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At least 235 records · Page 13Linked to original sources
PubMed1993

Medical malpractice involving colon and rectal disease: a 20-year review of United States civil court litigation.

To determine objectively the causes of malpractice litigation involving colon and rectal disease, a retrospective review was undertaken of all cases tried in the U.S. federal and state civil court system over a 21-year period from 1971 through 1991. Ninety-eight malpractice cases were identified from a computerized legal data base, involving 103 allegations of negligence. Allegations fell into five major categories: 1) failure to timely diagnose disease, principally colorectal cancer and appendicitis (n = 44/103; 43 percent); 2) iatrogenic colon injury (n = 25/103; 24 percent); 3) iatrogenic medical complications during diagnosis or treatment (n = 16/103; 15 percent); 4) sphincter injury with fecal incontinence, resulting from anorectal surgery or midline episiotomy (n = 10/103; 10 percent); and 5) lack of informed consent, especially regarding extent of procedures or risk of endoscopy (n = 8/103; 8 percent). These data may aid in design of risk prevention strategies related to the diagnosis and treatment of colorectal disease.

Anal Canal↗
PubMedDate not supplied

Impact of litigation on quality of life outcomes in patients with chronic low back pain.

Low back pain progresses to chronic low back pain (CLBP) in 5-10 per cent of patients. A Multi-disciplinary Pain Management Programme was tested in 20 patients (m = 4, f = 16). This regime involved psychological and behaviour modification strategies, combined with intensive exercise. Treatment outcome in terms of impairment was assessed by lumbar flexibility, trunk muscle endurance and pain. The disability assessed was exercise fitness and handicap was assessed using the Sickness Impact Profile (SIP) to define the impact of the condition on the patient's life. Overall the patients showed significant improvement (p < 0.05) in all of the measured variables. Patients with on-going litigation however (n = 11) showed no significant improvement in the SIP quality of life score, although they shared the significant improvements attained by the whole group in the domains of impairment (lumbar flexibility, trunk muscle endurance and pain) and disability (exercise fitness).

Adult↗
PubMed2000

Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims.

PURPOSE: To review the pattern of malpractice litigation related to regional anesthesia in Canada. SOURCE: The Canadian Medical Protective Association (CMPA) provided with information about all anesthesia claims that closed in the years 1990-1997. PRINCIPAL FINDINGS: In the period 1990-97 there were 7,909 closed legal actions involving all CMPA members (56,000). Of these, there were 310 cases involving anesthesiologists, of which 61 cases (approximately 20%) were related to regional anesthesia. Forty-two involved neuraxial blocks, and the legal outcome was favourable (dismissed or judgement in favour of the defendant doctor) in 37 claims. Nineteen claims involved peripheral nerve blocks. All these had favourable legal outcomes. Overall, 10% of regional anesthesia claims have unfavourable outcomes, compared with 28% of all anesthesia related claims and 30% of all CMPA members' claims. The degree of disability in the regional anesthesia claims were: none 10%; minor 49%; major 36%; catastrophic 5%. There were no deaths in the malpractice claims involving regional anesthesia, compared with 17% in the all anesthesia group and 11% in all members' claims. CONCLUSION: Twenty percent of all anesthesia claims in Canada are related to regional anesthesia. The legal outcome of these claims is favourable in 90%. Unfavourable clinical outcome is associated with catastrophic or major injury. There were no deaths in the regional anesthesia claims.

Anesthesia, Conduction↗
PubMed2005

Empirical limits for the forensic assessment of PTSD litigants.

This paper discusses the limits of expert opinion on posttraumatic stress disorder (PTSD) in personal injury claims. The construct of PTSD is hampered by several empirical limitations. Multiple reliable measures of PTSD exist, but have not been evaluated sufficiently within litigating samples and are infrequently used by forensic assessors. Common methods for trauma screening appear insensitive. Opinions about causation of PTSD and disability are complicated by retrospective memory biases, as well as the failure of most anxiety disorders to be detected within primary medical care. PTSD appears to have a steep spontaneous remission curve during the first year, but at least 10% of trauma-exposed people suffer chronic distress. Little is known about the course beyond 1 year. Efficacious psychological treatments have been developed for PTSD, but are not in common use limiting claimants' access to rehabilitative treatments. Research on functional disability associated with PTSD is in its infancy, but it seems likely that PTSD will account for only a part of the variance in work disability. We provide suggestions for improving forensic practice, advising the courts about the limitations of forensic opinions, and necessary research.

Disability Evaluation↗
PubMed1986

Obstetric malpractice litigation: the pathologist's view.

In obstetric malpractice litigation, there are two main bases of defense: the clinical basis and the pathogenesis basis. The malpractice suit in most cases involves an infant delivered at term that later develops cerebral palsy. Despite the fact that much information has been elucidated about the pathogenesis of cerebral palsy, the defense is often jeopardized by an inadequate presentation of relevant causal mechanisms, pathogenesis. Studies in recent years with correlated clinical and pathologic investigations have provided evidence that the occurrence of cerebral palsy is a time marker, reflecting cerebral damage incurred during the premature period, and does not result from the events of labor and delivery at term. There is broad need generally and in legal situations for clinicians and pathologists to become knowledgeable in comprehensively correlating obstetric factors with fetal-neonatal systemic pathologic conditions and with neuropathologic effects.

Brain↗
PubMed1990

The placenta in the litigation process.

The placenta accurately reflects many important prenatal events. It is therefore important that it be examined. This is especially useful in cases of possible future litigation, the "bad-baby cases." There is much experience now that pathologic findings in the placenta often have a decisive role in the accurate disposition of legal cases. This presentation describes the examination of the placenta and provides a brief review of the nature of placental lesions that most often impact cases of alleged malpractice.

Female↗
PubMed1991

Change in obstetric practice in response to fear of litigation in the British Isles.

The increased number of medical negligence claims against obstetricians and gynaecologists has led to concerns about a trend towards defensive medical practice in the UK. The attitudes of obstetricians in the British Isles to tests of fetal and maternal wellbeing, which may influence decisions about patient care, were investigated in 3194 Fellows and Members of the Royal College of Obstetricians and Gynaecologists. Perceived accuracy of tests ranged from 86.3% for fetal blood sampling to 25.9% for biochemical tests. Despite some tests being perceived as having poor accuracy, all were widely used even by those who deemed them inaccurate. The most frequent explanations given for this paradoxical finding were that such tests were an aid to clinical judgement and were necessary for medicolegal reasons. Our data indicate that tests deemed to be inaccurate are used in clinical practice because some obstetricians fear litigation. Our findings were not influenced by age, gender, grade of doctor, or site of practice.

Attitude of Health Personnel↗
PubMed1987

Children's reactions to sex abuse investigation and litigation.

This investigation attempted to begin to quantify the extent to which children are helped or further victimized by sex abuse investigation and litigation procedures. Although there is virtually no research on the subject, frequent assumptions have been made that these procedures often further victimize children. Significant changes in state legislation have and are being considered which would protect victims from further victimization. A child victim questionnaire was sent to the presidents of all area child abuse and neglect councils in the state of Iowa as well as to other personnel working with sexually abused children. The somewhat surprising findings revealed that of the 48 questionnaires returned only approximately 21% of the victims perceived that the questioning and investigation was harmful, while approximately 53% saw it as helpful. Other analyses found that ratings of helpfulness were not correlated with the age of the victim, the presence of a supportive adult during questioning, the number of abuse incidents, whether or not the interviews were videotaped, and whether or not the perpetrator was a family member. Testifying in court and high numbers of interviewers were associated with more negative ratings. The limitations and implications of the results are discussed along with suggestions for future research.

Adaptation, Psychological↗
PubMed1994

Misdiagnosis of acute appendicitis: common features discovered in cases after litigation.

To identify differences between correctly diagnosed appendicitis and misdiagnosed cases that resulted in litigation between 1982 and 1989 retrospective review of malpractice claims was conducted. A total of emergency department (ED) charts at the time of the initial ED visit were reviewed and compared with 66 concurrent controls. Missed cases appeared less acutely ill, had fewer complaints of right lower quadrant pain, received fewer rectal examinations, received intramuscular (IM) narcotic pain medication for undiagnosed abdominal pain or symptoms, and more often received an ED discharge diagnosis of gastroenteritis. Misdiagnosed patients had a 91% incidence of ruptured appendix, more extensive surgical procedures, and more postoperative complications. Data were analyzed using the Pearson's chi 2 Test, Mann-Whitney U Test, and stepwise discriminant analysis. Significance was defined as P < or = .05. Misdiagnosis of acute appendicitis is more likely to occur with patients who present atypically, are not thoroughly examined (as indexed by documentation of a rectal examination), are given IM narcotic pain medication and then discharged from the ED, are diagnosed as having gastroenteritis (despite the absence of the typical diagnostic criteria), and with patients who do not receive appropriate discharge or follow-up instructions.

Acute Disease↗
PubMed2006

Potential for interpretation disparities of Halstead-Reitan neuropsychological battery performances in a litigating sample.

The performances of 110 litigants on seven variables from the Halstead-Reitan neuropsychological battery (HRNB) were used to compare Heaton, Miller, Taylor, and Grant's (2004) Deficit Scale (DS) and Reitan and Wolfson's (1993) Neuropsychological Deficit Scale (NDS). Additional comparisons were made for people who passed or failed the Test of Memory Malingering (TOMM) to determine effects of effort on scores generated by either scoring system. Wilcoxon signed-rank tests revealed that all seven comparisons were significantly different for the full sample (p< or =0.001). The NDS indicated greater levels of impairment compared to DS across all variables. These findings were also obtained when considering effort, though TOMM failure was related to non-significant differences for two variables. These findings suggest that the two scoring systems are not equivalent, with Heaton et al.'s DS resulting in consistently higher identification rates of normal brain functioning compared to those generated from Reitan and Wolfson's NDS system.

Adult↗
PubMed2005

A defense attorney's perspective on medical negligence litigation.

Being named as a defendant in a lawsuit is an unnerving development. Proceeding through the discovery stage of a case can be a daunting prospect. Sitting through a trial, in which one's professional conduct is judged by six or twelve laypersons with little or no medical knowledge, often is gut wrenching. In this day and age, many physicians, including extremely well qualified specialists, often must deal with these realities. To cope best with these events, this article is an attempt to summarize certain legal principles that are relevant to these cases and to emphasize the practical realities that are attendant to medical negligence litigation.

Defensive Medicine↗
PubMed2005

Perinatal litigation and related nursing issues.

Obstetric and neonatal nurses are expected to provide an abundance of guidance, support, monitoring, and education to women and their babies during and after delivery. Nurses should adhere to standards of professional nursing practice. This will ensure that optimal and safe care is provided for the mother and fetus or neonate. Perinatal nurses are vulnerable to litigation should complications occur. Perinatal nurses are responsible for providing routine assessments as well as initiating and performing emergency interventions. This includes recognition of the symptoms of complications in the mother and the neonate, resuscitation, and activation of the emergency system. Occasionally, nurses are obliged to question the practice of other health care providers. Although perinatal nurses continue to be at risk for malpractice vulnerability, risk reduction techniques are available to them. This article provides the nurse with knowledge of legal proceedings and strategies to reduce liability when caring for pregnant women and newborns.

Humans↗
PubMed1987

Clinical guidelines, medical litigation, and the current medical defence system.

The introduction into National Health Service medical practice of guidelines designed to achieve more effective use of clinical resources is likely to encounter opposition owing to the increasing fear of litigation amongst clinicians. Hospital doctors are unusual amongst salaried professionals in being required to bear the cost of indemnity insurance themselves. The advantages for doctors commonly attributed to this arrangement are insubstantial. A system of no-fault compensation is unlikely to be implemented in this country in the foreseeable future. If guidelines are to achieve wide acceptability amongst clinicians, health authorities must accept full legal and financial responsibility for the actions of doctors in their employment, as they currently do for other health service staff.

Cost Control↗
PubMed1990

A review of prehospital care litigation in a large metropolitan EMS system.

A retrospective review of all claims brought against a large, metropolitan emergency medical services (EMS) system related to paramedic-patient encounters during the 12-year period from 1976 through 1987 was undertaken to review and describe the incidence and types of malpractice claims. During this period, EMS units responded to approximately 2 million calls and transported more than 1 million patients. Sixty claims occurred during the incidence study period (1976 through 1985). The overall litigation rate was one lawsuit per 27,371 paramedic-patient encounters and one lawsuit per 17,995 patient transports. While the total number of runs and transports did not change significantly during the study period, the data indicate a trend of increasing claims filed against the prehospital care provider. To date, 26 cases (38%) have been settled with the majority involving either no monetary awards or nominal out-of-court settlements.

Adolescent↗
PubMed1991

Effects of litigation on maintenance of psychological symptoms after severe hand injury.

Severe psychological symptoms after severe work-related hand injury, manifested as posttraumatic stress disorder, are not significantly potentiated or sustained by concomitant litigation if the patient has had early psychologic intervention. This study does not support assumptions about "accident neurosis" that delays recovery from the psychological sequelae of severe work-related hand injury.

Accidents, Occupational↗
PubMed1998

The breast radiation injury litigation and the clinical oncologist.

A number of women with breast cancer believed they were suffering injury because radiotherapy had been given negligently. In March 1995, their solicitors were permitted by the High Court, to select 10 cases in order to further a group action. In the legal exchanges which followed, the principal issues put forward by the plaintiffs went through a number of modifications until finally, in December 1997, they were abandoned. Two cases came to trial and after a hearing of 21 days, the Judge found no negligence. Clinical oncologists should be aware of the course of the litigation and consider the lessons to be learned.

Breast Neoplasms↗
PubMedDate not supplied

Anterior acromioplasty: effect of litigation and workers' compensation.

Seventy-five consecutive anterior acromioplasties were performed in 74 patients with chronic inflammation of the supraspinatus tendon caused by the impingement syndrome. Thirty-six patients (49%) had filed workers' compensation claims (group 1), 21 patients (28%) were involved in accident litigation (group 2), and 17 patients (23%) had no financial gain associated with their shoulder pain (group 3). The patients were followed up for a minimum of 12 months after surgery (range 12 to 48 months). Sixty-one patients (82%) had excellent results, 11 patients (15%) had good results, and 2 patients (3%) failed to improve from surgery. Ninety-one percent of employed patients were able to return to full employment. Although group 1 patients required a significantly longer time to return to work (average 14.2 weeks vs. 4.7 weeks in group 2 and 2.5 weeks in group 3), these patients were all involved in heavy labor demanding a more complete return of shoulder endurance. Satisfactory pain relief and return to preinjury work activities can be achieved by acromioplasty in patients who have the potential for secondary gain.

Accidents, Traffic↗
PubMed1997

Temporomandibular joint litigation: resolving issues of medical necessity and contract ambiguity.

Courts routinely award coverage for TMJ disorders under medical plans, despite exclusionary language and evidence that the insured failed to disclose preexisting treatment as required by the plan and neglected to attempt more conservative treatment first. Such decisions adversely affect both the health carrier and the plan participants. Various states have enacted legislation mandating coverage of TMJ; however, TMJ issues still exist and will remain a frequent topic for litigation until the judiciary recognizes that validating contract language ultimately benefits insureds as consumers and reinforces the integrity of the industry as a whole.

Humans↗