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PubMedDate not supplied

The role of the HMO risk manager in medical malpractice cases--Part I.

In an HMO's defense against a medical malpractice lawsuit, a risk manager faces questions and issues which are different from those raised in the defense of a traditional healthcare provider. While many of the established issues apply, there are also new statutes, regulations, and case decisions that are unique to HMOs. The result is a new and rapidly changing field. This is the first of a 2-part article.

Health Maintenance Organizations↗
PubMed1987

Medical malpractice in perspective. II--The implications for Britain.

The "malpractice crisis" in the United States cannot be understood in isolation. Litigation is precipitated by features of the American health care and social security systems. Relative to the United Kingdom, there are fewer barriers of access to the courts, although the role of contingency fees has probably been exaggerated. Given the great institutional differences between the UK and the USA, the crisis seems unlikely to be replicated here unless there are further moves towards privatising both the costs of providing health care and the costs of its failures. It is concluded that a marginal change in the frequency or average cost of claims could have a serious impact on National Health Service resources, the medical defence societies, recruitment to specialties, and clinical practice. Debate over possible reforms is compromised by the dearth of good empirical data. Any changes, however, must address both the deterrence of bad practice and the compensation of injured patients.

Humans↗
PubMed1977

Does the "missed" radiographic diagnosis constitute malpractice?

Recent studies confirm that radiologists disagree as often as 50% of the time and that as many as 30% of pathological findings are "missed." Legally, "simple" errors are not considered to constitute malpractice, but "negligent" errors are; yet there are no practical guidelines to help the courts or the medical profession distinguish between the two. A practical "standard of radiological practice" must be developed, possibly by the various radiological societies, so that the courts may more easily distinguish true negligence from "simple" errors. It is also suggested that review panels be organized to render a medical opinion as to whether or not they conform to standard radiological practice.

Diagnostic Errors↗
PubMed2000

An examination of whether discharging patients against medical advice protects physicians from malpractice charges.

OBJECTIVE: Many physicians believe that documenting a discharge as "against medical advice" protects them from legal actions for adverse consequences related to the discharge. The authors examined case law for evidence of such protection. METHODS: MEDLINE and PsycINFO databases were searched for relevant articles. The medmal. base of Lexis and West Group was searched for annotated case law. RESULTS: Four relevant cases were found in which medical authorities and physicians were sued for medical malpractice even though they discharged a patient against medical advice. In all cases the defendants prevailed. However, their success was not due to the fact that they used the procedure of discharging patients against medical advice. Rather, it was based on the plaintiffs' failure to prove negligence. The authors offer guidelines for physicians faced with the decision to discharge against medical advice. Physicians should perform a careful and well-documented examination. They should assess the severity of illness and the severity of the risk if the patient is discharged. They should engage in a constructive dialogue with the patient about grievances. They should ensure that the patient's withholding of consent for further hospitalization is informed with respect to risks, benefits, and alternatives. If the patient meets criteria for involuntary hospitalization, the patient should be committed. CONCLUSIONS: Good clinical practice and thorough documentation remain the best legal protection. Discharging a patient against medical advice may provide partial protection, but it is not a royal road to legal immunity.

Adult↗
PubMed2005

Neurologic patient safety: an in-depth study of malpractice claims.

This in-depth study of neurologic malpractice claims indicated authentic, preventable patient harm in 24 of 42 cases, enabling comparison with larger but administratively abstracted summary reports. Principal findings included the common occurrence of outpatient events, lapses in communication with patients and other providers, the need for follow-through by the consultant neurologist even when not primarily responsible, the frequency of diagnostic errors, and pitfalls associated with imaging.

Continuity of Patient Care↗
PubMed2001

Malpractice claims: outcome evidence to guide neurologic education?

The choice of objectives and content in neurologic education should be informed by evidence from patient outcomes and errors. Malpractice claims are proposed as one data source, although they only partially reflect health outcomes. Epidemiologic, statewide data suggest some provisional priorities for key topics and training targets, but require further research to assess their value for guiding neurologic education.

Humans↗
PubMed1986

The performance of medical malpractice review panels.

In this paper we present the results of an empirical study of Arizona's medical malpractice review panels. We compare insurance company claim files data from before and after the implementation of panels to analyze the effects of the panel system. The data indicate that although the frequency and average amount of recovery are not affected by the panel system, the system leads to an increase in the number of disputes seeking formal adjudication, an increase in the cost of the process, and a lengthening of the time within which disputes are resolved.

Arizona↗
PubMed1989

Effects of tort reforms on the value of closed medical malpractice claims: a microanalysis.

Tort reforms enacted by state legislatures mainly seek to reduce the rate of increase in medical malpractice insurance premiums and other costs of the professional liability system, such as "defensive medicine." We examine the effects tort reforms enacted during the 1970s have had on the probability that a claim will be paid, the amount of payment, and the speed with which the claim is resolved. Claims frequency is not used as a variable in this analysis, but findings from other studies pertaining to frequency are noted. This study uses two closed claims databases--one from the National Association of Insurance Commissioners, and one from the U.S. General Accounting Office. We merged the two data sets for purposes of this analysis. The observational unit was the individual claim. Data on tort reforms came from our own analysis of statutory changes by state. Dollar ceilings on recoveries ("caps") are shown to be the strongest reforms in terms of their impact on paid claim size. Most caps limit recovery for noneconomic loss, though some limit dollar awards. Other reforms that reduced payments per claim were costs awardable provisions and mandatory collateral offsets.

Insurance, Liability↗
PubMed1991

Practice guidelines and malpractice litigation: collision or cohesion?

Practice guidelines are standardized specifications for managing particular clinical problems and are intended to improve the outcomes of medical care by increasing adherence to standards of care. They are also meant to make medicine more cost-effective by eliminating unnecessary procedures. A relatively recent phenomenon, the practice guidelines now emerging will have implications for malpractice, which also intends to bring about better care. They will probably not revolutionize the procedures that courts use to determine negligence, but judges will integrate guidelines into their decision-making process. This development should be welcomed. Guidelines should prove to be useful as either inculpatory or exculpatory evidence of negligence. They are unlikely to generate much new litigation, although there is some potential for suits against those who issue guidelines, especially if guidelines are not revised as the technology of medical care changes.

Clinical Medicine↗
PubMed1992

The effects of tort reform on medical malpractice insurance markets: an empirical analysis.

I use statewide loss ratio data to assess empirically the manner in which tort reforms have affected relative prices and profitability, and underwriting risk in the medical malpractice insurance industry. The empirical evidence suggests that the imposition of statutory ceilings on recoveries both decreased risk and improved relative profitability. Reforms that codified the required standard of care appeared to have a beneficial effect on relative profitability in certain cases.

Humans↗
PubMed1984

Variation in the growth and incidence of medical malpractice claims.

This study analyzes the incidence of medical malpractice claims since 1976, using data drawn from the 1982 core survey of the American Medical Association's Socioeconomic Monitoring System. The data show that, on average, physicians incurred twice as many claims per year in the years 1976 to 1981 as they did during their careers prior to that period. Using Tobit analysis, we find the annual frequency of claims to be greater among surgeons, obstetricians and gynecologists (OBGs), physicians in group practice, and physicians in states which apply the legal doctrine of informed consent. In addition, we find that the number of years since medical residency is positively related to physicians' claims incidence during the first 27 years of practice, and that OBGs and medical specialists who spend more time with their patients per office visit incur fewer claims.

Data Collection↗
PubMed1985

State responses to the malpractice insurance "crisis" of the 1970s: an empirical assessment.

Almost all states enacted legislation in response to the rapid rise in malpractice insurance premiums which occurred during the mid-1970s. After describing the types of statutory changes enacted, this study evaluates the influence of these changes on levels and growth of premiums paid by general practitioners, ophthalmologists, and orthopedic surgeons during 1974-78. The empirical results of the study presented here give no indication that individual state legislative actions, or actions taken collectively, had their intended effects on premiums. Several explanations for this result are explored.

Economics, Medical↗
PubMed1991

Issues in information malpractice.

In today's information explosion environment, the health sciences librarian is increasingly placed in the role of interpreting, translating, and evaluating information for clientele. With this emerging role and the burgeoning of fee for service programs, the question of information malpractice liability becomes an increasingly important issue. This paper explores the basis for legal actions against librarians and offers some precautionary measures to help protect against such legal action.

Humans↗
PubMedDate not supplied

Caring for patients in a malpractice crisis: physician satisfaction and quality of care.

The rhetoric of malpractice reform is at fever pitch, but political advocacy does not necessarily reflect grassroots opinion. To determine whether the ongoing liability crisis has greatly reduced physicians' professional satisfaction, we surveyed specialist physicians in Pennsylvania. We found widespread discontent among physicians practicing in high-liability environments, which seems to be compounded by other financial and administrative pressures. Opinion alone should not determine public policy, but physicians' perceptions matter for two reasons. First, perceptions influence behavior with respect to practice environment and clinical decision making. Second, perceptions influence the physician-patient relationship and the interpersonal quality of care.

Attitude of Health Personnel↗
PubMedDate not supplied

Are damages caps regressive? A study of malpractice jury verdicts in California.

Caps on damages have emerged as the most controversial legislative response to the new malpractice crisis. We analyzed a sample of high-end jury verdicts in California that were subjected to the state's dollars 250,000 cap on noneconomic damages. We found strong evidence that the cap's fiscal impact was distributed inequitably across different types of injuries. In absolute dollar terms, the reductions imposed on grave injury were seven times larger than those for minor injury; the largest proportional reductions were for injuries that centered on pain and disfigurement. Use of sliding scales of damages instead of or in conjunction with caps would mitigate their adverse impacts on fairness.

Adolescent↗
PubMedDate not supplied

Malpractice premiums and physicians' income: perceptions of a crisis conflict with empirical evidence.

The conventional wisdom is that malpractice premiums have steadily risen and now constitute a crisis for medical practice. The best available data suggest otherwise. American Medical Association (AMA) surveys of self-employed physicians from 1970 to 2000 indicate that premiums rose until 1986, then declined until 1996, rose thereafter, but were lower in 2000 than in 1986. Other items represented a much greater share of total practice expenses in 1970 yet increased rapidly until 1996 and moderately thereafter, while spending on premiums fell during 1986-2000. National trends were reflected with variations in obstetrics/gynecology, surgery, and anesthesiology and in nine regions surveyed.

American Medical Association↗
PubMedDate not supplied

Mediating medical malpractice lawsuits against hospitals: New York City's Pilot Project.

The New York City Health and Hospitals Corporation participated in a feasibility study to measure the participants' satisfaction with mediation of medical malpractice lawsuits. Twenty-nine cases were referred to the study, twenty-four agreed to mediation, and nineteen were mediated. Satisfaction data indicate that the plaintiffs and their attorneys and the defendant's attorney were satisfied with the process whether or not settlement was reached. The mean length of a mediation was 2.34 hours. Of the cases mediated, thirteen settled, with a median payment of 111,000 dollars. The defendant's and plaintiffs' attorneys estimated spending approximately one-tenth the amount of time preparing their case for mediation that they would have spent preparing for trial.

Attitude↗
PubMedDate not supplied

Have state caps on malpractice awards increased the supply of physicians?

Twenty-seven states have laws that cap payments for noneconomic damages in malpractice cases. In this study we examined whether these laws have increased the supply of physicians, using county-level data from all fifty states from 1985 to 2000. Counties in states with a cap had 2.2 percent more physicians per capita because of the cap, and rural counties in states with a cap had 3.2 percent more physicians per capita. Rural counties in states with a dollar 250,000 cap had 5.4 percent more obstetrician-gynecologists and 5.5 percent more surgical specialists per capita than did rural counties in states with a cap above dollar 250,000.

Compensation and Redress↗