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As medical treatment has become increasingly complex over the years, patient care has become more and more dehumanized. The author explains how this feeling of dehumanization can cause patients to file malpractice suits and explores ways in which hosptial administrators can attempt to remedy the situation.
No-fault medical accident insurance could help solve some of the medical malpractice insurance problems that plague American physicians and hospitals. In Sweden, the Patient Injury Insurance Plan has been working for two years, and, with the statistics that are now available, the claims experiences under the new Swedish system can be compared with the claims experience in the United States under the traditional liability system. The author believes that an insurance system similar to the Swedish plan can work in the United States, but only if certain conditions are created.
What caused the malpractice crisis of the early 1970's, and why did it fade? And why are claims rising again now? The constantly increasing complexity of medical practice along with unrealistic patient expectations undoubtedly have a lot to do with the recent upswing.
A survey of Florida neurosurgeons was conducted in April 1993 with a 68% response rate. One hundred twenty-three (81%) had malpractice insurance. Of the 29 (19%) without insurance, all but one practiced in South Florida. Cost was the major factor in dropping coverage. The cutoff appeared to be in excess of $100,000 per year for coverage for $250,000 per incident. Over 50% have considered early retirement. Those without coverage are limiting patient access. The number unable to afford minimal coverage is likely to increase; consequently patient access will continue to decline unless reforms allow coverage at a reasonable cost.
This article explores the legal ramifications flowing from the negligent treatment of pressure ulcers. A review of litigated cases provides examples of how American courts deal with this complex condition. References that may be used to reduce vulnerability to malpractice claims are provided.
The Louisiana Medical Disclosure Panel is a group of physicians, attorneys, and an oral surgeon whose duty is to supply a format that should be used to provide adequate information for patients about to undergo medical or surgical therapy. The Panel also provides the list of risks the physician should outline to the patient in order to obtain informed consent before the procedure. Physicians who use the form and the list of risks the Panel developed afford themselves the best protection from malpractice litigation currently available in Louisiana.
A survey has been carried out of court rulings during the last decade in cases regarding patients' complaints about alleged medical malpractice. The character of the cases is described, both penal code/disciplinary cases and cases regarding compensation. A number of main themes is evaluated: the availability of case records to the patient; the possibility for patients to choose medical advisers; the lessening of the burden on patients to prove that physicians have been negligent; and the relaxation of the burden on patients to prove causality between the injury and the medical treatment given. These main themes are evaluated over time. The investigation should be seen in the light of the fact that Denmark has recently introduced a patient insurance scheme, and the study will be the starting point for a later evaluation of the importance of this scheme, with particular reference to an improvement in patients' rights.
Intracranial tumors affecting the visual system are a source of malpractice claims involving optometrists. Signs and symptoms of disease, such as papilledema, optic atrophy, decreased visual acuity, headache, loss of visual field, acute onset incomitant strabismus, and gradually worsening coordination, should prompt optometrists to rule out the possibility of an underlying intracranial lesion. Appropriate optometric and medical evaluation should be provided. Co-management of care with other health care practitioners should be scrupulously coordinated and documented.
Since the dawn of human history, the inherent morbidity and mortality of human beings has made the diagnosis and treatment of human disease a high-risk profession. The ancient risk of physical retribution against the physician has been replaced by the modern risk of economic indemnity or compensation. Monetary settlements and awards are at times so huge that they may result in personal bankruptcy and professional disgrace. This article should not discourage health care providers from continuing their pursuits, but encourage them to enhance their knowledge about how and why medical malpractice has developed. It has been intended to facilitate the "prudent practitioner" with a more thorough understanding of some of the elements of negligence that have caused concerns in the past and will certainly create new concerns as science continues to drag the law in its wake.
Medicine has more severely changed during the last three decades than in the whole time before. The development may be summarized in one sentence: With it's new techniques in diagnostic and treatment, medicine has become more successful and at the same time more complex and more dangerous. To protect the reputation of this profession and to ease the relationship between physicians and patients regarding malpractice, independent medical bodies of experts in the form of arbitration or expert committees were introduced in Germany in 1975.
Statistical malpractice is an insidious, and indeed prestige-laden and grant-rewarded, activity. Brilliantly clever, but fundamentally wrong-headed, number-crunchers are encouraged to devise inappropriate applications of mathematical methods to health problems. This species of misdirected zealot has so far been immune from criticism.
The South African courts have successfully avoided the proliferation of medical malpractice suits that is the America experience by implementing various mechanisms that are clearly protective of the medical practitioner whilst increasing the burden on the patient-plaintiff. Whilst the motive is laudable this has often led to tragic results and bizarre precedent.
Dental malpractice litigation in not that easy to commence. It is filled with procedural obstacles and rules that must be met by a plaintiff. Sometimes this can seem bewildering to a dentist, and while it is supposed to be designed to weed out frivolous lawsuits, it often causes more stress for the dentist rather than less.
Several branches of competence are needed to evaluate malpractice in dentistry: first a complete case history, secondly careful clinical observation and finally a correct procedure of radiographic documentation. This latter is able to prove existence of the treatment and its evolution, moreover it shows the bone, the dental components underneath the surface and the treatment becomes appraisable by different observers. In restorative dentistry, radiological findings allow us to demonstrate overcontoured restorations in approximal sites and, if necessary, identify the biological width. In endodontics the insufficient filling or the overfilling of the root channel can be demonstrated along with the material used for the filling and the presence of fractured instruments inside the channel. In prosthodontics, on the other hand, the quality of the abutments, fractured roots and/or prosthesis, symptoms of inadequate charge on the bone and overcontours with the subsequent periodontal damage can be seen. In orthodontics one can assess the appearance of infrabone pockets, reabsorptions and horizontal recessions. In extractive surgery it is again possible to identify through radiographic documentation small root fragments in the maxillary sinus (possible sinusitis associated) and maxillary fractures as a consequence of extractions. In the field of implantology, damage to noble structures due to inadequate case planning can be highlighted.
The insurance claims against Italian radiologists over a three-year period (1993-1995) were anonymously reviewed, based on pertinent data provided by the Insurance Company of the Italian Society of Medical Radiology. The incidence risk-rate of claims was 11.4 per thousand persons/year. The overall claims rate increased in 1995. Alleged malpractice accounted for more than 85% of the claims. Misdiagnosis represented the first and most important claim category (43.4% of the total). The most common misdiagnosis was the failure to diagnose fracture or dislocation. The second most common plaintiff's misdiagnosis argument was the failure to diagnose breast cancer. The second most frequent claim category (35.8%) were complications, frequently occurring during interventional radiology and contrast media injection. A minority of claims (11.3%) originated from patient injury occurring in the radiology department during exam execution. Finally, radiologists were frequently sued together with medical (or surgical) doctors in case of patient death, according to an Italian law (Art. 589 P.C.). Claims were more frequent in public health services and they were mostly related to emergency examinations and interventional procedures.
Evaluation of malpractice litigation considers any breach of the fiduciary responsibility of the dentist, violations of the standard of care, comparative patient negligence, possible defenses such as honest mistake and causation. Issues in determining damages and mitigation are also discussed and a series of questions is offered concerning evidence for various dental procedures. Emerging trends in litigation include disregard of manufacturers' precautionary instructions in using new materials.
A lawyer with more than twenty years of experience defending dentists in malpractice situations reflects on the attitudes he typically sees in dentist defendants. The "professional" orientation that patients should expect nothing more than that the dentist does his or her best, is often at odds with the patient plaintiff view that they will have their feelings recognized at almost any price. The lawyer's role is often one of education. As the facts and perspectives involved are revealed through disclosure, resolutions begin to emerge. The best approach is for dentists to learn to communicate with patients--from their perspectives.
As in Canada, medical malpractice premiums in the United Kingdom are on the rise. In recent years there has been a 15%-20% annual rise in the cost of claims, and litigation costs for the National Health Service are soaring. Now, reports Caroline Richmond, another surge of litigation may be on the horizon because a 1996 change makes it possible for lawyers to take cases on a contingency basis.