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PubMed1995

Psychological assessment of postdisaster class action and personal injury litigants: a case study.

The case study method is used to describe psychological assessments undertaken with victims of a combined natural/technological disaster for litigation purposes. A class action suit was filed in which the authors determined levels of traumatic stress in 27 plaintiffs as a group and relative to each other. The process was effective--the case was settled out of court in favor of the litigants. Individual litigants were satisfied with monetary awards received.

Adult↗
PubMed1995

'Compensation neurosis' revisited: outcome studies of the effects of litigation.

Although the term 'compensation neurosis' has been frequently used to describe personal injury litigants, its clinical validity--and the assumptions about individuals described by this label--have not been critically examined. This article reviews the concept of 'compensation neurosis' and follow-up studies of claimants for compensation following the finalisation of their legal proceedings. A follow-up study of 760 litigants found that, of the 264 subjects who were not working at the time of conclusion of litigation and who could be traced, 198 (75%) were not working after an average of 23 months following the finalization of their cases.

Adjustment Disorders↗
PubMed2006

The risk of malpractice litigation in care to head-injury patients in comparison with other high-risk patient groups: an inpatient-based epidemiological study in Taiwan.

BACKGROUND: The purpose of this study was to assess the risk of being sued in district courts for care for head-injury patients from the perspective of epidemiology. METHODS: This research was designed to be a retrospective population-based cohort study. We researched the incidences of litigations arising from head-injury inpatients under neurosurgical care, all neurosurgical inpatients, and birth inpatients in Taiwan, and computed their relative risks. The study period was from 1998 to 2002. RESULTS: The average annual incidence rate of becoming a plaintiff for head-injury neurosurgical inpatients was 15 per million; for all neurosurgical inpatients 11.8 per million; and for birth patients 33.5 per million. The relative risk comparing head-injured neurosurgical inpatients against all neurosurgical inpatients was 1.27; whereas comparing head-injury neurosurgical inpatients against birth inpatients was 0.45, and comparing all neurosurgical inpatients against birth inpatients, 0.35. CONCLUSIONS: The findings of our population-based study indicate that for the inpatient populations, whether head-injury patients or not, neurosurgeons in Taiwan are facing a relatively lower rate of litigation in comparison with those treating birth patients. Nonetheless, head-injury patients still pose a major challenge in the ED, and misdiagnosis remains the major complaint of plaintiffs in subsequent litigations.

Brain Injuries↗
PubMed2003

Litigants' epicondylitis.

The speculated pathological causes of tennis elbow and the part work might play in its causation are briefly reviewed. The excellent surgical results, whatever operative technique was employed in those surgical series reported prior to the wave of work-related upper limb disorders is noted. One hundred and eight consecutive patients with tennis elbow who were also litigants (seeking compensation) were reviewed and the result of treatment and specifically surgery, analysed. Disappointing results of surgery were found in litigants and recommendations are made as to the management of litigants epicondylitis.

Adult↗
PubMed2003

Chronic pain, work performance and litigation.

The overall population impact of chronic pain on work performance has been underestimated as it has often been described in terms of work-related absence, excluding more subtle effects that chronic pain may have on the ability to work effectively. Additionally, most studies have focussed on occupational and/or patient cohorts and treatment seeking, rather than sampling from the general population. We undertook a population-based random digit dialling computer-assisted telephone survey with participants randomly selected within households in order to measure the impact of chronic pain on work performance. In addition, we measured the association between pain-related disability and litigation. The study took place in Northern Sydney Health Area, a geographically defined urban area of New South Wales, Australia, and included 484 adults aged 18 or over with chronic pain. The response rate was 73.4%. Working with pain was more common (on an average 83.8 days in 6 months) than lost work days due to pain (4.5 days) among chronic pain participants in full-time or part-time employment. When both lost work days and reduced-effectiveness work days were summed, an average of 16.4 lost work day equivalents occurred in a 6-month period, approximately three times the average number of lost work days. In multiple logistic regression modelling with pain-related disability as the dependent variable, past or present pain-related litigation had the strongest association (odds ratio (OR)=3.59, P=0.001). In conclusion, chronic pain had a larger impact on work performance than has previously been recognised, related to reduced performance while working with pain. A significant proportion were able to work effectively with pain, suggesting that complete relief of pain may not be an essential therapeutic target. Litigation (principally work-related) for chronic pain was strongly associated with higher levels of pain-related disability, even after taking into account other factors associated with poor functional outcomes.

Age Distribution↗
PubMed2001

Child custody mediation and litigation: custody, contact, and coparenting 12 years after initial dispute resolution.

Long-term follow-up data were obtained on families who had been randomly assigned to mediate or litigate their child custody disputes. In comparison with families who litigated custody, nonresidential parents who mediated were more involved in multiple areas of their children's lives, maintained more contact with their children, and had a greater influence in coparenting 12 years after the resolution of their custody disputes. The increased involvement of nonresidential parents who mediated did not lead to an associated increase in coparenting conflict. Parents who mediated also made more changes in their children's living arrangements over the years. For the most part, the changes apparently reflect increased cooperation and flexibility. Satisfaction declined for parents (especially fathers) in both groups over time, but fathers remained much more satisfied if they mediated rather than litigated custody. Few differences in satisfaction were found between mothers in the 2 groups. The 12-year follow-up data indicate that, even in contested cases. mediation encourages both parents to remain involved in their children's lives after divorce without increasing coparenting conflict.

Adolescent↗
PubMed2002

Actual versus self-reported scholastic achievement of litigating postconcussion and severe closed head injury claimants.

Psychologists typically rely on patients' self-report of premorbid status in litigated settings. The authors examined the fidelity between self-reported and actual scholastic performance in litigating head injury claimants. The data indicated late postconcussion syndrome (LPCS) and severe closed head injury litigants retrospectively inflated scholastic performance to a greater degree than nonlitigating control groups. The LPCS group showed the highest magnitude of grade inflation, but discrepancy scores did not significantly correlate with a battery of malingering measures or with objective cerebral dysfunction. These findings support previous studies, which showed self-report is not a reliable basis for estimation of preinjury cognitive status. Retrospective inflation may represent a response shift bias shaped by an adversarial context rather than a form of malingering.

Adult↗
PubMed1999

Breast Cancer Litigation: An Update with Practice Guidelines.

Cases involving breast cancer are the second most common cause of malpractice litigation. The leading allegation is failure to diagnose, followed by improper treatment. The most common physicians involved are those giving direct care to women: obstetricians/gynecologists, family medicine physicians, and internists. This review addresses frequent areas of litigation, offering practice guidelines for avoidance of malpractice claims. In addition, two new areas of breast cancer management will be reviewed-breast cancer prevention and breast cancer genetic testing-as potential new areas of malpractice litigation.

Journal Article↗
PubMed1994

A review of transfusion-associated AIDS litigation: 1984 through 1993.

BACKGROUND: Since 1984, hundreds of lawsuits have been filed against health care providers in the United States, alleging transmission of human immunodeficiency virus by transfusion. While anecdotal reports of jury verdicts have been published, no quantitative study to identify trends in transfusion-associated AIDS litigation has been undertaken. STUDY DESIGN AND METHODS: To identify trends in lawsuits filed against health care providers alleging human immunodeficiency virus infection transmitted via transfusion, 163 legal actions were analyzed. Included were those for which the authors provided legal defense or consultation (n = 79) and cases reported nationally (n = 84). Cases were analyzed as to characteristics of defendant(s), date of transfusion and case filing, liability theories, and verdict, if applicable. RESULTS: Defendants were blood centers (74% of cases), hospitals (58%), and physicians (53%). Of physicians, surgeons were named in 78 percent of cases; 42 percent of these surgeons were cardiothoracic surgeons. Nationally, 14 cases have resulted in plaintiff awards totalling $75,420,798. Physicians have been liable for 41 percent of that sum, blood banks 31 percent, and hospitals 26 percent. Of the 10 liability theories raised, the most frequent were claims of medical negligence (46% of cases), failure to identify high-risk donors (45%), lack of informed consent (39%), and failure to conduct surrogate testing (39%). Twenty-six trial results favorable to health care providers were noted nationally, 17 occurring in the San Francisco Bay Area, where case filings peaked before 1990 (40/56) and where new case filings decreased (1990, 5; 1991, 3; 1992, 1; 1993, 0) as verdicts favoring health care providers were reported. CONCLUSION: Transfusion-associated AIDS litigation began with verdicts against blood banks, but has expanded to suits against physicians and hospitals that are based on theories of medical negligence and informed consent. Despite widely publicized verdicts for plaintiffs, health care professionals have successfully defended these lawsuits, and in one center of early litigation, a sharp decrease in new case filings has been observed.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Relation between negligent adverse events and the outcomes of medical-malpractice litigation.

BACKGROUND: We have previously shown that in New York State the initiation of malpractice suits correlates poorly with the actual occurrence of adverse events (injuries resulting from medical treatment) and negligence. There is little information on the outcome of such lawsuits, however. To assess the ability of malpractice litigation to make accurate determinations, we studied 51 malpractice suits to identify factors that predict payment to plaintiffs. METHODS: Among malpractice claims that we reviewed independently in an earlier study, we identified 51 litigated claims and followed them over a 10-year period to determine whether the malpractice insurer had closed the case. We obtained detailed summaries of the cases from the insurers and reviewed the litigation files if the outcome of a case differed from the outcome predicted in our original review. RESULTS: Of the 51 malpractice cases, 46 had been closed as of December 31, 1995. Among these cases, 10 of 24 that we originally identified as involving no adverse event were settled for the plaintiffs (mean payment, $28,760), as were 6 of 13 cases classified as involving adverse events but no negligence (mean payment, $98,192) and 5 of 9 cases in which adverse events due to negligence were found in our assessment (mean payment, $66,944). Seven of eight claims involving permanent disability were settled for the plaintiffs (mean payment, $201,250). In a multivariate analysis, disability (permanent vs. temporary or none) was the only significant predictor of payment (P=0.03). There was no association between the occurrence of an adverse event due to negligence (P = 0.32) or an adverse event of any type (P=0.79) and payment. CONCLUSIONS: Among the malpractice claims we studied, the severity of the patient's disability, not the occurrence of an adverse event or an adverse event due to negligence, was predictive of payment to the plaintiff.

Adolescent↗
PubMedDate not supplied

Overview of the nursing home litigation process.

An increasing number of nursing home litigations have been filed as a result of the growing nursing home population and laws regulating their care. Understanding the litigation process and developing an awareness of the issues examined by attorneys and experts for both the plaintiff and defense are important for nurses working in long-term care. Knowing the standards of care and the litigation process can prepare nurses to anticipate and successfully defend their positions.

Humans↗
PubMed2001

Malingering disorientation to time, personal information, and place in mild head injured litigants.

Suchy and Sweet (2000) found disorientation in 12 (24%) of 50 benefit-seeking patients. They suggested that this level of disorientation, particularly in a sample that should not experience disorientation, is comparable to published base rate studies of malingering. The present study examined disorientation to date and personal information/place as indicators of malingering following a mild head injury. A mild head injury group (MHIG) in litigation was compared to patient groups with diagnoses of a psychiatric condition, Alzheimer's disease, vascular dementia and moderate to severe closed head injury group not in litigation. In the MHIG, disorientation to date and personal information/place was present in 7.4 and 5.7% of the sample, respectively, and significantly less than that found in the other three neurological groups. Disorientation to date was more common in the MHIG when compared to the psychiatric controls, but not disorientation to personal information/place. Relying on disorientation as an indicator of malingering, at least for mild head injured litigants, may underestimate its prevalence.

Brain Injuries↗
PubMed1988

Appraisal of the event as a factor in coping with malpractice litigation.

The authors designed a study to explore medical malpractice litigation as a stressor, factors that contribute to doctors' appraisal of it, how they actually cope with it, and the potential effects on them and on their mode of practice. We interviewed 51 physicians who had been sued for medical malpractice. Those who identified litigation as their most stressful life event (Group 1, N = 11) experienced significantly more physical and emotional symptoms, especially those suggestive of a major depressive disorder, and used more emotion-focused coping mechanisms than those who identified some other event in life as being most stressful (Group 2, N = 39). The appraisal of litigation as one's most stressful life experience may be a useful predictor of coping response, with previous life experiences as a major contributing factor to this appraisal.

Adaptation, Psychological↗
PubMed2004

Nursing home litigation and tort reform: a case for exceptionalism.

The medical malpractice crisis that is currently spreading across the United States bears many similarities to earlier crises. One novel aspect of the current crisis is the explicit inclusion of litigation against nursing homes as a target of reform. Encouraged by the nursing home industry, policymakers are considering the extension of conventional medical malpractice tort reforms to the nursing home sector. In this article, we caution against such an approach. Nursing home litigation has a number of distinctive features that raise serious questions about the wisdom of implementing reforms generically across the care continuum. Drawing on findings from our previous study of nursing home litigation, we outline these features and argue for careful attention to them as policymakers evaluate options for reform.

Humans↗
PubMed1991

Forty years of litigation involving medical students and their education: II. Issues of finance.

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 cited judicial decisions during that time, 59 (54%) involved disputes over financing medical education; 43 (73%) were litigated since 1985. This dramatic increase arises primarily from challenges to National Health Service Corps obligations and from attempts to discharge or reorganize debt under the Bankruptcy Code. Medical school graduates enjoyed very little success in these cases. Analysis of court decisions points to a need for informed counseling for medical students, particularly as to the consequences of timing in default on service obligations and of incurring loans under the Health Education Assistance Loan (HEAL) program as opposed to other loan sources. The growing educational debt of today's medical students foreshadows continued litigation in this area.

Education, Medical, Undergraduate↗
PubMed1991

Forty years of litigation involving residents and their training: I. General programmatic issues.

An analysis of reported state and federal adjudication from 1950 through 1989 was undertaken to identify issues and trends in litigation involving residents and their training. Of the 174 decisions cited, 38 (22%) involved disputes over general programmatic issues. The great majority of these addressed academic administration, especially issues arising from dismissals of residents. During more recent periods, residency programs have accommodated to judicial scrutiny of dismissals and have prevailed more often than claimants in litigation. Successful accommodation by residency programs has apparently not operated as a disincentive to further litigation, however.

Accreditation↗
PubMed1991

Forty years of litigation involving residents and their training: II. Malpractice issues.

The authors reviewed 136 cases of malpractice litigation involving residents or programs of graduate medical education that were reported from 1950 through 1989. Before 1970 malpractice constituted the only area of reported litigation for residents. The number of malpractice cases involving residents increased substantially after 1975, paralleling the growth of malpractice cases nationally. The regional pattern of reported cases involving residents also corresponded with previous findings. Questions of vicarious liability, the applicable standard of care, and residents' supervision were at issue in the great majority of cases. Questions related to judicial procedure, immunity from liability, breach or causation, and informed consent were also litigated. Residents were on the side of the prevailing party in 44% of the cases. Malpractice continues to be the key legal issue facing programs of residency training.

Internship and Residency↗
PubMed1994

The problem-oriented psychiatric examination of the chronic pain patient and its application to the litigation consultation.

OBJECTIVE: The purpose of this paper is (a) to delineate the behavior problems or complaints of chronic pain patients (CPPs) as presented in the literature and to add those behavior problems that have not yet been identified; (b) to present a semistructured psychiatric interview format that would lead to the delineation of these problems; and (c) to present a format and structure for the proposed semistructured psychiatric interview that could be utilized for the purposes of medicolegal assessment of the CPP and the reporting of that assessment to the litigation process. SETTING: Any psychiatric/psychological examination of the CPP. METHODS: The pain literature was reviewed for any research reports that specifically addressed or delineated the types of behavior problems found within the chronic pain (CP) population. These behavior problems were placed in a semistructured interview format, organized in such a way as to facilitate reporting to the litigation process if necessary. RESULTS: This semistructured psychiatric examination format is presented. Controversial problem areas in this format are discussed with appropriate references. CONCLUSIONS: CPPs are seen for the psychiatric examination with a set of behavioral problems largely determined by their medical condition, the consequences of that condition, and the social circumstances surrounding that medical condition (e.g., the litigation process). The psychiatric examination should be tailored to this special set of problems.

Accidents↗