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PubMed1985

Psychiatric Malpractice: The Electroconvulsive Therapy Experience.

The malpractice experience of the American Psychiatric Association professional insurance program from 1972 to 1983 is reviewed. Seventeen cases among 711 "closed" cases related to electroconvulsive therapy (ECT). Nine were settled in favor of the psychiatrist; one case was tried and the jury found for the psychiatrist. Patients prevailed in seven cases by settlement. The author concludes that malpractice losses are not a significant factor in ECT practice or in its negative public image.

Journal Article↗
PubMed1978

Tax and Medicare aspects of hospital malpractice insurance (Part 2).

Any discussion of tax exemption for malpractice insurance associations must begin by recognizing that, although the tax-exempt status of certain forms of malpractice associations eventually should be recognized by the courts or Congress, resistance will presently be met from the Internal Revenue Service (IRS). For this reason, the authors focus first on the various possibilities for exemption under the Internal Revenue Code, second on the IRS position with respect to these different modes of exemption, and third on the type of arguments that can and should be made to support a claim to exemption.

Income Tax↗
PubMed1998

Relative income expectations, expected malpractice premium costs, and other determinants of physician specialty choice.

We analyze the effects of relative income expectations, expected malpractice premium cost, and other economic and noneconomic factors on physician specialty choice. The data for this paper are taken from responses of medical students who completed the Association of American Medical Colleges' Medical School Questionnaire and graduated from medical school in 1995. A random utility model is used to guide our thinking; the econometric technique is multinomial logit regression. Selection of a surgical or support specialty is found to be positively income motivated, while the influence of expected relative income is negatively related to the choice of primary-care and medical practices. Concern over malpractice premium cost is negatively related to surgical and positively related to primary-care selection. Other important determinants of choice are planned location of practice, length of residency, type of medical school attended, score on the science problems section of the Medical College Admission Test, predictable working hours and perceived prestige of the specialty. Policies that alter expected relative income, length of residency, desired location of practice, medical school attended, predictable working hours, and prestige of practice, rather than financial aid, may be appropriate for correcting a perceived maldistribution of physicians among specialties.

Adult↗
PubMed2003

Medical malpractice and facial nerve paralysis.

BACKGROUND: Iatrogenic facial nerve paralysis is a devastating surgical complication that occasionally results in litigation. OBJECTIVE: To analyze litigation trends to better understand the causes and outcomes of suits involving facial nerve paralysis to prevent future litigation and improve physician education. DESIGN: Retrospective review. SETTING: All US civil trials. PARTICIPANTS: All state and federal civil trials alleging malpractice and facial nerve paralysis were reviewed. METHODS: Jury verdict reviews from January 1, 1985, to December 31, 2000, were obtained from a computerized legal database and analyzed. Reviews compile data on defendants, plaintiffs, allegations of wrong doing, and expert witness specialties, and provide case summaries. Fifty-three cases from 19 of the 50 states were obtained. Data were entered into a spreadsheet for analysis. MAIN OUTCOME MEASURES: Verdicts and indemnity payments. RESULTS: Suits reviewed were as follows: cosmetic, 12 (23%); otologic, 13 (25%); nonneoplastic disease of the parotid or other benign conditions of the head and neck, 15 (28%); benign neoplasms of the parotid, 9 (17%); malignant neoplasms of the parotid, 1 (2%); and temporomandibular joint operations, 3 (6%) (percentages do not total 100 because of rounding). Allegations of negligence were frequently multiple and included lack of informed consent (16 [30%] of 53), failure to diagnose (10 [19%] of 53), and surgical misadventures (47 [89%] of 53). Excluding failure to obtain consent or to diagnose, 28 suits still alleged negligence based solely on a surgical misadventure. Of these suits, 12 (63%) resulted in plaintiff awards. CONCLUSIONS: Surgeons must emphasize and document the likelihood and consequences of this devastating complication to all patients undergoing surgery in this area. Risk management goals include a thorough and timely examination and careful and thoughtful surgical approaches. However, patient rapport and bedside manner may be the only protection the surgeon has from litigation arising from this complication.

Adult↗
PubMed1992

Causes of breast cancer malpractice litigation. A 20-year civil court review.

To determine objectively the patient and physician factors that lead to breast cancer malpractice litigation, a review was undertaken of all cases tried in the US federal and state civil court system over a 20-year period from 1971 through 1990. Forty-five cases were identified and all involved a delayed diagnosis of breast cancer (the mean delay was 15 months). The patients were young (mean age, 40 years). Of 45 cases studied, the majority of patients (37 [82%]) found a painless mass by self-examination of the breast. Only 22 patients (49%) had further workup, mostly by mammography (20 [44%]). The results of 16 mammograms (80%) were read as normal. Obstetricians and gynecologists were involved in the greatest number of cases (21 [50%]), followed by family practitioners and internists (17 [41%]), general surgeons (12 [28%]), and radiologists (4 [10%]).

Adult↗
PubMed1997

Malpractice litigation involving laparoscopic cholecystectomy. Cost, cause, and consequences.

OBJECTIVE: To analyze 44 cases of malpractice litigation involving laparoscopic cholecystectomy for cost, cause, and consequences of civil court actions. DESIGN: Survey of national jury verdict reporting services, covering 20 states during the 39-month interval from January 1, 1993, to April 30, 1996. The 44 laparoscopic cholecystectomies were performed during the 40-month interval from February 1, 1989, to June 30, 1992. MAIN OUTCOME MEASURES: Types of injuries leading to litigation, morbidity and mortality from injuries, trial verdicts, and cost of liability payments. RESULTS: The 44 injuries composed 4 main categories of injuries: (1) bile duct, n = 27, 61%; (2) bowel, n = 7, 16%; (3) major vascular, n = 4, 9%; and (4) other, n = 6, 14%. Bowel injuries involved trocar or cautery injury; vascular injuries all involved trocars. There were 7 deaths (16%) overall from either septic peritonitis resulting from bowel injury (4 patients [57%]) or bile peritonitis involving spills or cystic duct leaks (3 patients [43%]). No deaths resulted from injury to main bile ducts. Of the 44 cases, 21 (48%) settled out of court (mean payment, $469,711). Of the remaining 23 cases proceeding to trial, 19 (83%) were defended successfully while 4 (17%) concluded with plaintiff jury verdicts (mean payment, $188,772). CONCLUSIONS: Frequent settlements of cases involving laparoscopic cholecystectomy injuries that are litigated have resulted in a selection of cases of increased defensibility at trial. The high mortality rate from bowel injuries is a new medicolegal finding in laparoscopic cholecystectomies, as expensive to settle (mean payment, $438,000) as laparoscopic cholecystectomy bile duct injury (mean payment, $507,000).

Cholecystectomy, Laparoscopic↗
PubMed1977

Cancer and malpractice claims.

An analysis of 36 closed malpractice claims related to the diagnosis of cancer was conducted at a time when both subjects are receiving particular attention. Awareness of cancer statistics and the medicolegal literature is necessary. Factors related to the allegation of delay as well as the psychological aspects of cancer are presented. Suggestions for claims prevention have been delineated.

Adolescent↗
PubMed2002

The effects of defendant remorse on mock juror decisions in a malpractice case.

The purpose of this study was to observe the effects of defendant remorse on monetary damages awarded to a plaintiff in a malpractice case. In two experiments, the physician-defendant expressed remorse at the time of the incident and again at trial, expressed remorse at trial, explicitly demonstrated a lack of remorse at trial, or made no mention of remorse (or a lack thereof). Participants decided how much money to award to the plaintiff and evaluated both the plaintiff and the defendant on several dimensions. Participants awarded greater compensation when the physician expressed remorse at the time of the incident than in the other conditions, both when the plaintiff was the injured patient's spouse in a wrongful death suit (experiment 1) and when the patient sued on his own behalf (experiment 2). This effect of remorse was greater for males than for females (experiment 1) and for relatively severely injured plaintiffs (experiment 2).

Attitude↗
PubMed2003

Medical malpractice and the thyroid gland.

BACKGROUND: A medical malpractice litigation "crisis" exists in this country. Analyzing litigation trends through verdict summaries may help understand causes. METHODS: Jury verdict reviews from 1987-2000 were obtained from a computerized database. Reviews compile data on defendants, plaintiffs, allegations of wrongdoing, and verdict summaries. RESULTS: Thirty suits from nine states occurred. Plaintiffs were women in 80% of the cases, with a median age of 41. Fifty percent of patients (15 of 30) had a bad outcome, (9 of 30 dead, 4 of 30 with neurologic deficits, 1 blind, and 1 alive with cancer). Thirty percent alleged surgical complications, mostly recurrent laryngeal nerve injury, and 75% of cancer patients alleged a delay, either through falsely negative biopsies or no biopsy taken. Respiratory events occurred in 43% and frequently resulted in large awards. CONCLUSIONS: The liberal use of fine-needle aspiration and documentation of surgical risks may help reduce litigation. Complications and bad outcomes do not indicate negligence. Analysis may contribute to risk management strategies or litigation reform.

Age Distribution↗
PubMed1991

Office staff responsibilities in preventing surgery malpractice suits.

Improved communications, procedures, administration, and system routines in a medical office are everyone's responsibility. It is an area in the overall treatment of the medical malpractice disease in which the entire office staff plays a critical part. The reward is that everyone--the patient, the physician, and the staff--benefits. Office staff can make a vital contribution to achieving a pleasant, efficient office where very few mistakes occur and preventable errors are eliminated.

Communication↗
PubMed1999

High reliability perinatal units: an approach to the prevention of patient injury and medical malpractice claims.

Perinatal units differ in their ability to prevent patient injury and medical malpractice litigation. Obstetrical units with favorable performance are distinguished by common organizational and clinical features. Organizationally, they resemble what behavioral scientists define as "high-reliability organizations" (i.e., the ability to operate technologically complex systems essentially without error over long periods). Clinically, practices are based on nationally recognized guidelines and/or an operational philosophy of "safety first." These organizational and clinical features are described so that physicians, nurses, and administrators might view their own clinical environments in the context of this perspective.

Female↗
PubMed1982

Managing medical malpractice risk via system science.

The complexity of health care is increasing at an alarming rate. Medical malpractice risks, which are inherent elements of this complexity, threaten the survival of both physicians and hospitals. Technological advances, social concerns, legal ramifications, economic values, and political pressures all amplify risk for health care professionals. Federal government warnings to control health care costs compound the dilemma. System science provides a framework for identifying, analyzing, and ranking all types of risk so that they can be balanced against the more easily recognized benefits of health care. Rather than limiting the concept of risk management to the traditional concern for financial loss, this paper stresses a much broader scope of risk assessment and control. All medical activities that can lead to injury or death of any person, or damage to or loss of property, material, or reputation must be systematically managed regarding risk. A strong theoretical foundation is combined with the successful application of system science to managing risk at the Saint Joseph Medical Center in Burbank, California.

Financial Management↗
PubMed1979

Ingredients of a psychiatric malpractice lawsuit.

This is a review by two trial lawyers of the practical problems in trying a psychiatric malpractice lawsuit. The substantive rules of law which receive a good deal of attention are found to be most significant in the day-to-day suit than gathering together the facts and medical opinions and presenting them to the jury in a persuasive fashion.

Expert Testimony↗
PubMed1995

Did George McClellan commit malpractice?

In several sources, it is stated that Dr. George McClellan was one of the first surgeons to lose an ophthalmic malpractice case in the United States. Examining the original sources, one can conclude that he actually won a libel suit. The trial testimony gives a useful insight into cataract surgery in the 1820s as well as the medical climate of that period. This trial revealed to the public the existence of the secret medical society, Kappa Lambda.

Cataract Extraction↗
PubMed2002

Malpractice claims analysis yields widely applicable principles.

We received 50 claims of medical negligence in pediatric cardiology. From the analysis, patterns were identified and recommendations for improvement were found that apply generally to healthcare. Less than half (38%) of the claims were found to be medically meritorious. The impression of substandard care was often (7/50) created by an erroneous attribution of cause of death at autopsy. Both structured learning for caregivers and education of the public will reduce the frequency of malpractice forms-both valid and frivolous. Caregivers should document more effectively. The current tort system neither deters nor compensates as it was intended. The assignment of blame to a single individual is usually not in concert with the reality of modern medicine. Good health care is not a passive behavior; active participation by the public is required.

Cardiac Surgical Procedures↗
PubMed1998

The defendant in a medical malpractice suit: an integral part of the defense team.

This article explains the litigation process of a medical malpractice suit and offers suggestions to help pediatric radiologists cope with the stress of being sued. It provides tangible ways in which the pediatric radiologist can become an important part of the defense team. Our goal is to enable the pediatric radiologist to place the lawsuit in a proper perspective and demonstrate the importance of providing medical insight to aid in forming legal strategy.

Humans↗
PubMed2005

Malpractice in invasive cardiology: is angiography of abdominal aorta or subclavian artery appropriate in patients undergoing coronary angiography? A meta analysis.

BACKGROUND: Identification of peripheral vascular disease by angiography in patients undergoing coronary angiography may be considered as malpractice but sometimes seems to be justified under clear entry criteria. The present mata-analysis is aimed to analyze the appropriateness and results of screening angiography of subclavian or abdominal aorta performed at the time of coronary angiography. METHODS: A search of published literature for peripheral angiography in patients undergoing coronary angiography over the last 10 years was performed using the MEDLINE database. No language restriction was employed. Only studies enrolling more than 100 patients for abdominal aortography and 50 patients for subclavian/internal mammary artery angiography were considered. Reference lists from identified studies were also reviewed to identify other potentially relevant references. RESULTS: Twenty-nine studies were retrieved: 8 articles about subclavian artery (SA) and internal mammary (IMA) angiography and 21 about renal (RA) and aortoiliac (AOI) angiography. The total number of patients enrolled was 27,936. Nine studies out of 29 were prospective. Defined entry criteria were reported in 24 out of 29 studies. Significant SA and IMA stenosis were reported in 5.5 and 9% of patients, respectively. RA stenosis >50% was present in 12.7% of patients with CAD. Finally, undetected AOI disease was reported in 35.5% of patients undergoing coronary angiography. Mean complication rate was 0.8 +/- 0.6%. Predictors of SA and IMA stenosis were unclear. Age, multi-risk profile, multi-vessel CAD, history of PVD or carotid disease, severe hypertension, unexplained renal dysfunction or decreased creatinine clearance have been reported most frequently as predictors of RA and AOI disease in patients undergoing coronary angiography. CONCLUSIONS: Consistent evidence of appropriateness of renal angiography in selected patients undergoing coronary angiography have been produced in literature. IMA and AOI angiography seem to be not justified unless they are part of SA in patients scheduled for arterial conduit with brachial differential pressure, thoracic irradiation or surgery, or of abdominal angiography to detect RA stenosis in laboratories with radiological digital peripheral equipment.

Aorta, Abdominal↗
PubMed1984

Psychiatric malpractice due to ignorance. Reports of cases of psychiatric treatment and traumatic neurosis handled by the doctor's liability board in which damages have been claimed.

During the last 15 years, the Finnish insurance companies' doctor's liability board has handled six cases in which damages were claimed for psychiatric treatment or traumatic neuroses. Reports of these cases, grouped according to basis of indemnification, are given above. The board considered two of the claims unjustified and four justified. The party liable for damages was, in every case, the hospital. In Finland, claims for damages lodged with hospitals and doctors have not been very common. This is partly due to Finnish legislation. Claims for damages arising from psychiatric treatment are rare. In Finland, the party primarily responsible for injury to a patient is the employer (e.g. a hospital) and only secondly an employee. In practice, it is rare for a doctor to be required to pay damages for malpractice or neglect.

Expert Testimony↗