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PubMed1996

[Medical expert assessment in civil and criminal law from the legal liability viewpoint].

In view of the wide range of liability claims, expert medical reports constitute part of the basis of the work of liability insurers. However, the very different qualifications of experts often present the so-called "corporate physician" with great problems, since some expert reports are hardly acceptable, as the author discovered during many years of study of a large number of liability files. In addition, the most striking and frequently occurring criteria are discussed.

Expert Testimony↗
PubMed1985

The legal aspects of medical school admissions and dismissals.

Implementation of the recommendations made in 1982 by the Council on Medical Education of the American Medical Association which emphasize the importance of evaluating noncognitive abilities in both admission to and dismissal from medical school will become a source of litigation unless adequate guarantees of due process are afforded the medical school applicant and student. In this article, the authors review the law as it applies to medical school admissions and dismissals and offer recommendations intended to reduce the potential liability of medical schools using noncognitive evaluations.

Persons with Disabilities↗
PubMed1998

[Medical negligence in Puerto Rico: 1990-1996].

The purpose of this communication is to present the statistical information of the medical and hospital professional liability situation in Puerto Rico from 1990 to 1996. The Medical Institutional liability is a topic of great relevancy and importance to the people of Puerto Rico and the leaders responsible for establishing policies for the health care services. The Reports on Medical and Hospital Professional Liability from 1991 to the 1996 produced by the Examining Physicians Board were reviewed. The liability claims from 1991 to the 1996 totaled 4054. During the seven years analyzed, 3506 cases were closed against physicians and institutions, a payment was issued in 1272 cases (36.3%), for a total compensation of $56,268,053. The risk of a legal claim is greater for the group of Plastic Surgeons and Emergency Medicine. The probability of a plaintiff receiving a compensation payment in a case of medical malpractice is approximately 36%, usually receiving a third of the total of the award as suggested by the medical literature. A thoughtful analysis of the current medical liability situation and defensive medicine should be done with the purpose of protecting the fiduciary function of the physicians with respect to the health of their patients, this is the function that guarantees a physician-patient relationship that is healthy, righteous and empathic.

Defensive Medicine↗
PubMed1990

Tort reform legislation: can it help hospitals?

Tort reform is not just an esoteric debate for health care executives. On the local level, the medical malpractice liability crisis is having a very real effect on many hospitals. Although malpractice insurance premiums have moderated, access to care is being restricted in communities where obstetricians and family practitioners have decided to give up delivering babies. Nor does the future look any brighter. Experts predict that medical students will shun obstetrical and other high-risk specialties to avoid the high cost of malpractice insurance. On the national level, President Bush has expressed concern that the liability situation is adding to the high cost of health care. And a number of congressmen have responded with legislation.

American Medical Association↗
PubMed2003

Ectopic pregnancy and emergency care: ethical and legal issues.

Ectopic or tubal pregnancy presents a medical emergency that requires prompt treatment in order to contain risks of maternal death and morbidity, including loss of future fertility. Medical circumstances involving individual patients and resources of the prevailing health care system will determine the options and means of treatment. Termination of ectopic pregnancy does not constitute or directly implicate abortion. Any practice of deliberately delaying treatment of reliably diagnosed ectopic pregnancy, on non-clinical grounds, until rupture of the fallopian tube has occurred or is imminent, in order to justify termination of the ectopic pregnancy on grounds of saving the patient's life, is unethical and illegal. Those who undertake or counsel deliberate delay of medically-indicated treatment can be charged with criminal offences and civil (non-criminal) liability, and medical professional misconduct. On reliable diagnosis, prompt treatment to remove ectopic pregnancy is legally justified, and ethically and legally required.

Emergency Medical Services↗
PubMed1992

Closed liability claims analysis and the medical record.

An analysis of 353 closed claims involving obstetrician-gynecologists revealed that the 40 highest-paid claims (11.3%) accounted for 88.7% of the total dollars spent. Newborn obstetrics, maternal obstetrics, and delayed-diagnosis claims represented 80%. Five doctors represented in the top 13 claims had another one or two claims among the highest 40. Only one of these physicians is still in good standing with the insurance company. Twelve claims (30%) were judged to be nonmeritorious, resulting in indemnity in five cases. Most of these claims illustrated either deficits with the medical record or system failures. A number of these problems could be prevented by avoiding system failures and by regarding the medical record as a legal document. Lawsuits occasionally resulted in an unfair distribution of dollars to injured parties and led to justifiable restriction of few physicians. It is critical that there be a record of why something was done. If the record is silent, there is no defense. An erroneous decision may be defensible if the reasons leading to it are recorded in the chart.

Gynecology↗
PubMed2005

Orthopaedics and the law.

Understanding the relevant legal context is critical to the safe and successful practice of orthopaedic surgery. Specifically, three areas of liability are relevant to most physicians: medical malpractice, products liability, and the liability of health care organizations. Medical malpractice encompasses the professional physician-patient relationship with its implied contract, consent, fiduciary responsibilities, and duty to provide the standard of care, as well as certain common-law duties pertinent in special circumstances. Orthopaedic surgeons who design implants or who have a relationship with a device manufacturer are at risk for liability for a failed product. In general, the hospital entity is responsible for the actions of its physician-employees. Still unclear is the degree to which a physician is obligated to appeal to a third-party payer on behalf of a patient. Physicians should remember that, above all else, common sense with regard to the treatment, informed consent, and advocacy of patients is essential to avoiding many medical-legal pitfalls.

Ethics, Medical↗
PubMed2001

[Specialists and assistant physicians; disciplinary division of responsibilities].

In every day hospital practice, the division of responsibility between specialists and assistant physicians plays an important role. This division of responsibility has repercussions in disciplinary judgements concerning the conduct of the supervisor and the assistant physician. The problem with this is that disciplinary law assumes individual liability. If a patient chooses to lodge a claim solely against the assistant physician then whether the assistant physician can appeal to shortcomings in the supervision is dependent upon the situation concerned. The supervisor is obliged to ensure that the necessary supervision is given or if the assistant physician indicates that a given task is beyond his own abilities then the supervisor should carry this out or find someone else to carry it out on his behalf. Within jurisprudence the value of protocols is becoming increasingly important.

Employee Discipline↗