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Playing by the rules. How Intel avoids antitrust litigation.

Microsoft and Intel are both obvious targets for antitrust litigation; both wield considerable control in their respective segments of the computer industry. But while Mircrosoft has been mired in court for years now--its name and business practices dragged through the mud, and its very future as a single company thrown into doubt--Intel has avoided a prolonged, high-profile antitrust case. Intel's success is not a matter of luck. The company's antitrust compliance program, refined over many years, has been an integral element in the chip maker's business strategy. In this article, the authors suggest that Intel's approach to compliance provides a valuable model for any enterprise that may come under regulators' scrutiny. They describe how Intel created extremely conservative antitrust compliance standards and then instituted a series of unique training events that had active support from then--CEO Andy Grove and others in senior management. First, live training -- not just instructional pamphlets or videos -- was given to all affected employees. Those classes were followed by customized training programs for different parts of the company. Then, to drive antitrust awareness deeper into the company's memory, Intel carried out random audits of employees' files and conducted mock depositions. "It's fascinating to see," Grove says. "A memo is introduced into evidence and you shrug. You fully understand how that memo could be written. Moreover, you could have written it yourself. And then you see that memo turned into a tool and a weapon against you, in front of your eyes." Intel recognizes that no matter how cautious it is, it will always face extraordinary scrutiny as a market leader. But "since antitrust is embedded in everything we do," Grove says, "we can control our destiny."

Antitrust Laws↗

Not just malingering: syndrome diagnosis in traumatic brain injury litigation.

When patients present with syndromes we mistrust or misunderstand, clinician are often quick to make a determination of malingering. However, the use of malingering as a default diagnosis neglects a variety of clinical possibilities that may be relevant for treatment and forensic disposition. In neuropsychology, the growing use of a malingering diagnosis has recently been fueled by the increasingly adversarial nature of forensic brain injury litigation in which the goal is often less to provide an objective evaluation of cognition and personality as to brand all personal injury claimants as manipulative frauds. Less maliciously, but still disturbing, neuropsychologists whose knowledge base and clinical experience involves mainly the administration and scoring of psychometric tests may ignorantly, if innocently, overlook alternative diagnoses and syndromes that their education and training have ill-prepared them to recognize. And some patients do indeed malinger, and it is important to identify them, if only to spare legitimately injured claimants from being tarred with the same brush. This paper describes some of the syndromes that may present in clinical and forensic practice with brain-injured patients. It is to be considered a first step toward a practice model of neuropsychology that encourages the role of knowledge and clinical judgement in guiding the meaningful clinical interpretation of tests and measures.

Brain Concussion↗

The roles of experts and litigation support consultants in medical-legal claims.

Brain injury claims frequently involve the use of experts to evaluate and document extent of impairment. These experts can cover a wide array of specialities, many of which are delineated in this article. It is pointed out that there are crucial differences between a clinical evaluation and a medical-legal evaluation as the latter is generally more comprehensive and addresses many of the specific issues that arise in a forensic claim. It is suggested that use of a litigation support consultant can provide valuable assistance for the attorney at the outset and over the course of handling a claim such as with selection of experts and preparation for direct and cross examination of experts. Suggestions are also made about criteria for selection of experts such as to ensure that appropriate objectivity, and, consequently, admissibility of conclusions is maintained.

Brain Concussion↗

[A judgement in litigation over return of pathological samples].

The son of a deceased patient filed a law suit against a medical school hospital for return of all the pathological samples (paraffin blocks and preparations) made from part of the patient's corpse. The reason cited is that the samples included at least one type about which he had not given consent. The Tokyo distinct court passed a judgement, rejecting the defendant's claim that the consent was meant to be all-inclusive, and ordered the defendant to return all the samples still in their possession to the litigant. This judgement made the legal meaning clear as to the permission of a decreased person's family, both from the standpoint of public law and from that of private law. The judgement made the first impression on permitting their ownership.

Autopsy↗

Falls.... A prelude to litigation.

For years long-term care has found itself vulnerable to law suits. This is still true today. On any given day, nursing homes and the staff employed by them are only one unhappy client away from receiving a notice of intent. In today's litigious world, nursing homes must have in place, effective policies and procedures to minimize their risk for a lawsuit. Part of managing the risk, is having a multi-disciplinary team in place that takes a proactive approach to patient safety. The particularly high risk patients for incident are ambulatory patients with cognitive impairment. The multi disciplinary team must aggressively address each of these residents in relation to their fall risk. Implementation of a comprehensive plan of care, maintaining good communication between facility and the patients' physicians and families, and quality charting by the nursing staff, are some of the key elements in preventing litigation.

Accidental Falls↗

A practical method for the evaluation of symptom exaggeration in minor head trauma among civil litigants.

Forensic psychiatrists and psychologists are often called on to provide opinions and render testimony in which minor head trauma accompanied by persistent somatic, cognitive, and/or emotional symptoms is alleged. The frequency of persistent symptoms following such minor head injury is generally low. The forensic clinician therefore must differentiate between subtle brain dysfunction, symptom amplification, psychogenic-based causes for the presence of cognitive and other deficits, or frank malingering. The purpose of this article is twofold: first, to review critical issues related to the assessment of malingering and symptom exaggeration in mild head injury cases; and second, to offer a practical model for the assessment of amplified neuropsychological and psychiatric deficits in civil litigants in cases of minor head trauma.

Craniocerebral Trauma↗

Medical litigation. The aetiological role of psychological and interpersonal factors.

The present paper focuses upon psychological factors which may cause patients to make formal complaint or embark upon legal proceedings against a doctor despite competent medical management. Although the principles involved arose from experience of liaison psychiatry in neonatal and obstetric settings, they are more broadly applicable to other areas of medical practice. The corner stone of prevention is appropriate psychological management. One of the most common forms of psychological mismanagement is a failure to share information openly with patients when it becomes available. Sometimes, despite exemplary medical and psychological management, grievance proceedings are still initiated. Often in such cases the cause lies in the patient's psychopathology. Finally, formal complaint or litigation may arise as a result of the patient's unrealistic expectations of the doctor.

Adult↗

What litigators need to know about HIPAA.

HIPAA's Privacy Regulations impose a number of new requirements on Covered Entities concerning disclosure of an individual's personal health information. This Article briefly outlines the primary function of HIPAA's general nondisclosure rule and discusses the exceptions under which HIPAA permits disclosure in the course of litigation or government investigations.

Access to Information↗

Reducing litigation costs through better patient communication.

The most common cause of malpractice suits is failed communication with the patients and their families. Explore ways that better communication could lead to fewer malpractice claims and allow health care organizations to reduce litigation costs.

Communication↗

Public Interest Litigation (PIL) filed by Centre for Health and Allied Themes (CEHAT) and others in the Supreme Court of India in 2000.

The Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 [now renamed as Pre-conception and Pre-natal Diagnostic Techniques (Prohibition of Sex Selection) Act, 1994] came into operation with effect from 01.01.1996. The implementation of the Act rests with the States and UTs. However, nothing much happened till there was Public Interest Litigation (PIL) filed by Centre for Health and Allied Themes (CEHAT) and others in the Supreme Court of India in 2000. The Supreme Court intervened in response to this PIL and taking cognizance to the situation and prayers of the petitioners, ordered strict enforcement of the Act and gave number of directions in its several hearings. The Court heard the matter about 20 times since 2001. The PIL was disposed of in its last hearing on 5.9.2003. The final judgment dated 10.09.2003 reiterates all the earlier directions of the Supreme Court issued to Central Government, States/UTs for proper implementation of the Act.

Administrative Personnel↗

Federal Court permits contaminated-blood litigation to proceed.

In ongoing legal proceedings involving people infected with HIV through contaminated blood products, on 3 June 2004 Campbell J of the Federal Court permitted the plaintiffs to refile an amended statement of claim, thus allowing the litigation to proceed. As reported in a previous issue of the Review, the court had struck out their original statement of claim, ruling (among other things) that it disclosed no reasonable cause of action and constituted an abuse of process.

Blood↗

Roles of medical consultants and expert witnesses in cerebral palsy litigation: a review.

What is the role of the medical consultant and expert witness during the litigation process associated with cerebral palsy (CP)? To address this question, a review was undertaken of the world literature published on CP between 1861 and 2004. The appropriate Medical Subject Heading terms were selected and used in a search of the MEDLINE, ACOGNET and Cochrane Library databases. Also, a manual search was performed. A total of 3,168 articles on CP were reviewed. Of them, 143 met the inclusion/exclusion criteria. Analysis of the pertinent articles revealed that this is the first article to address the role of the medical consultant. The literature on CP is predominantly observational studies. At best, they can be qualified as grade C in the ranking of evidence-based medicine. A clinical study on CP cannot be well designed methodologically because of ethical and technical problems. There is no literature available to determine the role of the consultant in CP cases. The appraisal of suboptimal obstetric care should not be omitted or dismissed when present. Preconceived conclusions about causation based simply on the poor outcome of a child should be avoided. A well-documented hypoxic-ischemic brain insult during the antenatal period does not automatically exclude intrapartum suboptimal obstetric care. Lack of uniformity in policies among U.S. hospitals on umbilical cord and newborn blood gas analysis (<1 hour of neonatal life), fetal membrane microbiologic cultures and placental histology creates difficult tasksfor medicolegal reviewers. Lack of vital diagnostic elements will limit the objectivity of a consultant and expert witness. The human emotional aspect plays a significant role in reaching a jury verdict for plaintiffs, regardless of the weakness of a case.

Adult↗

Monetary lessons from litigation involving laparoscopic cholecystectomy.

Limited information exists on the relationship between adverse events associated with laparoscopic cholecystectomy (LC) and subsequent litigation. Out of 104 suits concerning LC, 18 cases were settled for 628,138 dollars; 48 cases resulted in a plaintiff's verdict with the plaintiff receiving 2,891,421 dollars; and 18 cases resulted in a surgeon's verdict. However, when multiple defendant cases were excluded, there was <20,000 dollars difference between a negotiated settlement and plaintiff's verdict. Given the minimal monetary differences between a settlement and a plaintiff's verdict, when a surgeon is the sole defendant in a malpractice case concerning LC, the surgeon should encourage their carriers not to settle before trial; as only a trial will exonerate the surgeon. However, this encouragement should be tempered when there are "red flags" that favor the plaintiff, including multiple defendants (especially a hospital), male plaintiffs, bile duct injuries, knowledgeable and well-financed plaintiff's attorneys, and certain plaintiff's venues.

Adult↗

Social Security preclusions in personal injury litigation.

This editorial scrutinises the impact of preclusion periods for social security entitlements upon personal injury practice. It identifies the differences in calculation in respect of the compensation part of lump sum payments, depending upon whether a plaintiff's case is settled or resolved by litigation. It examines the effect of s 1184K of the Social Security Act 1991 (Cth) and the circumstances in which the discretion to reduce or waive the preclusion period has been exercised in favour of recipients of lump sum payments. It argues that room remains for creative arguments on behalf of plaintiffs, highlighting the potential for the compensatory effect of the lump sum to be undercut if the preclusion provisions are fully applied.

Compensation and Redress↗

Minimizing medical litigation, part 2.

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.

Humans↗

On physicians and litigation.

Because litigation involving physicians has come to influence the practice of medicine in several ways, we describe many of the legal processes involved. We also offer specific advice in regard to steps which can be effectively taken, and those which should be avoided. We close with a plea for active participation by physicians in the judicial process and in the promulgation of appropriate legislation.

Expert Testimony↗

Carburetor burns: preventable injuries associated with high morbidity and frequent litigation.

We have identified carburetor burns as a significant cause of preventable morbidity, both from long-term functional and cosmetic standpoints. The epidemiology of carburetor burns and our experience are described. All of our patients were male, with a mean age of 35 years. Average burn size was 11.3%. The anatomic distribution of these burns, most often on the dominant hand and on the face, contributes to the morbidity of these burns. This injury has been associated with increasingly frequent litigation. We believe that an active education campaign and the addition of warning labels to car engine compartments would make an impact in decreasing the incidence of carburetor burns.

Adult↗

The problem of longterm disability payments and litigation in primary fibromyalgia: the Canadian perspective.

The determination of disability in fibromyalgia syndrome is problematic because of its perceived subjective nature and the absence of well defined criteria for diagnosis. This, together with an unclear idea of the natural history, creates problems in litigation and determination of rehabilitation costs. Lawyers and third party payers must cooperate with physicians to determine the "hidden costs" of fibromyalgia so that a fairer estimate of longterm disability is achieved.

Canada↗