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PubMed1979

Medical malpractice problem.

The medical malpractice problem is extremely complex and is perceived very differently by health care providers, patients, and other segments of society. As a widely recognized problem, it is of relatively recent origin. Its potential societal consequences include disruption of health services, waste and maldistribution of economic and human resources, and a severe strain on a variety of our traditional social institutions. The "crisis" of malpractice is a product of many forces, including a disturbing level of negligent and improper medical care, frequently unrealistic patient expectations, and the growing "philosophy of entitlement" which is rampant among Americans. Responses to the problem have sometimes been ill-advised and emotional. Most often, the problem is seen as one of inadequate or overpriced malpractice insurance, though careful analysis suggests that insurance issues are merely symptoms of the real problem. Nevertheless, insurance-based solutions have proven to be politically expedient and have produced at least temporary alleviation of the problem. Ultimately, though, other approaches will be necessary, and careful, objective research is required to identify and test long-term options.

History, 19th Century↗
PubMed1985

Physician medical malpractice.

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.

Insurance, Liability↗
PubMedDate not supplied

Stress management can lead to reduced malpractice.

The prevention of medical malpractice is not an easy task. There is no one factor that can be said to be the "cause" of malpractice claims. Many areas have been targeted for concern--interaction between an individual professional and the patient, interaction among members of the professional staff, use and outcome of the application of medical technology, management practices, occupational environment, level of education and training, and personal coping styles. Although the degree to which attention to stress management techniques can be expected to reduce malpractice claims is unclear, it seems certain that attempts to alleviate occupational stress would be productive.

Burnout, Professional↗
PubMedDate not supplied

Malpractice liability in health professional education.

Malpractice lawsuits filed against educators are a relatively new phenomenon. These suits have met with considerable resistance from the courts, which prefer not to involve themselves in assessing the quality of educational services. However, educators in the health professions are more susceptible to legal action because courts are more likely to recognize claims based on medical malpractice. This article reviews the case law regarding negligence as a basis for educational malpractice and suggests ways educators can avoid such litigation.

Education, Medical↗
PubMed1976

Some thoughts on dental malpractice.

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.

Dental Assistants↗
PubMed2000

Acute mesenteric ischemia and malpractice claims.

BACKGROUND: Acute mesenteric ischemia can be a difficult diagnosis to make, but delay contributes directly to infarction, and this may provide a setting for malpractice claims. METHODS: We reviewed 180 consecutive malpractice claims submitted by attorneys for medical expert (ME) review during the 12 years ending in late 1998. Seven cases involved acute mesenteric ischemia. RESULTS: Alleged failure to make a timely diagnosis was the basis for 5 of these claims, failure to provide anticoagulant protection for 1, and failure to prevent nonocclusive ischemic infarction for 1. Six claims were closed after ME review and 1 claim involving late diagnosis was settled before trial. CONCLUSIONS: The risk of a malpractice claim is reduced by consideration of computed tomography (CT), angiography, and surgical consultation as soon as a patient is seen whose differential diagnosis includes acute mesenteric ischemia.

Acute Disease↗
PubMed2000

[Malpractice in connection with radius fractures must be reduced. Clear guidelines for treatment and follow-up are required].

PSR handles the vast majority of malpractice injuries in Sweden. PSR is a claims handling company which settles claims for malpractice on behalf of the insurance company owned by the Swedish county councils: the County Councils Mutual Insurance Company. A central issue in the law regulating patient injuries in Swedish health care is to define injuries that could have been avoided if a certain therapeutic/diagnostic procedure or a more appropriate method had been utilized. PSR arranged a multiprofessional conference regarding guidelines to decrease the number of malpractice injuries in the treatment of distal radius fractures. Among the most important issues defined were: To improve and standardize diagnostic imaging Patient information Early decision making in surgery and physical/occupational therapy A more well-defined indication for surgery, in which type of trauma, biological age and functional demands are considered in addition to radiographs Less stereotyped thinking in follow-up Controlled randomized trials.

Clinical Competence↗
PubMed2001

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

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.

Australia↗
PubMedDate not supplied

Malpractice liability for informal consultations.

BACKGROUND: Informal ("curbside") consults are widely used by primary care physicians. These interactions occur in person, by telephone, or even by e-mail. Exposure to malpractice liability is a frequent concern of subspecialty physicians and influences their willingness to engage in this activity. To assess this risk, we reviewed reported judicial opinions involving informal consultation by physicians. METHODS: A search of the existing medical literature, and of the Westlaw national database was undertaken to identify reported judicial opinions involving informal physician consults that address whether informal consultations create a legal relationship between consulting specialist physicians and patients that gives rise to a legal duty of care owed by the consulting specialist to the patient. CONCLUSIONS: Courts have consistently ruled that no physician-patient relationship exists between a consultant and the patient who is the focus of the informal consultation. In the absence of such a relationship, the courts have found no grounds for a claim of malpractice. Malpractice risks associated with informal consultation appear to be minimal, regardless of the method of communication. While "informal consultation" is not a term used by the courts, the courts have applied a consistent set of criteria that help define the legal parameters of this activity.

Humans↗
PubMed2003

Orthopaedic malpractice claims in the VA medical system.

This study was undertaken to delineate the outcome of orthopaedic malpractice claims in the Veterans Affairs Medical Center (VAMC) system compared with the private sector. All orthopaedic administrative tort (malpractice) claims handled by the Office of Regional Counsel in Nashville, Tennessee during the 5-year period (8/93-7/98) were analyzed. Attention was directed at: 1) the number and type of claims, 2) the disposition of the claims, 3) the average award or settlement and range in size of awards (indemnity), and 4) the length of time required to process and dispose of each claim. These data were compared to those compiled in that segment of the private sector represented in the database of Physician Insurers Association of America (PIAA) for a similar five years (1/90-12/94). Twenty-six claims were filed in the 5-year study period and 22 were adjudicated by December 1999. Fourteen of 22 (64%) were defended successfully and eight (36%) resulted in an award to the claimant plaintiff. In the private sector those figures were 69% and 31%, respectively. The VAMC average indemnity was 20,404 dollars (range, 3500-100,000 dollars) versus 145,200 dollars in the private sector. Approximately 1% of all awards in the private sector were greater than 1,000,000 dollars. The length of time required by the VAMC to process and dispose of each claim ranged from 6 to 59 months and averaged 15.2 months. The settlement rate of orthopaedic medical malpractice claims involving the VAMC and the private sector is similar. It appears that the average award is greater in the private sector. This may reflect more claims and lesser awards in the VAMC. In both systems, most claims do not result in an indemnity.

Arthroplasty↗
PubMed2003

Malpractice reform: one state's example.

The medical malpractice liability crisis has resulted in soaring liability costs, the closing of major malpractice insurance companies, and many doctors abandoning the performance of high-risk procedures or medical practice altogether. The article explores how medical malpractice liability was addressed in the State of Pennsylvania, as well as recent attempts at tort reform by the federal government.

Compensation and Redress↗
PubMed1976

Arbitration of malpractice claims: a hospital-based pilot project.

In summary, the findings of this study indicate that the "simple existence" of an arbitration option and the logistical systems supporting it have produced positive results and have established significant trends in a group of hospitals participating in the Southern California Arbitration Project when compared to a group of Southern California hospitals that have not participated. Albeit inconclusive at this time, the concept may well be a feasible alternative to litigation in securing an expeditious and inexpensive resolution for malpractice cases. Arbitration, in and of itself, is most assuredly no panacea for the critical malpractice problem currently experienced throughout the country; however, its potential substantive contribution toward the resolution of malpractice claims is certainly one worthy of extensive experimentation and evaluation.

California↗
PubMedDate not supplied

One state's response to the malpractice insurance crisis: North Carolina's Rural Obstetrical Care Incentive Program.

In the period 1985-89, there was a severe drop in obstetrical services in rural areas of North Carolina, partly because of rising malpractice insurance rates. The State government responded with the Rural Obstetrical Care Incentive (ROCI) Program that provides a malpractice insurance subsidy of up to $6,500 per participating physician per year. Enacted into law in 1988, the ROCI Program was expanded in 1991, making certified nurse midwives eligible to receive subsidies of up to $3,000 per year. To participate, practitioners must provide obstetrical care to all women, regardless of their ability to pay for services. Total funding for the program has increased from $240,000 to $840,000, in spite of extreme budgetary constraints faced by the State. The program and how its implementation has maintained or increased access to obstetrical care in participating counties are described on the basis of site visits to local health departments in participating counties and data from the North Carolina Division of Maternal and Child Health. The program is of significance to policy makers nationwide as both a response to rising malpractice insurance rates and reduced access to obstetrical care in rural areas, and as an innovative, nontraditional State program in which the locus of decision making is at the county level.

Female↗
PubMed2003

Medical malpractice liability crisis meets markets: stress in unexpected places.

While the causes of rapidly rising medical malpractice insurance premiums remain contentious and unsettled, the consequences are rippling through communities, threatening to diminish patients' access to care and increase health care costs, with an uncertain impact on quality, according to findings from the Center for Studying Health System Change's (HSC) 2002-03 site visits to 12 nationally representative communities. The severity of malpractice insurance problems varied across communities, with some physicians changing how and where they care for patients. For example, rather than treat patients in their offices, more physicians are referring patients to emergency departments. And many physicians, especially those practicing in high-risk specialties, are unwilling to provide emergency department on-call coverage because of malpractice liability concerns.

Emergency Service, Hospital↗
PubMed2000

Defeating malpractice risk, Part 2.

Part 1 explored the basic elements of malpractice--duty, breach of duty, injury, and causation--and how to reduce malpractice risk for medication and equipment errors. This month, learn the malpractice risks and cautions for monitoring mistakes and patient falls. Test your knowledge with the questions below, then check your answers at http://www.nursingmanagement.com.

Accidental Falls↗
PubMed2004

Late complications after medical treatment--malpractice or fate?

During the past decade, interest in medical malpractice has increased both by the public and the authorities. Malpractice is likely to be considered if an adverse effect occurs shortly after medical intervention, but complications might lead to impairment or death of the patient even years after surgical treatment. Two unusual cases of such late complications are described. In the first case, the patient died from a complication, which was due to an unnoticeable malfunction of a surgical device. The second case concerns a retained surgical towel, which had remained within the abdominal cavity for 25 years without causing any complaints and had no influence on the cause of death. Medico-legal autopsy is an indispensable basic tool in the assessment of medical malpractice.

Aged↗
PubMed1992

Risk management and medical malpractice.

Medical malpractice claims are common and may be emotionally difficult for physicians. Most malpractice suits claim negligence. The most frequent types of claims include failure or delay in diagnosis, negligent treatment with drugs, failure to obtain consultation, failure to obtain informed consent, and negligent management of procedures. The most important risk-management strategy is the provision of good medical care. If a claim is filed, physicians should cooperate fully with the malpractice insurance carrier and refrain from discussing the case with colleagues.

Insurance, Liability↗
PubMed2005

Change in cesarean section rate as a reflection of the present malpractice crisis.

OBJECTIVE: To examine the potential effect of the malpractice crisis on the cesarean section rates of practicing obstetricians. METHODS: We reviewed the medical records of primagravid women, from both clinic and private practice settings, having singleton deliveries at Hartford Hospital from 1994 to 2003. The records of cesarean sections due to fetal distress and cephalopelvic disproportion (CPD) were further analyzed for three different two-year periods; 1994-1995, 1999-2000, and 2002-2003. Cases with accepted indications for elective cesarean sections were excluded. These included breech position, HIV, herpes, preeclampsia, placenta previa, and abruptio placenta. RESULTS: The private cesarean rate in 1994-1995 was 15.6%, 1999-2000 15.7%, and in 2002-2003 24.8%, a 58% increase. This is a significant increase that was not equally seen in the clinic population during the same period. CONCLUSION: The private, primagravid cesarean section rate has increased significantly in the last two years. A concurrent rise in medical malpractice actions and malpractice insurance premiums, without other attributable explanations, suggests this may be a major factor.

Cesarean Section↗