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PubMed1995

[Legal liability of subordinate physicians, legal liability for management responsibility from the jurisprudence viewpoint].

Within the bounds of the hospitalization contract and the department's work, the hospital management is liable for compensation for its own as well as its staff's culpable faults (liability of the accomplices) by contract and by offense. For the same damage, subordinate and senior physicians are liable by offense for malpractice and organization faults. To the outside, the hospital management and the medical staff are common debtors. To the inside, the hospital management bears the consequences by itself in case of a light negligence of a staff member, the damage is divided for medium negligence, and the staff member has to bear it alone after severe negligence. Beside the hospital, the physician with an authorization for billing is the contract partner of the patient with private treatment (physician side-contract). In a general practitioner hospital, the contract partner of the patient is only the general practitioner (divided hospitalization contract) and for work with outside-patients as a sideline the physician with an authorization for billing. Usually, the hospital management insures itself and all staff members for claims on compensation occurring during hospital tasks.

Ambulatory Care↗

PubMed1992

REMEDHOS: the development of a medical and hospital liability database in Quebec.

Confronted in 1985 with the sudden rise of costs for liability protection, the health care sector in Canada took note of the fact that little or no reliable data were available and easily accessible to assess the actual scope and nature of the phenomenon of increasing medical liability suits in Canada. In order to correct this situation, a computerized database was created covering malpractice suits launched against Quebec health care professionals and establishments. This article presents the methodology that was used for the creation of the database; it describes the material that was used, the technical instruments that were developed and the software utilized. It also describes the structure and content of the database and presents its practical application with respect to the areas of risk management, health care evaluation, professional controls and tort reform.

Databases, Factual↗

PubMed1984

Loss control/risk management. A survey of the contribution of autopsy examination.

I surveyed 183 hospitals with medical school pathology residency affiliations regarding their recognition and use of the autopsy in loss control/risk management. Thirty physician-owned, medical society-created professional liability companies and nine other malpractice liability underwriters were also surveyed. The results generally supported my bias for increased use of autopsy information in the field of hospital-risk management. I also examined an opposing minority view. Autopsy surgeons' and hospital administrators' responses supported increased use of autopsies in loss control activities for the following reasons: to eliminate suspicion, to provide reassurance to families, to substitute facts for conjecture, to construct a better defense, to reduce the number of claims, and to improve the quality of care.

Attitude of Health Personnel↗

PubMed1990

Setting up your own business. Facing the future as an entrepreneur.

Other areas of setting up and running a business also are important to explore, especially if the business plans to use employees. You will become an employer, and you must be familiar with rules and regulations that include areas such as the employee's right to a safe workplace, worker's compensation laws, unemployment compensation laws and tax liabilities, antidiscrimination laws, and wage and tax laws. If independent contractors are going to be used, you must recognize that well-developed contracts are a necessity. If you are going to market a new product, consult with an attorney whose practice concentrates in trademark and patent law before the product is shared with others. Being well informed about the proposed business venture, not only before its establishment but as it develops and grows, can help you be in the best position to have a successful business.

Accounting↗

PubMed1991

Medical malpractice: an empirical examination of the litigation process.

New data on medical malpractice claims against a single hospital in which a direct measure of the quality of medical care is available are used to investigate the roles of the negligence rule and incomplete information in the dispute settlement process in medical malpractice. We find that the quality of medical care (negligence) is an extremely important determinant of defendants' medical malpractice liability. More generally, we find that the data are consistent with a model in which plaintiffs are poorly informed ex ante about whether there has been negligence, file suit to gather information, and either drop the case if they find that negligence was unlikely or settle for a positive payoff if they find that negligence was likely. We also find that the cases are resolved earlier in the litigation process when the parties are more certain, one way or the other, about the likelihood of negligence.

Data Collection↗

PubMed1979

[Ophthalmological opinions for liability affairs material damage (Part I) (author's transl)].

German law abides anyone reponsible for the damage he or she has caused to another person's property or corporal integrity. This includes all medical costs directed towards the restitution of health as well as economical damage in direct consequence of the corporal damage. An ophthalmological expert is to state his opinion therefore in accordance with the specific conditions of every individual case and not just according to general charts. Financial compensation is only granted for the actual results of damage inquestion. Prior damage and disability have to be remarked but not to justify a financial compensation. The question of smart-money is dealt with in Part II.

Disability Evaluation↗

PubMed1998

The incentive effects of malpractice liability rules on dental practice behavior.

OBJECTIVES: The impact of malpractice liability rules on dental practice behavior was estimated using data from a 1992 nationwide survey of US general dentists. The study examined the premise that malpractice liability rules can affect quality of care and related resource allocation decisions by dentists, but that market features, such as relatively complete and "non-experience rated" malpractice insurance, are likely to weaken the incentive effects of malpractice liability. METHODS: General practice dentists in the United States were selected randomly, and 3,048 dentists were studied by mail survey. Secondary data on county-level characteristics were used to measure market area factors. Quality-of-care measures were derived from the survey about self-reported practice policies and behavior and participation in continuing education. Legal measures were assembled from state statutes and appellate court decisions. Ordinary least squares was used to assess the relation between legal variables and dependent variables of quality of care, continuing education, and the rate of dental output. RESULTS: Hypotheses about the effects of malpractice law on practice quality and participation in continuing education were not supported. The relation between pro-dentist law and output was supported. A number of legal provisions related to differences in practice behavior, but often in ways opposite to the expected direction. CONCLUSIONS: The direct effects of specific malpractice liability rules on dentist practice behavior often failed to point in the direction predicted by theory and were economically insignificant. It is possible that relatively complete malpractice liability insurance, coupled with "noisy" liability rules, substantially dulls the deterrent effect of malpractice liability. Other forces, such as the dentist's past malpractice claims experience, were more significant in shaping dentist behavior.

Education, Dental, Continuing↗

PubMed1990

[Medical malpractice in relation to its social political importance].

Despite an unchanged legal basis the number of proceedings concerning medical practitioner's liability has increased substantially and medical law has developed into an independent field of law in the last 20 years. On one hand this is a result of modern medicine's extended possibilities to act and control, on the other hand it is caused by the patient's changed attitude towards both, his disease and his physician. Hereby the mass media exercise considerable influence with their commentaries, that are often exaggerated in their criticism and their representation. But this development gives no rise to concern. The jurisdiction in the field of medical practitioner's liability is--apart from a few exceptions--not overstated but necessary for the safeguarding of the patient's interests. It doesn't impede progress, doesn't give cause for a defensive medicine and doesn't burden our public health system. For the patient's wellbeing it often even accomplishes the important function of convincing the public health administration, that sometimes shows a tendency to act economically, of strict medical demands. There still is no room for the general conclusion, that the control of medicine by jurisdiction has undermined the confidential relationship between patient and physician. The recently published result of an opinion poll has shown, that physicians still enjoy a high reputation, while journalists--in spite of some contradictory statements--find themselves in the last ranks.

Germany, West↗

PubMed1988

Some international law aspects of the Bhopal disaster.

This article explores certain international law aspects of the Bhopal disaster, namely the principles and rules of international law establishing international accountability for environmental damage; the criteria for determining the liability of the Union Carbide Company (U. S. A.) for the Bhopal disaster; the criteria for determining compensation; and the international remedies available to the Indian government in the event that Bhopal victims fail to get justice within the Indian court system. The article discusses two applicable sets of proposed international standards--the U. N. Draft Code of Conduct on Transnational Corporations, and the U. N. International Law Commission's Draft on International Liability for Injurious Consequences Arising out of Acts Not Prohibited by International Law. The scattered 'hard' and 'soft' jurisprudence of international environmental law establishes liability and accountability for environmental hazards. It makes both state and non-state entities liable to pay compensation to the victims of environmental pollution. This jurisprudence, in addition to domestic law analogies, can influence Indian courts in determining the amount of damages payable to the victims of the Bhopal disaster. The authors conclude that the Bhopal disaster has demonstrated that enforceable international standards are clearly and urgently needed for hazardous industries, especially those operating in developing countries. Such standards would eliminate, or at least narrow, the gap between standards prevailing in the developed countries and those in the Third World. Even without enforcement, international standards could provide norms for measuring the performance of individual companies engaged in hazardous activities such as the manufacture of MIC at Bhopal.

Accidents, Occupational↗

PubMed1993

A mandatory physician loss prevention seminar.

In summary, this article has reported on the experience of a mandatory physician loss prevention seminar that is sponsored by a professional liability company. The article includes only highlights of the seminar program; by no means is it a detailed report. Also, the literature cited in the references is hardly an exhaustive search. Implications for the development, implementation, and evaluation of a hospital-based seminar program were both implicitly and explicitly discussed, as were some of the seminar's limitations, both within the seminar and its evaluation. It is hoped this article will stimulate health care risk managers to either develop their own seminars or modify certain aspects of their existing seminars, both for their medical staff and hospital (employee) staff. Involvement in risk management/loss prevention seminars are both educational and challenging for the professional health care risk manager. They may also prevent claims, conserve the institution's financial resources, prevent patient injury, and improve the quality of patient care delivered.

California↗

PubMed2002

How liability law affects medical productivity.

Previous research suggests that "direct" reforms to the liability system-reforms designed to reduce the level of compensation to potential claimants-reduce medical expenditures without important consequences for patient health outcomes. We extend this research by identifying the mechanisms through which reforms affect the behavior of health care providers. Although we find that direct reforms improve medical productivity primarily by reducing malpractice claims rates and compensation conditional on a claim, our results suggest that other policies that reduce the time spent and the amount of conflict involved in defending against a claim can also reduce defensive practices substantially. In addition, we find that "malpractice pressure" has a more significant impact on diagnostic rather than therapeutic treatment decisions. Our results provide an empirical foundation for simulating the effects of untried malpractice reforms on health care expenditures and outcomes, based on their predicted effects on the malpractice pressure facing medical providers.

Aged↗

PubMed1980

Cumulative injury or disease claims: an attempt to define employers' liability for workers' compensation.

The workers' compensation systems of several states have been expanded in recent years to include injuries and diseases caused by cumulative injury and occupational stress. This expansion has placed a financial burden on the respective systems, on employers, and on consumers, who ultimately must pay the cost of claims through higher priced products or services. This expansion may not be justified from a social perspective, however; extant medical and sociological evidence is not conclusive as to whether occupational-stress injuries or diseases--such as coronary heart disease, hypertension, stroke, and neuropsychiatric illness--are the direct result of stressful work environments. Using the California workers' compensation system as a model, the authors submit that the underlying premises of liability governing the expanded systems should be reassessed based (1) on economic factors, specifically, the increasing costs of workers' compensation; (2) on the capacity of the system to process an ever-increasing number of claims; and (3) on the principle on which workers' compensation systems were established, that of equity between the employer and the employee. On the basis of these three factors, the authors evaluated three legislative approaches to restructuring the expanded system: presumption of compensability, apportionment of liability, and threshold of compensability. The first recognizes that although certain health problems are related to the workplace, the degree of causation is difficult to prove; under this approach, therefore, causation is presumed, and injury compensated, for all diseases and injuries that the system defines as work related. The second holds that where a causal relationship between the work and the injury can be proved, the employer nevertheless should be responsible only for that portion of the disability actually caused by the workplace. The third directs that the injured employee be compensated only when a direct causal link between the job and the injury or disease can be proved. The authors recommend that legislators implement this third alternative. For one reason, it is feasible economically; for a second, it would not burden the system or increase litigation; for a third, it is equitable to both employees and employers.

California↗

PubMed2002

International Task Force on Volunteer Cleft Missions.

The International Task Force on Volunteer Cleft Missions was set up to provide a report to be presented at the Eighth International Congress of Cleft Palate and Associated Craniofacial Anomalies on September 12, 1997, in Singapore. The aim of the report was to provide data from a wide range of different international teams performing volunteer cleft missions and, thereafter, based on the collected data, to identify common goals and aims of such missions. Thirteen different groups actively participating in volunteer cleft missions worldwide were selected from the International Confederation of Plastic and Reconstructive Surgery's list of teams actively participating in volunteer cleft missions. Because of the time frame within which the committee had to work, three groups that did not respond by the stipulated deadline were omitted from the committee. The represented members and their respective institutions have undertaken more than 50 volunteer cleft missions to underdeveloped nations worldwide within the last 3 years. They have visited over 20 different countries, treating more than 3,500 patients worldwide. Based on the data collected and by consensus, the committee outlined recommendations for future volunteer cleft missions based on 1) mission objectives, 2) organization, 3) personal health and liability, 4) funding, 5) trainees in volunteer cleft missions, and 6) public relations. The task force believed that all volunteer cleft missions should have well-defined objectives, preferably with long-term plans. The task force also decided that it was impossible to achieve a successful mission without good organization and close coordination. All efforts should be made, and care taken, to ensure that there is minimal morbidity and no mortality. Finally, as ambassadors of goodwill and humanitarian aid, the participants must make every effort to understand and respect local customs and protocol. The main aims are to provide top-quality surgical service, train local doctors and staff, develop and nurture fledgling cleft programs, and, finally, make new friends.

Cleft Palate↗

PubMed1995

[Legal liability in consultation of physicians of different specialties from the legal viewpoint].

Modern medicine is unthinkable without medical teamwork with differentiated cooperation. The horizontal division of the work, meaning the cooperation of physicians from different specialties on the basis of an equal order and the equal right in giving instructions, has to be differentiated from the relationship of subordinate and senior physicians in the vertical division of work which may be found in the relationship between the coordinator, subordinate physicians and the medical assistant staff. However, the danger of mistakes increases with the number of involved specialists. On one side, the jurisdiction has to protect the patient from the typical dangers of the division of work but has to protect the physician from an excessive liability for the malpractice of others on the other side. The necessary medico-legal rules in the area of the horizontal cooperation, after modification in the vertical cooperation as well, are the principle of a strict separation of work and the principle of trust. According to the principle of a strict separation of work, every specialist independently carries out the tasks entrusted to him without the right to instruct or supervise other specialists. The principle of trust means that every specialist may rely on the fact that the other partners will carry out their tasks with the necessary care. The limitations of trust are reached in a certain situation when a partner is not able to accomplish his tasks, i.e. due to incompetence, fatigue, or illness. Then, the physician, which is actually not in charge, has to act. Overlapping areas between the specialties should be discussed on-site or should be regulated by interdisciplinary agreements.

Clinical Competence↗

PubMed1985

Risk management in the dental office.

Owing to a massive increase in malpractice suits directed against dentists and an escalation in the amount of settlements and court ordered awards, professional liability premiums are increasing at an alarming rate. Perhaps more important to the dentist is the anguish caused by the legal process that exposes him or her to allegations made in the public arena of the courts and the press regarding the delivery of substandard care. In addition, the dentist may suffer considerable loss of money as a result of findings of negligence by the courts. The license to practice also is at risk. In today's environment, the practice of a health profession does not appear to be emotionally, professionally, or financially secure. Despite these disadvantages in the practice of dentistry, there is much the practitioner can do to reduce or eliminate legal vulnerability. In addition to maintaining a level of care that meets the standards of other dentists in the community through the process of quality assurance, legally sound office practices and practice management procedures may contribute significantly to minimizing legal risks. A process known as risk management is currently available to assist the practicing dentist in achieving these goals. The principles of risk management was borrowed from industry by the health care industry following the crisis in medical malpractice of the early 1970s. Its primary focus is the protection of resources from losses due to legal action. The activities associated with risk management are easily adapted to dental practice. The focus of these activities is directed at identifying areas of legal vulnerability, taking steps directed at reducing or eliminating them, and purchasing insurance to offset potential financial losses. The current areas of legal vulnerability center around issues of (1) absence of consent to care, (2) negligence, and (3) breach of contract. Consent to care, to be valid, must be informed and granted voluntarily. To meet the test of "informed," the information given to the patient must be in understandable language and contain the risks, benefits, and alternatives to the recommended treatment. In addition, the patient must be given an opportunity to have his or her questions answered. Obtaining consent from one having legal capacity to grant consent is another essential requirement. The treatment of minors and those that are emancipated, raises many problems with consent.(ABSTRACT TRUNCATED AT 400 WORDS)

Defensive Medicine↗

PubMed1989

Standard of care and anesthesia liability.

For the past 3 years, the Committee on Professional Liability of the American Society of Anesthesiologists has been studying records of closed malpractice claims files for anesthesia-related patient injuries. The database of 1004 lawsuits was examined to define the impact of the "standard of care," as judged by a practicing group of anesthesiologists, on the likelihood and amount of financial recovery. We found that payment was made in more than 80% of claims made by patients who were judged to have received substandard anesthetic care. Payment also was made in more than 40% of claims when the anesthesia care was judged to be appropriate. We conclude that in the tort-based system of compensation for anesthesia-related injury, the patient has a high probability of financial recovery for injury caused by substandard care. However, if the anesthesiologist provides appropriate care there is still a greater than 40% chance that payment will be made for the claim of malpractice.

Anesthesia↗

PubMed1995

Role of previous claims and specialty on the effectiveness of risk-management education for office-based physicians.

We analyzed the medical malpractice claims data of 1,903 physicians between 1981 and 1990 to assess the efficacy--a reduced incidence of future claims and decreased payout in the event of a claim--of risk-management education for office-based physicians. Physicians were participants in the Oregon Medical Association's medical liability program and represented all recognized specialties and all geographic areas of the state. Each physician's claim and payout history before and after 4 sequential risk-management education programs was entered into a random-effects probit model that allowed for a longitudinal rather than a cross-sectional analysis. For most physicians, there was increased claim vulnerability following 1 or 2 risk-management education courses but decreased vulnerability after additional courses. Among all physicians, having a previous claim substantially increased the risk for a future claim. Risk for an additional claim doubled (from 7% to 14%) for physicians who had a claim in the previous year. Of all specialists who have had claims, anesthesiologists (reduction in claims incidence from 18.8% to 9.1% and in payout from 14.6% to 5%) and obstetrician-gynecologists (reduction in claims incidence from 23.3% to 15.2% and in payout from 11.6% to 4.2%) benefit most from cumulative risk-management education.

Humans↗

PubMedDate not supplied

Responding to an emergency in and out of the office.

Moral duties aside, a physician generally has no legal liability to a stranger in a medical emergency if the physician decides to do nothing so long as the physician is not under a pre-existing duty or has created a risk of harm to such stranger. Missouri, like any other state, has a Good Samaritan statute specifically designed to encourage medical care providers to offer assistance to injured persons at the scene of an emergency or accident. Although, the statute on its face draws the line between ordinary negligence and gross negligence in extending the immunity to any qualified rescuer who provides emergency medical care without compensation at the scene of emergency, no Missouri case law has recognized "gross negligence" as a cause of action at common law. The practical effect is that it is unlikely any qualified rescuer will be held liable for a victim's injuries when the care was rendered in good faith during emergency and without compensation, however negligently, unless there is willful or wanton misconduct on the part of such rescuer.

Emergency Medical Services↗