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. Treating medical malpractice.

    PubMed

    Greene, J

    1996-06-10

    The tort reform issue is gathering steam again, despite national statistics indicating claims and payments in malpractice lawsuits are decreasing. Although federal and state governments are debating the issue, major tort reform hasn't occurred.

  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.

  4. Medical malpractice tort reform.

    PubMed

    Ottenwess, David M; Lamberti, Meagan A; Ottenwess, Stephanie P; Dresevic, Adrienne D

    2011-01-01

    A tort is generally defined as a civil wrong which causes an injury, for which a victim may seek damages, typically in the form of money damages, against the alleged wrongdoer. An overview of the tort system is detailed, specifically in the context of a medical malpractice lawsuit, in order to provide a better understanding of the practical evolution of medical malpractice litigation and its proposed reforms. Rising premiums and defensive medicine are also discussed as part of the tort reform dialogue. Because medical malpractice litigation will never disappear entirely, implementing sound risk management and compliance programs are critical to every radiology department in order to improve the safety and quality of the care that its radiologists and technologists provide.

  5. Educational Malpractice Worrying You?

    ERIC Educational Resources Information Center

    Kelly, Cynthia; McCarthy, Bernice

    1980-01-01

    Reviews case studies of students who were promoted regularly in public schools without having mastered basic skills required at each grade level. Questions whether schools would improve if students were permitted to sue for educational malpractice. Identifies basic rights of students, teachers, parents, and administrators with regard to education.…

  6. Malpractice in otology.

    PubMed

    Blake, Danielle M; Svider, Peter F; Carniol, Eric T; Mauro, Andrew C; Eloy, Jean Anderson; Jyung, Robert W

    2013-10-01

    (1) Analyze otologic procedural malpractice litigation in the United States of America. (2) Discuss ways to prevent future malpractice litigation. Case series with record review. The study is a case series with review of court records pertaining to otologic procedures using the Westlaw legal database. The phrase medical malpractice was searched with terms related to otology and neurotology obtained from the AAO-HNS website. Of the 47 claims that met inclusion criteria, 63.8% were decided in the physician's favor, 25.5% were decided in the plaintiff's favor (average payment $446,697), and 10.6% were settled out of court (average payment $372,607). Cerumen removal was the most common procedure leading to complaint (21.3%) and the most likely procedure to lead to payment (50.0%). Hearing loss was the most common injury claimed among all cases (53.2%) and resulted in a high proportion of cases that led to payment (40.0%). Other common alleged injuries were facial nerve injury (27.7%), tympanic membrane perforation (23.4%), need for additional surgery (42.6%), and lack of informed consent (31.9%). In addition, cases resulting from acoustic neuroma or stapedectomy resulted in higher payments to the plaintiffs (average $3,498,597 and $2,733,000, respectively). Malpractice trials were resolved in the defendant's favor in the majority of cases. Cerumen removal was the most common procedure leading to complaint and the procedure most likely to result in payment. Hearing loss was the most common injury cited. Payment was highest in acoustic neuroma and stapedectomy cases.

  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. 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,…

  9. 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

  10. Medical malpractice in hand surgery.

    PubMed

    Pappas, Nick D; Moat, Diane; Lee, Donald H

    2014-01-01

    The rise in medical malpractice claims over the past few decades has altered physicians' practice patterns and has had a considerable financial impact on the medical community as a whole. While numerous studies have analyzed the content and effect of these claims, only a handful of articles have addressed specifically the issue of medical malpractice in hand surgery. This article outlines the available literature on malpractice in hand surgery, offers guidance to hand surgeons on managing medical malpractice claims, and discusses preventative measures they might take to limit such claims from being filed in the future. We conclude that the key measures one can take to protecting oneself legally are knowing and abiding by the standard of care, keeping patients informed and developing good relationships with them, and meticulously documenting. Although some malpractice claims are unavoidable, we believe that one can limit his or her exposure to them by incorporating these measures into their respective practices.

  11. 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.

  12. 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.

  13. The Specter of Academic Malpractice

    ERIC Educational Resources Information Center

    Barnes, Carol

    1978-01-01

    The concept of academic malpractice is discussed in terms of student gains in consumerism regarding institutional accountability, and in terms of faculty rights to academic freedom and relationships with administrators. (LBH)

  14. Nursing malpractice: cause for consideration.

    PubMed

    Fiesta, J

    1999-02-01

    Because so many factors influence a patient's health, it's difficult to know with certainty that a nurse's error actually caused the negative outcome. In nursing malpractice cases, causation can be a successful defense strategy.

  15. Malpractice claims for endoscopy.

    PubMed

    Hernandez, Lyndon V; Klyve, Dominic; Regenbogen, Scott E

    2013-04-16

    To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time. There were 1901 endoscopy-related closed claims against all providers from 1985 to 2008. The specialties include: internal medicine (n = 766), gastroenterology (n = 562), general surgery (n = 231), general and family practice (n = 101), colorectal surgery (n = 87), other specialties (n = 132), and unknown (n = 22). Colonoscopy represented the highest frequencies of closed claims (n = 788) and the highest total indemnities ($54 093 000). In terms of mean claims payment, endoscopic retrograde cholangiopancreatography (ERCP) ranked the highest ($374  794) per claim. Internists had the highest number of total claims (n = 766) and total claim payment ($70  730  101). Only total claim payments for colonoscopy and ERCP seem to have increased over time. Indeed, there was an average increase of 15.5% per year for colonoscopy and 21.9% per year for ERCP after adjusting for inflation. There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation.

  16. State tort reforms and hospital malpractice costs.

    PubMed

    Ellington, Charles R; Dodoo, Martey; Phillips, Robert; Szabat, Ronald; Green, Larry; Bullock, Kim

    2010-01-01

    This study explored the relation between state medical liability reform measures, hospital malpractice costs, and hospital solvency. It suggests that state malpractice caps are desirable but not essential for improved hospital financial solvency or viability.

  17. Aspects of Malpractice in Prosthodontics.

    PubMed

    Nassani, Mohammad Zakaria

    2017-06-09

    Crowns, fixed partial dentures, and removable dentures are the popular prosthetic dental restorations in current dental practice. Prosthodontic rehabilitation of the mouth, particularly in advanced and complex cases, requires careful planning, adequate clinical skills, and exacting technical standards. While a successful outcome is the ultimate goal for any prosthodontic treatment, complications, injuries, dissatisfaction, and/or failure may occur. When such events develop as a result of negligence or violation of standards of care, they are considered under the term of malpractice and may incur ethical and medico-legal implications. This paper reviews and highlights some aspects of malpractice in prosthodontics. The current state of prosthodontic malpractice on a global level will also be evaluated. Standards of prosthodontic care, current literature of prosthodontic malpractice, where and how prosthodontic malpractice occurs, and recommendations for the future are presented. A thorough understanding of what is quality prosthodontic care and what disrupts this care can be a useful guard against professional litigation and may protect patients from poor quality of dental prosthetic care. © 2017 by the American College of Prosthodontists.

  18. 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

  19. Liability for Malpractice in Education.

    ERIC Educational Resources Information Center

    Loscalzo, Theresa E.

    1985-01-01

    Courts have not recognized claims of "educational malpractice," though they have held that such a claim could be formally pleaded with liability precluded by public policy considerations. A 1984 New York Court of Appeals decision in "Snow vs. State of New York" may be the initial breakdown to the barrier of public policy…

  20. Will Educational Malpractice Be Revived?

    ERIC Educational Resources Information Center

    Jurenas, Albert C.

    1992-01-01

    Predictions of death for educational malpractice may be premature. A shift in legal reasoning by the California Supreme Court and the Los Angeles School District's educational guarantee policy might influence future courts to look more favorably upon the claims of educationally impaired plaintiffs. (MLF)

  1. Educational Malpractice: Fantasy or Reality?

    ERIC Educational Resources Information Center

    Braverman, June R.

    1982-01-01

    Three educational malpractice cases and the issues arising from them are examined in this article. The cases are examined in terms of whether school administrators, teachers, and guidance counselors owe a legal duty to students to exercise the ordinary skill and competence of a reasonable and prudent member of their profession; whether educators…

  2. Ethical issues in medical malpractice.

    PubMed

    Solomon, Robert C

    2006-08-01

    The interrelationships between biomedical ethics and the law are perhaps nowhere as starkly apparent as in the realm of medical malpractice. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of futile care at the insistence of patients or families; and the various protections of Good Samaritan laws are just a few of these. In addition, the ethical principles governing the conduct of physicians serving as expert witnesses in medical malpractice cases have become a subject of intense interest in recent years.

  3. 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;…

  4. Nurse practitioner malpractice data: Informing nursing education.

    PubMed

    Sweeney, Casey Fryer; LeMahieu, Anna; Fryer, George E

    Nurse practitioners (NPs) are often identified in medical malpractice claims. However, the use of malpractice data to inform the development of nursing curriculum is limited. The purpose of this study is to examine medical errors committed by NPs. Using National Practitioner Data Bank public use data, years 1990 to 2014, NP malpractice claims were classified by event type, patient outcome, setting, and number of practitioners involved. The greatest proportion of malpractice claims involving nurse practitioners were diagnosis related (41.46%) and treatment related (30.79%). Severe patient outcomes most often occurred in the outpatient setting. Nurse practitioners were independently responsible for the event in the majority of the analyzed claims. Moving forward, nurse practitioner malpractice data should be continuously analyzed and used to inform the development of nurse practitioner education standards and graduate program curriculum to address areas of clinical weakness and improve quality of care and patient safety. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Malpractice in Cases of Pediatric Appendicitis.

    PubMed

    Sullins, Veronica F; Rouch, Joshua D; Lee, Steven L

    2017-03-01

    Appendicitis is one of the most common diagnoses in children and is frequently the focus of alleged malpractice. Causes for medical malpractice claims and outcomes of disputes in pediatric patients with appendicitis are currently unknown. A retrospective database review of all medical malpractice claims concerning the diagnosis of appendicitis from 1984 to 2013 in pediatric patients was performed. Alleged claims, causes of malpractice, and outcomes were recorded and analyzed. Of the 203 included cases, failure or delays in diagnosing appendicitis are the most common causes of malpractice lawsuits and account for the majority of the largest payments to plaintiffs outcomes. Cases that ultimately went to trial resulted in defense verdicts in 67.5%. Mortality occurred in 19.9% of included cases. Timely diagnosis of appendicitis in children should be the focus of physicians across all specialties to improve patient safety and potentially reduce medicolegal liability.

  6. The malpractice premium costs of obstetrics.

    PubMed

    Norton, S A

    1997-01-01

    This study examined, in 1992, the variation in the level of malpractice premiums, and the incremental malpractice premium costs associated with the practice of obstetrics for family practitioners and obstetricians. On average, in 1992 obstetricians and family practitioners providing obstetric services paid malpractice premiums of roughly $44,000 and $16,000, respectively. The incremental increase in malpractice premium costs represented roughly 70% of the premium the physicians would have paid had they not provided obstetric services. These results suggest that for both family practitioners and obstetricians, there is a considerable premium penalty associated with providing obstetric services which may have implications for women's access to obstetric services. Moreover, the results make it clear that physicians practicing in different states, and different specialists within a state, may face very different malpractice premium costs.

  7. Legal doctrines associated with medical malpractice.

    PubMed

    Kircher, J

    1986-06-01

    Malpractice is the legal charge against a professional accused of a private wrong. Claims must be filed under tort (or civil) law; specific statutes can vary from state to state. Legal doctrines associated with malpractice include respondeat superior, which places ultimate liability with a superior or employer; proximate cause, which states that the professional's negligence resulted in injury; and res ipsa loquitur, which allows malpractice to be proved without expert testimony. Traditionally, PAs have been protected by respondeat superior; however, while some legal precedents have assigned liability to the physician entirely, others have distributed it proportionately between the supervised nonphysician provider and the physician. Consequently, no clear guidelines exist for PAs regarding malpractice, since the degree of liability has not yet been definitely decided by the courts. However, in the current legal climate, more and more PAs assume malpractice liability, and are providing for personal coverage.

  8. Malpractice Litigation in Pediatric Ophthalmology.

    PubMed

    Engelhard, Stephanie B; Collins, Megan; Shah, Christopher; Sim, Austin J; Reddy, Ashvini K

    2016-11-01

    Understanding outcomes of pediatric malpractice litigation allows ophthalmologists to gain insight into how to best care for patients and prevent such litigation. To report and analyze the causes and outcomes of ophthalmology medical malpractice litigation involving patients younger than 18 years. The WestLaw database was reviewed from April 1 to 30, 2015, for ophthalmology-related lawsuits, including settlements and trial verdicts, in the United States from January 1, 1930, to December 31, 2014. Search terms included ophthalmology or ophthalmologist and malpractice anywhere in the retrieved documents. Cases in which the plaintiffs were younger than 18 years at the time of the inciting event were included. Pediatric cases were compared with adult cases. Pediatric malpractice case outcomes and settlement amounts. Sixty-eight ophthalmology malpractice cases involving plaintiffs younger than 18 years were included in the study. Thirty-five cases (51.5%) were resolved via jury trial. Of these 35 cases, verdicts in favor of the plaintiff were issued in 17 pediatric cases (48.6%), compared with 168 of 584 adult cases (28.8%) (difference, 33%; 95% CI, -24% to 64%; P = .01). The 17 cases that resulted in verdicts in favor of the pediatric plaintiff had a mean jury award of $4 815 693 (median, $883 281; range, $147 765-$42 061 690). Nine of the total 68 cases (13.2%) resulted in a settlement, with mean adjusted indemnities of $1 912 738 (median, $1 377 689; range, $92 070-$8 493 086). The remaining 24 cases (35.3%) involved appellate rulings, pretrial and posttrial relief rulings, and 1 bench verdict. Jury awards were higher in pediatric vs adult cases (difference, $3 422 134; 95% CI, -$3 422 134 to $8 731 916; P = .002), as were indemnity payments (difference, $1 186 757; 95% CI, -$69 074 to $3 342 588; P = .003). Cases involving legal blindness were more likely to result in verdicts in favor of the plaintiff

  9. Dissecting malpractice in pancreaticoduodenectomy cases.

    PubMed

    Anandalwar, Seema P; Scholer, Anthony J; Ninan, Gigio; Oliver, Joseph B; Christian, Derick; Eloy, Jean Anderson; Chokshi, Ravi J

    2017-05-15

    Medical malpractice is a growing concern for physicians in all fields. Surgical fields have some of the highest malpractice premiums and litigation rates. Pancreaticoduodenectomy (PD) has become a popular procedure; however, it is still associated with significant morbidity and mortality. This study is the first to analyze factors involved in litigation regarding PD cases. The Westlaw database was searched for jury verdicts and settlements using the terms "medical malpractice" and "pancreaticoduodenectomy". Twenty-nine cases from 1991 to 2012 were initially collected. Seven entries not involving PD and three duplicate cases were excluded. Nineteen cases were included for analysis. Of the 19 cases included in the analysis, three (15.8%) reached a settlement, three (15.8%) were ruled in favor of the plaintiff, and 13 (68.4%) were ruled in favor of the physician. The average settlement award was $398,333 (range, $195,000-500,000), and the average plaintiff award was $4,288,869 (range, $1,066,608-10,300,000). The most common factors raised in litigation included PD being allegedly unnecessary (47.4%), followed by postoperative negligence and misdiagnosis (36.8% each). The most common factors present in litigation included the allegation that PD was unnecessarily performed. The cases that are awarded large monetary sums are those that involve continued medical care. Ways to improve patient safety and limit litigation include increasing transparency and communication with a thorough discussion between surgeon and patient of the most common topics of litigation discussed. Published by Elsevier Inc.

  10. 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.

  11. [Judicial claims for medical malpractice].

    PubMed

    Llovet Delgado, J J

    1993-01-01

    Physicians' legal liability regarding malpractice has reached a previously unknown importance in Spain. This paper brings forward some statistical data on judicial claims presented by patients and their relatives. The whole of resolutions of the First and Second Court of the Supreme Court were collected between 1870 and 1992. In Madrid, the number of lawsuits in proceedings were obtained from a sample of the Courts at the Plaza de Castilla in April 1990, and figures on legal complaints, accusations and demands were obtained through consultations at the Medical College. The great majority of verdicts, both in Civil and Penal Jurisprudence, correspond to the last 13 years. In Madrid, the average of penal cases in proceedings was 3.8 per Court, and an appreciable increase of claims can be noticed, with an annual rate of about 0.4 per 100 physicians. Appealing to Justice in order to accuse a practitioner for presumed malpractice is no longer an unusual event. Various reasons contribute in this respect. However, other reasons exist to consider the Spanish situation very far from the level in the United States of America.

  12. Healthcare consumers' beliefs about medical malpractice lawsuits.

    PubMed

    Chandra, Ashish; Durand, Roger; Dickens, Kristy

    2009-01-01

    In the United States, malpractice tort reform has come to be regarded by many as a principal means of reducing the high costs of medical care. Despite growing popular sentiment for tort reform evidenced in public opinion polls and in earlier research, the authors wondered about the experiences and feelings that enhance this pro-malpractice-tort-reform position. The authors report the results of their comparative inquiry into consumers' beliefs that there are too many medical malpractice lawsuits. The authors analyze data derived from a nonprobability sample of consumer residents of West Virginia and of international residents of Houston, Texas, completed in 2007-2008. Only a small percentage (about 5%) of the consumer respondents reported having filed a medical malpractice claim. Of those who did file, about 70% agreed with the position that there are too many medical malpractice lawsuits filed each year. Consumers who reported that they did not feel that a lawsuit had much of an impact on a physician's practice or lifestyle were less inclined to also feel that too many medical malpractice lawsuits are filed. The authors also found evidence that feeling that there are too many medical malpractice lawsuits bore a weak, inverse relation to the belief that medical errors have been on the rise over the last 10 years.

  13. Patient Safety and the Malpractice System.

    PubMed

    Swift, James Q

    2017-02-26

    The cost of health care in the United States and malpractice insurance has escalated greatly over the past 30 years. In an ideal world, the goals of the tort system would be aligned with efforts at improving safety. In fact, there is little evidence that the tort system and the processes of risk management and informed consent have improved patient safety. The article explores the disunion between patient safety and the malpractice system.

  14. Electroconvulsive Therapy Malpractice: Verdict for the Defense.

    PubMed

    Goodman, Theodore; McCall, W Vaughn

    2015-09-01

    Malpractice cases involving electroconvulsive therapy (ECT) are rare. Even rarer are those malpractice cases alleging ECT-related brain damage. The few cases of ECT malpractice lawsuits are not described in the medical literature in detail. We provide a detailed account of a case of a patient and subsequent alleged ECT-related malpractice. The details of the case were collated using the handwritten notes of one of the authors who was present at the trial and the pretrial documents of discovery that were entered into evidence. The plaintiff alleged complete autobiographical amnesia after ECT, supposedly as a result of ECT-related brain damage. The defense was aided by the presence of extensive neurological examination and brain imaging both before and after ECT. The defense team also offered to the jury the concept of "dissociative amnesia" as an alternative explanation for the plaintiff's memory complaints. The case went to trial and was successfully defended. Electroconvulsive therapy malpractice cases alleging brain damage can be successfully defended, and the successful defense is aided by adequate documentation before, during, and after ECT. Malpractice cases, especially if they are baseless, can occur unpredictably, but they can be defended if the medical documentation is thorough.

  15. Malpractice litigation following spine surgery.

    PubMed

    Daniels, Alan H; Ruttiman, Roy; Eltorai, Adam E M; DePasse, J Mason; Brea, Bielinsky A; Palumbo, Mark A

    2017-10-01

    OBJECTIVE Adverse events related to spine surgery sometimes lead to litigation. Few studies have evaluated the association between spine surgical complications and medical malpractice proceedings, outcomes, and awards. The aim of this study was to identify the most frequent causes of alleged malpractice in spine surgery and to gain insight into patient demographic and clinical characteristics associated with medical negligence litigation. METHODS A search for "spine surgery" spanning February 1988 to May 2015 was conducted utilizing the medicolegal research service VerdictSearch (ALM Media Properties, LLC). Demographic data for the plaintiff and defendant in addition to clinical data for the procedure and legal outcomes were examined. Spinal cord injury, anoxic/hypoxic brain injury, and death were classified as catastrophic complications; all other complications were classified as noncatastrophic. Both chi-square and t-tests were used to evaluate the effect of these variables on case outcomes and awards granted. RESULTS A total of 569 legal cases were examined; 335 cases were excluded due to irrelevance or insufficient information. Of the 234 cases included in this investigation, 54.2% (127 cases) resulted in a defendant ruling, 26.1% (61) in a plaintiff ruling, and 19.6% (46) in a settlement. The awards granted for plaintiff rulings ranged from $134,000 to $38,323,196 (mean $4,045,205 ± $6,804,647). Awards for settlements ranged from $125,000 to $9,000,000 (mean $1,930,278 ± $2,113,593), which was significantly less than plaintiff rulings (p = 0.022). Compared with cases without a delay in diagnosis of the complication, the cases with a diagnostic delay were more likely to result in a plaintiff verdict or settlement (42.9% vs 72.7%, p = 0.007) than a defense verdict, and were more likely to settle out of court (17.5% vs 40.9%, p = 0.008). Similarly, compared with cases without a delay in treatment of the complication, those with a therapeutic delay were more

  16. Medical malpractice and corticosteroid use.

    PubMed

    Nash, John J; Nash, Amanda G; Leach, Matthew E; Poetker, David M

    2011-01-01

    To analyze malpractice litigation trends related to the administration of corticosteroids and the reported complications. Retrospective. Tertiary medical center. The WESTLAW database was reviewed from March 1996 to November 2008. Data were compiled on the demographics of the defendant, plaintiff, expert witness specialty, allegation, complication, indication for steroids, verdict, and judgment. Eighty-three cases met inclusion criteria and were selected for review. The most common conditions for which steroids were prescribed were pain (23%), asthma or another pulmonary condition (20%), a dermatologic condition (18%), a nondermatologic autoimmune condition (17%), and allergies (6%). Allegation of negligent use was the most common reason for a suit being filed (65%), followed by lack of proper informed consent (36%), failure to diagnose or misdiagnosis (22%), multiple allegations (25%), and wrongful death (4%). Verdicts for the defendant predominated (59%), whereas 24 cases (29%) were found for the plaintiff, and 10 cases (12%) settled out of court. The range of monetary awards was from $25,000 to $8.1 million. Complications reported were often multiple and included avascular necrosis (39%), mood changes (16%), visual complaints (14%), and infectious complications (14%). Three cases involved otolaryngologists. Although other specialties were more often involved in suits, otolaryngologists frequently prescribe corticosteroids and must be diligent in explaining potential side effects of steroids. The informed consent process, documentation, and close monitoring of patients are critical to avoid potential litigation.

  17. Physician Assistant and Nurse Practitioner Malpractice Trends.

    PubMed

    Brock, Douglas M; Nicholson, Jeffrey G; Hooker, Roderick S

    2016-07-25

    Trends in malpractice awards and adverse actions (e.g., revocation of provider license) following an act or omission constituting medical error or negligence were examined. The National Practitioner Data Bank was used to compare rates of malpractice reports and adverse actions for physicians, physician assistants (PAs), and nurse practitioners (NPs). During 2005 through 2014, there ranged from 11.2 to 19.0 malpractice payment reports per 1,000 physicians, 1.4 to 2.4 per 1,000 PAs, and 1.1 to 1.4 per 1,000 NPs. Physician median payments ranged from 1.3 to 2.3 times higher than PAs or NPs. Diagnosis-related malpractice allegations varied by provider type, with physicians having significantly fewer reports (31.9%) than PAs (52.8%) or NPs (40.6%) over the observation period. Trends in malpractice payment reports may reflect policy enactments to decrease liability. © The Author(s) 2016.

  18. Educational Malpractice. Liability of Educators, School Administrators, and School Officials.

    ERIC Educational Resources Information Center

    Collis, John

    This treatise is a compilation of various educational malpractice cases as well as other references regarding educational malpractice and related malpractice cases from other professions, such as medicine, law and psychiatry, and is intended to serve as a source for understanding the complex and sensitive problems relating to educational…

  19. 45 CFR 60.7 - Reporting medical malpractice payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 1 2011-10-01 2011-10-01 false Reporting medical malpractice payments. 60.7... Information § 60.7 Reporting medical malpractice payments. (a) Who must report. Each entity, including an... practitioner for medical malpractice, must report information as set forth in paragraph (b) of this section to...

  20. The physician's reaction to a malpractice suit.

    PubMed

    Lavery, J P

    1988-01-01

    A malpractice suit can have a devastating impact on a practitioner's professional and personal life. The physician's reaction to this event is profound, affecting his own life-style and that of family, colleagues, and patients. This commentary presents an analogy between the physician's reaction to a malpractice suit and the stages of grief described by Elisabeth Kübler-Ross: the sequence of denial, anger, bargaining, depression, and acceptance. Understanding the psychodynamics of this reaction can help physicians to cope with the problems inherent in a malpractice suit and to maintain a greater stability in their personal lives. Adverse effects on medical practice and private life-style, and on the legal proceedings, can be minimized.

  1. A look at Florida's malpractice crisis.

    PubMed

    Coleman, F C

    1985-08-01

    To solve the malpractice problem, the Florida Medical Association has attempted during the last decade to bring about tort reform through the legislative process, but early successes were declared unconstitutional or ignored by the courts. In 1984, the FMA organized a constitutional initiative campaign called REASON '84, and secured a record 630,000 signatures of registered Florida voters to place a constitutional amendment on the 1984 Florida General Election ballot. The Florida Supreme Court in October 1984 removed the Association's constitutional Amendment 9 from the ballot. Dr. Coleman, past president of the Florida Medical Association, wrote the following during his term as president about the malpractice problem and its grave implications.

  2. Educational Malpractice and the Reading Practitioner.

    ERIC Educational Resources Information Center

    Reilly, James B.

    Prompted by the increased possibility of teachers facing educational malpractice charges, this paper outlines the historical legal precedents through which plaintiffs have sought recognition for this new cause of action, the defenses established against it, and the rationale on which various courts have balanced their decisions. The paper also…

  3. How to Avoid an Educational Malpractice Suit.

    ERIC Educational Resources Information Center

    Patterson, Arlene H.

    Increasing demands for professional accountability in education, coupled with a growing tendency in the American public to seek redress through the courts, have given rise to the educational malpractice suit, alleging that students have failed to learn because schools have been negligent in their duty to educate. This chapter provides guidelines…

  4. Tort law and medical malpractice insurance premiums.

    PubMed

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

    2006-01-01

    This paper estimated the effects of tort law and insurer investment returns on physician malpractice insurance premiums. Data were collected on tort law from 1991 through 2004, and multivariate regression models, including fixed effects for state and year, were used to estimate the effect of changes in tort law on medical malpractice premiums. The premium consequences of national policy changes were simulated. The analysis found that the introduction of a new damage cap lowered malpractice premiums for internal medicine, general surgery, and obstetrics/gynecology by 17.3%, 20.7%, and 25.5%, respectively. Lowering damage caps by dollar 100,000 reduced premiums by 4%. Statutes of repose also resulted in lower premiums. No other tort law changes had the effect of lowering premiums. Simulation results indicate that a national cap of dollar 250,000 on awards for noneconomic damages in all states would imply premium savings of dollar 16.9 billion. Extending a dollar 250,000 cap to all states that do not currently have them would save dollar 1.4 billion annually, or about 8% of the total. A negative effect on malpractice premiums was found for the Dow Jones industrial average, but not for bond prices; effects of the Nasdaq index were not significant for internal medicine, but were marginally significant for surgery and obstetrics premiums.

  5. 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

  6. 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…

  7. 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…

  8. Medical Malpractice Lawsuits Involving Surgical Residents.

    PubMed

    Thiels, Cornelius A; Choudhry, Asad J; Ray-Zack, Mohamed D; Lindor, Rachel A; Bergquist, John R; Habermann, Elizabeth B; Zielinski, Martin D

    2017-08-30

    Medical malpractice litigation against surgical residents is rarely discussed owing to assumed legal doctrine of respondeat superior, or "let the master answer." To better understand lawsuits targeting surgical trainees to prevent future litigation. Westlaw, an online legal research database containing legal records from across the United States, was retrospectively reviewed for malpractice cases involving surgical interns, residents, or fellows from January 1, 2005, to January 1, 2015. Infant-related obstetric and ophthalmologic procedures were excluded. Involvement in a medical malpractice case. Data were collected on patient demographics, case characteristics, and outcomes and were analyzed using descriptive statistics. During a 10-year period, 87 malpractice cases involving surgical trainees were identified. A total of 50 patients were female (57%), and 79 were 18 years of age or older (91%), with a median patient age of 44.5 years (interquartile range, 45-56 years). A total of 67 cases (77%) resulted in death or permanent disability. Most cases involved elective surgery (61 [70%]) and named a junior resident as a defendant (24 of 35 [69%]). Cases more often questioned the perioperative medical knowledge, decision making errors, and injuries (53 [61%]: preoperative, 19 of 53 [36%]) and postoperative, 34 of 53 [64%]) than intraoperative errors and injuries (43 [49%]). Junior residents were involved primarily with lawsuits related to medical decision making (21 of 24 [87%]). Residents' failure to evaluate the patient was cited in 10 cases (12%) and lack of direct supervision by attending physicians was cited in 48 cases (55%). A total of 42 cases (48%) resulted in a jury verdict or settlement in favor of the plaintiff, with a median payout of $900 000 (range, $1852 to $32 million). This review of malpractice cases involving surgical residents highlights the importance of perioperative management, particularly among junior residents, and the importance of

  9. [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.

  10. [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.

  11. Case for tort reform in medical malpractice.

    PubMed

    DeLuke, Dean M

    2006-05-01

    Under tort law, injured parties have the basic right to seek indemnity for wrongful injury, including injury from medical malpractice. Unfortunately, the present system is associated with many undesirable secondary effects, including problems of patient access to care, excessive testing or overtreatment, and undertreatment due to doctors' fear of malpractice. Nationwide, there are innumerable cases of doctors abandoning obstetrical or other high risk practices, or migrating away from states with less friendly tort laws. The California MICRA legislation of 1976 is often cited as a model for tort reform, but even this model legislation may be insufficient to restore a beleaguered trust between medical providers and their patients. Several key research studies suggest that the jury system fails to fairly and reliably compensate injured patients, and fails to deter or discipline errant doctors. To adequately meet the common needs of patients and health care providers, there must be an appropriate emphasis on aggressive risk management, quality improvement, patient safety, professional oversight, and responsible insurance underwriting. Moreover, there must be a systemic improvement of the current tort system as it pertains to medical malpractice. Although incremental reforms at the state level are slowly occurring and should certainly be supported, a greater reward may ultimately stem from more radical restructuring to a system of medical tribunals.

  12. Malpractice claims related to tooth extractions.

    PubMed

    Koskela, Sanna; Suomalainen, Anni; Apajalahti, Satu; Ventä, Irja

    2017-03-01

    The aim of this study was to analyze malpractice claims related to tooth extractions in order to identify areas requiring emphasis and eventually to reduce the number of complications. We compiled a file of all malpractice claims related to tooth extractions (EBA code) between 1997 and 2010 from the Finnish Patient Insurance Centre. We then examined the data with respect to date, tooth, surgery, injury diagnosis, and the authority's decision on the case. The material consisted of 852 completed patient cases. Most of the teeth were third molars (66 %), followed by first molars (8 %), and second molars (7 %). The majority of claims were related to operative extraction (71 %) followed by ordinary extraction (17 %) and apicoectomy of a single-rooted tooth (7 %) or multi-rooted tooth (2 %). The most common diagnosis was injury of the lingual or inferior alveolar nerve. According to the authority's decision, the patient received compensation more often in cases involving a third molar than other teeth (56 vs. 46 %, P < 0.05). The removal of a mandibular third molar was the basis for the majority of malpractice claims. To reduce the numbers of lingual and inferior alveolar nerve injuries, the removal of mandibular third molars necessitates recent and high-quality panoramic radiograph, preoperative assessment of the difficulty of removal, and consciousness of the variable anatomical course of the lingual nerve.

  13. 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…

  14. Avoiding Counselor Malpractice. ACA Legal Series, Volume 12.

    ERIC Educational Resources Information Center

    Crawford, Robert L.

    The possibility of lawsuits is a general condition of citizenship; potential lawsuits based on allegations of malpractice is a routine part of professional practice. This monograph provides a guide for taking some reasonable precautions to avoid malpractice suits. The text provides an outline that counselors may use in developing a legal and…

  15. 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.

  16. Personal Malpractice Liability of Reference Librarians and Information Brokers.

    ERIC Educational Resources Information Center

    Gray, John A.

    1988-01-01

    Reviews common law contract and tort bases for malpractice liability and their applicability to reference librarians, special librarians, and information brokers. The discussion covers the legal bases for professional malpractice liability, the librarian-patron relationship, the likelihood of lawsuits, and the need for personal liability…

  17. Physician-patient language concordance and malpractice concerns.

    PubMed

    Chen, Jie; Fang, Hai; Rizzo, John A

    2011-11-01

    To study the association between physician-patient language concordance and physicians' malpractice concerns. We use a nationally representative physician data set, the 2008 Health Tracking Physician Survey maintained by the Center for Studying Health System Change. The Health Tracking Physician Survey includes 5 assessments of physicians' concerns about malpractice risk. Physicians are also asked the percentage of patients they have difficulty in understanding owing to language barriers. We estimate multivariate logistic regressions to investigate the association between physician-patient language concordance and physicians' malpractice concerns. Physicians who have difficulty understanding patients owing to language barriers are 27% to 74% more likely to order extra tests or ask for consultant opinions to avoid the risk of malpractice suits. They are also 30% to 90% more likely to worry or feel pressure about malpractice risk, compared with those without difficulty understanding patients owing to language barriers. It is important to understand the incentives associated with malpractice concerns to move physicians toward cost-effective healthcare delivery. Our results show that physicians having difficulty understanding patients owing to language barriers are more likely to have malpractice concerns. Understanding this association may have important implications for reducing physicians' malpractice concerns.

  18. Expert witness testimony in urology malpractice litigation.

    PubMed

    Sunaryo, Peter L; Svider, Peter F; Jackson-Rosario, Imani; Eloy, Jean Anderson

    2014-04-01

    To evaluate the credentials of urologists choosing to testify as expert witnesses. As health care reform has become an increasingly important topic in national debate, medical malpractice and related issues have come to the forefront of topics for discussion by the medical community. Physicians are often recruited to testify as expert witnesses in malpractice cases. Defining what constitutes an expert in this setting has been an area of controversy. The Westlaw legal database was searched for medical malpractice litigation. Data regarding number of years of experience and practice setting were obtained for urologists using private practice and hospital listings, academic faculty profiles, and state medical licensing databases. Scholarly impact, as measured by the h-index, was calculated by the Scopus database. Plaintiff expert witnesses were found to have slightly more years of experience vs defendant expert witnesses (35.7 vs 32.2 years, P = .01), but had a lower h-index (6.8 vs 10.2, P = .03), were less likely to practice in the academic setting (39% vs 60%, P = .001), and were more likely to testify multiple times. Urologists testifying for plaintiffs and defendants both had over 30 years of experience on average, with those in the latter having slightly less experience. Defendant witnesses, however, had greater scholarly impact and were more likely to practice in an academic setting. Organizations such as the American Urological Association may wish to re-evaluate guidelines on expert witness testimony, particularly regarding those who testify frequently. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Arbitration Agreements and Your Malpractice Coverage

    PubMed Central

    Butler, James R.

    1976-01-01

    With new legislation and favorable case law developments, many providers of health care services are turning to binding arbitration agreements as a partial solution to the medical malpractice crisis. Existing data indicate tremendous advantages can be gained from the use of such agreements, if they are carefully drawn to comply with new law, tailored to the particular situation in which they will be used and coupled with appropriate procedures to secure the intended benefits. Arbitration is not a substitute for insurance, but if a provider has taken the calculated risk of forgoing insurance he should not be without a carefully drawn binding arbitration agreement. PMID:969512

  20. Medical malpractice and head and neck cancer.

    PubMed

    Lydiatt, Daniel D

    2004-04-01

    The purpose of this review is to evaluate medical malpractice involving patients with head and neck cancer. In the United States, problems associated with the medical malpractice environment are reaching proportions that threaten the delivery of health care. Several methods to learn more about the trends and ramifications of litigation have been developed. Although patients with cancer of the head and neck bring suits rarely, when they do several themes seem prevalent. Delays in diagnosis are common allegations. Plaintiffs are frequently much younger than expected, and the oncologic outcome is frequently poor. Defendant physicians occasionally unwittingly add to the delay by not expecting the younger patient. The poor oncologic outcome may be related to the delay or to a biologically more aggressive disease. Relationships between these factors are explored. Consent issues are also relatively common. Physicians must strive to know as much as possible about tort reform, and to contribute to the process. Litigation analysis and other tools to expand our understanding can be used to educate ourselves and the legal community. Scientific standards must be developed along with clinical pathways to guide ourselves to prevent litigation. They may also guide the legal community to establish more rational standards of care based on a consensus of expert opinions.

  1. 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

  2. Physicians' fears of malpractice lawsuits are not assuaged by tort reforms.

    PubMed

    Carrier, Emily R; Reschovsky, James D; Mello, Michelle M; Mayrell, Ralph C; Katz, David

    2010-09-01

    Physicians contend that the threat of malpractice lawsuits forces them to practice defensive medicine, which in turn raises the cost of health care. This argument underlies efforts to change malpractice laws through legislative tort reform. We evaluated physicians' perceptions about malpractice claims in states where more objective indicators of malpractice risk, such as malpractice premiums, varied considerably. We found high levels of malpractice concern among both generalists and specialists in states where objective measures of malpractice risk were low. We also found relatively modest differences in physicians' concerns across states with and without common tort reforms. These results suggest that many policies aimed at controlling malpractice costs may have a limited effect on physicians' malpractice concerns.

  3. 45 CFR 60.7 - Reporting medical malpractice payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... note), (v) Date of birth, (vi) Name of each professional school attended and year of graduation, (vii... malpractice has occurred. (Approved by the Office of Management and Budget under control number 0915-0126) ...

  4. 45 CFR 60.7 - Reporting medical malpractice payments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... note), (v) Date of birth, (vi) Name of each professional school attended and year of graduation, (vii... malpractice has occurred. (Approved by the Office of Management and Budget under control number 0915-0126) ...

  5. The Teacher and Malpractice: Ten Ways to Invite a Lawsuit.

    ERIC Educational Resources Information Center

    Essex, Nathan L.

    1987-01-01

    Comments on the emerging concept in education of teacher malpractice, and identifies ten ways that teachers can be assured of entertaining a lawsuit in situations involving academic injury to students. (NKA)

  6. Commentary: malpractice reform in policy perspective.

    PubMed

    Bovbjerg, Randall R

    2007-06-01

    Enacted caps on malpractice awards and proposed early offer reform address the sometimes excessive verdicts of conventional liability and its very high overhead costs. However, such reforms greatly benefit medical defendants while doing too little for claimants or patients in general. Caps and early offer only affect current claims; far broader reforms are therefore needed to improve the woeful performance of liability as a general promoter of patient safety and injury compensation. Broad reforms, however desirable, seldom surmount high political and practical hurdles. A good, more evenhanded start would seek to make claims resolution faster, more accurate, more predictable, and less expensive, while separately promoting medical quality and safety as well as greater transparency for law, medicine, and insurance.

  7. 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

  8. Is failure to awaken and wean malpractice?

    PubMed

    Manthous, Constantine A

    2016-12-01

    Respiratory failure is among the most common primary causes of or complications of critical illness, and although mechanical ventilation can be lifesaving, it also engenders substantial risk of morbidity and mortality to patients. Three decades of research suggests that the duration of invasive mechanical ventilation can be reduced substantially, reducing morbidity and mortality. Mean duration of ventilation reported in recent international studies suggests a quality chasm in management of this common critical illness. This is a selective review of the literature and synthesis with precepts of medical professionalism and ethics. To the extent that daily wake-up-and-breathe reduces morbidity, mortality, and length of stay, failure to deploy this strategy is, by definition, malpractice (ie, poor practice). Practical measures are offered to close this quality chasm. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Commentary: Malpractice Reform in Policy Perspective

    PubMed Central

    Bovbjerg, Randall R

    2007-01-01

    Enacted caps on malpractice awards and proposed early offer reform address the sometimes excessive verdicts of conventional liability and its very high overhead costs. However, such reforms greatly benefit medical defendants while doing too little for claimants or patients in general. Caps and early offer only affect current claims; far broader reforms are therefore needed to improve the woeful performance of liability as a general promoter of patient safety and injury compensation. Broad reforms, however desirable, seldom surmount high political and practical hurdles. A good, more evenhanded start would seek to make claims resolution faster, more accurate, more predictable, and less expensive, while separately promoting medical quality and safety as well as greater transparency for law, medicine, and insurance. PMID:17517117

  10. Expert witness testimony in ophthalmology malpractice litigation.

    PubMed

    Huang, Grace; Fang, Christina H; Friedman, Remy; Bhagat, Neelakshi; Eloy, Jean Anderson; Langer, Paul D

    2015-03-01

    To examine the relative qualifications of expert witnesses testifying on behalf of plaintiffs vs defendants in ophthalmology malpractice litigation. Correlational and descriptive study; analysis of expert witness and physician demographic data available on several databases. The Westlaw legal database was searched for ophthalmologist expert witness testimony from January 2006 to June 2014. Physician demographic data were used as the main outcome measures, including length of experience, scholarly impact (as measured by the h-index), practice setting, and fellowship training status and were obtained from state medical licensing board sites and online medical facility and practice sites. H-indices were obtained from the Scopus database. Defendant and plaintiff expert witnesses had comparable mean years of experience (32.9 and 35.7, respectively) (P = .12) and scholarly impact (h-index = 8.6 and 8.3, respectively) (P = .42). Cases tended to resolve on the side of the expert witness with the higher h-index (P = .04). Significantly higher proportions of defendant witnesses were in academic practice (P < .05) and underwent fellowship training (P < .001). Ophthalmologist expert witnesses testifying for both plaintiffs and defendants had over 30 years of experience and high scholarly impact. Practitioners testifying on behalf of plaintiffs were statistically less likely to work in an academic setting and have subspecialty training. Scholarly impact of expert witnesses appeared to affect trial outcomes. Surgical societies should stringently police for appropriate expert witness testimony given by both plaintiff and defense experts in malpractice litigation. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Malpractice paid losses and financial performance of nursing homes.

    PubMed

    Zhao, Mei; Haley, D Rob; Oetjen, Reid M; Carretta, Henry J

    2011-01-01

    Florida's nursing home industry has experienced significant financial pressure over the past decade. One of the primary reasons is the dramatic increase in litigation activity for nursing home providers claiming negligent care and abuse. Although anecdotal reports indicate a higher cost because of malpractice in nursing facilities, few studies have examined the extent of malpractice paid losses and their effect on the financial performance of nursing homes. The purpose of this study was to examine the impact of malpractice paid losses on the financial performance of nursing homes. Medicare Cost Report data and Online Survey, Certification, and Reporting data for Florida skilled nursing facilities over the 6-year period from 2001 to 2006 were used to calculate the malpractice paid losses and the financial performance indicators as well as the nursing home organizational and market factors. Descriptive analysis and multivariate regression analysis were used to examine the effect of paid loss on financial performance. The paid loss for malpractice claims was strongly associated with financial performance. Nursing facilities with malpractice paid losses had consistently lower total margins over the study period. The threat of nursing home litigation may create an incentive for nursing homes to improve quality of care; however, large paid claims can also force nursing homes into a financial situation where the organization no longer has the resources to improve quality. Nursing home managers must assess their malpractice litigation risk and identify tactics to mitigate these risks to better provide a safe and secure environment for the older persons. In addition, this research offers support for local, state, and federal policymakers to revisit the issue of malpractice litigation and the nursing home industry through its insight on the relationship of nursing home margins and litigation.

  12. Tipping the scales: educating surgeons about medical malpractice.

    PubMed

    Raper, Steven E; Joseph, Johncy; Seymour, Wilda G; Sullivan, Patricia G

    2016-11-01

    In Pennsylvania, medical malpractice premiums are a major cost to surgeons. Yet surgeons often have little if any education in the basics of tort litigation or how to manage their risk. This work describes one approach for educating academic faculty surgeons on current concepts of medical malpractice and provide some guidance on how to "tip the scales of justice"; or minimize the risks of being named in a malpractice claim. The course had five parts: the basics of medical malpractice, the cost of malpractice insurance, current departmental claims experience, strategies for decreasing the risk of being named in a claim, and an overview of malpractice reforms. An anonymous seven question survey was cast in a five-point Likert scale format. A weighted average of 4.5 or above was considered satisfactory. Two free text questions asked about positive and negative aspects of the course. Eighty of 95 (84%) faculty attended either in person or by reviewing a web-based video. Quantitatively, five of seven questions had a weighted average of more than 4.5 (n = 48, response rate = 60%). Qualitatively, the course was reviewed very favorably. The high percentage of participation and overall survey results suggest that the course was successful. This course was one facet of an approach to decrease the risk of malpractice claims. Unique aspects of this course include an emphasis on state law, department-specific data, and strategies to minimize risk of future claims. Given the state-specific nature of malpractice claims and litigation, individual departments must particularize similar presentations. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. The Impact of Malpractice Liability Claims on Obstetrical Practice Patterns

    PubMed Central

    Gimm, Gilbert W

    2010-01-01

    Objectives This paper examines whether malpractice claims have any impact on obstetrical practice patterns (C-section rates) and physician delivery volume. Data Sources Secondary data from the 1992–2000 Florida Hospital Inpatient Discharge File, the Florida Medical Professional Liability Insurance Claims File, and the American Medical Association's Master File on physician characteristics. Study Design The effects of malpractice claims on C-section rates and physician delivery volume were estimated using panel data and a fixed-effects multivariate model. Data Collection Variables were constructed from each data source and merged into a single panel dataset using consistent physician identifiers. Principal Findings I did not find evidence that physicians changed their practice patterns by increasing C-section rates in response to malpractice claims. However, physicians performed six fewer inpatient deliveries 3 years after the closing of a malpractice claim, after controlling for individual- and market-level characteristics. Physicians with high malpractice awards of U.S.$250,000 or more performed 14 fewer deliveries on average. Conclusions Malpractice claims led to a small reduction in physician delivery volume, but they did not have a significant impact on C-section rates. PMID:19929964

  14. Malpractice in colorectal surgery: a review of 122 medicolegal cases.

    PubMed

    Gordhan, Chirag G; Anandalwar, Seema P; Son, Julie; Ninan, Gigio K; Chokshi, Ravi J

    2015-12-01

    Medical malpractice has become a rising concern for physicians, affecting the cost and delivery of health care. Colorectal procedures account for 24% of all general surgery cases, a high-risk specialty, with 15% of its physicians facing malpractice suit annually. The Westlaw legal database was used to identify colorectal malpractice cases. In all, 122 of 230 lawsuits were included in this study. A majority of 65.6% were physician verdicts, 19.7% plaintiff verdicts, and 14.8% reached a settlement. Plaintiff payments were found to be significantly higher than settlement awards. The most common cause of alleged malpractice was failure to recognize a complication in a timely manner (45.1%), followed by damage to surrounding tissues (36.1%). The most common cause of alleged malpractice was failure to recognize a complication in a timely manner, followed by damage to surrounding tissue. Plaintiff awards were significantly higher than settlement payments. It is important to understand the mechanism of malpractice allegations to better prevent litigation and improve patient care. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Primary care closed claims experience of Massachusetts malpractice insurers.

    PubMed

    Schiff, Gordon D; Puopolo, Ann Louise; Huben-Kearney, Anne; Yu, Winnie; Keohane, Carol; McDonough, Peggy; Ellis, Bonnie R; Bates, David W; Biondolillo, Madeleine

    Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims. To study patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project. Retrospective review of pooled closed claims data of 2 malpractice carriers covering most Massachusetts physicians during a 5-year period (January 1, 2005, through December 31, 2009). Data were harmonized between the 2 insurers using a standardized taxonomy. Primary care practices in Massachusetts. All malpractice claims that involved primary care practices insured by the 2 largest insurers in the state were screened. A total of 551 claims from primary care practices were identified for the analysis. Numbers and types of claims, including whether claims involved primary care physicians or practices; classification of alleged malpractice (eg, misdiagnosis or medication error); patient diagnosis; breakdown in care process; and claim outcome (dismissed, settled, verdict for plaintiff, or verdict for defendant). During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. Allegations were related to diagnosis in 397 (72.1%), medications in 68 (12.3%), other medical treatment in 41 (7.4%), communication in 15 (2.7%), patient rights in 11 (2.0%), and patient safety or security in 8 (1.5%). Leading diagnoses were cancer (n = 190), heart diseases (n = 43), blood vessel diseases (n = 27), infections (n = 22), and stroke (n = 16). Primary care cases were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non-general medical malpractice claims (P < .001). In Massachusetts, most primary care claims filed are related to alleged misdiagnosis. Compared with malpractice

  16. Malpractice risk and cost are significantly reduced after tort reform.

    PubMed

    Stewart, Ronald M; Geoghegan, Kathy; Myers, John G; Sirinek, Kenneth R; Corneille, Michael G; Mueller, Deborah; Dent, Daniel L; Wolf, Steven E; Pruitt, Basil A

    2011-04-01

    Rising medical malpractice premiums have reached a crisis point in many areas of the United States. In 2003 the Texas legislature passed a comprehensive package of tort reform laws that included a cap at $250,000 on noneconomic damages in most medical malpractice cases. We hypothesized that tort reform laws significantly reduce the risk of malpractice lawsuit in an academic medical center. We compared malpractice prevalence, incidence, and liability costs before and after comprehensive state tort reform measures were implemented. Two prospectively maintained institutional databases were used to calculate and characterize malpractice risk: a surgical operation database and a risk management and malpractice database. Risk groups were divided into pretort reform (1992 to 2004) and post-tort reform groups (2004 to the present). Operative procedures were included for elective, urgent, and emergency general surgery procedures. During the study period, 98,513 general surgical procedures were performed. A total of 28 lawsuits (25 pre-reform, 3 postreform) were filed, naming general surgery faculty or residents. The prevalence of lawsuits filed/100,000 procedures performed is as follows: before reform, 40 lawsuits/100,000 procedures, and after reform, 8 lawsuits/100,000 procedures (p < 0.01, relative risk 0.21 [95% CI 0.063 to 0.62]). Virtually all of the liability and defense cost was in the pretort reform period: $595,000/year versus $515/year in the postreform group (p < 0.01). Implementation of comprehensive tort reform in Texas was associated with a significant decrease in the prevalence and cost of surgical malpractice lawsuits at one academic medical center. Copyright © 2011. Published by Elsevier Inc.

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

    PubMed

    Jena, Anupam B; Schoemaker, Lena; Bhattacharya, Jay; Seabury, Seth A

    2015-11-04

    Is a higher use of resources by physicians associated with a reduced risk of malpractice claims? 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. 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. Within specialty and after adjustment for patient characteristics, higher resource use by physicians is associated with fewer malpractice claims. This study was supported by the Office of the Director, National Institutes of Health (grant 1DP5OD017897

  18. 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

  19. Salivary gland surgery and medical malpractice.

    PubMed

    Hong, Steven S; Yheulon, Christopher G; Sniezek, Joseph C

    2013-04-01

    To better understand the causes and outcomes of lawsuits involving salivary gland surgery by analyzing malpractice litigation trends to prevent future litigation and improve physician education. Analysis of a national database. All US civil trials. The WESTLAW database was reviewed from January 1987 to March 2011. Data were compiled on the demographics of the defendant, anatomic site of injury, initial pathology, nature of injury, legal allegations, verdicts, and indemnities. Twenty-six cases met inclusion criteria and were selected for review. Verdicts/settlements for the plaintiffs predominated (58%), and the average sum of the plaintiff's monetary award was $933,235. Sixteen cases (62%) involved injury to the parotid gland/duct, with 10 cases involving injury to the facial nerve. No cases were filed on the grounds of failure to use facial nerve monitoring. Nine cases (35%) involved injury to the submandibular gland/duct. The most common legal allegations listed were improper performance followed by unnecessary procedures. If failure or inadequate consent was a component of the legal allegations, the verdict outcome significantly favored the defendants. Our study reveals that the plaintiffs in litigations involving salivary gland surgery have a slight advantage in outcomes with a fairly substantial award. Our litigation review reiterates the importance of detailed anatomic knowledge of the lingual and facial nerve to avoid the pitfalls of surgical error and consequent litigation. In addition, thorough preoperative evaluation of salivary gland pathology, including radiographic studies and needle biopsy, may help avoid errors in diagnosis and subsequent litigations.

  20. 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.

  1. [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.

  2. The impact of defense expenses in medical malpractice claims.

    PubMed

    Carroll, Aaron E; Parikh, Parul Divya; Buddenbaum, Jennifer L

    2012-01-01

    The objective of this study was to take a closer look at defense-related expenses for medical malpractice cases over time. We conducted a retrospective review of medical malpractice claims reported to the Physician Insurers Association of America's Data Sharing Project with a closing date between January 1, 1985 and December 31, 2008. On average a medical malpractice claim costs more than $27,000 to defend. Claims that go to trial are much more costly to defend than are those that are dropped, withdrawn, or dismissed. However, since the overwhelming majority of claims are dropped, withdrawn, or dismissed, the total amount spent to defend them surpasses that spent on claims that go to trial. Defense attorney expenses account for the majority of defense-related expenses (74%), while expert witness expenses and other expenses split the remaining 26%. A strong association was also found between the average indemnity payment and the amount it costs to defend individual claims by specialty. Our study found that defense-related expenses for medical malpractice claims are not an insignificant cost. As state and federal governments debate how to repair the malpractice system, addressing the high cost of defending claims should not be ignored. © 2012 American Society of Law, Medicine & Ethics, Inc.

  3. Effects of health information technology on malpractice insurance premiums.

    PubMed

    Kim, Hye Yeong; Lee, Jinhyung

    2015-04-01

    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. To examine the effect of hospital IT on malpractice insurance expense, a generalized estimating equation (GEE) was employed. 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%. 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.

  4. 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

  5. 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. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Malpractice, tort reform, and you: an introduction to risk management.

    PubMed

    Feld, Andrew D; Walta, Douglas

    2004-02-01

    The current malpractice crisis has been called the "perfect storm". Doctors are finding practice costs unsustainable. Patients are finding access to care jeopardized. Cost of care is escalating. The system does not deter medical error, compensate most injured victims, produce any result quickly. These factors are creating enough of a crisis to urgently address and merit prompt solution. However, if history is any guide, the debate over malpractice will continue to rage. Reforms will likely be slow. Thus the practicing gastroenterologist, while working for or supporting efforts toward a solution, is well advised to keep up to date with the practice of gastroenterology, but also understand the medical legal matters and have a risk management strategy that will hopefully help keep the malpractice crisis a theoretical rather than personal concern. The following articles in this series are intended to help.

  7. 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…

  8. Malpractice in Teacher Education: The Improbable Becomes Increasingly Possible.

    ERIC Educational Resources Information Center

    Clear, Delbert

    1983-01-01

    In the past, the absence of performance standards for which teachers and teacher education institutions could be held accountable has helped protect teacher colleges from malpractice charges. As research identifies correlates between teacher behavior and student achievement, however, institutions which fail to teach minimum competencies may become…

  9. An overview of medical malpractice litigation and the perceived crisis.

    PubMed

    Litvin, S Gerald

    2005-04-01

    In this overview of medical malpractice litigation in the United States, practical and philosophic aspects of the so-called malpractice litigation crisis are addressed. After reviewing the historical, legal rationale for compensating victims of negligent conduct by others, attention is focused on the plight of physicians who are charged with medical negligence and the oppressive insurance premiums that impose a heavy burden on all health care providers, particularly those in the surgical fields. A variety of political solutions advanced to "correct" the problem is reviewed. A historical prospective of malpractice litigation in the United States is presented together with an analysis of various legislative proposals--many of which have already been enacted in various states that will ostensibly "cure" the problems that concern clinicians. Consideration of the various legislative proposals includes: arbitrary limits on pain and suffering awards (caps); elimination of joint and several liability; regulation of attorneys fees; elimination of the collateral source rule; abrogation of punitive damages; proposals for periodic payments; and statutes of repose. Various procedural changes in the processing of malpractice claims are reviewed and analyzed from the perspective of both fairness and efficacy.

  10. Medical malpractice in perspective. I--The American experience.

    PubMed Central

    Quam, L; Dingwall, R; Fenn, P

    1987-01-01

    Concern over the possibility of an American style medical malpractice "crisis" in the United Kingdom has recently been voiced by members of both medical and legal professions. The validity of such fears is examined by reviewing the conditions that have given rise to the current American difficulties. It is argued that the rise in malpractice insurance premiums and associated restrictions in availability should be seen against the background of underwriting problems specific to medical liability in conjunction with a general decline in reinsurance cover. The evidence in relation to the clinical and resource implications of malpractice is analysed. In particular, arguments that increased litigation has influenced the practice of "defensive" medicine and the choice of specialty are critically examined. Medical malpractice claims and insurance are only part of a professional environment which is undergoing dramatic social and economic changes, many of which seem more plausible candidates to be treated as important influences on the nature and organisation of health care in the United States. Images p1532-a PMID:3111624

  11. An improved accrual: reducing medical malpractice year-end adjustments.

    PubMed

    Frese, Richard C

    2012-08-01

    Healthcare organizations can improve their year-end malpractice insurance accruals by taking the following steps: Maintain productive communication. Match accrual and accounting policies. Adjust amount of credit to own historical loss experience. Request more frequent analysis. Obtain a second opinion.

  12. Professional Malpractice: Are Educators at Risk? Policy Bulletin.

    ERIC Educational Resources Information Center

    McCarthy, Martha

    Although no lawsuits claiming educational malpractice have yet been successful, it is conceivable that educators and school systems will be held legally accountable for correctly diagnosing pupils' needs, placing them in appropriate instructional programs, and reporting their progress to parents or guardians. This bulletin briefly examines…

  13. Malpractice Litigation and Nursing Home Quality of Care

    PubMed Central

    Konetzka, R Tamara; Park, Jeongyoung; Ellis, Robert; Abbo, Elmer

    2013-01-01

    Objective. To assess the potential deterrent effect of nursing home litigation threat on nursing home quality. Data Sources/Study Setting. We use a panel dataset of litigation claims and Nursing Home Online Survey Certification and Reporting (OSCAR) data from 1995 to 2005 in six states: Florida, Illinois, Wisconsin, New Jersey, Missouri, and Delaware, for a total of 2,245 facilities. Claims data are from Westlaw's Adverse Filings database, a proprietary legal database, on all malpractice, negligence, and personal injury/wrongful death claims filed against nursing facilities. Study Design. A lagged 2-year moving average of the county-level number of malpractice claims is used to represent the threat of litigation. We use facility fixed-effects models to examine the relationship between the threat of litigation and nursing home quality. Principal Findings. We find significant increases in registered nurse-to-total staffing ratios in response to rising malpractice threat, and a reduction in pressure sores among highly staffed facilities. However, the magnitude of the deterrence effect is small. Conclusions. Deterrence in response to the threat of malpractice litigation is unlikely to lead to widespread improvements in nursing home quality. This should be weighed against other benefits and costs of litigation to assess the net benefit of tort reform. PMID:23741985

  14. Evaluating the medical malpractice system and options for reform.

    PubMed

    Kessler, Daniel P

    2011-01-01

    The U.S. medical malpractice liability system has two principal objectives: to compensate patients who are injured through the negligence of healthcare providers and to deter providers from practicing negligently. In practice, however, the system is slow and costly to administer. It both fails to compensate patients who have suffered from bad medical care and compensates those who haven't. According to opinion surveys of physicians, the system creates incentives to undertake cost-ineffective treatments based on fear of legal liability--to practice "defensive medicine." The failures of the liability system and the high cost of health care in the United States have led to an important debate over tort policy. How well does malpractice law achieve its intended goals? How large of a problem is defensive medicine and can reforms to malpractice law reduce its impact on healthcare spending? The flaws of the existing system have led a number of states to change their laws in a way that would reduce malpractice liability--to adopt "tort reforms." Evidence from several studies suggests that wisely chosen reforms have the potential to reduce healthcare spending significantly with no adverse impact on patient health outcomes.

  15. 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.

  16. 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

  17. Physician Surveys to Assess Customary Care in Medical Malpractice Cases

    PubMed Central

    Hartz, Arthur; Lucas, Joshua; Cramm, Timothy; Green, Michael; Bentler, Suzanne; Ely, John; Wolfe, Steven; James, Paul

    2002-01-01

    OBJECTIVE Physician experts hired and prepared by the litigants provide most information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, we examined the feasibility and potential value of surveying community physicians to assess standard of care. DESIGN Seven physician surveys of mutually exclusive groups of randomly selected physicians. SETTING Iowa. PARTICIPANTS Community and academic primary care physicians and relevant specialists. INTERVENTIONS Included in each survey was a case vignette of a primary care malpractice case and key quotes from medical experts on each side of the case. Surveyed physicians were asked whether the patient should have been referred to a specialist for additional evaluation. The 7 case vignettes included 3 closed medical malpractice cases, 3 modifications of these cases, and 1 active case. MEASUREMENTS AND MAIN RESULTS Sixty-three percent of 350 community primary care physicians and 51% of 216 community specialists completed the questionnaire. For 3 closed cases, 47%, 78%, and 88% of primary care physician respondents reported that they would have made a different referral decision than the defendant. Referral percentages were minimally affected by modifying patient outcome but substantially changed by modifying patient presentation. Most physicians, even those whose referral decisions were unusual, assumed that other physicians would make similar referral decisions. For each case, at least 65% of the primary care physicians disagreed with the testimony of one of the expert witnesses. In the active case, the response rate was high (71%), and the respondents did not withhold criticism of the defendant doctor. CONCLUSIONS Randomly selected peer physicians are willing to participate in surveys of medical malpractice cases. The surveys can be used to construct the distribution of physician self-reported practice relevant to a particular malpractice case. This distribution may

  18. [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

  19. Association Between State Medical Malpractice Environment and Postoperative Outcomes in the United States.

    PubMed

    Minami, Christina A; Sheils, Catherine R; Pavey, Emily; Chung, Jeanette W; Stulberg, Jonah J; Odell, David D; Yang, Anthony D; Bentrem, David J; Bilimoria, Karl Y

    2017-03-01

    The US medical malpractice system assumes that the threat of liability should deter negligence, but it is unclear whether malpractice environment affects health care quality. We sought to explore the association between state malpractice environment and postoperative complication rates. This observational study included Medicare fee-for-service beneficiaries undergoing one of the following operations in 2010: colorectal, lung, esophageal, or pancreatic resection, total knee arthroplasty, craniotomy, gastric bypass, abdominal aortic aneurysm repair, coronary artery bypass grafting, or cystectomy. The state-specific malpractice environment was measured by 2010 medical malpractice insurance premiums, state average award size, paid malpractice claims/100 physicians, and a composite malpractice measure. Outcomes of interest included 30-day readmission, mortality, and postoperative complications (eg sepsis, myocardial infarction [MI], pneumonia). Using Medicare administrative claims data, associations between malpractice environment and postoperative outcomes were estimated using hierarchical logistic regression models with hospital random-intercepts. Measures of malpractice environment did not have significant, consistent associations with postoperative outcomes. No individual tort reform law was consistently associated with improved postoperative outcomes. Higher-risk state malpractice environment, based on the composite measure, was associated with higher likelihood of sepsis (odds ratio [OR] 1.22; 95% CI 1.07 to 1.39), MI (OR 1.14; 95% CI 1.06 to 1.23), pneumonia (OR 1.09; 95% CI 1.03 to 1.16), acute renal failure (OR 1.15; 95% CI 1.08 to 1.22), deep vein thrombosis/pulmonary embolism (OR 1.22; 95% CI 1.13 to 1.32), and gastrointestinal bleed (OR 1.18; 95% CI 1.08 to 1.30). Higher risk malpractice environments were not consistently associated with a lower likelihood of surgical postoperative complications, bringing into question the ability of malpractice lawsuits to

  20. 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.

  1. Malpractice insurance options: claims-made vs. occurrence coverage.

    PubMed

    Singer, P E

    1985-07-01

    Professional liability insurance is not the trivial matter it was once. Premium costs are significant, the threat of malpractice litigation is tangible, sources of coverage are diverse, and there has been a proliferation of insurance carriers of different genres. Such changes have elevated the choice of malpractice insurance policy to the status of a major decision about which practitioners must be well informed. Differences between claims-made and occurrence coverage are clarified, and the advantages and disadvantages of each type of coverage are canvassed. The benefits of insuring with a commercial carrier versus a physician-owned company are also discussed in the light of trends in the structure of the liability insurance industry.

  2. Physician communication skills and malpractice claims. A complex relationship.

    PubMed Central

    Adamson, T E; Tschann, J M; Gullion, D S; Oppenberg, A A

    1989-01-01

    We assessed the relationship between patients' opinions about their physicians' communication skills and the physician's history of medical malpractice claims. The sample consisted of 107 physicians and 2,030 of their patients who had had an operation or a delivery. Although patients tended to give their physicians favorable ratings, they were least satisfied with the amount of explanations they received. Patients gave higher ratings to general surgeons and obstetrician-gynecologists and poorer ratings to orthopedists and anesthesiologists. Women and better-educated patients gave higher ratings on explanations and communication to physicians with fewer claims. Men and patients with less education, however, gave higher ratings on these dimensions to physicians with more claims. These findings suggest the need for physicians to tailor their communications to a patient's individual needs. Improved communication between physicians and patients may result in fewer nonmeritorious malpractice claims while leading to less costly resolution of meritorious claims. PMID:2735043

  3. 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

  4. Controlling large malpractice claims: the unexpected impact of damage caps.

    PubMed

    Gronfein, W P; Kinney, E D

    1991-01-01

    Indiana's comprehensive malpractice reforms, inaugurated in 1975, include a cap on damages, a mandated medical review before trial, and a state insurance fund to pay claims equal to or greater than $100,000. We have found that the amount of compensation going to claimants with such large malpractice claims in Indiana is, on average, substantially higher than in Michigan and Ohio. Indiana's mean claim severity between 1977 and 1988 was $404,832, while the means for Michigan and Ohio were $290,022 and $303,220, respectively, with the difference between these three means being highly significant. Although data on claim and claimant characteristics reveal considerable interstate variation, the results of regression analyses show that Indiana claim payment amounts are higher than Michigan or Ohio payments, independent of the effect of factors such as sex, age, severity of injury, allegations of negligence, and year of settlement.

  5. The concept of error and malpractice in radiology.

    PubMed

    Pinto, Antonio; Brunese, Luca; Pinto, Fabio; Reali, Riccardo; Daniele, Stefania; Romano, Luigia

    2012-08-01

    Since the early 1970s, physicians have been subjected to an increasing number of medical malpractice claims. Radiology is one of the specialties most liable to claims of medical negligence. The etiology of radiological error is multifactorial. Errors fall into recurrent patterns. Errors arise from poor technique, failures of perception, lack of knowledge, and misjudgments. Every radiologist should understand the sources of error in diagnostic radiology as well as the elements of negligence that form the basis of malpractice litigation. Errors are an inevitable part of human life, and every health professional has made mistakes. To improve patient safety and reduce the risk from harm, we must accept that some errors are inevitable during the delivery of health care. We must play a cultural change in medicine, wherein errors are actively sought, openly discussed, and aggressively addressed. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Decreasing intrapartum malpractice: Targeting the most injurious neonatal adverse events.

    PubMed

    Santos, Palmira; Ritter, Grant A; Hefele, Jennifer L; Hendrich, Ann; McCoy, Christine Kocot

    2015-01-01

    Medical malpractice expenditures are mainly due to the occurrence of preventable harm with some of the highest liability rates in obstetrics. Establishing delivery system models which decrease preventable harm and malpractice risk have had varied results over the last decade. We conducted a case study of a risk reduction labor and delivery model at 5 demonstration sites. The model included standardized protocols for the most injurious events, training teams in labor and delivery emergencies, rapid reporting with cause analysis for all unplanned events, and disclosing unexpected occurrences to patients using coordinated communication and documentation. Each of the model's components required buy in from the hospital's clinical and administrative leadership, and it also required collaboration, training, and continual feedback to labor and delivery nurses, doctors, midwives, and risk managers. The case study examined the key elements in the development of the model based on interviews of all team members and document review. We also completed data analysis pre and post implementation of the new model to assess the impact on event reporting and high liability occurrence rates. After 27 months post implementation, reporting of unintended events increased significantly (43 vs 84 per 1000 births, p < .01) while high-risk malpractice events decreased significantly (14 vs 7 per 1000 births, p < .01). This decrease enabled money allotted for malpractice claims to be reallocated for the implementation of the new model at 42 additional labor and delivery sites. Due to these results, this multilevel integrated model showed promise. © 2015 American Society for Healthcare Risk Management of the American Hospital Association.

  7. Malpractice claims on emergency physicians: time and money.

    PubMed

    Cohen, Darien; Chan, Shu B; Dorfman, Marc

    2012-01-01

    Emergency medicine, with its limited time for patient encounters, unpredictable flow, and lack of a continuing patient-physician relationship, is a particularly high-risk field with regards to the issue of medical liability. There have been limited studies on the financial and time exposure emergency physicians face when confronted with a liability suit. Provide practicing physicians with guidance as to what can be expected if they are confronted with a medical malpractice claim, and contribute to the literature as the issue of tort reform is debated. Retrospective study of all closed malpractice claims involving emergency physicians insured by the Illinois State Medical Inter-insurance Exchange covering the 10-year period 1995 to 2004. Of 450 claims, there were 200 cases served. The median incident-to-close time was 45.5 months (interquartile range [IQR] 30.6-69.9). The median expense per claim served was $14,091 (IQR $3448-$44,363); 19.5% of cases resulted in an indemnity with a median of $220,000 (IQR $117,500-$700,000). Cases in which an indemnity was eventually made tended to be filed 7.7 months faster (p = 0.065) and took 14.1 months longer to close (p < 0.05). In cases with a payout of ≥ $1,000,000, 80% were in the ≤ 1-year age group. In this study, emergency physicians with malpractice suits can expect resolution of the case to take over 45 months after an alleged incident, and their malpractice insurer will incur over $14,000 in expenses regardless of the suit outcome. Cases involving patients aged ≤ 1 year may incur higher indemnity payments. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. 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.

  9. Defensive medicine and outcomes for medical malpractice liability.

    PubMed

    Genovese, Umberto; Amato, Simona; Del Sordo, Sara; Mobilia, Francesca; Casali, Michelangelo B

    2014-01-01

    Defensive medicine is a significant force driving the high costs of healthcare systems and has a substantial influence on physicians' behavior because they primarily concern about malpractice liability and not patient's health protection. This attitude disagrees with deontological duties and could impair physicians' ability of judgment and clinical reasoning. Reducing defensive medicine also could mean improving the quality in healthcare systems and eliminating unnecessary costs.

  10. Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons

    PubMed Central

    Smith, Timothy R.; Heary, Robert F.

    2012-01-01

    Background Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons’ perceptions of malpractice liability and defensive medicine practices. Methods A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices. Results A total of 1028 surveys were completed (31% response rate) by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a “major or extreme” burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns. Conclusions Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States. PMID:22761745

  11. Malpractice liability and defensive medicine: a national survey of neurosurgeons.

    PubMed

    Nahed, Brian V; Babu, Maya A; Smith, Timothy R; Heary, Robert F

    2012-01-01

    Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons' perceptions of malpractice liability and defensive medicine practices. A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices. A total of 1028 surveys were completed (31% response rate) by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a "major or extreme" burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns. Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.

  12. Medical malpractice reform and insurer claims defense: unintended effects?

    PubMed

    Ambrose, Jan M; Carroll, Anne

    2007-10-01

    In response to recent and past medical malpractice insurance crises, most states have implemented reforms meant to stabilize premiums and coverage availability. The importance of understanding whether these reforms implicitly affect the behavior and incentives of plaintiffs, attorneys, medical providers, and malpractice insurers in the intended way is crucial to policy makers, if they are to achieve their goal. This study specifically examines the effect of reforms on the claims defense efforts of insurers, given that defense expenses account for approximately 30 percent of malpractice premiums. Using state data for the period 1998-2002, we regress claims defense expenses against a variety of reform variables. These include seven tort reforms (noneconomic damage caps, punitive damage limits, attorney fee limits, modified collateral source rule, modified joint and several liability doctrine, mandatory pretrial screening, and statute of limitations) and two government-sponsored insurance mechanisms (joint underwriting associations and patient compensation funds). Claims defense expenses are found to be higher in the presence of noneconomic damage caps, punitive damage limits, and attorney fee limits--an unintended and counterproductive effect of reform--but are lower with mandatory pretrial screening and patient compensation funds.

  13. Analysis of Factors Associated With Rhytidectomy Malpractice Litigation Cases.

    PubMed

    Kandinov, Aron; Mutchnick, Sean; Nangia, Vaibhuv; Svider, Peter F; Zuliani, Giancarlo F; Shkoukani, Mahdi A; Carron, Michael A

    2017-07-01

    This study investigates the financial burden of medical malpractice litigation associated with rhytidectomies, as well as factors that contribute to litigation and poor defendant outcomes, which can help guide physician practices. To comprehensively evaluate rhytidectomy malpractice litigation. Jury verdict and settlement reports related to rhytidectomy malpractice litigations were obtained using the Westlaw Next database. Use of medical malpractice in conjunction with several terms for rhytidectomy, to account for the various procedure names associated with the procedure, yielded 155 court cases. Duplicate and nonrelevant cases were removed, and 89 cases were included in the analysis and reviewed for outcomes, defendant specialty, payments, and other allegations raised in proceedings. Data were collected from November 21, 2015, to December 25, 2015. Data analysis took place from December 25, 2015, to January 20, 2016. A total of 89 cases met our inclusion criteria. Most plaintiffs were female (81 of 88 with known sex [92%]), and patient age ranged from 40 to 76 years (median age, 56 years). Fifty-three (60%) were resolved in the defendant's favor, while the remaining 36 cases (40%) were resolved with either a settlement or a plaintiff verdict payment. The mean payment was $1.4 million. A greater proportion of cases involving plastic surgeon defendants were resolved with payment compared with cases involving defendants with ear, nose, and throat specialty (15 [36%] vs 4 [24%]). The most common allegations raised in litigation were intraoperative negligence (61 [69%]), poor cosmesis or disfigurement (57 [64%]), inadequate informed consent (30 [34%]), additional procedures required (14 [16%]), postoperative negligence (12 [14%]), and facial nerve injury (10 [11%]). Six cases (7%) involved alleged negligence surrounding a "lifestyle-lift" procedure, which tightens or oversews the superficial muscular aponeurosis system layer. In this study, although most cases of

  14. Malpractice awareness among surgeons at a teaching hospital in Pakistan.

    PubMed

    Sheikh, Asfandyar; Ali, Sajid; Ejaz, Sadaf; Farooqi, Marium; Ahmed, Syed Salman; Jawaid, Imran

    2012-11-06

    The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6%) was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9%) was most frequently disagreed. In the event of a medical error, majority (67.7%) were ready to disclose their error to the patient. The most

  15. Malpractice awareness among surgeons at a teaching hospital in Pakistan

    PubMed Central

    2012-01-01

    Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6%) was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9%) was most frequently disagreed. In the event of a medical error, majority (67.7%) were ready to disclose their error

  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. Perspective: Malpractice in an academic medical center: a frequently overlooked aspect of professionalism education.

    PubMed

    Hochberg, Mark S; Seib, Carolyn D; Berman, Russell S; Kalet, Adina L; Zabar, Sondra R; Pachter, H Leon

    2011-03-01

    Understanding how medical malpractice occurs and is resolved is important to improving patient safety and preserving the viability of a physician's career in academic medicine. Every physician is likely to be sued by a patient, and how the physician responds can change his or her professional life. However, the principles of medical malpractice are rarely taught or addressed during residency training. In fact, many faculty at academic medical centers know little about malpractice.In this article, the authors propose that information about the inciting causes of malpractice claims and their resolution should be incorporated into residency professionalism curricula both to improve patient safety and to decrease physician anxiety about a crucial aspect of medicine that is not well understood. The authors provide information on national trends in malpractice litigation and residents' understanding of malpractice, then share the results of their in-depth review of surgical malpractice claims filed during 2001-2008 against their academic medical center. The authors incorporated those data into an evidence-driven curriculum for residents, which they propose as a model for helping residents better understand the events that lead to malpractice litigation, as well as its process and prevention.

  18. 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…

  19. 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.…

  20. 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…

  1. Prevalence of Teachers' Professional Malpractices in Tanzanian Public Secondary Schools: What Ought to Be Done?

    ERIC Educational Resources Information Center

    Mfaume, Hamisi; Bilinga, Margareth

    2017-01-01

    This study explored stakeholders' views on preventive measures towards increasing teachers' malpractices in schools in Tanzania. Specifically, the study sought to identify prevalent forms of teachers' malpractices; explore factors for their occurrence; and explore views on how to forestall the problem. It draws on qualitative and quantitative data…

  2. 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.…

  3. Alleged malpractice in anesthesiology: analysis of a series of private insurance claims.

    PubMed

    Genovese, Umberto; Blandino, Alberto; Midolo, Riccardo; Casali, Michelangelo B

    2016-02-01

    Medical malpractice is currently a crucial topic and anesthesia is a key specialty for the improvement of patient safety. However, death and permanent impairment due to anesthesia still occur and studies of insurance analysis data are increasing. We investigated the main features of a major Italian insurance broker's archive in order to identify possible recurrent pitfalls in this critical field of medicine. Three hundred seventeen Italian claims were analyzed, filling out a standardized form that recorded information on patient and physician's characteristics, procedures, sequence and location of events and outcomes. The operative setting, the type of anesthesia performed the origin of the multidisciplinary team malpractice hypothesis, the final clinical outcome and the malpractice investigation results were also analyzed. In 225 malpractice claims, the adverse event was surgery-linked, either intraoperatively (114 cases) or postoperatively (111 cases): abdominal surgery (26%), orthopedics (22%), gynecology (20%), heart surgery (11%) and neurosurgery (9.5%) were the most frequently involved surgical specialties. In 92 cases, the claim was unlinked to a surgeon's activity, with dental damage in oral intubation procedures as the greatest contributor (42.3%). Anesthetists' malpractice was technically ascertained in 39% of cases, 74.8% resulting in permanent impairment. Malpractice was mainly suspected in surgery-linked procedures. Most of the claims were settled for procedural error in performing locoregional anesthesia and oral intubation procedures. 60% of all closed claims resulted in no malpractice ascertained. Confirmed malpractice typically deals with non surgery-linked and non multidisciplinary team cases, causing permanent impairment.

  4. 24 CFR 242.33 - Covenant for malpractice, fire, and other hazard insurance.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Covenant for malpractice, fire, and... HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR HOSPITALS Mortgage Requirements § 242.33 Covenant for malpractice, fire, and other hazard insurance. The mortgage shall contain a covenant binding the...

  5. 24 CFR 242.33 - Covenant for malpractice, fire, and other hazard insurance.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Covenant for malpractice, fire, and... HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR HOSPITALS Mortgage Requirements § 242.33 Covenant for malpractice, fire, and other hazard insurance. The mortgage shall contain a covenant binding the...

  6. 24 CFR 242.33 - Covenant for malpractice, fire, and other hazard insurance.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Covenant for malpractice, fire, and... HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR HOSPITALS Mortgage Requirements § 242.33 Covenant for malpractice, fire, and other hazard insurance. The mortgage shall contain a covenant binding the...

  7. 24 CFR 242.33 - Covenant for malpractice, fire, and other hazard insurance.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Covenant for malpractice, fire, and... HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR HOSPITALS Mortgage Requirements § 242.33 Covenant for malpractice, fire, and other hazard insurance. The mortgage shall contain a covenant binding the...

  8. 24 CFR 242.33 - Covenant for malpractice, fire, and other hazard insurance.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 24 Housing and Urban Development 2 2013-04-01 2013-04-01 false Covenant for malpractice, fire, and... HOUSING ACT AND OTHER AUTHORITIES MORTGAGE INSURANCE FOR HOSPITALS Mortgage Requirements § 242.33 Covenant for malpractice, fire, and other hazard insurance. The mortgage shall contain a covenant binding the...

  9. Reducing risk with clinical decision support: a study of closed malpractice claims.

    PubMed

    Zuccotti, G; Maloney, F L; Feblowitz, J; Samal, L; Sato, L; Wright, A

    2014-01-01

    Identify clinical opportunities to intervene to prevent a malpractice event and determine the proportion of malpractice claims potentially preventable by clinical decision support (CDS). Cross-sectional review of closed malpractice claims over seven years from one malpractice insurance company and seven hospitals in the Boston area. For each event, clinical opportunities to intervene to avert the malpractice event and the presence or absence of CDS that might have a role in preventing the event, were assigned by a panel of expert raters. Compensation paid out to resolve a claim (indemnity), was associated with each CDS type. Of the 477 closed malpractice cases, 359 (75.3%) were categorized as substantiated and 195 (54%) had at least one opportunity to intervene. Common opportunities to intervene related to performance of procedure, diagnosis, and fall prevention. We identified at least one CDS type for 63% of substantiated claims. The 41 CDS types identified included clinically significant test result alerting, diagnostic decision support and electronic tracking of instruments. Cases with at least one associated intervention accounted for $40.3 million (58.9%) of indemnity. CDS systems and other forms of health information technology (HIT) are expected to improve quality of care, but their potential to mitigate risk had not previously been quantified. Our results suggest that, in addition to their known benefits for quality and safety, CDS systems within HIT have a potential role in decreasing malpractice payments. More than half of malpractice events and over $40 million of indemnity were potentially preventable with CDS.

  10. 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…

  11. Medical Malpractice: Insurance Costs Increased but Varied among Physicians and Hospitals. Report to Congressional Requesters.

    ERIC Educational Resources Information Center

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

    This report concerns the medical malpractice situation in the United States and contains information on the cost of malpractice insurance for physicians and hospitals. The report contains an executive summary and four chapters. Chapter 1 reviews the background of the problem and the objectives, scope, and methodology of the report. Chapter 2…

  12. 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…

  13. The Effect of Medical Malpractice Liability on Rate of Referrals Received by Specialist Physicians

    PubMed Central

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

    2013-01-01

    Using nationally representative data from the U.S., 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 U.S. 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 noneconomic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on noneconomic 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

  14. Development of a Composite Measure of State-Level Malpractice Environment

    PubMed Central

    Chung, Jeanette W; Sohn, Min-Woong; Merkow, Ryan P; Oh, Elissa H; Minami, Christina; Black, Bernard S; Bilimoria, Karl Y

    2014-01-01

    Objective To develop a composite measure of state-level malpractice environment. Data Sources Public use data from the National Practitioner Data Bank, Medical Liability Monitor, the National Conference of State Legislatures, and the American Bar Association. Study Design Principal component analysis of state-level indicators (paid claims rate, malpractice premiums, lawyers per capita, average award size, and malpractice laws), with indirect validation of the composite using receiver-operating characteristic curves to determine how accurately the composite could identify states with high-tort activity and costs. Principal Findings A single composite accounted for over 73 percent of total variance in the seven indicators and demonstrated reasonable criterion validity. Conclusion An empirical composite measure of state-level malpractice risk may offer advantages over single indicators in measuring overall risk and may facilitate cross-state comparisons of malpractice environments. PMID:24117397

  15. 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.

  16. Forty years of litigation involving residents and their training: II. Malpractice issues.

    PubMed

    Helms, L B; Helms, C M

    1991-12-01

    The authors reviewed 136 cases of malpractice litigation involving residents or programs of graduate medical education that were reported from 1950 through 1989. Before 1970 malpractice constituted the only area of reported litigation for residents. The number of malpractice cases involving residents increased substantially after 1975, paralleling the growth of malpractice cases nationally. The regional pattern of reported cases involving residents also corresponded with previous findings. Questions of vicarious liability, the applicable standard of care, and residents' supervision were at issue in the great majority of cases. Questions related to judicial procedure, immunity from liability, breach or causation, and informed consent were also litigated. Residents were on the side of the prevailing party in 44% of the cases. Malpractice continues to be the key legal issue facing programs of residency training.

  17. Do the poor sue more? A case-control study of malpractice claims and socioeconomic status.

    PubMed

    Burstin, H R; Johnson, W G; Lipsitz, S R; Brennan, T A

    1993-10-13

    To evaluate whether socioeconomic status is associated with risk of malpractice claims, particularly among those who have suffered medical injury. Case-control study. Fifty-one hospitals in New York State. The presence and severity of medical injury, defined as disability at the time of discharge or prolongation of the hospitalization caused by medical treatment as opposed to the disease process, were assessed through review of approximately 31,000 hospital records in New York in 1984. These sampled records were then linked to formal malpractice claims. To estimate the risk of malpractice claims by age, gender, race, insurance status, and income, we conducted a case-control study of claimant cases matched with nonclaimant controls. The cases were all those patients who filed malpractice claims referring to alleged malpractice during a sampled hospitalization. Physician reviewers had previously judged the level of disability that resulted from the medical injury. Claimants (n = 51) were each matched with five nonclaimant controls on the basis of injury. Noninjured cases were matched with noninjured controls and injured cases were matched with injured controls. We found that poor patients (odds ratio [OR], 0.2; 95% confidence interval [CI], 0.03 to 0.8) and uninsured patients (OR, 0.1; 95% CI, 0.005 to 0.9) were significantly less likely to file malpractice claims, after controlling for the severity of medical injury. Among patients who suffered medical injury, the elderly (OR, 0.2; 95% CI, 0.03 to 0.9) were also less likely to file claims. Gender and race were not independently associated with risk of malpractice claims. Poor and uninsured patients are significantly less likely to sue for malpractice, even after controlling for the presence of medical injury. Fear of malpractice risk should not be a significant factor in the decision to serve the poor. Tort reforms that would protect physicians who serve the medically indigent from malpractice suits may not be

  18. Influencing factors leading to malpractice litigation in radical prostatectomy.

    PubMed

    Colaco, Marc; Sandberg, Jason; Badlani, Gopal

    2014-06-01

    The litigious nature of the medical-legal environment is a major concern for American physicians with an estimated cost of $10 billion. In this study we identify the causes of litigation in cases of radical prostatectomy as well as the factors that contribute to verdicts or settlements resulting in indemnity payments. Publicly available verdict reports were recorded using the Westlaw® legal database. To identify pertinent cases we used the search terms "medical malpractice" and "prostate" or "prostatectomy" with dates ranging from 2000 to 2013. Cases were evaluated for alleged cause of malpractice, resulting injury, findings and indemnity payment (if any). The database search yielded 222 cases, with 25 being relevant to radical prostatectomy. Of these cases 24.0% were settled out of court and the remaining 76.0% went to trial. Of those cases that went to trial 20.8% saw patients awarded damages. There was no significant difference in awards between verdict and settlement. Overall 36.0% of patients claimed that they did not receive proper informed consent and 16.0% claimed that the surgery was not the proper standard of care. Thirteen of the cases claimed negligence in the performance of the surgery with the bulk of these claims being the result of rectal perforation. The main issues that arise in radical prostatectomy malpractice litigation are those of informed consent and clinical performance. Comprehensive preoperative counseling, when combined with proper surgical technique, may minimize the impact of litigation. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  19. Operator-related aspects in endodontic malpractice claims in Finland.

    PubMed

    Vehkalahti, Miira M; Swanljung, Outi

    2017-04-01

    We analyzed operator-related differences in endodontic malpractice claims in Finland. Data comprised the endodontic malpractice claims handled at the Patient Insurance Centre (PIC) in 2002-2006 and 2011-2013. Two dental advisors at the PIC scrutinized the original documents of the cases (n = 1271). The case-related information included patient's age and gender, type of tooth, presence of radiographs, and methods of instrumentation and apex location. As injuries, we recorded broken instrument, perforation, injuries due to root canal irrigants/medicaments, and miscellaneous injuries. We categorized the injuries according to the PIC decisions as avoidable, unavoidable, or no injury. Operator-related information included dentist's age, gender, specialization, and service sector. We assessed level of patient documentation as adequate, moderate, or poor. Chi-squared tests, t-tests, and logistic regression modelling served in statistical analyses. Patients' mean age was 44.7 (range 8-85) years, and 71% were women. The private sector constituted 54% of claim cases. Younger patients, female dentists, and general practitioners predominated in the public sector. We found no sector differences in patients' gender, dentists' age, or type of injured tooth. PIC advisors confirmed no injury in 24% of claim cases; the advisors considered 65% of injury cases (n = 970) as avoidable and 35% as unavoidable. We found no operator-related differences in these figures. Working methods differed by operator's age and gender. Adequate patient documentation predominated in the public sector and among female, younger, or specialized dentists. Operator-related factors had no impact on endodontic malpractice claims.

  20. Nature of Medical Malpractice Claims Against Radiation Oncologists.

    PubMed

    Marshall, Deborah; Tringale, Kathryn; Connor, Michael; Punglia, Rinaa; Recht, Abram; Hattangadi-Gluth, Jona

    2017-05-01

    To examine characteristics of medical malpractice claims involving radiation oncologists closed during a 10-year period. Malpractice claims filed against radiation oncologists from 2003 to 2012 collected by a nationwide liability insurance trade association were analyzed. Outcomes included the nature of claims and indemnity payments, including associated presenting diagnoses, procedures, alleged medical errors, and injury severity. We compared the likelihood of a claim resulting in payment in relation to injury severity categories (death as referent) using binomial logistic regression. There were 362 closed claims involving radiation oncology, 102 (28%) of which were paid, resulting in $38 million in indemnity payments. The most common alleged errors included "improper performance" (38% of closed claims, 18% were paid; 29% [$11 million] of total indemnity), "errors in diagnosis" (25% of closed claims, 46% were paid; 44% [$17 million] of total indemnity), and "no medical misadventure" (14% of closed claims, 8% were paid; less than 1% [$148,000] of total indemnity). Another physician was named in 32% of claims, and consent issues/breach of contract were cited in 18%. Claims for injury resulting in death represented 39% of closed claims and 25% of total indemnity. "Improper performance" was the primary alleged error associated with injury resulting in death. Compared with claims involving death, major temporary injury (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.29-5.85, P=.009), significant permanent injury (OR 3.1, 95% CI 1.48-6.46, P=.003), and major permanent injury (OR 5.5, 95% CI 1.89-16.15, P=.002) had a higher likelihood of a claim resulting in indemnity payment. Improper performance was the most common alleged malpractice error. Claims involving significant or major injury were more likely to be paid than those involving death. Insights into the nature of liability claims against radiation oncologists may help direct efforts to improve quality of care

  1. Cleft Lip and Cleft Palate Surgery: Malpractice Litigation Outcomes.

    PubMed

    Justin, Grant A; Brietzke, Scott E

    2017-01-01

      This study examined malpractice claims related to cleft lip and cleft palate surgery to identify common allegations and injuries and reviewed financial outcomes.   The WestlawNext legal database was analyzed for all malpractice lawsuits and settlements related to the surgical repair of cleft lip and palate.   Inclusion criteria included patients undergoing surgical repair of a primary cleft lip or palate or revision for complications of previous surgery. Data evaluated included patient demographics, type of operation performed, plaintiff allegation, nature of injury, and litigation outcomes.   A total of 36 cases were identified, with 12 unique cases from 1981 to 2006 meeting the inclusion criteria. Six cases (50%) were decided by a jury and six by settlement. Five cases involved complications related to the specific surgery, and the other seven were associated with any surgery and perioperative care of children and adults. Cleft palate repair (50%) was the most frequently litigated surgery. Postoperative negligent supervision was the most common allegation (42%) and resulted in a payout in each case (mean = $3,126,032). Death (42%) and brain injury (25%) were the most frequent injuries reported. Financial awards were made in nine cases (after adjusting for inflation, mean = $2,470,552, range = $0 to $7,704,585). The awards were significantly larger for brain injury than other outcomes ($4,675,395 versus $1,368,131 after adjusting for inflation, P = .0101).   Malpractice litigation regarding cleft lip and palate surgery is uncommon. However, significant financial awards involving perioperative brain injury have been reported.

  2. The Impact of Incident Disclosure Behaviors on Medical Malpractice Claims.

    PubMed

    Giraldo, Priscila; Sato, Luke; Castells, Xavier

    2017-06-30

    To provide preliminary estimates of incident disclosure behaviors on medical malpractice claims. We conducted a descriptive analysis of data on medical malpractice claims obtained from the Controlled Risk Insurance Company and Risk Management Foundation of Harvard Medical Institutions (Cambridge, Massachusetts) between 2012 and 2013 (n = 434). The characteristics of disclosure and apology after medical errors were analyzed. Of 434 medical malpractice claims, 4.6% (n = 20) medical errors had been disclosed to the patient at the time of the error, and 5.9% (n = 26) had been followed by disclosure and apology. The highest number of disclosed injuries occurred in 2011 (23.9%; n = 11) and 2012 (34.8%; n = 16). There was no incremental increase during the financial years studied (2012-2013). The mean age of informed patients was 52.96 years, 58.7 % of the patients were female, and 52.2% were inpatients. Of the disclosed errors, 26.1% led to an adverse reaction, and 17.4% were fatal. The cause of disclosed medical error was improper surgical performance in 17.4% (95% confidence interval, 6.4-28.4). Disclosed medical errors were classified as medium severity in 67.4%. No apology statement was issued in 54.5% of medical errors classified as high severity. At the health-care centers studied, when a claim followed a medical error, providers infrequently disclosed medical errors or apologized to the patient or relatives. Most of the medical errors followed by disclosure and apology were classified as being of high and medium severity. No changes were detected in the volume of lawsuits over time.

  3. Burnout, job satisfaction, and medical malpractice among physicians.

    PubMed

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

    2013-01-01

    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. 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. 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. Physicians in Taiwan face both burnout and a high risk in medical malpractice. There is high

  4. 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

  5. Medical malpractice: some implications of contract and arbitration in HMOs.

    PubMed

    Stevens, C M

    1981-01-01

    The "crisis" of medical malpractice has led to increasing advocacy of abandoning the fault-finding and litigation approaches. Health maintenance organizations (HMOs) afford unique institutional settings for developing alternatives. Explicit contracts between provider-managers and member-patients can allow consumers to determine how risk-prevention-and overall quality-they are willing to invest in. Not just principles of economic efficiency, but also of distributional equity can inform HMO performance-standard contracts; and arbitration may be the best mode for managing disputes arising from them.

  6. Malpractice Litigation and Testicular Torsion: A Legal Database Review.

    PubMed

    Colaco, Marc; Heavner, Matthew; Sunaryo, Peter; Terlecki, Ryan

    2015-12-01

    The litigious nature of the American medical environment is a major concern for physicians, with an estimated annual cost of $10 billion. The purpose of this study is to identify causes of litigation in cases of testicular torsion and what factors contribute to verdicts or settlements resulting in indemnity payments. Publicly available jury verdict reports were retrieved from the Westlaw legal database (Thomson Reuters, New York, NY). In order to identify pertinent cases, we used the search terms "medical malpractice" and "testicular torsion" with date ranging from 2000 to 2013. Jury verdicts, depositions, and narrative summaries were evaluated for their medical basis, alleged malpractice, findings, and indemnity payment(s) (if any). Fifty-two cases were identified that were relevant to this study. Fifty-one percent of relevant cases were found in favor of the defendant physician, with the remaining 49% involving an indemnity payment (13% of which were settled). The most commonly sued medical providers were emergency physicians (48% of defendants), with urologists being second most common and making up 23% of the defendant pool. Emergency physicians were significantly more likely to make indemnity payments than urologists. Testicular torsion is a delicate condition and requires expertise in evaluation and treatment. When emergency physicians choose not to consult an urologist for possible torsion, they leave themselves open to litigation risk. When an urologist is involved in torsion litigation, they are rarely unsuccessful in their defense. Finally, ultrasound is no guarantee for success against litigation. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Malpractice liability, technology choice and negative defensive medicine.

    PubMed

    Feess, Eberhard

    2012-04-01

    We extend the theoretical literature on the impact of malpractice liability by allowing for two treatment technologies, a safe and a risky one. The safe technology bears no failure risk, but leads to patient-specific disutility since it cannot completely solve the health problems. By contrast, the risky technology (for instance a surgery) may entirely cure patients, but fail with some probability depending on the hospital's care level. Tight malpractice liability increases care levels if the risky technology is chosen at all, but also leads to excessively high incentives for avoiding the liability exposure by adopting the safe technology. We refer to this distortion toward the safe technology as negative defensive medicine. Taking the problem of negative defensive medicine seriously, the second best optimal liability needs to balance between the over-incentive for the safe technology in case of tough liability and the incentive to adopt little care for the risky technology in case of weak liability. In a model with errors in court, we find that gross negligence where hospitals are held liable only for very low care levels outperforms standard negligence, even though standard negligence would implement the first best efficient care level.

  8. Curb your premium: the impact of monitoring malpractice claims.

    PubMed

    Amaral-Garcia, Sofia; Grembi, Veronica

    2014-02-01

    We study a policy aimed at increasing the level of information on medical malpractice costs and the risk exposure of local public healthcare providers. The policy is based on enhanced monitoring of medical malpractice claims by the level of government that rules providers in a multilevel institutional setting. In particular, we implement a difference-in-differences strategy using Italian data at the provider level from 2001 to 2008 to evaluate the impact of monitoring claims on medical liability expenditures, measured as insurance premiums and legal expenditures, which was adopted by only some Regions. Our results show that this information-enhancing policy reduces paid premiums by around 15%. This reduced-form effect might arise by higher bargaining power on the demand side or increased competition on the supply side of the insurance market. Validity tests show that our findings are not driven by differential pre-policy trends between treated and control providers. Moreover, this policy could be cheaply implemented also in other institutional contexts with positive effects.

  9. The malpractice liability of radiology reports: minimizing the risk.

    PubMed

    Srinivasa Babu, Aparna; Brooks, Michael L

    2015-01-01

    The art and science of interpreting radiologic examinations, an ability that is acquired over years of training, is on display in every radiology report. It is vital that these reports be crafted so as to both reflect the radiologist's expertise and capability and eliminate any factors that might result in unintended harm to the patient. Unfortunately, a deficient report may result in legal action against the radiologist; thus, a thorough understanding of the litigious potential of the language used in radiology reports is crucial. It is important that ambiguous vocabulary, undefined modifiers, double negatives, and generalizations be avoided. Errors in radiology reports may result from inappropriate terminology, transcription mistakes, or deficient or inadequately documented communication. Critical findings that may have an immediate impact on patient management must be promptly communicated to the referring physician and such communication fully documented. A meticulous and well-written report is the best way for radiologists to care for their patients. In addition, a well-worded report can be the deciding factor in a successful defense against a malpractice claim. Understanding the legal implications of radiology reports will enable radiologists to develop strategies for avoiding malpractice suits. (©)RSNA, 2015.

  10. Taking the Initiative: Risk-Reduction Strategies and Decreased Malpractice Costs.

    PubMed

    Raper, Steven E; Rose, Deborah; Nepps, Mary Ellen; Drebin, Jeffrey A

    2017-08-12

    To heighten awareness of attending and resident surgeons regarding strategies for defense against malpractice claims, a series of risk reduction initiatives have been carried out in our Department of Surgery. We hypothesized that emphasis on certain aspects of risk might be associated with decreased malpractice costs. The relative impact of Department of Surgery initiatives was assessed when compared with malpractice experience for the rest of the Clinical Practices of the University of Pennsylvania (CPUP). Surgery and CPUP malpractice claims, indemnity, and expenses were obtained from the Office of General Counsel. Malpractice premium data were obtained from CPUP finance. The Department of Surgery was assessed in comparison with all other CPUP departments. Cost data (yearly indemnity and expenses), and malpractice premiums (total and per physician) were expressed as a percentage of the 5-year mean value preceding implementation of the initiative program. Surgery implemented 38 risk reduction initiatives. Faculty participated in 27 initiatives; house staff participated in 10 initiatives; and advanced practitioners in 1 initiative. Department of Surgery claims were significantly less than CPUP (74.07% vs 81.07%; p < 0.05). The mean yearly indemnity paid by the Department of Surgery was significantly less than that of the other CPUP departments (84.08% vs 122.14%; p < 0.05). Department of Surgery-paid expenses were also significantly less (83.17% vs 104.96%; p < 0.05), and surgical malpractice premiums declined from baseline, but remained significantly higher than CPUP premiums. The data suggest that educating surgeons on malpractice and risk reduction may play a role in decreasing malpractice costs. Additional extrinsic factors may also affect cost data. Emphasis on risk reduction appears to be cumulative and should be part of an ongoing program. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  11. How a Lumbar Diskectomy Influenced Medical Malpractice and the Landscape of Health Care.

    PubMed

    Yang, Brian W; Bi, Wenya Linda; Smith, Timothy R; Brewster, Ryan; Gormley, William B; Dunn, Ian F; Laws, Edward R

    2016-02-01

    Jeff Chandler was one of Hollywood's top leading men in the 1950s and 1960s. In 1961, at the peak of his career, Chandler died of complications following an aortic-iliac injury during a routine lumbar diskectomy. The subsequent public outcry and malpractice suit resulted in an unprecedented settlement award. Chandler's lawsuit marked a pivotal time in the evolution of medical malpractice and monetary awards. Before 1960, malpractice legal claims were rare, with little impact on the practice of medicine. Chandler's award, however, dwarfed the average malpractice verdict for its time and would influence the relationship between medicine and the legal world. This case helped issue a radical increase in total expenditure on medical liability insurance, frequency of successful claims, average numbers of neurosurgical malpractice suits, and financial award sizes. The trend ensuing from this time has continued to the contemporary era. To link Chandler's case to the current malpractice climate, we highlight the relationship of the case with 3 factors comprising the legal argument for the perpetuation of medical malpractice: 1) contingency fees, 2) citizen juries, and 3) the nature of tort law. This case illustrates an inflection point in American medical malpractice expenditure increases beginning in the 1960s to a current estimated $55.6 billion. As we investigate ways to provide value in health care, it is important to consider the historical factors that have influenced the status quo when seeking strategies to reform the malpractice system on both sides of the value equation: quality and cost. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Association Between State Medical Malpractice Environment and Surgical Quality and Cost in the United States.

    PubMed

    Bilimoria, Karl Y; Sohn, Min-Woong; Chung, Jeanette W; Minami, Christina A; Oh, Elissa H; Pavey, Emily S; Holl, Jane L; Black, Bernard S; Mello, Michelle M; Bentrem, David J

    2016-06-01

    The US medical malpractice system is designed to deter negligence and encourage quality of care through threat of liability. To examine whether state-level malpractice environment is associated with outcomes and costs of colorectal surgery. Observational study of 116,977 Medicare fee-for-service beneficiaries who underwent colorectal surgery using administrative claims data. State-level malpractice risk was measured using mean general surgery malpractice insurance premiums; paid claims per surgeon; state tort reforms; and a composite measure. Associations between malpractice environment and postoperative outcomes and price-standardized Medicare payments were estimated using hierarchical logistic regression and generalized linear models. thirty-day postoperative mortality; complications (pneumonia, myocardial infarction, venous thromboembolism, acute renal failure, surgical site infection, postoperative sepsis, any complication); readmission; total price-standardized Medicare payments for index hospitalization and 30-day postdischarge episode-of-care. Few associations between measures of state malpractice risk environment and outcomes were identified. However, analyses using the composite measure showed that patients treated in states with greatest malpractice risk were more likely than those in lowest risk states to experience any complication (OR: 1.31; 95% CI: 1.22-1.41), pneumonia (OR: 1.36; 95%: CI, 1.16-1.60), myocardial infarction (OR: 1.44; 95% CI: 1.22-1.70), venous thromboembolism (OR:2.11; 95% CI: 1.70-2.61), acute renal failure (OR: 1.34; 95% CI; 1.22-1.47), and sepsis (OR: 1.38; 95% CI: 1.24-1.53; all P < 0.001). There were no consistent associations between malpractice environment and Medicare payments. There were no consistent associations between state-level malpractice risk and higher quality of care or Medicare payments for colorectal surgery.

  13. Medical malpractice claims in obstetrics and gynaecology: comparisons between the United States and Britain.

    PubMed

    Quam, L; Dingwall, R; Fenn, P

    1988-05-01

    Obstetricians and gynaecologists have been particularly affected by the increase in the cost and number of medical malpractice claims in Britain. US obstetricians and gynaecologists have experienced a disproportionately higher rate of claim than other practitioners in that country. This article reviews the US experience of obstetrics and gynaecology malpractice claims and questions the validity of showing comparisons between the US and UK. However, even if British malpractice claims do not reach the level of American claims, the effects of claims on the National Health Service, recruitment to obstetrics and gynaecology, and clinical practice are significant.

  14. Malpractice liability, patient safety, and the personification of medical injury: opportunities for academic medicine.

    PubMed

    Sage, William M

    2006-09-01

    The political battle over trial lawyers and "tort reform" centers on whether or not to reduce incentives to sue for medical malpractice by capping damages in malpractice suits and limiting legal fees. But the current struggle mis-states the case for innovation in medical malpractice policy. Rather than focus exclusively on the financial consequences of legal claims, malpractice reform should move closer to the bedside, emphasizing error prevention, open communication, rapid compensation, and efficient insurance of the costs of injury. Academic health centers are well positioned to lead this effort in each of their three recognized missions: patient care, teaching, and research. Academic health centers enjoy greater institutional cohesiveness and research capacity than most other medical practice settings. Perhaps most important, their high visibility ensures that patients who suffer avoidable harm within their walls become salient to the public as individuals, not merely as dollar entries in a litigation ledger.

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

    PubMed

    Hambali, Siti Naaishah; Khodapanahandeh, Solmaz

    2014-04-07

    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.

  16. 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.

  17. The Impact of State Laws Limiting Malpractice Damage Awards on Health Care Expenditures

    PubMed Central

    Hellinger, Fred J.; Encinosa, William E.

    2006-01-01

    Twenty-eight states have laws that limit payments in malpractice cases, and several studies indicate that these laws reduce the frequency and severity of malpractice claims and lower premiums. Moreover, proponents believe that such laws reduce health care expenditures by reducing the practice of defensive medicine. However, there is a dearth of empirical evidence about the impact of these laws on the cost of health care. We used multivariate models and relatively recent data to estimate the impact of state tort reform laws that directly limit malpractice damage payments on health care expenditures. Estimates from these models suggest that laws limiting malpractice payments lower state health care expenditures by between 3% and 4%. PMID:16809580

  18. [Forensic medical examination of a medical malpractice case as a form of situational expertise].

    PubMed

    Leonov, S V; Kozlov, S V

    2011-01-01

    The authors propose to divide the process of forensic medical examination of a medical malpractice case into several stages and substantiate the possibility of their realization as a form of situational forensic medical expertise.

  19. The impact of state laws limiting malpractice damage awards on health care expenditures.

    PubMed

    Hellinger, Fred J; Encinosa, William E

    2006-08-01

    Twenty-eight states have laws that limit payments in malpractice cases, and several studies indicate that these laws reduce the frequency and severity of malpractice claims and lower premiums. Moreover, proponents believe that such laws reduce health care expenditures by reducing the practice of defensive medicine. However, there is a dearth of empirical evidence about the impact of these laws on the cost of health care. We used multivariate models and relatively recent data to estimate the impact of state tort reform laws that directly limit malpractice damage payments on health care expenditures. Estimates from these models suggest that laws limiting malpractice payments lower state health care expenditures by between 3% and 4%.

  20. 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

  1. 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.

  2. 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

  3. [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

  4. 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

  5. [Medical approach to liability for malpractice originating during health services].

    PubMed

    Haller, Herman

    2008-01-01

    In this paper approach of medical liability for malpractice originating during health services is analysed and elaborated. It coud be defined as comprehensive outcome of law, ethical, financial, environmental, staff and equipmental factors. Professional liability in medicine should be viewed from the next factors: competence, information, confidence, relationship between all partitioners, quality of health care, feasibility, economics, accepted scientific level, absence of conflic of interest and professional level. Today, medicine encounters explosion of knowledge and technology, new diseases, population ageing, informatic transformation, promotion of health, reinforcement of human rights and patient's rights, partnerships, role of health market as well as globalisation. In such circumstances medical staff achieve medical liability in more complex conditions and in growing population's expectations. Only partners relationship between all partitioner, deciders, participants and users of health system could define suitable and acceptable medical liability.

  6. The classic: Report of the Committee on Suits for Malpractice. 1879.

    PubMed

    Sanger, Eugene F

    2009-02-01

    This Classic Article is a reprint of the original work by E. F. Sanger, Report of the Committee on Suits for Malpractice. An accompanying biographical sketch of E. F. Sanger, AM, MD, is available at DOI 10.1007/s11999-008-0640-6 . The Classic Article is (c)1879 and is reprinted with courtesy from Sanger EF. Report of the Committee on Suits for Malpractice. Trans Maine Med Assoc.1879;6:1-22.

  7. Missed Diagnosis of Cardiovascular Disease in Outpatient General Medicine: Insights from Malpractice Claims Data.

    PubMed

    Quinn, Gene R; Ranum, Darrell; Song, Ellen; Linets, Margarita; Keohane, Carol; Riah, Heather; Greenberg, Penny

    2017-10-01

    Diagnostic errors are an underrecognized source of patient harm, and cardiovascular disease can be challenging to diagnose in the ambulatory setting. Although malpractice data can inform diagnostic error reduction efforts, no studies have examined outpatient cardiovascular malpractice cases in depth. A study was conducted to examine the characteristics of outpatient cardiovascular malpractice cases brought against general medicine practitioners. Some 3,407 closed malpractice claims were analyzed in outpatient general medicine from CRICO Strategies' Comparative Benchmarking System database-the largest detailed database of paid and unpaid malpractice in the world-and multivariate models were created to determine the factors that predicted case outcomes. Among the 153 patients in cardiovascular malpractice cases for whom patient comorbidities were coded, the majority (63%) had at least one traditional cardiac risk factor, such as diabetes, tobacco use, or previous cardiovascular disease. Cardiovascular malpractice cases were more likely to involve an allegation of error in diagnosis (75% vs. 47%, p <0.0001), have high clinical severity (86% vs. 49%, p <0.0001) and result in death (75% vs. 27%, p <0.0001), as compared to noncardiovascular cases. Initial diagnoses of nonspecific chest pain and mimics of cardiovascular pain (for example, esophageal disease) were common and independently increased the likelihood of a claim resulting in a payment (p <0.01). Cardiovascular malpractice cases against outpatient general medicine physicians mostly occur in patients with conventional risk factors for coronary artery disease and are often diagnosed with common mimics of cardiovascular pain. These findings suggest that these patients may be high-yield targets for preventing diagnostic errors in the ambulatory setting. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Obstetric and gynecologic malpractice claims in Saudi Arabia: Incidence and cause.

    PubMed

    AlDakhil, Lateefa O

    2016-05-01

    The occurrence of a bad outcome, injury or death of a patient during treatment increases the chance of malpractice litigation, increases legal responsibility and leads to increased fees for malpractice insurance. Physicians practicing obstetrics and gynecology face among the highest risks of malpractice litigation, and such litigation has led to an increase in the practice of defensive medicine and has made this specialty less appealing. Previous clinical data from Saudi Arabia have shown that more malpractice litigation concerns claims in obstetrics and gynecology than claims in any other field of medicine. To identify the main causes of obstetrics and gynecology (OBGYN) professional liability claims in Saudi Arabia to have a better understanding and management of risks. All OBGYN claims opened in Saudi Arabia between 2008 and 2013 were analyzed to identify the most common causes of claims. The results of these claims and the times until a final judgment made were also analyzed. Out of a total of 463 malpractice claims that were closed during the study period, 114 (24.6%) claims were in obstetrics and gynecology, and 92 (80.7%) of these claims concerned complications related to delivery room events. The most common causes of obstetric malpractice litigation were shoulder dystocia (brachial plexus injury) and fetal distress (hypoxic ischemic encephalopathy). Urinary system injury was the most common cause of gynecology cases. Most cases were decided in favor of the defendants with the exception of cases for which maternal and/or fetal death was the cause of litigation; nearly all of those cases were decided against the defendants. Obstetricians face a high risk of malpractice claims in Saudi Arabia, although most claims do not end in payments to plaintiffs. However, the effects of such claims on obstetric care should not be underestimated. Adherence to standards of care and careful documentation may decrease litigation and the number of indefensible malpractice

  9. 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

  10. Severe asphyxia due to delivery-related malpractice in Sweden 1990–2005

    PubMed Central

    Berglund, S; Grunewald, C; Pettersson, H; Cnattingius, S

    2008-01-01

    Objective To describe possible causes of delivery-related severe asphyxia due to malpractice. Design and setting A nationwide descriptive study in Sweden. Population All women asking for financial compensation because of suspected medical malpractice in connection with childbirth during 1990–2005. Method We included infants with a gestational age of ≥33 completed gestational weeks, a planned vaginal onset of delivery, reactive cardiotocography at admission for labour and severe asphyxia-related outcomes presumably due to malpractice. As asphyxia-related outcomes, we included cases of neonatal death and infants with diagnosed encephalopathy before the age of 28 days. Main outcome measure Severe asphyxia due to malpractice during labour. Results A total of 472 case records were scrutinised. One hundred and seventy-seven infants were considered to suffer from severe asphyxia due to malpractice around labour. The most common events of malpractice in connection with delivery were neglecting to supervise fetal wellbeing in 173 cases (98%), neglecting signs of fetal asphyxia in 126 cases (71%), including incautious use of oxytocin in 126 cases (71%) and choosing a nonoptimal mode of delivery in 92 cases (52%). Conclusion There is a great need and a challenge to improve cooperation and to create security barriers within our labour units. The most common cause of malpractice is that stated guidelines for fetal surveillance are not followed. Midwives and obstetricians need to improve their shared understanding of how to act in cases of imminent fetal asphyxia and how to choose a timely and optimal mode of delivery. Please cite this paper as:Berglund S, Grunewald C, Pettersson H, Cnattingius S. Severe asphyxia due to delivery-related malpractice in Sweden 1990–2005. BJOG 2008;115:316–323. PMID:18190367

  11. 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.

  12. How Concerns and Experiences with Medical Malpractice Affect Dermatopathologists’ Perceptions of Their Diagnostic Practices When Interpreting Cutaneous Melanocytic Lesions

    PubMed Central

    Carney, Patricia A.; Frederick, Paul D.; Reisch, Lisa M.; Knezevich, Stevan; Piepkorn, Michael W.; Barnhill, Raymond L.; Elder, David E.; Chb, MB; Geller, Berta M.; Titus, Linda; Weinstock, Martin A.; Nelson, Heidi D.; Elmore, Joann G.

    2015-01-01

    Objective To identify characteristics associated with past malpractice lawsuits and how malpractice concerns may affect interpretive practices. Methods We surveyed 207 of 301 (68.8%) eligible dermatopathologists who interpret melanocytic skin lesions in ten states. The survey assessed dermatopathologists’ demographic and clinical practice characteristics, perceptions of how medical malpractice concerns could influence their interpretive practices, and past malpractice lawsuits. Results Thirty-three percent of dermatopathologists reported past malpractice experiences. Factors associated with being sued included older age (57 years vs. 48, p<0.001), lack of board certification or fellowship training in dermatopathology (76.5% vs. 53.2%, p=0.001), and greater number of years interpreting melanocytic lesions (>20 years: 52.9% vs. 20.1%, p<0.001). Sixty four percent of participants reported being moderately or extremely confident in their melanocytic interpretations. Although most dermatopathologists believed that malpractice concerns increased their likelihood of ordering specialized pathology tests, obtaining recuts, and seeking a second opinion, none of these practices were associated with past malpractice. Most dermatopathologists reported concerns about potential harms to patients that may result from their assessments of melanocytic lesions. Conclusions Most dermatopathologists reported apprehension about how malpractice affects their clinical practice and are concerned about patient safety irrespective of whether they had actually experienced a medical malpractice suit. PMID:26559597

  13. Malpractice in distal radius fracture management: an analysis of closed claims.

    PubMed

    DeNoble, Peter H; Marshall, Astrid C; Barron, O Alton; Catalano, Louis W; Glickel, Steven Z

    2014-08-01

    Distal radius fractures comprise the majority of hand- and wrist-related malpractice claims. We hypothesized that a majority of lawsuits would be for malunions resulting from nonsurgical treatment. Additional goals of this study were to quantify costs associated with claims, determine independent risk factors for making an indemnity payment, and illustrate trends over time. Seventy closed malpractice claims filed for alleged negligent treatment of distal radius fractures by orthopedic surgeons insured by the largest medical professional liability insurer in New York State (NYS) from 1981 to 2005 were reviewed. We separately reviewed defendants' personal closed malpractice claim histories from 1975 to 2011. Overall incidence of malpractice claims among distal radius fractures treated in NYS was calculated using the NYS Statewide Planning and Research Cooperative System database and the 2008 American Academy of Orthopedic Surgeons census data. The overall incidence of malpractice claims for distal radius fracture management was low. Malunion was the most common complaint across claims regardless of treatment type. Claims for surgically treated fractures increased over time. A majority of claims documented poor doctor-patient relationships. Male plaintiffs in this group were significantly older than males treated for distal radius fractures in NYS. Most defendants had a history of multiple malpractice suits, all were male, and only a small percentage were fellowship-trained in hand surgery. Defendants lacking American Board of Orthopedic Surgery certification were significantly more likely to make indemnity payments. Thirty-eight of 70 cases resulted in an indemnity payment. Malunion and poor doctor-patient relationships are the major features of malpractice litigation involving distal radius fracture management. Older defendant age and lack of American Board of Orthopedic Surgery certification increase the likelihood of making an indemnity payment. Economic and

  14. How concerns and experiences with medical malpractice affect dermatopathologists' perceptions of their diagnostic practices when interpreting cutaneous melanocytic lesions.

    PubMed

    Carney, Patricia A; Frederick, Paul D; Reisch, Lisa M; Knezevich, Stevan; Piepkorn, Michael W; Barnhill, Raymond L; Elder, David E; Geller, Berta M; Titus, Linda; Weinstock, Martin A; Nelson, Heidi D; Elmore, Joann G

    2016-02-01

    We sought to identify characteristics associated with past malpractice lawsuits and how malpractice concerns may affect interpretive practices. We surveyed 207 of 301 (68.8%) eligible dermatopathologists who interpret melanocytic skin lesions in 10 states. The survey assessed dermatopathologists' demographic and clinical practice characteristics, perceptions of how medical malpractice concerns could influence their interpretive practices, and past malpractice lawsuits. Of dermatopathologists, 33% reported past malpractice experiences. Factors associated with being sued included older age (57 vs 48 years, P < .001), lack of board certification or fellowship training in dermatopathology (76.5% vs 53.2%, P = .001), and greater number of years interpreting melanocytic lesions (>20 years: 52.9% vs 20.1%, P < .001). Of participants, 64% reported being moderately or extremely confident in their melanocytic interpretations. Although most dermatopathologists believed that malpractice concerns increased their likelihood of ordering specialized pathology tests, obtaining recuts, and seeking a second opinion, none of these practices were associated with past malpractice. Most dermatopathologists reported concerns about potential harms to patients that may result from their assessments of melanocytic lesions. Limitations of this study include lack of validation of and details about the malpractice suits experienced by participating dermatopathologists. In addition, the study assessed perceptions of practice rather than actual practices that might be associated with malpractice incidents. Most dermatopathologists reported apprehension about how malpractice affects their clinical practice and are concerned about patient safety irrespective of whether they had actually experienced a medical malpractice suit. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  15. 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.

  16. Medical Malpractice Reform and Employer-Sponsored Health Insurance Premiums

    PubMed Central

    Morrisey, Michael A; Kilgore, Meredith L; Nelson, Leonard (Jack)

    2008-01-01

    Objective Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance. Data Sources/Study Setting Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions. Study Design Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums. Data Collection/Extraction Methods State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS. Principal Findings Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance. Conclusions The findings suggest that tort reforms have not translated into insurance savings. PMID:18522666

  17. Medical malpractice reform and employer-sponsored health insurance premiums.

    PubMed

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

    2008-12-01

    Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance. Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions. Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums. State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS. Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance. The findings suggest that tort reforms have not translated into insurance savings.

  18. Present status of obstetrics in family practice and the effects of malpractice issues.

    PubMed

    Bredfeldt, R; Colliver, J A; Wesley, R M

    1989-03-01

    A survey of 800 active members of the American Academy of Family Physicians 1985-1987 membership directory was conducted for the purpose of determining the impact, over time, of malpractice issues upon the practice of obstetrics by family physicians. The survey response rate was 60.4 percent. Almost 20 percent of all respondents reported that they have never provided obstetric care of any type. Another 40 percent have provided obstetric care previously but have now discontinued this care, while the remaining 40 percent currently offer obstetric care to their patients. The proportion of respondents who discontinued the practice of obstetrics because of increased risk of malpractice litigation increased significantly over the years from 1947 to 1986 (P = .0084). The proportion of respondents who discontinued obstetric practice because of increased malpractice insurance costs also increased significantly from 1945 to 1986 (P = .0002). The proportion of those entering practice during the past five years who decided not to offer obstetric services because of malpractice risks was significantly greater than the proportion entering practice earlier (21.0 percent vs 2.0 percent, P = .0090). Although the current patterns of obstetric practice showed regional variation, the accelerating impact of malpractice risk and insurance cost on these patterns was similar throughout the nation.

  19. Malpractice liability burden in midwifery: a survey of Michigan certified nurse-midwives.

    PubMed

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

    2008-01-01

    A statewide survey was conducted among 282 nurse-midwives in Michigan to examine the extent of their current medical liability burden. Two hundred ten responses were received for an adjusted response rate of 76.9%. Data from 145 certified nurse-midwives (CNMs) who were currently engaged in clinical practice in Michigan were used for this analysis. Sixty-nine percent of CNMs reported that liability concerns had a negative impact on their clinical decision making. Most CNMs (88.1%) acquired malpractice insurance coverage through an employer, whereas 4.9% were practicing "bare" due to difficulty in obtaining coverage. Thirty-five percent of the respondents had been named in a malpractice claim at least once in their career, and 15.5% had at least one malpractice payment of $30,000 or more made on their behalf. CNMs who purchased malpractice insurance coverage themselves or were going bare were significantly less likely to include obstetrics in their practice than their counterparts covered through an employer (70.6% versus 87.2%; P = .04). These findings among Michigan CNMs call for further investigation into the consequences of the current malpractice situation surrounding nurse-midwifery practice and its influence on obstetric care, particularly among women from disadvantaged populations.

  20. Learning From Lawsuits: Using Malpractice Claims Data to Develop Care Transitions Planning Tools.

    PubMed

    Arbaje, Alicia I; Werner, Nicole E; Kasda, Eileen M; Wu, Albert W; Locke, Charles F S; Aboumatar, Hanan; Paine, Lori A; Leff, Bruce; Davis, Richard O; Boonyasai, Romsai

    2016-06-10

    Our understanding of care transitions from hospital to home is incomplete. Malpractice claims are an important and underused data source to understand such transitions. We used malpractice claims data to (1) evaluate safety risks during care transitions and (2) help develop care transitions planning tools and pilot test their ability to evaluate care transitions from the hospital to home. Closed malpractice claims were analyzed for 230 adult patients discharged from 4 hospital sites. Stakeholders participated in 2 structured focus groups to review concerns. This led to the development of 2 care transitions planning tools-one for patients/caregivers and one for frontline care providers. Both were tested for feasibility on 53 patient discharges. Qualitative analysis yielded 33 risk factors corresponding to hospital work system elements, care transitions processes, and care outcomes. Providers reported that the tool was easy to use and did not adversely affect workflow. Patients reported that the tool was acceptable in terms of length and response burden. Patients were often still waiting for information at the time they applied the tool. Malpractice claims provided insights that enriched our understanding of suboptimal care transitions and guided the development of care transitions planning tools. Pilot testing suggested that the tools would be feasible for use with minor adjustment. The malpractice data can complement other approaches to characterize systems failures threatening patient safety.

  1. Malpractice claims in Swedish telenursing: lessons learned from interviews with telenurses and managers.

    PubMed

    Röing, Marta; Holmström, Inger K

    2015-01-01

    This study deals with serious malpractice claims within Swedish Healthcare Direct, the national telephone helpline in Sweden. At least 33 claims of malpractice have been filed since the service was created in 2003. Although a low number, consequences have been tragic. Research in Swedish telenursing on contributing systemic and organizational factors and consequences of malpractice claims is sparse. The objective was to explore the direct experience of telenurses' and call center managers' involvement in actual malpractice claims-with focus on factors that may have contributed to the claims-and on the consequences of the claims. Six telenurses and five managers agreed to participate in open-ended interviews. A directed content analysis approach was chosen to analyze the transcribed interview texts. Stress, shiftwork, fatigue, multitasking, understaffing, and factors embedded in the system could have contributed to the malpractice claims. Safety management was treated locally, with no attempts at organizational reforms. The solitary nature of the telenursing task emphasizes the importance of an organization, which works toward providing an environment where telenurses can feel safe and supported. This may require, in turn, a change in both organizational and professional attitudes toward safety and risk of error. The greatest hinder may be healthcare providers themselves. If the difficulties in recruiting participants for this study are any indication, reaching out to healthcare providers who remain silent may be the greatest challenge.

  2. 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.

  3. 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 must be reported to OWCP? 30.609 Section 30.609 Employees' Benefits OFFICE OF WORKERS' COMPENSATION... of allegations of medical malpractice in treating an illness covered by EEOICPA a recovery that...

  4. The number one myth of asset protection: why you can lose assets in a medical malpractice lawsuit.

    PubMed

    Mandell, David B

    2006-01-01

    The thinking of many physicians around the country, and unfortunately their advisers as well, is that there is little risk of a physician losing personal assets in a malpractice claim, especially with typical dollars 1-3 million malpractice insurance coverage. This article dispels that myth and shows that the benefit in engaging in asset protection planning far outweighs the cost.

  5. Commentary: Exploiting the overlap: using utilization management to reduce medical malpractice.

    PubMed

    Dulworth, Sherrie

    2003-01-01

    This report presents a practical way in which hospitals can reduce medical malpractice exposure that is related to omissions and delays in care. We illustrate our approach using the results of a risk/medical management study performed at an acute-care hospital. Traditional risk management (RM) often focuses retrospectively on adverse events and may miss opportunities to prevent errors related to omissions and delays in care. Close-to-real-time utilization management (UM) activity offers ready potential to improve quality and reduce medical malpractice--but only if UM can work synergistically with RM. It is our conclusion that hospitals can implement systematic processes to identify and intervene in patterns of omissions and delays and improve the communication and synergy among stakeholders and thereby improve patient safety and reduce their medical malpractice risks.

  6. Responding to the Medical Malpractice Insurance Crisis: A National Risk Management Information System

    PubMed Central

    Wess, Bernard P.; Jacobson, Gary

    1987-01-01

    In the process of forming a new medical malpractice reinsurance company, the authors analyzed thousands of medical malpractice cases, settlements, and verdicts. The evidence of those analyses indicated that the medical malpractice crisis is (1)emerging nation- and world-wide, (2)exacerbated by but not primarily a result of “predatory” legal action, (3)statistically determined by a small percentage of physicians and procedures, (4)overburdened with data but poor on information, (5)subject to classic forms of quality control and automation. The management information system developed to address this problem features a tiered data base architecture to accommodate medical, administrative, procedural, statistical, and actuarial analyses necessary to predict claims from untoward events, not merely to report them.

  7. Malpractice claims in gastrointestinal endoscopy: analysis of an insurance industry data base.

    PubMed

    Gerstenberger, P D; Plumeri, P A

    1993-01-01

    We investigated 610 endoscopy-associated and 486 gastroenterology-associated malpractice claim files of the Physicians Insurers Association of America data-sharing project. We determined the relative malpractice claim risk for each of the major types of endoscopic procedures by comparing claim frequencies with Medicare performance frequencies. Relative malpractice risks were 1.0 for sigmoidoscopy, 1.2 for esophagogastroduodenoscopy, 1.6 for endoscopic retrograde cholangiopancreatography, and 1.7 for colonoscopy. "Improper performance" was alleged in 54% of claims and "diagnosis error" in 24% of claims. Of 121 claim files alleging a diagnostic error, 74 (61%) pertained to missed malignancies, of which 69% were colorectal. Of 147 claims alleging iatrogenic injury, 140 (95%) involved perforation or similar direct injury to the gastrointestinal tract. Problems with consent were alleged in 44% of 158 endoscopy-related claim files alleging additional associated issues.

  8. ASTRO APEx(®) and RO-ILS™ are applicable to medical malpractice in radiation oncology.

    PubMed

    Zaorsky, Nicholas G; Ricco, Anthony G; Churilla, Thomas M; Horwitz, Eric M; Den, Robert B

    2016-11-01

    To analyze malpractice trials in radiation oncology and assess how ASTRO APEx(®) and RO-ILS™ apply to such cases. The Westlaw database was reviewed using PICOS/PRISMA methods. Fisher's exact and Mann-Whitney U tests were used to find factors associated with outcomes. Of 34 cases identified, external beam was used in 26 (77%). The most common factors behind malpractice were excessive toxicity (80%) and lack of informed consent (66%). ASTRO APEx pillars and ROI-LS had applicability to all but one case. Factors favoring the defendant included statute of limitations (odds ratio: 8.1; 95% CI: 1.3-50); those favoring the plaintiff included patient death (odds ratio: 0.7; 95% CI: 0.54-0.94). APEx and RO-ILS are applicable to malpractice trials in radiation oncology.

  9. Medical Malpractice in Dermatology-Part I: Reducing the Risks of a Lawsuit.

    PubMed

    Shah, Vidhi V; Kapp, Marshall B; Wolverton, Stephen E

    2016-12-01

    Malpractice risk is a common source of concern for the practicing physician. Dermatologists experience fewer lawsuits than most other specialists in medicine, but the risk is not negligible. All physicians should familiarize themselves with areas of potential risk and avoid medico-legal pitfalls. We present Part I of a two-part series addressing medico-legal questions common to most practitioners that cause a great deal of anxiety. Part I will focus upon risk management and prevention of future malpractice lawsuits, and Part II deals with suggestions and guidance once a lawsuit occurs. Herein, we discuss the primary sources of malpractice lawsuits delivered against healthcare practitioners including issues with informed consent, patient noncompliance, medical negligence, and inappropriate documentation, including use of electronic medical records. The overall goal is to effectively avoid these common sources of litigation. The risk management strategies discussed in this paper are relevant to the everyday practitioner and may offer physicians some degree of protection from potential liability.

  10. Retinopathy of prematurity malpractice claims: the Ophthalmic Mutual Insurance Company experience.

    PubMed

    Day, Shelley; Menke, Anne M; Abbott, Richard L

    2009-06-01

    To examine the causes of retinopathy of prematurity (ROP) malpractice claims filed with the Ophthalmic Mutual Insurance Company. All closed ROP malpractice claims were reviewed. Eight cases involved failure of transfer of care on patient discharge from the hospital, 3 cases demonstrated inappropriately long periods between follow-up examinations, 1 case was due to failure of outpatient referral from screening to the treating ophthalmologist, and 1 case concerned unsupervised resident provision of ROP care. Many preventable factors can be addressed to improve ROP care. It is essential to ensure that ophthalmologists, neonatologists, pediatricians, and families are updated on current guidelines for ROP screening and treatment and to facilitate follow-up appointments before patient discharge from the hospital. Doing so can help avoid future malpractice claims and patient harm.

  11. Influence of malpractice history on the practice of screening and surveillance for Barrett's esophagus.

    PubMed

    Rubenstein, Joel H; Saini, Sameer D; Kuhn, Latoya; McMahon, Laurence; Sharma, Pratima; Pardi, Darrell S; Schoenfeld, Philip

    2008-04-01

    Gastroenterologists' approach to surveillance for Barrett's esophagus is variable. We hypothesized that financial incentives and concerns over malpractice litigation influence gastroenterologists' usual practices regarding screening and surveillance. We surveyed gastroenterologists (N = 224) regarding their usual practice of screening or surveillance for Barrett's esophagus, belief in the efficacy of screening, knowledge of published guidelines, demographic factors, compensation structure, volume of endoscopies, and malpractice history. Practices were characterized as aggressive or conservative in the utilization of services compared with a published guideline. Twenty-one percent of attending gastroenterologists reported being identified as a defendant in at least one malpractice suit. Prior malpractice defendants had practiced gastroenterology longer and performed a higher volume of endoscopies, but had similar knowledge regarding published screening guidelines to those who had not been defendants. They were more likely to be aggressive rather than conservative in screening and surveillance for Barrett's esophagus (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.1-12), and remained so after controlling for other factors. In particular, they were more likely to recommend screening for populations with a lower risk of development of cancer, and to perform more frequent surveillance for low-grade dysplasia. Other factors were not associated with aggressive practice, including compensation structure. History of at least one prior malpractice suit appears to be associated with the more aggressive use of endoscopic screening and surveillance for Barrett's esophagus, irrespective of physician belief regarding the efficacy of that strategy in reducing mortality. Hypervigilance and fear of future malpractice suits may drive this increased use.

  12. Malpractice and the National Practitioner Data Bank: what OR nurses need to know.

    PubMed

    Goodman, R S

    1991-08-01

    The National Practitioner Data Bank will record any payments made for any reason related to a malpractice suit in a central data bank available to a number of designated parties. Hospitals will be required to request this information to screen applicants and at least every 2 years for appointment renewals. The data bank may also be consulted by hospitals and state licensing boards as they deem necessary and by professional societies when reviewing membership applications. It is in the best interests of all malpractice defendants to insist on adequate representation of their personal, professional, and financial interests, which may necessitate insurance carriers providing each defendant with individual counsel.

  13. Malpractice litigation in patients in relation to delivery of breast care in the NHS.

    PubMed

    Vijh, R; Anand, V

    2008-04-01

    Malpractice litigation involving patients with carcinoma of the breast has been evaluated in United States of America (USA). The extent of litigation in breast cancer has not been published in UK and malpractice claims in relation to overall breast care have not been published before. We sought to study and evaluate all the litigation claims in relation to breast care with the National Health Service Litigation Authority (NHSLA) from May 1995 to September 2005. We also studied changes in litigation claims and outcomes in incidents reported before and after January 1, 2000.

  14. Evaluation of the medical malpractice cases concluded in the General Assembly of Council of Forensic Medicine.

    PubMed

    Yazıcı, Yüksel Aydın; Şen, Humman; Aliustaoğlu, Suheyla; Sezer, Yiğit; İnce, Cengiz Haluk

    2015-05-01

    Malpractice is an occasion that occurs due to defective treatment in the course of providing health services. Neither all of the errors within the medical practices are medical malpractices, nor all of the medical malpractices result in harm and judicial process. Injuries occurring at the time of treatment process may result from a complication or medical malpractice. This study aims to evaluate the reports of the controversial cases brought to trial with the claim of medical malpractice, compiled by The Council of Forensic Medicine. Our study includes all of the cases brought to the Ministry of Justice, Council of Forensic Medicine General Assembly with the claim of medical malpractice within a period of 11 years between 2000 and 2011 (n=330). In our study, we saw that 33.3% of the 330 cases were detected as "medical malpractice" by the General assembly. Within this 33.3% segment cases, 14.2% of them resulted from treatment errors such as wrong or incomplete treatment and surgery, use of wrong medication, running late for a true diagnosis after necessary examination, inappropriate medical processes as well as applied treatment having causality with an emergent injury to the patient. 9.7% of them emerged from diagnosis errors like failure to diagnose, wrong diagnosis, lack of consultation request, lack of transfer to a top centre, lack of intervention resulting from not recognizing the postoperative complication on time. 8.8% of them occurred because of careless intervention such as lack of necessary care and attention, lack of post operation follow-ups, lack of essential informing, absenteeism when called for a patient, intervention under suboptimal conditions. Whereas 0.3% of them developed from errors due to inexperience, 0.3% of them were detected to have occurred because of the administrative mistakes following malfunction of healthcare system. It is very important to analyze the errors properly in order to get the medical malpractice under control. Going

  15. Medical malpractice, murder and the academic community: trouble ahead.

    PubMed

    Coats, A J

    2001-06-01

    The morale of the medical professional is at an historic low in many countries. The recent case of a UK general practitioner being convicted of being a mass murderer, combined with increasing criticism of medical negligence and malpractice and an excessive influence of the large pharmaceutical companies has lead to the perception that the profession is under siege. Our professional leadership have not had sufficient public awareness to allay these concerns, and the resulting dip in morale is fast turning into a dangerous rout. We must review what has lead to this situation and what we should be doing now to put it right.Clinical research is under attack and the motives and ethics of large pharmaceutical company sponsorships of clinical trials is under increasing question. At this time there is a risk that medicine, and academic medicine in particular, will lose its attractiveness and the pace of achievements we have seen and benefited from in the last 2 decades may slow. The public debate should move on, it should move on to evaluate how much it would cost to reduce medical error rates to an acceptable level (to stop them altogether is impossible). It should move on to how we can get clinical trials designed and paid for by the public purse rather than merely grumbling that pharmaceutical companies take too much control of trials that they almost alone now appear to be sponsoring. And we should move on to debate about the role and status of the medical profession in the modern era. We can no longer do our best in secret and expect the public to trust us unquestioningly. The public wants and needs to be involved in our decision-making problems and errors. Only through informed debate will we improve health for the while population, now and in the future.

  16. Assessing information system readiness for mitigating malpractice risk through simulation: results of a multi-site study.

    PubMed

    Wright, Adam; Maloney, Francine L; Wien, Matthew; Samal, Lipika; Emani, Srinivas; Zuccotti, Gianna

    2015-09-01

    To develop and test an instrument for assessing a healthcare organization's ability to mitigate malpractice risk through clinical decision support (CDS). Based on a previously collected malpractice data set, we identified common types of CDS and the number and cost of malpractice cases that might have been prevented through this CDS. We then designed clinical vignettes and questions that test an organization's CDS capabilities through simulation. Seven healthcare organizations completed the simulation. All seven organizations successfully completed the self-assessment. The proportion of potentially preventable indemnity loss for which CDS was available ranged from 16.5% to 73.2%. There is a wide range in organizational ability to mitigate malpractice risk through CDS, with many organizations' electronic health records only being able to prevent a small portion of malpractice events seen in a real-world dataset. The simulation approach to assessing malpractice risk mitigation through CDS was effective. Organizations should consider using malpractice claims experience to facilitate prioritizing CDS development. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Forty Years of Litigation Involving Residents and Their Training: II. Malpractice Issues.

    ERIC Educational Resources Information Center

    Helms, Lelia B.; Helms, Charles M.

    1991-01-01

    A review of 136 malpractice cases involving residents and resident programs 1950-83 found a substantial increase in cases after 1975. Most concerned vicarious liability, applicable standard of care, and resident supervision. Residents were on the side of the prevailing party in 44 percent of cases. (Author/MSE)

  18. The Educator and the Liability Law of Professional Malpractice: A Historical Analysis.

    ERIC Educational Resources Information Center

    Carter, David G., Sr.

    The issue of whether educators and the education profession can be held liable for professional judgments that result in the failure of students to succeed academically is addressed. An overview of past educational malpractice claims is presented, with an outline of the fundamental legal questions in several case histories. Judicial decisions in…

  19. Donohue v. Copiague Union Free School District: New York Chooses Not to Recognize "Educational Malpractice."

    ERIC Educational Resources Information Center

    Jorgensen, Cynthia A.

    1979-01-01

    Analyzes the court's opinion in the "Donohue" case and suggests that there was sufficient basis for the court to adopt an "educational malpractice" cause of action because the school district did not make means for remediation available to the plaintiff. Available from Albany Law School of Union University, 80 New Scotland…

  20. 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…

  1. [Judicial or administrative settlement of medical malpractice claims. Update on medical liability].

    PubMed

    Crégut, P

    2012-03-01

    Settlement of medical malpractice claims was radically changed by the Kouchner Law that set up a rapid, effective system of indemnification. Victims can choose between conventional court proceedings and a non-judicial conciliation procedure. Choice between the two processes depends on the circumstances of the case.

  2. 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.

  3. Records of medical malpractice litigation: a potential indicator of health-care quality in China.

    PubMed

    Wang, Zhan; Li, Niying; Jiang, Mengsi; Dear, Keith; Hsieh, Chee-Ruey

    2017-06-01

    To assess the characteristics and incidence of medical litigation in China and the potential usefulness of the records of such litigation as an indicator of health-care quality. We investigated 13 620 cases of medical malpractice litigation that ended between 2010 and 2015 and were reported to China's Supreme Court. We categorized each case according to location of the court, the year the litigation ended, the medical specialization involved, the severity of the reported injury, the type of allegation raised by the plaintiff - including any alleged shortcomings in the health care received - and the outcome of the litigation. The annual incidence of medical malpractice litigation increased from 75 in 2010 to 6947 in 2014. Most cases related to general surgery (1350 litigations), internal medicine (3500 litigations), obstetrics and gynaecology (1251 litigations) and orthopaedics (1283 litigations). Most of the reported injuries were either minor (1358 injuries) or fatal (4111 deaths). The most frequent allegation was of lack of consent or notification (1356 litigations), followed by misdiagnosis (1172 litigations), delay in treatment (1145 litigations) and alteration or forgery of medical records (975 litigations). Of the 11 014 plaintiffs with known litigation outcomes, 7482 (67.9%) received monetary compensation. Over our study period, the incidence of litigation over potential medical malpractice increased in China. As many of the cases related to alleged inadequacies in the quality of health care, records of medical malpractice litigation in China may be worth exploring as an indicator of health-care quality.

  4. 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.

  5. Malpractice claims regarding calls to Swedish telephone advice nursing: what went wrong and why?

    PubMed

    Ernesäter, Annica; Winblad, Ulrika; Engström, Maria; Holmström, Inger K

    2012-10-01

    We analysed the characteristics of all malpractice claims arising out of telephone calls to Swedish Healthcare Direct (SHD) during 2003-2010 (n = 33). The National Board of Health and Welfare's (NBHW) investigations describing the causes of the malpractice claims and the healthcare providers' reported measures were analysed using Qualitative Content Analysis. The original telephone calls themselves, which had been recorded, were analysed using the Roter Interaction Analysis System (RIAS). Among the 33 cases, 13 patients died and 12 were admitted to intensive care. Failure to listen to the caller (n = 12) was the most common reason for malpractice claims, and work-group discussion (n = 13) was the most common measure taken to prevent future re-occurrence. Male patients (n = 19) were in the majority, and females (n = 24) were the most common callers. The most common symptoms were abdominal (n = 11) and chest pain (n = 6). Telenurses followed up on caller understanding in six calls, and mainly used closed-ended questions. Despite the severity of these malpractice claims, the measures taken mainly addressed active failure, rather than the latent conditions. Third-party communication should be regarded as a risk. When callers make repeated contacts, telenurses need to re-evaluate their need for care.

  6. 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

  7. Health care providers and facilities: medical malpractice and tort reform--2005. End of Year Issue Brief.

    PubMed

    McKinley, Andrew

    2005-12-31

    As health care professionals continue to feel the crunch of rising malpractice insurance rates and increased jury awards, medical malpractice remains a priority for acute care professionals. Medical associations claim that rapidly increasing premiums and the declining number of insurers often lead physicians to stop practicing medicine or to relocate. This may lead to a shortage of physicians, particularly physicians who practice high-risk specialties such as neurology. The pressure to retain an adequate supply of health care professionals is particularly acute in rural areas. It is difficult to pinpoint the origins of the escalating cost of medical malpractice coverage. Insurers and physicians claim excessive litigation and overly generous jury awards have hardened the market. Trial lawyers and consumer advocacy groups assert insurance premium rates have not reflected increasing medical inflation or the payouts of jury awards during the last 30 years. The majority of states have some form of basic coverage requirement that medical malpractice insurers must offer. However, because of the complexities and variety of coverage plans, physicians often are unaware that gaps in coverage exist. As of May 2005, the American Medical Association (AMA) has declared a state

  8. Reformers, Batting Averages, and Malpractice: The Case for Caution in Value-Added Use

    ERIC Educational Resources Information Center

    Gleason, Daniel

    2014-01-01

    The essay considers two analogies that help to reveal the limitations of value-added modeling: the first, a comparison with batting averages, shows that the model's reliability is quite limited even though year-to-year correlation figures may seem impressive; the second, a comparison between medical malpractice and so-called educational…

  9. Predictors of Radiologists' Perceived Risk of Malpractice Lawsuits in Breast Imaging

    PubMed Central

    Dick, John F.; Gallagher, Thomas H.; Brenner, R. James; Yi, Joyce P.; Reisch, Lisa M.; Abraham, Linn; Miglioretti, Diana L.; Carney, Patricia A.; Cutter, Gary R.

    2011-01-01

    OBJECTIVE The shortage of radiologists in breast imaging may be related to heightened malpractice lawsuit concerns. Our objective was to examine radiologists' reported experiences and perceptions of future lawsuit risk and explore personal and professional factors that may be associated with elevated perceptions of risk. MATERIALS AND METHODS Radiologists who routinely interpret mammography examinations in diverse regions of the United States (Washington, Colorado, and New Hampshire) completed a mailed survey in 2002 and 2006, including questions on demographics, practice characteristics, and medicolegal experience and perceptions as well as a validated scale measuring reactions to uncertainty in clinical situations. A survey assessing the radiologists' work facilities was also completed in 2002. RESULTS Participation by eligible radiologists was 77% (139 of 181) in 2002 and 71% (84 of 118) in 2006. The percentage of radiologists reporting malpractice claims related to mammography in the previous 5 years was 8% on the 2002 survey and 10% on the 2006 survey. Radiologists' mean estimate of the probability of being sued for malpractice in the next 5 years (41% in 2002 and 35% in 2006) was markedly higher than the actual reported risk. Radiologists' age, sex, clinical experience, and workload were not associated with a higher perceived risk of being sued. Radiologists who reported higher perceived risk of lawsuits were more likely to have experienced a prior malpractice claim, to report knowing colleagues with prior lawsuits, and to score higher on a scale measuring anxiety caused by uncertainty in clinical situations. Radiologists working at facilities that did not use double reading reported higher perceived risk, but the difference was not statistically significant. CONCLUSION Radiologists working in breast imaging substantially overestimate their risk of a future malpractice lawsuit. Radiologists with higher risk perceptions show more negative reactions to

  10. It is easier to confuse a jury than convince a judge: the crisis in medical malpractice.

    PubMed

    Epstein, Nancy E

    2002-11-15

    A study of cervical spine malpractice cases was conducted. Identifying tort reform models may help to resolve a crisis in medical malpractice. To identify tort reform models that may help to resolve a crisis in medical malpractice. Medical malpractice faces a crisis. Insurance rates are exorbitant, yet many injured patients go uncompensated. Physicians practice defensive medicine for fear of suits, and society pays the price. Using, 36 malpractice cases involving cervical spine surgery were identified: 20 from California ($250,000 cap on pain and suffering) and 16 from New York ("the sky's the limit"). Queries included who sued, who was sued, who won, who lost, and why? Six different tort reform models also were identified and explored. Common bases for suits included failure to diagnose and treatment (56%), lack of informed consent (64%), new neurologic deficits (64%), and pain and suffering (72%). All of the six plaintiff verdicts (average, $4.42 million) and four of the nine settlements (average, $1.6 million) involving surgery that resulted in new postoperative quadriplegia appeared to be appropriate. However, the author could discern "no fault" in cases five defendants had settled, and the surgeons did not deserve to lose. On the other hand, the author found "fault" in five defense verdicts rendered to three newly quadriplegic patients and two with new postoperative root injuries. These patients deserved monetary awards, but received no compensation whatsoever. There currently are two models that would work better than the system in place in most states. These include the American Medical Association National Specialty Societies Medical Liability Project with the Alternative Dispute Resolution Model (SSMLP), and the Selective No Fault Models. Among the advantages shared by one or more of these models is their ability to reimburse injured patients while eliminating physician liability, to use malpractice panels rather than trials, and to put a cap on damages

  11. Statutory caps: an involuntary contribution to the medical malpractice insurance crisis or a reasonable mechanism for obtaining affordable health care?

    PubMed

    Chupkovich, P J

    1993-01-01

    A medical malpractice insurance crisis occurred in the mid-1970s and mid-1980s evidenced by escalating malpractice insurance rates and increasing numbers of malpractice claims. Insurance companies maintained that the increase in insurance rates was necessary because of the sharp rise in the number of malpractice lawsuits, astronomical damage awards, and ineffective mechanisms to prevent and to eliminate nonmeritorious claims. Physicians responded by forming their own insurance companies, cancelling high-risk procedures, and orchestrating intensive legislative lobbying for tort reform. Insurance companies, physicians, and the legislature collaborated efforts to resolve this medical malpractice crisis. A national debate erupted regarding the proper way to address the medical malpractice insurance crisis. Insurance companies and physicians pressured state legislatures to reform liability laws that, in their opinion, permitted recovery of excessive damage awards by plaintiffs. Consumer groups and lawyers suggested tighter regulation of the insurance industry. State legislatures, in an attempt to remedy the perception that injured plaintiffs were overcompensated for their injuries, enacted "tort reform legislation," which included statutory caps on damages recoverable in medical malpractice actions. As a result of the extensive lobbying effort by physicians and insurance companies, twenty-seven states enacted statutes limiting recovery of damages in medical malpractice lawsuits. Lawyers responded by challenging state malpractice legislation on constitutional grounds, alleging violations of federal and state equal protection and due process clauses and the Seventh Amendment right to a jury trial. Opponents of the cap also asserted violations of state constitution provisions such as the "open courts" provision or the "special legislation" clause. To date, the state courts have held that statutory caps are unconstitutional. Statutory caps and other tort reform measures are

  12. Medical Malpractice in Bariatric Surgery: a Review of 140 Medicolegal Claims.

    PubMed

    Choudhry, Asad J; Haddad, Nadeem N; Martin, Matthew; Thiels, Cornelius A; Habermann, Elizabeth B; Zielinski, Martin D

    2017-01-01

    Given the current rate of obesity in the USA, it has been estimated that close to half of the US adult population could be obese by 2030, resulting in greater demand for bariatric procedures. Our objective was to analyze malpractice litigation related to bariatric surgery. We conducted a retrospective review of Westlaw (Thompson Reuters) of all bariatric operations that resulted in the filing of a malpractice claim. Each case was reviewed for pertinent medicolegal information related to the procedure, claim, and trial. The search criteria yielded 298 case briefs, of which 140 met inclusion criteria. Thirty-two percent (n = 49) of cases involved male plaintiffs (patients). Mean patient age with standard deviation (SD) was 43 (10) years. The most common procedure litigated was the Roux-en-Y gastric bypass (76 %, n = 107). Overall, the most common alleged reason for a malpractice claim was delay in diagnosis or management of a complication in the postoperative period (n = 66, 47 %), the most common of which was an anastomotic leak (45 %, n = 34). Death was reported in 74 (52 %) cases. Fifty-seven cases (47 %) were decided in favor of the plaintiff (patient), with a median award payout of $1,090,000 (interquartile range [IQR] $412,500 to $2,550,000). Delay in diagnosing or managing complications in the postoperative setting, most commonly an anastomotic leak, accounted for the majority of malpractice claims. Measures taken to identify and address anastomotic leaks and other complications early in the postoperative period could potentially reduce the amount of filed malpractice claims related to bariatric surgery. III.

  13. An analysis of malpractice litigation related to the management of brain aneurysms.

    PubMed

    Gupta, Raghav; Griessenauer, Christoph J; Moore, Justin M; Adeeb, Nimer; Patel, Apar S; Ogilvy, Christopher S; Thomas, Ajith J

    2016-12-23

    OBJECTIVE Given the highly complex and demanding clinical environment in which neurosurgeons operate, the probability of facing a medical malpractice claim is high. Recent emphasis on tort reform within the political sphere has brought this issue to the forefront of medical literature. Despite the widespread fear of litigation in the medical community, few studies have provided an analysis of malpractice litigation in the field. Here, the authors attempt to delineate the medicolegal factors that impel plaintiffs to file medical malpractice claims related to the management of brain aneurysms, and to better characterize the nature of these lawsuits. METHODS The online legal database WestLawNext was searched to find all medical malpractice cases related to brain aneurysms across a 30-year period. All state and federal jury verdicts and settlements relevant to the search criterion were considered. RESULTS Sixty-six cases were obtained. The average age of the patient was 46.7 years. Seventy-one percent were female. The cases were distributed across 16 states. The jury found in favor of the plaintiff in 40.9% of cases, with a mean payout of $8,765,405, and in favor of the defendant in 28.8% of the cases. A failure to diagnose and/or a failure to treat in a timely manner were the 2 most commonly alleged causes of malpractice. Settlements, which were reached in 25.8% of the cases, had a mean payout of $1,818,250. Neurosurgeons accounted for 6.7% of all defendants. CONCLUSIONS Unlike other medical specialties, a majority of the verdicts were not in the defendant's favor. The mean payouts were nearly 5-fold less in cases in which a settlement was reached, as opposed to a summary judgment. Neurosurgeons accounted for a small percentage of all codefendants.

  14. The practice of cranial neurosurgery and the malpractice liability environment in the United States.

    PubMed

    Bekelis, Kimon; Missios, Symeon; Wong, Kendrew; MacKenzie, Todd A

    2015-01-01

    The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery. We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated. During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson's rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS. In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is necessary.

  15. Bariatric-related medical malpractice experience: survey results among ASMBS members.

    PubMed

    Dallal, Ramsey M; Pang, John; Soriano, Ian; Cottam, Daniel; Lord, Jeffrey; Cox, Susan

    2014-01-01

    The medicolegal aspects of bariatric surgery are very difficult to analyze scientifically because there is no central, searchable database of closed case claims and little incentive for malpractice insurers to divulge data. Examining medicolegal data may provide insight into the financial and psychological burden on physicians. Detailed data also may be used to improve patient safety and determine common causes of negligence. All U.S.-based members of the American Society of Metabolic and Bariatric Surgeons were asked to complete a survey regarding their bariatric-related medical malpractice experience. Of the 1672 eligible members that received the survey, 330 responded (19.7%). Mean years in practice was 15.3 ± 9. Mean annual cost of malpractice insurance was $59,200 ± $52,000 (N = 197). The respondent surgeons experienced 1.5 ± 3.2 lawsuits on average over the course of their practice. Of the 330 respondents, 144 (48%) did not report a bariatric-related lawsuit filed against them. Of the 464 lawsuits reported by 156 surgeons, 126 were settled out of court (27%), 249 were dropped (54%), and 54 (18%) went to trial. Seventy-two percent of cases that went to trial were found to be in favor of the defense. The mean lifetime amount paid for suits was $250,000±$660,000. The probability of a bariatric surgeon experiencing a lawsuit was independently associated with the years in practice (P = .03) and number of total cases the surgeon has performed (P = .01). The annual cost of malpractice insurance was independently predicted by the amount paid in previous claims (P = .01). The probability of a medical malpractice lawsuit correlates positively to the number of procedures performed and the number of years the surgeon has been in practice. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  16. The Practice of Cranial Neurosurgery and the Malpractice Liability Environment in the United States

    PubMed Central

    Wong, Kendrew; MacKenzie, Todd A.

    2015-01-01

    Object The potential imbalance between malpractice liability cost and quality of care has been an issue of debate. We investigated the association of malpractice liability with unfavorable outcomes and increased hospitalization charges in cranial neurosurgery. Methods We performed a retrospective cohort study involving patients who underwent cranial neurosurgical procedures from 2005-2010, and were registered in the National Inpatient Sample (NIS) database. We used data from the National Practitioner Data Bank (NPDB) from 2005 to 2010 to create measures of volume and size of malpractice claim payments. The association of the latter with the state-level mortality, length of stay (LOS), unfavorable discharge, and hospitalization charges for cranial neurosurgery was investigated. Results During the study period, there were 189,103 patients (mean age 46.4 years, with 48.3% females) who underwent cranial neurosurgical procedures, and were registered in NIS. In a multivariable regression, higher number of claims per physician in a state was associated with increased ln-transformed hospitalization charges (beta 0.18; 95% CI, 0.17 to 0.19). On the contrary, there was no association with mortality (OR 1.00; 95% CI, 0.94 to 1.06). We observed a small association with unfavorable discharge (OR 1.09; 95% CI, 1.06 to 1.13), and LOS (beta 0.01; 95% CI, 0.002 to 0.03). The size of the awarded claims demonstrated similar relationships. The average claims payment size (ln-transformed) (Pearson’s rho=0.435, P=0.01) demonstrated a positive correlation with the risk-adjusted hospitalization charges but did not demonstrate a correlation with mortality, unfavorable discharge, or LOS. Conclusions In the present national study, aggressive malpractice environment was not correlated with mortality but was associated with higher hospitalization charges after cranial neurosurgery. In view of the association of malpractice with the economics of healthcare, further research on its impact is

  17. 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.

  18. Analysis of 23 364 patient-generated, physician-reviewed malpractice claims from a non-tort, blame-free, national patient insurance system: lessons learned from Sweden.

    PubMed

    Pukk-Härenstam, K; Ask, J; Brommels, M; Thor, J; Penaloza, R V; Gaffney, F A

    2009-02-01

    In Sweden, patient malpractice claims are handled administratively and compensated if an independent physician review confirms patient injury resulting from medical error. Full access to all malpractice claims and hospital discharge data for the country provided a unique opportunity to assess the validity of patient claims as indicators of medical error and patient injury. To determine: (1) the percentage of patient malpractice claims validated by independent physician review, (2) actual malpractice claims rates (claims frequency / clinical volume) and (3) differences between Swedish and other national malpractice claims rates. DESIGN, SETTING AND MATERIAL: Swedish national malpractice claims and hospital discharge data were combined, and malpractice claims rates were determined by county, hospital, hospital department, surgical procedure, patient age and sex and compared with published studies on medical error and malpractice. From 1997 to 2004, there were 23 364 inpatient malpractice claims filed by Swedish patients treated at hospitals reporting 11 514 798 discharges. The overall claims rate, 0.20%, was stable over the period of study and was similar to that found in other tort and administrative compensation systems. Over this 8-year period, 49.5% (range 47.0-52.6%) of filed claims were judged valid and eligible for compensation. Claims rates varied significantly across hospitals; surgical specialties accounted for 46% of discharges, but 88% of claims. There were also large differences in claims rates for procedures. Patient-generated malpractice claims, as collected in the Swedish malpractice insurance system and adjusted for clinical volumes, have a high validity, as assessed by standardised physician review, and provide unique new information on malpractice risks, preventable medical errors and patient injuries. Systematic collection and analysis of patient-generated quality of care complaints should be encouraged, regardless of the malpractice compensation

  19. Medical malpractice in the management of small bowel obstruction: A 33-year review of case law.

    PubMed

    Choudhry, Asad J; Haddad, Nadeem N; Rivera, Mariela; Morris, David S; Zietlow, Scott P; Schiller, Henry J; Jenkins, Donald H; Chowdhury, Naadia M; Zielinski, Martin D

    2016-10-01

    Annually, 15% of practicing general surgeons face a malpractice claim. Small bowel obstruction accounts for 12-16% of all surgical admissions. Our objective was to analyze malpractice related to small bowel obstruction. Using the search terms "medical malpractice" and "small bowel obstruction," we searched through all jury verdicts and settlements for Westlaw. Information was collected on case demographics, alleged reasons for malpractice, and case outcomes. The search criteria yielded 359 initial case briefs; 156 met inclusion criteria. The most common reason for litigation was failure to diagnose and timely manage the small bowel obstruction (69%, n = 107). Overall, 54% (n = 84) of cases were decided in favor of the defendant (physician). Mortality was noted in 61% (n = 96) of cases. Eighty-six percent (42/49) of cases litigated as a result of failing to diagnose and manage the small bowel obstruction in a timely manner, resulting in patient mortality, had a verdict with an award payout for the plaintiff (patient). The median award payout was $1,136,220 (range, $29,575-$12,535,000). A majority of malpractice cases were decided in favor of the defendants; however, cases with an award payout were costly. Timely intervention may prevent a substantial number of medical malpractice lawsuits in small bowel obstruction, arguing in favor of small bowel obstruction management protocols. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Claims about Medical Malpractices Resulting in Maternal and Perinatal Mortality Referred to Iranian Legal Medicine Organization During 2011-2012.

    PubMed

    Taghizadeh, Ziba; Pourbakhtiar, Maryam; Ghadipasha, Masoud; Soltani, Kamran; Azimi, Khadijeh

    2017-01-01

    Obstetricians, gynecologists, and midwives are the most common specialists of the medical sciences group against whom medical malpractices are claimed, many of which are avoidable and preventable. Therefore, the present study was conducted to investigate the causes of claims regarding medical malpractices resulting in maternal and perinatal mortality. A descriptive cross-sectional study was conducted and 7616 claims of medical malpractices in the field of obstetrics, gynecology, and midwifery that were referred from all 31 provinces to the central commission of legal medicine were studied during 2011-2012. Therefore, the present research is a national inclusive study covering all the provinces across Iran. To collect information from the transcript of medical malpractices cases, a researcher-made checklist was used, and the collected data were analyzed. The results of the present study showed that among all the medical malpractice claims regarding pregnancy and childbirth (42.24%), the majority concerned perinatal death (71.82%) and maternal death (28.16%). Medical malpractice complaints are increasing; although, most of these claims are preventable. To achieve this aim, it is necessary for obstetricians, gynecologists, and midwives to try to reduce the complaints by paying more attention to the signs and symptoms of diseases, performing all the diagnostic and therapeutic measures according to the scientific criteria, and fully document patients' records. In addition, patients' acquaintance with the importance of measurements and examinations, before and during pregnancy care and even after childbirth is crucial.

  1. [Pitfalls in informed consent: a statistical analysis of malpractice law suits].

    PubMed

    Echigo, Junko

    2014-05-01

    In medical malpractice law suits, the notion of informed consent is often relevant in assessing whether negligence can be attributed to the medical practitioner who has caused injury to a patient. Furthermore, it is not rare that courts award damages for a lack of appropriate informed consent alone. In this study, two results were arrived at from a statistical analysis of medical malpractice law suits. One, unexpectedly, was that the severity of a patient's illness made no significant difference to whether damages were awarded. The other was that cases of typical medical treatment that national medical insurance does not cover were involved significantly more often than insured treatment cases. In cases where damages were awarded, the courts required more disclosure and written documents of information by medical practitioners, especially about complications and adverse effects that the patient might suffer.

  2. The practice of mediation to resolve clinical, bioethical, and medical malpractice disputes.

    PubMed

    Lee, Danny W H; Lai, Paul B S

    2015-12-01

    Mediation is a voluntary process whereby a neutral and impartial third party-t-he mediator--is present to facilitate communication and negotiation between the disputing parties so that amicable settlements can be agreed. Being confidential and non-adversarial in nature, the mediation process and skills are particularly applicable in clinical practice to facilitate challenging communications following adverse events, to assist bioethical decision making and to resolve disputes. Mediation is also a more effective and efficient means of dispute resolution in medical malpractice claims when compared with civil litigation. Health care mediation teams should be set up at individual facilities to provide education and consultation services to frontline staff and patients. At a community level, the Government, the mediation community, and the health care professionals should join forces to promote mediation as a means to settle medical malpractice claims outside of the courtroom.

  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. The admissibility of scientific evidence in psychiatric malpractice: junk science and the Daubert case.

    PubMed

    Tancredi, L R; Giannini, A J

    1994-12-01

    The defence in malpractice cases has traditionally relied upon a commonly accepted body of knowledge. According to the American 'Frye rule', this knowledge could either have been accepted generally or by a 'respectable minority' of physicians. The US Supreme Court, however, has recently ruled in the Daubert case that conclusions not subject to peer review are acceptable in malpractice cases. The authors analyse the implications of the Daubert decision using the case-study method. Two alternative-scenarios of a hypothetical case are analysed. The potential effect of Daubert places the US psychiatrist-defendant in an untenable position. Either use or non-use of non-peer-reviewed studies in clinical practice could produce a finding of negligence. Furthermore, the responsibility to assess scientific acceptability in US courts has shifted from expert witnesses to judges who are usually without scientific training.

  5. The flaws in state 'apology' and 'disclosure' laws dilute their intended impact on malpractice suits.

    PubMed

    Mastroianni, Anna C; Mello, Michelle M; Sommer, Shannon; Hardy, Mary; Gallagher, Thomas H

    2010-09-01

    Apologies are rare in the medical world, where health care providers fear that admissions of guilt or expressions of regret could be used by plaintiffs in malpractice lawsuits. Nevertheless, some states are moving toward giving health care providers legal protection so that they feel free to apologize to patients for a medical mistake. Advocates believe that these laws are beneficial for patients and providers. However, our analysis of "apology" and "disclosure" laws in thirty-four states and the District of Columbia finds that most of the laws have major shortcomings. These may actually discourage comprehensive disclosures and apologies and weaken the laws' impact on malpractice suits. Many could be resolved by improved statutory design and communication of new legal requirements and protections.

  6. Characterizing liability for cranial nerve injuries: a detailed analysis of 209 malpractice trials.

    PubMed

    Svider, Peter F; Sunaryo, Peter L; Keeley, Brieze R; Kovalerchik, Olga; Mauro, Andrew C; Eloy, Jean Anderson

    2013-05-01

    The potential for adverse events with lasting functional effects makes cranial nerve (CN) injury a target for litigation. Our objective was to comprehensively examine records of malpractice trials and detail issues influencing outcomes. Retrospective analysis. The Westlaw database (Thomson Reuters, New York, NY) was searched for jury verdict reports related to medical malpractice and CN injury. After excluding nonrelevant cases, we examined 209 trials for characteristics including nerve(s) injured, alleged causes of malpractice, demographic information, specialty, and outcome. The most commonly litigated CNs were VII (24.4%) and II (19.6%). Sixty-nine (33.0%) trials resulted in damages awarded. Outcomes varied, ranging from a 29.2% plaintiff success rate for CN XI injury to 48.4% for CN II injury. Plaintiffs had less success with increasing age. Average damages awarded were $1.7 million. The most commonly named defendants were otolaryngologists and general surgeons. Individual considerations varied but commonly included alleged deficits in informed consent (25.4%), unnecessary procedures (14.8%), undergoing additional surgery (25.8%), and untimely recognition of complications (23.9%). Malpractice trials were resolved in the defendant's favor the majority of the time. In cases where plaintiffs were successful, however, awards were considerable, averaging nearly $2 million. Factors influencing case outcome included age, location, perceived deficits in informed consent, allegedly unnecessary surgery, requiring additional surgery to repair a complication, and untimely recognition of complications. Although specific factors should be taken into consideration with each procedure, providing detailed informed consent and communicating with patients regarding expectations may minimize liability. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Hearing loss resulting in malpractice litigation: what physicians need to know.

    PubMed

    Reilly, Brian K; Horn, Gayle M; Sewell, Ryan K

    2013-01-01

    To evaluate the relationship between hearing loss and malpractice litigation. Retrospective study evaluating state and federal civil malpractice litigation pertaining to physician treatment and patient hearing loss in the United States during a 10-year period (2001-2011). A Westlaw search of the computer database Jury Verdicts-All for 2001-2011 was performed using the search terms "hearing loss" and "malpractice." This database includes jury verdicts, judgments, and settlements. Niney-four cases were analyzed. There were 53 verdicts favorable for the defense (56%), 28 verdicts favorable for the plaintiff (30%), and 12 settlements. One case resulted in a mistrial. Settlements ranged from $42,500 to $12,500,000, and verdicts ranged from $0 to $8,784,000. The average payout for adult plaintiffs was less ($549,157) than the payout for minors ($1,349,121). The average payout for a surgical case was $579,098, compared to $960,048 for medical etiology of hearing loss. Otolaryngologists were the most frequently sued treating physician for hearing loss; the second most common defendant was pediatricians (eight cases). In the 13 cases in which an otolaryngologist was sued, there were nine defense verdicts and four verdicts in plaintiffs' favor. The average indemnity for an otolaryngologist was $313,230. Otolaryngologists are successful in most (70%) hearing loss litigation brought against them. This is true regardless of whether the allegations are of medical error or include operative procedures. Pediatric patients received more favorable jury verdicts when litigating malpractice claims than their adult counterparts, and the payouts were highest when there was alleged birth trauma and/or meningitis. Finally, the severity and degree of hearing loss sustained correlate with higher payouts. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  8. In the eyes of the law: malpractice litigation in oculoplastic surgery.

    PubMed

    Svider, Peter F; Blake, Danielle M; Husain, Qasim; Mauro, Andrew C; Turbin, Roger E; Eloy, Jean Anderson; Langer, Paul D

    2014-01-01

    To assess characteristics associated with various outcomes of malpractice litigation, resulting from injuries sustained during oculoplastic procedures. The Westlaw legal database (Thomson Reuters, New York, NY, U.S.A.) was used to obtain jury verdicts and settlements. Pertinent data were extracted from 69 malpractice cases litigated from 1988 to 2012 involving oculoplastic procedures, including alleged cause of malpractice, outcome, and defendant specialty. The most commonly litigated surgical procedures were blepharoplasty (63.8% of total) and brow lift surgery (11.6%). The most commonly alleged complications included excessive scarring (24.6%), lagophthalmos (24.6%), visual defects (23.2%), and exposure keratitis (21.7%). Plastic surgeons were the most commonly named defendants (46.4%), followed by both comprehensive ophthalmologists and fellowship-trained ophthalmic plastic surgeons (17.3% each). A defense verdict was held in 60.9% of cases, a plaintiff verdict in 31.9% of cases, and a settlement was reached in 7.2% of cases. Blindness, cranial nerve injury, and the allegation of a permanent deficit increased the likelihood of a case being resolved with payment to the plaintiff (Fisher exact tests, p < 0.05). Most litigated oculoplastic malpractice cases were resolved in favor of the defendant, while settlements and plaintiff decisions averaged $455,703. Blepharoplasty constituted two-thirds of cases, with the most frequently cited associated complications being unsightly scarring, lagophthalmos, and visual deficits. An alleged lack of informed consent (30.4%) or the need for additional surgery (39.1%) was present in a considerable proportion of cases, emphasizing the importance of a detailed informed consent and clear communication preoperatively regarding patient expectations.

  9. Study of medical students' malpractice fear and defensive medicine: a "hidden curriculum?".

    PubMed

    Johnston, William F; Rodriguez, Robert M; Suarez, David; Fortman, Jonathan

    2014-05-01

    Defensive medicine is a medical practice in which health care providers' primary intent is to avoid criticism and lawsuits, rather than providing for patients' medical needs. The purpose of this study was to characterize medical students' exposure to defensive medicine during medical school rotations. We performed a cross-sectional survey study of medical students at the beginning of their third year. We gave students Likert scale questionnaires, and their responses were tabulated as a percent with 95% confidence interval (CI). Of the 124 eligible third-year students, 102 (82%) responded. Most stated they rarely worried about being sued (85.3% [95% CI=77.1% to 90.9%]). A majority felt that faculty were concerned about malpractice (55.9% [95% CI=46.2% to 65.1%]), and a smaller percentage stated that faculty taught defensive medicine (32.4% [95% CI=24.1% to 41.9%]). Many students believed their satisfaction would be decreased by MC and lawsuits (51.0% [95% CI=41.4% to 60.5%]). Some believed their choice of medical specialty would be influenced by MC (21.6% [95% CI=14.7% to 30.5%]), and a modest number felt their enjoyment of learning medicine was lessened by MC (23.5% [95% CI=16.4% to 32.6%]). Finally, a minority of students worried about practicing and learning procedures because of MC (16.7% [95% CI=10.7% to 25.1%]). Although third-year medical students have little concern about being sued, they are exposed to malpractice concerns and taught considerable defensive medicine from faculty. Most students believe that fear of lawsuits will decrease their future enjoyment of medicine. However, less than a quarter of students felt their specialty choice would be influenced by malpractice worries and that malpractice concerns lessened their enjoyment of learning medicine. [West J Emerg Med. 2014;15(3):293-298.].

  10. 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.

  11. 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.

  12. Counting the cost: the consequences of increased medical malpractice litigation in South Africa.

    PubMed

    Malherbe, J

    2012-12-11

    We live in uncertain times. The recession in Europe and ongoing political instability in the Middle East are each examples of what could legally be termed a 'statement of fact'. The rising cost of healthcare in South Africa is another fact. This phenomenon is accompanied by an even more disturbing trend: a steep rise in medical malpractice litigation. An important question to consider is what effect this increase is having on healthcare provision in South Africa generally.

  13. Relationship Between Malpractice Litigation Pressure and Rates of Cesarean Section and Vaginal Birth After Cesarean Section

    PubMed Central

    Yang, Y. Tony; Mello, Michelle M.; Subramanian, S. V.; Studdert, David M.

    2011-01-01

    Background Since the 1990s, nationwide rates of vaginal birth after cesarean section (VBAC) have decreased sharply and rates of cesarean section have increased sharply. Both trends are consistent with clinical behavior aimed at reducing obstetricians’ exposure to malpractice litigation. Objective To estimate the effects of malpractice pressure on rates of VBAC and cesarean section. Research Design, Subjects, Measures We used state-level longitudinal mixed-effects regression models to examine data from the Natality Detail File on births in the United States (1991–2003). Malpractice pressure was measured by liability insurance premiums and tort reforms. Outcome measures were rates of VBAC, cesarean section, and primary cesarean section. Results Malpractice premiums were positively associated with rates of cesarean section (β = 0.15, P = 0.02) and primary cesarean section (β = 0.16, P = 0.009), and negatively associated with VBAC rates (β = −0.35, P = 0.01). These estimates imply that a $10,000 decrease in premiums for obstetrician-gynecologists would be associated with an increase of 0.35 percentage points (1.45%) in the VBAC rate and decreases of 0.15 and 0.16 percentage points (0.7% and 1.18%) in the rates of cesarean section and primary cesarean section, respectively; this would correspond to approximately 1600 more VBACs, 6000 fewer cesarean sections, and 3600 fewer primary cesarean sections nationwide in 2003. Two types of tort reform—caps on noneconomic damages and pretrial screening panels—were associated with lower rates of cesarean section and higher rates of VBAC. Conclusions The liability environment influences choice of delivery method in obstetrics. The effects are not large, but reduced litigation pressure would likely lead to decreases in the total number cesarean sections and total delivery costs. PMID:19169125

  14. 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

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

    PubMed

    Renkema, Erik; Broekhuis, Manda; Ahaus, Kees

    2014-01-25

    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. 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. 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. 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 can rely on the hospital management after

  16. Radiology medical malpractice suits in gastrointestinal radiology: prevalence, causes, and outcomes.

    PubMed

    Baker, Stephen R; Shah, Shivam; Ghosh, Shanchita; Castro, Alejandro

    2015-04-01

    The purpose of this study is to determine the prevalence, causes, and outcomes of GI malpractice suits in a survey of 8,401 radiologists. The malpractice histories of 8,401 radiologists from 47 states were evaluated from credentialing data of all radiologists participating in the network of One Call Medical Inc. Thirty-two percent of radiologists were defendants in at least one malpractice suit. Of the 4,073 total claims, 346 (8.49 %) were related to the gastrointestinal system. The most frequent primary allegations were failure to diagnose, 65.9 %, and procedural complications, 17.1 %. The commonest missed diagnoses were malignancy, 31.6 %; pneumoperitoneum, 19.3 %; and appendicitis, 14.5 %. Payment to the plaintiff occurred in 75.8 % of claims pertinent to cancer, 73.2 % for missed pneumoperitoneum, and 62.5 % related to appendicitis. Of cases in which a ruling was made in favor of the plaintiff, median payments for pneumoperitoneum was $215,000, for primary cancer $200,000, and for appendicitis $60,000. Among procedurally related errors resulting in judgment against a defending radiologist, 78.6 % of claims regarding retained foreign body, 75 % of barium enema cases, and 62.5 % of liver biopsy resulted in a payment to the plaintiff. Among all resolved cases, the median award was $30,000 for unrecognized foreign body retention, $100,000 for barium enema complications, and $400,000 for liver biopsy complication. Of all GI malpractice claims, failure to diagnose was the most prevalent. Among them, approximately three fourths of claims related to either the diagnosis of primary cancer or for detection of a pneumoperitoneum.

  17. A critical analysis of melanoma malpractice litigation: Should we biopsy everything?

    PubMed

    Rayess, Hani M; Gupta, Amar; Svider, Peter F; Raza, S Naweed; Shkoukani, Mahdi; Zuliani, Giancarlo F; Carron, Michael A

    2017-01-01

    The aim of this study was to evaluate factors raised in malpractice litigation related to the diagnosis and management of melanoma and to further assess issues impacting outcome. Retrospective chart review. The Westlaw legal database was searched for malpractice litigation resolved over the last 20 years relating to melanoma. Cases were evaluated for allegations, defendant specialty, outcome, and other issues raised. Of the 80 cases evaluated, 49% were resolved in the defendants' favor. In greater than 80% of cases, there was alleged misdiagnosis. In 35% of cases, the patient had expired secondary to melanoma at the time of litigation. There was no statistical difference in payments upon comparison of cases with and without mortality. A greater proportion of cases with dermatologists and pathologists as defendants involved alleged misdiagnosis. The most common locations for melanoma were the extremities and the head-and-neck region, at 32.5% and 22.5%, respectively. Location did not significantly impact the outcome of cases. Malpractice litigation relating to melanoma involves numerous physicians, including dermatologists, pathologists, and otolaryngologists. Alleged misdiagnosis of a pigmented lesion was the most common cause of litigation and involved physicians from numerous specialties. Patients who were misdiagnosed had a significantly higher likelihood of having active disease at the time of litigation. Ultimately improved methods of detecting concerning pigmented lesions need to be developed. Factors such as death and poor cosmetic outcome did not significantly impact litigation outcome. NA Laryngoscope, 127:134-139, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  18. Errors and malpractice lawsuits in radiology: what the radiologist needs to know.

    PubMed

    Busardò, Francesco Paolo; Frati, Paola; Santurro, Alessandro; Zaami, Simona; Fineschi, Vittorio

    2015-09-01

    All medical specialties dealing with patients include an intrinsic risk in exposing them to issues resulting from human errors. Radiology is not spared from this risk since it includes "decision-making under conditions of uncertainty." In medical imaging, the line between the word "error" and misdiagnosis or discrepancy is very difficult to demarcate, mainly because the diagnostic process is not a binary relation and it is not always possible to establish if a pathological condition is present or not. The error in radiology is strongly related to the diagnostic process; hence, it can be defined as a "diagnostic error" which represents the most common cause of medical malpractice suits against radiologists. In this paper, the authors described the features of errors occurring in radiology, trying to establish their impact and prevalence. Secondly, some data coming from different countries were compared in order to highlight the most frequent causes leading to malpractice lawsuits in radiology and how the phenomenon of malpractice in this field is represented worldwide.

  19. Back to the future: Can conversation analysis be used to judge physicians' malpractice history?

    PubMed

    Frankel, Richard M; Levinson, Wendy

    2014-01-01

    In its monograph Crossing the Quality Chasm, the Institute of Medicine asserted that 44,000 to 98,000 lives are lost every year due to avoidable medical errors, more than 80% of which involved breakdowns in communication. Medical malpractice claims also involve errors that cause harm, including death. Reasons for malpractice claims have been investigated using variables such as age, race, country of origin, and gender none of which are predictive. One promising area that has not systematically been studied is the role of face-to-face communication in malpractice claims. To better understand this phenomenon, we tape-recorded 125 doctors (divided equally between surgeons and primary care practitioners), each with 10 consecutive patients. Half of these doctors had been sued at least twice, while the rest had never been sued. We then did a qualitative analysis based on a single taped encounter per doctor using conversation analysis (CA), in order to try to identify which doctors had claims or no-claims histories. While we were able to identify two out of every three no-claims primary care doctors, we were much less successful in identifying those with claims. Surprisingly, in the surgeon group, predictions based on CA were worse than by chance probability. We discuss the implications of our findings for the field of outcome-based communication analysis.

  20. 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.

  1. Analysis of malpractice claims with a focus on oxytocin use in labour.

    PubMed

    Jonsson, Maria; Nordén, Solveig Lindeberg; Hanson, Ulf

    2007-01-01

    The objective of this study was to analyse the motives behind disciplinary action in obstetric malpractice cases concerning delivery, and to evaluate the frequency of inappropriate oxytocin use in these cases. An analysis of all malpractice claims resulting in disciplinary action against physicians and midwives during the period 1996-2003. Investigations and decisions made by the Board of Medical Responsibility were reviewed with special focus on the use of oxytocin. Of 77 cases, 60 regarded patients in labour. In the majority, there had been a normal pregnancy and spontaneous start of labour (78%). At the beginning of labour, 87% showed a normal fetal heart rate (FHR) pattern, indicating fetal well-being. In 70%, there was adverse fetal outcome with brain damage or death. The most common reason for disciplinary action was improper interpretation of fetal monitor tracings and corresponding failure to recognise fetal distress (76%). Injudicious use of oxytocin was common (68.5%), and was the primary reason for disciplinary action in 33% of the cases. In a Swedish setting, a few common clinical problems pervade; interpretation of FHR patterns and the use of oxytocin account for the majority of rulings of negligence in malpractice cases regarding delivery. Analysis of the cases suggests that the adverse fetal outcomes could possibly have been prevented.

  2. 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

  3. Malpractice burden, rural location, and discontinuation of obstetric care: a study of obstetric providers in Michigan.

    PubMed

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

    2009-01-01

    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. 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. 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. 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 4-fold higher likelihood of withdrawing obstetric care when compared with urban family physicians. 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.

  4. Analysis of diagnostic error in paid malpractice claims with substandard care in a large healthcare system.

    PubMed

    Holohan, Thomas V; Colestro, Janice; Grippi, John; Converse, Jane; Hughes, Michael

    2005-11-01

    Although claims databases are not representative of all care delivery, their predisposition toward serious unintended injury can complement resource-intensive chart reviews and guide patient safety initiatives. Non-Veterans Health Administration (VA) practitioners reviewed 1,949 VA malpractice claims paid during fiscal years 1998 through 2003. The portion associated with substandard care, the severity of harm, and types of negligence were identified. Negligent adverse events occurred in 37% (n = 723) of paid VA malpractice claims. These had high proportions of serious injury (55%) and morbidity (37%). Diagnostic negligent adverse events were most frequent (45%) and with 41% associated morbidity. The annual incidence of diagnosis-related paid VA malpractice claims was 1.95 per 100,000 patients and predicts that 122 of every 100,000 patients may have diagnostic negligent adverse events. Comparisons against non-VA data suggest this to be a healthcare industry problem. Diagnosis-related negligent adverse events are a serious problem in the healthcare industry.

  5. 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

  6. Malpractice Liability Risk and Use of Diagnostic Imaging Services: A Systematic Review of the Literature.

    PubMed

    Li, Suhui; Brantley, Erin

    2015-12-01

    A widespread concern among physicians is that fear of medical malpractice liability may affect their decisions for diagnostic imaging orders. The purpose of this article is to synthesize evidence regarding the defensive use of imaging services. A literature search was conducted using a number of databases. The review included peer-reviewed publications that studied the link between physician orders of imaging tests and malpractice liability pressure. We identified 13 peer-reviewed studies conducted in the United States. Five of the studies reported physician assessments of the role of defensive medicine in imaging-order decisions; five assessed the association between physicians' liability risk and imaging ordering, and three assessed the impact of liability risk on imaging ordering at the state level. Although the belief that medical liability risk could influence decisions is highly prevalent among physicians, findings are mixed regarding the impact of liability risk on imaging orders at both the state and physician level. Inconclusive evidence suggests that physician ordering of imaging tests is affected by malpractice liability risk. Further research is needed to disentangle defensive medicine from other reasons for inefficient use of imaging. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  7. Characteristics of paid malpractice claims settled in and out of court in the USA: a retrospective analysis.

    PubMed

    Rubin, Jessica B; Bishop, Tara F

    2013-06-20

    An analysis of paid malpractice claims judged in court compared with those settled out of court may help explain perceptions of malpractice risk. A retrospective analysis and cross-sectional comparison of malpractice claims. Evaluated trends in the number and proportion of paid claims, and mean payment amount by resolution type; identified patient, physician and claim characteristics associated with each resolution type. Examined the effects of resolution type on payment amount and time to claim resolution. Claims paid on behalf of US physicians reported in the National Practitioner Data Bank (NPDB) from 2005 to 2009. Type of resolution, claim characteristics, payment amount and time to resolution. Between 2005 and 2009, there were 58 667 claims paid on behalf of US physicians. Of these paid claims, 56 850 (96.9%) were settled outside court, and 1817 (3.1%) were judged in court. There was no significant change in the proportion of paid claims resolved by settlement versus judgement over time (p=0.83); nor was there a significant change in the mean payment amount in either resolution group (settlement, p=0.94; judgement, p=0.36). The claims in which the physicians were under 50, had prior malpractice reports, which were paid by a state malpractice programme, for adverse events to a fetus, and for surgical or obstetric error were more likely to be judged in court. The mean payment amount (US$592 283 vs US$317 447, p<0.01), per cent of payments over US$1 million (41.82% vs 15.43%, p<0.01), and time to decision (6.50 years vs 4.93 years, p<0.01) were significantly higher in judged claims. Although only a very small percentage of paid malpractice claims in the USA are judged in court, a number of characteristics differ between settled and judged claims. Such differences may influence perceptions of malpractice risk and future reform efforts.

  8. Trends in malpractice claims for obstetric and gynecologic procedures, 2005 through 2014.

    PubMed

    Glaser, Laura M; Alvi, Farah A; Milad, Magdy P

    2017-09-01

    Interest in medical malpractice and areas of medicolegal vulnerability for practicing obstetricians and gynecologists has grown substantially, and many providers report changing surgical practice out of fear of litigation. Furthermore, education on medical malpractice and risk management is lacking for obstetrics and gynecology trainees. Recent obstetric and gynecologic malpractice claims data are lacking. We report on recent trends in malpractice claims for obstetrics and gynecology procedures, and compare these trends to those of other medical specialties. We sought to evaluate recent trends in malpractice claims for obstetrics and gynecology procedures and compare these to other medical specialties. A search was performed on all medicolegal claims data for obstetrics and gynecology procedures from Jan. 1, 2005, through Dec. 31, 2014, using the Physician Insurers' Association of America data-sharing project, which was created to identify medical professional liability trends. Data from 20 insurance carriers were reviewed based on a search using International Classification of Diseases, Ninth Revision codes and unique database-specific codes. Of the 10,915 total claims closed from 2005 through 2014, the majority (59.5%) were dropped, withdrawn, or dismissed. The average indemnity of the remaining paid claims (31.1%) was $423,250. The most frequently litigated procedure was operative procedures on the uterus; 27.8% of cases were paid with an average indemnity of $279,384. The procedure associated with the highest proportion of paid claims was vacuum extraction. The average indemnity for paid obstetrics and gynecology procedural claims was 27% higher than that for all medical specialties combined. Obstetrics and gynecology procedural claims had the second highest average indemnity payment and the fifth highest paid-to-closed ratio of all medical specialties. Litigation claims for obstetrics and gynecology procedures have higher average indemnity payments and higher

  9. Rates and Characteristics of Paid Malpractice Claims Among US Physicians by Specialty, 1992-2014.

    PubMed

    Schaffer, Adam C; Jena, Anupam B; Seabury, Seth A; Singh, Harnam; Chalasani, Venkat; Kachalia, Allen

    2017-05-01

    Although physician concerns about medical malpractice are substantial, national data are lacking on the rate of claims paid on behalf of US physicians by specialty. To characterize paid malpractice claims by specialty. A comprehensive analysis was conducted of all paid malpractice claims, with linkage to physician specialty, from the National Practitioner Data Bank from January 1, 1992, to December 31, 2014, a period including an estimated 19.9 million physician-years. All dollar amounts were inflation adjusted to 2014 dollars using the Consumer Price Index. The dates on which this analysis was performed were from May 1, 2015, to February 20, 2016, and from October 25 to December 16, 2016. For malpractice claims (n = 280 368) paid on behalf of physicians (in aggregate and by specialty): rates per physician-year, mean compensation amounts, the concentration of paid claims among a limited number of physicians, the proportion of paid claims that were greater than $1 million, severity of injury, and type of malpractice alleged. From 1992-1996 to 2009-2014, the rate of paid claims decreased by 55.7% (from 20.1 to 8.9 per 1000 physician-years; P < .001), ranging from a 13.5% decrease in cardiology (from 15.6 to 13.5 per 1000 physician-years; P = .15) to a 75.8% decrease in pediatrics (from 9.9 to 2.4 per 1000 physician-years; P < .001). The mean compensation payment was $329 565. The mean payment increased by 23.3%, from $286 751 in 1992-1996 to $353 473 in 2009-2014 (P < .001). The increases ranged from $17 431 in general practice (from $218 350 in 1992-1996 to $235 781 in 2009-2014; P = .36) to $114 410 in gastroenterology (from $276 128 in 1992-1996 to $390 538 in 2009-2014; P < .001) and $138 708 in pathology (from $335 249 in 1992-1996 to $473 957 in 2009-2014; P = .005). Of 280 368 paid claims, 21 271 (7.6%) exceeded $1 million (4304 of 69 617 [6.2%] in 1992-1996 and 4322 of 54 081 [8.0%] in 2009

  10. Medicare and Medicaid; payment for the cost of malpractice insurance--HCFA. Interim final rule with comment period.

    PubMed

    1986-04-01

    In this final rule we are adopting an apportionment methodology for determining reasonable cost reimbursement for hospital malpractice insurance costs. The new apportionment policy for hospitals will divide total malpractice insurance premium cost into two components. The "administrative component," which accounts for 8.5 percent of total premium cost, will be included in the General and Administrative cost center and will be apportioned on the basis of the individual hospital's Medicare utilization rate. The "risk component," which comprises 91.5 percent of total cost, will be apportioned on the basis of a formula that takes into account the individual hospital's utilization as well as the national Medicare patient utilization rate and the national Medicare malpractice loss ratio (as adjusted to account for associated claims handling costs). Effectively, the "scaling factor formula" will relate the national utilization rate to the adjusted national loss ratio. As a hospital's own utilization rate exceeds or falls below the national utilization rate, the risk component will be reimbursed on the basis of a "scaling factor" that is more or less than the national Medicare malpractice loss ratio. Different apportionment policies are being adopted for Medicare skilled nursing facilities and for providers of services under the Medicaid and Maternal and Child Health programs. This final rule replaces our current apportionment policy for reimbursement of malpractice insurance costs and is applicable, subject to the rules of reopening and administrative finality, to cost reporting periods beginning on or after July 1, 1979.

  11. Medical Malpractice in Dermatology-Part II: What To Do Once You Have Been Served with a Lawsuit.

    PubMed

    Shah, Vidhi V; Kapp, Marshall B; Wolverton, Stephen E

    2016-12-01

    Facing a malpractice lawsuit can be a daunting and traumatic experience for healthcare practitioners, with most clinicians naïve to the legal landscape. It is crucial for physicians to know and understand the malpractice system and his or her role once challenged with litigation. We present part II of a two-part series addressing the most common medicolegal questions that cause a great deal of anxiety. Part I focused upon risk-management strategies and prevention of malpractice lawsuits, whereas part II provides helpful suggestions and guidance for the physician who has been served with a lawsuit complaint. Herein, we address the best approach concerning what to do and what not to do after receipt of a legal claim, during the deposition, and during the trial phases. We also discuss routine concerns that may arise during the development of the case, including the personal, financial, and career implications of a malpractice lawsuit and how these can be best managed. The defense strategies discussed in this paper are not a guide separate from legal representation to winning a lawsuit, but may help physicians prepare for and cope with a medical malpractice lawsuit. This article is written from a US perspective, and therefore not all of the statements made herein will be applicable in other countries. Within the USA, medical practitioners must be familiar with their own state and local laws and should consult with their own legal counsel to obtain advice about specific questions.

  12. Which is feared more: harm to the ego or financial peril? A survey of anesthesiologists' attitudes about medical malpractice.

    PubMed

    Burkle, Christopher M; Martin, David P; Keegan, Mark T

    2012-09-01

    This article reports the results of a study of anesthesiologists to assess their concerns regarding medical malpractice liability risk. Specifically, it explored whether their fears stem more from being named as a party to a suit or from the financial impact of damage awards. According to the respondents, their reputation among patients and colleagues is of greater concern than the financial impact of a malpractice suit. Forty-six percent of the 149 respondents reported a constant fear of malpractice risk; 43% were concerned about their reputation among colleagues and 57% feared their reputation would be compromised among patients. A large majority voiced concern about potential inclusion in the National Practitioner Data Bank (83%) and their rankings on online physician-grading sites (85%). Forty-one percent said financial consequences were a concern, and 54% indicated that obtaining affordable liability coverage was an issue.

  13. 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.

  14. 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

  15. A look inside the courtroom: an analysis of 292 cosmetic breast surgery medical malpractice cases.

    PubMed

    Paik, Angie M; Mady, Leila J; Sood, Aditya; Eloy, Jean Anderson; Lee, Edward S

    2014-01-01

    Malpractice claims affect the cost and quality of health care. The authors examine litigation in cosmetic breast surgery and identify factors influencing malpractice litigation outcomes. The Westlaw database was searched for jury verdict and settlement reports related to medical malpractice and cosmetic breast surgeries. Cases included for analysis were examined for year, geographic location, patient demographics, procedure performed, alleged injury, causes of action, verdict, and indemnity payments. Of 292 cases, the most common injury sustained was disfigurement (53.1%). Negligent misrepresentation had a 98% greater chance of resolution in favor of the plaintiff (relative risk [RR], 1.98; 95% confidence interval [CI], 1.41-2.79), and fraud had a 92% greater chance of disposition in favor of the plaintiff (RR, 1.92; 95% CI, 1.32-2.80). The most common causes of action cited were negligence (88.7%) and lack of informed consent (43.8%). One hundred sixty-nine (58.3%) cases resulted in favor of the defendant and 121 (41.7%) cases were disposed in favor of the plaintiff; 97 (33.4%) cases resulted in damages awarded and 24 (8.3%) cases resulted in settlement. No significant difference was found between the medians of indemnity payments awarded to plaintiffs ($245 000) and settlements ($300 000). Based on this study, negligent or intentional misrepresentation strongly favors plaintiffs in either awarded damages or settlements in cases of cosmetic breast surgery litigation. This study emphasizes that transparency and adequate communication are at the crux of the physician-patient relationship and are tools by which plastic surgeons may reduce the frequency of litigations, thereby containing health care costs at a minimum.

  16. Characteristics of Orthopaedic Malpractice Claims of Pediatric and Adult Patients in Private Practice.

    PubMed

    Oetgen, Matthew E; Parikh, P Divya

    2016-03-01

    Medical liability exposure varies based on scope of practice, patient demographics, and location of practice. There is a generally held belief that treatment of pediatric patients increases one's medicolegal risk. We examined a large national database of orthopaedic malpractice claims to determine if pediatric malpractice claims were associated with a less favorable medicolegal outcome compared with adults. Physician Insurers Association of America is an association of medical liability insurance carriers providing liability coverage for 60% of private practice physicians in the United States. The Physician Insurers Association of America data registry of closed medical liability claims was examined, including all orthopaedic claims between 1985 and 2012 in this review. Claims were categorized based on the age of the claimant (pediatric: less than 21 y, adult: 21 y or older). These groups were compared based on percentage of claims resulting in payment, indemnity paid, and years between occurrence of incident and filing of claim. In addition, the top 10 most prevalent claims were identified and compared between groups. A total of 25,702 closed orthopaedic claims were included. Pediatric claims accounted for 13% of the data. The average time from incident to claim filing was 1.92 years for pediatrics and 1.59 years for adults. Pediatric claims resulted in a higher percent of payment (33% vs. 30%) and average indemnity paid ($189,732 vs. $180,171) compared with adults. Five of the top 10 conditions resulting in a claim in each group were the same. Comparing these 5 conditions, in general there were minimal differences in the average time to claim filing between the groups, but larger average indemnity paid in the pediatric group. There appear to be moderate differences in outcomes of orthopaedic malpractice claims between adult and pediatric patients. The longer statute of limitations associated with pediatric claims does not appear to portend a less favorable

  17. Effects of the malpractice crisis on access to and incidence of high-risk procedures: evidence from Florida.

    PubMed

    Dranove, David; Gron, Anne

    2005-01-01

    There is much debate on how recent increases in medical malpractice premiums affect patients' access to care. We examined activity levels of neurosurgeons and obstetricians, as well as the incidence of high-risk surgery and patients' travel times in Florida, where malpractice insurance premiums have soared since 2000. Compared with 1997-2000, we found that during 2000-2003, many neurosurgeons cut back their volume of brain surgeries and that craniotomy patients traveled longer for care without any significant change in the overall incidence of craniotomies. Women undergoing high-risk deliveries did not see increases in travel times.

  18. [Fighting malpractice and uncooperative behaviour in the "Swiss Archive for Veterinary Science" 1816-2016].

    PubMed

    Jenny, U

    2017-01-01

    Already back in the 18th century, the treatment of sick animals was reserved for licensed veterinarians in most Cantons. Various articles from the first 100 years of the Swiss Archives for Veterinary Science show that over and over again unqualified people offered their services to livestock owners. A detailed article from the year 1843 on the resulting situation in the Canton of Berne and the need for corrective measures are presented. At the beginning of the 20th century articles about malpractice among veterinarians, especially regarding the trade of medication predominate.

  19. Are damages caps regressive? A study of malpractice jury verdicts in California.

    PubMed

    Studdert, David M; Yang, Y Tony; Mello, Michelle M

    2004-01-01

    Caps on damages have emerged as the most controversial legislative response to the new malpractice crisis. We analyzed a sample of high-end jury verdicts in California that were subjected to the state's dollars 250,000 cap on noneconomic damages. We found strong evidence that the cap's fiscal impact was distributed inequitably across different types of injuries. In absolute dollar terms, the reductions imposed on grave injury were seven times larger than those for minor injury; the largest proportional reductions were for injuries that centered on pain and disfigurement. Use of sliding scales of damages instead of or in conjunction with caps would mitigate their adverse impacts on fairness.

  20. Analysis of Malpractice Claims Associated with Surgical Site Infection in the Field of Plastic Surgery

    PubMed Central

    2016-01-01

    Postoperative infections are rare after plastic surgery; however, when present, they can affect the aesthetic outcome. Currently, many malpractice lawsuits are associated with surgical site infection. The present study aimed to analyze malpractice claims associated with surgical site infection in the field of plastic surgery through a review of Korean precedents. We analyzed the type of procedure, associated complications, and legal judgment in these cases. Most claimants were women, and claims were most often related to breast surgery. The common complications related to surgical site infection were deformity, scar, and asymmetry. Among the 40 cases, 34 were won by the plaintiff, and the mean claim settlement was 2,832,654 KRW (USD 2,636.6). The reasons for these judgements were as follows: 1) immediate bacterial culture tests were not performed and appropriate antibiotics were not used; 2) patients were not transferred to a high-level hospital or the infection control department was not consulted; 3) surgical site infection control measures were not appropriate; and 4) surgical procedures were performed without preoperative explanation about surgical site infection. The number of claims owing to surgical site infection after surgery is increasing. Infection handling was one of the key factors that influenced the judgement, and preoperative explanation about the possibility of infection is important. The findings will help surgeons achieve high patient satisfaction and reduce liability concerns. PMID:27822936

  1. Adverse events during pediatric dental anesthesia and sedation: a review of closed malpractice insurance claims.

    PubMed

    Chicka, Maggie C; Dembo, Jeffrey B; Mathu-Muju, Kavita R; Nash, David A; Bush, Heather M

    2012-01-01

    The purpose of this study of closed malpractice insurance claims was to provide descriptive data of adverse events related to child sedation and anesthesia in the dental office. The malpractice claims databases of two professional liability carriers were searched using pre-determined keywords for all closed claims involving anesthesia in pediatric dental patients from 1993-2007. The database searches resulted in 17 claims dealing with adverse anesthesia events of which 13 involved sedation, 3 involved local anesthesia alone, and 1 involved general anesthesia. Fifty-three percent of the claims involved patient death or permanent brain damage; in these claims, the average patient age was 3.6 years, 6 involved general dentists as the anesthesia provider, and 2 involved local anesthesia alone. Local anesthetic overdoses were observed in 41% of the claims. The location of adverse event occurrence was in the dental office where care was being provided in 71% of the claims. Of the 13 claims involving sedation, only 1 claim involved the use of physiologic monitoring. Very young patients (≤ 3-years-old) are at greatest risk during administration of sedative and/or local anesthetic agents. Some practitioners are inadequately monitoring patients during sedation procedures. Adverse events have a high chance of occurring at the dental office where care is being provided.

  2. 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

  3. The disruptive orthopaedic surgeon: implications for patient safety and malpractice liability.

    PubMed

    Patel, Pranay; Robinson, Brooke S; Novicoff, Wendy M; Dunnington, Gary L; Brenner, Michael J; Saleh, Khaled J

    2011-11-02

    Disruptive physician behavior imperils patient safety, erodes the morale of other health care providers, and dramatically increases the risk of malpractice litigation. Increasing patient volume, decreasing physician reimbursement, malpractice litigation, elevated stress, and growing job dissatisfaction have been implicated in disruptive behavior, which has emerged as one of the major challenges in health care. Because the aging patient population relies increasingly on orthopaedic services to maintain quality of life, improving professionalism and eradicating disruptive behavior are urgent concerns in orthopaedic surgery. Although many steps have been taken by The Joint Commission to improve patient care and define disruptive behavior, there is further room for improvement by physicians. Barriers to eliminating disruptive behavior by orthopaedic surgeons include fear of retaliation, lack of awareness among the surgeon's peers, and financial factors. Surgeons have a duty to address patterns of negative peer behavior for the benefit of patient care. This manuscript addresses the causes and consequences of disruptive physician behavior as well as management strategies, especially in orthopaedic surgery.

  4. Randomized Trial of Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project.

    PubMed

    Schiff, Gordon D; Reyes Nieva, Harry; Griswold, Paula; Leydon, Nicholas; Ling, Judy; Federico, Frank; Keohane, Carol; Ellis, Bonnie R; Foskett, Cathy; Orav, E John; Yoon, Catherine; Goldmann, Don; Weissman, Joel S; Bates, David W; Biondolillo, Madeleine; Singer, Sara J

    2017-08-01

    Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools. Chart reviews conducted at baseline and postintervention for intervention sites. Staff and patient survey data collected at baseline and postintervention for intervention and control sites. Chart reviews demonstrated significant improvements in documentation of abnormal results, patient notification, documentation of an action or treatment plan, and evidence of a completed plan (all P<0.001). Mean days between laboratory test date and evidence of completed action/treatment plan decreased by 19.4 days (P<0.001). Staff surveys showed modest but nonsignificant improvement for intervention practices relative to controls overall and for the 3 high-risk domains that were the focus of PROMISES. A consortium of stakeholders, quality improvement tools, coaches, and learning network decreased selected ambulatory safety risks often seen in malpractice claims.

  5. Health and life insurance as an alternative to malpractice tort law

    PubMed Central

    2010-01-01

    Background Tort law has legitimate social purposes of deterrence, punishment and compensation, but medical tort law does none of these well. Tort law could be counterproductive in medicine, encouraging costly defensive practices that harm some patients, restricting access to care in some settings and discouraging innovation. Discussion Patients might be better served by purchasing combined health and life insurance policies and waiving their right to pursue malpractice claims. The combined policy should encourage the insurer to profit by inexpensively delaying policyholders' deaths. A health and life insurer would attempt to minimize mortal risks to policyholders from any cause, including medical mistakes and could therefore pursue systematic quality improvement efforts. If policyholders trust the insurer to seek, develop and reward genuinely effective care; identify, deter and remediate poor care; and compensate survivors through the no-fault process of paying life insurance benefits, then tort law is largely redundant and the right to sue may be waived. If expensive defensive medicine can be avoided, that savings alone could pay for fairly large life insurance policies. Summary Insurers are maligned largely because of their logical response to incentives that are misaligned with the interests of patients and physicians in the United States. Patient, provider and insurer incentives could be realigned by combining health and life insurance, allowing the insurer to use its considerable information access and analytic power to improve patient care. This arrangement would address the social goals of malpractice torts, so that policyholders could rationally waive their right to sue. PMID:20525190

  6. 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…

  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. 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.

  9. Lack of physician-patient communication as a key factor associated with malpractice litigation in neonatal brachial plexus palsy.

    PubMed

    Domino, Joseph; McGovern, Connie; Chang, Kate W C; Carlozzi, Noelle E; Yang, Lynda J S

    2014-02-01

    Perinatal disorders are prone to malpractice litigation. Neonatal brachial plexus palsy (NBPP) results from stretching the nerves in the perinatal period and may lead to paresis or paralysis and sensory loss in the affected arm. Little is known about the key factors associated with malpractice litigation by families of patients with NBPP and whether these factors reflect the practice environment or are inherent to the condition. In this study, the authors documented the percentage of families of NBPP patients at a specialty center that had filed a malpractice suit and described the key factors associated with that pursuit of legal action. The families/caregivers of 51 patients with NBPP who had presented to the University of Michigan Interdisciplinary Brachial Plexus Program participated in this study. A qualitative research design was applied using both a questionnaire to examine psychosocial factors and a dynamic tool to measure health outcomes from the patient perspective via parent proxy (Patient-Reported Outcomes Measurement Information System [PROMIS] assessment instruments). Statistical analysis included the Fisher exact test, chi-square test, and Student t-test. The study protocol was approved by the University of Michigan institutional review board. Forty-seven percent of the families pursued malpractice litigation. In comparing patient families that had pursued legal action with those that had not, significant differences were revealed in the perception that the sustained birth injury was unnecessary (p = 0.002), the information received in the perinatal period was inadequate (p = 0.003), family concerns were ignored in the perinatal period (p = 0.005), and family concerns were not adequately addressed (p < 0.001). Sixty-six percent of the families received external advice to pursue legal action. The PROMIS survey revealed significant group differences in depressive symptoms (p = 0.008), fatigue (p = 0.02), pain (p = 0.01), and anger (p = 0.004). In

  10. Malpractice litigation after surgical injury of the spinal accessory nerve: an evidence-based analysis.

    PubMed

    Morris, Luc G T; Ziff, David J S; DeLacure, Mark D

    2008-01-01

    To review the background, case characteristics, and outcomes of malpractice litigation resulting from surgical injury of the spinal accessory nerve. Retrospective review of indemnity insurance cases (part 1) and court trials (part 2) between January 1, 1985, and January 1, 2007. In part 1, records of the Medical Liability Mutual Insurance Company identified 41 lawsuits in New York State; part 2 was a review of a national legal database (WestLaw) that identified 81 court trials. Case details were analyzed, and awards were adjusted for inflation. For part 1, of 41 indemnity insurance cases, 39 (95%) involved a posterior triangle lymph node biopsy. Defendants were mainly general surgeons and otolaryngologists. Most lawsuits against surgeons (22 of 34 [65%]) were settled before trial, and only 4 of 34 (12%) were discontinued. Of these 34 cases, 28 (82%) ultimately compensated the plaintiff. The mean inflation-adjusted pretrial settlement was $264 395, and the mean settlement at trial was $443 538. Cases reaching trial received significantly higher settlements (P = .01). For part 2, 81 cases of alleged surgical injury to the spinal accessory nerve were identified. Defendant physicians were mainly general surgeons and otolaryngologists. Most operations were cervical lymph node biopsies (55 [68%]), followed by sebaceous cyst excisions (6 [7%]), neck dissections (4 [5%]), and other procedures (12 [15%]). Morbidity included weakness (81 patients [100%]), pain (30 patients [37%]), inability to work (20 patients [25%]), need for a nerve repair procedure (16 patients [20%]), deformity (9 patients [11%]), and numbness (4 patients [5%]). Types of malpractice alleged included negligent surgical technique (79 cases [98%]), lack of informed consent (17 cases [21%]), and failure to diagnose the injury (16 cases [20%]). Thirty-seven cases (46%) were decided for the defendant, 32 (40%) were decided for the plaintiff, and 12 (15%) were settled (percentages do not total 100 because of

  11. Trends in medical malpractice claims in patients with cleft or craniofacial abnormalities in the United States.

    PubMed

    Rawal, Rounak B; Kilpatrick, Lauren A; Wood, Jeyhan S; Drake, Amelia F

    2016-11-01

    To describe medical malpractice trends in patients with cleft and/or craniofacial abnormalities. A modified Delphi approach was used to gather search terms. Search settings included "all jury verdicts and settlements", with jurisdiction of "all states" and "all federal courts" (by court and circuit). A retrospective review of WestLawNext legal database was conducted. Cases were excluded if they did not have a direct association from the patient's craniofacial anomaly or if they were not related to malpractice. Forty-two cases met inclusion criteria. Cases closed between 1981 and 2014 were included. The mean payment among claims with an indemnity payment was $3.9 million. Of cases brought to trial, 62% were in favor of the plaintiff. Amongst physicians named as co-defendants, pediatricians were most commonly named (24%), followed by plastic surgeons (16%), obstetricians (7.8%), and radiologists (7.8%). "Missed diagnosis" was the most common type of negligent claim (45%), followed by "surgical error" (21%), and "medication error" (17%). "Anoxic brain injury" resulted in the highest median indemnity payment for complication of patient management ($3.5 million), followed by "wrongful birth" ($1.03 million), and "minor physical injury" ($520,000). No specific type of negligent claim (p = 0.764) nor complication of patient management (p = 0.61) was associated with a greater indemnity payment. Mean indemnity payment was $920,000 prior to 2001 and $4.4 million after 2001 (p = 0.058). Mean indemnity payments were fourteen-fold greater in patients as compared to those in the overall population ($3.9 million versus $274,887) and seven-fold greater than those in the average pediatric population ($3.9 million versus $520,923). All healthcare providers should be aware of the associated medical malpractice claims that may be incurred when treating patients at risk for these conditions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  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. 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

  14. Medical Malpractice in Uveitis: A Review of Clinical Entities and Outcomes.

    PubMed

    Reddy, Ashvini K; Engelhard, Stephanie B; Shah, Christopher T; Sim, Austin J; Thorne, Jennifer E

    2016-08-11

    To guide risk management in uveitis. Retrospective review of malpractice verdicts, rulings, and settlements. The WestLaw® database was reviewed for lawsuits related to uveitis in the United States from 1930-2014. Twenty-five cases met inclusion criteria, and 48% of these were infectious. Overall, 64% of outcomes favored the defendant ophthalmologist. The most common diagnoses were viral retinitis (28%), iritis (12%), syphilis (8%), and toxoplasmosis (8%). Seven suits (28%) were resolved by settlement, with mean adjusted indemnities of $724,302 (median, $409,390; range, $127,837-2,021,887). Two cases (8%) resulted in plaintiff verdict, with adjusted awards of $1,399,800 and $630,799. Despite being a rare diagnosis, viral retinitis (especially acute retinal necrosis) is the most common clinical entity associated with litigation in uveitis and should be considered early. Educating patients about potential adverse events, early testing for syphilis, and maintaining a positive relationship may also minimize risk.

  15. A better approach to medical malpractice claims? The University of Michigan experience.

    PubMed

    Boothman, Richard C; Blackwell, Amy C; Campbell, Darrell A; Commiskey, Elaine; Anderson, Susan

    2009-01-01

    The root causes of medical malpractice claims are deeper and closer to home than most in the medical community care to admit. The University of Michigan Health System's experience suggests that a response by the medical community more directly aimed at what drives patients to call lawyers would more effectively reduce claims, without compromising meritorious defenses. More importantly, honest assessments of medical care give rise to clinical improvements that reduce patient injuries. Using a true case example, this article compares the traditional approach to claims with what is being done at the University of Michigan. The case example illustrates how an honest, principle-driven approach to claims is better for all those involved-the patient, the healthcare providers, the institution, future patients, and even the lawyers.

  16. Mediating medical malpractice lawsuits against hospitals: New York City's Pilot Project.

    PubMed

    Hyman, Chris Stern; Schechter, Clyde B

    2006-01-01

    The New York City Health and Hospitals Corporation participated in a feasibility study to measure the participants' satisfaction with mediation of medical malpractice lawsuits. Twenty-nine cases were referred to the study, twenty-four agreed to mediation, and nineteen were mediated. Satisfaction data indicate that the plaintiffs and their attorneys and the defendant's attorney were satisfied with the process whether or not settlement was reached. The mean length of a mediation was 2.34 hours. Of the cases mediated, thirteen settled, with a median payment of 111,000 dollars. The defendant's and plaintiffs' attorneys estimated spending approximately one-tenth the amount of time preparing their case for mediation that they would have spent preparing for trial.

  17. Root Canal Stripping: Malpractice or Common Procedural Accident—An Ethical Dilemma in Endodontics

    PubMed Central

    Ciobanu, Ionela Elisabeta; Rusu, Darian; Didilescu, Andreea Cristina

    2016-01-01

    Root canal stripping is defined as an oblong, vertical perforation that appears especially in the middle section of curved root canals during endodontic treatments with nickel-titanium (Ni-Ti) instruments. Its occurrence may drastically affect the outcome of the treatment, transforming a common otherwise efficient endodontic procedure into a complication such as tooth extraction. In order to discuss the ethical and legal consequences, two cases of dental strip perforations are herewith presented. Due to the existence of risk factors for dental strip perforation, experience of the clinician and the use of magnification and modern imagistic methods (CBCT) may avoid or reduce the frequency of this type of accidents. Under correct working circumstances, dental stripping should not be regarded as a malpractice but as a procedural accident. However, the patient must always be informed, before and during the endodontic procedure, about the event and the possible complications that may occur. PMID:27672458

  18. Mandatory presuit mediation: 5-year results of a medical malpractice resolution program.

    PubMed

    Jenkins, Randall C; Smillov, Arlene E; Goodwin, Matthew A

    2014-01-01

    The Florida Patient Safety and Presuit Mediation Program (FLPSMP) is a mandatory mediation program designed to provide deserving patients with fast, fair compensation while limiting the healthcare provider expenses incurred during traditional litigation. Mediation occurs before litigation begins; therefore, patients with meritorious claims receive compensation often years earlier than they would with extended litigation. This early mediation fosters confidential and candid communication between doctors and patients, which promotes early fact-finding and candid discussion. The program went into effect across the University of Florida (UF) Health system on January 1, 2008. In an article previously published in this journal, we discussed the positive trend observed 2 years after the implementation of the FLPSMP. This article incorporates 5 years of data, which includes new benchmarks with state and national data, to demonstrate that the program can be used successfully as a medical malpractice solution. © 2014 American Society for Healthcare Risk Management of the American Hospital Association.

  19. Accidents, claiming, and regional subcultures: are medical errors and malpractice lawsuits related to social capital?

    PubMed

    Williams, Jackson

    2008-01-01

    This study examined states' performance on Patient Safety Indicators (PSIs), statistics on malpractice lawsuits, and analogous data on automobile accidents to identify state-level patterns in safety and claiming. Hospital safety varied in a pattern similar to highway safety on the state level, suggesting that cultural traits may play a greater role than differences in legal or other environmental factors. States performing well or poorly in hospital and driver safety tended to correspond with states grouped together in regional culture typologies developed by Elazar and Lieske. Traits of regional culture also are associated with variations in tort claiming. The paper offers a theory of social capital as an important factor affecting safety and tort claiming. Where the regional culture is one of high cohesion and trust, people may exercise a higher degree of caution and vigilance in their interaction with others, and feel less inclination to file lawsuits subsequent to accidents.

  20. Gene technology in medical diagnostics and criminal procedure and liability for malpractice in Germany.

    PubMed

    Deutsch, E; Füllmich, R; Poppe, H

    1990-01-01

    The increasing employment of gene technological procedures in medical diagnostics and criminal procedure has forced both the medical and the legal professions to focus their attention on the complex question of liability of physicians, lab technicians, and other personnel involved in applying these measures. This article gives an outline, by citing practical cases, of the major aspects of liability for malpractice that are relevant under German law. Bearing in mind that this article will be read predominantly by members of the Anglo-American common-law legal system, the legal aspects - even though they are German legal aspects - are viewed in the light of the common law. The article examines three major issues: (a) liability for diagnoses employing gene technological procedures: (b) liability for wrong testimony based on 'genetic finger-printing': and (c) the donor's rights concerning his or her DNA-probe.

  1. Medical malpractice charges in Germany--role of the forensic pathologist in the preliminary criminal proceeding.

    PubMed

    Dettmeyer, Reinhard; Egl, Monika; Madea, Burkhard

    2005-03-01

    Medical malpractice charges from 1989 to 2002 were evaluated. A rising number of cases during this period is evident. The charges of practice falling below the standard of care (n = 285) were surveyed to determine who informed the prosecution, which clinical subjects are involved, what kind of charges can be found and whether such allegations can be appropriately assessed by means of a forensic autopsy. Forensic pathologists were found to be useful for ascertainment and interpretation of autopsy findings. If special questions arise, an additional expert opinion should be suggested by the forensic pathologist. There was no relevant shift in the range of subjects involved compared to former studies. The investigated charges might represent only a small fraction of cases of medical practice falling below the standard of care.

  2. Root Canal Stripping: Malpractice or Common Procedural Accident-An Ethical Dilemma in Endodontics.

    PubMed

    Ciobanu, Ionela Elisabeta; Rusu, Darian; Stratul, Stefan-Ioan; Didilescu, Andreea Cristina; Cristache, Corina Marilena

    2016-01-01

    Root canal stripping is defined as an oblong, vertical perforation that appears especially in the middle section of curved root canals during endodontic treatments with nickel-titanium (Ni-Ti) instruments. Its occurrence may drastically affect the outcome of the treatment, transforming a common otherwise efficient endodontic procedure into a complication such as tooth extraction. In order to discuss the ethical and legal consequences, two cases of dental strip perforations are herewith presented. Due to the existence of risk factors for dental strip perforation, experience of the clinician and the use of magnification and modern imagistic methods (CBCT) may avoid or reduce the frequency of this type of accidents. Under correct working circumstances, dental stripping should not be regarded as a malpractice but as a procedural accident. However, the patient must always be informed, before and during the endodontic procedure, about the event and the possible complications that may occur.

  3. Educational Malpractice

    ERIC Educational Resources Information Center

    University of Pennsylvania Law Review, 1976

    1976-01-01

    Various theories are examined upon which a student might base a suit against a teacher, administrator, school, or school district for his failure to learn because of teacher negligence or incompetence. Outlines a broad range of arguments indicating strengths and weaknesses and appropriate situations for each.

  4. Otolaryngology and medical malpractice: A review of the past decade, 2001-2011.

    PubMed

    Hong, Steven S; Yheulon, Christopher G; Wirtz, Eric D; Sniezek, Joseph C

    2014-04-01

    To better understand the causes and outcomes of lawsuits involving otolaryngologists in the past decade by analyzing malpractice litigation trends to prevent future litigation and improve physician education. Analysis of a national database for all US civil trials. The Westlaw database was reviewed from 2001 to 2011. Data were compiled on the demographics of the plaintiffs, use of expert witnesses, procedures, nature of the injury, legal allegations, verdicts, and indemnities. One hundred ninety-eight cases met inclusion criteria. Verdicts for the defendant/otolaryngologist predominated (58%), whereas the average award when the verdict favored the plaintiff was $1,782,514. When otolaryngologists were used as expert witnesses by the defense, the verdict outcome statistically favored the defendant. Two of the most commonly cited legal allegations were improper performance and failure to diagnose and treat. Fifty-one cases involved allegations of wrongful death, with the overall outcome favoring the plaintiffs (51%). The average indemnities in these cases were significantly higher for plaintiff verdicts at $2,552,580 versus settlements at $992,896. Forty-two cases involved malignancy, with the two most common allegations being failure to diagnose and treat (79%) and delay in diagnosis (74%). Our study reveals that in the past decade, in significant malpractice litigations, overall outcomes favored otolaryngologists. The average awards was significantly higher when cases involved malignancy. Our analysis reveals the importance of meticulous surgical techniques and thorough preoperative evaluations. Last, when otolaryngologists are defendants in litigation, our review reiterates the value of the otolaryngologist as the defense's expert witnesses. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  5. Does diagnostic delay of colorectal cancer result in malpractice claims? A retrospective analysis of the Swedish board of malpractice from 1995–2008

    PubMed Central

    2012-01-01

    Aim Delay in the diagnosis of colorectal cancer (CRC) may have important clinical and medico-legal implications. This study identifies the claims made on the basis of delay in the diagnosis of CRC to the Swedish insurance agency (whose English name is The County Council´s Mutual Insurance Company) and the impact and consequences of the delay on prognosis, treatment and survival for patients who reported the claims. The Company handles claims of medical malpractice where claimants seek compensation for alleged suffering and/or negative clinical impacts of diagnostic delays. Material and methods Between January 1, 1995 and December 31, 2008, a total of 80 patients filed claims for negative effects resulting from delays in the diagnosis of CRC. Review of the claims led to identification of delay for 62 patients. The clinical symptoms that were overlooked and other causes of delay that had any relation to therapy, prognosis and economic compensation were evaluated. Results The median delay in the diagnosis of CRC was six months. This delay was considered to have had an impact on the therapy in 20 % of the cases. The prognosis was postulated to have been adversely affected for 15 % of the patients. The delay was mainly caused by incomplete consideration of the symptoms hematoschisis or anaemia, changed bowel routine, or incomplete clinical or radiological examination and by misinterpretations of the results. No impact of duration of delay on survival was identified. The importance of identifying concomitant metastatic disease at diagnosis was overwhelming. Economic compensation was given in 79 % of the cases. Conclusion This study found that claims for compensation for delay in diagnosis of CRC are rare. The delay in the diagnosis of the primary tumour was considered to have had an impact on the magnitude of therapeutic measures for a fifth of the patients who filed claims. Economic compensation for the patients´ injuries was given in almost 80 % of the cases

  6. An analysis of causative factors in closed criminal medical malpractice cases of the Taiwan Supreme Court: 2000-2014.

    PubMed

    Wu, Kuan-Han; Cheng, Shih-Yu; Yen, Yung-Lin; Wu, Chien-Hung; Tsai, Ming-Ta; Cheng, Fu-Jen

    2016-11-01

    Most medical malpractice in Taiwan leads to criminal prosecution. This study examined the epidemiologic factors and clinical errors that led to medical malpractice convictions in Taiwanese criminal prosecutions. A retrospective, 15-year population-based review of criminal Supreme Court judgments pertaining to medical malpractice against physicians and nurses was conducted. Eighty-four cases were reviewed, yielding data that included the number and specialty involved, accused hospitals, the diagnosis, the time interval between incidents to closure, result of adjudication, the origin of cases (private vs. public prosecution), the result of medical appraisal, and the primary error. Overall, the cases averaged 7.6years to achieve final adjudication. Seventy-five percent were settled in favor of the clinician; twenty-three physicians and three nurses were found guilty, but all of these avoided imprisonment via probation or replacement with forfeit. The single most risky specialty was emergency medicine (22.6% of the cases), with 36.8% of those resulting in guilty verdicts. The most common diagnosis groups were infectious diseases (23.8%), intracranial hemorrhages (10.7%), and acute coronary syndrome (9.5%). Public prosecutions had a 41.2% conviction rate; no guilty verdicts resulted from private prosecution. Nineteen (22.6%) cases were commuted, and 73.7% of those had a controversial appraisal result. The characteristics of criminal malpractice prosecution in Taiwan that could be improved to relieve the stress of frivolous lawsuits on the judicial process include lengthy jurisdiction process; low public-prosecution conviction rate; frequent commuted jurisdiction related to a controversial appraisal; and zero imprisonment rate for clinicians.

  7. Trends in malpractice litigation in relation to the delivery of breast care in the National Health Service.

    PubMed

    Morgan, Jenna L; Vijh, Rajesh

    2013-10-01

    Malpractice litigation involving the delivery of breast care has been evaluated in the United States of America (USA) but is a relatively new area of study in the United Kingdom (UK). We sought to study and evaluate the emerging trends in litigation claims in relation to breast disease with the National Health Service Litigation Authority (NHSLA) over the last 15 years, up to December 2010. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. 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.

  9. 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

  10. Criminal law as a response to medical malpractice: pluses and minuses--comparing Italian and U.S. experiences.

    PubMed

    Di Landro, Andrea R

    2012-06-01

    The paper is divided into three parts. The first part sets out the comparative differences between the tort of malpractice in common law and the criminal negligence in civil law: while the common law takes for mens rea only the "gross" negligence, and rarely medical negligence, other law systems instead (and particularly Italian law) criminalize also ordinary negligence, frequently in medical malpractice cases. The second part of the paper addresses the pluses of using criminal law as response to medical malpractice: inadequate medical self-policing and "repeat offenders" problems are analysed, in the perspective of the patient, of the doctor, of the insurance company, and of the community. The third part addresses the minuses of the criminal law as response: medical "shame and blame" mentality, criminal stigma and culture of fear are disincentives to incident reporting and to system analysis (the most important means of prevention); "defensive medicine" and "courts-abiding medicine" are managed not yet in the patient's exclusive interest, but in the egoistic/utilitarian aim to avoid denunciations; finally, the uncertainty of the medicine, the accusatory system and the proof "beyond a reasonable doubt" seem hardly compatible with each other.

  11. Medical malpractice predictors and risk factors for ophthalmologists performing LASIK and PRK surgery.

    PubMed Central

    Abbott, Richard L

    2003-01-01

    PURPOSE: To identify physician predictors in laser-assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) surgery that correlate with a higher risk for malpractice liability claims and lawsuits. METHODOLOGY: A retrospective, longitudinal, cohort study comparing physician characteristics of 100 consecutive Ophthalmic Mutual Insurance Company (OMIC) LASIK and PRK claims and suits to demographic and practice pattern data for all active refractive surgeons insured by OMIC between 1996 and 2002. Background information and data were obtained from OMIC underwriting applications, a physician practice pattern survey, and claims file records. Using an outcome of whether or not a physician had a prior history of a claim or suit, logistic regression analyses were used separately for each predictor as well as controlling for refractive surgery volume. RESULTS: Logistic regression analysis demonstrated that the most important predictor of filing a claim was surgical volume, with those performing more surgery having a greater risk of incurring a claim (odds ratio [OR], 31.4 for >1,000/year versus 0 to 20/year; 95% confidence interval [CI], 7.9 - 125; P = .0001). Having one or more prior claims was the only other predictor examined that remained statistically significant after controlling for patient volume (OR, 6.4; 95% CI 2.5 - 16.4; P = .0001). Physician gender, advertising, preoperative time spent with patient, and comanagement appeared to be strong predictors in multivariate analyses when surgical volume was greater than 100 cases per year. CONCLUSION: The chances of incurring a malpractice claim or suit for PRK or LASIK correlates significantly with higher surgical volume and a history of a prior claim or suit. Additional risk factors that increase in importance with higher surgical volume include gender, advertising, preoperative time spent with patient, and comanagement with optometrists. These findings may be used in the future to help improve the

  12. 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. © 2016 John Wiley & Sons, Ltd.

  13. Comparison of plaintiff and defendant expert witness qualification in malpractice litigation in otolaryngology.

    PubMed

    Eloy, Jean Anderson; Svider, Peter F; Patel, Dharti; Setzen, Michael; Baredes, Soly

    2013-05-01

    Malpractice litigation contributes to rising health care costs in the United States. The role of expert witness testimony has been controversial in the past, with medical professional societies issuing statements regarding ethical obligations of physicians. Our objectives were to examine the relative qualifications of expert witnesses testifying on behalf of plaintiffs vs defendants. Analysis of expert witness and physician demographic data available on several databases. The Westlaw legal database (Thomson Reuters, New York, New York) was searched for otolaryngologist expert witness testimony. Length of experience, practice setting, and subspecialty training information were obtained from hospital, practice, departmental, and state licensing board sites. Scholarly impact was assessed using calculation of the h-index from the Scopus database. Plaintiff expert witnesses had significantly less experience than those testifying for defendants (31.8 vs 35.4 years, P = .047) and lower scholarly impact (h = 6.3 vs 10, P = .045). A significantly higher proportion of defendant witnesses were in academic practice (49.3% vs 31.7%, P = .042). No differences were detected in postresidency fellowship training patterns. Upon comparison of otolaryngologist expert witnesses, practitioners testifying on behalf of plaintiffs had statistically fewer years of experience, had a lower scholarly impact, and were less likely to work in an academic setting. Otolaryngologists who repeatedly served as expert witnesses were more likely to be testifying on behalf of plaintiffs than defendants. Professional societies need to frequently update guidelines on expert witness testimony and address the ethical obligations of practitioners.

  14. Occlusion and temporomandibular disorders: a malpractice case with medical legal considerations.

    PubMed

    Bucci, M B; Aversa, M; Guarda-Nardini, L; Manfredini, D

    2011-01-01

    Occlusion and temporomandibular The issue of temporomandibular disorders (TMD) diagnosis and treatment has become a matter of increasing interest in the medical legal field in recent years. The old-fashioned theories based on the occlusal paradigm was proven to be erroneous, and clinicians who still provide irreversible treatments to TMD patients have to be conscious of the potential legal consequences of their behavior. The present paper described an illustrative case report of a patient to whom extensive and irreversible occlusal therapies were performed with the unique aim to provide relief from TMD symptoms. The treatment was unsuccessful and the dental practitioner was called into cause for a professional liability claim. The clinician was judged guilty of malpractice on the basis of the lack of scientific evidence of the irreversible occlusal approaches to TMD, which were erroneously used and did not give the patient any benefit, thus forcing him to a non necessary financial and biological cost. The failure to satisfy the contract with the patient, which is usually not covered by any insurance company, forced the practitioner to give the money back to the patient. The ethical and legal implications of such case were discussed, with particular focus on the concept that medical legal advices need to satisfy the highest standards of evidence and have to be strictly based on scientific knowledge.

  15. Medical malpractice and the professional legal responsibility of the sports physician.

    PubMed

    Verzeletti, Andrea

    2013-09-01

    As with other medical specialties, litigation in sports medicine appears to be on the increase. In most countries, the applicable legal standard is "good medical practice" as identified with reference to the physician's own field of specialisation: what is commonly done by physicians in the same specialty generally serves as the standard by which a physician's conduct is measured. To enhance the quality of sports medicine practice, medical societies have been issuing guidelines for use by sports physicians, and a number of courts have recognised guidelines as evidence of good medical practice. One potential field of malpractice in sports medicine relates to privacy issues: an athlete should be asked to fill in a consent form if the medical information needs to be shared with other parties. Another relevant field is doping: for any act of drug prescription to be legally sound, sports physicians have to be aware of the requirements of the World Anti-Doping Agency Code and its international standards. Ultimately, the best way for sports physicians to avoid sources of liability is for them to keep up to date with the latest research and to act in a careful and diligent manner.

  16. A modified no-fault malpractice system can resolve multiple healthcare system deficiencies.

    PubMed

    Segal, Jeffrey J; Sacopulos, Michael

    2009-02-01

    Medical professional liability in the United States, as measured by total premiums paid by physicians and healthcare facilities, costs approximately $30 billion a year in direct expenses, less than 2% of the entire annual healthcare expenditures. Only a fraction of those dollars reach patients who are negligently injured. Nonetheless, the tort system has far-reaching effects that create substantial indirect costs. Medical malpractice litigation is pervasive and physicians practice defensively to avoid being named in a suit. Those extra expenditures provide little value to patients. Despite an elaborate existing tort system, patient safety remains a vexing problem. Many injured patients are denied access to timely, reasonable remedies. We propose a no-fault system supplemented by a variation of the traditional tort system whereby physicians are incentivized to follow evidence-based guidelines. The proposed system would guarantee a substantial decrease in, but not elimination of, litigation. The system would lower professional liability premiums. Injured patients would ordinarily be compensated with no-fault disability and life insurance proceeds. To the extent individual physicians pose a recurrent danger, their care would be reviewed on an administrative level. Savings would be invested in health information technology and purchase of insurance coverage for the uninsured. We propose a financial model based on publicly accessible sources.

  17. A Modified No-fault Malpractice System Can Resolve Multiple Healthcare System Deficiencies

    PubMed Central

    Sacopulos, Michael

    2008-01-01

    Medical professional liability in the United States, as measured by total premiums paid by physicians and healthcare facilities, costs approximately $30 billion a year in direct expenses, less than 2% of the entire annual healthcare expenditures. Only a fraction of those dollars reach patients who are negligently injured. Nonetheless, the tort system has far-reaching effects that create substantial indirect costs. Medical malpractice litigation is pervasive and physicians practice defensively to avoid being named in a suit. Those extra expenditures provide little value to patients. Despite an elaborate existing tort system, patient safety remains a vexing problem. Many injured patients are denied access to timely, reasonable remedies. We propose a no-fault system supplemented by a variation of the traditional tort system whereby physicians are incentivized to follow evidence-based guidelines. The proposed system would guarantee a substantial decrease in, but not elimination of, litigation. The system would lower professional liability premiums. Injured patients would ordinarily be compensated with no-fault disability and life insurance proceeds. To the extent individual physicians pose a recurrent danger, their care would be reviewed on an administrative level. Savings would be invested in health information technology and purchase of insurance coverage for the uninsured. We propose a financial model based on publicly accessible sources. Electronic supplementary material The online version of this article (doi:10.1007/s11999-008-0577-9) contains supplementary material, which is available to authorized users. PMID:18979149

  18. Physicians' explanatory behaviours and legal liability in decided medical malpractice litigation cases in Japan.

    PubMed

    Hamasaki, Tomoko; Hagihara, Akihito

    2011-04-21

    A physician's duty to provide an adequate explanation to the patient is derived from the doctrine of informed consent and the physician's duty of disclosure. However, findings are extremely limited with respect to physicians' specific explanatory behaviours and what might be regarded as a breach of the physicians' duty to explain in an actual medical setting. This study sought to identify physicians' explanatory behaviours that may be related to the physicians' legal liability. We analysed legal decisions of medical malpractice cases between 1990 and 2009 in which the pivotal issue was the physician's duty to explain (366 cases). To identify factors related to the breach of the physician's duty to explain, an analysis was undertaken based on acknowledged breaches with regard to the physician's duty to explain to the patient according to court decisions. Additionally, to identify predictors of physicians' behaviours in breach of the duty to explain, logistic regression analysis was performed. When the physician's explanation was given before treatment or surgery (p = 0.006), when it was relevant or specific (p = 0.000), and when the patient's consent was obtained (p = 0.002), the explanation was less likely to be deemed inadequate or a breach of the physician's duty to explain. Patient factors related to physicians' legally problematic explanations were patient age and gender. One physician factor was related to legally problematic physician explanations, namely the number of physicians involved in the patient's treatment. These findings may be useful in improving physician-patient communication in the medical setting.

  19. Comparing 20 years of national general surgery malpractice claims data: obesity versus morbid obesity.

    PubMed

    Weber, Cynthia E; Talbot, Lindsay J; Geller, Justin M; Kuo, Marissa C; Wai, Philip Y; Kuo, Paul C

    2013-03-01

    We hypothesized that the increasing body mass index of the population has affected general surgery malpractice claims. We queried the Physician Insurers Association of America database from 1990 to 1999 (ie, period 1) and 2000 to 2009 (ie, period 2) for claims associated with obesity and morbid obesity. We analyzed the error involved, injury severity, procedure, and outcome. Five hundred seventy-five claims were identified. The percentage of paid claims did not differ by body mass index. Improper performance was the most common alleged error, gastric bypass was the most common procedure, and death was the most common injury. For obesity claims, the case was more likely to be settled in period 1 and withdrawn/dismissed in period 2 (P < .001). The number of morbid obesity claims rose from 9 in period 1 to 249 in period 2. The significant rise in morbid obesity claims between periods is likely caused by the substantial increase in the number of bariatric procedures performed. Copyright © 2013 Elsevier Inc. All rights reserved.

  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.

  1. Outcomes of medical malpractice claims in assisted reproductive technology over a 10-year period from a single carrier.

    PubMed

    Letterie, Gerard

    2017-04-01

    Medical malpractice claims vary by specialty. Contributory factors to malpractice in reproductive endocrinology and infertility (REI) are not well defined. We sought to determine claims' frequency, basis of claims, and outcomes of settled claims in REI. This is a retrospective, descriptive review of 10 years of claims. The setting is private practices. Claims were monitored within one malpractice carrier between 2006 and 2015 covering 10 practices and 184,015 IVF cycles. Total claims, basis of claims, and indemnity paid were evaluated. There were 176 incidents resulting in 30 settled claims with indemnity payments in 21. Categories of claims settled included misdiagnosis (N = 4), lack of informed consent (N = 5), embryology errors (N = 8), and surgical complications (N = 4). Total and average awards were $15,062,000 and $717,238, respectively. Misdiagnosis and lack of informed consent had highest total award amount at $11,583,000 accounting for 76% of award dollars. The two highest awards were $4.5 million and $3.0 million for cancer and genetic misdiagnosis, respectively. Excluding these two awards, payments totaled $7,562,000, ranged from $6000 to $900,000 and averaged $170,363. Errors in handling of embryos were highest in frequency accounting for 38% of claims paid for a total of $1,593,000 with average payment of $199,188. Settlements for surgical complications totaled $1,855,000 and averaged $463,750 per claim. Misdiagnosis and lack of informed consent are the highest award categories. Embryology lab errors are the most frequent causes of claims with the lowest award per settlement. The average cost for claims settled is relatively high compared to settlements in other specialties.

  2. Analysis of professional malpractice claims in implant dentistry in Italy from insurance company technical reports, 2006 to 2010.

    PubMed

    Pinchi, Vilma; Varvara, Giuseppe; Pradella, Francesco; Focardi, Martina; Donati, Michele D; Norelli, Gianaristide

    2014-01-01

    The aim of the study was to analyze the characteristics of implant dentistry claims in Italy based on insurance company technical reports for malpractice claims. One hundred twenty-one technical reports of cases of professional malpractice in implant dentistry between 2006 and 2010 were included in the study. Data included the sex and age of the patient and dentist, the kind of negligence claimed, and the damages awarded as a consequence of the alleged misconduct. Of the cases examined in this study, 9.9% went to court. The patients were female in 73.6% of the cases. Most of the technical errors were committed during implant insertion (82.6%). In 50.4% of cases, the technical error involved the surrounding structures, such as damage to the inferior alveolar nerve (32.2%) or the lingual nerve (2.5%), invasion of the maxillary sinus (9.1%), or pulpal dental necrosis in adjacent teeth (6.6%). Incomplete clinical documentation was apparent in 54.5% of cases. In 9.9% of cases, a civil suit had already been filed before a visit, and medicolegal advice from the insurance expert had been procured. The discrepancy between the total number of cases examined and those that went to court indicates that implant malpractice claims in Italy are most often settled out of court. The large number of intraoperative errors seen and the high proportion of injuries to surrounding structures suggest that implant dentists would benefit from further specific training. Also, clinical documentation vital to a defense against any claims relating to professional misconduct was incomplete or absent in more than half of the cases.

  3. Closed Claims Analysis of Medical Malpractice Lawsuits Involving Midwives: Lessons Learned Regarding Safe Practices and the Avoidance of Litigation.

    PubMed

    McCool, William F; Guidera, Mamie; Griffinger, Ellie; Sacan, Dulcy

    2015-01-01

    The risk of litigation remains of concern to midwives, their practice partners, employers, and malpractice insurance providers. Closed claims analysis is a method of examining risk patterns and behaviors in lawsuits, including those involving health care practices. The purpose of this investigation was to evaluate claims brought against midwives, with the intent of developing strategies to decrease the incidence of litigation. Data were collected in joint meetings with members of the American College of Nurse-Midwives (ACNM); the American Association of Birth Centers; the American International Group (AIG), a major malpractice insurer for certified nurse-midwives/certified midwives (CNMs/CMs); and Contemporary Insurance Services, an independent insurance agency that has worked with AIG to facilitate the writing of malpractice insurance policies for CNMs/CMs. The purpose of the meetings was to review 162 litigation cases that involved midwives insured by AIG and had been closed between the years 2002 and 2011. Follow-up analyses of data and reporting of results were performed by the authors, who are members of the Professional Liability Section of the ACNM Division of Standards and Practice. Findings reflected 7 major categories of liability risk ranging from the most prevalent (ie, fetal/newborn complications or death) to the least prevalent (ie, attending a vaginal birth after cesarean). Data also were examined regarding the highest amounts incurred in court decisions or pretrial settlements because they were related to types of adverse outcomes that occurred. Recommendations for improving clinical practice and avoiding litigation based on findings from the closed claims analysis include, but are not limited to, the need for thorough and accurate documentation in practice, appropriate and timely consultation and collaboration, and the presence of practitioners whose clinical skills match the level of care assessed to be necessary for each woman for whom care is

  4. Resolving Malpractice Claims after Tort Reform: Experience in a Self-Insured Texas Public Academic Health System.

    PubMed

    Sage, William M; Harding, Molly Colvard; Thomas, Eric J

    2016-12-01

    To describe the litigation experience in a state with strict tort reform of a large public university health system that has committed to transparency with patients and families in resolving medical errors. Secondary data collected from The University of Texas System, which self-insures approximately 6,000 physicians at six health campuses across the state. We obtained internal case management data for all medical malpractice claims closed during 1 year before and 6 recent years following the enactment of state tort reform legislation. We retrospectively reviewed information about malpractice claimants, malpractice claims, and the process and outcome of dispute resolution. We accessed an internal case management database, supplemented by both electronic and paper records compiled by the university's Office of General Counsel. Closed claims dropped from 244 in 2001-2002 to an annual mean of 96 in 2009-2015, closures following lawsuits from 136 in 2001-2002 to an annual mean of 28 in 2009-2015, and paid claims from 60 in 2001 to an annual mean of 20 in 2009-2015. Patterns of resolution suggest efforts by the university to provide some compensation to injured patients in cases that were no longer economically viable for plaintiffs' lawyers to litigate. The percentage of payments relating to cases in which lawsuits had been filed decreased from 82 percent in 2001-2002 to 47 percent in 2009-2012 and again to 29 percent in 2012-2015, although most paid claimants were represented by attorneys. Unrepresented patients received payment in 13 cases closed in 2009-2012 (22 percent of payments; mean amount $60,566) and in 24 cases closed in 2012-2015 (41 percent of payments; mean amount $109,410). Even after tort reform, however, claims that resulted in payment remained slow to resolve, which was worsened for claimants subject to Medicare secondary payer rules. Strict confidentiality became a more common condition of settlement, although restrictions were subsequently relaxed

  5. Lessons learned in otologic surgery: 30 years of malpractice cases in the United States.

    PubMed

    Ruhl, Douglas S; Hong, Steven S; Littlefield, Philip D

    2013-09-01

    To analyze malpractice litigation trends to better understand the causes and outcomes of suits involving otologic surgeries to prevent future litigation and improve physician awareness. Court records of legal trials from 1983 to 2012 were obtained from 2 major computerized databases-WESTLAW and LexisNexis. Data were compiled on the demographics of the defendant, plaintiff, use of otolaryngologists/otologists as expert witnesses, nature of injury, type of surgery, legal allegations, verdicts, and judgments. Fifty-eight unique cases met inclusion criteria and were selected for review. The most common surgeries that went to trial were mastoidectomy (48%), ossiculoplasty (21%), and tympanoplasty (16%). Eleven (19%) of the cases were resolved through a settlement before a verdict was reached. Verdicts in favor of the plaintiffs (31%) were awarded an average of $1,131,189. The most common alleged injuries were hearing loss (45%) and facial nerve injury (38%). Of the cases found in favor of the plaintiff, the most common reasons cited were improper performance of the surgery (50%), failure to properly diagnose and treat (33%), and inadequate informed consent and delay in diagnosis (22% each). Case outcomes involving pediatric patients were not significantly different than those of adults (p = 0.34); however, adults received higher financial awards on average ($1 million versus $232,000; p < 0.0003). Obtaining an appropriate diagnosis, thoroughly discussing all options and potential risks, presenting realistic expectations, and executing the surgery correctly are crucial to patient care. Understanding the reasons surgeons go to trial may assist in mitigating risk for potential lawsuits.

  6. Diagnostic imaging rates for head injury in the ED and states' medical malpractice tort reforms.

    PubMed

    Smith-Bindman, Rebecca; McCulloch, Charles E; Ding, Alexander; Ding, Alex; Quale, Christopher; Chu, Philip W

    2011-07-01

    Physicians' fears of being sued may lead to defensive medical practices, such as ordering nonindicated medical imaging. We investigated the association between states' medical malpractice tort reforms and neurologic imaging rates for patients seen in the emergency department with mild head trauma. We assessed neurologic imaging among a national sample of 8588 women residing in 10 US states evaluated in an emergency setting for head injury between January 1, 1992, and December 31, 2001. We assessed the odds of imaging as it varied by the enactment of medical liability reform laws. The medical liability reform laws were significantly associated with the likelihood of imaging. States with laws that limited monetary damages (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.40-0.99), mandated periodic award payments (OR, 0.64; 95% CI, 0.43-0.97), or specified collateral source offset rules (OR, 0.62; 95% CI, 0.40-0.96) had an approximately 40% lower odds of imaging, whereas states that had laws that limited attorney's contingency fees had significantly higher odds of imaging (OR, 1.5; 95% CI, 0.99-2.4), compared to states without these laws. When we used a summation of the number of laws in place, the greater the number of laws, the lower the odds of imaging. In the multivariate analysis, after adjusting for individual and community factors, the total number of laws remained significantly associated with the odds of imaging, and the effect of the individual laws was attenuated, but not eliminated. The tort reforms we examined were associated with the propensity to obtain neurologic imaging. If these results are confirmed in larger studies, tort reform might mitigate defensive medical practices. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Physicians' explanatory behaviours and legal liability in decided medical malpractice litigation cases in Japan

    PubMed Central

    2011-01-01

    Background A physician's duty to provide an adequate explanation to the patient is derived from the doctrine of informed consent and the physician's duty of disclosure. However, findings are extremely limited with respect to physicians' specific explanatory behaviours and what might be regarded as a breach of the physicians' duty to explain in an actual medical setting. This study sought to identify physicians' explanatory behaviours that may be related to the physicians' legal liability. Methods We analysed legal decisions of medical malpractice cases between 1990 and 2009 in which the pivotal issue was the physician's duty to explain (366 cases). To identify factors related to the breach of the physician's duty to explain, an analysis was undertaken based on acknowledged breaches with regard to the physician's duty to explain to the patient according to court decisions. Additionally, to identify predictors of physicians' behaviours in breach of the duty to explain, logistic regression analysis was performed. Results When the physician's explanation was given before treatment or surgery (p = 0.006), when it was relevant or specific (p = 0.000), and when the patient's consent was obtained (p = 0.002), the explanation was less likely to be deemed inadequate or a breach of the physician's duty to explain. Patient factors related to physicians' legally problematic explanations were patient age and gender. One physician factor was related to legally problematic physician explanations, namely the number of physicians involved in the patient's treatment. Conclusion These findings may be useful in improving physician-patient communication in the medical setting. PMID:21510891

  8. [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.

  9. Urethral catheters and medical malpractice: a legal database review from 1965 to 2015

    PubMed Central

    Osterberg, E. Charles; Chang, Helena; Gaither, Thomas W.; Alwaal, Amjad; Fox, Ryan; Breyer, Benjamin N.

    2016-01-01

    Background Urethral catheters (UCs) are commonly used in medicine and are associated with complications such as urinary tract infections (UTIs) and trauma. Given UC complications and their ubiquitous usage in healthcare, there is a potential for liability risk. We aim to explore litigation involving UC-related complications. Methods The LexisNexis legal database was queried for all state and federal cases from January 1965 through October 2015 using the terms “urethral catheter” or “Foley catheter” in combination with “medical malpractice”, “negligence”, “medical error”, and “trauma”. Each case was reviewed for reported medical characteristics and legal aspects, including the outcome of the case. Results Our search yielded 29 cases. Urologists were the most common providers cited as defendants (21%), all of whom were successful in their defense. The most common malpractice claim was for traumatic insertion (48%). Pain was the most common type of damage claimed by plaintiffs (28%), followed by UTI (24%). Nineteen (66%) cases favored defendants, while 10 (34%) cases favored the plaintiffs, of which 2 (7%) were settled out of the court. In settled cases, the mean settlement received by plaintiffs was $55,750 (range, $25,000–$86,500). The mean award to plaintiffs for cases determined by the court was $112,991 (range, $4,000–$325,000). Conclusions Despite widespread usage of UC over a 50-year period, lawsuits centered on UC misuse are rare at the state and federal court levels. Of litigated cases, urologists are commonly involved yet have successful defenses. PMID:27785434

  10. Possible gasoline-induced chronic liver injury due to occupational malpractice in a motor mechanic: a case report.

    PubMed

    Gunathilaka, Mahesh Lakmal; Niriella, Madunil Anuk; Luke, Nathasha Vihangi; Piyarathna, Chathura Lakmal; Siriwardena, Rohan Chaminda; De Silva, Arjuna Priyadarshin; de Silva, Hithanadura Janaka

    2017-07-03

    Hydrocarbon-induced occupational liver injury is a well-known clinical entity among petroleum industry workers. There are many types of hydrocarbon exposure, with inhalation being the most common. Hydrocarbon-induced occupational liver injury is a rarely suspected and commonly missed etiological agent for liver injury. We report a case of a non-petroleum industry worker with chronic liver disease secondary to hydrocarbon-induced occupational liver injury caused by chronic low-grade hydrocarbon ingestion due to occupational malpractice. A 23-year-old Sri Lankan man who was a motor mechanic presented to our hospital with decompensated cirrhosis. He had been chronically exposed to gasoline via inadvertent ingestion due to occupational malpractice. He used to remove gasoline from carburetors by sucking and failed to practice mouth washing thereafter. On evaluation, he had histologically proven established cirrhosis. A comprehensive history and workup ruled out other nonoccupational etiologies for cirrhosis. The patient's long-term occupational gasoline exposure and clinical course led us to a diagnosis of hydrocarbon-induced occupational liver injury leading to decompensated cirrhosis. Hydrocarbon-induced occupational liver injury should be considered as a cause when evaluating a patient with liver injury with possible exposure in relevant occupations.

  11. [Medico-legal assessment in neurological malpractice based on casework material collected at the Department of Forensic Medicine, Medical University of Białystok].

    PubMed

    Ptaszyńska-Sarosiek, Iwona; Niemcunowicz-Janica, Anna; Janica, Jerzy; Dopierała, Tomasz; Załuski, Janusz; Wardaszka, Zofia

    2007-01-01

    Medical malpractice results from inadequate professional knowledge, incompliance to the present state of medical knowledge or negligence and inattention. The aim of the paper was the analysis of medical malpractice cases based on material in the field of neurology. The cases were assessed according to the number and type in 32 medico-legal opinions issued by specialist teams of forensic medicine and neurology in the Department of Forensic Medicine, Medical University of Białystok in the years 2001-2006. In 11 cases (34%) medical malpractice was concluded with reference to improper treatment after head injury or brain pathology, inadequate care at neurology unit, lacked or delayed diagnostics of head pathology and injury, non-referral to hospital by neurologists. In the material analysed diagnostic errors predominated. Majority of them originated from the open health care system. Incompetence of neurologists with regard to differential diagnostics resulting in misdiagnosis and improper therapy was noted. In one third of the overall cases medical malpractice was concluded. The most common causes included misinterpretation of disease signs and symptoms, misapplication of available diagnostic potential and unjustified delay before commencing diagnostics.

  12. The fear factor. Malpractice reforms haven't done much to end defensive medicine and the costs it adds to the system.

    PubMed

    Robeznieks, Andis

    2010-09-13

    The latest flurry of research seems to show that malpractice reforms haven't done much to stop defensive medicine. The solution depends on whom you ask. "The focus ought to be on preventing medical errors--and not on taking away people's rights and capping their damages once they've been injured," says Todd Smith, left, of the Illinois Trial Lawyers Association.

  13. Legal aspects of cruise medicine - can a non-US ship's doctor be sued for malpractice in Florida?

    PubMed

    Dahl, Eilif

    2014-01-01

    An English ship's doctor treated a non-US female patient for abdominal discomfort on a foreign-flagged cruise ship off the coast of Haiti. In Mexico the patient underwent abdominal surgery, followed by complications, for which her lawyers wanted to take the ship's doctor to court in Florida, USA. A trial court granted their wish, but this decision was reversed on appeal as the factors discussed were insufficient to establish Florida jurisdiction over the ship's doctor. The decision is not about whether malpractice occurred; it is about limiting the possibility of taking the ship's doctor to a court in a location preferred by the plaintiffs' lawyers. The appeal court ruling is important for non-US doctors working as independent contractors on cruise vessels that visit US ports, and it will hopefully prevent some of the more frivolous law suits from being filed in the future.

  14. Surgical Adverse Events, Risk Management, and Malpractice Outcome: Morbidity and Mortality Review Is Not Enough

    PubMed Central

    Morris, John A.; Carrillo, Ysela; Jenkins, Judith M.; Smith, Philip W.; Bledsoe, Sandy; Pichert, James; White, Andrew

    2003-01-01

    Objective To review all admissions (age > 13) to three surgical patient care centers at a single academic medical center between January 1, 1995, and December 6, 1999, for significant surgical adverse events. Summary Background Data Little data exist on the interrelationships between surgical adverse events, risk management, malpractice claims, and resulting indemnity payments to plaintiffs. The authors hypothesized that examination of this process would identify performance improvement opportunities overlooked by standard medical peer review; the risk of litigation would be constant across the three homogeneous patient care centers; and the risk management process would exceed the performance improvement process. Methods Data collected included patient demographics (age, gender, and employment status), hospital financials (hospital charges, costs, and financial class), and outcome. Outcome categories were medical (disability: <1 month, 1–6 months, permanent/death), legal (no legal action, settlement, summary judgment), financial (indemnity payments, legal fees, write-offs), and cause and effect analysis. Cause and effect analysis attempts to identify system failures contributing to adverse outcomes. This was determined by two independent analysts using the 17 Harvard criteria and subdividing these into subsystem causative factors. Results The study group consisted of 130 patients with surgical adverse events resulting in total liabilities of $8.2 million. The incidence of adverse events per 1,000 admissions across the three patient care centers was similar, but indemnity payments per 1,000 admissions varied (cardiothoracic = $30, women’s health = $90, trauma = $520). Patient demographics were not predictive of high-risk subgroups for adverse events or litigation. In terms of medical outcome, 51 patients had permanent disability or death, accounting for 98% of the indemnity payments. In terms of legal outcome, 103 patients received no indemnity payments, 15

  15. A survey of emergency physicians' fear of malpractice and its association with the decision to order computed tomography scans for children with minor head trauma.

    PubMed

    Wong, Andrew C; Kowalenko, Terry; Roahen-Harrison, Stephanie; Smith, Barbara; Maio, Ronald F; Stanley, Rachel M

    2011-03-01

    The objective of the study was to determine whether fear of malpractice is associated with emergency physicians' decision to order head computed tomography (CT) in 3 age-specific scenarios of pediatric minor head trauma. We hypothesized that physicians with higher fear of malpractice scores will be more likely to order head CT scans. Board-eligible/board-certified members of the Michigan College of Emergency Physicians were sent a 2-part survey consisting of case scenarios and demographic questions. Effect of fear of malpractice on the decision to order a CT scan was evaluated using a cumulative logit model. Two hundred forty-six members (36.5%) completed the surveys. In scenario 1 (infant), being a male and working in a university setting were associated with reduced odds of ordering a CT scan (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.18-0.88; and OR, 0.35; 95% CI, 0.13-0.96, respectively). In scenario 2 (toddler), working for 15 years or more, at multiple hospitals, and for a private group were associated with reduced odds of ordering a CT scan (OR, 0.46; 95% CI, 0.26-0.79; OR, 0.36; 95% CI, 0.16-0.80; and OR, 0.51; 95% CI, 0.27-0.94, respectively). No demographic variables were significantly associated with ordering a CT scan in scenario 3 (teen). Overall, the fear of malpractice was not significantly associated with ordering a CT scan (OR, 1.28; 95% CI, 0.73-2.26; and OR, 1.70; 95% CI, 0.97-3.0). Only in scenario 2 was high fear significantly associated with increased odds of ordering a CT scan (OR, 2.09; 95% CI, 1.08-4.05). Members of Michigan College of Emergency Physicians with a higher fear of malpractice score tended to order more head CT scans in pediatric minor head trauma. However, this trend was shown to be statistically significant only in 1 case and not overall.

  16. Patient information on drug therapy. A problem of medical malpractice law: between product safety and user safety.

    PubMed

    Hart, Dieter

    2007-04-01

    Medicinal products are associated with risks as well as potential therapeutic benefits. This is reflected by the legal requirements for patient information on drug therapy which can be differentiated into general product information, regulated by pharmaceutical (i. e. product safety) law, and individual patient information on the treatment with the product, which is subject to medical malpractice law. The physician's duty to inform the patient comprises therapeutic information as well as information required for informed consent. Therapeutic information intends to empower the patient to comply with the requirements of treatment and to protect him/her against preventable danger and risk; it is part of the medical treatment, aimed at the individual patient and his/her personal situation. Information required for informed consent enables the patient to a self-determined decision on the treatment offered; it can be divided into information on the course of treatment and risk information. Product information and treatment information complement each other; the former should be the basis of individual information on the concrete treatment, provided by the physician in a mandatory oral conversation with the patient. Product information cannot replace the physician's individual information about the treatment.

  17. Sudden perinatal death due to rupture of congenital cardiac diverticulum. Pathological findings and medico-legal investigations in malpractice charge.

    PubMed

    Marchesi, Matteo; Boracchi, Michele; Gentile, Guendalina; Maghin, Francesca; Zoja, Riccardo

    2017-09-01

    Congenital diverticula of the left ventricle, very rare malformations, are determined by an abnormal embryonic development of the ventricular wall and can be isolated or associated to other cardiac anomalies. In most of the cases, these pathologies are not symptomatic and in some patients can be associated to ventricular arrhythmia, cardiac rupture with tamponade and sudden death. Authors are presenting the case of a sudden death in an 8-weeks-old newborn due to rupture of a cardiac congenital diverticulum of the left ventricle, discovered only at the moment of the autopsic examination. The parents of the victim pressed charges against the medical staff that was appointed to the cares, blaming them with malpractice. The missed diagnosis of a cardiac congenital diverticulum of the left ventricle, a rare pathology, reflects the trickiness of the medical management that can lead to medico-legal controversies and, even though such rare conditions must be always taken into consideration when investigating possible dysfunction causing the death, diagnostic difficulties, in the case in exam, justify the missed diagnosis intra-vitam of cardiac ventricular diverticulum. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. How risky is caring for emergency patients at risk of malpractice litigation: a population based epidemiological study of Taiwan's experiences

    PubMed Central

    Yang, Che-Ming; Tsai, Shin-Han; Chiu, Wen-Ta

    2009-01-01

    Background Emergency medicine has generally been considered a high risk specialty. The purpose of this study is to assess the risk of being sued in the district courts for caring emergency room (ER) patients from the perspective of epidemiology. Methods This research was designed to be a retrospective population based cohort study. We intended to find out the incidence of litigations arising from ER patients and that of birth inpatients in Taiwan, and computed their relative risks. The inclusion criterion was set to be incidents transpired in the time period of 1998 to 2002. The study materials included the reimbursement claim dataset of the National Health Insurance from 1998 to 2002, and the district court decision database of the Judicial Yuan from 1999 to 2006. Results The average annual incidence rate of becoming a plaintiff for ER patients is 0.86 per million, and for birth patients is 33.5 per million. There is a statistically significant difference between birth patients and ER patients. The relative risk comparing ER patients against birth inpatients is 0.03. Conclusion The findings of this population based study indicate that the patient population emergency physicians are facing in Taiwan have relatively lower risks of developing litigation in comparison with the patients that come to give birth. Due to the large volume of ER patients, malpractice still pose a major threat in the emergency department, and misdiagnosis remains the major complaint of plaintiffs in subsequent litigations. PMID:19761596

  19. Civil money penalties for failure to report on medical malpractice payments and for breaching the confidentiality of information--HHS. Final rule.

    PubMed

    1991-06-21

    This final rule establishes civil money penalties (CMPs) pursuant to title IV of Public Law 99-660, the Health Care Quality Improvement Act of 1986 (HCQIA), as amended by section 402(a) of Public Law 100-177. Section 421(c) of HCQIA establishes a CMP against any entity that fails to report information that is required to be reported on medical malpractice payments. Section 427(b) of HCQIA establishes a CMP against any person that breaches the confidentiality of information which is reported or furnished pursuant to HCQIA and which the Secretary has established the National Practitioner Data Bank to collect and disseminate.

  20. Medical Malpractice Claims Related to Cataract Surgery Complicated by Retained Lens Fragments (An American Ophthalmological Society Thesis)

    PubMed Central

    Kim, Judy E.; Weber, Paul; Szabo, Aniko

    2012-01-01

    Purpose: To review malpractice claims associated with retained lens fragments during cataract surgery to identify ways to improve patient outcomes. Methods: Retrospective, noncomparative, consecutive case series. Closed claims data related to cataract surgeries complicated by retained lens fragments (1989 through 2009) from an ophthalmic insurance carrier were reviewed. Factors associated with these claims and claims outcomes were analyzed. Results: During the 21-year period, 117 (12.5%) of 937 closed claims associated with cataract surgery were related to retained lens fragments with 108 unique cataract surgeries, 97% against cataract surgeon and 3% against retinal surgeon. Twelve (11%) of 108 claims were resolved by a trial, 30 (28%) were settled, and 66 (61%) were dismissed. The defendant prevailed in 83% of trials. Indemnity payments totaling more than $3,586,000 were made in 32 (30%) of the claims (median payment, $90,000). The difference between the preoperative visual acuity and the final visual acuity was predictive of an indemnity payment (odds ratio [OR], 2.28; P=.001) and going to a trial (OR, 2.93; P=.000). Development of corneal edema was associated with an indemnity payment (OR, 3.50; P=.037). Timing of referral and elevated intraocular pressure (IOP) were statistically significant in univariate analyses but not in multivariate analyses for a trial. Conclusions: Whereas the majority of claims were dismissed, claims associated with greater visual acuity decline, corneal edema, or elevated IOP were more likely to result in a trial or payment. Ways to reduce significant vision loss, including improved management of corneal edema and IOP, and timely referral to a subspecialist should be considered. PMID:23818737

  1. Orthopedic board certification and physician performance: an analysis of medical malpractice, hospital disciplinary action, and state medical board disciplinary action rates.

    PubMed

    Kocher, Mininder S; Dichtel, Laura; Kasser, James R; Gebhardt, Mark C; Katz, Jeffery N

    2008-02-01

    Specialty board certification status has become the de facto standard of competency by which the profession and the public recognize physician specialists. However, the relationship between orthopedic board certification and physician performance has not been established. Rates of medical malpractice claims, hospital disciplinary actions, and state medical board disciplinary actions were compared between 1309 board-certified (BC) and 154 non-board-certified (NBC) orthopedic surgeons in 3 states. There was no significant difference between BC and NBC surgeons in medical malpractice claim proportions (BC, 19.1% NBC, 16.9% P = .586) or in hospital disciplinary action proportions (BC, 0.9% NBC, 0.8% P = 1.000). There was a significantly higher proportion of state medical board disciplinary action for NBC surgeons (BC, 7.6% NBC, 13.0% P = .028). An association between board certification status and physician performance is necessary to validate its status as the de facto standard of competency. In this study, BC surgeons had lower rates of state medical board disciplinary action.

  2. The effect of threshold amounts for reporting malpractice payments to the National Practitioner Data Bank: analysis using the closed claims data base of the Office of the Assistant Secretary of Defense (Health Affairs).

    PubMed

    Metter, E J; Granville, R L; Kussman, M J

    1997-04-01

    The study determines the extent to which payment thresholds for reporting malpractice claims to the National Practitioner Data Bank identifies substandard health care delivery in the Department of Defense. Relevant data were available on 2,291 of 2,576 medical malpractice claims reported to the closed medical malpractice case data base of the Office of the Assistant Secretary of Defense (Health Affairs). Amount paid was analyzed as a diagnostic test using standard of care assessment from each military Surgeon General office as the criterion. Using different paid threshold amounts per claim as a positive test, the sensitivity of identifying substandard care declined from 0.69 for all paid cases to 0.41 for claims over $40,000. Specificity increased from 0.75 for all paid claims to 0.89 for claims over $40,000. Positive and negative predictive values and likelihood ratio were similar at all thresholds. Malpractice case payment was of limited value for identifying substandard medical practice. All paid claims missed about 30% of substandard care, and reported about 25% of acceptable medical practice.

  3. Stuck in a moment: an ex ante analysis of patient complaints in plastic surgery, used to predict malpractice risk profiles, from a large cohort of physicians in the patient advocacy reporting system.

    PubMed

    Hultman, C Scott; Gwyther, Robert; Saou, Michael A; Pichert, James W; Catron, Thomas F; Cooper, William O; Hickson, Gerald B

    2015-06-01

    Unsolicited patient complaints (UPCs) serve as a powerful predictor of increased risk of malpractice claims, and reductions in UPCs, through targeted physician interventions, lower incidence of lawsuits and decrease cost of risk management. We analyzed UPCs, verified by trained counselors in patient relations, to determine the malpractice risk of plastic surgeons, compared to dermatologists, all surgeons, and all physicians, from a national patient complaint registry. We examined the patient complaint profiles and risk scores of 31,077 physicians (3935 surgeons, 338 plastic and reconstructive surgeons, and 519 dermatologists), who participated in the Patient Advocacy Reporting System, a national registry of UPCs. Patient complaint data were collected from 70 community and academic hospitals across 29 states, from 2009 to 2012. In addition to determining the specific complaint mix for plastic surgery compared to all physicians, each physician was assigned a patient complaint risk score, based on a proprietary weighted-sum algorithm, with a score higher than 70, indicative of high risk for malpractice claims. Patient complaint profiles and risk scores were compared between all groups, using Wilcoxon rank and χ analysis. P values less than 0.05 were assigned statistical significance. Over this 4-year period, the majority of plastic surgeons (50.8%) did not generate any patient complaints, but those who did received an average of 9.8 complaints from 4.8 patients. The percentage of physicians at high risk for malpractice claims, based upon the Patient Advocacy Reporting System index score of patient complaints, was as follows: all physicians, 2.0%; all surgeons, 4.1%; plastic and reconstructive surgeons, 2.4%; dermatologists, 1.4%. Physicians (from 2012 only) who were identified by their sponsoring institutions as "reconstructive" plastic surgeons (n = 41) were 5 times as likely to have a high risk score, compared to physicians who were identified as "plastic" surgeons

  4. 25-Year summary of US malpractice claims for diagnostic errors 1986-2010: an analysis from the National Practitioner Data Bank.

    PubMed

    Saber Tehrani, Ali S; Lee, HeeWon; Mathews, Simon C; Shore, Andrew; Makary, Martin A; Pronovost, Peter J; Newman-Toker, David E

    2013-08-01

    We sought to characterise the frequency, health outcomes and economic consequences of diagnostic errors in the USA through analysis of closed, paid malpractice claims. We analysed diagnosis-related claims from the National Practitioner Data Bank (1986-2010). We describe error type, outcome severity and payments (in 2011 US dollars), comparing diagnostic errors to other malpractice allegation groups and inpatient to outpatient within diagnostic errors. We analysed 350 706 paid claims. Diagnostic errors (n=100 249) were the leading type (28.6%) and accounted for the highest proportion of total payments (35.2%). The most frequent outcomes were death, significant permanent injury, major permanent injury and minor permanent injury. Diagnostic errors more often resulted in death than other allegation groups (40.9% vs 23.9%, p<0.001) and were the leading cause of claims-associated death and disability. More diagnostic error claims were outpatient than inpatient (68.8% vs 31.2%, p<0.001), but inpatient diagnostic errors were more likely to be lethal (48.4% vs 36.9%, p<0.001). The inflation-adjusted, 25-year sum of diagnosis-related payments was US$38.8 billion (mean per-claim payout US$386 849; median US$213 250; IQR US$74 545-484 500). Per-claim payments for permanent, serious morbidity that was 'quadriplegic, brain damage, lifelong care' (4.5%; mean US$808 591; median US$564 300), 'major' (13.3%; mean US$568 599; median US$355 350), or 'significant' (16.9%; mean US$419 711; median US$269 255) exceeded those where the outcome was death (40.9%; mean US$390 186; median US$251 745). Among malpractice claims, diagnostic errors appear to be the most common, most costly and most dangerous of medical mistakes. We found roughly equal numbers of lethal and non-lethal errors in our analysis, suggesting that the public health burden of diagnostic errors could be twice that previously estimated. Healthcare stakeholders should consider diagnostic safety a critical health policy issue.

  5. 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…

  6. 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…

  7. Overcoming Managerial Malpractice.

    ERIC Educational Resources Information Center

    Gilley, Jerry W.

    2000-01-01

    Describes managerial failures and suggests performance management as a way to address the performance improvement process. Explains how performance management allows organizations to address performance failures that prevent the achievement of business results and is used to develop and improve the organization's human and material resources. (LRW)

  8. [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.

  9. Analysis of birth-related medical malpractice litigation cases in Japan: review and discussion towards implementation of a no-fault compensation system.

    PubMed

    Uesugi, Nana; Yamanaka, Michiko; Suzuki, Toshihiro; Hirahara, Fumiki

    2010-08-01

    We examined birth-related malpractice civil litigation cases in Japan to clarify the actual status related to the implementation of an obstetrical no-fault compensation system in 2009. In this retrospective review, we analyzed legal and medical information from 64 cases with a delivery date after 1987 and a judgment date between April 1997 and March 2007. The malpractice claim was accepted in 44 cases and rejected in 20 cases. The period from the delivery to the judgment date was lengthy (90.1 months overall). The average amount of damages awarded was yen97 810,000 for cases of cerebral palsy (CP). Preterm births and less than 2500 g infants represented a higher incidence rate in the rejected cases. There were 32 cases (50.0%) with CP, 18 (28.1%) with infant death, 10 (15.6%) with neonatal death, and 4 (6.3%) with fetal death. Twenty-three of 44 accepted cases (52.3%) and 11/20 rejected cases (55.0%) had a gestational age of more than 33 weeks at birth and weighed more than 2000 g. Forced deliveries were performed in 45/64 cases (70.3%), and augmentation/induction of labor was performed in 28/64 cases (43.8%). There were 13/16 (81.3%) accepted cases that underwent vacuum and/or forceps extraction after labor augmentation/induction. More than half of our cases could be sufficient for a no-fault compensation system in Japan. Though the system is considered to have some problems that need to be solved, this finding suggests that many children and their families may benefit from the new system without having to file.

  10. A comparison of calls subjected to a malpractice claim versus 'normal calls' within the Swedish healthcare direct: a case-control study.

    PubMed

    Ernesäter, Annica; Engström, Maria; Winblad, Ulrika; Holmström, Inger K

    2014-10-03

    The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. In many countries, telephone advice nursing is patients' first contact with healthcare. Telenurses' assessment of callers' symptoms and needs are based on verbal communication only, and problems with over-triage and under-triage have been reported. A total sample of all reported medical errors (n=33) during the period 2003-2010 within Swedish Healthcare Direct was retrieved. Corresponding calls were thereafter identified and collected as sound files from the manager in charge at the respective call centres. For technical reasons, calls from four of the cases were not possible to retrieve. For the present study, matched control calls (n=26) based on the patient's age, gender and main symptom presented by the caller were collected. Male patients were in majority (n=16), and the most common reasons for calling were abdominal pain (n=10) and chest pain (n=5). There were statistically significant differences between the communication in the cases and controls: telenurses used fewer open-ended medical questions (p<0.001) in the cases compared to the control calls; callers provided telenurses with more medical information in the control calls compared to the cases (p=0.001); and telenurses used more facilitation and patient activation activities in the control calls (p=0.034), such as back-channel response (p=0.001), compared to the cases. The present study shows that telenurses in malpractice claimed calls used more closed-ended questioning compared to those in control calls, who used more open-ended questioning and back-channel response, which provided them with richer medical descriptions and more information from the caller. Hence, these communicative techniques are important in addition to solid medical and nursing competence and sound decision aid systems. Published by the BMJ Publishing Group Limited. For permission to use (where not

  11. [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. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  12. 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. Copyright © 2011 John Wiley & Sons, Ltd.

  13. Using malpractice claims to identify risk factors for neurological impairment among infants following non-reassuring fetal heart rate patterns during labour.

    PubMed

    Kesselheim, Aaron S; November, Martin T; Lifford, Karen L; McElrath, Thomas F; Puopolo, Ann L; Orav, E John; Studdert, David M

    2010-06-01

    We sought to use a novel case-selection methodology to identify antenatal or intrapartum risk factors associated with neonatal neurological impairment following non-reassuring fetal heart rate patterns during labour. We used a retrospective case-control design with bivariate and multivariate conditional logistic regression. Cases were births in which electronic fetal monitoring (EFM) showed non-reassuring patterns and the infant had neurological disability. Controls were births in which EFM was non-reassuring but the infant was born healthy. We identified 36 cases from among malpractice claims filed with a liability insurer in Massachusetts between 1985 and 2001 and randomly selected 70 controls, matching them to cases by hospital, birth date and gestational age. More cases had maternal antenatal vaginal bleeding (P = 0.004), a prolonged latent phase or protracted dilation during the first stage of labour (P = 0.03), and protracted descent or prolonged second stage (P = 0.01). More cases also had minimal variability on EFM on admission (P = 0.02) and during the second stage (P = 0.02). Multivariate analysis highlighted three significant predictors of neurological injury following complicated labour: antenatal vaginal bleeding (OR = 27.1), prolonged latent phase or protracted dilation in the first stage (OR = 4.0) and EFM showing minimal variability in the first stage (OR = 4.3). These promising initial findings suggest that future research into outcomes from complicated labour with non-reassuring heart rate patterns should focus on maternal history of vaginal bleeding, slow labour and minimal variability on EFM.

  14. 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

  15. 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

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

    2016-03-02

    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. Cross-sectional analysis of systematic reviews and survey of their authors. 118 systematic reviews published in four journals (Ann Int Med, BMJ, JAMA, Lancet), and the Cochrane Library, in 2013. 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. 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. 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 when, and how, to report suspected misconduct is needed. Published by the BMJ

  16. Kirit C. Shah, M.D. v. Stan Harris and Nancy Harris. "Construction of Legal Arguments, Statutes of Limitations, and Medical Malpractice." Lesson Plans for Secondary Teachers on How Lawyers Prepare Their Arguments. Courts in the Classroom: Curriculum Concepts and Other Information on Indiana's Courts for the K-12 Educator.

    ERIC Educational Resources Information Center

    Osborn, Elizabeth

    Stan and Nancy Harris filed a complaint against Kirit C. Shah, M.D., for misdiagnosing Mr. Harris's illness, charging Dr. Shah with negligence and asking for damages. A medical malpractice action in Indiana is governed by a two year statute of limitations. Because the Harrises failed to bring their action against Dr. Shah within this two year…

  17. The other side of vitamin D therapy: 
a case series of acute kidney injury due to malpractice-related vitamin D intoxication
.

    PubMed

    Wani, Muzafar; Wani, Imtiaz; Banday, Khurshid; Ashraf, Mohd

    2016-11-01

    Vitamin D deficiency is highly prevalent in Indian Kashmir. Many people get injectable vitamin D (600,000 IU/injection). At times, the dose prescribed is far above the permissible limit. We report 62 patients with malpractice-related vitamin D intoxication, presenting with hypercalcemia and acute kidney injury (AKI). The diagnosis was made on basis of (1) history of multiple intramuscular vitamin D injections (2) toxic serum levels of 25-OH vitamin D and (3) exclusion of common causes of hypercalcemia (malignancy and hyperparathyroidism). Their presentation was either de novo AKI in 51 (group 1) or acute on top of chronic kidney disease in 11 (group 2). The mean age was 60 ± 14 vs. 62 ± 13 years, approximate number of vitamin D injections received ranged from 4 to 28 (2.4 - 16.8 million units) vs. 3 to 24 (1.8 - 14.4 million units), mean creatinine at presentation was 3.2 ± 0.9 vs. 4.5 ± 1.1 mg/dL, which decreased to 1.2 ± 0.2 vs. 3.3 ± 1.0 mg/dL, mean serum calcium on admission was 13.7 ± 1.4 vs. 13.6 ± 2.0 mg/dL which decreased to 10.7 ± 1.2 vs. 11.0 ± 1.0 mg/dL on follow-up of 7.2 ± 0.6 months, mean vitamin D level was 313.3 ± 54.8 (range 235 - 375) vs. 303.7 ± 48.4 (range 210 - 375) nmol/L and mean PTH was 18.1 ± 9.6 (range 6.2 - 32) vs. 52.3 ± 12.6 (range 28 - 88) pg/mL in group 1 vs. group 2, respectively. The clinical presentation was weakness, constipation, abdominal pain, nausea, vomiting, anorexia, altered sensorium, and oliguria. The treatment received was intravenous fluids (normal saline) in all in group 1 and in 8/11 in group 2, short course of steroids (prednisolone) in 44, and bisphosphonate in 6. This is the largest case series of AKI secondary to vitamin D toxicity ever reported.
.

  18. Educational Malpractice: Educate or Litigate.

    ERIC Educational Resources Information Center

    Foster, William F.

    1986-01-01

    It is suggested that educators be held accountable to their students for the quality and adequacy of the educational services they provide. Extension of liability to education can have a positive impact on the educational process. (Author/LMO)

  19. Educational Tort Liability and Malpractice.

    ERIC Educational Resources Information Center

    Connors, Eugene T.

    Using as examples some of the more important court cases from the 1970s, as well as a few older but still important cases, this book discusses tort litigation as it affects educators. Chapter 1 presents all of the elements important to educational tort law and discusses tort terminology as well as events commonly occurring in tort actions. With…

  20. [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.

  1. Malpractice Issues in the Academic Medical Center.

    ERIC Educational Resources Information Center

    Rich, Ben A.

    1986-01-01

    A discussion of legal issues in the academic medical center focuses on standards of care applicable to practitioners, special problems of patient care delivery, and the special status of public academic medical centers. Informed consent to care, relations with affiliated institutions, and private/non-private patient status are also considered.…

  2. Administrative Malpractice: The Limits of Common Sense

    ERIC Educational Resources Information Center

    Bogue, E. Grady

    1978-01-01

    An administrator with a hybrid disposition, part scholar and part riverboat gambler, may serve more effectively than either model alone, suggests this executive of the Tennessee Higher Education Commission. Many academic administrators try to live by common sense, which is often yesterday's heresy. (Author/LBH)

  3. Educational Best Practice or Malpractice? Our Choice.

    ERIC Educational Resources Information Center

    Van Bockern, Steve; Wenger, Laurie

    1999-01-01

    Emerging research on the brain and learning is challenging long established notions about how children should be taught. The authors use this research as a basis for providing more powerful strategies for reaching all students, including those with learning and behavior problems that have led to educational failure. Suggests ideas and practical…

  4. 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.

  5. 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…

  6. Malpractice Claims against Social Workers: First Facts.

    ERIC Educational Resources Information Center

    Reamer, Frederic G.

    1995-01-01

    Summarizes claims data drawn from the records of the National Association of Social Workers Insurance Trust from 1969 to 1990. Provides data for frequency and cost of claims for various claims categories and offers suggestions for minimizing the occurrence of liability claims. The majority of claims against individual practitioners involve…

  7. A Crack in the Educational Malpractice Wall

    ERIC Educational Resources Information Center

    DeMitchell, Terri A.; DeMitchell, Todd A.

    2007-01-01

    As a former school law attorney and a former superintendent, the authors were constantly concerned about potential liability when a student's constitutional rights may have been violated or when a student was physically injured. While educators can be held liable for infringing on students' rights and for negligence that causes students physical…

  8. Educational Malpractice: Legal Cases and Educators' Views

    ERIC Educational Resources Information Center

    Teh, Mui-Kim

    2008-01-01

    The notion of being negligently and legally liable for poor teaching that results in the failure of students being able to achieve expected educational outcomes is an unimaginable prospect. However, there is an emerging trend of legal proceedings being brought against teachers, blaming them for low scores in literacy, numeracy or even the failure…

  9. Improving the medical malpractice litigation process.

    PubMed

    Struve, Catherine T

    2004-01-01

    Critics charge that judges and juries are incompetent to address medical liability issues. Some advocate shifting authority away from ordinary judges and juries, either by appointing "expert" decisionmakers, such as "medical screening panels" or specialized "medical courts," or by instituting caps on damages. Problems with the tort liability system may weigh in favor of a shift to a no-fault administrative compensation system. If the current fault-based system is retained, however, policymakers should not adopt half-measures by creating "expert" panels or "expert" courts. Rather, they should better equip the existing decisionmakers to deal with liability and damages questions.

  10. 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…

  11. 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

  12. [Medical malpractice in relation to its social political importance].

    PubMed

    Franzki, H

    1990-02-01

    Despite an unchanged legal basis the number of proceedings concerning medical practitioner's liability has increased substantially and medical law has developed into an independent field of law in the last 20 years. On one hand this is a result of modern medicine's extended possibilities to act and control, on the other hand it is caused by the patient's changed attitude towards both, his disease and his physician. Hereby the mass media exercise considerable influence with their commentaries, that are often exaggerated in their criticism and their representation. But this development gives no rise to concern. The jurisdiction in the field of medical practitioner's liability is--apart from a few exceptions--not overstated but necessary for the safeguarding of the patient's interests. It doesn't impede progress, doesn't give cause for a defensive medicine and doesn't burden our public health system. For the patient's wellbeing it often even accomplishes the important function of convincing the public health administration, that sometimes shows a tendency to act economically, of strict medical demands. There still is no room for the general conclusion, that the control of medicine by jurisdiction has undermined the confidential relationship between patient and physician. The recently published result of an opinion poll has shown, that physicians still enjoy a high reputation, while journalists--in spite of some contradictory statements--find themselves in the last ranks.

  13. 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…

  14. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... practitioner for whose benefit the payment is made— (i) Name; (ii) Work address; (iii) Home address, if known; (iv) Social Security number, if known, and if obtained in accordance with section 7 of the Privacy Act...) acting within the scope of his or her training program that otherwise would warrant reporting for...

  15. 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…

  16. 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…

  17. Malpractice claims and avoidance of complications in endoscopic surgery.

    PubMed

    Ates, Senem; Tulandi, Togas

    2013-06-01

    Laparoscopy has become a valuable tool for the gynaecologist in the diagnosis and treatment of a variety of gynecological disorders. Its quicker recovery time and other advantages has benefitted countless women. Laparoscopic procedures, however, have their own associated risks and complications, and the surgeon must become thoroughly familiar with these. This awareness will help reduce patient morbidity and mortality, and potentially avoid the stress and burden of litigation, which has been increasing in recent years. Complications of gynaecologic laparoscopy include entry-related problems, and injuries to bowel, urinary tract, blood vessels, and nerves. Although some of these complications have been well described, some have emerged recently in relation to new technology and techniques. In this chapter, we discuss some of the complications of endoscopic surgery, including their incidence, prevention, and medico-legal implications, and provide a brief overview of their management. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Discounting medical malpractice claim reserves for self-insured hospitals.

    PubMed

    Frese, Richard; Kitchen, Patrick

    2011-01-01

    The hospital CFO often works with the hospital's actuary and external auditor to calculate the reserves recorded in financial statements. Hospital management, usually the CFO, needs to decide the discount rate that is most appropriate. A formal policy addressing the rationale for discounting and the rationale for selecting the discount rate can be helpful to the CFO, actuary, and external auditor.

  19. 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…

  20. Episiotomy in modern obstetrics--necessity versus malpractice.

    PubMed

    Pietras, Jolanta; Taiwo, Bernice Folake

    2012-01-01

    Episiotomy is now one of the most common procedures performed in obstetrics. At the beginning of its existence, it was performed very carefully and used in exceptional circumstances. In the second half of the twentieth century, its use became so widespread that it was almost regarded as a standard procedure in labor rooms. Authors intend to provide answers to the question as to whether it was an appropriate move in this discussion. Undoubtedly, there are reasons for which an incision is an appropriate decision, sometimes necessary, but in recent years its usefulness and relevance, in particular its routine, too widespread use are starting to be increasingly questioned and subjected to doubt, both by various women's organizations, individuals interested in the issue, stakeholders, as well as professionals. Poland is still one of the few European countries where routine episiotomy is so far regarded as an important and recognized part of patient management during almost every childbirth taking place in a hospital setting. This topic currently causes broad discussion in the media, the press and among the public. Hence, the aim of this work is to discuss key issues on episiotomy, the arguments for and against episiotomy based on literature review and available studies and reports. It is also going to present the opinion of different authors and the existing differences in their views on the above issue.

  1. Research malpractice and the issue of incidental findings.

    PubMed

    Milstein, Alan C

    2008-01-01

    Human subject research involving brain imaging is likely to reveal significant incidental findings of abnormal brain morphology. Because of this fact and because of the fiduciary relationship between researcher and subject, board-certified or board-eligible radiologists should review the scans to look for any abnormality, the scans should be conducted in accordance with standard medical practice for reviewing the clinical status of the whole brain, and the informed consent process should disclose the possibility that incidental findings may be revealed and what consequences will follow. In the event such findings are revealed, qualified physicians should explain to the subject the significance of the findings and the alternatives available.

  2. Medical Malpractice: No Agreement on the Problems or Solutions.

    DTIC Science & Technology

    1986-02-01

    34 , " " " " " , ,’ ",,, " "’, . ’, ", " ,,, ,, -. ".. ",, " -,, ,%, .,,, .,, ..,, .. .- ,, .,. . , .. .,. . . .... ,,. . .,ID Executive Summary K Media ...frequently during most of 1985 for various reasons. The media have reported that: . Physician and hospital insurance premiums have risen significantly...some specialties rose several hundred percent in a single year. Notwithstanding the increases in premiums, many insurers pulled out of the market

  3. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... of 1974; (v) Date of birth; (vi) Name of each professional school attended and year of graduation... Management and Budget has approved the information collection requirements in this section under...

  4. Why winners win: decision making in medical malpractice cases.

    PubMed

    Crawford, Linda S

    2007-01-01

    A high percentage of physicians will, at some time in their careers, face a lawsuit, possibly finding themselves in the courtroom even when they have not made a medical mistake. Despite the presumption that juries are biased in favor of injured plaintiffs, physicians win most of their trials. Why this occurs and how juries make their decisions are topics of ongoing interest. Research has been done on jury decision making, including what, if any, the roles of race and sex play in the process. It is essential that those who enter the courtroom understand both the power they have to influence the outcome of their own trials and why it is that issues of character continue to be so important to juries.

  5. [Tracing of analysis and prophylaxis on medical malpractice in Japan].

    PubMed

    Oshida, S

    2000-11-01

    The role of drugs, especially injectables, in medical treatment is extremely important. In Japan, accidents associated with injections were not uncommon. Post-injection neuroparalysis of the radial nerve and sciatic nerve was associated with problems in textbooks, which described injection sites at the regions of neural passage. Then, in the 1970s, quadriceps femoral muscle contracture and deltoid muscle contracture became a social problem. When the author examined the osmotic pressure of various injectables, some injectables were found to deviate from the physiological range. When 335 injectables were evaluated for the potential to cause hemolysis, many injectables marketed for intramuscular injection gave strong hemolytic reaction, which attracted attention. Next, 89 types of injectables were tested for the potential to cause muscle damage by injecting into the femoral muscle of rabbits, and severe muscular damages were observed with antipyretics, analgesics, and antibiotics. The group lawsuit of Yamanashi Prefecture was settled at the Tokyo High Court in 1989, with the pharmaceutical company agreeing to pay over 2.95 billion yen as settlement. Giving drugs to patients occupies an important place among medical act. Medical disputes concerning accidents of wrong drugs and wrong usage are common. Obviously health care workers should exercise great caution in their duties, but without measures taken against medical equipment and drugs, such as containers and seals, this type of accidents will not be reduced. Through giving numerous speeches and lectures on medical accidents throughout the years, the author had felt strongly the need for teaching materials such as video tapes that can be used for self-learning. In 1999, the video entitled "Medical Accident-Learning from Actual Cases-" was finally completed, which consists of 6 parts (1. General consideration, 2. Blood transfusion, 3. Drug administration, 4. Surgery, 5. Examinations, 6. Management). For each area, typical incidents are presented as reproduced video taping. Then the criminal responsibility, civil responsibility and administrative responsibility of the doctor or nurse concerned are questioned in the form of questionnaires. Subsequently, the author also published a commentary book for the video that provides commentaries of the cases.

  6. Does Medical Malpractice Law Improve Health Care Quality?

    PubMed

    Frakes, Michael; Jena, Anupam B

    2016-11-01

    We assess the potential for medical liability forces to deter medical errors and improve health care treatment quality, identifying liability's influence by drawing on variations in the manner by which states formulate the negligence standard facing physicians. Using hospital discharge records from the National Hospital Discharge Survey and clinically-validated quality metrics inspired by the Agency for Health Care Research and Quality, we find evidence suggesting that treatment quality may improve upon reforms that expect physicians to adhere to higher quality clinical standards. We do not find evidence, however, suggesting that treatment quality may deteriorate following reforms to liability standards that arguably condone the delivery of lower quality care. Similarly, we do not find evidence of deterioration in health care quality following remedy-focused liability reforms such as caps on non-economic damages awards.

  7. An Online Lab Examination Management System (OLEMS) to Avoid Malpractice.

    PubMed

    Kolhar, Manjur; Alameen, Abdalla; Gharsseldien, Zakaria Mokhtar

    2017-03-20

    Examination and evaluation are two important phases of education at any level of a student's curriculum. However, these assessment processes are problematic in the sense that they encourage learners to devise ways to be dishonest. The traditional way of conducting exams is particularly conducive to dishonesty. In view of this, this letter proposes an online lab examination management system to prevent misconduct and to secure the process of lab examination.

  8. Assessment of Malpractice Claims Associated With Acute Compartment Syndrome.

    PubMed

    DePasse, John Mason; Sargent, Rachel; Fantry, Amanda J; Bokshan, Steven L; Palumbo, Mark A; Daniels, Alan H

    2017-06-01

    Because acute compartment syndrome is one of the few limb-threatening and life-threatening orthopaedic conditions and is difficult to diagnose, it is a frequent source of litigation. Understanding the factors that lead to plaintiff verdicts and higher indemnity payments may improve patient care by identifying common pitfalls. The VerdictSearch legal claims database was queried for the term "compartment syndrome." After 46 cases were excluded for missing information or irrelevancy, 139 cases were reviewed. The effects of plaintiff demographics, mechanism of injury, and complications were assessed. Of 139 cases, 37 (27%) were settled, 69 (50%) resulted in a defendant ruling, and 33 (24%) resulted in a plaintiff ruling. Juries were more likely to rule in favor of juvenile plaintiffs than adult patients (P = 0.002) and female plaintiffs than male plaintiffs (P = 0.008), but indemnity payments were not affected by the age or sex of the plaintiff. Plaintiffs who experienced acute compartment syndrome as a complication of surgery were more likely to win their suit and receive higher awards (P < 0.05), compared with those in whom the condition developed as a result of trauma. Amputation or delay in diagnosis or treatment did not affect plaintiff verdicts or awards. Defendants were more likely to lose a lawsuit concerning the management of acute compartment syndrome if the patient was a woman or child or if acute compartment syndrome developed as a complication of a surgical procedure.

  9. 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…

  10. Assessing malpractice lawsuits for death or injuries due to amniotic fluid embolism.

    PubMed

    Zaami, S; Marinelli, E; Montanari Vergallo, G

    2017-01-01

    Amniotic fluid embolism (AFE) is a pregnancy complication known to be extremely hard to diagnose, since it manifests itself abruptly and with no warning signs, presenting an incidence rate of about 1 in 40000 deliveries, and maternal morbidity and mortality ranging from 20% to 60%. Although almost a century has gone by since it was first identified (1926) and despite medical research having been conducted on such a syndrome, diagnostic procedures and treatment methods have not yet been clarified enough. Specific biochemical markers have been produced in research laboratories, but their clinical value results to be limited, given how rapid the pathological process moves forward. At the time being, no diagnosis is feasible which may effectively prevent the disease from occurring. Certainly, a multidisciplinary approach might contribute to saving the lives of mother and infant, as well as ensuring better life standards. The paper's authors aim to highlight the medico-legal issues, in light of several rulings from the Italian Constitutional Court as well as lower courts. The authors also advocate for the creation of a nation-wide registry meant to collect all signaled AFE instances so that research on this as yet devastating syndrome can be conducted based on hard data.

  11. 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…

  12. 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…

  13. "Diagnosis as Treatment: A Case of Educational Malpractice." On Behalf of Children.

    ERIC Educational Resources Information Center

    Trent, Allen

    2003-01-01

    Discusses the tendency of schools to follow up poor standardized test scores with test-taking instruction, and the limitations of these standardized tests for providing authentic assessment of academic abilities. Suggests four prescriptions for educators, administrators, parents and policy makers for improving the administration and use of…

  14. 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,…

  15. Educational Malpractice: Can the Judiciary Remedy the Growing Problem of Functional Illiteracy?

    ERIC Educational Resources Information Center

    Klein, Alice J.

    1979-01-01

    Investigates the viability of a negligence action for inadequate public school education. Explores the problems inherent in proving each element of negligence, the available defense, and the potential consequences for plaintiffs, defendants, and educational policy-making that would flow from judicial recognition of a cause of action. Journal…

  16. Educational Malpractice: California School District Held Not Liable for Negligence in Instruction in Academic Subjects

    ERIC Educational Resources Information Center

    Martinez, Susanne

    1977-01-01

    This article reviews a suit brought by a high school graduate against a public school district alleging negligence and misrepresentation in academic instruction. The complaint alleged that the plaintiff was unable to read or write above fifth grade level because of the school's failure to educate him. The case was dismissed. (Author/GC)

  17. 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…

  18. Fewer Successful Malpractice Claims in U.S., but Higher Payouts

    MedlinePlus

    ... to reason that the average claim amount would increase, as has occurred, Schaffer concluded. Schaffer and his colleagues came up with their numbers through a review of the National Practitioner Data Bank, a federally maintained database that tracks medical ...

  19. Act first and look up the law afterward?: medical malpractice and the ethics of defensive medicine.

    PubMed

    De Ville, K

    1998-12-01

    This essay examines the so-called phenomenon of "defensive medicine" and the problematic aspects of attempting to maintain the safest legal position possible. While physicians face genuine litigation threats they frequently overestimate legal peril. Many defensive practices are benign, but others alter patient care and increase costs in ways that are ethically suspect. Physicians should learn to evaluate realistically the legal risks of their profession and weigh the emotional, physical, and financial costs to the patient before employing a defensive measure.

  20. 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

    ... not limit coverage to childhood vaccinations; and (3) To add the following new example as subsection 6... history of the FSHCAA and is declining to adopt additional recommendations at this time, as these... statutory language, its regulatory implementation, and the legislative history of the FSHCAA and...

  1. 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.

  2. 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…

  3. 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

  4. Malpractice issues in radiology: medicare compliance versus standard of care conformance--real or imaginary conflict?

    PubMed

    Duszak, Richard; Berlin, Leonard

    2010-06-01

    Plaintiff's Attorney (Pl Att:: Doctor, the record shows that the patient was referred to the hospital's radiology department by her gynecologist for a screening mammogram. The record also shows that when completing the mammography information form, the patient wrote that she had a lump in her left breast, correct? Defendant Radiologist (Df Ra:): Yes. Pl Att: But your technologist performed, and you interpreted, a screening mammogram. Doesn't the radiology standard of care require you to do a diagnostic mammogram when the patient has a breast lump? Df Ra:: Well, normally yes, but if it's going to be a diagnostic mammogram, then the referring physician has to order it. In this case our tech called the gynecologist and asked him whether he wanted to order a diagnostic study, and he said no, he didn't feel the lump, and that we should only do a plain screening mammogram. Pl Att:: Please explain something. You're agreeing that a woman with a breast lump should have a diagnostic mammogram, but you are saying that you didn't do one because the patient's physician wouldn't order it? Don't you have a duty to do the diagnostic mammogram in a case like this on your own, without having to ask permission from the patient's gynecologist? Df Ra:: Only the treating physician can change a screening mammogram into a diagnostic mammogram, and I am not the treating physician. If I went ahead and did a diagnostic mammography examination on my own, it would be Medicare fraud, and our hospital's compliance officer says it could result in our hospital being fined and thrown out of the Medicare program. Pl Atty: What prevents you then from recommending-not ordering, but just recommending-a diagnostic mammogram in your report, because the patient says she's got a lump? Df Rad: Well, according to our hospital's compliance officer, that would also be fraud.

  5. Minimizing malpractice risks by role clarification. The confusing transition from tort to contract.

    PubMed

    Green, J A

    1988-08-01

    The purposes and applications of informed consent are the subject of confusion and controversy according to a President's Commission report. The Commission suggests shared decision making as the new ideal for physician-patient relationships, but notes that such a changed ideal will not be initiated by court action. The four models of decision making are the traditional model, informed consent, collaboration, and patient choice. Misunderstandings about these and other terms arise when they are implied; therefore, they should be defined expressly. Mutual expectations should be ascertained and common misunderstandings that erode relationships and lead to litigation should be clarified. Without agreements, different models may be selected and expectations about responsibility may differ. Such agreements may be documented by notes in patients' charts, supported by intake procedures that teach patients about defining responsibility, and questionnaires that elicit values, needs, and preferences. The literature on the evolution of contract principles in health care is reviewed, with informed consent viewed as a judicial stepping stone from tort to contract. A framework for defining mutual expectations is presented. Physicians' patterns of allocating responsibility by express and implied agreements should be evaluated and changes made where needed.

  6. 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

    ... hospital call or hospital emergency room coverage is required by the hospital as a condition for obtaining... the FTCA involving individual emergency care provided to a non-health center patient and updating the... Health and Human Services, 5600 Fishers Lane, Room 15C-26, Rockville, Maryland 20857. Instructions: All...

  7. Litigation in nontraumatic aortic diseases--a tempest in the malpractice maelstrom.

    PubMed

    Elefteriades, John A; Barrett, Peter W; Kopf, Gary S

    2008-01-01

    Physicians are vulnerable to highly litigated thoracic aortic diseases. On the basis of a review of litigated cases, we aim to determine legally protective strategies for physicians and methods to improve treatment. Thirty-three nontraumatic, thoracic aorta-related legal cases were analyzed. Twenty-three patients (69.7%) had dissections (21 ascending, 2 descending), 8 (24.2%) had aneurysms and 2 had miscellaneous other phenomena (1 coarctation and 1 iatrogenic descending aortic rupture). The adverse event was death in 30 (90.9%) patients and paraplegia or stroke in 3 (9.1%). Allegations included: failure/delay in diagnosis (19), delay in surgery (4), error in surgical technique (5), failure to prevent paraplegia (2) and miscellaneous (3). Medical treatment was retrospectively judged suboptimal in 22 cases (66.6%) for reasons consonant with allegations. Aortic disease can be diagnostically elusive, as 'the great masquerader'. Emergency physicians must maintain a high index of suspicion for aneurysm and dissection. The D-dimer test can effectively rule out aortic dissection. 'Triple rule-out' CT scans should be performed liberally. CT scan readers must remember to evaluate the aorta. Operating room administrators must be aware that postponing a scheduled thoracic aortic case may result in interim rupture and consequent litigation. With virulent thoracic aortic diseases, adverse outcome itself does not imply substandard care. 2007 S. Karger AG, Basel

  8. [Clinical practice guidelines: juridical and medico legal issues in health care malpractice liability].

    PubMed

    Moreschi, Carlo; Broi, Ugo Da

    2014-01-01

    Clinical Practice Guidelines are clinical tools addressed to medical and health professionals and are normally employed to improve quality and safety of diagnostic and therapeutical procedures but may sometimes limit the autonomy of medical and other health care professionals. The adherence to Clinical Practice Guidelines should not be an exclusive step to evaluate the liability and respect of standards of care in case of medico-legal investigations being each clinical case very specific. Medical liability and respect of standards of care should be evaluated with the support of Clinical Practice Guidelines and the extensive examination of all specific features, professional background and experience requested to treat each single patient.

  9. Computer-based simulation training in emergency medicine designed in the light of malpractice cases.

    PubMed

    Karakuş, Akan; Duran, Latif; Yavuz, Yücel; Altintop, Levent; Calişkan, Fatih

    2014-07-27

    Using computer-based simulation systems in medical education is becoming more and more common. Although the benefits of practicing with these systems in medical education have been demonstrated, advantages of using computer-based simulation in emergency medicine education are less validated. The aim of the present study was to assess the success rates of final year medical students in doing emergency medical treatment and evaluating the effectiveness of computer-based simulation training in improving final year medical students' knowledge. Twenty four Students trained with computer-based simulation and completed at least 4 hours of simulation-based education between the dates Feb 1, 2010 - May 1, 2010. Also a control group (traditionally trained, n =24) was chosen. After the end of training, students completed an examination about 5 randomized medical simulation cases. In 5 cases, an average of 3.9 correct medical approaches carried out by computer-based simulation trained students, an average of 2.8 correct medical approaches carried out by traditionally trained group (t = 3.90, p < 0.005). We found that the success of students trained with simulation training in cases which required complicated medical approach, was statistically higher than the ones who didn't take simulation training (p ≤ 0.05). Computer-based simulation training would be significantly effective in learning of medical treatment algorithms. We thought that these programs can improve the success rate of students especially in doing adequate medical approach to complex emergency cases.

  10. [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.

  11. Medical Malpractice Claims Against Military and Civilian Personnel of the Armed Forces

    DTIC Science & Technology

    1977-08-24

    Civilian Personnel of the Armed Forces References: (a) Public Law 94-464, & l(a), 90 Stat. 1985, Title 10, United States Code, SectionD TI 1089 (f)ELECTE (b...OF AUTHORITY 1. The authority vested in the Secretary of Defense by I, ’I Title 10, U.S. C., section 1089 (f) (reference (a)) to hold harm- /’i...Title 10, U.S. C., section 1089 (f) (reference (a)). D. PROCEDURES 1. In all cases under Title 10, U.S.C., section 1089 , medical per- sonnel shall be

  12. [Malpractice in neurology in the case material of the Forensic Medicine Department, Medical University of Białystok].

    PubMed

    Ptaszyńska-Sarosiek, Iwona; Niemcunowicz-Janica, Anna; Sackiewicz, Adam; Szeremeta, Michał; Okłota, Magdalena; Wardaszka, Zofia

    2009-01-01

    The paper presents an analysis of legal opinions compiled by the Forensic Medicine Department, Medical University of Białystok in the years 2003-2008. The above-mentioned opinions addressed medical treatment in the area of neurology. During this period, opinions were given in 142 cases, the majority of them representing idiopathic diseases (such as strokes, cerebral aneurysms, cerebral infections), followed by falls from high altitudes and traffic road accidents, further followed by fights, medical treatment and work accidents. In sixteen (11.27%) of such cases, the employed medical procedures were found to be incorrect; what might be qualified as medical decisive errors, committed in emergency ambulances or in admission rooms. Incorrect medical treatment consisted in negligence to perform necessary diagnostic examinations. In ten of the analyzed cases, the patients ultimately died.

  13. 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. ...

  14. 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…

  15. [Organisational responsibility versus individual responsibility: safety culture? About the relationship between patient safety and medical malpractice law].

    PubMed

    Hart, Dieter

    2009-01-01

    The contribution is concerned with the correlations between risk information, patient safety, responsibility and liability, in particular in terms of liability law. These correlations have an impact on safety culture in healthcare, which can be evaluated positively if--in addition to good quality of medical care--as many sources of error as possible can be identified, analysed, and minimised or eliminated by corresponding measures (safety or risk management). Liability influences the conduct of individuals and enterprises; safety is (probably) also a function of liability; this should also apply to safety culture. The standard of safety culture does not only depend on individual liability for damages, but first of all on strict enterprise liability (system responsibility) and its preventive effects. Patient safety through quality and risk management is therefore also an organisational programme of considerable relevance in terms of liability law.

  16. Beliefs about tobacco industry (mal)practices and youth smoking behaviour: insight for future tobacco control campaigns (Canada).

    PubMed

    Leatherdale, Scott T; Sparks, Robert; Kirsh, Victoria A

    2006-06-01

    To examine how student beliefs about tobacco industry behaviour and marketing practices were related to occasional and regular smoking among 9th to 12th graders. These findings can provide insight for developing new tobacco industry denormalization messages for youth smoking populations. Cross-sectional data were collected from 14,767 grade 9 to 12 students attending 22 secondary schools within one Public Health Region of Canada using the Tobacco Module of School Heath Action, Planning and Evaluation System (SHAPES). Logistic regression analyses were used to determine if different beliefs about tobacco companies were able to differentiate never smokers from occasional smokers, and occasional smokers from regular smokers. Occasional and regular smoking behaviour was significantly related to student beliefs about tobacco companies doing good things in the community, manipulating young people to think smoking is cool, advertising to youth, and using athletes and sports sponsorships to get young people to smoke. This study identified that beliefs about tobacco industry behaviour and marketing practices were related to youth smoking behaviour. In order to address the unique needs of smoking youth, discussions for future tobacco industry denormalization campaigns should consider messages tailored to focus on corporate social responsibility, sport and cultural event sponsorship and industry manipulation.

  17. 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…

  18. 20 CFR 10.717 - Is a settlement or judgment received as a result of allegations of medical malpractice in...

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 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....

  19. 20 CFR 10.717 - Is a settlement or judgment received as a result of allegations of medical malpractice in...

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 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....

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 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....

  1. 20 CFR 10.717 - Is a settlement or judgment received as a result of allegations of medical malpractice in...

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 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....

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

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 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 documents...

  3. 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 documents...

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

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., paramedic, or other supporting personnel (including medical and dental technicians, nurse assistants... wrongful actions or omissions occurred during the performance of medical, dental, or related health...

  5. 32 CFR 536.80 - Payment of costs, settlements, and judgments related to certain medical malpractice claims.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., paramedic, or other supporting personnel (including medical and dental technicians, nurse assistants... wrongful actions or omissions occurred during the performance of medical, dental, or related health...

  6. 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

    ..., paramedic, or other supporting personnel (including medical and dental technicians, nurse assistants... wrongful actions or omissions occurred during the performance of medical, dental, or related health...

  7. 32 CFR 536.80 - Payment of costs, settlements, and judgments related to certain medical malpractice claims.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., paramedic, or other supporting personnel (including medical and dental technicians, nurse assistants... wrongful actions or omissions occurred during the performance of medical, dental, or related health...

  8. 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

    ..., paramedic, or other supporting personnel (including medical and dental technicians, nurse assistants... wrongful actions or omissions occurred during the performance of medical, dental, or related health...

  9. Lethal Bochdalek hernia in a three-year-old: pathological findings and medicolegal investigation in accusation of malpractice.

    PubMed

    Mobilia, Francesca; Andreola, Salvatore; Gentile, Guendalina; Palazzo, Elisa; Rancati, Alessandra; Zoja, Riccardo

    2013-01-01

    Diaphragmatic hernias can be a pitfall for paediatric diagnostics, especially in the cases of late presentation, which can also have medico-legal ramifications as exposed. A three-year-old boy was taken to a children's hospital after an episode of abdominal pain and vomiting of food. A physical examination proved normal, with mild ketonuria being found and he was discharged. Three months later for the same signs and symptoms, he was taken once more to hospital, where he arrived in a state of cardiac arrest and died. A lawsuit was begun against the doctors who had examined him three months earlier. The autopsy found herniation of the abdominal organs into the left pleural cavity through a defect in the left hemidiaphragm. The cause of death was identified as cardiac tamponade caused by mechanical compression of multiple herniated abdominal organs. The histopathological examination revealed marked atelectasis of the left lung, with non-expansion of 60-90% of the alveoli which suggested an acute mechanism that proved fatal, and the doctors were acquitted. The features of this disease and the possible difficulties in its diagnosis highlight the need for the utmost attention in differential diagnosis, even at an age where the discovery of a diaphragmatic hernia is exceedingly rare.

  10. Pharmacy Malpractice: The rate and prevalence of dispensing high-risk prescription-only medications at community pharmacies in Saudi Arabia.

    PubMed

    Alshammari, Thamir M; Alhindi, Salman A; Alrashdi, Ahmed M; Benmerzouga, Imaan; Aljofan, Mohamad

    2017-07-01

    To assess the compliance of community pharmacies with the regulations that prohibit the dispensing of prescription-only medications in the absence of a physician prescription in Saudi Arabia. A cross-sectional study was conducted in the period between October 2014 and January 2015. A list of 10 prescription-only medications were selected to be studied. 150 community pharmacies were visited across 6 major regions in Saudi Arabia to assess the prevalence of non-compliance among community pharmacies. Pharmacies were selected in random and researchers (disguised as patients) requested to purchase prescription-only medications in the absence of a prescription. Not all medications were purchased at once. Data were recorded per pharmacy, where pharmacies that approved dispense of the selected drug were scored as non-compliant and the pharmacies that rejected dispense of the selected drug were scored as compliant. Compliance rate was calculated per region per drug. Pharmacies based in governmental hospitals were visited in parallel. A total of 20 were visited. Data and statistical analysis were performed using Statistical Analyses Software (SAS 9.3). A total of 150 pharmacies were visited over a period of 3 months. On average, the percent approved dispense of prescription-only drugs across 6 regions in Saudi Arabia is 63% and the percent rejected dispense is 37% representing a significant non-compliance rate regarding the selected list of medications in this study. The frequency of dispense per medication across 6 major regions in Saudi Arabia is as follows: Isosorbide dinitrate (86%), Enoxaparin (82%), nitroglycerin (74%), Propranolol (73%), Verapamil (70%), Warfarin (65%), Methyldopa (64%), Ciprofloxacin (57%) and Codeine (4%). Non-compliance of community pharmacies with the law of pharmaceutical practice is at an alarming rate in the Kingdom of Saudi Arabia and authoritative figures must intervene to impede and combat such activities.

  11. Radiologist Found Liable for Malpractice in Israel for Causing a Patient's Suicide by Sending a "Bad News" Report: Can This Happen in the United States?

    PubMed

    Berlin, Leonard; Sosna, Jacob; Halevy, Dan

    2017-02-01

    The purpose of this article is to present an example of a non-U.S. lawsuit in which a radiologist was found negligent in the case of a psychiatric patient who died by suicide after reading a radiology report sent directly to him. Although the lawsuit and its outcome do not influence laws in the United States or any country other than the one in which the case was tried, it should stimulate the radiologic community into giving serious thought to the format and manner in which reports of radiologic examinations are communicated to patients.

  12. 45 CFR 60.2 - Applicability of these regulations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... requirements applicable to hospitals; health care entities; Boards of Medical Examiners State licensing...) making payments as a result of medical malpractice actions or claims. They also establish procedures...

  13. Reducing the Budget Deficit: The President’s Fiscal Commission and Other Initiatives

    DTIC Science & Technology

    2011-04-29

    numerous additional savings proposals from the Medicare and Medicaid programs, medical malpractice reform, and transforming the Federal Employees...accounts. In terms of health spending, the report recommended reforming the nation’s malpractice laws by limiting pain and suffering awards and...initiative/about. The task force comprised 19 members: former public officials representing all levels of government, academics , think tank experts, and

  14. Legal aspects of medication administration.

    PubMed

    Fiesta, J

    1998-01-01

    The author reviews several cases involving medication errors and advises that one way to make a malpractice case worse is to be accused of delay in informing the patient or family of the circumstances. If fraud or intentional concealment is established, punitive damages may be awarded--which are not covered by malpractice insurance policies since this is an intentional act.

  15. 75 FR 13290 - Agency Information Collection Activities: Proposed Collection: Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-19

    ... malpractice payments, adverse licensure actions, adverse clinical privileging actions, adverse professional.... Due to overlap in requirements for the Healthcare Integrity and Protection Data Bank (HIPDB), some of... 60.6(b) Revisions to Action 109 1 109 30 54.5 25 1,362.50 60.7(b) Medical Malpractice Payment Report...

  16. Medical Liability in the Light of New Hungarian Civil Code

    ERIC Educational Resources Information Center

    Barzó, Tímea

    2015-01-01

    The number of medical malpractice lawsuits filed each year in Hungary has considerably increased since the change of regime. 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.

  17. Medical Liability in the Light of New Hungarian Civil Code

    ERIC Educational Resources Information Center

    Barzó, Tímea

    2015-01-01

    The number of medical malpractice lawsuits filed each year in Hungary has considerably increased since the change of regime. 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.

  18. 38 CFR 14.601 - Investigation and development.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... development. 14.601 Section 14.601 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... development. (a) Development of untoward incidents. (1) A report of any collision involving a Government-owned.... (b) Development of medical malpractice claims. In medical malpractice cases, the Regional Counsel may...

  19. 38 CFR 14.601 - Investigation and development.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... development. 14.601 Section 14.601 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... development. (a) Development of untoward incidents. (1) A report of any collision involving a Government-owned.... (b) Development of medical malpractice claims. In medical malpractice cases, the Regional Counsel may...

  20. 38 CFR 14.601 - Investigation and development.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... development. 14.601 Section 14.601 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... development. (a) Development of untoward incidents. (1) A report of any collision involving a Government-owned.... (b) Development of medical malpractice claims. In medical malpractice cases, the Regional Counsel may...

  1. 38 CFR 14.601 - Investigation and development.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... development. 14.601 Section 14.601 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS... development. (a) Development of untoward incidents. (1) A report of any collision involving a Government-owned.... (b) Development of medical malpractice claims. In medical malpractice cases, the Regional Counsel may...

  2. Health care reform 2010: a fresh view on tort reform.

    PubMed

    Stimson, C J; Dmochowski, Roger; Penson, David F

    2010-11-01

    We reviewed the state of medical malpractice tort reform in the context of a new political climate and the current debate over comprehensive health care reform. Specifically we asked whether medical malpractice tort reform is necessary, and evaluated the strengths and weaknesses of contemporary reform proposals. The medical, legal and public policy literature related to medical malpractice tort reform was reviewed and synthesized. We include a primer for understanding the current structure of medical malpractice law, identify the goals of the current system and analyze whether these goals are presently being met. Finally, we describe and evaluate the strengths and weaknesses of the current reform proposals including caps on damages, safe harbors and health care courts. Medical malpractice tort law is designed to improve health care quality and appropriately compensate patients for medical malpractice injuries, but is failing on both fronts. Of the 3 proposed remedies, caps on damages do little to advance the quality and compensatory goals, while safe harbors and health care courts represent important advancements in tort reform. Tort reform should be included in the current health policy debate because the current medical malpractice system is not adequately achieving the basic goals of tort law. While safe harbors and health care courts both represent reasonable remedies, health care courts may be preferred because they do not rely on jury determination in the absence of strong medical evidence. Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  3. Medicolegal issues with regard to melanoma and pigmented lesions in dermatopathology.

    PubMed

    Marsch, Amanda; High, Whitney A

    2012-10-01

    Understanding malpractice risk and practicing risk management strategies results in better care and a less stressful environment of practice. Errors in diagnosis are most commonly related to melanoma and neoplasms of the skin. To offset the threat of malpractice litigation, malpractice data can be used to focus safety efforts on common diagnostic errors. Recognition of sources of error in the analysis of pigmented lesions by dermatopathologists, and the development of new immunohistochemical or genotypic techniques for the recognition and distinction of malignant disease from benign pigmented lesions, will also provide important improvements in care and diagnosis in the future. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. [Responsibilities of the resident in anesthesiology and postoperative care].

    PubMed

    Barrios Flores, L F

    2004-01-01

    Among medical specialties, anesthesiology/postoperative care has one of the highest rates of malpractice claims. This article treats the responsibilities of interns and residents in anesthesiology, their supervisors, and the institutions where they practice and receive training.

  5. Pacific Partners Wargame Analysis

    DTIC Science & Technology

    2014-09-01

    such as medical qualifications and malpractice considerations, can be explored as part of interoperability. Partner nations are motivated to...specialized problems. Intellectual exchanges and fora involving experts from government, industry, academic and other institutions could be employed in

  6. Writing Teachers Should Be Prepared for Legal Challenges.

    ERIC Educational Resources Information Center

    Sneed, Don

    1986-01-01

    Explores the nature of court litigation concerning academic accountability and malpractice. Discusses the implications of such litigation for writing instructors, and presents questions writing teachers should ask themselves in preparation for possible law suits. (HTH)

  7. 32 CFR 231.9 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... union facility. A facility employing a communications system with the parent credit union to conduct.... (t) Malpractice. Any unreasonable lack of skill or fidelity in fiduciary duties or the intentional...

  8. 20 CFR 10.806 - How are the maximum fees defined?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... based on a relative value scale that considers skill, labor, overhead, malpractice insurance and other related costs; and a monetary value assignment (conversion factor) for one unit of value in each of...

  9. Iatrogenic death: A review of cases from 1990-2000 investigated at the Department of Forensic Medicine, Vienna.

    PubMed

    Paula, Pia; Pöttinger, Iris; Kordina, Nicole; Schneider, Barbara; Risser, Daniele U

    2011-09-01

    Medical malpractice is a global problem which can have considerable financial and legal consequences for the community as well as personal consequences for those involved. Austria does not record any statistical and epidemiological data concerning medical malpractice cases. Data from 7,211 autopsy cases from the Department of Forensic Medicine in Vienna covering the period from 1990 to 2000 were analyzed. Fifty-five autopsy reports that were filed as suspected medical malpractice were recorded and analyzed. Thirty cases were classified as surgical incidents, 19 cases as negligence, and 6 cases as medication incidents. Out of a total of 40 cases from available court files, 36 cases were dropped, there were 2 acquittals and only two resulted in convictions. The number of instances of medical malpractice leading to iatrogenic deaths in Austria seems to be very low in comparison to other countries. The possibility that many cases go unnoticed needs to be taken into consideration.

  10. How liability law affects medical productivity.

    PubMed

    Kessler, Daniel P; McClellan, Mark B

    2002-11-01

    Previous research suggests that "direct" reforms to the liability system-reforms designed to reduce the level of compensation to potential claimants-reduce medical expenditures without important consequences for patient health outcomes. We extend this research by identifying the mechanisms through which reforms affect the behavior of health care providers. Although we find that direct reforms improve medical productivity primarily by reducing malpractice claims rates and compensation conditional on a claim, our results suggest that other policies that reduce the time spent and the amount of conflict involved in defending against a claim can also reduce defensive practices substantially. In addition, we find that "malpractice pressure" has a more significant impact on diagnostic rather than therapeutic treatment decisions. Our results provide an empirical foundation for simulating the effects of untried malpractice reforms on health care expenditures and outcomes, based on their predicted effects on the malpractice pressure facing medical providers.

  11. 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.

  12. A bill to amend chapter 171 of title 28, United States Code, (commonly referred to as the Federal Torts Claim Act) to extend medical malpractice coverage to free clinics and the officers, governing board members, employees, and contractors of free clinics in the same manner and extent as certain Federal officers and employees.

    THOMAS, 111th Congress

    Sen. Leahy, Patrick J. [D-VT

    2009-08-05

    08/05/2009 Read twice and referred to the Committee on the Judiciary. (text of measure as introduced: CR S8867) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  13. Health Care Technology Assessment. Hearing Before the Committee on Labor and Human Resources. United States Senate, Ninety-Eighth Congress, Second Session on Examination of the Health Cost Containment Issue: Health Technology Assessment; General Cost Containment Strategies; and Cost Implications of Defensive Medicine and Medical Malpractice.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

    This committee hearing was held to consider factors in federal suport of health care services, including the roles of professional organizations, insurance companies, and hospitals. The process of evaluating whether the use of medical technology, diagnostic tests, and therapeutic procedures are cost-effective and beneficial is identified as…

  14. A Primary Care Workload Production Model for Estimating Relative Value Unit Output

    DTIC Science & Technology

    2011-03-01

    that a similar future production capacity will be possible, as in the period studied. Significance of Study The academic body of knowledge...Conversion Factors (Adapted from AMA, 2010) To calculate payment amounts using the Medicare system, the practice expense, malpractice insurance and RVUs... Malpractice (PLI) RVU x PLI GPCI = Total RVU x CY 2011 Conversion Factor of $33.9764 = Payment Here, the Geographic Price

  15. Civil-Military Relations in Mexico: A Way Ahead

    DTIC Science & Technology

    2011-10-28

    Academic scholarship on civil-military affairs has consistently identified three common elements that are generally required for democratic control of the...21. 50 Henry Garcia-Valderamma, Mexico’s Military Malpractice : Business as Usual or about Face?, Washington, DC: The Council on Hemispheric Affairs...2006. Garcia-Valderamma, Henry. Mexico’s Military Malpractice : Business as Usual or about- Face? Washington, DC: The Council on Hemispheric Affairs

  16. The genesis of plastic surgeon claims. A review of recurring problems.

    PubMed

    Gorney, M; Martello, J

    1999-01-01

    The authors examine several cases in which malpractice claims are the result of either poor documentation, lack of preoperative photographs, inadequate informed consent, or poor patient-selection criteria. In each case, they discuss what errors took place and the end result of the claim. The cases presented in the article are intended to help readers avoid potential medical malpractice traps in the future and be diligent with office documentation.

  17. Reducing Risk with Clinical Decision Support

    PubMed Central

    Maloney, F.L.; Feblowitz, J.; Samal, L.; Sato, L.; Wright, A.

    2014-01-01

    Summary Objective Identify clinical opportunities to intervene to prevent a malpractice event and determine the proportion of malpractice claims potentially preventable by clinical decision support (CDS). Materials and Methods Cross-sectional review of closed malpractice claims over seven years from one malpractice insurance company and seven hospitals in the Boston area. For each event, clinical opportunities to intervene to avert the malpractice event and the presence or absence of CDS that might have a role in preventing the event, were assigned by a panel of expert raters. Compensation paid out to resolve a claim (indemnity), was associated with each CDS type. Results Of the 477 closed malpractice cases, 359 (75.3%) were categorized as substantiated and 195 (54%) had at least one opportunity to intervene. Common opportunities to intervene related to performance of procedure, diagnosis, and fall prevention. We identified at least one CDS type for 63% of substantiated claims. The 41 CDS types identified included clinically significant test result alerting, diagnostic decision support and electronic tracking of instruments. Cases with at least one associated intervention accounted for $40.3 million (58.9%) of indemnity. Discussion CDS systems and other forms of health information technology (HIT) are expected to improve quality of care, but their potential to mitigate risk had not previously been quantified. Our results suggest that, in addition to their known benefits for quality and safety, CDS systems within HIT have a potential role in decreasing malpractice payments. Conclusion More than half of malpractice events and over $40 million of indemnity were potentially preventable with CDS. PMID:25298814

  18. Unconventional dentistry: Part III. Legal and regulatory issues.

    PubMed

    Goldstein, B H

    2000-10-01

    This is the third in a series of 5 articles providing a contemporary overview and introduction to unconventional dentistry (UD) and its correlation to unconventional medicine (UM). UD presents issues of dental quackery, fraud and malpractice, and it also engenders professional concerns about public protection and professional risks. Case reports illustrate numerous issues. The reader is encouraged to evaluate the cases for problems related to malpractice, fraud, ethics, behaviours and professionalism. A discussion of ethical issues is beyond the scope of this paper.

  19. Medical professional liability and health care system reform.

    PubMed

    Dove, James T; Brush, John E; Chazal, Richard A; Oetgen, William J

    2010-06-22

    Few issues elicit more emotion from physicians than medical malpractice. The very word "malpractice" implies guilt and immediately places the involved physician on the defensive. Defensive medicine adds 5% to 9% to the cost of medical care. Numerous solutions have been proposed, but special interests have blocked the implementation of these solutions in most states. Tort reform is necessary to control the escalation of medical costs. Copyright (c) 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. The 2009 Influenza A(H1N1) Outbreak: Selected Legal Issues

    DTIC Science & Technology

    2009-05-06

    RL34708, Religious Exemptions for Mandatory Healthcare Programs: A Legal Analysis, by Cynthia Brougher. 102 The Center for Law and the Public’s...scenarios, questions have arisen regarding the potential civil liability of VHPs, particularly with regard to medical malpractice liability. The civil...Service Act Provisions Providing Immunity from Medical Malpractice Liability, by Henry Cohen; CRS Report 97-579, Making Private Entities and Individuals

  1. The 2009 Influenza A(H1N1) Outbreak: Selected Legal Issues

    DTIC Science & Technology

    2009-05-21

    Religious Exemptions for Mandatory Healthcare Programs: A Legal Analysis, by Cynthia Brougher. 102 The Center for Law and the Public’s Health tracks...questions have arisen regarding the potential civil liability of VHPs, particularly with regard to medical malpractice liability. The civil liability of...Immunity from Medical Malpractice Liability, by Henry Cohen; CRS Report 97-579, Making Private Entities and Individuals Immune from Tort Liability by

  2. [Medical responsibility and nosocomial infections].

    PubMed

    Scolan, V; Telmon, N; Rouge, J C; Rouge, D

    2000-04-01

    Modifications of the civil and administrative jurisprudence regarding nosocomial infections reflect the will to pay the patient for compensation for injury. The June 29, 1999 decree of the French Court of Cessation shows the transition from presumption of malpractice to obligation of safety. The authors describe those modifications, including the physician's and hospital liabilities, and assess their consequences, as proof of an external cause is now mandatory while proof of absence of malpractice is no longer sufficient.

  3. Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists

    PubMed Central

    Reuveni, I; Pelov, I; Reuveni, H; Bonne, O; Canetti, L

    2017-01-01

    Objective Psychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice liability that is not for the sole benefit of the patient's mental health and well-being. The objectives of this study were to assess the scope of DP practised by psychiatrists and to understand whether awareness of DP correlated with defensive behaviours. Methods A questionnaire was administered to 213 Israeli psychiatry residents and certified psychiatrists during May and June 2015 regarding demographic data and experience with malpractice claims, medicolegal literature and litigation. Four clinical scenarios represented defensive behaviours and reactions (feelings and actions) to malpractice claims. Results Forty-four (20.6%) certified psychiatrists and four (1.9%) residents were directly involved in malpractice claims, while 132 (62.1%) participants admitted to practising DP. Residents acknowledged the practice of DP more than did senior psychiatrists (p=0.038). Awareness of DP correlated with unnecessary hospitalisation of suicidal patients, increased unnecessary follow-up visits and prescribing smaller drug dosages than required for pregnant women and elderly patients. Conclusions This study provides evidence that DP is well established in the routine clinical daily practice of psychiatrists. Further studies are needed to reveal whether DP effectively protects psychiatrists from malpractice suits or, rather, if it impedes providing quality psychiatric care and represents an economic burden that leads to more harm for the patient. PMID:28320795

  4. Burnout, depression, and career satisfaction: cross-sectional study of obstetrics and gynecology residents.

    PubMed

    Becker, Julie L; Milad, Magdy P; Klock, Susan C

    2006-11-01

    This study was undertaken to measure career satisfaction among obstetrics and gynecology residents and assess its relationship to burnout, depression, and malpractice concerns. A 63-item, anonymous, self-administered survey was distributed to residents at 23 randomly selected obstetric and gynecologic residency programs in the United States. The outcome measures included the Maslach Burnout Inventory-Human Services Survey, the Center for Epidemiological Studies-Depression Scale, and perceptions of malpractice and career satisfaction. Eighty-three percent of the residents were either "very or somewhat satisfied" with their career choice. The majority (89.8%) showed evidence of moderate burnout and 34.2% were considered depressed. Ninety-six percent were concerned about malpractice with 35% pursuing fellowship solely because of malpractice concerns. Residents dissatisfied with their career choice were twice as likely to be depressed (30% vs 55%, P = .03). Both emotional exhaustion (P < .0001) and consideration of fellowship because of malpractice (P < .0001) were strongly predictive of diminishing career satisfaction. Resident career satisfaction was inversely correlated with burnout and depression, which were more prevalent than expected. Overall, residents were satisfied with their career choice, but also negatively influenced by malpractice concerns.

  5. Controlling Legal Risk for Effective Hospital Management.

    PubMed

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

    2016-04-01

    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. 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. 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). 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.

  6. Revisiting Postoperative Vision Loss following Non-Ocular Surgery: A Short Review of Etiology and Legal Considerations.

    PubMed

    Mendel, Ehud; Stoicea, Nicoleta; Rao, Rahul; Niermeyer, Weston; Revilla, Stephen; Cluse, Marcus; Sandhu, Gurneet; Todaro, Gerald J; Bergese, Sergio D

    2017-01-01

    Postoperative vision loss (POVL) following non-ocular surgery is a serious complication where the causes are not fully understood. Studies have identified several causes of POVL as well as risk factors and prevention strategies. POVL research is made difficult by the fact that cases are often subject to malpractice claims, resulting in a lack of public access to case reports. This literature review was conducted in order to identify legal issues as a major barrier to studying POVL and address how this affects current knowledge. Informed consent provides an opportunity to overcome legal challenges by reducing malpractice litigation through educating the patient on this outcome. Providing pertinent information regarding POVL during the informed consent process has potential to reduce malpractice claims and increase available clinical information.

  7. Low costs of defensive medicine, small savings from tort reform.

    PubMed

    Thomas, J William; Ziller, Erika C; Thayer, Deborah A

    2010-09-01

    In this paper we present the costs of defensive medicine in thirty-five clinical specialties to determine whether malpractice liability reforms would greatly reduce health care costs. Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.

  8. Revisiting Postoperative Vision Loss following Non-Ocular Surgery: A Short Review of Etiology and Legal Considerations

    PubMed Central

    Mendel, Ehud; Stoicea, Nicoleta; Rao, Rahul; Niermeyer, Weston; Revilla, Stephen; Cluse, Marcus; Sandhu, Gurneet; Todaro, Gerald J.; Bergese, Sergio D.

    2017-01-01

    Postoperative vision loss (POVL) following non-ocular surgery is a serious complication where the causes are not fully understood. Studies have identified several causes of POVL as well as risk factors and prevention strategies. POVL research is made difficult by the fact that cases are often subject to malpractice claims, resulting in a lack of public access to case reports. This literature review was conducted in order to identify legal issues as a major barrier to studying POVL and address how this affects current knowledge. Informed consent provides an opportunity to overcome legal challenges by reducing malpractice litigation through educating the patient on this outcome. Providing pertinent information regarding POVL during the informed consent process has potential to reduce malpractice claims and increase available clinical information. PMID:28695122

  9. 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.

  10. Determining legal responsibility in otolaryngology: a review of 44 trials since 2008.

    PubMed

    Svider, Peter F; Husain, Qasim; Kovalerchik, Olga; Mauro, Andrew C; Setzen, Michael; Baredes, Soly; Eloy, Jean Anderson

    2013-01-01

    Medicolegal factors contribute to increasing healthcare costs through the direct costs of malpractice litigation, malpractice insurance premiums, and defensive medicine. Malpractice litigation trends are constantly changing as a result of technological innovations and changes in laws. In this study, we examine the most recent legal decisions related to Otolaryngology and characterize the factors responsible for determining legal responsibility. The Westlaw legal database (Thomson Reuters, New York, NY) was used to search for jury verdicts since 2008 in Otolaryngology malpractice cases. The 44 cases included in this analysis were studied to determine the procedures most commonly litigated and progressing to trial, as well as the year, location, alleged cause of malpractice, specialty of co-defendants, and case outcomes. Out of the 44 cases included in this analysis, physicians were not found liable in 36 (81.8%) cases. Rhinologic procedures comprised 38.6% of cases litigated, and rulings were in physicians' favor in 66.7% of endoscopic sinus surgery (ESS) cases and all non-ESS rhinologic cases. A perceived lack of informed consent was noted in 34.1% of cases. The 8 jury awards averaged $940,000 (range, $148,000-$3,600,000). Otolaryngologists were not found liable in the majority of cases reviewed. Rhinologic surgeries were the most common procedures resulting in litigation. Adenotonsillectomies, thyroidectomies, and airway management are also well-represented. Perceived deficits in informed consent and misdiagnosis were noted in a considerable proportion of otolaryngologic malpractice cases resulting in jury decisions. Copyright © 2013 Elsevier Inc. All rights reserved.

  11. Medical Liability and Patient Law in Germany: Main Features with Particular Focus on Treatments in the Field of Interventional Radiology.

    PubMed

    Sommer, S A; Geissler, R; Stampfl, U; Wolf, M B; Radeleff, B A; Richter, G M; Kauczor, H-U; Pereira, P L; Sommer, C M

    2016-04-01

    On February 26th, 2013 the patient law became effective in Germany. Goal of the lawmakers was a most authoritative case law for liability of malpractice and to improve enforcement of the rights of the patients. The following article contains several examples detailing legal situation. By no means should these discourage those persons who treat patients. Rather should they be sensitized to to various aspects of this increasingly important field of law. To identify relevant sources according to judicial standard research was conducted including first- and second selection. Goal was the identification of jurisdiction, literature and other various analyses that all deal with liability of malpractice and patient law within the field of Interventional Radiology--with particular focus on transarterial chemoembolization of the liver and related procedures. In summary, 89 different sources were included and analyzed. The individual who treats a patient is liable for an error in treatment if it causes injury to life, the body or the patient's health. Independent of the error in treatment the individual providing medical care is liable for mistakes made in the context of obtaining informed consent. Prerequisite is the presence of an error made when obtaining informed consent and its causality for the patient's consent for the treatment. Without an effective consent the treatment is considered illegal whether it was free of treatment error or not. The new patient law does not cause material change of the German liablity of malpractice law. •On February 26th, 2013 the new patient law came into effect. Materially, there was no fundamental remodeling of the German liability for medical malpractice. •Regarding a physician's liability for medical malpractice two different elements of an offence come into consideration: for one the liability for malpractice and, in turn, liability for errors made during medical consultation in the process of obtaining informed consent.

  12. Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists.

    PubMed

    Reuveni, I; Pelov, I; Reuveni, H; Bonne, O; Canetti, L

    2017-03-20

    Psychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice liability that is not for the sole benefit of the patient's mental health and well-being. The objectives of this study were to assess the scope of DP practised by psychiatrists and to understand whether awareness of DP correlated with defensive behaviours. A questionnaire was administered to 213 Israeli psychiatry residents and certified psychiatrists during May and June 2015 regarding demographic data and experience with malpractice claims, medicolegal literature and litigation. Four clinical scenarios represented defensive behaviours and reactions (feelings and actions) to malpractice claims. Forty-four (20.6%) certified psychiatrists and four (1.9%) residents were directly involved in malpractice claims, while 132 (62.1%) participants admitted to practising DP. Residents acknowledged the practice of DP more than did senior psychiatrists (p=0.038).Awareness of DP correlated with unnecessary hospitalisation of suicidal patients, increased unnecessary follow-up visits and prescribing smaller drug dosages than required for pregnant women and elderly patients. This study provides evidence that DP is well established in the routine clinical daily practice of psychiatrists. Further studies are needed to reveal whether DP effectively protects psychiatrists from malpractice suits or, rather, if it impedes providing quality psychiatric care and represents an economic burden that leads to more harm for the patient. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  13. The US Medical Liability System: evidence for legislative reform.

    PubMed

    Guirguis-Blake, Janelle; Fryer, George E; Phillips, Robert L; Szabat, Ronald; Green, Larry A

    2006-01-01

    Despite state and federal efforts to implement medical malpractice reform, there is limited evidence on which to base policy decisions. The National Practitioner Data Bank (NPDB) offers an opportunity to evaluate the effects of previous malpractice tort reforms on malpractice payments and premiums. For every state and the District of Columbia, we calculated the number of malpractice payments, total amount paid, and average payment from NPDB data reported from 1999 through 2001. We analyzed 44,913 claims using logistic regression to study associations between payments, physician premiums, and 10 state statutory tort reforms. Wide variations exist in malpractice payments among states. The reforms most associated with lower payments and premiums were total and noneconomic damage caps. Mean payments were 26% lower in states with total damage caps (196,495.34 dollars vs 265,554.50 dollars, P = .001). Mean payments were 22% less in states with noneconomic damage caps (219,225.98 dollars vs 279,849.86 dollars, P = .010). Total damage caps were associated with lower mean annual premiums, especially for obstetricians (22,371.57 dollars vs 42,728.68 dollars, P <.001). Hard noneconomic damage caps were associated with premium reductions for obstetricians (30,283.75 vs 45,740.88; P = .039). Significant reductions in malpractice payments could be realized if total or noneconomic damage caps were operating nationally. Hard noneconomic damage and total damage caps could yield lower premiums. If tied to a comprehensive plan for reform, the money saved could be diverted to implement alternative approaches to patient compensation or be used to achieve other systems reform benefiting patients, employers, physicians, and hospitals.

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

    PubMed

    AbuDagga, Azza; Wolfe, Sidney M; Carome, Michael; Oshel, Robert E

    2016-01-01

    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. 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. 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 were not disciplined by medical boards for this

  15. 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.

  16. The law and dentoalveolar complications: trends and controversies.

    PubMed

    Curley, Arthur W

    2011-08-01

    Complications are an inherent part of oral and maxillofacial surgery. A risk in surgery is a complication that occurs despite treatment that meets or exceeds the professional standard of care. When treatment fails to meet the standard of care, a complication may be considered the result of malpractice, resulting in claims for compensation. Whether a surgical procedure meets the standard of care is determined by expert witnesses evaluating the evidence. This article reviews legal issues and cases where complications have resulted in claims of malpractice. Recommendations for patient communication and documentation to reduce or eliminate such claims are presented. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Dubin calls on CMPA to eliminate fee differentials, adopt flat fee for all physicians.

    PubMed

    Sullivan, P

    1997-03-01

    Charles Dubin's massive review of the Canadian Medical Protective Association supports the CMPA's policy of maintaining a large reserve for malpractice coverage, but calls for a major overhaul of the association's fee structure. Regardless of the risks their practices pose, says Dubin, all doctors should pay the same fee in order to keep physicians practising in high-risk specialties such as obstetrics and orthopedic surgery. The alternative, said CMPA president Dr. Bill Thomas, is an exodus from certain specialties because of massive bills for malpractice insurance.

  18. 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…

  19. 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)

  20. Regulation of Health Policy: Patient Safety and the States

    DTIC Science & Technology

    2005-05-01

    relationship between AE and malpractice.26, 27 Finally, we searched Internet databases—including Google,™ MEDLINE,® Westlaw ,® and PubMed®—for the current...State legislation,” which revealed no matches), and Westlaw revealed 149 matches. We excluded reports of pending legislation, unless it appeared that

  1. 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)

  2. New Directions--In Social Studies

    ERIC Educational Resources Information Center

    Prince, Doris

    1978-01-01

    Failure to become involved in the critical issues of our times is viewed as a critical malpractice for all ages of students. Discusses some promising practices designed to help students to see social problems from a world perspective and to help them relate to their own social and political world. (Author/RK)

  3. Demographic, Educational, and Psychosocial Factors Influencing the Choices of Primary Care and Academic Medical Careers.

    ERIC Educational Resources Information Center

    Rubeck, Robert F.; And Others

    1995-01-01

    A survey of 246 primary care and 90 academic physicians found that for the former, length of training, direct patient contact, and threats of malpractice suits were significant influences in career choice. For the latter, long-term research participation, intellectual stimulation, specialty content, and mentor or role model were more significant…

  4. The Overreliance of Accreditors on Consensus Standards.

    ERIC Educational Resources Information Center

    Murray, Frank B.

    2001-01-01

    Argues that the legitimacy of accreditation in teacher education is rooted in political consensus, power, and scholarship. Because these roots are fragile, there is no accepted concept of educational malpractice. The legitimacy of accreditation should be rooted in scholarly evidence that the program has fulfilled the claim that its graduates are…

  5. Psychological Factors Associated with Language in the Education of the African-American Child.

    ERIC Educational Resources Information Center

    Hilliard, Asa G., III

    1983-01-01

    The effects of language in education are rarely accounted for in (1) measurement of intelligence; (2) diagnosis of language, speech, or learning pathology; (3) reading ability measurement; and (4) educator attitudes toward language variations. Educational malpractice in these areas may have negative effects on identity development among…

  6. Consumer Rights in Academe.

    ERIC Educational Resources Information Center

    Vago, Stephen

    1979-01-01

    Attempts in both academia and the legal arena to delineate the concepts of academic fraud and malpractice and to develop the positive implications of the student as a responsible consumer may lead to the establishment of a more appropriate student-institution relationship for today's highly diversified and demanding college learners. (Author/EB)

  7. Rebels without a Clause: Towards an Institutional Framework for Dealing with Plagiarism by Students

    ERIC Educational Resources Information Center

    Park, Chris

    2004-01-01

    This paper explores why an institutional framework for dealing with plagiarism by students is necessary and it outlines the main ingredients of such a framework that has been developed at Lancaster University. It defines plagiarism as a form of academic malpractice and frames it as a breach of academic integrity. The framework places a strong…

  8. Postmodern Moonshine in English 101

    ERIC Educational Resources Information Center

    Miller, Nan

    2006-01-01

    Theorists have usurped English composition. They have banished great literature as the residual oppression of dead white males. They control groups like the NCTE and MLA, which announce that exercises in grammar and the mechanics of writing are "deleterious" for students tantamount to "malpractice." Nan Miller reminds those…

  9. A Second Survey of Graduates of a Traditionally Black College of Medicine.

    ERIC Educational Resources Information Center

    Johnson, Davis G.; And Others

    1989-01-01

    A 1985-86 Howard University College of Medicine survey of graduates confirmed that the predominantly Black alumni were continuing to provide patient care to a substantial number of poor Blacks in urban areas. Findings included concerns about malpractice suits and physician impairment. (Author/MLW)

  10. A Common Law Remedy for the Educational Harms Caused by Incompetent or Careless Teaching.

    ERIC Educational Resources Information Center

    Elson, John

    1978-01-01

    Discusses the general policy considerations that will bear on a court's willingness to decide issues of educational negligence (malpractice) and sets forth alternative legal theories that could support such a cause of action and analyzes their relative probabilities of success. Available from Northwestern University School of Law, Chicago,…

  11. How Issues of Professional Liability Are Taught in U.S. Medical Schools.

    ERIC Educational Resources Information Center

    Hamilton, Thomas E.

    1991-01-01

    A survey of 120 medical schools found 61 percent have curricula on professional liability. Many indicated students' training has been compromised or jeopardized by physicians' concerns about medicolegal issues, and many had students named in malpractice suits. Findings suggest issues of professional liability have significantly affected…

  12. Reinventing Education through School Improvement Research That Has Resulted in Student Gains.

    ERIC Educational Resources Information Center

    Achilles, C. M.; Nye, B. A.

    Some of the concern about educators' failures to build a strong educational foundation revolves around the idea of "professional" and its relationship to the concept of "malpractice." Educators usually claim that education is a profession of practice and thus ought to embody at least a generalized statement about professional…

  13. Improving Learner Achievement through Evaluation by Objectives.

    ERIC Educational Resources Information Center

    Sullivan, Howard J.

    Evaluation techniques were designed to improve learner performance through use of pre-specified popular instructional objectives. Current curriculum planning and evaluation practices are examined. Two common evaluation malpractices are: (1) the tendency to treat the content of the program as the most important criterion for evaluation, (2) the…

  14. Demographic, Educational, and Psychosocial Factors Influencing the Choices of Primary Care and Academic Medical Careers.

    ERIC Educational Resources Information Center

    Rubeck, Robert F.; And Others

    1995-01-01

    A survey of 246 primary care and 90 academic physicians found that for the former, length of training, direct patient contact, and threats of malpractice suits were significant influences in career choice. For the latter, long-term research participation, intellectual stimulation, specialty content, and mentor or role model were more significant…

  15. Medicolegal issues in cluster headache.

    PubMed

    Loder, Elizabeth; Loder, John

    2004-04-01

    This paper identifies legal issues of relevance to the diagnosis and treatment of cluster headache, including areas of actual and potential malpractice liability. Legal topics that are relevant to cluster headache can be divided into five categories: diagnostic-related issues, risks inherent in the disease process, prescribing and treatment-related problems, research-related issues, and disability determination.

  16. 38 CFR 17.56 - Payment for non-VA physician and other health care professional services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... nationally uniform relative value for the service; a geographic adjustment factor for each physician fee... the relative values into payment amounts. For each physician fee schedule service, there are three relative values: An RVU for physician work; an RVU for practice expense; and an RVU for malpractice...

  17. 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.…

  18. 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.

  19. The National Practitioner Data Bank: information for and about midwifery.

    PubMed

    Jevitt, Cecilia; Schuiling, Kerri Durnell; Summers, Lisa

    2005-01-01

    The National Practitioner Data Bank (NPDB), mandated by federal legislation in 1986, serves as a mechanism to protect the public from unsafe practitioners who attempt to avoid discovery of prior negligent behavior or malpractice record(s) by moving from state to state. Reporting to the NPDB about malpractice payments on behalf of nurse-midwives began in 1990. Reporting of providers excluded from Medicare and Medicaid program participation began in September 1999. Practitioners who were already in an excluded status at that time were reported. Reports of adverse action against a nurse-midwife can be submitted to the NPDB by a state licensure board, a governmental agency, hospitals, health maintenance organizations, or other health care organizations. Reporting of licensing actions and clinical privilege actions are not required, although these may be voluntarily reported. The NPDB received 484 reports about nurse-midwives from September 1, 1999, to March 31, 2005. Of the 484 reports, 375 have an obstetric malpractice code. The median claim payment made on behalf of nurse-midwives during this period is 225,000 dollars. Although limited, the NPDB is the only systematic national source of nurse-midwifery malpractice data collection.

  20. 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.…

  1. 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,…

  2. [Healthcare mediation model for nerologists].

    PubMed

    Ando, Tetsuo

    2011-11-01

    Mediation offers a process by which two parties work towards an agreement with the aid of a neutral third party. Physicians and nurses can apply healthcare mediation model to ordinary medical practice for preventing conflict. Communication using mediation skills improves patient-physician relationship, and prevents medical malpractice and conflict.

  3. A Note on Academic Plagiarism.

    ERIC Educational Resources Information Center

    Saunders, David

    1993-01-01

    It is argued that academic plagiarism is not addressed as vigorously as needed because the university code of professional conduct is not fully evolved and does not consider plagiarism as malpractice. In treating the problem, it is suggested that one place to start is teaching proper use of citation and annotation. (MSE)

  4. Influencers of Career Choice among Allied Health Students.

    ERIC Educational Resources Information Center

    Brown-West, Anne P.

    1991-01-01

    Major influences on career choice among 153 allied health students were need to help others, prestige, autonomy, and advancement and income potential. Risk of malpractice suits and Acquired Immune Deficiency Syndrome were negative influences for medical laboratory majors, but not for dietetics and physical therapy majors. (SK)

  5. 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…

  6. 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…

  7. 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.

  8. 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.

  9. Instructional Activities of Staff Personnel in the Affective Domain in Selected Secondary Schools in Southern Nigeria

    ERIC Educational Resources Information Center

    Olubor, R. O.; Ogonor, B. O.

    2007-01-01

    The tendency of restive secondary school graduates to be used in carrying out vices such as violence, examination malpractice, thuggery and cultism has necessitated this study. In total, 250 secondary school teachers undertaking part-time bachelor of education program in the University of Benin, formed the sample of this study. Simple percentage,…

  10. 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…

  11. 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,…

  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. Teacher Education in Central Equatoria, South Sudan

    ERIC Educational Resources Information Center

    Hahs Brinkley, Catherine

    2016-01-01

    Without education, many South Sudanese will continue living in poverty. There are numerous factors that limit their educational opportunities including tribal warfare, colonialism, missionary malpractice, civil wars, a high illiteracy rate, low government funding, and threats of war. These factors have left a substantial deficiency in available…

  14. 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.…

  15. 32 CFR 537.8 - Investigation.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., for example, vehicle defects or improper maintenance, road design and absence of warning signs, products liability, medical malpractice in civilian treatment facilities. Where the employment of experts... (HIPAA) medical release form (sample posted at the USARCS Web site; see § 537 (b)(4)) permitting USARCS...

  16. 32 CFR 537.8 - Investigation.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., for example, vehicle defects or improper maintenance, road design and absence of warning signs, products liability, medical malpractice in civilian treatment facilities. Where the employment of experts... (HIPAA) medical release form (sample posted at the USARCS Web site; see § 537 (b)(4)) permitting USARCS...

  17. 32 CFR 537.8 - Investigation.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., for example, vehicle defects or improper maintenance, road design and absence of warning signs, products liability, medical malpractice in civilian treatment facilities. Where the employment of experts... (HIPAA) medical release form (sample posted at the USARCS Web site; see § 537 (b)(4)) permitting USARCS...

  18. Legal issues related to vascular access devices and infusion therapy.

    PubMed

    Masoorli, Sue

    2005-01-01

    Infusion therapies are being delivered in many healthcare settings including hospitals, homecare settings, long-term care facilities, occupational health facilities, outpatient units, and physician offices. Nurses who infuse medications must be properly educated to recognize vascular access complications and initiate the proper interventions. This article discusses the high-risk areas of nursing malpractice related to infusion therapies.

  19. The Course in Professionalism at the University of Pennsylvania.

    ERIC Educational Resources Information Center

    Riser, Wayne H.

    1979-01-01

    A course to help students adjust to a practicing career as a veterinarian included sessions on: opportunities in the field, choosing a specialty and location; applying for jobs; women in practice; finances; improving professional skills; the veterinarian as hospital administrator; and malpractice and health insurance. (BH)

  20. Suicide and the Standard of Care: Optimal vs. Acceptable.

    ERIC Educational Resources Information Center

    Berman, Alan L.; Cohen-Sandler, Roni

    1982-01-01

    Discusses accepted standards of care for suicidal patients from the perspectives of the law, malpractice insurance claims, the mental health professions, and the ideal. A review of decisions of professional liability provides guidelines for what the court considers to be adequate care, suggesting an acceptance of minimal standards. (JAC)