Liability Costs Research Articles

Resilience Training Program Reduces Physiological and Psychological Stress in Police Officers.

Research suggests that police work is among the most stressful occupations in the world and officers typically suffer a variety of physiological, psychological, and behavioral effects and symptoms. Officers operating under severe or chronic stress are likely to be at greater risk of error, accidents, and overreactions that can compromise their performance, jeopardize public safety, and pose significant liability costs to the organization. Therefore, this study explored the nature and degree of physiological activation typically experienced of officers on the job and the impact of the Coherence Advantage resilience and performance enhancement training on a group of police officers from Santa Clara County, California.Areas assessed included vitality, emotional well-being, stress coping and interpersonal skills, work performance, workplace effectiveness and climate, family relationships, and physiological recalibration following acute stressors. Physiological measurements were obtained to determine the real-time cardiovascular impact of acutely stressful situations encountered in highly realistic simulated police calls used in police training and to identify officers at increased risk of future health challenges.The resilience-building training improved officers' capacity to recognize and self-regulate their responses to stressors in both work and personal contexts. Officers experienced reductions in stress, negative emotions, depression, and increased peacefulness and vitality as compared to a control group. Improvements in family relationships, more effective communication and cooperation within work teams, and enhanced work performance also were noted.Heart rate and blood pressure measurements taken during simulated police call scenarios showed that acutely stressful circumstances typically encountered on the job result in a tremendous degree of physiological activation, from which it takes a considerable amount of time to recover.Autonomic nervous system assessment based on heart rate variability (HRV) analysis of 24-hour electrocardiogram (ECG) recordings revealed that 11% of the officers were at higher risk for sudden cardiac death and other serious health challenges. This is more than twice the percentage typically found in the general population and is consistent with epidemiological data indicating that police officers have more than twice the average incidence of cardiovascular-related disease.The data suggest that training in resilience building and self-regulation skills could significantly benefit police organizations by improving judgment and decision making and decreasing the frequency of onthe-job driving accidents and the use of excessive force in high-stress situations. Potential outcomes include fewer citizens' complaints, fewer lawsuits, decreased organizational liabilities, and increased community safety. Finally, this study highlights the value of 24-hour HRV analysis as a useful screening tool to identify officers who are at increased risk, so that efforts can be made to reverse or prevent the onset of disease in these individuals.

Excess healthcare costs associated with prior workers' compensation activity

Workers compensation (WC) does not fully compensate workplace injuries and illnesses. This work examines whether cost shifting occurs to group health insurance for work-related injuries and illnesses. Thomson Reuters MarketScan databases of medical insurance claims were used. WC and other benefit system data, employee status and types of medical insurance coverage were also available. Medical cost was analyzed using two-part models: the first part modeled the monthly probability of a worker having any group health medical claims, and the second part modeled the total monthly cost of those medical claims. Models included an estimate of a worker's annual medical costs prior to a WC claim. The predicted monthly medical costs were derived by retransformation using Duan's smearing factor. Individuals with prior WC claims were more likely to file a group health medical claim compared to those with no prior WC claims (OR = 1.25) and incurred a higher average monthly medical costs (among nonunion hourly men aged 18-34 years with prior WC claims: $203.72 vs. $160.29 with no prior claim, an increase of $43). These increases were observed in all industrial sectors with the service sector having the highest monthly increase ($66). The results reveal that individuals with prior WC claims had higher probability of filing a group health medical claim and higher average monthly medical costs in all sectors. This suggests that a part of employer liability costs related to WC gets shifted to the group health medical insurance system.

Civil Liability, Safety and Nuclear Parks: Is Concentrated Management Better?

Ultra-hazardous risky activities as nuclear industry cannot be considered as normal i.e. industries without abnormal environmental and health risks. Consequently, the industrial organization of these specific sectors is of the utmost importance. This paper aims at studying this question. We focus on the associated costs of prevention and civil liability. We analyze how civil liability rules may contribute to extend or to discourage the expansion of nuclear parks to new operators. The paper compares the consequences of extending the management of nuclear stations to several independent operators. This question can apply to the unification process of the European electricity market in which several public and private nuclear power operators are running. The paper shows that the choice between either a monopolistic scheme (one operator managing several plants) or a decentralized one (one operator by station) depends on the condition of application of the legal civil liability regime and on the strength of the safety control exerted by the Nuclear Regulatory Authorities. It is shown that when the control is high, then the safety costs generated by the monopolistic organization are less than the same costs of a decentralized one. However, conditions on the insurance policy can mitigate this result.

Pricing for Multiline Insurer: Frictional Costs, Insolvency, and Asset Allocation

AbstractThis article examines multiline insurance pricing based on the contingent claim approach in a limited liability and frictional costs environment. Capital allocation is based on the value of the default option, which satisfies the realistic assumption that each distinct line undertakes a pro rata share of deficit caused by insurer insolvency. Premium levels, available assets, and default risk interact with each other and reach equilibrium at the fair premium. The assets available to pay for liabilities are not predetermined or given; instead, the premium income and investment income jointly influence the available assets. The results show that equity allocation does not influence the overall fair premium. For a given expected loss, the premium‐to‐expected‐loss ratio for firms offering multiple lines is higher than that for firms only offering a single line, due to the reduced risk achieved through diversification. Premium‐to‐expected‐loss ratio and equity‐to‐expected‐loss ratio vary across lines. Lines having a higher possibility or claim amount not being paid in full exhibit lower premium‐to‐expected‐loss ratio and higher equity‐to‐expected‐loss ratio. Positive correlation among lines of business results in lower premium‐to‐expected‐loss ratio than when independent losses are assumed. Positive correlation between investment return and losses reduces the insolvency risk and leads to a higher premium‐to‐expected‐loss ratio.

The welfare effects of medical malpractice liability

We use variation in the generosity of local juries to identify the causal impact of medical malpractice liability on social welfare. Growth in malpractice payments contributed at most 5% points to the 33% total real growth in medical expenditures from 1990 to 2003. On the other hand, malpractice leads to modest mortality reductions; the value of these more than likely exceeds the costs of malpractice liability. Therefore, reducing malpractice liability is unlikely to have a major impact on health care spending, and unlikely to be cost-effective over conventionally accepted values of a statistical life.

Consulting revenue sharing, auditor effort and independence, and the regulation of auditor compensation

The joint provision of audit and non-audit services by audit firms to their audit clients has posed a threat to auditor independence. To mitigate the independence problem, the US Securities and Exchange Commission (SEC) issued a regulation (SEC, 2003) that prohibits audit partners from receiving compensation for the sale of non-audit services to their audit clients. This study examines the effects of this regulatory change on the effort and reporting decisions of audit partners. We show that partners in an audit firm strategically change the firm’s liability-sharing rule. As a consequence, the regulation restores truthful reporting but has an undesirable negative effect on audit effort. The effect of the regulation on the welfare of the economy (defined as the total payoff to both audit firms and their clients) hinges on the tradeoff between the benefit of the regulation, which is derived from the inducement of truthful reporting, and the cost of the regulation, which results from less diligent audit work. We show that the regulation is more likely to increase the welfare in a strong legal regime (where the legal liability cost of auditor litigation is high) than in a weak legal regime.

The grey escape: investigating older people's use of the free bus pass

Since 2008 most older people in England have benefited from unlimited area-wide free travel by bus after the morning peak period. The official policy rhetoric supporting implementation of the measure drew significantly on the need to reduce social exclusion amongst older people. However, despite a substantial increase in the number of concessionary journeys in England and the associated cost liabilities for local authorities and possibly also operators, there is currently only limited understanding of the wide ranging effects on bus use of providing a free pass, and in particular to whom benefits from the policy accrue. In part, this circumstance results from a methodological focus by evaluation studies hitherto that has emphasised aggregate-level data, often at the expense of the very rich contextual information about how the individual benefits from using a pass. This article presents insights into the perceptions, motivations and decisions relating to use of free bus passes, highlighting the existence of both tangible and intangible benefits which arise. It offers a fresh insight into previously undefined uses and benefits derived from possessing and using a concessionary bus pass. This article concludes by noting possible policy implications of the research in the context of the UK's ageing population and for other international contexts where the transport intervention of free bus travel is being considered.

Corporate environmental disclosure practices in India

PurposeThe purpose of this paper is to identify the existing status of environmental disclosure practices in Indian core sector companies.Design/methodology/approachWaste disposal costs and other environmental liability costs are crucial information to be disclosed by core sector companies as they have direct impact on the environment. A content analysis of the annual reports of select core sector companies across four industries, viz. Oil and petrochemicals, Mining and minerals, Steel and Cement, has been undertaken to study the extent and nature of their environmental disclosures in their annual reports for 2007‐2008.FindingsThe study shows that the level of disclosure of environmental information varies across industries as well as companies and the information revealed in the annual reports is found to be more qualitative than quantitative.Practical implicationsThe disclosure made by the core sector companies does not adequately cover the informational needs of stakeholders. However, the increasing disclosure trends can be considered as a first step toward improved environmental disclosure. The study therefore supports the need for a suitable framework for environmental disclosure, such that all the stakeholders can use it as credible information.Originality/valueThis study contributes to the literature by evaluating voluntary environmental disclosures made by Indian core sector companies in their annual report. Further work based on this preliminary finding may be done to assess the status of environmental disclosure for a larger sample of Indian core sector companies.

Ethical Concerns and Career Satisfaction in Obstetrics and Gynecology: A Review of Recent Findings From the Collaborative Ambulatory Research Network

Obstetricians-gynecologists (ob-gyns) are frequently confronted with situations that have ethical implications (e.g., whether to accept gifts or samples from drug companies or disclosing medical errors to patients). Additionally, various factors, including specific job-related tasks, costs, and benefits, may impact ob-gyns' career satisfaction. Ethical concerns and career satisfaction can play a role in the quality of women's health care. This article summarizes the studies published between 2005 and 2009 by the Research Department of the American College of Obstetricians and Gynecologists, which encompass ethical concerns regarding interactions with pharmaceutical representatives and patient safety/medical error reporting, as well as ob-gyn career satisfaction. Additionally, a brief discussion regarding ethical concerns in the ob-gyn field, in general, highlights key topics for the last 30 years. Ethical dilemmas continue to be of concern for ob-gyns. Familiarity with guidelines on appropriate interactions with industry is associated with lower percentages of potentially problematic relationships with pharmaceutical industries. Physicians report that the expense of patient safety initiatives is one of the top barriers for improving patient safety, followed by fear of liability. Overall, respondents reported being satisfied with their careers. However, half of the respondents reported that they were extremely concerned about the impact of professional liability costs on the duration of their careers. Increased familiarity with guidelines may lead to a decreased ob-gyn reliance on pharmaceutical representatives and free samples, whereas specific and practical tools may help them implement patient safety techniques. The easing of malpractice insurance and threat of litigation may enhance career satisfaction among ob-gyns. This article will discuss related findings in recent years. Obstetricians & Gynecologists and Family Physicians. After the completing the CME activity, physicians should be better able to analyze how interactions with pharmaceutical industry may pose ethical dilemmas, examine current barriers to implementing patient safety initiatives, and evaluate the factors that influence career satisfaction among obstetrician-gynecologists.

Enlisting Bars and Restaurants in the Prevention of Intoxication and Subsequent Harms: Why It Matters

g d b a t d c t t n w f f l t t Inthe reviewpaper in this issue of theAmerican Journal of Preventive Medicine, the Task Force on Community Preventive Services (the Task Force) looks at two different strategies by which servers of alcoholic beverages might be motivated to implement responsible beverage service (RBS)practiceson theirpremises.Whether via thedeterrent effect of exposure to large liability costs or more direct penalties of the law, these mechanisms are meant to achieve a reduction in intoxication and related harm through the intervention of a server who is expected tomonitor the drinker’s consumption and refuse service when and if the patron reaches a point of obvious intoxication. The other major strategy to achieve the same end, not covered in this review but in an earlier Task Force review, is the use of server training tomake servers aware of the laws requiring responsible service and to provide skills in identifying intoxicated patrons and how to deal with them effectively. The independent Task Force, via their Community Guides, not only provides valuable guidance to policymakers and practitioners, it also helps the entire field of prevention research to celebrate progress that has been made but too often obscured until a coherent set of related articles is brought together and evaluated. In their review, the authors of this specific review have found that “the number and consistency of findings indicate strong evidence of the effectiveness of dram shop laws in reducing alcohol-related harms.” The evidence in support of enhanced enforcement was too limited and inconsistent to form a recommendation. That dram shop laws encourage responsible service may seem obvious in retrospect, but as the authors make clear, current dram shop liability varies widely across jurisdictions, can result from either statutes or case law, and may haveprovisions restricting their applicationorpossible penalties. To find that dram shop liability can be effective nev-

Physician liability insurance reform

Summary Rapidly rising medical malpractice insurance costs are causing reduced access to health care services. Physicians and other health care professionals are limiting or discontinuing high-risk procedures and services to reduce their malpractice insurance cost and potential liability; patients are forced to travel greater distances to obtain these health care services. The cause of the rapid rise in medical malpractice premiums and the effects of the tort system upon these increases continue to be debated among stakeholders. Nevertheless, studies have demonstrated that the current tort system fails in its goals to compensate victims of medical negligence and as deterrence to the occurrence of medical errors. A broad-based approach that includes insurance reform, enhancements to the physician peer review system, a protected system of reporting medical errors, and federally funded studies to determine alternate methods of resolving medical malpractice claims are required to restructure the current medical liability system.

Psychiatrists Vie for AMA Positions: Harris Seeks Board of Trustees Seat

Back to table of contents Previous article Next article Professional NewsFull AccessPsychiatrists Vie for AMA Positions: Harris Seeks Board of Trustees SeatMark MoranMark MoranSearch for more papers by this authorPublished Online:20 May 2011https://doi.org/10.1176/pn.46.10.psychnews_46_10_8_2AbstractPsychiatrist Patrice Harris, M.D., is a candidate for the Board of Trustees of the AMA.Patrice Harris, M.D.Credit: Jolene Butts FreemanHarris, who is chair of the AMA Council on Legislation and serves as a delegate from APA to the AMA, is supported in her candidacy for the board by the Section Council on Psychiatry (which includes APA, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Psychiatry and the Law), the Medical Association of Georgia, and the Southeastern Delegation to the AMA House of Delegates. The election will be held at next month's meeting of the AMA House of Delegates in Chicago.In an interview with Psychiatric News, Harris said that the AMA Board of Trustees will be involved in the coming year in a range of issues affecting every physician in America. These include the physician response to the ever-evolving health care landscape, access to care, efforts to replace the flawed Medicare physician payment formula, mechanisms for funding graduate medical education, looming physician workforce shortages, and strategies for reducing the costs of defensive medicine and malpractice liability. Additionally, the board will need to address how to increase AMA membership.As a private-practice physician, public health administrator, patient advocate, and medical society lobbyist, Harris said that she brings the skills and the experience necessary to contribute as an effective board member on all of these issues. "My experience has given me a keen understanding of what is needed to ensure that physicians are in the lead in discussions and debate about an evolving health care system," she said. "My work as chair of the Council on Legislation and as a lobbyist in Georgia has taught me the perils of division and the importance of unity. As physicians, we need to speak with one voice." In addition to the private practice of general and child and adolescent psychiatry, Harris is director of health services for Fulton County, Ga., which includes Atlanta. She directs all county health services, including health partnerships that deliver a wide range of public safety, behavioral health, and primary care treatment and prevention services. Harris told Psychiatric News that psychiatry is an integral and valued member of the house of medicine at the AMA and that physicians of every specialty have come to recognize mental health as an essential part of general medical health. She noted that AMA support was crucial to the passage of parity legislation and that the organization continues to be a leader on issues of vital importance to psychiatry—especially scope-of-practice issues. "The AMA Scope of Practice Partnership has been enormously helpful to APA district branches in responding to efforts to grant psychologists and other nonphysicians the right to practice medicine by legislative fiat," she said. She added that the "medical home," with which many states are experimenting as a model for delivery system reform, must have room for psychiatrists. "It is vital that we are at the table as these new care models are piloted to ensure that psychiatrists are considered as integral leaders of health teams." she said. APA members who wish to aid in Harris's candidacy should contact physicians active in their state medical societies and request that the state's AMA delegates vote for her in June. ISSUES NewArchived

New Directions in Medical Liability Reform

Traditional strategies for medical liability reform have had limited success in controlling malpractice costs and have not improved health care quality. Future directions will be informed by evaluations of approaches aimed at reducing liability costs and improving safety.

Malpractice Risk and Cost Are Significantly Reduced after Tort Reform

Rising medical malpractice premiums have reached a crisis point in many areas of the United States. In 2003 the Texas legislature passed a comprehensive package of tort reform laws that included a cap at $250,000 on noneconomic damages in most medical malpractice cases. We hypothesized that tort reform laws significantly reduce the risk of malpractice lawsuit in an academic medical center. We compared malpractice prevalence, incidence, and liability costs before and after comprehensive state tort reform measures were implemented. Two prospectively maintained institutional databases were used to calculate and characterize malpractice risk: a surgical operation database and a risk management and malpractice database. Risk groups were divided into pretort reform (1992 to 2004) and post-tort reform groups (2004 to the present). Operative procedures were included for elective, urgent, and emergency general surgery procedures. During the study period, 98,513 general surgical procedures were performed. A total of 28 lawsuits (25 pre-reform, 3 postreform) were filed, naming general surgery faculty or residents. The prevalence of lawsuits filed/100,000 procedures performed is as follows: before reform, 40 lawsuits/100,000 procedures, and after reform, 8 lawsuits/100,000 procedures (p < 0.01, relative risk 0.21 [95% CI 0.063 to 0.62]). Virtually all of the liability and defense cost was in the pretort reform period: $595,000/year versus $515/year in the postreform group (p < 0.01). Implementation of comprehensive tort reform in Texas was associated with a significant decrease in the prevalence and cost of surgical malpractice lawsuits at one academic medical center.

Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program

Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program

Medical malpractice - april 2011 update.

Although the malpractice crisis--the inability of health care providers to obtain affordable liability insurance--has abated in many states, medical liability costs and pressures remain a concern. In addition, the perceived threat of litigation spurs "defensive medicine"--the practice of ordering services primarily to reduce the physician's liability exposure rather than because they are medically necessary. There is wide consensus that liability pressure undermines efforts to curb overuse of health services, although there is disagreement about the magnitude of its effect. This Update reviews the evidence on the effects of medical malpractice reforms published since the Medical Malpractice: Impact of the Crisis and Effects of State Tort Reforms synthesis was released in 2006. Key findings include: Except for caps on noneconomic damages, there is little evidence that other traditional tort reforms affect medical liability costs or defensive medicine. Average awards are reduced by 20 percent to 30 percent, and premiums in states with caps on noneconomic damages rise 6 percent to 13 percent more slowly than premiums in states without caps. There is evidence that tort reforms-particularly caps on noneconomic damages-reduce health spending, but the size of the reduction is subject to debate. Because of the lack of success of many traditional tort reforms, a number of innovated tort reforms are receiving increased attention. Although they show promise in theory, they have not been widely evaluated so the evidence of their effectiveness is weak.

Rationalizing Costs in Investment Treaty Arbitration

International investment and related disputes are on the rise. With national courts generally unavailable and difficulties resolving disputes through diplomacy, investment treaties give investors a right to seek redress and arbitrate directly with states. The costs of these investment treaty arbitrations - including the costs of lawyers for both sides, as well as administrative and tribunal expenses - are arguably substantial. This Article offers empirical research indicating that even partial costs could represent more than 10% of an average award. The data suggested a lack of certainty about total costs, which parties had ultimate liability for costs, and the justification for those cost decisions. Although there were signs of balance and a preference for parties to be responsible for their own costs, there was neither a universal approach to cost allocation nor a reliable relationship between cost shifts and losing. Awards typically lacked citation to legal authority and provided minimal rationale, and the justifications for cost decisions exhibited broad variation. Small pockets of coherence existed. Tribunals typically decided costs only in the final award; and as the amount investors claimed increased, tribunal costs also increased. Such a combination of variability and convergence can disrupt the value of arbitration for investors and states. In light of the data, but recognizing the need for additional research to replicate and expand upon the initial findings, this Article recommends states consider implementing measures that encourage arbitrators to consider specific factors when making cost decisions, obligate investors to particularize their claimed damages at an early stage, and facilitate the use of other Alternative Dispute Resolution (ADR) strategies. Establishing such procedural safeguards can aid the legitimacy of a dispute resolution mechanism with critical implications for the international political economy.

Off-Duty and Under Arrest

The findings of independent commissions and research derived from a data set of career-ending misconduct among New York Police Department (NYPD) officers suggests that police engage in a wide variety of crimes while they are off duty including domestic violence, bar fights, drunk driving, burglary, and sex offenses (Fyfe &amp; Kane, 2006; Kane &amp; White, 2009; Mollen Commission, 1994). The off-duty misbehavior of police is an important concern for police agencies exposed to potential liability costs, and scholars engaged in debates about whether studies on police deviance should include acts committed while an officer is technically off duty. The problem for scholars interested in understanding off-duty police misconduct is that virtually all of the existing data describes the misbehavior of NYPD police. The purpose of the current study is to explore the nature and character of off-duty police crime in the United States through a content analysis of news articles on arrested off-duty police officers. Data are presented in terms of the arrested off-duty officer(s), his or her agency, and case outcomes including legal and/or employment dispositions. The article includes a discussion regarding the generalizability of existing data on off-duty police crime and the policy implications of our research.

Using Artificial Neural-Networks in Stochastic Differential Equations Based Software Reliability Growth Modeling

Due to high cost of fixing failures, safety concerns, and legal liabilities, organizations need to produce software that is highly reliable. Software reliability growth models have been developed by software developers in tracking and measuring the growth of reliability. Most of the Software Reliability Growth Models, which have been proposed, treat the event of software fault detection in the testing and operational phase as a counting process. Moreover, if the size of software system is large, the number of software faults detected during the testing phase becomes large, and the change of the number of faults which are detected and removed through debugging activities becomes sufficiently small compared with the initial fault content at the beginning of the testing phase. Therefore in such a situation, we can model the software fault detection process as a stochastic process with a continuous state space. Recently, Artificial Neural Networks (ANN) have been applied in software reliability growth prediction. In this paper, we propose an ANN based software reliability growth model based on Ito type of stochastic differential equation. The model has been validated, evaluated and compared with other existing NHPP model by applying it on actual failure/fault removal data sets cited from real software development projects. The proposed model integrated with the concept of stochastic differential equation performs comparatively better than the existing NHPP based model.

Deepwater Horizon: The Legal Fallout—The Framework for Liability, Fines, and Penalties for Oil Pollution

On April 20, 2010, an explosion occurred on the Deepwater Horizon offshore drilling unit resulting in the death of eleven workers, and subsequently a continuous and uncontrolled release of crude oil and natural gas from the wellhead for a total of eighty-six days. The Oil Pollution Act of 1990 (OPA) provides a comprehensive liability and compensation scheme by creating strict liability for the responsible party of a vessel or facility from which the oil was released subject to statutory limitations, and very limited applicable defenses. The owner of the Deepwater Horizon and the operator of the Macondo well were designated responsible parties under OPA subjecting them to liability for removal costs and damages. In addition, the Clean Water Act imposes civil and administrative fines on a per-day-per-barrel basis without limitation. Other federal statutes which are used to impose criminal liability are the Migratory Bird Treaty Act, the Endangered Species Act, and the River and Harbors Act of 1899.