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Medicaid program; third party liability for medical assistance; FFP rates for skilled professional medical personnel and supporting staff; and sources of state share of financial participation--HCFA. Final regulations.

These final regulations--(1) Broaden the scope of services for which a State must collect from third parties the cost of medical assistance furnished to Medicaid recipients, revise the methods of paying claims involving third party liability, and make conforming changes to incorporate a statutory provision that requires the assignment of medical support rights and other third part payments and cooperation in establishing paternity and obtaining support as a condition of eligibility for Medicaid; (2) Revise and clarify criteria used in determining whether skilled professional medical personnel and directly supporting staff involved in the administration of the Medicaid program qualify for 75 percent Federal matching; and (3) Clarify policy to permit public and private donations to be used as a State's share of financial participation in the entire Medicaid program, instead of only for training expenditures. These amendments are a combination of steps to remove unnecessary requirements in our regulations and to include provisions that will improve the administration of the Medicaid program. They also conform the Medicaid regulations to certain provisions of the Deficit Reduction Act of 1984 (Pub. L. 98-369).

Allied Health Personnel↗

[Expert commission for questions of physician malpractice. More than 10 years service for the patient and physician--report from the Südbaden District Chamber of Medicine].

The provision of an objective expertise on medical practice by an expert commission and arbitration board aims to make it easier for the patient to prove a justified claim, and for the physician to reject unfounded accusations made against him. A retrospective consideration of the activities of the expert commission on questions of medical liability at the Medical Society of Baden-Württemberg for the region covered by the District Medical Society Südbaden shows that the expert commission is being approached progressively more often. The medical discipline most frequently involved is surgery. Although claims are more frequently made against hospital doctors than against doctors in private practice, the latter are more likely to be guilty of maltreatment. Iatrogenic mistakes made during routine treatments can lead to serious consequences for the patient. An analysis of the activities of the expert commissions can open up new possibilities for quality control in medical care and further medical education.

Expert Testimony↗

[Civil, criminal and ethical liability of medical doctors].

In the last years doctors have been the target of a growing number of civil, criminal law suits, as well as ethical procedures. Medicine is a widely targeted career, not only owing to its inherent risks, but also owing to a mistaken approach of the Judiciary Power about the obligations of medical doctors. Decisions of the Medical Board in ethical procedures have an impact in civil and criminal justice and therefore should be followed closely. The purpose of this review is to provide a wide view from a doctor-lawyer perspective of cases involving civil, criminal liability of anesthesiologists as well as ethical procedures against them, in an effort to make them comprehensible to doctors. After a brief historical introduction civil liability foundations and legal articles are examined. Responsibilities of doctors, hospitals and health insurance providers are discussed separately, as well as reparation mechanisms. Crimes possible to occur during medical practice and respective penalties are described; the direct relationship between crime and civil reparation is demonstrated. The administrative nature of ethical procedure is described, emphasizing that the legal character of its penalties often serve as grounds for civil and criminal justice decisions. Prevention is still the best medicine. Good medical practice and a good medical-patient relationship are still the best ways to minimize lawsuits and their repercussions. Doctors should have some knowledge of juridical mechanisms in lawsuits and ethical procedures, but should not take defense initiatives without prior consultation of an attorney. Civil, criminal and ethical liability of physicians.

Brazil↗

Post-Perruche: what responsibilities for professionals?

Damage compensation relating to handicapped new-borns, the wrongful life law, was put in place after a great controversy in France by the Perruche ruling of November 13th 2000. The French parliaments have voted a special law against wrongful life action. But questions about medical liability are not answered by the new law. For wrongful life, what are now the medical errors likely to directly provoke a handicap or aggravate it or obstruct measures to alleviate it? For a wrongful birth claim it limits parental damages to psychological damages only, due to a lack of mental preparation, whilst denying economic losses, thus preventing complete compensation arising from medical malpractice for all the other types of difficulty suffered by the parents. Why does it give a new definition of medical malpractice as a "characterized fault" and insist upon the qualification 'blatant" in the field of medical liability? For health professionals, it is a question of knowing and being acquainted with the errors that fall under their liability with regard to handicapped persons and a "characterized fault" with regard to parents. It is through a review of past and present case law that we will try to answer these medical questions. All court rulings that awarded monetary damages to the child were reviewed. We include only three decisions after the new law, which do not allow damage compensation in respect of a handicapped new-born. The rulings incorporate decisions taken by the French Supreme Court, of the council of state as well as by courts of appeal. Failure of voluntary termination of pregnancy, missing rubella immune antibody, omission of mandatory tests during pregnancy, typical medical fetal malpractice, were and are professional faults.

Compensation and Redress↗

The medical record. Informing your patients before they consent.

In the language of medical liability, no concept has received as much misinterpretation as "informed consent." In the last five years, most medical liability carriers have experienced a significant increase in claims that allege failure to obtain a proper informed consent prior to treatment. The authors discuss forensic testing of the medical record and offer recommendations for record-keeping. These suggestions, if followed, will help establish the reliability of the record as an accurate reflection of the treatment of the patient in any given case.

Adult↗

Medicaid program; third party liability for medical assistance; FFP rates for skilled professional medical personnel and supporting staff; and sources of state share of financial participation--HCFA. Proposed rules.

These proposed regulations would--(1) Broaden the scope of services for which a State must collect from third parties the cost of medical assistance furnished to Medicaid recipients, remove the specific requirements for the terms of cooperative agreements for third party collections, and revise the methods of paying claims involving third party liability; (2) Clarify criteria used in determining whether skilled professional medical personnel and supporting staff involved in the administration of the Medicaid program quality for 75 percent Federal matching; and (3) Clarify policy to permit public and private donations to be used as a State's share of financial participation in the entire Medicaid program, instead of only for training expenditures. The proposed amendments would clarify policy and reduce program expenditures.

Allied Health Personnel↗

Creating a safe environment.

William Sage provides an excellent rationalization for today's medical liability crisis. Patient safety and a safe environment are related concepts directed at helping to resolve this crisis. His paper helps to bring the complexities into perspective and suggests the need for an even better definition of "avoidable error" and for a righting of the tort system in the direction of the health care provider. I discuss here two ideas concerning injury compensation tables and medical liability specialty courts to help bring about this "righting."

Compensation and Redress↗

Medical liability-the crisis, the reality, and the data: the University of Michigan story.

BACKGROUND: This study describes, quantifies, and evaluates the University of Michigan Department of Surgery medical malpractice experience for the 1992 to 2002 period. The goal is to gain an understanding of what our claims experience has been, what services are highest risk, and where the financial exposure lies. STUDY DESIGN: The study analyzed 308 medical malpractice cases within the Department of Surgery from 1992 through 2002. RESULTS: There were 263 cases involving a single surgical service (defendant-only) and 70 shared cases involving multiple services. One hundred forty-four cases (47%) were settled with no payment to the plaintiff. Settlements for all cases totaled Dollars 38,718,254. The per-case expense (not including legal fees) was Dollars 125,708. Legal expenses for all cases totaled Dollars 5,356,588, averaging Dollars 17,391 per case. CONCLUSIONS: Understanding and sharing institutional data on medical malpractice is critical to developing effective strategies for managing malpractice risk. Although many institutions treat these data as proprietary and confidential, communication of this information generates a better understanding of the opportunities that are available for development and implementation of appropriate risk-management tools.

Hospitals, University↗

Managed care liability for medical malpractice and utilization review.

Managed care subscribers alleging harm due to physician negligence often assert claims against their managed care plans as well. This article reviews five theories of liability under which relief has been sought and describes some of the defenses managed care organizations have raised to avoid liability.

Health Maintenance Organizations↗

Medicaid program; third party liability for medical assistance; correction--HCFA. Final rule.

This final rule amends a provision in the Medicaid regulations relating to the methods that a State must use to pay providers for Medicaid claims that involve third party liability payments. The amendment is necessary to assure that regulations published on November 12, 1985, regarding recovery of reimbursement of a claim payment involving third party liability are implemented properly.

Centers for Medicare and Medicaid Services, U.S.↗

Canadian medical malpractice liability: an empirical analysis of recent trends.

The determinants of the frequency of Canadian malpractice claims, the proportion of claims that result in payment, and the severity of these claims are examined. Inter-specialty variation in the frequency of malpractice claims is almost entirely related to the differential performance of major surgery. Various legal doctrines concerning both compensation and liability appear responsible for approximately half of the upward trend in the propensity to initiate malpractice litigation. We believe that the remaining explanations for growth in claims frequency are changes in social attitudes toward risk-bearing, increasing social distance between patients and physicians, and innovations in medical technology.

Canada↗

[Risk management from the judicial perspective].

The jurisdification of medicine is an unstoppable force that finds its visible expression in a medical liability boom which--apart from the negative impact of legal and out-of-court proceedings on the bond of the doctor-patient relationship--bears considerable economic disadvantages for the providers of care. It is therefore necessary to fight in particular the legally influenced causes of medical liability for which risk management seems to be a suitable, effective tool. As the examples taken from the jurisdiction in the organisational sector will demonstrate, risk management pinpoints the sources of trouble so that we are able to learn from current errors and provide appropriate remedies for the future. Risk management, though, is not a "unique event", but a dynamic, repetitive process that has to be institutionally secured by appointing a risk manager so that the proposals discussed, recommendations and essential measures can actually be implemented.

Germany↗