Medical professional liability insurance market.
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Insurance, Liability↗
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Medicine and the law: summary of selected Texas trial verdicts in medical professional liability cases.
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Malpractice↗
[Expert evidence. General prerequisites and procedural characteristics for expert opinions].
In view of the boom in medical liability suits, which centre around medical malpractice, the decision of the medical expert is the pivot in the conflict between doctor and patient. Therefore, from a legal point of view it is extremely important that the expert is well prepared for a courtroom appearance. Beginning from a systematic and logical structure of the expert opinion, the most important demands on quality are dealt with: professional competence, objectivity and impartiality, intellectual integrity and intelligibility of speech, duty to give a strictly personal delivery of the opinion, limitation to the medical specialty, no legal comments, no insinuation and strict adherence to the theme. As an aid to the Judge, the expert must have a certain degree of background legal knowledge. This includes the peculiarities of civil and criminal procedures with respect to the burden of proof, the causality of medical or organisational errors in treatment leading to injury or even death of the patient, the significance of the term "a probability bordering on certainty", the meaning of "gross" errors in treatment, the guidelines and the medical standards. The obligation of the medical expert in questions of medical malpractice is not only an extremely responsible and difficult one, but also not without risk for the expert himself. Since August 2002 gross negligent errors by the expert are also liable for compensation in law under [section sign] 839a of the German Civil Code Book.
Expert Testimony↗
[Freedom to cure and alternative medicine].
The problem area of unconventional methods of treatment involves addressing a complex web of legal questions (constitutional law, criminal law, medical liability law, social insurance law, medical professional law). However, proceeding from the basis of statutory health insurance law, all individual questions can be resolved uniformly if the customary statutory or contractual "scientific-basis-clauses" intended to restrict the use of unconventional methods of treatment are understood merely as a criterion for a medical-acceptability test that respects the individual physician's discretion as regards treatment and appraisal. Methods of "outsiders" are then not generally excluded; rather, an individual weighing-up of the benefits has to be carried out in each case.
Complementary Therapies↗
[Medical risk and liability in stomatology in the year 2000].
In the current context of scientific progress, the evolution of medical liability is directly related to the increasing potential danger of medical procedures, the widening field of medical intervention, the growing concern about becoming a victim, and the changing notions about responsibility. We present here recent changes in administrative and legal jurisprudence. As administrative instances have progressively acquired more and more freedom of action, they have successively accepted hypotheses of presumed misconduct, abandoned the prerequisite of major misconduct, and allowed cases of liability without misconduct. The attitudes of legal instances remained unchanged for a long period before developing the concept of lost opportunity, then the presumption of misconduct in the case of nosocomial infections, and more recently, the notions of prejudice resulting from lack of information and the obligation for safe outcome accessory to the obligation to use available means. The future remains quite uncertain. One can expect a convergence between administrative and judiciary judges. For many, this unification will lead to a desirable "block of competency". We are probably moving towards the notion of objective responsibility which would allow indemnities to be awarded for medical accidents, but leaving open the possibility of court action for misconduct. The question remains open concerning the modalities of implementation: legislation or jurisprudence with its inherent risks.
France↗
The liabilities and consequences of medical device development.
A large increase in medical products liability litigation during the past 40 years has resulted in a flood of litigation against drug and device manufacturers. The medical technology and chemical industries are prime targets for products liability litigation. Physicians and other health care providers are willing to accept a reasonable degree of risk associated with the use of a medical product when compared to the benefit to be achieved by that product but lay juries are less likely to tolerate the concept of an acceptable failure rate. Plaintiffs' lawyers believe that the medical products industry should be held to a standard of absolute liability and that anyone injured by a medical product is entitled to recover without regard for the circumstances. Large compensatory and punitive damage awards, the high cost of insurance, large defense costs, and low profit margins have forced some companies to remove their products from the market. The medical or biomaterials manufacturer can significantly reduce its exposure for products liability by adopting a successful product safety program. Manufacturers have significant control over the quality, safety, and reliability of their products through appropriate design, testing, manufacture, labeling, and sale of quality products.
Biotechnology↗
Beyond MICRA: new ideas for liability reform. American College of Physicians.
The existing medical liability system does not work. It does not deter negligence, provide timely compensation to injured persons, or resolve disputes fairly. Studies show that a large percentage of injured patients are not compensated and that physicians feel vulnerable to a lawsuit whether or not they practice high-quality medicine. The arbitrariness and inefficiency of the system disrupts the physician-patient relationship, increases health care costs, and, in some cases, hurts access to care. As a result, comprehensive changes to the liability system must be made. The American College of Physicians makes the following recommendations. 1. Congress should immediately pass the tort reforms contained in the California Medical Injury Compensation Reform Act (MICRA), particularly caps on noneconomic damages, as necessary short-term changes to a flawed system. 2. Federal legislation should be enacted that overturns recent court decisions that have relied on the Employee Retirement Income Security Act of 1974, a federal law that regulates pensions and other benefit plans, to bar plaintiffs from suing their health plan for negligence if the plan's benefits or treatment decisions lead to an injury. 3. Demonstration projects should be created and funded to examine the feasibility of using a set of caps for noneconomic damage awards that are based on the severity of injury suffered and the injured party's age. A set of caps could be seen as fairer to injured persons than flat caps but would still protect physicians from unlimited awards. 4. Demonstration projects should be authorized and funded to test enterprise liability and no-fault systems. These systems could take many forms, including administrative approaches; lists of accelerated compensation events; "early offer of settlement" approaches; and organizational liability for health plans, hospitals, or health systems. Such long-term reforms are consistent with trends in health care delivery and are necessary to promote quality of care, compensate injured persons, and protect physicians.
Health Care Reform↗
The impact of United States law on medicine as a profession.
The evolution of US law has had an enormous influence on medicine as a profession, and much of this legal evolution can be attributed to changes in the science and practice of medicine. This changing legal framework and its intersection with medicine has many facets. Three of the most important facets concern the evolution of the no duty-to-treat principle and the role of modern health care financing and civil rights law in altering this rule, the manner in which advances in medicine led courts and legislatures to change the standards against which professional medical liability is measured, and the basic loss of highly preferential treatment under US laws aimed at preventing anticompetitive conduct by businesses. However, despite the impact on the profession of an evolving legal system, concern over the integrity of medical professionalism continues to significantly influence both laws and lawmakers, including legislatures, regulatory agencies, and the courts.
Civil Rights↗
Lipoplasty claims experience of U.S. insurance companies.
An analysis of medical liability claims for lipoplasty (liposuction) from January of 1985 through June of 1998 compared the insurance industry experience of plastic surgeons with that of other physicians. The Data Sharing Project database of the Physician Insurers Association of America, a trade association of professional liability companies owned and operated by medical professionals that collectively insure approximately 60 percent of America's private practice physicians, was queried. Of the nearly 45,000 total entries in the database, 292 were claims for adverse events related to lipoplasty or liposuction. These raw data were stratified by physician specialty, severity of complication, practice location, patient gender, indemnity payment, and other insurance industry-relevant variables. To simplify interspecialty comparisons, we normalized the claims rate to incidents per 100 insured physicians. The indexed lipoplasty claims rate was 3.0 per 100 insured plastic surgeons and 4.1 for other surgeons; the indexed lipoplasty claims rate for nonsurgical specialists was 2.5 per 100 insured dermatologists and 2.3 for other nonsurgeons. The higher claims rate for surgeons most likely reflects the wider scope of full-service aesthetic surgery performed by surgical specialists. Nearly two-thirds of claims (65.4 percent) during the 13-year survey period were the result of hospital-based lipoplasty; 20.9 percent were office-based claims. The prevalence of hospital-based claims may be a consequence of both historical bias introduced by hospital-based specialty surgery in the early years and prudent patient safety considerations during performance of complex or prolonged procedures in more recent years.Two-thirds of the claims (67 percent) arose from informed-consent or breach-of-contract issues, far higher than the 26 percent aggregate claims norm. The mean indemnity payment was $94,534 per lipoplasty claim; claims paid against board-certified specialists averaged $83,350. Consistent with national lipoplasty demographics, 87 percent of claims were brought by women and 13 percent were brought by men. Seven fatalities (three women and four men) were noted; cause of death is not recorded in this type of database.
Data Collection↗
Avoiding administrators' liability.
Radiology administrators have been mostly untouched by the medical liability crisis, but legal experts warn that lawsuits could be targeted at health care administrators. Consequently, administrators should take several precautions to limit their changes of being drawn into a lawsuit.
Financial Management↗
[Civil responsibility of medical care activities in regard to the precautionary principle].
In the absence of a legal body regulating the precaution, do we have to confine the principle to public health? A negative answer is required at a time the medical liability is increasing more and more and the obligation to take all means is slipping toward to a strict obligation as to the result. The respect of the principle of precaution can be found in the obligation for the doctor to prove that he has fully informed the patient, but the medicine specificity requires delimitation of this obligation outlines.
Decision Making↗
Civil liability in oral & maxillofacial surgery: Α systematic review.
Maxillofacial surgery is a surgical specialty with anatomical, functional, and aesthetic requirements, which makes it a field at increased risk of medical negligence and subsequent legal claims. The review was conducted in accordance with the PRISMA guidelines and used international medical and legal databases. Studies that analyzed court decisions, insurance claims, or recorded compensation data related to maxillofacial surgery were included. The extracted data included, among others, the year and country of publication, the causes of action, and the amounts of financial compensation. Most lawsuits originate from countries with developed medical liability systems, primarily the United States and the United Kingdom, and there has been an increasing trend in publications over the last two decades. The most common causes of lawsuits involve nerve injuries, delayed or incorrect diagnoses, technical errors during surgery, and inadequate informed consent. The amounts of compensation vary widely, from lower five-digit amounts in milder cases to particularly high amounts in cases of permanent functional or aesthetic damage, placing a significant overall financial burden on health systems. Medical negligence in maxillofacial surgery constitutes an important forensic and socioeconomic issue. Understanding the causes of lawsuits and their financial consequences can help improve clinical practice, inform patients, and prevent legal disputes.
Humans↗
Access to medical records, Part 2: liability for improper disclosure of medical records.
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Confidentiality↗
Product liability in the medical laboratory.
Under recent product liability legislation patients who suffer damage from any treatment materials administered to them will not have to prove negligence in order to claim compensation for any injury suffered. Optimum quality assurance and detailed documentation will be necessary for defence against litigation by a patient. Transfusion medicine is the main area of laboratory practice where litigation can be expected, but implications for other medical laboratories are referred to.
Blood Transfusion↗
The "future trends" in neurosurgery are here. The 1975 AANS presidential address.
The President of The American Association of Neurological Surgeons discusses the three major problems of his year in office -- medical education, neurosurgical manpower, and professional medical liability -- and the attempts that are being made to solve them.
Education, Medical, Continuing↗
[Risks and responsibilities in diagnostic and interventional radiology. Ethical and medicolegal considerations].
Medical risk management has one main purpose: to ensure the safety of care. The law of March 2002 has generated a true cultural revolution. The radiologist is involved with new and difficult areas of medical liability due to technical advances, the increasing number of imaging techniques, the increasing complexity of imaging techniques, their efficiency and the need for multidisciplinary approach. Imaging recommendations requiring increasing levels of technical and clinical skills. The radiologist is liable with regards to the indications of imaging studies, and also with regards to informed consent. The prevention of medicolegal problems is achieved by competency, which must be combined to good liability insurance and ongoing vigilance supported by appropriate continuous medical education.
France↗
[No spectacular rise in claims for medical damages in The Netherlands: 1993-'01 compared to 1980-'90].
OBJECTIVE: To acquire insight into the number and nature of claims for damages that were filed in the period 1993/'01 in hospitals insured by MediRisk and to compare this with the period 1980/'90. DESIGN: Descriptive. METHOD: Data were collected from the registration system for insurance claims maintained by MediRisk, an insurer of medical liability risks. The data were processed up to and including 31 October 2002. There were 4058 claims in 3316 closed and 742 open dossiers. The results were compared with those from a comparable investigation into the period 1980/'90 (3970 claims; 1550 dossiers investigated). The number of invasive medical interventions in the period 1990-2001 was obtained from Prismant in Utrecht. Study of the dossiers yielded information about the use of legal procedures. RESULTS: Compared to 1980/'90 there was a 34% increase in the number of claims for damages following medical interventions during the period 1993/'01. This increase was smaller than the growth in the number of high-risk interventions (47%). The percentage of rejected claims for damages was 6o in the period 1980/'90 and 68 in 1993/'01. In both periods, most of the claims pertained to surgical specialisms, in particular general surgery. In 370 of the 3316 closed dossiers (11%) a legal procedure was mentioned: complaints committee (5%; in 1980/'90 hospitals were not required to have a complaints committee), civil court (3%; this was 4% in 1980/'90) and the Medical Disciplinary Board (3%; this was 6% in 1980/'90). CONCLUSION: The increase in the number of claims for damages filed against hospitals insured with MediRisk was limited compared to the number of medical interventions carried out. The number of legal procedures arising from these claims did rise in the absolute sense, but fell in relation to the number of claims for damages.
Humans↗
REMEDHOS: the development of a medical and hospital liability database in Quebec.
Confronted in 1985 with the sudden rise of costs for liability protection, the health care sector in Canada took note of the fact that little or no reliable data were available and easily accessible to assess the actual scope and nature of the phenomenon of increasing medical liability suits in Canada. In order to correct this situation, a computerized database was created covering malpractice suits launched against Quebec health care professionals and establishments. This article presents the methodology that was used for the creation of the database; it describes the material that was used, the technical instruments that were developed and the software utilized. It also describes the structure and content of the database and presents its practical application with respect to the areas of risk management, health care evaluation, professional controls and tort reform.
Databases, Factual↗