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PubMed2006

A 12-year follow-up study of malpractice claims against radiologists in Italy.

PURPOSE: Malpractice claims filed against radiologists have become a relevant phenomenon in Italy and are a real risk in the radiologists' professional activity. MATERIALS AND METHODS: Insurance claims of Italian radiologists over the 1993-2004 period were anonymously assessed. A total of 990 insurance claims were classified according to cause: (1) missed diagnosis, (2) complications of the radiological procedure, (3) failure to order further radiological examinations, (4) radiation treatment, (5) slip-and-fall injuries, (6) miscellaneous causes. RESULTS: A total of 990 claims were filed during the period, with most claims being filed a considerable time after the event. As a consequence, the estimated incidence may be 44 per 1,000. In other words, 44% of Italian radiologists have received, or will receive, a summons regarding their professional activity of the past 10 years. Misdiagnosis made up the first and most important claim category. Missed abnormalities on breast radiographs accounted for the greatest percentage of cases. Missed bone abnormalities were the following most common diagnostic errors. Complications following interventional procedures accounted for 10% of all cases. A few cases resulted from the radiologist's failure to order further diagnostic examinations. Lastly, radiologists were frequently named as one of multiple defendants, together with medical (or surgical) doctors, in cases of patient death in roughly 6% of all cases. CONCLUSIONS: The risk of medical malpractice litigation for Italian radiologists is by now comparable to that for American radiologists. Strict adherence to radiological standards may be a means of reducing the risk of legal action and obviating litigation.

Follow-Up Studies↗
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↗
PubMedDate not supplied

Surviving a malpractice suit. Personal experience and general information.

Few CNMs to date have been sued and fewer yet have been through the trauma of a malpractice suit. The following article is a synopsis of the malpractice process from summons through trial. Interspersed throughout are personal recollections and responses of one CNM who endured a two-week trial.

Communication↗
PubMed1984

Physician perceptions of medical malpractice and defensive medicine.

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.

Attitude of Health Personnel↗
PubMed2005

A plaintiff attorney's candid view of medical malpractice.

The human dynamics of medical malpractice litigation is more nuanced than many doctors suspect. The purpose of this article is to provide some candid insights into the process. The article presents three subjects that doctors are not likely to learn on their own, even if they read all of the law books or had the misfortune of running the gauntlet of their own medical malpractice lawsuit. Those subjects are: (1) the top five reasons why doctors get sued, (2) avoiding less than optimal legal representation, and (3) the importance of nonmedical issues in litigation.

Humans↗
PubMed2006

Ethical issues in medical malpractice.

The interrelationships between biomedical ethics and the law are perhaps nowhere as starkly apparent as in the realm of medical malpractice. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of futile care at the insistence of patients or families; and the various protections of Good Samaritan laws are just a few of these. In addition, the ethical principles governing the conduct of physicians serving as expert witnesses in medical malpractice cases have become a subject of intense interest in recent years.

Advance Directives↗
PubMed2004

Malpractice and system of expertise in anaesthetic procedures in Turkey.

Deaths which occur during the administration of anaesthetics require medicolegal investigations. The objective of this study is to form a database for future comparisons related to anaesthetic-associated malpractice claims and also to investigate the system of expertise, pertaining to such procedures. The decisions of the Supreme Health Council, whose expert opinion is requested by legal authorities (judges, prosecutors) for health workers brought to trial in a criminal court, were examined retrospectively over the period 1995-1999. In 21 (2.3%) of the 888 decision reports prepared by the council the team members (the anaesthesiologist , the anaesthetic assistant, the anaesthetic technician, the nurse) were directly interrogated. Data concerning these 21 council decisions were evaluated within the scope of this study. It was found that 57% of the 21 decisions were related to medical procedures carried out in state hospitals. Of the 21 cases, 62% were males, 38% females. General anaesthesia was applied to 19 of the cases while one received regional (local) anaesthesia and one axillary blockade. Twenty died of complications associated with anaesthesia. Autopsy was performed on 11 (55%) of the dead. Health workers were found to have different degrees of liability in the 16 (76%) of the 21 decision reports. In their medical practices, anaesthesiologists , like other specialists, are subject to legal procedures in the country where they perform their duties, to national and international principles of ethics, and to diagnostic and curative standards/procedures relevant to the scientific level of the country concerned. In anaesthetic malpractice claims, certain standards need to be followed in inquiries and approaches so as to determine the real reasons behind the disabilities and/or deaths which occur. In order that sound evaluations could be made in such cases, the experts as well as the system of expertise should be efficient and authorized.

Adolescent↗
PubMed2005

Dental malpractice cases in Turkey during 1991-2000.

OBJECTIVES: Doctors can face punitive and legal consequences if patients are not satisfied with the medical treatment. The purpose of this study is to provide a database for dental malpractice cases in Turkey. METHODS: This study is based on the decisions of High Health Council (HHC) in medical malpractice cases. Between 1991 and 2000, 1548 decisions were made by the HHC. 14 (0.9%) of these decisions were related to dentistry. This study examines the 8 decisions under which the dentists are found to be at fault. RESULTS: As three of these cases are based on the same facts they are examined together. Of the dentists consulted on 11 decisions, nine were male and two were female. In four cases the HHC gave its expert opinion before the trial, in five cases during criminal trial and in two cases during compensation trial. In five cases patients received surgical treatment, in four cases prosthetic treatment and in two cases endodontic treatment. Nine of these treatments were carried out at private dental practice. In eight reported decisions negligence and inadequate treatment were identified. Most of negligence was caused during surgical intervention. In two cases, treatments resulted in death. CONCLUSIONS: Like all other medical staff dentists are under the obligation to comply with the legal rules in the country they practice. They also have to consider ethical principles as well as the acceptable standards and protocols of diagnosis and treatment.

Adolescent↗
PubMed2006

Medicolegal analysis of 100 malpractice claims against bariatric surgeons.

BACKGROUND: Very few studies have addressed malpractice litigation specific to bariatric surgery. This study was designed to analyze litigation trends in bariatric surgery to prevent further lawsuits and improve patient care. METHODS: A total of 100 consecutive bariatric lawsuits were reviewed by a consortium of experienced bariatric surgeons and an attorney specializing in medical malpractice. RESULTS: Of the 100 lawsuits, 45% were reviewed for defense attorneys. The mean patient age was 40 years (range 18-65), 75% were women, 81% had a body mass index of <60, 31% were diabetic, and 38% had sleep apnea. Of the surgeons, 42% had <1 year of experience, and 26% had done <100 cases. Although 69% of the physicians were members of the American Society of Bariatric Surgery, only 22% had detailed consent forms. The surgical procedures were performed between 1997 and 2005 and included Roux-en-Y gastric bypass (78% total, 33% open, and 45% laparoscopic), vertical banded gastroplasty (3%), minigastric bypass (6%), biliopancreatic diversion/duodenal switch (4%), and revision (9%). Of the 100 cases, 32% involved an intraoperative complication and 72% required additional surgery. The most common adverse events initiating litigation were leaks (53%), intra-abdominal abscess (33%), bowel obstruction (18%), major airway events (10%), organ injury (10%), and pulmonary embolism (8%). From these injuries, 53 patients died, 28% had a full recovery, 12% had a minor disability, and 7% had major disabilities. Evidence of potential negligence was found in 28% of cases. Of these cases, 82% resulted from a delay in diagnosis and 64% from misinterpreted vital signs. CONCLUSIONS: This study found that leaks and delayed diagnosis were the most common cause of litigation. Even experienced bariatric surgeons should understand the most common errors made by others to prevent complications and avoid litigation.

Adolescent↗
PubMed1995

Practice and malpractice expenses in maxillofacial prosthetics.

Recent changes in Medicare reimbursement methods have made the estimation of specific practice and malpractice expenses in maxillofacial prosthetics more important. New reimbursement models such as the resource-based relative value scale used by Medicare and an increasing number of private carriers require accurate and specialty-specific values for these parameters. The Health Care Financing Administration's estimates of practice expense values in all specialties of medicine are significantly lower than those suspected in maxillofacial prosthetics. There is concern that the assignment of erroneous values in maxillofacial prosthetics could lead to inadequate reimbursement. Because the American Dental Association provides only aggregate specialty values, a survey of the general membership of the Academy of Maxillofacial Prosthetics was undertaken to determine these values more accurately. Practice expense values were found to be significantly higher than those in medicine, whereas malpractice expense values were lower. In addition, practice expense values in the survey were found to be greater than the ADA's aggregate specialty calculations.

American Dental Association↗
PubMed1998

Malpractice risks for urologists.

OBJECTIVES: To obtain data regarding the frequency of malpractice suits against urologists. METHODS: Those urologists listed in the Best Doctors in America were sent an anonymous survey that requested their personal malpractice history (group A). Additionally, the professional responsibility history of the candidates for recertification by the American Board of Urology in 1996 (group B) was reviewed. RESULTS: One hundred ten urologists in the United States in group A were surveyed. Ninety-one (83%) responded. Seventy (77%) had been sued (average 2.36 claims per physician who had been sued). Forty-four percent of the claims resulted in payment to the plaintiff. Claims frequency of group A was 0.09 claims per physician per year. Urologists in the Northeast, North Central, and Mid-Atlantic Sections of the American Urological Association were less likely to be sued than urologists in the other five sections. There were 246 urologists in group B. One hundred twenty-two (49%) reported a claim against them (average 1.9 claims per physician who had been sued). Twenty-nine percent of the closed claims resulted in payment to the plaintiff. Claims frequency of group B was 0.09 claims per physician per year. CONCLUSIONS: Most urologists can expect to be sued at least twice in their professional careers. The longer one is in practice, the greater the chance of a suit being filed. Where one practices may be a factor in the likelihood of being sued. There does not seem to be a direct or inverse correlation between professional reputation and the incidence of being sued.

Humans↗
PubMed1981

The National Association of Insurance Commissioners (NAIC) Medical Malpractice Closed Claim Study 1975-1978. A review of dermatologic claims.

The National Association of Insurance Commissioners (NAIC) Medical Malpractice Closed Claim Study 1975-1978 is the first major uniform nationwide survey of its kind. A total of 71,782 closed claims were reviewed during a 3 1/2-year period. Approximately one third of these claims involved indemnity payments. A review of the dermatologic closed claims with indemnity payments included in the study revealed that dermatologists accounted for 127 claims representing 0.7% of total paid claims, with payments totaling +2,549,125 representing 0.6% of total indemnity dollars paid. Since our specialty represents 1.4% of all practicing physicians, it is clear that the NAIC study reaffirms dermatology as being among the lowest malpractice risk specialties.

Dermatology↗
PubMed1999

Malpractice in psychotherapy. An overview.

A generation ago, psychotherapy was rarely the subject of a malpractice suit. Most litigation involving psychiatrists resulted from physical harm, rather than emotional harm, to the patient. During the last twenty-five years, the situation has changed with juries returning verdicts in a large number of cases awarding damages totaling millions of dollars. More recently, restrictions on bringing medical malpractice claim generally have multiplied, but now the role of managed care is affecting the standard of care and choice of treatment.

Duty to Warn↗
PubMed1985

The ten-year malpractice experience of a large urban EMS system.

Malpractice is a recognized and growing problem for physicians and hospitals, but it is difficult to ascertain the risk of malpractice in the prehospital arena. Dade County, Florida (greater Miami), with a population of 1.7 million, currently is served by 339 certified paramedics. During the decade of 1972 to 1982, Dade County Fire Rescue handled 265,060 incidents; 16 claims were filed with the Risk Management Division of Dade County. The claims were produced by 11 incidents, which yields a rate of one per 24,096 incidents. The two greatest problems identified were inadequate record keeping and "gray zone" patients who do not fit any particular protocol.

Aged↗
PubMed1999

Malpractice or maloccurrence: A detailed analysis of two cases.

Sometimes neurologists face malpractice suits that occur from cases when a patient's diagnosis is not foreseeable. This requires that neurologists make clear and accurate notes on patient charts to show current reasoning in expectation that eventually, the neurologist may have to defend his or her misdiagnosis in court. Two current trial cases are presented in this article. You decide, which case should be considered malpractice or maloccurrence?

Adult↗
PubMed1999

Clinical practice guidelines for pressure ulcer prevention can prevent malpractice lawsuits in older patients.

OBJECTIVE: To evaluate the impact of implementation of and compliance with practice guidelines for pressure ulcer (PU) prevention using medical malpractice litigation data. SETTING AND SUBJECTS: Forty-nine plaintiffs whose respective compensations ($14,418,770 in 35 plaintiffs) or dismissals had been reported in 2 legal databases. PU verdicts and settlements for plaintiffs 60 years of age and older were evaluated using the American Geriatric Society's Clinical Practice Guidelines, "Pressure Ulcers in Adults: Prediction and Prevention." METHODS: Litigation analysis was used to identify the effect, implementation of, and compliance with PU prevention practice guidelines on malpractice awards in PU lawsuits. Data were obtained using fact patterns from 2 legal databases, LEXIS and WESTLAW. Potential decreases in plaintiff awards and prevention of disability were calculated assuming that health care defendants had modified their behavior to conform to the practice guidelines. Possible increases in defendant awards were used to estimate the added risks to health care professionals of adopting these guidelines as the standard of care. MAIN OUTCOME MEASURES: Projected changes in verdicts, monetary awards expressed in dollars, and disability score. RESULTS: Had health care defendants followed these guidelines, $11,389,989 might have been saved in 20 lawsuits. Violations of guidelines appeared to "cluster" together, with many plaintiffs alleging breeches of several interrelated guidelines. It appears that improving the level of care required to remedy 1 guideline variation could improve the outcomes for the entire cluster. In contrast, the use of the guidelines in court as the standard of care against defendant health care professionals might have contributed to changing only 4 of 14 defense verdicts. CONCLUSIONS: Use of clinical pathways in these settings can benefit both caregivers and patients by favorably modifying preventive practice patterns while decreasing vulnerability to litigation. Conversely, the continuing threat of fault-based litigation against substandard practitioners and facilities provides an ongoing safeguard of patient rights and reduces the risk of subsequent disability.

Aged↗
PubMed1998

Medical malpractice in twentieth century United States. The interaction of technology, law and culture.

Although medical malpractice litigation in the United States has generated extensive professional and scholarly attention, few analyses of the issue have explored its underlying causes. This essay develops and employs an historical framework to explain the late 20th century phenomenon and concludes that widespread medical malpractice suits are the result of a combination of short-term topical causes and long-term cultural changes that are ignored or left untouched by most reform efforts. Most importantly, however, the development and proliferation of new and improved medical technologies has played a pivotal role throughout the entire history of the litigation, an effect that has become most prominent and important in the last third of the 20th century.

Culture↗
PubMedDate not supplied

Defense of breast cancer malpractice claims.

The goal of this study was to determine whether factors associated with the successful defense and cost of malpractice cases involving the failure to diagnose breast cancer could be identified in medical and legal records. Secondary goals were to develop a multidisciplinary clinical algorithm utilizing National Comprehensive Cancer Network (NCCN) practice guidelines with practitioner risk management strategies. Physician deviations from these guidelines were tracked to identify high-risk areas in the diagnosis of breast cancer. A multidisciplinary clinical algorithm was introduced and practitioner risk management issues were addressed. In this study specific medical, legal, and cost factors were retrospectively abstracted and analyzed to identify associations between medical and legal factors and medicolegal outcome. ProMutual handled 156 malpractice cases involving breast cancer between January 22, 1986, and November 20, 1997. Of the total, 124 cases involving 212 defendants were closed. The closed cases were analyzed, using multivariable stepwise logistic and linear regression, to identify associations between clinical factors and case outcome. Women's health practitioners (WHPs), including obstetrician-gynecologists (OB-GYNs), family medicine, and internal medicine clinicians, were the largest group of defendants (97). Others included radiologists (43), surgeons (33), and pathologists (3). OB-GYNs accounted for 31% of these defendants, with a cost of more than $16 million. The greatest number of specialists represented in the open cases were radiologists, with 38% of the total. The defense model predicts that the probability of successful defense is lessened with inadequate record keeping, a patient that has metastasis and is alive, and a delay in diagnosis of 12 months or more. The overall indemnity model predicts a higher indemnity with the spread of disease at the time of evaluation, a patient who has metastasis and is alive, and a date of occurrence closer to the present. Indemnity is less in patients who have had a lymph node dissection, who have died, or who are alive without metastasis. The WHP model predicts an increased overall indemnity with the spread of disease at the time of evaluation and the presence of a mass without pain. Indemnity decreases with a history of pregnancy, absence of presenting symptoms, or presentation with pain with or without a mass, and the performance of a lymph node dissection.

Algorithms↗