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PubMed2003

Exaggerated MMPI-2 symptom report in personal injury litigants with malingered neurocognitive deficit.

Traditional MMPI-2 validity scales, the Lees-Haley Fake Bad Scale (FBS), and the Arbisi and Ben Porath Infrequency Psychopathology Scale (F(p)) were evaluated in 33 personal injury litigants who had failed forced-choice symptom validity testing and other measures of effort in patterns consistent with the Slick, Sherman, and Iverson (1999) criteria for definite and probable malingered neurocognitive deficit (MND). The FBS was more sensitive to symptom exaggeration than F, Fb, and F(p). The definite and probable MND litigants also produced mean elevations on MMPI-2 scales 1, 3 and 7 that were significantly higher than those produced by various clinical groups including non-litigating severe closed head injury, multiple sclerosis, spinal cord injury, chronic pain, and depression. These data suggest that MMPI-2 profiles characteristic of malingered injury differ from those associated with malingered psychopathology.

Adult↗
PubMed1991

Is money a cure? Follow-up of litigants in England.

American and British authors collaborated on a follow-up study in England of accident victims who brought litigation which had been resolved. Eighteen subjects who had complained of psychiatric symptoms during the course of the litigation were recruited from the British psychiatrist's files. Based on review of court documents and extensive interviews of the subjects, the authors describe case examples that demonstrate a complicated relationship between monetary compensation and outcome. Some of the litigants improved after they received compensation, but this seemed to be related to issues besides the money, e.g., feelings about their impairment, family support, the loss or gain of a relationship, personality characteristics, and ability to return to work. The authors discuss the results of this study in light of differences between the British and American legal systems.

Accidents↗
PubMed1990

Prison mental health services: results of a national survey of standards, resources, administrative structure, and litigation.

The formation of adequate mental health systems within prisons has accelerated as a result of successful class action lawsuits. Our recent national survey questioned all state correctional departments about the existence of standards in each system, compliance with such standards, prevalence of class action lawsuits involving the issue of providing adequate mental health services for inmates, issues related to consent decrees, available mental health resources within the correctional system, and the administrative structure of the mental health system. Our purpose was to identify those factors correlated with certified class action lawsuits involving issues related to mental health services. Twenty-one states were involved in such litigation. Only the presence of psychiatric hospitals operated by the department of corrections correlated with the presence of certified class action lawsuits involving mental health services. Prison systems larger than 15,000 inmates were at higher risk for such litigation. Smaller systems having psychiatric hospitals run by the state mental health agency appeared to be at less risk for such litigation.

Jurisprudence↗
PubMed1990

Malpractice litigation as a factor in choosing a medical specialty.

Although many factors have been identified as influencing specialty choice, there has been no research focusing on the effects of the current climate of medical practice, including litigation. Our study examines medical students' and residents' awareness of the malpractice litigation environment and their reasons for choosing a specialty that is at either high or low risk for malpractice suits. Longitudinal data showed that students continued to choose high-risk specialties (40%) even though they perceived problems in the current climate of litigation. Among the reasons for their choices were enjoyment and being able to practice in a procedure-oriented specialty that is effective in its mode of treatment. Those who chose low-risk specialties (60%) rated as important the variety of diseases seen and the opportunity to know patients well. Issues related to the malpractice climate were important only to those who switched from a high- to a low-risk specialty. These findings have implications for professional staffing needs.

Career Choice↗
PubMed1989

The impact of litigation and court decisions on clinical practice.

Malpractice litigation has dramatically increased in recent years, posing a major challenge to psychiatrists and other clinicians. The author reviews the current legal situation and major court decisions, and then addresses five categories of litigation specifically affecting psychiatry: (1) patients' acts of violence; (2) patient suicides; (3) patient injuries that result from negligent treatment; (4) faulty initiation, process, or termination of treatment; and (5) liability arising from employer, supervisory, or consultative relationships. He concludes that a sensitive and effective relationship between treaters and patients remains the best safeguard against malpractice litigation.

Humans↗
PubMed1997

Suicide litigation as an agent of change in jail and prison: an initial report.

The effectiveness of psychiatric and psychological forensic experts in litigation concerning suicide in correctional settings is more of an art than a science. Although experts for both plaintiff and defense play equally important roles in assisting the finders of fact and contributing to just decisions, the expert's role and agenda for the plaintiffs are especially instructive to both sides involved in the adversarial process. The author summarizes the most relevant organizational standards for practice guidelines for suicide prevention in correctional settings and illustrates how these can be applied as standards for liability. Using these standards together with his extensive forensic experience in this area, the author illustrates how suicide litigation and the expert's participation in this process can promote improved care for potentially suicidal inmates.

Expert Testimony↗
PubMed1998

Common bile duct injuries during laparoscopic cholecystectomy that result in litigation.

BACKGROUND: Iatrogenic common bile duct injury is the worst complication of laparoscopic cholecystectomy. The goal of this study is to increase awareness of the problem and educate surgeons about the consequences of these injuries. METHODS: A total of 46 bile duct injuries were analyzed by review of medical records, cholangiograms, videotapes, and surgeon statements. All cases were involved in malpractice litigation. RESULTS: All types of injuries were represented. There were 15 transections, 11 excisions, 6 lacerations, 8 clip impingements, 3 burns, 2 bile leaks, and 1 cystic duct leak. In all, 72% of these injuries occurred in elective cases in which there was no acute inflammation. Cholangiograms were performed in 16 cases, but they were misinterpreted in 11 of them. Injury type and severity was similar in patients with and without cholangiography. A total of 80% of these injuries were not detected at the initial surgery. The average delay in diagnosis was 10 days. Complications were worse in patients with delayed diagnosis. Primary surgeons had less successful outcomes from repairs than referral surgeons (27% versus 79%). In 86% of cases, litigation was resolved in favor of plaintiffs by settlement or verdicts. The average award was $214,000. CONCLUSIONS: Factors that predispose to lawsuits include treatment failures in immediately recognized injuries, complications that result from delays in diagnosis, and misinterpretation of abnormal cholangiograms. Injury prevention can be improved by increased awareness of common mistakes,. Improved cholangiographic technique and interpretation should decrease injury severity, delays in diagnosis, and subsequent morbidity.

Adult↗
PubMed1987

Legal standards of causation in chemical exposure litigation.

A discussion of the legal process that resolves disputes involving the questions of causation of exposure to chemical substances is presented. Toxicologists and pharmacologists called upon to testify in private litigation of whether or not exposure to a particular chemical caused an illness will have a clearer view of the law's notion of causation by the examples cited. The trends in the law on this subject are reviewed and ways are offered for scientists to influence future chemical exposure litigation.

Chemical Industry↗
PubMed2006

Worker's compensation litigation of the upper extremity claim.

This article presents an overview of the issues presented to physicians and lawyers in evaluating, treating, litigating, and concluding an upper extremity workers' compensation claim. This analysis includes a review of the unique considerations involved in the workers' compensation patient/claimant, a general examination of workers' compensation law, and the interplay between litigation and the medical management of the patient.

Arm Injuries↗
PubMed2007

MMPI-2 validity, clinical and content scales, and the Fake Bad Scale for personal injury litigants claiming idiopathic environmental intolerance.

BACKGROUND: Idiopathic environmental intolerance (IEI) is a descriptor for nonspecific complaints that are attributed to environmental exposure. METHODS: The Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was administered to 50 female and 20 male personal injury litigants alleging IEI. RESULTS: The validity scales indicated no overreporting of psychopathology. Half of the cases had elevated scores on validity scales suggesting defensiveness, and a large number had elevations on Fake Bad Scale (FBS) suggesting overreporting of unauthenticated symptoms. The average T-score profile for females was defined by the two-point code type 3-1 (Hysteria-Hypochondriasis), and the average T-score profile for males was defined by the three-point code type 3-1-2 (Hysteria, Hypochondriasis-Depression). On the content scales, Health Concerns (HEA) scale was significantly elevated. CONCLUSION: Idiopathic environmental intolerance litigants (a) are more defensive about expressing psychopathology, (b) express distress through somatization, (c) use a self-serving misrepresentation of exaggerated health concerns, and (d) may exaggerate unauthenticated symptoms suggesting malingering.

Adult↗
PubMed2005

Litigation.

The law in relation to clinical practice is specialised and complex. Most practitioners have a rudimentary understanding of the basic concepts. This chapter explores the principles of duty of care, breach and causation, and how-using case law-they are applied to neonatal care. It considers the roles and responsibilities of the practitioner and the organisation in providing standards of care that are supportable in the current clinical governance and medicolegal climate. The problems facing practitioners who find themselves involved in a case many years after the actual clinical events are also discussed, and some risk management suggestions are made. Detailed and good-quality published data on the extent and nature of neonatal cases is lacking in the UK but should be improved by the changes that have occurred following the establishment of the National Health Service Litigation Authority. Finally, consideration is given to the difficulties parents, practitioners and experts can face in dealing with information and expectations in adverse clinical outcomes when litigation is inevitable.

Female↗
PubMed1998

Pain clinic management of medico-legal litigants.

A preliminary study was undertaken to determine the relationship between a patient's compensation claim and their management in pain clinics. Fifty consecutive patients with compensation claims and undergoing treatment in local pain clinics were selected from the senior author's medico-legal practice. An initial postal survey of UK pain clinics was undertaken to establish the percentage of patients in pain clinics with musculoskeletal pain and also what proportion of clinics enquire as to the litigation status of their patients. Medical reports available from both plaintiff and defence were reviewed together with the hospital's and general practitioner's notes. Musculo-skeletal pain contributes on average 55 per cent of the pain clinic workload and the majority of pain clinics establish the litigation status of their patients. Of the patient series, the senior author assessed 98 per cent as having exaggerated symptoms in 44 percent and 20 percent were proven to be malingering via covert video evidence. The results suggest that many patients with compensation claims seek to cloak inappropriate symptomatology with verification and medical support in pain clinics. The wisdom and expense of treating such patients in pain clinics is questioned and the need for a nationwide study on this matter identified.

Adult↗
PubMed1998

The effect of ongoing litigation on outcome scores following open reduction and internal fixation of the calcaneum.

All sixteen patients who had undergone open reduction and internal fixation (ORIF) of the calcaneum by the senior author between April 1993 and August 1996 were included in the study. Two had died from unrelated illnesses and one had failed to attend any follow-up following discharge. The remaining 13 were reviewed by the main author. As part of a complete clinical, radiological and functional assessment, Buckley and Meek (B&M) and Kerr and Atkins (K&A) outcome scores were calculated as well as a satisfaction score obtained by a visual analogue scale (VAS). Statistical analysis of the results using Wilcoxen's paired and unpaired ranking scores showed that the initial grade of the fracture, degree of operative reduction, correction of width of the heel and post-operative ranges of motion had no significant correlation to either B&M or K&A outcome scores or to the VAS score. However, the presence of ongoing litigation was significantly correlated to the scores (VAS < 0.01, B&M < 0.05, K&A < 0.05). These findings cast doubt on the validity of post operative scoring for fracture of the calcaneum in the presence of ongoing litigation.

Calcaneus↗
PubMed1997

Temporomandibular disorders, headaches, and neck pain after motor vehicle accidents: a pilot investigation of persistence and litigation effects.

STATEMENT OF PROBLEM: There is a lack of long-term follow-up studies that involve post-motor vehicle accident temporomandibular disorders and compensation. PURPOSE OF STUDY: The purposes of this retrospective pilot study were (1) to assess patients who had previously been treated for temporomandibular disorders after motor vehicle accidents to determine the nature of their symptoms in terms of jaw, head, and neck pain and jaw dysfunction and (2) to determine whether there was a difference in the pain and dysfunction between those who had settled and those who had not settled their insurance claims. MATERIAL AND METHODS: Thirty previously treated patients with temporomandibular disorders after motor vehicle accidents were questioned by telephone regarding litigation status and current jaw, head, and neck pain and jaw dysfunction symptoms. They did not differ substantially from a smaller group who were not able to be interviewed. Descriptive statistics were calculated and statistical tests were performed. A total of 22 patients had their claims settled. RESULTS: Approximately three fourths had persistent complaints of jaw pain, jaw dysfunction, and headache, and more than 80% reported persistent neck pain. No apparent differences were found between those who had and had not settled their insurance claims. CONCLUSION: Jaw, head and neck pain, and jaw dysfunction continued to be problems for the majority of this patient population, regardless of litigation status in this retrospective study.

Accidents, Traffic↗
PubMed2002

Alternatives to litigation for health care conflicts and claims: alternative dispute resolution in medicine.

Health care has undergone radical changes, and it may be predicted that further changes are in the offing as the burdens and the benefits of the newer configurations become known. Change in any system stresses it, creating opportunities for conflict as people and organizations adjust to new realities and encounter changed expectations. The opportunities for conflict in health care (and legal conflict with it), therefore, have been and will continue to be a measurable part of health care's daily life. Many of these conflicts can be managed through one or another of the several forms of ADR. Some ADR procedures are most productive when used as alternatives to impending litigation. Others may be employed when litigation is not likely but when the persistence of conflict, such as that within a newly structured provider organization, would otherwise take its toll on the productivity of the organization and those who work within it. The challenge in using ADR for any of these problems is similar to what physicians understand as differential diagnosis. A good therapy applied to the wrong case yields a bad result. The world of ADR has matured to the point at which the salient features of both cases and procedures are well-enough understood to allow for low-risk and high-benefit applications. This is particularly true for disputes involving allegations of medical error, where the indicators of efficacy are very positive and the risks to safety are comfortably low. Mediation in particular, but mediation of the interest-based style rather than the settlement conference style, deserves fuller consideration and broader use.

Delivery of Health Care↗
PubMed2000

Litigation of laparoscopic major vessel injuries in Canada.

This study is a review of conditions and circumstances associated with 15 injuries to great vessels during laparoscopic surgery. Thirteen cases were litigated in Canada and two occurred in the author's operating room. Body habitus may have been an underlying factor in the injuries. Most injuries were entry related and independent on complexity of surgery. One was caused by the Veress needle and one by a secondary trocar, and three occurred during dissection of adhesions. Ten were primary trocar injuries, 9 after pneumoperitoneum and 1 at direct trocar insertion. Of these, five were caused by reusable and five by disposable trocars with so-called safety shields. In 6 of 15 cases recognition of the injury was delayed; 5 in the recovery room. Eleven women had uncomplicated recovery. Of 13 litigated cases, 8 (62%) resulted in settlement.

Adult↗
PubMed2006

Litigation in otolaryngology - trends and recommendations.

BACKGROUND: Seeking to identify where litigious claims against otolaryngologists are targeted (i.e. areas of highest risk) within the NHS and private sector would have positive implications in risk management and limiting the amount of litigation against otolaryngologists. METHOD: The National Health Service Litigation Authority (NHSLA) and Medical Defence Union (MDU) were contacted and anonymous data obtained on claims within ENT. RESULTS: 887 claims were notified - 457 NHSLA and 430 MDU. The commonest claim in both groups was failure or delay in diagnosis (12 per cent NHSLA, 23 per cent MDU). The other commonest claims were all related to complications (nerve damage 10 per cent, deafness 8 per cent and dental damage 5 per cent). Dissatisfaction with results was 8 per cent total and, within the private sector, was almost exclusively in rhinology. CONCLUSIONS: This study once again emphasizes the need for thorough clinical assessment, record keeping and good communication with patients. Recognising these areas of highest risk may limit future claims.

Humans↗
PubMedDate not supplied

Emergency medical services liability litigation in the United States: 1987 to 1992.

INTRODUCTION: Although emergency medical services (EMS) liability litigation is a concern of many prehospital health care providers, there have been no studies of these legal cases nationwide and no local case studies since 1987. METHODS: A retrospective case series was obtained from a computerized database of trial court cases filed against EMS agencies nationwide. All legal cases that met the inclusion criteria were included in the study sample. These cases must have involved either ambulance collisions (AC) or patient care (PC) incidents, and they must have been closed between 1987 and 1992. RESULTS: There were 76 cases that met the inclusion criteria. Half of these cases involved an AC, and the other cases alleged negligence of a PC encounter. Thirty (78.9%) of the plaintiffs in the AC cases were other motorists, and 35 (92.1%) of the plaintiffs in the PC cases were EMS patients. Almost half of the cases named an individual (usually an emergency medical technician or paramedic) as a codefendant. Thirty-one (40.8%) of the cases were closed without any payment to the plaintiff. There were five cases with plaintiffs' awards or settlements greater than [US] $1 million. Most (71.0%) of the ACs occurred in an intersection or when one vehicle rear-ended another vehicle. The most common negligence allegations in the PC cases were arrival delay, inadequate assessment, inadequate treatment, patient transport delay, and no patient transport. CONCLUSION: Risk management for EMS requires specific knowledge of the common sources of EMS liability litigation. This sample of recent legal cases provides the common allegations of negligence. REcommendations to decrease the legal risk of EMS agencies and prehospital providers are suggested.

Accidents, Traffic↗