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PubMed2001

Radiofrequency medial branch neurotomy in litigant and nonlitigant patients with cervical whiplash: a prospective study.

STUDY DESIGN: The efficacy of radiofrequency medial branch neurotomy to treat cervical zygapophysial joint pain from whiplash was compared prospectively in litigants and nonlitigants. OBJECTIVES: 1) To assess the effect of monetary gain on treatment of zygapophysial joint pain in cervical whiplash. 2) To determine whether radiofrequency medial branch neurotomy is effective treatment for whiplash. SUMMARY OF BACKGROUND DATA: The influence of litigation on treatment outcome is a subject of controversy in both the medical and legal professions. This is the first study to examine this issue in a prospective manner using a previously proven diagnostic and therapeutic method. METHODS: Sixty patients with cervical whiplash who remained symptomatic after 20 weeks of conservative management were referred for radiofrequency cervical medial neurotomy. The patients were classified as litigant or nonlitigant based on whether the potential for monetary gain via litigation existed. Each group underwent identical evaluation and treatment. Patients were observed for 1 year. Visual analogue scores and self-reported improvement were obtained before, immediately after, and 1 year after radiofrequency cervical medial neurotomy. RESULTS: Forty-six patients completed the study. The overall reduction in cervical whiplash symptoms and visual analogue pain scores were significant immediately after treatment (nonlitigants vs. litigants: 2.0 vs. 2.5, P = 0.36) and at 1 year (nonlitigants vs. litigants: 2.9 vs. 4.0, P = 0.05). One-year follow-up scores were higher than immediate post-treatment scores (nonlitigants vs. litigants: 2.5 vs. 3.6). The difference between litigants and nonlitigants in the degree of symptomatology or response to treatment did not reach significance. CONCLUSIONS: These results demonstrate that the potential for secondary gain in patients who have cervical facet arthropathy as a result of a whiplash injury does not influence response to treatment. These data contradict the common notion that litigation promotes malingering. This study also confirms the efficacy of radiofrequency medial branch neurotomy in the treatment of traumatic cervical facet arthropathy.

Accidents, Traffic↗
PubMed1994

Litigation and chronic facial pain.

Clinical studies have suggested that the presence of litigation in chronic pain syndromes may complicate diagnostic and treatment strategies. In addition, psychosocial factors may be prevalent in such cases. The present study explored the possible correlation in the facial pain population between patients in litigation and psychological disturbance as measured by the Minnesota Multiphasic Personality Inventory. Beck Depression Inventory and Wahler Symptom Checklist scores also were compared. One hundred eleven patients diagnosed with chronic facial pain were asked if they currently were involved in litigation related to their medical complaints. The result revealed that 18% of the 111 patients were in litigation at the time of their initial visit. The Minnesota Multiphasic Personality Inventory profiles showed that 45% of the litigation patients had four or more clinical scales above 70 (significantly elevated) on the Minnesota Multiphasic Personality Inventory. In contrast, only 18% of the patients who were not in litigation had four or more scales above the 70 criteria. Beck and Wahler scores also were more elevated for the litigation group. The results of the study indicate that chronic facial pain patients in litigation may present with more psychological disturbance as compared to those patients not in litigation.

Chronic Disease↗
PubMed1997

Impact of litigation on senior clinicians: implications for risk management.

OBJECTIVES: To investigate the impact of litigation on consultants and senior registrars and to establish their views on methods of reducing adverse events and litigation. DESIGN: Postal survey. SETTING: Acute hospitals in the North Thames (West) Regional Health Authority. SUBJECTS: 1011 consultants and senior registrars in acute hospitals. MAIN MEASURES: Perceived causes and effects of adverse events; views on methods of reducing litigation and adverse events. RESULTS: 769 (76%) doctors responded. 288 (37%) had been involved in litigation at some point during their career; 213 surgeons (49%) and 75 (23%) doctors in the medical specialties. Anger, distress, and feeling personally attacked were common responses to litigation. Clinicians' views on reducing litigation emphasised the need for change at the clinical level. Supervision of junior staff, workload, and training in communication skills were to the fore. CONCLUSIONS: The high frequency of doctors who have experienced litigation and the emotional responses described indicate that clinicians require support at several levels. At a personal level, support can be offered to clinicians going through the litigation process or after an adverse event. Also, managerial support is needed by offering financial and practical help in correcting the factors that have been consistently identified as producing high risk situations to minimise the possibility of a reoccurrence. Accidents in medicine are, by their very nature, costly in human and financial terms and the root causes must be tackled. Recommendations are made for clinicians and risk management teams.

Attitude of Health Personnel↗
PubMed2001

The effects of litigation on symptom expression: a prospective study following mild traumatic brain injury.

OBJECTIVE: To prospectively assess the association between litigation and neurobehavioural symptoms following mild Traumatic Brain Injury (TBI). DESIGN: a prospective study with the inception cohort assessed on average 42.2(17.2) days after injury. SETTING: an outpatient clinic within a large general hospital. PATIENTS: a consecutive sample of 100 clinic attenders with mild TBI. OUTCOME MEASURES: A cognitive screen (Mini-Mental State Examination (MMSE), Galveston Orientation and Amnesia Test (GOAT), a measure of psychological distress (the 28 item General Health Questionnaire (GHQ)) and two head injury outcome measures, the Glasgow Outcome Scale (GOS) and the Rivermead Head Injury Follow-up Questionnaire (RHFUQ). RESULTS: Demographic characteristics, TBI severity ratings and premorbid risk factors for poor outcome did not differ between litigants (27.8 per cent of the sample) and non-litigants. However, litigants were significantly more anxious (p<0.0001), depressed (p<0.01), had greater social dysfunction (p<0.0001) and had poorer outcome on the GOS (p<0.002) and RHFUQ (p<0.002). There were no cognitive differences between the groups. CONCLUSIONS: the data demonstrate an association between litigation and increased psychological distress at the outset of the litigation process. While association is not synonymous with causality, the absence of demographic, premorbid and TBI related differences between litigants and non-litigants suggests that the pursuit of compensation may influence the subjective expression of symptoms following mild traumatic brain injury.

Adult↗
PubMed1998

Physician concerns about vaccine adverse effects and potential litigation.

OBJECTIVE: To understand physician concerns about litigation and beliefs regarding vaccine safety. DESIGN: A stratified random sample of family physicians, pediatricians, and general practitioners younger than 65 years who were in office-based practices across the United States was selected from the American Medical Association list that includes nonmembers. A standardized telephone survey was conducted by trained interviewers in 1995. PARTICIPANTS: Physicians seeing 5 or more patients per week younger than 6 years and having 50% or more primary care patients were eligible for the study. RESULTS: Of the 1236 physicians who were surveyed, 32% and 13% overestimated the risk for serious adverse effects related to pertussis and measles vaccines, respectively. Among physicians who thought that serious adverse effects from diphtheria and tetanus toxoids and pertussis vaccine (DTP) were unlikely, 15% were highly concerned about litigation; however, among those with higher ratings of the likelihood of serious adverse effects, 38% were highly concerned about vaccine litigation (P < .01). Of those aware of the Vaccine Injury Compensation Program, only 41% believed that it afforded a high level of liability protection; 22% believed that it gives little protection, and 37% gave an intermediate answer. Among physicians highly concerned about vaccine litigation, 22% were unlikely to recommend the third dose of DTP for a child with a fever of 39.4 degrees C and no other symptoms after the second dose of DTP, whereas among those expressing little concern about litigation, only 12% were unlikely to vaccinate (P < .05). Although some physicians were concerned about litigation, most (86%) encouraged vaccination even if a parent was argumentative about possible adverse effects. CONCLUSION: Physicians' perceptions about the risk for adverse effects and protection afforded by the Vaccine Injury Compensation Program influence their concern about litigation and, to a lesser extent, their reported likelihood to administer immunizations.

Adult↗
PubMed1991

The role of litigation in predicting disability outcomes in chronic pain patients.

This study examined the extent to which being involved in civil and industrial litigation predicted outcome in an population of chronic pain patients. Data were collected in a structured telephone interview for a litigant group of 80 patients and a nonlitigant group of 47 patients. There were no significant differences in the amount of medication used, the number of hours spent resting per day, or the number of individuals who were able to return to work. Litigants showed significantly higher levels of depression. Multiple regression analyses indicated that litigation was not the primary predictor of downtime or medication use. Litigation was found to be the primary predictor of Zung depression scores. Discriminant function analyses indicated that litigation was not the most important variable in distinguishing between those working and not working. Results lend support to previous studies that suggest that the suspicion and disbelief with which litigating patients are often treated is unfounded.

Adult↗
PubMed1999

Litigation and public health policy making: the case of tobacco control.

Many tobacco control advocates, believing that legislators and regulators have failed to enact and implement sufficiently stringent tobacco control laws, have supported litigation as a means of achieving public health policy goals. In this article, we examine the relationship between litigation and public health policy formulation in the context of the debate over tobacco control policy. The fundamental questions are how social policy should be made regarding the use of tobacco products, and which institutions should be responsible for controlling tobacco use: the market, the political system (i.e., the legislative and regulatory branches of government), or the courts. On balance we conclude that litigation is a second-best solution. We see a distinct role for litigation as a complement to a broader, comprehensive approach to tobacco control policy making, rather than as an alternative to the traditional political apparatus of formulating and implementing public health policy. Our analysis suggests that, in general, public health goals are more directly achievable through the political process than through litigation, though situations such as those concerning tobacco control blur the bounds between litigation and the politics of public health. Litigation has stimulated a national debate over the role of smoking in society and may well move the policy agenda. But we conclude that a sustained legislative and regulatory presence ought to be the foundation of meaningful policy changes.

Humans↗
PubMed2002

Characteristics of compensable disability patients who choose to litigate.

This study tested the hypothesis that personal characteristics, when profiled by performance on MMPI-2 scales related to attention-seeking behavior through somatization, would differ between compensable personal injury claimants who choose to go to litigation and those who choose not to litigate. The authors examined the MMPI-2 profiles and other file data, including type and severity of injury, on 96 patients who litigated and 46 who chose not to litigate. The profiles of the two groups differed significantly overall. The difference was accounted for by the litigating patients' significantly higher scores on the hypochondriasis (Hs), depression (D), and hysteria (Hy) scales. The Hs and Hy differences held up separately in claimants with physical injuries and in claimants whose injuries were psychological only. The differences also persisted after severity of injury was held constant. The profiles of the two groups did not differ in either defensiveness or exaggeration (i.e., on the validity scales L, F, and K). At least some of the differences in reported impairments between patients in general and personal injury claimants appear to be related to whether the patients choose to litigate, and the choice to litigate could be a function of personality-related, rather than situational, factors. A more definitive test of this hypothesis would require the availability of preinjury personality data.

Adult↗
PubMed1996

Carpal tunnel syndrome. Effects of litigation on utilization of health care and physician workload.

We performed a study consisting of two parts to investigate the impact of litigation on patient recovery and physician workload. We received 556 replies from a questionnaire sent to hand surgeons and discovered that 98.20% of them felt that litigation increased the subjective complaints of patients. Most of these physicians (89.75%) also felt that litigation led to a worse result from treatment. Second, we undertook a retrospective chart review of 447 patients to see if there was a correlation between litigation, patient utilization of health care and physician workload. We found that workers' compensation patients with pending litigation went to the doctor's office more. They also had more letters, phone calls, and forms associated with their care, had more nerve conduction studies performed, and took longer to be discharged from care than patients with non-work-related carpal tunnel syndrome as well as workers' compensation patients who did not have pending litigation. These results indicated that litigation does affect patient utilization of health care and increases the workload on the physician.

Adult↗
PubMed2002

The fake bad scale in atypical and severe closed head injury litigants.

The correlational and diagnostic properties of Lees-Haley's MMPI-2 Fake Bad Scale (FBS) were examined in litigating atypical minor, litigating moderate-severe, and non-litigating moderate-severe head injury samples. Overall, the FBS was sensitive to both litigation status and nonconforming versus conforming symptom courses. The FBS appeared superior to the MMPI-2 F and F-K scales in differentiating atypical from real brain-injury outcomes. High FBS scorers also had higher scores on somatic complaining (Hs, Hy) and to a lesser degree with psychotic complaints (F, Pa, Sc). FBS showed significant associations with various neuropsychological symptom validity measures. FBS appears to capture a hybrid of infrequent symptom reporting styles with an emphasis on unauthentic physical complaints. However, FBS also correlated with documented abnormal neurological signs within a litigating moderate-severe brain-injury group. Its use as a symptom infrequency measure may have to be modified in more severe injury litigants, as some FBS items may reflect true long-term outcome in severe cerebral dysfunction.

Adult↗
PubMed1998

The war against junk science: the use of expert panels in complex medical-legal scientific litigation.

In the legal context, junk science is defined as evidence that is outside of mainstream scientific or medical views. Junk science does not have indicia of reliability and is not generally accepted. Despite the lack of scientific reliability, US courts, expert witnesses and juries are increasingly reliant on junk science in making causation decisions in complex medical liability cases. Courts have accepted junk science even where reliable scientific evidence is available. The United States silicone gel breast implant litigation is a prime example of this phenomenon. The issue of whether silicone breast implants are associated with disease has been a controversial subject for scientists and physicians, an emotional issue for women who have breast implants, and a lucrative business for the lawyers and expert witnesses who are the proponents of junk science. Junk science has provided to juries a quick and convenient explanation for claimed diseases or syndromes which have required years for reliable scientists to conclude are not related to breast implants. The breast implant litigation highlights the often dramatic difference between decisions based upon junk science and decisions grounded in scientific method, fact and reality. Recently, judges involved in the breast implant litigation have become concerned about the use of junk science in light of the growing body of legitimate scientific evidence that breast implants do not cause disease. Several judges have been motivated to take the unique and novel approach of convening scientific panels of independent experts to study the scientific issues and make findings to the court. Through the use of independent scientific experts, several judges have meaningfully assessed the evidence that the litigants present and have prevented or strictly limited the use of junk science in the courtroom. Using this procedure, other judges are weighing the evidence for future cases. This paper will briefly explore the background of mass tort medical products litigation and the development of junk science. The paper will then focus on the history of the breast implant litigation and the steps that the courts have already taken to combat junk science, including the use of scientific panels.

Biocompatible Materials↗
PubMed1998

Use of the label "litigation neurosis" in patients with somatoform pain disorder.

The use of the term "litigation neurosis"--a condition with controversial clinical significance--might correspond to the expression for a difficult physician-patient relationship. The characteristics of patients with a DSM-III-R diagnosis of somatoform pain disorder who had been labeled "litigation neurosis" by their physicians were explored. Among 74 patients referred to a pain clinic, 30% had been labeled litigation neurosis, and among 81 patients referred while claiming disability benefits, 19% had been thus categorized. The attribution of this label was neither correlated to actually being involved in a claim for disability benefits nor to involvement in legal action. Patients who had been designated with litigation neurosis were characterized by a lower educational level, a higher rate of DSM-III-R major depression, and a much higher frequency of personality disorders than patients who were not thus labeled. We postulate that the communication style of patients with this constellation of characteristics, in particular the presence of psychiatric comorbidity, may have engendered a difficult doctor-patient relationship, leading physicians to use the label in the absence of objective evidence of litigation or involvement in legal action. We agree that the inappropriate use of labels such as "litigation neurosis" should be questioned.

Adult↗
PubMed2002

The significance of time factors in cerebral palsy litigation.

OBJECTIVE: to demonstrate the significance of the lengths of time taken to initiate and conclude litigation concerning cerebral palsy. DESIGN: documentary analysis of 142 closed legal files (92 Scottish; 50 English) relating to births from 1980-1996. Claim outcome, and the dates of birth, legal notification and conclusion of the claim, were analysed using Microsoft Excel. SETTING: health service legal offices in Scotland and England. FINDINGS: successful claims were raised more quickly (on average two years compared with 3.6 years for unsuccessful claims). They also took longer to be decided (six years compared with three years). On average the children of successful and unsuccessful litigants were, respectively, 7.8 and 6.6 years old by the time the claim was decided. Over the period studied there was a steady reduction in the length of time taken to initiate litigation, although successful claims were on average raised more quickly. Overall success rate was 27%. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: most cerebral palsy claims do not satisfy the requirements of the law of medical negligence. Lengthy periods of time are involved irrespective of outcome: while successful litigants continue to sue more quickly, their claims take longer to be resolved. The extensive period from birth to closure of claim, and uncertainty over the legal outcome, may cause significant distress for practitioners and parents of children with cerebral palsy. Knowledge of the likely duration of the legal process can help practitioners and the families involved to come to terms with this important feature of litigation. Health service claims managers may also be helped in terms of understanding the more likely duration (and therefore cost implications) of cerebral palsy claims. For successful litigants there are questions about the justice of having to wait, on average, nearly eight years for compensation.

Cerebral Palsy↗
PubMed1997

Memory performance after head injury: contributions of malingering, litigation status, psychological factors, and medication use.

Impaired memory test performance can reflect a host of factors, such as head injury/postconcussive syndrome, involvement in litigation, malingering behavior, psychological distress, and medication use. Such factors are important in interpreting memory test performances in patients referred in the context of litigation. We examined memory test performance in mild head-injured patients in litigation, mild to moderate head-injured patients not in litigation, severely head-injured patients not in litigation, depressed patients, and patients with somatization disorders. Findings showed that several memory tests were useful in distinguishing probable malingerers from the other groups. There was a complex interaction among malingering status, psychological status, and medication use in the prediction of memory test results. Although nonneurological factors were related to memory impairment, litigation status alone was not predictive of memory performance. The results emphasize the need to consider nonneurological factors in the interpretation of poor memory performance in patients seen for forensic evaluation.

Adult↗
PubMed2002

New perspectives on litigation and the public's health.

This article provides redacted versions of three presentations by distinguished individuals with long experience in litigation or regulation to protect the public's health. A central theme is the need to develop partnerships to promote protection efforts. Jan Schlichtmann is internationally recognized for his representation of eight Massachusetts families engaged in legal action against two major companies, W. R. Grace and Beatrice Foods, in a fight to obtain justice in a groundbreaking case that has been the subject of many press and journal reports along with a nationally best-selling book and motion picture titled A Civil Action. His inspiring story of a long and difficult struggle to uncover the truth about contaminants in drinking water caused by buried wastes and to bring public health authorities and others together in a partnership to address the problem is a model of the use of litigation tools to protect the public's health. Diana Bontá, Director of the California Department of Health Services, discusses the efforts of her department to ensure the integrity of the Medi-Cal program that her department administers and the proper uses of litigation, including decisions to avoid litigation, for the purpose of protecting the public's health. She focuses on regulatory and legal efforts to protect her state's citizens and their environment, with an emphasis on the use of common sense in making decisions about whether to litigate and on partnering with advisory groups and members of the public as a means of aiding her department's accomplishment of its mission. Finally, Sandy Praeger, a state senator from Kansas, discusses efforts to use the law and regulation for the purpose of protecting the Kansas River. She stresses the importance of using sound judgment, backed by assessment of the legislative and physical environments, to make the right decisions regarding the use of the law for public health protection. She also points out that sometimes one can use the legislative process as an alternative to litigation to get a message out and force a correct decision.

California↗
PubMed1996

Temporomandibular disorders, headaches, and neck pain following motor vehicle accidents and the effect of litigation: review of the literature.

A literature review concerning the relationships between motor vehicle accidents and temporomandibular disorders, whiplash, headache, neck pain, and litigation was undertaken. The review shows that many patients recover or resume work prior to settlement, but most unsuccessfully treated patients do not generally recover following the settlement of legal claims; the postinjury problems are not strictly psychologic. Litigating patients and nonlitigating patients are often not dramatically different in most important regards (including pain and return to work), with litigating patients deserving the same treatment as other patients with chronic pain. It was found that postinjury neck symptoms and headaches can be persistent. Employment appears to be a better predictor of long-term outcome than compensation and litigation. In addition, limited consensus is available concerning prognostic factors. Patients with postinjury temporomandibular disorders tend to respond less well to treatment than do noninjury patients with temporomandibular disorders, as do litigating compared to nonlitigating temporomandibular disorders patients, but a cause and effect relationship is not known. The incidence of temporomandibular disorders following motor vehicle accidents may not be as high as has been claimed in whiplash cases. More research is required in the area of temporomandibular disorders, motor vehicle accidents, and litigation.

Accidents, Traffic↗
PubMed2000

American medical malpractice litigation in historical perspective.

Medical malpractice and the problems associated with it remain an important issue in the US medical community. Yet relatively little information regarding the long-term history of malpractice litigation can be found in the literature. This article addresses 2 questions: (1) when and why did medical malpractice litigation originate in the United States and (2) what historical factors best explain its subsequent perpetuation and growth? Medical malpractice litigation appeared in the United States around 1840 for reasons specific to that period. Those reasons are discussed in the context of marketplace professionalism, an environment that provided few quality controls over medical practitioners. Medical malpractice litigation has since been sustained for a century and a half by an interacting combination of 6 principal factors. Three of these factors are medical: the innovative pressures on American medicine, the spread of uniform standards, and the advent of medical malpractice liability insurance. Three are legal factors: contingent fees, citizen juries, and the nature of tort pleading in the United States. Knowledge of these historical factors may prove useful to those seeking to reform the current medical malpractice litigation system.

History, 19th Century↗
PubMed2003

Standard of care and liability in medical malpractice litigation in Japan.

Although the incidence of medical malpractice litigation is increasing in Japan, it remains unclear whether medical malpractice litigation gives doctors and hospitals, an economic incentive to provide high-quality medical care by requiring that they compensate patients for harm caused by negligence. Therefore, to evaluate whether the medical malpractice litigation system contributes to the delivery of high-quality medical care, we first analyzed the decisions made in medical malpractice cases between 1986 and 1998 in ten district courts (n=421). We found the following results: (1) the probability that patients received compensation and the amount of compensation received, increased with the level of negligence, for all injury severity levels; (2) the significant predictors that a case would be decided in favor of the patient were the patient's legal basis (P=0.00) and the severity of injury (P=0.02). Although, it seems that Japanese medical malpractice litigation gives doctors an economic incentive to avoid delivering substandard medical care, since both the severity of injury and negligence were significant predictors, medical litigation in Japan might in fact corrupt the compensation process by creating an adversarial atmosphere.

Compensation and Redress↗