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At least 163 records · Page 9Linked to original sources
PubMedDate not supplied

Liability immunity as a legal defense for recent emergency medical services system litigation.

BACKGROUND: Although many emergency medical services (EMS) providers are concerned about liability litigation, no comprehensive, national studies of EMS appelate cases have been published. Information about these cases and the use of liability immunity (sovereign immunity, emergency medical care immunity, or Good Samaritan immunity) as a defense could be used for EMS risk management and better patient care. OBJECTIVE: To review recent EMS system civil litigation cases to determine their common characteristics and the number that used liability immunity as a legal defense. METHODS: An observational study of the WESTLAW computerized database of legal cases from all state and federal appellate courts. All legal cases that named a member of the EMS system as a defendant, involved either a patient-care incident or ambulance collision, and received an appellate court opinion from 1987 through 1992, were studied. RESULTS: Eighty-six cases were identified and analyzed. Most cases (85%) were related to a patient-care incident, and 71% of the cases involved a death or significant physical injury. More than 49% of the patient cases alleged inadequate assessment or treatment, and 27% alleged delay in ambulance arrival or no ambulance arrival. There were 11 cases (15%) that alleged no transport of the patient to the hospital. Liability immunity was used as a defense in 53% of the cases. The appellate courts ruled in favor of 68% of the defendants that did not use an immunity defense and in favor of 72% of those that did use liability immunity. CONCLUSION: There have been a large number of recent appellate cases involving EMS systems. The common characteristics of many of these cases demonstrate the need for providing rapid ambulance arrival, proper assessment and treatment, and rapid patient transportation to a hospital. Although liability immunity was used as a legal defense by most EMS system defendants, the appellate court outcome was similar regardless of its use.

Defensive Medicine↗
PubMed1991

Child custody mediation and litigation: further evidence on the differing views of mothers and fathers.

An earlier study was replicated in which parents were randomly assigned to negotiate child custody disputes either in mediation or through the adversary system. In both the initial study (Emery & Wyer, 1987a) and the present replication, mediation greatly reduced the frequency of custody hearings, allowed settlements to be reached in half the time, and substantially improved the satisfaction reported by fathers. Considerably fewer differences were found for mothers who used the alternative forms of dispute resolution, however. Some differences found in both studies favored the women who litigated. No consistent differences in the psychological adjustment of mothers or fathers who mediated or litigated emerged across the two studies. Although careful consideration of findings argues against the conclusion that mediation is "good" for fathers and "bad" for mothers, findings point to the conflicting perspectives of men and women who contest child custody.

Adolescent↗
PubMed1994

Child custody mediation and litigation: parents' satisfaction and functioning one year after settlement.

A 1-year follow-up study was conducted on families randomly assigned to settle custody disputes either in mediation or through adversary procedures. Consistent with Time 1 reports, at Time 2 fathers who mediated were substantially more satisfied than were fathers who litigated. Fathers who mediated also complied more with child support orders. Contrary to prediction, the greater satisfaction and compliance of fathers did not lead to increased satisfaction among mothers who mediated. In contrast to Time 1, at follow-up mothers who mediated were significantly less satisfied than were mothers who litigated, but selective attrition may account for these differences. The psychological adjustment of mothers and fathers was not significantly different between settlement groups at Time 2, but mothers in both groups reported less satisfaction with dispute settlement and less dysphoria at Time 2 than they had reported at Time 1.

Child↗
PubMed1997

Infective endocarditis and the dental practitioner: a review of 53 cases involving litigation.

OBJECTIVE: To review episodes of infective endocarditis involving dental procedures that have resulted in litigation and to determine if any clinical recommendations can be obtained. DESIGN: 13-year retrospective study. INTERVENTION: Patient records were analysed to identify the probable cause of infective endocarditis. All were judged to be caused by dental manipulations on the basis of dental procedure, cardiac pathology, infecting micro-organism and time between onset of infection and dental manipulation. MAIN OUTCOME MEASURES: Cases were analysed to check if appropriate national guidelines on antibiotic prophylaxis were followed. Status of patient dental records was also evaluated. RESULTS: Dental procedures implicated in infective endocarditis were exodontia (23), scaling (21), root canal therapy with extra-canal instrumentation (7) and minor oral surgery (2). No medical history was recorded in 10 patients. In a further 31 medical history was inadequate or out of date. Dentists involved with these cases failed to give prophylactic antibiotics (48), prescribed incorrect antibiotics (2), or gave antibiotics at inappropriate times (2). There was one episode of prophylaxis with amoxycillin failing despite it being given correctly. CONCLUSIONS: If litigation is to be avoided dental practitioners must keep accurate dental records, take an appropriate medical history that is kept up to date and adhere to national guidelines on antibiotic prophylaxis.

Adult↗
PubMed2002

Delay in the clinical diagnosis of breast cancer: estimating its effect on prognosis, with particular reference to medical litigation.

Medical malpractice litigation is increasing. Delay in diagnosis is the commonest basis for litigation involving the treatment of breast cancer. When delay in diagnosis has occurred, any losses for which a plaintiff seeks compensation require estimates to be made of any change in prognosis over the period of the delay relative to the extent of disease found when treatment is finally undertaken. We have examined the natural history of breast cancer and have attempted to provide evidence-based quantitative guidelines for the evaluation of the losses which may be claimed in malpractice cases.

Journal Article↗
PubMed2000

Litigation and defensive clinical practice: quantifying the problem.

OBJECTIVE: To assess the evidence for claims about a rise in defensive clinical practice, particularly within maternity care; to describe an attempt to quantify the extent of defensive practice; and to identify areas for further research. DESIGN: Review of existing literature and a large scale postal survey. PARTICIPANTS: Over 2000 midwives and obstetricians, mostly based in Scotland. FINDINGS: Several claims have been made about the incidence of litigation, and its apparent effects on clinical practice. These effects, referred to as defensive practice, include both risk avoidance and risk-reduction strategies. Fears about recruitment to and retention within high-risk specialties have been expressed, especially in the USA. A majority of those midwives and obstetricians surveyed believed that litigation has caused a rise in defensiveness, and there was some agreement between the two groups about what constitutes defensive practice. However, there were discrepancies between the examples of defensive practice given by practitioners and what they admitted their own response to be. CONCLUSIONS: Defensiveness is believed to be fairly commonplace, but because of difficulties in defining and quantifying the concept of defensiveness it is unclear what the exact implications for clinical practice may be. Further research is required to establish this.

Data Collection↗
PubMed2005

Litigating for Native American health: the liability of alcoholic beverage makers and distributors.

Native American populations have long experienced excess morbidity and mortality attributable to alcohol. Historically, alcohol was introduced to the Native American population by European settlers, and was used to help those settlers get land and goods from the Indian population. In modern times, alcohol beverage makers and distributors continue to supply and market their products to Native American populations in amounts and manners that contribute to continuing health and safety problems. When some other products have been over-supplied or over-promoted to the detriment of the public's health, litigation has been brought against the makers or dealers of those products, sometimes using the legal theory of public nuisance. This article explores the potential for litigation brought by Native Americans against alcoholic beverage makers and distributors.

Alcoholic Beverages↗
PubMed2002

Fear of litigation may increase resuscitation of infants born near the limits of viability.

OBJECTIVES: To explore how fear of litigation influences neonatal treatment decisions. STUDY DESIGN: In a mailed survey, we presented a hypothetical vignette of a premature infant to 1000 neonatologists. We asked them to estimate prognosis, indicate appropriate intervention, and respond to parental treatment requests. Subjects were randomly assigned to receive one of two questionnaires, "litigious" or "nonlitigious," which differed only in the description of the infant's parents. RESULTS: The response rate was 63.0%. The vast majority of respondents deferred to parental requests rather than adhering to their best judgment. They deferred whether or not parents requested treatment and whether or not parents were described as litigious (P <.0001). Among those respondents who shifted their resuscitation opinion after parental introduction, respondents to the nonlitigious version were more likely to shift their opinion from "treat" to "do not treat" after parental requests to "use your best judgment" (P <.042). The influence of parental litigiousness was primarily seen among neonatologists who thought that the infant's prognosis was dismal (P <.044). CONCLUSIONS: There is a strong disposition among neonatologists toward respecting parental wishes. This disposition is stronger when neonatologists are given additional reason to be concerned about litigation.

Adult↗
PubMed1999

Health care practice and the minimisation of patient medical litigation.

This article explores why patients sue their health care providers. Following an extensive literature review, it identifies 'sue' motivators and then examines the legal basis of medical litigation by reviewing contemporary case law. Armed with the 'sue' motivators and having considered the types of claims brought against health care providers, the article focuses upon what health care providers may do to minimise litigation. It recommends specific provocative measures, which are based upon satisfying a myriad of patient needs through consenting practices, and early recognition and resolution of patient issues by providers.

Australia↗
PubMed2005

Ecological validity of the WMS-III rarely missed index in personal injury litigation.

The purpose of this study was to evaluate the clinical utility of the Rarely Missed Index (RMI) to detect cognitive exaggeration in 78 nonlitigant patients (i.e., Mixed Clinical group) and 158 personal injury litigants (i.e., 20 Suspected Exaggerators, 12 Borderline Exaggerators, 126 Genuine Responders). The base rate for probable malingered neurocognitive dysfunction in the litigant sample was 12.7%. The false positive error rate of the RMI in the Genuine Responder and Mixed Clinical group ranged from 5.4% to 8.6%. Positive RMI scores were found in 25% and 41.7% of the Suspected Exaggerator and Borderline Exaggerator groups respectively. The clinical utility of the RMI to identify Suspected Exaggerators versus individuals in the Genuine Responder and Mixed Clinical groups revealed low sensitivity (sensitivity = .25), very high specificity (range = .91 to .95), moderate positive predictive power (range = .50 to .71), and moderate to high negative predictive power (range = .68 to .83). These results do not support the use of the RMI as a reliable predictor of cognitive exaggeration.

Adult↗
PubMed1999

Equipment standards: history, litigation, and advice.

The authors present a concise history of the development of national and international standards for surgical equipment. Standards-writing organizations, surgical and other specialty societies, universities, test houses, and the U.S. government have influenced this process, which is now manifested in complex interactions between national and international standards-writing organizations, and in CE (Conformité Europeene) marks being placed on surgical equipment in the United States and elsewhere. The history of litigation in standards development is also reviewed. Recommendations to maximize patient safety and to help ensure successful, cost-effective defense in litigation for surgeons who use equipment and may suffer its malfunctions are given. Overall, the complicated oversight of surgical equipment standards and the approval process appears to be contributing to the improving and outstanding results of U.S. surgery reported by the U.S. government.

Equipment Failure↗
PubMed2003

Trouble in academia: ten years of litigation in medical education.

BACKGROUND: This study looks at a disturbing increase in medical education ("ME") litigation over the past ten years (1993-2002). METHOD: Using the LEXIS/NEXIS online legal database, this study identifies and analyzes cases in which a medical student, resident, or faculty member ("ME participants") was involved in a lawsuit with their respective institution or some other aspect of ME. RESULTS: The majority of claims lodged against institutions by ME participants concern the ME participant's termination from their respective institution and allege institutional discrimination or the failure to provide adequate due process protections. CONCLUSION: Discrimination and due process claims are direct challenges to the effectiveness of an institution's policies and procedures regarding physician review, promotion, and termination. All relevant events in a student or resident's education, positive and negative, must be fully documented. The failure to establish and faithfully implement comprehensive policies and procedures leaves institutions particularly vulnerable to this most frequent cause of litigation.

Civil Rights↗
PubMedDate not supplied

Chronic pain and posttraumatic stress symptoms in litigating motor vehicle accident victims.

OBJECTIVE: There has been little research examining chronic pain and posttraumatic stress symptoms in persons injured in motor vehicle accidents. The purpose of this study was to evaluate differences in physical injury and impairment, psychological distress, and pain coping strategies in litigating chronic pain patients low and high in motor vehicle accident-related posttraumatic stress symptoms. DESIGN: A total of 160 consecutive chronic pain patients referred for psychological-legal assessment underwent semistructured interview and testing. The testing battery included the Minnesota Multiphasic Personality Inventory-2, the Multidimensional Pain Inventory, the Sickness Impact Profile, and the Coping Strategies Questionnaire. Using the sample-specific median split of 18 posttraumatic stress symptoms on the Minnesota Multiphasic Personality Inventory-2 Posttraumatic Stress Disorder scale, chronic pain patients were categorized as evidencing low or high levels of posttraumatic stress symptoms. RESULTS: The findings indicate that participants evidencing high posttraumatic stress symptoms had more physical impairment, psychological distress, and maladaptive pain coping strategies and were more likely to be treated with antidepressants, other medications, and psychological management than participants evidencing low posttraumatic stress symptoms. A discriminant function analysis was performed using the full combination of physical injury and impairment, psychological distress, and pain coping variables in the prediction of posttraumatic stress symptom-defined group membership. The resulting discriminant function accounted for 61% of the between-group variance and correctly classified 92% of participants who were low in posttraumatic stress symptoms and 88% of participants who were high in posttraumatic stress symptoms. CONCLUSIONS: Chronic pain and posttraumatic stress symptoms in litigating motor vehicle accident victims are associated with increased physical and psychological morbidity.

Accidents, Traffic↗
PubMed1997

Permanent disability: the legacy of tort litigation.

The therapeutic alliance essential during the long process between the injury and the final appeal in the resulting tort is discussed. The core thesis is that once the patient with orthopaedic problems initiates litigation, he or she starts to become invested in permanent disability, and the slide down the slippery slope of a lifetime of disability has begun. This is not a lament about the role of lawyers, courts, and litigation. They are facts, part of the working conditions of the orthopaedic physician. What happens after acknowledging these facts is the topic of discussion. How can one do the best job of damage control in the face of a totally toxic situation? How can the physician become a stabilizing force in the spin toward permanence in disability?

Disability Evaluation↗
PubMed2001

A litigation primer for the health physicist.

This primer presents a basic overview of legal terminology and theories that may be encountered by the health physicist relative to radiation-related litigation. Legal terms are defined, and the progression of a sample radiation injury claim is explained from the filing of a claim through the appeal process. The objective of the primer is to establish a basic foundation of legal concepts on which to build further understanding. The legal system is an arena with which most health physicists have essentially no familiarity or, at best, limited knowledge. The chances are increasing that health physics professionals may be involved in radiation injury litigation in some way, requiring a basic understanding of these concepts.

Health Physics↗
PubMed1989

Practice changes in response to the malpractice litigation climate. Results of a Maryland physician survey.

Data from a 1987 survey of Maryland physicians in three specialties (internal medicine, family or general practice, and obstetrics-gynecology) were used to study the types of changes physicians have made in their practices during the last 2 years as a result of the current malpractice litigation climate. Overall, 51% reported making some type of practice change. The practice changes that physicians reported reflect both risk-reduction (e.g., increased use of tests) and risk-avoidance (e.g., cutting back high-risk patients) strategies, although risk-reduction actions were reported more frequently. Raising patient fees was also reported. Specialty predicts whether or not physicians make each type of change; in particular, obstetrician-gynecologists are more likely to report practice changes of all types. Prior litigation experience does not, in general, predict practice changes. The implications of the types of changes reported for access to care and costs of care were considered.

Data Collection↗
PubMed1994

Successful treatment of low back pain and neck pain after a motor vehicle accident despite litigation.

OBJECTIVE: This prospective study evaluated 39 consecutive patients with low back pain (LBP) or neck pain that resulted from a motor vehicle accident who had litigation pending. METHODS: Patients completed a McGill Pain Questionnaire (MPQ) to quantify pain and an Oswestry Low Back Disability Questionnaire (OSW) to quantify function and were interviewed regarding medications and work status at initial and final visits. RESULTS: Thirty-three patients completed an MPQ at initial and final visits. Pain decreased in 29 (88%) and increased in four (12%). Thirty-eight patients completed an OSW at initial and final visits. Function improved in 34 and worsened in four. The authors observed statistically significant improvements in pain, function, and medication use. CONCLUSION: Patients with low back pain or neck pain resulting from a motor vehicle accident showed a statistically significant improvement with treatment despite ongoing litigation.

Accidents, Traffic↗
PubMed1989

Causation and disease: biomedical science in toxic tort litigation.

Inferences concerning the etiology of disease in human populations are derived from complex quantitative and biologic data. Interpreting these inferences in toxic tort litigation poses difficult problems for courts. Fundamental differences exist between courtroom and scientific criteria of causation. These differences need not be irreconcilable if courts understand the nature, strengths, and limitations of scientific evidence. We discuss the interpretation of basic scientific principles of disease causation in the context of legal rules of evidence, and develop an epidemiologic evidentiary standard for toxic tort litigation.

Causality↗