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[Medical expert assessment in civil and criminal law from the legal liability viewpoint].

In view of the wide range of liability claims, expert medical reports constitute part of the basis of the work of liability insurers. However, the very different qualifications of experts often present the so-called "corporate physician" with great problems, since some expert reports are hardly acceptable, as the author discovered during many years of study of a large number of liability files. In addition, the most striking and frequently occurring criteria are discussed.

Expert Testimony↗

New York State pharmacists' attitudes toward needle and syringe sales to injection drug users before implementation of syringe deregulation.

In May 2000, New York State passed legislation permitting the sale, purchase, and possession of up to 10 needles and syringes without a prescription. The law is intended to reduce the transmission of human immunodeficiency virus (HIV) and hepatitis among injection drug users (IDUs), their sexual partners, and their children. To obtain baseline information about the attitudes and likely practices of New York State pharmacists, we distributed a self-administered questionnaire to attendees of the state pharmacy association meeting in June 2000. Of 48 usable responses, 19% were from New York City and the rest from New York State. Of the 48, 42% were unaware of the new law before the day of the survey, and 60% were somewhat or very willing to sell needles and syringes to an IDU. Of those who were not willing to sell to an IDU, 82% cited familiarity of the customer as a very important consideration in their decision making. Those who were not willing to sell to an IDU were more concerned about the detrimental impact of syringe sales on the community, were less likely to be aware of the new law, and were more likely to be concerned about legal liability for syringe sales. Over 80% of all pharmacists believed that syringe sales to IDUs are an important preventive health measure. The majority also favored learning more about the law. Compared to other state surveys of pharmacists, these preliminary data show a similar level of interest in becoming involved with syringe availability programs.

Attitude of Health Personnel↗

[Epithelioma cuniculatum plantare in the region of a skin scar due to mechanical trauma. Insurance law aspects of scar carcinomas].

We herein report a case of a highly differentiated verrucous squamous cell carcinoma of the sole of the left forefoot ("epithelioma" or "carcinoma cuniculatum plantare") that had--as a specific feature--developed within a preexisting long-standing skin scar due to an earlier occupational crush injury. Because of expansive tumor growth extending to the metatarsal bones and penetrating the tissue between the tendons, an ultrashort amputation of the hindfoot was performed according to the method of Chopart. The pathogenetic mechanisms possibly underlying the formation of scar carcinomas are discussed. For judgement of legal liability insurance questions, the criteria indicating a causal relationship between traumatic scars and cancer development are presented.

Accidents, Occupational↗

School injuries: what we know, what we need.

Schools are the site of a substantial number of unintentional injuries each year. Current knowledge regarding the study of causes and implications of school injury is summarized in a review of the research literature. A discussion of future investigations and better management of school injuries focuses on research issues, practical management, and nursing concerns. Operational definitions and reporting mechanisms are emphasized as research needs. Practical management and nursing concerns include routine reporting, student supervision, treatment of injuries, communication with parents, and legal (liability) responsibilities.

Adolescent↗

Part 2. Distinguishing physical characteristics and management of brachial plexus injuries.

Brachial plexus injuries (BPI) are usually readily apparent at or shortly after birth. Failure of caregivers to recognize and appropriately treat BPI may contribute to the risk of life-long neuromuscular dysfunction for the infant and represents a serious medical-legal liability for the delivery provider. This article is the second in a series on BPI and provides a standard classification and a systematic guide to physical examination of the infant with suspected BPI. Conditions that mimic BPI are discussed along with diagnostic studies used to confirm this disorder. The natural history and predictors of outcome are presented along with a sample treatment protocol. Pictures and video clips are provided to enhance the reader's understanding of the consequences of this injury and the potential for improvement with surgical treatment. Useful Internet resources for parents, focused discharge planning, and guidelines for appropriate monitoring and follow-up are provided. Advantages of early referral and management by a multidisciplinary team at a brachial plexus specialty center are discussed.

Birth Injuries↗

"Captain of the ship" doctrine continues to take on water.

The captain of the ship doctrine, which has been interpreted to mean that the surgeon's mere presence in the OR subjects him or her to legal liability for everyone's negligence in that room (akin to the responsibility of the captain of a ship who is held responsible for everything that happens on that ship), emerged in 1949 and grew in popularity through the 1950s. The major reason for this doctrine's popularity was that injured patients were precluded from suing hospitals under the then applicable charitable immunity doctrine. Charitable immunity declined in the 1960s, and by the 1970s, so too was the captain of the ship doctrine in decline. Pennsylvania, which first used the picturesque phrase in 1949, rejected the doctrine in 1974. In the meantime, it has come under much criticism, even among states that adopted it. Despite this decline and despite court language that sometimes borders on ridicule (e.g., anachronistic, prostrate doctrine, indiscriminate repetition), the felicity of the phrase has kept it alive in some states and in many ORs, even in states that have expressly rejected the doctrine. Even more than 20 years after its first rejection, however, courts still are being asked to adopt the doctrine. In 2001, the Wisconsin Supreme Court declined to adopt the doctrine, adding to the litany of states that have taken an express position against it.

Cholecystectomy↗

Use of physical restraints in nursing homes in New South Wales, Australia.

A 48 item postal survey was completed voluntarily by 285/445 (64%) Directors of Nursing (hereafter DONs) of nursing homes in New South Wales, Australia, to obtain information about the use of physical restraints. Of a total of approximately 16,397 (11,719 females; 4678 males) residents of nursing homes from which information was obtained, 15.3% (2516) were physically restrained. Females comprised 11.2% (1839) and males 4.1% (677) of this group. The commonest forms of physical restraint were vests (25.3%), restraining belts (18.9%), bedrails (17.2%), lap trays (14.4%) and gerichairs (10.5%). The commonest patient-oriented reason for using physical restraints was to 'prevent falls' (84.2%) and the commonest nurse-oriented reasons were 'because no alternative exists' (39.6%) and 'to reduce legal liability' (20%). The correlation between the size of nursing homes (bed numbers) and the number of residents who were physically restrained was weak (r = 0.1771, alpha = 0.05), suggesting that nursing home size did not predict the use of physical restraints. Correlations between the total number of staff, the total number of untrained staff (Assistants In Nursing) and the number of residents who were physically restrained were also weak (r = 0.1792; 0.0921 respectively; alpha = 0.05), suggesting that these factors also had little predictive influence on the use of physical restraints. The findings of this research indicate that the extent to which physical restraints are currently being used in nursing homes in New South Wales should be of concern.

Accidental Falls↗

Medicolegal genetic issues.

As genetic advances are made at an increasingly rapid rate, the physician practicing in this specialty must be aware of the most current data, risks, and options for treatment to comply with the standard of care. Only by arming himself or herself with this information, imparting it to the patient, and appropriately documenting that the patient has been informed, can today's practitioner expect to stay abreast of legal liability and the potentially enormous damages accompanying genetic lawsuits.

Genetic Counseling↗

From courtroom to couch. Working with repressed memory and avoiding lawsuits.

Hundreds of lawsuits have been filed during the last decade against therapists who work with patient having repressed memories. These lawsuits claim that therapists are engaged in "repressed memory" therapy, which does not retrieve memories, but instead actually imparts false beliefs, which serve as "pseudo-memories". This article explores the issues of repressed, false, and implanted memories. Advice is given concerning good therapeutic practice and the avoidance of legal liability.

Adolescent↗

The legal responsibilities of the health-care librarian.

This article discusses the legal responsibilities that information intermediaries have towards the users of their services. The areas of law that affect legal liability are contract law, tort and strict liability. The likelihood of health-care librarians being held liable for the service they provide is assessed, and methods of reducing this risk are discussed. The key issues are: whether the recipient is relying on the information you provide and whether this reliance is reasonable; whether money changed hands; and whether the institution is under a statutory obligation to provide the information. All-embracing exclusion clauses are often used as an attempt to exclude liability, but their validity in law is doubtful, and they should be replaced by more reasonable ones. Adhering to good professional practice, and avoiding interpreting information for laymen are ways of minimizing liability. If court proceedings do take place, professional indemnity insurance can reduce financial loss.

Insurance, Liability↗