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PubMed2000

American medical malpractice litigation in historical perspective.

Medical malpractice and the problems associated with it remain an important issue in the US medical community. Yet relatively little information regarding the long-term history of malpractice litigation can be found in the literature. This article addresses 2 questions: (1) when and why did medical malpractice litigation originate in the United States and (2) what historical factors best explain its subsequent perpetuation and growth? Medical malpractice litigation appeared in the United States around 1840 for reasons specific to that period. Those reasons are discussed in the context of marketplace professionalism, an environment that provided few quality controls over medical practitioners. Medical malpractice litigation has since been sustained for a century and a half by an interacting combination of 6 principal factors. Three of these factors are medical: the innovative pressures on American medicine, the spread of uniform standards, and the advent of medical malpractice liability insurance. Three are legal factors: contingent fees, citizen juries, and the nature of tort pleading in the United States. Knowledge of these historical factors may prove useful to those seeking to reform the current medical malpractice litigation system.

History, 19th Century↗
PubMed2004

Assessment of occupational safety and health programs in small businesses.

BACKGROUND: Occupational safety and health (OSH) programs are a strategy for protecting workers' health, yet there are few peer-reviewed reports on methods for assessing them, or on the prevalent characteristics of OSH programs, especially in small businesses. METHODS: We adapted an occupational safety and health administration (OSHA) survey instrument to assess: management commitment and employee participation, workplace analysis, hazard prevention and control, and education and training. This was supplemented by a series of open-ended questions. We administered the survey in 25 small worksites. RESULTS: Scores for each element ranged widely, with distribution of most scores being positively skewed. Barriers to addressing OSH included lack of time and in-house expertise, and production pressures. External agents, including corporate parents, liability insurers, and OSHA, played an important role in motivating OSH programs. CONCLUSIONS: Small businesses were able to mount comprehensive programs, however, they may rely on outside resources for this task. Being small may not be a barrier to meeting the requirements of an OSHA program management rule.

Commerce↗
PubMed1985

Occupational health reporting systems in Sweden.

Legislation covering worker's compensation influences occupational health reporting and data gathering. Five programs recently enacted in Sweden are outlined and discussed. These include: 1) Labour Market No-Fault Liability Insurance, 1974; 2) The National Sickness Insurance Act, 1977; 3) The Work Injury Insurance Act, 1977; 4) The Work Environment Act, 1977; 5) The Occupational Injury Information System, 1979.

Humans↗
PubMedDate not supplied

Why today?

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Accidents, Traffic↗
PubMed2002

Access rights for outdoor recreation in New Zealand: some lessons for open country in England and Wales.

Access opportunities for outdoor recreation in New Zealand and England and Wales are classified according to their conformity with collective, citizenship or exclusion rights and their degrees of permanence. Alternative criteria for the apportionment of access rights are considered in the context of this classification. Different criteria for rights apportionment are found to be appropriate according to different circumstances in the context of pluralist provision. Policy developments in New Zealand are compared with those in England. After 150 years of a dominance of collective rights in New Zealand current policy is shifting provision towards exclusionary rights. In England, there is a policy shift in the other direction, towards collective rights. Lessons for the development of collective rights in England are drawn from the New Zealand experience in relation to styles of governance, public preferences, public cost, insurance liability and the potential of markets.

Civil Rights↗
PubMed1996

Notification of adverse health effects due to chemicals: two different ways in Germany.

The reporting of adverse health effects caused by chemical substances is regulated in Germany by the Ordinance on Industrial Diseases and the Chemical Substances Act. This retrospective analysis is based on the latest available annual reports for the year 1993, published by the Federal Ministry of Labor and Social Order, the Employers' Liability Insurance Associations and the Federal Institute of Consumer Health Protection and Veterinary Medicine. The list of occupational diseases (first published in 1925) currently includes diseases caused by a group of 27 chemicals. In 1993 there were 3,835 (3.5%) reported cases of suspected intoxication. Chemical substances caused 1.5% of all occupational accidents. In addition to this traditional procedure, it has even been necessary for physicians to report intoxications and diseases due to household chemicals and diseases attributed to environmental causes since 1990. Nation-wide 805 cases were registered in 1993. These figures reflect different legal conditions and show various outcomes. A result of this synopsis is, that the chemical industry in this country copes with the specific dangers of its trade, as accidents by fall and diseases due to physical effects are predominant. The applied preventive measures prove their value and are effective. Special attention should be paid to the correct use of chemicals by consumers and the risks for children.

Accidents↗
PubMed2001

[Nitrate headache in blasting work].

CASE REPORT: A 34-year-old white male was executing blasting works in an operation of a quarry several times a month during a period of 1 year. Each time he worked with explosives, he complained of headache, vertigo and concentration failure which started shortly after beginning and continued several hours after. The results of the physical examination on a day without blasting works were normal. Because of the exact working parallel appearance of the symptoms we did further explorations at the workplace which showed the usage of nitroglycerin blasting agents without observance of the safety regulations. The symptoms only at blasting workdays with normal clinical findings at break led considering the relation with the occupational conditions to the diagnosis "headache due to exposure to nitroglycerin explosives". It was reported to the employer's liability insurance association as an occupational disease with the aim of improving occupational conditions. CONCLUSION: Occupational toxic agents as a potential trigger of unclear headache support the requirement of an exact anamnesis of working conditions and environment.

Diagnosis, Differential↗
PubMed2003

Early secondary prevention of occupational skin disease in Germany: the dermatologist's procedure in perspective.

The dermatologist's procedure was introduced in 1972 as a "procedure of early detection of occupational skin disease" by industrial, agricultural and public-sector employers' liability insurance funds of Germany's statutory occupational accident insurance. To date, it represents the most relevant tool for secondary prevention in industrial dermatology in Germany. According to the intention of this procedure, insured parties who are likely to have an occupational skin disease have to be offered preventive measures and, if necessary, given appropriate treatment to avoid job-loss. In co-operation with the Central Federation of the Industrial Professional Associations, the Task Force on Occupational and Environmental Dermatology of the German Dermatological Society, and the Professional Organisation of German Dermatologists, a study group was constituted in 1999 to improve the traditional dermatologist's procedure. In October 2002 a controlled intervention study was started in North-western Germany to establish the definitive value of the "optimised" dermatologist's procedure. Past, present, and future of this specific procedure are discussed.

Dermatology↗
PubMed2004

Contact sensitizations in metalworkers with occupational dermatitis exposed to water-based metalworking fluids: results of the research project "FaSt".

BACKGROUND: The composition of water-based metalworking fluids (wb MWF) is complex, and various admixtures may be added before or during usage. Wb MWF may cause irritant as well as allergic contact dermatitis. While several current case reports point towards allergens particularly related to wb MWF, systematic studies have not been performed for several years. From 1999 to 2001, a study on contact allergies among patients with occupational dermatitis (OD) called "Fruhzeitige Erkennung allergener Stoffe bei beruflicher und nicht-beruflicher Exposition" (German acronym: FaSt) was conducted by the Information Network of Departments of Dermatology (IVDK), funded by the employers' liability insurances in Germany (HVBG). OBJECTIVE: The objective of FaSt was to detect sensitization patterns related to particular occupational exposures. METHODS: Anamnestic and clinical data were gathered using a standardised questionnaire. Patch test results were recorded by computer within the IVDK routine procedure. In addition to descriptive statistical analyses, logistic regression analysis was performed to control the effect of potential confounders. RESULTS: Among the 1842 OD patients in the FaSt study, there were 160 metalworkers exposed to wb MWF, whose data is presented in this paper. A specific allergen pattern of these patients can be described: most frequently, sensitizations to monoethanolamine (MEA), colophony/abietic acid, and fragrance mix were observed. Additionally, cobalt, formaldehyde, formaldehyde releasers and other biocides are important allergens in these patients. CONCLUSIONS: Preventive measures and aimed in-depth research may be based on these results. The special MWF test series have to be kept up to date based on exposure information from the MWF industry and on continuous surveillance of the target group.

Adult↗
PubMed1979

Insurance.

Explore the source record for details and available documents.

Humans↗
PubMed1998

Occupationally related tumors in tar refinery workers.

BACKGROUND: The study comprised 606 workers with tar-induced dermatosis employed in a German tar refinery. During the period from 1946 to 1996 they were recognized as having an occupational disease. OBJECTIVE: The aim of this study was to characterize the histologic findings and the localization of the occupational dermatosis and to determine the latency period of the carcinomas from the beginning of exposure in the tar refinery to the first occurrence of malignant skin tumors. Furthermore, the study aimed to check whether other skin changes were frequently diagnosed in addition to known tar-induced tumors. METHODS: The data were collected retrospectively from the documents of the Employer's Liability Insurance Association. RESULTS: Surgical removal of 4754 skin tumors was documented up to the end of 1996 in the study. In 90% of cases the histologic diagnosis was confirmed. Among other conditions, this yielded 2490 precancerous stages, 380 squamous cell carcinomas, 218 basal cell carcinomas, and 182 keratoacanthomas. The skin tumors were found mainly in the facial area, as well as on the forearms and hands. Latency from the first exposure in the tar refinery until manifestation of tar-induced dermatosis covered a period of 57 years. CONCLUSION: In comparison to the general population, the ratio of squamous cell to basal cell carcinomas was shifted toward the squamous cell carcinomas (1.7:1). Sunlight is known to be a cofactor in the pathogenesis of keratosis, squamous cell carcinomas, and basal cell carcinomas. However, the difference in location of these tumors shows that the role sunlight plays in the pathogenesis of precancerous lesions and squamous cell carcinomas may be overvalued. The latency period from the beginning of exposure to the manifestation of squamous cell carcinomas could not be evaluated because of an intervention bias as a result of preventive excisions of precancerous lesions. The frequent occurrence of keratoacanthomas (in 18.7% of the workers) and the early age at which this disease became manifest relative to the general population (median, 55 years) indicate that employment in a tar refinery can primarily or secondarily cause keratoacanthomas.

Adolescent↗
PubMed2002

The EORTC Boron Neutron Capture Therapy (BNCT) Group: achievements and future projects.

Boron Neutron Capture Therapy (BNCT) is an experimental treatment modality that takes place in a nuclear research reactor. To progress from preclinical studies to patient treatment is a challenge requiring strict quality management and special solutions to licensing, liability, insurance, responsibility and logistics. The European Organisation for the Research and Treatment of Cancer (EORTC) BNCT group has started the first European clinical trial of BNCT for glioblastoma patients at the European High Flux Reactor (HFR) in Petten, The Netherlands, conducted by the Department of Radiotherapy of the University of Essen, Germany. A very strict quality management had to be installed following the European rules on safety and quality assurance for nuclear research reactors, for radioprotection, for radiotherapy and for clinical trials. The EORTC BNCT Group has created a virtual European-wide hospital to handle the complex management of patients treated with BNCT. New clinical trials are currently under development.

Boron Neutron Capture Therapy↗
PubMed2004

[Four years of quality assurance of dermatologic procedures: report from the ABD clearing institution].

BACKGROUND: Expert dermatologic evaluation is the most relevant tool for secondary prevention in occupational dermatology in Germany. If there is a possibility of a work-related skin disorder in an employee, dermatologists may conduct the relevant diagnostic procedures (e.g. patch-and prick-tests, serology) at the expenses of the public employers' liability insurance fund (UVT). Most dermatologists make careful use of this unparalleled privilege, which is also an obligation. However, recently, with an increasing number of dermatologist's reports submitted, there have been occasional complaints by the UVT concerning overly extensive testing. In 1999 the Task Force on Occupational and Environmental Dermatology (ABD) of the German Dermatological Society established a clearing procedure. Two experienced occupational dermatologists will--separately--give their expert opinion on dermatologist's reports which have been forwarded anonymously by the UVT for expert review. RESULTS: Thus far, from May 1999 to May 2003 155 dermatologist's reports have been submitted to the clearing procedure. The complaints were in > 95% of cases considered justified by the experts. Their criticism was primarily directed towards excessive testing procedures and failure to provide sufficient clinical information. CONCLUSIONS: The UVT does not undertake such extensive preventive efforts for any other occupational disease. Therefore, quality management of the dermatologist's procedure--conducted by dermatologists and providing transparency--is essential to maintain and develop this effective tool of secondary prevention for the benefit of workers and employers.

Germany↗
PubMed1993

[Chemical and thermal eye burns in the residential area of RWTH Aachen. Analysis of accidents in 1 year using a new automated documentation of findings].

BACKGROUND: Until now there were no statistical data on the incidence and the prevalence of eye burns. Therefore we studied all patients coming to our hospital from the area of Aachen with eye burns during the time from September 1990 until August 1991. PATIENTS AND METHODS: All patients underwent a standardized examination including special history of the burning agent, industrial medical aspects and the employers liability insurance association. The documentation of the anterior eye segment pathology was scored separately for each eye encoded by location and special items. This documentation was worked up by the aid of a database (Filemaker II). 171 patients with eye burns were documented during one year. 65 patients had both eyes burned resulting in 236 documented records. RESULTS: The 171 accidents can be divided in 104 (61%) industrial accidents and 64 (37%) housework accidents. 3 accidents were of unknown origin. Classification of burns was scored according to Reim 1991. 208 (88%) eyes showed score I burns, 27 (11.5%) score II and only one patient showed a score III eye burn. We saw 121 (70%) male patients, 39 (23%) female patients and 11 children (7%). The main age group ranged from 16-45 years. 28% (n = 30) of all accidents happened in machine factories, which have thereby in our study the highest incidence of industrial accidents. CONCLUSION: By means of a one-year statistic we found that over 60% of all eye burns were industrial accidents, 28 in machine factories and 20% in service industries. 37% houseworks accidents are very difficult to prevent because of a deficit of safety rules.

Accidents, Home↗
PubMed2003

The laborist: a new focus of practice for the obstetrician.

The practice of obstetrics has changed dramatically in the last decade. Evidence exists for a marked increase in professional dissatisfaction, substance abuse, poor personal relationships, and burnout. These conditions are now being seen in younger physicians and in training programs. Physicians have stopped practicing obstetrics at a much younger age and are increasingly quitting training programs. These findings, along with the recent professional liability insurance crisis, leave many communities with a shortage of physicians who practice obstetrics. A potential solution for alleviating some of these conditions is the introduction of a physician whose sole focus of practice is managing the patient in labor. This physician, called the "laborist," may be able to improve patient care and satisfaction because the laborist will have no other distractions during this time. Also, the laborist will remove from the obstetrician the need to be always available to the laboring patient, which potentially may decrease stress, improve physician well-being, increase length of professional practice, and decrease burnout.

Burnout, Professional↗