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Legal issues in allergy and clinical immunology.

Clinical risk management for the allergist focuses primarily on concerns regarding adverse occurrences and the possibility of civil litigation as a result of negligence or professional liability. Risk is substantially reduced with an understanding of such predictable drug reactions as overdosage, side effects, secondary effects, and drug interactions. In addition, all clinicians who prescribe have a duty to disclose to their patients the possibility of unpredictable reactions, including intolerance, idiosyncrasy, and allergy or hypersensitivity. This disclosure should be part of a comprehensive discussion of the risks and benefits of, and alternatives to, therapeutic agents and procedures they recommend. The process of informed consent becomes even more critical with the increasing influence of hospital and managed care formularies on prescribing decisions. Although cost effectiveness is an important factor in prescribing decisions, the possibility of adverse effects, treatment failure, noncompliance, and other negative considerations must also be weighed.

Allergy and Immunology↗

Assessing legal responsibility for implant failure.

The number of malpractice suits related to implants has recently increased significantly, with awards that are among the largest in dentistry. This article discusses the principles involved in assessing liability for implant failure and the various clinical situations that can affect liability in implant practice. The author also provides a list of the interrogatories required of defendants in malpractice suits related to implants.

Dental Implantation, Endosseous↗

Medical and legal issues in the cardiovascular evaluation of competitive athletes.

Healthy-appearing competitive athletes may harbor unsuspected cardiovascular disease with the potential to cause sudden death. This fact raises issues of physician responsibility in preparticipation screening and eligibility/disqualification decisions. A number of medical-legal cases now represent a framework for screening and eligibility decision making in high school and college athletes. Physicians screening competitive athletes should strictly adhere to recommendations from the American Heart Association. Precedent exists for disqualifying athletes with heart disease from competition to prevent unnecessary exposure to risk of injury or death. By virtue of the court decision in Larkin v Archdiocese of Cincinnati, high school students with heart disease have no compelling right to participate in interscholastic sports without medical clearance. In Knapp v Northwestern University, an appellate court ruled that college athletes can be medically disqualified from sports and supported the use of national association medical guidelines by team physicians in formulating eligibility/disqualification decisions. This medical-legal analysis provides guidelines for physicians participating in medical evaluations of competitive athletes by clarifying the standard of care, potential pitfalls, and the evolving liability associated with this clinical practice.

Cardiovascular Diseases↗

Medical-legal issues of mild traumatic brain injury.

Numerous concussions/mild traumatic brain injuries occur each year during athletic participation by a variety of athletes not only in the United States but around the globe. A variety of standards-type statements have been developed by various athletic and sports medicine groups that can be used to improve and standardize the diagnosis and treatment of these injuries. These standards can also be used to assist practitioners in sports medicine clearance for participation and return-to-play decisions. In a medical-legal arena these statements can be used to support the care that is provided to athletes and thus serve as a "shield" to medical-legal claims and suits. However, these standards can also be used to attack the service that is provided and then be used as a "sword." Legal issues surrounding standards statements regarding these injuries and the diagnosis and management of them should be recognized and appreciated by sports medicine providers and used to balance the applicable medical and legal risks associated with their practices.

Athletic Injuries↗

A plaintiff attorney's candid view of medical malpractice.

The human dynamics of medical malpractice litigation is more nuanced than many doctors suspect. The purpose of this article is to provide some candid insights into the process. The article presents three subjects that doctors are not likely to learn on their own, even if they read all of the law books or had the misfortune of running the gauntlet of their own medical malpractice lawsuit. Those subjects are: (1) the top five reasons why doctors get sued, (2) avoiding less than optimal legal representation, and (3) the importance of nonmedical issues in litigation.

Humans↗

Risk management for the endoscopy center.

Risk management, as applied to practice in the endoscopy center, is a framework of processes that attempt to minimize medical errors, prevent adverse events and patient injury, reduce the probability of malpractice actions being brought, and limit the financial and personal psychological costs that accompany malpractice lawsuits. This article summarizes the components of these processes, building on a foundation of applied legal concepts and pertinent malpractice claim data.

Ambulatory Surgical Procedures↗

Addiction and disability: moral and policy issues.

This article discusses the conceptual, ethical, and policy issues raised by the legal classification of drug addiction as an impairment, and of some nonusing drug addicts as people with disabilities. It focuses on the questions of (1) what moral judgments, if any, underlie the classification of addiction as an impairment; (2) whether it makes sense to apportion the burdens of drug addiction between chemical, biological, social, political, and other causes; (3) how considerations of distributive justice may compel or constrain measures to ease the burdens of drug addiction; and (4) whether it is justifiable to deny the current users of illegal substances legal protections available to the current users of legal substances.

Attitude to Health↗

The evaluation and understanding of pain: clinical and legal/forensic perspectives.

The evaluation and proper clinical and legal management of pain clients defy simple remedies. Historically, human pain has challenged the most sophisticated of philosophical, theological, and biomedical explanations. Following an historical overview of pain concepts and treatment, this paper discusses the prevalence in and influence of pain on the modern world. One perspective for viewing multifaceted pain issues is a model developed by John Loeser. This four-level model addresses not only tissue damage (Nociception), but also the patient's perception of such damage (Pain), the negative emotional reactions to such perceptions (Suffering), as well as the pain activity stemming from such damage (Pain Behavior)--all issues critical in medical management as well as in personal injury litigation. Several methods for classifying pain are discussed, including acute vs chronic pain, benign vs cancer pain, "real" vs psychogenic pain, and a multiaxial coding schema for pain which encompasses a number of professional disciplines. Clinical pain assessment is then reframed and translated into a legal format more relevant to forensic discovery and case development.

Expert Testimony↗