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PubMedDate not supplied

Risk management fights back--the hospital's response to the malpractice explosion.

The development of hospital Risk Management prevention programs will lead to improved patient care and reduce the number and cost of future medical malpractice actions. An effective Risk Management Program must gear itself toward improving patient care through identifying and reducing hospital risks. This, in turn, will tend to reduce mortality and morbidity, and, in time, reduce the number of claims filed against the hospital, as well as decreasing the liability in each case. The ultimate goal of a successful Risk Management Program is to both improve patient care, and to reduce the cost of medical malpractice for the institution.

Financial Management↗
PubMed1988

Appraisal of the event as a factor in coping with malpractice litigation.

The authors designed a study to explore medical malpractice litigation as a stressor, factors that contribute to doctors' appraisal of it, how they actually cope with it, and the potential effects on them and on their mode of practice. We interviewed 51 physicians who had been sued for medical malpractice. Those who identified litigation as their most stressful life event (Group 1, N = 11) experienced significantly more physical and emotional symptoms, especially those suggestive of a major depressive disorder, and used more emotion-focused coping mechanisms than those who identified some other event in life as being most stressful (Group 2, N = 39). The appraisal of litigation as one's most stressful life experience may be a useful predictor of coping response, with previous life experiences as a major contributing factor to this appraisal.

Adaptation, Psychological↗
PubMed1994

Problem areas in pathology practice. Uncovered by a review of malpractice claims.

The authors present the results of a review of 53 pathology malpractice claims and incident reports. The review was conducted by The Doctors Company in 1989 and 1992. Many of the claims fell into broad diagnostic categories that suggested common underlying problems. These categories include malignant lymphoma, malignant melanoma, breast fine-needle aspiration, cervical Papanicolaou (Pap) smears, prostate needle biopsies, and errors by expert consultants. Sixteen cases are presented, chosen to illustrate some of the errors in judgment and communication that can result in a malpractice claim. Specific recommendations will be made to address repetitive problems of pathology practice as uncovered by this review. Some of these problems suggest topics for continuing medical education programs as well as subjects that need further emphasis in residency training. Since 1989, the claims frequency for pathology (number of claims per 100 insured physicians per year) has increased from 8.8 to 10%, whereas for all physicians the claims frequency has decreased from 18 to 17.2%. This review is an attempt to identify some of the causes responsible for this increase and to suggest both diagnostic and quality assurance strategies for dealing with them.

Adolescent↗
PubMed1976

The medical malpractice problem, and some possible solutions.

The solutions to the problems of medical malpractice and malpractice insurance coverage are primarily in the hands of state legislatures. Legislation enacted has been primarily palliative, to assure continued availability of professional liability insurance. Unfortunately, no limit can be placed on the costs of such coverage. Unfortunately, too, no long-term solution has been forthcoming. Any long-term solution must encompass some method or methods of reducing injuries to patients and at the same time changing the system from defense of the physician to compensation of the patient. If such changes are not forthcoming, physicians will become uninsurable and the private practice of medicine as we now know it will disappear in this country.

Anesthesiology↗
PubMed2000

The virtuous orthopaedist has fewer malpractice suits.

It generally is believed that physicians who have poor relationships with their patients are more likely to be sued. We studied certain physician characteristics and related them to their number of malpractice suits and the amount paid to settle those claims. Physicians with better rapport with their patients, who took more time to explain, and who were available had fewer malpractice suits. The most significant correlation was found in time spent with the patient. As the time spent increased, the number of suits decreased.

Humans↗
PubMedDate not supplied

Malpractice and the perinatal nurse.

Perinatal nurses are at higher risk for involvement in a malpractice suit than are their colleagues in other medical specialties. That risk can be minimized. A review of selected obstetrical malpractice claims reveals that key issues for perinatal nurses who want to avoid litigation include sound and current education in the interpretation of fetal heart rate tracings, the adoption of well-designed policies for the administration of oxytocin, ability and willingness to use the chain of command, comprehensive and objective documentation, and awareness of the fact that making the patient's well-being the focus of every nursing action is the perinatal nurse's best defense.

Female↗
PubMed1994

Does physician performance explain interspecialty differences in malpractice claim rates?

Physician specialty has been consistently associated with different malpractice claim rates, with neurosurgery, orthopedics, and obstetrics and gynecology having the highest rates. Whether these differences reflect physician performance or other aspects of patient care that are unique for each specialty is unclear. A retrospective cohort study was performed including 12,829 physicians involved in 8,221 closed cases from 1977 to 1991. For each case an assessment was made whether the plaintiff received an award and whether the physician care of the patient was indefensible. An award was made to the plaintiff in 42% of cases. Physician care was considered indefensible in 23% of the cases. The specialties with the highest award rates were anesthesiology (58.3%), obstetrics and gynecology (47.5%), and radiology (43.0%). Neurosurgery had the lowest rate of award (30.2%). The specialties with the highest indefensibility rates were radiology (36%), obstetrics and gynecology (27%), and anesthesiology (27%). Neurosurgery had the lowest indefensibility rate (10%). These results were unchanged after controlling for physician age, degree, site of training, certification status, and severity of patient injury. In conclusion, differences in award rate and indefensibility are present, but not large enough to explain the large variation in specialty claim rates. This suggests that the variation in malpractice rates results from factors other than a meaningful difference in physician performance.

Clinical Competence↗
PubMed1979

Malpractice insurance at optometric institutions.

The optometric educator needs insurance against malpractice suits. A survey was made of the policies available at twelve schools and colleges of optometry in the United States. The object of this survey was to compare the various protections offered by the optometric institutions and also to inform the educators of what is available to them. It was found that coverage and premiums vary considerably between the institutions. At only one of the twelve schools and colleges of optometry responding to this survey were faculty members required to pay for their own policies, but to avoid undue risk, two other colleges highly recommended that their faculty purchase their own coverage. Implications of the low number of claims brought against optometric teaching facilities and other factors are discussed in light of the "malpractice insurance crisis."

Faculty↗
PubMed1995

Medical characteristics of 61 unwarranted malpractice claims.

We describe malpractice claims closed by plaintiff attorneys after initial medical expert (ME) review. This retrospective study includes 61 cases, of which 33 originated in hospitals, 18 in physicians' offices, and 10 in nursing homes. No claims were against state or federal agencies. The reviews were done between 1987 and 1994 for 29 attorneys from 11 states. The cases fell into 12 diagnostic groups, and leading causes for action were late diagnosis (13 cases), drug administration (11 cases), sepsis (6 cases), and strokes (5 cases). We conclude that internists are particularly liable to unwarranted malpractice claims when unexpected complications occur and when treatment fails to cure infectious disease. However, such claims may be terminated following the initial ME review.

Accidental Falls↗
PubMed1997

Stroke and malpractice claims.

We describe 15 malpractice claims that were filed after the patients had strokes. Both embolic and thrombotic, sterile and infected strokes led to claims. Ten of the claims alleged physician failure to protect the patient, two alleged physician failure to react as called for by symptoms, and three were related to medication. We conclude that physicians should advise patients of the possibility of stroke when circumstances warrant it, as well as documenting their judgment and suggested preventive practices. These cases further suggest that treatment decisions supported by documented second opinions may reduce the number of malpractice claims for strokes.

Anti-Bacterial Agents↗
PubMed1998

Pulmonary embolism and malpractice claims.

BACKGROUND: Deep venous thrombosis (DVT) with pulmonary embolization (PE) often occurs as an unexpected event with fatal consequences. This provides a setting for malpractice claims. METHODS: We reviewed 160 consecutive malpractice claims submitted by attorneys for medical expert review during the 11-year period ending in 1997. Seven cases involved DVT with PE. RESULTS: Alleged failure to anticipate and reduce the chance of PE was the basis for six of the claims. All six patients were at risk for lower extremity DVT, and one had a history of DVT 6 months earlier. The PE was manifested by sudden death in three cases. The seventh case represented a complication of heparin therapy for PE. CONCLUSIONS: We conclude that risk management for PE should focus primarily on DVT. Physicians should perform and document an examination for DVT whenever there is a history of lower extremity stasis or it is likely to occur. They should also consider documenting a concurring second opinion when making anticoagulant-related decisions.

Adult↗
PubMed1999

Necrotizing fasciitis and malpractice claims.

BACKGROUND: Necrotizing fasciitis (NF) is an aggressive bacterial infection of the superficial fascia and subcutaneous tissues that is increasing in incidence. The high toll exacted by this illness provides a setting for malpractice claims. METHOD: We reviewed 180 consecutive malpractice claims submitted by attorneys for medical expert review between 1987 and late 1997. Four cases involved NF. RESULTS: Alleged failure to obtain timely surgical consultation was the basis for three claims, and alleged failure to prevent NF by proper nursing care was the basis for the fourth. Three cases were closed and one was settled. CONCLUSIONS: The cornerstone of risk management for a clinical presentation compatible with NF is immediate surgical consultation, with other diagnostic steps a secondary consideration.

Adult↗
PubMed2004

Medical malpractice and head and neck cancer.

PURPOSE OF REVIEW: The purpose of this review is to evaluate medical malpractice involving patients with head and neck cancer. In the United States, problems associated with the medical malpractice environment are reaching proportions that threaten the delivery of health care. RECENT FINDINGS: Several methods to learn more about the trends and ramifications of litigation have been developed. Although patients with cancer of the head and neck bring suits rarely, when they do several themes seem prevalent. Delays in diagnosis are common allegations. Plaintiffs are frequently much younger than expected, and the oncologic outcome is frequently poor. Defendant physicians occasionally unwittingly add to the delay by not expecting the younger patient. The poor oncologic outcome may be related to the delay or to a biologically more aggressive disease. Relationships between these factors are explored. Consent issues are also relatively common. SUMMARY: Physicians must strive to know as much as possible about tort reform, and to contribute to the process. Litigation analysis and other tools to expand our understanding can be used to educate ourselves and the legal community. Scientific standards must be developed along with clinical pathways to guide ourselves to prevent litigation. They may also guide the legal community to establish more rational standards of care based on a consensus of expert opinions.

Critical Pathways↗
PubMed1989

The malpractice crisis and the doctor-patient relationship.

The current medical malpractice crisis in the United States provides an opportunity to explore the medical profession's response to threats to its autonomy of practice. Drawing on commentary in medical journals, I reveal the way in which physicians, and some lawyers, have explicitly targeted doctor-patient interaction as a seat for malpractice reform. A good deal of attention is being given to developing a better rapport with patients, providing information and involving the patient in decision-making about care. Such reforms should be welcomed. But any benefits need to be weighed against the possibility that changes in the doctor-patient relationship may also have a covert purpose; as reform is focused at the interactional level, attention is drawn away from medical practice to the patient as the source of negligent injury. This can have negative consequences for patients who, in responding to this interactional gloss, may fail to gain compensation for the real errors of medical practice.

Clinical Competence↗
PubMed1996

Medical students' perceptions of medical malpractice.

Despite increasing interest in medical malpractice in the UK, there is very little empirical research on doctors' own concerns. This paper explores first and fifth year medical students' knowledge about malpractice, their attitudes toward litigation and its perceived significance for their future practice.

Adolescent↗
PubMed1976

Perspectives in malpractice.

Medical malpractice dates from Biblical days. And since then, much has been written on the subject. This article is a general overview of the historical, legal, and professional aspects of medical malpractice.

Legislation, Medical↗
PubMed1978

Medical malpractice insurance. Part I: A consideration of some of the factors.

The "crisis" of medical malpractice insurance is a product of a number of factors, both social and economic. Physicians, patients, insurance companies, and lawyers have all made individual and collective contributions. Social forces, changing physicians' roles and reorientation of patient attitudes have made institution of litigation against doctors much more culturally acceptable. Contingency fees, the need for compensation, and aggressive legal attitudes have increased the number of lawsuits and the size of awards, inflation, recession, and other economic developments have caused the insurance industry to be concerned about their financial welfare. The responses of various groups to these factors are presented, and their effect upon the cost and availability of medical malpractice insurance are considered.

Economics, Medical↗
PubMed1986

Radiology malpractice lawsuits: California jury verdicts.

In 1983, 16 out of every 100 U.S. physicians were sued for medical malpractice. The authors reviewed the courtroom results of all 144 lawsuits involving California radiologist defendants reported in Jury Verdicts Weekly (JVW) between 1971 and 1985. Almost half (66 of 144) of the lawsuits involved allegations of "failure to diagnose" (misinterpretations and oversights). About one third (45 of 144) involved procedure complications (angiography, 22; myelography, 11; intravenous contrast administration, 5; other, 7). About three fourths (93 of 127) of the verdicts favored the radiologist defendants. The authors' finding support the American College of Radiology Malpractice Awareness Task Force recommendations.

California↗