizing procedures for withholding treatment. When first published,…

  19. Legal Considerations in Clinical Decision Making.

    ERIC Educational Resources Information Center

    Ursu, Samuel C.

    1992-01-01

    Discussion of legal issues in dental clinical decision making looks at the nature and elements of applicable law, especially malpractice, locus of responsibility, and standards of care. Greater use of formal decision analysis in clinical dentistry and better research on diagnosis and treatment are recommended, particularly in light of increasing…

  20. Liability of College Faculty and Administrators

    ERIC Educational Resources Information Center

    Wall, Patricia S.; Sarver, Lee

    2014-01-01

    According to a "Wall Street Journal"/NBC News poll, 59 percent of all adults consider education essential to getting ahead in life. At the same time, an increasing number of adults have begun to blame educators for their failure in life, claiming educational malpractice. Historically, education has been more of an issue at the state and…

  1. Health courts: an alternative to traditional tort law.

    PubMed

    Miller, Lisa A

    2011-01-01

    The current adversarial tort-based system of adjudicating malpractice claims is flawed. Alternate methods of compensation for birth injuries related to oxygen deprivation or mechanical injury are being utilized in Virginia and Florida. Although utilization of both of these schemes is limited, and they are not without problems in application, both have been successful in reducing the number of malpractice claims in the tort system and in reducing malpractice premiums. While the Florida and Virginia programs are primarily focused on compensation, other models outside the US focus include compensation as well as enhanced dispute resolution and potential for clinical practice change through peer review. Experts in the fields of law and public policy in the United States have evaluated a variety of approaches and have proposed models for administrative health courts that would provide both compensation and dispute resolution for medical and nursing malpractice claims. These alternative models are based on transparency and disclosure, with just compensation for injuries, and opportunities for improvements in patient safety. PMID:21540680

  2. Quality and Safety in Health Care, Part XIV: The External Environment and Research for Diagnostic Processes.

    PubMed

    Harolds, Jay A

    2016-09-01

    The work system in which diagnosis takes place is affected by the external environment, which includes requirements such as certification, accreditation, and regulations. How errors are reported, malpractice, and the system for payment are some other aspects of the external environment. Improving the external environment is expected to decrease errors in diagnosis. More research on improving the diagnostic process is needed. PMID:27280903

  3. Emerging Issues in Special Education Tort Liability: Implications for Special Educators and Teacher Trainers.

    ERIC Educational Resources Information Center

    McAfee, James K.

    1987-01-01

    Critical issues in tort liability that confront special educators and teacher trainers include malpractice (failure to learn), misdiagnosis, immunity, impact of a handicap on standard of care, confidentiality, access to emergency medical services, the use of aversive consequences, child abuse and corporal punishment, and school violence.…

  4. Nursing Home Litigation and Tort Reform: A Case for Exceptionalism

    ERIC Educational Resources Information Center

    Studdert, David M.; Stevenson, David G.

    2004-01-01

    The medical malpractice crisis that is currently spreading across the United States bears many similarities to earlier crises. One novel aspect of the current crisis is the explicit inclusion of litigation against nursing homes as a target of reform. Encouraged by the nursing home industry, policymakers are considering the extension of…

  5. The advent of clinical standards for professional liability.

    PubMed

    Holzer, J F

    1990-02-01

    The development of clinically based written standards to reduce the frequency and severity of medical malpractice loss appears to be gaining in popularity among provider specialty groups and professional liability underwriters. To date, such standards have addressed problems in specialties such as obstetrics and anesthesia where dollar losses associated with malpractice claims have been high. Guidelines can be developed and used by providers on a purely voluntary basis or mandated on an involuntary basis by third parties such as malpractice insurance companies or legislators. Because the advent of risk-control standards is a relatively new phenomenon, formal scientific studies on the long-term benefits of such guidelines have not yet been published. However, it appears that sharp reductions of malpractice losses in specialties such as anesthesia have coincided with the implementation of formal written standards specifically designed for liability control. This has led some liability insurance carriers to decrease premiums associated with specialists following such standards. Many providers are understandably concerned about the potential use of written standards by plaintiff attorneys in medical malpractice suits. Although it is possible that such policies and guidelines could be admitted into evidence to show that a provider breached the legal duty or standard of care owed to a patient, it is uncertain whether these risk-control standards could ultimately pass the evidentiary rules of relevancy or materiality in a given lawsuit. It is clear, however, that the consensus-based process of creating clinical standards and guidelines specifically for controlling professional liability losses is itself a powerful and emerging standard for health care risk management programs. PMID:2110357

  6. Quasi-Experiment Study on Effectiveness Evaluation of Health Communication Strategies

    PubMed Central

    2016-01-01

    This experimental study examined differences in doctor-patient relationships according to the health communication strategies during cases of medical malpractices occurred at primary medical institution. A total of 116 subjects aged in their 20s-50s was sampled. The first medical malpractice scenario chosen was the medical malpractice case most frequently registered at the Korean Medical Association Mutual Aid and the second scenario was associated with materials and devices as the cause of malpractice. Four types of crisis communication strategy messages were utilized, consisting of denial, denial + ingratiation, apology, and apology + ingratiation. Subjects were classified into four research groups by crisis communication strategy to measure levels of trust, control mutuality, commitment, and satisfaction, before and after the occurrence of medical malpractice and application of communication strategies. The findings of this study revealed that the apology strategy, compared with the denial strategy, showed a smaller difference before and after the application of communication strategies in all variables of trust (F = 8.080, F = 5.768), control mutuality (F = 8.824, F = 9.081), commitment (F = 9.815, F = 8.301), and satisfaction (F = 8.723, F = 5.638). Further, a significant interaction effect was shown between variables. The apology strategy, compared with the denial strategy, was effective in the improvement of doctor-patient relationships in both Scenarios I and II. For Scenario I, the apology strategy without ingratiation boosted commitment and satisfaction, but for Scenario II, utilizing the apology strategy with ingratiation boosted the effectiveness of trust and commitment. PMID:27365998

  7. Quasi-Experiment Study on Effectiveness Evaluation of Health Communication Strategies.

    PubMed

    Song, Dae Jong; Choi, Jae Wook; Kim, Kyunghee; Kim, Min Soo; Moon, Jiwon Monica

    2016-07-01

    This experimental study examined differences in doctor-patient relationships according to the health communication strategies during cases of medical malpractices occurred at primary medical institution. A total of 116 subjects aged in their 20s-50s was sampled. The first medical malpractice scenario chosen was the medical malpractice case most frequently registered at the Korean Medical Association Mutual Aid and the second scenario was associated with materials and devices as the cause of malpractice. Four types of crisis communication strategy messages were utilized, consisting of denial, denial + ingratiation, apology, and apology + ingratiation. Subjects were classified into four research groups by crisis communication strategy to measure levels of trust, control mutuality, commitment, and satisfaction, before and after the occurrence of medical malpractice and application of communication strategies. The findings of this study revealed that the apology strategy, compared with the denial strategy, showed a smaller difference before and after the application of communication strategies in all variables of trust (F = 8.080, F = 5.768), control mutuality (F = 8.824, F = 9.081), commitment (F = 9.815, F = 8.301), and satisfaction (F = 8.723, F = 5.638). Further, a significant interaction effect was shown between variables. The apology strategy, compared with the denial strategy, was effective in the improvement of doctor-patient relationships in both Scenarios I and II. For Scenario I, the apology strategy without ingratiation boosted commitment and satisfaction, but for Scenario II, utilizing the apology strategy with ingratiation boosted the effectiveness of trust and commitment. PMID:27365998

  8. Cross-Sectional Analysis of the 1039 U.S. Physicians Reported to the National Practitioner Data Bank for Sexual Misconduct, 2003–2013

    PubMed Central

    AbuDagga, Azza

    2016-01-01

    Background Little information exists on U.S. physicians who have been disciplined with licensure or restriction-of-clinical-privileges actions or have had malpractice payments because of sexual misconduct. Our objectives were to: (1) determine the number of these physicians and compare their age groups’ distribution with that of the general U.S. physician population; (2) compare the type of disciplinary actions taken against these physicians with actions taken against physicians disciplined for other offenses; (3) compare the characteristics and type of injury among victims of these physicians with those of victims in reports for physicians with other offenses in malpractice-payment reports; and (4) determine the percentages of physicians with clinical-privileges or malpractice-payment reports due to sexual misconduct who were not disciplined by medical boards. Methods and Results We conducted a cross-sectional analysis of physician reports submitted to the National Practitioner Data Bank (NPDB) from January 1, 2003, through September 30, 2013. A total of 1039 physicians had ≥ 1 sexual-misconduct–related reports. The majority (75.6%) had only licensure reports, and 90.1% were 40 or older. For victims in malpractice-payment reports, 87.4% were female, and “emotional injury only” was the predominant type of injury. We found a higher percentage of serious licensure actions and clinical-privileges revocations in sexual-misconduct–related reports than in reports for other offenses (89.0% vs 68.1%, P = < .001, and 29.3% vs 18.8%, P = .002, respectively). Seventy percent of the physicians with a clinical-privileges or malpractice-payment report due to sexual misconduct were not disciplined by medical boards for this problem. Conclusions A small number of physicians were reported to the NPDB because of sexual misconduct. It is concerning that a majority of the physicians with a clinical-privileges action or malpractice-payment report due to sexual misconduct

  9. Unconstrained Respiration Measurement and Respiratory Arrest Detection Method by Dynamic Threshold in Transferring Patients by Stretchers

    NASA Astrophysics Data System (ADS)

    Kurihara, Yosuke; Watanabe, Kajiro; Kobayashi, Kazuyuki; Tanaka, Hiroshi

    General anesthesia used for surgical operations may cause unstable conditions of the patients after the operations, which could lead to respiratory arrests. Under such circumstances, nurses could fail in finding the change of the conditions, and other malpractices could also occur. It is highly possible that such malpractices may occur while transferring a patient from ICU to the room using a stretcher. Monitoring the change in the blood oxygen saturation concentration and other vital signs to detect a respiratory arrest is not easy when transferring a patient on a stretcher. Here we present several noise reduction system and algorithm to detect respiratory arrests in transferring a patient, based on the unconstrained air pressure method that the authors presented previously. As the result, when the acceleration level of the stretcher noise was 0.5G, the respiratory arrest detection ratio using this novel method was 65%, while that with the conventional method was 0%.

  10. Homicide committed by psychiatric patients: Psychiatrists' liability in Italian law cases.

    PubMed

    Terranova, Claudio; Rocca, Gabriele

    2016-01-01

    Interest in psychiatrists' professional liability in Italy has increased in recent years because of the number of medical malpractice claims. Professional liability for failure to prevent violent behaviour by psychiatric patients is particularly debated. This study describes three Italian cases in which health professionals - physicians and nurses - were found guilty of manslaughter for murders committed by psychiatric patients. Examination of the cases focuses on claims of malpractice, patients' characteristics, the circumstances of the homicide and the reasons for the court's judgment. In particular, the predictability of violent behaviour and the concept of causal links are examined in detail. The cases provide an opportunity for a study of comparative jurisprudence. The topics discussed are relevant not only to practicing psychiatrists but also to experts assessing medical liability in cases of criminal acts committed by psychiatric patients. PMID:26130750

  11. The spectrum of medical errors: when patients sue

    PubMed Central

    Kels, Barry D; Grant-Kels, Jane M

    2012-01-01

    Inarguably medical errors constitute a serious, dangerous, and expensive problem for the twenty-first-century US health care system. This review examines the incidence, nature, and complexity of alleged medical negligence and medical malpractice. The authors hope this will constitute a road map to medical providers so that they can better understand the present climate and hopefully avoid the “Scylla and Charybdis” of medical errors and medical malpractice. Despite some documented success in reducing medical errors, adverse events and medical errors continue to represent an indelible stain upon the practice, reputation, and success of the US health care industry. In that regard, what may be required to successfully attack the unacceptably high severity and volume of medical errors is a locally directed and organized initiative sponsored by individual health care organizations that is coordinated, supported, and guided by state and federal governmental and nongovernmental agencies. PMID:22924008

  12. Mobile health applications: the patchwork of legal and liability issues suggests strategies to improve oversight.

    PubMed

    Yang, Y Tony; Silverman, Ross D

    2014-02-01

    Mobile health (mHealth) technology has facilitated the transition of care beyond the traditional hospital setting to the homes of patients. Yet few studies have evaluated the legal implications of the expansion of mHealth applications, or "apps." Such apps are affected by a patchwork of policies related to medical licensure, privacy and security protection, and malpractice liability. For example, the privacy protections of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 may apply to only some uses of the apps. Similarly, it is not clear what a doctor's malpractice liability would be if he or she injured a patient as the result of inaccurate information supplied by the patient's self-monitoring health app. This article examines the legal issues related to the oversight of health apps, discusses current federal regulations, and suggests strategies to improve the oversight of these apps. PMID:24493764

  13. Informed consent and its implications in family practice.

    PubMed

    Mangold, W J

    1975-04-01

    The doctrine of informed consent has had its practical introduction to medical malpractice litigation in the past five years. Its definition has not changed since the days when its definitive application was only a fond dream of the malpractice plaintiffs attorneys. However, with neh new methods of presenting this theory to the courts, and with the newly emerging practice fo having rulings on matters of law substituted by judges for prevailing standards of medical practice, the implications for family physicians have become tremendous. Hopefullum by understanding the principles involved in its application in the pertinent landmark cases, family physicians will be better able to abid the pitfalls engendered by the doctrine of informed consent. PMID:1127387

  14. Personal protection: vicarious liability as applied to the various business structures.

    PubMed

    Winrow, Brian; Winrow, Amanda R

    2008-01-01

    Within the field of midwifery, the issue of vicarious liability has become an emerging issue. The doctrine of respondeat superior imputes liability to an employer without direct negligence. While the issue of vicarious liability has been explored in the past, those studies were focused on the vicarious liability of certified nurse-midwives/certified midwives (CNMs/CMs) for the negligence of their employees. This article explores the issue of vicarious liability under the doctrine of respondeat superior as applied within a practice consisting of two or more co-owners. This issue is of heightened importance, because CNMs/CMs increasingly enter into ventures with other CNMs/CMs in order to pool their resources. Many CNMs/CMs unsuspectingly assume the risks for the malpractice of their colleagues. This increased risk can be minimized by forming their practice as a limited liability entity, thus avoiding personal liability for the malpractice of their co-owner(s). PMID:18308265

  15. [Expert Opinion Cases - What documentation is necessary from a legal perspective?].

    PubMed

    Weis, Evelyn

    2016-05-01

    Doctors are obliged by professional code and civil law (630 f German Civil Code [BGB] §) to document their medical activities in relation to patients. The documentation serves as proof of executed measures and thus for backing up medical/therapeutic issues. Documentation shall be made immediately after or during the treatment and if the original content remains recognizable, can be supplemented/modified. The patient record may be kept in paper form or in electronic form. Medical records are to be stored at least for 10 years. Some special laws (eg. laws governing X rays, Transfusion Act) require that documents be stored for longer periods. Documentation errors are - unlike patient information errors/medical malpractice - no basis for damages claims by the patient, but may result in medical malpractice process with the burden of proof in favor of the patient (§ 630 h BGB). The patient has, in principle, the right to inspect the medical documents relating to him. PMID:27219297

  16. Negligence, genuine error, and litigation.

    PubMed

    Sohn, David H

    2013-01-01

    Not all medical injuries are the result of negligence. In fact, most medical injuries are the result either of the inherent risk in the practice of medicine, or due to system errors, which cannot be prevented simply through fear of disciplinary action. This paper will discuss the differences between adverse events, negligence, and system errors; the current medical malpractice tort system in the United States; and review current and future solutions, including medical malpractice reform, alternative dispute resolution, health courts, and no-fault compensation systems. The current political environment favors investigation of non-cap tort reform remedies; investment into more rational oversight systems, such as health courts or no-fault systems may reap both quantitative and qualitative benefits for a less costly and safer health system. PMID:23426783

  17. Safe Practice of Cosmetic Dermatology: Avoiding Legal Tangles

    PubMed Central

    Sacchidanand, Sarvajnamurthy A; Bhat, Shilpa

    2012-01-01

    The present day dermatologists, in addition to conventional skin physicians, are also dermatologic-surgeons and cosmetologists in their practice. The cosmetic procedures have the inherent risk of malpractice litigations leaving an unsatisfied patient and a troublesome lawsuit against the doctor. A MEDLINE search was conducted for article with words such as legal issues and dermatology, malpractice in dermatology, safe practice of cosmetology etc. The selected articles are scrutinized and compiled so as to help the young dermatologists to have a comprehensive overview of safe cosmetology practice. This article aims at sensitizing the young dermatologists for the possible complications and provides an overview of safe practice. It also provides a list of simple routine precautions which helps the dermatologist to avoid unnecessary trips to the courthouse. PMID:23112511

  18. "Health courts" and accountability for patient safety.

    PubMed

    Mello, Michelle M; Studdert, David M; Kachalia, Allen B; Brennan, Troyen A

    2006-01-01

    Proposals that medical malpractice claims be removed from the tort system and processed in an alternative system, known as administrative compensation or "health courts," attract considerable policy interest during malpractice "crises," including the current one. This article describes current proposals for the design of a health court system and the system's advantages for improving patient safety. Among these advantages are the cultivation of a culture of transparency regarding medical errors and the creation of mechanisms to gather and analyze data on medical injuries. The article discusses the experiences of foreign countries with administrative compensation systems for medical injury, including their use of claims data for research on patient safety; choices regarding the compensation system's relationship to physician disciplinary processes; and the proposed system's possible limitations. PMID:16953807

  19. “Health Courts” and Accountability for Patient Safety

    PubMed Central

    Mello, Michelle M; Studdert, David M; Kachalia, Allen B; Brennan, Troyen A

    2006-01-01

    Proposals that medical malpractice claims be removed from the tort system and processed in an alternative system, known as administrative compensation or ‘health courts,’ attract considerable policy interest during malpractice ‘crises,’ including the current one. This article describes current proposals for the design of a health court system and the system's advantages for improving patient safety. Among these advantages are the cultivation of a culture of transparency regarding medical errors and the creation of mechanisms to gather and analyze data on medical injuries. The article discusses the experiences of foreign countries with administrative compensation systems for medical injury, including their use of claims data for research on patient safety; choices regarding the compensation system's relationship to physician disciplinary processes; and the proposed system's possible limitations. PMID:16953807

  20. [Death on the operating table. Anesthesiologic and medicolegal aspects].

    PubMed

    Dettmeyer, R; Reber, A

    2003-12-01

    Since death on the operating table is a relatively rare incident, it raises a number of special medicolegal questions that are discussed in this article. One of the major concerns for medical personnel is being accused of malpractice during treatment, as it is an obvious presumption on the part of laymen that death was directly related to the medical treatment as compared with other in-hospital deaths. Questions such as who is responsible for issues of informed consent and liability are discussed. Other important aspects such as communication with the bereaved, transparent chronological documentation of the death circumstances, questions regarding certification of death, questions arising from autopsy done to determine the reason of death, questions about malpractice, legal requirements concerning confidential medical communication and information about what must be sent to the professional indemnity insurance company are elucidated. There is also some special information presented for cases that involve the deaths of Jehovah's Witnesses. PMID:14714560

  1. Finance issue brief: insurer liability: year end report-2003.

    PubMed

    MacEachern, Lillian

    2003-12-31

    When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those were questions 35 states considered in 1999, and at least 32 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves. PMID:14964230

  2. Finance issue brief: insurer liability: year end report-2002.

    PubMed

    Morgan, Rachel; MacEachern, Lillian

    2002-12-31

    When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those were questions 35 states considered in 1999, and at least 32 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves. PMID:12886933

  3. Finance, providers issue brief: insurer liability.

    PubMed

    Rothouse, M; Stauffer, M

    2000-05-24

    When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those were questions 35 states considered in 1999, and at least 32 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves. PMID:11073416

  4. Finance, providers issue brief: insurer liability.

    PubMed

    Rothouse, M

    1999-07-01

    When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those are questions 29 states considered in 1998, and at least 35 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves. PMID:11073388

  5. ASSESSMENT OF PRACTICE AT RETAIL PHARMACIES IN PAKISTAN: EXTENT OF COMPLIANCE WITH THE PREVAILING DRUG LAW OF PAKISTAN.

    PubMed

    Ullah, Hanif; Zada, Wahid; Khan, Muhammad Sona; Iqbal, Muhammad; Chohan, Osaam; Raza, Naeem; Khawaja, Naeem Raza; Abid, Syed Mobasher Ali; Murtazai, Ghulam

    2016-01-01

    The main objective of this study was to assess the practice at retail pharmacies in Pakistan and to compare the same in rural and urban areas. The maintenance of pharmacy and drug inspectors' visit was also assessed. This cross sectional study was conducted in Abbottabad, Pakistan during October-November, 2012. A sample of 215 drug sellers or drug stores was selected by employing convenient sampling method. With a response rate of 91.6%, 197 drug sellers participated in this study. All the drug sellers were male. Overall, 35% (n = 197) of the drug sellers did not have any professional qualification. A majority of the drug sellers were involved in various malpractices like selling of medicines without prescription (80.7%), prescribing practice (60.9%), prescription intervention (62.4%) and selling of controlled substances (66%) without a license for selling it. These malpractices were significantly higher in rural area than that in urban area. PMID:27476300

  6. Perspectives on Mississippi's 21st century Physician Workforce Supply: findings from the 2007 MSMD survey.

    PubMed

    Street, Debra; Cossman, Jeralynn S

    2008-04-01

    The capacity to recruit and retain physicians to practice in Mississippi has been a perennial concern of the profession. In the first Mississippi Physician Workforce Study (2003) conducted at the height of the state 'malpractice crisis,' Professor Cossman identified several looming threats to effective Mississippi physician recruitment and retention, including a high percentage of physicians who reported they were considering relocation or retirement in the near future. In this article, Street and Cossman report survey findings from actively practicing physicians (N=848) who responded to the second Mississippi Physician Workforce Study (2007 MSMD). This analysis updates perspectives on the physician workforce supply in the aftermath of malpractice legislative reform and Hurricane Katrina. PMID:19297906

  7. Coping with bad news: the physician executive's role in a lawsuit.

    PubMed

    Gorney, Mark

    2002-01-01

    In these days of doctors, lawyers and lawsuits, chances of an American physician finishing his or her career without a malpractice claim are growing more remote. Every physician executive overseeing the activities of a group of peers knows this and should be prepared to assist the physician who is sued. Examine four key ways to help your physicians deal with the stress of a lawsuit. PMID:11957406

  8. Healthcare reform: the good, the bad, and the transformational.

    PubMed

    Mulvany, Chad

    2010-06-01

    Aspects of the recent landmark healthcare reform legislation likely to prove beneficial to hospitals include changes to insurance markets, malpractice reform demonstrations, and funding to help hospitals with high volumes of preventable readmissions. Hospitals are likely to be adversely affected by scheduled payment cuts and the employer "free rider" penalty. The legislation also poses transformational opportunities and challenges for hospitals, stemming from measures designed to change the care delivery system and provisions regarding hospitals' tax-exempt status and pricing transparency. PMID:20533678

  9. Quality and Safety in Health Care, Part XIII: Detecting and Analyzing Diagnostic Errors.

    PubMed

    Harolds, Jay A

    2016-08-01

    There are many ways to help determine the incidence of errors in diagnosis including reviewing autopsy data, health insurance and malpractice claims, patient health records, and surveys of doctors and patients. However, all of these methods have positive and negative points. There are also a variety of ways to analyze diagnostic errors and many recommendations about how to decrease the frequency of errors in diagnosis. Overdiagnosis is an important quality and safety issue but is not considered an error. PMID:27163458

  10. Ethics in conflict: yesterday's standards-outdated guide for tomarrow?

    PubMed

    Welles, C

    1976-01-01

    Health care today is influenced by government controls, consumerism, malpractice litigation, unionism, and professionalism. Are there universal standards the serious health professional can or must accept, or should he formulate his own? In this paper, the sources of ethical criteria for occupational therapy are reviewed and assessed. It is recommended that a code of ethics for today be formulated for occupational therapy using the ethical principles proposed in this paper. PMID:1247078

  11. [Risk and suicide in open door institutions. Liability and forensic issues].

    PubMed

    Toro-Martínez, Esteban

    2014-01-01

    Suicide is a complex issue and a source of discussion between different disciplines. Suicide assessment and management research had received a huge attention in the field. Argentina has a legal framework focused on protecting human rights. Malpractice and liability discussion is offered in cases of suicide in psychiatric patients recently admitted to an inpatient setting. Imminent and certain risk of damage is the legal requirement for involuntary psychiatric admission in terms of Mental Health Law in Argentina. PMID:25546544

  12. Past and present of risk management in healthcare.

    PubMed

    Messano, Giuseppe Alessio; De Bono, Virgilio; Di Folco, Francesco; Marsella, Luigi Tonino

    2014-01-01

    The present article describes the history of risk management, how it was born and how it has evolved, with a specific focus on healthcare. Risk management was a strategy initially used primarily in the economic and business sector. We analysed how the continuous increase of medical malpractice lawsuits involving demands for compensation led to the adoption of risk management strategies in healthcare. The various clinical risk-management strategies adopted in different countries and in different historical periods are also described. PMID:25353272

  13. A case of stillbirth: the importance of placental investigation in medico-legal practice.

    PubMed

    Marchetti, Daniela; Belviso, Maura; Fulcheri, Ezio

    2009-03-01

    The authors present a case of stillbirth in which histologic examination of the placenta provides the opportunity to make a definitive diagnosis of a death due to fetal thrombotic vasculopathy (FTV). Establishing the etiology in cases of stillbirth may avoid medical malpractice litigation. The better knowledge of the cause of stillbirths also helped obstetricians to recognize factors that could have prejudiced future pregnancies. PMID:19237859

  14. Litigation risks for infusion specialists. Understanding the issues.

    PubMed

    Collins, S E

    2001-01-01

    The legal aspects of caring for patients and the fear of disciplinary actions or malpractice suits understandably are matters of great concern for infusion specialists. This article is intended to be a broad overview of some of the legal causes of action that may arise through the rendering of professional nursing care, as well as an introduction to patients' rights to self-determination, informed consent, and informed refusal as a special area of litigation risk for the infusion specialist. PMID:11758262

  15. Patient satisfaction.

    PubMed

    Prakash, Bhanu

    2010-09-01

    Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. Patient satisfaction is thus a proxy but a very effective indicator to measure the success of doctors and hospitals. This article discusses as to how to ensure patient satisfaction in dermatological practice. PMID:21430827

  16. Defensive medicine or economically motivated corruption? A confucian reflection on physician care in China today.

    PubMed

    Chen, Xiao-Yang

    2007-01-01

    In contemporary China, physicians tend to require more diagnostic work-ups and prescribe more expensive medications than are clearly medically indicated. These practices have been interpreted as defensive medicine in response to a rising threat of potential medical malpractice lawsuits. After outlining recent changes in Chinese malpractice law, this essay contends that the overuse of expensive diagnostic and therapeutic interventions cannot be attributed to malpractice concerns alone. These practice patterns are due as well, if not primarily, to the corruption of medical decision-making by physicians being motivated to earn supplementary income, given the constraints of an ill-structured governmental policy by the over-use of expensive diagnostic and therapeutic interventions. To respond to these difficulties of Chinese health care policy, China will need not only to reform the particular policies that encourage these behaviors, but also to nurture a moral understanding that can place the pursuit of profit within the pursuit of virtue. This can be done by drawing on Confucian moral resources that integrate the pursuit of profit within an appreciation of benevolence. It is this Confucian moral account that can formulate a medical care policy suitable to China's contemporary market economy. PMID:18027252

  17. Abortion issue goes to US courts.

    PubMed

    Charatan, F B

    1995-04-22

    The antiabortion groups and their lawyers have added a new weapon to their arsenal against physicians who perform abortions in the US: malpractice lawsuits. The nonprofit educational organization Life Dynamics generates material for personal injury lawyers and is participating in 80 cases. It has assembled 642 lawyers and 500 physicians in its abortion malpractice program. Life Dynamics calls for persons to support lawsuits to increase malpractice insurance rates of abortionists, thereby forcing them out of business. Its 2-day 1994 seminar in Texas addressed abortion injuries, an alleged link between abortion and breast cancer, and abortion as a likely source of post-traumatic stress disorder. A lawyer and general counsel of the Arizona Right-to-Life has filed two lawsuits against a Phoenix physician who performs abortion. The trial judge dismissed both cases and fined the lawyer for frivolous lawsuits. An appeal overturned the fines. The lawyer has three more lawsuits on the docket. The physician had complained to the Arizona Bar Association about the lawyer. Even though the physician's insurance company did not pay any claims, its underwriters deemed him an actuarial risk, thereby making him essentially uninsurable. Local medical associations have failed to take a position on the lawyer's legal misconduct because they do not want to alienate some members. The Planned Parenthood Federation of America agreed that the lawsuits brought against the Phoenix physician were fraudulent and that they do not aim to protect women but to revoke their right to choose. PMID:7728049

  18. Liability for managed care decisions: the Employee Retirement Income Security Act (ERISA) and the uneven playing field.

    PubMed Central

    Mariner, W K

    1996-01-01

    As managed care organizations expand their programs of quality assurance and physician evaluation, more medical malpractice lawsuits may be brought against managed care organizations on the ground that, like hospitals, they are legally responsible for negligent corporate acts that injure patients. However, the federal Employee Retirement Income Security Act (ERISA) shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA. Unlike patients with other types of insurance, patients in ERISA health plans do not have a malpractice remedy for a managed care organization's negligence. A few federal appeals courts recently recognized that ERISA plans can be vicariously liable for their physicians' medical malpractice, but only if the physician is the plan's employee or agent. Yet ERISA still prohibits negligence claims against ERISA health plans for injuries resulting from denial of plan benefits, failure to use qualified physicians, utilization review, or improper plan administration. Current managed care operations do not neatly distinguish between administering benefits and controlling quality of care. Neither should the law. ERISA should be amended to provide employees with the same remedies that patients in non-ERISA plans enjoy. PMID:8659664

  19. Legal considerations for protecting the physician's assets.

    PubMed

    Wolf, Jerome L

    2011-01-01

    Most states require that as a consideration of obtaining and maintaining a medical license, all applicants must demonstrate "financial responsibility." Usually this includes: (1) establishing an escrow account of cash and/or readily marketable securities; (2) an irrevocable, non-transferable letter of credit; or (3) in most cases, medical malpractice insurance coverage. In recent years, some states have passed legislation that provides that under certain circumstances, a physician may qualify to forego any of the financial requirements, commonly referred to as "going bare." In this regard, much of the impetus for the recently enacted Obama healthcare plan was the rising cost of healthcare in the United States arising from the extensive, and, to some, unnecessary and extraneous testing and retesting to confirm medical diagnosis and treatment-for the patient's benefit but, as importantly, to forestall a potential medical malpractice claim. As the political challenge to what is commonly referred to as "Obamacare" proceeds, and in the absence of any legislative support for "tort reform" and limitations on frivolous malpractice claims, it is abundantly clear that an integral part of any professional's "estate planning" should include and incorporate the asset protection and exempt property statutes available under the laws of the jurisdiction where the physician resides. PMID:21595387

  20. [Cases from the area between geriatrics and trauma surgery. Examples from the medical arbitration board].

    PubMed

    Lucke, C; Westermann, K; Lucke, M; Schellmann, W D; Wohlers, C

    2010-06-01

    Medical arbitration boards ("Schlichtungsstellen", expert panels for extrajudicial malpractice claim resolution) try to settle claims of suspected malpractice between patients and their physicians and to avoid court trials. Numerous studies found an increasing incidence of adverse events with rising age. Injuries that occur in the hospital are frequently beyond the specialty of the treating physician. Therefore, the physician has to broaden his diagnostic view beyond the borders of his own specialty to recognize injuries in his patients and to prevent malpractice claims.In this paper, we report on adverse events in elderly patients where the geriatrician/internist was accused of negligence for not having promptly recognized a fracture after a fall or having chosen an inadequate operative procedure. For example, the importance of weight bearing osteosynthesis, mandatory in hip fractures in the elderly population to prevent long-term immobilization, is discussed.Adverse events due to negligence are more frequent among the elderly; the reasons are discussed. They will never be entirely preventable. The data presented in this report may be helpful to recognize fractures in time and to ensure adequate treatment, in order to reduce the number of court claims. PMID:19802515

  1. The National Practitioner Data Bank: the first 4 years.

    PubMed

    Oshel, R E; Croft, T; Rodak, J

    1995-01-01

    The National Practitioner Data Bank became operational September 1, 1990, as a flagging system to identify health care practitioners who may have been involved in incidents of medical incompetence. Query volumes have grown substantially over the Data Bank's first 4 years of operation. The greatest increase has come in the number of voluntary queries. By the end of 1994, the Data Bank had processed more than 4.5 million requests for information on practitioners, more than 1.5 million of which were received in 1994 alone. The proportion of queries for which the Data Bank contains information on the practitioner in question has grown as the Data Bank has come to contain more reports. During 1994, 7.9 percent of queries were matched. The Data Bank contained more than 97,500 reports at the end of 1994. More than 82 percent of the reports concerned malpractice payments. Licensure reports made up the bulk of the rest. Physicians predominate in reports, accounting for slightly more than 76 percent of the total. The remainder are related to dentists (16 percent) and all other types of practitioners (8 percent). Since reporting of adverse actions is mandatory only for physicians and dentists, the proportion of reports attributable to these types of practitioners is higher than it would be if adverse action reporting requirements were uniform for all practitioners. State malpractice payment rates and adverse action rates vary widely, but a State's rate in any given year is highly correlated with its rate in any other year. State malpractice rates are not strongly correlated with adverse action rates, neither are the rates for physicians strongly correlated with those for dentists. There is a weak tendency for States with smaller physician populations to have higher levels of licensure and privileging actions. PMID:7638325

  2. Post-Perruche: what responsibilities for professionals?

    PubMed

    Clement, R; Rodat, O

    2006-03-01

    Damage compensation relating to handicapped new-borns, the wrongful life law, was put in place after a great controversy in France by the Perruche ruling of November 13th 2000. The French parliaments have voted a special law against wrongful life action. But questions about medical liability are not answered by the new law. For wrongful life, what are now the medical errors likely to directly provoke a handicap or aggravate it or obstruct measures to alleviate it? For a wrongful birth claim it limits parental damages to psychological damages only, due to a lack of mental preparation, whilst denying economic losses, thus preventing complete compensation arising from medical malpractice for all the other types of difficulty suffered by the parents. Why does it give a new definition of medical malpractice as a "characterized fault" and insist upon the qualification 'blatant" in the field of medical liability? For health professionals, it is a question of knowing and being acquainted with the errors that fall under their liability with regard to handicapped persons and a "characterized fault" with regard to parents. It is through a review of past and present case law that we will try to answer these medical questions. All court rulings that awarded monetary damages to the child were reviewed. We include only three decisions after the new law, which do not allow damage compensation in respect of a handicapped new-born. The rulings incorporate decisions taken by the French Supreme Court, of the council of state as well as by courts of appeal. Failure of voluntary termination of pregnancy, missing rubella immune antibody, omission of mandatory tests during pregnancy, typical medical fetal malpractice, were and are professional faults. PMID:16681112

  3. The legal status of clinical practice parameters: an annotated bibliography.

    PubMed

    Kapp, M B

    1993-01-01

    An important recent development in American medicine has been the strong push in the last few years toward the formal creation, dissemination, and enforcement of explicit clinical practice guidelines or parameters relating to the quality and efficacy of various medical interventions, parameters that would guide the decisions and actions of physicians and other health care providers (1-3). Medical societies (4), governmental agencies such as the federal Agency for Health Care Policy and Research, and insurers are utilizing a variety of approaches to the development of practice parameters for medical diagnosis and intervention, including informal consensus development, formal consensus development, evidence-based guideline development, and explicit guideline development (5). The number and variety of practice parameters has burgeoned in response to the wide national variations in medical practice patterns, without corresponding differences in clinical outcomes, that have been documented by health services researchers. Several commentators have expressed serious skepticism about the probable impact of practice parameters, surmising that they will be used extensively in a negative manner in medical malpractice litigation (6, 7). Many physicians in particular have asked "how they [practice parameters] can be implemented without courting the ruin of the individual practitioner" (8). In response to these anxieties, a new medicolegal literature has arisen to address the relationship between the development of clinical practice parameters and the physician's exposure to malpractice litigation and adverse judgments, as well as the implications for malpractice insurance premiums. This growing literature has now achieved a critical mass. The major contributions to this corpus at present are listed and annotated below. PMID:8334377

  4. Selective sex identification of foetus banned.

    PubMed

    She, W

    1996-06-01

    The Chinese Government has recently issued a series of decrees to ban the illegal identification of fetal sex in the wake of a serious sex imbalance of newborn babies. The Law on the Health Care for Mothers and Infants of the People's Republic of China, which came into force in June 1995, explicitly bans the malpractice of identifying the sex of the fetus. Violators are, depending on the nature of the case, subject to penalties ranging from disciplinary sanctions to revocation of business licenses. The malpractice of fetal sex identification has become rampant in recent years as a result of a growing tendency of preference for boys over girls. Such fetal sex determination often results in the discontinuation of pregnancy and, consequently, a serious imbalance of sexes among newborns. Statistics show that the sex ratio at birth in some parts of the country is very high. Demographers repeatedly warn of the serious social consequences that will arise from such imbalance. The Central Government and provincial governments have mapped out a series of regulations banning fetal sex identification without medical authorization. Fujian, a coastal province in east China, recently adopted measures to control the use of ultrasound scanning machines for fetal sex identification. Among other measures, there is a massive publicity campaign to increase awareness of the serious situation and educate the public on the new measures. Medical care institutions and family planning organizations are urged to inform their staff of the new regulations, and notices banning the malpractice should be posted in conspicuous places in major medical venues. PMID:12291695

  5. A Legal Analysis of the Precedents of Medical Disputes in the Cosmetic Surgery Field

    PubMed Central

    Park, Bo Young; Kim, Min Ji; Kang, So Ra

    2016-01-01

    Background Disputes regarding medical malpractice occur between practitioners and patients. As patients have become increasingly aware regarding medical care, an increase in the unexpected side effects of procedures has been observed, thereby leading to an increase in disputes regarding medical malpractice. In this study, we reviewed trends in precedents involving cosmetic surgery-related medical disputes, with the goal of helping to prevent unnecessary disputes in the future. Methods We conducted a search of the judgments made in South Korean courts between 2000 and 2013 that were related to the field of plastic surgery. A total of 54 judgments were analyzed, and the selected precedents were reviewed and classified according to the kind of negligence involved. Results The claim amounts ranged from under 8 million KRW (6,991 USD) to 750 million KRW (629,995 USD). The most common ratio of the judgment amount to the claim amount was 20%–30%. The judgments were classified according to the following categories: violation of the duty of explanation in 17 cases (29%), violation of the duty of care in 10 cases (17%), violation of both duties in 20 cases (35%), and no violation of duty in six cases (10%). Conclusions Cosmetic surgery-related suits require different approaches than general malpractice suits. The Supreme Court requires plastic surgeons to determine the type, timing, methods, and scope of their treatments when considering possible results. Therefore, practitioners should be educated on their rights and responsibilities to enable them to cope with any possible medical dispute that may arise. PMID:27218027

  6. Chinese regulation of off-label use of drugs.

    PubMed

    Ma, Feng; Lou, Nan

    2013-01-01

    China has significant gaps and weaknesses in its regulatory oversight of the off-label use of drugs. As in the United States, the off-label prescribing of drugs is not prohibited in China if there is a sound scientific basis. Physicians are allowed to prescribe off-label drugs based on their medical judgment if they follow certain requirements. There is some constraint on the right to prescribe by the imposition of malpractice liability if patients are harmed from improper off-label prescribing. However, damages awarded to successful plaintiffs are usually insignificant compared to malpractice damage awards in the U.S. Advertisement of off-label use is prohibited in China. All drug advertisements in China are subject to pre-approval, and must be based on information included in the approved package insert. However, the term "advertisement" is poorly defined. As a result, non-advertisement promotion of drugs for on-label or off-label use exist in a unregulated gray area. To better address the problem of inappropriate off-label promotion and use, China should (i) regulate both drug advertisements and non-advertisement promotion under a standard requiring off-label use to have a sound scientific basis, (ii) introduce harsher regulatory penalties, and (iii) increase compensation available for victims of medical malpractice. Such reform would not only discourage improper off-label use by introducing penalties (or increasing existing penalties) for improper promotion, but would also provide reasonable compensation for victims harmed by off-label use. PMID:24640468

  7. Fertility rhymes with liability: medical liability in 'ART'.

    PubMed

    Raposo, Vera Lúcia

    2015-01-01

    Medical malpractice claims have been growing all over the world. Medical acts involving new technologies and complex scientific acknowledgements are especially at stake, since they look particularly threatening to patients and judges and are, effectively, potentially more risky. The reason is that, side by side with traditional medical faults, new sources of liability emerge, as for instance the exchange or misappropriation of genetic material or surplus embryos. The present study analyses some of those new medical faults with the aim of alerting health institutions and health professionals, enlightening them about the juridical consequences of those conducts and providing simple tips to avoid lawsuits and condemnations. PMID:26665349

  8. The "nuts & bolts" of becoming an aesthetic provider: part 2-building your aesthetic practice.

    PubMed

    Brennan, Connie

    2014-01-01

    Part 2 of this three-part series of articles on becoming an aesthetic provider centers on the steps necessary to build an aesthetic practice. We will discuss the legal (e.g., licensure, scope of practice, malpractice, and documentation) and the business aspects (e.g., "your brand," staff development, networking, marketing, and revenue possibilities) of building a successful aesthetic practice. On the basis of years of experience, "pearls and pitfalls" will be discussed so novice, intermediate, and advanced aesthetic providers can minimize mistakes and maximize their success in this exciting and growing profession. PMID:24583661

  9. Fact and fancy. What can we really tell from the placenta?

    PubMed

    Macpherson, T

    1991-07-01

    Considerable interest in the clinical significance of placental abnormalities has been fueled by malpractice claims when perinatal outcome is less than optimal. The pathologist must be aware of those placental lesions that may contribute to perinatal morbidity and mortality. This article reviews the abnormalities of placentation, placental weight, maternal uteroplacental blood flow, villous histological makeup, fetoplacental blood flow, the umbilical cord, and the membranes, as well as the problems of multiple pregnancy. The important contribution of abnormal uteroplacental blood flow to adverse perinatal outcome is emphasized, as is the need to determine the extent of placental damage when evaluating the contribution thereto of particular placental abnormalities. PMID:2064525

  10. [Paolo Zacchia--the spiritual father of forensic medicine].

    PubMed

    Händel, Konrad

    2003-01-01

    Paolo Zacchia (1584-1659) was the personal physician of the popes Innocent X and Alexander VII, legal advisor to the Rota Romana and head of the health system in the Papal States. His most important work, written in Latin, is entitled "Quaestiones Medico-Legales" and was published in 9 volumes between 1621 and 1651. Even after Zacchia's death comprehensive reprints were published at several places up to the late 18th century. Zacchia covered all the medicolegal issues of his time including the problem of "malpractice" and medical ethics. He is rightly considered an outstanding representative of his profession, whose "Quaestiones Medico-Legales" gave legal medicine its name. PMID:14639809

  11. Legal accountability in the operating room.

    PubMed

    Furay, C J

    1989-06-01

    Malpractice implies misconduct and refers to a lack of skill or fidelity in the performance of professional duties. Health-care providers are not absolute guarantors of a favorable result; they are merely required to possess and exercise the knowledge and skill necessary to perform their tasks. The buyer of a product may assume liability by failing to exercise recommended precautions or by failing to relay the manufacturer's warning. Hospitals have the duty to furnish adequate equipment for diagnosis and treatment; if proper and safe products and equipment are not provided, the hospital can be found liable. PMID:2734816

  12. The Emerging Issue of Digital Empathy.

    PubMed

    Terry, Christopher; Cain, Jeff

    2016-05-25

    Empathy can have strong positive effects on patient outcomes, increase patient satisfaction, and reduce malpractice litigation. With modern advances in technology, however, the appropriate expression of empathy in today's age is being threatened, largely as a result of psychological processes that form online disinhibition. The digitization of health care and the corresponding decrease in the expression of empathy may be cause for concern. Because empathy is strongly correlated to positive health outcomes and is an important part of health professions in general, the construct of digital empathy should be considered for integration into health professions curricula. PMID:27293225

  13. Doing Psychiatry Right: A Case of Severe Avoidant Personality Disorder with Obsessive-compulsive Personality Disorder, Obsessive Compulsive Disorder, Intermittent Explosive Disorder and Sexual Paraphilias

    PubMed Central

    Hebbar, Sudhir

    2014-01-01

    Over dependence on pharmacotherapy in psychiatry, known as biological imperialism, is a world-wide phenomenon. Some authors have opined that the inadequate and ineffective utilization of psychotherapeutic interventions and only dependence on pharmacotherapy amounts to institutional malpractice. Here is an example of such a case. A young male mainly received multiple psychotropic medicines, including clozapine (and also a failed psychotherapy) over a period of 4 years, without any benefit. His global assessment of function score remained at 30. However, with proper diagnosis and effectively conducted psychotherapy a significant improvement in Global assessment of functioning score of 70 was achieved, over a period of 1½ years. PMID:25035563

  14. Don't lose your home in a lawsuit...or waste the equity.

    PubMed

    Mandell, David B

    2005-01-01

    Like most of us, a physician's home constitutes a major asset. Under normal circumstances, it is subject to attachment by creditors in a malpractice judgment or in any other litigation settlement that may exceed the limits of insurance coverage. This article describes the author's view of substandard options to shield a home from creditors. While some of these techniques have validity for certain planning purposes, they do not provide the optimal protection that physicians may desire. The author then proposes strategies that may be suitable for many individuals. PMID:16302439

  15. Six things every plastic surgeon needs to know about teamwork training and checklists.

    PubMed

    Harden, Stephen W

    2013-03-01

    More than 20 years of teamwork, research, and experience in high-risk industries such as aviation, nuclear power, and military operations have clearly demonstrated that teamwork training and checklist usage can overcome the primary causes of adverse events. There is a growing body of evidence that checklist programs have the same error-reducing effect in operating rooms (OR) as in other industries. The benefits include documented improvements in patient safety and quality care; a better office, surgery center, or hospital in which to practice medicine; reduced exposure to malpractice risk; and increased efficiency in the OR. PMID:23417721

  16. Emerging medicolegal issues in the practice of pediatric sleep medicine.

    PubMed

    Sachdeva, Ramesh C; D'Andrea, Lynn A

    2009-10-01

    With the rapid growth in the field of pediatric sleep medicine, health care providers need to be aware of several emerging legal issues that have the potential of impacting their clinical practice. This article provides an overview of emerging legal areas that might impact the practice of pediatric sleep medicine, and discusses civil liability emerging from medical malpractice, issues that health care providers must be aware of including issues related to providing care for minors, and newer areas that relate to legal prosecution for health care fraud as it may relate to violations of quality of care. PMID:19836702

  17. [Perspectives in medical liability].

    PubMed

    Pizarro W, Carlos

    2008-04-01

    The progressive increase of medical negligence law suits requires an updated analysis of the current situation of medical liability in Chile. The application of a new criminal procedure will avoid criminal prosecution of doctors, transferring to the civil courts the pecuniary sanctions for malpractice. Medical negligence and damage inflicted by doctors that require compensation are explained. The most likely evolution of medical liability is proposed, through an increase in civil liability insurance and the necessary standardization of rules applicable to professional liability. PMID:18769798

  18. [Defensive Medicine: Defensive Medicine: Overview of the literature].

    PubMed

    Panella, Massimiliano; Leigheb, Fabrizio; Rinaldi, Carmela; Donnarumma, Chiara; Tozzi, Quinto; Di Stanislao, Francesco

    2015-01-01

    A literature review was performed on the subject of defensive medicine, in order to gather information and evidence for identifying a shared definition of this phenomenon, identify its causes, quantify its frequency and its economic impact.Results show that defensive medicine is primarily the result of medical professionals adapting to the pressure of litigation risks, and whose behaviour is motivated by fear of malpractice claims rather than by the patient's health. Defensive medicine seems to have become a diffuse phenomenon, afflicting all diagnostic-therapeutic areas and some disciplines to a greater degree, and leading to a large waste of human, organizational and economic resources. PMID:26241515

  19. Medical liability reform crisis 2008.

    PubMed

    Weinstein, Stuart L

    2009-02-01

    The crisis of medical liability has resulted in drastic increases in insurance premiums and reduced access for patients to specialty care, particularly in areas such as obstetrics/gynecology, neurosurgery, and orthopaedic surgery. The current liability environment neither effectively compensates persons injured from medical negligence nor encourages addressing system errors to improve patient safety. The author reviews trends across the nation and reports on the efforts of an organization called "Doctors for Medical Liability Reform" to educate the public and lawmakers on the need for solutions to the chaotic process of adjudicating medical malpractice claims in the United States. PMID:18989732

  20. The logic of collaboration in education and the human services.

    PubMed

    Lawson, Hal

    2004-08-01

    Collaboration is a complex intervention with multiple components. It is both a process innovation and a product innovation, and it entails institutional development and change. These and other defining features implicate its contingencies. For example, collaboration is tailor made for needs, problems, and opportunities that manifest novelty, complexity, uncertainty, and interdependent relationships. Contingencies like these signal important constraints. For example, collaboration exacts steep transaction costs. Its potential benefits justify these costs and serve as incentives for its development. In fact, collaboration may be a defining feature of competent and optimal practice, and the failure to collaborate may be indicative of negligence and malpractice. PMID:15369966

  1. Amending the National Practitioner Data Bank reporting requirements: are small claims predictive of large claims?

    PubMed

    Rolph, J E; Pekelney, D; McGuigan, K

    1993-01-01

    This study addresses whether a physician incurring small malpractice claims is predictive of large claims. This is one consideration behind reevaluating whether all claims that result in an indemnity payment should continue to be reported to the National Practitioner Data Bank, or whether claims with payments below some "floor" should be excluded. Using a claims database from 3,098 physicians for 1977-1986, both cross-sectional and longitudinal analyses show that an individual having a small claim (under $30,000) is indicative of a propensity to incur large claims. This finding is robust to the cutpoint between large and small claims. PMID:8288406

  2. [Feeding venomous insects among the people and the measures to curb and control this addiction by the government in the Song Dynasty].

    PubMed

    Li, Yuqing

    2014-01-01

    Feeding venomous insects, a mystic witchcraft of producing poisonous materials to spoil other people has a long history which was still popular in the southern part of the Song Dynasty, aiming at revenge of one's enemy and the occupation of other's property. The Song government took a strict measures to tackle it, including enacting a decree to prohibiting it, encouraging people to report such malpractice, punishing heavily the person committing such criminal behavior and, at the same time, providing recipes and medicines to remedy its ensued disorders. All of these were helpful to the improvement of social morality. PMID:24774887

  3. Foreign body ingestion during dental implant procedures.

    PubMed

    Santos, Thiago de Santana; Antunes, Antonio Azoubel; Vajgel, André; Cavalcanti, Thames Bruno Barbosa; Nogueira, Luiz Ricardo Gomes de Caldas; Laureano Filho, José Rodrigues

    2012-03-01

    Two cases of swallowing of foreign material related to dental implants during dental practice are described. A conservative approach by clinical-radiographic follow-up was performed in both cases; however, one of the patients required colonoscopy under general anesthesia for the removal of the impacted foreign body from the intestinal region. These complications not only have associated economic cost but also carry the risk of malpractice litigation against the professional; thus, the surgeon was responsible for all the costs of hospital and surgery management of this case. Details of the clinical signs, radiographic examinations, type of treatment, and follow-up are presented. PMID:22446442

  4. The Emerging Issue of Digital Empathy

    PubMed Central

    Cain, Jeff

    2016-01-01

    Empathy can have strong positive effects on patient outcomes, increase patient satisfaction, and reduce malpractice litigation. With modern advances in technology, however, the appropriate expression of empathy in today’s age is being threatened, largely as a result of psychological processes that form online disinhibition. The digitization of health care and the corresponding decrease in the expression of empathy may be cause for concern. Because empathy is strongly correlated to positive health outcomes and is an important part of health professions in general, the construct of digital empathy should be considered for integration into health professions curricula. PMID:27293225

  5. Patient transitions from inpatient to outpatient: where are the risks? Can we address them?

    PubMed

    McLeod, Lou Anne

    2013-01-01

    Transitions of care from the inpatient to outpatient setting can be dangerous. Studies have shown that almost half of all hospitalized patients experience a medical error after discharge. With efforts to decrease the cost of healthcare, patients are discharged "quicker and sicker" oftentimes leaving families to manage the patient's recovery with little support. Most medical errors can be traced back to communication breakdowns and lack of systems to follow up on needed care. Inpatient and outpatient providers must work together to develop processes to address these deficits or face decreasing reimbursement and malpractice claims. PMID:23335297

  6. [The phenomenon of covert self-mutilation in the surgical routine].

    PubMed

    Werdin, F; Amr, A; Eckhardt-Henn, A

    2016-02-01

    Factitious disorders are conditions which are unknown to many physicians but have a prevalence of 1-5 % in outpatient departments and hospitals. In order to avoid prolonged and complicated (false) treatment in surgery this article gives a review of the definition, epidemiology and pathogenesis of factitious disorders as well as clinical symptoms and therapy options. A focus is placed on the identification of patients, treatment strategies and the prevention of malpractice. Additionally, clinical features of the disorder are illustrated with the description of some characteristic cases. PMID:25971613

  7. Toward a conceptual reexamination of the patient-physician relationship in the healthcare institution for the new millennium.

    PubMed Central

    Fredericks, Marcel; Odiet, Jeff A.; Miller, Steven I.; Fredericks, Janet

    2006-01-01

    There is a crisis in the patient-physician relationship. Mass media, managed care and malpractice are just a few factors that contribute to a lack of trust, understanding and loyalty in the patient-physician relationship. We have experienced some select concepts within the Society, Culture and Personality (SCP) model. In it, we explore how social class, age, race, ethnicity and family background of the patient impact upon the patient-physician relationships. The analysis of the sick role is most prominent, and in this interactive process empathy must be given to each person who seeks medical help. PMID:16573302

  8. Crisis in medico-legal death investigation.

    PubMed Central

    Carter, Joye M.

    2002-01-01

    There is a crisis in the field of medico-legal death investigation! This medical practice is one that most physicians do not think about until they are called in the middle of the night and informed that their patient has died and medical history is requested. Worse still, the trauma surgeon may need to explain why the patient did not survive the life-saving techniques used at his or her medical institution. The worst-case scenario is when the clinician is hit with a malpractice lawsuit. PMID:11837352

  9. Risk management information for HIV infection.

    PubMed

    Edwards, A J

    1990-01-01

    This article discusses HIV infection in terms of the risk manager's information needs in the health care environment. The malpractice problem, increasing workman's compensation suits, the greater role of the ombudsman, implementation of the National Practitioner Data Bank, and the Joint Commission on Accreditation of Health Care Organizations' (JCAHO) emphasis on clinical excellence are conditions which have given greater importance to the risk manager's position. Included in this article are hedges to retrieve various components of risk management and a select bibliography from AIDSLINE. PMID:10110456

  10. [Selected medical closed claims in the field of regional anaesthesia].

    PubMed

    Kessler, Paul; Schaffartzik, Walter; Neu, Johann

    2016-05-01

    Legal malpractice cases in regional anaesthesia comprise a significant number of all cases before the expert commissions and arbitration boards of the state medical associations. One reason for this is the increasing use of neuraxial and peripheral regional blocks in orthopaedics and traumatology. Only in about one fourth of the reviewed cases could either a causal relationship between substandard performance and patient injury or an inadequate obtaining of informed consent be established. In the great majority of cases patients' claims were unfounded, since the patients' injuries were adjudged to be unavoidable and adequate consent had been abtained prior to performance of the blocks. PMID:27213606

  11. ACOG Committee Opinion No. 374: Expert testimony.

    PubMed

    2007-08-01

    It is the duty of obstetricians and gynecologists who testify as expert witnesses on behalf of defendants, the government, or plaintiffs to do so solely in accordance with their judgment on the merits of the case. Obstetrician-gynecologists must limit testimony to their sphere of medical expertise and must be prepared adequately. They must make a clear distinction between medical malpractice and medical maloccurrence. The acceptance of fees that are greatly disproportionate to those customary for professional services can be construed as influencing testimony given by the witness, and it is unethical to accept compensation that is contingent on the outcome of litigation. PMID:17666622

  12. Physician Tiering by Health Plans in Massachusetts

    PubMed Central

    Wadgaonkar, Ajay D.; Schneider, Eric C.; Bhattacharyya, Timothy

    2010-01-01

    Background: Physician tiering is an emerging health-care strategy that purports to grade physicians on the basis of cost-efficiency and quality-performance measures. We investigated the consistency of tiering of orthopaedic surgeons by examining tier agreement between health plans and physician factors associated with top-tier ranking. Methods: Health plan tier, demographic, and training data were collected on 615 licensed orthopaedic surgeons who accepted one or more of three health plans and practiced in Massachusetts. We then computed the concordance of physician tier rankings between the health plans. We further examined the factors associated with top-tier ranking, such as malpractice claims and socioeconomic conditions of the practice area. Results: The concordance of physician tiering between health plans was poor to fair (range, 8% to 28%, κ = 0.06 to 0.25). The percentage of physicians ranked as top-tier varied widely among the health plans, from 21% to 62%. Thirty-eight percent of physicians were not rated top-tier by any of the health plans, whereas only 5.2% of physicians were rated top-tier by all three health plans. Multivariate analysis showed that board certification, accepting Medicaid, and practicing in a suburban location were the independent factors associated with being ranked in the top tier. More years in practice or fewer malpractice claims were not related to tier. Conclusions: Current methods of physician tiering have low consistency and manifest evidence of geographic and demographic biases. PMID:20844163

  13. Surgical errors and risks – the head and neck cancer patient

    PubMed Central

    Harréus, Ulrich

    2013-01-01

    Head and neck surgery is one of the basic principles of head and neck cancer therapy. Surgical errors and malpractice can have fatal consequences for the treated patients. It can lead to functional impairment and has impact in future chances for disease related survival. There are many risks for head and neck surgeons that can cause errors and malpractice. To avoid surgical mistakes, thorough preoperative management of patients is mandatory. As there are ensuring operability, cautious evaluation of preoperative diagnostics and operative planning. Moreover knowledge of anatomical structures of the head and neck, of the medical studies and data as well as qualification in modern surgical techniques and the surgeons ability for critical self assessment are basic and important prerequisites for head and neck surgeons in order to make out risks and to prevent from mistakes. Additionally it is important to have profound knowledge in nutrition management of cancer patients, wound healing and to realize and to be able to deal with complications, when they occur. Despite all precaution and surgical care, errors and mistakes cannot always be avoided. For that it is important to be able to deal with mistakes and to establish an appropriate and clear communication and management for such events. The manuscript comments on recognition and prevention of risks and mistakes in the preoperative, operative and postoperative phase of head and neck cancer surgery. PMID:24403972

  14. Restructuring of the jurisprudence course taught at the Canadian Memorial Chiropractic College

    PubMed Central

    Gleberzon, Brian J.

    2010-01-01

    Introduction: The process by which the jurisprudence course was restructured at the Canadian Memorial Chiropractic College is chronicled. Method: A Delphi process used to restructure the course is described, and the results of a student satisfaction survey are presented. Results: When asked “I think this material was clinically relevant,” over 81% of the 76 students who respondents strongly agreed or agreed with this statement; 100% of students agreed or strongly agreed that scope of practice; marketing, advertising and internal office promotion; record keeping; fee schedules; malpractice issues and; professional malpractice issues and negligence was clinically relevant. When asked “I think this material was taught well,” a minimum of 89% of students agreed or strongly agreed with this statement. Discussion: This is the first article published that described the process by which a jurisprudence course was developed and assessed by student survey. Summary: Based on a survey of student perceptions, restructuring of the jurisprudence course was successful in providing students with clinically relevant information in an appropriate manner. This course may serve as an important first step in development a ‘model curriculum’ for chiropractic practice and the law courses in terms of content, format and assessment strategies. PMID:20195427

  15. A Large-Scale Analysis of Impact Factor Biased Journal Self-Citations

    PubMed Central

    Waltman, Ludo

    2016-01-01

    Based on three decades of citation data from across scientific fields of science, we study trends in impact factor biased self-citations of scholarly journals, using a purpose-built and easy to use citation based measure. Our measure is given by the ratio between i) the relative share of journal self-citations to papers published in the last two years, and ii) the relative share of journal self-citations to papers published in preceding years. A ratio higher than one suggests that a journal’s impact factor is disproportionally affected (inflated) by self-citations. Using recently reported survey data, we show that there is a relation between high values of our proposed measure and coercive journal self-citation malpractices. We use our measure to perform a large-scale analysis of impact factor biased journal self-citations. Our main empirical result is, that the share of journals for which our measure has a (very) high value has remained stable between the 1980s and the early 2000s, but has since risen strongly in all fields of science. This time span corresponds well with the growing obsession with the impact factor as a journal evaluation measure over the last decade. Taken together, this suggests a trend of increasingly pervasive journal self-citation malpractices, with all due unwanted consequences such as inflated perceived importance of journals and biased journal rankings. PMID:27560807

  16. The medical liability climate and prospects for reform.

    PubMed

    Mello, Michelle M; Studdert, David M; Kachalia, Allen

    2014-11-26

    For many physicians, the prospect of being sued for medical malpractice is a singularly disturbing aspect of modern clinical practice. State legislatures have enacted tort reforms, such as caps on damages, in an effort to reduce the volume and costs of malpractice litigation. Attempts to introduce similar traditional reform measures at the federal level have so far failed. Much less prominent, but potentially more important, are proposed alternative approaches for resolving medical injuries; a number of these efforts are currently being tested in federally sponsored demonstration projects. These nontraditional reforms have considerable promise for addressing some of the system's most challenging issues, including high costs and barriers to accessing compensation. In this Special Communication, we review recent national trends in medical liability claims and costs, which indicate a sharp reduction in the rate of paid claims and flat or declining levels in compensation payments and liability insurance costs over the last 7 to 10 years. We discuss a number of nontraditional reform approaches--communication-and-resolution programs, presuit notification and apology laws, safe harbor legislation, judge-directed negotiation, and administrative compensation systems--and we conclude by describing several forces likely to shape change in the medical liability environment over the next decade. PMID:25358122

  17. [Situation of legal conflicts in criminal proceedings].

    PubMed

    Krause, Daniel M

    2003-11-01

    Criminal proceedings against physicians involving an alleged professional malpractice usually represent a complex problem raising issues in various (potential) areas of conflict. In many cases such proceedings are accompanied by liability actions in civil courts, occasionally proceedings have been initiated by the Medical Board in order to clarify a case of professional misconduct. Often, a medical malpractice insurance is involved. In order to protect the physician's interests in the best possible way, any action in the various matters needs concerted efforts. No statement or comment regarding the allegations should be rendered to the prosecution before access to the investigation file has been granted. No negative conclusions may be drawn from the use of the right to refuse testimony. The preparation of a written statement requires a thorough legal and factual analysis of the allegations as well as the evidence they are based on. In this respect professional legal assistance is essential. It does not constitute a breach of the doctor-patient confidentiality if the physician discloses information in order to defend himself against criminal allegations. If several physicians are charged with an offense it is recommendable in most cases to coordinate defense activities. PMID:14710646

  18. Pathologists and the judicial process: how to avoid it.

    PubMed

    Epstein, J I

    2001-04-01

    This review article covers the full range of issues concerning malpractice as it relates to pathologists. Following a brief summary as to the incidence and general statistics on the outcome of lawsuits as well as common pathology misdiagnoses resulting in lawsuits, the definition of malpractice is discussed. These include duty, breech of standard of care, proximal cause, and damage. Details are provided as to what a pathologist should do from the initial threat of a lawsuit, to the initial lawsuit, and through the initial physician/lawyer meeting. An in-depth analysis as to how pathologists should handle themselves through the discovery process and, in particular, deposition is provided. Plaintiff attorneys' goals at deposition are covered in depth. These goals include: 1) education about the pathologist's case and strategies; 2) impeachment of the pathologist's credibility; and 3) judgment as to how effective a witness the pathologist will be at trial. Various types of plaintiff's attorney at deposition are summarized. Also discussed is the post-deposition meeting with the legal representative, whether to settle, and specific issues relating to trial. Finally, general tips on how to avoid a lawsuit in pathology are reviewed. PMID:11257629

  19. Amputations in Sickle Cell Disease: Case Series and Literature Review.

    PubMed

    Maximo, Claudia; Olalla Saad, Sara T; Thome, Eleonora; Queiroz, Ana Maria Mach; Lobo, Clarisse; Ballas, Samir K

    2016-06-01

    In this study, we describe four new patients with sickle cell disease who had limb amputations. Two of the patients had sickle cell anemia [Hb S (HBB: c.20A > T) (β(S)/β(S))] with refractory leg ulcers that required amputations. The third patient had sickle cell trait with an extensive leg ulcer that was associated with epidermoid carcinoma. The fourth patient had amputations of both forearms and feet due to a misdiagnosis of dactylitis. Review of the literature showed that the indications for amputations in sickle cell disease included three distinct categories: mythical beliefs, therapeutic and malpractice. All therapeutic amputations were for severely painful, large, recalcitrant leg ulcers that failed non-interventional therapies. Amputation resulted in pain relief and better quality of life. Phantom neuropathic pain was not a major issue post-operatively. It was absent, transient or well controlled with antidepressants. Limb function was restored post-amputation with prosthetic artificial limbs, wheelchairs or crutches. Malpractice amputations were due to misdiagnosis or to cryotherapy by exposing the painful limb to ice water resulting in thrombosis, gangrene and amputation. We strongly suggest that leg amputations should be considered in the management of certain patients with severe extensive refractory leg ulcers, and topical cryotherapy should never be used to manage sickle cell pain. PMID:27117565

  20. THE LIABILITY FORMS OF THE MEDICAL PERSONNEL.

    PubMed

    Bărcan, Cristian

    2015-01-01

    Current legislation, namely Law no. 95/2006 on healthcare reform in the medical malpractice domain stipulates that medical staff can be held accountable in the following forms: disciplinary liability, administrative liability, civil liability and criminal liability. Each form of legal liability presents its features, aspects that are found mainly in the procedural rules. However, the differences between the various legal forms of liability are not met only in the procedural rules but also in their effects and consequences. It is necessary to know what the procedure for disciplinary responsibility, administrative liability, civil liability, or criminal liability is. In addition to the differentiation determined by the consequences that may arise from the different forms of legal liability, it is important to know the competent authorities to investigate a case further and the solutions which various public institutions can take regarding the medical staff. Depending on the type of legal liability, authorities have a specialized authority. If the Disciplinary Committee is encountered at the College of Physicians, it may not intervene in cases before the monitoring and competence for malpractice cases Committee. The latter two committees cannot intervene directly in the legal assessment of civil or criminal cases, as no criminal investigation authorities cannot intervene in strictly civilian cases. Therefore, the importance of knowing the competent institutions is imperative. PMID:26978868

  1. Protecting patients' rights in New Zealand.

    PubMed

    Paterson, R

    2005-03-01

    For 30 years, medical malpractice litigation has effectively been barred in New Zealand by accident compensation laws. Victims of medical error are rehabilitated and compensated through a no-fault, state-funded compensation scheme. Patients' rights (and providers' duties) are set out in a Code of Consumers' Rights, which applies to all providers of health and disability services, ranging from surgeons to traditional Maori healers and unpaid caregivers. Organisational providers such as hospitals are also covered. Complaints alleging a breach of the Code are resolved at the lowest appropriate level by a statutory Ombudsman, the Health and Disability Commissioner. Resolution techniques include advocacy, mediation and investigation, which may result in a finding of breach of the Code. The emphasis is on "resolution, not retribution" and "learning, not lynching". The Commissioner makes remedial recommendations, but does not award damages. Competence concerns are referred to professional registration boards, and serious breaches are referred for disciplinary proceedings. The New Zealand model of legislating patients' rights and enforcing them via an independent Commissioner is an interesting variant of professional self-regulation, and seeks to promote resolution of individual complaints and systemic improvements in health care quality. Investigation reports are widely distributed to promote learning. Despite initial professional resistance, the Office is becoming recognised for its key role in a regulatory system where medical malpractice claims are barred. A case study involving misdiagnosis of a fatal heart attack illustrates the flexibility of the New Zealand response to medical errors. PMID:15887613

  2. The liability of medical directors for utilization review decisions.

    PubMed

    Trueman, David L

    2002-01-01

    Managed Care Organizations (MCOs) have turned to numerous cost-containment measures to combat rising healthcare costs. One of the most common is the use of utilization review to ascertain whether a recommended mode of treatment is "medically necessary." When the medical director of an MCO determines that care recommended by a patient's treating physician is not medically necessary and not eligible for coverage (and, as a result, potentially unattainable due to cost), the stage is set for litigation. In such situations, medical directors may become potentially liable for disciplinary action by their state medical licensing board as well as lawsuits for malpractice or negligence. However, plaintiffs wishing to recover damages for improper determinations of this nature or state boards trying to discipline these physicians, face the hurdles of the preemptive force of ERISA, and state doctrines to the effect that corporations (and, derivatively, their medical directors) cannot practice medicine and therefore cannot be liable for malpractice. Conflicting decisions and opinions make it impossible at the present time to have a settled expectation regarding the potential liability of medical directors in this context, although the law appears to be moving toward the treatment of utilization review as medical decisionmaking; therefore, it appears likely that the activities of medical directors increasingly will face state oversight--including the imposition of common law liability in appropriate situations. PMID:11974520

  3. The legal system, insurance, and health care. What can be done about the liability problem? An ECRI technology management assessment.

    PubMed

    1986-01-01

    Health care providers are currently experiencing a malpractice "crisis" that, in some regions and for some medical specialties, is as serious as the one that occurred a decade ago. Whether providers themselves, the insurance industry, or lawyers and the legal system are seen as responsible for today's crisis depends primarily on the observer. However, evidence indicates that, in health care, negligence by those who provide services (physicians and hospital personnel) is a more important factor in the health care liability crisis than is so for other sectors of society that also face liability-insurance problems (e.g., municipal governments, light aircraft manufacturers, ski-slope operators). While physicians and hospitals can participate in legislative efforts to achieve tort reform and more stringent regulation of liability insurers, this study suggests that they will have more success in reducing malpractice insurance premium rates by concentrating instead on improving the quality of patient care. Towards this end, a number of specific actions are outlined, ranging from greater use of patient-care protocols and algorithms to increased activity by state medical licensing and disciplinary boards. PMID:10276862

  4. A study of clinical decision making by certified registered nurse anesthetists.

    PubMed

    Kremer, Michael J; Faut-Callahan, Margaret; Hicks, Frank D

    2002-10-01

    Anesthesia outcomes and related risk factors have been studied for more than 100 years. Varying sample sizes and research methods have been used, with research findings that were open to multiple interpretations. Research with closed malpractice claims demonstrates that American Society of Anesthesiologists physical status II patients undergoing elective procedures are most likely to experience damaging events intraoperatively with resultant postoperative adverse outcomes. The process of care, including clinical decision making, contributes to adverse outcomes. Clinical decision making can be difficult to assess and measure. In this study, the cognitive psychology framework of information-processing theory and literature pertaining to the use of heuristics, or rules of thumb, and clinical biases, were used to analyze cases from the AANA Foundation closed malpractice claims database. This database contains more than 300 files involving St Paul Fire and Marine Insurance Company-covered CRNAs from across the United States. These files were analyzed by 10 CRNA investigators on the AANA Closed Claims research team. Variables such as inadequate preinduction activities, e.g., incomplete preanesthetic assessments, and use of cognitive biases and inaccurate probability estimation were associated with adverse outcomes in this research sample. Teaching of decision science in basic and continuing nurse anesthesia education is advocated. PMID:12425129

  5. [Infection after anterior cruciate ligament reconstruction: grave error in treatment?].

    PubMed

    Regauer, M; Neu, J

    2012-09-01

    A 28-year-old patient showed clear signs of knee joint infection 8 days after arthroscopic reconstruction of the anterior cruciate ligament. The treating physicians recommended further observation although they stated that a knee joint infection could not be reliably excluded. One week later arthroscopic revision was performed and intraoperative smear tests showed infection by Pseudomonas aeruginosa. Therefore, another 6 days later the obviously infected transplant had to be removed. In the long run painful and limited range of motion of the affected knee joint persisted. The patient complained about medical malpractice concerning management of the complication. The expert opinion stated that due to the fateful course of infection the tendon graft could not be retrieved after the eighth day post surgery anyway. Thus, only flawed delay of treatment was criticized. The arbitration board argued, however, that scientific data concerning the fate of infected tendon grafts do not support the expert opinion and that immediate arthroscopy and antibiotic treatment at least had the potential to influence the course of infection in a positive manner. Evidence clearly shows that survival of an infected tendon graft depends on early diagnosis and emergency treatment rather than just on fate. Due to the fact that, although having in mind the possibility of a knee joint infection, the necessary therapy was delayed for 8 days, the arbitration board considered the described medical malpractice a severe treatment error, leading to reversal of evidence in favour of the patient. PMID:22706649

  6. [Conservative treatment of distal radius fracture. Consequences of an uncritical follow-up].

    PubMed

    Huber-Wagner, S; Beirer, M; Neu, J

    2014-11-01

    A 74-year-old woman sustained a fracture of the distal radius with an additional fracture of the styloid process of the ulna due to a fall. After reduction under local anesthesia immobilization treatment in a forearm cast was initiated. Despite increasing secondary dislocation during radiological x-ray follow-up control, the bone was described as correctly aligned by the treating physician and non-operative treatment was continued. After a total treatment period of 9 months including 7 months of physiotherapy the patient still presented a limited range of motion and local soft tissue swelling of the right wrist. The patient filed a complaint for wrong treatment of the distal radius fracture resulting in severe pain and considerable deformity of the right wrist leading to a significant handicap during activities of daily living. The expert opinion of the arbitration board ascertained a case of medical malpractice in terms of the indications. Due to the initial presence of criteria of radiological instability, an operative treatment had already been indicated at the first presentation. In addition, secondary dislocation during radiological follow-up examination should have led to conversion of treatment in favor of surgery. The arbitration board furthermore concluded that iatrogenic malpractice led to a severe deformity of the right wrist which would result in a loss of grip strength and future arthritic deformation of the wrist. Legal aspects of the case are discussed. PMID:25277732

  7. [Cases from the expert commission of the North Rhine medical council: expert commissions and arbitration boards by medical councils].

    PubMed

    Hannappel, J; Weber, B; Smentkowski, U

    2012-11-01

    Following a description of the structure and function of the expert commission for medical malpractice of the North Rhine medical council, important legal technical terms and the consequences, such as the definition of accusable medical malpractice and severe (in legal terms gross) negligence will be presented. The article reports on the legal consequences of the lack of informed consent, on the significance of insufficient informed consent and under which conditions a transfer of liability becomes valid. From the statistical information in the archives of the expert commission it can be seen that in processes against urologists approximately 31% of urologists in private practice were affected compared to 69% of hospital urologists. Approximately 20% involved accusations of false diagnosis and 80% involved accusations of false treatment. Of the processes involving urological diagnostic errors prostate cancer was at the forefront, followed by processes involving delayed or falsely diagnosed bladder cancer. For processes due to operative treatment errors prostate cancer also occupied first place, followed by accusations of treatment errors involving penile and urethral operations. A differentiated presentation of processes involving non-operative treatment errors revealed an accumulation of accusations for mistakes in the treatment of urolithiasis, in medicinal treatment and also in tumor therapy. Following a description of typical individual cases, indications for avoidance of legal proceedings will be given. PMID:23150128

  8. Maintaining proper dental records.

    PubMed

    Leeuw, Wilhemina

    2014-01-01

    Referred to as Standard of Care, the legal duty of a dentist requires exercising the degree of skill and care that would be exhibited by other prudent dentists faced with the same patient-care situation. Primarily, the goal of keeping good dental records is to maintain continuity of care. Diligent and complete documentation and charting procedures are essential to fulfilling the Standard of Care. Secondly, because dental records are considered legal documents they help protect the interest of the dentist and/or the patient by establishing the details of the services rendered. Patients today are better educated and more assertive than ever before and dentists must be equipped to protect themselves against malpractice claims. Every record component must be handled as if it could be summoned to a court room and scrutinized by an attorney, judge or jury. Complete, accurate, objective and honest entries in a patient record are the only way to defend against any clinical and/or legal problems that might arise. Most medical and dental malpractice claims arise from an unfavorable interaction with the dentist and not from a poor treatment outcome. By implementing the suggestions mentioned in this course, dental health care professionals can minimize the legal risks associated with the delivery of dental care to promote greater understanding for patients of their rights and privileges to their complete record. PMID:24834675

  9. [Legal implications of complementary and alternative therapies].

    PubMed

    Bergmann, Karl Otto

    2008-01-01

    Complementary therapies require a differentiated treatment by all the legal fields involved. First, this refers to medical malpractice law dealing with the question of medical indication, its interaction with "classical" medicine and the need for extensive patient information on the potential ineffectiveness of the--partly very expensive--complementary therapies. Second, it also refers to the legal specifications of the medical profession as well as health insurance law. The question is whether the expenses of an alternative therapy are borne by the statutory or private health insurance and whether it is justified to try a complementary therapy when faced with an incurable disease. In the following the range of legal aspects shall be illuminated on the basis of the relevant jurisdiction. PMID:19213454

  10. Pediatric Chiropractic Care: The Subluxation Question And Referral Risk.

    PubMed

    Homola, Samuel

    2016-02-01

    Chiropractors commonly treat children for a variety of ailments by manipulating the spine to correct a 'vertebral subluxation' or a 'vertebral subluxation complex' alleged to be a cause of disease. Such treatment might begin soon after a child is born. Both major American chiropractic associations - the International Chiropractic Association and the American Chiropractic Association - support chiropractic care for children, which includes subluxation correction as a treatment or preventive measure. I do not know of any credible evidence to support chiropractic subluxation theory. Any attempt to manipulate the immature, cartilaginous spine of a neonate or a small child to correct a putative chiropractic subluxation should be regarded as dangerous and unnecessary. Referral of a child to a chiropractor for such treatment should not be considered lest a bad outcome harms the child or leads to a charge of negligence or malpractice. PMID:26806448

  11. Retaining medical directors in community health centers. The importance of administrative relationships.

    PubMed

    Cochran, Christopher; Peltier, James W

    2003-01-01

    Physician retention has become a critical issue for maintaining the success of today's health care organizations. With many external factors--increasing malpractice premiums, lower reimbursement rates, and managed care controls--driving physicians out of the practice, it is imperative to understand how the internal functions of the organization can help maintain satisfaction in the workplace and prevent physicians from leaving (Reece, 2000; Taylor, 2002). This is especially important in Community and Migrant Health Centers (C/MHCs), federally supported health clinics providing care to low-income and uninsured patients in medically underserved communities and neighborhoods. In this study, we examine the medical directors' roles and responsibilities, their relationships with the C/MHC administrators, and whether these impact satisfaction and, ultimately retention in the centers. PMID:12856504

  12. Retrospective analysis of survey data relating to the employment conditions of Canadian veterinary graduates for the years 2008 to 2013

    PubMed Central

    Jelinski, Murray D.; Lissemore, Kerry

    2015-01-01

    Six years of survey data generated from the “Annual New Graduate Survey” were collated and analyzed for trends. Canadian veterinary colleges graduated 14.9% more veterinarians in 2013 than 2008; 79.3% of graduates were female and this percentage was similar across all colleges (P = 0.51). The average base salary for new graduates remained constant at ~$69 000/annum for the years 2011 to 2013. However, the mean base salary of those employed in western Canada and Ontario was higher than that of employees in Quebec and the Maritimes (P < 0.001). There were no differences in the base salaries paid to males and females (P = 0.18) nor in what small animal, food animal, and equine practices were paying new graduates (P = 0.94). The 3 most common employee benefits were: a continuing education allowance, paid licensing fees, and paid malpractice insurance premiums. PMID:26483581

  13. The Family Physician in the Witness Box

    PubMed Central

    Emson, H. E.

    1983-01-01

    The doctor appearing in court must learn a new language and be prepared to deal with the legal profession, which is quite different from his own. Adequate preparation for a court case can make it less confusing; this article gives guidelines for doctors occasionally called to give evidence, or who are accused of malpractice. Doctors called as witnesses must consult with lawyers early, to determine exactly what information the court wants and the form a report should take. Physicians should carefully study and summarize all their evidence in non-technical language before a court appearance. By learning some legal language, they can also understand and adequately answer lawyers' questions. A physician accused of negligence must make no admissions before the case and have no contact with the plaintiff other than to formally acknowledge the charge. The Canadian Medical Protective Association should be contacted as soon as possible. PMID:21283283

  14. The "saw-it-all-along" effect: demonstrations of visual hindsight bias.

    PubMed

    Harley, Erin M; Carlsen, Keri A; Loftus, Geoffrey R

    2004-09-01

    The authors address whether a hindsight bias exists for visual perception tasks. In 3 experiments, participants identified degraded celebrity faces as they resolved to full clarity (Phase 1). Following Phase 1, participants either recalled the level of blur present at the time of Phase 1 identification or predicted the level of blur at which a peer would make an accurate identification. In all experiments, participants overestimated identification performance of naive observers. Visual hindsight bias was greater for more familiar faces--those shown in both phases of the experiment--and was not reduced following instructions to participants to avoid the bias. The authors propose a fluency-misattribution theory to account for the bias and discuss implications for medical malpractice litigation and eyewitness testimony. PMID:15355129

  15. When systems fail: improving care through technology can create risk.

    PubMed

    Bagalio, Sharon A

    2007-01-01

    Emerging medical technology is transforming the care of the modern-day patient. Hospital performance and patient safety is improving, lowering professional liability and medical malpractice costs. This advanced technology affects not only diagnosis and treatment but also hospital productivity and revenue. However, it also exposes hospitals and medical personnel to a number of unforeseeable risks. This article examines ongoing efforts to improve patient safety through the use of technology, automation and complex systems operations. It discusses the importance of skilled negotiation when vying for technology contracts and the value of maintaining a reliable data center to support it. Technology risk exposure is now a reality. A hospital needs to know how to protect itself from cyber liability, business interruption, and data loss and theft by ensuring that there is adequate coverage. PMID:20200890

  16. Federal administrative health courts are unconstitutional: a reply to Elliott, Narayan, and Nasmith.

    PubMed

    Widman, Amy; Hochberg, Francine A

    2008-08-01

    This commentary responds to the essay by Elliott, Narayan, and Nasmith wherein they propose that the federal government may preclude plaintiffs with medically inflicted injuries from bringing state common-law tort claims against those whose negligence caused their injury. The administrative system championed by Elliott and other proponents is a radical departure from the current civil justice system. Specifically, we argue that the administrative health courts, as proposed, violate the commerce clause, the spending clause, the Seventh Amendment, and separation of powers principles. The commentary concludes that such a system is fatally flawed and cannot withstand constitutional scrutiny. Moreover, we are not persuaded that Congress will be able to ground such a radical constitutional restructuring in any sound public policy, as the majority of studies do not evidence Elliott, Narayan, and Nasmith's presumption that the civil justice system has failed in the medical malpractice context. PMID:18617675

  17. Molecular digital pathology: progress and potential of exchanging molecular data.

    PubMed

    Roy, Somak; Pfeifer, John D; LaFramboise, William A; Pantanowitz, Liron

    2016-09-01

    Many of the demands to perform next generation sequencing (NGS) in the clinical laboratory can be resolved using the principles of telepathology. Molecular telepathology can allow facilities to outsource all or a portion of their NGS operation such as cloud computing, bioinformatics pipelines, variant data management, and knowledge curation. Clinical pathology laboratories can electronically share diverse types of molecular data with reference laboratories, technology service providers, and/or regulatory agencies. Exchange of electronic molecular data allows laboratories to perform validation of rare diseases using foreign data, check the accuracy of their test results against benchmarks, and leverage in silico proficiency testing. This review covers the emerging subject of molecular telepathology, describes clinical use cases for the appropriate exchange of molecular data, and highlights key issues such as data integrity, interoperable formats for massive genomic datasets, security, malpractice and emerging regulations involved with this novel practice. PMID:27471996

  18. THE PARAMETERS OF INFORMED CONSENT

    PubMed Central

    Raab, Edward L

    2004-01-01

    ABSTRACT Purpose To describe the components of a proper informed consent; which risks must be disclosed and which need not; additional safeguards for incapacitated persons, minors, and research subjects; and where the law will imply consent that is not otherwise obtained. Methods Summarization of current law obtained from legal treatises, reports of recent cases, and personal experience as a reviewer and expert. Results Lack of informed consent can reinforce a claim of medical malpractice or serve as an alternative point of attack when the case is otherwise weak. Special requirements must be met when patients are the subjects of clinical research. Conclusion Demonstration of a well-conducted process, not merely of a paper, not only protects the physician from exposure to liability, but increases the patient’s autonomy in decisions concerning health and encourages compliance with treatment. PMID:15747761

  19. [International and Israeli physicians' health--information and action plan].

    PubMed

    Reis, Shmuel; Sayag, Shlomit; Karkabi, Khalid; Alroi, Gideon

    2008-03-01

    Physician health is a matter of interest for patients' physicians and their teams, managers and policy-makers. It has an impact on public health, physician impairment, patient safety, resource allocation and malpractice litigation. International medical literature, unlike Israel publications, is extensively preoccupied with the domain. Based on 2 MD thesis dissertations, Ministry of Health data and a literature search, the present review addresses many issues. It deals with: physicians' physical and mental health internationally and in Israel, prevention and health promotion, burn-out, the professional lifespan and career, health services utilization, legal and administrative aspects, boundaries, physicians' characteristics and vulnerability, interpersonal relations, care provided by physicians, physicians as patients and finally the impaired physician. International recommendations as well as a proposal for a local action plan are presented. PMID:18488866

  20. Scandal and psychiatry in early nineteenth-century Prussia.

    PubMed

    Yamanaka, Hiroshi

    2003-06-01

    An analysis of the Ernst Horn (1774-1848) malpractice scandal at Berlin's Charité Hospital in the second decade of the nineteenth century reveals two interesting facets. One was the social pressure put upon Horn to publish detailed inside information about the hospital, which ironically was to build his reputation as a pioneering clinical psychiatrist. The other was the professional antagonism among the physicians involved in she scandal. The behaviour of J. C. Reil (1759-1813) in this affair stood in sharp contrast to that of J. G. Langermann (1768-1832) and C. W. Hufeland (1762-1836), who were in charge of the hospital's administration. Much of the deep mutual antipathy among the players may be interpreted as an antagonism between the opposing camps of statists and academicians. PMID:14518486

  1. Fibular nerve palsy after hip replacement: Not only surgeon responsibility. Hereditary neuropathy with liability to pressure palsies (HNPP) a rare cause of nerve liability.

    PubMed

    Logroscino, G; Del Tedesco, F; Cambise, C; Coraci, D; Donati, F; Santilli, V; Padua, L

    2016-06-01

    Mononeuropathy after surgery may occur and hereditary neuropathy with liability to pressure palsies is a possible pathological condition related to paresis after hip surgery. We present a case of 66-year-old man presenting severe weakness at inferior limb muscles after hip prosthesis revision. Clinic and electrophysiology showed severe right fibular nerve damage and ultrasound found a marked enlargement of the same nerve, associated with focal enlargements in other nerves. A diagnosis of hereditary neuropathy with liability to pressure palsies was suspected and confirmed by genetic test. The patient gradually recovered returning to a normal daily active life. Ultrasound was crucial for diagnosis. The suspicion and diagnosis of latent neuropathy, which can occur after surgical intervention, may lead to a better understand of the risks of the surgery, specific for the patient, and avoid the wrong attribution to surgical malpractice. PMID:27084090

  2. Frustrated mastery. The cultural context of death in America.

    PubMed Central

    Callahan, D

    1995-01-01

    The care of dying patients as a problem in the United States cannot be well understood apart from understanding the way in which American culture has responded to the problem of death. This country seems unusual among developed countries in its passion to conquer death, often acting as if death were simply one more disease to be overcome. American medicine has been influenced by this background culture, while adding some idiosyncratic features of its own. A powerful attraction to technology, a fear of malpractice litigation, and a fundamental ambivalence about the response physicians should have to death help to explain why the care of dying patients has been so difficult, so controversial, and so troubling to both the medical and the lay communities. PMID:7571584

  3. Overhead analysis in a surgical practice: a brief communication.

    PubMed

    Frezza, Eldo E

    2006-08-01

    Evaluating overhead is an essential part of any business, including that of the surgeon. By examining each component of overhead, the surgeon will have a better grasp of the profitability of his or her practice. The overhead discussed in this article includes health insurance, overtime, supply costs, rent, advertising and marketing, telephone costs, and malpractice insurance. While the importance of evaluating and controlling overhead in a business is well understood, few know that overhead increases do not always imply increased expenses. National standards have been provided by the Medical Group Management Association. One method of evaluating overhead is to calculate the amount spent in terms of percent of net revenue. Net revenue includes income from patients, from interest, and from insurers less refunds. Another way for surgeons to evaluate their practice is to calculate income and expenses for two years, then calculate the variance between the two years and the percentage of variance to see where they stand. PMID:16968190

  4. Attitudes towards academic cheating during nursing studies.

    PubMed

    Balik, C; Sharon, D; Kelishek, S; Tabak, N

    2010-12-01

    Nursing Student cheating is a cause for concern. Research to examine the attitudes of nursing students to academic cheating and what this may predict for their professional practice after graduation was conducted. A convenience sample of 228 students found a strong tendency to see academic dishonesty as normative. The most compelling factor in the decision to plagiarize or not is the 'survival instinct'. This does not necessarily mean that the student perceives copying as ethical. Correlations were found between personal characteristics and attitude towards cheating. It is recommended: (a) To raise awareness of the frequency of academic dishonesty and its implications for professional malpractice. (b) To institute a policy promoting academic integrity by ensuring all involved, including the students become partners in rule enforcement. (c) To establish a policy of penalties sufficiently strong to deter all, students and staff, from dishonest practices. PMID:22145550

  5. The irresponsible expert witness: a failure of biomedical graduate education and professional accountability.

    PubMed

    Brent, R L

    1982-11-01

    Many forces have created the epidemic of negligence and malpractice litigation. One of the contributing factors to the rising rate of nonmeritorious litigation is the increasing number of unequalified and irresponsible expert witnesses. The high remuneration has attracted physician-scientists who are unaware of the proper role of an expert witness. They are frequently manipulated by the attorneys and function as partisans rather than scholars. The role of the expert witness should be taught in medical and graduate school. Testimony should be taught in medical and graduate school. Testimony should be treated as a scholarly endeavor and experts should be encouraged to seek peer review of their opinions and not to testify secretly and in isolation. It is suggested that greater visibility of experts and their testimony (light of day phenomenon) should raise the quality of expert witness testimony and encourage more qualified experts to participate as expert witnesses, thus removing the stigmata usually associated with unqualified expert witnesses. PMID:7133826

  6. Submitting a manuscript for peer review – integrity, integrity, integrity

    PubMed Central

    Murphy, Sean P.; Bulman, Christopher; Shariati, Behnam; Hausmann, Laura

    2014-01-01

    Publication of a flawed manuscript has significant consequences for the progress of science. When this proves to be intentional, science is brought into disrepute and this puts even more pressure on the shrinking resources that society is prepared to invest in research. All scientific journals, including the Journal of Neurochemistry, have witnessed a marked increase in the number of corrections and retractions of published papers over the last 10 years, and uncovered a depressingly large number of fabrications amongst submitted manuscripts. The increase in number of ‘spoiled’ manuscripts reflects not only the improved methods that journals employ to detect plagiarism in its many forms, but also suggests a measurable change in the behavior of authors. The increased policing of submissions by reviewers, editors and publishers expends time and money. The sanctions imposed by journal editors on authors found guilty of malpractice are transparent and severe. PMID:24410543

  7. Risk management in surgery

    PubMed Central

    MESSANO, G.A.; SPAZIANI, E.; TURCHETTA, F.; CECI, F.; CORELLI, S.; CASCIARO, G.; MARTELLUCCI, A.; COSTANTINO, A.; NAPOLEONI, A.; CIPRIANI, B.; NICODEMI, S.; DI GRAZIA, C.; MOSILLO, R.; AVALLONE, M.; ORSINI, S.; TUDISCO, A.; AIUTI, F.; STAGNITTI, F.

    2013-01-01

    Summary Malpractice is the responsible for the greatest number of legal claims. At the present time, legal actions against physicians in Italy are 15,000 per year, and a stunning increase about costs to refund patients injured by therapeutic and diagnostic errors is expected. The method for the medical prevention is “Risk Management”, that is the setting-up of organizational instruments, methods and actions that enable the measurement or estimation of medical risk; it allows to develop strategies to govern and reduce medical error. In the present work, the reconstruction about the history of risk management in Italy was carried out. After then the latest initiatives undertaken by Italy about the issue of risk management were examined. PMID:24091181

  8. Medico-legal issues in cardiology.

    PubMed

    Abbott, Ryan; Cohen, Michael

    2013-01-01

    The aim of this article is to educate physicians about the current litigation climate in cardiology and cardiac surgery, with a focus on the most frequently litigated areas of practice, including failure to diagnose and treat myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention, and the use of tissue plasminogen activator. Empirical research on cardiology malpractice is presented, along with a sampling of up-to-date cases designed to illustrate common issues and important themes. The principles for reducing legal liability are also discussed, including the informed consent process, spoliation of records, and the role of documentation. Finally, practical recommendations are provided for cardiologists and cardiac surgeons to limit their legal liability. PMID:23422021

  9. Quality of health care and the role of relationships: bridging the medico-legal divide.

    PubMed

    Mor, Sagit; Einy, Orna Rabinovich

    2012-01-01

    This Article focuses on an often overlooked barrier to efforts to enhance the quality of health care: the relationship crisis that currently exists between physicians and patients. This state of affairs has resulted from the divide between the medical and legal worlds. The medical arena has understandably tended to view the doctor-patient relationship as a purely medical issue, ignoring the law's impact in generating and sustaining problematic relationship patterns. The legal world has yet to fully recognize this state of affairs, and the law's role in its evolution and persistence. We offer a relational approach to health-care law as a means of bridging the divide between the two disciplines. In the malpractice context, this would entail adopting a no-fault compensation scheme, which is committed to strengthening collaborative doctor-patient relations, enhancing patient safety and systemic learning, while providing adequate compensation. PMID:22616544

  10. Proceedings in a disciplinary action at the Malaysian Medical Council.

    PubMed

    Mahmud, M N

    2005-08-01

    Members of the medical profession are expected to be well aware and abide by the revised code of ethics adopted by the Malaysian Medical Council on 9th December 1986. Under the Act Council may, in the exercise of its disciplinary jurisdiction, impose punishments related to misconduct or malpractices. When a complaint or information is made against any practitioner, the President shall forward such complaint to the Chairman of the Preliminary Investigation Committee. The procedure of the disciplinary inquiry is not exactly like those in the court of law but the same principle of justice is adhered to and all evidence used to make a decision must only be those that are admissible in accordance with the rule of evidence. PMID:16315621

  11. Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study.

    PubMed

    Marchant, Gary E; Scheckel, Kathryn; Campos-Outcalt, Doug

    2016-03-01

    As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed. PMID:27256135

  12. Sovereigns under Siege. How the medical profession is changing in Italy.

    PubMed

    Toth, Federico

    2015-07-01

    In this article, the concept of medical dominance is "unfolded" into four different components: 1) professional autonomy; 2) superiority over other healthcare professions; 3) influence on policy makers; 4) authority with respect to patients. These four components will serve to bring to surface the transformations which the medical profession in Italy is currently undergoing. Special emphasis is placed on the challenges that Italian physicians are facing and the strategies they are adopting to try to maintain their dominant position. Coming to conclusions, Italian physicians seem to retain their supremacy over other healthcare professions, and are particularly adept at controlling the legislative process on healthcare issues. Conversely, Italian physicians are losing their influence on patients (as evidenced by the growing number of allegations of malpractice) and complain that their professional autonomy is diminishing and their work has become far too bureaucratized. PMID:26000859

  13. Traumatized by practice: PTSD in physicians.

    PubMed

    Lazarus, Arthur

    2014-01-01

    Posttraumatic stress disorder (PTSD) is underrecognized in physicians, even though it may be more prevalent in physicians than in the general population in the United States. Five types of physicians appear to be particularly prone to developing PTSD: (1) emergency physicians; (2) physicians practicing in underserved and remote areas; (3) physicians in training (i.e., medical residents); (4) physicians involved in malpractice litigation; and (5) physicians who are "second victims" in the sense that they are indirectly exposed to trauma. In addition to experiencing trauma, the cumulative stress of practice may cause PTSD. The road to recovery for physicians with PTSD entails proper diagnosis and treatment, which includes maintaining a high index of suspicion for the occurrence of PTSD in predisposed physicians, and individual or group therapy. Physicians in leadership positions should advocate for effective support programs for their colleagues with PTSD. PMID:25807606

  14. [Faults and failure of tonsil surgery and other standard procedures in otorhinolaryngology].

    PubMed

    Windfuhr, J P

    2013-04-01

    Septoplasty, tonsillectomy (with and without adenoidectomy) and cervical lymph node excision are amongst the most common 50 inpatient operations in Germany. Intracapsular tonsillectomies (i.e., tonsillotomies) are increasingly performed. The aim of this study was to evaluate alleged medical malpractice, technical traps and pitfalls associated with tonsillectomy (TE), adenoidectomy (AE), tonsillotomy (TT), septoplasty (SP) and cervical lymph node excision (LN).A questionnaire was sent to the Regional Medical Conciliation Boards, Medical Services of the Health Insurance Companies (MDK) and Regional Institutes of Forensic Medicine in Germany to collect anonymized cases of complications or medico legal implications following TE, TT, AE, LN and SP. The results were discussed in the light of the contemporary medical literature and published verdicts in Germany.The response rate of our survey was 55.9%. The Institutes of Forensic Medicine contributed 9 cases, 49 cases were submitted by the Regional Conciliation Boards and none by MDK. All forensic cases were associated with exsanguinations following tonsillectomy including 2 children (5 and 8 years of age) and 7 adults (aged 20-69 years). The fatal post-tonsillectomy hemorrhage (PTH) had occurred 8.7 days on average; 4 patients experienced the bleeding episode at home (day 5, 8, 9 and 17, respectively). Repeated episodes of bleeding requiring surgical intervention had occurred in 6 patients. 3 Conciliation Boards submitted expert opinions concerning cases TT (1), AE (4), LN (3), SP (16) and TE (25). Cases with lethal outcome were not registered. Only 3 of the 49 cases were assessed as surgical malpractice (6.1%) including lesion of the spinal accessory nerve, wrong indication for TE and dental lesion after insertion of the mouth gag. The review of the medico legal literature yielded 71 published verdicts after AE and TE (29), LN (28) and SP (14) of which 37 resulted in compensation of malpractice after LN (16; 57%), TE

  15. Barriers, legal issues, limitations and ongoing questions in telemedicine applied to stroke.

    PubMed

    de Bustos, Elisabeth Medeiros; Moulin, Thierry; Audebert, Heinrich J

    2009-01-01

    The use of telemedicine services, such as telestroke, is still highly fragmented and its deployment in an integrative healthcare system is challenging. Factors impeding the growth of telemedicine include confidence and malpractice issues, technical advances, reimbursement, licensing, credentialing costs, cost effectiveness, and legal issues. These barriers, limitations and requirements in the routine use of telemedicine are reviewed, in addition to medical activities, the objectives of telestroke, technical aspects, funding, legal issues, evaluation and quality management. As telemedicine induces a new form of interrelationship between health care providers, mutual trust and acceptance need to be developed in telemedicine services. Furthermore, education and training will be crucial in order to facilitate the use of telestroke over the next decade. PMID:19546540

  16. Issues in forensic psychiatry in Islamic jurisprudence.

    PubMed

    Chaleby, K S

    1996-01-01

    There are few other specialties in psychiatry where the cultural nature and social norms of a society has more impact than the specialty of forensic psychiatry. In the Muslim and Arab worlds, Islamic principles govern the foundation of thoughts required to make laws. Those necessarily include legal issues in psychiatry. The impact of these matters on individuals as patients and the community at large can not be overestimated. Those issues will include laws of involuntary hospitalization and evaluation of mental competence toward different life functions such as commercial interaction, writing a will, marriage, divorce, and child custody. Islamic law has a definite position on criminal responsibility as well as other vital matters such as compensation of damages, including medical malpractice. This article discusses problems and peculiarities involved in the canonization of these laws in islamic communities, considering different arguments presented from one point of view versus another. PMID:8891327

  17. Contemporary practice in forensic odontology

    PubMed Central

    Gupta, Shalini; Agnihotri, Archana; Chandra, Akhilesh; Gupta, Om Prakash

    2014-01-01

    Forensic odontology plays a major role in the identification of those individuals who cannot be identified visually or by other means. The unique nature of dental anatomy and placement of custom restorations ensure accuracy when the techniques are correctly employed. It is evident that identification of victims in accidents and natural calamities is of utmost importance and is a challenging task. The teeth may also be used as weapons and under certain circumstances; they may provide information regarding the identity of the biter. Dental professionals play a major role in keeping accurate dental records and providing all necessary information so that legal authorities may recognize malpractices, negligence, fraud child abuse and also, identify an individual. In this article, we will discuss such evolvement of the subject. PMID:25328306

  18. Utilizing social networks, blogging and YouTube in allergy and immunology practices.

    PubMed

    Dimov, Ves; Eidelman, Frank

    2015-01-01

    Online social networks are used to connect with friends and family members, and increasingly, to stay up-to-date with the latest news and developments in allergy and immunology. As communication is a central part of healthcare delivery, the utilization of such networking channels in allergy and immunology will continue to grow. There are inherent risks to online social networks related to breaches of patient confidentiality, professionalism and privacy. Malpractice and liability risks should also be considered. There is a paucity of information in the literature on how social network interventions affect patient outcomes. The allergy and immunology community should direct future studies towards investigating how the use of social networks and other technology tools and services can improve patient care. PMID:26163316

  19. Immunomodulatory potential of shatavarins produced from Asparagus racemosus tissue cultures

    PubMed Central

    Pise, Mashitha Vinod; Rudra, Jaishree Amal; Upadhyay, Avinash

    2015-01-01

    Medicinal properties of Asparagus racemosus (vernacular name: Shatavari) are attributed to its steroidal saponins called shatavarins. This plant is facing the threat of being endangered due to several developmental, seasonal constrains and malpractices involved in its collection and storage. To support its conservation, a tissue culture protocol is standardized which produces 20 fold higher levels of shatavarin. Here we evaluate the bioactivity and immunomodulatory potential of in vitro produced shatavarins from cell cultures of AR using human peripheral blood lymphocytes. In vitro produced shatavarin stimulated immune cell proliferation and IgG secretion in a dose dependent manner. It stimulated interleukin (IL)-12 production and inhibited production of IL-6. It also had strong modulatory effects on Th1/Th2 cytokine profile, indicating its potential application for immunotherapies where Th1/Th2 balance is envisaged. Our study demonstrating the bioactivity of tissue cultured AR extracts supports further in vivo evaluation of its immunomodulatory efficacy. PMID:26283842

  20. Criminal prosecution arising from medical mishaps: a Japanese perspective.

    PubMed

    Tsukamoto, Yasushi

    2005-12-01

    In Japan, the number of physicians being investigated on suspicion of medical malpractice has increased. Specifically, the criminal prosecutions arising from professional negligence resulting in bodily injury or death have also increased. Article 21 of the Japanese Physician's Act compels a doctor to notify the district police when he diagnoses a death to be 'unnatural'. Originally this provision was to increase public safety through crime detection, but one recent criminal case broadened the application of this article to include the death from a mishap during medical treatment. This criminal case made a tremendous impact on physicians, as the convictions and sentences forced physicians to notify the police even when it is not certain the patient died of the malady or of the medical misconduct itself. Besides, we wonder if such obligation of doctors to notify such 'unnatural' death from medical mishap may be against a person's privilege against self-incrimination which is assured by Japanese Constitutional Law (article 38). PMID:16440862

  1. Medical responsibility in the operating room: the example of an amniotic fluid embolism.

    PubMed

    Franchitto, Nicolas; Minville, Vincent; Dédouit, Fabrice; Telmon, Norbert; Rougé, Daniel

    2012-07-01

    Amniotic fluid embolism (AFE) continues to be one of the most feared complications of pregnancy. A healthy 32-year-old woman died during delivery after a normal 39-week third pregnancy. The family filed a complaint with a criminal court as the causes of death appeared unclear. No risk factor associated with AFE was identified. Clinical presentation was typical, including sudden onset of cardiovascular and respiratory symptoms. Autopsy confirmed the histological diagnosis of amniotic embolism and excluded an iatrogenic cause of death or anesthetic malpractice. This article highlights the value of both antemortem records and histological features in establishing the diagnosis of AFE and demonstrates the fundamental importance of autopsy in an unexpected death related directly or indirectly to a medical procedure. PMID:22372588

  2. Submitting a manuscript for peer review--integrity, integrity, integrity.

    PubMed

    Murphy, Sean P; Bulman, Christopher; Shariati, Behnam; Hausmann, Laura

    2014-02-01

    Publication of a flawed manuscript has significant consequences for the progress of science. When this proves to be intentional, science is brought into disrepute and this puts even more pressure on the shrinking resources that society is prepared to invest in research. All scientific journals, including the Journal of Neurochemistry, have witnessed a marked increase in the number of corrections and retractions of published articles over the last 10 years, and uncovered a depressingly large number of fabrications among submitted manuscripts. The increase in number of 'spoiled' manuscripts reflects not only the improved methods that journals employ to detect plagiarism in its many forms but also suggests a measurable change in the behavior of authors. The increased policing of submissions by reviewers, editors, and publishers expends time and money. The sanctions imposed by journal editors on authors found guilty of malpractice are transparent and severe. PMID:24410543

  3. Weighted estimating equations with nonignorably missing response data.

    PubMed

    Troxel, A B; Lipsitz, S R; Brennan, T A

    1997-09-01

    We propose weighted estimating equations for data with nonignorable nonresponse in order to reduce the bias that can occur with a complete case analysis. A survey concerning medical practice guidelines, malpractice litigation, and settlement provides the framework. The survey was sent to recipients in two waves: those who responded on the first or second wave are used to estimate a nonignorable nonresponse model, while the fraction of recipients who never responded is used to allow the percentage of missing data to change with each wave. We use the structure of the GEE of Liang and Zeger (1986, Biometrika 73, 13-22), adding weights equal to the inverse probability of being observed. We present simulations demonstrating the bias that can occur with an unweighted analysis and use the survey data to illustrate the methods. PMID:9290219

  4. Forensic odontology: the roles and responsibilities of the dentist.

    PubMed

    Avon, Sylvie Louise

    2004-01-01

    Dentistry has much to offer law enforcement in the detection and solution of crime or in civil proceedings. Forensic dental fieldwork requires an interdisciplinary knowledge of dental science. Most often the role of the forensic odontologist is to establish a person's identity. Teeth, with their physiologic variations, pathoses and effects of therapy, record information that remains throughout life and beyond. The teeth may also be used as weapons and, under certain circumstances, may leave information about the identity of the biter. Forensic odontology has an important role in the recognition of abuse among persons of all ages. Dental professionals have a major role to play in keeping accurate dental records and providing all necessary information so that legal authorities may recognize malpractice, negligence, fraud or abuse, and identify unknown humans. PMID:15245686

  5. Patients with borderline personality disorder who are chronically suicidal: therapeutic alliance and therapeutic limits.

    PubMed

    Jimenez, Xavier F

    2013-01-01

    Therapeutic work with patients who are chronically suicidal and have borderline personality disorder (BPD) is challenging, and clinicians often resort to setting firm limits or excessively cautious interventions in efforts to prevent manipulation, regression, or over-dependence. Litigation and malpractice fears reinforce these stances, and reduced compensation for additional time and energy devoted to patients adds further disincentives to sole providers. However, elements of the working alliance and therapeutic limits are within the therapist's control. A case vignette illustrates an individual therapist's modification of usual therapeutic limits while working with a chronically suicidal patient with BPD within a dialectical behavior therapy (DBT) framework over a 16-week period. Discussions regarding the case, interventions used, DBT, and legality concerns follow. PMID:23909059

  6. [Risk management--a new aspect of quality assessment in intensive care medicine: first results of an analysis of the DIVI's interdisciplinary quality assessment research group].

    PubMed

    Stiletto, R; Röthke, M; Schäfer, E; Lefering, R; Waydhas, Ch

    2006-10-01

    Patient security has become one of the major aspects of clinical management in recent years. The crucial point in research was focused on malpractice. In contradiction to the economic process in non medical fields, the analysis of errors during the in-patient treatment time was neglected. Patient risk management can be defined as a structured procedure in a clinical unit with the aim to reduce harmful events. A risk point model was created based on a Delphi process and founded on the DIVI data register. The risk point model was evaluated in clinically working ICU departments participating in the register data base. The results of the risk point evaluation will be integrated in the next data base update. This might be a step to improve the reliability of the register to measure quality assessment in the ICU. PMID:17089287

  7. Legal and regulatory education and training needs in the healthcare industry.

    PubMed

    Henson, Steve W; Burke, Debra; Crow, Stephen M; Hartman, Sandra J

    2005-01-01

    As in any other industry, laws and regulations significantly impact the functioning of the healthcare industry. Some laws, such as those relating to malpractice and social insurance systems, affect the manner in which the industry operates. Other laws, such as those regulating antitrust and employment practices, affect the organization and the environment in which the industry operates. It is increasingly important that practitioners and managers be cognizant of this complex and dynamic legal minefield. This study examined healthcare managers and executives' knowledge of 9 key issues in the legal and regulatory environment of the healthcare industry. Specifically, the study focused on knowledge concerning tort and contract liability, insurance law, labor and employment regulation, criminal and ethical responsibility, antitrust regulation, the law governing business associations and recent developments. Findings suggest that the levels of knowledge required to manage legal and regulatory issues are much greater than the existing levels of knowledge. PMID:16331074

  8. Genomic knowledge sharing: A review of the ethical and legal issues.

    PubMed

    Francis, Leslie P

    2014-12-01

    The importance of genomic information for care of individual patients and for the development of knowledge about treatment efficacy is becoming increasingly apparent. This information is probabilistic and involves the use of large data sets to increase the likelihood of detecting low frequency events. Duties and rights of patients with respect to this information have been much discussed, including informed consent to the use of individual information, privacy and confidentiality, rights to know or not to know, and individual ownership of information about themselves. But this is only one side of the information equation. On the other side of the equation are duties of information holders: malpractice and duties to warn, responsibilities of data stewardship, intellectual property and ownership, reciprocity, and justice. This article argues that if we take duties of patients to share information seriously, we must also consider duties on the part of information holders about how they protect and use information. PMID:27294025

  9. Stiver v. Parker.

    PubMed

    1992-09-15

    In this Michigan negligence case, the U.S. Court of Appeals, Sixth Circuit, determined the rights and duties in a surrogacy agreement established prior to Michigan's 1988 statutory criminalization of such agreements. Due to the surrogate mother's exposure to cytomegalovirus, the baby suffered birth defects. The source of the cytomegalovirus was undetermined; it could have been the contracting father or the mother's husband, who was actually the biological father of the child. Although the agreement provided that the mother assumed all risks of injury or loss, the court held that the "special relationship" created by the agreement imposed a duty on the surrogacy broker to act for the mother's protection. The court further held that a jury should determine whether the broker breached this duty, as well as the issue of causation regarding the source of the cytomegalovirus. Because this was not a medical malpractice case, expert testimony about the broker's standard of care was not required. PMID:11648601

  10. Primary care at the worksite: policy issues.

    PubMed

    Burgel, B J

    1996-05-01

    1. Primary care delivery at the worksite is a feasible reality. It is most feasible, however, for those large employers already assuming financial responsibility for providing employee health care benefits. 2. Ethical and legal questions arise with the delivery of worksite primary care services: how best to safeguard personal health information; and how best to manage the potential malpractice liability risks in a client-provider relationship at the worksite. 3. Primary care at the worksite requires primary care providers (a nurse practitioner and/or a physician) with generalist preparation in adult or family practice, in addition to specialty expertise in occupational health and safety. 4. Occupational health and safety must be a priority at all times, with the key goal to prevent work related injury and illness through engineering, administrative, and personal protective controls. PMID:8788399

  11. Neonatal euthanasia: A claim for an immoral law

    PubMed Central

    Martinovici, Dana

    2013-01-01

    Active ending of the life of a newborn baby is a crime. Yet its clandestine practise is a reality in several European countries. In this paper, we defend the necessity to institute a proper legal frame for what we define as active neonatal euthanasia. The only legal attempt so far, the Dutch Groningen protocol, is not satisfactory. We critically analyse this protocol, as well as several other clinical practises and philosophical stances. Furthermore, we have tried to integrate our opinions as clinicians into a law project, with the purpose of pinpointing several issues, specific of perinatality that should be addressed by such a law. In conclusion, we argue that the legalisation of neonatal euthanasia under exceptional circumstances is the only way to avoid all the “well-intentioned” malpractices associated with ending life at the very dawn of it. PMID:24068880

  12. Shared liability? Consultants, pharmacists, and the emergency physician: legal cases and caveats.

    PubMed

    Moore, Joshua J; Matlock, Aaron G

    2014-05-01

    In caring for patients in the Emergency Department (ED), the emergency physician (EP) will often utilize consulting specialists and pharmacists. In the event of an untoward patient outcome, disagreement may arise regarding the liability of each provider. Here, we review a series of malpractice cases involving consulting physicians and pharmacists to illustrate the legal principles of physician-patient relationships and physician duty. Determination of liability in the courts will rest, in part, on whether a physician-patient relationship was formed via an "affirmative act". Consulting physicians may establish a relationship through an overt or implied agreement to participate in a patient's care, or by reviewing specific tests and studies for the purpose of diagnosis and treatment. The courts have defined the duty of the pharmacist to safely dispense medication, and have ascribed the duty to warn of medication side effects to the prescribing physician. PMID:24462033

  13. [Carbon monoxide poisoning caused by medical error. Fatalities in connection with medical measures in Leipzig and Hannover].

    PubMed

    Hunger, H; Tröger, H D; Urban, R

    1990-01-01

    There are significant differences in the frequency of CO intoxication and its relation to other not natural causes of death between the autopsy cases of Leipzig (DDR) and Hannover (BRD). While the percentage of all autopsies in Leipzig runs up to 7.6%, in Hannover it runs up to only 1.5%. Beside the well-known cases of not recognized CO intoxication at the autopsy with or without following intoxication of other persons, two concrete cases of not recognized CO intoxication with the survival of the victims discussed. The not noticed CO intoxication followed by the death of the victim is usually considered in medicolegal opinious as "medical malpractice". In cases of survived not noticed CO intoxications this opinion ist only supposed in special cases with longer anamnesis and a typical seasonal rythmic of symptoms. PMID:2241778

  14. Legal obstacles to medical communities' full participation in managed care.

    PubMed

    Hilgers, D W

    1995-01-01

    Strong physician-driven delivery systems are vital to the creation of a quality medical system for the United States. To compete with employers, insurers, hospitals, and the government, physicians must consolidate. Physicians do not generally have the necessary capital, management skills, or desire to manage large organizations, however. In addition, antitrust restrictions, antireferral statutes, insurance regulation, and malpractice liability risks are major legal obstacles that restrain physicians from consolidating. The government needs to recognize the problems that federal and state laws have created for the development of physician-driven delivery systems. The benefit to the medical system by relaxing these laws will outweigh any potential risk of loss to the public. PMID:7600242

  15. Simultaneous shoulder and elbow dislocation

    PubMed Central

    Çobanoğlu, Mutlu; Yumrukcal, Feridun; Karataş, Cengiz; Duygun, Fatih

    2014-01-01

    Ipsilateral shoulder and elbow dislocation is very rare and only six articles are present in the literature mentioning this kind of a complex injury. With this presentation we aim to emphasise the importance of assessing the adjacent joints in patients with trauma in order not to miss any accompanying pathologies. We report a case of a 43-year-old female patient with ipsilateral right shoulder and elbow dislocation treated conservatively. The patient reported elbow pain when first admitted to emergency service but she was diagnosed with simultaneous ipsilateral shoulder and elbow injury and treated conservatively. As a more painful pathology may mask the additional ones, one should hasten to help before performing a complete evaluation. Any harm caused to the patient due to this reason would not be a complication but a malpractice. PMID:24859563

  16. [Young man with gunshot wound (GSW)--what killed Ernst vom Rath?].

    PubMed

    Shasha, Shaul M; Eithan, Arieh; Feinsod, Moshe; Georg M, Weisz

    2013-11-01

    On the morning of November 7, 1938 vom Rath, a diplomat at the German embassy in Paris, was shot by Herschel Grynzspan, a Jewish teenager. Of the 5 shots fired, 2 hit vom Rath, one in the right shoulder and one in the abdomen. He was rushed to Alma Women's Hospital near the embassy, where emergency surgery was undertaken. Two days later his condition deteriorated rapidly and succumbed 55 hours after the shooting. It is believed that the assassination triggered the "Kristallnacht"--the organized Nazi pogrom against Jews across Germany. Based on the Alma hospital registry, autopsy findings and articles from recent years, the course of his condition and possible cause of his death are discussed. The possibility of malpractice, and even medical fraud, which led to his death are also mentioned. PMID:24416826

  17. Immunomodulatory potential of shatavarins produced from Asparagus racemosus tissue cultures.

    PubMed

    Pise, Mashitha Vinod; Rudra, Jaishree Amal; Upadhyay, Avinash

    2015-01-01

    Medicinal properties of Asparagus racemosus (vernacular name: Shatavari) are attributed to its steroidal saponins called shatavarins. This plant is facing the threat of being endangered due to several developmental, seasonal constrains and malpractices involved in its collection and storage. To support its conservation, a tissue culture protocol is standardized which produces 20 fold higher levels of shatavarin. Here we evaluate the bioactivity and immunomodulatory potential of in vitro produced shatavarins from cell cultures of AR using human peripheral blood lymphocytes. In vitro produced shatavarin stimulated immune cell proliferation and IgG secretion in a dose dependent manner. It stimulated interleukin (IL)-12 production and inhibited production of IL-6. It also had strong modulatory effects on Th1/Th2 cytokine profile, indicating its potential application for immunotherapies where Th1/Th2 balance is envisaged. Our study demonstrating the bioactivity of tissue cultured AR extracts supports further in vivo evaluation of its immunomodulatory efficacy. PMID:26283842

  18. Consent and the Indian medical practitioner

    PubMed Central

    Kumar, Ajay; Mullick, Parul; Prakash, Smita; Bharadwaj, Aseem

    2015-01-01

    Consent is a legal requirement of medical practice and not a procedural formality. Getting a mere signature on a form is no consent. If a patient is rushed into signing consent, without giving sufficient information, the consent may be invalid, despite the signature. Often medical professionals either ignore or are ignorant of the requirements of a valid consent and its legal implications. Instances where either consent was not taken or when an invalid consent was obtained have been a subject matter of judicial scrutiny in several medical malpractice cases. This article highlights the essential principles of consent and the Indian law related to it along with some citations, so that medical practitioners are not only able to safeguard themselves against litigations and unnecessary harassment but can act rightfully. PMID:26755833

  19. Social media in the health-care setting: benefits but also a minefield of compliance and other legal issues.

    PubMed

    Moses, Richard E; McNeese, Libra G; Feld, Lauren D; Feld, Andrew D

    2014-08-01

    Throughout the past 20 years, the rising use of social media has revolutionized health care as well as other businesses. It allows large groups of people to create and share information, ideas, and experiences through online communications, and develop social and professional contacts easily and inexpensively. Our Gastroenterology organizations, among others, have embraced this technology. Although the health-care benefits may be many, social media must be viewed through a legal lens, recognizing the accompanying burdens of compliance, ethical, and litigation issues. Theories of liability and risk continue to evolve as does the technology. Social media usage within the medical community is fraught with potential legal issues, requiring remedial responses to meet patients' needs and comply with current laws, while not exposing physicians to medical malpractice and other tort risks. PMID:24980878

  20. MEDICAL REVIEW AND ADVISORY BOARD

    PubMed Central

    Sadusk, Joseph F.

    1955-01-01

    The Medical Review and Advisory Board has been established as a committee of the Commission on Professional Welfare of the California Medical Association to make studies and recommendations toward solution of the growing problems of professional liability insurance and malpractice actions in California. The members of the Board are: Joseph F. Sadusk, Jr., Oakland, Chairman; Wilbur Bailey, M.D., Los Angeles, vice-chairman; Howard W. Bosworth, M.D., Los Angeles; H. I. Burtness, M.D., Santa Barbara; Paul W. Frame, Jr., M.D., Sacramento; Verne G. Ghormley, M.D., Fresno; Carl M. Hadley, M.D., San Bernardino; Joseph J. O'Hara, M.D., San Diego; William F. Quinn, M.D., Los Angeles; Rees B. Rees, M.D., San Francisco; and Bernard Silber, M.D., Redwood City; Mr. Rollen Waterson, 564 Market Street, San Francisco 4, is executive secretary, and Mr. Howard Hassard is legal counsel. PMID:13260939

  1. ["Is there a doctor on board?" - legal aspects of medical care in emergency situations during spare time].

    PubMed

    Lindner, Christina; Lindner, Gregor; Exadaktylos, Aristomenis K

    2013-12-11

    Medical emergencies on international flights are not uncommon. In these situations the question often arises whether physicians are obliged to render first aid and whether omission leads to legal consequences. The general obligation to aid those in need applies to everyone, not only to physicians. Evading this duty makes liable to prosecution for omittance of defence of a third person in line with Art. 128 of the Swiss Penal Code, punishable by custodial sentence up to three years or an equivalent punitive fine. Vocational and professional law extend the duty to aid for physicians to urgent cases. Although resulting from the performance of a legal obligation, malpractice occurred in the course of first aid can lead to claims for compensation - even from foreign patients, and that according to their own domestic law. PMID:24326050

  2. The occupational toxicologist: professionalism, morality and ethical standards in the context of legal and non-litigation issues.

    PubMed

    Ballantyne, Bryan

    2005-01-01

    By its very nature, practice and intended applications, the profession of occupational toxicology has individual and collective responsibilities related to the design, conduct, interpretation and extrapolation of laboratory and controlled human clinical studies in order to determine the potential for industrial xenobiotics to produce adverse effects. The implications for health-related adverse effects in the workplace, and in the domestic and general environment carries many and various responsibilities for the toxicologist which are related to multiple and wide-ranging ethical issues. This review presents and discusses some of the major areas where the occupational toxicologist may experience potential ethical problems related to the conduct of routine professional activities. Emphasis is placed on the design, conduct, interpretation and reporting of laboratory studies; animal welfare; regulatory activities; human clinical volunteer studies; roles and responsibilities in defining workplace safety and protective measures; malpractices in various disciplines and work practices; misconduct in publication; and codes of ethical behavior. PMID:16158389

  3. Legal, ethical and professional concepts within the operating department.

    PubMed

    Wilson, Rachel

    2012-03-01

    There are a number of desirable healthcare practices, such as the requirement for consent and confidentiality, and a respect for the patient, that are ethically sound and legally required (Staunton & Chiarella 2008). The purpose of the law is to provide a deterrent to malpractice, and compensation when things go wrong. All health professionals should be actively aware of the law and its various key concepts. These are primarily negligence, consent, accountability, confidentiality and advocacy (Watson & Tilley 2004). This article is designed to identify the concepts that are important within the operating department. Legal, ethical and professional perspectives that underpin these concepts will be discussed along with relevant case law, ethical theory and the Health Professions Council's (HPC) code of conduct. PMID:22493868

  4. The Prevention of Positioning Injuries during Gynecologic Operations. Guideline of DGGG (S1-Level, AWMF Registry No. 015/077, February 2015)

    PubMed Central

    Fleisch, M. C.; Bremerich, D.; Schulte-Mattler, W.; Tannen, A.; Teichmann, A. T.; Bader, W.; Balzer, K.; Renner, S. P.; Römer, T.; Roth, S.; Schütz, F.; Thill, M.; Tinneberg, H.; Zarras, K.

    2015-01-01

    Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Positioning injuries after lengthy gynecological procedures are rare, but the associated complications can be potentially serious for patients. Moreover, such injuries often lead to claims of malpractice and negligence requiring detailed medical investigation. To date, there are no binding evidence-based recommendations for the prevention of such injuries. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. The recommendations cover: PMID:26365999

  5. Would evidence-based regulation improve the practice and management of patient care?

    PubMed

    Waldman, J Deane; Smith, Howard L

    2012-01-01

    The use of evidence to achieve sound medical diagnoses and optimal treatment plans is considered a standard of practice for healthcare providers. Indeed, failure to do so is prima facie evidence of malpractice. Health and medical care managers have begun espousing a similar philosophy: to make decisions that are data-driven rather than based on logic, intuition, personal preference, or last experience. Unfortunately, regulatory policies and practices in patient care are not always founded upon strong evidence. As a result, unintended consequences often surface after the passage of legislation or the adoption of policies by nongovernmental entities. These dysfunctions might be avoided if policymakers embraced evidence-based protocols commonly found throughout medicine and its management. This paper reviews the dilemmas that unfold when policy is formed without giving sufficient attention, in advance, to "hard" evidence. PMID:22920022

  6. Analysis of the Istanbul Forensic Medicine Institute expert decisions on recurrent laryngeal nerve injuries due to thyroidectomy between 2008–2012

    PubMed Central

    Karakaya, M. Arif; Koç, Okay; Ekiz, Feza; Ağaçhan, A. Feran; Göret, Nuri Emrah

    2016-01-01

    Objective: The aim of this study was to evaluate the approach of Forensic Medicine Institution for recurrent laryngeal nerve injuries. In addition, parameters that were taken into consideration by Forensic Medicine Institution in the differentiation of complication and malpractice were evaluated. Material and Methods: The files of 38 patients, with recurrent laryngeal nerve injury following thyroidectomy, that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008–2012 were retrospectively investigated. Data regarding expert decisions, age, gender, diagnosis, hospital type, preoperative vocal cord examination, intraoperative nerve monitoring (IONM), identification of nerve injury during operation, repair of nerve during operation, and type of injury were assessed. Results: Surgeons were found to be faulty in all files with bilateral nerve injury, however, one-sided injury files were considered as a medical complication. Twenty-one (55.2%) patients were female, and 17 (44.8%) were male, with a mean age of 35,8 in women, and 34,1 in men. None of these patients had undergone preoperative vocal cord assessment. The recurrent laryngeal nerve was intraoperatively identified in 21 (55.2%) patients, while it was not seen in 17 (44.8%) patients. IONM was not applied in any patients. There was no attempt for nerve repair during any operation. Nineteen patients had unilateral, and 19 patients had bilateral nerve damage. Conclusion: Bilateral recurrent laryngeal nerve injuries are considered as malpractice, when imaging or pathology reports fail to state a cause for difficulty in nerve identification. PMID:26985157

  7. Current coding practices and patterns of code use of registered dietitian nutritionists: the Academy of Nutrition and Dietetics 2013 coding survey.

    PubMed

    Parrott, J Scott; White, Jane V; Schofield, Marsha; Hand, Rosa K; Gregoire, Mary B; Ayoob, Keith T; Pavlinac, Jessie; Lewis, Jaime Lynn; Smith, Karen

    2014-10-01

    Coding, coverage, and reimbursement for nutrition services are vital to the dietetics profession, particularly to registered dietitian nutritionists (RDNs) who provide clinical care. The objective of this study was to assess RDN understanding and use of the medical nutrition therapy (MNT) procedure codes in the delivery of nutrition services. Its design was an Internet survey of all RDNs listed in the Academy of Nutrition and Dietetics (Academy)/Commission on Dietetics Registration database as of September 2013 who resided in the United States and were not retired. Prior coding and coverage surveys provided a basis for survey development. Parameters assessed included knowledge and use of existing MNT and/or alternative procedure codes, barriers to code use, payer reimbursement patterns, complexity of the patient population served, time spent in the delivery of initial and subsequent care, and practice demographics and management. Results show that a majority of respondents were employed by another and provided outpatient MNT services on a part-time basis. MNT codes were used for the provision of individual services, with minimal use of the MNT codes for group services and subsequent care. The typical patient carries two or more diagnoses. The majority of RDNs uses internal billing departments and support staff in their practices. The payer mix is predominantly Medicare and private/commercial insurance. Managers and manager/providers were more likely than providers to carry malpractice insurance. Results point to the need for further education regarding the full spectrum of Current Procedural Terminology codes available for RDN use and the business side of ambulatory MNT practice, including the need to carry malpractice insurance. This survey is part of continuing Academy efforts to understand the complex web of relationships among clinical practice, coverage, MNT code use, and reimbursement so as to further support nutrition services codes revision and/or expansion

  8. Litigations and the Obstetrician in Clinical Practice.

    PubMed

    Adinma, Jib

    2016-01-01

    The expectation of obstetrics is a perfect outcome. Obstetrics malpractice can cause morbidity and mortality that may engender litigation. Globally, increasing trend to litigation in obstetrics practice has resulted in high indemnity cost to the obstetrician with consequent frustration and overall danger to the future of obstetrics practice. The objective was to review litigations and the Obstetrician in Clinical Practice, highlighting medical ethics, federation of gynecology and obstetrics (FIGO's) ethical responsibility guideline on women's sexual and reproductive health and right; examine the relationship between medical ethics and medical laws; X-ray medical negligence and litigable obstetrics malpractices; and make recommendation towards the improvement of obstetrics practices to avert misconduct that would lead to litigation. Review involves a literature search on the internet in relevant journals, textbooks, and monographs. Knowledge and application of medical ethics are important to the obstetricians to avert medical negligence that will lead to litigation. A medical negligence can occur in any of the three triads of medicare viz: Diagnosis, advice/counseling, and treatment. Lawsuits in obstetrics generally center on errors of omission or commission especially in relation to the failure to perform caesarean section or to perform the operation early enough. Fear of litigation, high indemnity cost, and long working hours are among the main reasons given by obstetricians for ceasing obstetrics practice. Increasing global trend in litigation with high indemnity cost to the obstetrician is likely to jeopardize the future of obstetrics care especially in countries without medical insurance coverage for health practitioners. Litigation in obstetrics can be prevented through the Obstetrician's mindfulness of its possibility; acquainting themselves of the medical laws and guidelines related to their practice; ensuring adequate communication with, and consent of

  9. Associations between Physician Characteristics and Quality of Care

    PubMed Central

    Orler, Rachel L.; Friedberg, Mark W.; Adams, John L.; McGlynn, Elizabeth A.; Mehrotra, Ateev

    2010-01-01

    BACKGROUND Physicians’ performance on measures of clinical quality is rarely available to patients. Instead, patients are encouraged to select physicians on the basis of characteristics such as education, board certification, and malpractice history. In a large sample of Massachusetts physicians, we examined the relationship between physician characteristics and performance on a broad range of quality measures. METHODS We calculated overall performance scores on 124 quality measures from RAND’s Quality Assessment Tools for each of 10,408 Massachusetts physicians using claims generated by 1.13 million adult patients. The patients were continuously enrolled in 1 of 4 Massachusetts commercial health plans during 2004–2005. Physician characteristics were obtained from the Massachusetts Board of Registration in Medicine. Associations between physician characteristics and overall performance scores were assessed using multivariate linear regression. RESULTS The mean overall performance score was 62.5%% (5th to 95th percentile range, 48.2% to 74.9%). Three physician characteristics were independently associated with significantly higher overall performance: female gender (1.6 percentage points higher than male, p<0.001), board certification (3.3 percentage points higher than non-certified, p<0.001), and graduation from a domestic medical school (1.0 percentage points higher than international, p<0.001). There was no association between performance and malpractice claims or disciplinary action. CONCLUSION Few characteristics of individual physicians were associated with higher performance on measures of quality, and observed associations were small in magnitude. Publicly available characteristics of individual physicians are poor proxies for performance on clinical quality measures. PMID:20837830

  10. The PRONE score: an algorithm for predicting doctors’ risks of formal patient complaints using routinely collected administrative data

    PubMed Central

    Spittal, Matthew J; Bismark, Marie M; Studdert, David M

    2015-01-01

    Background Medicolegal agencies—such as malpractice insurers, medical boards and complaints bodies—are mostly passive regulators; they react to episodes of substandard care, rather than intervening to prevent them. At least part of the explanation for this reactive role lies in the widely recognised difficulty of making robust predictions about medicolegal risk at the individual clinician level. We aimed to develop a simple, reliable scoring system for predicting Australian doctors’ risks of becoming the subject of repeated patient complaints. Methods Using routinely collected administrative data, we constructed a national sample of 13 849 formal complaints against 8424 doctors. The complaints were lodged by patients with state health service commissions in Australia over a 12-year period. We used multivariate logistic regression analysis to identify predictors of subsequent complaints, defined as another complaint occurring within 2 years of an index complaint. Model estimates were then used to derive a simple predictive algorithm, designed for application at the doctor level. Results The PRONE (Predicted Risk Of New Event) score is a 22-point scoring system that indicates a doctor's future complaint risk based on four variables: a doctor's specialty and sex, the number of previous complaints and the time since the last complaint. The PRONE score performed well in predicting subsequent complaints, exhibiting strong validity and reliability and reasonable goodness of fit (c-statistic=0.70). Conclusions The PRONE score appears to be a valid method for assessing individual doctors’ risks of attracting recurrent complaints. Regulators could harness such information to target quality improvement interventions, and prevent substandard care and patient dissatisfaction. The approach we describe should be replicable in other agencies that handle large numbers of patient complaints or malpractice claims. PMID:25855664

  11. Investigation on Legal Problems Encountered by Emergency Medicine Physicians in Turkey

    PubMed Central

    Kayipmaz, Afsin Emre; Giray, Tufan Akin; Yesilagac, Hasan; Ozel, Betul Akbuga; Celikel, Elif; Karagun, Ozlem

    2015-01-01

    Background Medicine is a profession that carries certain risks. One risky area of practice is the emergency department. Emergency physicians diagnose and treat a high volume of patients, and are also responsible for preparing reports for forensic cases. In this study, we aim to investigate emergency physicians’ legal-administrative problems and reveal their level of understanding on forensic cases. Methods An electronic questionnaire form was prepared after the approval of an ethical committee. This form was sent to the residents, specialists and academicians of emergency medicine by e-mail. The physicians were asked to fill out the form online. All the gathered data was analyzed. Descriptive statistics were presented as frequency percentages with mean and standard deviation. Chi-square tests were used to compare the groups. Correlation between number of complaint cases and age, sex, career, institution, and duration of service in emergency department were investigated. p<0.05 was considered statistically significant. Results 294 physicians participated in the questionnaire. According to the questionnaire, 170 of the physicians were reported to the patient communication units due to medical malpractice. Mean number of compliant reports was 3.20±3.5. 29 of the physicians received administrative penalties. 42 of the physicians were judged in the court for medical malpractice. 1 physician was fined 5000 Turkish Liras as a result of these judgments. Conclusion We found that the number of complaint reports is negatively correlated with duration of service in emergency medicine and age. There was a significant difference between number of complaint reports and career (p<0.05). The physicians’ level of awareness on forensic cases was found to be insufficient. Lack of legislation knowledge may be an important cause of complaint reports concerning emergency physicians, who have a high load of patients. Thus, we think that increasing the frequency of post

  12. Integrating risk management data in quality improvement initiatives within an academic neurosurgery department.

    PubMed

    McLaughlin, Nancy; Garrett, Matthew C; Emami, Leila; Foss, Sarah K; Klohn, Johanna L; Martin, Neil A

    2016-01-01

    OBJECT While malpractice litigation has had many negative impacts on health care delivery systems, information extracted from lawsuits could potentially guide toward venues to improve care. The authors present a comprehensive review of lawsuits within a tertiary academic neurosurgical department and report institutional and departmental strategies to mitigate liability by integrating risk management data with quality improvement initiatives. METHODS The Comprehensive Risk Intelligence Tool database was interrogated to extract claims/suits abstracts concerning neurosurgical cases that were closed from January 2008 to December 2012. Variables included demographics of the claimant, type of procedure performed (if any), claim description, insured information, case outcome, clinical summary, contributing factors and subfactors, amount incurred for indemnity and expenses, and independent expert opinion in regard to whether the standard of care was met. RESULTS During the study period, the Department of Neurosurgery received the most lawsuits of all surgical specialties (30 of 172), leading to a total incurred payment of $4,949,867. Of these lawsuits, 21 involved spinal pathologies and 9 cranial pathologies. The largest group of suits was from patients with challenging medical conditions who underwent uneventful surgeries and postoperative courses but filed lawsuits when they did not see the benefits for which they were hoping; 85% of these claims were withdrawn by the plaintiffs. The most commonly cited contributing factors included clinical judgment (20 of 30), technical skill (19 of 30), and communication (6 of 30). CONCLUSIONS While all medical and surgical subspecialties must deal with the issue of malpractice and liability, neurosurgery is most affected both in terms of the number of suits filed as well as monetary amounts awarded. To use the suits as learning tools for the faculty and residents and minimize the associated costs, quality initiatives addressing the

  13. Disclosing Harmful Mammography Errors to Patients1

    PubMed Central

    Gallagher, Thomas H.; Cook, Andrea J.; Brenner, R. James; Carney, Patricia A.; Miglioretti, Diana L.; Geller, Berta M.; Kerlikowske, Karla; Onega, Tracy L.; Rosenberg, Robert D.; Yankaskas, Bonnie C.; Lehman, Constance D.; Elmore, Joann G.

    2009-01-01

    Purpose: To assess radiologists’ attitudes about disclosing errors to patients by using a survey with a vignette involving an error interpreting a patient's mammogram, leading to a delayed cancer diagnosis. Materials and Methods: We conducted an institutional review board–approved survey of 364 radiologists at seven geographically distinct Breast Cancer Surveillance Consortium sites that interpreted mammograms from 2005 to 2006. Radiologists received a vignette in which comparison screening mammograms were placed in the wrong order, leading a radiologist to conclude calcifications were decreasing in number when they were actually increasing, delaying a cancer diagnosis. Radiologists were asked (a) how likely they would be to disclose this error, (b) what information they would share, and (c) their malpractice attitudes and experiences. Results: Two hundred forty-three (67%) of 364 radiologists responded to the disclosure vignette questions. Radiologists’ responses to whether they would disclose the error included “definitely not” (9%), “only if asked by the patient” (51%), “probably” (26%), and “definitely” (14%). Regarding information they would disclose, 24% would “not say anything further to the patient,” 31% would tell the patient that “the calcifications are larger and are now suspicious for cancer,” 30% would state “the calcifications may have increased on your last mammogram, but their appearance was not as worrisome as it is now,” and 15% would tell the patient “an error occurred during the interpretation of your last mammogram, and the calcifications had actually increased in number, not decreased.” Radiologists’ malpractice experiences were not consistently associated with their disclosure responses. Conclusion: Many radiologists report reluctance to disclose a hypothetical mammography error that delayed a cancer diagnosis. Strategies should be developed to increase radiologists’ comfort communicating with

  14. Review of LCA studies of solid waste management systems – Part II: Methodological guidance for a better practice

    SciTech Connect

    Laurent, Alexis; Clavreul, Julie; Bernstad, Anna; Bakas, Ioannis; Niero, Monia; Gentil, Emmanuel; Christensen, Thomas H.; Hauschild, Michael Z.

    2014-03-01

    Highlights: • We perform a critical review of 222 LCA studies of solid waste management systems. • We analyse the past LCA practice against the ISO standard and ILCD Handbook guidance. • Malpractices exist in many methodological aspects with large variations among studies. • Many of these aspects are important for the reliability of the results. • We provide detailed recommendations to practitioners of waste management LCAs. - Abstract: Life cycle assessment (LCA) is increasingly used in waste management to identify strategies that prevent or minimise negative impacts on ecosystems, human health or natural resources. However, the quality of the provided support to decision- and policy-makers is strongly dependent on a proper conduct of the LCA. How has LCA been applied until now? Are there any inconsistencies in the past practice? To answer these questions, we draw on a critical review of 222 published LCA studies of solid waste management systems. We analyse the past practice against the ISO standard requirements and the ILCD Handbook guidelines for each major step within the goal definition, scope definition, inventory analysis, impact assessment, and interpretation phases of the methodology. Results show that malpractices exist in several aspects of the LCA with large differences across studies. Examples are a frequent neglect of the goal definition, a frequent lack of transparency and precision in the definition of the scope of the study, e.g. an unclear delimitation of the system boundaries, a truncated impact coverage, difficulties in capturing influential local specificities such as representative waste compositions into the inventory, and a frequent lack of essential sensitivity and uncertainty analyses. Many of these aspects are important for the reliability of the results. For each of them, we therefore provide detailed recommendations to practitioners of waste management LCAs.

  15. Litigations and the Obstetrician in Clinical Practice

    PubMed Central

    Adinma, JIB

    2016-01-01

    The expectation of obstetrics is a perfect outcome. Obstetrics malpractice can cause morbidity and mortality that may engender litigation. Globally, increasing trend to litigation in obstetrics practice has resulted in high indemnity cost to the obstetrician with consequent frustration and overall danger to the future of obstetrics practice. The objective was to review litigations and the Obstetrician in Clinical Practice, highlighting medical ethics, federation of gynecology and obstetrics (FIGO’s) ethical responsibility guideline on women's sexual and reproductive health and right; examine the relationship between medical ethics and medical laws; X-ray medical negligence and litigable obstetrics malpractices; and make recommendation towards the improvement of obstetrics practices to avert misconduct that would lead to litigation. Review involves a literature search on the internet in relevant journals, textbooks, and monographs. Knowledge and application of medical ethics are important to the obstetricians to avert medical negligence that will lead to litigation. A medical negligence can occur in any of the three triads of medicare viz: Diagnosis, advice/counseling, and treatment. Lawsuits in obstetrics generally center on errors of omission or commission especially in relation to the failure to perform caesarean section or to perform the operation early enough. Fear of litigation, high indemnity cost, and long working hours are among the main reasons given by obstetricians for ceasing obstetrics practice. Increasing global trend in litigation with high indemnity cost to the obstetrician is likely to jeopardize the future of obstetrics care especially in countries without medical insurance coverage for health practitioners. Litigation in obstetrics can be prevented through the Obstetrician's mindfulness of its possibility; acquainting themselves of the medical laws and guidelines related to their practice; ensuring adequate communication with, and consent of

  16. Litigation in obstetrics: a lesson learnt and a lesson to share.

    PubMed

    Chou, Min Min

    2006-03-01

    A perfect baby is the expectation of all parents, and a perfect outcome is the mission of obstetrics. Every obstetrician dreads to hear that there is an unexpected maternal mortality and/or severe fetal injury at the hospital. The role of a perceived public expectation of perfection in obstetric medicine reflects a belief that bad outcomes in obstetrics should not be tolerated and that every maternal-fetal injury merits financial compensation and punishment. What has brought these troubling times to obstetric medicine? The drivers behind malpractice crises are the four leading interest groups in the medical-legal debate: pregnant patients and their environment (husband, parents, relatives, friends, legislators, and the media), health-care providers, insurance companies, and trial attorneys. Litigation in obstetrics is the result of a complex of events when malpractice (presumed or real) impacts on the attitude of pregnant women and their environment. In such complexity, information is mandatory but may often be misinterpreted. If messages are not tailored to the receiver's capacity, communicating well with the pregnant patient becomes crucial. Therefore, to reduce medical-legal issues in obstetrics, increasing attention and an applicable standard of obstetric care to avoid negligence and medical errors should go along with better communication with pregnant women. Communication should be clear, targeted, effective, flexible, and empathic to share a common language and decisions. This review briefly presents and discusses some of the most frequently encountered medical-legal claim cases in obstetric practice. In-depth review of pregnancy-related deaths and major morbidities can help determine strategies needed to continue making pregnancy safer. PMID:17272201

  17. Professional liability risks and risk management for nurses in telehealth.

    PubMed

    McLean, Pat

    2003-01-01

    This paper will identify professional liability risks including licensure and malpractice risks associated with the delivery of professional health care services by nurses through the medium of information and communications technology (ICT). Risk management strategies to address these risks will be presented. In Canada, telehealth is defined as "the use of communications and information technology to deliver health and healthcare services and information over large and small distances" (Industry Canada, 1997). The use of ICT to deliver professional health care services in Canada is growing rapidly. New health care call centres, staffed by registered nurses, have burgeoned in the past 2 years and other health care organizations are now offering similar services. Whereas, in the "good old days", all health care providers were cautioned against giving health care information over the telephone because of the risk of error and possible malpractice suits, this is now an accepted practice. It is important to recognize that the legal risks are as high as they ever were unless they are appropriately managed through a variety of risk management strategies. Self-regulating groups of Canadian health professionals are also struggling with the legal ramifications of telehealth in relation to the locus of accountability of the health professional, when the client lives in a different jurisdiction from the nurse. This presentation will stress the importance of risk management in telehealth delivery. It is vitally important for the protection of the public and of health care professionals that telehealth services are delivered in a way that minimizes the risk of harm and subsequent legal action. PMID:15074758

  18. Restructuring American health care financing: first of all, do no harm!

    PubMed

    Berk, P D

    1993-07-01

    Health care costs are climbing throughout the western world. Aging populations and the costs of advanced technology are the principal forces behind much of this global increase. No country has yet succeeded in containing these growing costs other than by some form of rationing. A variety of experimental strategies, including managed competition, are being considered or tested, but none is clearly effective. American health care expenditures differ, not in that they are rising, but in their enormously high starting point. Among other things, our higher costs reflect administrative costs of more than 20%, double those of Canada and nearly triple the European average; a malpractice system that, whatever its possible advantages, costs more than 10 times as much as it pays out to the injured; the enormous medical costs of poverty; maldistribution of physician specialties and incomes; and reimbursement systems that eliminate consumer input and oversight. Restructuring the system of health care financing to bring administrative costs in line with those of other nations could save at least $70 billion annually; another $25 billion or more could be saved by replacing the malpractice system with more cost-effective alternatives. These savings could defray the costs of insuring all those not now covered, without increasing either costs to the middle class, through taxation of benefits, or total health care expenditures. With all Americans covered, the necessary restructuring of the system of health care delivery could be conducted without the current pressure for immediate drastic reform, which carries with it the risk of serious error. In dealing with the sick, physicians are taught to apply two maxims: "primum non nocere" or "first of all, do no harm!"; and the rule of therapeutic restraint. The latter states that a severe chronic illness may respond better, and with fewer complications, to gradual corrective measures than to highly aggressive therapy. Both rules could well

  19. Trends in endodontic claims in Italy.

    PubMed

    Pinchi, Vilma; Pradella, Francesco; Gasparetto, Laura; Norelli, Gian-Aristide

    2013-02-01

    According to the scant data available in the literature, endodontic claims are common among dental professional liability cases and the second most common type of claim. This study aimed to describe the characteristics of endodontic claims in Italy and the most frequently disputed errors, and the discussion below includes consideration of ethical and medico-legal aspects thereof. We retrospectively analysed 120 technical reports written on cases of professional malpractice in endodontics in the last 5 years. The complainant patients were males in 22.5% of the cases, while females made up the remaining 77.5%. In the dentist sample, male operators were more often involved in litigation cases (80%) than female operators. The most frequently claimed technical errors were: lack of a complete filling of root canal/s (71.7%), the perforation of tooth structure (12.7%), extrusion of sealing materials beyond the apex of the tooth (9.6%) and the fracture of an endodontic instrument (5.9%). In 1.7% of cases it was found that the expert did not make any errors performing the endodontic therapy. In only very few cases (2.7%) no therapy was considered necessary, while the most common therapeutic solution involved in endodontic misconduct was tooth extraction (53.0%). In many cases the dentist preferred to extract the endodontically undertreated tooth and substitute it prosthetically rather than trying to re-treat it. The discrepancy between the total number of cases examined and those that eventually go to court leads us to believe that the majority of endodontic malpractice cases are resolved in out-of-court settlements. PMID:23410021

  20. [Patients' rights--doctors' duties].

    PubMed

    Jaeger, L; Bertram, E; Grate, S; Mischkowsky, T; Paul, D; Probst, J; Scala, E; Wbllenweber, H D

    2015-06-01

    On 26 February 2013 the new "Law on Patients' Rights" (hereinafter also the "Law") became effective. This Law strengthens patients' rights vis-à-vis the insurdnce company and also regulates patients' rights regarding their relation to the doctor. This has consequences for the laws on medical liability all doctors must consider. The doctor's performance is and remains a service and such service does not hold any guarantee of success. Nevertheless, this Law primarily reads as a "law on the duties of physicians". To duly take into account these duties and to avoid mistakes and misinterpretation of the Law, the Ethics Committee of the Consortium of Osteosynthesis Trauma Germany (AOTRAUMA-D) has drafted comments on the Law. Brief summaries of its effects are to be found at the end of the respective comment under the heading "Consequences for Practice". The text of the law was influenced particularly by case law, as continuously developed by the German Federal Court of Justice ("BGH"). The implementation of the Law on Patients' Rights was effected by the newly inserted sections 630a to 630h of the German Civil Code (the "BGB"), which are analysed below. The following comments are addressed to physicians only and do not deal with the specific requirements and particularities of the other medical professions such as physiotherapy, midwifery and others so on. Special attention should be paid to the comments on the newly inserted Duty to inform, which has to be fullfilled prior to any diagnostic or therapeutic procedure (sec. 630c para 2 sentence 1 BGB). Under certain conditions the doctor also has to inform the patient about the circumstances that lead to the presumed occurance of a therapeutic or diagnostic malpractice (sec. 630c para. 2 sentence 2 BGB), based on the manifestation of an undesired event or an undesired outcome. As before, the patient's valid consent to any procedure (sec. 630d BGB) is directly linked to the comprehensive and timely provision of information

  1. Medical error reduction and tort reform through private, contractually-based quality medicine societies.

    PubMed

    MacCourt, Duncan; Bernstein, Joseph

    2009-01-01

    The current medical malpractice system is broken. Many patients injured by malpractice are not compensated, whereas some patients who recover in tort have not suffered medical negligence; furthermore, the system's failures demoralize patients and physicians. But most importantly, the system perpetuates medical error because the adversarial nature of litigation induces a so-called "Culture of Silence" in physicians eager to shield themselves from liability. This silence leads to the pointless repetition of error, as the open discussion and analysis of the root causes of medical mistakes does not take place as fully as it should. In 1993, President Clinton's Task Force on National Health Care Reform considered a solution characterized by Enterprise Medical Liability (EML), Alternative Dispute Resolution (ADR), some limits on recovery for non-pecuniary damages (Caps), and offsets for collateral source recovery. Yet this list of ingredients did not include a strategy to surmount the difficulties associated with each element. Specifically, EML might be efficient, but none of the enterprises contemplated to assume responsibility, i.e., hospitals and payers, control physician behavior enough so that it would be fair to foist liability on them. Likewise, although ADR might be efficient, it will be resisted by individual litigants who perceive themselves as harmed by it. Finally, while limitations on collateral source recovery and damages might effectively reduce costs, patients and trial lawyers likely would not accept them without recompense. The task force also did not place error reduction at the center of malpractice tort reform -a logical and strategic error, in our view. In response, we propose a new system that employs the ingredients suggested by the task force but also addresses the problems with each. We also explicitly consider steps to rebuff the Culture of Silence and promote error reduction. We assert that patients would be better off with a system where

  2. Feasibility and Satisfaction with a Tailored Web-based Audit Intervention for Recalibrating Radiologists’ Thresholds for Conducting Additional Work-up

    PubMed Central

    Carney, Patricia A.; Geller, Berta M.; Sickles, Edward A.; Miglioretti, Diana L.; Aiello Bowles, Erin J.; Abraham, Linn; Feig, Stephen A.; Brown, David; Cook, Andrea J.; Yankaskas, Bonnie C.; Elmore, Joann G.

    2010-01-01

    Purpose To examine the feasibility of and satisfaction with a tailored web-based intervention designed to decrease radiologists' recommendation of inappropriate additional work-up following a screening mammogram. Methods We developed a web-based educational intervention designed to reduce inappropriate recall. Radiologists were randomly assigned to participate in an early intervention group or a late (control) intervention group, the latter of which served as a control for a nine-month follow-up period, after which they were invited to participate in the intervention. Intervention content was derived from our prior research and included three modules: 1) an introduction to audit statistics for mammography performance; 2) a review of data showing radiologists' inflated perceptions of medical malpractice risks related to breast imaging, and 3) a review of data on breast cancer risk among women seen in their practices. Embedded within the intervention were individualized audit data for each participating radiologists obtained from the national Breast Cancer Surveillance Consortium. Results Seventy-four radiologists (37.8%; 74/196) consented to the intervention, which was completed by 67.5% (27/40) of those randomized to the early intervention group and 41.2% (14/34) of those randomized to the late (control) group. Thus, a total of 41 (55%) completed the intervention. On average, three log-ins were used to complete the program (range 1–14), which took approximately 1 hour. Ninety-five percent found the program moderately to very helpful in understanding how to calculate basic performance measures. Ninety-three percent found viewing their own performance measures moderately to very helpful, and 83% reported it being moderately to very important to learn that the breast cancer risk in their screening population program was lower than perceived. The percentage of radiologists who reported that the risk of medical malpractice influences their recall rates dropped from 36

  3. Complementary and integrative medical therapies, the FDA, and the NIH: definitions and regulation.

    PubMed

    Cohen, Michael H

    2003-01-01

    The National Center for Complementary and Alternative Medicine (NCCAM) presently defines complementary and alternative medicine (CAM) as covering "a broad range of healing philosophies (schools of thought), approaches, and therapies that mainstream Western (conventional) medicine does not commonly use, accept, study, understand, or make available. The research landscape, including NCCAM-funded research, is continually changing and subject to vigorous methodologic and interpretive debates. Part of the impetus for greater research dollars in this arena has been increasing consumer reliance on CAM to dramatically expand. State (not federal) law controls much of CAM practice. However, a significant federal role exists in the regulation of dietary supplements. The U.S. Food and Drug Administration (FDA) regulates foods, drugs, and cosmetics in interstate commerce. No new "drug" may be introduced into interstate commerce unless proven "safe" and "effective" for its intended use, as determined by FDA regulations. "Foods", however, are subject to different regulatory requirements, and need not go through trials proving safety and efficacy. The growing phenomenon of consumer use of vitamins, minerals, herbs, and other "dietary supplements" challenged the historical divide between drugs and foods. The federal Dietary Supplements Health Education Act (DSHEA) allows manufacturers to distribute dietary supplements without having to prove safety and efficacy, so long as the manufacturers make no claims linking the supplements to a specific disease. State law regulates the use of CAM therapies through a variety of legal rules. Of these, several major areas of concern for clinicians are professional licensure, scope of practice, and malpractice. Regarding licensure, each state has enacted medical licensing that prohibits the unlicensed practice of medicine and thereby criminalizes activity by unlicensed CAM providers who offer health care services to patients. Malpractice is

  4. Identification of a Herbal Powder by Deoxyribonucleic Acid Barcoding and Structural Analyses

    PubMed Central

    Sheth, Bhavisha P.; Thaker, Vrinda S.

    2015-01-01

    Background: Authentic identification of plants is essential for exploiting their medicinal properties as well as to stop the adulteration and malpractices with the trade of the same. Objective: To identify a herbal powder obtained from a herbalist in the local vicinity of Rajkot, Gujarat, using deoxyribonucleic acid (DNA) barcoding and molecular tools. Materials and Methods: The DNA was extracted from a herbal powder and selected Cassia species, followed by the polymerase chain reaction (PCR) and sequencing of the rbcL barcode locus. Thereafter the sequences were subjected to National Center for Biotechnology Information (NCBI) basic local alignment search tool (BLAST) analysis, followed by the protein three-dimension structure determination of the rbcL protein from the herbal powder and Cassia species namely Cassia fistula, Cassia tora and Cassia javanica (sequences obtained in the present study), Cassia Roxburghii, and Cassia abbreviata (sequences retrieved from Genbank). Further, the multiple and pairwise structural alignment were carried out in order to identify the herbal powder. Results: The nucleotide sequences obtained from the selected species of Cassia were submitted to Genbank (Accession No. JX141397, JX141405, JX141420). The NCBI BLAST analysis of the rbcL protein from the herbal powder showed an equal sequence similarity (with reference to different parameters like E value, maximum identity, total score, query coverage) to C. javanica and C. roxburghii. In order to solve the ambiguities of the BLAST result, a protein structural approach was implemented. The protein homology models obtained in the present study were submitted to the protein model database (PM0079748-PM0079753). The pairwise structural alignment of the herbal powder (as template) and C. javanica and C. roxburghii (as targets individually) revealed a close similarity of the herbal powder with C. javanica. Conclusion: A strategy as used here, incorporating the integrated use of DNA

  5. Quality of care developments. 1993 update.

    PubMed

    Sundwall, D N

    1993-06-01

    This monograph offers an overview of quality of care developments at the federal and state government levels, as well as in the private sector. Although health care reform legislation focuses on access, costs, and delivery systems, initiatives involving the quality of care not only will continue but are included in most of the reform efforts being proposed and those already under way. At the federal level... At the Health Care Financing Administration (HCFA), publication of Medicare mortality data is delayed and the Peer Review Organization (PRO) program is undergoing a major change of emphasis under a "quality improvement initiative." The Clinical Laboratory Improvement Act (CLIA) has taken effect amidst controversy and further rulemaking is expected to correct flaws. The Agency for Health Care Policy and Research (AHCPR) is forging ahead with new practice guidelines while it starts to evaluate their effectiveness. Data on the patient outcomes in organ transplant centers, first published last year, now will be published on a regular basis. The National Practitioner Data Bank continues functioning amidst criticism and varying recommendations for change, from excluding information on small malpractice claims (e.g., less than $30,000) to opening up the data bank to the public (as proposed by Rep. Ron Wyden). Other federal developments include various quality-related reports from the Inspector General of HHS, the General Accounting Office, the Prospective Payment Assessment Commission, and the Physician Payment Review Commission, plus QI initiatives in Veterans Administration hospitals and the CHAMPUS programs. Among the states... Florida has included outcome data reporting and dissemination in its health care reform plan while Illinois struggles with whether physician-specific data will be made public. An innovative effort to test whether practice guidelines can reduce malpractice costs is underway in Maine, while Indiana began an outcome data project. Among

  6. What's the difference? Comparison of American and Japanese medical practice.

    PubMed

    Kitano, Masami

    2007-09-01

    Medical systems in the USA such as EBM., DRG., Informed Consent and Second Opinion have already been introduced into the Japanese medical system. However, some of these systems have met resistance from a part of the population due to the differences of social structures, morals and customs between the two countries. Briefly, I described the medical education and licensure, the private practice and "open hospital system" of the USA. The following 4 topics which drew great interest in Japan will be discussed. 1) CEREBRAL DEATH AND BIOETHICS: Cerebral death has been restrictively accepted as human death since the 1980's only in terms of terminal cares in clinical medicine. The rather simplified current neurological criteria for death are approved in the USA. In order for an organ transplant to take place, a potential donor must be diagnosed as brain dead. However, Japanese society has not accepted the concept of cerebral death completely because of an accident in the 1960's where an organ was improperly removed when the donor who was not in the state of brain death. Recently, more people in Japan are showing interest in Dignity and Euthanasia from the point of view of "Right to die". 2) MALPRACTICE AND LITIGATION: "To err is human" was introduced by the Institute of Medicine for Risk Management. Accidental deaths of patients under medical care ranks No.8 in total number of deaths in the USA. There are 100,000 malpractice cases in the "Lawsuit Society" of America, which is 100 times that of Japan. Furthermore, the legal fees and insurance premiums are extremely high in the US as opposed to very low in Japan. 3) HEALTH CARE INSURANCE: To reduce medical costs, the insurance companies introduced "Competitive Managed Care" which resulted in the formation of "Health Maintenance Organizations" (HMO). Furthermore, when you compare the two countries in respect to those who have health insurance, 44 million in the USA carry no health insurance, whereas in Japan, the government

  7. Caring and uncaring encounters within nursing and health care from the cancer patient's perspective.

    PubMed

    Halldórsdóttir, S; Hamrin, E

    1997-04-01

    The aim of this phenomenological study was to explore caring and uncaring encounters with nurses and other health professionals from the perspective of the person who has been diagnosed and treated for cancer. Through thematic analysis of in-depth dialogues with five women and four men in the remission or recovery phase of cancer, three major categories regarding caring and uncaring encounters were identified. The essential structure of a caring encounter was found to be threefold: 1. the nurse/health professional perceived as caring: an indispensable companion on the cancer trajectory; 2. the resulting mutual trust and caring connection; and 3. the perceived effect of the caring encounter: a sense of solidarity, empowerment, well-being, and healing. The essential structure of an uncaring encounter is also threefold: 1. the nurse/health professional perceived as uncaring: an unfortunate hindrance to the perception of well-being and healing; 2. the resulting sense of mistrust and disconnection; and 3. the perceived effect of the uncaring encounter: a sense of uneasiness, discouragement, and a sense of being broken down. The findings emphasize the primacy of competence in professional caring, as well as that of genuine concern, openness and a willingness to connect with others. The often devastating effects of uncaring encounters on the recipient of nursing and health care raises the question whether uncaring as an ethical and a professional problem should perhaps be dealt with as malpractice in nursing and health care. PMID:9145561

  8. Telehealth Regulatory and Legal Considerations: Frequently Asked Questions

    PubMed Central

    Cason, Jana; Brannon, Janice A.

    2011-01-01

    As telehealth gains momentum as a service delivery model in the United States within the rehabilitation professions, regulatory and legal questions arise. This article examines the following questions: Is there a need to secure licenses in two states (i.e., where the practitioner resides, and where the client is located), before engaging in telehealth?Do state laws differ concerning if and how telehealth can occur?Do any states expressly disallow telehealth?Can services delivered through telehealth be billed the same way as services provided in-person?If practitioners fulfill the requirements to maintain licensure (e.g., continuing education obligations) in their state of residence, do they also need to fulfill the requirements to maintain licensure for the state in which the client resides?Will professional malpractice insurance cover services delivered through telehealth?Does a sole practitioner need to abide by HIPAA regulations?Responses to these questions are offered to raise awareness of the regulatory and legal implications associated with the use of a telehealth service delivery model within the professions of occupational therapy, physical therapy, speech-language pathology and audiology. PMID:25945185

  9. Human Reliability and the Cost of Doing Business

    NASA Technical Reports Server (NTRS)

    DeMott, Diana

    2014-01-01

    Most businesses recognize that people will make mistakes and assume errors are just part of the cost of doing business, but does it need to be? Companies with high risk, or major consequences, should consider the effect of human error. In a variety of industries, Human Errors have caused costly failures and workplace injuries. These have included: airline mishaps, medical malpractice, administration of medication and major oil spills have all been blamed on human error. A technique to mitigate or even eliminate some of these costly human errors is the use of Human Reliability Analysis (HRA). Various methodologies are available to perform Human Reliability Assessments that range from identifying the most likely areas for concern to detailed assessments with human error failure probabilities calculated. Which methodology to use would be based on a variety of factors that would include: 1) how people react and act in different industries, and differing expectations based on industries standards, 2) factors that influence how the human errors could occur such as tasks, tools, environment, workplace, support, training and procedure, 3) type and availability of data and 4) how the industry views risk & reliability influences ( types of emergencies, contingencies and routine tasks versus cost based concerns). The Human Reliability Assessments should be the first step to reduce, mitigate or eliminate the costly mistakes or catastrophic failures. Using Human Reliability techniques to identify and classify human error risks allows a company more opportunities to mitigate or eliminate these risks and prevent costly failures.

  10. Assisted reproduction on treacherous terrain: the legal hazards of cross-border reproductive travel.

    PubMed

    Storrow, Richard F

    2011-11-01

    The growing phenomenon of cross-border reproductive travel has four significant legal dimensions. First, laws that ban or inhibit access to assisted reproductive procedures in one country lead patients and physicians to travel to other countries to acquire, to contribute to or to provide assisted reproductive services. Such laws may include provisions that criminalize those who assist or advise patients to undertake such travel. Second, the law may expressly criminalize crossing borders to obtain, to be a donor for or to perform certain procedures. Third, the law may interfere with the ultimate goal of reproductive travellers by refusing to recognize them as the parents of the child they have crossed borders to conceive. Finally, facilitating cross-border reproductive travel may expose physicians, attorneys and brokers to malpractice or other civil liability. This article explores these legal dimensions of cross-border reproductive care and uses the legal doctrines of proportionality, extraterritoriality and comity to assess the legality and normative validity of governmental efforts to curb or limit assisted reproductive practices. PMID:21962773

  11. Surgical streams in the flow of health care financing. The role of surgery in national expenditures: what costs are controllable?

    PubMed Central

    Moore, F D

    1985-01-01

    The dollar flow in United States medical care has been analyzed in terms of a six-level model; this model and the gross 1981 flow data are set forth. Of the estimated $310 billion expended in 1981, it is estimated that $85-$95 billion was the "surgical stream", i.e., that amount expended to take care of surgical patients at a variety of institutional types and including ambulatory care and surgeons' fees. Some of the determinants of surgical flow are reviewed as well as controllable costs and case mix pressures. Surgical complications, when severe, increase routine operative costs by a factor of 8 to 20. Maintenance of high quality in American surgery, despite new manpower pressures, is the single most important factor in cost containment. By voluntary or imposed controls on fees, malpractice premiums, case mix selection, and hospital utilization, a saving of $2.0-$4.0 billion can be seen as reachable and practical. This is five per cent of the surgical stream and is a part of the realistic "achievable" savings of total flow estimated to be about +15 billion or 5 per cent. PMID:3918514

  12. Antibiotics and oral contraceptives.

    PubMed

    Rubin, D F

    1981-04-01

    Dermatologists often prescribe oral tetracycline for the control of acne, primarily, and to a much lesser extent, for the treatment of cutaneous infections. A number of the patients taking tetracycline are also taking birth control pills. A recent article in the British Medical Journal (1980;1:293) indicates that this combination can lead to a failure of the (OC) oral contraceptive. Such failure had been associated with ampicillin as well. It is believed that the mechanism for this was the disturbance in normal gut flora, with consequent effects on bacterial hydrolysis of steroid conjugates. This would interrupt the enterohepatic circulation of contraceptive steroids, resulting in a less than normal concentration of circulating steroids. It was recommended that women taking low-dose OCs take extra precautions against pregnancy during any cycle in which antibiotics are given. In regard to our care of and responsibilities to our patients, and in an era when malpractice suits for all types of reasons are more common, it certainly behooves dermatologists to recognize and be concerned about this potential consequence of prescribing oral antibiotics. PMID:7212735

  13. Medicare program; revisions to payment policies under the physician fee schedule for calendar year 2006 and certain provisions related to the Competitive Acquisitions Program of outpatient drugs and biologicals under Part B. Final rule with comment.

    PubMed

    2005-11-21

    This rule addresses Medicare Part B payment policy, including the physician fee schedule that are applicable for calendar year (CY) 2006; and finalizes certain provisions of the interim final rule to implement the Competitive Acquisition Program (CAP) for Part B Drugs. It also revises Medicare Part B payment and related policies regarding: Physician work; practice expense (PE) and malpractice relative value units (RVUs); Medicare telehealth services; multiple diagnostic imaging procedures; covered outpatient drugs and biologicals; supplemental payments to Federally Qualified Health Centers (FQHCs); renal dialysis services; coverage for glaucoma screening services; National Coverage Decision (NCD) timeframes; and physician referrals for nuclear medicine services and supplies to health care entities with which they have financial relationships. In addition, the rule finalizes the interim RVUs for CY 2005 and issues interim RVUs for new and revised procedure codes for CY 2006. This rule also updates the codes subject to the physician self-referral prohibition and discusses payment policies relating to teaching anesthesia services, therapy caps, private contracts and opt-out, and chiropractic and oncology demonstrations. As required by the statute, it also announces that the physician fee schedule update for CY 2006 is -4.4 percent, the initial estimate for the sustainable growth rate for CY 2006 is 1.7 percent and the conversion factor for CY 2006 is $36.1770. PMID:16299947

  14. How to Avoid and Deal with Pelvic Mesh Litigation.

    PubMed

    Karlovsky, Matthew E

    2016-08-01

    Medical malpractice as it relates to transvaginal mesh implantation adds another level of responsibility when deciding on surgical options to repair stress urinary incontinence or pelvic organ prolapse. As mesh is a viable option for repair, the informed consent process must involve a time commitment to discuss thoroughly the knowns and unknowns about mesh, and potentially must cover other aspects related to surgery: FDA classification of mesh, experience, potential off label usage, and conflicts of interest. A therapeutic alliance must be developed between physician and patient to allay possible fears about the intrinsic uncertainty of surgery. Proper risk assessment of the patient and pre-operative judgment as to when and if mesh implantation is appropriate are decisions that must be documented. Resolution of a conflict from a complication can be dealt with formally or informally. Above all, sharp skills, good communication, broad knowledge base of mesh surgeries, complication management, knowledge of guidelines, along with methodical documentation can mitigate or avert mesh-related litigation. PMID:27287606

  15. A Secure RFID Tag Authentication Protocol with Privacy Preserving in Telecare Medicine Information System.

    PubMed

    Li, Chun-Ta; Weng, Chi-Yao; Lee, Cheng-Chi

    2015-08-01

    Radio Frequency Identification (RFID) based solutions are widely used for providing many healthcare applications include patient monitoring, object traceability, drug administration system and telecare medicine information system (TMIS) etc. In order to reduce malpractices and ensure patient privacy, in 2015, Srivastava et al. proposed a hash based RFID tag authentication protocol in TMIS. Their protocol uses lightweight hash operation and synchronized secret value shared between back-end server and tag, which is more secure and efficient than other related RFID authentication protocols. Unfortunately, in this paper, we demonstrate that Srivastava et al.'s tag authentication protocol has a serious security problem in that an adversary may use the stolen/lost reader to connect to the medical back-end server that store information associated with tagged objects and this privacy damage causing the adversary could reveal medical data obtained from stolen/lost readers in a malicious way. Therefore, we propose a secure and efficient RFID tag authentication protocol to overcome security flaws and improve the system efficiency. Compared with Srivastava et al.'s protocol, the proposed protocol not only inherits the advantages of Srivastava et al.'s authentication protocol for TMIS but also provides better security with high system efficiency. PMID:26084587

  16. Inspection of alleged design and construction deficiencies in the Nuclear Materials Storage Facility at the Los Alamos National Laboratory

    SciTech Connect

    1997-01-16

    On June 8, 1994, the Office of Inspections, Office of Inspector General (OIG), Department of Energy (DOE), received a letter dated May 31, 1994, from a complainant concerning the Nuclear Materials Storage Facility (NMSF) at the Los Alamos National Laboratory. The complainant alleged that the NMSF, completed in 1987, was so poorly designed and constructed that it was never usable and that DOE proposed to gut the entire facility and sandblast the walls. According to the complainant, ``these errors are so gross as to constitute professional malpractice in a commercial design setting.`` The complainant further stated that ``DOE proposes to renovate this facility to store large amounts of plutonium (as much as 30 metric tons, by some accounts), and it is imperative that the public receive some assurance that this waste will not recur and that the facility will be made safe.`` The purpose of our inspection was to determine if the allegations regarding the design and construction of the NMSF were accurate, and if so, to determine if the Government could recover damages from the Architect/Engineer and/or the construction contractor. We also reviewed the Department`s proposed actions to renovate the NMSF.

  17. Accidental Ingestion of a Foreign Body of Orthodontic Origin - A Review of Risks, Complications and Clinical Recommendations.

    PubMed

    Handa, Ashish; Handa, Jasleen Kaur

    2016-01-01

    Ingestion/aspiration episodes of foreign bodies are potential complications in almost all branches of dentistry. Occasionally, orthodontic appliances or small orthodontic components are accidentally swallowed and have caused problems with either the airway or the gastrointestinal tract, especially where the patient is supine or semi-recumbent. Despite their rare occurrence, the morbidity from a single incident and the level of specialized medical care that may be needed on emergency basis to manage such incidents is too high to ignore. Moreover, there is also the related risk of malpractice litigation given the fact that these incidents are preventable and increasing awareness among people. This article attempts to review potential risks and complications of ingestion/aspiration episodes based on relevant literature and describe the type of appliances and their parts most likely to cause problems. Certain recommendations based on best available evidence to minimize the incidence of such events are proposed, and strategies to aid the clinician in the event of such an emergency are also formulated. PMID:27319041

  18. Psychopharmacology of lycanthropy.

    PubMed Central

    Davis, W M; Wellwuff, H G; Garew, L; Kydd, O U

    1992-01-01

    OBJECTIVE: To develop pharmacotherapies for the orphan disease lycanthropy through the pursuit of the etiologic hypothesis of a genetically determined hypersecretion of endogenous lycanthropogens. DESIGN: Quadruple-blind, Rubik's Cube matrix analysis. SETTING: Community practice and malpractice. PARTICIPANTS: Subjects selected from inbred Ruficolla populations in Mississippi, Georgia, North Carolina and Minnesota. All who entered the study finished it. INTERVENTIONS: Chemical screening of blood samples over a hypothesized secretory cycle of lycanthropogen peaking on the day of maximum lunar illumination. Administration of synthetic lycanthropogens for behavioural testing. Experimental lycosomatization through the illumination method of Kirschbaum. OUTCOME MEASURES: None were post hoc, but some are still in hock. MAIN RESULTS: Two putative lycanthropogens were isolated from the blood samples. Structural elucidation and synthesis permitted animal and clinical trials; in each of these, behavioural dysfunction was observed. Antilycanthropogen strategies included application of the principle of caged compounds and generation of a therapeutic immunoglobulin. The effects of a newly developed antihirsutic agent seemed promising. An interaction of the lycanthropogen-secretion system and ethanol was noted, which may explain behavioural aspects of alcoholism. CONCLUSIONS: The incidence of lycomania in North America is underestimated. Soon-to-be-available pharmacotherapies should promote its early detection and treatment. Full control may depend upon advances in gene therapy. PMID:1555146

  19. Use of assessment to reinforce patient safety as a habit

    PubMed Central

    Galbraith, R M; Holtman, M C; Clyman, S G

    2006-01-01

    The US spends far more than any other nation on health care. Physicians undergo lengthy and comprehensive training that is carefully scrutinized, and are held to high standards in national examinations. At best the care delivered matches or exceeds that in any other country. And yet, often simple preventable medical errors occur at alarming and unacceptable rates. The public, corporate consumers of health care, large payors and malpractice insurance carriers are all becoming impatient with the pace of improvement. The medical profession recognizes that dealing with this problem is an urgent priority and is grappling to find the best approaches. This paper focuses on the constructive use of assessment to embed a pervasive and proactive culture of patient safety into practice, starting with the trainee and extending out into the practice years. This strategy is based on the adage that “assessment drives curriculum” and proposes a series of new assessment tools to be added to all phases of the training‐practice continuum. PMID:17142605

  20. Medicine beyond borders: the legal and ethical challenges.

    PubMed

    Kassim, Puteri Nemie J

    2009-09-01

    The ease and affordability of international travel has contributed to the rapid growth of the healthcare industry where people from all around the world are traveling to other countries to obtain medical, dental, and surgical care while at the same time touring, vacationing and fully experiencing the attractions of the countries that they are visiting. A combination of many factors has led to the recent increase in popularity of medical tourism such as exorbitant costs of healthcare in industrialized nations, favorable currency exchange rates in the global economy, rapidly improving technology in many countries of the world and most importantly proven safety of healthcare in selected foreign nations. Nevertheless, the development of medical tourism has certainly awakened many ethical and legal issues, which must be addressed. Issues pertaining to malpractice, consumer protection, organ trafficking, alternative medicine and telemedicine need comprehensive legal regulatory framework to govern them. Ethical issues are also been raised by the promotion of medical tourism in particular those pertaining to doctor and patient relationship. A future, where medical law is subsumed into various legal and ethical dimensions, poses serious challenges for the practice and ethics of medicine. PMID:20157960

  1. [Repatriation of patients fallen ill abroad].

    PubMed

    Felkai, Péter; Gorove, László

    2009-08-30

    Due to our medical ethics, welfare of the patient is the first to consider. The therapy applied should not be influenced by any financial, administrative or political considerations. Yet, patient repatriation is such a special medical field, where the interest of an insurance company can often owerwrite medical considerations. The missing protocol of long-distance patient transportation and of repatriation in general, the by-passing of medical responsibility enables malpractice. Unfortunately, practitioners know little about the basic terms of repatriation. The authors review the indications and basic terms of patient repatriation, and the basic considerations on the fit-for-transportation of the patient. The patient transportation vehicles and their availability for the different forms of repatriation modalities are analysed as well. It was found that the form and timing of repatriation should be carefully selected, in order to prevent further deterioration of the patient's status; it must ensure maximum protection of the patient during the transport. The patient's interest must be the first, all the other considerations (financial, social etc.) may come afterwards. PMID:19692312

  2. A conceptual model of emergency physician decision making for head computed tomography in mild head injury.

    PubMed

    Probst, Marc A; Kanzaria, Hemal K; Schriger, David L

    2014-06-01

    The use of computed tomographic scanning in blunt head trauma has increased dramatically in recent years without an accompanying rise in the prevalence of injury or hospital admission for serious conditions. Because computed tomography is neither harmless nor inexpensive, researchers have attempted to optimize utilization, largely through research that describes which clinical variables predict intracranial injury, and use this information to develop clinical decision instruments. Although such techniques may be useful when the benefits and harms of each strategy (neuroimaging vs observation) are quantifiable and amenable to comparison, the exact magnitude of these benefits and harms remains unknown in this clinical scenario. We believe that most clinical decision instrument development efforts are misguided insofar as they ignore critical, nonclinical factors influencing the decision to image. In this article, we propose a conceptual model to illustrate how clinical and nonclinical factors influence emergency physicians making this decision. We posit that elements unrelated to standard clinical factors, such as personality of the physician, fear of litigation and of missed diagnoses, patient expectations, and compensation method, may have equal or greater impact on actual decision making than traditional clinical factors. We believe that 3 particular factors deserve special consideration for further research: fear of error/malpractice, financial incentives, and patient engagement. Acknowledgement and study of these factors will be essential if we are to understand how emergency physicians truly make these decisions and how test-ordering behavior can be modified. PMID:24560384

  3. Radiology reporting, past, present, and future: the radiologist's perspective.

    PubMed

    Reiner, Bruce I; Knight, Nancy; Siegel, Eliot L

    2007-05-01

    Although imaging technologies have undergone dramatic evolution over the past century, radiology reporting has remained largely static, in both content and structure. Existing free-text (prose) reports have been criticized for a number of inherent deficiencies, including inconsistencies in content, structure, organization, and nomenclature. A number of new initiatives and technologies now present the radiology community with the unique opportunity to fundamentally change the radiology report from free to structured text. These new developments include a standardized nomenclature (RadLex), automated information technologies (picture archiving and communications systems and electronic medical records), and automated data tracking and analysis software (natural-language processing). Despite the increasing availability of these tools and technologies for revolutionizing reporting, clinical, psychologic, legal, and economic challenges have collectively limited structured reporting to mammography. These challenges are most evident in the current environment of heightened expectations for improved quality, timeliness, and communication, along with increasing stress, fatigue, and malpractice concerns. In conclusion, the authors present an alternative to traditional reporting that attempts to address some of these diverse challenges while incorporating the aforementioned initiatives and technologic developments. This approach uses a graphical symbol language that is directly mapped to a standardized lexicon (RadLex) and is automatically converted into a structured hierarchical text report, which can then be much more easily searched and analyzed. PMID:17467614

  4. Prevention and management of accidental foreign body ingestion and aspiration in orthodontic practice.

    PubMed

    Umesan, Uday Kumar; Chua, Kui Lay; Balakrishnan, Priya

    2012-01-01

    Among the myriad emergencies that could arise in the dental clinical setting there are a few that occur occasionally despite being entirely preventable. Ingestion or aspiration of dental materials, appliances, or instruments comprises this category. Regardless of incidence, foreign body ingestion or aspiration episodes are recognized as potential complications in the specialty of orthodontics. Despite their infrequent occurrence, the morbidity from a single incident and the amount of specialty medical care that may be needed to manage such incidents is too high to ignore. There is also the associated risk of malpractice litigation given the fact that these incidents are preventable. At present, no clear guidelines exist regarding prevention of this emergency in practice. This article attempts to review relevant literature and aims to formulate certain recommendations based on best available evidence to minimize the incidence of such events, while also suggesting guidelines toward making their management more effective. A flow chart outlining management options and strategies to aid the clinician in the event of such an emergency is also presented. PMID:22701326

  5. A Clinical Communication Strategy to Enhance Effectiveness and CAHPS Scores: The ALERT Model

    PubMed Central

    Hardee, James T; Kasper, Ilene K

    2008-01-01

    The Consumer Assessment of Healthcare Providers and Systems (CAHPS) program is a national annual report that surveys patients and rates health plans on a variety of metrics, including claims processing, customer service, office staff helpfulness, and ability to get needed care. Although physicians may feel they have no immediate control over many aspects of this questionnaire, there is an important area of the survey where they do have direct control: “how well the doctor communicates.” It is well established that effective physician–patient communication has beneficial effects not only on physician and patient satisfaction but also on adherence to medical advice, diagnostic accuracy, and malpractice risk. The creators of the CAHPS survey developed and incorporated four questions seeking to ascertain the patient's impression of the physician's communication skills. These questions assess how well the physician listened carefully to the patient, how often the physician explained things understandably, how often the physician showed respect for what the patient said, and how often the physician spent enough time with the patient. Many excellent clinical communication models exist that touch on aspects of the CAHPS topics, but it behooves physicians to be mindful of the exact survey questions. The ALERT model of communication was developed to facilitate physicians' recall of these measures. By incorporating key verbal and nonverbal communication skills, clinicians can address and improve their scores on this important area of the CAHPS survey. PMID:21331215

  6. Patients use an internet technology to report when things go wrong

    PubMed Central

    Wasson, John H; MacKenzie, Todd A; Hall, Michael

    2007-01-01

    Background As patients directly experience harm from adverse events, investigators have proposed patient‐report to complement professional reporting of adverse events. Objective To investigate how an automated health assessment system can be used to identify adverse events. Design and setting Internet survey responses from April 2003 to April 2005 involving communities and clinical practices across the USA. Patients 44 860 adults aged 19–69 years. Outcome Patient perceptions of adverse events experienced during the previous year. Independent legal review was also used to estimate how many patient‐reports were serious enough to be potentially compensable. Results Although patient reports of possible adverse events was low (1.4%), the percentage of adverse events was eight times higher for patients with the greatest burden of illness than for those with the least (3.4% vs 0.4%). Two expert malpractice attorneys agreed that 9% of the adverse events seemed to be serious. Conclusions Patients will use internet technology to report their perceptions of health‐related adverse events. Some of the patient‐reported events reported will be serious. PMID:17545349

  7. Personal professional indemnity and contractual issues for trainees in obstetrics and gynaecology.

    PubMed

    Chatterjee, J; Datta, S; Butt, S; Harpwood, V

    2013-02-01

    Over the last few decades, more healthcare professionals have faced investigation into complaints about medical care and healthcare outcomes (Department of Health 2003). With increasing medical negligence cases being brought against doctors, it is time to carefully consider the implications of such actions to ensure appropriate safeguards (Ferner and McDowell 2006). At a time when the culture of 'no win, no fee' is rampant, the jobbing frontline doctor is on the back-foot trying to untangle the legalities of a malpractice claim (Ferner and McDowell 2006). Reassuringly, the numbers of doctors referred to the GMC or having to face legal procedures or claims for compensation are still very small (National Audit Office 2001). An essential issue for all doctors is having appropriate indemnity cover in the event that their practice is challenged. The opt-out for the European Working Time Regulations (EWTR) has caused further confusion as to what is covered for junior doctors by individual indemnity policies and the employer's liability scheme. Recently, the RCOG Trainees committee and the BMA Junior Doctors Association issued a joint advice regarding this issue (RCOG 2010). In this paper, we consider the differences in cover provided by the employer's liability scheme, individual professional indemnity schemes and the role of professional bodies. We also seek to clarify the understanding of these surrounding EWTR and the voluntary opt-out clause and provide up-to-date information on medico-legal issues and protection schemes regarding legal liabilities. PMID:23445131

  8. Assessment, origin, and implementation of breath volatile cancer markers.

    PubMed

    Haick, Hossam; Broza, Yoav Y; Mochalski, Pawel; Ruzsanyi, Vera; Amann, Anton

    2014-03-01

    A new non-invasive and potentially inexpensive frontier in the diagnosis of cancer relies on the detection of volatile organic compounds (VOCs) in exhaled breath samples. Breath can be sampled and analyzed in real-time, leading to fascinating and cost-effective clinical diagnostic procedures. Nevertheless, breath analysis is a very young field of research and faces challenges, mainly because the biochemical mechanisms behind the cancer-related VOCs are largely unknown. In this review, we present a list of 115 validated cancer-related VOCs published in the literature during the past decade, and classify them with respect to their "fat-to-blood" and "blood-to-air" partition coefficients. These partition coefficients provide an estimation of the relative concentrations of VOCs in alveolar breath, in blood and in the fat compartments of the human body. Additionally, we try to clarify controversial issues concerning possible experimental malpractice in the field, and propose ways to translate the basic science results as well as the mechanistic understanding to tools (sensors) that could serve as point-of-care diagnostics of cancer. We end this review with a conclusion and a future perspective. PMID:24305596

  9. Patient Decision Aids: A Case for Certification at the National Level in the United States.

    PubMed

    Poddar, Urbashi; Brownlee, Shannon; Stacey, Dawn; Volk, Robert J; Williams, John W; Elwyn, Glyn

    2015-01-01

    Patient decision aids enable patients to be better informed about the potential benefits and harms of their healthcare options. Certification of patient decision aids at the national level in the United States is a critical step towards responsible governance-primarily as a quality measure that increases patients' safety, as mandated in the U.S. Patient Protection and Affordable Care Act (PPACA). Certification would provide a verification process to identify conflicts of interest that may otherwise bias the scientific evidence presented in decision aids. Certification also benefits clinicians who may otherwise face malpractice claims based on harm to patients caused by possible reliance on patient decision aids that are inaccurate, incomplete, or presented in a manner that biases the patient's decision. Existing work by the International Patient Decision Aid Standards Collaboration could guide the establishment of a certification process within the U.S. This article argues for national certification of patient decision aids and discusses how that may be achieved. PMID:26752384

  10. The relationship of forensic odontology with various dental specialties in the articles published in the Journal of Forensic odonto-stomatology from 2005 to 2012

    PubMed Central

    Shamim, Thorakkal

    2015-01-01

    Background: There is a paucity of information about the relationship of forensic odontology with various dental specialties in the articles published in the Journal of Forensic Odonto-Stomatology. This study aimed to find the relationship of forensic odontology with various dental specialties in the articles published in the Journal of Forensic Odonto-Stomatology from 2005 to 2012 over an 8-year period. Methods: Bibliometric analysis was performed using web-based search during December 2013. Results: Out of the total 97 published articles, the maximum number of published articles were related to oral medicine and radiology (20) and community dentistry (20), followed by orthodontics (18), prosthodontics (15), and oral pathology and microbiology (8), pedodontics (7), oral and maxillofacial surgery (4) and conservative dentistry and endodontics (3). Among the articles published in Journal of Forensic Odonto-Stomatology, mass disasters (10) and bite mark analysis (10), followed by sexual dimorphism (8) and dental fraud and malpractice (8), followed by craniofacial superimposition (6) and identification (6) form the major attraction of the contributors. Conclusion: This paper has tried to evaluate the new working classification proposed for forensic odontology based on its relationship with other dental specialties. PMID:26097336

  11. Peer Support for Clinicians: A Programmatic Approach.

    PubMed

    Shapiro, Jo; Galowitz, Pamela

    2016-09-01

    Burnout is plaguing the culture of medicine and is linked to several primary causes including long work hours, increasingly burdensome documentation, and resource constraints. Beyond these, additional emotional stressors for physicians are involvement in an adverse event, especially one that involves a medical error, and malpractice litigation. The authors argue that it is imperative that health care institutions devote resources to programs that support physician well-being and resilience. Doing so after adverse and other emotionally stressful events, such as the death of a colleague or caring for victims of a mass trauma, is crucial as clinicians are often at their most vulnerable during such times. To this end, the Center for Professionalism and Peer Support at Brigham and Women's Hospital redesigned the peer support program in 2009 to provide one-on-one peer support. The peer support program was one of the first of its kind; over 25 national and international programs have been modeled off of it. This Perspective describes the origin, structure, and basic workings of the peer support program, including important components for the peer support conversation (outreach call, invitation/opening, listening, reflecting, reframing, sense-making, coping, closing, and resources/referrals). The authors argue that creating a peer support program is one way forward, away from a culture of invulnerability, isolation, and shame and toward a culture that truly values a sense of shared organizational responsibility for clinician well-being and patient safety. PMID:27355784

  12. Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment.

    PubMed

    McGrath, James

    2002-01-01

    This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment. PMID:15212044

  13. Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment.

    PubMed

    McGrath, James

    2002-01-01

    This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment. PMID:15212041

  14. Assessment, origin, and implementation of breath volatile cancer markers

    PubMed Central

    Haick, Hossam; Broza, Yoav Y.; Mochalski, Pawel; Ruzsanyi, Vera; Amann, Anton

    2016-01-01

    A new non-invasive and potentially inexpensive frontier in the diagnosis of cancer relies on the detection of volatile organic compounds (VOCs) in exhaled breath samples. Breath can be sampled and analyzed in real-time, leading to fascinating and cost-effective clinical diagnostic procedures. Nevertheless, breath analysis is a very young field of research and faces challenges, mainly because the biochemical mechanisms behind the cancer-related VOCs are largely unknown. In this review, we present a list of 115 validated cancer-related VOCs published in the literature during the past decade, and classify them with respect to their “fat-to-blood” and “blood-to-air” partition coefficients. These partition coefficients provide an estimation of the relative concentrations of VOCs in alveolar breath, in blood and in the fat compartments of the human body. Additionally, we try to clarify controversial issues concerning possible experimental malpractice in the field, and propose ways to translate the basic science results as well as the mechanistic understanding to tools (sensors) that could serve as point-of-care diagnostics of cancer. We end this review with a conclusion and a future perspective. PMID:24305596

  15. Composition of commercial truffle flavored oils with GC-MS analysis and discrimination with an electronic nose.

    PubMed

    Pacioni, Giovanni; Cerretani, Lorenzo; Procida, Giuseppe; Cichelli, Angelo

    2014-03-01

    Truffles are among the most expensive foods and their quality depends on their unique aroma, composed of complex mixtures of lipophilic volatile organic compounds (VOCs). There are many foods flavored with truffle, and oils are particularly common. Using DHS-GC-MS and an electronic nose (MOS), 18 samples of olive oil flavored with white and black truffles from the Italian market were subjected to a blind analysis. Qualitative and quantitative analysis with DHS-GC-MS detected the presence of 63 VOCs, 32 of which can be attributed to olive oil, also defective, and 19 to truffles, while 12 foreign compounds are of dubious origin (synthesis and/or demolition). The data obtained with the electronic nose (MOS), processed statistically, was able to discriminate the aromas coincident with the three species of truffle declared on the label (the white truffle Tuber magnatum and the black truffles Tuber melanosporum and Tuber aestivum), demonstrating the potential and reliability of this technique, confirming the established malpractice of the use of bismethyl(dithio)methane in black truffles flavorings. PMID:24176309

  16. Evaluating awareness regarding oral hygiene practices and exploring gender differences among patients attending for oral prophylaxis

    PubMed Central

    Oberoi, Sukhvinder Singh; Mohanty, Vikrant; Mahajan, Ananya; Oberoi, Avneet

    2014-01-01

    Background: Oral hygiene is intimated in health of all parts of the body including oral cavity. The understanding of actual practices in keeping the oral heath at standard based on patient's perceptions of oral health care is vital. Understanding the effect of gender on oral health would facilitate the development of successful attitude and behavior modification approach towards sustainable oral health. Purpose of Study: To evaluate awareness regarding oral hygiene practices and exploring gender differences among patients attending for oral prophylaxis. Materials and Methods: A survey was conducted among 250 patients attending the department of periodontology, Maulana Azad institute of dental sciences for oral prophylaxis. A structured questionnaire was used to collect information regarding practices and perception about oral hygiene. Results: Majority of the patients (60.4%) felt that oral hygiene is mandatory for overall health of the body. The use of toothpaste and toothbrush (83.6%) was the most preferred cleaning aid among the study population in the present study. The major constraint for avoiding dental examination was no felt need (41.2%) followed by cost of dental treatment (26.8%) and time constraints (24.0%). Conclusions: Professional plaque removal and regular follow-up combined with oral hygiene instructions to the patients can minimize the level of gingival inflammation and swelling. The poor resources for dental care, common malpractices and nonavailability of professional care are the main barriers in seeking optimum oral hygiene. PMID:25024553

  17. Neglect of the elderly: forensic entomology cases and considerations.

    PubMed

    Benecke, Mark; Josephi, Eberhard; Zweihoff, Ralf

    2004-12-01

    Wounds of living persons are a potential target for the same flies that live, or feed early on corpses. This can lead to complications in estimation of PMI but also allows to determine additional information that might be valuable in a trial, or during the investigations [e.g., M. Benecke, R. Lessig, Child neglect and forensic entomology, Forensic Sci. Int. 120 (2001) 155-159]. With forensic entomology, and forensic entomologists being more and more present, even lower profile cases like the neglect of elderly people (without violence being used against them; i.e., natural death) comes to our attention. Furthermore, much more people grow older than in the past years which leads to increased awareness of malpractice of caregivers in the professional, and personal environment [DPA (German Press Agency), Studie an 17000 Leichen: Jeder Siebte vor Tod falsch gepflegt (Every seventh elderly person not cared for sufficiently), German Press Agency dpa # 051402, Jan 3, Jan 5, 2003] . We briefly sketch three cases in which forensic entomology helped to better understand the circumstances of death, and the type and intensity of neglect before death. PMID:15639575

  18. [Selected legal aspects of the protection of the unborn child in the light of the draft amendment to the Polish Penal Code].

    PubMed

    Urbaniak, Moniak; Spaczyński, Robert Z

    2015-10-01

    Criminal Law Codification Commission, acting at the Ministry of Justice prepared proposals for amendments in the Polish Penal Code, related to offenses against life and health that were presented to the public in 2013. The draft provides for the protection of the child in the prenatal stage, introducing a new category of the entity to be protected, which is "unborn child" and "unborn child able to live outside the mother's body". These regulations provide for mothers criminal liability and responsibility of the medical staff (a doctor), as well as the child's father to the extent in which he is obliged to take steps aimed at rescuing the fetus. It is doctor's responsibility to show particular care for human health and life since a doctor has special medical knowledge and that is regulated by art. 30 of the act on professions of doctor and dentist. The proposed rule changes were not brought before the legislature in the current term of the Sejm (2011-2015), but due to the development of medicine, including obstetrical ultrasound, which enables visualization of a child that moves in the womb and is treated as a separate entity with distinct personal features the grounds are given for the opinion that the issue of the legal status of the unborn child, particularly in the context of causing death of a child in the last phase before birth as a result of medical malpractice or other external factors will be back in the public discussion. PMID:26677590

  19. Changing the law, changing the culture: rethinking the "sleepy resident" problem.

    PubMed

    Whetsell, Jennifer F

    2003-01-01

    Ms. Whetsell examines the Bell Regulations, which limit New York's hospital residents' work hours and require increased supervision from senior doctors, in light of the currently pending federal bill that seeks to do the same. The article argues that the federal government should draw lessons from the New York experience before proceeding with similar guidelines. The article notes that many roadblocks have prevented successful implementation of the New York policy, including a long-standing tradition of "hazing" first-year residents with long, unsupervised hours; medical community resistance to the notion of residents' sleep deprivation and dislike of government interference; and a general fear within the medical community of increased medical malpractice liability and other indicia of "blame culture." The Article concludes that the most effective approach to patient safety related to residency sleep deprivation should work within hospital culture, not against it. The proposed alternative approach would encourage patient safety strategies that value teamwork and cross-discipline collaboration, and consequently result in greater satisfaction for residents, hospitals, and patients. PMID:12705204

  20. The new genetics

    SciTech Connect

    Jaroff, L.

    1991-01-01

    Knowing the location and make-up of each of the 50,000 to 100,000 human genes will revolutionize the practice of medicine. This knowledge will lead to tailor-made therapies not only for treating disease but also for preventing it - in short, to a new concept of patient care. The Human Genome Project, a 15-year, $3 billion quest to determine the nucleotide sequence of the entire human genome, will make this possible. In The New Genetics, Leon Jaroff recounts the long path of discovery thatt has led to this huge new scientific venture - from the theory of heredity put forth by Aristotle more than 2,000 years ago to the current attempts to treat adenosine deaminase (ADA) deficiency and malignant melanoma via gene therapy. Against this background, the geneticists, molecular biologists, clinicians, and ethicists involved in the Human Genome Project describe their work and how it will provide physicians with ever more precise and effective tools to treat human disease. Jaroff also reveals the other, more problematic side of the story. Patients with an undesirable genetic profile may be subject to discrimination by private insurers. Physicians who fail to recommend genetic screening may find themselves victims of malpractice or wrongful-life suits. Indeed, these issues and others have already begun to affect physicians. The New Genetics makes it abundantly clear tha a revolution has arrived, and that physicians must be prepared to cope with the new order.

  1. A review of medical image watermarking requirements for teleradiology.

    PubMed

    Nyeem, Hussain; Boles, Wageeh; Boyd, Colin

    2013-04-01

    Teleradiology allows medical images to be transmitted over electronic networks for clinical interpretation and for improved healthcare access, delivery, and standards. Although such remote transmission of the images is raising various new and complex legal and ethical issues, including image retention and fraud, privacy, malpractice liability, etc., considerations of the security measures used in teleradiology remain unchanged. Addressing this problem naturally warrants investigations on the security measures for their relative functional limitations and for the scope of considering them further. In this paper, starting with various security and privacy standards, the security requirements of medical images as well as expected threats in teleradiology are reviewed. This will make it possible to determine the limitations of the conventional measures used against the expected threats. Furthermore, we thoroughly study the utilization of digital watermarking for teleradiology. Following the key attributes and roles of various watermarking parameters, justification for watermarking over conventional security measures is made in terms of their various objectives, properties, and requirements. We also outline the main objectives of medical image watermarking for teleradiology and provide recommendations on suitable watermarking techniques and their characterization. Finally, concluding remarks and directions for future research are presented. PMID:22975883

  2. Physician-patient communication: a lost art?

    PubMed

    Frymoyer, John W; Frymoyer, Nan P

    2002-01-01

    In the face of rapid advances in technology, there has been a progressive deterioration of effective physician-patient communication. The American Academy of Orthopaedic Surgeons has identified that patients rate the orthopaedic profession as high in technical and low in communication skills. Poor communication, especially patient-interviewing skills, has been identified in medical students as well as in practicing physicians. Effective communication is associated with improved patient and physician satisfaction, better patient compliance, improved health outcomes, better-informed medical decisions, and reduced malpractice suits, and it likely contributes to reduced costs of care. Recognition of the importance of communication has influenced medical schools to revise curricula and to teach communication skills in residency training and continuing medical education programs. National certifying examinations also are being designed to incorporate these skills. Although written material is useful in increasing awareness of the importance of good physician-patient communication, behavioral change is more likely to occur in a workshop environment. The American Academy of Orthopaedic Surgeons is taking leadership in designing and implementing such an approach for its membership. PMID:11929204

  3. [The physician in the Greek city].

    PubMed

    Koelbing, H M

    1989-01-01

    In the cities of ancient Greece, as well as later in Rome, the doctor's responsibility was already a controversial subject. The practice of healing was not subject to any official regulation: no protection of good physicians, no punishment of malpractice. While physicians often lead an itinerant life, cities endeavoured to secure the presence of a good one by appointing him town or public physician on the basis of a one-year contract. This did not mean, however, a "health service" free of charge for patients. The variety of healing persons including midwives and medicals slaves is reviewed. Some short texts which were added in later times to the "Works of Hippocrates" ("Physician", "Precepts", "Decorum") provide us with some information on a physician's daily life (see also H.M. Koelbing, The Hippocratic physician at his patient's bedside, in Practitioner 224, 1980, 551-554). From Hippocrates ("Prognostic") to the hellenistic period ("Decorum"), we note an important change as to the revelation of a bad prognosis: Hippocrates advocates the blunt information of the patient when there is no hope for him; but his follower in a later century takes into consideration the patient's psychology. He hides the cruel truth from him while informing openly his relatives and near friends. This is the first time in history we come across the principle of the doctor's double truth, strongly, advocated e.g. by Thomas Percival in his "Medical Ethics" (1803), but much disputed today. PMID:2673940

  4. Effective Communication About the Use of Complementary and Integrative Medicine in Cancer Care

    PubMed Central

    Cohen, Lorenzo

    2014-01-01

    Abstract Complementary and integrative medicine (CIM) is becoming an increasingly popular and visible component of oncology care. Many patients affected by cancer and their family members are looking for informed advice and desire communication with their physicians about CIM use. Patients affected by cancer come to discuss CIM use with intense emotions and are experiencing an existential crisis that cannot be ignored. Effective communication is crucial in establishing trust with these patients and their families. Communication is now recognized as a core clinical skill in medicine, including cancer care, and is important to the delivery of high-quality care. The quality of communication affects patient satisfaction, decision-making, patient distress and well-being, compliance, and even malpractice litigation. The communication process about CIM use requires a very sensitive approach that depends on effective communication skills, such as experience in listening, encouraging hope, and ability to convey empathy and compassion. This process can be divided into two parts: the “how” and the “what”. The “how” relates to the change in clinician attitude, the process of gathering information, addressing patients' unmet needs and emotions, and dealing with uncertainty. The “what” relates to the process of information exchange while assisting patients in decisions about CIM use by using reliable information sources, leading to informed decision-making. PMID:23863085

  5. Challenges in ethics, safety, best practices, and oversight regarding HIT vendors, their customers, and patients: a report of an AMIA special task force.

    PubMed

    Goodman, Kenneth W; Berner, Eta S; Dente, Mark A; Kaplan, Bonnie; Koppel, Ross; Rucker, Donald; Sands, Daniel Z; Winkelstein, Peter

    2011-01-01

    The current commercial health information technology (HIT) arena encompasses a number of competing firms that provide electronic health applications to hospitals, clinical practices, and other healthcare-related entities. Such applications collect, store, and analyze patient information. Some vendors incorporate contract language whereby purchasers of HIT systems, such as hospitals and clinics, must indemnify vendors for malpractice or personal injury claims, even if those events are not caused or fostered by the purchasers. Some vendors require contract clauses that force HIT system purchasers to adopt vendor-defined policies that prevent the disclosure of errors, bugs, design flaws, and other HIT-software-related hazards. To address this issue, the AMIA Board of Directors appointed a Task Force to provide an analysis and insights. Task Force findings and recommendations include: patient safety should trump all other values; corporate concerns about liability and intellectual property ownership may be valid but should not over-ride all other considerations; transparency and a commitment to patient safety should govern vendor contracts; institutions are duty-bound to provide ethics education to purchasers and users, and should commit publicly to standards of corporate conduct; and vendors, system purchasers, and users should encourage and assist in each others' efforts to adopt best practices. Finally, the HIT community should re-examine whether and how regulation of electronic health applications could foster improved care, public health, and patient safety. PMID:21075789

  6. An Electronic Patient Risk Communication Board

    PubMed Central

    Ohashi, Kumiko; Caligtan, Christine A.; Benoit, Angela N.; Breydo, Eugene M.; Carroll, Diane L.; Keohane, Carol A.; Bates, David W.; Dykes, John S.; Dykes, Patricia C.

    2012-01-01

    Communication failures have been identified as the root cause of the majority of medical malpractice claims and patient safety violations. We believe it is essential to share key patient risk information with healthcare team members at the patient’s bedside. In this study, we developed an electronic Patient Risk Communication Board (ePRCB) to assist in bridging the communication gap between all health care team members. The goal of the ePRCB is to effectively communicate the patient’s key risk factors, such as a fall risk or risk of aspiration, to the healthcare team and to reduce adverse events caused by communication failures. The ePRCB will transmit patient risk information and tailored interventions with easy-to-understand icons on an LCD screen at the point of care. A set of patient risk reminder icons was developed and validated by focus groups. We used the results of the evaluation to refine the icons for the ePRCB. PMID:24199109

  7. Legal issues concerning electronic health information: privacy, quality, and liability.

    PubMed

    Hodge, J G; Gostin, L O; Jacobson, P D

    1999-10-20

    Personally identifiable health information about individuals and general medical information is increasingly available in electronic form in health databases and through online networks. The proliferation of electronic data within the modern health information infrastructure presents significant benefits for medical providers and patients, including enhanced patient autonomy, improved clinical treatment, advances in health research and public health surveillance, and modern security techniques. However, it also presents new legal challenges in 3 interconnected areas: privacy of identifiable health information, reliability and quality of health data, and tortbased liability. Protecting health information privacy (by giving individuals control over health data without severely restricting warranted communal uses) directly improves the quality and reliability of health data (by encouraging individual uses of health services and communal uses of data), which diminishes tort-based liabilities (by reducing instances of medical malpractice or privacy invasions through improvements in the delivery of health care services resulting in part from better quality and reliability of clinical and research data). Following an analysis of the interconnectivity of these 3 areas and discussing existing and proposed health information privacy laws, recommendations for legal reform concerning health information privacy are presented. These include (1) recognizing identifiable health information as highly sensitive, (2) providing privacy safeguards based on fair information practices, (3) empowering patients with information and rights to consent to disclosure (4) limiting disclosures of health data absent consent, (5) incorporating industry-wide security protections, (6) establishing a national data protection authority, and (7) providing a national minimal level of privacy protections. PMID:10535438

  8. The systems approach for applying artificial intelligence to space station automation (Invited Paper)

    NASA Astrophysics Data System (ADS)

    Grose, Vernon L.

    1985-12-01

    The progress of technology is marked by fragmentation -- dividing research and development into ever narrower fields of specialization. Ultimately, specialists know everything about nothing. And hope for integrating those slender slivers of specialty into a whole fades. Without an integrated, all-encompassing perspective, technology becomes applied in a lopsided and often inefficient manner. A decisionary model, developed and applied for NASA's Chief Engineer toward establishment of commercial space operations, can be adapted to the identification, evaluation, and selection of optimum application of artificial intelligence for space station automation -- restoring wholeness to a situation that is otherwise chaotic due to increasing subdivision of effort. Issues such as functional assignments for space station task, domain, and symptom modules can be resolved in a manner understood by all parties rather than just the person with assigned responsibility -- and ranked by overall significance to mission accomplishment. Ranking is based on the three basic parameters of cost, performance, and schedule. This approach has successfully integrated many diverse specialties in situations like worldwide terrorism control, coal mining safety, medical malpractice risk, grain elevator explosion prevention, offshore drilling hazards, and criminal justice resource allocation -- all of which would have otherwise been subject to "squeaky wheel" emphasis and support of decision-makers.

  9. Cross-border issues in the development of medical tourism in Malaysia: legal challenges and opportunities.

    PubMed

    Nemie, Puteri; Kassim, Jahn

    2009-08-01

    Strategically located at the crossroads of Asia, Malaysia has become one of the key players in the fast-growing and lucrative market for health care services in Asia. Medical travel across international boundaries has been made possible through affordable airfares and the favourable exchange rates of the Malaysian ringgit has contributed to the rise of the "medical tourism phenomenon" where medical travel is combined with visiting popular tourist destinations in Malaysia. Further, competitive medical fees and modern medical facilities have also made Malaysia a popular destination for medical tourists. Nevertheless, the increased number of foreign patients has opened up possibilities of Malaysian health care providers being subjected to malpractice claims and triggering a myriad of cross-border legal issues. Presently, there is no internationally accepted legal framework to regulate medical tourism and issues of legal redress in relation to unsatisfactory provision of treatment across international boundaries. The economic benefits of medical tourism must be based upon a solid legal regulatory framework and strong ethical standards as well as upon high-quality medical and health care services. It is therefore important to assess the existing legal framework affecting the development of medical tourism in Malaysia in order to explore the gaps, deficiencies and possibilities for legal and regulatory reform. PMID:19771987

  10. A matter of accuracy. Nanobiochips in diagnostics and in research: ethical issues as value trade-offs.

    PubMed

    Le Roux, Ronan

    2015-04-01

    The paper deals with the introduction of nanotechnology in biochips. Based on interviews and theoretical reflections, it explores blind spots left by technology assessment and ethical investigations. These have focused on possible consequences of increased diffusability of a diagnostic device, neglecting both the context of research as well as increased accuracy, despite it being a more essential feature of nanobiochip projects. Also, rather than one of many parallel aspects (technical, legal and social) in innovation processes, ethics is considered here as a ubiquitous system of choices between sometimes antagonistic values. Thus, the paper investigates what is at stake when accuracy is balanced with other practical values in different contexts. Dramatic nanotechnological increase of accuracy in biochips can raise ethical issues, since it is at odds with other values such as diffusability and reliability. But those issues will not be as revolutionary as is often claimed: neither in diagnostics, because accuracy of measurements is not accuracy of diagnostics; nor in research, because a boost in measurement accuracy is not sufficient to overcome significance-chasing malpractices. The conclusion extends to methodological recommendations. PMID:24793012

  11. Use of assessment to reinforce patient safety as a habit.

    PubMed

    Galbraith, R M; Holtman, M C; Clyman, S G

    2006-12-01

    The US spends far more than any other nation on health care. Physicians undergo lengthy and comprehensive training that is carefully scrutinized, and are held to high standards in national examinations. At best the care delivered matches or exceeds that in any other country. And yet, often simple preventable medical errors occur at alarming and unacceptable rates. The public, corporate consumers of health care, large payors and malpractice insurance carriers are all becoming impatient with the pace of improvement. The medical profession recognizes that dealing with this problem is an urgent priority and is grappling to find the best approaches. This paper focuses on the constructive use of assessment to embed a pervasive and proactive culture of patient safety into practice, starting with the trainee and extending out into the practice years. This strategy is based on the adage that "assessment drives curriculum" and proposes a series of new assessment tools to be added to all phases of the training-practice continuum. PMID:17142605

  12. [Errors in surgery. Strategies to improve surgical safety].

    PubMed

    Arenas-Márquez, Humberto; Anaya-Prado, Roberto

    2008-01-01

    Surgery is an extreme experience for both patient and surgeon. The patient has to be rescued from something so serious that it may justify the surgeon to violate his/her integrity in order to resolve the problem. Nevertheless, both physician and patient recognize that the procedure has some risks. Medical errors are the 8th cause of death in the U.S., and malpractice can be documented in >50% of the legal prosecutions in Mexico. Of special interest is the specialty of general surgery where legal responsibility can be confirmed in >80% of the cases. Interest in mortality attributed to medical errors has existed since the 19th century; clearly identifying the lack of knowledge, abilities, and poor surgical and diagnostic judgment as the cause of errors. Currently, poor organization, lack of team work, and physician/ patient-related factors are recognized as the cause of medical errors. Human error is unavoidable and health care systems and surgeons should adopt the culture of error analysis openly, inquisitively and permanently. Errors should be regarded as an opportunity to learn that health care should to be patient centered and not surgeon centered. In this review, we analyze the causes of complications and errors that can develop during routine surgery. Additionally, we propose measures that will allow improvements in the safety of surgical patients. PMID:18778549

  13. The Function of a Medical Director in Healthcare Institutions: A Master or a Servant

    PubMed Central

    Kossaify, Antoine; Rasputin, Boris; Lahoud, Jean Claude

    2013-01-01

    The function of a medical director is presented along with features of efficiency and deficiencies from the perspective of healthcare system improvement. A MEDLINE/Pubmed research was performed using the terms “medical director” and “director”, and 50 relevant articles were selected. Institutional healthcare quality is closely related to the medical director efficiency and deficiency, and a critical discussion of his or her function is presented along with a focus on the institutional policies, protocols, and procedures. The relationship between the medical director and the executive director is essential in order to implement a successful healthcare program, particularly in private facilities. Issues related to professionalism, fairness, medical records, quality of care, patient satisfaction, medical teaching, and malpractice are discussed from the perspective of institutional development and improvement strategies. In summary, the medical director must be a servant to the institutional constitution and to his or her job description; when his or her function is fully implemented, he or she may represent a local health governor or master, ensuring supervision and improvement of the institutional healthcare system. PMID:25114566

  14. Appropriate use of medical interpreters.

    PubMed

    Juckett, Gregory; Unger, Kendra

    2014-10-01

    More than 25 million Americans speak English "less than very well," according to the U.S. Census Bureau. This population is less able to access health care and is at higher risk of adverse outcomes such as drug complications and decreased patient satisfaction. Title VI of the Civil Rights Act mandates that interpreter services be provided for patients with limited English proficiency who need this service, despite the lack of reimbursement in most states. Professional interpreters are superior to the usual practice of using ad hoc interpreters (i.e., family, friends, or untrained staff). Untrained interpreters are more likely to make errors, violate confidentiality, and increase the risk of poor outcomes. Children should never be used as interpreters except in emergencies. When using an interpreter, the clinician should address the patient directly and seat the interpreter next to or slightly behind the patient. Statements should be short, and the discussion should be limited to three major points. In addition to acting as a conduit for the discussion, the interpreter may serve as a cultural liaison between the physician and patient. When a bilingual clinician or a professional interpreter is not available, phone interpretation services or trained bilingual staff members are reasonable alternatives. The use of professional interpreters (in person or via telephone) increases patient satisfaction, improves adherence and outcomes, and reduces adverse events, thus limiting malpractice risk. PMID:25369625

  15. Private sector approach to health care reform. Interview by Thomas G. Goodwin.

    PubMed

    O'Brien, R

    1991-01-01

    The Healthcare Leadership Council (HLC) was formed in 1990 by 50 CEOs of hospitals, hospital systems, pharmaceutical companies, medical device manufacturers, Insurers and medical professionals. HLC is a coalition to develop the necessary consensus to realistically influence health care reforms. HLC urges that the "U.S. public policy goal should be to seek the best mechanism for balancing quality, access and affordability." As for access for the poor, the HLC would standardize eligibility for Medicaid at the federal poverty level, establishing a minimum basic benefit and payment plan with funding to come from specific taxes. For the employed uncovered, HLC would extend the exemption from state mandates to small employers; enact appropriate market reforms and provide income-related subsidies for those near the poverty line and for small employers; encourage employer-provided coverage for all employees on a voluntary basis.... HLC also backs state subsidized uninsurable risk pools for people whose conditions would make premiums too expensive. As for affordability of health care, HLC says consumers should become involved in cost-effective health care plans, appropriate employee cost sharing, lifestyle incentives/penalties, etc. Also, legislation should be overridden that inhibits innovation, creativity (state-mandated benefits, restrictions on selective contracting, CON requirements...), and medical malpractice tort reform measures also should be enacted. What follows is an in-depth interview with HLC Chairman G. Robert O'Brien, president of CIGNA Employee Benefits Companies. PMID:10109943

  16. The timely diagnosis of breast cancer. Principles of risk management for primary care providers and surgeons.

    PubMed

    Osuch, J R; Bonham, V L

    1994-07-01

    Alleged delay in the diagnosis of breast cancer is one of the most common reasons for medical malpractice claims in the United States, accounting for the largest indemnity payments of any single medical condition. Although the diagnosis of breast cancer can be challenging and sometimes difficult, principles of management exist to assist health providers in pursuing a resolution of any breast complaint. Studies have shown that when litigation is pursued for alleged failure to diagnose breast cancer, multiple specialists are named in the suit. In most cases, patients filing claims of alleged failure to diagnose breast cancer are premenopausal, while the majority of women diagnosed with breast cancer are postmenopausal. This reflects, in part, the challenge of diagnosing the disease in women who have difficult clinical exams to interpret, as well as dense parenchyma on mammograms, which decreases the sensitivity of the radiograph interpretation. Principles of risk management to avoid a delay in diagnosis include (1) pursuing every breast complaint to resolution, (2) following breast cancer screening guidelines, (3) establishing an office tracking system for breast cancer screening reminders, (4) tracking results of all mammograms and follow-up studies ordered, (5) referring premenopausal women for the evaluation of any breast mass that persists through a menstrual cycle, (6) considering any asymmetrical breast finding as a cause for concern, (7) referring every woman with a breast finding on physical examination for consultation, regardless of the mammogram report, and (8) carefully documenting patient history, physical exam findings, clinical impression, and follow-up plans. PMID:8004597

  17. [Inspection of guidelines for hepatocellular carcinoma].

    PubMed

    Arii, Shigeki

    2010-04-01

    An evidence-based clinical guideline for diagnosing and treating hepatocellular carcinoma patients was published in 2005, based on 7,118 original English papers(published between 1966-2002)and edited by the executive members of the Liver Cancer Study Group of Japan (Chief Editor, Professor M. Makuuchi, MD). These were composed of 58 clinical questions which covered prevention, surveillance, diagnosis, surgery, transplantation, chemotherapy, radiotherapy, chemoembolization and ablation therapy. The surveys investigating the validity and usefulness of this guideline revealed that it is well worked out and considered useful by medical practitioners. This guideline changed the therapeutic strategy of 20% of the experts. However, 43% of experts and 30% of non experts believed that this guideline restricted their medical discretion. Moreover, the percentage of medical practitioners who felt that medical malpractice suits would increase exceeded those who did not. A revised 2009 version was published based on the evaluation of 2,950 original papers (published between 2002-2007). Major revisions were not made, but clinical questions and scientific statements were updated. However, this version of the guideline does not provide clear recommendations in about 40% of the clinical questions because of lack of evidence. The guideline must be utilized based on an appropriate understanding of medical science and medical practice, and not on dogmatism. PMID:20414014

  18. [Influence of clinical guidelines on medical practitioners].

    PubMed

    Arii, Shigeki

    2007-09-01

    Evidenced-based clinical guidelines for diagnosing and treating hepatocellular carcinoma patients were published in 2005, which were edited by the executive members of the Liver Cancer Study Group of Japan (Chief Editor, Professor Masatosi Makuuchi, MD). This article presents the results of two surveys investigating the validity and usefulness of those guidelines. The author's opinions regarding the evaluation of the guidelines and guideline-based clinical practice are also presented. The surveys revealed that the guidelines are well known and thought to be useful by medical practitioners. The guidelines had changed the therapeutic strategy of 20% of experts in the field. However, 43% of experts and 30% of nonexperts believed that the guidelines restricted their medical discretion. Additionally, the percentage of physicians who felt that medical malpractice suits would increase exceeded those who did not. However, the guidelines do not provide clear recommendations in about 45% of diagnostic and therapeutic points because of a lack of evidence. The recommendations on these points in the guidelines require the commonsense discretion of physicians. The guidelines should be followed based on an understanding of biology and medicine, and not based on dogmatism. PMID:17907456

  19. Disclosure-and-resolution programs that include generous compensation offers may prompt a complex patient response.

    PubMed

    Murtagh, Lindsey; Gallagher, Thomas H; Andrew, Penny; Mello, Michelle M

    2012-12-01

    Under "disclosure-and-resolution" programs, health systems disclose adverse events to affected patients and their families; apologize; and, where appropriate, offer compensation. Early adopters of this approach have reported reduced liability costs, but the extent to which these results stem from effective disclosure and apology practices, versus compensation offers, is unknown. Using survey vignettes, we examined the effects of different compensation offers on individuals' responses to disclosures of medical errors compared to explanation and apology alone. Our results show that although two-thirds of these individuals desired compensation offers, increasing the offer amount did not improve key outcomes. Full-compensation offers did not decrease the likelihood of seeking legal advice and increased the likelihood that people perceived the disclosure and apology as motivated by providers' desire to avoid litigation. Hospitals, physicians, and malpractice insurers should consider this complex interplay as they implement similar initiatives. They may benefit from separating disclosure conversations and compensation offers and from excluding physicians from compensation discussions. PMID:23213152

  20. [Resolution of medical complaints by arbitration. Analysis of 140 cases].

    PubMed

    Valle-González, A

    2000-01-01

    The author studied 140 complex medical complaints handled by an Alternative Disputes Resolution Institution (CONAMED), between June 1996 and December 1999. There were 79 females and 61 males, cases originated in public hospitals 93 (66.4%) and private hospitals or practitioners 47 (33.6%). Several cases were treated sequentially in both types of institutions. The medical specialties involved were in frequency order: Neurosurgery, General Surgery, Gyn-Ob, Anesthesiology, Traumatology and Orthopedics, Oncology, Emergency, and 22 others. The causes of complaints were: Surgical treatment, Medical treatment, Diagnosis, Anesthesia, and mixed causes. There were 59 deaths, 43 anatomic or functional loses, disability or sequelae; and 34 recoveries. CONAMED delivered 27 arbitration verdicts, 94 expert opinions asked by prosecutors or human rights organizations, and 1 technical advice to medical authorities. Some resolutions included more than one case. More than half of physicians involved were found not guilty of malpractice. Even though the main CONAMED purpose is to improve the quality of Medical Care acting as The Health Ombudsman, its performance may be on behalf of medical practitioners. PMID:10992645

  1. Review of LCA studies of solid waste management systems--part II: methodological guidance for a better practice.

    PubMed

    Laurent, Alexis; Clavreul, Julie; Bernstad, Anna; Bakas, Ioannis; Niero, Monia; Gentil, Emmanuel; Christensen, Thomas H; Hauschild, Michael Z

    2014-03-01

    Life cycle assessment (LCA) is increasingly used in waste management to identify strategies that prevent or minimise negative impacts on ecosystems, human health or natural resources. However, the quality of the provided support to decision- and policy-makers is strongly dependent on a proper conduct of the LCA. How has LCA been applied until now? Are there any inconsistencies in the past practice? To answer these questions, we draw on a critical review of 222 published LCA studies of solid waste management systems. We analyse the past practice against the ISO standard requirements and the ILCD Handbook guidelines for each major step within the goal definition, scope definition, inventory analysis, impact assessment, and interpretation phases of the methodology. Results show that malpractices exist in several aspects of the LCA with large differences across studies. Examples are a frequent neglect of the goal definition, a frequent lack of transparency and precision in the definition of the scope of the study, e.g. an unclear delimitation of the system boundaries, a truncated impact coverage, difficulties in capturing influential local specificities such as representative waste compositions into the inventory, and a frequent lack of essential sensitivity and uncertainty analyses. Many of these aspects are important for the reliability of the results. For each of them, we therefore provide detailed recommendations to practitioners of waste management LCAs. PMID:24388596

  2. Social media in disaster risk reduction and crisis management.

    PubMed

    Alexander, David E

    2014-09-01

    This paper reviews the actual and potential use of social media in emergency, disaster and crisis situations. This is a field that has generated intense interest. It is characterised by a burgeoning but small and very recent literature. In the emergencies field, social media (blogs, messaging, sites such as Facebook, wikis and so on) are used in seven different ways: listening to public debate, monitoring situations, extending emergency response and management, crowd-sourcing and collaborative development, creating social cohesion, furthering causes (including charitable donation) and enhancing research. Appreciation of the positive side of social media is balanced by their potential for negative developments, such as disseminating rumours, undermining authority and promoting terrorist acts. This leads to an examination of the ethics of social media usage in crisis situations. Despite some clearly identifiable risks, for example regarding the violation of privacy, it appears that public consensus on ethics will tend to override unscrupulous attempts to subvert the media. Moreover, social media are a robust means of exposing corruption and malpractice. In synthesis, the widespread adoption and use of social media by members of the public throughout the world heralds a new age in which it is imperative that emergency managers adapt their working practices to the challenge and potential of this development. At the same time, they must heed the ethical warnings and ensure that social media are not abused or misused when crises and emergencies occur. PMID:24306994

  3. Medicolegal liability in surgical pathology: a consideration of underlying causes and selected pertinent concepts.

    PubMed

    Wick, Mark R

    2007-05-01

    Malpractice actions against surgical pathologists are still relatively uncommon, but they have increased in frequency over time and are associated with sizable indemnity figures. This discussion categorizes areas of liability in surgical pathology into three groups: those that represent health system flaws (problems with specimen identification, or transportation, or both; lack of clinical information or erroneous information; sampling effects and defects; and poorly reproducible or poorly defined diagnostic or prognostic criteria), others that exist at the interface between the system and individuals (allowing clinicians to bypass pathologic review of referred specimens; acceding to clinical demands for inadvisable procedures; and working in a disruptive environment), and truly individual errors by pathologists (lapses in reasoning; deficiencies concerning continuity in the laboratory; invalid assumptions regarding recipients of surgical pathology reports; over-reliance on the results of "special" tests; and problems with peer consultation). Finally, two important topic areas are discussed that commonly enter into lawsuits filed against surgical pathologists; namely, "delay in diagnosis" of malignant neoplasms and "failure to provide adequate prognostic information." Based on a review of the pertinent literature, we conclude that the clinical courses of most common malignancies are not affected in a significant manner by delays in diagnosis. Moreover, the practice of using "personalized external validity" for supposedly prognostic tests is examined, with the resulting opinion that prognostication of tumor behavior in individual patients is not reliable using anything but anatomic staging systems. PMID:17633350

  4. Pharmacy and the health-care environment.

    PubMed

    Oddis, J A

    1986-06-01

    The current revolution in the delivery of health care is examined, possibilities for the future are considered, and preparations for meeting the challenges of the future are discussed. The main elements in the revolution involve changes in the economic, business, and technological aspects of health-care delivery. The economic influences have included diagnosis-related groups (DRGs) and the Gramm-Rudman-Hollings legislation as it affects Medicare. Hospitals and hospital pharmacists have had to look closely at their own involvement and take measures to cut costs. The care of the elderly and the indigent and the issue of malpractice will require particular attention. Diversification and incorporation have brought many changes. Among them are the blurring of the traditional roles of pharmacy practice, as evidenced, for example, in the area of home health care. The changes made possible by technology are inseparable from the other current trends, and they add another dimension to health-care considerations--that of moral choices. Furthermore, pharmacy practitioner organizations will have to develop strategies for controlling the destiny of the profession in a corporate atmosphere. Pharmacists can achieve their full potential as society's drug therapy experts if they are flexible and creative enough to apply, in this new environment, the basic principles for which the profession has long stood. PMID:3728477

  5. Who owns the image? Archiving and retention issues in the digital age.

    PubMed

    Mezrich, Jonathan L; Siegel, Eliot

    2014-04-01

    Patients are often confused with respect to the ownership of radiologic images and the extent to which they may exert rights over their own imaging. In general, a facility that generates imaging maintains "ownership" rights. Patients have a right to inspect their images and obtain copies but they may not have the images or reports modified or stricken. Facilities may use images not only for treatment purposes but also have rights to use images with respect to educational training, quality control, and research, subject to HIPAA requirements. A facility has statutory obligations with respect to record retention and may face financial penalty and malpractice consequences for failure to retain images. Bankruptcy and state laws address issues of transfer of ownership of a patient's images in cases in which a facility goes out of business. Future questions remain as to whether the length of time a facility maintains images should increase as digital storage media improve and whether the use of inter-facility image sharing via "cloud" technology should alter obligations with respect to which facility must retain the images. PMID:24503046

  6. What's new in acute compartment syndrome?

    PubMed

    Harvey, Edward J; Sanders, David W; Shuler, Michael S; Lawendy, Abdel-Rahman; Cole, Ashley L; Alqahtani, Saad M; Schmidt, Andrew H

    2012-12-01

    Acute compartment syndrome (ACS) after trauma is often the result of increased size of the damaged tissues after acute crush injury or from reperfusion of ischemic areas. It usually is not solely caused by accumulation of free blood or fluid in the compartment, although that can contribute in some cases. There is no reliable and reproducible test that confirms the diagnosis of ACS. A missed diagnosis or failure to cut the fascia to release pressure within a few hours can result in severe intractable pain, paralysis, and sensory deficits. Reduced blood circulation leads to oxygen and nutrient deprivation, muscle necrosis, and permanent disability. Currently, the diagnosis of ACS is made on the basis of physical examination and repeated needle sticks over a short time frame to measure intracompartmental pressures. Missed compartment syndromes continue to be one of most common causes of malpractice lawsuits. Existing technology for continuous pressure measurements are insensitive, particularly in the deep tissues and compartments, and their use is restricted to highly trained personnel. Newer concepts of the pathophysiology accompanied by new diagnostic and therapeutic modalities have recently been advanced. Among these are the concept of inflammatory mediators as markers and anti-inflammatories as medical adjunct therapy. New diagnostic modalities include near-infrared spectroscopy, ultrafiltration catheters, and radio-frequency identification implants. These all address current shortcomings in the diagnostic armamentarium that trauma surgeons can use. The strengths and weaknesses of these new concepts are discussed to allow the trauma surgeon to follow current evolution of the field. PMID:22913965

  7. Legal issues of computer imaging in plastic surgery: a primer.

    PubMed

    Chávez, A E; Dagum, P; Koch, R J; Newman, J P

    1997-11-01

    Although plastic surgeons are increasingly incorporating computer imaging techniques into their practices, many fear the possibility of legally binding themselves to achieve surgical results identical to those reflected in computer images. Computer imaging allows surgeons to manipulate digital photographs of patients to project possible surgical outcomes. Some of the many benefits imaging techniques pose include improving doctor-patient communication, facilitating the education and training of residents, and reducing administrative and storage costs. Despite the many advantages computer imaging systems offer, however, surgeons understandably worry that imaging systems expose them to immense legal liability. The possible exploitation of computer imaging by novice surgeons as a marketing tool, coupled with the lack of consensus regarding the treatment of computer images, adds to the concern of surgeons. A careful analysis of the law, however, reveals that surgeons who use computer imaging carefully and conservatively, and adopt a few simple precautions, substantially reduce their vulnerability to legal claims. In particular, surgeons face possible claims of implied contract, failure to instruct, and malpractice from their use or failure to use computer imaging. Nevertheless, legal and practical obstacles frustrate each of those causes of actions. Moreover, surgeons who incorporate a few simple safeguards into their practice may further reduce their legal susceptibility. PMID:9385982

  8. Discussing harm-causing errors with patients: an ethics primer for plastic surgeons.

    PubMed

    Vercler, Christian J; Buchman, Steven R; Chung, Kevin C

    2015-02-01

    Plastic surgery is a field that demands perfection, yet despite our best efforts errors occur every day. Most errors are minor, but occasionally patients are harmed by our mistakes. Although there is a strong ethical requirement for full disclosure of medical errors, data suggest that surgeons have a difficult time disclosing errors and apologizing. "Conventional wisdom" has been to avoid frank discussion of errors with patients. This concept is fueled by the fear of litigation and the notion that any expression of apology leads to malpractice suits. Recently, there has been an increase in the literature pointing to the inadequacy of this approach. Policies that require disclosure of harm-causing medical errors to the patient and the family, apology, and an offer of compensation cultivate the transparency necessary for quality improvement efforts as well as the positive moral development of trainees. There is little published in the plastic surgery literature regarding error disclosure to provide guidance to practitioners. In this article, we will review the ethical, therapeutic, and practical issues involved in discussing the error with the patient and apologizing by presenting a representative case. This primer will provide an understanding of the definition of medical error, the ethical support of error disclosure, the barriers to disclosure, and how to overcome those barriers. PMID:24830658

  9. Evolving medical service in the information age: a legal analysis of applying telemedicine programs in Taiwan.

    PubMed

    Wu, Hsing-Hao

    2008-12-01

    In the face of the information age, Internet and telecommunication technologies have been widely applied in various settings. These innovational technologies have been used in the areas of e-commerce, long distance learning programs, entertainment, e-government, and so on. In recent years, the evolution of Internet technology is also pervading the health care industry. This dramatic trend may significantly alter traditional medical practice as well as the means of delivery of health care. The idea of telemedicine is to use modern information technology as a means or platform to deliver health care service in remote areas and to manage medical information in digitalized forms. The progress of developing telemedicine, however, is rather slow. The main reason for this slow progress is not technological but rather legal. Health care providers are reluctant to promote this innovation in medical service mainly due to uncertain legal consequences and ethical concerns. Although there are many legal challenges surrounding telemedicine, this note will examine major legal issues including licensure, malpractice liability, and privacy protection. Furthermore, I will discuss the potential of applying telemedicine programs in Taiwan's National Health Insurance Program (hereinafter referred to as NHI). PMID:19202856

  10. Cloudy confidentiality: clinical and legal implications of cloud computing in health care.

    PubMed

    Klein, Carolina A

    2011-01-01

    The Internet has grown into a world of its own, and its ethereal space now offers capabilities that could aid physicians in their duties in numerous ways. In recent years software functions have moved from the individual's local hardware to a central server that operates from a remote location. This centralization is called cloud computing. Privacy laws that speak to the protection of patient confidentiality are complex and often difficult to understand in the context of an ever-growing cloud-based technology. This article is a review of the legal background of protected health records, as well as cloud technology and physician applications. An attempt is made to integrate both concepts and examine Health Insurance Portability and Accountability Act (HIPAA) compliance for each of the examples discussed. The legal regulations that may inform care and standards of practice are reviewed, and the difficulties that arise in assessment and monitoring of the current situation are analyzed. For forensic psychiatrists who may be asked to provide expert opinions regarding malpractice situations pertaining to confidentiality standards, it is important to become acquainted with the new digital language from which these questions may arise. PMID:22159987

  11. Environmental market factors associated with physician career satisfaction.

    PubMed

    Mazurenko, Olena; Menachemi, Nir

    2012-01-01

    Previous research has found that physician career satisfaction is declining, but no study has examined the relationship between market factors and physician career satisfaction. Using a theoretical framework, we examined how various aspects of the market environment (e.g., munificence, dynamism, complexity) are related to overall career satisfaction. Nationally representative data from the 2008 Health Tracking Physician Survey were combined with environmental market variables from the 2008 Area Resource File. After controlling for physician and practice characteristics, at least one variable each representing munificence, dynamism, and complexity was associated with satisfaction. An increase in the market number of primary care physicians per capita was positively associated with physician career satisfaction (OR = 2.11, 95% CI: 1.13 to 3.9) whereas an increase in the number of specialists per capita was negatively associated with physician satisfaction (OR = 0.68, 95% CI: 0.48 to 0.97). Moreover, an increase in poverty rates was negatively associated with physician career satisfaction (OR = 0.95, 95% CI: 0.91 to 1.01). Lastly, physicians practicing in states with a malpractice crisis (OR = 0.81, 95% CI: 0.68 to 0.96) and/or those who perceived high competition in their markets (OR = 0.76, 95% CI: 0.61 to 0.95) had lower odds of being satisfied. A better understanding of an organization's environment could assist healthcare managers in shaping their policies and strategies to increase physician satisfaction. PMID:23087994

  12. Remedies by competitors for false advertising.

    PubMed

    Hirsch, B D; Wilcox, D P

    1990-05-01

    Patients who are victimized as a consequence of false medical advertising are not the only ones who can sue for damages. Under section 43(a) of the Lanham Act, effective November 17, 1989, anyone "who believes that he or she is or is likely to be damaged" by deceptive advertising may bring a civil action for damages (1). Competing physicians may sue other physicians who falsely advertise that they possess unique skills and achieve better results than other physicians because they employ exclusive methods of treatment or claim that certain surgical procedures they perform in the office are absolutely safe and without risk or who advertise false professional credentials to lure patients. Voluntary informed consent excludes the use of deceit. Misrepresentation through advertising deprives a patient of the right to exercise an informed consent (2). A patient who relies on a doctor's false advertising in agreeing to a procedure that causes the patient injury may sue for malpractice even if the procedure was performed without negligence. False medical advertising also exposes the advertiser to litigation by competitors for unfair competition. This article is concerned with the remedy that may be available for instituting private litigation against physicians and other health care providers who engage in untruthful advertising. PMID:2343426

  13. Hereditary breast and gynecological tumors: Italian legal issues.

    PubMed

    DI Vella, Giancarlo

    2016-10-01

    The availability of diagnostic and therapeutic procedures that lower the risk for developing hereditary family-related tumors is weighed against Italian ethical and legal provisions. The healthcare environment in which a professional works should require that he possess specific technical, relational and medical competencies based upon legal orientation in addition to scientific evidence. Particular emphasis is attributed to the doctor-patient relationship, with explicit reference to the following: 1) all of the information at hand that is required to achieve a "therapeutic alliance" that combines the best interests of the patient with treatment options; 2) the completeness and intelligibility of health records, as they are likely to explain the background logic and the following of scientific clinical procedure; 3) the observance of guidelines and protocols, and their relevance to the legal responsibility of the individual and health care companies; 4) the need of a multidisciplinary approach in the treatment of these patients and the obligation of the team to have malpractice insurance. Advances on "provisions concerning liability of health personnel", which is currently awaiting approval, allows the professional to protect the patient's health without the fear of being unnecessarily censured, and unjustified from a penal or civil point of view which can deteriorate the relationship of trust and cooperation established. PMID:26924172

  14. Lessons from London: the British are reforming their national health service.

    PubMed

    Vall-Spinosa, A

    1991-12-01

    In an effort to keep abreast of the changing needs of a more affluent society and to ensure better value for money, the British are reforming their National Health Service. They are promoting competition and entrepreneurship, and directing funding to follow a patient rather than flowing directly to institutions. British physicians are resisting these changes. The United States, in the middle of a health care crisis of its own, can learn a great deal from Britain, especially in the area of controlling expenditures. The low cost of the National Health Service can be attributed to four major factors: (1) It is general practitioner driven and no patient accesses a specialist or hospital directly. (2) Hospitals, which employ all the specialists and supply most of the technology, operate on very tight, cash-limited budgets. (3) Administrative costs are very low. (4) The expense of malpractice is not (yet) a major concern. Changes occurring in both countries foretell a future wherein our health care systems may look very much alike. PMID:1746650

  15. The Legal Past, Present and Future of Prenatal Genetic Testing: Professional Liability and Other Legal Challenges Affecting Patient Access to Services

    PubMed Central

    Pergament, Deborah; Ilijic, Katie

    2014-01-01

    This chapter is an overview of the current status of the law in the United States regarding prenatal genetic testing with an emphasis on issues related to professional liability and other challenges affecting patient access to prenatal genetic testing. The chapter discusses the roles that federal regulations, promulgated by the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC), play in the regulation of prenatal genetic tests. The chapter discusses tort litigation based on allegations of malpractice in the provision of prenatal genetic testing and how courts have analyzed issues related to causation, damages and mitigation of damages. The chapter provides reference information regarding how individual states address causes of action under the tort theories of wrongful birth and wrongful life. The chapter concludes with a discussion of future legal issues that may affect clinical prenatal genetic testing services arising from the continued expansion of prenatal genetic testing, legal restrictions on access to abortion and the potential development of embryonic treatments. PMID:26237611

  16. [The punishment of a pharmacist in Istanbul in 1853].

    PubMed

    Altintas, A

    1998-01-01

    Yakop who ran a pharmacy in Istanbul was accused of malpractice in 1853. The pharmacist had prepared a bottle of cod liver oil for a patient and a bottle of croton oil for another one. He had neglected to label the bottles which were administered by mistake to the patients by his apprentice. The patient who drank a spoonful of croton oil was intoxicated immediately and died. As soon as the event was reported, the police asked the deceased person's family if they intended to sue the pharmacist. They did not. However, the police forces started an investigation and asked the School of Medicine whether the pharmacist was guilty. The School answered that the pharmacist had neglected to label the bottles and was found guilty of causing the death. The Supreme Court took up the matter and sentenced Mr. Yakop to six months imprisonment and decided to close his pharmacy. The decision was published in Takvim-i Vekayi, the official newspaper of the State. PMID:11624174

  17. Experimental and Numerical Analysis of the Effects of Curing Time on Tensile Mechanical Properties of Thin Spray-on Liners

    NASA Astrophysics Data System (ADS)

    Guner, D.; Ozturk, H.

    2016-08-01

    The effects of curing time on tensile elastic material properties of thin spray-on liners (TSLs) were investigated in this study. Two different TSL products supplied by two manufacturers were tested comparatively. The "dogbone" tensile test samples that were prepared in laboratory conditions with different curing times (1, 7, 14, 21, and 28 days) were tested based on ASTM standards. It was concluded that longer curing times improves the tensile strength and the Young's Modulus of the TSLs but decreases their elongation at break. Moreover, as an additional conclusion of the testing procedure, it was observed that during the tensile tests, the common malpractice of measuring sample displacement from the grips of the loading machine with a linear variable displacement transducer versus the sample's gauge length had a major impact on modulus and deformation determination of TSLs. To our knowledge, true stress-strain curves were generated for the first time in TSL literature within this study. Numerical analyses of the laboratory tests were also conducted using Particle Flow Code in 2 Dimensions (PFC2D) in an attempt to guide TSL researchers throughout the rigorous PFC simulation process to model support behaviour of TSLs. A scaling coefficient between macro- and micro-properties of PFC was calculated which will help future TSL PFC modellers mimic their TSL behaviours for various tensile loading support scenarios.

  18. Rising from Plagiarising.

    PubMed

    Mohan, Muralee; Shetty, Deepthi; Shetty, Tripthi; Pandya, Kalpa

    2015-09-01

    Amongst the various forms of scientific misconduct, plagiarism has become increasingly prevalent in today's scientific process. Plagiarism is copying another author's ideas or words and portraying them as your own. Inclusion of another source's contents without giving credit to the source results in this unethical practice. Text derived directly from a source must always be put under quotation marks. Decreased awareness about plagiarism and what exactly constitutes it results in unintentional plagiarism. Plagiarism can be that of the ideas in which the author projects others' ideas as his own. It can also be that of the text also known as word to word plagiarism. Mosaic plagiarism is another form. Various guidelines formulated by esteemed scientific bodies such as World Association of Medical Editors, Committee on publication Ethics have provided an insight to authors, editors, publishers and peer reviewers into the practice of ethical writing. By understanding the true essence of plagiarism and following strict guidelines, it is certainly possible to avoid plagiarism. Various softwares are available to detect plagiarism. These softwares have a wide database which is scanned to reveal any kind of malpractice. If detected, it can have grave consequences causing not only retraction of the article but also loss of dignity. Failure to detect plagiarism reflects negatively on a journal. Originality is the true essence of any research or scientific paper. Any violation of this fact is an unforgivable offence. Thus, this review article attempts to cover the meaning, types, risks and ways to avoid plagiarism. PMID:26225041

  19. Descriptive Study of Occupational Accidents and their Causes among Electricity Distribution Company Workers at an Eight-year Period in Iran

    PubMed Central

    Rahmani, Abdolrasoul; Khadem, Monireh; Madreseh, Elham; Aghaei, Habib-Allah; Raei, Mehdi; Karchani, Mohsen

    2013-01-01

    Background Occupational accidents are unplanned events that cause damage. The socio-economic impacts and human costs of accidents are tremendous around the world. Many fatalities happen every year in workplaces such as electricity distribution companies. Some electrical injuries are electrocution, electric shock, and burns. This study was conducted in an electricity distribution company (with rotational 12-hour shift work) in Iran during an 8-year period to survey descriptive factors of injuries. Methods Variables collected included accident time, age of injured worker, employment type, work experience, injury cause, educational background, and other information about accidents. Results Results indicated that most of the accidents occurred in summer, and 51.3% were during shift work. Worker negligence (malpractice) was the cause of 75% of deaths. Type of employment had a significant relationship with type of injuries (p < 0.05). Most injuries were electrical burns. Conclusion High rate of accidents in summer may be due to the warm weather or insufficient professional skills in seasonal workers. Shift workers are at risk of sleep complaints leading to a high rate of work injuries. Acquiring knowledge about safety was related to job experiences. Temporary workers have no chance to work all year like permanent workers, therefore impressive experiences may be less in them. Because the lack of protective equipment and negligence are main causes of accidents, periodical inspections in workshops are necessary. PMID:24106647

  20. Legal issues in the practice of critical care medicine: a practical approach.

    PubMed

    Szalados, James E

    2007-02-01

    The intensive care unit is characterized by severely ill patients who frequently succumb to their disease, despite complex modern therapies and the best efforts of dedicated care teams. Although critical care is not historically characterized as a high-risk medical specialty with respect to litigation, the urgency, complexity, and invasive nature of intensive care unit care clearly increases legal risk exposure. Physicians do not practice in a vacuum. Instead, the practice of medicine is increasingly affected by government regulation, societal pressures, and pubic expectations. Law governs the interactions among the government, institutions, and individuals. Therefore, at a time when the practice of medicine itself is becoming increasingly more complex, physicians and other healthcare providers also face increasing administrative and legal challenges. Therefore, it is imperative that physicians develop an understanding of basic substantive and procedural law; first, so that their practices can be more focused and rewarding and less a fear of the unknown; second, that we can work proactively to minimize our legal risk; third, so that we can better communicate with risk managers, attorneys, and insurers; and finally, so that we can better understand and participate in future legal, legislative, regulatory, and public policy development. Accordingly, this general overview briefly addresses the substantive law of medical malpractice, informed consent, the law relating to research in critical care, Emergency Medical Treatment and Active Labor Act, the False Claims Act, peer review, state board disciplinary issues, and the Health Insurance Portability and Accountability Act; in addition, relevant procedural considerations will be briefly summarized. PMID:17242606

  1. Challenges in ethics, safety, best practices, and oversight regarding HIT vendors, their customers, and patients: a report of an AMIA special task force

    PubMed Central

    Berner, Eta S; Dente, Mark A; Kaplan, Bonnie; Koppel, Ross; Rucker, Donald; Sands, Daniel Z; Winkelstein, Peter

    2010-01-01

    The current commercial health information technology (HIT) arena encompasses a number of competing firms that provide electronic health applications to hospitals, clinical practices, and other healthcare-related entities. Such applications collect, store, and analyze patient information. Some vendors incorporate contract language whereby purchasers of HIT systems, such as hospitals and clinics, must indemnify vendors for malpractice or personal injury claims, even if those events are not caused or fostered by the purchasers. Some vendors require contract clauses that force HIT system purchasers to adopt vendor-defined policies that prevent the disclosure of errors, bugs, design flaws, and other HIT-software-related hazards. To address this issue, the AMIA Board of Directors appointed a Task Force to provide an analysis and insights. Task Force findings and recommendations include: patient safety should trump all other values; corporate concerns about liability and intellectual property ownership may be valid but should not over-ride all other considerations; transparency and a commitment to patient safety should govern vendor contracts; institutions are duty-bound to provide ethics education to purchasers and users, and should commit publicly to standards of corporate conduct; and vendors, system purchasers, and users should encourage and assist in each others' efforts to adopt best practices. Finally, the HIT community should re-examine whether and how regulation of electronic health applications could foster improved care, public health, and patient safety. PMID:21075789

  2. National program for family planning and primary health care Pakistan: a SWOT analysis

    PubMed Central

    2013-01-01

    Background The National Program for Family Planning and Primary Healthcare was launched in 1994. It is one of the largest community based programs in the world, providing primary healthcare services to about 80 million people, most of which is rural poor. The program has been instrumental in improving health related indicators of maternal and child health in the last two decades. Methods SWOT analysis was used by making recourse to the structure and dynamics of the program as well as searching the literature. SWOT analysis Strengths of the program include: comprehensive design of planning, implementation and supervision mechanisms aided by an MIS, selection and recruitments processes and evidence created through improving health impact indicators. Weaknesses identified are slow progress, poor integration of the program with health services at local levels including MIS, and de-motivational factors such as job insecurity and non-payment of salaries in time. Opportunities include further widening the coverage of services, its potential contribution to health system research, and its use in areas other than health like women empowerment and poverty alleviation. Threats the program may face are: political interference, lack of funds, social threats and implications for professional malpractices. Conclusion Strengthening of the program will necessitate a strong political commitment, sustained funding and a just remuneration to this bare foot doctor of Pakistan, the Lady Health Worker. PMID:24268037

  3. [Undislocated fracture of cuneiform I bone complicated by language barrier].

    PubMed

    Lang, C F; Greipel, J M

    2013-12-01

    A 30-year-old non-German speaking patient suffered an ankle sprain while playing beach volleyball. Conventional radiography did not reveal any fractures. The patient was treated with a Geisha cast for immobilization and relief and was also informed about pain-dependent weight bearing using an illustrated information sheet. In the course of the healing process the patient consulted the orthopedic department a second time. During a third visit he left before consultation as he felt that the waiting time was too long. Because he disagreed with the treatment he visited an orthopedist who ordered a magnetic resonance imaging (MRI) scan of the patient’s foot. The MRI scan revealed an undislocated fracture of the cuneiform I bone. A control scan was conducted 2 months later and complex regional pain syndrome (CRPS) was diagnosed. The orthopedist ordered treatment based on a therapy with a VacoPed® orthesis. When there was no improvement in the healing process the patient sued the orthopedic surgeon for medical malpractice due to incorrect load and subsequent pain for € 40,000. All courts up to the Federal Court of Germany dismissed the case as no expert witnesses could find any errors in treatment. The court held that the medical information of the non-German speaking patient was sufficient against the defendant’s arguments. It is, however, noteworthy that the burden of proof for sufficient medical information of a patient is always placed on the treating physician. PMID:24121317

  4. It is time to wash the linen.

    PubMed

    Bajaj, Rajiv

    2007-01-01

    The unethical practice of commissions in private healthcare requires an open debate since it leads to expensive and hazardous healthcare. Doctors are accused of being sales agents and law breakers, private hospitals resemble luxury hotels, the consumer has become fair game whenever he/she has money, and our profession and society are rendered insensitive to human suffering. At the root of this malaise is the unplanned promotion of healthcare as a free market product. This very complex product, which is required in times of stress and vulnerability, has been institutionalized as a business for profiteering in the absence of adequate checks and balances. The product is inherently unsuited for the free market because the consumer cannot be king unless he is empowered to choose wisely. Not enough has been done to address this deficiency. Efforts are required to strengthen non-profit health facilities; to make the consumer wise and minimize her/his exposure to doctored health information. The present unethical practices of our profession are not the fault of doctors or the Medical Council of India, and punitive measures would be inappropriate. We should start with the creation of a government health website which educates the public about modern healthcare, and by regulating advertisement of health products. Since health personnel, officials and news media are directly benefited by the present malpractices, corrective will require consumer participation. PMID:17867621

  5. Continuing problems with patient self-determination.

    PubMed

    White, B D; Singer, P A; Siegler, M

    1993-01-01

    Cruzan v. Director, Missouri Department of Health, the first "right to do die" case to be decided by the United States Supreme Court, constitutionalizes the principle of patient self-determination. The case encourages competent patients to reflect thoughtfully about the possibility that one day they may be incapacitated just as Nancy Beth Cruzan was and to prepare for that possibility by completing an advance directive. Furthermore, the recently enacted Patient Self-Determination Act requires hospitals to ask adult patients upon admission whether they have advance directives. However, a number of practical concerns arise for physicians about operationalizing these patient self-determination principles within their states and their scopes of practice. Will physicians be prosecuted for "assisting suicides" if they withdraw feeding tubes or forgo other life-sustaining treatments? Will physicians be liable in medical malpractice for "undertreatment" or "overtreatment" in such cases? Will physicians be asked to violate their own moral codes in treating patients? Will others intrude into the traditional physician-patient relationship and decision-making process? Will physicians be caught in the middle of troublesome family, staff, and institutional disputes? How will physicians learn of patients' advance directives? Will physicians be asked to continue care in futile cases? Will Cruzan's self-determination doctrine be improperly extended? Successful implementation of patient self-determination principles will require consideration and discussion of these practical physician concerns. PMID:8161890

  6. Not only a clinical nightmare: amniotic fluid embolism in court.

    PubMed

    Busardo, Francesco P; Gulino, Matteo; Di Luca, Natale M; Vergallo, Gianluca M; Pacchiarotti, Arianna; Frati, Paola

    2014-01-01

    Amniotic fluid embolism (AFE) is an uncommon obstetric condition involving usually women in labour or in the early post-partum period. Clinical consequences of this unpredictable and unpreventable pathology may be extremely serious with high morbidity and mortality rates. Data obtained from the US Amniotic Fluid Embolism Registry show that the process is more similar to anaphylaxis than to embolism, and the term anaphylactoid syndrome of pregnancy has been suggested because foetal tissue or amniotic fluid components are not universally found in women who present signs and symptoms related to AFE. The first aim of this paper has been to focus on the medico-legal aspects concerning the misdiagnosis and the treatment of the AFE and the Authors, with this purpose in mind, reviewed the main national law cases on medical malpractice claims involving both physicians and hospitals. The second aim has been to highlight the need to introduce a National register as a useful tool to raise the awareness of this disease among physicians and to improve the quality of care, which can be achieved through a proper identification and reporting of AFE cases. The application of a national register may limit the number of medico-legal litigations, which according to the national and foreign Jurisprudence are not currently based in favour of the predictability of AFE, but they focus their discussion on the importance of a prompt medical assistance when the effects of this disorder occur. PMID:24804728

  7. Professional conduct: when patient requests exceed the boundaries of dental care.

    PubMed

    Chiodo, G T; Tolle, S W

    1998-01-01

    This discussion began with a question regarding the possibility of defining the elements of unprofessional conduct. It is likely that the many elements that may be intrinsic to this definition are, in part, temporally situated--that is, unprofessional behavior is defined somewhat differently today than in 1940. The three cases presented underscore this point. It is not likely that dentists of two or three decades ago were confronted with patients desiring pierced tongues, radio stations that saw dental offices as ideal participants in publicity stunts, or individuals admitting their dentist was an instrument of erotic pleasure. Despite this dynamic nature of new challenges to professional conduct, many elements are constant. Certainly the ethical obligations of beneficence, nonmalficence, respect for autonomy, and justice have remained since the time of Galen. We have proposed that one modern-day element of defining professional conduct is the performance of a professional action for a nonprofessional purpose. These types of actions can be harmful to patients and embarrassing to the profession. Finally, it is likely that the dentist who cooperates in any of the scenarios presented could be held to violation of malpractice standards and/or be reprimanded by state dental boards. In addition to these legal entanglements, it is clear that knowingly and willingly participating in any of the presented cases comprises unethical behavior. PMID:9663069

  8. [Not Available].

    PubMed

    Santoro, Valeria; Lozito, Piercarlo; Donno, Antonio De; Grassi, Felice Roberto; Introna, Francesco

    2009-01-01

    The Authors describe two cases of alleged malpractice due to overfilling. The aim of this article is to underline some medico-legal aspects regarding the quantity of extruded material which may be considered acceptable and the consequent damage to the patient. Two cases are presented here: In the first case, the dentist's liability is clear due to excessive extrusion of endodontic material beyond the apical region combined with incomplete obturation of the canals. In the second case however, because two different dentists were involved, establishing the connection of causality between their work and the damage reported by the patient was not easy. This situation makes it difficult to establish the limits of potential responsibility, coupled with the complete absence of radiographic signs of periapical rarefaction and the small quantities of material beyond the apex. From a medico-legal point of view, a dentist may be held responsible for compensation and financial expenses of a patient for restoration of damage resulting from a dental procedure.Italian guidelines offer no indications as to when overfilling should be considered the result of a procedural error, or if it fits within the range labelled as "acceptable" and this gap offers extremely subjective interpretations of legal consultants. So, it would therefore be useful to adopt more precise qualitative/dimensional parameters, keeping in mind that the guidelines offer therapeutic recommendations and are not rigid protocols. PMID:19543544

  9. [Legal medicine and dentistry].

    PubMed

    D'Attilio, M; Centobeni, R; D'Arcangelo, C

    1996-04-01

    With reference to cases of American dentists sued for "malpractice" during the 80s, the authors summarise the causes why, initially, the American lawyers found it difficult to plead on behalf of their clients. Therefore, the authors suggest a number of measures in order to reduce the probability of being sued by patients. In particular, they focus attention on:--the duty to treat patients, with reference to experimentation on humans within the context of scientific research and citing the Declaration of Helsinki;--informed consent, with particular emphasis on the need to inform the patient regarding all aspects of treatment, including any risks or presumed complications that might arise during and after treatment;--professional liability, drawing a distinction between moral responsibility (regulated by the Code of Professional Practice) and legal liability (involving the legal field). Lastly, the authors underline the need to perfect and increase the awareness of the "management" risk of a dental practice, drawing special attention to the need to keep precise records on patients receiving treatment: radiographical and photographical examination, remote and recent medical history, the current state of teeth and gums, the presence of clicks and/or crepitus on ATM, cephalea, spontaneous and/or provoked pain involving masticatory and cervical muscles, obtaining the informed consent of the patient. PMID:8926985

  10. Angels of mercy? The legal and professional implications of withdrawal of life-sustaining treatment by nurses in England and Wales.

    PubMed

    Birchley, Giles

    2012-01-01

    In circumstances where life-sustaining treatment appears merely to be drawing out the inevitable, it is usual practice for the healthcare team to withdraw aggressive life-sustaining measures, once agreement is reached with the patient and their family. Common law gives doctors several defences to allegations of criminality or malpractice in taking the key actions that withdraw treatment and result in the patient's death; however, the legal defensibility of nurses undertaking this role has not been explored. In the absence of a specific body of law related to nurses taking the actions that withdraw life-sustaining treatment, I discuss the probable legal response by considering parallel cases. Examining some of the circumstances in which doctors are allowed to take life, I argue that the legal dispensation by which doctors are permitted to perform these tasks rests largely on their identity as doctors rather than any distinctive feature of their activities themselves. This uniqueness means that medical law for nurses is quite distinct from that for doctors. While it may nevertheless give nurses practical exemption from the legal consequences of their actions in withdrawal, it depends upon a judicial view that nurses are instruments of doctors. This judicial position is at odds with nurses' professional responsibilities, which envisage them as independent professionals who are liable for their own actions, inviting potentially adverse consequences from their professional registrar. PMID:22452808

  11. The expert witness: defending the profession or prosecuting your peers.

    PubMed

    Haas, R E; Bradshaw, M J

    1999-05-01

    The use of CRNAs as expert witnesses in court cases is well-established. The CRNA who acts as a legal consultant or an expert witness is not retained merely to pontificate in the courtroom based on their considerable experience and expertise. The CRNA will undertake many roles in the process of assisting the attorney including those of (1) record reviewer and data analyst, (2) researcher and retriever, (3) synthesizer, and (4) teacher. Beyond these roles is the philosophical premise that the person best suited to evaluate the competence of a nurse anesthetist is another nurse anesthetist. Poor practitioners who are a danger to the public ought to be held accountable for their failings, whereas excellent practitioners who are mistakenly accused of negligence ought to be defended. Although challenging and time consuming, the role of the legal consultant and expert witness is rewarding in both financial and personal satisfaction terms. The role and functions of the CRNA who takes on the challenges of appearing as an expert witness or legal consultant is explored. The fine points of medical malpractice is not discussed, except as a cursory overview. The goal is to provide the practicing CRNA with the basic tools needed for these roles. PMID:10504913

  12. Development of surface enhanced Raman scattering (SERS) spectroscopy monitoring of fuel markers to prevent fraud

    NASA Astrophysics Data System (ADS)

    Wilkinson, Timothy; Clarkson, John; White, Peter C.; Meakin, Nicholas; McDonald, Ken

    2013-05-01

    Governments often tax fuel products to generate revenues to support and stimulate their economies. They also subsidize the cost of essential fuel products. Fuel taxation and subsidization practices are both subject to fraud. Oil marketing companies also suffer from fuel fraud with loss of legitimate sales and additional quality and liability issues. The use of an advanced marking system to identify and control fraud has been shown to be effective in controlling illegal activity. DeCipher has developed surface enhanced Raman scattering (SERS) spectroscopy as its lead technology for measuring markers in fuel to identify and control malpractice. SERS has many advantages that make it highly suitable for this purpose. The SERS instruments are portable and can be used to monitor fuel at any point in the supply chain. SERS shows high specificity for the marker, with no false positives. Multiple markers can also be detected in a single SERS analysis allowing, for example, specific regional monitoring of fuel. The SERS analysis from fuel is also quick, clear and decisive, with a measurement time of less than 5 minutes. We will present results highlighting our development of the use of a highly stable silver colloid as a SERS substrate to measure the markers at ppb levels. Preliminary results from the use of a solid state SERS substrate to measure fuel markers will also be presented.

  13. [Interactions between criminal justice and other areas of law from the viewpoint of the civil rights judge].

    PubMed

    Rumler-Detzel, P

    1998-10-01

    More than in the past, patients are consulting lawyers to check medical treatment for malpractice. One of 10,000 city-inhabitants institutes proceedings for compensations. In the past, a charge was brought at the same time to achieve examination of patients records and to obtain an expert opinion at government expenses. Due to recent jurisdiction, the patient got the right to examine treatment records without the necessity to specify his reasons. Settlement institutions of the society of physicians of Germany facilitate an examination of a treatment procedure for mistakes without costs. Therefore, there is no more incentive for a charge to achieve compensations. The continuation of civil proceedings may not depend on the result of the investigation proceedings due to the different kind of evidence. The special duties of civil courts working with medical liability and expert opinions seem to show that civil proceedings are suited the best to clarify a dispute between physicians and patients. This also avoids to pillories the physician. PMID:9885177

  14. Prevention and management of accidental foreign body ingestion and aspiration in orthodontic practice

    PubMed Central

    Umesan, Uday Kumar; Chua, Kui Lay; Balakrishnan, Priya

    2012-01-01

    Among the myriad emergencies that could arise in the dental clinical setting there are a few that occur occasionally despite being entirely preventable. Ingestion or aspiration of dental materials, appliances, or instruments comprises this category. Regardless of incidence, foreign body ingestion or aspiration episodes are recognized as potential complications in the specialty of orthodontics. Despite their infrequent occurrence, the morbidity from a single incident and the amount of specialty medical care that may be needed to manage such incidents is too high to ignore. There is also the associated risk of malpractice litigation given the fact that these incidents are preventable. At present, no clear guidelines exist regarding prevention of this emergency in practice. This article attempts to review relevant literature and aims to formulate certain recommendations based on best available evidence to minimize the incidence of such events, while also suggesting guidelines toward making their management more effective. A flow chart outlining management options and strategies to aid the clinician in the event of such an emergency is also presented. PMID:22701326

  15. [The circulation of anesthetic agents at Edouard-Herriot Hospital].

    PubMed

    Chamouard, V; Polosse, M; Nageotte, A; Claveranne, J P; Mercatello, A

    1999-03-01

    In order to improve quality, practice evaluation is a major tool for hospital management. For many years anaesthesia has been monitored by some form of quality assurance programme. However, despite the improvement in anaesthetic techniques, major problems persist, particularly with the use of anaesthetic agents. Drug administration is the first cause for malpractice and death in anaesthesia. The aim of this study was to analyse drug circuits in anaesthesia, with special reference to French regulations. In 13 theatres, doctors and nurse anaesthetists were interviewed by a pharmacist with a focus on following items: prescription, preparation, administration, management, storage, conservation, information, and regulations. Results demonstrated that practice organisation and information transfers were mainly by oral route. The low proportion of written information, especially for preoperative prescription, did not comply with regulations. Nurse anaesthetists were the main actors in drug handling. Common practice patterns throughout the hospital were non existing. In each theatre, a storage of usual drugs for four weeks was found, whereas in pharmacies drugs were stocked for a 2-week period only. Standardised and written procedures, as well as pharmaceutical practice guidelines, are essential for decreasing the risk and improving quality. Such a procedure requires the full participation of anaesthetists and nurses. PMID:10228678

  16. Lessons from London: the British are reforming their national health service.

    PubMed Central

    Vall-Spinosa, A

    1991-01-01

    In an effort to keep abreast of the changing needs of a more affluent society and to ensure better value for money, the British are reforming their National Health Service. They are promoting competition and entrepreneurship, and directing funding to follow a patient rather than flowing directly to institutions. British physicians are resisting these changes. The United States, in the middle of a health care crisis of its own, can learn a great deal from Britain, especially in the area of controlling expenditures. The low cost of the National Health Service can be attributed to four major factors: (1) It is general practitioner driven and no patient accesses a specialist or hospital directly. (2) Hospitals, which employ all the specialists and supply most of the technology, operate on very tight, cash-limited budgets. (3) Administrative costs are very low. (4) The expense of malpractice is not (yet) a major concern. Changes occurring in both countries foretell a future wherein our health care systems may look very much alike. PMID:1746650

  17. Neonatal asphyxia and forensic medicine.

    PubMed

    d'Aloja, E; Müller, M; Paribello, F; Demontis, R; Faa, A

    2009-01-01

    In the last decades, the scientific literature addressing neonatal encephalopathy has grown in a logarithmic way and malpractice claims in obstetrics and neonatology have become a major threat to the health service. At the moment, scientific evidence are insufficient to clearly identify in each single case whether the hypoxic insult has developed in the course of labor or in the first few hours after the birth or, otherwise, whether the damage has to recognize a remote and long-lasting cause acting during pregnancy. Several authors feel that this scientific uncertainty leads to a higher percentage of civil suit decisions prone to recognizing a guilty medical behavior, and they wish a more in-depth analysis of all these cases to clearly identify all the data either in favor or in contrary to the assumption of the existence of a causal correlation between neonatal encephalopathy and medical misbehavior. This article will focus on the medico-legal approach to a hypoxic-ischemic event in the perinatal period, addressing the relevant data to be collected in order to establish the medical and juridical cause of the neonatal damage. PMID:19757333

  18. Unconscious fantasy as a special class of mental representation: a contribution to a model of mind.

    PubMed

    Erreich, Anne

    2015-04-01

    Philosophers of mind and cognitive psychologists have proposed that "mind" consists of myriad mental representations, namely, conscious and unconscious representations of belief/desire intentions. It is argued here that unconscious fantasies constitute a subset of the domain of mental representations, those concerned with conflicting wishes, affects, and defensive maneuvers. This proposal anchors the unconscious fantasy construct in a model of mind that accords with contemporary academic views in cognitive and developmental psychology and philosophy of mind, thus allowing psychoanalysts to enter into dialogue with those disciplines. Given this formulation, unconscious fantasy might well serve as a theoretical construct that applies to a large group of theories that share certain criteria regarding mentation. An analyst would then be at liberty to commingle insights from a menu of different theories without committing metatheoretical malpractice, resulting in a principled version of theoretical pluralism. Published case material from Kleinian, close process monitoring, and self psychological perspectives demonstrates how this redefined unconscious fantasy construct can encompass two major types of interventions that analysts make: content and process interpretations. PMID:25762692

  19. Role of natural and human factors in the degradation of the environment in central, eastern, and northern Saudi Arabia

    SciTech Connect

    Alwelaie, A.N.A.

    1985-01-01

    The roles of natural and human factors in the arid lands have long been a matter of concern to many researchers. This study tries to find out the causes of degradation of natural environments in the central, eastern, and northern parts of Saudi Arabia. The decrease in rainfall leads to increasing aridity and, thus paves the way for greater deterioration of the environment as the carrying capacity of the arid lands decreases. This study determines that human activities have had adverse effects on the arid lands of Saudi Arabia. Causes of degradation of environment in the study area include: (1) drought: (2) agricultural malpractice and soil degradation; (3) use of wood for fuel; (4) water wastage; (5) wind-blown sand; (6) pressure of locusts; (7) hunting; (8) societal instability; (9) oil rush and population pressure; (10) management of the environment; (11) overgrazing of pastures. An analysis of people's attitudes towards their environment in relation to their beliefs finds that the attitude of people towards the idea of conservation is not as positive as the attitude of Islam.

  20. Indian Supreme Court demands cleaner blood supply.

    PubMed

    Kumar, S

    1996-01-13

    The government of India recently admitted in parliament that 25% of the country's blood banks remain unlicensed. The Supreme Court has directed the government to establish a National Council for Blood Transfusion in an attempt to curb malpractice, malfunctioning, and corruption in the national blood banking system, and to ensure a safe blood supply. Furthermore, the Court advised the government to enact separate legislation for regulating the collection, processing, storage, distribution, and transportation of blood and the operation of blood banks. Legal action will be taken if any blood banks remain ill equipped or unlicensed after the period of one year. Agencies have been directed to take steps to eliminate professional blood selling within two years. They have also been asked to ensure that there are trained drug inspectors to check upon the banks. To boost funding for the councils, the government has been advised to allow 100% exemption upon income tax to those who donate money to the organizations. The Director General of Health Services has been asked to submit a report on action taken by July 16, 1996, to ensure compliance. PMID:8538304