Malpractice Actions Research Articles

Characteristics of Paid Malpractice Claims Among Resident Physicians From 2001 to 2015 in the United States.

Limited information exists about medical malpractice claims against physicians-in-training. Data on residents' involvement in malpractice actions may inform perceptions about medicolegal liability and influence clinical decision-making at a formative stage. This study aimed to characterize rates and payment amounts of paid malpractice claims on behalf of resident physicians in the United States. Using data from the National Practitioner Data Bank, 1,248 paid malpractice claims against resident physicians (interns, residents, and fellows) from 2001 to 2015, representing 1,632,471 residents-years, were analyzed. Temporal trends in overall and specialty-specific paid claim rates, payment amounts, catastrophic (> $1 million) and small (< $100,000) payments, and other claim characteristics were assessed. Payment amounts were compared with attending physicians during the same time period. The overall paid malpractice claim rate was 0.76 per 1,000 resident-years from 2001 to 2015. Among 1,194 unique residents with paid claims, 95.7% had exactly 1 claim, while 4.3% had 2-4 claims during training. Specialty-specific paid claim rates ranged from 0.12 per 1,000 resident-years (pathology) to 2.96 (obstetrics and gynecology). Overall paid claim rates decreased by 52% from 2001-2005 to 2011-2015 (95% confidence interval [CI]: 0.45, 0.59). Median inflation-adjusted payment amount was $199,024 (2015 dollars), not significantly different from payments made on behalf of attending physicians during the same period. Proportions of catastrophic (11.2%) and small (33.1%) claims did not significantly change over the study period. From 2001 to 2015, paid malpractice claim rates on behalf of resident physicians decreased by 52%, while median payment amounts were stable. Resident paid claim rates were lower than attending physicians, while payment amounts were similar.

Sanksi Administratif Malpraktik Bagi Dokter Dan Rumah Sakit Di Indonesia

This study aimed to examine the forms of sanctions for malpractice committed by doctors and hospitals in the perspective of positive Indonesian law. The method used is the normative legal research method or the library legal research method is the method or method used in legal research conducted by using existing library materials. The results showed malpractice actions carried out by doctors and hospitals have clear legal responsibilities stipulated in Act Number 29 of 2004 concerning Medical Practices. Administratively, all forms of malpractice carried out by doctors and hospitals can be threatened with imprisonment, civil, administrative sanctions, and fines. As for hospitals, they can be sentenced directly and indirectly. In the later, final stages, the final stages of court decisions made by doctors and hospitals can be carried out on license revocation.

Malpractice Law and Psychiatry: An Overview.

Fortunately, psychiatrists are less likely to be sued for malpractice than most physicians in other specialties. However, once sued, psychiatrists must navigate a complicated and nonintuitive legal process. This article reviews the major elements of a malpractice claim, the litigation process in medical malpractice cases, and the common allegations of negligence that are encountered in such cases. The major types of malpractice insurance coverage are reviewed, and recommendations about liability prevention and how to best respond to a malpractice action are presented.

Boundaries, Professionalism, and Malpractice in Psychiatry.

Boundary violations are an uncommon but nonetheless important cause of malpractice action against the psychiatrist. Although not all boundary crossings are boundary violations, boundary violations include various breaches ranging from sexual liaisons to inappropriate online behaviors. Sexual boundaries merit consideration not only with patients but also with former patients and family members of patients, partially because of the imbalance of power in the relationship. Some states have also imposed criminal penalties for certain types of boundary violations. Internet and e-mail boundaries also are critical for psychiatrists to consider. Online behaviors that are problematic or risky are explored. Questions for ethical self-reflection are posed. Recommendations are made throughout the article regarding avoiding boundary violations.

Report of a Collaboration Between a Law School and an Emergency Medicine Residency Program for a Full-scale Medical Malpractice Litigation Simulation.

Medical malpractice litigation is a prevalent challenge for emergency physicians, but there is a dearth of dedicated training in residency programs on this subject. As a result, when emergency physicians become the subject of a medical malpractice action they often find themselves ill-equipped to successfully navigate the process. We sought to create an in-depth medical malpractice simulation encompassing all key aspects of medical practice litigation. We collaborated with a law school for a semester-long simulation of a fabricated medical malpractice case brought against an emergency medicine (EM) resident. In harnessing the legal expertise of law students and faculty we were able to deliver a months-long medical malpractice simulation to our EM residency program. Similarly, in lending the medical expertise of our residents and faculty to the project, the law students were afforded a unique practical experience in learning to litigate medical malpractice. The project resulted in a rich educational experience for both the EM residents and the law students. We present a guide for replication by any residency program in collaboration with a law school.

TANGGUNG JAWAB DOKTER TERHADAP PASIEN DALAM HAL TERJADINYA MALPRAKTIK MEDIK DILIHAT DARI PERSPEKTIF HUKUM PERDATA

A doctor are obligated to do their duty with his or her ability and responsibility. However, doctor also make mistake because of neglect. The mistake in serving the patient is called medical malpractice. Their mistakes or negligence bring harm to the patient. Example is a case that happened to M S in Medan, North Sumatera. She came to the gynaecologist to treat her disease. Because the mistake of the doctors in surgery, the patient became disable for the rest of her life. The problems in this research is How the relationship between doctor and patient in a medical action according to the civil law? How is the responsibility of the doctors to the patient in medical malpractice action as case?. the writer used juridical normative method. The research done by the writer resulted in doctor and patient relationship in civil law point of view, which is the bonded relationship between medical service as the medical act between the provider of medical services with the receiver. The civil law responsibility of the doctor in case of medical malpractice comes from two basic law they are the responsibility as a doctor and the responsibility against law.

Invited commentary

The authors reviewed a highly selected cohort of medical malpractice cases that involve the placement of inferior vena cava filters. The state cases that populate the LexisNexis and Westlaw databases are chosen because they either represent a unique or important application of the law or have been subject to the appellate process. They may represent as little as 5% of the cases filed. As referenced in the paper, there are a large number of cases that are either settled or simply not chosen to be a part of these databases. In addition, because it appears that the original charts of these patients were not evaluated, it must be remembered that all clinical factual material is based on the filings of the plaintiff/patient. On occasion, the defendant's response to the facts submitted is also cited in the court documents. Accordingly, the indications for the procedure, hypercoagulable status, diagnosis of recurrent pulmonary embolism, and device migration may not correctly reflect the medical facts. Therefore, the application of any conclusions derived from this paper is significantly limited. In addition, the terms academic center, private practitioner, and community hospital are not defined, further limiting the impact of these data. Outcomes and associated factors in malpractice litigation involving inferior vena cava filtersJournal of Vascular Surgery: Venous and Lymphatic DisordersVol. 6Issue 4PreviewPlacement of inferior vena cava (IVC) filters is a controversial focus of medical malpractice. Clinicians currently have little information to guide them regarding key issues and outcomes in litigation. In this retrospective legal case review, we analyzed the factors associated with malpractice actions involving IVC filters. Full-Text PDF

DETECTION OF ANEURYSM OF THE ASCENDING AORTA IN HYPERTENSIVE PATIENTS

Hypertension (HTN) is a known risk for development of aneurysm of the ascending aorta (AscAoA) which is among the top 10 cardiovascular (CV) disorders resulting in claim payment in malpractice actions. However, AscAoA has the highest claim payment ($417 K) of any CV diagnosis. Echocardiography (2-D

Malpractice litigation in the endovascular era

ObjectiveThe standard of care in the treatment of vascular disease continues to evolve as endovascular therapies develop. Currently, it is unclear how medical malpractice litigation has adapted to the “endovascular era.” This retrospective case review is the most comprehensive analysis to date of malpractice actions involving endovascular procedures performed by vascular surgeons (VSs), interventional radiologists (IRs), interventional cardiologists (ICs), and cardiothoracic surgeons (CTSs). MethodsThe legal databases LexisNexis and Westlaw were searched for all published legal cases in the United States involving endovascular procedures. The search was limited to state and federal cases up to and including the year 2016. Keywords included “malpractice,” “vascular,” “endovascular,” “catheter,” “catheterization,” “stent,” “angiogram,” “angiography,” and “surgery.” Cases involving tax revenue, insurance disputes, Social Security Disability, and hospital employment contract disputes were excluded. Data were analyzed using χ2 test. ResultsThere were 2115 initial search results identified, and 369 cases were included in final analysis. The rate of endovascular procedure-related lawsuits (per 1000 active physicians in the specialty) was highest for ICs (105.56), whereas rates for VSs and IRs were comparable (18.47 and 16.85, respectively); 93% of the IC cases were related to coronary interventions. Overall, 55% (148/271 classifiable cases) of actions were related to elective procedures. For VSs specifically, 46% (25/54) of cases arose from diagnostic angiography and inferior vena cava filter placement, two relatively minor procedure types. Overall, 83% (176/211 finalized cases) of verdicts favored defendants, with no significant differences across the specialties; 43% (157/368) of total cases involved death of the patient. Among the four specialties, there was a significant (P = .0004) difference in the primary allegation (informed consent, preprocedure negligence, intraprocedure complications, or postprocedure complications) underlying the litigation. For CTSs and VSs, there was a predominance of informed consent and preprocedure negligence allegations (70% [7/10] and 52% [28/54], respectively). Intraprocedure negligence was the most common allegation for IRs (59% [23/39]), whereas allegations were more evenly distributed among ICs. ConclusionsKey issues were identified regarding malpractice litigation involving the specialties that commonly perform endovascular procedures. Despite the increasing number of ICs doing peripheral interventions, a large majority of IC cases were related to coronary treatments. A surprisingly large percentage of VS cases were related to seemingly minor cases. There were significant interspecialty differences in the primary underlying allegations. As the scope of endovascular procedures broadens and deepens, it is important for clinicians to be aware of legal considerations relevant to their practice.

Dog bite injuries: can the old dog be taught new tricks?

Dog bite injuries are a common cause of patient presentation to NHS emergency departments (EDs) and minor injuries units, and are generally associated with a low level of acuity, despite an inherent capacity for significant soft tissue damage to be inflicted by canine jaws capable of exerting terrific bite forces. Anatomical sites for injury correlate to victim age, with hand and wrist injuries predominating in the adult population. The most common complication is infection secondary to inoculation of oral flora, with the hands being particularly vulnerable due to their anatomy. Injuries to structures such as tendons can be discreet, and retained foreign bodies can easily be overlooked. Wound care has a propensity to attract a disproportionately high level of malpractice actions, and approaches to the management of dog bite injuries have largely been empirical, which may render the practitioner particularly exposed. In response to increasing pressures on healthcare systems, paramedics with extended scopes of practice, including wound care and suturing, are being utilised to assess, manage, treat, and either refer or discharge patients with apparently minor injuries, in strategies aimed at reducing hospital admissions. This article adopts a case study format to examine and evaluate treatment modalities and the current evidence base informing best practice in terms of dog bite injuries from the perspective of a paramedic practitioner, with critical reflection on the decision making process and complexities of such episodes of care in the pre-hospital setting.

Communication-related allegations against physicians caring for premature infants.

Maternal-fetal medicine physicians (MFMp) and neonatal-perinatal medicine physicians (NPMp) caring for premature infants and their families are exposed to significant risk for malpractice actions. Effective communication practices have been implicated to decrease litigious intentions but the extent of miscommunication as a cause of legal action is essentially unknown in this population. Analysis of communication-related allegations (CRAs) may help toward improving patient care and physician-patient relationships as well as decrease litigation risks. We retrospectively reviewed the Westlaw database, a primary online legal research resource used by United States lawyers and legal professionals, for malpractice cases against physicians involving premature infants. Inclusion criteria were: 22 to 36 weeks gestational age, cases related to peripartum events through infant discharge and follow-up, and legal records with detailed factual narratives. The search yielded 736 legal records, of which 167 met full inclusion criteria. A CRA was identified in 29% (49/167) of included cases. MFMp and/or NPMp were named in 104 and 54 cases, respectively. CRAs were identified in 26% (27/104) and 35% (19/54) of MFMp- and NPMp-named cases, respectively, with a majority involving physician-family for both specialties (81% and 74%, respectively). Physician-family CRAs for MFMp and NPMp most often regarded lack of informed consent (50% and 57%, respectively), lack of full disclosure (41% and 29%, respectively) and lack of anticipatory guidance (36% and 21%, respectively). This study of a major legal database identifies CRAs as significant causes of legal action against MFMp and NPMp involved in the care of high-risk women and infants delivered preterm. Physicians should be especially vigilant with obtaining genuine informed consent and maintaining open communication with families.

Defending Against the Lost Chance Claim Lurking Within Plaintifffs Petition; Lagniappe: How to Avoid Being Taxed with $155,000 of Plaintifffs Costs

This paper examines the latest standards applied by Louisiana courts regarding a plaintiff attorneys attempt to assert a medical malpractice action on the theory of loss of a chance of survival. The paper provides guidance for defense counsel on the best ways to combat a plaintiff's attempt to add a claim for lost chance of survival, particularly when plaintiff attempts to do so at a very late date. The paper also examines the latest Louisiana law regarding a plaintiff's ability to recover costs following a successful jury verdict, and provides guidance to defense counsel on how best to minimize such recovery.

Risk Management Considerations When Treating Suicidal Patients

Back to table of contents Previous article Next article Professional NewsFull AccessRisk Management Considerations When Treating Suicidal PatientsKristen Lambert,J.D., M.S.W., L.I.C.S.W.Kristen Lambert,Search for more papers by this authorJ.D., M.S.W., L.I.C.S.W.Published Online:3 Jan 2017https://doi.org/10.1176/appi.pn.2017.1a21AbstractAs with other cases, careful documentation along with taking a few extra precautions may reduce your liability risk if a patient dies by suicide.One of the most common claims against psychiatrists arises when a patient commits or attempts suicide. The holiday season is a time when suicides typically increase, and as we conclude our celebrations, it is important to address risk management issues when treating potentially suicidal patients. An article published by Harvard Public Health referenced a 2001 study that surveyed patients between the ages of 13 and 34 who survived a near fatal suicide attempt. The respondents were asked how much time passed between making the decision to take their lives and the attempt. The study showed that 24 percent said in less than 5 minutes; 48 percent said less than 20 minutes; 70 percent said less than one hour; and 86 percent said less than eight hours, according to a 2013 report, “Guns and Suicide,” edited by Madeline Drexler.Considering that it may be an impulsive act, and knowing a patient cannot remain on an inpatient unit indefinitely, how do you minimize risk when treating patients? When evaluating whether the standard of care was breached in a suicide/attempted suicide case, courts often focus on foreseeability and causation. These issues are not always black and white. With respect to foreseeability, courts may consider whether the suicide could have been predicted, whether there was sufficient evidence for an identifiable risk of harm, and whether enough was done to protect the patient. Also, was it reasonable to foresee that the patient might die by suicide? And if the psychiatrist anticipated the potential for suicide risk, did he or she conduct a suicide assessment? The thoroughness of the assessment, as evidenced by the documentation, often becomes the critical issue in malpractice actions. The best strategy is to document your assessment thoroughly. Some of what is important includes documentation of the following:Risk factors.Specific threats.Ability to follow through.Thought process on hospitalization: Why hospitalization is recommended or not. When indicated, discussion with family members or significant others.This article cannot fully discuss all of the issues to consider when treating a suicidal patient and despite your best preventative measures. In the event that you may have a patient who dies by suicide, however, awareness of the recurring issues in these type of cases and the employment of appropriate risk management processes can reduce the likelihood of being sued and can increase the chances of successfully defending actions that may be filed. The following are some strategies that may minimize risk:Conduct complete timely/thorough risk assessments.Document thoroughly as you always do, including reasons for taking and not taking certain actions.Understand your state’s laws regarding breaching confidentiality and when you can do so.Understand your state’s laws regarding the discussion of firearms ownership and possession with patients.Understand your state’s laws regarding “duty to warn” and civil commitment.Should you have questions, consult an attorney or risk management professional. ■Allied World, through its subsidiaries, is a global provider of innovative property, casualty, and specialty insurance and reinsurance solu-tions. Allied World is the APA-endorsed carrier for the professional liability program through its strategic relationship with the American Profes-sional Agency Inc., the program administrator. This information is provided as a risk manage-ment resource and should not be construed as legal, technical, or clinical advice. Consult your professional advisors or legal counsel for guid-ance on issues specific to you. This material may not be reproduced without the permission of Allied World. Risk management services are pro-vided by or arranged through AWAC Services Company, a member company of Allied World.Kristen Lambert, J.D., M.S.W., L.I.C.S.W., is vice president of the Psychiatric and Professional Liability Risk Management Group of AWAC Services Company, a member company of Allied World. ISSUES NewArchived

Failures of foreseeability: Risk management considerations in reducing allegations of sexual violence in psychiatric units.

This article begins with a brief discussion of findings on causal factors leading to allegations of sexual violence in health care facilities and then offers the author's account of 4 such cases that he reviewed, 3 of which occurred in psychiatric units. These cases show remarkably similar variables, especially involving decisions to allow male and female patients to commingle, the inadequate physical layout of the units, poor or absent video surveillance, and staff unacquainted with institutional policies on patient safety or refusing to enforce relevant rules. These variables arguably amount to "failures of foreseeability" that reasonably cautious health care personnel should recognize as facilitating or enabling sexual violence. As such, the proactive message of this article for health care risk management urges critical and robust attention paid to a unit's environmental/physical design as well as to performance factors among personnel so as to prevent sexual attacks and diminish the probability of malpractice actions.

AMA to State Medical Boards: Don’t Ask About Past Mental Illness

AMA to State Medical Boards: Don’t Ask About Past Mental Illness

What? A Resident as an Expert Witness?

What? A Resident as an Expert Witness?

Regulators at the Margins: The Impact of Malpractice Insurers on Solo and Small Firm Lawyers

Solo and small firm lawyers comprise more than three-fifths of all lawyers in private practice and are disproportionately subject to discipline sanctions. Sociolegal scholars have long sought to identify the factors that influence the behavior of these lawyers. Research suggests that lawyer professional liability (“LPL”) insurers regulate the behavior of large firm lawyers through the underwriting process, premium pricing, contract design, and risk management practices in order to reduce the risk of loss. This article explores whether LPL insurers also regulate the behavior of solo and small firm lawyers in ways that encourage responsible conduct. The articles draws on interviews of insurance industry executives, risk management counsel, and insured lawyers, as well as surveys of lawyers and insurer documents, to explore the impact of LPL insurers on the work lives of solo and small firm lawyers. The research reveals that unlike LPL insurers of large law firms, LPL insurers appear to regulate the behavior of solo and small firm lawyers in limited ways. The article explores the reasons why this is the case. It also discusses solo and small firm lawyers’ attitudes about malpractice actions, which shed additional light on the likely efficacy of insurers’ efforts to regulate the behavior of these lawyers. The article identifies a much more effective regulator of lawyer conduct — title insurers — and explains how this regulation occurs and the conditions that make effective regulation possible. It suggests some steps that LPL insurers could take to further encourage solo and small firm lawyers to engage in more responsible behavior.

Human Error in Medication Administration Process

Context: Medication administration errors is continuous problem in hospitals and occur too frequently, error is unavoidable human action, since medication treatment is a risky procedure that deal with human live therefore error in this process can lead to dangerous consequences on patient well-being, traditionally nurses were blamed for those errors and considered as malpractice action since medication treatment is manly performed by nurses. Objectives: The current study examines the conditions that influence medication error in the perspective systemic approach. Methods: reviewing medication error contributing conditions topic is outlined, exploiting different perspective of how error occurs in medication process. Results and conclusion: the present study concluded that system approach permit a comprehensive set of contributing conditions underlying medication error to be recognize and addressed, rather than just adopt individual centered approach, Future studies should examine underlying conditions, in the perception of work practice environment conditions, team work conditions, task related conditions and individual conditions. DOI: 10.5901/mjss.2016.v7n3s1p403

Loss of Opportunity

Several months ago, I looked at the issue of what type of malpractice insurance a transport medical director should carry and some of the issues related to malpractice litigation. This month, I have reached into an obscure corner of medical malpractice law and examine the “loss of opportunity doctrine.” Loss of opportunity is a legal canon permitting recovery of damages for the elimination or reduction of prospects for achieving a more favorable outcome in a given clinical scenario. In medical malpractice actions, the loss of opportunity doctrine permits a claimantwith a 50% or less chance of survival or better outcome to recover damages for any negligence of the physician that reduced this chance of survival or better outcome. Insurance underwriters, physician groups, and many legislatures who understand that the loss of opportunity doctrine has opened the door and lowered the barriers to suits against physicians would like to see the law of medical liability codified and stabilized, by statute, to prevent the courts from expanding opportunities to sue such as those contained in the loss of opportunity doctrine. The loss of opportunity doctrine adversely affects the cost and availability of care. The Massachusetts Supreme Judicial Court inMatsuyama v Birnbaum1 described how to apply the loss of opportunity doctrine in a specific language that is included in the Massachusetts Superior Court Civil

Estate Planning Malpractice: Is Strict Privity Here to Stay?

Under Maryland case law, a plaintiff in an estate planning malpractice action must be in strict privity with the attorney who drafted the will. To date, Maryland has not extended the third-party beneficiary exception to the estate planning arena.Legatees specifically identified in a will by name or class are generally precluded from bringing a cause of action against the attorney for the attorney's alleged negligence, because in Maryland in order to recover for legal malpractice, a plaintiff must:show: (1) the attorney's employment; (2) his neglect of a reasonable duty; and (3) loss to the client proximately caused by that neglect of duty. See Noble v. Bruce, 349 Md. 730,739 (citing Flanherty v. Weinberg, 303 Md. 116,128 (1985); see also Bradley Fogel, Attorney v. Client - Privity, Malpractice, and the Lack of Respect for the Primacy of the Attorney-Client Relationship in Estate Planning, 68 Tenn. L. Rev. 261,267 (2001).Maryland is in the minority of states that still adhere to the strict privity rule in the context of estate planning. Most other jurisdictions have relaxed the privity barrier in order to allow a legitimately aggrieved beneficiary to have a means of recourse against an attorney who planned the distribution of the decedent's estate in a negligent manner. Other jurisdictions following strict privity, have carved out the third-party beneficiary exception in the estate-planning context-where the attorney's negligence was facially demonstrated on the will itself. See Hamilton v. Needham, 519 A.2d 172 (D.C. 1988).