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PubMed1994

A statistical model for predicting the outcome in breast cancer malpractice lawsuits.

OBJECTIVE: To analyze specific medical, legal, and cost factors that predict the probability of successfully defending lawsuits filed because of failure to diagnose breast cancer. METHODS: Seventy-six malpractice cases handled by the Massachusetts Medical Professional Insurance Association between June 29, 1983 and December 30, 1993 were abstracted and analyzed using univariate analysis, multivariate stepwise logistic and least-square regression analysis, and the Cox proportional hazards model to identify statistically significant associations between clinical factors and medicolegal outcomes. RESULTS: Obstetrician-gynecologists were defendants in the largest number of cases (38) and incurred the highest total indemnity ($7,629,570). The probability of defending a suit successfully increased with smaller tumor size and younger patients (less than 40 years of age). The failure to perform a biopsy was associated with a decreased probability of successful defense. Variables predicting high case cost included younger patient age, an increased length of delay in diagnosis, and the failure to perform a biopsy. The presence of metastasis at diagnosis was associated with an increased interval from diagnosis to the initiation of a suit. CONCLUSION: Statistical models that use medicolegal and cost factors can predict both the probability of a successful defense and the total cost of a breast cancer malpractice case.

Adult↗
PubMed1994

Proposed changes in malpractice law. Are they enough?

Most of the healthcare reform plans recently introduced in Congress propose changes in medical liability law. Will these changes suffice to stem the rising tide of malpractice suits? How will healthcare professionals be affected by the legislation? The authors, a physician and an attorney, address these and other questions as they analyze the malpractice provisions of five plans and offer their own recommendations for reform.

Fees and Charges↗
PubMed1993

Patient-centered computing: can it curb malpractice risk?

The threat of a medical malpractice suit represents a major cause of career dissatisfaction for American physicians. Patient-centered computing may improve physician-patient communications, thereby reducing liability risk. This review describes programs that have sought to enhance patient education and involvement pertaining to 5 major categories of malpractice lawsuits: Diagnosis, medications, obstetrics, surgery, and treatment errors.

Computer Systems↗
PubMed1993

Psychiatric malpractice: the low frequency risks.

This article updates a long-term study of psychiatric malpractice. The American Psychiatric Association professional liability insurance programme has insured an average of 10,000 psychiatrists each year since 1984. Two thousand malpractice insurance cases have been entered into a purpose configured relational database to permit analysis of clinical, demographic and economic variables. The results to date are reported and specific low frequency risks identified. Their significance for governmental and private sector mental health professionals is discussed.

Databases, Factual↗
PubMed1993

Listening and talking to patients. A remedy for malpractice suits?

This study evaluates the hypothesis that the way physicians communicate with patients and the degree patients perceive physician fault for bad medical outcomes are risk factors for the initiation of malpractice lawsuits. The study involved 160 adults who viewed a videotape of a physician treating a patient while using either positive or negative communication behaviors. Participants were told that the case had either a positive result, a bad result through no fault of the physician, a bad result for uncertain reasons, or a bad result that was the physician's fault. Participants then rated their litigious feelings. Results showed that the use of negative communication behaviors by the physician increased litigious intentions. An increased perception of physician fault for the bad result also increased litigious intentions. Uncertainty as to the reason for the bad outcome, however, raised litigious feelings nearly as much as did perceived physician fault. The results of the study support the hypothesis that altering the way physicians communicate and improving patient education can affect the risk of malpractice lawsuits.

Adult↗
PubMed1993

The effects of malpractice on Mississippi physicians.

Medical malpractice and its effects on physicians in Mississippi is reviewed to assess its effects upon decisions in practice, patient care, and the physical and emotional toll on physicians. Through a random survey of 500 physicians in Mississippi across all areas of medicine it was determined that 47.3% of the respondents had been involved in malpractice litigation, a higher percentage than the United States average in 1989. The predominant emotional response to litigation was anger. Most physicians did not seek outside help as an aid in coping.

Adaptation, Psychological↗
PubMed1993

Comparison of German and United States malpractice systems.

Germany has successfully contained overall health-care costs while providing virtually universal access to high quality services. The country's medical and legal systems create a climate characterized by less pressure for malpractice litigation and greater efficiency of resolution. This analysis reviews characteristics that may be useful in reducing the $20 billion annual costs associated with medical malpractice in the United States. Some features of the German model may be unattractive. Further investigation appears warranted.

Cost Control↗
PubMed1996

A new resource for managing malpractice risks in managed care.

The risk of malpractice liability faced by physicians is exacerbated by third-party intrusions such as those encountered in today's managed care environment. The likelihood that a malpractice action will be brought is increased by the interaction among patients, families, or physicians who are at high risk for litigation and situations (eg, denial of treatment benefits by the managed care organization) that create adversity. To prevent the ready translation of resource adversity into an adversarial physician-patient-family relationship, a forensic psychiatric consultation is recommended.

Family↗
PubMed1977

Where is the malpractice crisis taking us?

There have been several approaches taken to solve the malpractice insurance problem in this country. However, since the cost of malpractice insurance continues to climb, the changes so far have not solved the problem, and more changes seem inevitable. A major change could be the development of a patient insurance plan that would provide compensation for certain injuries related to medical care. The insurance coverage would be centered on hospital care. If certain requirements are met, the plan may not be more expensive than the current tort liability system, and would offer several advantages. In addition to the patient injury insurance, there could be federal assumption of liability for national immunization programs.

Costs and Cost Analysis↗
PubMed1996

[Development of expert assessment in the malpractice lawsuit from the viewpoint of the judge].

The expert testimony in medical malpractice suits is being criticized until today. The most important objection: The medical experts do not obey their duty to be impartial; they are reluctant to testify against their colleagues regardless of the merits of the plaintiffs' case. But owing to ignorance they often violate further duties they have to comply with as experts, too. The medical profession in the past neglected the instruction-of physicians, who act as experts in malpractice cases. But judges are also responsible for the situation: Not in all cases they do pay enough attention to the selection, instruction and questioning of the medical expert. Many mistakes made in the field of expert testimony meanwhile are recognized and eliminated. Nevertheless seminars for the further instruction of physicians and lawyers are urgently necessary in order to improve the medical expert testimony.

Criminal Law↗
PubMed1997

Malpractice in gynecologic cytology: a need for expert witness guidelines.

The malpractice claims activity in anatomic pathology has sharply increased in recent years. On a relative and absolute basis, a leading area of increase for claims is cervicovaginal (Pap smear) cytology. As never before, pathologists are faced with the threat of litigation and acting as defendants in medical-legal actions. Defending claims of malpractice in Pap smear litigation can be difficult. The expert witness for the plaintiff often performs a selective retrospective review of the Pap smear of the plaintiff, compared with the screening examination performed by the defendant. In addition, it is unclear whether atypical or dysplastic cells are within the standard of practice and should be discovered by the Pap smear screener. A proposal for a forum to develop guidelines for expert witness testimony in Pap smear cytology is discussed.

Expert Testimony↗
PubMed1998

[Malpractice claims against radiologists. Analysis of the five-year period 1993-1997].

INTRODUCTION: The insurance claims against Italian radiologists over a five-year period (1993-97) were anonymously evaluated, based on pertinent data provided by the Insurance Company of the Italian Society of Medical Radiology. MATERIAL AND METHODS: The database analyzed represents over one third of Italian radiologists. A total number of 171 insurance claims were analyzed and classified by cause as due to: 1) misidiagnosis; 2) alleged malpractice when performing the examination; 3) missed referral to other diagnostic/therapeutic procedures; 4) iatrogenic lesions by ionizing/nonionizing radiations; 5) patient's injury occurring during the examination; 6) lawsuits after the Italian Code of Criminal Procedure (art. 589) in case of patient's death (although not directly related to the radiologist's work). RESULTS: In the first three-year period, the rate of claims was 25.8 per thousand persons/year. Each Italian radiologist has a 90% risk of being sied by a patient once in his/her professional life (35 years). Alleged malpractice accounted for more than 75% of the claims. Misdiagnosis represented the first and most important claims category (43.9% of total). The most common misdiagnoses were the failure to diagnose lesions affecting bones and joints, chest, abdomen and breast. The second most important claim category (20.5%) was complications, frequently occurring during interventional procedures and contrast media injection. Fewer claims (7.6%) originated from patient's injury occurring in the radiology department during the execution of the examination. Finally, radiologists were frequently sved together with medical (or surgical) doctors in case of patient's death, according to the Italian Code of Criminal Procedure. CONCLUSIONS: Legal claims against radiologists are a relevant phenomenon also in our country and represent an actual risk for radiologists' professional activity.

Humans↗
PubMed1998

Forensic medicine, its tasks and duties in medical malpractice and medico-legal litigation.

Forensic medicine assists in clarification of cases of violent death, assessment of bodily damage and indemnity, especially in cases of work injuries, it also deals with deaths that occur within two hours of a doctor's intervention. As "legal medicine", forensic medicine is taught both to medical students and to students of the juridical faculties. In cases of medical malpractice, forensic pathologists give opinions in courts. Cases of alleged malpractice are handled differently in different countries. Establishment of expert committees in the Czech Republic represents a reasonable solution to this problem. Activities of the committees are described.

Czech Republic↗
PubMed1998

[Revision of the medical malpractice law? Need for action and reform from the viewpoint of the physician].

With regard to the revision of the criminal code, the BJM has suggested two regulations concerning the lawsuit of medical malpractice. The text expounds the contence of section 229 E (wrongful treatment, personal injury) and section 230 E (unwillful negligence). It appears disturbing that constitutes for wrongful treatment in the context of assault upon the patient have been included in criminal law so the offence is now rated at the same level as (grievous) personal injury. The aim of the revision being further protection of personal rights and the right of self-determination. The proposed section 229 E and section 230 E are not able to guard the clinician against allegations of assault under criminal law prosecution. The code of civil law should suffice to balance most conditions of malpractice and assault upon the patient. Prosecution by criminal code should be held back for willful offences and wanton or reckless negligence.

Germany↗
PubMed1994

The admissibility of scientific evidence in psychiatric malpractice: junk science and the Daubert case.

The defence in malpractice cases has traditionally relied upon a commonly accepted body of knowledge. According to the American 'Frye rule', this knowledge could either have been accepted generally or by a 'respectable minority' of physicians. The US Supreme Court, however, has recently ruled in the Daubert case that conclusions not subject to peer review are acceptable in malpractice cases. The authors analyse the implications of the Daubert decision using the case-study method. Two alternative-scenarios of a hypothetical case are analysed. The potential effect of Daubert places the US psychiatrist-defendant in an untenable position. Either use or non-use of non-peer-reviewed studies in clinical practice could produce a finding of negligence. Furthermore, the responsibility to assess scientific acceptability in US courts has shifted from expert witnesses to judges who are usually without scientific training.

Journal Article↗
PubMed1998

Applying no-fault compensation criteria to obstetric malpractice claims.

Objective: To determine in obstetric malpractice cases the incidence of adverse events (AE), defined in the litigation literature as an injury caused by medical management, and to determine the proportion of cases that would meet no-fault criteria.Methods: In a retrospective cohort design, all neonatal outcome claims (n = 47) occurring between January 1992 and December 1993 were reviewed from carriers in Massachusetts, Colorado, and Utah. Two obstetricians determined whether an AE occurred, as defined above. The cases were then reevaluated according to Swedish Compensatory Event (SCE) criteria, which compensate AEs due to avoidable or substandard care, and to Florida Neurological Injury Compensation Association (NICA) criteria, which compensate neurologic injury following peripartum oxygen deprivation or mechanical injury.Results: An AE occurred in only 23/47 claims, representing 49% (95% CI 34-64%). SCE criteria were met in all 23 of the cases with an AE. NICA criteria were met in 9/23, or 39% (95% CI 19-61%), of the cases with an AE. Neither SCE nor NICA criteria were satisfied in any of the 24 cases without an AE. There were strong relationships between an occurrence of an adverse event and fulfilling criteria for SCE (P <.001) and NICA (P <.001).Conclusion: Neonatal injury caused by medical management occurs in less than half of the obstetric malpractice claims. No-fault compensation criteria can be successfully applied to claims, and both the SCE and NICA methods are specific in avoiding compensation to claims without an AE. The SCE criteria are more sensitive than the NICA criteria for compensating AEs. Applying the SCE system to claims would result in a larger proportion of claims successfully meeting no-fault criteria than using the NICA system.

Journal Article↗
PubMed1987

Accounting guidelines developed for malpractice claims.

Recently, the AICPA developed a Statement of Position on medical malpractice claims of healthcare providers. The statement was developed to provide guidance and consistency for accounting and reporting practices for healthcare providers. The proper application of the Statement of Position requires a thorough understanding of the provider's claim and incident identification procedures. And this understanding becomes more critical as providers begin to realize the restrictive opportunities of conventional malpractice insurance coverage.

Accounting↗
PubMed1989

Implementing medical staff malpractice insurance requirements.

Hospitals have recently begun to explore and adopt medical staff membership criteria that go beyond simply determining a practitioner's ability to practice medicine. Medical competence and expertise will always play a central role in medical staff membership decisions. However, the increasing competition among hospitals for patients with the attendant pressure to contain health care costs has caused hospitals to consider business factors in the composition of their medical staffs. To ensure their own survival, hospitals need to be efficient and sensitive to the financial dynamics of the industry as they determine the composition of their medical staffs. One response to the new business reality of health care by hospitals is the adoption of minimum medical malpractice insurance requirements for medical staff members. In large part, hospitals have adopted these requirements at the insistence of certain insurance carriers. Although there has not been much litigation over this issue, a handful of cases has held that such requirements are reasonable because they help to protect the hospital's assets and to ensure that patients have a source of funds for recovering damages caused by malpractice. These courts have recognized that it is a board's duty to protect the financial well-being of the hospital and that such requirements help to satisfy this duty. This article will describe the case law that upholds such requirements, analyze the problem regarding practitioners who cannot comply with a hospital's insurance requirements because such coverage is not available to them, and discuss the problems and possible resolutions regarding adoption and implementation of such a requirement.

Insurance, Liability↗