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PubMed1989

The AMA alternative to medical liability litigation: pros, cons, and fatal flaws.

The AMA proposal for an administrative scheme to replace professional liability litigation has many positive features. It abolishes jury trial and allows administrative determination of fault, representation by appointed lawyers, and limited recovery but for a wider range of injuries during treatment. Attractive as these provisions may seem to medical providers, several of them are radical enough to ensure rejection by the courts as unconstitutional. The "total package" approach to professional liability reform is less promising than concentration on the introduction of a few key items of proven or probable efficacy. Medical providers should concentrate their limited resources on tort reform providing for "caps" on noneconomic damages (pain and suffering), an absolute statute of limitations, reversal of the collateral sources (double recovery) rule, limitations on attorneys' fees, and periodic payments, rather than lump sums, for large awards. The new TMA proposal for neurological birth injuries is discussed briefly.

American Medical Association↗
PubMed1989

Removing the mandibular third molar: neurosensory deficits and consequent litigation.

Neurosensory dysfunction, on an iatrogenic basis, appears to be increasing at an alarming rate in the oral surgical section of dental practice. This is particularly so with respect to the impacted lower wisdom tooth. With changing social mores and more sophisticated consumerism, increasing litigious tendencies within the general population and a more informed public, there is a parallel increase in malpractice lawsuits related to this complication. This article presents the documentation supporting this impression and discusses methods of diminishing the likelihood of successful litigation against the dentist. Clinical aspects of mandibular third molar removal are explored with a view to surgical approach and anatomic awareness relevant to the subject. The current status of informed consent is presented, along with one example of a written form which might be applicable under the circumstances.

Canada↗
PubMed1989

Endodontics and litigation: an American perspective.

Dentists can reduce the risk of legal entanglements following endodontic treatment. Dentists should not fail to meet the standard of care required at one or more of the several stages in endodontic treatment: at diagnosis, in record keeping, by accidentally treating the wrong tooth, by not using rubber dam, by breaking endodontic instruments in the root canal, by using inappropriate endodontic implants, by creating root perforations, by failing to give adequate instructions for home care and by not providing emergency care. Recognition of problems likely to rise to litigation and the methods to be used in their avoidance are emphasized.

Dental Implantation, Endosseous, Endodontic↗
PubMed1989

Radiation litigation in retrospect.

Most of the radiation litigation filed against the United States pursuant to the Federal Tort Claims Act has been defended by asserting federal sovereign immunity or by proving that the plaintiff's injury is unrelated to his radiation exposure. This paper reports that the second defense is best advanced by comprehensive pretrial investigation of the plaintiff's claim, which frequently results in voluntary dismissal of the legal action.

Humans↗
PubMed1986

Use and misuse of epidemiologic data in the courtroom: defining the limits of inferential and particularistic evidence in mass tort litigation.

Medical epidemiology is the cornerstone for understanding the safety and efficacy of drugs and medical devices. Epidemiologic principles provide a statistical basis for determining correlations, and ultimately mathematical causation, between two series of events. Medical epidemiologic evidence and statistical inferences are useful and are now routinely accepted in the courtroom. The complex distribution systems that provide fungible goods throughout the country often preclude the identification of the specific source of an allegedly defective product. An expansion of the principles established in Summers v. Tice and Ybarra v. Spangard provide a logical and rational means for the courts to address products liability issues in cases involving multiple and unnamed defendants. This Article discusses the impact of epidemiology on the judicial process, both in the nature of judicial decision-making and in the nature of the law itself. Part III B discusses the "weak" and "strong" versions of the traditional preponderance of the evidence rule, as recast by recent products liability litigation. The remainder of the Article defines the useful and appropriate scope of epidemiologic evidence, concluding that "intentless" epidemiologic evidence alone cannot support an award of punitive damages.

2,4,5-Trichlorophenoxyacetic Acid↗
PubMed1986

The role of the psychiatrist in evaluating a prison mental health system in litigation.

Federal courts during the past 14 years have recognized that many prisons in the United States have provided constitutionally inadequate medical and psychiatric services. Our recent national survey indicates that at least 20 states have had at least one part of their correctional system included in a certified class action suit that alleged insufficient mental health services for inmates. This article reviews the role of the expert psychiatric witness during the phases of litigation that involve proposed remedial plans and compliance in implementing remedial plans. Available epidemiologic data about psychiatric disorders among prison inmates, standards for correctional mental health care, and various mental health system models are briefly reviewed. A comprehensive approach to evaluating proposed remedial plans and assessing issues of compliance with accepted plans is described. Special attention is directed toward psychiatric issues unique to a correctional system.

Forensic Psychiatry↗
PubMed1986

Medical malpractice litigation in ophthalmology: the New Jersey experience.

One hundred twenty-one medical malpractice claims against ophthalmologists are analyzed with respect to the specific allegation, the ophthalmic cause of litigation, and disposition. Failure or delay in diagnosis was responsible for 35% of claims and 63% of patient indemnification. Allegations of failure to diagnose most commonly concerned retinal detachment. While an identical number of claims were closed with payment because of errors in treatment, the indemnity for these claims was less by a factor of nearly half. The greatest number of claims alleging negligent treatment involved complications of cataract surgery.

Humans↗
PubMed1985

Products liability issues in school asbestos litigation.

The hazards posed by deteriorating friable asbestos in the nation's schools are causing serious concerns for public health officials, school boards, parents and school employees. Reports by both the Environmental Protection Agency and the U.S. Attorney General's Office agree that both school children and school employees stand a substantially increased risk of contracting some form of asbestos-related disease as a result of exposure to deteriorating asbestos materials in school buildings. School systems plagued by the asbestos hazards are now filing suits against asbestos manufacturers alleging causes of action in breach of warranty, negligence and strict products liability in tort. Some plaintiffs in school asbestos litigation seek to recover the costs of EPA-mandated asbestos inspection and abatement programs which have already been completed. Still others request injunctions to compel the manufacturers themselves to conduct inspections and finance abatement. This Note examines the school asbestos situation from a legal perspective and focuses primarily on whether the schools' claims should be considered as economic losses or as property damage. It examines the impact of statutes of limitations on these cases under both contract and tort theories. The Note argues that school asbestos claims should be decided under a strict products liability standard.

Adult↗
PubMed1978

Medical litigation in Canada.

It is impossible to predict the future of medical malpractice litigation in Canada. However, the statistics indicate that medical malpractice claims are steadily increasing. Action whould be taken now to ensure that the problem does not reach crisis proportions. In so far as the medical profession itself is concerned, it should ensure that the competence of medical practitioners remains on the highest possible level.

Adolescent↗
PubMed1982

Plaintiffs' view of malpractice litigation.

All of us want to improve the quality of practice in our professions and develop methods for ridding ourselves of the incompetent practitioner. Unfortunately, PSROs and state licence review committees have proved completely inadequate. Committed dentists, doctors, and lawyers are as frustrated as the general public when they attempt to establish reasonable standards by which to police their respective professions. Although no one likes to be sued, I would suggest that the private lawsuit has developed into the most helpful tool for accomplishing mutual interprofessional aims and upgrading all of the professions. Certainly the competent individual who makes an honest mistake that causes harm should be financially responsible to the injured party. More importantly, especially since most lawsuits involve in minority of practitioners who hurt the public and the profession, both in stature and financially through increased insurance rates, the malpractice lawsuit provides a fact-gathering process upon which both education and discipline can be predicted. Individual dentists, when they see examples of consistently poor work, are still understandably reluctant to file charges. They have enough to occupy their time in keeping up with their own practices and continuing education. They are understandably reluctant to become self-appointed policemen or keepers of the community conscience. Where, however, the information can be brought to the attention of a dental society, with the facts already marshaled through the litigation process, such groups have in recent years been much more ready to act. Since their action comes as a response to demands and pressures external to the profession, it is more easily accepted by other dentists, and therefore more likely to be effective.

Defensive Medicine↗
PubMedDate not supplied

Trends in malpractice litigation.

Physicians who make mistakes are not necessarily negligent, contrary to prevailing opinion in the medical community. The article discusses the legal concepts of "standard of care" and "proximate cause." The incidence of favorable jury verdicts in those cases in which malpractice suits are litigated is quite high. The effects of insurance company policies in decisions about settlements on the incidence of claims is discussed and alternatives are suggested. The prevailing belief that a consent form with a patient's signature on it is sufficient to prevent a malpractice suit is also discussed.

Informed Consent↗
PubMed1994

Adopting strategies to reduce healthcare litigation and complaints.

Patients are bringing more court actions and are making more formal complaints then ever before. The reasons are various and range from the Patient's Charter making patients more informed to the publicity of successful court cases and complaints alerting patients to their right to sue and complain. Whatever the reason for bringing the claim or making the complaint it is important for healthcare to reflect on the reasons for the increase and to adopt strategies for reduction. Litigation and complaints cost health authorities and patients valuable time and money. Going to court and mounting a formal complaint can also be an emotionally stressful experience for all those involved.

Malpractice↗
PubMed1993

The military health care provider in litigation: an overview.

Nowhere is the importance of readiness more critical than in the context of the health care provider preparing for an appearance in court. Accordingly, it is necessary to maintain a general working knowledge of both the general principles associated with the rendering of health care services in the military and the basic tactics that lawyers may employ toward health care providers during litigation.

Expert Testimony↗
PubMedDate not supplied

Tobacco litigation as a public health and cancer control strategy.

OBJECTIVE: To provide an overview of the class action and medical cost reimbursement suits of the third wave of tobacco litigation and to analyze their chances for success and their efficacy as a public health and cancer control strategy. METHOD/DATA SOURCES: The application of standard, predictive legal reasoning to documents from three class action lawsuits, four of the five state medical cost reimbursement lawsuits, documents from the tobacco industry, and appropriate secondary sources. CONCLUSIONS: Victory in any of the class actions would result in a transfer of costs, albeit an inefficient one, from injured smokers to the tobacco industry. Victory in any of the medical cost reimbursement suits would result in a transfer of costs from injured states forced to shoulder the economic burden of tobacco-induced illnesses to the tobacco industry. Such a transfer of costs would likely have the immediate impact of significantly lowering cigarette consumption, while the long-term effects would probably be much more devastating. Victory in at least some of the third wave cases is likely, because a number of factors promise to enable plaintiffs to overcome the previously impenetrable defenses of the tobacco industry.

Health Policy↗
PubMed1996

The vascular patient as a litigant.

First medico-legal reports were written on 97 consecutive vascular patients (M-74; F-23). There was a four-fold increase in requests, from 17 reports in 1985-90 to 80 reports in 1990-95. There were 48 reports in connection with medical negligence claims with equal numbers instructed for the plaintiff patient and the defendant doctor; 32 industrial injury reports for vibration white finger; and 17 reports after work and road accidents. For medical negligence cases, the mean patient age was 47 years and 40 per cent of litigants were women. Twenty-one of 27 reports in arterial cases supported the defence, compared with seven of 16 venous cases and four of five others. Claims arose when advice or a procedure was followed by an unexpectedly bad outcome, such as amputation, paralysis or death, and following lesser damage when pre-operative expectations were high. Independent sympathetic explanations were helpful when patients and relatives experienced difficulties in coming to terms with seriously adverse events. Factors associated with successful defence included senior clinical involvement, clear and complete medical and nursing records, and the seeking of a colleague's opinion when a complication occurred. These findings show an increase in medico-legal activity which shows no sign of abating. It is likely that many more reports will be required in the future, to respond to overtures from vascular patients and their advisers.

Accidents↗
PubMed1997

"Litigation cells" in the Papanicolaou smear: extramural review of smears by "experts".

This paper presents a historical review of litigation involving false-negative Papanicolaou smears. The impact of the look back provision of the Clinical Laboratory Improvement Amendments of 1988 and the media attention focused on false-negative Papanicolaou smears is discussed. The problem types of cervicovaginal smears, including the categories of atypical squamous and/or glandular cells of undetermined significance, are also described.

Diagnostic Errors↗
PubMedDate not supplied

An overview of litigation concerning needlestick injuries in defective design and negligent use of equipment cases.

Needlestick injury litigation has occurred in several settings, but in recent years, the primary basis for lawsuits involves the transmission of deadly diseases or the fear of acquiring those diseases. These cases may be divided into situations that concern defective product designs and situations where there has been negligent use of or disposal of the needles. This article provides exemplary cases that discuss both the law and factual issues surrounding needlestick injuries.

Equipment Design↗