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PubMed1993

Litigation involving medical faculty and academic medical centers, 1950-1991.

An analysis is presented of 240 cases of litigation involving medical faculty, medical schools, and academic medical centers reported over the period 1950-1991. The number of reported cases increased dramatically over the study period in association with the expansion of the national medical educational enterprise. These cases can be conveniently divided by the issues they dealt with into three broad areas: general administration (89 cases), clinical affairs (108 cases), and research issues (43 cases). Cases of litigation related to general administration were most often concerned with the hiring, promotion and/or tenure, and discharge of faculty, with nearly half of these alleging discrimination. General administrative disputes also arose over allocation of departmental resources and responsibilities, faculty conduct, Veterans Affairs, relationships, employee benefits, system-wide discrimination, and collective bargaining. Courts generally supported the exercise of administrative discretion, yet examined procedures carefully. Litigation related to clinical affairs increased dramatically in recent years. Issues litigated reflect the complexity of the existing academic health care system and environment: sovereign immunity and/or malpractice, practice plans, staff privileges, indemnification, access to peer review records or other records, and conduct of practice. Outcomes of clinically related litigation through 1991 indicate substantial leeway for medical faculty, medical schools, and academic medical centers to innovate and advance their patient mission. Litigation related to medical research also accelerated recently. Issues litigated involved grants and/or personnel management, research risks, commercialization, research funding, ethics, and research animals. Litigation has paralleled (1) federal policy initiatives designed to stimulate collaboration between industry and academia and (2) the growth of regulations designed to monitor policy areas affecting research. The exposure of academic medical administrators and faculty to litigation has increased in the last 40 years. Medical schools and academic medical centers should take active steps to reduce future risks of litigation.

Academic Medical Centers↗
PubMed2003

News media reporting on civil litigation and its influence on civil justice decision making.

The news media have the potential to act as a powerful influence on the civil litigation system, influencing decision making in particular cases and on the system more generally as media reports influence the decision making of various participants in the system. This paper reviews the research that has examined the relationship between news media reporting and civil litigation and proposes a framework that integrates this work and provides guidance for future research efforts. Specifically, we discuss the nature of media reporting on civil litigation, perceptions of the civil litigation system held by the public and legal actors, and the potential influence of news reporting about civil litigation on the decision making of jurors, judges, civil litigants, and policymakers. Overall, the research suggests that news reporting of civil litigation presents a systematically distorted picture of civil litigation and that this reporting can influence perceptions and outcomes of civil litigation in various ways. However, there are many gaps in the existing research that need to be filled. The proposed organizational scheme helps to identify ways that future research can provide links between the findings of existing research and to identify ways in which this research can be extended to new areas.

Civil Rights↗
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↗
PubMed2005

Results of multiple-slide, blinded review of Papanicolaou slides in the context of litigation. Determining what can be detected regularly and reliably.

BACKGROUND: Multiple-slide, blinded review has been endorsed by several cytology and pathology organizations as the most appropriate method for the review of cervicovaginal specimens in the context of litigation. This process involves review of litigation slides in a blinded manner by multiple independent cytotechnologists and the comparison of those results with those of validation cases that are comprised of known abnormalities with biopsy follow-up. To the authors' knowledge, the results of this method have not been previously published. METHODS: The results of the blinded review program at the Center for Cytopathology and Molecular Research at the Medical University of South Carolina for the years 1998-2004 were reviewed. RESULTS: A total of 135 litigation slides and 122 validation slides were reviewed. The interpretations of these cases were found to be significantly different (P < 0.001). Litigation cases were significantly more likely to be interpreted as either negative for intraepithelial lesion (NIL) or atypical squamous cells/atypical glandular cells (ASC/AGC) (P < 0.001). The results appeared to be independent of the individual cytotechnologists involved. Approximately 10% of litigation cases were called at least ASC/AGC by all observers and 4% were interpreted as NIL by all observers. For litigation cases, ASC/AGC was found to be just as reproducible as high-grade squamous intraepithelial lesion. The results demonstrated that only 10% of litigation cases are regularly and reliably identified as abnormal, whereas a single review as performed by an expert cytologist can be expected to classify 56% of cases as abnormal. CONCLUSIONS: This program suggests that a majority of litigation cases are not regularly and reliably identified as abnormal, and a single review will routinely overestimate the percentage of cases that are identified regularly and reliably.

Adult↗
PubMed2006

Applying lessons from tobacco litigation to obesity lawsuits.

This discussion examines the use of litigation as a strategy to protect the public health. The history of tobacco litigation provides a model to evaluate potential litigation strategies against other industries that pose a threat to public health, particularly the food industry. This paper demonstrates that although legislation would be a preferable solution, lessons from the tobacco wars suggest that effective national legislation is unlikely at the present time. Based on the differences and similarities between the tobacco and food industries, it predicts the effectiveness of particular kinds of obesity litigation and the food industry's likely response. The tobacco industry has vigorously fought individual injury lawsuits and has had remarkable success in resisting such cases. The food industry is likely to successfully employ a similar "scorched earth" litigation strategy in individual injury cases. However, the tobacco industry did agree to the Master Settlement Agreement in the lawsuits brought by the state attorneys general because they were a unique kind of litigation with a finite number of plaintiffs. Likewise, state lawsuits under consumer protection acts may be a distinct type of litigation that permits cases to focus on deceptive advertisements while avoiding complicated causation issues. Such lawsuits have the potential to be a useful tool to fight obesity and enlist the efforts of the food industry in resisting the epidemic. Understanding the lessons of tobacco can save public health advocates much time and many resources and thus allow tobacco litigation to benefit public health in new ways.

Consumer Advocacy↗
PubMed2004

Private enforcement: litigation as a tool to prevent obesity.

Private enforcement, or litigation, has played a historic role in protecting public health in the United States. Litigation is often employed as a means to protect public health when government regulation is absent or ineffectual. Litigation has been successfully employed to control both asbestos and tobacco and is poised for success in combating the obesity epidemic. Litigation is effective because it makes public industry practices and increases industry self-policing. Litigation related to obesity would likely employ theories of "unfair and deceptive trade practice" or general "personal injury" or tort claims. While opponents to the use of litigation often cite personal responsibility and the individual as the true locus of liability, these arguments fail to take into account the context of an individual's choice. While litigation can be effective, media attention and current political discourse on "tort reform" has engendered a set of legislative actions that would foreclose litigation as a public health strategy.

Adolescent↗
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↗
PubMedDate not supplied

Outcome of calcaneal fractures treated operatively and non-operatively. the effect of litigation on outcomes.

BACKGROUND: The optimum management of calcaneal fractures is controversial. These injuries are frequently associated with compensation litigation, which effects the outcome. AIMS: To assess the outcome of operatively and conservatively managed intra-articular calcaneal fractures and to examine the effect of compensation litigation on outcome. METHODS: This was a retrospective study of calcaneal fractures from a single regional trauma unit, with management decided by the admitting consultant surgeon's preference. Fifty-four patients (33 operative, 21 conservative) with an average follow-up of 40 months (range 14-78 months) were reviewed. Sixteen patients (30%) were pursuing a compensation case resulting from the injury. RESULTS: Despite similar fractures, medical co-morbidity and trauma energy, significantly worse outcome scores were seen in litigants (p < 0.0001). Footwear fitting problems were greater in litigants. Time off work was more than twice that of non-litigants (14.5 vs 6 months, p < 0.01). Results were similar between the operative and non-operative groups in terms of functional score, footwear problems and time off work. CONCLUSIONS: Litigation was the major determinant of outcome following calcaneal fracture repair; highlighting the unreliability of subjective evaluation in determining outcome in the face of litigation. No subset of patients appeared to significantly benefit from internal fixation of their fracture.

Absenteeism↗
PubMed2006

The effect of litigation on long term cognitive and psychosocial outcome after severe brain injury.

A number of studies have questioned the reliability of psychological data collected from those involved in litigation following mild head trauma. This study examines two severely injured groups, one litigant, the other non-litigant, at 4 months and 10 years post injury. No differences were identified between the groups on measures of cognitive ability to suggest underachievement at an early stage of recovery, when the litigant group was assessed medico-legally or after an interval of 10 years post injury. Measures of psychosocial outcome and psychological morbidity at 10 years post injury failed to show any significant differences between the groups, indicating that the process of litigation did not have any long term effects in respect of illness behaviour. The results of this study are consistent with data from another study that assessed litigants and non-litigants after severe head injury, but differs from studies that examine cases of minor injury.

Adaptation, Psychological↗
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↗
PubMed2006

Litigation in Argentina: challenging the tobacco industry.

OBJECTIVE: To evaluate the processes and outcomes of tobacco litigation in Argentina and to analyse the strategies of the tobacco industry to oppose litigation using tobacco industry documents. METHODS: A systematic search of tobacco industry documents on the internet dating from 1978 to 2002. Law library searches using Argentinean official and unofficial reports systems were combined with computerised online searches. RESULTS: There have been at least 15 failed litigation cases in Argentina and the tobacco industry presented a concerted defence in every claim regardless of cost. We categorised 11 cases as product liability and nicotine addiction, two as health care reimbursement, and two as criminal law and secondhand smoke. Industry strategies included hiring legal consultants from prestigious international and Argentinean law firms and developing litigation prevention programmes. Industry monitored legal academic meetings, controlled the development of new product liability legislation, obtained favourable opinions from experts, and closely observed the development of litigation in Argentina. CONCLUSION: The strategies used by the industry have been successful in preventing recovery for tobacco injuries through litigation. Argentinean health advocates and lawyers need to be aware of the roles and strategies of the tobacco industry in order to develop effective litigation in Argentina.

Argentina↗
PubMed2006

Epidemiology of the third wave of tobacco litigation in the United States, 1994-2005.

OBJECTIVE: To describe the epidemiology of litigation against the tobacco industry in the United States during the years 1994-2005 (described as the "third wave" of tobacco litigation). "Epidemiology" refers to the study of the distribution and determinants of disease in populations. We apply the term "epidemiology" to the litigation context for purposes of characterising qualitatively and, to the extent possible, quantitatively the variety of cases litigated against tobacco manufacturers and allied tobacco interests during the third wave and their impact on the tobacco industry. METHODS: The data for this paper come from legal cases identified in the Tobacco Deposition and Trial Testimony Archive (DATTA) collection (http://tobaccodocuments.org/datta), transcripts of testimony and related documents found in DATTA, government-mandated reports filed by tobacco manufacturers with the US Securities and Exchange Commission, investment company reports, reports and analyses published by the news media, a variety of informational documents produced by the Tobacco Control Resource Center at the Northeastern University School of Law, and legal settlement documents provided by the National Association of Attorneys General. RESULTS: The US tobacco industry faced a far greater number of lawsuits, and a greater variety of types of lawsuit, between 1994 and 2005 than it had in previous years. Plaintiffs won 31 (41%) of the 75 cases that were tried to verdict during the years 1995-2005. Seven plaintiffs have been paid awards totalling US$115 million, including interest, following the exhaustion of appeals. Based on an evaluation of litigation brought against US industry leader Philip Morris, the total number of cases pending peaked in 2000, dropping off modestly since then. For example, 36 class actions were pending in 2000, while 33 were pending in 2005. In the same time period, individual actions fell from a total of 3385 to 2863. While the playing field has been levelled to some degree in the tobacco litigation arena with respect to the resources brought to bear by plaintiffs and defendants, tobacco industry defendants continue to employ far greater financial and human resources than their adversaries. CONCLUSIONS: The third wave of tobacco litigation has represented a sea change in efforts to hold the tobacco industry in the United States accountable in American courtrooms. While tobacco manufacturers continue to do their utmost to make these cases difficult to pursue, many of the cases that have gone to trial have met with success in recent years, which suggests that plaintiffs' lawyers are now better equipped to persuade juries of the defendants' culpability.

Archives↗
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↗
PubMed2004

Association between civil procedure and medical malpractice litigation in Japan.

The effect of shortcomings in the system of civil procedure in Japan, such as excessive delay and possible mistaken judgment on the existence of negligence, on medical malpractice litigation and legal outcomes has not been examined. Using data on judgments and the decisions in medical malpractice litigation by the Tokyo and Osaka District Courts, we examined the association between civil procedure and medical malpractice litigation, and predictors of the decisions of medical malpractice litigation. The basis of the civil procedure to secure quick decisions was related to the amount of medical malpractice litigation, but not to the decisions in medical malpractice litigation. Negligence and a factor other than negligence were related to the rate of decisions in favor of the plaintiff. Although the study implies that shortcomings in civil procedure negatively influence medical malpractice litigation, it was not determined whether decisions were made based on mistaken judgment concerning the existence of negligence. Since there are methodological limitations to this study, further studies are necessary to verify these findings.

Compensation and Redress↗