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PubMed1995

[Liability in consultation of physicians from different specialties from the physician's viewpoint].

The limitations of each specialty are laid down in the rules for continuing education for physicians. The necessary cooperation between the surgeon and the anesthesiologist is discussed on the example of the polytraumatized patient and the pain therapy after surgery. All rights and duties of the emergency team have to be laid down by the hospital management. The medical responsibilities for the therapeutic actions are on the side of the specialists.

Anesthesiology↗
PubMed2002

Physician vacancy. What is the impact and what can you do?

Doctors are leaving the profession in record numbers, yet the number of slots in medical schools has remained the same for the last two decades. How is this physician shortage affecting hospitals and patient care, and what can trustees do?

Career Mobility↗
PubMed2006

Principles for supporting task substitution in Australian general practice.

The workforce crisis in Australian general practice provides an impetus to consider new roles for other health professionals. Any innovations need to be appraised in advance for their potential risks and benefits. We propose six principles for this appraisal. These are the need for the new roles to: support the relationship between patients and their general practitioners; be clearly defined, aligned with competency and with relevant professional registration; be supported by practice systems providing safeguards against medical error; be underpinned by a system ensuring informed patient consent to activities being undertaken by members of the general practice team; be supported by effective medical indemnity insurance and be supported with appropriate financing.

Attitude of Health Personnel↗
PubMed2005

Torts, expertise, and authority: liability of physicians and managed care organizations.

We examine optimal individual and entity-level liability for negligence when expected accident costs depend on both the agent's level of expertise and the principal's level of authority. We consider these issues in the context of physician and managed care organization (MCO) liability for medical malpractice. Under current law, physicians generally are considered independent contractors and hence MCOs are not liable for negligent acts by physicians. We find that the practice of reviewing the medical decisions of physicians affects their incentives to take care, which in turn implies that it is efficient for MCOs to be held liable for the torts committed by their physicians.

Clinical Competence↗
PubMed1990

Hospital complaints procedures and no fault liability.

This article considers the extent to which it would be feasible to introduce 'no fault liability' for medical accidents, while the present system for dealing with complaints procedures remains in force. What is needed, it is argued, is a genuinely independent review process for dealing with complaints about clinical judgments.

Defensive Medicine↗
PubMed1995

Removing the shadow of the law from the debate about genetic testing of children.

When physicians view efforts to obtain genetic testing for children as unwise or contrary to the children's interests, they face difficult problems both of ethics and of communicating with the parents. Contrary to the suggestions of some, the law has little to say about how physicians resolve these dilemmas. Parents do not have a constitutionally protected right to demand that unwilling physicians perform these tests. In addition, there is little risk of liability for damages unless the child suffers physical harm as a result of the physician's refusal to do the test. The debate about genetic testing of children needs to take place with a clear understanding of the law's limited impact.

Child↗
PubMed1988

Legal rights and duties in the AIDS epidemic.

This article provides an overview of some major areas of legal concern in which the AIDS epidemic is having an impact. The rights of infected individuals to testing, treatment, and confidentiality are reviewed, and emphasis is given to their claims to nondiscrimination regarding access to health care, employment, housing, education, insurance, and related interests. Infected persons' duties to contain transmission of AIDS are outlined under principles of criminal and civil law, including liability for provision of contaminated blood products. Uninfected people's general rights to protection are considered, and health professionals' and authorities' rights and duties are given more detailed attention. In conclusion, some legal developments outside the United States are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed1981

Psychotherapeutic injury: reshaping the implied contract as an alternative to malpractice.

Despite the enormous number of Americans who seek psychiatric aid for their emotional problems, malpractice actions against psychiatrists are surprisingly rare. In this Article, Professors Feldman and Ward suggest that this stage of affairs is caused not by the extraordinary competence of the psychiatric profession, but rather by the particularly severe legal obstacles that confront injured psychiatric patients. The elements of the traditional tort cause of action--especially causation--are not easily proved by plaintiffs claiming psychiatric injury. Moreover, recent cases show that courts are growing even more unsympathetic to those patients who suffer most grievously from unscrupulous psychiatrists. To remedy this problem, the authors reach to the historical origins of medical malpractice liability, and advocate the revival of an implied contract to treat with skill and care. By imposing a fiduciary obligation on the psychiatrist in the performance of this contract, the authors overcome the obstacles of proof that arise from traditional tort law. This alternative approach should bring a new balance to the law of psychiatric malpractice, in which aggrieved patients will be compensated for thier injuries, but innovative practitioners will not be unduly deterred from medical experimentation.

Female↗
PubMed1998

Effects of central nervous system polypharmacy on falls liability in community-dwelling elderly.

BACKGROUND: While central nervous system (CNS) active medications such as psychotropics and narcotic analgesics have been implicated in contributing to falls in older adults, the combined effect of multiple CNS-active medications has not been investigated. The purpose of this study was to examine the influence, in community-dwelling elderly, of (1) taking multiple CNS-active medications on fall liability and (2) individual classes of CNS-active medications (using discrete drug classification) on the risk of falls after controlling for important confounders--age, mobility, cognition and depression. METHODS: 305 community-dwelling male veterans (age: 70-104) were screened at study entry for mobility, cognition and depression. CNS-active medications were categorized as benzodiazepines, other sedative-hypnotics, neuroleptics, tricyclic antidepressants, and opioid analgesics. Subjects were prospectively followed for 6 months to monitor falls; at the end of this time period, subjects were classified as fallers (at least one fall) or nonfallers. The relationship between CNS-active drug use and falls was examined using multivariable analyses. RESULTS: The risk of falls was significantly greater in CNS-active medication users as compared with nonusers. Adjusted odds ratio for one CNS-active drug was 1.54 (95% confidence interval 1.07-2.22) and for two or more agents 2.37 (95% confidence interval 1.14-4.94). CONCLUSIONS: In community-dwelling elderly, the use of multiple CNS-active medications is associated with enhanced falls liability, over and above the use of one CNS-active drug alone. This apparent dose-response relationship provides support for causality.

Accidental Falls↗
PubMed1996

The influence of the Product Liability Act, governmental regulation, and medical economics on medical devices and their clinical applications.

The advancement of medical technology constantly demands the introduction of safer and more efficient medical instruments and devices. Recent litigation and rulings against the manufacturers of breast implants and the subsequent refusal of major plastic companies to supply materials to them are seriously threatening the production and development of other permanent implants such as ventricular assist devices and even disposable catheters. In addition, government overregulation also discourages and hinders production and clinical applications of new instruments. Current trends such as cost effectiveness measures and economic restraints imposed by government agencies and managed care systems are endangering investments from the medical and industrial communities to exploit more expensive and sophisticated instrument technologies. The resultant lack of grant money and pressure from animal rights advocates also suppress experimentation on primates and domestic laboratory animals.

Animal Testing Alternatives↗
PubMed2002

Genetic testing in the workplace: the employer's coin toss.

A toss of the coin by the modern-day employer reveals two options regarding genetic testing in the workplace. The employer may choose to take advantage of increasingly precise, available, and affordable genetic testing in order to ascertain the genetic characteristics--and deficiencies--of its employees. This outcome exposes the employer to a vast array of potential litigation and liability relating to the Americans with Disabilities Act, the Fourth Amendment, Title VII of the Civil Rights Act, and state legislation designed to protect genetic privacy. Alternatively, the employer may neglect to indulge in this trend of genetic testing and may face liability for employer negligence, violations of federal legislation such as OSHA regulations, and increased costs associated with insuring the health of genetically endangered employees. In the rapidly developing universe of genetic intelligence, the employer is faced with a staggering dilemma.

Carpal Tunnel Syndrome↗
PubMed1998

[Liability of the pneumonologist. Recent medical civil legislation].

The clinician engages his penal, private and administrative responsibilities whenever he performs a medical act. Common law applies for private practice, as is the case of most pneumologists. Actually, there is little common law jurisprudence directly concerning pneumological situations. We present here the current trends and recent decisions made by judges faced with cases engaging physician's responsibilities.

Ambulatory Care↗
PubMedDate not supplied

When it's okay to say you're sorry.

Traditionally, physicians have been warned not to express sympathy to a patient whose treatment has not been successful, lest such a statement could be construed as an admission of liability in a court of law. It is now realized that a patient whose physician expresses sympathy is less likely to bring suit than a patient who feels angry and alone in his or her disappointment. Fortunately, legislation is being passed in some states which disallows the admissibility of a physician's "benevolent gesture" in court.

Attitude of Health Personnel↗
PubMed2001

Is your on-call system falling apart? Act now, or risk EMTALA violations.

According to a new report from the General Accounting Office, increased liability risks stemming from EMTALA regulations have made specialists reluctant to take call for the ED. If a consultant can't be reached or refuses to report to the ED, staff should not hesitate to call the chief of staff or administrator. Your policy should address obligations of on-call specialists for acceptance and refusal of transfer patients. To ensure adequate coverage, fee-for-service arrangements may be more effective than stipends.

Economics, Medical↗
PubMed2003

Changing the law, changing the culture: rethinking the "sleepy resident" problem.

Ms. Whetsell examines the Bell Regulations, which limit New York's hospital residents' work hours and require increased supervision from senior doctors, in light of the currently pending federal bill that seeks to do the same. The article argues that the federal government should draw lessons from the New York experience before proceeding with similar guidelines. The article notes that many roadblocks have prevented successful implementation of the New York policy, including a long-standing tradition of "hazing" first-year residents with long, unsupervised hours; medical community resistance to the notion of residents' sleep deprivation and dislike of government interference; and a general fear within the medical community of increased medical malpractice liability and other indicia of "blame culture." The Article concludes that the most effective approach to patient safety related to residency sleep deprivation should work within hospital culture, not against it. The proposed alternative approach would encourage patient safety strategies that value teamwork and cross-discipline collaboration, and consequently result in greater satisfaction for residents, hospitals, and patients.

Fatal Outcome↗
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↗