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[Malpractice--unnatural death. Medico-legal problems in the diagnostic activity of pathologists (author's transl)].

According to definitions of medical malpractice and of unnatural death it is established that medical measures under criminal principles of causality come into consideration as causes of death even without proof of guilt. That clinical and scientific sections are turned into means of judicial redress by the provisions of the Cemetery and Burial Act is challenged. It is recommended--as has been the case in other European countries for a long time--that all doctors have a duty of compulsory notification of signs of unnatural death.

Germany, West↗

Medical malpractice and the standard of care.

The reader is introduced to the doctrine of the standard of care as it pertains to the medical profession and how the standard is determined and applied during a malpractice trial or an administrative proceeding. The various techniques utilized to establish the standard of care are reviewed in the context of their application.

Expert Testimony↗

Malpractice--the syndrome of the 80s.

The current malpractice situation exists for the following reasons: 1) society's belief that all wrongs must have a reason and that the wrong must be put right, 2) the pervasive lottery mentality, 3) the inability of many individuals to accept responsibility for themselves or their actions, and 4) an increasing incidence of true medical negligence. The physician who gives careful detail to practice style, who constantly attempts to upgrade his skills and knowledge, and who prepares himself when involved in the inevitable legal quagmire will survive during this difficult time to practice the healing arts.

Attitude↗

Perinatal malpractice. Risks and prevention.

An analysis of 25 perinatal malpractice cases filed in Wisconsin between 1978 and 1984 clearly revealed that the unfavorable outcomes were preventable and caused by professional negligence. Each case was settled or adjudicated in favor of the plaintiff, and the awards totaled $25.1 million. Although cases with a total recovery of over $1 million are relatively infrequent, they are not so rare as to be considered extra-ordinary occurrences. Fifty-six percent of physicians involved failed to recognize a high-risk pregnancy or fetal distress, while 44% failed to render proper care. The most common errors involved inadequate fetal monitoring, the injudicious use of oxytocin and the failure to recognize a high-risk pregnancy, such as prematurity or postterm or multiple gestation. The purpose of this study was to examine the medicolegal issues operating in such cases in order to develop guidelines for reducing professional negligence, thereby preventing injury to women and their newborns.

Female↗

Counterattack--medical malpractice.

This month's column introduces eight principles designed to help the gastroenterologist in his or her continuing battle for peace (of mind), justice (for both), and the un-American way (avoidance of malpractice suits).

Defensive Medicine↗

Legal and malpractice implications of radial keratotomy.

Radial keratotomy has the potential to produce a new malpractice crisis for ophthalmology. Though the surgery is often successful in reducing myopia, there are a great many undesirable side effects. The endothelial cell loss frequently resulting from the procedure bodes long term caution.

Advertising↗

Medical malpractice litigation in ophthalmology: the New Jersey experience.

One hundred twenty-one medical malpractice claims against ophthalmologists are analyzed with respect to the specific allegation, the ophthalmic cause of litigation, and disposition. Failure or delay in diagnosis was responsible for 35% of claims and 63% of patient indemnification. Allegations of failure to diagnose most commonly concerned retinal detachment. While an identical number of claims were closed with payment because of errors in treatment, the indemnity for these claims was less by a factor of nearly half. The greatest number of claims alleging negligent treatment involved complications of cataract surgery.

Humans↗

The effective use of a questioned document examiner in medical malpractice cases.

The successful use of questioned document examiners in medical malpractice cases requires: Knowing what a document examiner can do in examining medical records; Defining in advance the areas of the records to be examined and the specific purposes thereof; Choosing a properly qualified questioned document examiner; Agreeing with the examiner on the cost and scope of his examination and prospective testimony; Evaluating the examiner's laboratory report in light of the claims made in the case; Conducting a proper pretrial conference with the examiner, covering not only the examiner's prospective testimony but possible opposing testimony.

Dental Records↗

Preferred provider organization liability for physician malpractice.

The preferred provider organization (PPO) is a recent innovation in the health care industry, designed to reduce costs through selective contracting and utilization controls. This Note examines malpractice liability theories potentially applicable to PPOs. The Note compares PPOs to other health care institutions, including hospitals and HMOs, and concludes that PPOs are at minimal risk of incurring liability for physician negligence.

Insurance, Health↗

Malpractice liability of allied health professionals: developments in an area of critical concern.

Malpractice litigation has become a serious concern of health professionals, as well as a contributor to escalating health-care costs. Allied health professionals have had their conduct called into question in a number of such suits, but so far these have received little scholarly attention. The developing body of allied health professions law is described and analyzed herein, with particular attention given to the issues of fact and law that are most frequently disputed. The need for legal development that includes sensitivity to the knowledge, abilities, and practices distinctive to the various health professions is stressed.

Allied Health Personnel↗

Malpractice law and emergency department medicine.

This article summarizes current law pertaining to medical malpractice litigation, focusing on the special medical/legal problems encountered by the emergency physician and defining the applicable legal standard of care. The discussion includes the issues of informed consent, documentation of emergency room treatment, advice and instruction to patients, legal abandonment, and the implications of the failure of an attending physician to authorize admission of an emergency department patient contrary to the advice of the emergency physician. The requirements for countersuits against lawyers and patients for the initiation of frivolous or malicious lawsuits is summarized.

Critical Care↗

Malpractice issues in heart transplantation.

As organ transplantation procedures become accepted as standard medical practice, it is anticipated that the frequency of liability claims against transplant care providers will increase. This article examines current statutory and common law analyses of malpractice issues in transplantation, with particular attention given to issues of informed consent as they arise both for the organ donor and donee.

Death↗

Medical malpractice and negligence. Sociodemographic characteristics of claimants and nonclaimants.

We compared a sample of 200 patients who filed a claim of malpractice or negligence against a large urban teaching hospital and its physicians, with a randomly drawn sample of 549 patients who had never filed a claim against the hospital. The two groups were compared on distributions by race, religion, occupation, age, and sex. In proportion to their representation in the control group, whites filed significantly more claims than nonwhites (P less than .001), Jewish people filed more claims than Protestants, and blue-collar workers brought fewer claims than white-collar or retired/unemployed workers. Claimants were significantly older than nonclaimants (P less than .05). Women filed a statistically nonsignificant greater number of claims than men did (P greater than .20).

Black or African American↗

Contingent fees in medical malpractice litigation - a qualitative assessment.

The medical profession has experienced high liability insurance premiums accompanied by widespread use of contingent fees in medical malpractice litigation. It is worthwhile, therefore, to assess qualitatively the merits of contingent fees, the evidence suggesting that they are associated with unjustified litigation and their implications for the medical and legal professions.

Fees and Charges↗

Decision analysis and dental malpractice suits.

This article introduced the reader to the basic notions of decision analysis. The generic structure of decisions was introduced by means of an example. Using the concepts for analyzing malpractice suits was then discussed in the context of a hypothetical problem. Two points are worth noting: (1) decision analysis constructs have wide applicability, since the ingredients germane to decision problems across disciplines have important similarities; and (2) the purpose of engaging in formal analysis is to enhance understanding and description of a problem and to aid the decision-maker to be more explicit and more comprehensive in his search for a preferred course of action. Undoubtedly the article has raised some questions in the minds of the readers. In an elementary exposition such as this it is difficult to do full justice to the topics of decision analysis. The following references may be of interest.

Cost-Benefit Analysis↗

[Malpractice in otorhinolaryngology. Report of experiences of the Board of Arbitration in Hannover].

In this article we report on the observations of an arbitration board for medical indemnity problems. The task of this board is to settle disputes concerning the reproach of medical malpractice privately. The producers of the arbitration board are explained. In a survey the proceedings with claims against otorhinolaryngologists are presented. Iatrogenic damages were most often seen after nasal sinus surgery. Recurrent laryngeal nerve palsy after thyroidectomy, spinal accessory palsy after posterior triangle operations and complications after intramuscular injections are frequent iatrogenic injuries of general interest.

Adenoidectomy↗

Medical malpractice: some implications of contract and arbitration in HMOs.

The "crisis" of medical malpractice has led to increasing advocacy of abandoning the fault-finding and litigation approaches. Health maintenance organizations (HMOs) afford unique institutional settings for developing alternatives. Explicit contracts between provider-managers and member-patients can allow consumers to determine how risk-prevention-and overall quality-they are willing to invest in. Not just principles of economic efficiency, but also of distributional equity can inform HMO performance-standard contracts; and arbitration may be the best mode for managing disputes arising from them.

Collective Bargaining↗

Plaintiffs' view of malpractice litigation.

All of us want to improve the quality of practice in our professions and develop methods for ridding ourselves of the incompetent practitioner. Unfortunately, PSROs and state licence review committees have proved completely inadequate. Committed dentists, doctors, and lawyers are as frustrated as the general public when they attempt to establish reasonable standards by which to police their respective professions. Although no one likes to be sued, I would suggest that the private lawsuit has developed into the most helpful tool for accomplishing mutual interprofessional aims and upgrading all of the professions. Certainly the competent individual who makes an honest mistake that causes harm should be financially responsible to the injured party. More importantly, especially since most lawsuits involve in minority of practitioners who hurt the public and the profession, both in stature and financially through increased insurance rates, the malpractice lawsuit provides a fact-gathering process upon which both education and discipline can be predicted. Individual dentists, when they see examples of consistently poor work, are still understandably reluctant to file charges. They have enough to occupy their time in keeping up with their own practices and continuing education. They are understandably reluctant to become self-appointed policemen or keepers of the community conscience. Where, however, the information can be brought to the attention of a dental society, with the facts already marshaled through the litigation process, such groups have in recent years been much more ready to act. Since their action comes as a response to demands and pressures external to the profession, it is more easily accepted by other dentists, and therefore more likely to be effective.

Defensive Medicine↗