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PubMed1986

Malpractice and radiologists, update 1986: an 11.5-year perspective.

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.

Accidents↗

PubMedDate not supplied

An alternative method of determining standard of care in alleged cases of malpractice.

BACKGROUND: Physician experts hired and prepared by litigants provide most information on standard of care for medical malpractice cases. Because this information may not be objective or accurate, we examined the feasibility and potential value of surveying peer physicians to assess standard of care. METHODS: The survey method was evaluated for a medical malpractice case involving a patient hospitalized with abdominal pain. An abstract of the medical record was created that included the patient characteristics and physician decisions most likely to influence patient outcome. The abstract and questionnaire were sent to 16 academic family physicians and to 20 randomly chosen primary care physicians in Iowa who practiced in communities of similar size to the defendant's community. RESULTS: All 16 academic and 18 (90%) community physicians completed the survey. All respondents judged the patient as presenting with an acute abdomen, and 89% of the community physicians and 100% of the academic physicians judged the care as below standard. More than half the physicians surveyed listed the autopsy diagnosis (perforated ulcer) in their differential. CONCLUSION: Surveys of randomly selected physicians are feasible to perform for medical malpractice cases. A pro-physician bias has little if any influence on the results.

Adult↗

PubMed2006

Medical malpractice litigation related to gastrointestinal endoscopy in Japan: a two-decade review of civil court cases.

AIM: To examine the allegations in malpractice litigations related to gastrointestinal endoscopy in Japan. METHODS: A retrospective review of cases tried in the civil court system during the 21-year period from 1985 to 2005, identified in a computerized legal database, was undertaken. RESULTS: Eighteen malpractice litigations and a total of 30 allegations were identified. Of the 18 (44%) malpractice litigations, 8 (44%) were related to esophagogastroduodenoscopy, 4 (22%) to colonoscopy, 4 (22%) to endoscopic sphincterotomy, and 2 (11%) to endoscopic retrograde cholangiopancreatography. Seventeen (94%) cases pertained to complications, and the remaining (6%) case pertained to misdiagnosis. In 10 cases, the patient died of the complications. Allegations were categorized as: (1) performance error during the endoscopic procedure (n = 12, 40%); (2) lack of informed consent (n = 9, 30%); (3) performance error during the treatment after the endoscopic procedure (n = 4, 13%); (4) premedication error (n = 3, 10%); (5) diagnostic error (n = 1, 3%); and (6) indication error for the endoscopic procedure (n = 1, 3%). CONCLUSION: These data may aid in the design of risk prevention strategies to be used by gastrointestinal endoscopists.

Endoscopy, Gastrointestinal↗

PubMed2004

Malpractice experience and the incidence of cesarean delivery: a physician-level longitudinal analysis.

This study examines the influence of malpractice claims on the practice behavior of a panel of obstetricians in Florida during the period 1992-1995 to determine whether physicians respond to malpractice events by performing more cesareans, consistent with the notion that cesarean sections are employed as "defensive medicine." Findings indicate that clinical events resulting in claims that lead to substantial indemnity payments have a significant, modest effect on physician practice behavior: physicians experiencing those claims increase their risk-adjusted cesarean rates by about one percentage point. Malpractice experience does not appear to affect patient mix, but claims with large payouts may affect patient volume.

Cesarean Section↗

PubMed1992

The influence of standard of care and severity of injury on the resolution of medical malpractice claims.

OBJECTIVE: To explore how frequently physicians lose medical malpractice cases despite providing standard care and to assess whether severity of patient injury influences the frequency of plaintiff payment. DESIGN: Retrospective cohort study. SETTING: Physicians from the state of New Jersey insured by one insurance company from 1977 to 1992. PARTICIPANTS: A total of 12,829 physicians involved in 8231 closed malpractice cases. MEASUREMENTS: Physician care and claim severity were prospectively determined by the insurance company using a standard process. RESULTS: Physician care was considered defensible in 62% of the cases and indefensible in 25% of the cases, in almost half of which the physician admitted error. In the remaining 13% of cases, it was unclear whether physician care was defensible. The plaintiff received a payment in 43% of all cases. Payment was made 21% of the time if physician care was considered defensible, 91% if considered indefensible, and 59% if considered unclear. The severity of the injury was classified as low, medium, or high in 28%, 47%, and 25% of the cases, respectively. Severity of injury had a small but significant association (P < 0.001) with the frequency of plaintiff payment (low severity, 39%; medium severity, 43%; and high severity, 47%). The severity of injury was not associated with the payment rate in cases resolved by a jury (low severity, 23%; medium severity, 25%; and high severity, 23%). CONCLUSIONS: In malpractice cases, physicians provide care that is usually defensible. The defensibility of the case and not the severity of patient injury predominantly influences whether any payment is made. Even in cases that require a jury verdict, the severity of patient injury has little effect on whether any payment is made. Our findings suggest that unjustified payments are probably uncommon.

Cohort Studies↗

PubMed1991

Medical malpractice: an empirical examination of the litigation process.

New data on medical malpractice claims against a single hospital in which a direct measure of the quality of medical care is available are used to investigate the roles of the negligence rule and incomplete information in the dispute settlement process in medical malpractice. We find that the quality of medical care (negligence) is an extremely important determinant of defendants' medical malpractice liability. More generally, we find that the data are consistent with a model in which plaintiffs are poorly informed ex ante about whether there has been negligence, file suit to gather information, and either drop the case if they find that negligence was unlikely or settle for a positive payoff if they find that negligence was likely. We also find that the cases are resolved earlier in the litigation process when the parties are more certain, one way or the other, about the likelihood of negligence.

Data Collection↗

PubMed1993

Cost implications of malpractice and adverse events.

The ninth most common allegation against hospitals in 1989 was infection/contamination exposure, with the average claim costing nearly $34,000. Most malpractice claims are associated with inpatient surgery, according to 1990 statistics, and the average cost of a claim for infection and contamination related to surgery was over $64,000 in 1990. Physicians currently pay as much as $50,000 annually for malpractice insurance, and hospitals in some major metropolitan areas pay $8,000 per bed for insurance. An estimated 5% of hospitalized patients acquire nosocomial infections at an annual cost of approximately $10 billion. Prolonged hospitalization, usually for parenteral antibiotic treatment, accounts for more than three-fourths of this cost. To reduce the costs of malpractice, nosocomial infections can be prevented through infection-control programs, or damages can be reduced by treating infections with more efficacious and safer drugs that decrease the pain and suffering associated with the infection.

Cost Control↗

PubMed1994

Ounces of malpractice prevention.

The source of malpractice claims, contrary to widely held views, is not simply improper or inadequate medical care. In the majority of cases, malpractice litigation ensues because of negative nonclinical factors and the incidence of an unexpected result in medical treatment. High on the list of nonclinical causes are faults in the physician-patient relationship. Patients who are unhappy with the manner in which they have been treated by physicians are much more likely to sue when the outcome is even moderately untoward. Key to reducing the incidence of malpractice suits is helping physicians understand that attention has to be paid to their behavior.

Humans↗

PubMed1997

Reducing malpractice risk through more effective communication.

UNLABELLED: This activity is designed for physicians, health plan administrators, and other providers. GOAL: To help physicians, health plan administrators, and other providers learn more about the relationship between provider communication behaviors and subsequent negligence litigation and learn how to reduce malpractice risk through improving communication behaviors. OBJECTIVES: 1. To describe research findings concerning the relationship between provider communication behaviors and subsequent claims of negligence. 2. To describe the major interviewing deficiencies that have been identified as precipitants of malpractice litigation. 3. To describe three functions of effective interviewing. 4. To describe training and learning methods that can improve provider-patient relationships, leading to improved clinical outcomes and decreased malpractice risk.

Communication↗

PubMed1979

The trial of a malpractice case: Part one.

The following discussion was presented by the late Mr. Levine, one of the country's most successful malpractice lawyers, during a series of lectures on medical malpractice. It is an invaluable, no-holds-barred introduction for administrators, risk management directors, physicians and attorneys to the real world of malpractice litigation.

Clinical Competence↗

PubMed1980

The trial of a malpractice case: part two.

Expert Testimony↗

PubMed1979

Why a new malpractice crisis is coming.

This article predicts escalating premiums and a greater risk of malpractice suits based on the increasing frequency and cost of claim payouts. The number of insurance claims increased by 12% in 1978 after a decrease of 11% in 1976 and by 2% in 1977. The percentage of premium income paid out has followed the same pattern. It was a high of 66.5% in 1975 and then fell into the 40% range in the next two years. Last year it bounced back to 60.6%. Some insurance authorities view the 1976-77 drop in claims as artificial and attribute it to a reluctance to file suits during the period immediately following new malpractice laws. The reluctance to sue has apparently relaxed. About 16% of the cases actually go to court. Out of those, 90% of the verdicts favor doctors. The rise in cases going to court shows that reform! legislation passed in several states to reduce malpractice litigation is not yet working. The average payout was up 20% between 1976 and 1978 with the greatest rise in large awards; million-dollar settlements are not uncommon. Escalating payouts are attributed to general inflation anf rising medical costs. In addition, the public has become better medically informed and been taught that for every wrong ther is a remedy.

Insurance, Liability↗

PubMedDate not supplied

Medical malpractice arbitration.

The medical malpractice problem has been a major contributor to the inflationary trend in healthcare costs. Arbitration, as an alternative to litigation, can be effective in alleviating many of the problems associated with malpractice suits. Authors Corbett and Leap present the results of their study of arbitration, including an examination of existing medical malpractice arbitration panels and their effectiveness. The results of the study are encouraging as arbitration is seen to bring advantages to both the plaintiff and the defendant, as well as reducing the amount of litigation and insurance-related problems.

Conflict, Psychological↗

PubMed1984

Malpractice bill stirs discussion, raises moral questions.

Catholic health care providers should raise a number of ethical considerations in the debate surrounding the Moore-Gephardt bill, which would establish an alternative malpractice liability system. The proposal encourages states to enact legislation under which providers and patients would reach settlements that compensate for economic losses resulting from negligent treatment. In states that do not enact such laws, HR 5400 would apply to federal program patients only. Under the proposal, if a health care provider who is potentially liable for malpractice offers to compensate for the patient's actual economic loss, the patient would be forever barred from bringing a malpractice suit against the provider. The recovery would be limited to the individual's net economic loss. Though the bill's sponsors have performed a considerable service in identifying a major problem and generating public discussion, the bill raises several important moral questions. How much "defensive medicine," for example, is actually prudent practice that is in patients' best interests? Will thorough and holistic care be sacrificed in the proposal's attempt to save money? If states do not enact an alternative liability system for all patients and the proposal affects only federal program patients, will the result be disproportionate treatment among categories of patients? And is it fair to deny persons recovery for their emotional distress, physical impairment, pain and suffering, and similar kinds of damages? These are but a few of the issues that Catholic providers should raise in the debate, which otherwise might well be oriented toward fiscal concerns only.

Catholicism↗

PubMedDate not supplied

Mastering malpractice risk management: a must for health care professionals.

Neither tort reform nor new forms of carrier coverage, self-insurance or other financing vehicles provide sufficient remedy for the malpractice crisis, according to a TPF&C/Tillinghast specialist in the field. He explains why this is so and suggests how health care providers--like it or not, now quite firmly in the malpractice insurance business--can learn a critical "second profession": financing and managing the economic risk of malpractice.

Actuarial Analysis↗

PubMed1988

Providers must plan for accrual of medical malpractice claims.

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.

Accounting↗

PubMed1980

Physician countersuits--a solution to the malpractice dilemma?

Following a period of relative passiveness among physicians, during which most lived in trepidation of a malpractice action being filed against them, there emerges a new era of physician activism. This activism haqs taken the form of countersuits, based most commonly upon malicious prosecution either as a single cause of action or in conjunction with abuse of process or defamation suits. This Article will explore the derivations and positive and negative effects of malpractice suits, the possibilities of a physician being wrongfully sued, the potential ways in which the doctor can counterattack, and the effectiveness of countersuits in solving the malpractice problem.

Defensive Medicine↗

PubMed1981

Psychotherapeutic injury: reshaping the implied contract as an alternative to malpractice.

Despite the enormous number of Americans who seek psychiatric aid for their emotional problems, malpractice actions against psychiatrists are surprisingly rare. In this Article, Professors Feldman and Ward suggest that this stage of affairs is caused not by the extraordinary competence of the psychiatric profession, but rather by the particularly severe legal obstacles that confront injured psychiatric patients. The elements of the traditional tort cause of action--especially causation--are not easily proved by plaintiffs claiming psychiatric injury. Moreover, recent cases show that courts are growing even more unsympathetic to those patients who suffer most grievously from unscrupulous psychiatrists. To remedy this problem, the authors reach to the historical origins of medical malpractice liability, and advocate the revival of an implied contract to treat with skill and care. By imposing a fiduciary obligation on the psychiatrist in the performance of this contract, the authors overcome the obstacles of proof that arise from traditional tort law. This alternative approach should bring a new balance to the law of psychiatric malpractice, in which aggrieved patients will be compensated for thier injuries, but innovative practitioners will not be unduly deterred from medical experimentation.

Female↗