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PubMed2002

Medical malpractice and cancer of the larynx.

OBJECTIVE: To analyze the frequency, clinical characteristics, and legal outcomes of malpractice litigation initiated by patients with cancer of the larynx. STUDY DESIGN: Retrospective review of 23 jury verdict reports from 11 states. METHOD: Jury verdict reviews from 1976 to 1997 were obtained from a computerized legal database compiled from all state and federal civil court decisions. Reviews compile pertinent data on defendants, plaintiffs, verdict outcomes, indemnity payments, allegations of wrongdoing, and provide case summaries. RESULTS: Delays in diagnosis were alleged in 19 of 23 (83%) suits. Hoarseness was present in 10 of 19 (53%), a neck mass in 3 of 19 (16%), and no biopsy was taken in 11 of 19 (58%) of those delayed. Mean age was 47 years, with a peak incidence in the general population of 70 to 74 years. Laryngectomy was alleged to be a result or complication of delay in 12 of 19 (63%). Over half of the patients delayed received compensation, and over half of the defendants were in general practice. Outcome was poor with a 35% mortality and a total of 47% either dead of disease or alive with disease. Complications, incorrect diagnosis, and informed consent did not play a significant role in initiating litigation. CONCLUSIONS: The delayed diagnosis of cancer of the larynx associated with litigation is frequently seen in younger patients presenting with hoarseness or neck masses. These patients frequently have poor outcomes. Patients with symptoms of cancer of the larynx must be aggressively evaluated regardless of age. Risk management goals to prevent delays in diagnosis may help prevent subsequent litigation.

Age Factors↗
PubMed2002

Cancer of the oral cavity and medical malpractice.

OBJECTIVE: To analyze malpractice litigation initiated by patients with cancer of the oral cavity as a result of allegations concerning their diagnosis and treatment. STUDY DESIGN: Retrospective review. METHODS: Jury verdict reviews from 1984 to 2000 were obtained from a computerized legal database and analyzed. Reviews compile pertinent data on defendants, plaintiffs, verdict outcomes, indemnity payments, and allegations of wrongdoing and provide case summaries. Fifty cases from 21 of all 50 states were obtained. Data were entered into a spreadsheet for analysis. RESULTS: Overall, a young age (mean age, 45 y) and poor oncological outcome (47% dead) were seen. The younger age group (<47 y) had a better outcome (65% without disease), were more often misdiagnosed (19%), won awards (60%), and had higher awards (average award, $755,824) as compared with those older than 47 years of age, who had 39% without disease, 0% misdiagnosed, and 52% who won awards that were less, on average, at $495,417. Failure to diagnose the cancer was alleged, overall, in 43 of 50 cases (86%), and in general practice, dentists, and otolaryngologist in 100%, 85%, and 89%, respectively. Suits alleging a delay in diagnosis of less than 3 months were defendant verdicts in 86%, and of more than 3 months, in 40%. Failures to perform biopsy and to refer were common allegations. CONCLUSIONS: Young age of patients bringing litigation is seen in patients with oral cancer. These patients frequently have poor oncological outcomes. Risk management goals to prevent delays in diagnosis may help prevent subsequent litigation.

Adult↗
PubMed1988

Malpractice claims experience associated with fertility-control services among young obstetrician-gynecologists.

Threatened and actual medical malpractice claims associated with delivery of fertility-control services are studied in a national sample of 1,420 recently trained obstetrician-gynecologists who had been in practice an average of 3 years at the time of the survey. Nine percent of respondents report having been threatened with a fertility-control-related lawsuit, and 5.5% report being named as a defendant in such a suit. The types of services named most frequently as the basis of threatened lawsuits are sterilizations and abortions. In logistic regression analyses, variables found to significantly increase the risk of both threatened and actual lawsuits are number of years in practice and number of abortions provided during the last year of practice. Treatment of more minority patients significantly reduces the risk of both threatened and actual claims. Type of practice arrangement, physician gender, and attitudes toward physician-patient communication are among the variables found not to affect the risk of litigation. Implications for provision of fertility-control services are discussed.

Abortion, Induced↗
PubMed1989

Practice changes in response to the malpractice litigation climate. Results of a Maryland physician survey.

Data from a 1987 survey of Maryland physicians in three specialties (internal medicine, family or general practice, and obstetrics-gynecology) were used to study the types of changes physicians have made in their practices during the last 2 years as a result of the current malpractice litigation climate. Overall, 51% reported making some type of practice change. The practice changes that physicians reported reflect both risk-reduction (e.g., increased use of tests) and risk-avoidance (e.g., cutting back high-risk patients) strategies, although risk-reduction actions were reported more frequently. Raising patient fees was also reported. Specialty predicts whether or not physicians make each type of change; in particular, obstetrician-gynecologists are more likely to report practice changes of all types. Prior litigation experience does not, in general, predict practice changes. The implications of the types of changes reported for access to care and costs of care were considered.

Data Collection↗
PubMed1997

Iatrogenic hypoglycemia and malpractice claims.

Iatrogenic neuroglycopenia represents a medical emergency for which accepted and usually effective treatment exists. Treating physicians face a malpractice risk if there is permanent neurologic damage and there is a perception of failure to act prudently both before and after the damaging episode. We report two cases to illustrate the medical and legal issues that may be raised in such claims.

Aged↗
PubMed2005

Impact of malpractice caps on use and outcomes of radical cystectomy for bladder cancer: data from the surveillance, epidemiology, and end results program.

PURPOSE: The impact of malpractice awards on insurance premiums and health care delivery generates much concern. To our knowledge no data exist regarding the impact of caps, or upper limits, on awards for noneconomic damages (also termed pain and suffering) on health care delivery patterns or outcomes. We investigated the effect of caps on the use of and outcomes following aggressive surgical treatment (radical cystectomy) in patients with bladder cancer. MATERIALS AND METHODS: We performed a retrospective cohort study of patients with bladder cancer who underwent radical cystectomy, identified from the Surveillance, Epidemiology, and End Results (SEER) Program database. Cystectomy rates and post-cystectomy disease specific survival were compared between SEER regions with and without a cap, while controlling for other variables. RESULTS: A significantly greater proportion of patients with stages III and IV bladder cancer underwent cystectomy in SEER regions with a cap. Cap status was a significant predictor of survival from bladder cancer. CONCLUSIONS: Radical cystectomy for bladder cancer is performed more often even for advanced bladder cancer in geographic regions with a cap with a positive impact on survival. The institution of caps may have beneficial effects on patterns of health care beyond that of merely decreasing insurance premium costs.

Adult↗
PubMed2003

Medical aspects of malpractice crisis in Greece: medical responsibility: a doctor's view.

Malpractice and medical liability have been introduced into Greek reality over the last decade. Forensic sciences hold a key role in the investigation of medical liability cases. Along these lines, the medical examiner stands between colleagues and lawyers, who have divergent intentions in the investigation of such cases. This article offers an overview of the rapidly changing reality in Greece and approaches medical liability from the doctor's viewpoint. The role of forensic science and the medical examiner is portrayed, along with the emerging difficulties in the investigation of medical liability cases. Also attempted is an interpretation of the crisis phenomena that are very often seen between doctors and lawyers. However, the intent of this article is to search for ways to turn competition and tension between medical and law professionals into cooperation and understanding for the best interest for both professions and, more importantly, for the community.

Forensic Medicine↗
PubMed2003

Surgical adverse events, risk management, and malpractice outcome: morbidity and mortality review is not enough.

OBJECTIVE: To review all admissions (age > 13) to three surgical patient care centers at a single academic medical center between January 1, 1995, and December 6, 1999, for significant surgical adverse events. SUMMARY BACKGROUND DATA: Little data exist on the interrelationships between surgical adverse events, risk management, malpractice claims, and resulting indemnity payments to plaintiffs. The authors hypothesized that examination of this process would identify performance improvement opportunities overlooked by standard medical peer review; the risk of litigation would be constant across the three homogeneous patient care centers; and the risk management process would exceed the performance improvement process. METHODS: Data collected included patient demographics (age, gender, and employment status), hospital financials (hospital charges, costs, and financial class), and outcome. Outcome categories were medical (disability: <1 month, 1-6 months, permanent/death), legal (no legal action, settlement, summary judgment), financial (indemnity payments, legal fees, write-offs), and cause and effect analysis. Cause and effect analysis attempts to identify system failures contributing to adverse outcomes. This was determined by two independent analysts using the 17 Harvard criteria and subdividing these into subsystem causative factors. RESULTS: The study group consisted of 130 patients with surgical adverse events resulting in total liabilities of $8.2 million US dollars. The incidence of adverse events per 1,000 admissions across the three patient care centers was similar, but indemnity payments per 1,000 admissions varied (cardiothoracic = $30 US dollars, women's health = $90 US dollars, trauma = $520 US dollars). Patient demographics were not predictive of high-risk subgroups for adverse events or litigation. In terms of medical outcome, 51 patients had permanent disability or death, accounting for 98% of the indemnity payments. In terms of legal outcome, 103 patients received no indemnity payments, 15 patients received indemnity payments, four suits remain open, and in eight cases charges were written off ($0.121 million US dollars). To date, no cases have been adjudicated in court. Cause and effect analysis identified 390 system failures contributing to the adverse events (mean 3.0 failures per adverse event); there were 4.7 failures per adverse event in the 15 indemnity cases. Five categories of causes accounted for 75% of the failures (patient management, n = 104; communication, n = 89; administration, n = 33; documentation, n = 32; behavior, n = 23). The current medical review process would have identified 104 of 390 systems failures (37%). CONCLUSIONS: This study demonstrates no rational link between the tort system and the reduction of adverse events. Sixty-three percent of contributing causes to adverse events were undetected by current medical review processes. Adverse events occur at the interface between different systems or disciplines and result from multiple failures. Indemnity costs per hospital day vary dramatically by patient care center (range $3.60-97.60 US dollars a day). The regionalization of healthcare is in jeopardy from the burden of high indemnity payments.

Academic Medical Centers↗
PubMed2005

Risk management strategies in physical therapy: documentation to avoid malpractice.

PURPOSE: This article aims to highlight the importance of a complete and accurate medical record as it pertains to potential risk exposure in the outpatient physical therapy profession. DESIGN/METHODOLOGY/APPROACH: Basic charting rules, correction and alteration recommendations, documentation of telephone conversations, informed consent, exculpatory release forms and incident reports are discussed. Basic risk management strategies are reviewed that may reduce outpatient physical therapy practitioners' malpractice exposure. FINDINGS: The authors contend that quality and thorough documentation is as important as the quality of the care that is delivered to patients, since medical records are legal documents and serve as valuable evidence as to what transpired between patients and the healthcare providers. ORIGINALITY/VALUE: Practical documentation strategies are described in a manner that will inform physical therapists of their legal obligations relating to patient care.

Ambulatory Care↗
PubMed1988

The effect of the New Zealand Accident Compensation legislation on medical malpractice.

The New Zealand Accident Compensation Act 1972 and its amending Act of 1982 have substantially altered the attitudes of the law, the medical profession and the public, to personal injury by accident. The element of fault is removed and the uncertainty of the outcome of a claim under adversarial court action no longer exists. Rehabilitation assistance on recovery from injury as well as accident prevention measures are cited in the Act as statutory responsibilities of the New Zealand Accident Compensation Corporation. Mechanisms of dealing with medical malpractice, with illustrative examples from ophthalmic practice, are described. Most such incidents are described as medical misadventure.

Accidents↗
PubMed2004

Malpractice risks associated with colon cancer and inflammatory bowel disease.

Analyses of lawsuits against gastroenterologists suggest that the disorders of colon cancer and inflammatory bowel disease are among the more common disorders resulting in malpractice claims, with colon cancer suits receiving some of the highest monetary judgments. Unfortunately, that composite data does not specify the exact alleged wrongdoing, but uses global categories such as "errors of diagnosis." This review will focus on potential legal pitfalls regarding those disorders. The focus is on the legal theories, not the exact medical approach recommended, and is intended as general education, and not legal advice for any specific patient.

Colorectal Neoplasms↗
PubMed1988

Patient complaints of dental malpractice in Denmark 1983-86.

A system for handling complaints of dental malpractice was established in 1983 in an agreement between the Danish Dental Association and the National Health Insurance. Description is given of the system comprising county dental complaints boards and a national dental complaints board. Reports of all complaints directed to the boards during the first 3 1/2 years were analyzed: 533 complaints to the county boards and 111 appeals to the national board. The complaints corresponded to 5 complaints per 100 dentists per year with considerable regional variation. Most complaints were reported in fixed and removable prosthetics, and most claims were of an economic nature. Almost two-thirds of the complaints were supported by the boards. Themes for further study as well as certain problems concerning consumer satisfaction weighed against the responsibility to survey dentists' work are pointed out.

Consumer Behavior↗
PubMed1995

Dentists' attitudes toward frustrating patient visits: relationship to satisfaction and malpractice complaints.

A 22-item questionnaire measuring physician frustration in communicating with patients was adapted to dentists, and its reliability and validity assessed, in a sample of 289 English dental surgeons in general practice in Greater Manchester. Subscales were derived assessing the concepts of unpleasant dentist feelings, lack of communication, patient non-compliance, patient control, and practice organization with Cronbach's alpha ranging from 0.59 to 0.77. Three of five subscale scores (unpleasant feelings, lack of communication, and practice organization) were significantly greater for dentists who had official malpractice complaints to insurers. Similarly, all five subscores were greater for dentists who reported larger numbers of unsatisfactory visits and expressed greater dissatisfaction with dental practice.

Adult↗
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↗
PubMed1994

Dentists' response to financial incentives in a mail survey of malpractice liability experience.

This two-part methodologic research was designed to evaluate the effects of a financial incentive on questionnaire response rate and response bias for general dentists surveyed by mail. Subjects were 517 clinicians randomly selected from a two-state population of practitioners insured by a single malpractice liability carrier. Subjects received a check for either $5 or $10 in the original mailing. In Study 1, a single mailing and postcard follow-up resulted in a 57.8 percent (111/192) response rate. In Study 2, employing Dillman's Total Design Method, a 69.6 percent (208/299) response was obtained after a third mailing. Analysis of response rate by incentive level in each study revealed no significant differences. In contrast, early responders (first mailing and follow-up postcard) differed from late responders (second and third mailings) on age (41.4 vs 37.0 years; T = 2.17; P = .032), non-Caucasians (27.7% vs 63.9%; chi 2 = 17.3; df = 4; P < .002), females (13.9% vs 27.8%; chi 2 = 3.9; df = 1; P < .05), foreign-trained (7.0% vs 19.4%; chi 2 = 16.5; df = 2; P < .001), and dissatisfaction with practice (31% vs 51%; chi 2 = 7.8; df = 4; P = .10). Thus, the magnitude of the financial incentive in this experiment had no differential effect on response rate. But differences in responses from late responders (proxies for nonresponders) on demographic characteristics and key study variables suggest the persistence of response bias despite an acceptable response rate. Future dental health survey research should employ tests for response bias on both sets of variables.

Adult↗