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PubMed2005

Epidemiology and etiology of malpractice lawsuits involving children in US emergency departments and urgent care centers.

OBJECTIVE: To obtain epidemiologic outcome information about pediatric lawsuits that originate in the emergency department and urgent care center. METHODS: This was an anonymous retrospective review of all closed pediatric claims in the Physician Insurers Association of America database during a 16-year period (1985-2000). This database, containing data from 20 major malpractice insurance firms, insuring 25% US physicians, was queried for epidemiologic outcome information about pediatric lawsuits originating in US emergency departments and urgent care centers. RESULTS: There were 2283 closed claims reviewed. Of these, 96% originated in the emergency department, and 4% originated in an urgent care center. Nonteaching hospitals were the sites for 79% of claims. Suits involved emergency department physicians in 29%, pediatricians in 19%, board-certified physicians in 46%, US graduates in 70%, and full-time physicians in 96% of cases. In 66% of cases, doctors had a previous claim. In 65% of cases, more than 1 defendant was involved. Patients were boys in 59% and were younger than 2 years in 47%. The most common diagnoses involved in the lawsuits were meningitis, appendicitis, arm fracture, and testicular torsion. Cases in which the child died were most often from meningitis or pneumonia. The most common misadventures were diagnostic error (39%), and no medical error identified in 18%. OUTCOME: Cases were settled in 93% (indemnity paid in 30%). There was a judgment for the doctor in 5.5% and for the patient in 1.4%. The average indemnity/claim was US66,000 dollars in 1985 versus US218,000 dollars (+330%) in 1997. The average indemnity ranged from US7000 dollars for emotional injury, US149,000 dollars for death of the patient, US300,000 dollars for major permanent injury, and US540,000 dollars for quadriplegic from injury. There was no significant difference between teaching versus nonteaching hospitals, between urgent care center versus emergency department, US graduate physician versus non-US graduate, or physician age. Indemnity paid/claim for full-time physicians was US161,000 dollars versus US91,000 dollars for part-time physicians. Total paid to plaintiffs was US116 million dollars. Legal cost of defending the cases was US36 million dollars (including defense attorney fees, US24 million dollars, and expert witness fees, US3.4 million dollars). CONCLUSIONS: Malpractice suits most often involved fractures, meningitis, and appendicitis. Most suits are settled; many are apparently frivolous. Paid indemnities have dramatically increased in recent years. Verdicts decided by juries favored the doctor in 80% of suits.

Adolescent↗
PubMed2002

Physicians and genetic malpractice.

Primary care physicians are unprepared for the increase in demands for prenatal genetic testing. Often, they do not possess the necessary knowledge, skills or attitudes to provide genetic counselling. Yet, since the demand for prenatal genetic services is growing faster than the number of genetic professionals, the responsibility of genetic counselling will fall to these physicians. Physicians who lack genetic literacy may find themselves the targets of lawsuits for wrongful birth and wrongful life. Wrongful birth and wrongful life claims (in the context of genetics) both assert that but for the physician's negligence, the handicapped child would not have been born. Such medical malpractice suits against physicians exist in the United States, the United Kingdom, Canada and Australia. This paper discusses the case law on wrongful birth/life cases in these four countries. The authors conclude that as the number and availability of prenatal genetic tests increases, so too will the number of genetic malpractice claims, unless the education of physicians and medical students in genetics is promoted, possibly with the Internet as the new educational paradigm.

Australia↗
PubMedDate not supplied

Continuing decline in service delivery for family physicians: is the malpractice crisis playing a role?

PURPOSE: This study was conducted to monitor trends in the reduction and elimination of services offered by family physicians. In addition, we examined whether the malpractice situation may be influencing these trends. METHODS: We surveyed all family physicians in rural Florida and an equal number of randomly selected, urban, family physicians in the state. We examined changes in professional liability insurance (PLI) premiums, and changes in services offered, practice satisfaction, and future practice plans. RESULTS: Overall, 308 (42.1%) family physicians responded. Results suggest that 60.3% of them reduced or eliminated services in the last year. Specifically, almost two thirds of respondents had eliminated hospital-based surgeries (65.2%) and vaginal deliveries (64.5%). Furthermore, endoscopies were decreased or eliminated by 69% of survey participants, and coverage of emergency departments and nursing homes was reduced or eliminated by 64.1% and 56.4% of respondents, respectively. Increases in the PLI averaged 78.2%. Overall increases in the PLI were significantly related to a decrease or elimination of services offered by family physicians. Dissatisfaction with practice was relatively high (36.8%) and was associated with both the reduction of services and an intention to leave practice within 2 years. No major differences in these trends were noted between rural and urban family physicians. CONCLUSIONS: Access to care provided by rural and urban family physicians in Florida is being hampered by the malpractice situation and other factors. Policymakers may need to focus on these factors in an effort to relieve additional barriers to care for vulnerable populations.

Adult↗
PubMedDate not supplied

The number one myth of asset protection: why you can lose assets in a medical malpractice lawsuit.

The thinking of many physicians around the country, and unfortunately their advisers as well, is that there is little risk of a physician losing personal assets in a malpractice claim, especially with typical dollars 1-3 million malpractice insurance coverage. This article dispels that myth and shows that the benefit in engaging in asset protection planning far outweighs the cost.

Compensation and Redress↗
PubMed2006

DNA analysis as a tool for breast cancer malpractice determination: an interdisciplinary approach.

Malpractice in breast cancer can be seen as false-negative or false-positive findings which may result in either late or incorrect therapies. Biopsy material can be unintentionally interchanged, leading to incorrect treatment, and psychological damage to the patient. There is an obvious need for individualization of the tissue samples in such cases. In this study we used a multidisciplinary approach to integrate DNA technology that has been standardized and used in forensic science for other purposes, mainly to prove malpractice that has been the result of interchanging tissue samples in breast cancer. The main focus of the study was to evaluate the applicability of the technique, therefore we studied the samples of a 58-year-old female for whom the result of pathological analysis was reported as 'invasive ductal carcinoma'. The patient was surgically treated by a modified mastectomy technique and referred for chemotherapy. Prior to chemotherapy we found that the tissue samples analyzed did not belong to the patient in question. We used a battery of 15 polymorphic STR loci to identify the sample and we had strong evidence for exclusion of the patient. The analysis was done on both blood and buccal swab of the patient and on the tissue sample. We concluded that the technique is applicable and useful; however care should be taken in the interpretation of the results because the mutations in the tumoral tissues are very well known. Therefore, the maximum of informative loci should be studied and loss of heterozygosity should always be considered. We should also have in mind the possibility of intentional interchange which gives the results value in medico-legal investigations.

Biopsy↗
PubMed1992

Factors that prompted families to file medical malpractice claims following perinatal injuries.

OBJECTIVE: To identify self-reported reasons that prompt families to file malpractice claims following perinatal injuries. DESIGN: Families were interviewed by telephone using a questionnaire that contained structured and open-ended questions. PARTICIPANTS: Mothers of infants who had experienced permanent injuries or deaths and had closed malpractice claims in Florida between 1986 and August 1989 were interviewed. Questionnaires were completed by 127 (35%) of a total of 368 such families. OUTCOME MEASURES: Reasons prompting families to file and families' descriptions of medical events, advice from acquaintances, and the quality of physician-family communication. RESULTS: Families volunteered numerous reasons for filing: advised by knowledgeable acquaintances (33% of respondents), recognized cover-up (24%), needed money (24%), recognized that their child would have no future (23%), needed information (20%), and decided to seek revenge or protect others from harm (19%). Over one third of all families indicated that they were told by medical personnel prior to filing that the care provided had caused their children's injuries. Families expressed dissatisfaction with physician-patient communication. Families believed that physicians would not listen (13% of sample), would not talk openly (32%), attempted to mislead them (48%), or did not warn about long-term neurodevelopmental problems (70%). CONCLUSION: Families give many reasons for filing a claim. Obtaining money may not be the only goal for some families who file suit.

Family↗
PubMed1991

Dental malpractice in Sweden.

This study reports and analyses the handling of malpractice cases by the Swedish authorities from an odontological and legal point of view, in order to find explanatory factors and create a basis for prevention and discussion of the principles for processing such cases. Women report their dentists more often than men. The main reasons for complaint are "faulty management/performance of treatment," "unsatisfactory technical/esthetic quality," and "wrong diagnosis/indication." Many cases concern elementary and well-known clinical principles for investigation, treatment planning, and clinical management. Private practitioners from the Stockholm region are most often involved in malpractice cases, and most of the complaints concern prosthodontic treatment. Poor record keeping is not uncommon.

Adolescent↗
PubMed1991

Malpractice and the National Practitioner Data Bank: what OR nurses need to know.

The National Practitioner Data Bank will record any payments made for any reason related to a malpractice suit in a central data bank available to a number of designated parties. Hospitals will be required to request this information to screen applicants and at least every 2 years for appointment renewals. The data bank may also be consulted by hospitals and state licensing boards as they deem necessary and by professional societies when reviewing membership applications. It is in the best interests of all malpractice defendants to insist on adequate representation of their personal, professional, and financial interests, which may necessitate insurance carriers providing each defendant with individual counsel.

Databases, Factual↗
PubMed1990

Medication errors: 1977 to 1988. Experience in medical malpractice claims.

MIIENJ has paid $30,144,636 in indemnity from 1977 through 1988 for medical malpractice suits arising from medication errors. A review of these files revealed that patients incurred death and serious morbidity, and that several specific behavior errors accounted for the majority of patient injury. Among the damages that occurred during that time period were 88 deaths, 15 patients with profound brain damage, 15 patients who alleged that they had become addicted to medications prescribed for pain, 10 patients who required amputations of limbs, and 12 patients who suffered some degree of hearing loss or decreased visual acuity. The predominant categories where insureds incurred difficulty were in disregarding patient allergies to specific drugs (acetylsalicylic acid (aspirin), penicillin and its derivatives); prescribing drugs without consideration of the patient's medical history; failing to monitor therapy with anticoagulants, nonsteroidal anti-inflammatory drugs, digitalis derivatives, theophylline, and aminoglycoside antibiotics; antibiotic therapy; and errors in the writing of prescriptions. In order to reduce the number of patient injuries and accompanying medical malpractice suits from medication errors, the following suggestions are offered: 1. Heed the patient's warning regarding drug allergies and prescribe a substitute drug, especially if the drug is aspirin or penicillin (and derivatives) or if the patient gives a history of having asthma. If the patient gives a history of aspirin sensitivity, make certain the drug you are prescribing does not contain aspirin as one of its components. Often physicians stated that they were not aware that aspirin was contained in the drug they prescribed for patients with a documented allergy to aspirin.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Medical experts compete to testify for malpractice plaintiffs.

This article describes the activities of physicians who offer their services for hire as witnesses and consultants to attorneys in malpractice litigation. Cases illustrating the extent of the problem are discussed along with legal and ethical restrictions on witnesses and contingent-fee payment of medicolegal consultants. A common belief is that the ever-present threat of malpractice litigation, which hangs over the heads of physicians like the sword of Damocles, is due to avaricious lawyers, unrealistic expectations of patients, and the reckless generosity of juries with other people's money. But physicians also have exacerbated a troublesome situation. Gone is the universal reluctance of doctors to testify against other doctors.

Ethics, Medical↗
PubMed1989

Use marketing to reduce malpractice costs in health care.

Marketing may have contributed to malpractice litigation by elevating public expectations. If all of the four basic functions of marketing--intelligence, strategy, operations, and communications--are applied well, then marketing may have a significant impact on malpractice risks and costs.

Advertising↗
PubMed1989

[Experiences with medical expert committees--procedures in physician malpractice claims].

For the relaxation of the physician-patient relationship from 1975 on Settlement Institutions and Expert Commissions were established at all General Medical Councils of the Federal Republic of Germany. The first Settlement Institution was founded on April 24th, 1975 in Bavaria, the first Expert Commission on December 12th, 1975 in North-Rhine. These institutions without example met all requirements and have stand the test. Quality standards are ensured by cooperation of lawyers. The 7288 reproaches of malpractice during the 12,5 years at the Expert Commission North Rhine are analyzed. Out of these 7288 reproaches 1126 cases of malpractice were assessed.

Expert Testimony↗
PubMed1989

Physician communication skills and malpractice claims. A complex relationship.

We assessed the relationship between patients' opinions about their physicians' communication skills and the physician's history of medical malpractice claims. The sample consisted of 107 physicians and 2,030 of their patients who had had an operation or a delivery. Although patients tended to give their physicians favorable ratings, they were least satisfied with the amount of explanations they received. Patients gave higher ratings to general surgeons and obstetrician-gynecologists and poorer ratings to orthopedists and anesthesiologists. Women and better-educated patients gave higher ratings on explanations and communication to physicians with fewer claims. Men and patients with less education, however, gave higher ratings on these dimensions to physicians with more claims. These findings suggest the need for physicians to tailor their communications to a patient's individual needs. Improved communication between physicians and patients may result in fewer nonmeritorious malpractice claims while leading to less costly resolution of meritorious claims.

Age Factors↗
PubMed1989

Obstetric and gynecologic malpractice in Louisiana: incidence and impact.

A survey of Louisiana obstetricians and gynecologists on the subject of professional liability was conducted in July 1988 by the Louisiana Section of the American College of Obstetricians and Gynecologists. Survey results disclose that the incidence of obstetric and gynecologic malpractice claims approximated the national incidence of such claims. The economic impact of these claims is less than that experienced on a nationwide basis. However, 85% of survey respondents indicated that they had made changes in their practice as a result of the risk of malpractice litigation. Many of these changes have adverse implications for the patient. If the present trends continue, it is likely that Louisiana women will find obstetric services more expensive and much less available.

Gynecology↗
PubMed1989

Medical charts and malpractice: how to avoid costly errors and omissions.

A thorough and well-organized medical chart can prevent malpractice from occurring, discourages the filing of groundless lawsuits, and is a useful tool in defending a physician in a medical malpractice action. This paper suggests methods by which a physician may improve record keeping and minimizing medico-legal exposure.

Defensive Medicine↗
PubMed1977

Medical and educational malpractice issues in patient education.

This paper discusses the concept of educational malpractice as a cause of prolonged patient morbidity equal in magnitude to medical malpractice. Statements by national groups sanctioning and urging increased patient education efforts are reviewed. An example of specially designed problem-oriented patient education materials development, the concept of an "Educational Prescription," the place for the "Educational Prescription" in problem-oriented medical records, and the value of hospital-based patient education as a cost-containment activity.

Hospitals↗
PubMed1988

"Magical thinking," suicide, and malpractice litigation.

Prospective clinical assessment of suicidality differs significantly from that used retrospectively in malpractice litigation. In the latter context, the judge or jury may be susceptible to hindsight reasoning and a disproportionate emphasis on the specific method of suicide, exaggerating its foreseeability and "magically" linking the means of death to the treating clinician, especially in the case of suicide by an overdose of prescribed medication. Such magical thinking, moreover, is rooted in the clinical context of suicide: The errors of reasoning observed in the courtroom exhibit striking parallels with the mind-set of the suicidal patient. An understanding of these dynamics suggests appropriate precautions for the clinician and thus contributes to the prevention both of suicide and of malpractice litigation.

Humans↗
PubMed1988

Malpractice liability in private practice of nutrition.

To date, no dietitian has been successfully sued in a malpractice case. However, as the number of dietitians in private practice increases, the risk of such suits increases proportionally. What is malpractice law and how does it apply to dietitians? What tests do the courts apply to determine whether injuries a patient has suffered were the fault of the health professional caring for that patient? What circumstances might ameliorate the patient's claims and limit the liability of the dietitian? Even though each case will be decided independently on the basis of the evidence presented in court, general principles and guidelines govern the courts' decision-making process. Among the elements that must be proved by a patient seeking legal redress are actual injury, a relationship of duty between the parties, breach of that duty, and a cause-and-effect relationship between the breach of duty and the injury suffered. Awareness of those principles can assist dietitians in conforming their conduct to practices that minimize their risk of liability.

Dietetics↗