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PubMed1984

Double jeopardy: suicide and malpractice.

Psychiatric malpractice is not a common occurrence. However, the suicide of a patient under treatment is an event that may lead to legal action. The author details the basic facts and ideas necessary to an understanding of this phenomenon. The plaintiff must ultimately prove that there was a dereliction of professional duty that led directly to the death. Several cases from the legal literature are presented to illustrate how judges evaluate this type of claim. Recommendations designed to minimize the risk of being found negligent are offered, and include detailing the specifics of suicide precautions, careful documentation of decisions to grant patients increased freedom, consultation from supervisors or colleagues, and outreach to survivors. Suicide is not always preventable, but following appropriate standards of care is likely to convince the court that no liability need be attached to the patient's demise.

Adult↗
PubMed1985

Liability and liability insurance for medical malpractice.

Physicians typically carry virtually complete malpractice insurance coverage. This contradicts standard theoretical predictions that under a negligence rule of liability there should be no demand for insurance, and insurance policies under moral hazard will contain co-payment provisions. It is argued that judicial 'errors' in defining negligence generate a demand for liability and legal defense insurance. Physician co-payment undermines the insurer's incentives for legal defense and thus induces a trade-off between loss reduction by injury prevention and by legal defense. Fee-for-service reimbursement further distorts the physician's choice between injury prevention and insurance. Implications for the deterrent function of the tort system are discussed.

Actuarial Analysis↗
PubMed1990

Equity and accuracy in medical malpractice insurance pricing.

This study examines alternative classification approaches for setting medical malpractice insurance premiums. Insurers generally form risk classification categories on factors other than the physician's own loss experience. Our analysis of such classification approaches indicates different but no more categories than now used. An actuarially-fair premium-setting scheme based on the frequency and severity of the individual physician's losses would substantially penalize adverse experience. Alternatively, premiums could be set for groups of physicians, such as hospital medical staffs. Our simulations suggest that even staffs at rather small hospitals may be large enough to be experience-rated.

Actuarial Analysis↗
PubMed1986

Medico-legal assessment of malpractice under the Austrian penal code.

In recent years, Austria has seen some change in the approach to errors in medical practice. The privileged position of the medical practitioner within the meaning of the former penal code, in force till 1974, no longer exists; however, errors leading to insignificant damage to the patient's health may remain free from punishment. In any case, nowadays, the categories of the dogmatics of negligence are applied to the doctor's professional activity. The traditional concept of 'malpractice' as formerly applied has virtually been displaced from the medico-legal assessment of an error in medical practice. The patient-doctor relationship based on trust is increasingly being supplemented by legal norms. Accordingly, the doctor's liability appears increasingly as the doctor's typical professional risk. Yet, in Austria, the doctor's liability is still kept within limits. The situation, with some cases in point, is analysed and described.

Austria↗
PubMedDate not supplied

Attending physician coverage in a teaching hospital's emergency department: effect on malpractice.

It seems self-evident that the establishment of 24-hour per day attending physician coverage in a teaching hospital's emergency department would enhance risk management. However, prior to this study, little investigation had been done to corroborate the effects of full-time emergency department attending physician coverage. In a retrospective study from a large teaching hospital's emergency department, malpractice claims filed for 1985-1987 (part-time attending physician coverage) were analyzed and compared to those for 1987-1989 (full-time attending physician coverage). A total of 98 claims were filed; these data were derived from 466,862 patient visits. Attending physician presence increased from 6000 hours per year in 1985-1987 to 26,280 hours per year in 1987-1989. There was an 18.5% decrease in claims filed, and a 70.1% decrease in disbursements for the first 2 years after the introduction of full-time attending physician coverage as compared with the preceding 2 years. These findings suggest that full-time attending physician coverage in the emergency department is associated with improved risk management.

Emergency Service, Hospital↗
PubMed2006

Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers.

STUDY OBJECTIVES: Diagnostic errors in the emergency department (ED) are an important patient safety concern, but little is known about their cause. We identify types and causes of missed or delayed diagnoses in the ED. METHODS: This is a review of 122 closed malpractice claims from 4 liability insurers in which patients had alleged a missed or delayed diagnosis in the ED. Trained physician reviewers examined the litigation files and the associated medical records to determine whether an adverse outcome because of a missed diagnosis had occurred, what breakdowns were involved in the missed diagnosis, and what factors contributed to it. Main outcome measures were missed diagnoses, process breakdowns, and contributing factors. RESULTS: A total of 79 claims (65%) involved missed ED diagnoses that harmed patients. Forty-eight percent of these missed diagnoses were associated with serious harm, and 39% resulted in death. The leading breakdowns in the diagnostic process were failure to order an appropriate diagnostic test (58% of errors), failure to perform an adequate medical history or physical examination (42%), incorrect interpretation of a diagnostic test (37%), and failure to order an appropriate consultation (33%). The leading contributing factors to the missed diagnoses were cognitive factors (96%), patient-related factors (34%), lack of appropriate supervision (30%), inadequate handoffs (24%), and excessive workload (23%). The median numbers of process breakdowns and contributing factors per missed diagnosis were 2 and 3, respectively. CONCLUSION: Missed diagnoses in the ED have a complex cause. They are typically the result of multiple breakdowns in the diagnostic process and several contributing factors.

Adolescent↗
PubMed2005

Malpractice reforms: are they fair?

In the debate over medical malpractice reform, the dimension of fairness often is invoked but is poorly understood. This article describes the factors that promote fairness in public policy and then examines whether proposed or enacted tort reforms would be fair. It finds that many of the reforms that are being promoted by perinatologists would be unfair; however, some reforms, including one broad-ranging proposal that was put forward by the Institute of Medicine, could satisfy fairness criteria depending on how they were implemented.

Compensation and Redress↗
PubMedDate not supplied

Closed claims analysis of 65 medical malpractice cases involving nurse-midwives.

The threat of litigation in clinical midwifery is evident in daily practice. Although midwives have not had the same risk of claims and suits as obstetricians, all obstetric providers are potentially subject to claims of malpractice. Closed claims analysis has been used in the past to review risk patterns and to heighten awareness of certain risks. It is a methodology that can suggest corrective or preventive action for future practice and thereby minimize the risk of future errors. An analysis of nurse-midwifery closed claims can help to evaluate past risk and proactively modify future liability.

Diagnostic Errors↗
PubMed2005

Basics of elder law and legal liabilities of negligence and malpractice for physicians as they apply to individuals with disabilities.

This article provides information regarding the issues that physicians face when dealing with elderly patients with cognitive deficits. It includes a discussion of basic legal terms and concepts that medical personnel should understand, various difficulties encountered by patients and families in crisis situations, and how the legal system deals with these issues. It concludes with a general discussion of the legal liabilities of negligence and malpractice.

Adult↗
PubMed2006

Psychiatry malpractice and administrative inquiries of alleged physician misconduct.

Practicing psychiatrists face a range of professional liability from malpractice litigation and from inquiries and hearings conducted by health care agencies. The causes of an action and the standards by which physician conduct is measured vary widely between these two processes. Many psychiatrists do not appreciate sufficiently the gravity of the risks they may face from an administrative sanction. Understanding the legal and administrative expectations of practicing psychiatrists serves practitioners' professional risk management. Those psychiatrists who choose to participate as expert witnesses for courts or administrative agencies need to familiarize themselves with the applicable legal standards and the respective roles of experts in these two different settings. The courts and administrative agencies have different social missions and correspondingly differing expectations of the expert opinions admitted.An expert's function as educator about the application of psychiatric knowledge and treatments to legal contexts is optimized when that expert clearly understands the function of the opinion that is sought. As educators about special knowledge to the adjudicating body, experts are advocates for their objectively generated and scientifically grounded opinion. Psychiatry is increasingly under the purview of regulations from multiple sources private and public. This article has reviewed medicolegal concepts and terms of psychiatrists' exposure to liability from a comparative point of view. Familiarity assists psychiatrists in navigating the complex legal arena in which they practice and provides a foundation for psychiatrists to work to change the multitude of laws and regulations when doing so is in the best interests of their patients and of their discipline of medicine.

Confidentiality↗
PubMed1987

Preventing a successful malpractice claim.

All of these strategies combine to make it less likely that a suit will be filed. But the strategies of complying with the standard of care and accurately documenting that care also combine to make it less likely that a suit will be successful. Injury is just one element of a successful malpractice suit. The plaintiff's attorney must also convince the judge or jury that the defendant failed to meet the standard of care and that failure caused the patient's injury. By complying with the standards of care and documenting that care, the nurse makes it easier for his or her attorney to counter arguments that the standard of care was not met. Accurate documentation can also fortify arguments that the nurse's actions did not cause the injury. There is nothing magical about these five strategies. Nurses will recognize each as actions good nurses perform in the course of their practice. Providing good nursing care also provides the best legal protection.

Documentation↗
PubMed1987

Malpractice and periodontal disease.

The treatment of periodontal disease is, at the present time, the focus of a large percentage of all dental malpractice cases. Consequently, dentists may find it helpful to be aware of the somewhat unique nature of litigation arising out of professional services provided with respect to periodontal disease. The operation of the statute of limitations in this context, whereby a dentist--at least in many states--can be sued several years after treatment of a patient terminates, makes caution, in terms of the maintenance of records and the purchase of insurance, an absolute essential.

Dental Records↗
PubMed2004

Protect yourself from malpractice suits.

There are many areas in the practice of gynecology that can lead to malpractice lawsuits for a practitioner who is not careful, even if he or she practices good medicine. Potential risks include failure to diagnose cancer, not following up with patients, failure to thoroughly check test results, and not keeping proper documentation. The cautious physician will attend to every problem that a patient presents, make sure that patients follow instructions, keep meticulous documentation, and always follow up to make sure his or her patient is progressing well.

Breast Neoplasms↗
PubMed1976

Avoiding malpractice suits through the use of informed consent.

The doctrine of informed consent is based on a long tradition of promoting self-autonomy and rational decision-making. The amount of information required to be disclosed by the doctor to the patient is that which permits the patient to decide for himself whether or not to undergo the recommended treatment. It includes information about risks of death or serious bodily harm, probability of success, problems of recuperation, and alternative modes of treatment. Disclosing such information contributes to the doctor-patient relationship and therefore makes recourse to malpractice litigation in the face of an unsatisfactory or untoward result less likely. Attempts to abolish the doctrine are potentially counterproductive and could lead to widespread mistrust of the medical profession on the part of a society that increasingly demands more information in all areas. Physicians will best serve both themselves and their patients by fully disclosing all relevant information before asking patients to consent to specific therapies.

Adult↗
PubMed2001

Medical malpractice, murder and the academic community: trouble ahead.

The morale of the medical professional is at an historic low in many countries. The recent case of a UK general practitioner being convicted of being a mass murderer, combined with increasing criticism of medical negligence and malpractice and an excessive influence of the large pharmaceutical companies has lead to the perception that the profession is under siege. Our professional leadership have not had sufficient public awareness to allay these concerns, and the resulting dip in morale is fast turning into a dangerous rout. We must review what has lead to this situation and what we should be doing now to put it right.Clinical research is under attack and the motives and ethics of large pharmaceutical company sponsorships of clinical trials is under increasing question. At this time there is a risk that medicine, and academic medicine in particular, will lose its attractiveness and the pace of achievements we have seen and benefited from in the last 2 decades may slow. The public debate should move on, it should move on to evaluate how much it would cost to reduce medical error rates to an acceptable level (to stop them altogether is impossible). It should move on to how we can get clinical trials designed and paid for by the public purse rather than merely grumbling that pharmaceutical companies take too much control of trials that they almost alone now appear to be sponsoring. And we should move on to debate about the role and status of the medical profession in the modern era. We can no longer do our best in secret and expect the public to trust us unquestioningly. The public wants and needs to be involved in our decision-making problems and errors. Only through informed debate will we improve health for the while population, now and in the future.

Ethics, Medical↗
PubMed1990

Preventability of malpractice claims in emergency medicine: a closed claims study.

We conducted a retrospective study of 262 malpractice claims against emergency physicians insured in Massachusetts by the state-mandated insurance carrier; these 262 claims were closed in the years 1980 through 1987. A total of $11,800,156 in indemnity and expenses was spent for these 262 claims. In 211 cases, the allegation was failure to diagnose a medical or surgical problem. One hundred eighty-four of these cases were included in the following eight diagnostic categories: chest pain, abdominal pain, wounds, fractures, pediatric fever/meningitis, aortic aneurysm, central nervous system bleeding, and epiglottitis. These eight categories accounted for 66.44% of the total dollars spent for the 262 claims. Because of the high incidence and dollar losses attached to these eight diagnostic categories, the Massachusetts Chapter of the American College of Emergency Physicians (MACEP) has developed clinical guidelines for the evaluation of these high-risk areas. Of the 184 high-risk claims, 99 claim files were reviewed; 45 of these reviewed claims were judged by physician reviewers as preventable by the application of the MACEP high risk clinical guidelines. From 22.26% to 46.4% of the $11,800,156 spent on the 262 claims could have been saved by the application of the MACEP clinical guidelines.

Chest Pain↗
PubMed1984

Malpractice in the emergency department--review of 200 cases.

Two hundred consecutive cases brought to the attention of a malpractice insurer by evidence of expected legal action were reviewed. Of these cases, 132 (66%) were attributed primarily to misdiagnosis, and 87 of these would have satisfied admission criteria. The most common error was grossly deficient examination relating to the chief complaint. Focused attention to physical examination and diagnostic skills, history taking, and minimal use of laboratory studies could have avoided the initiation of the majority of cases.

Diagnostic Errors↗
PubMed1996

Malpractice claims against emergency physicians in Massachusetts: 1975-1993.

This study reviewed 549 malpractice claims filed against emergency physicians in Massachusetts from 1975 through 1993, with a total of $39,168,891 of indemnity and expense spent on the 549 closed claims. High-risk diagnostic categories (chest pain, abdominal pain, wounds, fractures, pediatric fever/meningitis, epiglottitis, central nervous system bleeding, and abdominal aortic aneurysm) accounted for 63.75% of all closed claims and 64.23% of the total indemnity and expense spent on closed claims. Missed myocardial infarction (chest pain) claims accounted for 25.47% of the total cost of closed claims but only 10.38% of closed claims. The number of claims for missed myocardial infarction increased in the post-1988 closed claim group compared to the pre-1988 group; fractures and wounds were significantly less frequent in the post-1988 group. The frequency of high-risk claims decreased in the post-1988 group, largely because of the decline in fracture and wound claims. The category of missed myocardial infarction had a larger percentage of claims closed with indemnity payment than without indemnity payment. This parameter may serve as a marker for the overall seriousness of claims associated with a particular allegation, unlike the average cost per claim, which may be skewed by a few large awards.

Diagnostic Errors↗