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Professional liability has become an uncomfortable fact of life for hospitals--one trustees cannot ignore. However, by identifying the areas of potential liability exposure and keeping informed, boards can help their hospitals cope with this disturbing reality.
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This paper discusses the economic and legal incentives for using biological monitoring to detect occupational disease. The limitations of workers' compensation statutes and the various theories of liability for occupational disease are described. After a description of the general principles governing liability, the following issues are discussed: the liability that may result when employers fail to biologically monitor their employees; the company physician's personal liability; liability of manufacturers of hazardous substances; and the employer's duty to report known diseases to affected employees.
PURPOSE: Various public and private initiatives encourage physicians to coordinate care for patients who have multiple chronic conditions, but physicians may resist doing so for fear of liability. This article assesses the extent of liability risk. METHODS: This qualitative study combines legal research with key informant interviews. Relevant legal authorities were identified through literature searches in legal databases. In-depth interviews were conducted with a purposive sample of 16 key informants who have relevant expertise in malpractice insurance, risk management, or liability law. Additionally, 19 other participants with relevant experience in case management or managed care were briefly queried about their liability experience relating to care management. RESULTS: Some aspects of care coordination for patients with multiple chronic conditions hold potential for higher liability. Physicians coordinating care have a broader responsibility for patients with complex conditions who have a greater chance of poor outcomes. Care coordinators may be held to a higher standard of care by adopting best practices guidelines or by making medical decisions on issues that require specialized expertise. Other aspects, however, lower liability risk: elderly patients are less likely to sue, care coordination should improve outcomes, and the information systems that support enhanced care coordination target the major sources of medical error in primary care. On balance, the liability risks of care coordination are commensurate with other risks in primary care practice. Liability insurers indicated no reluctance to insure physicians who coordinate care for patients with multiple chronic conditions and no strong tendency to attribute higher risk to this role. Physicians who currently perform these or similar functions have not encountered demonstrably higher liability. CONCLUSIONS: Physicians' perceptions about the liability risks of coordinating care for patients with multiple chronic conditions do not match evidence about the factors actually driving liability. It appears from many informed sources that there is no strong basis for physicians who perform these functions to have serious concerns about liability; instead, care coordination done well may lower liability risks.
Some of the possible legal implications of the production, marketing and use of expert systems are examined in this paper. The relevance of a legally useful definition of expert systems, comprising systems designed for use by both laymen and professionals, is related to the distinctions inherent in the legal doctrine underlying provision of goods and provision of services. The liability of the sellers and users of, and contributors to, expert systems are examined in terms of professional malpractice as well as product liability. A recurring theme indicates that legislators may be inclined to restrict possibilities of liability suits in order to avoid disincentives to the creation of expert systems.
Harmonisation of personal injury compensation in the European Union (EU) is crucial. Continuing on from the work begun by the European Federation of Medical Academies, a working party of the XVth Committee of the French National Academy of Medicine has sought to go beyond the restrictive framework of automobile accident compensation in order to address more universal concerns, regardless of the causes and effects of bodily injury. The specific situation of injuries resulting from medical acts was considered, both for its medicolegal complexity and its potential human consequences. After recalling relevant European legislation, the authors consider the different philosophies of medical liability and health care systems in Europe. Methodological convergence is required to achieve harmonisation of personal injury compensation regimes, and especially for the classification of different types of bodily injury, the role of social services, and the establishment of a reference for medical evaluation of injury with built-in compensation levels. The doctrines and concepts of all EU member states (civil law, common law, Nordic medical liability regimes, etc.) are discussed, together with means of facilitating their harmonisation.
Texas physicians won one of their biggest victories ever in the battle over tort reform in 1995. At the urging of the Texas Medical Association and other groups, lawmakers enacted legislation requiring plaintiffs in medical liability cases to post cost bonds and expert reports showing their cases have merit. Rules for expert witnesses were tightened. And, physicians and other defendants were given some relief from joint and several liability, which often leaves defendants who were only marginally at fault facing multimillion-dollar judgments because they have "deep pockets."
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Civil processes and criminal procedures against physicians and/or medical assistants due to retained foreign bodies following surgery are not uncommon within the framework of the booming liability disputes in hospitals. As the protection and safety of the patient is the highest priority, the physician must take all feasible and reasonable precautions against such a possibility during both in- and outpatient operations.These include clear, written instructions for the assisting medical personnel in relation to count control, its documentation, final revision and specification in the surgical report. The delegation of swab and instrument counts to reliable OP nurses and other personnel is juristically possible and leads to their own responsibility, based on principle of basic trust, i.e. the physician can rely on the correct count of abdominal sponges, swabs etc. If an error does occur, the organizational liability does not fall on those responsible for the operation.
Most hospitals and health systems perceive and treat the year-2000 faulty computer code as a technical problem, but it is a high-level management problem. If hospitals don't start preparing comprehensively, they will face a host of consequences. Experts say spillover will extend into business issues, finances and liability. But providers must choose their most important priorities and develop contingency plans.
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State governments are experimenting with a variety of innovative approaches to the current tort system for medical malpractice liability. One such approach is to apply the concept of no-fault liability to medical practice. States such as Virginia and Florida have already adopted a limited version of such a concept. This article examines the problems of the current tort system, different types of no-fault medical insurance alternatives and their advantages, and the experiences of the states of Virginia and Florida with their limited no-fault malpractice insurance systems. The author concludes that the concept of no-fault compensation for medical malpractice is a promising remedy. However, it is a medicine that will require more testing before it can be pronounced a cure for the disease that plagues the current system.
BACKGROUND: Respiratory complications were associated with half of pediatric malpractice claims from the 1970s to 1980s in the ASA Closed Claims Database. Advances in pediatric anesthesia practice have occurred in the 1980s and 1990s and may be reflected in liability trends. METHODS: We reviewed 532 pediatric (age < or =16 yr) malpractice claims from our database over three decades (1973-2000), using logistic regression analysis to evaluate trends over time. Claims from 1990 to 2000 (1990s) were reviewed in detail to determine damaging events and injuries. Multiple logistic regression analysis evaluated factors associated with claims for death/brain damage (BD) compared with claims for less severe injuries. RESULTS: From 1973 to 2000, there was a decrease in the proportion of claims for death/BD (P = 0.002) and respiratory events (P < 0.001), particularly for inadequate ventilation/oxygenation (P < 0.001). However, claims for death (41%) and BD (21%) remained the dominant injuries in pediatric anesthesia claims in the 1990s. Half of the claims in 1990-2000 involved patients 3 yr or younger and one-fifth were ASA 3-5. Cardiovascular (26%) and respiratory (23%) events were the most common damaging events. Factors associated with claims for death/BD in the 1990s when compared with claims for less severe injuries were cardiovascular events (odds ratio [OR] = 6.6, 95% confidence interval [CI] = 2.5-17.8), respiratory events (OR = 3.7, 95% CI = 1.5-9.4), and ASA status 3-5 (OR = 3.1, 95% CI = 1.3-7.8). CONCLUSIONS: Death/BD remained the dominant injuries in pediatric anesthesia malpractice claims in the 1990s. Cardiovascular events joined respiratory events as the major sources of liability.