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PubMedDate not supplied

Changing patterns of obstetric practice in Washington State: the impact of tort reform.

Rapidly rising malpractice premiums have profoundly altered patterns of obstetrical practice. In the summer of 1986, the state of Washington enacted major tort reform legislation intended to stabilize the costs of liability insurance. Following passage of the legislation, we surveyed obstetricians, family physicians, and midwives in the state to assess the likely impact of tort reform on future practice patterns. Largely because of malpractice concerns, 40% of family physicians, 15% of obstetricians, and 27% of midwives had discontinued obstetrical practice. Although obstetrical participation has decreased most dramatically for family physicians, the mean number of deliveries per physician has increased to the extent that the proportion of deliveries attended by family physicians has remained stable at about 30%. However, as fewer family physicians practice obstetrics, the availability of care has diminished in rural areas. The passage of tort reform legislation has induced one-third of those respondents currently practicing obstetrics to at least temporarily continue to practice obstetrics. Despite tort reform, however, the majority of respondents either do not provide or ration care to the medically indigent. The major deleterious social impact of the professional liability problem is reduced access to care in rural areas and a severe curtailment of care to the medically indigent. Tort reform alone will not solve these problems.

Family Practice↗
PubMed1994

Blending reform of tort liability and health insurance: a necessary mix.

The thesis of this Article is that making more health insurance benefits available to more people, far from lessening injury victims' proclivity to sue in tort (as conventional wisdom argues), will increase such suits. Thus, it is necessary to accompany any increases in health care coverage with the type of tort reform proposed herein. This reform would allow parties to opt out of the cumbersome and expensive tort claim process with its compensation of noneconomic losses by substituting quicker and surer compensation of any unmet economic losses.

Cost Allocation↗
PubMed1980

The disabled physician in civilian practice.

In the wake of the 1975 malpractice insurance crises, a flurry of state legislation intended to secure the private professional liability insurance market included attempts to revitalize the scope and authority of state boards of medical registration and quality assurances. Biannual registration, continuing medical education, and concerted response to alleged wrongdoing have resulted. So sensitive is the issue of incapacitation among health care providers that organized medical associations have recognized the need for and have begun to implement plans for disabled physicians.

California↗
PubMed2006

[Epithelioma cuniculatum plantare in the region of a skin scar due to mechanical trauma. Insurance law aspects of scar carcinomas].

We herein report a case of a highly differentiated verrucous squamous cell carcinoma of the sole of the left forefoot ("epithelioma" or "carcinoma cuniculatum plantare") that had--as a specific feature--developed within a preexisting long-standing skin scar due to an earlier occupational crush injury. Because of expansive tumor growth extending to the metatarsal bones and penetrating the tissue between the tendons, an ultrashort amputation of the hindfoot was performed according to the method of Chopart. The pathogenetic mechanisms possibly underlying the formation of scar carcinomas are discussed. For judgement of legal liability insurance questions, the criteria indicating a causal relationship between traumatic scars and cancer development are presented.

Accidents, Occupational↗
PubMed1979

FTC allegations cause rift in AMA house.

The AMA attempted to close ranks on a number of potentially devisive issues at its interim meeting in December. Among the issues disputed were alleged AMA antitrust violations dealing with chiropractors and advertising policies and the association's position on national health insurance. Other medical staff issues put before the delegates included voluntary cost containment, due process, liability insurance requirements, and PSRO data confidentiality.

Advertising↗
PubMed1986

Hospital utilization by health maintenance organizations. Separating apples from oranges.

The hospitalization rate of HMOs is reported to be 444 bed days per 1,000 enrollees per year. It is often forgotten that there is also out-of-plan utilization. A review of previous studies and a survey of reporting practices by three HMOs illustrate many problems with HMO utilization data. HMO rates, like those of other insurers, reflect only the hospital admissions that the plans know about and pay for, not the total hospital experience of their enrollees. While only a thorough tracking of subscriber utilization of all insurers and institutions will provide estimates of the magnitude of unreported admissions and their impact on utilization rates, this report enumerates the ways in which patients may receive inpatient care without the HMO having a record of the admissions and/or having to pay for them. It was found that admissions can be unreported when another insurer or institution pays (e.g., Medicare, No Fault, Workmen's Compensation, duplicate coverage, school health and liability insurance or VA, military, municipal, and state hospitals); when the HMO does not cover benefits (e.g., cosmetic and oral surgery, experimental procedures, long-term psychiatric, chronic, or rehabilitation stays); and when HMO coverage is denied for procedural reasons (e.g., catastrophic stays covered by reinsurance, newborns, voluntary "leakage," or improper following of HMO procedures). True HMO rates are unknown but are estimated by some authors to be 7-37% higher than the reported figure, depending on which types of unreported use are estimated. There is a need for future analyses to quantify true hospitalization rates of enrollees of HMOs and other insurers.

Adolescent↗
PubMed1981

Liability of the pharmacist as a therapeutic consultant.

The legal implications of pharmacists serving as therapeutic consultants to other health professionals are discussed. The legal view of the consultant relationship and the relative liability exposure of the primary practitioner and the consultant are reviewed. The pharmacist's liability when serving as a therapeutic consultant is considered in light of the high standard of care that would probably be used in evaluating the pharmacist's performance. Other legal issues considered include potential criminal liability of the pharmacist, whether responses should be in writing, impact of charging for therapeutic consultation services, and coverage for such activities under professional liability insurance policies. By being aware of the legal implications in these areas, pharmacists may limit their liability exposure to an acceptable level.

Pharmaceutical Services↗
PubMed1992

Employee lawsuit insurance covers possible liability under new laws.

Employers faced with increased liability under recently enacted federal legislation can now turn to insurance companies for protection against suits involving personnel practices. At least two insurance companies are now offering policies that protect companies against litigation for wrongful dismissal, sexual harassment, and/or discriminatory employment practices and procedures.

Costs and Cost Analysis↗
PubMed1997

[From lack of organization to risk management--current aspects of hospital liability].

The hospitals are not only subjected to an increased density of rules. The hospital of today is changing to a service business. In the hospital administration, the medical and management competences are merging. A major part of the hospital responsibilities, i.e. hospital hygiene, supply of medicines, radiation protection, documentation and information, and securing of traffic, is spread over different departments. The quality of care in a 24-hour-system with a high degree of division of labor depends on good communication and organization. On one hand, it is complaint about the increasing fees of third party liability insurances but effective consequences to avoid risks, on the other hand, have not yet be drawn.

Germany↗