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At least 127 records · Page 7Linked to original sources
PubMed2005

[Consequence of evidence-based medicine and individual case appraisal of the Robodoc method for the MDK, and the malpractice management of insurance funds and the principles of managing innovations].

PURPOSE: Robots in Total Hip Replacement were introduced to utilize the precision of an industrial robot for reaming the femur. This method has been discussed controversially from the beginning of its clinical application in Germany. Criticism increased recently especially in respect of alleged malpractice. Aim of this study was to describe the consequences of the results of a systematic review and the evaluation of malpractice accusations for statutory health insurance and medical advisory services. METHOD: Robot-assisted total hip replacement was evaluated by a Health Technology Assessment report, especially concerning proof of clinical benefit and specific complications of this method. 44 cases of alleged malpractice reported to health insurance were assessed as well and compared with the results of the systematic review. RESULTS: The HTA report showed no proof of clinical benefit but pointed to increased rates of complications. In the 44 evaluated cases the entire range of endoprosthesis- but no robot-specific complications could be identified. CONCLUSION: Patients must be informed about risks, complications, benefits and especially alternatives to a robot-assisted operation. The prospective procedure of management of assumed malpractice concerning Robodoc can not be standardised, but each case must be evaluated individually. Consequently, implementation of a structured malpractice management system for health insurance and medical advisory services should be useful. Additionally, health service should implement an "early warning system" for innovative procedures.

Arthroplasty, Replacement, Hip↗
PubMed1978

Doctors, damages and deterrence. An economic view of medical malpractice.

Damages awarded in a malpractice suit must be viewed not only as compensating the victim but also as deterring health-care providers from negligent behavior. Economic analysis of the malpractice system indicates that awards can send a signal to providers that informs them how much to invest in avoiding mishaps. The malpractice system is beset by difficulties, but not the ones commonly incriminated. The signal to the physician, as determined by the number of claims and size of awards ("expected damages"), appears to be insufficient for ideal deterrence. Moreover, the deterrence signal is attenuated because malpractice premiums are set for groups of physicians, not for individuals according to their record of previous malpractice incidents. Replacing the present tort system with a no-fault insurance scheme would not necessarily be cheaper, and might well abolish the deterrent signal or distort clinical decision making.

Cost-Benefit Analysis↗
PubMed1991

Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III.

BACKGROUND AND METHODS: By matching the medical records of a random sample of 31,429 patients hospitalized in New York State in 1984 with statewide data on medical-malpractice claims, we identified patients who had filed claims against physicians and hospitals. These results were then compared with our findings, based on a review of the same medical records, regarding the incidence of injuries to patients caused by medical management (adverse events). RESULTS: We identified 47 malpractice claims among 30,195 patients' records located on our initial visits to the hospitals, and 4 claims among 580 additional records located during follow-up visits. The overall rate of claims per discharge (weighted) was 0.13 percent (95 percent confidence interval, 0.076 to 0.18 percent). Of the 280 patients who had adverse events caused by medical negligence as defined by the study protocol, 8 filed malpractice claims (weighted rate, 1.53 percent; 95 percent confidence interval, 0 to 3.2 percent). By contrast, our estimate of the statewide ratio of adverse events caused by negligence (27,179) to malpractice claims (3570) is 7.6 to 1. This relative frequency overstates the chances that a negligent adverse event will produce a claim, however, because most of the events for which claims were made in the sample did not meet our definition of adverse events due to negligence. CONCLUSIONS: Medical-malpractice litigation infrequently compensates patients injured by medical negligence and rarely identifies, and holds providers accountable for, substandard care.

Clinical Competence↗
PubMed2002

Surgeons' tone of voice: a clue to malpractice history.

BACKGROUND: Interpersonal aspects of care, such as the communication behaviors of physicians, are often cited as central to patients' decisions to initiate malpractice litigation. Relatively little is known, however, about the impact of the communication behaviors of surgeons. In the current study, we investigated the relationship between judgments of surgeons' voice tone and their malpractice claims history. METHODS: We examined the relationship between surgeons' voice tone during routine office visits and their history of malpractice claims. Surgeons were audiotaped while speaking to their patients during office visits, and very brief samples of the conversations were rated by coders blind to surgeons' claims status. Two 10-second clips were extracted for each surgeon from the first and last minute of their interactions with 2 different patients. Several variables were rated that assessed warmth, hostility, dominance, and anxiety from 10-second voice clips with content and 10-second voice clips with just voice tone. RESULTS: Controlling for content, ratings of higher dominance and lower concern/anxiety in their voice tones significantly identified surgeons with previous claims compared with those who had no claims (odds ratio [OR] 2.74, 95% confidence interval [CI] 1.16 to 6.43 for dominance; OR 0.46, 95% CI 0.21 to 1.01 for concern/anxiety). CONCLUSIONS: Surgeons' tone of voice in routine visits is associated with malpractice claims history. This is the first study to show clear associations between communication and malpractice in surgeons. Specific types of affect associated with claims can be judged from brief audio clips, suggesting that this method might be useful in training surgeons.

Communication↗
PubMed1989

Cost, correlates and effects of malpractice litigation in family practice residency programmes in the United States.

A survey of family practice residency programme directors in the United States was undertaken to look at the impact of malpractice and malpractice insurance on residency education. Of 385 programmes 276 (71.7%) responded to the 20 question survey. The results indicated a mean rate of 0.043 claims per resident or faculty member in the previous year. One-fifth of the respondents did not report the type of malpractice insurance retained for residents and over half did not report the cost of insurance for residents. Current problems with liability were most often related to the region of the country, number of visits to the family practice centre, the number of residents, the number of faculty, the type of faculty employer and the type of resident employer. Programmes which anticipated future problems with liability were most likely to be those with current problems. The areas identified as most concerning to residents included: obstetrics, cost of malpractice insurance, difficulty obtaining coverage, and the general anxiety created by malpractice litigation.

Education, Medical, Graduate↗
PubMed1982

The medieval medical third party: compulsory consultation and malpractice insurance.

Medical third-party intervention was a venerable medieval tradition. Fifteenth century London's medical malpractice legislation and court cases contained forms of peer review, compulsory consultation for critical cases, and a malpractice insurance "floater" policy for conditions likely to lead to death, maiming, or accusations of malpractice. A four-part Latin document from 1415 and a few earlier and later manuscript rules demonstrate the role of politics in medical ethics; civil enforcement of surgical guild regulations; and ingenious forms of protection for patient, practitioner, the surgical profession, and the English citizenry. Pairing compulsory consultation with malpractice insurance policies for high-risk cases offers inspiration for alleviating some modern malpractice perils.

Consultants↗
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↗
PubMed1975

Malpractice and employment of allied health personnel.

Increased costs of malpractice insurance and physician fear of involvement in malpractice suits have been suggested as inhibiting greater employment and utilization of allied health personnel in physicians' offices, since physicians are liable for acts of negligence by their employees. However, data obtained from a survey conducted by the American Medical Association in 1971 suggest that malpractice insurance expenses vary within only a relatively narrow range with the number of allied health personnel employed by physicians. Thus, malpractice insurance expense per se is probably not a significant factor in influencing physicians' decisions to hire aides. On the other hand, nonpecuniary aspects of the malpractice situation may still be an important deterrent to greater employment of allied health personnel.

Allied Health Personnel↗
PubMed1986

Medical malpractice and the primary care physician: lowering the risks.

The medical malpractice crisis is gaining increasing attention in the United States today. Before the early 1970s, physicians in primary care specialties considered themselves safe from the threat of malpractice suits. Today, however, primary care physicians are being named as defendants in malpractice suits at an accelerating rate. After providing an overview of the medical malpractice problem, we present data from patient satisfaction surveys revealing that patients are not as satisfied with their physicians as they once were. We then review the common reasons why patients contact lawyers, examine the most frequent clinical situations that result in malpractice suits, and conclude with specific recommendations which, if followed, may decrease the liability risks for primary care physicians.

Consumer Behavior↗
PubMedDate not supplied

Malpractice: provider risk or consumer protection?

The National Practitioner Data Bank (NPDB) began operation in September 1990 as a clearinghouse for adverse action, licensure, and malpractice information in an effort to protect consumers and promote quality in health care. This study analyzed 66,107 and 1291 records of payments made for 50,396 physicians and 1218 nurses, respectively, from 1994 through 1998, to describe characteristics, trends, and risk factors of malpractice payment for physicians and nurses. The median payments, more often settlements paid by insurance companies than judgments in courts of law, were higher for physicians than for nurses. Mean payments were higher for residents than for non-resident physicians; median payments for residents were slightly lower than other physicians when adjusted for number of providers included in the payment. On the state level, correlation analyses suggested a significant positive association between the nurse rate of malpractice payments that were made and median per capita income, number of physicians per 1000 residents, and number of attorneys per 1000 residents; analysis revealed a significant negative association between this rate and the percentage of residents residing in rural areas and the number of nurses per 1000 residents. Although findings suggested that payment trends remained stable, there was great regional variation in the risk of malpractice payment for both physicians and nurses. The physician risk ranged from a low of 0.73% per physician per year in Alabama to a high of 3.7% in Wyoming, and the nurse risk ranged from a low of 0% per nurse per year in Vermont to a high of 0.075% in the District of Columbia. If the quality of health care provided by physicians and nurses does not vary geographically in the United States, then such a great discrepancy seems to challenge the notion that the risk of malpractice litigation consistently promotes the quality of health care.

Benchmarking↗
PubMed2006

The National Practitioner Data Bank and anesthesia malpractice payments.

A publicly available SPSS database was obtained at the National Practitioner Data Bank website (www.npdb-hipdb.com). After analysis, we found that between 1991 and 2004, there were 276,274 medical malpractice-related payments in the United States. During that period, 8297 anesthesia-related malpractice payments were made on behalf of practitioners in the United States. When adjusted for population growth, there was a 27.7% decrease in the annual number of anesthesia malpractice payments per 100,000 people during the period 2001-2004 as compared with the period a decade earlier 1991-1994 (0.26 versus 0.19). Also, the median anesthesia malpractice payments, adjusted to 2005 dollars, increased significantly from 1991 to 1994 and 2001 to 2004 (69,330 dollars versus 205,222 dollars). We conclude that over the past 14 yr, whereas the number of anesthesia malpractice payments has decreased, the median payment of cases has increased.

Adolescent↗
PubMed2001

Medical malpractice, mistake prevention, and compensation.

Clinicians' fear of malpractice litigation is the most significant obstacle to the open reporting of medical mistakes. Without open reporting of medical mistakes, however, root cause analysis of mistakes cannot be done, thus undermining efforts to implement safeguards to minimize the occurrence of future mistakes. Efforts to prevent medical mistakes, therefore, must first directly address clinicians' fear of malpractice litigation. In this paper, we explore the relationship between the current malpractice system and clinicians' fear of litigation. Ultimately, we argue that both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken.

Attitude of Health Personnel↗
PubMed1999

The medical malpractice risk associated with bariatric surgery.

BACKGROUND: Bariatric surgery has been classified as high risk by the medical malpractice industry, but it is unclear what data support this classification. When a small group of physicians is separated from their peers and asked to support their malpractice claims, their premiums will often rise unfairly in relation to the outcome of the claims. This report outlines the results of a survey sent to the members of the American Society for Bariatric Surgery (ASBS) asking for information on malpractice claims. METHODS: Surveys were mailed to the 285 ASBS members requesting which bariatric operations were performed, how many procedures were completed each year, details of any suits filed against the member including final outcome, and information on whether the members also performed gastric surgery for ulcer disease. RESULTS: Surveys were returned by 165 members (58%) from surgeons in 33 states and Washington, D.C. Malpractice claims had been made after 107 bariatric procedures and three ulcer procedures with the risk of a suit being filed for a bariatric procedure being approximately 1.6/1,000 cases. The average monetary award was $88,667. Of the suits that resulted in a jury trial, 14% agreed with the plaintiff. Over half the cases that had been resolved were either dropped or dismissed before trial. CONCLUSIONS: The incidence of suit being brought against ASBS members performing bariatric procedures is low. Once filed, most cases do not reach a jury trial. Settlements are usually under $100,000. These data suggest that this group of bariatric surgeons do not represent a disproportionately large risk pool for medical malpractice insurance companies.

Gastric Bypass↗
PubMed1987

'Lumping it': the hidden denominator of the medical malpractice crisis.

In a recent article, Miller has reminded us that medical malpractice litigation is not simply an economic problem which inhibits medical practice and increases health care costs. She argues that it has three broader "societal objectives": reparation, emotional vindication, and deterrence. Viewed in the broader perspective of social values, the Maine data suggest that our current approach to medical malpractice does not perform well. Significant numbers of respondents believe that they have been neither vindicated nor compensated for their own or their relatives' illness, injury, or death; and that they have not had the opportunity to protect others from harm. As Miller suggests in her review of British alternatives to medical malpractice litigation, there may be more efficient and effective means of reparation. There may also be more direct and less costly means to deter incompetent practitioners and vindicate those who are harmed. We shall never discover these alternatives if we view the medical malpractice "crisis" as a simple or straightforward problem of costs of premiums, costs of settlements, and costs of judgments; numerators. Medical malpractice litigation is the expression of deep and highly complicated problems, which cannot be solved or even significantly alleviated by false solutions motivated only by concerns of costs and cost containment. They can be addressed only by careful, thoughtful, and comprehensive analysis.

Adult↗
PubMed1980

Malpractice and radiologists.

Malpractice liability has become an unavoidable concern of most radiologists. Much has been written on the definition and causes of malpractice, the legal mechanics of a malpractice lawsuit, what to do after getting sued, and how to avoid a lawsuit in the first place. But there is little documentation on incidence of malpractice suits filed against radiologists and other physicians involved with radiologic procedures. In an effort to provide some practical perpectives of the malpractice problem and how it relates to the users of ionizing radiation, this report reviews all such lawsuits filed in the past 5 years in a large metropolitan region.

Malpractice↗
PubMed1995

Medical malpractice involving radiologic colon examinations: a review of 38 recent cases.

OBJECTIVE: Our purposes were to determine the causes of malpractice claims against radiologists performing contrast examinations of the colon and to design strategies to reduce litigation and diminish patient morbidity. MATERIALS AND METHODS: Reports of malpractice claims were collected from legal journals and databases between 1985 and 1994. For this period, 38 plaintiffs raised 52 allegations of malpractice that involved radiologists performing barium or Hypaque (meglumine diatrizoate; Winthrop Pharmaceuticals, New York, NY) colon examinations. For the 38 cases, 18 plaintiffs for decedents alleged that failure to diagnose colorectal cancer by barium enema examination caused delay in treatment and the patient's death. Eighteen plaintiffs alleged that improper performance of barium (17 cases) or meglumine diatrizoate (one case) colon examinations caused perforation of the colon, resulting in significant morbidity (15 cases) or death (three cases). Miscellaneous causes for malpractice claims were recorded in two cases. RESULTS: In 18 cases of failure to diagnose colorectal cancer, the initial radiographs were interpreted as follows: normal findings in 14 cases, diverticulosis in one case, and spastic bowel in two cases; in the remaining case, colon cancer was missed because of nonopacification of the cecum. In retrospect, 17 of 18 colorectal cancers were visualized. The delay in the diagnosis of colorectal cancer ranged from 5 to 72 months. Missed colorectal cancers occurred in the cecum (two cases), transverse colon (two cases), rectosigmoid area (nine cases), or unspecified area (five cases). In 18 cases of colon perforation, the site was the cecum (one case), transverse colon (one case), extraperitoneal rectum (seven cases), rectosigmoid area (one case), colostomy stoma (two cases), or unspecified area (six cases). One patient experienced anaphylactic shock that required hospitalization. One underwent unnecessary surgery because barium enema films showing colon cancer were mislabeled with her name. CONCLUSION: On the basis of our analyses of malpractice claims, we suggest strategies to prevent medicolegal litigation. Strategies include communicating with the patient about the type and indications of the barium enema examination, performing digital rectal examinations on all patients to detect distal rectal lesions or strictures, recognizing colon perforation, and obtaining immediate surgical consultation if colon perforation occurs. The number of missed colon cancers may be reduced by reading twice or reviewing at a later time all barium enema examinations.

Adult↗
PubMed1984

Psychiatric malpractice: some aspects of cause.

The legal concept of malpractice is rooted in the issue of negligence. Liability and duty are related matters which bear on the doctor-patient relationship. The quality of the doctor-patient relationship appears to be the crucial factor related to the emergence of malpractice claims in general medicine and surgery and also in psychiatry. Two methods for assessing negligence are described and their limitations discussed. An alternative concept of a "malpractice threshold" is proposed. This threshold is derived from the arithmetic product of two variables (risk and doctor-patient rapport) which, when exceeded, triggers a patient response in the form of a lawsuit. Brief clinical examples are provided. Review of a large number of psychiatric malpractice cases may permit quantification of these variables. The identification and study of such factors is a rational step toward the prevention of incidents which may give rise to claims of malpractice.

Malpractice↗
PubMed1986

Legal doctrines associated with medical malpractice.

Malpractice is the legal charge against a professional accused of a private wrong. Claims must be filed under tort (or civil) law; specific statutes can vary from state to state. Legal doctrines associated with malpractice include respondeat superior, which places ultimate liability with a superior or employer; proximate cause, which states that the professional's negligence resulted in injury; and res ipsa loquitur, which allows malpractice to be proved without expert testimony. Traditionally, PAs have been protected by respondeat superior; however, while some legal precedents have assigned liability to the physician entirely, others have distributed it proportionately between the supervised nonphysician provider and the physician. Consequently, no clear guidelines exist for PAs regarding malpractice, since the degree of liability has not yet been definitely decided by the courts. However, in the current legal climate, more and more PAs assume malpractice liability, and are providing for personal coverage.

Malpractice↗