Incidence Of Litigation Research Articles

Reevaluating Informed Consent: Integrating Shared Decision-Making into Spinal Surgery for Better Patient Outcomes.

Narrative review. The objectives of this study were to answer the following questions: (1) What is the quality of informed consent in spine surgery, including both neurosurgery and orthopaedic spine surgery? (2) What limitations impede the ability of surgeons to engage in effective shared decision-making (SDM) and obtain adequate informed consent? (3) What strategies and solutions may improve the quality of informed consent and SDM? (4) What factors decrease the incidence of litigation in spine surgery? N/A. SDM is a collaborative process where patients are involved in their treatment choices through open communication about risks, alternatives, and postoperative expectations. Informed consent is a vital component of this process, ensuring that patients are fully informed and empowered to make decisions based on their values and preferences. This review highlights the current state of informed consent within the context of SDM in spine surgery and explores how enhancing this process can improve patient outcomes, reduce dissatisfaction, and decrease litigation. By emphasizing patient autonomy and improving the quality of risk communication, SDM fosters better physician-patient relationships and more positive clinical outcomes. Orthopaedic surgery and neurosurgery are highly litigated specialties, with failure to obtain informed consent frequently cited in lawsuits. These legal challenges are costly and time-consuming for both physicians and patients. Integrating SDM into the informed consent process can help mitigate these issues, leading to improved patient satisfaction and fewer legal disputes.

Can accolades make stakeholders tolerant: Award-winning and corporate litigation risk

Based on a sample of Chinese listed companies from 2007 to 2022, this paper examines whether corporate accolades are associated with a lower incidence of litigation. By holding earnings and other determinants of litigation, we find that obtaining and disclosing awards can reduce information asymmetry and improve corporate reputation, thereby reducing the litigation risk of firms. Our results still hold after a series of robustness tests. Further analysis finds that the mitigation effect of awards is more pronounced in operation disputes and debt disputes.

Thoracic Surgery Litigation: Analysis Using the Westlaw Legal Database

BackgroundIn the United States, medical malpractice bears a significant financial risk associated with surgery, particularly in the field of cardiothoracic surgery. Approximately 18.9% of cardiothoracic surgeons face litigation. We report an analysis of litigation in thoracic surgery. MethodsThe Westlaw legal database was used to identify thoracic surgery cases. Search terms were identified for various thoracic procedures. Case characteristics were analyzed. ResultsMedical malpractice in thoracic surgery results in a median payout of $1,183,000 million for plaintiff verdicts and a mean settlement award of $550,000. Outcomes of litigation are variable. Geographic location does not play a significant role in litigation. Thoracic surgeons in New York, California, Florida, and Illinois faced the most lawsuits. Intraoperative or procedural error and inadequate informed consent accounted for 52% of all cases. ConclusionsAttempts to increase patient understanding and education may be beneficial for reducing litigation. Analysis of why New York, California, and Illinois are highly litigious is warranted. Future analysis would also be useful to evaluate whether advances in techniques, such as robotic or thoracoscopic approaches, are associated with reduced incidence of litigation.

An Analysis of Medical Malpractice Litigation due to Intravenous Steroid Treatment for Acute Spinal Cord Injury.

Retrospective cohort study. To evaluate the incidence of litigation due to using or foregoing methylprednisolone (MP), naloxone, or tirilazad for treatment of acute spinal cord injury (ASCI) through querying the Westlaw and VerdictSearch databases. There is historic controversy regarding the use of intravenous steroids for treatment of ASCI. Many highlight that MP continues to be used for ASCI treatment mainly as a defensive medicine tactic due to the fear of malpractice litigation. Westlaw and VerdictSearch were queried for cases involving steroid treatment for ASCI between the years 1998 and 2021. Collected data for each case included year of case hearing, verdict ruling, location of filed claim, and the plaintiff's basis of litigation. Cases were reviewed and categorized by two independent reviewers based on the grievance(s) levied by the plaintiff. Inclusion criteria for topic relevance was defined as a plaintiff's basis of litigation resting on a claim of medical malpractice due to the use, or lack thereof, of MP, naloxone, or tirilazad for treatment of ASCI. Upon review of 238 cases, case claims were grouped into five categories based on reason for litigation: Social Security benefits (171), lawsuit due to vaccination (25), medical malpractice unrelated to steroid use (16), fungal infections due to MP injections (4), and other (22). Zero cases were found to be related to lawsuits filed due to steroid use or lack thereof for ASCI treatment. Our findings suggest there is limited risk of malpractice litigation due to steroid use or lack thereof in the treatment of ASCI. As such, steroid-related treatment decisions for ASCI should be informed by evidence-based approaches to care not influenced by medicolegal concerns.

Are State-Owned Enterprises Equally Reliable Information Suppliers? An Examination of the Impacts of State Ownership on Earnings Management Strategies of Chinese Enterprises

Earnings management refers to a company’s use of either accounting techniques (accrual-based earnings management) or real economic activities (real earnings management) to manipulate reported earnings and mislead users of financial information. It often indicates serious ethical issues in a company’s management, which will affect the reliability and sustainability of a firm’s services in the supply chain. Using A-share listed Chinese firms on the Shanghai and Shenzhen Stock Exchanges, we investigated the impacts of state ownership on management’s decision to select real or accrual-based earnings management strategies. We found that state-owned enterprises (SOEs) tend to favor real earnings management over accrual-based earnings management more than non-SOEs. Furthermore, those SOEs that are controlled by the central government engage in real earnings management more often than those controlled by local governments. We also examined whether media attention and litigation interact with state ownership to affect earnings management. We found that SOEs, especially central SOEs, with a high level of media attention or an incidence of litigation, are more likely to use real earnings management. Our research can assist firms in making better decisions in selecting business partners and service suppliers in an emerging market through the assessment of management integrity.

Reducing Obstetric Errors and Improving Patient Safety

The first global initiative to improve patient safety was passed by the World Health Assembly in 2002. Notwithstanding, patients continue to experience healthcare related harms despite advancements in medical technologies. Patient safety strategies do exist in certain institutions; however, they may not be consistent, well applied or appreciated by all staff. Errors in obstetric care are common due to the dynamic nature of the discipline and are associated with a high incidence of litigation, which drives interest away from obstetric practice. This article aims to improve our understanding of medical errors and related terminology, explore strategies to reduce errors in obstetrics and improve patient safety in all areas of care. Reporting systems and guidelines are also suggested with a view to achieving improved patient outcomes in the field.

A case of stillbirth caused by rupture of an intrahepatic hemangioma and the wish for litigation

A very uncommon case of an intrahepatic hemangioma rupture as a cause of a stillborn baby is presented. It seems that the event could not be detected. However, the idea of litigation pushed parents to ascertain hypothetical liability of physicians 10 years after the stillbirth. The reason that parents do not comprehend that such a rare event could occur and opt for litigation was investigated. The conclusion seems that some patients’ beliefs do not agree with physician counseling and cause the failure of the medical goals for the best care; thus, an improvement in counseling would still be ineffective. Rather, lowering parents’ expectations from medical assessments and care seems the right way to reduce the incidence of litigation.

The Effectiveness and Incidence of Litigation as a Policy Instrument: The Case of the New Source Review Settlements

Enforcing regulations through litigation against noncompliant firms is an important policy tool for environmental regulators. In this paper, I provide new empirical evidence on the effectiveness of this mechanism by examining the effects of a major environmental enforcement initiative, which led one-third of the US coal-fired power plant fleet to come under a consent decree. I show that legal settlements arising out of this initiative caused large decreases in pollution emissions, which further led to meaningful improvements in local air quality and decreases in local cardiovascular and respiratory mortality rates. I then show suggestive evidence that in regulated electricity markets average electricity retail price and utility revenues increased following a settlement, implying that a substantial proportion of overall costs were borne by ratepayers.

Disclosure and the outcome of securities litigation

We examine the impact of disclosure by defendant firms on the outcome of securities fraud class actions. We hypothesize that firms issuing a higher quantity of disclosure will experience more adverse litigation outcomes, given the strict pleading standards of the Private Securities Litigation Reform Act (PSLRA). Using broad measures of disclosure derived from press releases issued during the class period, we find that more disclosure increases the likelihood that the judge will allow a lawsuit to proceed rather than dismissing it. Our results provide new insights to the literature on disclosure and litigation by studying the outcome rather than incidence of litigation, or the plaintiffs’ decision to sue. We strengthen the inference that the features of the PSLRA create a positive relationship between overall disclosure and the likelihood of settlement by showing that the relationship holds when controlling for forward-looking disclosure and ex ante litigation risk, and by providing evidence that more public disclosures allow plaintiffs to present more extensive cases.

Why go to court? Bargaining failure under the shadow of trial with complete information

Why do legal disputes ever go to trial? Prior research emphasizes the role of mistakes, irrationalities, or asymmetric information because rational litigants with complete or symmetric information should choose pre-trial settlements over the costs and risks of trial. Using a dynamic incomplete-contracting framework, we provide an overlooked rationale for going to court. Even though risky and costly, going to court can be both rational and socially efficient when a court decision enhances property rights and deters future costly litigation. Experimental evidence supports these predictions. Our findings provide new insights into the incidence of litigation and trial.

Missed Acute Appendicitis on Multidetector Computed Tomography and Magnetic Resonance Imaging: Legal Ramifications, Challenges, and Avoidance Strategies

The failure to diagnose acute appendicitis (AA) is the third most common medical malpractice allegation related to gastrointestinal disease. There is a paucity of detailed data on this topic; however, publications by Whang et al and by Berlin and Berlin, which analyzed all types of malpractice suits against radiologists, have shown that the incidence of litigation has increased over time in the United States. This is likely true for cases of AA as well. The misinterpretation of cross-sectional imaging in patients with suspected appendicitis may be caused by suboptimal technique, errors of omission, i.e, missing key findings, failure to review a portion of the examination, and satisfaction of search error. This article summarizes the published legal, clinical, and imaging literature regarding litigation in cases of missed AA, and reviews optimized multidetector computed tomography and magnetic resonance imaging protocols for the diagnosis of AA, with examples shown of challenging cases.

Records of medical malpractice litigation: a potential indicator of health-care quality in China.

ObjectiveTo assess the characteristics and incidence of medical litigation in China and the potential usefulness of the records of such litigation as an indicator of health-care quality.MethodsWe investigated 13 620 cases of medical malpractice litigation that ended between 2010 and 2015 and were reported to China’s Supreme Court. We categorized each case according to location of the court, the year the litigation ended, the medical specialization involved, the severity of the reported injury, the type of allegation raised by the plaintiff – including any alleged shortcomings in the health care received – and the outcome of the litigation.FindingsThe annual incidence of medical malpractice litigation increased from 75 in 2010 to 6947 in 2014. Most cases related to general surgery (1350 litigations), internal medicine (3500 litigations), obstetrics and gynaecology (1251 litigations) and orthopaedics (1283 litigations). Most of the reported injuries were either minor (1358 injuries) or fatal (4111 deaths). The most frequent allegation was of lack of consent or notification (1356 litigations), followed by misdiagnosis (1172 litigations), delay in treatment (1145 litigations) and alteration or forgery of medical records (975 litigations). Of the 11 014 plaintiffs with known litigation outcomes, 7482 (67.9%) received monetary compensation.ConclusionOver our study period, the incidence of litigation over potential medical malpractice increased in China. As many of the cases related to alleged inadequacies in the quality of health care, records of medical malpractice litigation in China may be worth exploring as an indicator of health-care quality.

Patents Protecting Biologics or Small Molecule Drugs are Litigated, Not Others Awarded to Drug Discovery Companies

Assuming that litigated patents are valuable, the incidence of litigation for patents protecting biologics (146 patents), small molecules (1822) or issued to drug-discovery companies per se (1929) was examined. This was done by accessing the litigation database of the company MaxVal. 20% of those protecting biologics, 40% protecting small molecules and 1% of those issued to the companies were litigated (although only 0.3% of those issued to companies that do not protect biologics or small molecules). The average time between the grant of a patent and its first litigation was 15.7, 7.8 and 2.7 (2.0) years respectively. Thus, the relevant patents of this study were litigated much later than the average litigated patent. Each litigated patent was litigated 1.7, 5.6 and 2.4 (1.0) times respectively. In each category, most litigants were companies, with very few litigations involving academic institutions or the USPTO, and no non-profit organizations. These results should be of interest to drug-discovery companies, to those who fund or acquire such companies and to non-profit drug-discovery centres.

Screening of Alleged Medical Malpractice in Egypt (Fayoum Governorate)

Background and Objectives: Medical malpractice is a legal cause of action that occurs when a physician deviates from required substandard and causes deterioration, disability, harm or death to a patient. This study documented all the reported malpractice cases according to the forensic medicine authority in Fayoum Governrate in the in the course of regular and proper health service Methods: All cases of medical malpractice claims of several medical specialties referred to the Forensic Medicine Authority, in 2012-2016 were checked (n=55). Results: The present study shows that 87.3% of the study group were adults, and 12.7% of them were children, 50.9% of them were males and 49.1% were females, and as regards to the place of residence, 47.3% of the victims were from urban places. The study has also pointed out that the majority of malpractices occurred in general hospitals (67.3%), more than in clinics and private hospitals. The 40% of malpractice were complications of surgery, then 23.6% of them were due to negligence, then 21.8% of patients had medication errors, and the least percentage of 14.5% had forgotten gauze and the majority of malpractices occurred in obstetrics and gynaecology which represent (36.4%) of the cases. Conclusion: It is extremely essential to analyse the errors properly in order to get the medical malpractice under control to avoid incidence of litigation and to propose professional standards as well as accurate references in connection with medico-legal procedures.

Closed Claims Analysis of Medical Malpractice Lawsuits Involving Midwives: Lessons Learned Regarding Safe Practices and the Avoidance of Litigation.

The risk of litigation remains of concern to midwives, their practice partners, employers, and malpractice insurance providers. Closed claims analysis is a method of examining risk patterns and behaviors in lawsuits, including those involving health care practices. The purpose of this investigation was to evaluate claims brought against midwives, with the intent of developing strategies to decrease the incidence of litigation. Data were collected in joint meetings with members of the American College of Nurse-Midwives (ACNM); the American Association of Birth Centers; the American International Group (AIG), a major malpractice insurer for certified nurse-midwives/certified midwives (CNMs/CMs); and Contemporary Insurance Services, an independent insurance agency that has worked with AIG to facilitate the writing of malpractice insurance policies for CNMs/CMs. The purpose of the meetings was to review 162 litigation cases that involved midwives insured by AIG and had been closed between the years 2002 and 2011. Follow-up analyses of data and reporting of results were performed by the authors, who are members of the Professional Liability Section of the ACNM Division of Standards and Practice. Findings reflected 7 major categories of liability risk ranging from the most prevalent (ie, fetal/newborn complications or death) to the least prevalent (ie, attending a vaginal birth after cesarean). Data also were examined regarding the highest amounts incurred in court decisions or pretrial settlements because they were related to types of adverse outcomes that occurred. Recommendations for improving clinical practice and avoiding litigation based on findings from the closed claims analysis include, but are not limited to, the need for thorough and accurate documentation in practice, appropriate and timely consultation and collaboration, and the presence of practitioners whose clinical skills match the level of care assessed to be necessary for each woman for whom care is offered.

Complications and outcomes following central neuraxial anesthesia in a sub-Saharan Tertiary Hospital: The legal implication

BackgroundComplications following central neuraxial anesthesia have led to litigations and claims in developed nations, however, the incidence of litigation is low in our environment. Anesthetist practicing in Nigeria need to be aware that such complications are not uncommon.Aim and objectiveTo determine central neuraxial anesthesia related complications and the legal implications.MethodThis was a prospective observational study conducted in 821 patients scheduled for surgery under central neuraxial anesthesia from February 2012 to January 2013. The choice of anesthesia depended on the indication and the duration of surgery.ResultsThe observed complications of central neuraxial anesthesia, which may result in litigation included inadvertent high block (22.4%), paresthesia during needle placement (6.2%), inadequate block (3%), failed block (1.2%), and postdural puncture headache (1.15%). Others were seizure (0.1%), meningism (0.1%), persistent pain in the lower limb for 48 hours (0.1%), back pain (0.7%) and cardiac arrest (0.49%); three of the four cardiac arrest died. There was, however, no report of litigation or claim in this study.ConclusionWe have demonstrated that complications, which may result in litigation and claim following central neuraxial anesthesia is not a rare occurrence in our institution. However, there was no record of litigation or claim in our review. Anesthetist in Nigeria need to be aware of the legal implication of such complications. When performing blocks, well recognized complications should be discussed before obtaining consent. If any untoward effect occurs, a detailed note of the findings and treatment should be documented for future reference.

Scoliosis and litigation

In 2010/2011, 2053 spinal infusions were carried out for scoliosis, of which 1328 were in children. In contrast there were 224 549 admissions in total for spinal disorders1 and therefore scoliosis cases proceeding to litigation are relatively uncommon. There may be other reasons for the lower incidence of litigation in scoliosis patients including the fact that almost all of these operations are carried out in tertiary centres as planned cases during daylight hours. Multidisciplinary teams of surgeons, physicians and other healthcare professionals manage the patients, and in many cases two senior surgeons operate together which may reduce the risks in these cases. Furthermore, the consenting process is generally carried out by more senior members of the team; the patients and their families are usually in no doubt that this is a major operation not without significant risk, and patients are rarely given the impression that complete correction of the deformity will take place. Although curve progression and prevention of pain are the main indications for surgery, improvement in cosmesis is also an important aim of the surgery. However, I am not aware that failure to improve appearance has been a cause for litigation. The majority of claimants in scoliosis cases are children and their families. Because many operations are carried out early in childhood, there is a very long trail of cases. Adults have to commence proceedings within three years of the perceived injury, while children have until the age of 21 to do so. In many cases the surgeon in charge of the case may be retired or may have died. The causes of allegations of negligence/breach of duty include neurological injury; failure of instrumentation or other instrumentation problems; nonunion of fusion; choice of wrong levels; failure to identify pre-operative abnormalities; failure to use spinal cord monitoring; failure …

Assessing the Advocacy of Negotiated Rulemaking: A Response to Philip Harter

For many years, advocates of negotiated rulemaking have advanced enthusiastic claims about how negotiated rulemaking would reduce litigation and shorten the rulemaking process. In an earlier study, I tested these claims systematically by assessing the effectiveness of negotiated rulemaking against existing rulemaking processes. I found that negotiated rulemaking neither saves time nor reduces litigation. Recently, Philip Harter, a longtime advocate of negotiated rulemaking, has criticized my study and asserted that negotiated rulemaking has succeeded remarkably in achieving its goals. Harter criticized the way I measured the length of the rulemaking process, claimed that I failed to appreciate differences in litigation, and suggested that my results did not matter in any case since negotiated rulemaking has resulted in rules that are demonstrably better than rules developed through conventional regulatory practices. In this paper, I respond to Harter's continued defense of negotiated rulemaking, showing why none of his criticisms undercuts the findings of my original research. Harter disregarded basic standards for empirical research in the arguments he advanced to criticize the way I analyzed rulemaking duration and the incidence of litigation. Moreover, Harter has failed to provide any credible evidence to support his present claim that negotiated rulemaking has resulted in rules that are better than those developed through conventional processes. The absence of support for Harter's criticisms, like the absence of support for the claims made by other advocates of negotiated rulemaking over the years, serves only to underscore the conclusion of my original research that the promises made for negotiated rulemaking remain unfulfilled.

Mastopexy

Mastopexy includes multiple skin incision design and parenchymal manipulation options. Patient evaluation includes assessment of goals, degree of ptosis, tissue volume, skin quality, and breast position on the chest wall. There are critical technical details for each of the three incision options, the various methods of parenchymal manipulation, and implant placement. The potential for complications is greatest for combined augmentation and mastopexy. Although they are effective, mastopexy procedures have the greatest incidence of litigation among aesthetic breast procedures.

Rules-Based Accounting Standards and Litigation

ABSTRACT Some claim that rules-based accounting standards shield firms from litigation, while others argue that violations of detailed rules give plaintiffs a “roadmap” to successful litigation. We inform this debate by investigating whether rules-based standards are associated with the incidence and outcome of securities class action litigation. Overall, our results suggest that rules-based standards are associated with a lower incidence of litigation but are not associated with litigation outcomes. These results are of interest in the debate regarding the switch from a more rules-based U.S. GAAP to a more principles-based IFRS. JEL Classifications: K22, K41, M41.