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PubMed1998

Forensic medicine, its tasks and duties in medical malpractice and medico-legal litigation.

Forensic medicine assists in clarification of cases of violent death, assessment of bodily damage and indemnity, especially in cases of work injuries, it also deals with deaths that occur within two hours of a doctor's intervention. As "legal medicine", forensic medicine is taught both to medical students and to students of the juridical faculties. In cases of medical malpractice, forensic pathologists give opinions in courts. Cases of alleged malpractice are handled differently in different countries. Establishment of expert committees in the Czech Republic represents a reasonable solution to this problem. Activities of the committees are described.

Czech Republic↗
PubMed1998

Results of elective lumbar discectomy for patients involved in the workers' compensation system.

We compared the outcomes from lumbar discectomy for patients who were workers' compensation claimants and/or who were involved in active litigation with patients who underwent elective lumbar discectomy, but who were not involved with either compensation or litigation. Eighty-two consecutive patients who underwent elective lumbar discectomy by the senior author were identified from 1989 through 1994. Those patients who underwent a primary discectomy with a minimum of 6 months' follow-up were studied. Patients were excluded if a spinal fusion was performed or if a multilevel laminectomy procedure was required. Patients were classified as compensation patients if they were involved in either worker's compensation claims or active litigation at the time of the lumbar discectomy. The compensation group was further divided into three subsets of patients: those involved in active litigation without compensation, those involved in both compensation and litigation, and those pursuing workers' compensation claims without litigation. The control group was comprised of patients who were not in any way involved with compensation or litigation. Outcome assessment and ratings were determined independently by the coauthors, not the primary surgeon. Outcome was based on pain, employment status, analgesic use, and level of activity. Fifty-four patients met the inclusion criteria. Average follow-up for the compensation patients was 40 weeks. Follow-up for the noncompensation patients averaged 51 weeks. Eighty-one percent of our patients in the noncompensation group achieved a good result. Only 1 of 27 patients was categorized as having a poor outcome. Conversely, patients who were actively involved in the compensation and/or litigation process had significantly poorer outcomes, with only 29% of the patients receiving a good outcome evaluation (p = < 0.0002). Legal involvement was associated with poorer outcome in compensation patients (p = < 0.001).

Adult↗
PubMed1998

Validation of reliable digits for detection of malingering.

This study is a cross validation of the previous work by Greffenstein, Baker, and Gola (1994) and Greiffenstein, Gola, and Baker (1995) on the Reliable Digits (RD) method of detecting possible malingering. This study consisted of 47 mild brain-injured litigating and 49 mild brain-injured non-litigating participants. The result of this study was that only 4.1% of the non-litigating participants were classified as malingering by RD, while 48.9% of the litigating participants were classified as malingering by RD. Comparing litigating participants' performance on a forced choice task with their RD revealed that 77.8% (7/9) who failed the forced choice task also failed RD. RD classified more litigating patients as malingering than did the forced choice task and none of the non-litigating participants failed forced choice. These findings underscore the previous recommendations of Greiffenstein et al. (1994, 1995), that it is important to assess motivation on specific neuropsychological tests and that motivation on neuropsychological tests is not an all or none phenomenon.

Adult↗
PubMed2003

The structure of medical malpractice decision-making in Japan.

The article summarises the problems in the medical malpractice litigation systems in the United Kingdom and Japan, demonstrating the similarities and identifying the length of time between initiating an action and its decision and other factors responsible for lengthy litigation. Based on analysis of decisions of medical malpractice cases between 1986 and 1998 in Japan, the functioning of the Japanese medical malpractice litigation system is discussed. Lengthy litigation is shown to be correlated with outcome and implies that the Japanese medical dispute resolution mechanism favours those who can endure lengthy litigation, namely the defendants, who are physicians or hospitals. In view of the similarities between the two systems, it is likely that the same bias--that the wealthier party in the litigation is more likely to win the case--also occurs in medical malpractice litigation in the United Kingdom and Australia.

Compensation and Redress↗
PubMed2005

Medicolegal aspects of the orthopaedic care for shoulder injuries.

The medicolegal aspects of orthopaedic care increasingly are becoming an important focus of physicians. Because of the rarity of publications on the subject, I will examine medical litigation in orthopaedics, specifically in regards to shoulder injuries. There are several reasons for recent increases in malpractice litigation. Increased orthopaedic specialization and advanced technologies have raised patient expectations while the media have informed patients of the potential financial rewards of litigation. I will discuss three cases of litigation regarding shoulder injuries including reasons for malpractice and what can be done to avoid it. In Case 1 I examine an implant failure of a rotator cuff repair. The failure was caused by a manufacturing error; therefore, the importance of being familiar with the equipment and the companies that a physician deals with is emphasized in this case. Case 2 is another failed rotator cuff repair; this litigation stemmed from poor patient selection and a lack of preoperative patient-physician communication. Finally, Case 3 involved retained hardware, a surgical mistake that often results in a substantial settlement because it is considered indefensible. These cases highlight the potential for malpractice and can be applied more broadly to all branches of orthopaedics. Most litigation, however, can be avoided with careful diagnostic procedures, greater experience with equipment, and better communication.

Adult↗
PubMed1997

Equity and adequacy in school funding.

Since 1971, most states have been subject to lawsuits seeking to reform their education funding systems. These cases are litigated on the basis of state (not federal) constitutional language and generally seek either greater equity in funding among school districts or a guaranteed level of adequate funding for education. State supreme courts have found the finance systems unconstitutional in 16 states, and many states are still actively involved in litigation. Even where litigation has not occurred or has not succeeded, the prospect of litigation has prompted revisions of state funding policies. Despite the predominant role equity and adequacy play in litigation, there are no universally accepted definitions for either of these words in education funding. Most commonly, equity is measured in terms of the variation in per-pupil revenues among school districts in a single state. By this measure, some states have greater funding equity than others, and in most states wealthy districts have significantly higher per-pupil expenditures than do poor districts. Equity is likely to be greater when the residents of poor districts pay higher taxes. (In some states, residents in poorer areas pay twice as much of their income in local taxes as do residents of wealthier communities.) Equity is also greater in those states where the state's share of the education budget is higher and where the state consistently targets its contributions to lower-income districts. Much of current litigation and legislative activity in education funding seeks to assure "adequacy," that is, a sufficient level of funding to deliver an adequate education to every student in the state. Most states have not explicitly addressed the questions of how much education is "adequate" or how educational standards can be converted to a finance formula. Several approaches to calculating the cost of an adequate education are described.

Adolescent↗