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PubMed1991

Malpractice reports in prosthodontics in Sweden.

Prosthodontics is the branch most often involved in dental malpractice cases in Sweden. The number of cases has increased with the growing production of fixed prosthodontics after the introduction of the National Dental Insurance Scheme and the increase in the number of dentists. Prosthodontic treatment accounted for one-third of the working hours of private practitioners but two-thirds of the sanctions during the period 1974-78. The patients' complaints are often justified in some parts. The most common faults are elementary and have been similar throughout the whole period 1947-1988. Bridges (2-4 units), complete dentures and single crowns are the constructions most often involved in complaints. The maxillary frontal and premolar regions are in this order the regions most often involved. There are no differences between different age groups of dentists concerning the quantity of faults, but there is probably concerning the quality of faults because older dentists get more severe sanctions than younger.

Adult↗
PubMed1991

Res ipsa loquitur in Canadian medical malpractice cases 1975-1988.

There is a perception in some quarters that courts too often, in the interest of compensating victims, find the medical profession at fault for 'failed medical care' which does not amount to negligence. If this were true, judges would likely make liberal use of the evidentiary rules res ipsa loquitur. However, a study of Canadian medical malpractice cases from 1975 to 1988 indicates that this is not the case and that judges on the contrary reject such a liberal use of the rule. Res ipsa loquitur was pleaded in only 37 of 142 cases, it was applied in only 14 of these cases, and the defendant was found liable in only ten of the cases in which it was applied. Furthermore, there is little evidence in these cases that judges are as a matter of policy trying to find legal rules to justify compensating more victims of medical misadventure, regardless of fault. On the contrary, judges not infrequently express sympathy for the plaintiff but nevertheless find for the defendant.

Canada↗
PubMed1991

Psychiatric malpractice: recent clinical loss experience in the United States.

This article presents a survey of recent trends in psychiatric malpractice litigation and its consequences in the United States. More particularly, it investigates the factors that trigger such litigation, the nature of the complaints and claims, the characteristics of patient and psychiatrist and the cost it involves for the parties concerned.

Adolescent↗
PubMed1991

Medical malpractice and access to obstetrical care in Alabama.

The medical malpractice insurance crisis of the mid-1980s has abated, but nonetheless there are concerns that the threat of liability continues to have a deleterious effect on access to obstetrical services for low income women. Currently, at the national level there is discussion over whether the tort system should be replaced with a no fault compensation scheme similar to the worker's compensation system. Florida and Virginia have already enacted no fault compensation schemes for certain birthrelated neurological injuries. After reviewing the situation in Alabama with respect to claim frequency and severity, insurance costs and access to obstetrical care, we will examine proposals for a fundamental restructuring of the medical liability system.

Alabama↗
PubMed1991

Can practice guidelines reduce the number and costs of malpractice claims?

Practice guidelines have the potential to reduce the number of malpractice cases and the costs of settling them. However, for practice guidelines to exert any influence, they must be assumed to be (1) developed for conditions or procedures that frequently lead to events for which negligence claims are filed; (2) widely accepted in the medical profession; (3) fully integrated into clinical practice; and (4) straightforward and readily interpreted in a litigation setting. Because the validity of each of these assumptions can be questioned, the idea that inserting practice guidelines into the existing litigation process will generate large savings in the near future is overly optimistic.

Clinical Medicine↗
PubMed1991

Attorneys fear patient transfer claims in malpractice cases.

Hospitals are facing a new legal hurdle: the possibility that plaintiffs' attorneys will allege the violation of a federal patient transfer statute as part of their medical malpractice cases. Since the patient transfer law was enacted in 1986, additional laws, including two amendments passed last year, have placed new requirements on hospitals.

Emergency Service, Hospital↗
PubMed1991

The legal liability of doctors and hospitals for medical malpractice.

A broad overview of the fundamental principles relating to legal liability for medical malpractice is presented. The issues expounded, discussed and illustrated are the nature and consequences of the relationship between doctor/hospital and patient, effective consent as a requisite of lawful medical interventions, emergency treatment, medical negligence and the vicarious liability of doctors/hospitals for the negligence of others.

Hospitals↗
PubMed1990

Gene technology in medical diagnostics and criminal procedure and liability for malpractice in Germany.

The increasing employment of gene technological procedures in medical diagnostics and criminal procedure has forced both the medical and the legal professions to focus their attention on the complex question of liability of physicians, lab technicians, and other personnel involved in applying these measures. This article gives an outline, by citing practical cases, of the major aspects of liability for malpractice that are relevant under German law. Bearing in mind that this article will be read predominantly by members of the Anglo-American common-law legal system, the legal aspects - even though they are German legal aspects - are viewed in the light of the common law. The article examines three major issues: (a) liability for diagnoses employing gene technological procedures: (b) liability for wrong testimony based on 'genetic finger-printing': and (c) the donor's rights concerning his or her DNA-probe.

DNA Fingerprinting↗
PubMed1990

Effects of tort reforms and other factors on medical malpractice insurance premiums.

We use state-level data on physician malpractice premiums, claims, and awards, provided by insurance companies for the years 1974 to 1986, to evaluate the effectiveness of the various tort reforms that have been legislated during the 1970s and 1980s. In addition to the tort reforms, our analysis of premiums considers insurers' anticipated losses, returns on investments, the type of insurer, and premium regulation. Our results suggest that the only reforms that significantly lower premiums are those that either impose a cap on the amount of physician liability or reduce the amount of time a plaintiff has to initiate a claim. We also find that premiums are lower when states regulate rates by requiring prior approval of premiums. In addition, it appears that the observed cyclicality in premiums is due, in part, to fluctuations in the real interest rates available to insurers as returns on investments. Unfortunately, we did not find as strong a link between the determinants of premiums, claims, and awards as might be expected.

Fees and Charges↗
PubMedDate not supplied

A survey of obstetric malpractice in western frontier areas.

A mail survey of 524 physicians in the frontier areas of Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming, and the rural areas of Utah was conducted; 286 valid responses were collected (54.6%). Of the respondents, 97% had at some time practiced obstetrics, and, of those now practicing obstetrics, 39% reported they would discontinue providing obstetrical care within the next year. Of those stopping, 95% indicated that malpractice was a major factor in their decision. Of the respondents, 74% indicated that access to obstetric services would be a problem in their areas if they discontinued this type of care.

Humans↗
PubMed1990

Forensic psychiatry and malpractice.

This paper concerning the last 87 malpractice cases referred to the Department of Psychiatry and Law, Menninger Clinic, includes 57 suits against mental health practitioners and/or institutions, and 30 nonpsychiatric suits against general hospitals, surgeons, obstetricians, etc. A patient was available for interview in only 12 percent of the psychiatric cases; in 88 percent we reviewed medical records and consulted with attorneys. In the psychiatric cases the crucial question was whether a generally accepted standard of care was breached. The inherent problems of applying appropriate criteria to standards of care by practitioners and institutions are discussed. In half the psychiatric cases we found no significant deviation from acceptable clinical performance; in half we concluded that negligent practice had occurred. We did see a litigant for evaluation in 90 percent of the nonpsychiatric cases. The main issue involving them concerned harm or disability related to presumed negligence by medical personnel. How we evaluate such cases and apply disability criteria is discussed.

Disability Evaluation↗
PubMed1989

Psychiatric malpractice: ten years' loss experience.

The American Psychiatric Association authorized a study of cases closed before 1984 in its professional liability insurance programme. However, efforts to control the cost of medical malpractice insurance have failed. Psychiatrists may derive some comfort in knowing that their specialty continues to enjoy favourable rating compared with other forms of practice.

Costs and Cost Analysis↗
PubMed1989

Malpractice liability of the military physician.

This article discusses the immunity from personal malpractice liability given to military physicians under the Gonzales Act. Exceptions are discussed in relation to recent court decisions.

Humans↗
PubMed1989

Medical malpractice experience of physicians. Predictable or haphazard?

This study uses a large malpractice database from Florida to assess the concentration of losses among physicians, predictability of claims experience, characteristics of physicians with favorable vs unfavorable experience, and effects of claims experience on physicians' practice decisions and on actions taken by the state's licensing board. Most payments by insurers involved a comparatively small number of physicians. Physicians with relatively prestigious credentials had no better, and on some indicators, worse claims experience. If anything, physicians with adverse claims experience were less likely to make subsequent changes in their practice, such as quitting practice or moving to another state. Physicians with very poor claims histories were more likely to have complaints filed against them with the Florida licensing board, but the sanctions against physicians with either poor or excellent histories were not severe. Physicians with adverse claims experience from incidents that arose between 1975 and 1980 had appreciably worse claims experience from incidents that arose during 1981 to 1983.

Anesthesiology↗
PubMedDate not supplied

Some distinctions between malpractice and disciplinary proceedings.

Today most dentists are aware of the amount of litigation initiated by former patients alleging misconduct. However, few dentists seem to be aware of the number of disciplinary proceedings that have been brought against dentists and hygienists. This article describes some of the more significant differences between malpractice litigation and disciplinary proceedings.

Humans↗
PubMed1989

A review of 50 malpractice claims.

A study of 50 malpractice claims reveals that, although claims against optometrists have increased in number over the past two decades, the relative cost of professional liability insurance coverage has remained stable. The most common cause of claims is misdiagnosis of intraocular disease, principally retinal detachment, open-angle glaucoma, and tumors. Corneal disease and complications of contact lens wear also contribute to errors of diagnosis. The great majority of claims alleging misdiagnosis involve optometrists who have failed to use diagnostic drugs for dilation of the pupil; few claims are due to adverse responses to ophthalmic drugs. Failure to prescribe polycarbonate plastic as the spectacle lens material for patients at risk for ocular injury constitutes another cause of claims. A small number of claims allege failure to offer binocular vision therapy to amblyopic children.

Amblyopia↗
PubMed1989

An analysis of closed obstetric malpractice claims.

We reviewed all closed obstetric claims in the records of a major physician-sponsored malpractice insurer that has written policies from 1982 to the present. Of the 54 files closed during the 6.5-year period covered by this study, 21 (39%) involved physician reports of bad outcomes that did not lead to a formal claim. Of the 33 formal claims, 14 (42%) were dismissed, either by the plaintiff's attorney or by the courts. Eighteen of the remaining 19 claims were settled before trial, with an average payment to the plaintiff of $185,000. The one suit that went to trial resulted in a defense verdict. A review of the case histories demonstrated that in the majority of cases when a payment was made, probable medical negligence had taken place. Non-meritorious claims were not compensated. For those cases in which a payment was made, the size of the settlement was commensurate with the seriousness of the injury, which almost always involved damage to the infant. Poor physician judgment was the most common source of error.

Costs and Cost Analysis↗