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[Legal liability of the hospital].

Civil liability of the hospital institution for damages due to hospital treatment means liability for malpractice by the hospital staff. Such liability depends on whether the mistake was made during inpatient or out-patient care; it further depends on the hospitalization contract. If a health-service patient or a private patient has been harmed during treatment in a hospital, the hospital institution is liable for all staff members including the coordinator of the medical staff. However, if the hospitalization agreement stipulates that the coordinator of the medical staff shall be the contracting party only with respect to medical treatment, the hospital institution is not liable for the coordinator's behaviour. In case of outpatient treatment, the hospital institution is liable only for medical treatment provided by the hospital itself (i.e. in case of out-patient surgery) and not for medical treatment within the coordinators own out-patient department. The hospital institution has to organize the hospital's activities properly to avoid liability for faulty organisation. I.e the hospital institution has to provide sufficient staff out of office hours, to lay nonskidding floors or to instruct the staff properly in case a patient wishes to make his last will and testament. Regardless of a fault, the hospital institution is always liable for use of defective medical instruments. The hospital institution may try to avoid liability for tort (including compensation for immaterial damage) by proof of proper selection and supervision of the staff. However, such relief is very difficult and not available for key personnel.

Germany↗

Legal aspects of telepathology.

The legal aspects of telecommunication are discussed briefly. Telepathology induces no new legal conditions; however, due to its somewhat higher diagnostic error rate specific problems may occur. Both the pathologist and hospital should clarify the internal liability conditions. The pathologist should be aware that he is still liable for errors induced by the technician, even without having the possibility of responsibility or any supervision.

Communication↗

Moving beyond the blame game.

Americans do not have to put up with a dysfunctional medical malpractice liability system that raises costs, lowers quality, limits access, and erodes trust. The key is to offer something better: a systematic approach that brings runaway malpractice costs under control while at the same time protecting patients and improving the quality of care that they can expect to receive. We are coming to recognize that we really cannot sue our way to better healthcare. If the nation's goal is to stretch our finite healthcare dollars by improving the transparency, accountability, and overall effectiveness of the healthcare system, malpractice liability reform clearly has to be part of the foundation on which we build in the years ahead.

Compensation and Redress↗

Closed liability claims analysis and the medical record.

An analysis of 353 closed claims involving obstetrician-gynecologists revealed that the 40 highest-paid claims (11.3%) accounted for 88.7% of the total dollars spent. Newborn obstetrics, maternal obstetrics, and delayed-diagnosis claims represented 80%. Five doctors represented in the top 13 claims had another one or two claims among the highest 40. Only one of these physicians is still in good standing with the insurance company. Twelve claims (30%) were judged to be nonmeritorious, resulting in indemnity in five cases. Most of these claims illustrated either deficits with the medical record or system failures. A number of these problems could be prevented by avoiding system failures and by regarding the medical record as a legal document. Lawsuits occasionally resulted in an unfair distribution of dollars to injured parties and led to justifiable restriction of few physicians. It is critical that there be a record of why something was done. If the record is silent, there is no defense. An erroneous decision may be defensible if the reasons leading to it are recorded in the chart.

Gynecology↗

Say no to inadequate tort reform.

From his vantage point as president of a large multispecialty group practice. Dr Montgomery has observed the direct effects that medical malpractice liability has had on healthcare costs. Here he offers a counterpoint to the Clinton plan's malpractice provisions and enumerates his own recommendations for meaningful tort reform.

Group Practice↗

Admission and termination policies. Minimizing risk and liability.

Changes in Medicare reimbursement coupled with the demands of managed care plans to reduce resource utilization continue to challenge patient management in home care. As home care agencies endeavor to achieve optimal outcomes with reduced resources, professional liability exposures may increase. Agencies should protect themselves using sound admission, care management, and discharge policies, as well as other risk management options.

Aged↗

Directors' and officers' liability: a crisis in the making. A national survey conducted by Opinion Research Corporation and Research Strategies Corporation for Peat Marwick.

The survey upon which this column is based was mentioned in the last issue of VAL in the special report on H.R. 911, an important bill for the voluntary sector introduced by Representative John Porter (R-Ill.) in February. H.R. 911 encourages states to exempt all volunteers from civil liability except for acts of willful and wanton misconduct. The survey results are reprinted here with permission from the report, Directors' and Officers' Liability: A Crisis in the Making, which was based on a study of national not-for-profit voluntary organizations, undertaken by Peat Marwick in cooperation with INDEPENDENT SECTOR.

Administrative Personnel↗

Choosing to do obstetrics in practice: factors affecting the decisions of third-year family practice residents.

To investigate factors influencing a resident's decision to participate in obstetrical care, a survey was undertaken of program directors and third-year residents from the 16 Michigan family practice residency programs. Responses indicated that the majority of third-year residents (55%) intended to practice obstetrics on graduation. Rural practice plans were significantly correlated with a decision to practice obstetrics, but suburban practice plans were negatively correlated. Residents who reported the presence of a good family practice obstetric role model were significantly more likely to practice obstetrics; residents deciding against obstetrical practice expressed concerns about legal liability and malpractice fees. These findings have important implications for family practice training programs if obstetrics is to remain a central part of comprehensive family care.

Career Choice↗

Issues in information malpractice.

In today's information explosion environment, the health sciences librarian is increasingly placed in the role of interpreting, translating, and evaluating information for clientele. With this emerging role and the burgeoning of fee for service programs, the question of information malpractice liability becomes an increasingly important issue. This paper explores the basis for legal actions against librarians and offers some precautionary measures to help protect against such legal action.

Humans↗

Avoiding administrators' liability.

Radiology administrators have been mostly untouched by the medical liability crisis, but legal experts warn that lawsuits could be targeted at health care administrators. Consequently, administrators should take several precautions to limit their changes of being drawn into a lawsuit.

Financial Management↗

Liability for infectious diseases in day care: legal and practical considerations.

A lawsuit directed by parents at a day care program following an outbreak of infectious disease would most likely be based on the legal theory of negligence--the failure to exercise due care as required by circumstances. In the determination of liability for infectious diseases in child day care, the element of causation is most critical. Did the day care facility's actions or failure to act cause the harm? Another important question is whether an infectious disease can be occupational and under what circumstances. Although worker's compensation laws initially had no provisions for occupational disease, now all states recognize responsibility for them. Awareness of potential problems with legal liability and establishment of procedures to minimize risk are important for day care providers, public health officials, clinicians, and parents.

Child Day Care Centers↗

Medicolegal aspects of asbestos for pathologists.

The two principal legal remedies available to victims of asbestos-related disease are (1) claims for benefits under workers' compensation laws and (2) suits for damages under the laws of products liability. The medicolegal issues and the part of the consulting pathologist as medicolegal consultant and expert witness in each of these legal proceedings are essentially the same.

Asbestos↗

[Interactions between criminal justice and other areas of law from the viewpoint of the civil rights judge].

More than in the past, patients are consulting lawyers to check medical treatment for malpractice. One of 10,000 city-inhabitants institutes proceedings for compensations. In the past, a charge was brought at the same time to achieve examination of patients records and to obtain an expert opinion at government expenses. Due to recent jurisdiction, the patient got the right to examine treatment records without the necessity to specify his reasons. Settlement institutions of the society of physicians of Germany facilitate an examination of a treatment procedure for mistakes without costs. Therefore, there is no more incentive for a charge to achieve compensations. The continuation of civil proceedings may not depend on the result of the investigation proceedings due to the different kind of evidence. The special duties of civil courts working with medical liability and expert opinions seem to show that civil proceedings are suited the best to clarify a dispute between physicians and patients. This also avoids to pillories the physician.

Civil Rights↗

Alcoholic beverage server liability and the reduction of alcohol-involved problems.

Legal liability of alcoholic beverage servers has been suggested as a means to stimulate preventive serving practices and thus reduce alcohol-involved problems. A number of variables contribute (both negatively and positively) to the potential of such liability and a conceptual model that links these variables was developed. In this project, an expert legal panel was used to identify and rate the major legal factors contributing to server liability. As a result each state was ranked according to its relative level of liability exposure. States that ranked highest in server liability were found to have more publicity about such liability, greater awareness and higher concern among licensed establishment owners/managers and different serving practices compared to states with lowest liability exposure. As a result we conclude that server liability has a real potential for reducing alcohol-involved problems but additional research is needed.

Accidents, Traffic↗

Subscriber suits: how to avoid them.

As HMOs and PROs become more significant elements of the health delivery system, they also become more likely targets for lawsuits. This article identifies twelve major liability risks of these organizations as well as those who provide services to HMOs and PPOs. Also presented are steps that can be taken to help protect against those risks.

Financial Management↗

Effects of the medical liability system in Australia, the UK, and the USA.

Although the direct costs of the medical liability system account for a small fraction of total health spending, the system's indirect effects on cost and quality of care can be much more important. Here, we summarise findings of existing research on the effects of the medical liability systems of Australia, the UK, and the USA. We find systematic evidence of defensive medicine--medical practice based on fear of legal liability rather than on patients' best interests. We conclude with discussion of four avenues for reform of traditional tort compensation for medical injury and several suggestions for future research.

Australia↗

Supervisor personal liability for ADA discrimination. Emerging issues for hospital administrators and physicians.

This article discusses emerging and conflicting trends in recent Americans with Disabilities Act discrimination legal decisions in which plaintiffs seek compensatory or punitive damages directly from supervisors and their employers, creating potential issues of personal liability for physicians or hospital administrators, for example. Also addressed in the article are potential problems employers face if supervisors are held personally liable for Americans with Disabilities Act discrimination.

Persons with Disabilities↗