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PubMed1997

[Forensic autopsy after possible medical malpractice. A 3-year material from the Institute of Forensic Medicine in Oslo, 1993-95].

According to Norwegian law, cases where medical diagnostic procedures or treatment may have caused death shall be reported to the police. During the period 1993-1995, an autopsy was performed at the Institute of Forensic Medicine, Oslo, in 76 cases of such deaths in hospital. In only one case did the police investigation result in a sentence for malpractice. The chief county medical officers react more often; in 16% of the cases, hospital procedures were criticised, or the hospitals were advised to improve hospital routines, and another 14% of the cases were reported to the Norwegian Board of Health. Thus, as expected, the chief county medical officers react more often with criticism than the police do with accusation. The appearance of the police in the hospital often implies a serious conflict of cultures. There are good arguments for specialists in forensic medicine acting as intermediaries between the health service and the judicial system.

Aged↗
PubMed1997

Discourage malpractice lawsuits: a commonsense approach.

They key to avoiding malpractice lawsuits is prevention. There are a number of practices that dentists should use to help them avoid such lawsuits. By following these practices in the office every day, much of the patient misconception and confusion that leads to a lawyer finding grounds for a suit can be avoided.

California↗
PubMed1992

Dentists, malpractice and not knowing enough: legal liability for failing to keep up with the profession.

The law imposes an obligation on you to keep current with the developments of your profession, particularly those developments which directly affect the health of your patients. From a legal perspective, you risk liability when your professional inquisitiveness and awareness falls below that of the reasonable specialist. While there is a substantial risk of being overwhelmed by the explosion of new dental knowledge, the alternative of being sued for malpractice is less attractive.

British Columbia↗
PubMed1976

Arbitration agreements and your malpractice coverage.

With new legislation and favorable case law developments, many providers of health care services are turning to binding arbitration agreements as a partial solution to the medical malpractice crisis. Existing data indicate tremendous advantages can be gained from the use of such agreements, if they are carefully drawn to comply with new law, tailored to the particular situation in which they will be used and coupled with appropriate procedures to secure the intended benefits. Arbitration is not a substitute for insurance, but if a provider has taken the calculated risk of forgoing insurance he should not be without a carefully drawn binding arbitration agreement.

Costs and Cost Analysis↗
PubMedDate not supplied

Professional liability (malpractice) coverage of humanist scholars functioning as clinical medical ethicists.

In contrast to theoretical discussions about potential professional liability of clinical ethicists, this report gives the results of empirical data gathered in a national survey of clinical medical ethicists. The report assesses the types of activities of clinical ethicists, the extent and types of their professional liability coverage, and the influence that concerns about legal liability has on how they function as clinical ethicists. In addition demographic data on age, sex, educational background, etc. are reported. The results show that while nearly one third (28.9%) of the ethicists regularly make recommendations about patient care, only 10.8% of them regularly make entries in the medical record; only approximately half (53.0%) of them are covered by professional liability (malpractice) insurance; and the vast majority (84.3%) of them say that concerns about legal liability do not influence the way the function as clinical ethicists.

Consultants↗
PubMed2005

Recurrent laryngeal nerve damage and phonetic modifications after total thyroidectomy: surgical malpractice only or predictable sequence?

Modifications of phonation occurring after total thyroidectomy (TT) are usually attributed to surgical malpractice, but other causes of voice impairment even in nonoperated subjects should also be taken into account. This study analyzes 208 patients who underwent TT from January 1, 1999 through December 31, 2001. Follow-up ended on December 31, 2003. Only cases in which the surgeon ruled out the possibility of operative damage to the laryngeal nerves were included. All patients underwent pre- and postoperative clinical and instrumental nose and throat examination (NTE). Preoperatively, 86 patients (41%) showed hoarseness or dysphagia: 4 (2%) monoplegia and 12 (6%) hypomobility of the vocal cords due to impaired function of the recurrent laryngeal nerve (RLN); 6 (3%) cord hypotonia due to impairment of the superior laryngeal nerve (SLN); 34 (16%) dysphagia: and 30 (14%) hoarseness due to other causes. At follow-up 1 month after surgery, 71 patients (34%) had an onset of previously absent signs and symptoms: 8 (4%) had palsy of one vocal cord (2% permanent); 6 (3%) had cord hypomobility (all temporary); 12 (6%) had cord hypotonia due to disease of the SLN, 4 of which (2%) were permanent; 44 patients (21%) had symptoms due to scarring and adhesions between the laryngotracheal axis and the prethyroid muscles and between these and the skin. One patient (0.5%) had a nodular cord lesion that occurred after 3 months. Overall, more than one-third of the patients had preoperative voice modifications or swallowing impairment, around one-third had these problems after TT, and less than one-third were free of pre- and postoperative complications. The surgeon's care to avoid damage to the anatomica integrity of the of laryngeal nerves does not exclude functional problems of the nerves and of laryngeal dynamics. In fact, such problems could be referred to outcomes linked to the operation itself (hematoma, edema, scarring adhesion) or to events that only temporarily follow surgery but must be considered as an unavoidable sequel (e.g., neuritis, viral neuritis, myopathy). The patient should undergo a careful clinical and instrumental NTE to detect conditions prior to surgery, and the information provided by the surgeons should be thorough to allow the patient to be aware of all possible sequels and consequences.

Cranial Nerve Diseases↗
PubMed2000

[Diuretic therapy of hypertensives with Type 2 diabetes; rational therapy or malpractice?].

There is overwhelming evidence that effective antihypertensive therapy with diuretics reduces total mortality and cardiovascular morbidity. Therefore, diuretics have a well established place in the pharmacotherapy of hypertension. However, their role in the treatment of hypertensives with type-II-diabetes is a matter of controversy due to their potentially adverse effects on glucose-, lipid- and electrolyte metabolism which--in type-II-diabetics--may potentially offset the beneficial effects of blood pressure lowering. However, results of large-scale, prospective, randomised intervention trials demonstrate that in type-II-diabetics the beneficial effects of blood pressure reduction per se are more important than any potentially adverse effects on metabolic surrogate parameters. The reduction in total mortality and cardiovascular morbidity as a result of effective antihypertensive therapy is more pronounced in type-II-diabetics than in non-diabetics. This holds also true for a diuretic based antihypertensive therapy in type-II-diabetics. Clearly their effects on glucose-, lipid- and electrolyte metabolism are of minor, if any, clinical relevance. The hypertensive type-II-diabetic benefits from diuretics--they prolong life and improve its quality. Therefore, antihypertensive therapy with diuretics constitutes a rational pharmacotherapy founded on the principles of evidence based medicine and must not be considered as malpractice.

Antihypertensive Agents↗
PubMed1995

Malpractice coverage for health professionals with physical, mental, or substance-abuse impairments. How do insurance companies make their decisions?

How do insurance companies decide whether or not to provide malpractice insurance to health professionals? What information do they gather on applicants and renewing policyholders? Who has the responsibility to determine if health professionals are suffering from physical, mental, or substance-abuse impairments that make them unfit to care for patients? The authors conducted a survey to find the answers to these questions.

Data Collection↗
PubMed1986

Ectopic pregnancy: a malpractice paradigm.

Subtle sonographic findings and other nonspecific clinical presentations often lead to missed diagnoses that can have significant legal implications. This communication discusses current diagnostic and laboratory methods used to evaluate patients with a suspected ectopic pregnancy in light of the concepts of "missed lesions" as they relate to negligence and malpractice theory.

Female↗
PubMed1992

Special report on reimbursement. Medicare program abandons 1986 malpractice rule.

Hospitals with claims "properly pending" before fiscal intermediaries or in the courts need do nothing in order to obtain corrected reimbursement for fiscal years so pending. However, to speed processing of corrected reimbursements for fiscal years pending in appeals before the PRRB, hospitals should request that the Board determine its jurisdiction and remand to the fiscal intermediary for payment as soon as possible. It will be helpful to include with any such request a copy of the notice of program reimbursement and the original appeal letter for each fiscal year under appeal. Despite the fact that HCFA Ruling 91-1 effectively concedes that HCFA has applied an invalid regulation to all fiscal years since May 1, 1986, HCFA counsel have stated that HCFA will not permit reopening of closed cost reports to correct the inappropriate apportionment of malpractice insurance costs. Nevertheless, hospitals that do not presently have a claim or appeal pending have several options. Under the Provider Reimbursement Manual, HIM-15, sections 2930-2931, fiscal intermediaries are required to reopen cost reports filed within the three-year reopening period to correct errors. Accordingly, should a fiscal intermediary deny a provider's reopening request, the provider should seriously consider taking an appeal to the PRRB. The PRRB's jurisdiction to review fiscal intermediary denials of requests to reopen cost reports was affirmed by the United States Court of Appeals for the Ninth Circuit, see State of Oregon v. Bowen, 854 F.2d 346 (9th Cir. 1988), a decision that is controlling in California, Oregon, Washington, Nevada, Arizona, Montana, Idaho, Hawaii, Alaska, Guam, and the Northern Mariana Islands.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Allocation↗
PubMed1981

Getting ready for the next malpractice insurance crisis.

In light of indications that another malpractice insurance crisis may be just around the corner, hospital managements should be analyzing the available insurance options. This article reviews the advantages and disadvantages of commercial insurance, self-insurance, and captive insurance and suggests when each is appropriate.

Hospitals↗
PubMed1988

Malpractice premium expenses: another "crisis" and its implications.

The continuing increase in malpractice claims, the severity of these claims, and onerous insurance premiums are contributing to the persistent crisis in this area. It is unclear whether there will be another general withdrawal of insurance availability. Rather, it seems more likely that problems will be isolated in certain geographical areas and among certain specialties. There is a high probability that physicians will selectively withdraw certain services in general or for specific patient groups. Data strongly indicate that certain subgroups of physicians such as obstetricians, younger doctors in general, and those in nonsolo practice are currently bearing more of the increased costs than some of their colleagues. Clearly, those in certain states are also differentially and adversely impacted.

Data Collection↗
PubMed1988

Formation and operation of a captive insurance company for malpractice coverage.

With the onset of the "malpractice crisis" of spiralling insurance costs in the 1970s, many medical groups began viewing self-insurance as a viable alternative to conventional carriers. Captive insurance companies are not without their risks, but continue to hold promise for controlling escalating insurance costs and providing a positive cash flow for the parent company.

Group Practice↗
PubMed1987

Medicare program; Provider Reimbursement Review Board jurisdiction over challenge to apportionment of malpractice insurance costs--HCFA. Notice of HCFA ruling.

This notice announces a HCFA Ruling relating to the jurisdiction of the Provider Reimbursement Review Board (PRRB) over challenges to the application or validity of our regulations concerning apportionment of malpractice insurance costs under the Medicare program. A related HCFA Ruling, 86-2, was issued on this matter on July 2, 1986. this Ruling announces that providers may request consideration by PRRB of appeals where a Notice of Program Reimbursement (NPR) has not yet been issued.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

[Scientometric and publication malpractices. The appearance of globalization in biomedical publishing].

Attention is drawn to publication and scientometric malpractices utilized by biomedical authors who do not adhere to the accepted ethical norms. The difference between duplicate/redundant and bilingual publications is defined. In the course of discussion of the manipulations that may be observed in the field of scientometry, it is pointed out that abstract of congress lectures/posters can not be taken into consideration for scientometric purposes even if such abstracts are published in journals with impact factors. A further behavioral form is likewise regarded as unacceptable from the aspect of publication ethics: when a physician who has participated in a multicentre, randomized clinical trial receives recognition (in an appendix or in an acknowledgement of an article) as having contributed data, but assesses this appreciation as co-authorship and thereby attempts to augment the value of his or her publication activity. The effects of globalization on biomedical publication activity are considered, and evidence is provided that the rapidly spreading electronic publication for a give rise to new types of ethical dilemmas. It is recommended that, in the current age of Anglo-American globalization, greater emphasis should be placed on the development of medical publication in the mother tongue (Hungarian).

Bibliometrics↗
PubMed1991

Psychiatric Malpractice and ECT: A Review of 1,700 Claims.

A total of 1,700 psychiatric malpractice claims filed from 1984 to 1990 were reviewed. Twenty-two cases involved ECT. Only four cases had complaints that referred to side effects, complications, or appropriateness of ECT. In the remainder, ECT was given in the past and/or the complaint was unrelated to the use of ECT. These data show a low frequency of lawsuits related to the use of ECT. The cost of resolving ECT cases was less than the average of all psychiatric claims. Patient satisfaction with the effectiveness of ECT may explain these findings.

Journal Article↗
PubMed1975

Malpractice aspects of medically prescribed exercise.

Stress exercise testing of suspected or known cardiacs and medical recommendations to patients to undertake physical fitness conditioning exercise programs constitute medical treatment in the eyes of the law and as such render the prescribing and supervising physicians legally responsible for harmful consequences to the patient to the same degree and under the same legal principles applicable for other medically prescribed diagnostic and therapeutic procedures. The physician who employs a stress exercise test or who recommends that a patient engage in exercise as part of a prophylactic, rehabilitative, or therapeutic program must be alert to those aspects of his recommendations which possess potential malpractice hazards. In particular, he should direct his attention to recognized indications and contraindications of exercise test and exercise programs. Furthermore, he should perform an adequate preexercise screening examination and he must make sure that the exercise is properly monitored; that it is immediately terminated upon onset of signs or symptoms of impending serious reactions; that adequate advance preparations have been made for the treatment of foreseeable emergencies, particularly those requiring cardiopulmonary resuscitation and advanced life support; and that such treatment is in full accord with generally accepted and proper medical standards. Finally, the physician must make certain that he adequately informs the patient of the potential risks and hazards associated with exercise stress testing and exercise programs so that the consent to such procedures can be classified legally as valid and "informed".

Exercise Test↗
PubMed2003

Surviving medical malpractice madness.

Mind-bending increases in medical malpractice insurance rates are driving physicians out of certain regions or out of medicine altogether, forcing hospitals to make tough choices such as eliminating services or cutting staff. Hospitals desperate to keep physicians are trying a number of strategies, from banding together to start their own insurance companies to reducing the amount of insurance they require their doctors to carry.

Data Collection↗