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PubMed1991

Forty years of litigation involving medical students and their education: I. General educational issues.

An analysis of reported state and federal adjudication from 1950 through 1989 was undertaken to identify trends in litigation involving medical students and undergraduate medical education. Of the 110 decisions cited, 51 (46%) involved disputes over general educational issues. A majority of the decisions affecting general education involved admissions and dismissal processes. Recently courts have begun scrutinizing readmission, course repetition, and cheating. Medical schools have accommodated to judicial scrutiny of general educational issues and have prevailed more often than claimants in litigation during this period, but litigation has not decreased as precedent and procedure have become clearer. Instead, litigation has continued unabated in alternative areas and at different levels of the educational process.

Education, Medical, Undergraduate↗
PubMed2001

An overview of the current state of radiation litigation.

Over the last three decades, radiation litigation has become a unique field of toxic tort litigation, with many new precedent setting decisions providing guidelines establishing how cases will be litigated in the future. This article will provide a summary of the status of the issues that are being litigated in radiation cases, and suggest recommendations on how pending issues should be resolved in the future.

Environmental Exposure↗
PubMed2001

Application of the Supreme Court's Daubert criteria in radiation litigation.

In 1993, the U.S. Supreme Court set forth the standard for determining the admissibility of expert scientific evidence in litigation. This standard is known as the Daubert criteria, named after the pertinent case, Daubert v. Merrell Dow Pharmaceuticals, Inc. The Daubert criteria require the courts to determine whether an expert's testimony reflects scientific knowledge, whether his/her findings are derived by the scientific method, and whether the work product is based on good science. The Daubert criteria are especially important in radiation litigation because issues involving radiation doses and effects are often complex and thus a jury will typically rely heavily on the analysis and opinions of experts. According to the Daubert criteria, scientific opinions must be based on a methodology that has a valid, testable hypothesis; has been subject to peer review; and is generally accepted in the scientific community. Additionally, the expert must be qualified to present opinions based on the methodology. Although the application of the Daubert criteria in radiation litigation is highly dependent on the specific court and judge presiding over the case, there have been recent high-profile cases in which application of the criteria has resulted in the dismissal of analysis and opinions offered by scientific experts. Reasons for the dismissals have included basic scientific errors such as failure of the expert to consider all possible explanations for an observed phenomenon, the selective use of data by the expert, and the failure to acknowledge and resolve inconsistencies between the expert's results and those of other investigators. This paper reviews the Daubert criteria as they apply to radiation litigation and provides examples of the application of the criteria from recent judgments involving the Three Mile Island and Hanford Downwinders cases.

Expert Testimony↗
PubMedDate not supplied

Device-related litigation & clinical engineering.

The investigation of patient-related incidents often must include consideration of the role of the associated medical devices. In addition to being good practice from quality review perspectives, federally mandated MDR requirements generally need to include clinical engineering input. Medical devices also play a significant role in patient litigation aimed at medical providers, hospitals and device manufacturers. Clinical engineering has an important role to play in supporting and tracking litigation as it relates to medical equipment. This role requires an understanding of the litigation process and active participation as a claim progresses. It also should include careful evaluation of the assertions and defenses raised by the various parties both during and at the conclusion of litigation.

Biomedical Engineering↗
PubMed2002

Breast implant-related silicone granulomas: the literature and the litigation.

Formation of a granuloma is a common tissue response to the presence of a variety of foreign materials. A silicone granuloma is, by definition, a type of tissue reaction elicited occasionally by silicone. Granulomas of this sort have not engendered a great deal of attention in the scientific literature since their first description in 1964, and they were considered by most surgeons through the 1980s to be an incidental finding of little or no consequence. Since it is tangible and readily visible to juries, the silicone granuloma became a frequent issue in breast implant litigation in the 1990s. Although most other complaints in this litigation have been subjective or causally unrelated to silicone, the presence of a granuloma has been used as a basis of local complication claims and, more creatively, as a mechanism for hypothetical systemic disease occurrence. This review examines the basic science and the clinical literature pertaining to breast implant-related silicone granulomas, viewing them in a context of current clinical thought and frequent issues of litigation. Clinically apparent silicone granulomas are a relatively rare complication of breast implant placement and surgical resection is indicated when they are symptomatic or of diagnostic concern. There is no evidence in the peer-reviewed scientific literature to support frequent plaintiff theories in litigation that silicone granulomas play some role in implant-related systemic disease. In fact, the very existence of such diseases, themselves, is equally unsubstantiated.

Breast Implants↗
PubMed2000

The new public health litigation.

In recent years there has been an increasing use of litigation as a public health tool. Litigation has been brought to advance policies concerning such matters as tobacco, gun violence, and lead paint. This article discusses this development and the criticism that can be leveled at using litigation to develop public health policy. The article concludes that, although litigation may not always be successful, it can deter dangerous activities and play an important role in advancing the political and social struggle for public health.

Democracy↗
PubMedDate not supplied

The rise of nursing home litigation: findings from a national survey of attorneys.

Lawsuits against nursing homes are a relatively recent phenomenon. Despite a growing sense of alarm among policymakers, little is known about these lawsuits' scale, dynamics, or outcomes. To describe these characteristics, we conducted a Web-based survey of attorneys nationwide who bring and defend this litigation. Our respondents and their firms were involved in 4,677 and 8,256 claims, respectively, in 2001; more than half of these claims were in Florida and Texas. The costs of nursing home litigation are substantial, both in the aggregate and per claim, especially in states where the litigation is most prevalent. These findings elevate concerns about quality of nursing home care and indicate that litigation diverts resources from resident care, which may fuel quality problems.

Aged↗
PubMed1980

The ordinary and the extraordinary in institutional litigation.

Institutional litigation, in which courts are requested to oversee the operation of large public institutions, has been frequently attacked as a departure from the traditional model of litigation. In this Article, Professors Eisenberg and Yeazell argue that the procedures and remedies employed in institutional litigation are not unprecedented but have analogues in older judicial traditions. Nor, they assert, do the doctrines of separation of powers and federalism present any obstacles to institutional litigation. They conclude that the novelty lies in the newly created substantive rights which courts are asked to enforce.

Civil Rights↗
PubMed2002

Class action litigation in correctional psychiatry.

Class action litigation has been instrumental in jail and prison reform during the past two decades. Correctional mental health systems have significantly benefited from such litigation. Forensic psychiatrists have been crucial in the litigation process and the subsequent evolution of correctional mental health care systems. This article summarizes information concerning basic demographics of correctional populations and costs of correctional health care and provides a brief history of such litigation. The role of psychiatric experts, with particular reference to standards of care, is described. Specifically discussed are issues relevant to suicide prevention, the prevalence of mentally ill inmates in supermax prisons, and discharge planning.

Forensic Psychiatry↗
PubMed1998

An overview of Medicaid managed care litigation.

Since the enactment of Medicaid in 1965, states have had the option of offering beneficiaries enrollment in managed care arrangements. With the advent of mandatory managed care reaching millions of beneficiaries (including a growing proportion of disabled recipients), the amount and scope of litigation involving Medicaid managed care plans can be expected to grow. A review of the current litigation regarding Medicaid managed care reveals two basic types of lawsuits: (1) those that challenge the practices of managed care companies under various federal and state laws that safeguard consumer rights, protect health care quality, and prohibit discrimination; and (2) suits that assert claims arising directly under the Medicaid statute and implementing regulations, as well as claims related to Constitutional safeguards that undergird the program. Lawsuits asserting claims arising under Medicaid tend to raise two basic questions: (1) the extent to which enrollment in a Medicaid managed care plan alters existing Medicaid beneficiary rights and state agency duties under federal or state Medicaid law; and (2) the extent to which managed care companies, as agents of the state, act under "color of law" (i.e., undertaking to perform official duties or acting with the imprimatur of state authority). Additionally, states might see an increase in litigation brought by prospective and current contractors who assert that they have been wrongfully denied contracts or improperly penalized for poor performance. These assertions may involve claims that are grounded in federal and state law, the Medicaid statute, and the Constitution. Moreover, in light of the consumer protection elements of the managed care reforms contained in the Balanced Budget Act, future managed care litigation may focus on the manner in which companies carry out states' obligations toward managed care enrollees. Resolution of Medicaid managed care cases involves the application of general principles of administrative and regulatory law. Thus, Medicaid managed care cases have implications for other public purchasers of managed care arrangements, including state mental health and alcohol and substance abuse agencies.

Consumer Advocacy↗
PubMed2004

Medical liability. The dilemma of litigations.

OBJECTIVE: Most if not all of the physicians are ill prepared when it comes to facing a medical litigation. Having witnessed that first hand on numerous occasions made me decide to write on this issue to offer some insight and advice on the matter as it is obvious no one is immune in the medical profession. In addition, the number of medical litigation cases is on the rise. There is no doubt that the matter is of great importance not only to doctors, medical and dental students but also to other health care workers. METHODS: The data of the cases submitted to the Medico-legal committee of the Ministry of Health, Riyadh, Kingdom of Saudi Arabia from various parts of the country for the period 1420 through to 1423 H (1999-2003) were examined and analyzed. A total of 2223 cases were referred to the various committees over the past 4-years for considerations. RESULTS: Obstetrics lead the way in being the most litigation prone medical specialty. Surgery takes the second place followed by internal medicine pediatrics being the fourth in order of frequency. The other specialties are some where in between. Least number of malpractice lawsuits were filed against the dental profession. CONCLUSION: Litigations can not be totally prevented but it could be limited to only the legitimate ones.

Cross-Sectional Studies↗
PubMed1990

Image processing by computer analysis--potential use and application in civil and criminal litigation.

The image processing by computer analysis has established a data base for applications in the industrial world. Testing has proved that the same system can provide documentation and evidence in all facets of modern day life. The medicolegal aspects in civil and criminal litigation are no exception. The primary function of the image processing system is to derive all of the information available from the image being processed. The process will extract this information in an unbiased manner, based solely on the physics of reflected light energy. The computer will analyze this information and present it in pictorial form, with mathematical data to support the form presented. This information can be presented in the courtroom with full credibility as an unbiased, reliable witness. New scientific techniques shown in the courtroom are subject to their validity being proven. Past imaging techniques shown in the courtroom have made the conventional rules of evidence more difficult because of the different informational content and format required for presentation of these data. I believe the manner in which the evidence can now be presented in pictorial form will simplify the acceptance. Everyone, including the layman, the judge, and the jury, will be able to identify and understand the implications of the before and after changes to the image being presented. In this article, I have mentioned just some of the ways in which image processing by computer analysis can be useful in civil and criminal litigation areas: existing photographic evidence; forensic reconstruction; correlation of effect evidence with cause of evidence; medical records as legal protection; providing evidence of circumstance of death; child abuse, with tracking over time to prevent death; investigation of operating room associated deaths; detection of blood at the scene of the crime and on suspected objects; use of scales at the scene of the crime; providing medicolegal evidence beyond today's technology; and a new theory and technique on using polygraph information in litigation. I am sure that the professionals in the forensic field will be able to think of many more applications where the image processing by computer analysis tool will be able to provide solutions to complex problems. The next time you say to yourself, "I wish they would have preserved this," or, "It's too bad they didn't do an autopsy," think of this new tool that is available to help you get the documentation and answers that will stand up to the scrutiny of the civil and criminal litigation system.

Accidents, Traffic↗
PubMed1985

Pending litigation and rehabilitation outcome of chronic back pain.

The effects of pending litigation for compensation on treatment outcomes of patients with chronic low back pain, were assessed. The 81 patients with chronic low back pain who participated in a six-week behavioral treatment program organized around the theme of self-control, were differentiated according to whether there were unsettled legal claims for compensation. Scales from the MMPI and Health Index were administered before and after treatment. Three behavioral measures of physical mobility were obtained from representative subsamples in each group before and after treatment and at one and three months follow-up. Results indicated that after treatment, patients without litigation pending obtained significantly greater reductions on the Hypochondriasis and Hysteria scales of the MMPI and achieved relatively greater improvements on two behavior measures. Because patients with litigation pending also evidenced significant behavioral gains, the belief that these patients are at risk for treatment appears to be true only in relation to the patients without current litigation rather than in an absolute sense.

Back Pain↗
PubMed1986

Medical malpractice litigation: do the British have a better remedy?

Medical malpractice claims are filed nearly ten times more frequently in America than they are in Great Britain. British patients generally adopt a less adversarial stance toward medical malpractice than do American patients. This Article examines the British malpractice system, as compared with the American system, and explores the differences between the two, in terms of costs and fees, liability rules, statutory provisions, and judicial attitudes toward malpractice litigation. The Article also discusses British social and institutional factors, such as the "taint" of litigation and the National Health Service, and evaluates how these factors affect British malpractice litigation. The Article presents the alternative forums available to British patients in seeking satisfaction for their medical service complaints. The Article concludes with an evaluation of how these factors achieve the three societal objectives of malpractice litigation: reparation, emotional vindication and deterrence.

Attitude↗
PubMed1986

Fathers and sons: some effects of prolonged custody litigation.

In all jurisdictions, for a variety of reasons, child custody and visitation issues may be reopened at any time. The children at issue, already likely to have been traumatized by problems in the parental marriage and subsequent separation and divorce, are affected further by still more litigation. The cases of three preadolescent boys who are the subjects of such prolonged litigation are presented. In each, the boys resided with their mothers as the primary custodial parents, the fathers having generally liberal rights of visitation. Regardless of which parent raised further court-related issues after the original agreements, the father-son relationship was most severely affected by continuing legal actions and related parental actions. Each child became increasingly fearful of the next anticipated visit by the father, who was cast into the role of villain by the child. Efforts to improve these damaged relationships through joint parent-child therapeutic attempts were largely of little avail. In spite of what may have been good experience with the person of the judge who dealt with earlier litigation, the children became fearful of what the next might be like or might do, viewing the judge as the person in power to whom parents and attorneys alike deferred. It is suggested that, wherever possible, prolonged litigation be avoided in the best interests of the child and of preserving necessary child-parent relationships.

Child↗
PubMed1998

The credible forensic psychiatric evaluation in multiple chemical sensitivity litigation.

The forensic psychiatrist must be able to perform a credible psychiatric evaluation and render a competent psychiatric opinion in hotly contested multiple chemical sensitivity (MCS) litigation. Forensic psychiatrists are often requested to evaluate MCS claimants by third party payers, employers, lawyers, and government agencies regarding health care costs and disability payments, workers' compensation claims, unemployment benefits, workplace accommodation reimbursements for special housing and environmental needs, civil litigation, and other claims. The credible forensic psychiatric evaluation of MCS litigants is described using the multiaxial diagnostic system of DSM-IV. Forensic psychiatrists must avoid becoming polarized by the current MCS controversy. The ethical requirements of honesty and striving for objectivity can be met by keeping separate the roles of therapist and expert, staying abreast of the scientific literature regarding MCS, and understanding the role of the psychiatric expert in MCS litigation.

Ethics, Professional↗
PubMed1998

HIV infection and AIDS in the public health and health care systems: the role of law and litigation.

The AIDS Litigation Project has reviewed nearly 600 reported cases involving individuals with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) in the federal and state courts in the United States between 1991 and 1997. Cases were identified through a federal and 50-state computer and library search. An important subset of litigation relates to HIV/AIDS in the public health and health care systems, since the law affects health care institutions and professionals, patients, and public health policy in America. This subset of HIV/AIDS litigation includes testing and reporting; privacy, the duty to warn, and the right to know; physician standards of care in prevention and treatment; and discrimination and access to health care. In broad terms, the review demonstrates a reliance on voluntary testing and protection of patient privacy through HIV-specific statutes and the common law. Negligence with potential civil and criminal liability has been alleged in cases of erroneous or missed diagnosis of HIV infection. In the first AIDS case to be considered by the Supreme Court, the Court will decide whether patients with asymptomatic HIV infection are protected under the Americans With Disabilities Act. Considerable progress has been made, both socially and legally, during the first 2 decades of the epidemic, but much still needs to be accomplished to protect privacy, prevent discrimination, and promote tolerance.

AIDS Serodiagnosis↗
PubMed1997

Malpractice litigation involving laparoscopic cholecystectomy. Cost, cause, and consequences.

OBJECTIVE: To analyze 44 cases of malpractice litigation involving laparoscopic cholecystectomy for cost, cause, and consequences of civil court actions. DESIGN: Survey of national jury verdict reporting services, covering 20 states during the 39-month interval from January 1, 1993, to April 30, 1996. The 44 laparoscopic cholecystectomies were performed during the 40-month interval from February 1, 1989, to June 30, 1992. MAIN OUTCOME MEASURES: Types of injuries leading to litigation, morbidity and mortality from injuries, trial verdicts, and cost of liability payments. RESULTS: The 44 injuries composed 4 main categories of injuries: (1) bile duct, n = 27, 61%; (2) bowel, n = 7, 16%; (3) major vascular, n = 4, 9%; and (4) other, n = 6, 14%. Bowel injuries involved trocar or cautery injury; vascular injuries all involved trocars. There were 7 deaths (16%) overall from either septic peritonitis resulting from bowel injury (4 patients [57%]) or bile peritonitis involving spills or cystic duct leaks (3 patients [43%]). No deaths resulted from injury to main bile ducts. Of the 44 cases, 21 (48%) settled out of court (mean payment, $469,711). Of the remaining 23 cases proceeding to trial, 19 (83%) were defended successfully while 4 (17%) concluded with plaintiff jury verdicts (mean payment, $188,772). CONCLUSIONS: Frequent settlements of cases involving laparoscopic cholecystectomy injuries that are litigated have resulted in a selection of cases of increased defensibility at trial. The high mortality rate from bowel injuries is a new medicolegal finding in laparoscopic cholecystectomies, as expensive to settle (mean payment, $438,000) as laparoscopic cholecystectomy bile duct injury (mean payment, $507,000).

Cholecystectomy, Laparoscopic↗