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PubMed2007

[Expert opinion aspects of thrombosis prophylaxis].

The boom in medical liability shows no sign of easing even for thrombosis prophylaxis, so that it is becoming increasingly more common that experts must decide whether this has been correctly carried out. From this point of view they are legally only "assistants" to the judge, but practically they make the decision in liability disputes. It is therefore of great importance that the experts fulfil their key role in an unbiased and professionally competent manner and limit their opinions to their own field of expertise. They must also be fully aware of the different prerequisites for liability in both civil and criminal proceedings and the legal definitions of, for example the terms "standard medical professional practice", "grossly" negligent treatment, "a probability bordering on certainty", "obligation to the evidential value" and be familiar with the facts in question. Without this necessary knowledge in the legal field, regrettable judicial errors will always reoccur.

Anticoagulants↗
PubMed1995

[Medical malpractice from the viewpoint of the insurer].

The task of the insurer for medical liability insurance is to care about the interests of the contract partner by defending unjustified claims, satisfying claims of compensation of harmed patients, and supporting the medical society in developing methods to prevent harm. The criminal law and the liability law are demonstrated.

Germany↗
PubMed1990

Barriers to prescribing the Copper T 380A intrauterine device by physicians.

From a questionnaire sent to all obstetricians and gynecologists and all family and general practitioners in San Diego County, California, regarding the Copper T 380A intrauterine device, substantial barriers to prescribing it were identified. Of all physicians responding, 40% reported that they were not recommending the Copper T 380A to anyone, the single most common reason given being concern about medical liability. A lack of knowledge about the new device, a lack of intrauterine device insertion skills, and certain medical practice settings were also important barriers to prescribing it. The new intrauterine device is considered in the context of innovation-diffusion theory. Substantial amounts of education and training and improvement in the medical-legal climate are needed before current barriers to prescribing the new device are removed.

Attitude of Health Personnel↗
PubMedDate not supplied

Implant dentistry at the focus of liability lawsuits.

PURPOSE: In recent years, the growing readiness on the part of dental patients to take legal action has resulted in an increasing number of medical liability lawsuits. The aim of this retrospective analysis was to highlight aspects of these lawsuits of special significance, to subject them to both qualitative and quantitative analysis, and to show how conflicts can be avoided. MATERIALS AND METHODS: Forty relevant court decisions from the year 1984 onwards were found in online databases and through direct inquiries at the courts. These were supplemented by 21 reports prepared by experts at the University of Muenster, Department of Dental Medicine, commissioned by courts in connection with ongoing lawsuits. Analysis was initially based on formal aspects of the cases and reports. It was later supplemented by differentiated assignment of the questions addressed by the courts to the expert consultants. The principles underlying the judgments as to the liability arising from the terms of the contract were also assigned to the expert consultants in a differentiated manner. RESULTS: The results revealed marked differences in the frequency of liability-prone aspects of treatment. While the majority of judgments referred to the obligation to take due care during the preparatory and treatment phases, infringement of the obligations to provide information and to keep records played more than a minor role. Moreover, 90% of all cases represented combined charges covering various aspects, including those related to consequential failings. DISCUSSION AND CONCLUSION: The detailed qualitative analysis of the grounds quoted and of the lines of reasoning can therefore be summed up in clearly defined recommendations aimed at helping the clinician avoid conflicts by observing the judicial requirements.

Compensation and Redress↗
PubMed1994

XNEOr: development and evaluation of an expert system to improve the quality and cost of decision-making in neuro-oncology.

The treatment of brain tumors requires a large team of medical experts. However, the process of medical decision-making for these patients is hampered by the frequent inaccessibility of the experts because of conflicting scheduling, inconsistencies in the management of different patients, and the fact that multiple experts often yield multiple opinions. The goals of this work were (1) to develop and validate an expert system to assist the medical team deliver efficient, quality care to children with recurrent medulloblastoma, a common type of pediatric brain tumor, and (2) to determine if the expert system can be used as an educational tool. The results of our study indicate that residents enjoy learning by using XNEOr, the brain tumor expert system. XNEOr enabled residents to order appropriate ancillary tests for patients and to make fewer incorrect treatment decisions. The potential net effect of residents using XNEOr may be increased patient and family satisfaction and decreased probability of medical liability. At a time of important changes in our health care system, novel expert systems hold promise as tools to reduce medical costs, improve the quality of multi-expert medical care, and advance health care education.

Brain Neoplasms↗
PubMed1994

Pregnancy care liability misperceptions among medical students in Florida.

BACKGROUND: Previous studies have demonstrated a professional liability insurance (PLI) fee misperception among medical students that had a direct influence on their subsequent decision making concerning the provision of pregnancy care (PC) in family practice (FP). In Florida, the paucity of family physicians providing PC and prenatal services led to the present study, which was designed to survey those senior medical students in Florida who were interested in FP to determine their opinions regarding pregnancy care-related liability issues. METHODS: All fourth-year medical students in the three allopathic medical schools in Florida who were members of a family practice interest group (FPIG) were mailed a short questionnaire by an independent researcher. The questionnaire asked students about a) whether they planned to deliver babies in practice, b) the cost of first-year liability insurance, and c) the risk of being sued if they provided PC in family practice. RESULTS: Fifty-one medical students (64% of the FPIG members in Florida) provided responses to the mail survey. Of the 51 respondents, 57% plan to enter FP residencies, and 31% were either somewhat likely or very likely to provide PC in FP. Those unlikely to do PC listed PLI cost and risk as their primary concerns. A comparison of medical students planning to provide PC with those not planning to provide PC services revealed average estimates of PLI premiums that were discordant by $5,000 per year. Furthermore, estimates in both groups exceeded the actual first-year rates of PLI insurance by more than $20,000 per year. Ninety percent of the students estimated that the actual risk of being sued for malpractice while providing PC was "high." Students' perceptions of PC PLI cost, and risk of being sued, were learned primarily from sources outside of the medical school. CONCLUSIONS: This study suggests a problem in the medical education of FP-bound students that allows students to develop misperceptions about the liability cost and risk of providing PC in FP.

Adult↗
PubMed2006

Trends in malpractice premiums for dermatologists: results of a national survey.

OBJECTIVE: To analyze professional liability premiums in dermatology and factors associated with premium variation. DESIGN: This study examines data from a survey of dermatologists conducted in 2004. RESULTS: Survey respondents (n = 1095) reported mean medical liability premiums of $10,898 in 2004 (95% confidence interval, $10,295-$11,501). Premiums increased by 24.4% in 2003 and 16.7% in 2004. There was substantial variation by state, and mean premiums were higher in American Medical Association (AMA)-declared "crisis states" than in those states listed as "currently OK" ($11,669 vs $9527; P = .03). Premium growth from 2002 through 2004 was higher in AMA crisis states and in states without $250 000 caps in place for noneconomic damages. Even when excluding payment for cosmetic riders, premium levels were higher for dermatologists spending more than 10% of their time in cosmetic practice ($13,816 vs $10,185; P<.001) or more than 30% of their time in noncosmetic surgery ($12,551 vs $10,453; P = .01). CONCLUSIONS: While premiums paid by dermatologists for professional liability insurance in 2004 were well below those experienced by higher-risk specialties, geographic factors and state tort law variation seem to be affecting dermatology premiums in much the same way they affect the field of medicine as a whole.

Costs and Cost Analysis↗
PubMed1987

The effect of malpractice liability on the delivery of rural obstetrical care.

A telephone survey of all non-governmental obstetricians, family physicians, general practitioners, and osteopathic physicians in rural Arizona was undertaken to determine the effects of medical liability issues on the availability of rural obstetrical services. One hundred ninety-one (88.8%) responded, and after exclusion of those who had never provided obstetrical care, 126 physicians remained for evaluation. These included 32 obstetricians, 55 family physicians, 25 general practitioners, and 14 osteopaths. During the past three years, 26 (20.6%) had discontinued providing obstetrical service, citing liability issues as the reason. An additional 12 physicians (9.5%) planned to discontinue obstetrics upon expiration of their 1986 malpractice insurance policy. By the end of 1986, the number of obstetrical providers in rural Arizona will have decreased by 30.1 percent. Women in many rural areas already have pregnancy outcomes that are inferior to their urban counterparts. A further decrease in the availability of obstetrical providers may have additional adverse effect on pregnancy outcomes.

Arizona↗
PubMed1989

The legal liability of the medical consultant in pregnancy.

The potential for professional liability that accompanies complications associated with obstetric care can be minimized by an understanding of the roles and responsibilities of both the consultant and the obstetrician. Critical to this is a fundamental knowledge of the medical malpractice action from a legal perspective. This article discusses several issues involved in professional liability as it relates to the obstetrician/gynecologist.

Clinical Competence↗
PubMed2006

Ethical issues in medical malpractice.

The interrelationships between biomedical ethics and the law are perhaps nowhere as starkly apparent as in the realm of medical malpractice. Although ethical and legal conduct and practices are often in harmony, in many areas ethical principles and the issues surrounding medical liability appear to come into conflict. Disclosure of errors; quality improvement activities; the practice of defensive medicine; dealing with patients who wish to leave against medical advice; provision of futile care at the insistence of patients or families; and the various protections of Good Samaritan laws are just a few of these. In addition, the ethical principles governing the conduct of physicians serving as expert witnesses in medical malpractice cases have become a subject of intense interest in recent years.

Advance Directives↗
PubMed1979

Comparison of state legislation regarding professional liability.

The so-called malpractice crisis of the mid-1970s alerted physicians to the need for legislative involvement in order to achieve needed malpractice tort reform. There has been a positive effort to modify the medical liability situation in each of our 50 states. A review of this legislative activity from 1975 through 1977 is presented. It is anticipated that a new malpractice crisis may develop during the early 1980s. Actuarial data now being collected plus the effects of such innovations as arbitration, pretrial screening panels, collateral source rules, and periodic funding of malpractice claims may provide an equitable approach to any future malpractice tort reform.

Humans↗
PubMed1990

'Puffing' in medical advertising expands liability.

Advertising is nothing new to the medical profession, although for many years reputable doctors did not advertise their skills. In 1975, the Federal Trade Commission (FTC) successfully argued in a case that was appealed to the Supreme Court that the AMA had unlawfully restricted medical advertising. While the FTC usurped the job of policing medical advertising, it seems to regard medical adverstising as a local problem not worthy of FTC attention. It has avoided setting standards for medical advertising and has failed to initiate significant enforcement against deceptive medical advertising. This article briefly reviews the historical role of advertising in modern American medicine and discusses advertising in relation to risk management.

Advertising↗
PubMed2006

Payment for telephone care.

Telephone care in pediatrics requires medical judgment, is associated with practice expense and medical liability risk, and can often substitute for more costly face-to-face care. Despite this, physicians are infrequently paid by patients or third-party payors for medical services provided by telephone. As the costs of maintaining a practice continue to increase, pediatricians are increasingly seeking payment for the time and work involved in telephone care. This statement reviews the role of telephone care in pediatric practice, the current state of payment for telephone care, and the practical issues associated with charging for telephone care services, a service traditionally provided gratis to patients and families. Specific recommendations are presented for appropriate documenting, reporting, and billing for telephone care services.

After-Hours Care↗
PubMed1987

Retiree medical benefit plans and the impact of the bankruptcy filing of LTV Corp.

In the past two decades, post-retirement medical benefit programs have become a significant feature in the benefits packages of many employers. Soaring medical costs and decreasing work forces have made it increasingly difficult for employers to pay for these programs, while at the same time, Congress has made it more difficult for employers to prefund them. The critical level of unfunded retiree medical liability faced by many companies was brought to prominence when LTV Corp., the nation's second largest steel producer, filed for bankruptcy reorganization and promptly terminated its retiree medical benefit plan.

Aged↗
PubMed1992

Physician relations: an evolving service not meeting its potential.

The relatively new concept of physician relations can help hospitals work with their medical staff as colleagues rather than competitors. Every hospital has someone performing at least some physician relation tasks, but too often that person is at the level of an administrative assistant. Only a few hospitals have full-blown physician relations departments with full responsibility for medical staff relations, quality assurance, credentialing and medical liability.

Florida↗
PubMed1991

Managed care's paradoxical effect.

This paper addresses the efforts made by the managed care industry to cut costs in the spending of the health-care dollar. It focuses on what appears to be disproportionate attention being paid to the dollar at the expense of appropriate patient care. It examines the effects of cuts in the mental health-care dollar as this relates to shorter lengths of stay in more expensive settings and not effectively utilizing a continuum of care. It also shows how managed care has impacted medical liability and the legal implications thereof.

Adolescent↗
PubMed1987

The future of pathology. Council on Long Range Planning and Development.

The American Medical Association Council on Long Range Planning and Development has identified trends in the environment of medicine and has assessed their likely implications for the pathology specialty. Competition and economic pressures focused on the hospital setting are likely to continue to affect the choice of delivery site for pathology practice. During the past decade, the pathology specialty has been subject to extensive regulation, placing a new focus on the role of the laboratory within the hospital and generating new ventures for the provision of pathology services. A continuing challenge to the specialty is management innovation and adaptation in the face of regulatory restrictions and cost-containment experiments. The significant forces for change affecting the demand for services and the shape of future provision of pathology services include rapid advances in technology and scientific knowledge, funding for biomedical research, training for research pathologists, demographic trends in the population, and medical liability trends. Finally, with renewed emphasis on quality of care in the health professions, the pathology specialty has the potential to make substantial contributions to the quality and art of medical practice and is likely to remain at the center of efforts to refine methods of quality assessment and implementation.

American Medical Association↗
PubMed2004

[Medicolegal aspects in neuroradiologic emergencies].

Naturally, neuroimaging emergencies are a component of the global subject of emergencies that have for several years been a frequent subject in the press. The current situation is the consequence of the evolution of ideas from contractual liability to the frequently discussed principle of precaution. Examples offered by the daily practice allow to emphasize the main difficulties: diagnosis of headaches, seizure episode on public roads, head trauma, stroke... The medical liability of the neuroradiologist is not the same for diagnostic or interventional neuroradiology; it can sometimes be shared with other physicians. This liability includes the indication, the quality of the diagnosis, the information of the patient and relatives, the communication of results with other physicians, the maintenance of the equipment... Knowledge of potential pitfalls allows preventive measures including competence of the neuroradiologist, informed patient consent, and written precise protocols are the most important. However, according to the evolution of our societies, it is likely that it will become increasingly difficult to achieve a professional neuroradiology career without being questioned; it is thus advisable to be prepared for such eventuality.

Clinical Competence↗