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PubMed1987

Medical malpractice in diagnostic radiology: claims, compensation, and patient injury.

The purpose of this study is to provide more information to diagnostic radiologists regarding claims, compensation, and patient injury in medical malpractice cases. Malpractice cases filed against the U.S. government were reviewed. The most common claim was misdiagnosis of a malignancy (30% of the cases); in these cases the claimants received relatively high compensation. Most of these cases involved failure to diagnose lung carcinomas on chest radiographs and failure to diagnose colon carcinomas on barium enema studies. The findings emphasize the importance of having the members of a radiology department, regardless of professional level, work together as a team.

Diagnostic Errors↗
PubMed1993

Breast cancer malpractice litigation in New York State.

PURPOSE: To identify causes of purported malpractice in diagnosis and treatment of breast cancer. MATERIALS AND METHODS: The authors reviewed cases from The New York Jury Verdict Reporter listed between 1985 and 1991 to look for those in which there was alleged delay in diagnosis or treatment of breast cancer. RESULTS: Of 34 cases identified, 32 (94%) were based on presumed delay in diagnosis and only two (6%) on claims of therapeutic malpractice. Delay in diagnosis was commonly claimed in patients younger than 50 years (76%). Palpable masses were present in 94% of these cases. Either mammograms were not obtained (16 cases, 50%) or findings were interpreted as normal or as fibrocystic disease (12 cases, 38%). Specialists most frequently cited were gynecologists (16 of 39,41%). Highest awards (> or = $1 million) were more commonly given to patients younger than 50 years with proved distant or nodal metastasis (six of 34, 18%). CONCLUSION: Emphasis on early diagnosis has led to the perception that purported delay in diagnosis, however short, even in the presence of a palpable mass, changes the chances for survival.

Adult↗
PubMed1979

Psychiatric malpractice: the California experience.

The cost of psychiatric malpractice insurance has increased dramatically in recent years. To shed light on the extent to which this increase is justified the author polled 133 California psychiatrists who had indicated experience with some form of claims activity over the past 5 years. The 107 respondents reported 105 cases, of which 57 (54%) resulted in no more than a notification of a possible claim, 22 (21%) did not proceed beyond legal deposition, 20 (19%) were settled by dollar payment before trial, and 6 (6%) were left to the courts. The author recommends tort reform and refinement of reported claim and loss data to contain the cost of malpractice insurance.

Adolescent↗
PubMed1984

Physicians' self-reports of reactions to malpractice litigation.

The authors devised a survey as a first step in assessing physicians' perceptions of the impact of medical malpractice litigation on their professional practice and personal lives. Subjects were a sample of physicians in Cook County, Ill., who had been sued during 1977-1981. Many respondents reported changes in how they practiced their profession. Two clusters of self-reported symptoms in reaction to the litigation also emerged. Further studies, including clinical interviews, are needed to clarify the impact of medical malpractice suits on the sociological reality of medical practice.

Adjustment Disorders↗
PubMed1984

Psychiatric malpractice: a review of the national loss experience.

The authors examine the outcome of 217 malpractice actions against psychiatrists from 1974 to 1978. Claims against psychiatrists represented only 0.3% of the 71,788 claims against all physicians. Loss experience was developed as a function of procedure (ECT, psychotherapy), type of injury (suicide, diagnostic error), and the patient's psychiatric diagnosis. Over one-third of the claims were closed without payment; the average paid indemnity was $31,000. Diagnostic errors and suicide were the major sources of loss. Only a few cases went to trial. These data illustrate that psychiatry has one of the best malpractice claim records.

Depressive Disorder↗
PubMed1985

Sued and nonsued physicians' self-reported reactions to malpractice litigation.

To assess the impact of malpractice litigation on physicians' personal and professional lives, the authors surveyed a random sample of the Chicago Medical Society membership. Although both sued and nonsued physicians reported changes in professional behavior and emotional reactions to both the threat and actuality of litigation, sued physicians reported significantly more symptoms than nonsued physicians. Significantly more of them reported that they were likely to stop seeing certain types of patients, think of retiring early, and discourage their children from entering medicine. Malpractice litigation may affect not only physicians' personal and professional lives but also the delivery of health care.

Attitude of Health Personnel↗
PubMed1988

Ostensible agency: another malpractice hazard.

Under the tort doctrine of ostensible (apparent) agency, a psychiatrist was named as a codefendant in a psychiatric malpractice suit against a nonmedical psychotherapist employed in his medical group, who had treated the plaintiff in her private practice in the same offices. The psychiatrist was later dismissed as a defendant, but to avoid being sued in such a case, a psychiatrist contemplating an association with another professional should 1) check the professional's record with the appropriate licensing agency, 2) require proof of licensure and malpractice insurance, 3) require that the professional's private patients sign disclosure statements, and 4) assure that names on written materials are kept separate.

Allied Health Personnel↗
PubMed1978

Malpractice in outpatient psychotherapy.

There are many potential causes for malpractice actions in outpatient psychotherapy. Pertinent cases are reviewed, their implications discussed, and means by which practitioners can avert malpractice are described.

Ambulatory Care↗
PubMed1980

Malpractice liability in a patient's suicide.

The increased number of malpractice suits has had an impact on the practice of medicine. Fourteen of the most common reasons for suits against psychiatrists are listed. Prominent among them is the failure to care for an obvious suicide risk. The suicidal potential of all patients must be explored. Affirmative answers to three or more of twelve questions point to a high suicide risk, and psychiatric hospitalization should be seriously considered. Specific suicide precautions should be indicated. The legal doctrine of "res ipsa loquitur" in relation to malpractice suits is discussed. It is concluded that there are not fixed legal standards of care or supervision of suicidal patients.

Hospital Units↗
PubMed2002

The use of experts in medical malpractice litigation in Japan.

In medical malpractice litigation, the cooperation of medical experts is important. However, the appointment of experts has become problematic in Japan, apparently because many medical experts refuse to act in this capacity. However, this supposition has not until now been supported by quantitative evidence, since the fact that so few judgments in Japan are published made it impossible to investigate the situation. Therefore, we aim to show the state of the use of experts in medical malpractice litigation using objective data. Over the last ten years, the rate of the use of experts has averaged only 22.5%, varying according to region. Experts were used in 24.5% of cases involving an attorney on the patient's side, and in only 3.4% of cases where no attorney was used. The success rate of patients was higher when experts were adopted (39.1%) than when they were not (29.9%). The length of litigation involving experts was 4.0 years, and 2.7 years when no expert was involved. This research suggested the necessity of establishing a formal cooperation system as soon as possible in Japan with no regional maldistribution.

Expert Testimony↗
PubMed2004

Do malpractice concerns, payment mechanisms, and attitudes influence test-ordering decisions?

Greater understanding is needed of nonclinical factors that determine neurologists' decisions to order tests. The authors surveyed 595 US neurologists and utilized demographic information, attitude scales, and clinical scenarios to evaluate the influence of nonclinical factors on test-ordering decisions. Greater test reliance, higher malpractice concerns, and receiving reimbursement for testing were all associated with a higher likelihood of test ordering. These findings have implications for training needs and suggest malpractice worries may inflate health care costs.

Age Factors↗
PubMed1991

Controlling large malpractice claims: the unexpected impact of damage caps.

Indiana's comprehensive malpractice reforms, inaugurated in 1975, include a cap on damages, a mandated medical review before trial, and a state insurance fund to pay claims equal to or greater than $100,000. We have found that the amount of compensation going to claimants with such large malpractice claims in Indiana is, on average, substantially higher than in Michigan and Ohio. Indiana's mean claim severity between 1977 and 1988 was $404,832, while the means for Michigan and Ohio were $290,022 and $303,220, respectively, with the difference between these three means being highly significant. Although data on claim and claimant characteristics reveal considerable interstate variation, the results of regression analyses show that Indiana claim payment amounts are higher than Michigan or Ohio payments, independent of the effect of factors such as sex, age, severity of injury, allegations of negligence, and year of settlement.

Cost Control↗
PubMed1994

The value of liability in medical malpractice.

In this paper I estimate the strength of medical providers' incentive to avoid negligent medical care, taking account of the facts that many victims of medical malpractice do not file claims, many nonvictims do file claims, legal costs are high, and the legal system makes errors. Despite these problems, the negligence system creates a strong financial incentive for medical providers to avoid substandard care: The average cost of negligence is $135,000 per malpractice claim involving negligence and $3,500 per occurrence of negligent medical care. These substantial penalties suggest that if liability were abolished without adopting effective alternative sanctions for negligent medical care, the number and cost of medically caused injuries and deaths could rise sharply.

Consumer Advocacy↗
PubMedDate not supplied

Effects of the malpractice crisis on access to and incidence of high-risk procedures: evidence from Florida.

There is much debate on how recent increases in medical malpractice premiums affect patients' access to care. We examined activity levels of neurosurgeons and obstetricians, as well as the incidence of high-risk surgery and patients' travel times in Florida, where malpractice insurance premiums have soared since 2000. Compared with 1997-2000, we found that during 2000-2003, many neurosurgeons cut back their volume of brain surgeries and that craniotomy patients traveled longer for care without any significant change in the overall incidence of craniotomies. Women undergoing high-risk deliveries did not see increases in travel times.

Female↗
PubMed1994

Dental malpractice liability insurance market: surveys of insurers and insurance commissioners.

Surveys of malpractice insurers and state insurance commissioners in 1992 show a highly concentrated market with opportunities for greater competition. Fewer than 50 firms write coverage nationally. Weighted premiums for $1 million/$3 million coverage vary across U.S. census divisions from $1,700 in the South to $3,000 in the Northeast. These data may be of interest to practitioners who purchase insurance and will aid dental associations in effectively participating in revisions of malpractice liability statutes as part of overall health care reform.

Data Collection↗
PubMed1998

Use of the Physician Insurers Association of America database as a surveillance tool for diabetes-related malpractice claims in the U.S.

OBJECTIVE: To examine the available national surveillance data on malpractice claims associated with diabetes and to determine the medical specialties having the highest number of claims and the classes and costs of filed claims relating to diabetes. RESEARCH DESIGN AND METHODS: Data was abstracted from the Data Sharing Reports (DSRs) of the Physicians Insurers Association of America (PIAA), as well as a search of the PIAA's computerized database for the period spanning 1 January 1985 to 31 December 1996. Data on numbers of claims, medical causes of loss, indemnity paid, demographics of claimants and physicians, severity, and medical specialties with diabetes-related claims were available. RESULTS: A total of 906 diabetes claims were reported to PIAA, and the total indemnity paid was $26,892,848. A significant downward trend (P = 0.004) was noted for the period between 1993 and 1996. Diabetes claimants were older and predominantly male, relative to all claimants. Ophthalmology, internal medicine, and general and family practice had the highest rates of reported claims at 16.5, 13.6, and 13.4 diabetes claims per 1,000 claims, respectively. Of the diabetes-related injuries, 44% occurred in the practitioners office, as compared with 27% for all claims. A greater proportion of diabetes claims were associated with the highest level of severity of injury with respect to all claims compiled by the PIAA. CONCLUSIONS: The database of the PIAA can be a useful resource to monitor trends in diabetes-related malpractice. Further study into whether claims result from lack of adherence to practice guidelines is needed. Prevention programs designed to reduce the liability among high-risk specialties may also lead to improved care for the patient with diabetes.

Databases, Factual↗
PubMed2026

How Following Medical Artificial Intelligence Advice Can Mitigate Malpractice Liability: Cross-National Insights from a Randomized Trial.

Artificial intelligence (AI) increasingly influences clinical decision-making, yet its recommendations may diverge from standard care. Although malpractice concerns are thought to discourage physicians from following AI advice, experimental evidence from the United States suggests the opposite: lay jurors are more likely to hold physicians liable when they reject AI recommendations. Whether this pattern extends to systems in which court-appointed experts, not lay jurors, determine liability remains unknown. Methods: To examine how physicians and laypeople in expert-based and lay-juror legal systems evaluate physicians' acceptance or rejection of AI recommendations, particularly when those recommendations deviate from standard care, we designed a randomized vignette study: a 2 &#xd7; 2 factorial design varying the AI recommendation (standard vs. nonstandard care) and a fictional physician's decision (accept vs. reject). The study was conducted online in 2023 among nationally representative samples of U.S. and German adults and from 2023 to 2024 among German physicians. In total, 387 German physicians, 2291 U.S. adults, and 2283 German adults participated; those not completing the survey or failing attention checks were excluded per preregistered criteria. Participants were randomly assigned to 1 of 4 vignettes, varying the AI recommendation (standard vs. nonstandard care) and physician's decision (accept vs. reject). The reasonableness of the fictional physician's decision was measured, rated by participants on a Likert scale. Results: Analysis, following preregistered exclusion criteria, included 248 German physicians, 1202 U.S. adults, and 1358 German adults. Physicians accepting standard-care AI recommendations were rated more reasonable than those rejecting them (U.S. laypeople: t = 5.36; 95% CI, 0.45-0.97; P < 0.001; German physicians: t = 2.47; 95% CI, 0.14-1.30; P = 0.02; German laypeople: t = 4.14; 95% CI, 0.27-0.76; P < 0.001). Ratings of physicians accepting versus rejecting AI nonstandard-care recommendations were statistically equivalent. Equivalence was tested at an &#x3b1;-value of 0.05 using a two 1-sided tests procedure, reported with 90% CIs per standard convention (U.S. laypeople: t = -4.90; 90% CI, -0.1 to 0.36; P < 0.001; German physicians: t = -1.76; 90% CI, -0.12 to 0.67; P = 0.04; German laypeople: t = 5.35; 90% CI, -0.35 to 0.06; P < 0.001). Conclusion: Across the United States and Germany, samples representative of lay jurors and court-appointed experts viewed accepting standard-care AI advice as more reasonable, whereas accepting or rejecting nonstandard-care AI advice was judged similarly. Contrary to predictions, malpractice liability regimes do not necessarily pose a barrier to AI use in precision medicine.

Artificial Intelligence↗
PubMed1985

Malpractice and nurse educators: defining legal responsibilities.

This article discusses the malpractice crisis in the health professions as it threatens to affect nurse educators. There is a concise explanation and review of immunity and liability doctrines for supervisory personnel. The most common conditions for patient injury are examined, and pertinent legal decisions are cited. Examples are provided for the problem areas of negligence and several practical recommendations are presented for the nurse educator who wishes to do everything possible to minimize exposure to claims of malpractice.

Communication↗