Science.gov

Sample records for malpractice

  1. Information Practice and Malpractice.

    ERIC Educational Resources Information Center

    Mintz, Anne P.

    1985-01-01

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

  2. Physician medical malpractice

    PubMed Central

    LeMasurier, Jean

    1985-01-01

    Malpractice insurance premiums for physicians have increased at an average rate of over 30 percent per year. This rate is significantly higher than health care cost inflation and the increase in physician costs. Trends indicate that malpractice related costs, both liability insurance and defensive medicine costs, will continue to increase for the near future. Pressures to limit physician costs under Medicare raise a concern about how malpractice costs can be controlled. This paper presents an overview of the problem, reviews options that are available to policymakers, and discusses State and legislative efforts to address the issue. PMID:10311396

  3. The Malpractice Feud

    PubMed Central

    Obayuwana, Alphonsus O.

    1981-01-01

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

  4. 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

  5. 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.

  6. [International malpractice law].

    PubMed

    Stellpflug, M H

    2001-10-01

    According to German Civil Law the liability of a physician in telemedicine can be based on the breach of contractual duties or tort. In telemedicine doctor and patient are separated by distance. In the case of cross border telemedicine Medical Malpractice Law becomes an international issue with many new questions arising. The rules and regulations of "private international law" determine which law has to be applied. The German private international law allows the patient to choose either the law of the state in which the doctor acts or that state in which the therapeutical damage is being suffered. Another important question arises in determining the jurisdiction (of a court). The European agreements give the patient the right to choose. A "choice of jurisdiction clause" or a "choice of law clause" can help to decide with binding force which law and what jurisdiction has to be applied. However, various regulations concerned with consumer protection restrict the permission of such agreements.

  7. [International malpractice law].

    PubMed

    Stellpflug, M H

    2001-10-01

    According to German Civil Law the liability of a physician in telemedicine can be based on the breach of contractual duties or tort. In telemedicine doctor and patient are separated by distance. In the case of cross border telemedicine Medical Malpractice Law becomes an international issue with many new questions arising. The rules and regulations of "private international law" determine which law has to be applied. The German private international law allows the patient to choose either the law of the state in which the doctor acts or that state in which the therapeutical damage is being suffered. Another important question arises in determining the jurisdiction (of a court). The European agreements give the patient the right to choose. A "choice of jurisdiction clause" or a "choice of law clause" can help to decide with binding force which law and what jurisdiction has to be applied. However, various regulations concerned with consumer protection restrict the permission of such agreements. PMID:11688223

  8. Malpractice in psychotherapy: an overview.

    PubMed

    Conte, H R; Karasu, T B

    1990-04-01

    This paper gives a capsule review of the major issues on the subject of malpractice for individual practitioners of psychotherapy. It examines the elements necessary to support a malpractice claim and presents examples of cases in specific areas of liability. Historically, the field of psychotherapeutic malpractice was largely inactive. However, recent court rulings reveal that psychotherapists are no longer immune to malpractice suits. In decreasing order of the likelihood of the plantiffs being successful in their suits are cases involving the misuse of the therapeutic relationship, breach of confidentiality, and cases that involve prevention of harm to third parties and to patients themselves. Malpractice suits based on negligence in providing appropriate treatment are beginning to emerge and will probably increase in frequency as the efficacy of biological treatment is demonstrated. Available solutions to the problems of malpractice are discussed. It is suggested that in addition to the existing external sanctions, there is a need for consultation plus educational programs to enhance our ability to practice within the boundaries that the courts have set for us.

  9. Autopsy profiles of malpractice cases.

    PubMed

    Pakis, Isil; Yayci, Nesime; Karapirli, Mustafa; Gunce, Elif; Polat, Oguz

    2009-01-01

    Claims for medical malpractice and the number of lawsuits filed thereafter are increasing in Turkey as is the case throughout the world. In the present study all files issued by the associated boards of the Council of Forensic Medicine between 2001 and 2005 were studied and of those, 525 death cases in which there was a medical malpractice claim were included. 303 of the cases (57.7%) were male, 215 (41%) were female, while no gender was mentioned in seven cases (1.3%). The age of the subjects ranged between 0 and 90, with an average of 26.8. 147 cases (28%) were related to Emergency Units. 92% of the cases (482 cases) were resolved in the Council of Forensic Medicine, Ministry of Justice. 167 of the resolved cases were concluded as medical malpractice.

  10. 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

  11. Anatomy of a malpractice lawsuit.

    PubMed

    Prevatt, Haley A; Sturgill, T Cornelius; Austin, J Brent; Seif, Elizabeth R; Schwartz, Richard W

    2007-03-01

    Given the prevalence of medical malpractice lawsuits, physicians are often thrust into the legal world without the education of a juris doctor. The risk of facing suit varies among specialties, but there is no guarantee any physician will proceed through his or her career without being a defendant in a lawsuit. Every physician stands a significant chance of being sued. Although a lawsuit is an exhausting and intimidating situation in and of itself, the ramifications of a plaintiff's verdict could have chilling effects on the physician's life, both professionally and personally. Therefore, it is imperative that every physician have an understanding of the legal process of which he or she may become involved. This article provides a practical guide for the physician, including the fundamental procedures of a medical malpractice lawsuit, the behavior that will be expected or required of the defendant physician, and the effect of disobeying the required procedures.

  12. Some thoughts on dental malpractice.

    PubMed

    Morris, W O

    1976-06-01

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

  13. [Postvaccinal complication and medical malpractice law].

    PubMed

    Posa, A; Zierz, S

    2016-06-01

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

  14. 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;…

  15. The Current Controversy of Educational Malpractice.

    ERIC Educational Resources Information Center

    McGee, Jerry C.; Andrews, Kathy

    The educational malpractice debate surfaced in the 1970's and has intensified during recent years. The fundamental issue is whether a student or a parent may seek monetary damages for negligence in classifying, placing, or teaching the student. The courts have consistently denied claims of educational malpractice, basing their decisions on…

  16. 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.

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

    PubMed

    Frese, Richard C; Kitchen, Patrick J

    2012-11-01

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

  18. American medical malpractice litigation in historical perspective.

    PubMed

    Mohr, J C

    2000-04-01

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

  19. THE CALIFORNIA MEDICAL MALPRACTICE PICTURE.

    PubMed

    RUBSAMEN, D S

    1963-11-01

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

  20. 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…

  1. 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…

  2. Medical malpractice: the experience in Italy.

    PubMed

    Traina, Francesco

    2009-02-01

    At the present time, legal actions against physicians in Italy number about 15,000 per year, and hospitals spend over 10 billion euros (approximately 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.

  3. Medical Malpractice: The Experience in Italy

    PubMed Central

    2008-01-01

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

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

    PubMed

    Pilling, János; Erdélyi, Kamilla

    2016-04-24

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

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

    PubMed

    Fraser, J J

    1997-01-01

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

  6. The Current State of Medical Malpractice in Urology.

    PubMed

    Sherer, Benjamin A; Coogan, Christopher L

    2015-07-01

    Medical malpractice can present an unwelcome professional, emotional, and economic burden to the practicing urologist. To date, there is a paucity of data specific to urologic malpractice in the literature. We performed a comprehensive literature search to identify and evaluate recent studies related to urologic malpractice. We also analyzed 6249 closed urologic claims from the largest available specialty-specific data set gathered by Physician Insurers Association of America from 1985 to 2012. The resulting comprehensive review seeks to raise awareness of current trends in the malpractice environment specific to urologic surgery while also helping urologists identify opportunities for risk management and improved patient care.

  7. 45 CFR 60.7 - Reporting medical malpractice payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... amount specified at 42 CFR 1003.103(c). (d) Interpretation of information. A payment in settlement of a... 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...

  8. 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.

  9. 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…

  10. Doctors, damages and deterrence. An economic view of medical malpractice.

    PubMed

    Schwartz, W B; Komesar, N K

    1978-06-01

    Damages awarded in a malpractice suit must be viewed not only as compensating the victim but also as deterring health-care providers from negligent behavior. Economic analysis of the malpractice system indicates that awards can send a signal to providers that informs them how much to invest in avoiding mishaps. The malpractice system is beset by difficulties, but not the ones commonly incriminated. The signal to the physician, as determined by the number of claims and size of awards ("expected damages"), appears to be insufficient for ideal deterrence. Moreover, the deterrence signal is attenuated because malpractice premiums are set for groups of physicians, not for individuals according to their record of previous malpractice incidents. Replacing the present tort system with a no-fault insurance scheme would not necessarily be cheaper, and might well abolish the deterrent signal or distort clinical decision making.

  11. The Regulation of Medical Malpractice in Japan

    PubMed Central

    2008-01-01

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

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

    PubMed

    Zhu, Sun; Li, Lei; Li, Yuanchao

    2011-05-01

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

  13. Medical Malpractice Arbitration Act: Michigan's experience with arbitration.

    PubMed

    Bedikian, M

    1984-01-01

    In the 1970's, Michigan and other states were confronted with a medical malpractice crisis of astronomical proportions. The escalating number of medical malpractice lawsuits and concomitant increase in malpractice premiums for health care providers fostered a divisive climate among doctors, lawyers and patients. In response to this crisis, the Michigan legislature enacted the Medical Malpractice Arbitration Act. The Act establishes a process whereby patients may agree to arbitrate any claims rather than pursue them through the courts. Part II of this Article discusses the historical evolution of arbitration as a precursor to its establishment as a resolution modality for health care disputes. Part III describes the statutory framework of the Michigan Medical Malpractice Arbitration Act. Part IV discusses the contractual and constitutional challenges to the arbitration statute and their resolution in Morris v. Metriyakool. As the law respecting arbitration becomes less vulnerable to judicial perforation, this Author suggests that other jurisdictions treat the Michigan Medical Arbitration Program as an archetype, susceptible to replication.

  14. 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

  15. The Perceptions of Chicago Area Principals Regarding Liability for Educational Malpractice.

    ERIC Educational Resources Information Center

    Rosenblum, Eileen

    Because of the growing frequency of educational malpractice lawsuits, this study reviewed the current status of case law regarding educational malpractice, and then compared these findings to the perceptions of Chicago area principals regarding educational malpractice liability due to misfeasance (mistaken actions) or nonfeasance (acts omitted).…

  16. 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.

  17. Providers must plan for accrual of medical malpractice claims.

    PubMed

    Zatorski, R

    1988-11-01

    Because of the change in accounting regulations that requires accrual for certain medical malpractice claims, healthcare providers could soon be experiencing significant effects on their financial results. AICPA Statement Position 87-1, "Accounting for Asserted and Unasserted Medical Malpractice Claims of Health Care Providers and Related Issues," states that if healthcare providers have not transferred all risk for medical malpractice claims arising out of occurrences prior to the financial statement date to a third party, some accrual will be required. Providers need to prepare themselves for the financial problems that could arise from these reporting guidelines. Estimating the potential accrual amounts with advanced planning and extensive data gathering and analysis could lower a healthcare provider's financial risk.

  18. 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. PMID:25891287

  19. 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

  20. Contingent Fees in Medical Malpractice Litigation—A Qualitative Assessment

    PubMed Central

    Ottensmeyer, David J.; Smith, Howard L.; Porter, James

    1983-01-01

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

  1. 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... amount specified at 42 CFR 1003.103(c). (d) Interpretation of information. A payment in settlement of a... malpractice has occurred. (Approved by the Office of Management and Budget under control number 0915-0126)...

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

    ERIC Educational Resources Information Center

    Jenkins, Ruth L.

    1983-01-01

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

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

    PubMed

    Kinney, E D

    1995-01-01

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

  4. 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…

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

    PubMed

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

    1983-08-01

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

  6. [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

  7. 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.

  8. 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.

  9. 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

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

    PubMed

    Penchansky, R; Macnee, C

    1994-08-01

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

  11. Malpractice and radiologists, update 1986: an 11. 5-year perspective

    SciTech Connect

    Berlin, L.

    1986-12-01

    All medical malpractice lawsuits filed in Cook County, IL, from January 1, 1980, through June 30, 1986, were reviewed and compared with similar data for the period of January 1, 1975, through December 30, 1979. A total of 11,203 suits were filed during the 11.5-year period; of these, 1391 (12%) were radiology related. The latter were categorized into six groups. The largest was missed radiologic diagnoses, which accounted for 40% of the total. The remaining groups included complications, 19%; failure to order, 17%; radiation therapy, 11%; slip and fall, 5%; and miscellaneous, 8%. Over the 1975-1986 period, the rise in the number of suits alleging radiologic misses outpaced all other groups. Although the most common type of miss continues to involve fractures, the frequency of missed carcinomas has grown at a disproportionately faster rate. Misses specifically involving CT, nuclear medicine, and sonography also are becoming more prevalent. Radiographic misses continue to occur at an average rate of 30%, with little hope of improvement. Methods to combat the rising number of malpractice suits are discussed. It is concluded that although programs to educate radiologists on risk management should continue, the ultimate solution may be a more enlightened public attitude as to what actually constitutes malpractice, and institution of tort reform measures by federal and state legislatures.

  12. 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

  13. 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'…

  14. 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... of allegations of medical malpractice in treating an illness covered by EEOICPA a recovery that must be reported to OWCP? Since an injury caused by medical malpractice in treating an...

  15. 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…

  16. 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…

  17. 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.…

  18. 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

  19. 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.

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

    PubMed

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

    2013-10-01

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

  1. 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

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

    PubMed

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

    2016-08-01

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

  3. Law & psychiatry: reforming malpractice: the prospects for change.

    PubMed

    Appelbaum, Paul S

    2011-01-01

    Previous efforts to change the U.S. medical malpractice system have involved such initiatives as time limits on filing claims, caps on noneconomic damages, and limiting attorneys' fees. This column briefly reviews such past efforts and describes several new approaches. They include programs that encourage prompt disclosure of errors and offers of compensation, efforts to mediate complaints outside the courts, and use of administrative processes to adjudicate claims. "No-fault" systems, such as those in New Zealand, Sweden, and Denmark, may be most likely to satisfy the interests of both patients and physicians but may not be politically acceptable in the United States.

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

    PubMed

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

    2016-08-01

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

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

    PubMed Central

    2008-01-01

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

  6. The medical malpractice 'crisis': recent trends and the impact of state tort reforms.

    PubMed

    Thorpe, Kenneth E

    2004-01-01

    By many accounts, the United States is in the midst of its third medical malpractice "crisis." Physicians in several states are facing high and rising premiums. The largest national medical malpractice carrier and some large multistate physician-backed liability firms have recently left the market. Rising premiums are traced largely to increases in claims severity. Capping malpractice payments has been advanced as one approach to slowing the growth in premiums. This analysis finds that premiums in states that cap awards are 17.1 percent lower than in states that don't cap. At issue, however, is whether these stopgap solutions promote the goals of the U.S. liability system.

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

    PubMed

    1986-06-01

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

  8. [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

  9. The medical malpractice TPA: Taking it to the next level.

    PubMed

    Sicard, Lauren E; Ruzzo, Loreto

    2016-04-01

    Risk managers whose organizations self-insure their medical professional liabilities often find themselves dealing with their institution's third-party administrator (TPA), the independent entity that manages claims against the organization and its employees. By understanding better the purpose and operations of a TPA, risk managers can enhance their organizations' litigation outcomes while adding new tools to improve patient safety and quality of care. Viewing the TPA simply as an expense item to be reduced to its lowest possible level deprives the organization of a valuable resource in the form of high-quality data on the drivers of professional liability losses. This article identifies the qualities found in an exceptional medical malpractice TPA and suggests ways to create an effective partnership that will reduce the total cost of claims while supporting the risk manager's mission. PMID:27088774

  10. Commentary: Binding Early Offers versus Caps for Medical Malpractice Claims?

    PubMed Central

    O'Connell, Jeffrey

    2007-01-01

    Like damages caps, early offer reform promises reduction in the costs of medical liability cases. In contrast to damages caps, early offer reform offers advantages to both claimant and defendant. Under early offer, the defendant would have the option to offer an injured patient periodic payments for the patient's net economic losses as they accrue, but not payments for noneconomic losses (pain and suffering). If an early offer were made and accepted, that would settle the claim. This commentary1 explains how an early offer reform might work and summarizes data from a recent closed claim study of medical malpractice cases in Texas and Florida. The data show widespread opportunities for successful early offers and provide evidence that substantial per case savings would result. PMID:17517116

  11. 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

  12. Commentary: binding early offers versus caps for medical malpractice claims?

    PubMed

    O'Connell, Jeffrey

    2007-06-01

    Like damages caps, early offer reform promises reduction in the costs of medical liability cases. In contrast to damages caps, early offer reform offers advantages to both claimant and defendant. Under early offer, the defendant would have the option to offer an injured patient periodic payments for the patient's net economic losses as they accrue, but not payments for noneconomic losses (pain and suffering). If an early offer were made and accepted, that would settle the claim. This commentary(1) explains how an early offer reform might work and summarizes data from a recent closed claim study of medical malpractice cases in Texas and Florida. The data show widespread opportunities for successful early offers and provide evidence that substantial per case savings would result.

  13. [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.

  14. The Ecology of Defensive Medicine and Malpractice Litigation.

    PubMed

    Antoci, Angelo; Fiori Maccioni, Alessandro; Russu, Paolo

    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

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

    PubMed

    Greenberg, Michael D

    2009-01-01

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

  16. 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.

  17. 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

  18. 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.

  19. Malpractice and system of expertise in anaesthetic procedures in Turkey.

    PubMed

    Ozdemir, M Hakan; Cekin, Necmi; Can, I Ozgür; Hilal, Ahmet

    2005-10-29

    Deaths which occur during the administration of anaesthetics require medicolegal investigations. The objective of this study is to form a database for future comparisons related to anaesthetic-associated malpractice claims and also to investigate the system of expertise, pertaining to such procedures. The decisions of the Supreme Health Council, whose expert opinion is requested by legal authorities (judges, prosecutors) for health workers brought to trial in a criminal court, were examined retrospectively over the period 1995-1999. In 21 (2.3%) of the 888 decision reports prepared by the council the team members (the anaesthesiologist , the anaesthetic assistant, the anaesthetic technician, the nurse) were directly interrogated. Data concerning these 21 council decisions were evaluated within the scope of this study. It was found that 57% of the 21 decisions were related to medical procedures carried out in state hospitals. Of the 21 cases, 62% were males, 38% females. General anaesthesia was applied to 19 of the cases while one received regional (local) anaesthesia and one axillary blockade. Twenty died of complications associated with anaesthesia. Autopsy was performed on 11 (55%) of the dead. Health workers were found to have different degrees of liability in the 16 (76%) of the 21 decision reports. In their medical practices, anaesthesiologists , like other specialists, are subject to legal procedures in the country where they perform their duties, to national and international principles of ethics, and to diagnostic and curative standards/procedures relevant to the scientific level of the country concerned. In anaesthetic malpractice claims, certain standards need to be followed in inquiries and approaches so as to determine the real reasons behind the disabilities and/or deaths which occur. In order that sound evaluations could be made in such cases, the experts as well as the system of expertise should be efficient and authorized.

  20. 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

  1. 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.

  2. Dental malpractice: baseline data from insurance claims closed in 1970, with analysis.

    PubMed Central

    Clark, N; Paquin, N; Nevin, J

    1984-01-01

    A study of dental malpractice claims closed during the 1970s was conducted using closed claim data available as a byproduct of a survey conducted by the Secretary's Commission on Medical Malpractice, U.S. Department of Health, Education, and Welfare. The intent of the authors of this study is to establish a baseline that can be used for future comparisons of dental malpractice. Far fewer cases of dental malpractice were found than expected, and specialists such as oral surgeons were at higher risk than general practitioners. One-half of the claims resulted in no payment to the plaintiff. Trial verdicts were reached in just over 7 percent of the cases, and 93 percent of the verdicts were in favor of the defendant. The amount of damages paid to claimants for dental cases was approximately one-third that paid on claims involving physicians or medical specialists. The median award to the plaintiff for dental malpractice was $750. Ninety-five percent of the awards made were under $5,000. PMID:6422499

  3. Medical malpractice in the age of technology: how specialty societies can make a difference.

    PubMed

    Anscher, Mitchell S; Anscher, Barbara M

    2006-01-01

    In the United States, medical malpractice litigation, and the rising cost of malpractice insurance, is a crisis that threatens to restrict patient access to high-risk services, especially obstetrics and certain surgical procedures. Radiation Oncology, though a small specialty, is very technologically oriented. Because the history of product liability and malpractice litigation in this country parallels the technologic revolution, practitioners of this specialty are clearly at risk for litigation. Because legislative relief is unlikely to be forthcoming in the near future, many specialty societies have assumed the responsibility for devising means to protect members from frivolous law suits, without compromising a patient's right to due process. To date, Radiation Oncology societies have not taken a leadership role in this movement, preferring instead to cede this responsibility to the American College of Radiology. Opportunities exist for specialty societies to define standards of care and establish guidelines for expert witness testimony. To date, the courts have been supportive of these efforts. Herein, we summarize some of the salient issues of the malpractice crisis facing Radiation Oncology and offer suggestions for change within the specialty to better address the malpractice problem.

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

    PubMed

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

    2016-09-01

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

  5. 32 CFR 536.81 - Payment of costs, settlements, and judgments related to certain legal malpractice claims.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... related to certain legal malpractice claims. 536.81 Section 536.81 National Defense Department of Defense... legal malpractice claims. (a) General. Costs, settlements, and judgments cognizable under 10 U.S.C. 1054... member of a legal staff will be paid if: (1) The alleged negligent or wrongful actions or...

  6. 32 CFR 536.81 - Payment of costs, settlements, and judgments related to certain legal malpractice claims.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... related to certain legal malpractice claims. 536.81 Section 536.81 National Defense Department of Defense... legal malpractice claims. (a) General. Costs, settlements, and judgments cognizable under 10 U.S.C. 1054... member of a legal staff will be paid if: (1) The alleged negligent or wrongful actions or...

  7. 32 CFR 750.54 - Payment of costs, settlements, and judgments related to certain medical or legal malpractice claims.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... related to certain medical or legal malpractice claims. 750.54 Section 750.54 National Defense Department... § 750.54 Payment of costs, settlements, and judgments related to certain medical or legal malpractice... any attorney, paralegal, or other member of a legal staff) while acting as DON personnel will be...

  8. 32 CFR 750.54 - Payment of costs, settlements, and judgments related to certain medical or legal malpractice claims.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... related to certain medical or legal malpractice claims. 750.54 Section 750.54 National Defense Department... § 750.54 Payment of costs, settlements, and judgments related to certain medical or legal malpractice... any attorney, paralegal, or other member of a legal staff) while acting as DON personnel will be...

  9. 32 CFR 536.81 - Payment of costs, settlements, and judgments related to certain legal malpractice claims.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... related to certain legal malpractice claims. 536.81 Section 536.81 National Defense Department of Defense... legal malpractice claims. (a) General. Costs, settlements, and judgments cognizable under 10 U.S.C. 1054... member of a legal staff will be paid if: (1) The alleged negligent or wrongful actions or...

  10. 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

    ... related to certain medical or legal malpractice claims. 750.54 Section 750.54 National Defense Department... § 750.54 Payment of costs, settlements, and judgments related to certain medical or legal malpractice... any attorney, paralegal, or other member of a legal staff) while acting as DON personnel will be...

  11. 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.

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

    PubMed

    Fraser, J J

    2001-03-01

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

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

    PubMed

    Manning, M M

    1992-01-01

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

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

    PubMed

    Meyer, Donald J

    2006-09-01

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

  15. 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

  16. Will Birth Attendants Need to Promote High-Tech Intervention to Afford Malpractice Insurance?

    PubMed Central

    Humenick, Sharron S.

    2004-01-01

    In this column, the author examines the trends of the midwifery model of care versus nonmedically indicated cesarean births and their effect on malpractice insurance rates. Childbirth educators are encouraged to support a health-care system that promotes normal birth. PMID:17273368

  17. But These Six Factors Have Reduced the Threat of Education Malpractice Suits.

    ERIC Educational Resources Information Center

    Leary, James L.

    1987-01-01

    Discusses several factors (aside from state immunity statutes) reducing the threat of education malpractice suits in recent years, including improved community attitudes and involvement in schools, more facilitative leadership roles for principals, increased importance of staff development, and expanded options for students through new…

  18. 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…

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

    PubMed

    Fiester, Autumn

    2004-01-01

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

  20. 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.

  1. [Medical expert opinion: performance, the appearance in court in cases of medical malpractice].

    PubMed

    García-Garduza, Ismael

    2011-01-01

    In several lawsuits, including one for medical malpractice, there is a phase with the participation of experts who analyze the evidence in order to issue an opinion which is explained at the hearing at court, thus resulting in the medical expert act that all physicians should know. This article discusses legal, medical and ethical characteristics in an expert performance in medical malpractice cases. The expert having access to the original evidence is in a powerful situation and has an advantageous position in a trial for medical malpractice. His opinion has legal effects, therefore, the issue of partial, erroneous or badly founded points of view, and a unprepared, unethical and malicious performance at the hearing, produces adverse effects in the trial transcending to consequences to the ones involved. To apply correctly the principles of ethics and knowledge, the medical expert will make good use of the information obtained during his research both in his opinion and during his appearance in court. Analyzing and using it properly, he will make his point of view meet its goal of establishing the facts in the investigation of an alleged medical malpractice and the authorities or officials will have strong evidence to enable them to determine their decision, thus contributing to the development of the society and the proper use of the law within it.

  2. 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…

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

    ERIC Educational Resources Information Center

    Nelson, F. Howard

    1982-01-01

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

  4. 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

  5. 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

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

    PubMed

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

    2014-01-01

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

  7. Improve medical malpractice law by letting health care insurers take charge.

    PubMed

    Reinker, Kenneth S; Rosenberg, David

    2011-01-01

    This essay discusses unlimited insurance subrogation (UIS) as a means of improving the deterrence and compensation results of medical malpractice law. Under UIS, health care insureds could assign their entire potential medical malpractice claims to their first-party commercial and government insurers. UIS should improve deterrence by establishing first-party insurers as plaintiffs to confront liability insurers on the defense side, leading to more effective prosecution of meritorious claims and reducing meritless and unnecessary litigation. UIS should improve compensation outcomes by converting litigation cost- and risk- laden "tort insurance" into cheaper and enhanced first-party insurance. UIS also promises dynamic benefits through further reforms by contract between the first-party and liability insurers that would take charge of system. No UIS-related costs are apparent that would outweigh these benefits.

  8. 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

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

    PubMed

    Constantino, Rose E

    2007-01-01

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

  10. Comparison of the clinical diagnosis and subsequent autopsy findings in medical malpractice.

    PubMed

    Pakis, Isil; Polat, Oguz; Yayci, Nesime; Karapirli, Mustafa

    2010-09-01

    The rate of diagnostic error has not declined over the last 30 years despite the improvement in diagnosis methods. Today, the probability to encounter a major diagnostic change in autopsy is still high. The special autopsy that provides clinicians the necessary feedback is performed seldom in our country. This study has been started upon the claim that the malpractice cases in scope of forensic cases could be a very useful database. About 525 cases with faulty medical application that resulted in death have been encountered according to the cases that have been sent to the Forensic Medical Institution, which has been the consultative authority of the Ministry of Justice between the years 2001 and 2005. Among these, 375 cases on which autopsies have been conducted are included in the scope of the study. The cases with and without major diagnostic changes have been compared in aspects of gender, age groups, and period spent in health units. When the concordance between autopsy and clinical diagnosis for the 375 cases that were included in the study is examined, it can be seen that clinical diagnosis is verified with autopsy in 49.1% of the cases whereas neither autopsy nor clinical diagnosis was encountered in 14.7% of them. The diseases where diagnostic faults are mostly encountered are ruptured aortic aneurysm, myocardial infarction and pneumonia. The majority of the cases without a clinical diagnosis comprises of complications that occur after operations. In the study, considerable major diagnostic changes were realized after autopsy, which shows that autopsy has an important place in Turkey in spite of the improved methods of diagnosis. Also, in the cases with major diagnostic changes, the medical malpractice rate was high. This shows that autopsy is influential in revealing medical malpractice failures. In the study, we found out that the number of autopsies was high in the cases with a malpractice claim. We aim to increase this number. We are sure that such

  11. 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.

  12. 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.

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

    PubMed

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

    2015-01-01

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

  14. 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.

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

    PubMed

    Grembi, Veronica; Garoupa, Nuno

    2013-10-01

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

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

    PubMed Central

    Fountain, Tamara R.

    2014-01-01

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

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

    PubMed

    Lapuyade, Keith D; Sorkin, Alison C

    2013-12-01

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

  18. 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. PMID:15318567

  19. 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

  20. Relative income expectations, expected malpractice premium costs, and other determinants of physician specialty choice.

    PubMed

    Kiker, B F; Zeh, M

    1998-06-01

    We analyze the effects of relative income expectations, expected malpractice premium cost, and other economic and noneconomic factors on physician specialty choice. The data for this paper are taken from responses of medical students who completed the Association of American Medical Colleges' Medical School Questionnaire and graduated from medical school in 1995. A random utility model is used to guide our thinking; the econometric technique is multinomial logit regression. Selection of a surgical or support specialty is found to be positively income motivated, while the influence of expected relative income is negatively related to the choice of primary-care and medical practices. Concern over malpractice premium cost is negatively related to surgical and positively related to primary-care selection. Other important determinants of choice are planned location of practice, length of residency, type of medical school attended, score on the science problems section of the Medical College Admission Test, predictable working hours and perceived prestige of the specialty. Policies that alter expected relative income, length of residency, desired location of practice, medical school attended, predictable working hours, and prestige of practice, rather than financial aid, may be appropriate for correcting a perceived maldistribution of physicians among specialties.

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

    ERIC Educational Resources Information Center

    Mawdsley, Ralph D.; Cumming, J. Joy

    2008-01-01

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

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

    PubMed

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

    2014-11-01

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

  3. 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…

  4. 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.

  5. 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

    ... 32 National Defense 5 2011-07-01 2011-07-01 false Payment of costs, settlements, and judgments related to certain medical or legal malpractice claims. 750.54 Section 750.54 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY CLAIMS GENERAL CLAIMS REGULATIONS Military Claims Act § 750.54 Payment of costs, settlements,...

  6. 32 CFR 536.81 - Payment of costs, settlements, and judgments related to certain legal malpractice claims.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 3 2011-07-01 2009-07-01 true Payment of costs, settlements, and judgments related to certain legal malpractice claims. 536.81 Section 536.81 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY CLAIMS AND ACCOUNTS CLAIMS AGAINST THE UNITED STATES Claims Cognizable Under the Military Claims Act §...

  7. 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

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

    PubMed

    Wienke, Albrecht

    2013-01-01

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

  9. 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. PMID:27672458

  10. 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

  11. 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.

  12. 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

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

    PubMed

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

    1983-01-01

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

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

    PubMed

    High, Whitney A

    2008-06-01

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

  15. 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.

  16. 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.

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

    PubMed

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

    2015-12-01

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

  18. Res ipsa loquitur in Canadian medical malpractice cases 1975-1988.

    PubMed

    Neff, C; Cook, R

    1991-01-01

    There is a perception in some quarters that courts too often, in the interest of compensating victims, find the medical profession at fault for 'failed medical care' which does not amount to negligence. If this were true, judges would likely make liberal use of the evidentiary rules res ipsa loquitur. However, a study of Canadian medical malpractice cases from 1975 to 1988 indicates that this is not the case and that judges on the contrary reject such a liberal use of the rule. Res ipsa loquitur was pleaded in only 37 of 142 cases, it was applied in only 14 of these cases, and the defendant was found liable in only ten of the cases in which it was applied. Furthermore, there is little evidence in these cases that judges are as a matter of policy trying to find legal rules to justify compensating more victims of medical misadventure, regardless of fault. On the contrary, judges not infrequently express sympathy for the plaintiff but nevertheless find for the defendant.

  19. 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.

  20. 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.

  1. 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.

  2. 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.

  3. Effects of tort reforms and other factors on medical malpractice insurance premiums.

    PubMed

    Zuckerman, S; Bovbjerg, R R; Sloan, F

    1990-01-01

    We use state-level data on physician malpractice premiums, claims, and awards, provided by insurance companies for the years 1974 to 1986, to evaluate the effectiveness of the various tort reforms that have been legislated during the 1970s and 1980s. In addition to the tort reforms, our analysis of premiums considers insurers' anticipated losses, returns on investments, the type of insurer, and premium regulation. Our results suggest that the only reforms that significantly lower premiums are those that either impose a cap on the amount of physician liability or reduce the amount of time a plaintiff has to initiate a claim. We also find that premiums are lower when states regulate rates by requiring prior approval of premiums. In addition, it appears that the observed cyclicality in premiums is due, in part, to fluctuations in the real interest rates available to insurers as returns on investments. Unfortunately, we did not find as strong a link between the determinants of premiums, claims, and awards as might be expected.

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

    PubMed

    Cicconi, Michela; Mangiulli, Tatiana; Bolino, Giorgio

    2014-10-01

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

  5. Loss of a chance in medical malpractice litigation: expanding liability of health professionals versus providing justice to those who have lost.

    PubMed

    Meldrum, M A

    2001-11-01

    The loss of a chance doctrine in medical malpractice litigation is essentially based on the perceived unfairness of denying recovery to a patient when a health provider's malpractice has reduced the patient's chance of a better outcome. It is the thesis of the article that loss of a chance must the recognised at law, notwithstanding that the chance is less than even or not subject to the benefit of statistical and/or scientific proof and that each lost chance should be assessed according to the value of that chance. Varying approaches to allocating value to the chance lost are examined both historically and internationally. The author contends that the policy arguments--which include potential for increased medical malpractice litigation, tainted reputations and an increase in professional indemnity policies--are insignificant when compared to the value and quality of human life and therefore cannot be supported.

  6. 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

  7. 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

  8. Medical Malpractice in Connecticut: Defensive Medicine, Real Problem or a Red Herring – Example of Assessment of Quality Outcomes Variables

    PubMed Central

    Ridic, Goran; Howard, Tim; Ridic, Ognjen

    2012-01-01

    Material and method: Using the survey data obtained from doctors in Connecticut, we estimate the “true” costs of defensive medicine and medical malpractice awards via litigation in the overall aggregate picture of U.S. national annual health expenditures. Results and discusion: Progressives claim that these costs amount only to approximately 2% of total annual health expenditures, while conservatives claim that these costs are much higher, in the neighborhood of 10%. Conservatives want to reform the current medical malpractice system because the savings could be significant. Progressives claim that this issue is a “red herring” in the overall picture of health care reform and that other factors such as hospital costs, payments to physicians and pharmaceutical prices are the largest contributors to runaway health care costs, currently amounting to 18% of GDP. The health of the national economy, deficit reduction and future prosperity will depend upon the speed and quality of the cost reducing solutions. Conclusion: An in-depth look into cost and profit structure of each provider’s procedure and legislative push for price and quality transparency of the informed and educated constituents are recommended to improve this serious national, socio-economic problem. PMID:23322952

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

    PubMed

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

    2014-09-01

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

  10. 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. PMID:24677121

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

    PubMed

    2002-05-01

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

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

    PubMed Central

    Moon, Hyun Seog

    2015-01-01

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

  13. 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

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

    PubMed Central

    2011-01-01

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

  15. 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)

  16. [Suicide and malpractice].

    PubMed

    Catanesi, Roberto; Carabellese, Felice

    2011-01-01

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

  17. 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…

  18. [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.

  19. A comparison of calls subjected to a malpractice claim versus ‘normal calls’ within the Swedish Healthcare Direct: a case–control study

    PubMed Central

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

    2014-01-01

    Objectives The purpose of this study is to compare communication patterns in calls subjected to a malpractice claim with matched controls. Setting 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. Participants 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. Results 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. Conclusions 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. PMID:25280808

  20. [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.

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

    PubMed

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

    2012-04-01

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

  2. 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

  3. The Malpractice of Statistical Interpretation

    ERIC Educational Resources Information Center

    Fraas, John W.; Newman, Isadore

    1978-01-01

    Problems associated with the use of gain scores, analysis of covariance, multicollinearity, part and partial correlation, and the lack of rectilinearity in regression are discussed. Particular attention is paid to the misuse of statistical techniques. (JKS)

  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. PMID:16334583

  5. Medical Malpractice and the Sports Medicine Clinician

    PubMed Central

    White, Richard A.

    2008-01-01

    More individuals are participating in athletics today than ever before. Physicians treating athletes confront unique diagnostic and treatment challenges and an increased risk of legal liability. The key areas regarding liability are preparticipation examinations, determination of eligibility, evaluation of significant on-field injuries, and information disclosure. The issues surrounding preparticipation physicals and determination of eligibility are closely linked. Physicians must be prepared to seek guidance from specialists, particularly when there are cardiac, spinal, or neurologic issues. Appropriate on-field evaluation of potential concussions, spinal injuries, and heat stroke are key areas of concern for the physician. Privacy issues have become more complex in the age of federal regulation. Physicians and all athletic staff should be aware of privacy laws and ensure proper consent documentation is obtained from all athletes or their parents. All athletic programs should develop a plan that details roles and procedures to be followed in a medical emergency. Sports caregivers must take affirmative steps that better protect their patients from harm and physicians from legal liability. PMID:18989733

  6. 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…

  7. 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.

  8. [Revision of the medical malpractice law? Malpractice in an international comparison].

    PubMed

    Deutsch, E

    1998-10-01

    An international comparison shows that the German criminal law is severe on physicians. In the majority of the other countries the doctor is just liable for criminal or gross negligence. There are some countries where lack of informed consent leads to a special criminal action. The comparative law shows us that it is better to keep the current criminal law.

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

    PubMed

    Ryan, Marsha

    2002-12-01

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

  10. 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…

  11. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Data Bank, in accordance with regulations at 45 CFR part 60, subpart B, as applicable, regarding any... of 1974; (v) Date of birth; (vi) Name of each professional school attended and year of graduation... have a minimum of three individuals appointed by the Director, Medical-Legal Affairs (including...

  12. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Data Bank, in accordance with regulations at 45 CFR part 60, subpart B, as applicable, regarding any.... Notwithstanding the provisions of paragraph (b) of this section, actions of a licensed trainee (intern or...

  13. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Data Bank, in accordance with regulations at 45 CFR part 60, subpart B, as applicable, regarding any.... Notwithstanding the provisions of paragraph (b) of this section, actions of a licensed trainee (intern or...

  14. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Data Bank, in accordance with regulations at 45 CFR part 60, subpart B, as applicable, regarding any.... Notwithstanding the provisions of paragraph (b) of this section, actions of a licensed trainee (intern or...

  15. 38 CFR 46.3 - Malpractice payment reporting.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Data Bank, in accordance with regulations at 45 CFR part 60, subpart B, as applicable, regarding any.... Notwithstanding the provisions of paragraph (b) of this section, actions of a licensed trainee (intern or...

  16. Can a Student Sue the Schools for Educational Malpractice?

    ERIC Educational Resources Information Center

    Abel, David

    1974-01-01

    This article addresses the policy questions raised in the Doe case by examining the legal issues posed by the plaintiff's complaint and by the defendant's demurrer (a motion to dismiss, asserting that even if all the facts presented by Doe's complaint are true, they do not constitute sufficient grounds for the court to rule in favor of the…

  17. 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…

  18. 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…

  19. 45 CFR 60.7 - Reporting medical malpractice payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Section 60.7 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION NATIONAL... whole or in part of a claim or a judgment against such physician, dentist, or other health care...) Where an action or claim has been filed with an adjudicative body, identification of the...

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

    PubMed

    Horch, R E

    2016-04-01

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

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

    PubMed

    Ryan, Marsha

    2002-12-01

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

  2. 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…

  3. Epidemiological case survey of medical malpractice in some medical and surgical specialties.

    PubMed

    Di Nunno, Nunzio; Luigi, Vimercati; Viola, Luigi; Francesco, Vimercati

    2005-05-10

    According to the common view held by the general public, doctors can never make professional mistakes, as if by virtue of their profession they were bound to be infallible. Moreover, when mistakes do occur in the medical field they are seen in a personal light, being attributed to an individual professional figure who is expected to answer for them in both the penal and the civil field. In this paper, the authors made a retrospective analysis of 37 of all the 725 legal suits filed in some hospitals of the Apulian region (South Italy) during the period between 1991 and 2000, being all those lodged against operators in the neurological, urological, otorhino-laryngoiatric and cardiosurgical fields, recorded in the Archives of the Health Services of Bari, Brindisi, Lecce and Taranto or in those of our Forensic Department following consultations on medical and surgical responsibility.

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

    PubMed Central

    2014-01-01

    Background 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. Methods 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. Results 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). Conclusions 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. PMID:25064122

  5. 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.

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

    PubMed

    Berger, Vance W

    2015-08-01

    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.

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

    PubMed

    1996-01-01

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

  8. 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.

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

    PubMed

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

    2010-01-01

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

  10. 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…

  11. 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

  12. Impacts of the medical malpractice slowdown in Los Angeles County: January 1976.

    PubMed Central

    James, J J

    1979-01-01

    The Los Angeles County (California) physician strike of January 1976 resulted in a partial withdrawal of physician services. Among recorded impacts were a $17.5 million loss in hospital revenues and an $8.5 million pay loss for hospital employees. Several surveys revealed no evidence of a significant impact on the general public in finding medical care. Analysis of emergency room visits and paramedical ambulance calls showed no significant increases during the strike. County mortality statistics for the strike were not affected. Eighty-eight fatalities among 2,171 patients transferred during the strike were analyzed; a Case Attributable Mortality Probability generated on 21 cases selected for final review by a five-physician multispecialist panel indicated that 29 per cent of the Attributable Mortality could be ascribed to the strike itself and 71 per cent to ongoing "patient dumping" from private sector to County hospitals. Even if sample attributable mortality rates were generalized to overall county deaths, the resultant figures are below the estimated range of 55 to 153 deaths that did not occur because of the number of elective operations not performed secondary to the strike. PMID:434272

  13. 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…

  14. 78 FR 58202 - Federal Tort Claims Act (FTCA) Medical Malpractice Program Regulations: Clarification of FTCA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-23

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

  15. 76 FR 10825 - Federal Tort Claims Act (FTCA) Medical Malpractice Program Regulations: Clarification of FTCA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-02-28

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

  16. [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.

  17. 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....

  18. 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....

  19. 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…

  20. Litigation, electronic fetal monitoring, and the obstetric nurse.

    PubMed

    McRae, M J

    1993-01-01

    Using excerpts from actual lawsuits that allege malpractice and name obstetric nurses as defendants, this article explores the process and some possible outcomes of malpractice litigation. It discusses the duty of the nurse, the concept of reasonably prudent practice, and the role of the expert. In addition, it identifies some institutional standards that can mitigate potential damages in malpractice claims.

  1. Malpraxis risk management in implantology.

    PubMed

    Lupu, I C; Forna, Norina Consuela

    2014-01-01

    In present practice there is an increased demand from patients for prosthetic implant restoration solutions. At the same time one can notice a possible vulnerability regarding allegations of malpractice, as evidenced by the growing number of complaints of malpractice also maintained by negative reports, frequently incomplete or incorrectly documented from the press. This should require practitioners to have a professional attitude.

  2. Teleradiology: a case study of the economic and legal considerations in international trade in telemedicine.

    PubMed

    McLean, Thomas R; Richards, Edward P

    2006-01-01

    Growth in the global market for telemedical services is being driven by economics. Two operational models are already recognizable. "Nighthawk" providers are virtually indistinguishable from their domestic counterparts with respect to medical malpractice liability and price for service. Indian providers, in contrast, offer deep price discounts on services, but jurisdictional loopholes are likely to allow these providers a method to avoid medical malpractice liability. Hospitals that outsource their radiology services need to be aware of these differences, because hiring Indian telemedical providers will likely result in a shift of medical malpractice liability from providers to hospitals.

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

    ERIC Educational Resources Information Center

    DeMers, Stephen T.

    1994-01-01

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

  4. Examining Tennessee's collateral source rule.

    PubMed

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

    2008-11-01

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

  5. The disappearing doctor.

    PubMed

    Shinkman, Ron

    2005-06-01

    As medical malpractice premiums continue to rise, physicians are leaving practice in record numbers, and states are taking matters into their own hands. See what the AMA's "crisis states" and, in some cases hospitals, are doing to stem the exodus.

  6. [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.

  7. Lower anxiety in today's high 'sue-ciety'.

    PubMed

    Chesteen, S A; Gahin, F S; Lally, J M

    1994-01-01

    Physician malpractice claims are part of the reason for the increased level of health care costs in the United States, according to authors Susan A. Chesteen, Ph.D., Fikry S. Gahin, Ph.D., and Joan M. Lally, Ph.D., of the University of Utah David Eccles School of Business. They present the results of a survey conducted on the residents of Utah on malpractice and discuss the implications for health care providers.

  8. Controlling Legal Risk for Effective Hospital Management

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Pope, Thaddeus Mason; Hexum, Melinda

    2014-01-01

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

  10. 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.

  11. An anatomic-based approach to the iatrogenic spinal accessory nerve injury in the posterior cervical triangle: How to avoid and treat it.

    PubMed

    Cesmebasi, Alper; Spinner, Robert J

    2015-09-01

    Iatrogenic injury of the spinal accessory nerve (SAN) is a significant reducible risk with any invasive procedure involving the posterior cervical triangle. Most commonly associated with cervical lymph node biopsy, it affects 3-6% of patients and serves as a major cause of avoidable medical malpractice litigation. Medical malpractice cases not only affect the primary surgeon but also may include the repairing surgeon through a shift of blame. For this reason, we discuss the strategies all clinicians may utilize in approaching iatrogenic SAN injuries. By taking basic precautionary measures based on simple application of anatomy in the management of these patients, clinicians may protect themselves from needless malpractice litigation. A thorough knowledge of the anatomy and application in preventative strategies may provide guidance for clinicians in reducing the incidence of iatrogenic injuries, providing effective postinjury management, and ensuring the salvaging surgeon is not at fault if litigation is pursued. PMID:26060941

  12. Managed care, liability, and ERISA.

    PubMed

    Stone, A A

    1999-03-01

    Congress originally passed ERISA to secure the contractual benefits negotiated between employers and employees. In 1974, when the statute quickly moved through Congress, no one realized what its eventual significance for health care would be. Certainly no one expected that ERISA preemption would allow MCHPs to reduce professional standards of care while being protected from liability. The Department of Labor believes that it was never the intention of Congress to preempt ordinary damage claims for malpractice. There are now chinks in the legal armor of ERISA created by activists' courts as in the Dukes case. Even conservative Judges recognize the injustice of results, such as Corcoran. The American medical profession has traditionally complained about malpractice litigation and the wastefulness of defensive medicine. Perhaps ERISA will make the profession recognize that malpractice liability can serve a useful purpose.

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

    PubMed

    Klevno, V A

    2012-01-01

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

  14. Physician advertising: some reasons for caution.

    PubMed

    Yarborough, M

    1989-12-01

    Physician advertising is a growing trend which, proponents contend, will bring needed reforms to health care. Among these reforms are better informed patients, reduction in the price of health care, improvement in the quality of care, and reduction in the incidence of malpractice litigation and the cost of malpractice insurance. I argue that physician advertising probably will not accomplish these goals. I also discuss problems with the intent, content, monitoring, and costs of advertising, along with how it may adversely affect the way physicians perceive one another.

  15. Medical and legal considerations in managing patients with musculoskeletal tumors.

    PubMed

    Morris, Carol D; Bal, B Sonny; D'Elia, Elizabeth M; Benevenia, Joseph

    2014-01-01

    At some point in their careers, many orthopaedic surgeons will have to navigate the legal system as it pertains to medical malpractice. An orthopaedic surgeon will find it helpful to review information on the basic legal elements of medical malpractice law along with suggestions on how he or she can assist the legal defense team if a lawsuit is filed. Surgeons who face litigation within the context of managing patients with musculoskeletal tumors should be aware of the common pitfalls in managing these patients. Knowledge of complementary strategies can provide good patient care and reduce legal risks when caring for patients with musculoskeletal neoplasms.

  16. Medical negligence--prevention and management.

    PubMed

    Chao, T C

    1987-04-01

    The rising spate of malpractice cases against doctors appearing in the press and annual reports of medical insurance companies causes concern. Are our doctors more careless or is the public more conscious of litigation? A well publicized malpractice case can ruin the doctor's career and practice. It is well worth a doctor's while to know the pitfalls and learn how to prevent them, and if a mistake happens, how to manage it. Not all mistakes amount to negligence. How will the court view these cases? Some local cases are cited to illustrate the difference between misadventure and negligence. They will serve as guidelines for good medical practice.

  17. Minimizing medical litigation, part 2.

    PubMed

    Harold, Tan Keng Boon

    2006-01-01

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

  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. 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…

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

    ERIC Educational Resources Information Center

    Nonnenkamp, Donna J.

    2013-01-01

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

  1. Liability of College Faculty and Administrators

    ERIC Educational Resources Information Center

    Wall, Patricia S.; Sarver, Lee

    2014-01-01

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

  2. 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 theorists of the…

  3. 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…

  4. 42 CFR 415.70 - Limits on compensation for physician services in providers.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... reasonable compensation equivalency limit by the cost of the malpractice insurance expense related to the... 42 Public Health 3 2012-10-01 2012-10-01 false Limits on compensation for physician services in providers. 415.70 Section 415.70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT...

  5. 20 CFR 10.806 - How are the maximum fees defined?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... to procedures identified by Health Care Financing Administration Common Procedure Coding System... 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...

  6. The Prevalence and Special Educational Requirements of Dyscompetent Physicians

    ERIC Educational Resources Information Center

    Williams, Betsy W.

    2006-01-01

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

  7. Liability.

    ERIC Educational Resources Information Center

    Hollander, Patricia A.

    Recent court cases involving tort liabilities of institutions of higher education are discussed in this chapter. Issues addressed include negligence citations for injuries in physical education classes, a wrongful death suit, medical malpractice cases, and slip and fall accidents. Other cases included fraudulent misrepresentation, defamation of…

  8. 75 FR 73169 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ... viewing by the public, including any personally identifiable or confidential business information that is... Codes for AMA RUC Review e. Updating Equipment and Supply Price Inputs for Existing Codes f. Other... Services Effective Before the Next 5-Year Review 3. Revised Malpractice RVUs for Selected Disc...

  9. Negligence: the different focus of medical and legal concerns.

    PubMed

    Hodgson, John

    This article looks at additional areas where medical practice has been instrumental in developing the law. These cases do not involve malpractice, but do highlight how the different concerns, priorities and methodologies of medicine and law can produce problems and anomalies. One focus is on causation in relation to industrial disease, and the other on liability for negligently inflicted psychological harm.

  10. Helping Student Teachers Avoid Adverse Legal Actions.

    ERIC Educational Resources Information Center

    Peach, Larry; Reddick, Thomas L.

    1984-01-01

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

  11. Evaluation of nursing students' training in medical law.

    PubMed

    Kurban, Nevin Kuzu; Savaş, Halide; Cetinkaya, Bengü; Turan, Türkan; Kartal, Asiye

    2010-11-01

    There is no co-ordinated focus on liabilities arising from nurses' medical interventions in terms of occupational, administrative, civil legal and criminal activities. However, the Turkish Criminal Code, the Turkish Medical Ethics Code of Practice, and guidelines for patients' rights offer some framework for the relevant ethical principles and responsibilities of nurses. The aim of this study was to investigate the evaluation of nursing students' training in their legal liabilities. The sample consisted of 309 students who were taking a course entitled 'Nurses' legal liabilities under Turkish criminal and civil law arising from medical interventions'. Data were obtained by means of self-administered questionnaires and McNemar's test was used to evaluate the answers. In conclusion, after their training, a great majority of the students demonstrated an improvement in terms of their percentage of correct answers relating to malpractice. This does not, however, mean that they will not face malpractice charges after graduating, but their increased awareness of the issue may encourage them to make more effort to reduce the risk of mistakes. It is recommended that nursing faculty carry out studies into medical malpractice, that they focus more on this subject in nursing education, and that all nursing schools review their curricula from the point of view of malpractice.

  12. 42 CFR 411.357 - Exceptions to the referral prohibition related to compensation arrangements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... nonmonetary compensation limit on the physician self-referral Web site: http://www.cms.hhs.gov/PhysicianSelf... physician self-referral web site: http://www.cms.hhs.gov/PhysicianSelfReferral/10_CPI-U_Updates.asp. (6) The... than the physician) that is providing malpractice insurance (including a self-funded...

  13. 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…

  14. Professional Satisfaction among California General Dentists.

    ERIC Educational Resources Information Center

    Shugars, Daniel A.; And Others

    1990-01-01

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

  15. Refereeing of Scholarly Works for Primary Publishing.

    ERIC Educational Resources Information Center

    Dalton, Margaret Stieg

    1995-01-01

    Refereeing describes the process by which an independent expert assists a journal editor in evaluating materials submitted for publication. Discusses the history, purposes, and criticisms of refereeing, as well as technical aspects that include standards, rejection rates, interrater reliability and bias, the referees, ethics and malpractice,…

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

    PubMed

    Harolds, Jay A

    2016-09-01

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

  17. 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)

  18. Cryonic Suspension and the Law.

    ERIC Educational Resources Information Center

    Smith, George P.; Hall, Clare

    1987-01-01

    Analyzes three central problems which adversely affect use, development, and perfection of cryonic suspension of individuals: the extent to which a physician may be guilty of malpractice in assisting with a suspension; the need for a recognition of suspension; and the present effect of the law's anachronistic treatment of estate devolution upon a…

  19. 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.…

  20. Fraud, Ethics, and the Disciplinary Contexts of Science and Scholarship.

    ERIC Educational Resources Information Center

    Fox, Mary Frank

    1990-01-01

    Posits the disciplinary context is the locus of legitimate and illegitimate activity in science and scholarship. Compares structural features of sciences and social sciences that influence malpractice rates, type, and detection. These features include research activity, replication and replicability, coauthorship, plagiarism, locus of creativity…

  1. Models of care and organization of services.

    PubMed

    Markova, Alina; Xiong, Michael; Lester, Jenna; Burnside, Nancy J

    2012-01-01

    This article examines the overall organization of services and delivery of health care in the United States. Health maintenance organization, fee-for-service, preferred provider organizations, and the Veterans Health Administration are discussed, with a focus on structure, outcomes, and areas for improvement. An overview of wait times, malpractice, telemedicine, and the growing population of physician extenders in dermatology is also provided.

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

    PubMed

    Zinka, Bettina; Neelmeier, Tim

    2013-01-01

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

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

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

    PubMed

    Miller, Lisa A

    2011-01-01

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

  5. Keene v. Brigham and Women's Hospital, Inc.: On the Value of a Life with Mental Retardation.

    ERIC Educational Resources Information Center

    Vitello, Stanley J.

    2003-01-01

    Analysis of the Keene malpractice court case, which awarded compensatory damages to a child with severe disabilities probably contracted shortly after birth, focuses on how the court calculated life expectancy and the loss of life enjoyment, concluding discrimination against people with mental retardation, in that the decision assumes these…

  6. 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…

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

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-16

    ... National Practitioner Data Bank (NPDB) as authorized under Title IV of the Health Care Quality Improvement... trends in data, quality assurance, risk management, medical liability and malpractice; (5) conducts and... Administration (HRSA) (60 FR 56605, as amended November 6, 1995; as last amended at 75 FR 7608-7610...

  8. The Law and Health Personnel; A Study of Minnesota Law Related to Selected Health Manpower Categories.

    ERIC Educational Resources Information Center

    American Rehabilitation Foundation, Minneapolis, Minn. Inst. for Interdisciplinary Studies.

    This report surveys Minnesota laws relating to the use of health manpower. It presents a summary of Minnesota licensure laws as they apply to categories of health personnel and paramedical personnel currently unrecognized by the law. An analysis is also made of malpractice decisional law to examine whether such laws prohibit or inhibit optimal…

  9. Attention Students: Be Advised...

    ERIC Educational Resources Information Center

    Lindenberg, Steven P.

    1976-01-01

    A survey of the short history of the issue of counselor certification and licensure are the springboard for imagined future outcomes. Questions to ponder concern how licensure will come about, who will regulate the profession, and what part counselors must take to avoid the dilemma of lawsuits and malpractice. (MPJ)

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

    ERIC Educational Resources Information Center

    Stone, Carolyn

    2002-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  12. Effective communication: a powerful risk management tool.

    PubMed

    Husserl, F

    1993-01-01

    Physicians can employ communication techniques to improve patient diagnoses, outcomes, and satisfaction and ultimately to decrease their risk of malpractice suit. The skills outlined in this article form the basis of the Miles Program for Physician-Patient Communication of which the author is a participant.

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

    ERIC Educational Resources Information Center

    Studdert, David M.; Stevenson, David G.

    2004-01-01

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

  14. The Status of Dental Ethics Instruction.

    ERIC Educational Resources Information Center

    Odom, John G.

    1988-01-01

    A survey of dental schools in 1980 showed that 13 of the 55 responding schools provided no formal instruction in ethics. The status of instruction in dental ethics in 1986 is discussed. Survey data showed that schools providing ethics instruction often confused law, jurisprudence, and avoidance of malpractice with ethics. (MLW)

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

    PubMed Central

    2016-01-01

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

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

    PubMed

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

    2016-07-01

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

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

    PubMed

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

    2016-07-01

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

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

    PubMed Central

    AbuDagga, Azza

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

  20. Brachial neuritis or Parsonage-Turner syndrome: A problem of liability. A presentation of 3 cases.

    PubMed

    Rodríguez-Hornillo, M; de la Riva, M C; Ojeda, R

    2016-01-01

    Neuralgic amyotrophy, brachial neuritis or Parsonage-Turner syndrome is a rare neuromuscular involvement of unknown aetiology. When it onsets in connection with a health care act, such as childbirth or surgery, a malpractice argument is often used as a cause of adverse outcome, usually due to an incorrect position of the patient on the operating table, a circumstance which directly involves the anesthesia area. Three cases are presented of Parsonage-Turner syndrome following very different surgery, with different results as regards prognosis. A review and discussion of bibliography is presented on the possibility that such circumstances are the subject of malpractice claims. Special emphasis is placed on the most currently accepted aetiopathogenic theories, and the relationship of this syndrome with the surgical act as a determining medico-legal aspect. Valuation parameters are proposed. PMID:26948383

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

    PubMed

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

    2016-01-01

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

  2. Brachial neuritis or Parsonage-Turner syndrome: A problem of liability. A presentation of 3 cases.

    PubMed

    Rodríguez-Hornillo, M; de la Riva, M C; Ojeda, R

    2016-01-01

    Neuralgic amyotrophy, brachial neuritis or Parsonage-Turner syndrome is a rare neuromuscular involvement of unknown aetiology. When it onsets in connection with a health care act, such as childbirth or surgery, a malpractice argument is often used as a cause of adverse outcome, usually due to an incorrect position of the patient on the operating table, a circumstance which directly involves the anesthesia area. Three cases are presented of Parsonage-Turner syndrome following very different surgery, with different results as regards prognosis. A review and discussion of bibliography is presented on the possibility that such circumstances are the subject of malpractice claims. Special emphasis is placed on the most currently accepted aetiopathogenic theories, and the relationship of this syndrome with the surgical act as a determining medico-legal aspect. Valuation parameters are proposed.

  3. The spectrum of medical errors: when patients sue

    PubMed Central

    Kels, Barry D; Grant-Kels, Jane M

    2012-01-01

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

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

    PubMed

    MacEachern, Lillian

    2003-12-31

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

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

    PubMed

    Morgan, Rachel; MacEachern, Lillian

    2002-12-31

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

  6. Finance, providers issue brief: insurer liability.

    PubMed

    Rothouse, M; Stauffer, M

    2000-05-24

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

  7. Finance, providers issue brief: insurer liability.

    PubMed

    Rothouse, M

    1999-07-01

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

  8. LASERS and the LAW: what the dermatologist needs to know.

    PubMed

    Goldberg, David J

    2013-12-01

    Dermatologic laser surgery is a continuously evolving field of medicine. According to the American Society for Dermatologic Surgery, over 100 million laser and light source cosmetic procedures were performed by its members in 2003. Procedures, which include hair removal, nonablative treatments, as well as removal of pigmented lesions, tattoos, and unwanted vascular lesions, have revolutionized this field. With an increasing number of physicians and nonphysicians performing these procedures and with the availability of increasingly powerful laser technologies, the potential for problems and their legal consequences continue to increase. This article will address the concept of negligence and the potential for a resultant medical malpractice lawsuit that may arise in such a setting. Inherent in this issue are the associated problems that arise when these procedures are performed by physician extenders. An understanding of the basic principals of a cause of action in medical malpractice will likely protect a physician from losing such a case in a court of law. PMID:24800427

  9. “Health Courts” and Accountability for Patient Safety

    PubMed Central

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

    2006-01-01

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

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

    PubMed

    Winrow, Brian; Winrow, Amanda R

    2008-01-01

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

  11. Negligence, genuine error, and litigation.

    PubMed

    Sohn, David H

    2013-01-01

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

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

    PubMed

    Weis, Evelyn

    2016-05-01

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

  13. The medical-legal responsibilities of a dialysis unit medical director.

    PubMed

    Vaqar, Sarosh; Murray, Brian; Panesar, Mandip

    2014-01-01

    The specialty of Nephrology, by virtue of its relationship with the dialysis procedure, is highly vulnerable to litigation. As is the case with all nephrologists, a dialysis unit medical director is not immune to medical malpractice suits, and can be held liable for any act of perceived or potential harm to any dialysis patient, regardless of the director's level of involvement. The medical director, per the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation, accepts the responsibilities, accountability, and consequent legal liabilities of the quality of the medical care provided to every dialysis patient in the unit. This review is a synopsis of lawsuits filed against medical directors of dialysis units in the past forty years. Six categories of legal actions were noted; medical malpractice, fraudulent claims, self-referral and Stark Law, discrimination, negligence, and violation of patient autonomy and dignity.

  14. Patient satisfaction.

    PubMed

    Prakash, Bhanu

    2010-09-01

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

  15. The ECG dilemma: guidelines on improving interpretation.

    PubMed

    Mele, Paul F

    2008-01-01

    The "ECG Dilemma" was recognized by the American College of Cardiology (ACC) and the American Heart Association more than 10 years ago. Estimates put the number of patients suffering from significant ECG interpretation errors every year in the same range as deaths from diabetes. Missed MI ranks in the top tier of malpractice dollars lost. Guidelines have been put forth to reduce these losses and improve patient safety and quality of care. These guidelines, and suggestions towards implementing them, are discussed.

  16. Securing insurance protection against fraud and abuse liability.

    PubMed

    Callison, S

    1999-07-01

    Healthcare organizations concerned about corporate compliance need to review securing appropriate insurance coverage as part of their corporate compliance program. Provider organizations often mistakenly expect that their directors and officers liability (D&O), malpractice, or standard errors and omissions (E&O) insurance policies will cover the cost of Medicare fraud and abuse fines. The insurance industry has developed a specific billing E&O insurance product to cover providers that run afoul of government fraud and abuse statutes. PMID:10558007

  17. Securing insurance protection against fraud and abuse liability.

    PubMed

    Callison, S

    1999-07-01

    Healthcare organizations concerned about corporate compliance need to review securing appropriate insurance coverage as part of their corporate compliance program. Provider organizations often mistakenly expect that their directors and officers liability (D&O), malpractice, or standard errors and omissions (E&O) insurance policies will cover the cost of Medicare fraud and abuse fines. The insurance industry has developed a specific billing E&O insurance product to cover providers that run afoul of government fraud and abuse statutes.

  18. How ethics committees can safely navigate untested legal waters.

    PubMed

    Ahern, M L

    1984-10-01

    If hospital ethics committees are to meet their goal of ensuring that society's ethical maturation follows technology's growth and impact, they need to carefully formulate their functions before putting them in operation. The author provides some important guidelines on how to match the function and form of ethics committees so that potential legal problems, such as guardianship, informed consent, malpractice, and statutory civil rights issues, can be avoided.

  19. Ethics and risk management in administrative child and adolescent psychiatry.

    PubMed

    Sondheimer, Adrian

    2010-01-01

    This article examines ethics (the philosophic study of "doing the right thing") and risk management (the practice that seeks to manage the likelihood of "doing the wrong thing") and the relationship between them in the context of administrative child and adolescent psychiatry. Issues that affect child and adolescent psychiatrists who manage staff and business units and clinical practitioners who treat and manage individual patients are addressed. Malpractice, budgeting, credentialing, boundaries, assessment, documentation, treatment, research, dangerousness, and confidentiality are among the topics reviewed.

  20. American Indian women, HIV/AIDS, and health disparity.

    PubMed

    Vernon, Irene S

    2007-01-01

    Data are presented regarding the prevalence of HIV/AIDS among American Indian women. Health disparities found among American Indians are discussed and biological, economic, social, and behavioral risk factors associated with HIV are detailed. Recommendations are suggested to alleviate the spread of HIV among American Indian women and, in the process, to diminish a culture of treatment malpractice and a weakening of treatment ethics, racism, and genderism.

  1. Patient satisfaction.

    PubMed

    Prakash, Bhanu

    2010-09-01

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

  2. [Perspectives in medical liability].

    PubMed

    Pizarro W, Carlos

    2008-04-01

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

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

    PubMed

    Toro-Martínez, Esteban

    2014-01-01

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

  4. Compensability of, and legal issues related to, coccidioidomycosis.

    PubMed

    Haley, Luann

    2007-09-01

    Legal issues that may develop when treating patients with coccidioidomycosis include allegations of medical malpractice, claims for workers' compensation benefits, and civil actions against business owners. In states where the disease is most prevalent, California recognizes cocci diodomycosis as a compensable condition, although Arizona does not. In civil actions, the state courts have not imposed liability on any business or institution for those that claim to have developed cocci diodomycosis on or near the premises of the business.

  5. Abortion issue goes to US courts.

    PubMed

    Charatan, F B

    1995-04-22

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

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

    PubMed

    Chen, Xiao-Yang

    2007-01-01

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

  7. Attitude and tendency of cheating behaviours amongst undergraduate students in a Dental Institution of India.

    PubMed

    Monica, M; Ankola, A V; Ashokkumar, B R; Hebbal, I

    2010-05-01

    Honesty and integrity are key characteristics expected of a doctor, although academic misconduct amongst medical students is not new. Academic integrity provides the foundation upon, which a flourishing academic life rests. The aim of this study was to investigate the attitude of undergraduate dental students about the seriousness of cheating behaviours and to determine the rate of malpractice amongst these students. A self designed closed ended questionnaire was distributed to 300 undergraduate students in a Dental Institution in India, to rate the seriousness of six cheating behaviours and to assess the rate of malpractice. The response rate was 100%. Two of the six cheating behaviours were considered by at least 61% of the students as very serious cheating behaviours. Almost 70% of the students agreed that they have involved in malpractice in examinations at least once. The majority also felt that cheating in examinations will not have any significant effect on their future. This study has revealed that cheating is an important issue, which needs to be addressed for the benefit of the society at large.

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

    PubMed

    Mariner, W K

    1996-06-01

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

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

    PubMed

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

    1995-01-01

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

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

    PubMed Central

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

    1995-01-01

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

  11. Post-Perruche: what responsibilities for professionals?

    PubMed

    Clement, R; Rodat, O

    2006-03-01

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

  12. Health law and mental health law courses in US medical schools.

    PubMed

    Felthous, A R; Miller, R D

    1987-01-01

    Results of a recent survey of all 127 medical schools in the United States indicate that about two fifths of medical schools offer a separate course that focuses on topics in medicine and law and a number of medical schools integrate health law topics into other courses. Presumably reflecting concern over temporary medical malpractice litigation, most health law courses include informed consent, medical malpractice, privileged/confidential information, and patients' rights. In contrast, schools that offer a course on psychiatry and law are clearly in a minority. It is elective at all but two of the 13 schools with such a course. Although the hours allotted and the format of these courses vary greatly, courses typically cover most of the topics listed on the questionnaire. Most of the courses are led or co-led by a member of the American Academy of Psychiatry and the Law. Information from two additional surveys suggests two related factors that may influence a medical school to present a separate course on health law. Medical licensing boards were surveyed to determine which states require physicians to be examined on health law. In two states that require physicians to pass a separate medical jurisprudence examination for licensure, all four-year medical schools offer a course on health law for medical students. Medical malpractice companies providing coverage in all 50 states and the District of Columbia were surveyed to determine which states have the highest claim rates. The claim rate per 1,000 physicians insured per year was significantly greater in states with health law courses than was the rate in states without such courses. PMID:3427235

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

    PubMed Central

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

    2006-01-01

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

  14. [Genomics innovative teaching pattern based upon amalgamation between modern educational technology and constructivism studying theory].

    PubMed

    Liang, Xu-Fang; Peng, Jing; Zhou, Tian-Hong

    2007-04-01

    In order to overcome various malpractices in the traditional teaching methods, and also as part of the Guangdong province molecular biology perfect course project, some reforms were carried out to the teaching pattern of genomics. The reforms include using the foreign original teaching materials, bilingual teaching, as well as taking the constructivism-directed discussion teaching method and the multimedia computer-assisted instruction. To improve the scoring way and the laboratory course of the subject, we carried on a multiplex inspection systems and a self-designing experiments. Through the teaching reform on Genomics, we have gradually consummated the construction of molecular biology curriculum system.

  15. The optimal negligence standard in health care under supply-side cost sharing.

    PubMed

    Olbrich, Anja

    2008-06-01

    This paper elaborates on the optimal negligence standard in a world where physicians choose their level of care subject to erroneous court judgements and to the degree of supply-side cost sharing. Uncertain liability in malpractice lawsuits leads physicians to provide excessive and insufficient care, which results in a loss of social welfare. The standard that maximizes welfare depends on the cost share: Under traditional, close to full cost reimbursement it is lower than the first-best level of care, while under substantial supply-side cost sharing it increases and may even exceed the first best.

  16. Review of antibiotics and indications for prophylaxis.

    PubMed

    Weiss, Adam; Dym, Harry

    2012-01-01

    Antibiotic prophylaxis to prevent infective endocarditis has been controversial through the years, with various changes made to recommendations provided to treating physicians and dentists. The dentist must always use his or her best judgment when applying any guideline. However, it is important to remember that the guidelines may be cited in any malpractice litigation as evidence of the standard of care. Early diagnosis with prompt treatment with effective antimicrobial therapy is the best way to lower the mortality and morbidity. When prescribing antibiotics, the clinician must realize that the overprescription of antibiotics has led to resistance to antibiotic regimens and the rise of antibiotic-resistant bacteria.

  17. [The contribution of N.I. Pirogov to the development of forensic medicine (on the occasion of his 200th birthday anniversary)].

    PubMed

    Isakov, V D; Tolmachev, I A; Ozeretskovskiĭ, L B; Tiurin, M V; Belousova, O D

    2011-01-01

    The main facets of professor N.I. Pirogov's professional activity are outlined. Forensic medicine (in the first place its organizational and practical aspects) was an integral component of his scientific and clinical work, along with applied anatomy and surgery. Landmark publications of N.I. Pirogov are listed with special reference to those concerned with forensic medical expertise of medical malpractice cases, postmortem inspection and intravital examination procedures, wound ballistics studies, the atlas of forensic pathology, etc. The surgeon and anatomist N.I. Pirogov can be justly regarded as a founder of forensic medicine in this country. PMID:21866839

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

    PubMed

    Harden, Stephen W

    2013-03-01

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

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

    PubMed

    Brennan, Connie

    2014-01-01

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

  20. 'Over-servicing 'underservicing' and 'abandonment': What is the law?

    PubMed

    McQuoid-Mason, D J

    2015-03-01

    The Ethical Rules and Policy Document of the Health Professions Council of South Africa (HPCSA) do not define 'over-servicing', 'underservicing' and 'abandonment. The HPCSA Guidelines on Over-servicing, Perverse Incentives and Related Matters define 'over-service' only. The converse of this definition can be used to define 'underservicing'. The courts do not refer to these concepts, but apply general rules regarding professional negligence and malpractice based on what a reasonably competent doctor in the same position would do. In deciding the standard to be adopted, the courts may consult the ethical rules of the medical profession, but are not bound to take them into account.

  1. Your right to blow the whistle.

    PubMed

    Peate, Ian

    The NHS Constitution has now enshrined within it a number of pledges concerning whistle blowing. This comes as a result of a recent Department of Health (DH) public consultation concerning the Constitution and whistle blowing (DH, 2011). Changes to the Constitution will add an expectation that staff should raise concerns at the earliest opportunity. It also pledges that NHS organizations should support staff by ensuring their concerns are fully investigated and that there is someone independent, outside of their team, to speak to. It will aim to add clarity around the existing legal right for staff to raise concerns about safety, malpractice or other wrong doing without suffering any detriment.

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

    PubMed

    Li, Yuqing

    2014-01-01

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

  3. The Emerging Issue of Digital Empathy

    PubMed Central

    Cain, Jeff

    2016-01-01

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

  4. Medical liability reform crisis 2008.

    PubMed

    Weinstein, Stuart L

    2009-02-01

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

  5. [The contribution of N.I. Pirogov to the development of forensic medicine (on the occasion of his 200th birthday anniversary)].

    PubMed

    Isakov, V D; Tolmachev, I A; Ozeretskovskiĭ, L B; Tiurin, M V; Belousova, O D

    2011-01-01

    The main facets of professor N.I. Pirogov's professional activity are outlined. Forensic medicine (in the first place its organizational and practical aspects) was an integral component of his scientific and clinical work, along with applied anatomy and surgery. Landmark publications of N.I. Pirogov are listed with special reference to those concerned with forensic medical expertise of medical malpractice cases, postmortem inspection and intravital examination procedures, wound ballistics studies, the atlas of forensic pathology, etc. The surgeon and anatomist N.I. Pirogov can be justly regarded as a founder of forensic medicine in this country.

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

    PubMed

    Lawson, Hal

    2004-08-01

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

  7. The medical liability crisis of 2003: must we squander the chance to put patients first?

    PubMed

    Hatlie, Martin J; Sheridan, Susan E

    2003-01-01

    Medical liability reform should be aligned with a patient-centered, systems-based approach to preventing injury. Lessons learned about medical risk are now buried by the legal system, and communication about risk is haphazard among health care providers and across the interfaces of our legal, regulatory, and health care systems. Tort reform can be a vehicle for breaking down systemic barriers. Proposed reforms include (1) requiring disclosure of medical errors and restricting the use of information disclosed as evidence of guilt; (2) outlawing confidentiality agreements when malpractice cases are settled; (3) abolishing the National Practitioner Data Bank; and (4) establishing a national patient safety authority.

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

    PubMed

    Li, Yuqing

    2014-01-01

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

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

    PubMed

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

    2016-02-01

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

  10. Case reports. II. Sterilization litigation.

    PubMed

    Soderstrom, R M

    1988-03-01

    Legal questions will continue to increase with this popular operation because sterilization is the second most common procedure performed by gynecologists. Because of patient's expectation, the sterilization patient is particularly vulnerable to suggestions of malpractice after a complication or failure. Careful preoperative preparation of the patient and family; strict attention to equipment, education and outcome statistics; a conscientious concern when complications do occur will help to reduce sterilization legal claims. A thorough knowledge of the proper management after a complication must be part of the education process. Success following legal defense will be measured by a proper preparation, good records, and an impressive, knowledgeable expert witness.

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

    PubMed Central

    Hebbar, Sudhir

    2014-01-01

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

  12. Risk management information for HIV infection.

    PubMed

    Edwards, A J

    1990-01-01

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

  13. Avoiding the Legal “Blemish”

    PubMed Central

    Michaels, Brent D.; Momin, Saira B.

    2009-01-01

    In today’s legal environment, it is unlikely that a physician will complete a medical career without being introduced to the legal system in some way. Despite this, medical education often does not incorporate a basic teaching of general legal principles, and many physicians are left unaware of some of the important legal aspects of practicing medicine. The purpose of this article is to provide a background of the essential legal principles of a malpractice action as well as review the fundamentals of the legal process, provide published caselaw of prior dermatological pitfalls, and ultimately, provide suggestions to better prepare the dermatologist to practice medicine. PMID:20725583

  14. The Emerging Issue of Digital Empathy.

    PubMed

    Terry, Christopher; Cain, Jeff

    2016-05-25

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

  15. Team Physicians, Sports Medicine, and the Law: An Update.

    PubMed

    Koller, Dionne L

    2016-04-01

    The recognition of sports medicine and promulgation of practice guidelines for team physicians will push general medical malpractice standards to evolve into a more specialized standard of care for those who practice in this area. To the extent that practicing medicine in the sports context involves calculations that do not arise in typical medical practice, the sports medicine community can help elucidate those issues and create appropriate guidelines that can serve to inform athlete-patients and educate courts. Doing so will help best set the terms by which those who practice sports medicine are judged.

  16. Issues in physician contracting.

    PubMed

    Fanburg, John D; Leone, Alyson M

    2005-09-01

    Dermatologists will enter into a number of different contracts during their professional careers. It is important that in each agreement they enter, dermatologists reap the benefits that they aspire for and understand the consequences of each provision. This article addresses just a few of the different issues that arise in physician contracting, such as choosing the appropriate form of business entity; the importance of a writing; term and termination of the contract; compensation models; benefits, vacation and other time off included in the contract; malpractice insurance; and restrictive covenants. Each provision should be carefully analyzed to ensure that it will protect the best interests of the dermatologist in that situation. PMID:16202950

  17. Let's think about human factors, not human failings.

    PubMed

    Mossman, Douglas

    2009-01-01

    Doctors typically think about medical errors as potential causes of malpractice litigation, as failures by individuals, and as evidence of personal incompetence that may deserve sanctions. Other professions take a different view: designing of safer systems, rather than criticism and punishment, is the way to prevent unintentional mishaps. In his article, Jeffrey Janofsky shows how psychiatrists can think about making care systems safer for patients. He also provides a splendid example of how forensic psychiatrists should conceptualize legal and medical problems encountered in clinical practice.

  18. Torts and innovation.

    PubMed

    Parchomovsky, Gideon; Stein, Alex

    2008-11-01

    This Essay exposes and analyzes a hitherto overlooked cost of tort law: its adverse effect on innovation. Tort liability for negligence, defective products, and medical malpractice is determined by reference to custom. We demonstrate that courts' reliance on custom and conventional technologies as the benchmark of liability chills innovation and distorts its path. Specifically, recourse to custom taxes innovators and subsidizes replicators of conventional technologies. We explore the causes and consequences of this phenomenon and propose two possible ways to modify tort law in order to make it more welcoming to innovation.

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

    PubMed

    Raposo, Vera Lúcia

    2015-01-01

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

  20. Medical Liability Reform Crisis 2008

    PubMed Central

    2008-01-01

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

  1. Influencers of career choice among allied health students.

    PubMed

    Brown-West, A P

    1991-01-01

    This study focused on the factors that influence students' choice of an allied health profession. A survey of 153 students in three allied health programs at the University of Connecticut revealed that "the need to help others," "prestige," "professional autonomy," "opportunities for advancement," "income potential," and "the effect of the specialty on family and personal life," were the major influencers of career choice among allied health students. Only a few students regarded malpractice suits and AIDS as negative influencers. While medical laboratory science majors regarded these as important factors, dietetics and physical therapy majors did not. The article suggests further use of these findings by program directors and career counselors. PMID:1761410

  2. Brief introduction of the construction of the military medical institution management laws and regulations of the CPLA.

    PubMed

    Xuejun, Tian

    2012-03-01

    The paper introduces the developing history of the military medical institution management laws and regulations of the Chinese People's Liberation Army, which consists of 9 categories, including general principles, medical division and transfer system, medical quality, personnel resources, department construction, medical equipment, Medicines and preparation, Medical Malpractice handling and hospital infection control. And in this paper, we summarizes the legislation organization into 3 levels, discuss the relationship between the Military Medical Institution Management Law and related laws as well as the national regulations. PMID:22908735

  3. Making customer-service a priority in health care organizations.

    PubMed

    O'Hagan, Joshua; Persaud, David

    2008-01-01

    Improving customer-service in health care organizations has been linked to better patient care, satisfied staff, a reduction in preventable medical errors, fewer malpractice lawsuits and improved revenue. However, it has been observed that there is sometimes a gap between the level of customer-service provided by health care organizations and their clients' expectations. This paper integrates, synthesizes and extends theory and practice from existing literature to provide health care organizations with strategies for closing this gap. Methods are also outlined for creating, implementing and evaluating an organizational plan for improving customer-service.

  4. A case of pain, factitious disorder and boundary violations.

    PubMed

    Cote, I

    2001-01-01

    Although health professionals are usually familiar with factitious disorders, evaluating such cases may be complicated, particularly in the legal arena. This article describes a patient who presented with pain complaints to numerous doctors. Eventually, a malpractice suit was brought against one of the patient's physicians who had diagnosed her condition as multiple personality disorder (dissociative identity disorder). Factitious disorder and the doctor's prescription of pain medications were issues raised during the trial. In view of the issue of harm, physicians' responsibilities and limitations during ongoing medical care are addressed in this case report.

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

    PubMed

    2007-08-01

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

  6. Association between physician explanatory behaviors and substandard care in adjudicated cases in Japan

    PubMed Central

    Hagihara, Akihito; Hamasaki, Tomoko; Abe, Takeru

    2011-01-01

    Background: When a physician provides an insufficient explanation to a patient, such as regarding diagnosis, treatment, drug use, or prognosis, the physician is deemed to have delivered substandard care. It is likely that the standards applied to physicians’ explanations have changed as a result of the increased importance of patients’ rights of self-determination. However, little or no research on decisions in medical malpractice cases has been conducted with respect to this issue. Methods: Based on decisions made in 366 medical malpractice cases between 1979 and 2008 focused primarily on the physician’s duty to explain relevant issues to patients, we examined the association between physicians’ explanatory behaviors and court decisions with respect to breaches of duty. Results: We found that physicians’ explanatory behaviors, including relevant and specific explanations provided before treatment or surgery, were important for fulfilling a physician’s duty to explain. The data also revealed that six of the 16 types of explanatory behaviors had improved during the past three decades. However, these improvements did not contribute to the fulfillment of the physician’s duty to explain. Conclusion: We found that there was an association between physicians’ explanatory behaviors and judicial decisions concerning substandard care, and courts were increasingly likely to consider inadequate explanatory behaviors to be a breach of the duty of care. PMID:21556315

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

    PubMed

    Chorus, Caspar; Waltman, Ludo

    2016-01-01

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

  8. Challenges in contemporary academic neurosurgery.

    PubMed

    Black, Peter M

    2006-03-01

    Traditionally, the ideal academic neurosurgeon has been a "quadruple threat," with excellence in clinical work, teaching, research, and administration. This tradition was best exemplified in Harvey Cushing, who developed the field of neurosurgery 90 years ago. This paradigm will probably have to change as academic neurosurgeons face major challenges. In patient care, these include increasing regulatory control, increasing malpractice costs, consolidation of expensive care in academic centers, and decreasing reimbursement; in resident teaching, work hour limitations and a changing resident culture; in research, the increasing dominance of basic scientists in governmental funding decisions and decreased involvement of neurosurgeons in scientific review committees; and in administration, problems of relationships in the workplace, patient safety, and employment compliance in an increasingly bureaucratic system. To meet these challenges, the new academic neurosurgeon will probably not be a quadruple threat personally but will be part of a quadruple threat in a department and institution. Neurosurgeons in such a setting will have to work with hospital, medical school, and national and international groups to address malpractice, reimbursement, subspecialization, and training problems; find supplemental sources of income through grants, development funds, and hospital support; lead in the development of multidisciplinary centers for neuroscience, brain tumor, spine, and other initiatives; and focus on training leaders for hospital, regional, and national groups to reconfigure neurosurgery. Collaboration, flexibility, and leadership will be characteristic of the academic neurosurgeon in this new era.

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

    PubMed Central

    Waltman, Ludo

    2016-01-01

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

  10. The medical liability climate and prospects for reform.

    PubMed

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

    2014-11-26

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

  11. When patients are harmed, but are not wronged: ethics, law, and history.

    PubMed

    Klaas, Paul B; Berge, Keith H; Klaas, Kelsey M; Klaas, James P; Larson, Annalise Noelle

    2014-09-01

    Iatrogenic injury-injury caused unintentionally by medical treatment-breaks the oldest and most famous rule of medical ethics: primum non nocere, or above all, do no harm. Medical malpractice law, however, focuses on whether an injury was caused by negligence, not on whether an injury was iatrogenic. Iatrogenic injury inflicted without negligence is a common pattern in medical malpractice lawsuits; it is likely the pattern of Jacobs v Cross (Minnesota, 1872), in which Dr W. W. Mayo testified as an expert witness. As a matter of law, the doctor defendants should win all those lawsuits, for iatrogenic injury inflicted without negligence is not a legal wrong in the United States and has not been considered a legal wrong for hundreds of years. However, the medical ethics applicable to doctors' duties to report incompetence in colleagues, including those who inflict excessive iatrogenic injury, have developed dramatically over time. In 1872, the ethical codes in the United States exhorted doctors not to criticize another doctor, even if incompetent. Today, doctors in the United States are ethically required to report an incompetent colleague.

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

    PubMed Central

    Gleberzon, Brian J.

    2010-01-01

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

  13. Maintaining proper dental records.

    PubMed

    Leeuw, Wilhemina

    2014-01-01

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

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

    PubMed

    Epstein, J I

    2001-04-01

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

  15. THE LIABILITY FORMS OF THE MEDICAL PERSONNEL.

    PubMed

    Bărcan, Cristian

    2015-01-01

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

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

    PubMed

    Hannappel, J; Weber, B; Smentkowski, U

    2012-11-01

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

  17. An empirical investigation of the differences between male and female medical school physicians.

    PubMed

    Deshpande, Sagar S; Deshpande, Satish P

    2011-01-01

    The purpose of this research was to investigate gender-related differences among medical school faculty in a variety of areas such as information technology, medical malpractice, compensation, patient care, and carrier satisfaction. The Center for Studying Health System Change's 2008 Health Tracking Physician survey data consisting of 326 medical school faculty belonging to the American Medical Association were used in this study. t Tests indicate that female physicians practicing in medical schools were younger, had less experience, reported lower compensation, and were more likely to be primary care physicians. Male medical school physicians were significantly more concerned about being involved in a malpractice lawsuit. They reported a significantly higher percentage on income based on productivity-related factors. Male physicians also reported getting a significantly higher level of goods and services from drug companies. They also provided more hours of medical service for no or reduced fee in the previous month and higher levels of career satisfaction. Implications of this research are discussed.

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

    PubMed

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

    2016-06-01

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

  19. The medical liability climate and prospects for reform.

    PubMed

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

    2014-11-26

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

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

    PubMed Central

    Harréus, Ulrich

    2013-01-01

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

  1. Authorship issues

    PubMed Central

    Bavdekar, Sandeep B.

    2012-01-01

    Authorship is a highly sought attribute, as it is associated with recognition for creativity. In addition, it is associated with multiple benefits such as peer recognition, better evaluation and financial gains. These possibilities spur scientists to author articles, but some take recourse to unethical practice of honorary authorships. Another unethical practice is that of ghostwriting. It is a phenomenon wherein individuals who write the articles are not named as authors and are not even acknowledged to be associated with the manuscript. Reputed and renowned scientists, who have not participated in the conduct of the study or in the manuscript preparation, are enrolled by the industry to allow their names to be mentioned as authors. This phenomenon is harmful not only because it suppresses the contribution of ghost-authors but also because the guest “authors” bestow underserved credibility upon an “industry-written” paper. The readers have no way of knowing the bias that may have crept in. The journal editors, institution, and government agencies need to come together to ensure that these malpractices are curbed by employing various measures such as creating awareness amongst authors, academicians, and administrators; enunciating and implementing policies to dissuade unethical behavior, protecting whistle-blowers, and providing punishments to those indulging in malpractices. All of us should remember that if unchecked, these deviant behaviors have the potential to compromise the credibility of scientific research and scientific publications. PMID:22345922

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

    PubMed

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

    2016-06-01

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

  3. Protecting patients' rights in New Zealand.

    PubMed

    Paterson, R

    2005-03-01

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

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

    PubMed

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

    2013-11-01

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

  5. Lessons from the past: directions for the future. Do new marketed surgical procedures and grafts produce ethical, personal liability, and legal concerns for physicians?

    PubMed

    Ostergard, Donald R

    2007-06-01

    New procedures and materials for incontinence and prolapse are proliferating rapidly. Surgical procedures were developed by physicians and carried their names, but over the last 15 years, these procedures are developed by industry and bear the trade names of the companies selling the kits needed to perform them. The Food and Drug Administration (FDA) approves devices, not procedures, and does not require submission of efficacy or adverse-event data to gain this approval by the 510-K process. Evidence-based medicine is lacking in the performance of these procedures that may be considered experimental by an insurance company or malpractice carrier with denial of payment or coverage. Physicians and hospitals are exposing themselves to financial, legal, and ethical risks when performing or allowing such procedures to be performed. Informed consent from the patient cannot be obtained. We must not confuse medical marketing with evidence-based medicine.

  6. [Troubled times in care of the elderly. Increasing number of the "oldest old" and demented, shortage of general practitioners and lack of clarity with regards to locating resources].

    PubMed

    Wimo, A

    2000-05-17

    The media image of general breakdown in care of the elderly, replete with portrayals of malpractice and maltreatment, is analyzed in the light of changes in demographics, care resources and care delivery systems during the past decades. A substantial increase in the number of people aged 80 years or more, increasing numbers of elderly persons with dementia, deinstitutionalization of health care, together with the present economic crisis, place a considerable burden on the care system, as illustrated by an increased nursing load, a decrease in the number of elderly persons receiving home services, and a concentration of support to the most impaired. The author calls attention to the need for refined methods for describing care delivery systems, longitudinal population based studies, and a national hospital plan. Primary health care, already pushed to the limit by dwindling resources and job vacancies, is hard put to shoulder the burden of responsibility for the elderly. PMID:10909226

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

    PubMed

    Homola, Samuel

    2016-02-01

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

  8. Last call for informed consent: confused proxies in extra-emergency conditions.

    PubMed

    Vyshka, Gentian; Seferi, Arsen; Myftari, Kreshnik; Halili, Vera

    2014-01-01

    Informed consent has become a part of medical practice in Albania only recently, during a time when there has been a substantial increase in claims of malpractice. Its original aim was to provide patients with information to help them make decisions on particular health interventions. We describe the case of a patient who developed an unexpected surgical complication and desperately needed a second intervention, and the futility of obtaining informed consent in the setting of a medical emergency. The circumstances of the emergency might turn out to be too complicated and confusing for the proxies. The, role of proxies is not defined in the Albanian laws and bylaws. Seeking and eventually obtaining the necessary signatures and permissions in an emergency cannot be justified because the lack of time in such circumstances might be a major obstacle to sound and comprehensive communication, and lack of communication could give rise to mistrust, with all its potential consequences.

  9. Florida court asked to decide legality of limiting suits.

    PubMed

    1996-06-14

    The state Supreme Court of Florida will rule on the legitimacy of a statute that restricts the ability of a plaintiff to sue for damages arising from HIV-contaminated blood transfusion. Under the malpractice law, patients have 4 years from the time of injury to file suit. In most HIV and AIDS cases, however, symptoms do not appear within the 4-year period. The Broward County Circuit Court recently dismissed a contaminated blood transfusion suit based on the expiration of the 4-year statute of repose. The Court of Appeals held the trial judge's application of the law correct, but found the statute uniquely unfair and harsh in HIV/AIDS cases. The State Supreme Court has been asked to rule on the issue.

  10. Careful telemedicine planning limits costly liability exposure.

    PubMed

    Edelstein, S A

    1999-12-01

    Recent Federal and state legislation and new payment opportunities from Medicare, Medicaid, and private payers may make it possible to offer telemedicine as a viable, cost-effective alternative to traditional care delivery in communities where access to health care is limited. Originally, nonexistent payment and expensive technology held back telemedicine but, these barriers are giving way to specific applications that can yield dramatic cost savings for group practices in the delivery of medical care while adding features and benefits not typically available in traditional delivery settings. Before joining a telemedicine network, group practices need to negotiate a variety of legal issues related to the corporate practice of medicine, patient confidentiality and privacy, malpractice, informed consent, licensure and credentialing, intellectual property, Medicare and Medicaid payment, fraud and abuse, medical device regulation, and antitrust.

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

    PubMed

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

    2013-12-11

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

  12. Consent and the Indian medical practitioner

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2004-09-01

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

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

    PubMed

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

    2014-08-01

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

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

    PubMed

    Francis, Leslie P

    2014-12-01

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

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

    PubMed

    Bagalio, Sharon A

    2007-01-01

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

  17. Criminal justice procedures in civil commitment.

    PubMed

    Slovenko, R

    1977-11-01

    The actions of federal district courts and state legislatures in recent years have resulted in the growing application of procedures of the criminal justice system to the civil commitment process. Increasingly patients can be confined only if they are dangerous to others, and increasingly due-process procedures of the criminal law are required, to the detriment of the patient's treatment and his survival in the community. The author says that allegations of patients' being railroaded into hospitals are, with few exceptions, fictitious. Abuses thet do exist should be handled through writs of habeas corpus and malpractice suits, remedies much more available now than in the past. The principal abuse in commitment occurs not when patients are admitted, the author believes, but at discharge, when so many patients are turned out into communities that lack proper services for them.

  18. The peer review privilege: a law in search of a valid policy.

    PubMed

    Goldberg, B A

    1984-01-01

    The peer review privilege prevents patient-plaintiffs from obtaining the hospital records prepared in connection with quality review proceedings. The privilege, created by statute in most states, is rationalized by the need for confidentiality in promoting complete and candid peer review. In this Article, the Author argues that the privilege cannot effectively promote confidentiality since a common exception allows physicians to obtain the records when seeking judicial review of proceedings leading to their exclusion or dismissal from hospital medical staffs. More significantly, the Author notes that while the privilege began as a device to protect physicians from testifying against their will in malpractice suits--a condonation of the "conspiracy of silence"--it has evolved into a vehicle which enables hospitals to conceal the evidence of their own neglect.

  19. Criminal justice procedures in civil commitment.

    PubMed

    Slovenko, R

    1977-11-01

    The actions of federal district courts and state legislatures in recent years have resulted in the growing application of procedures of the criminal justice system to the civil commitment process. Increasingly patients can be confined only if they are dangerous to others, and increasingly due-process procedures of the criminal law are required, to the detriment of the patient's treatment and his survival in the community. The author says that allegations of patients' being railroaded into hospitals are, with few exceptions, fictitious. Abuses thet do exist should be handled through writs of habeas corpus and malpractice suits, remedies much more available now than in the past. The principal abuse in commitment occurs not when patients are admitted, the author believes, but at discharge, when so many patients are turned out into communities that lack proper services for them. PMID:914239

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

    PubMed

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

    2015-01-01

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

  1. Disclosure of harmful medical errors in out-of-hospital care.

    PubMed

    Lu, Dave W; Guenther, Elisabeth; Wesley, Allen K; Gallagher, Thomas H

    2013-02-01

    Safety experts and national guidelines recommend disclosing harmful medical errors to patients. Communicating with patients and families about errors respects their autonomy, supports informed decisionmaking, may decrease malpractice costs, and can enhance patient safety. Yet existing disclosure guidelines may not account for the difficulty in discussing out-of-hospital errors with patients. Emergency medical services (EMS) providers operate in unpredictable environments that require rapid interventions for patients with whom they have only brief relationships. EMS providers also have limited access to patient medical data and risk management resources, which can make conducting disclosure conversations even more difficult. In addition, out-of-hospital errors may be discovered only after the transition of care to the inpatient setting, further complicating the question of who should disclose the error. EMS organizations should support the disclosure of out-of-hospital errors by fostering a nonpunitive culture of error reporting and disclosure, as well as developing guidelines for use by EMS systems.

  2. Medicolegal education and crisis in interprofessional relations.

    PubMed

    Naitove, B J

    1982-01-01

    An increase in malpractice claims is only one indication of the problem physicians and attorneys have in their interprofessional relations. This note explores the factors, such as increased specialization and social responsibility, that have given these professionals a myopic view of their respective roles. The note suggests that the crisis in interprofessional relations can be alleviated by interdisciplinary education in professional schools. It examines the problems inherent in current interdisciplinary programs and offers a model program jointly taught to law and medical students. The model course uses a problem solving approach that forces each student to examine the methods and limitations of both professions and to develop a concept of the professional's role in society.

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

    PubMed

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

    2016-09-01

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

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

    PubMed

    Avon, Sylvie Louise

    2004-01-01

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

  5. Watermarking as a traceability standard.

    PubMed

    Coatrieux, Gouenou; Quantin, Catherine; Allaert, François-André

    2012-01-01

    The exponential increase in the number of electronic document exchanges in healthcare has considerably increased the risk of document drop-out or address errors. It may therefore be important to know to whom the information belongs and who produced it. This becomes a major concern when the document has been involved in processes leading to the choice of therapy and eventually in cases where patients seek damages for medical malpractice. Watermarking, which is the embedding of security elements, such as a digital signature, within a document, can help to ensure that a digital document is reliable. However, at the same time, questions arise about the validity of watermarking-based evidence. In this paper, beyond the technical aspects, we discuss the worldwide legal acceptability of watermarking and the need for its recognition as a standard according to technical characteristics that the CEN and ISO need to agree on.

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

    PubMed

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

    2005-01-01

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

  7. Revisions to direct fee payment rules. Final rules.

    PubMed

    2015-01-01

    We are adopting, with two revisions, our interim final rules that implemented amendments to the Social Security Act (Act) made by the Social Security Disability Applicants' Access to Professional Representation Act of 2010 (PRA). The interim final rules made permanent the direct fee payment rules for eligible non-attorney representatives under titles II and XVI of the Act and for attorney representatives under title XVI of the Act. They also revised some of our eligibility policies for non-attorney representatives under titles II and XVI of the Act. Based on public comment and subsequent inquiries, we are revising our rules to clarify that an eligible non-attorney representative's liability insurance policy must include malpractice coverage. We are also reaffirming that a business entity legally permitted to provide the required insurance in the States in which the non-attorney representative conducts business must underwrite the policies.

  8. SOAP to SNOCAMP: improving the medical record format.

    PubMed

    Larimore, W L; Jordan, E V

    1995-10-01

    Not since the development of the SOAP note in the problem-oriented medical record has there been a significant need to alter the format of medical record documentation. With the intrusion of third-party audits, malpractice attorney subpoenas, medical guidelines, and reimbursement code criteria into the practice of medicine, there is a need to expand the traditional SOAP note. This article proposes a new acronym, "SNOCAMP," for medical record documentation. SNOCAMP retains the SOAP format, which includes subjective, objective, assessment, and plan of treatment, with the addition of nature of the presenting complaint, counseling, and medical decision-making. It is hoped that this new, more explicit format will prove successful in meeting the divergent needs of practicing physicians, the patients they serve, and the inquiring minds that look over their shoulders.

  9. An electronic patient risk communication board.

    PubMed

    Ohashi, Kumiko; Caligtan, Christine A; Benoit, Angela N; Breydo, Eugene M; Carroll, Diane L; Keohane, Carol A; Bates, David W; Dykes, John S; Dykes, Patricia C

    2012-01-01

    Communication failures have been identified as the root cause of the majority of medical malpractice claims and patient safety violations. We believe it is essential to share key patient risk information with healthcare team members at the patient's bedside. In this study, we developed an electronic Patient Risk Communication Board (ePRCB) to assist in bridging the communication gap between all health care team members. The goal of the ePRCB is to effectively communicate the patient's key risk factors, such as a fall risk or risk of aspiration, to the healthcare team and to reduce adverse events caused by communication failures. The ePRCB will transmit patient risk information and tailored interventions with easy-to-understand icons on an LCD screen at the point of care. A set of patient risk reminder icons was developed and validated by focus groups. We used the results of the evaluation to refine the icons for the ePRCB.

  10. [The child as damage--physicians' liability in cases involving reproductive and prenatal medicine].

    PubMed

    Schreiber, Hans-Ludwig

    2002-07-01

    In case of medical malpractice courts grant the parents of unwanted or handicapped children damages towards the costs of alimony. In this article the development of the courts' rulings and the criticism made of them will be presented in detail. Granting damages towards the costs of alimony does not call into question the right to live of an unborn child. It is rather just another case of professional liability of physicians. Regarding the development of the law, with respect to the legal admissibility of induced abortions, including those undertaken during late stages of pregnancy, the physician may come under pressure to recommend an abortion to rule out any claims for damages. This subject is in need of legal regulation pursuant to the forthcoming medical reproduction law.

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

    PubMed Central

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

    2015-01-01

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

  12. Neonatal euthanasia: A claim for an immoral law

    PubMed Central

    Martinovici, Dana

    2013-01-01

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

  13. The mat study: global insight into the medication administration process.

    PubMed

    Elganzouri, Erika; Standish, Cynthia; Androwich, Ida

    2009-01-01

    An important aspect of global patient safety that has recently become a focal topic is preventing adverse drug events. As many as 7,000 patients die every year as a result of medication errors. (1) According to Bates, Spell, & Cullen, adverse drug events can cost up to an average of $8.4 million per year in a 700 bed hospital, not including injury to patient or malpractice costs. (2) Errors can occur throughout the process of ordering a medicine, dispensing, retrieving, and administrating process. Safety measures have been implemented for physicians prescribing medication and pharmacists dispensing medication through MARs and CPOE. However, there is no safety net for nursing. Bar coding can offer that safety net and allow the nurse to verify "the five rights" of medication administration electronically. However, prior to implementation of a bar coding medication system (BCMA), it is important for an institution to gain full understanding of its current nursing work flow during the medication administration process.

  14. Acute myocarditis mimicking acute myocardial infarction: a clinical nightmare with forensic implications.

    PubMed

    Pomara, Cristoforo; Villani, Angelo; D'Errico, Stefano; Riezzo, Irene; Turillazzi, Emanuela; Fineschi, Vittorio

    2006-09-10

    Authors present the case of the sudden death of a 30-year-old man, 3 h since his hospitalization by the onset of aspecific chest pain. ECG findings revealed the presence of localized ST segment elevation in precordial leads (V1-V4) and DII-DII, and aVF mimicking acute antero-inferior myocardial infarction. A diagnosis of acute antero-inferior myocardial infarction was advanced and the patient introduced to thrombolytic therapy. Suddenly, on ECG monitor, conduction abnormalities were early recorded (ventricular extrasystole) followed by ventricular tachycardia degenerating in fatal ventricular fibrillation. An alleged medical malpractice was sued against the cardiologist. A complete immunohistochemical study was performed. Histologically, the heart presented massive interstitial lymphocytic infiltrate and focal myocytes necrosis. The diagnosis of acute lymphocytic myocarditis was established as the cause of death.

  15. Cesarean Section: A Seven-Year Study

    PubMed Central

    Weekes, Leroy R.

    1983-01-01

    This paper reports a seven-year study of cesarean section practices at the Queen of Angels Hospital, Los Angeles, California. Indications for this procedure are listed in detail and an attempt is made to explain its increasing frequency. Practicing physicians were interviewed and testimony seemed to indicate, as was suspected, that fear of malpractice suits was one of the reasons for cesarean section. The conventional wisdom of “once a section always a section” is questioned with regard to an increasing number of trials of labor and vaginal deliveries, when they are considered feasible and safe. The federal government is manifesting serious interest in this increased number of operative deliveries in the light of cost effectiveness. PMID:6864826

  16. Risk management in surgery

    PubMed Central

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

    2013-01-01

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

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

    PubMed

    Dimov, Ves; Eidelman, Frank

    2015-01-01

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

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

    PubMed

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

    2016-03-01

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

  19. Contemporary practice in forensic odontology

    PubMed Central

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

    2014-01-01

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

  20. Circular on early marriage, March 1988.

    PubMed

    1988-01-01

    This Circular calls on government at all levels in Hunan, China, to summon the departments concerned thoroughly to investigate the problem of early child-bearing so that they can do a good job in managing the problems of unregistered cohabiting and of unmarried mothers. The Circular recommends that: "It is necessary to criticize and educate, and even punish by discipline, those parents who connive with their sons and daughters in practicing unregistered cohabiting." It also states the following: "It is necessary to keep a strict check on registry personnel who do not carry out their duties properly. Those who violate laws and discipline, engage in malpractices for selfish ends, and practice bribery and corruption, resulting in early marriage and child-bearing, must be dealt with strictly. Legal sanctions must be enforced against those who break the law." PMID:12289639

  1. [Information guided technology and procedure in neurosurgical field].

    PubMed

    Iseki, Hiroshi; Muragaki, Yoshihiro; Nakamura, Ryoichi; Nanbu, Kyojiro; Hori, Tomokatsu

    2007-01-01

    Translational Research is the research to apply and mediate a fundamental research result to the clinical field effectively. The integration of the diagnosis and the treatment is an important item in the life science field from the viewpoint of quality of therapy and minimally invasive therapy. The standardization of mechanical interface of the medicine related machine, system and a medical information system are important from the viewpoint such as prevention of medical malpractice. A high function operating robot (manipulator) as an endoscopic robot and image-guided minimally invasive device are important in the point of view of the development of a medical device shown with a medical device industry vision. We describe an outline of our ongoing development of endoscope system, intraoperative MRI (intelligent operating theater) and robot surgery system in neurosurgical field.

  2. Medicolegal aspects of prescribing dermatological medications in pregnancy.

    PubMed

    Gupta, Rishu; High, Whitney A; Butler, Daniel; Murase, Jenny E

    2013-12-01

    Medications are commonly used during pregnancy; in fact, female patients take an average of 2.9 medications during pregnancy. Due to this high prevalence, malpractice litigation poses a high legal risk to dermatologists who prescribe medications to female patients who are or may become pregnant. This article introduces the medicolegal risks involved in prescribing dermatological medications to a pregnant patient and discusses ways for a dermatologist to mitigate those risks. International safety classification systems are reviewed, and potential high risk dermatologic medications prescribed in acne, psoriasis, atopic dermatitis, and connective tissue disease are discussed. In addition, the article summarizes resources available to patients as well as the important elements for dermatologists to include when documenting their discussion with the patient in the medical record. PMID:24800428

  3. Supporting second victims of patient safety events: shouldn't these communications be covered by legal privilege?

    PubMed

    de Wit, Mélanie E; Marks, Clifford M; Natterman, Jeffrey P; Wu, Albert W

    2013-01-01

    Adverse events that harm patients can also have a harmful impact on health care workers. A few health care organizations have begun to provide psychological support to these Second Victims, but there is uncertainty over whether these discussions are admissible as evidence in malpractice litigation or disciplinary proceedings. We examined the laws governing the admissibility of these communications in 5 states, and address how the laws might affect participation in programs designed to support health care workers involved in adverse events. We found that privilege is uneven from state-to-state, and also unclear. Ambiguity alone could have a chilling effect on Second Victim programs. We propose legislation to protect volunteer and health care worker communications provided by peer counselors, or failing this, updating of statutory provisions to explicitly include these communications within the ambit of existing protections. Enhancing protections could help to foster an environment of healing for both patients and caregivers.

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

    PubMed Central

    Jelinski, Murray D.; Lissemore, Kerry

    2015-01-01

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

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

    PubMed Central

    Callahan, D

    1995-01-01

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

  6. [Medical errors in obstetrics].

    PubMed

    Marek, Z

    1984-08-01

    Errors in medicine may fall into 3 main categories: 1) medical errors made only by physicians, 2) technical errors made by physicians and other health care specialists, and 3) organizational errors associated with mismanagement of medical facilities. This classification of medical errors, as well as the definition and treatment of them, fully applies to obstetrics. However, the difference between obstetrics and other fields of medicine stems from the fact that an obstetrician usually deals with healthy women. Conversely, professional risk in obstetrics is very high, as errors and malpractice can lead to very serious complications. Observations show that the most frequent obstetrical errors occur in induced abortions, diagnosis of pregnancy, selection of optimal delivery techniques, treatment of hemorrhages, and other complications. Therefore, the obstetrician should be prepared to use intensive care procedures similar to those used for resuscitation.

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

    PubMed

    Mahmud, M N

    2005-08-01

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

  8. Simplifying the negotiating process with physicians: critical elements in negotiating from private practice to employed physician.

    PubMed

    Gallucci, Armen; Deutsch, Thomas; Youngquist, Jaymie

    2013-01-01

    The authors attempt to simplify the key elements to the process of negotiating successfully with private physicians. From their experience, the business elements that have resulted in the most discussion center on the compensation including the incentive plan. Secondarily, how the issue of malpractice is handled will also consume a fair amount of time. What the authors have also learned is that the intangible issues can often be the reason for an unexpectedly large amount of discussion and therefore add time to the negotiation process. To assist with this process, they have derived a negotiation checklist, which seeks to help hospital leaders and administrators set the proper framework to ensure successful negotiation conversations. More importantly, being organized and recognizing these broad issues upfront and remaining transparent throughout the process will help to ensure a successful negotiation.

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

    PubMed

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

    2016-03-01

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

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

    PubMed

    Dimov, Ves; Eidelman, Frank

    2015-01-01

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

  11. Circular on early marriage, March 1988.

    PubMed

    1988-01-01

    This Circular calls on government at all levels in Hunan, China, to summon the departments concerned thoroughly to investigate the problem of early child-bearing so that they can do a good job in managing the problems of unregistered cohabiting and of unmarried mothers. The Circular recommends that: "It is necessary to criticize and educate, and even punish by discipline, those parents who connive with their sons and daughters in practicing unregistered cohabiting." It also states the following: "It is necessary to keep a strict check on registry personnel who do not carry out their duties properly. Those who violate laws and discipline, engage in malpractices for selfish ends, and practice bribery and corruption, resulting in early marriage and child-bearing, must be dealt with strictly. Legal sanctions must be enforced against those who break the law."

  12. Patient Decision Aids: A Case for Certification at the National Level in the United States.

    PubMed

    Poddar, Urbashi; Brownlee, Shannon; Stacey, Dawn; Volk, Robert J; Williams, John W; Elwyn, Glyn

    2015-01-01

    Patient decision aids enable patients to be better informed about the potential benefits and harms of their healthcare options. Certification of patient decision aids at the national level in the United States is a critical step towards responsible governance-primarily as a quality measure that increases patients' safety, as mandated in the U.S. Patient Protection and Affordable Care Act (PPACA). Certification would provide a verification process to identify conflicts of interest that may otherwise bias the scientific evidence presented in decision aids. Certification also benefits clinicians who may otherwise face malpractice claims based on harm to patients caused by possible reliance on patient decision aids that are inaccurate, incomplete, or presented in a manner that biases the patient's decision. Existing work by the International Patient Decision Aid Standards Collaboration could guide the establishment of a certification process within the U.S. This article argues for national certification of patient decision aids and discusses how that may be achieved.

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

    PubMed

    Toth, Federico

    2015-07-01

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

  14. Improving empathy and relational skills in otolaryngology residents: a pilot study.

    PubMed

    Riess, Helen; Kelley, John M; Bailey, Robert; Konowitz, Paul M; Gray, Stacey Tutt

    2011-01-01

    Physician empathy and relational skills are critical factors predicting quality of care, patient safety, patient satisfaction, and decreasing malpractice claims. Studies indicate that physician empathy declines throughout medical training, yet little is published about methods to enhance empathy, especially in surgical residency training. The Accreditation Council for Graduate Medical Education requires competencies in 6 areas, including interpersonal skills and communication. To address this important problem, the first author developed an innovative empathy-relational skills training protocol focusing on the underlying neurobiological mechanisms of empathy and the interpersonal processes that positively affect the patient-doctor relationship. The authors tested the effectiveness of this protocol in a pilot study with 11 otolaryngology residents. Results showed that a brief series of 3 empathy training sessions can significantly improve physicians' knowledge of the neurobiology and physiology of empathy, as well as their self-reported capacity to empathize with patients. A trend toward increased patient satisfaction was observed.

  15. Attitudes towards academic cheating during nursing studies.

    PubMed

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

    2010-12-01

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

  16. The critical role of ERISA in state health reform.

    PubMed

    Chirba-Martin, M A; Brennan, T A

    Despite prominent roles for employers and state regulation in the Clinton administration's Health Security Act, relatively little attention has been accorded to the impact of federal preemption of state legislation through the Employee Retirement Income Security Act (ERISA). As interpreted by the U.S. Supreme Court, ERISA permits state regulation of insured employee health plans but otherwise preempts analogous regulation relating to self-insured benefit plans. This has prompted lower courts to find that hospital rate-setting legislation, regulation of preferred provider organizations (PPOs), and medical malpractice suits for utilization review decisions are preempted by ERISA. Several issues with major implications for health reform remain unresolved, such as the availability of ERISA preemption to self-insured health alliances and health maintenance organizations (HMOs).

  17. [Unconventional diagnostic and therapeutic methods in environmental medicine].

    PubMed

    Oepen, I

    1998-07-01

    In the sphere of environmental medicine--analogous to other fields like oncology and chronic diseases--not only proven and approved methods, but also unconvential methods are offered, without evidence of efficacy. The application of these methods has the possible consequence of wrong diagnosis and malpractice. Examples are discussed such as Kirlian photography, electroacupuncture according to Voll, bioresonance diagnosis/therapy, kinesiology, regulation therapy according to Rost, "clinical ecology" according to Runow with, among others, the provocation/neutralisation test, a vaccination therapy with E. coli and finally electrosmog as an environmental noxa. Concerning the admissibility of contested methods, statements of medical specialist societies, judgements, and the law of medical products are quoted. In conclusion, the question of the origin of the ideas and alleged results of unconvential medicine is followed up and conclusions are drawn. PMID:9738351

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

    PubMed

    Moore, Joshua J; Matlock, Aaron G

    2014-05-01

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

  19. IUD litigation: the Planned Parenthood experience.

    PubMed

    York, S S

    1989-01-01

    This review of the IUD litigation experience of Planned Parenthood in the U.S. from 1977-1988 involved 18 injuries allegedly caused by the plaintiff's use of an IUD. These 18 IUD cases represent 9.8% of the total malpractice lawsuits involving Planned Parenthood in the period. 7 were dismissed, 8 were settled, 1 was decided in favor of the defense, and 2 were decided in favor of the plaintiff. While the disposition of these cases is similar to the overall malpractice experience nationally, it is unusual in that twice as many verdicts were for the plaintiff. It is likely that the public perception that IUDs are dangerous made it difficult to select an impartial jury. Pelvic inflammatory disease (PID) was the most common alleged injury, 15 of 18. Even though the scientific evidence predicts otherwise, 15 of the 16 cases of PID occurred over 4 months after insertion. 8 of 15 cases involves Copper-7 IUDs, 4 Dalkon shields, 1 a Progestasert, and 2 Saf-T-Coils. The other 2 cases were 1 uterine perforation and 1 pregnancy. Of the 8 cases that were settles, the mean payment was $20,912, and the median $10,000. These payments are about 25% higher than average non-IUD cases. Payments by insurance companies averaged $21,644 in the late 1970s for IUD claims. In jury cases involving IUDs and Planned Parenthood, the average jury award was $50,000. It is recommended that providers take care especially to comply fully with an IUD manufacturer's protocol, and obtain full and complete informed consent with documentary proof to decrease the possibility of an adverse outcome in potential litigation.

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

    PubMed

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

    2014-10-01

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

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

    PubMed

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

    2016-01-01

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

  2. [Current legal problems of sterilization].

    PubMed

    Eser, A; Koch, H G

    1982-06-01

    Voluntary sterilization has not yet acquired comprehensive legal formulation. Thus there is a legal vacuum which physicians have attempted to fill by relying on their internal professional regulations. These provide for sterilization on an indication; however, an offense against this rule is not punishable in the courts. There is a prohibition, in particular, against so-called "courtesy sterilization," but this is of little significance today when so many social indications for sterilization can be found. But in general these professional regulations provide no useful assistance in deciding when a sterilization is permitted. In criminal law sterilization done by free will is not punishable nor is any indication required. The law deals in detail with the meaning and definition of the "free will" of the person being sterilized. This involves: capacity to have a free will, what to do about persons lacking that capacity (especially minors), and necessity to ensure that that woman understands all the consequences of sterilization. The civil courts have much more to do with sterilization than the criminal ones. One ground for suit is that the sterilization was "contrary to accepted morality," although the courts will generally hold that the woman herself cannot assert this claim. Another ground is lack of consent by the woman. Another ground is improper performance by the physician, i.e., malpractice. Thus the physician has to fear most the charges of no valid consent or malpractice. Questions of insurance law are also pertinent, since an insured person can be compensated for sterilization only if the procedure is legal.

  3. Litigations and the Obstetrician in Clinical Practice

    PubMed Central

    Adinma, JIB

    2016-01-01

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

  4. The search for the elusive electronic medical record system--medical liability, the missing factor.

    PubMed

    Grams, R R; Moyer, E H

    1997-02-01

    Over the past few years, the traditional paper-based medical record system has come under close scrutiny by every participant in the healthcare industry. Some groups, especially federal agencies such as Medicare and Medicaid, HMOs, and other third party payors, have begun to demand changes in medical record documentation, and have become very assertive as to what goals and objectives will be met. In contrast, the medical liability insurance industry has remained almost invisible during this period of transition. At a recent electronic medical records (EMR) conference participants attending a software development workshop were asked if they had their systems reviewed from a medicolegal standpoint by a malpractice insurance carrier. In response to this inquiry, not one software vendor raised their hand to indicate this had been accomplished, or was even contemplated. In the author's opinion, the key missing factor in the current quest for a paperless medical office system rests in the domain of those who represent the medical liability industry. All of these gate-keepers of medical loss and risk prevention will eventually be called upon, either by choice or necessity, to validate every working EMR system that is used in medical practices in the future. This article will explore the best information published from this currently silent sector of the industry, and proposes an active involvement by the medical liability industry in the current EMR design and development processes taking place. In addition, there are 10 minimum EMR design criteria contained in this article that are recommended for implementation based upon 16 years of medical malpractice experience and loss prevention input.

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

    SciTech Connect

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

    2014-03-01

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

  6. Litigations and the Obstetrician in Clinical Practice.

    PubMed

    Adinma, Jib

    2016-01-01

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

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

    PubMed

    MacCourt, Duncan; Bernstein, Joseph

    2009-01-01

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

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

    PubMed

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

    2015-06-01

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

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

    PubMed

    MacCourt, Duncan; Bernstein, Joseph

    2009-01-01

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

  10. Snyder v. American Association of Blood Banks: a re-examination of liability for medical practice guideline promulgators.

    PubMed

    Noble, A; Brennan, T A; Hyams, A L

    1998-02-01

    Medical practice guidelines are playing an increasingly important role in both the medical and the legal context. As tools for the health practitioner, it is thought that medical practice guidelines may contribute to an increase in the quality of patient care and cost-effectiveness. In the legal setting, guidelines may improve the functioning of the medical malpractice system by creating more rational, predictable standards of care. The development and promulgation of medical practice guidelines, while increasing, are still evolving. A number of concerns, especially in the areas of physician autonomy, physician control, and ethics, as well as efficacy, need to be resolved. The use of such guidelines as the legal standard of care in malpractice cases evokes similar concerns, along with fears that the use of guidelines at trial may either lower the standard of care, or, conversely, raise the standard of care to levels that are difficult to meet. Adding to this controversy is the recent case of Snyder v. American Association of Blood Banks (1996), in which the New Jersey Supreme Court upheld a jury finding that the American Association of Blood Banks (AABB) was liable to a plaintiff who contracted AIDS from an HIV-tainted transfusion, for negligent failure to adopt guidelines requiring blood testing for surrogate markers. This opinion is significant as the first to find a duty of care running from a medical guideline promulgator to a third person, the injured patient. The opinion is examined in depth and within the context of other relevant case law. The impact the opinion will have is difficult to gauge. The somewhat unique facts of the case, as well as the court's unusually stinging critique of the defendant, AABB, and its motivations informing its response to the concerns about blood contamination, may limit its value as precedent. However, precedent does exist in analogous non-medical cases for promulgator liability. The pros and cons of promulgator liability are

  11. Journals publishing bio-medicolegal research in Europe.

    PubMed

    Boscolo-Berto, Rafael; Viel, Guido; Cecchi, Rossana; Terranova, Claudio; Vogliardi, Susanna; Bajanowski, Thomas; Ferrara, Santo Davide

    2012-01-01

    Fragmentation of bio-medicolegal knowledge has led to a proliferation of ultra-specialised sub-disciplines and branches, often published in 'field-oriented' scientific journals.The aim of this work is to provide an in-depth analytical picture of bio-medicolegal sources of publication, within and outside the traditional conception of legal medicine. An extensive search of bio-medicolegal articles published in the last five and a half years was performed on the MEDLINE database according to MeSH terms combined with free-text protocols. We performed a systematic analysis of targeted journals after merging, selecting and categorising all retrieved records, taking into account data from the 2009 JCR Science Edition (released on June 2010); 1,037 different journals were identified, of which only 48 (4.6%) focus specifically on bio-medicolegal matters, and of which only seven (14.6%) have an impact factor (IF). Despite this apparent dispersion, 47% of articles were published in bio-medicolegal journals (BML), of which 70.2% were in journals with IF (BML-IF). Articles published in BML-IF journals (33% of total papers) reach almost 50%, mainly in "Forensic Science International", "International Journal of Legal Medicine" and "Journal of Forensic Sciences". Instead, publications in not specifically bio-medicolegal journals (Not BML-IF) are greatly scattered and even fragmented in about 650 journals.The sub-disciplines that appear most frequently in Not BML-IF rather than BML-IF journals are Forensic Psychiatry (48.2% vs. 5.1%), Criminology (37.1% vs. 8.3%), Malpractice (50.7% vs. 4.0%), Medical Law and Ethics (46.4% vs. 6.9%) and Clinical Forensic Medicine (39.5% vs. 21.3%). The proposed bibliometric analysis revealed the preference of Forensic Pathology, Criminalistics (Biological), Forensic Genetics, Forensic Anthropology and Forensic Entomology for journals traditionally considered pertinent to the medico-legal discipline, with a considerable dispersion involving

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

    PubMed

    Kitano, Masami

    2007-09-01

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

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

    PubMed Central

    Sheth, Bhavisha P.; Thaker, Vrinda S.

    2015-01-01

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

  14. Disclosing Medical Mistakes: A Communication Management Plan for Physicians

    PubMed Central

    Petronio, Sandra; Torke, Alexia; Bosslet, Gabriel; Isenberg, Steven; Wocial, Lucia; Helft, Paul R

    2013-01-01

    Introduction: There is a growing consensus that disclosure of medical mistakes is ethically and legally appropriate, but such disclosures are made difficult by medical traditions of concern about medical malpractice suits and by physicians’ own emotional reactions. Because the physician may have compelling reasons both to keep the information private and to disclose it to the patient or family, these situations can be conceptualized as privacy dilemmas. These dilemmas may create barriers to effectively addressing the mistake and its consequences. Although a number of interventions exist to address privacy dilemmas that physicians face, current evidence suggests that physicians tend to be slow to adopt the practice of disclosing medical mistakes. Methods: This discussion proposes a theoretically based, streamlined, two-step plan that physicians can use as an initial guide for conversations with patients about medical mistakes. The mistake disclosure management plan uses the communication privacy management theory. Results: The steps are 1) physician preparation, such as talking about the physician’s emotions and seeking information about the mistake, and 2) use of mistake disclosure strategies that protect the physician-patient relationship. These include the optimal timing, context of disclosure delivery, content of mistake messages, sequencing, and apology. A case study highlighted the disclosure process. Conclusion: This Mistake Disclosure Management Plan may help physicians in the early stages after mistake discovery to prepare for the initial disclosure of a medical mistakes. The next step is testing implementation of the procedures suggested. PMID:23704848

  15. Peer Support for Clinicians: A Programmatic Approach.

    PubMed

    Shapiro, Jo; Galowitz, Pamela

    2016-09-01

    Burnout is plaguing the culture of medicine and is linked to several primary causes including long work hours, increasingly burdensome documentation, and resource constraints. Beyond these, additional emotional stressors for physicians are involvement in an adverse event, especially one that involves a medical error, and malpractice litigation. The authors argue that it is imperative that health care institutions devote resources to programs that support physician well-being and resilience. Doing so after adverse and other emotionally stressful events, such as the death of a colleague or caring for victims of a mass trauma, is crucial as clinicians are often at their most vulnerable during such times. To this end, the Center for Professionalism and Peer Support at Brigham and Women's Hospital redesigned the peer support program in 2009 to provide one-on-one peer support. The peer support program was one of the first of its kind; over 25 national and international programs have been modeled off of it. This Perspective describes the origin, structure, and basic workings of the peer support program, including important components for the peer support conversation (outreach call, invitation/opening, listening, reflecting, reframing, sense-making, coping, closing, and resources/referrals). The authors argue that creating a peer support program is one way forward, away from a culture of invulnerability, isolation, and shame and toward a culture that truly values a sense of shared organizational responsibility for clinician well-being and patient safety.

  16. Social media in disaster risk reduction and crisis management.

    PubMed

    Alexander, David E

    2014-09-01

    This paper reviews the actual and potential use of social media in emergency, disaster and crisis situations. This is a field that has generated intense interest. It is characterised by a burgeoning but small and very recent literature. In the emergencies field, social media (blogs, messaging, sites such as Facebook, wikis and so on) are used in seven different ways: listening to public debate, monitoring situations, extending emergency response and management, crowd-sourcing and collaborative development, creating social cohesion, furthering causes (including charitable donation) and enhancing research. Appreciation of the positive side of social media is balanced by their potential for negative developments, such as disseminating rumours, undermining authority and promoting terrorist acts. This leads to an examination of the ethics of social media usage in crisis situations. Despite some clearly identifiable risks, for example regarding the violation of privacy, it appears that public consensus on ethics will tend to override unscrupulous attempts to subvert the media. Moreover, social media are a robust means of exposing corruption and malpractice. In synthesis, the widespread adoption and use of social media by members of the public throughout the world heralds a new age in which it is imperative that emergency managers adapt their working practices to the challenge and potential of this development. At the same time, they must heed the ethical warnings and ensure that social media are not abused or misused when crises and emergencies occur.

  17. Human Reliability and the Cost of Doing Business

    NASA Technical Reports Server (NTRS)

    DeMott, Diana

    2014-01-01

    Most businesses recognize that people will make mistakes and assume errors are just part of the cost of doing business, but does it need to be? Companies with high risk, or major consequences, should consider the effect of human error. In a variety of industries, Human Errors have caused costly failures and workplace injuries. These have included: airline mishaps, medical malpractice, administration of medication and major oil spills have all been blamed on human error. A technique to mitigate or even eliminate some of these costly human errors is the use of Human Reliability Analysis (HRA). Various methodologies are available to perform Human Reliability Assessments that range from identifying the most likely areas for concern to detailed assessments with human error failure probabilities calculated. Which methodology to use would be based on a variety of factors that would include: 1) how people react and act in different industries, and differing expectations based on industries standards, 2) factors that influence how the human errors could occur such as tasks, tools, environment, workplace, support, training and procedure, 3) type and availability of data and 4) how the industry views risk & reliability influences ( types of emergencies, contingencies and routine tasks versus cost based concerns). The Human Reliability Assessments should be the first step to reduce, mitigate or eliminate the costly mistakes or catastrophic failures. Using Human Reliability techniques to identify and classify human error risks allows a company more opportunities to mitigate or eliminate these risks and prevent costly failures.

  18. Review of LCA studies of solid waste management systems--part II: methodological guidance for a better practice.

    PubMed

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

    2014-03-01

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

  19. Telehealth Regulatory and Legal Considerations: Frequently Asked Questions

    PubMed Central

    Cason, Jana; Brannon, Janice A.

    2011-01-01

    As telehealth gains momentum as a service delivery model in the United States within the rehabilitation professions, regulatory and legal questions arise. This article examines the following questions: Is there a need to secure licenses in two states (i.e., where the practitioner resides, and where the client is located), before engaging in telehealth?Do state laws differ concerning if and how telehealth can occur?Do any states expressly disallow telehealth?Can services delivered through telehealth be billed the same way as services provided in-person?If practitioners fulfill the requirements to maintain licensure (e.g., continuing education obligations) in their state of residence, do they also need to fulfill the requirements to maintain licensure for the state in which the client resides?Will professional malpractice insurance cover services delivered through telehealth?Does a sole practitioner need to abide by HIPAA regulations?Responses to these questions are offered to raise awareness of the regulatory and legal implications associated with the use of a telehealth service delivery model within the professions of occupational therapy, physical therapy, speech-language pathology and audiology. PMID:25945185

  20. Radiation safety in high-altitude air traffic

    NASA Technical Reports Server (NTRS)

    Foelsche, T.

    1977-01-01

    Results of an experimental and theoretical study on dose equivalent rates at high altitudes are presented. The flight personnel flying 500 hours per year at SST cruise altitude in high latitudes (maximum of radiation) would be exposed to less than 14% of the maximum permissible dose rate (MPD) for radiation workers (5 rem/yr), averaged over the solar cycle. One-half or more is due to energetic secondary neutrons that are penetrant and highly biologically effective. Passengers would, in general, be exposed only to the low-level galactic cosmic rays, except for a relative few who encounter rare, intense, and energetic solar-particle events. If the airplane descends to subsonic altitudes during events such as that of Feb. 23, 1956 - the most intense and unique giant energy event of the last 35 years - passenger exposure even then remains at or below permissible levels (0.5 rem for the general population). Systems of radiation monitoring are briefly discussed which will prevent false alarms and which would be useful in disproving overexposure in potential malpractice suits against the airlines. In subsonic jet transports the exposure of the crews is lower by a factor 3 to 4; for passengers it is about the same for the same distance traveled. Solar events, except for giant energy events, will yield only a minor fraction of the MPD of the general population.

  1. IUDs no longer profitable in U.S. market.

    PubMed

    1986-01-01

    Ortho Pharmaceuticals and G.D. Searle & Company have decided to stop supplying IUDs to the US market because it is no longer profitable for them to do so. The Lippes Loop IUD, manufactured by Ortho Pharmaceuticals, and the Copper-7 and Tatum-T IUDs, manufactured by G.D. Searle, continue to have Food and Drug Administration (FDA) approval. These decisions were not related to issues of safety or effectiveness and will not affect supplies to programs in developing countries. product liability suits such as those brought against Searle are an increasingly common feature of health care product manfacturing in the US. Medical malpractice suits also are increasing dramatically. Searle spent $1.5 million successfully defending the Copper-7 in 4 recent trials initiated by women who claimed Searle's IUDs had caused such problems as pelvic inflammatory disease (FE). Although IUD use has been linked to an increased incidence of PID, the exact nature of that link remains controversial, and not every woman is at higher risk. Long before the Ortho and Searle decisions, the US Agency for International Development began the process of shifting to the Copper-T 380A, which is approved by the FDA and manufactured by Finishing Enterprises in New York but not marketed directly in the US. The primary effect of the Searle and Ortho decisions has been to shift entirely to providing Copper-T 380A IUDs.

  2. Medical tourism: the trend toward outsourcing medical procedures to foreign countries.

    PubMed

    York, Diane

    2008-01-01

    The rising costs of medical treatment in the United States are fueling a movement to outsource medical treatment. Estimates of the number of Americans traveling overseas for treatment range from 50,000 to 500,000. Charges for common procedures such as heart bypass can be $11,000 in Thailand compared to $130,000 in the United States. Knee replacement in the United States can cost $40,000 compared to $13,000 in Singapore.A new industry, medical tourism, has been created to advise patients on the appropriate facility in the right country for their condition, handle all travel arrangements, teleconference with physicians, and send medical records. To respond to the growth in medical travel, the Joint Commission (formerly the Joint Commission on Accreditation of Health Care Organizations) initiated the Joint Commission International (JCI) to accredit hospitals worldwide. Although outcome statistics from hospitals outside the United States are rare, first-person reports on quality are numerous. Making surgery possible for uninsured and underinsured individuals or self-insured state, municipal, and private entities is a major benefit of medical tourism. Mitigating against medical travel are the lack of legal remedies in place for malpractice and the possibility that travel itself can impose risk to patients. For example, lengthy air flights where the patient is in a fixed position for hours at a time can cause embolisms. If the trend toward medical tourism continues, continuing education, credentialing, and certification services may be required to help assure patient safety. PMID:18521877

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

    PubMed

    Halldórsdóttir, S; Hamrin, E

    1997-04-01

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

  4. Financial Resources for Conducting Athletic Training Programs in the Collegiate and High School Settings

    PubMed Central

    Rankin, James M.

    1992-01-01

    The distribution of resources to athletic training programs varies greatly, depending on the size and scope of the athletic program. No research has been found that assesses the differences in dollars allocated within various athletic training settings or assesses whether the different program levels allocate similar proportions of their resources to like categories of expenditures. In this study, I assessed the financial resources available to athletic training programs at major football NCAA Division IA schools, small football NCAA Division IA schools, NCAA Division IAA schools, NCAA Division II schools, NCAA Division III schools, and high schools. All schools had men's and women's sports and football programs. Categories assessed included: size and scope of the athletic program, supplies and equipment, operating expenses, medical expenses, salaries and benefits, malpractice insurance, and use of competitive bids in purchasing. Data supported the conclusion of wide disparities within many categories and in total expenses. Large-scale football NCAA Division IA programs spent $925.86 per athlete, while NCAA Division III programs spent $181.22, and high school programs spent $95.62. However, athletic trainers at all levels are conducting athletic training programs governed by the same professional competencies and standards of care. PMID:16558190

  5. Why can Taiwan utilize criminal law to discipline physicians?

    PubMed

    Ger, Jiin

    2009-04-01

    Modern medicine was first introduced into Taiwan by missionary hospitals in 1865. However, Japanese governors following Japan's medical reform applied modern medicine as the standard of practice in the year 1896. They also imported 150 doctors from Japan to promote public hygiene and control infectious diseases, such as malaria, plague, cholera, dysentery, etc. The reasons that the Courts started to use criminal law to deal with medical malpractice during 1950-1960s may be attributed to the following: costly and ineffective civil actions, chaotic medical licensing, a period of upheaval during the 1947 massacre (228 incident), Chinese Civil War (1947-1949), political unrest, "White Terror" and "Espionage Act" during the period of martial law (1949-1987), social injustice and economic depression. The general environment for medical practice in Taiwan has changed greatly in the past 60years. It is time for us to look around the world to set up standards of negligence for both clinical and criminal cases as soon as possible. In the mean time, the Department of Health should consider adopting the Good Medical Practice guidelines from the United Kingdom to strengthen the administrative power to regulate physicians' behaviors.

  6. Chemical characterization of a commercial Commiphora wightii resin sample and chemical profiling to assess for authenticity.

    PubMed

    Ahmed, Rida; Ali, Zulfiqar; Wu, Yunshan; Kulkarni, Swapnil; Avery, Mitchell A; Choudhary, Muhammed Iqbal; Khan, Ikhlas A

    2011-06-01

    The gum resin of Commiphora wightii [(Hook. ex Stocks) Engl.] is an ayurvedic medicine for the treatment of arthritis, inflammation, obesity, lipid disorders, and cardiovascular diseases and is known as guggul. Morphologically, it is not easy to distinguish guggul from closely related gum resins of other plants. Reliability of the commercially available guggul is critical due to the high risk of adulteration. To check authenticity, a commercial guggul sample was investigated for its chemical markers and 17 metabolites were identified, including three new, 20(S),21-epoxy-3-oxocholest-4-ene (1), 8 β-hydroxy-3,20-dioxopregn-4,6-diene (2), and 5-(13' Z-nonadecenyl)resorcinol (17) from the ethyl acetate soluble part. During the current study, compounds 14- 17 were identified as constituents of Mangifera indica gum, as an adulterant in the commercial guggul sample. This discovery highlighted the common malpractices in the trade of medicinal raw material in the developing world. The structures of the compounds were deduced by the spectroscopic technique and chemical methods, as well as by comparison with the reported data. The structure of 20(S),21-epoxy-3-oxocholest-4-ene (1) was also unambiguously deduced by single-crystal X-ray diffraction technique. PMID:21240842

  7. Assessment, origin, and implementation of breath volatile cancer markers

    PubMed Central

    Haick, Hossam; Broza, Yoav Y.; Mochalski, Pawel; Ruzsanyi, Vera; Amann, Anton

    2016-01-01

    A new non-invasive and potentially inexpensive frontier in the diagnosis of cancer relies on the detection of volatile organic compounds (VOCs) in exhaled breath samples. Breath can be sampled and analyzed in real-time, leading to fascinating and cost-effective clinical diagnostic procedures. Nevertheless, breath analysis is a very young field of research and faces challenges, mainly because the biochemical mechanisms behind the cancer-related VOCs are largely unknown. In this review, we present a list of 115 validated cancer-related VOCs published in the literature during the past decade, and classify them with respect to their “fat-to-blood” and “blood-to-air” partition coefficients. These partition coefficients provide an estimation of the relative concentrations of VOCs in alveolar breath, in blood and in the fat compartments of the human body. Additionally, we try to clarify controversial issues concerning possible experimental malpractice in the field, and propose ways to translate the basic science results as well as the mechanistic understanding to tools (sensors) that could serve as point-of-care diagnostics of cancer. We end this review with a conclusion and a future perspective. PMID:24305596

  8. Why can Taiwan utilize criminal law to discipline physicians?

    PubMed

    Ger, Jiin

    2009-04-01

    Modern medicine was first introduced into Taiwan by missionary hospitals in 1865. However, Japanese governors following Japan's medical reform applied modern medicine as the standard of practice in the year 1896. They also imported 150 doctors from Japan to promote public hygiene and control infectious diseases, such as malaria, plague, cholera, dysentery, etc. The reasons that the Courts started to use criminal law to deal with medical malpractice during 1950-1960s may be attributed to the following: costly and ineffective civil actions, chaotic medical licensing, a period of upheaval during the 1947 massacre (228 incident), Chinese Civil War (1947-1949), political unrest, "White Terror" and "Espionage Act" during the period of martial law (1949-1987), social injustice and economic depression. The general environment for medical practice in Taiwan has changed greatly in the past 60years. It is time for us to look around the world to set up standards of negligence for both clinical and criminal cases as soon as possible. In the mean time, the Department of Health should consider adopting the Good Medical Practice guidelines from the United Kingdom to strengthen the administrative power to regulate physicians' behaviors. PMID:19254863

  9. Use of assessment to reinforce patient safety as a habit

    PubMed Central

    Galbraith, R M; Holtman, M C; Clyman, S G

    2006-01-01

    The US spends far more than any other nation on health care. Physicians undergo lengthy and comprehensive training that is carefully scrutinized, and are held to high standards in national examinations. At best the care delivered matches or exceeds that in any other country. And yet, often simple preventable medical errors occur at alarming and unacceptable rates. The public, corporate consumers of health care, large payors and malpractice insurance carriers are all becoming impatient with the pace of improvement. The medical profession recognizes that dealing with this problem is an urgent priority and is grappling to find the best approaches. This paper focuses on the constructive use of assessment to embed a pervasive and proactive culture of patient safety into practice, starting with the trainee and extending out into the practice years. This strategy is based on the adage that “assessment drives curriculum” and proposes a series of new assessment tools to be added to all phases of the training‐practice continuum. PMID:17142605

  10. Utilization of intrauterine contraceptive devices by patients of the Planned Parenthood Federation of America.

    PubMed

    Burnhill, M S

    1996-12-01

    Since 1988, IUD use by patients at Planned Parenthood of America clinics has remained constant at 0.7% of the approximately 1.8 million patients receiving contraception each year. In the past 7 years, only 18 perforations, 60 infections, and 27 difficult removals have been reported from these clinics. Moreover, there has been no evidence that the IUD poses health risks to acceptors or a major expense to the provider's malpractice insurance company. In large part, Planned Parenthood's excellent safety record associated with IUD use reflects implementation of a uniform set of IUD guidelines. These guidelines permit Planned Parenthood clinicians to provide prophylactic antibiotics in cases where an acceptor considered at low current risk of sexually transmitted diseases has a past history of pelvic inflammatory disease, gonorrhea, chlamydia infection, or mucopurulent cervicitis. Implementation of these guidelines is augmented by careful physical examination and explanation of the risks and benefits of IUD use. Planned Parenthood also distributes forms outlining the risk associated with pregnancy with an IUD in place. Finally, Planned Parenthood, unlike most other clinics, makes IUDs available to nulliparous women who clearly understand the risks.

  11. Current techniques for AB0-incompatible living donor liver transplantation.

    PubMed

    Rummler, Silke; Bauschke, Astrid; Bärthel, Erik; Jütte, Heike; Maier, Katrin; Ziehm, Patrice; Malessa, Christina; Settmacher, Utz

    2016-09-24

    For a long time, it was considered medical malpractice to neglect the blood group system during transplantation. Because there are far more patients waiting for organs than organs available, a variety of attempts have been made to transplant AB0-incompatible (AB0i) grafts. Improvements in AB0i graft survival rates have been achieved with immunosuppression regimens and plasma treatment procedures. Nevertheless, some grafts are rejected early after AB0i living donor liver transplantation (LDLT) due to antibody mediated rejection or later biliary complications that affect the quality of life. Therefore, the AB0i LDLT is an option only for emergency situations, and it requires careful planning. This review compares the treatment possibilities and their effect on the patients' graft outcome from 2010 to the present. We compared 11 transplant center regimens and their outcomes. The best improvement, next to plasma treatment procedures, has been reached with the prophylactic use of rituximab more than one week before AB0i LDLT. Unfortunately, no standardized treatment protocols are available. Each center treats its patients with its own scheme. Nevertheless, the transplant results are homogeneous. Due to refined treatment strategies, AB0i LDLT is a feasible option today and almost free of severe complications. PMID:27683633

  12. Feasibility of streamlining an interactive Bayesian-based diagnostic support tool designed for clinical practice

    NASA Astrophysics Data System (ADS)

    Chen, Po-Hao; Botzolakis, Emmanuel; Mohan, Suyash; Bryan, R. N.; Cook, Tessa

    2016-03-01

    In radiology, diagnostic errors occur either through the failure of detection or incorrect interpretation. Errors are estimated to occur in 30-35% of all exams and contribute to 40-54% of medical malpractice litigations. In this work, we focus on reducing incorrect interpretation of known imaging features. Existing literature categorizes cognitive bias leading a radiologist to an incorrect diagnosis despite having correctly recognized the abnormal imaging features: anchoring bias, framing effect, availability bias, and premature closure. Computational methods make a unique contribution, as they do not exhibit the same cognitive biases as a human. Bayesian networks formalize the diagnostic process. They modify pre-test diagnostic probabilities using clinical and imaging features, arriving at a post-test probability for each possible diagnosis. To translate Bayesian networks to clinical practice, we implemented an entirely web-based open-source software tool. In this tool, the radiologist first selects a network of choice (e.g. basal ganglia). Then, large, clearly labeled buttons displaying salient imaging features are displayed on the screen serving both as a checklist and for input. As the radiologist inputs the value of an extracted imaging feature, the conditional probabilities of each possible diagnosis are updated. The software presents its level of diagnostic discrimination using a Pareto distribution chart, updated with each additional imaging feature. Active collaboration with the clinical radiologist is a feasible approach to software design and leads to design decisions closely coupling the complex mathematics of conditional probability in Bayesian networks with practice.

  13. Discussing harm-causing errors with patients: an ethics primer for plastic surgeons.

    PubMed

    Vercler, Christian J; Buchman, Steven R; Chung, Kevin C

    2015-02-01

    Plastic surgery is a field that demands perfection, yet despite our best efforts errors occur every day. Most errors are minor, but occasionally patients are harmed by our mistakes. Although there is a strong ethical requirement for full disclosure of medical errors, data suggest that surgeons have a difficult time disclosing errors and apologizing. "Conventional wisdom" has been to avoid frank discussion of errors with patients. This concept is fueled by the fear of litigation and the notion that any expression of apology leads to malpractice suits. Recently, there has been an increase in the literature pointing to the inadequacy of this approach. Policies that require disclosure of harm-causing medical errors to the patient and the family, apology, and an offer of compensation cultivate the transparency necessary for quality improvement efforts as well as the positive moral development of trainees. There is little published in the plastic surgery literature regarding error disclosure to provide guidance to practitioners. In this article, we will review the ethical, therapeutic, and practical issues involved in discussing the error with the patient and apologizing by presenting a representative case. This primer will provide an understanding of the definition of medical error, the ethical support of error disclosure, the barriers to disclosure, and how to overcome those barriers.

  14. Composition of commercial truffle flavored oils with GC-MS analysis and discrimination with an electronic nose.

    PubMed

    Pacioni, Giovanni; Cerretani, Lorenzo; Procida, Giuseppe; Cichelli, Angelo

    2014-03-01

    Truffles are among the most expensive foods and their quality depends on their unique aroma, composed of complex mixtures of lipophilic volatile organic compounds (VOCs). There are many foods flavored with truffle, and oils are particularly common. Using DHS-GC-MS and an electronic nose (MOS), 18 samples of olive oil flavored with white and black truffles from the Italian market were subjected to a blind analysis. Qualitative and quantitative analysis with DHS-GC-MS detected the presence of 63 VOCs, 32 of which can be attributed to olive oil, also defective, and 19 to truffles, while 12 foreign compounds are of dubious origin (synthesis and/or demolition). The data obtained with the electronic nose (MOS), processed statistically, was able to discriminate the aromas coincident with the three species of truffle declared on the label (the white truffle Tuber magnatum and the black truffles Tuber melanosporum and Tuber aestivum), demonstrating the potential and reliability of this technique, confirming the established malpractice of the use of bismethyl(dithio)methane in black truffles flavorings. PMID:24176309

  15. Risk management tips for video technology.

    PubMed

    Pickering, A M

    1995-01-01

    Proper management of the videotaping of medical procedures begins with identifying the purpose of the video; determining whether it is educational, diagnostic-related, or for "public relations" purposes; and obtaining a clearly defined consent that addresses an understanding of all risks and expectations involved. Although an exception to the policy may become necessary in some instances, addressing the key issues in policies and procedures before taping is the key to minimizing risks. Videotapes are useful as a teaching tool, but they also can easily become a part of the discovery process in a malpractice suit. Given the current nature of discovery in most states, many courts would require disclosure of the videotape. Although this may be disturbing to many health care providers, it should also be considered that the videotape could contain a valid record that the procedure was performed correctly, clearing the physician or facility involved of charges of negligence. With video cameras in such common use today, a positive, proactive position on the benefits involved in videotaping should be taken to minimize the potential negative ramifications that could occur.

  16. Psychopharmacology of lycanthropy.

    PubMed Central

    Davis, W M; Wellwuff, H G; Garew, L; Kydd, O U

    1992-01-01

    OBJECTIVE: To develop pharmacotherapies for the orphan disease lycanthropy through the pursuit of the etiologic hypothesis of a genetically determined hypersecretion of endogenous lycanthropogens. DESIGN: Quadruple-blind, Rubik's Cube matrix analysis. SETTING: Community practice and malpractice. PARTICIPANTS: Subjects selected from inbred Ruficolla populations in Mississippi, Georgia, North Carolina and Minnesota. All who entered the study finished it. INTERVENTIONS: Chemical screening of blood samples over a hypothesized secretory cycle of lycanthropogen peaking on the day of maximum lunar illumination. Administration of synthetic lycanthropogens for behavioural testing. Experimental lycosomatization through the illumination method of Kirschbaum. OUTCOME MEASURES: None were post hoc, but some are still in hock. MAIN RESULTS: Two putative lycanthropogens were isolated from the blood samples. Structural elucidation and synthesis permitted animal and clinical trials; in each of these, behavioural dysfunction was observed. Antilycanthropogen strategies included application of the principle of caged compounds and generation of a therapeutic immunoglobulin. The effects of a newly developed antihirsutic agent seemed promising. An interaction of the lycanthropogen-secretion system and ethanol was noted, which may explain behavioural aspects of alcoholism. CONCLUSIONS: The incidence of lycomania in North America is underestimated. Soon-to-be-available pharmacotherapies should promote its early detection and treatment. Full control may depend upon advances in gene therapy. PMID:1555146

  17. Neglect of the elderly: forensic entomology cases and considerations.

    PubMed

    Benecke, Mark; Josephi, Eberhard; Zweihoff, Ralf

    2004-12-01

    Wounds of living persons are a potential target for the same flies that live, or feed early on corpses. This can lead to complications in estimation of PMI but also allows to determine additional information that might be valuable in a trial, or during the investigations [e.g., M. Benecke, R. Lessig, Child neglect and forensic entomology, Forensic Sci. Int. 120 (2001) 155-159]. With forensic entomology, and forensic entomologists being more and more present, even lower profile cases like the neglect of elderly people (without violence being used against them; i.e., natural death) comes to our attention. Furthermore, much more people grow older than in the past years which leads to increased awareness of malpractice of caregivers in the professional, and personal environment [DPA (German Press Agency), Studie an 17000 Leichen: Jeder Siebte vor Tod falsch gepflegt (Every seventh elderly person not cared for sufficiently), German Press Agency dpa # 051402, Jan 3, Jan 5, 2003] . We briefly sketch three cases in which forensic entomology helped to better understand the circumstances of death, and the type and intensity of neglect before death. PMID:15639575

  18. Early struggles to identify ethical standards in dentistry: Dr. Benjamin Brown and the amalgam war of the 1840s.

    PubMed

    Meyerhof, Peter G

    2007-01-01

    Dr. Benjamin Boyer Brown was one of the leading physicians and dentists in St. Louis during the 1830s and 1840s as well as one of its most esteemed citizens for his charitable and educational works. He was also one of the founders of organized dentistry, first editor of the Dental Register of the West, as well as a respected researcher and educator in dentistry, and a member of the American Society of Dental Surgery, a forerunner of the American Dental Association. This society, declared the use of amalgam to be not only unethical but malpractice, and members were forced to sign a pledge not to use it. Although many dentists opposed this decision and ignored the pledge altogether, Dr. Brown was morally unwilling to remain quiet. He vocally opposed the decision of his colleagues to ban amalgam on ethical grounds. In spite of his appeal for reason and his high profile, he was one of the few dentists to be expelled from organized dentistry. He moved to California during the height of the gold rush to begin a new life. Dr. Brown's experience illustrates several issues in dental ethics that remain with us today.

  19. Role of natural and human factors in the degradation of the environment in central, eastern, and northern Saudi Arabia

    SciTech Connect

    Alwelaie, A.N.A.

    1985-01-01

    The roles of natural and human factors in the arid lands have long been a matter of concern to many researchers. This study tries to find out the causes of degradation of natural environments in the central, eastern, and northern parts of Saudi Arabia. The decrease in rainfall leads to increasing aridity and, thus paves the way for greater deterioration of the environment as the carrying capacity of the arid lands decreases. This study determines that human activities have had adverse effects on the arid lands of Saudi Arabia. Causes of degradation of environment in the study area include: (1) drought: (2) agricultural malpractice and soil degradation; (3) use of wood for fuel; (4) water wastage; (5) wind-blown sand; (6) pressure of locusts; (7) hunting; (8) societal instability; (9) oil rush and population pressure; (10) management of the environment; (11) overgrazing of pastures. An analysis of people's attitudes towards their environment in relation to their beliefs finds that the attitude of people towards the idea of conservation is not as positive as the attitude of Islam.

  20. Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment.

    PubMed

    McGrath, James

    2002-01-01

    This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment.

  1. Physician's error: medical or legal concept?

    PubMed

    Mujovic-Zornic, Hajrija M

    2010-06-01

    This article deals with the common term of different physician's errors that often happen in daily practice of health care. Author begins with the term of medical malpractice, defined broadly as practice of unjustified acts or failures to act upon the part of a physician or other health care professionals, which results in harm to the patient. It is a common term that includes many types of medical errors, especially physician's errors. The author also discusses the concept of physician's error in particular, which is understood no more in traditional way only as classic error in acting something manually wrong without necessary skills (medical concept), but as an error which violates patient's basic rights and which has its final legal consequence (legal concept). In every case the essential element of liability is to establish this error as a breach of the physician's duty. The first point to note is that the standard of procedure and the standard of due care against which the physician will be judged is not going to be that of the ordinary reasonable man who enjoys no medical expertise. The court's decision should give finale answer and legal qualification in each concrete case. The author's conclusion is that higher protection of human rights in the area of health equaly demands broader concept of physician's error with the accent to its legal subject matter.

  2. [Resolution of medical complaints by arbitration. Analysis of 140 cases].

    PubMed

    Valle-González, A

    2000-01-01

    The author studied 140 complex medical complaints handled by an Alternative Disputes Resolution Institution (CONAMED), between June 1996 and December 1999. There were 79 females and 61 males, cases originated in public hospitals 93 (66.4%) and private hospitals or practitioners 47 (33.6%). Several cases were treated sequentially in both types of institutions. The medical specialties involved were in frequency order: Neurosurgery, General Surgery, Gyn-Ob, Anesthesiology, Traumatology and Orthopedics, Oncology, Emergency, and 22 others. The causes of complaints were: Surgical treatment, Medical treatment, Diagnosis, Anesthesia, and mixed causes. There were 59 deaths, 43 anatomic or functional loses, disability or sequelae; and 34 recoveries. CONAMED delivered 27 arbitration verdicts, 94 expert opinions asked by prosecutors or human rights organizations, and 1 technical advice to medical authorities. Some resolutions included more than one case. More than half of physicians involved were found not guilty of malpractice. Even though the main CONAMED purpose is to improve the quality of Medical Care acting as The Health Ombudsman, its performance may be on behalf of medical practitioners.

  3. [Development of medical tourism in Georgia. Problems and prospectiv (review)].

    PubMed

    Gerzmava, O; Lomtadze, L; Kitovani, D; Kadjrishvili, M

    2011-10-01

    Medical tourism is the movement of patients through a global network of health services. Medical tourists seek affordable healthcare on a timely basis in a variety of destination nations. The expansion of global medical services has sparked immense economic growth in developing nations and has created a new market for advertising access to care. Beyond offering a unique untapped market of services, medical tourism has invited a host of liability, malpractice and ethical concerns. The explosion of off-shore "mini-surgical" vacations will surely incite global unification and increased access, quality and affordability of care. Medical tourism is a dynamic subset of global health care that incorporates a variety of services, procedures and venues of care. Health insurance coverage, the impact on domestic and global markets, and the use of international standards of care will be examined in combination with quality, access and cost parameters. The global nature of medical tourism invites a variety of legal and ethical issues and calls for an organizational body to monitor this new phenomenon. Finally, the future implications of the globalization of health services and systems will be discussed.

  4. Who owns the image? Archiving and retention issues in the digital age.

    PubMed

    Mezrich, Jonathan L; Siegel, Eliot

    2014-04-01

    Patients are often confused with respect to the ownership of radiologic images and the extent to which they may exert rights over their own imaging. In general, a facility that generates imaging maintains "ownership" rights. Patients have a right to inspect their images and obtain copies but they may not have the images or reports modified or stricken. Facilities may use images not only for treatment purposes but also have rights to use images with respect to educational training, quality control, and research, subject to HIPAA requirements. A facility has statutory obligations with respect to record retention and may face financial penalty and malpractice consequences for failure to retain images. Bankruptcy and state laws address issues of transfer of ownership of a patient's images in cases in which a facility goes out of business. Future questions remain as to whether the length of time a facility maintains images should increase as digital storage media improve and whether the use of inter-facility image sharing via "cloud" technology should alter obligations with respect to which facility must retain the images.

  5. Complementary therapies in pediatrics: a legal perspective.

    PubMed

    Cohen, Michael H; Kemper, Kathi J

    2005-03-01

    Increasing use of complementary and alternative medicine (CAM) therapies such as chiropractic, massage therapy, and herbal medicine, raises questions about the clinically appropriate use of CAM in pediatrics. Nonjudicious use of CAM therapies may cause either direct harm or, by creating an unwarranted financial and emotional burden, indirect harm. When advising patients concerning CAM therapies, pediatricians face 2 major legal risks: medical malpractice and professional discipline. Pediatricians can incorporate these considerations into advising and clinical decision-making about CAM therapies to address the best interest of the pediatric patient while helping to manage potential liability risk. This article provides a suggested framework, including asking the following questions: (1) Do parents elect to abandon effective care when the child's condition is serious or life-threatening? (2) Will use of the CAM therapy otherwise divert the child from imminently necessary conventional treatment? (3) Are the CAM therapies selected known to be unsafe and/or ineffective? (4) Have the proper parties consented to the use of the CAM therapy? (5) Is the risk-benefit ratio of the proposed CAM therapy acceptable to a reasonable, similarly situated clinician, and does the therapy have at least minority acceptance or support in the medical literature? Such an approach ideally can help guide the pediatrician toward clinical conduct that is clinically responsible, ethically appropriate, and legally defensible. PMID:15741385

  6. Restraint and seclusion in psychiatric treatment settings: regulation, case law, and risk management.

    PubMed

    Recupero, Patricia R; Price, Marilyn; Garvey, Keelin A; Daly, Brian; Xavier, Sarah L

    2011-01-01

    Changing federal regulations, civil rights and malpractice cases, and new treatment methods have influenced the use of restraint and seclusion (R&S) in inpatient psychiatric treatment settings, such that restraint and seclusion today are among the most highly regulated practices in psychiatry. Despite increased pressure from regulatory bodies and litigation, the use of R&S remains controversial and risky. These procedures can compromise safety if performed incorrectly or monitored inadequately, but intervention by restraint or seclusion may be necessary to maintain safety on the treatment unit, especially during emergencies. Case law and medical research have demonstrated the importance of a patient-focused, treatment-oriented approach toward risk management. Analysis of specific clinical scenarios can help to develop risk mitigation strategies that are therapeutically conceptualized rather than driven by regulation. Insights drawn from clinical cases that have resulted in litigation can offer an opportunity to develop an approach oriented to patient care from a clinical or risk management perspective. In this article, we seek to provide a foundation for evaluation of current protocols, an analysis of adverse R&S events, and strategies to minimize risk. PMID:22159974

  7. Discussing harm-causing errors with patients: an ethics primer for plastic surgeons.

    PubMed

    Vercler, Christian J; Buchman, Steven R; Chung, Kevin C

    2015-02-01

    Plastic surgery is a field that demands perfection, yet despite our best efforts errors occur every day. Most errors are minor, but occasionally patients are harmed by our mistakes. Although there is a strong ethical requirement for full disclosure of medical errors, data suggest that surgeons have a difficult time disclosing errors and apologizing. "Conventional wisdom" has been to avoid frank discussion of errors with patients. This concept is fueled by the fear of litigation and the notion that any expression of apology leads to malpractice suits. Recently, there has been an increase in the literature pointing to the inadequacy of this approach. Policies that require disclosure of harm-causing medical errors to the patient and the family, apology, and an offer of compensation cultivate the transparency necessary for quality improvement efforts as well as the positive moral development of trainees. There is little published in the plastic surgery literature regarding error disclosure to provide guidance to practitioners. In this article, we will review the ethical, therapeutic, and practical issues involved in discussing the error with the patient and apologizing by presenting a representative case. This primer will provide an understanding of the definition of medical error, the ethical support of error disclosure, the barriers to disclosure, and how to overcome those barriers. PMID:24830658

  8. The Legal Past, Present and Future of Prenatal Genetic Testing: Professional Liability and Other Legal Challenges Affecting Patient Access to Services.

    PubMed

    Pergament, Deborah; Ilijic, Katie

    2014-12-15

    This chapter is an overview of the current status of the law in the United States regarding prenatal genetic testing with an emphasis on issues related to professional liability and other challenges affecting patient access to prenatal genetic testing. The chapter discusses the roles that federal regulations, promulgated by the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC), play in the regulation of prenatal genetic tests. The chapter discusses tort litigation based on allegations of malpractice in the provision of prenatal genetic testing and how courts have analyzed issues related to causation, damages and mitigation of damages. The chapter provides reference information regarding how individual states address causes of action under the tort theories of wrongful birth and wrongful life. The chapter concludes with a discussion of future legal issues that may affect clinical prenatal genetic testing services arising from the continued expansion of prenatal genetic testing, legal restrictions on access to abortion and the potential development of embryonic treatments.

  9. Remedies by competitors for false advertising.

    PubMed

    Hirsch, B D; Wilcox, D P

    1990-05-01

    Patients who are victimized as a consequence of false medical advertising are not the only ones who can sue for damages. Under section 43(a) of the Lanham Act, effective November 17, 1989, anyone "who believes that he or she is or is likely to be damaged" by deceptive advertising may bring a civil action for damages (1). Competing physicians may sue other physicians who falsely advertise that they possess unique skills and achieve better results than other physicians because they employ exclusive methods of treatment or claim that certain surgical procedures they perform in the office are absolutely safe and without risk or who advertise false professional credentials to lure patients. Voluntary informed consent excludes the use of deceit. Misrepresentation through advertising deprives a patient of the right to exercise an informed consent (2). A patient who relies on a doctor's false advertising in agreeing to a procedure that causes the patient injury may sue for malpractice even if the procedure was performed without negligence. False medical advertising also exposes the advertiser to litigation by competitors for unfair competition. This article is concerned with the remedy that may be available for instituting private litigation against physicians and other health care providers who engage in untruthful advertising. PMID:2343426

  10. Why a "dental surgeon" for identification in forensic science?

    PubMed

    Sukul, Biswajit; Deb, Uttam; Ghosh, Supratim

    2010-11-01

    Dentistry has much to offer law enforcement in the detection and solution of crime or in civil proceedings. Forensic dental fieldwork requires an interdisciplinary knowledge of dental science and forensic science. Most often the role of the forensic odontologist is to establish a person's identity. Teeth, with their physiologic variations, pathoses and effects of therapy, record information that remains throughout life and beyond. The teeth may also be used as weapons and, under certain circumstances, may leave information about the identity of the culprit. Forensic odontology has an important role in the recognition of abuse among persons of all ages. Dental professionals have a major role to play in keeping accurate dental records and providing all necessary information so that legal authorities may recognise malpractice, negligence, fraud or abuse, and identify unknown human. Forensic odontology involves the management, examination, evaluation and presentation of dental evidence in criminal or civil proceedings, all in the interest of justice. The forensic odontologist assists legal authorities by examining dental evidence in different situations. PMID:21510577

  11. Forensic psychiatry: the need for self-regulation.

    PubMed

    Appelbaum, P S

    1992-01-01

    The shortcomings of forensic psychiatrists in the courtroom fall into two categories: failure to meet expected levels of performance in evaluation and testimony; and unethical behavior or deliberate misfeasance. Legal mechanisms for controlling the quality of testimony have been inadequate to the task. Courts rarely make use of their powers to screen expert witnesses with care; and post-hoc remedies, such as malpractice actions or charges of perjury, are almost unheard of. Psychiatry has been equally ineffective to date in responding to these problems, with educational programs usually reaching those least in need of help, and ethical codes either not addressing forensic issues or lacking powers of enforcement. Each class of problem calls for a distinct response. Inadequate performance in forensic work can be monitored and corrected by implementation of a program of peer review of forensic testimony. Preliminary attempts indicate the feasibility and utility of this effort. Unethical behavior, on the other hand, should be addressed by clear standards of forensic ethics, enforced by the relevant professional organizations. Forensic psychiatry bears the responsibility of cleaning its own house.

  12. Evolving medical service in the information age: a legal analysis of applying telemedicine programs in Taiwan.

    PubMed

    Wu, Hsing-Hao

    2008-12-01

    In the face of the information age, Internet and telecommunication technologies have been widely applied in various settings. These innovational technologies have been used in the areas of e-commerce, long distance learning programs, entertainment, e-government, and so on. In recent years, the evolution of Internet technology is also pervading the health care industry. This dramatic trend may significantly alter traditional medical practice as well as the means of delivery of health care. The idea of telemedicine is to use modern information technology as a means or platform to deliver health care service in remote areas and to manage medical information in digitalized forms. The progress of developing telemedicine, however, is rather slow. The main reason for this slow progress is not technological but rather legal. Health care providers are reluctant to promote this innovation in medical service mainly due to uncertain legal consequences and ethical concerns. Although there are many legal challenges surrounding telemedicine, this note will examine major legal issues including licensure, malpractice liability, and privacy protection. Furthermore, I will discuss the potential of applying telemedicine programs in Taiwan's National Health Insurance Program (hereinafter referred to as NHI). PMID:19202856

  13. A review of medical image watermarking requirements for teleradiology.

    PubMed

    Nyeem, Hussain; Boles, Wageeh; Boyd, Colin

    2013-04-01

    Teleradiology allows medical images to be transmitted over electronic networks for clinical interpretation and for improved healthcare access, delivery, and standards. Although such remote transmission of the images is raising various new and complex legal and ethical issues, including image retention and fraud, privacy, malpractice liability, etc., considerations of the security measures used in teleradiology remain unchanged. Addressing this problem naturally warrants investigations on the security measures for their relative functional limitations and for the scope of considering them further. In this paper, starting with various security and privacy standards, the security requirements of medical images as well as expected threats in teleradiology are reviewed. This will make it possible to determine the limitations of the conventional measures used against the expected threats. Furthermore, we thoroughly study the utilization of digital watermarking for teleradiology. Following the key attributes and roles of various watermarking parameters, justification for watermarking over conventional security measures is made in terms of their various objectives, properties, and requirements. We also outline the main objectives of medical image watermarking for teleradiology and provide recommendations on suitable watermarking techniques and their characterization. Finally, concluding remarks and directions for future research are presented.

  14. A joint FED watermarking system using spatial fusion for verifying the security issues of teleradiology.

    PubMed

    Viswanathan, P; Krishna, P Venkata

    2014-05-01

    Teleradiology allows transmission of medical images for clinical data interpretation to provide improved e-health care access, delivery, and standards. The remote transmission raises various ethical and legal issues like image retention, fraud, privacy, malpractice liability, etc. A joint FED watermarking system means a joint fingerprint/encryption/dual watermarking system is proposed for addressing these issues. The system combines a region based substitution dual watermarking algorithm using spatial fusion, stream cipher algorithm using symmetric key, and fingerprint verification algorithm using invariants. This paper aims to give access to the outcomes of medical images with confidentiality, availability, integrity, and its origin. The watermarking, encryption, and fingerprint enrollment are conducted jointly in protection stage such that the extraction, decryption, and verification can be applied independently. The dual watermarking system, introducing two different embedding schemes, one used for patient data and other for fingerprint features, reduces the difficulty in maintenance of multiple documents like authentication data, personnel and diagnosis data, and medical images. The spatial fusion algorithm, which determines the region of embedding using threshold from the image to embed the encrypted patient data, follows the exact rules of fusion resulting in better quality than other fusion techniques. The four step stream cipher algorithm using symmetric key for encrypting the patient data with fingerprint verification system using algebraic invariants improves the robustness of the medical information. The experiment result of proposed scheme is evaluated for security and quality analysis in DICOM medical images resulted well in terms of attacks, quality index, and imperceptibility.

  15. Modelling guidelines--terminology and guiding principles

    NASA Astrophysics Data System (ADS)

    Refsgaard, Jens Christian; Henriksen, Hans Jørgen

    2004-01-01

    Some scientists argue, with reference to Popper's scientific philosophical school, that models cannot be verified or validated. Other scientists and many practitioners nevertheless use these terms, but with very different meanings. As a result of an increasing number of examples of model malpractice and mistrust to the credibility of models, several modelling guidelines are being elaborated in recent years with the aim of improving the quality of modelling studies. This gap between the views and the lack of consensus experienced in the scientific community and the strongly perceived need for commonly agreed modelling guidelines is constraining the optimal use and benefits of models. This paper proposes a framework for quality assurance guidelines, including a consistent terminology and a foundation for a methodology bridging the gap between scientific philosophy and pragmatic modelling. A distinction is made between the conceptual model, the model code and the site-specific model. A conceptual model is subject to confirmation or falsification like scientific theories. A model code may be verified within given ranges of applicability and ranges of accuracy, but it can never be universally verified. Similarly, a model may be validated, but only with reference to site-specific applications and to pre-specified performance (accuracy) criteria. Thus, a model's validity will always be limited in terms of space, time, boundary conditions and types of application. This implies a continuous interaction between manager and modeller in order to establish suitable accuracy criteria and predictions associated with uncertainty analysis.

  16. Identification of radiolucent foreign bodies in tissue using optoacoustic spectroscopic imaging

    NASA Astrophysics Data System (ADS)

    Page, Leland; Maswadi, Saher; Glickman, Randolph D.

    2011-03-01

    One of the leading causes of medical malpractice claims in emergency medicine is the misdiagnosis of the presence of foreign bodies. Radiolucent foreign bodies are especially difficult to differentiate from surrounding soft tissue, gas, and bone using existing clinical imaging modalities. Because many radiolucent foreign bodies have sufficient contrast for imaging in the optical domain, we are exploring the use of laser-induced optoacoustic imaging for the detection of foreign bodies, especially in orbital and craniofacial injuries, in which the foreign bodies are likely to lie within the penetration depth of visible and near infrared wavelengths. In order to evaluate the performance of optoacoustic imaging for clinical detection and characterization, common foreign bodies have been scanned over a range of visible and near infrared wavelengths to obtain the spectroscopic properties of the materials commonly associated with these foreign bodies. The foreign bodies are also being embedded in realistic ex vivo tissue phantoms to evaluate the changes that may occur in the spectroscopic absorption of the materials due to the interaction with tissue absorbers. Ultimately, we anticipate that spectroscopic characterization will help identify specific wavelengths to be used for imaging foreign bodies that will provide useful diagnostic data about the material properties of the object, thereby enabling the characterization, as well as the location, of the objects. This information will aid the clinician in choosing the optimal treatment course for the patient.

  17. Misdescription of packaged foods: a case study from the United Arab Emirates.

    PubMed

    Premanandh, J; Sabbagh, Aman; Maruthamuthu, M

    2013-01-01

    Food misdescription has become of paramount importance as consumers come into contact daily with a great variety of foods. The controversies surrounding genetically modified organism (GMO) labelling and malpractices in the food chain have forced regulatory authorities to authenticate food from production to consumption. This paper reports the results of a surveillance programme conducted in the United Arab Emirates (UAE) market to assess the status of food misdescription and authenticity. A DNA test was used to screen random samples of processed meat products bought from supermarkets in the UAE. A total of 246 samples were analysed from different geographical locations. The majority of samples showed a high standard of legal compliance, with over 95% confirmed for authenticity. However, 5% of samples were found to contain undeclared species. In conclusion, this study confirms the presence of undeclared food in the UAE market. Regular surveillance and monitoring programmes along with strict implementation of the Food and Adulteration Act may alleviate misdescription issues to a greater extent. PMID:24127869

  18. Medicine beyond borders: the legal and ethical challenges.

    PubMed

    Kassim, Puteri Nemie J

    2009-09-01

    The ease and affordability of international travel has contributed to the rapid growth of the healthcare industry where people from all around the world are traveling to other countries to obtain medical, dental, and surgical care while at the same time touring, vacationing and fully experiencing the attractions of the countries that they are visiting. A combination of many factors has led to the recent increase in popularity of medical tourism such as exorbitant costs of healthcare in industrialized nations, favorable currency exchange rates in the global economy, rapidly improving technology in many countries of the world and most importantly proven safety of healthcare in selected foreign nations. Nevertheless, the development of medical tourism has certainly awakened many ethical and legal issues, which must be addressed. Issues pertaining to malpractice, consumer protection, organ trafficking, alternative medicine and telemedicine need comprehensive legal regulatory framework to govern them. Ethical issues are also been raised by the promotion of medical tourism in particular those pertaining to doctor and patient relationship. A future, where medical law is subsumed into various legal and ethical dimensions, poses serious challenges for the practice and ethics of medicine.

  19. Disclosure-and-resolution programs that include generous compensation offers may prompt a complex patient response.

    PubMed

    Murtagh, Lindsey; Gallagher, Thomas H; Andrew, Penny; Mello, Michelle M

    2012-12-01

    Under "disclosure-and-resolution" programs, health systems disclose adverse events to affected patients and their families; apologize; and, where appropriate, offer compensation. Early adopters of this approach have reported reduced liability costs, but the extent to which these results stem from effective disclosure and apology practices, versus compensation offers, is unknown. Using survey vignettes, we examined the effects of different compensation offers on individuals' responses to disclosures of medical errors compared to explanation and apology alone. Our results show that although two-thirds of these individuals desired compensation offers, increasing the offer amount did not improve key outcomes. Full-compensation offers did not decrease the likelihood of seeking legal advice and increased the likelihood that people perceived the disclosure and apology as motivated by providers' desire to avoid litigation. Hospitals, physicians, and malpractice insurers should consider this complex interplay as they implement similar initiatives. They may benefit from separating disclosure conversations and compensation offers and from excluding physicians from compensation discussions.

  20. A conceptual model of emergency physician decision making for head computed tomography in mild head injury.

    PubMed

    Probst, Marc A; Kanzaria, Hemal K; Schriger, David L

    2014-06-01

    The use of computed tomographic scanning in blunt head trauma has increased dramatically in recent years without an accompanying rise in the prevalence of injury or hospital admission for serious conditions. Because computed tomography is neither harmless nor inexpensive, researchers have attempted to optimize utilization, largely through research that describes which clinical variables predict intracranial injury, and use this information to develop clinical decision instruments. Although such techniques may be useful when the benefits and harms of each strategy (neuroimaging vs observation) are quantifiable and amenable to comparison, the exact magnitude of these benefits and harms remains unknown in this clinical scenario. We believe that most clinical decision instrument development efforts are misguided insofar as they ignore critical, nonclinical factors influencing the decision to image. In this article, we propose a conceptual model to illustrate how clinical and nonclinical factors influence emergency physicians making this decision. We posit that elements unrelated to standard clinical factors, such as personality of the physician, fear of litigation and of missed diagnoses, patient expectations, and compensation method, may have equal or greater impact on actual decision making than traditional clinical factors. We believe that 3 particular factors deserve special consideration for further research: fear of error/malpractice, financial incentives, and patient engagement. Acknowledgement and study of these factors will be essential if we are to understand how emergency physicians truly make these decisions and how test-ordering behavior can be modified.

  1. Cloudy confidentiality: clinical and legal implications of cloud computing in health care.

    PubMed

    Klein, Carolina A

    2011-01-01

    The Internet has grown into a world of its own, and its ethereal space now offers capabilities that could aid physicians in their duties in numerous ways. In recent years software functions have moved from the individual's local hardware to a central server that operates from a remote location. This centralization is called cloud computing. Privacy laws that speak to the protection of patient confidentiality are complex and often difficult to understand in the context of an ever-growing cloud-based technology. This article is a review of the legal background of protected health records, as well as cloud technology and physician applications. An attempt is made to integrate both concepts and examine Health Insurance Portability and Accountability Act (HIPAA) compliance for each of the examples discussed. The legal regulations that may inform care and standards of practice are reviewed, and the difficulties that arise in assessment and monitoring of the current situation are analyzed. For forensic psychiatrists who may be asked to provide expert opinions regarding malpractice situations pertaining to confidentiality standards, it is important to become acquainted with the new digital language from which these questions may arise. PMID:22159987

  2. Hereditary breast and gynecological tumors: Italian legal issues.

    PubMed

    DI Vella, Giancarlo

    2016-10-01

    The availability of diagnostic and therapeutic procedures that lower the risk for developing hereditary family-related tumors is weighed against Italian ethical and legal provisions. The healthcare environment in which a professional works should require that he possess specific technical, relational and medical competencies based upon legal orientation in addition to scientific evidence. Particular emphasis is attributed to the doctor-patient relationship, with explicit reference to the following: 1) all of the information at hand that is required to achieve a "therapeutic alliance" that combines the best interests of the patient with treatment options; 2) the completeness and intelligibility of health records, as they are likely to explain the background logic and the following of scientific clinical procedure; 3) the observance of guidelines and protocols, and their relevance to the legal responsibility of the individual and health care companies; 4) the need of a multidisciplinary approach in the treatment of these patients and the obligation of the team to have malpractice insurance. Advances on "provisions concerning liability of health personnel", which is currently awaiting approval, allows the professional to protect the patient's health without the fear of being unnecessarily censured, and unjustified from a penal or civil point of view which can deteriorate the relationship of trust and cooperation established.

  3. Social media in disaster risk reduction and crisis management.

    PubMed

    Alexander, David E

    2014-09-01

    This paper reviews the actual and potential use of social media in emergency, disaster and crisis situations. This is a field that has generated intense interest. It is characterised by a burgeoning but small and very recent literature. In the emergencies field, social media (blogs, messaging, sites such as Facebook, wikis and so on) are used in seven different ways: listening to public debate, monitoring situations, extending emergency response and management, crowd-sourcing and collaborative development, creating social cohesion, furthering causes (including charitable donation) and enhancing research. Appreciation of the positive side of social media is balanced by their potential for negative developments, such as disseminating rumours, undermining authority and promoting terrorist acts. This leads to an examination of the ethics of social media usage in crisis situations. Despite some clearly identifiable risks, for example regarding the violation of privacy, it appears that public consensus on ethics will tend to override unscrupulous attempts to subvert the media. Moreover, social media are a robust means of exposing corruption and malpractice. In synthesis, the widespread adoption and use of social media by members of the public throughout the world heralds a new age in which it is imperative that emergency managers adapt their working practices to the challenge and potential of this development. At the same time, they must heed the ethical warnings and ensure that social media are not abused or misused when crises and emergencies occur. PMID:24306994

  4. National program for family planning and primary health care Pakistan: a SWOT analysis

    PubMed Central

    2013-01-01

    Background The National Program for Family Planning and Primary Healthcare was launched in 1994. It is one of the largest community based programs in the world, providing primary healthcare services to about 80 million people, most of which is rural poor. The program has been instrumental in improving health related indicators of maternal and child health in the last two decades. Methods SWOT analysis was used by making recourse to the structure and dynamics of the program as well as searching the literature. SWOT analysis Strengths of the program include: comprehensive design of planning, implementation and supervision mechanisms aided by an MIS, selection and recruitments processes and evidence created through improving health impact indicators. Weaknesses identified are slow progress, poor integration of the program with health services at local levels including MIS, and de-motivational factors such as job insecurity and non-payment of salaries in time. Opportunities include further widening the coverage of services, its potential contribution to health system research, and its use in areas other than health like women empowerment and poverty alleviation. Threats the program may face are: political interference, lack of funds, social threats and implications for professional malpractices. Conclusion Strengthening of the program will necessitate a strong political commitment, sustained funding and a just remuneration to this bare foot doctor of Pakistan, the Lady Health Worker. PMID:24268037

  5. An Electronic Patient Risk Communication Board

    PubMed Central

    Ohashi, Kumiko; Caligtan, Christine A.; Benoit, Angela N.; Breydo, Eugene M.; Carroll, Diane L.; Keohane, Carol A.; Bates, David W.; Dykes, John S.; Dykes, Patricia C.

    2012-01-01

    Communication failures have been identified as the root cause of the majority of medical malpractice claims and patient safety violations. We believe it is essential to share key patient risk information with healthcare team members at the patient’s bedside. In this study, we developed an electronic Patient Risk Communication Board (ePRCB) to assist in bridging the communication gap between all health care team members. The goal of the ePRCB is to effectively communicate the patient’s key risk factors, such as a fall risk or risk of aspiration, to the healthcare team and to reduce adverse events caused by communication failures. The ePRCB will transmit patient risk information and tailored interventions with easy-to-understand icons on an LCD screen at the point of care. A set of patient risk reminder icons was developed and validated by focus groups. We used the results of the evaluation to refine the icons for the ePRCB. PMID:24199109

  6. Misdescription of packaged foods: a case study from the United Arab Emirates.

    PubMed

    Premanandh, J; Sabbagh, Aman; Maruthamuthu, M

    2013-01-01

    Food misdescription has become of paramount importance as consumers come into contact daily with a great variety of foods. The controversies surrounding genetically modified organism (GMO) labelling and malpractices in the food chain have forced regulatory authorities to authenticate food from production to consumption. This paper reports the results of a surveillance programme conducted in the United Arab Emirates (UAE) market to assess the status of food misdescription and authenticity. A DNA test was used to screen random samples of processed meat products bought from supermarkets in the UAE. A total of 246 samples were analysed from different geographical locations. The majority of samples showed a high standard of legal compliance, with over 95% confirmed for authenticity. However, 5% of samples were found to contain undeclared species. In conclusion, this study confirms the presence of undeclared food in the UAE market. Regular surveillance and monitoring programmes along with strict implementation of the Food and Adulteration Act may alleviate misdescription issues to a greater extent.

  7. Rising from Plagiarising.

    PubMed

    Mohan, Muralee; Shetty, Deepthi; Shetty, Tripthi; Pandya, Kalpa

    2015-09-01

    Amongst the various forms of scientific misconduct, plagiarism has become increasingly prevalent in today's scientific process. Plagiarism is copying another author's ideas or words and portraying them as your own. Inclusion of another source's contents without giving credit to the source results in this unethical practice. Text derived directly from a source must always be put under quotation marks. Decreased awareness about plagiarism and what exactly constitutes it results in unintentional plagiarism. Plagiarism can be that of the ideas in which the author projects others' ideas as his own. It can also be that of the text also known as word to word plagiarism. Mosaic plagiarism is another form. Various guidelines formulated by esteemed scientific bodies such as World Association of Medical Editors, Committee on publication Ethics have provided an insight to authors, editors, publishers and peer reviewers into the practice of ethical writing. By understanding the true essence of plagiarism and following strict guidelines, it is certainly possible to avoid plagiarism. Various softwares are available to detect plagiarism. These softwares have a wide database which is scanned to reveal any kind of malpractice. If detected, it can have grave consequences causing not only retraction of the article but also loss of dignity. Failure to detect plagiarism reflects negatively on a journal. Originality is the true essence of any research or scientific paper. Any violation of this fact is an unforgivable offence. Thus, this review article attempts to cover the meaning, types, risks and ways to avoid plagiarism. PMID:26225041

  8. Perioral soft-tissue rejuvenation techniques to enhance esthetic restorative dentistry.

    PubMed

    Niamtu, Joseph

    2003-11-01

    Every practitioner has the obligation to offer his or her patients the latest advances in their profession. Dentistry has made a shift over the past 50 years from caries restoration and prosthetic replacement to preventative and esthetic rejuvenation. Related dental specialties have also blossomed with new procedures and an expanded scope of practice. This shift has also included more comprehensive care and treatment of the oral and maxillofacial region. Modern esthetic dentists realize the facial soft tissues serve as a frame for their restorative artwork. Contemporary oral and maxillofacial surgery includes cosmetic facial surgery. Procedures for such surgery are taught in oral and maxillofacial surgery residency programs, are part of the oral and maxillofacial surgery board exams, and are covered by oral and maxillofacial surgery malpractice companies. Esthetic dentists should understand facial aging, as well as the basic procedures available for facial rejuvenation by the oral and maxillofacial surgeon. Contemporary esthetic dentistry goes beyond the oral cavity, and the smile is truly enhanced by simultaneous facial rejuvenation. This article discusses the process of perioral facial aging and various cosmetic facial surgery options.

  9. The impact of health care economics on surgical education.

    PubMed

    Margolin, David A

    2012-09-01

    Just like the world economy in 2012, health care is in a state of flux. The current economic environment will impact not only current colorectal surgery residents, but also future generations of surgical trainees. To understand the economic impact of the current health care environment on colorectal surgery residencies, we need to know the basics of graduate medical education (GME) funding for all residents. Since the 1960s with the initiation of Medicare, the federal government through the Center for Medicare and Medicaid Services (CMS) has been the largest source of GME funding. There are two types of costs associated with GME. Direct GME (DME) funding covers costs directly attributed to the training of residents. These costs include residents' stipends, salaries, and benefits; cost of supervising faculty; direct program administration costs; overhead; and malpractice coverage. Indirect GME (IME) costs are payments to hospitals as an additional or add-on payment for the increased cost of care that is generally found in teaching hospitals. In 2010, President Barak Obama signed into law H.R. 3200, the Patient Protection and Affordable Care Act (PPACA). In 2011, the Supreme Court held that the majority of the PPACA is constitutional. Although the true impact of this bill is unknown, it will change the formula for Medicare GME reimbursement as well as shift unused residency positions to primary care. PMID:23997674

  10. Challenges in ethics, safety, best practices, and oversight regarding HIT vendors, their customers, and patients: a report of an AMIA special task force.

    PubMed

    Goodman, Kenneth W; Berner, Eta S; Dente, Mark A; Kaplan, Bonnie; Koppel, Ross; Rucker, Donald; Sands, Daniel Z; Winkelstein, Peter

    2011-01-01

    The current commercial health information technology (HIT) arena encompasses a number of competing firms that provide electronic health applications to hospitals, clinical practices, and other healthcare-related entities. Such applications collect, store, and analyze patient information. Some vendors incorporate contract language whereby purchasers of HIT systems, such as hospitals and clinics, must indemnify vendors for malpractice or personal injury claims, even if those events are not caused or fostered by the purchasers. Some vendors require contract clauses that force HIT system purchasers to adopt vendor-defined policies that prevent the disclosure of errors, bugs, design flaws, and other HIT-software-related hazards. To address this issue, the AMIA Board of Directors appointed a Task Force to provide an analysis and insights. Task Force findings and recommendations include: patient safety should trump all other values; corporate concerns about liability and intellectual property ownership may be valid but should not over-ride all other considerations; transparency and a commitment to patient safety should govern vendor contracts; institutions are duty-bound to provide ethics education to purchasers and users, and should commit publicly to standards of corporate conduct; and vendors, system purchasers, and users should encourage and assist in each others' efforts to adopt best practices. Finally, the HIT community should re-examine whether and how regulation of electronic health applications could foster improved care, public health, and patient safety.

  11. [Selected legal aspects of the protection of the unborn child in the light of the draft amendment to the Polish Penal Code].

    PubMed

    Urbaniak, Moniak; Spaczyński, Robert Z

    2015-10-01

    Criminal Law Codification Commission, acting at the Ministry of Justice prepared proposals for amendments in the Polish Penal Code, related to offenses against life and health that were presented to the public in 2013. The draft provides for the protection of the child in the prenatal stage, introducing a new category of the entity to be protected, which is "unborn child" and "unborn child able to live outside the mother's body". These regulations provide for mothers criminal liability and responsibility of the medical staff (a doctor), as well as the child's father to the extent in which he is obliged to take steps aimed at rescuing the fetus. It is doctor's responsibility to show particular care for human health and life since a doctor has special medical knowledge and that is regulated by art. 30 of the act on professions of doctor and dentist. The proposed rule changes were not brought before the legislature in the current term of the Sejm (2011-2015), but due to the development of medicine, including obstetrical ultrasound, which enables visualization of a child that moves in the womb and is treated as a separate entity with distinct personal features the grounds are given for the opinion that the issue of the legal status of the unborn child, particularly in the context of causing death of a child in the last phase before birth as a result of medical malpractice or other external factors will be back in the public discussion.

  12. [Penal liability from retained foreign body inside the surgical site].

    PubMed

    Angiò, L G; Ventura Spagnolo, E; Pirrone, G; Cardia, G

    2011-03-01

    The Authors focus on the liability of the surgery team members in the case they inadvertently forget behind in the patient's body a foreign object, which causes injuries and/or death. The Authors underline that, according to the current case law regarding medical malpractice, both the main surgeon and their assistant/subordinate are liable for engaging in a markedly imprudent and/or negligent conduct, such as not double-checking scrupulously the surgical site before its closure in order to highlight forgotten foreign bodies. As well, the Authors underline that either the circulator nurse or the theatre nurse can be considered punishable by law when that medical error occurs, even if they are responsible for the count of the instruments used in the course of the surgery. Conversely, the main surgeon and his or her assistant are always directly responsible, due to the fact that the nurses' count procedure represents merely an additional control measure, without substituting at all the check the surgeons must obligatory conduct on the surgical site. Finally, the Authors point out that, as the count procedure is performed by the members of a surgical team, where a hierarchy-based relationship rules, the main surgeon is the liable for any preventable and avoidable adverse event provoked by the nursing staff as a consequence of the objective responsibility due to culpa in eligendo and culpa in vigilando.

  13. Experimental and Numerical Analysis of the Effects of Curing Time on Tensile Mechanical Properties of Thin Spray-on Liners

    NASA Astrophysics Data System (ADS)

    Guner, D.; Ozturk, H.

    2016-08-01

    The effects of curing time on tensile elastic material properties of thin spray-on liners (TSLs) were investigated in this study. Two different TSL products supplied by two manufacturers were tested comparatively. The "dogbone" tensile test samples that were prepared in laboratory conditions with different curing times (1, 7, 14, 21, and 28 days) were tested based on ASTM standards. It was concluded that longer curing times improves the tensile strength and the Young's Modulus of the TSLs but decreases their elongation at break. Moreover, as an additional conclusion of the testing procedure, it was observed that during the tensile tests, the common malpractice of measuring sample displacement from the grips of the loading machine with a linear variable displacement transducer versus the sample's gauge length had a major impact on modulus and deformation determination of TSLs. To our knowledge, true stress-strain curves were generated for the first time in TSL literature within this study. Numerical analyses of the laboratory tests were also conducted using Particle Flow Code in 2 Dimensions (PFC2D) in an attempt to guide TSL researchers throughout the rigorous PFC simulation process to model support behaviour of TSLs. A scaling coefficient between macro- and micro-properties of PFC was calculated which will help future TSL PFC modellers mimic their TSL behaviours for various tensile loading support scenarios.

  14. Case consultation: ablatio penis.

    PubMed

    Money, J

    1998-01-01

    In male infants, traumatic ablation of the penis, with or without loss of the testicles may occur as a sequel to mutilatory violence, accidental injury, or circumcision error. Post-traumatically, one program of case management is surgical sex reassignment to live as a girl, with female hormonal therapy at the age of puberty. The other program is genital reconstructive surgery to live as a boy, with male hormonal therapy at puberty if the testicles are missing. In both programs, the long term outcome is less than perfect and is contingent on intervening variables that include societal ideology; surgical technology; juvenile and adolescent timing and frequency of hospital admissions construed by the child as nosocomial abuse; development of body image; health and sex education; fertility versus sterility; coitus and orgasm; possible lesbian orientation if living as a girl; and long-term cost accounting, including the psychic cost of being a pawn in possible malpractice litigation on whose disability a very large fortune in compensation may devolve. There is, as yet, no unanimously endorsed set of guidelines for the treatment of genital trauma and mutilation in infancy, and no provision for a statistical depository for outcome data.

  15. Unconscious fantasy as a special class of mental representation: a contribution to a model of mind.

    PubMed

    Erreich, Anne

    2015-04-01

    Philosophers of mind and cognitive psychologists have proposed that "mind" consists of myriad mental representations, namely, conscious and unconscious representations of belief/desire intentions. It is argued here that unconscious fantasies constitute a subset of the domain of mental representations, those concerned with conflicting wishes, affects, and defensive maneuvers. This proposal anchors the unconscious fantasy construct in a model of mind that accords with contemporary academic views in cognitive and developmental psychology and philosophy of mind, thus allowing psychoanalysts to enter into dialogue with those disciplines. Given this formulation, unconscious fantasy might well serve as a theoretical construct that applies to a large group of theories that share certain criteria regarding mentation. An analyst would then be at liberty to commingle insights from a menu of different theories without committing metatheoretical malpractice, resulting in a principled version of theoretical pluralism. Published case material from Kleinian, close process monitoring, and self psychological perspectives demonstrates how this redefined unconscious fantasy construct can encompass two major types of interventions that analysts make: content and process interpretations. PMID:25762692

  16. The Function of a Medical Director in Healthcare Institutions: A Master or a Servant

    PubMed Central

    Kossaify, Antoine; Rasputin, Boris; Lahoud, Jean Claude

    2013-01-01

    The function of a medical director is presented along with features of efficiency and deficiencies from the perspective of healthcare system improvement. A MEDLINE/Pubmed research was performed using the terms “medical director” and “director”, and 50 relevant articles were selected. Institutional healthcare quality is closely related to the medical director efficiency and deficiency, and a critical discussion of his or her function is presented along with a focus on the institutional policies, protocols, and procedures. The relationship between the medical director and the executive director is essential in order to implement a successful healthcare program, particularly in private facilities. Issues related to professionalism, fairness, medical records, quality of care, patient satisfaction, medical teaching, and malpractice are discussed from the perspective of institutional development and improvement strategies. In summary, the medical director must be a servant to the institutional constitution and to his or her job description; when his or her function is fully implemented, he or she may represent a local health governor or master, ensuring supervision and improvement of the institutional healthcare system. PMID:25114566

  17. The function of a medical director in healthcare institutions: a master or a servant.

    PubMed

    Kossaify, Antoine; Rasputin, Boris; Lahoud, Jean Claude

    2013-01-01

    The function of a medical director is presented along with features of efficiency and deficiencies from the perspective of healthcare system improvement. A MEDLINE/Pubmed research was performed using the terms "medical director" and "director", and 50 relevant articles were selected. Institutional healthcare quality is closely related to the medical director efficiency and deficiency, and a critical discussion of his or her function is presented along with a focus on the institutional policies, protocols, and procedures. The relationship between the medical director and the executive director is essential in order to implement a successful healthcare program, particularly in private facilities. Issues related to professionalism, fairness, medical records, quality of care, patient satisfaction, medical teaching, and malpractice are discussed from the perspective of institutional development and improvement strategies. In summary, the medical director must be a servant to the institutional constitution and to his or her job description; when his or her function is fully implemented, he or she may represent a local health governor or master, ensuring supervision and improvement of the institutional healthcare system.

  18. Effective Communication About the Use of Complementary and Integrative Medicine in Cancer Care

    PubMed Central

    Cohen, Lorenzo

    2014-01-01

    Abstract Complementary and integrative medicine (CIM) is becoming an increasingly popular and visible component of oncology care. Many patients affected by cancer and their family members are looking for informed advice and desire communication with their physicians about CIM use. Patients affected by cancer come to discuss CIM use with intense emotions and are experiencing an existential crisis that cannot be ignored. Effective communication is crucial in establishing trust with these patients and their families. Communication is now recognized as a core clinical skill in medicine, including cancer care, and is important to the delivery of high-quality care. The quality of communication affects patient satisfaction, decision-making, patient distress and well-being, compliance, and even malpractice litigation. The communication process about CIM use requires a very sensitive approach that depends on effective communication skills, such as experience in listening, encouraging hope, and ability to convey empathy and compassion. This process can be divided into two parts: the “how” and the “what”. The “how” relates to the change in clinician attitude, the process of gathering information, addressing patients' unmet needs and emotions, and dealing with uncertainty. The “what” relates to the process of information exchange while assisting patients in decisions about CIM use by using reliable information sources, leading to informed decision-making. PMID:23863085

  19. Tipping the scales.

    PubMed

    1998-12-01

    In the US, the October 1998 murder of a physician who performed abortions was an outward manifestation of the insidious battle against legal abortion being waged by radical Christian social conservatives seeking to transform the US democracy into a theocracy. This movement has been documented in a publication entitled, "Tipping the Scales: The Christian Right's Legal Crusade Against Choice" produced as a result of a 4-year investigation conducted by The Center for Reproductive Law and Policy. This publication describes how these fundamentalists have used sophisticated legal, lobbying, and communication strategies to further their goals of challenging the separation of church and state, opposing family planning and sexuality education that is not based solely on abstinence, promoting school prayer, and restricting homosexual rights. The movement has resulted in the introduction of more than 300 anti-abortion bills in states, 50 of which have passed in 23 states. Most Christian fundamentalist groups provide free legal representation to abortion clinic terrorists, and some groups solicit women to bring specious malpractice claims against providers. Sophisticated legal tactics are used by these groups to remove the taint of extremism and mask the danger posed to US constitutional principles being posed by "a well-financed and zealous brand of radical lawyers and their supporters." PMID:12294553

  20. Low Apgar scores and birth asphyxia. Misconceptions that promote undeserved negligence suits.

    PubMed

    Giacoia, G P

    1988-08-01

    The temptation to specify cause-and-effect relationships in cases of neurologic handicap has created a number of misconceptions that have stimulated irresponsible malpractice litigation focusing on childbirth. Paradoxically, the number of such lawsuits is on the increase, even though obstetric and neonatal care has improved dramatically since Virginia Apgar introduced her scoring system in 1953. Nowadays, no evidence of intrapartum hypoxia is found in the majority of newborns who require resuscitation. Consequently, the value of using the Apgar score as an index for assessing asphyxia should be vigorously questioned. It should also be stressed that asphyxial damage may occur without respiratory depression. The recent proliferation of articles linking fetal scalp or cord blood evidence of metabolic acidosis to birth asphyxia threatens to create another legal booby trap. Although the development of fetal metabolic acidosis reflects oxygen deprivation, this fact should not be misconstrued to mean that any degree of oxygen deprivation can damage the brain. Available data make it quite clear that the fetus can sustain transient episodes of hypoxemia without ill effects. In those neonates born with low Apgar scores, cord blood gases should be measured to exclude hypoxemia. Securing such data can protect practitioners from subsequent legal inquiry. Routine determination of cord blood gases is not recommended, however, because a substantial number of newborns who are born acidotic have normal Apgar scores.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3399471

  1. Environmental market factors associated with physician career satisfaction.

    PubMed

    Mazurenko, Olena; Menachemi, Nir

    2012-01-01

    Previous research has found that physician career satisfaction is declining, but no study has examined the relationship between market factors and physician career satisfaction. Using a theoretical framework, we examined how various aspects of the market environment (e.g., munificence, dynamism, complexity) are related to overall career satisfaction. Nationally representative data from the 2008 Health Tracking Physician Survey were combined with environmental market variables from the 2008 Area Resource File. After controlling for physician and practice characteristics, at least one variable each representing munificence, dynamism, and complexity was associated with satisfaction. An increase in the market number of primary care physicians per capita was positively associated with physician career satisfaction (OR = 2.11, 95% CI: 1.13 to 3.9) whereas an increase in the number of specialists per capita was negatively associated with physician satisfaction (OR = 0.68, 95% CI: 0.48 to 0.97). Moreover, an increase in poverty rates was negatively associated with physician career satisfaction (OR = 0.95, 95% CI: 0.91 to 1.01). Lastly, physicians practicing in states with a malpractice crisis (OR = 0.81, 95% CI: 0.68 to 0.96) and/or those who perceived high competition in their markets (OR = 0.76, 95% CI: 0.61 to 0.95) had lower odds of being satisfied. A better understanding of an organization's environment could assist healthcare managers in shaping their policies and strategies to increase physician satisfaction. PMID:23087994

  2. Neglect of the elderly: forensic entomology cases and considerations.

    PubMed

    Benecke, Mark; Josephi, Eberhard; Zweihoff, Ralf

    2004-12-01

    Wounds of living persons are a potential target for the same flies that live, or feed early on corpses. This can lead to complications in estimation of PMI but also allows to determine additional information that might be valuable in a trial, or during the investigations [e.g., M. Benecke, R. Lessig, Child neglect and forensic entomology, Forensic Sci. Int. 120 (2001) 155-159]. With forensic entomology, and forensic entomologists being more and more present, even lower profile cases like the neglect of elderly people (without violence being used against them; i.e., natural death) comes to our attention. Furthermore, much more people grow older than in the past years which leads to increased awareness of malpractice of caregivers in the professional, and personal environment [DPA (German Press Agency), Studie an 17000 Leichen: Jeder Siebte vor Tod falsch gepflegt (Every seventh elderly person not cared for sufficiently), German Press Agency dpa # 051402, Jan 3, Jan 5, 2003] . We briefly sketch three cases in which forensic entomology helped to better understand the circumstances of death, and the type and intensity of neglect before death.

  3. Development of surface enhanced Raman scattering (SERS) spectroscopy monitoring of fuel markers to prevent fraud

    NASA Astrophysics Data System (ADS)

    Wilkinson, Timothy; Clarkson, John; White, Peter C.; Meakin, Nicholas; McDonald, Ken

    2013-05-01

    Governments often tax fuel products to generate revenues to support and stimulate their economies. They also subsidize the cost of essential fuel products. Fuel taxation and subsidization practices are both subject to fraud. Oil marketing companies also suffer from fuel fraud with loss of legitimate sales and additional quality and liability issues. The use of an advanced marking system to identify and control fraud has been shown to be effective in controlling illegal activity. DeCipher has developed surface enhanced Raman scattering (SERS) spectroscopy as its lead technology for measuring markers in fuel to identify and control malpractice. SERS has many advantages that make it highly suitable for this purpose. The SERS instruments are portable and can be used to monitor fuel at any point in the supply chain. SERS shows high specificity for the marker, with no false positives. Multiple markers can also be detected in a single SERS analysis allowing, for example, specific regional monitoring of fuel. The SERS analysis from fuel is also quick, clear and decisive, with a measurement time of less than 5 minutes. We will present results highlighting our development of the use of a highly stable silver colloid as a SERS substrate to measure the markers at ppb levels. Preliminary results from the use of a solid state SERS substrate to measure fuel markers will also be presented.

  4. Disclosure-and-resolution programs that include generous compensation offers may prompt a complex patient response.

    PubMed

    Murtagh, Lindsey; Gallagher, Thomas H; Andrew, Penny; Mello, Michelle M

    2012-12-01

    Under "disclosure-and-resolution" programs, health systems disclose adverse events to affected patients and their families; apologize; and, where appropriate, offer compensation. Early adopters of this approach have reported reduced liability costs, but the extent to which these results stem from effective disclosure and apology practices, versus compensation offers, is unknown. Using survey vignettes, we examined the effects of different compensation offers on individuals' responses to disclosures of medical errors compared to explanation and apology alone. Our results show that although two-thirds of these individuals desired compensation offers, increasing the offer amount did not improve key outcomes. Full-compensation offers did not decrease the likelihood of seeking legal advice and increased the likelihood that people perceived the disclosure and apology as motivated by providers' desire to avoid litigation. Hospitals, physicians, and malpractice insurers should consider this complex interplay as they implement similar initiatives. They may benefit from separating disclosure conversations and compensation offers and from excluding physicians from compensation discussions. PMID:23213152

  5. [Resolution of medical complaints by arbitration. Analysis of 140 cases].

    PubMed

    Valle-González, A

    2000-01-01

    The author studied 140 complex medical complaints handled by an Alternative Disputes Resolution Institution (CONAMED), between June 1996 and December 1999. There were 79 females and 61 males, cases originated in public hospitals 93 (66.4%) and private hospitals or practitioners 47 (33.6%). Several cases were treated sequentially in both types of institutions. The medical specialties involved were in frequency order: Neurosurgery, General Surgery, Gyn-Ob, Anesthesiology, Traumatology and Orthopedics, Oncology, Emergency, and 22 others. The causes of complaints were: Surgical treatment, Medical treatment, Diagnosis, Anesthesia, and mixed causes. There were 59 deaths, 43 anatomic or functional loses, disability or sequelae; and 34 recoveries. CONAMED delivered 27 arbitration verdicts, 94 expert opinions asked by prosecutors or human rights organizations, and 1 technical advice to medical authorities. Some resolutions included more than one case. More than half of physicians involved were found not guilty of malpractice. Even though the main CONAMED purpose is to improve the quality of Medical Care acting as The Health Ombudsman, its performance may be on behalf of medical practitioners. PMID:10992645

  6. Ondine's Curse - Genetic and Iatrogenic Central Hypoventilation as Diagnostic Options in Forensic Medicine.

    PubMed

    Susło, Robert; Trnka, Jakub; Siewiera, Jacek; Drobnik, Jarosław

    2015-01-01

    In the Nordic mythology a man lost his ability to breathe without remembering it after he was cursed by water nymph - referred to as 'Ondine's curse' - and then he died as soon as he fell asleep. Family medicine specialists are familiar with many sleeping disorders that their patients commonly call by the term Ondine's Curse. In medical sciences this term is historically related to the group of conditions that have as the common denominator seemingly spontaneous onset of life-threatening hypoventilation. The physiology and genetics specialists focus mainly on congenital central hypoventilation syndrome (CCHS), which was proven to be linked to several genetic mutations. Anesthesiologists tend to be more interested in similarly manifesting iatrogenic condition. Typically, patients that were previously subjected to general anesthesia, after temporarily waking up and regaining the spontaneous respiratory drive, later fall back into unconsciousness and develop hypoventilation. Anesthesiologists also call it Ondine's curse because of the sudden and unexpected sleep onset. The iatrogenic Ondine's curse is proven to be precipitated by delayed anesthetics release from patients' fat tissue - where it was deposited at the time general anesthesia was administered - back into bloodstream. Forensic medicine has to consider the latter form of Ondine's curse called scenario more often, as they investigate sudden deaths related to surgery and general anesthesia in the post-operational care period. These cases may also fall into the category of medical malpractice-related deaths.

  7. Medicolegal errors in the ED related to the involuntary confinement of psychiatric patients.

    PubMed

    Reeves, R R; Pinkofsky, H B; Stevens, L

    1998-11-01

    To determine the effectiveness of emergency department (ED) physicians properly and correctly completing documents required for emergency confinement of psychiatric patients, 1,000 Physician Emergency Certificates filed by ED physicians in the Shreveport, Louisiana, region were reviewed for appropriateness and for correctness of completion based on the applicable state law. Of the Physician Emergency Certificates reviewed 4.2% were incomplete or inappropriate. The most significant sources of error involved incomplete documentation of the mental status examination and not documenting the specific reason (dangerous to self, dangerous to others, or gravely disabled) for the patient meeting requirements for involuntary confinement. Other errors included confinement for reasons not appropriate for a psychiatric unit. This study suggests that ED physicians should be more cautious and thorough in completing the documents required for emergency confinement of psychiatric patients, so that the physician is less likely to be sued for malpractice or charged with the false imprisonment of such patients, and the patient's civil liberties are protected.

  8. Telemedicine for wound management.

    PubMed

    Chittoria, Ravi K

    2012-05-01

    The escalating physiological, psychological, social and financial burdens of wounds and wound care on patients, families and society demand the immediate attention of the health care sector. Many forces are affecting the changes in health care provision for patients with chronic wounds, including managed care, the limited number of wound care therapists, an increasingly ageing and disabled population, regulatory and malpractice issues, and compromised care. The physician is also faced with a number of difficult issues when caring for chronic wound patients because their conditions are time consuming and high risk, represent an unprofitable part of care practice and raise issues of liability. Telemedicine enhances communication with the surgical wound care specialist. Digital image for skin lesions is a safe, accurate and cost-effective referral pathway. The two basic modes of telemedicine applications, store and forward (asynchronous transfer) and real-time transmission (synchronous transfer, e.g. video conference), are utilized in the wound care setting. Telemedicine technology in the hands of an experienced physician can streamline management of a problem wound. Although there is always an element of anxiety related to technical change, the evolution of wound care telemedicine technology has demonstrated a predictable maturation process.

  9. Challenges in ethics, safety, best practices, and oversight regarding HIT vendors, their customers, and patients: a report of an AMIA special task force

    PubMed Central

    Berner, Eta S; Dente, Mark A; Kaplan, Bonnie; Koppel, Ross; Rucker, Donald; Sands, Daniel Z; Winkelstein, Peter

    2010-01-01

    The current commercial health information technology (HIT) arena encompasses a number of competing firms that provide electronic health applications to hospitals, clinical practices, and other healthcare-related entities. Such applications collect, store, and analyze patient information. Some vendors incorporate contract language whereby purchasers of HIT systems, such as hospitals and clinics, must indemnify vendors for malpractice or personal injury claims, even if those events are not caused or fostered by the purchasers. Some vendors require contract clauses that force HIT system purchasers to adopt vendor-defined policies that prevent the disclosure of errors, bugs, design flaws, and other HIT-software-related hazards. To address this issue, the AMIA Board of Directors appointed a Task Force to provide an analysis and insights. Task Force findings and recommendations include: patient safety should trump all other values; corporate concerns about liability and intellectual property ownership may be valid but should not over-ride all other considerations; transparency and a commitment to patient safety should govern vendor contracts; institutions are duty-bound to provide ethics education to purchasers and users, and should commit publicly to standards of corporate conduct; and vendors, system purchasers, and users should encourage and assist in each others' efforts to adopt best practices. Finally, the HIT community should re-examine whether and how regulation of electronic health applications could foster improved care, public health, and patient safety. PMID:21075789

  10. Descriptive Study of Occupational Accidents and their Causes among Electricity Distribution Company Workers at an Eight-year Period in Iran

    PubMed Central

    Rahmani, Abdolrasoul; Khadem, Monireh; Madreseh, Elham; Aghaei, Habib-Allah; Raei, Mehdi; Karchani, Mohsen

    2013-01-01

    Background Occupational accidents are unplanned events that cause damage. The socio-economic impacts and human costs of accidents are tremendous around the world. Many fatalities happen every year in workplaces such as electricity distribution companies. Some electrical injuries are electrocution, electric shock, and burns. This study was conducted in an electricity distribution company (with rotational 12-hour shift work) in Iran during an 8-year period to survey descriptive factors of injuries. Methods Variables collected included accident time, age of injured worker, employment type, work experience, injury cause, educational background, and other information about accidents. Results Results indicated that most of the accidents occurred in summer, and 51.3% were during shift work. Worker negligence (malpractice) was the cause of 75% of deaths. Type of employment had a significant relationship with type of injuries (p < 0.05). Most injuries were electrical burns. Conclusion High rate of accidents in summer may be due to the warm weather or insufficient professional skills in seasonal workers. Shift workers are at risk of sleep complaints leading to a high rate of work injuries. Acquiring knowledge about safety was related to job experiences. Temporary workers have no chance to work all year like permanent workers, therefore impressive experiences may be less in them. Because the lack of protective equipment and negligence are main causes of accidents, periodical inspections in workshops are necessary. PMID:24106647

  11. Physicians with the least experience have higher cost profiles than do physicians with the most experience

    PubMed Central

    Mehrotra, Ateev; Reid, Rachel O.; Adams, John L.; Friedberg, Mark W.; McGlynn, Elizabeth A.; Hussey, Peter S.

    2013-01-01

    Health plans and Medicare are using cost profiles to identify high-cost physicians in the hope of lowering total health care spending, but it is unclear which types of physicians will be most affected. Using cost profiles created from health plan claims, we examined which physician characteristics are associated with higher costs. Our strongest association was related to a physician’s year of experience. Compared to the most experienced physicians, the least experienced physicians had 13 percent higher overall costs. We found no association between costs and other factors such as malpractice claims, disciplinary action, board certification status, and the size of the group in which the physician practices. While winners and losers are inevitable in any cost profiling effort, physicians with less experience are more likely to be negatively affected by policies that utilize cost profiles. For example, they could be excluded from high-value networks or receive lower payments under Medicare’s planned value-based payment program. Further, our results raise the possibility that the more costly practice style of newly trained physicians may be a driver of rising health care costs. PMID:23129676

  12. Chemical characterization of a commercial Commiphora wightii resin sample and chemical profiling to assess for authenticity.

    PubMed

    Ahmed, Rida; Ali, Zulfiqar; Wu, Yunshan; Kulkarni, Swapnil; Avery, Mitchell A; Choudhary, Muhammed Iqbal; Khan, Ikhlas A

    2011-06-01

    The gum resin of Commiphora wightii [(Hook. ex Stocks) Engl.] is an ayurvedic medicine for the treatment of arthritis, inflammation, obesity, lipid disorders, and cardiovascular diseases and is known as guggul. Morphologically, it is not easy to distinguish guggul from closely related gum resins of other plants. Reliability of the commercially available guggul is critical due to the high risk of adulteration. To check authenticity, a commercial guggul sample was investigated for its chemical markers and 17 metabolites were identified, including three new, 20(S),21-epoxy-3-oxocholest-4-ene (1), 8 β-hydroxy-3,20-dioxopregn-4,6-diene (2), and 5-(13' Z-nonadecenyl)resorcinol (17) from the ethyl acetate soluble part. During the current study, compounds 14- 17 were identified as constituents of Mangifera indica gum, as an adulterant in the commercial guggul sample. This discovery highlighted the common malpractices in the trade of medicinal raw material in the developing world. The structures of the compounds were deduced by the spectroscopic technique and chemical methods, as well as by comparison with the reported data. The structure of 20(S),21-epoxy-3-oxocholest-4-ene (1) was also unambiguously deduced by single-crystal X-ray diffraction technique.

  13. Thai men's health and sexual attitude

    PubMed Central

    Kongkanand, Apichat; Permpongkosol, Sompol; Tantiwongse, Kavirach

    2011-01-01

    Men's health awareness, including the research and study of quality of life, sexual desires and risk factors, has increased worldwide. In Thailand, this advancement is made possible by cooperation, research and sponsorship from the local Thai community. This article aims to illustrate the sexual attitudes of Thai people, to determine the degree of erectile dysfunction (ED) and to investigate how to manage and cope with ED in a Thai community. We reviewed the relevant literature from Thai-based articles and surveys in regard to men's health, sexual attitudes, the prevalence of ED and common risk factors in the Thai community. The primary risk factor for ED in Thai men was age-related health decline and the presence of vascular disease. Most Thai men will seek consultation from their partner in regard to ED. The main presentation of metabolic disease in Thai patients was dyslipidemia. New selective serotonin reuptake inhibitors are not available for premature ejaculation in Thai communities. The debate in regard to malpractice compensation is an issue that should be closely monitored. There is currently a shortage of home care for the elderly in Thailand. The insights provided by the articles helped recruit the study patients and in turn, helped us gain knowledge that can be translated into improved men's health care in Thailand. PMID:21666699

  14. The science of medical decision making: neurosurgery, errors, and personal cognitive strategies for improving quality of care.

    PubMed

    Fargen, Kyle M; Friedman, William A

    2014-01-01

    During the last 2 decades, there has been a shift in the U.S. health care system towards improving the quality of health care provided by enhancing patient safety and reducing medical errors. Unfortunately, surgical complications, patient harm events, and malpractice claims remain common in the field of neurosurgery. Many of these events are potentially avoidable. There are an increasing number of publications in the medical literature in which authors address cognitive errors in diagnosis and treatment and strategies for reducing such errors, but these are for the most part absent in the neurosurgical literature. The purpose of this article is to highlight the complexities of medical decision making to a neurosurgical audience, with the hope of providing insight into the biases that lead us towards error and strategies to overcome our innate cognitive deficiencies. To accomplish this goal, we review the current literature on medical errors and just culture, explain the dual process theory of cognition, identify common cognitive errors affecting neurosurgeons in practice, review cognitive debiasing strategies, and finally provide simple methods that can be easily assimilated into neurosurgical practice to improve clinical decision making.

  15. Expert Witness: A system for developing expert medical testimony

    NASA Technical Reports Server (NTRS)

    Lewandowski, Raymond; Perkins, David; Leasure, David

    1994-01-01

    Expert Witness in an expert system designed to assist attorneys and medical experts in determining the merit of medical malpractice claims in the area of obstetrics. It substitutes the time of the medical expert with the time of a paralegal assistant guided by the expert system during the initial investigation of the medical records and patient interviews. The product of the system is a narrative transcript containing important data, immediate conclusions from the data, and overall conclusions of the case that the attorney and medical expert use to make decisions about whether and how to proceed with the case. The transcript may also contain directives for gathering additional information needed for the case. The system is a modified heuristic classifier and is implemented using over 600 CLIPS rules together with a C-based user interface. The data abstraction and solution refinement are implemented directly using forward chaining production and matching. The use of CLIPS and C is essential to delivering a system that runs on a generic PC platform. The direct implementation in CLIPS together with locality of inference ensures that the system will scale gracefully. Two years of use has revealed no errors in the reasoning.

  16. Evaluating awareness regarding oral hygiene practices and exploring gender differences among patients attending for oral prophylaxis

    PubMed Central

    Oberoi, Sukhvinder Singh; Mohanty, Vikrant; Mahajan, Ananya; Oberoi, Avneet

    2014-01-01

    Background: Oral hygiene is intimated in health of all parts of the body including oral cavity. The understanding of actual practices in keeping the oral heath at standard based on patient's perceptions of oral health care is vital. Understanding the effect of gender on oral health would facilitate the development of successful attitude and behavior modification approach towards sustainable oral health. Purpose of Study: To evaluate awareness regarding oral hygiene practices and exploring gender differences among patients attending for oral prophylaxis. Materials and Methods: A survey was conducted among 250 patients attending the department of periodontology, Maulana Azad institute of dental sciences for oral prophylaxis. A structured questionnaire was used to collect information regarding practices and perception about oral hygiene. Results: Majority of the patients (60.4%) felt that oral hygiene is mandatory for overall health of the body. The use of toothpaste and toothbrush (83.6%) was the most preferred cleaning aid among the study population in the present study. The major constraint for avoiding dental examination was no felt need (41.2%) followed by cost of dental treatment (26.8%) and time constraints (24.0%). Conclusions: Professional plaque removal and regular follow-up combined with oral hygiene instructions to the patients can minimize the level of gingival inflammation and swelling. The poor resources for dental care, common malpractices and nonavailability of professional care are the main barriers in seeking optimum oral hygiene. PMID:25024553

  17. Legal issues concerning electronic health information: privacy, quality, and liability.

    PubMed

    Hodge, J G; Gostin, L O; Jacobson, P D

    1999-10-20

    Personally identifiable health information about individuals and general medical information is increasingly available in electronic form in health databases and through online networks. The proliferation of electronic data within the modern health information infrastructure presents significant benefits for medical providers and patients, including enhanced patient autonomy, improved clinical treatment, advances in health research and public health surveillance, and modern security techniques. However, it also presents new legal challenges in 3 interconnected areas: privacy of identifiable health information, reliability and quality of health data, and tortbased liability. Protecting health information privacy (by giving individuals control over health data without severely restricting warranted communal uses) directly improves the quality and reliability of health data (by encouraging individual uses of health services and communal uses of data), which diminishes tort-based liabilities (by reducing instances of medical malpractice or privacy invasions through improvements in the delivery of health care services resulting in part from better quality and reliability of clinical and research data). Following an analysis of the interconnectivity of these 3 areas and discussing existing and proposed health information privacy laws, recommendations for legal reform concerning health information privacy are presented. These include (1) recognizing identifiable health information as highly sensitive, (2) providing privacy safeguards based on fair information practices, (3) empowering patients with information and rights to consent to disclosure (4) limiting disclosures of health data absent consent, (5) incorporating industry-wide security protections, (6) establishing a national data protection authority, and (7) providing a national minimal level of privacy protections. PMID:10535438

  18. Identification of a person with the help of bite mark analysis

    PubMed Central

    Verma, Anoop K.; Kumar, Sachil; Bhattacharya, Sandeep

    2013-01-01

    Background Forensic dentistry is an essential part of Forensic science, mainly involves the identification of an assailant by comparing a record of their dentition (set of teeth) with a record of a bite mark left on a victim. Other uses in law for dentists include the identification of human remains, medico-legal assessment of trauma to oral tissues, and testimony about dental malpractice. While the practice of human identification is well established, validated and proven to be accurate, the practice of bite mark analysis is less well accepted. The principle of identifying an injury as a bite mark is complex and, depending on severity and anatomical location, highly subjective. Following the identification of an injury as a bite mark, the comparison of the pattern produced to a suspect's dentition is even more contentious and an area of great debate within contemporary odontological practice. Like fingerprints and DNA, bite marks are unique to an individual – such as distance and angles between teeth, missing teeth, fillings and dental work. This type of impression evidence can be left in the skin of a victim and also can be in food, chewing gum and other miscellaneous items such as pens and pencils. The advent of DNA analysis and its recovery from bite marks has offered an objective method of bite mark analysis. PMID:25737891

  19. Personal professional indemnity and contractual issues for trainees in obstetrics and gynaecology.

    PubMed

    Chatterjee, J; Datta, S; Butt, S; Harpwood, V

    2013-02-01

    Over the last few decades, more healthcare professionals have faced investigation into complaints about medical care and healthcare outcomes (Department of Health 2003). With increasing medical negligence cases being brought against doctors, it is time to carefully consider the implications of such actions to ensure appropriate safeguards (Ferner and McDowell 2006). At a time when the culture of 'no win, no fee' is rampant, the jobbing frontline doctor is on the back-foot trying to untangle the legalities of a malpractice claim (Ferner and McDowell 2006). Reassuringly, the numbers of doctors referred to the GMC or having to face legal procedures or claims for compensation are still very small (National Audit Office 2001). An essential issue for all doctors is having appropriate indemnity cover in the event that their practice is challenged. The opt-out for the European Working Time Regulations (EWTR) has caused further confusion as to what is covered for junior doctors by individual indemnity policies and the employer's liability scheme. Recently, the RCOG Trainees committee and the BMA Junior Doctors Association issued a joint advice regarding this issue (RCOG 2010). In this paper, we consider the differences in cover provided by the employer's liability scheme, individual professional indemnity schemes and the role of professional bodies. We also seek to clarify the understanding of these surrounding EWTR and the voluntary opt-out clause and provide up-to-date information on medico-legal issues and protection schemes regarding legal liabilities.

  20. [Selected legal aspects of the protection of the unborn child in the light of the draft amendment to the Polish Penal Code].

    PubMed

    Urbaniak, Moniak; Spaczyński, Robert Z

    2015-10-01

    Criminal Law Codification Commission, acting at the Ministry of Justice prepared proposals for amendments in the Polish Penal Code, related to offenses against life and health that were presented to the public in 2013. The draft provides for the protection of the child in the prenatal stage, introducing a new category of the entity to be protected, which is "unborn child" and "unborn child able to live outside the mother's body". These regulations provide for mothers criminal liability and responsibility of the medical staff (a doctor), as well as the child's father to the extent in which he is obliged to take steps aimed at rescuing the fetus. It is doctor's responsibility to show particular care for human health and life since a doctor has special medical knowledge and that is regulated by art. 30 of the act on professions of doctor and dentist. The proposed rule changes were not brought before the legislature in the current term of the Sejm (2011-2015), but due to the development of medicine, including obstetrical ultrasound, which enables visualization of a child that moves in the womb and is treated as a separate entity with distinct personal features the grounds are given for the opinion that the issue of the legal status of the unborn child, particularly in the context of causing death of a child in the last phase before birth as a result of medical malpractice or other external factors will be back in the public discussion. PMID:26677590