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PubMed2001

Barriers to provision of obstetric services by family physicians in Louisiana.

The purpose of this paper is to identify family physicians' perceived barriers to providing obstetrical services in Louisiana. A questionnaire was sent to 585 active members of the Louisiana Academy of Family Physicians; 308 (52.5%) were returned. Only 10.4% currently provide obstetric services; 56.4% did so in the past. Physicians in urban practices were significantly more likely to offer obstetric services than those in rural practices (13.9% and 6.7%). The most common barriers related to the cost of malpractice insurance and protection from legal liability (32.8%), followed by lack of coverage (19.7%), not having enough time (12.8%), and lifestyle protection (11.3%). Respondents who provided obstetric care in the past were not significantly more likely to identify the cost of malpractice insurance as a barrier than those who had never provided OB services (35.9% and 29.1%). Barriers to providing obstetric services by Louisiana's family physicians result in only 1 in 10 doing so despite the emphasis given to obstetrics in their residency programs.

Attitude of Health Personnel↗
PubMed1975

Malpractice law and the dietitian.

The recent increase in lawsuits against health care personnel makes it advisable that dietitians recognize the potential for legal liability as they practice their profession. Whatever the exact nature of a dietitian's daily duties, an awareness and understanding of the concepts governing the law of malpractice will enable him/her to minimize exposure to liability. To accomplish this, the dietitian should exercise at least a standard of care accepted as competence for the profession. By so doing, the dietitian can insure not only less exposure to malpractice suits, but also attainment of an important goal: delivery of high-quality care to patients.

Diet Therapy↗
PubMed2002

[Advance medical directives].

A patient's rights to autonomy and to participate in the decision making process is a fundamental ethical principle. However, for the non-competent patient, participation in decision-making is more problematic. A survey carried out in Israel found that less than half of the offspring of terminally ill elderly patients knew the request of their parents regarding life-supporting measures. A solution to this problem is the use of medical advance directives (MADs). In the U.S.A (in 1991) it was required by a federal law to inform every hospitalized patient of his right to use MADs. The experience from the use of MADs in the USA during the last 10 years show that: 1) Most lay persons as well as medical staff support the use of MADs 2) The rate of the use of MADs is about 20%, and among long term care hospitalized patients it is even higher. 3) Sex, age, level of education, morbidity and income were found to be significant factors. 4) Education on the use of the MADs raised the rate of use. 5) Most of the patients who had MADs did not discuss the issue of life supporting treatment with their physicians. 6) Patients who had MADs received less aggressive treatment with reduced medical cost. 7) There is a preference to write generic MADs. Arguments supporting the use of MADs state that they: extend patient autonomy; relieve patient anxiety regarding unwanted treatment; relieve physicians' anxiety concerning legal liability; reduce interfamily conflicts, and they also lower health care costs. Arguments opposing the use claim that they: violate sanctity of life; promote an adversarial physician-patient relationship; may lead to euthanasia; fail to express the patient's current wishes and may even counteract physicians' values. On the basis of experience in the USA and the positive attitude regarding MADs, it appears that MADs can also be applicable in Israel.

Advance Directives↗
PubMed2002

Business law. Fundamentals for the occupational health nurse.

1. A basic understanding of the judicial system will enable occupational health nurses to read court opinions and have a better understanding of whether or how they or their companies are affected by the decision. With this knowledge, occupational health nurses can help their organization avoid legal liability by ensuring that the company does not act contrary to the decisions of the controlling courts. 2. As they are often involved in the process of contracting for goods and services, occupational health nurses need to be aware of general contract terminology and negotiating techniques so they will be better able to protect their companies. In addition, occupational health nurses can also assist in the actual contract drafting process with knowledge of a few concepts, such as the description, caption, operative language of the agreement, and definitions, of a contract. 3. Occupational health nurses are often called upon to be expert witnesses and can play an integral part in the litigation process. Because of the importance of expert witnesses, occupational health nurses must have an understanding of how to effectively provide expert witness testimony.

Commerce↗
PubMed2003

Off-label use of prescription medication: nursing implications.

Although the FDA has stated that an approved medication may be prescribed for an off-label use, practitioners who prescribe, dispense, or administer these agents should have a full understanding of the rational for such use, as well as the potential legal liabilities. Nurses are responsible for their patients and must be concerned about the consequences of their actions so as not to incur liability (Christensen, 2002). The decision to use drugs for unapproved treatments should be based on an understanding of the risks and benefits of such treatment to the patient. This is especially important to nurses, many of whom work with other medical personnel who prescribe off-label drugs for patients. This issue is also of concern to nurse practitioners who have prescribing privileges and may be directly involved with recommending off-label uses of drugs. The potential for unexpected adverse effects should always be a concern when drugs are used in an off-label manner (Breton, 2001).

Drug Approval↗
PubMed2003

Undesirable reactions of domestic pigeons to vaccination against paramyxovirus type 1.

Subcutaneous vaccination of fancy and racing pigeons with inactivated oil-based vaccines protects against all clinical manifestations caused by the Paramyxovirus type 1. Correct application of the vaccine may occasionally result in the development of granulomas or abscess-like lesions on the site of vaccine application. Although protected against disease as proven by challenge experiments, a variable proportion of vaccinated pigeons do not react with the formation of detectable serum antibodies. The pathogenesis of granuloma and abscess-like lesion developments and the failure to form humoral antibodies are presently not understood. Questions relating to legal liability of vaccinating veterinarians are briefly discussed.

Abscess↗
PubMed2005

Grant's Application: it's time for a new approach to a "public interest" exclusion from patentability.

This article reviews the recent IP Australia decision in Grant's Application [2004] APO 11 about an innovation patent for a way of protecting assets against a loss of ownership as a result of a legal liability. The significance of this decision was to expose the tortured reasoning necessary to exclude from patentability an invention that was arguably contrary to the "public interest". The article asserts that the effect of the decision revoking the patent was correct, but that the reasoning points to a need to reconsider the "public interest" limits on patentability. The article then considers the approach that should be adopted in formalising a "public interest" exemption from patentability that is practical and generally applicable.

Australia↗
PubMed1992

The utilization of medical and nonmedical specialties in the assessment of child abuse in the military community.

The Family Advocacy Program is a Department of Defense-mandated program that is administered individually by the branches of the U.S. Armed Forces. Factors were sought that may influence the ultimate disposition of a suspected abuse case on a given base. Navy Child Abuse Subcommittees were exclusively chaired by pediatricians, while the Army and the Air Force used social workers and psychologists. The Army and Air Force used the same medical specialists to run the larger Family Advocacy Programs, while the Navy used non-medical active duty officers. Base authorities made the final judgment to implement a treatment plan more frequently at Navy and Army commands. The implications of overutilization of medical specialists and increased legal liability of non-medical personnel are discussed.

Child↗
PubMedDate not supplied

Responding to an emergency in and out of the office.

Moral duties aside, a physician generally has no legal liability to a stranger in a medical emergency if the physician decides to do nothing so long as the physician is not under a pre-existing duty or has created a risk of harm to such stranger. Missouri, like any other state, has a Good Samaritan statute specifically designed to encourage medical care providers to offer assistance to injured persons at the scene of an emergency or accident. Although, the statute on its face draws the line between ordinary negligence and gross negligence in extending the immunity to any qualified rescuer who provides emergency medical care without compensation at the scene of emergency, no Missouri case law has recognized "gross negligence" as a cause of action at common law. The practical effect is that it is unlikely any qualified rescuer will be held liable for a victim's injuries when the care was rendered in good faith during emergency and without compensation, however negligently, unless there is willful or wanton misconduct on the part of such rescuer.

Emergency Medical Services↗
PubMedDate not supplied

Ingestion of dental mirror fragments: report of case.

A case is reported in which one treated pediatric patient gave his plastic, disposable dental mirror to a 2.5-year-old sibling, who while playing chewed on the mirror and the mirrored glass surface broke in the child's mouth. After thorough examination including x-rays, the patient was released with no further complications. Potentially severe injuries could have occurred, resulting in legal liabilities.

Child, Preschool↗
PubMed1990

Emergency patients who leave without being seen: are urgently ill or injured patients leaving without care?

Against Medical Advice (AMA) patients present troubling legal liabilities for emergency medicine physicians. One subset of AMA patients, those who present for care but leave the emergency department prior to evaluation by a physician, represent a potential source of liability. A total of 291 consecutive "Left Without Being Seen" (LWBS) patients were retrospectively studied to see how many died, required admission, or returned for outpatient medical care within 7 days. Nearly half (44%) were found to seek repeat care at clinics or the Emergency Department. Only 5 of 291 (1.7%) required admission. There were no documented deaths. Because of the difficulty in reliably predicting which patients would choose to leave without being seen, an attempt was made to identify specific LWBS patients who would seek a return visit or require admission. With the exception of one specific age group (infants less than 12 months of age), or a chief complaint referable to the cardiovascular system, no presenting parameter of the LWBS patient, including sex, chief complaint, duration of chief complaint, wait in the emergency department, and vital signs, was significantly helpful in differentiating those patients who would later return or require admission.

Adolescent↗
PubMed1990

Residents' views of the value of moonlighting.

The opportunity for residents to moonlight is threatened by legal liability concerns and legislation designed to limit the duration of workdays and workweeks. We sought the opinion of all 40 second- or third-year residents and fellows in a hybrid university/community hospital internal medicine residency program regarding their motivation to moonlight and the value of their experiences. Sixty-five percent were moonlighters; moonlighters had a higher average debt ($41 644) than nonmoonlighters ($32 917). Residents viewed moonlighting as a positive educational experience that helped them with career decisions. They believed they acquired important skills and knowledge not learned elsewhere, and that moonlighting did not interfere with their job and educational responsibilities. A program in operation for 10 years that was designed to control, monitor, and facilitate moonlighting experiences is described. We believe our residents' positive views may be in part a result of the supervision and integration of moonlighting in a residency training program with a controlled workload.

Attitude of Health Personnel↗
PubMed1989

[Injuries and traumatic fatalities in sports with special reference to criminal responsibility].

Out of 13 deaths connected with sport, seven were due to a natural death (coronary death) and six were of traumatic origin (cranial and spinal injuries predominated). On the basis of such cases of sport death and expertise on sport injuries with regard to their etiology, the appraisal of sport accidents with regard to legal liability is described. Questions of liability apply both to the institutions responsible for sporting facilities in injuries indirectly connected with sport as well as fellow sportsmen/women as causers of accidents.

Accidents↗
PubMed1986

Perimortem cesarean delivery.

Postmortem cesarean delivery is an operation that has been practiced since antiquity. In previous centuries low infant survival rates led to negative opinions regarding the operation's usefulness. A review of the past centuries' cases and a review of fetal physiology suggest that to obtain optimum infant survival, cesarean delivery should be initiated within four minutes of maternal cardiac arrest. The physiology of cardiopulmonary resuscitation during pregnancy is analyzed, and recent cases of maternal cardiac arrest with successful maternal resuscitation are reviewed. This data suggests that perimortem cesarean delivery initiated within four minutes of maternal cardiac arrest will yield the highest rates of maternal survival. Legal liability from the operation is minimal.

Cesarean Section↗
PubMed1987

Performance management: an essential program for poison centers.

Medico-legal liability and cost effectiveness mandate that poison information specialist performance be optimal. To maximize performance we developed and implemented a performance management program to achieve the objectives of high quality assurance in a cost-effective environment. The program can objectively assess, monitor, develop, discipline and financially compensate poison center staff. The performance standards, jointly developed by the staff and management, are the cornerstone of the program. They serve as a means of measuring and quantifying poison information specialist performance based upon compliance with responsibilities outlined in the standards. Our program enables the poison information specialist to optimize performance and also be cognizant of suboptimal work. Each staff person works with management to develop personal goals, objectives, and a plan for professional growth. Performance standards facilitate good management by improving communication, providing objective feedback, making orientation consistent, and providing an objective basis for promotion and compensation. They also provide an objective basis for dismissing unsatisfactory employees when performance is consistently suboptimal. Since personnel salaries account for 80% of a poison center's budget, effective performance management is essential.

Employee Performance Appraisal↗
PubMed1987

A program of poison center services to business and industry.

Poison information centers have been developed to serve the poison information, treatment, and prevention education needs of the residents within their regions. These services are generally provided and funded by hospital-based centers. A limited number of centers receive local and state government financial support. In general poison information centers are nonrevenue-generating and rely upon these sources of fiscal support. As cost containment within the health care industry becomes more critical, poison centers are falling victims to budget cuts and even being eradicated in the interest of saving money. The private sector has provided grants to poison centers, but this represents a short term solution to a long term problem--the need for consistent funding. Business and industry have been overlooked as a source of potential revenue. Our poison center has developed an extensive program of services for the private sector. These include providing 24-hour-a-day poison information service on their behalf; developing a workers' right-to-know program; identifying epidemiologic trends with their products, preparing exposure reports; etc. These services are provided for a specific fee which is determined by anticipated call volume, number of products to be included, medical and legal liability, etc. By providing services to the private sector, we have reduced the financial liability of our poison center by over 25%.

Commerce↗