Malpractice Liability Research Articles

Risk management and provider liabilities in infantile cerebral palsy based on malpractice litigation cases

AimInfantile cerebral palsy (CP) severely affects the survival and quality of life of infants. CP is typically caused by multiple factors, leading to causal uncertainty of the role of medical errors in CP and resulting in frequent medical disputes. No relevant research exists on risk management and malpractice liabilities in CP, including in China. MethodA retrospective analysis of 400 CP malpractice litigation cases from 18th June 1999 to 23rd November 2017, collected from China Judgments Online, included basic case information, CP risk factors, medical errors, medical malpractice liability determination, and compensation. ResultsUp to 63.5% of infants with CP were affected by asphyxia, followed by hypoxic-ischemic encephalopathy (63.3%), neonatal infection (52.3%) and intracranial hemorrhage (36.0%). Most (89.1%) of civil judgments resulted in liability for medical errors, with the highest proportion of ultimate liability. The three most frequent medical errors were failure of completing delivery in time (30.2%), incomplete assessment of birth process detection (28.8%), and nonstandard medical records (25.3%). Each case involved 2.5 medical errors on average. No difference in the distribution of medical errors between premature and full-term CP infants (P > 0.05) was found. Compensation for damage was awarded in 91.4% of claims, and the mean value of compensation was $73,506. The mean value of the total actual loss of the family was $128,198. InterpretationContradictions between the doctors and patients were prominent in malpractice CP litigation cases, with a total loss of $3.97 billion attributable to new CP cases in China in 2017. Asphyxia was the most frequent risk factor for CP since it may easily draw the attention of the sufferer's family. Medical service providers did not pay attention to risk management in preterm infants. The importance of fetal monitoring and standardized medical record writing should be emphasized.

Review of Neurosurgery Medical Professional Liability Claims in the United States.

Due to disparaging costs and rates of malpractice claims in neurosurgery, there has been significant interest in identifying high-risk specialties, types of malpractice claims, and characteristics of claim-prone physicians. To characterize the malpractice claims against neurosurgeons. This was a comprehensive analysis of all malpractice liability claims involving a neurosurgeon as the primary defendant, conducted using the Physician Insurers Association of America Data Sharing Project from January 1, 2003 and December 31, 2012. From 2003 to 2012, 2131 closed malpractice claims were filed against a neurosurgeon. The total amount of indemnity paid collective between 1998 to 2002, 2003 to 2007, and 2008 to 2012 was $109 614 935, $140 031 875, and $122 577 230, respectively. Of all the neurosurgery claims, the most prevalent chief medical factor was improper performance (42.1%, $124 943 933), presenting medical condition was intervertebral disc disorder (20.6%, $54 223 206), and operative procedure performed involved the spinal cord and/or spinal canal (21.0%, $62 614 995). Eighty-five (22.91%) of the total neurosurgery claims resulted in patient death, resulting in $32 067 759 paid. Improper performance of the actual procedure was the most prevalent and highest total paid cause for patient death ($9 584 519). From 2003 to 2012, we found that neurosurgery malpractice claims rank among one of the most costly and prevalent, with the average indemnities paid annually and the overall economic burden increasing. Diagnoses and procedures involving the spine, along with improper performance, were the most prevalent malpractice claims against neurosurgeons. Continued medical malpractice reform is essential to correct the overall health care cost burdens, and ultimately improve patient safety.

Sustaining and spreading quality improvement: Decreasing intrapartum malpractice risk.

Malpractice liability is an ongoing problem in obstetrics. However, developing, sustaining, and spreading effective interventions is challenging. The aim of this study is to examine the spread and sustainability of a multilevel integrated practice and coordinated communication model 66 months after its original implementation. Data on labor and delivery patients from 37 hospitals (5 beta sites and 32 expansion sites) were analyzed for the 81-month time period from January 2010 through September 2016. High-risk occurrence rates per 1000 live births decreased by over 70% at both beta and expansion sites. The likelihood of a high-risk occurrence was statistically significantly lower during the final study period than in the preintervention period at both beta sites (odds ratio [OR]=0.218; p<.0001) and expansion sites (OR=0.288; p<.001). The multilevel integrated practice and coordinated communication model was successfully spread and sustained. Key elements contributing to this success included developing and maintaining evidence-based guidelines, ensuring leadership buy-in and support, collecting and reporting performance measures, holding teams accountable, providing training, and ensuring transparent communication.

Medical malpractice regulation. Civil, administrative, and criminal liability

The evolution of the modern Romanian society reveals an increasing trend as to the liability for medical malpractice, which in correlation with recent amendments of relevant legislation should make healthcare professionals increase their awareness in this matter. In the analysis below, malpractice was defined from a theoretical and practical perspective, and approached from its potential consequences. As liability for malpractice could be variable subject to the nature and importance of the damages incurred, the analysis herein describes the civil, administrative, and criminal liability in general, as well as the main causes for the occurrence of malpractice (e.g. professional errors, lack of information and consent of the patients, reuse of single-use medical devices, etc.). Furthermore, a few recommendations have been further provided in order to eliminate or diminish malpractice from the healthcare professionals and medical institutions day-to-day activity.

The Practical Effect of New Ethics Rules: Responding to Subpoenas and Document Requests About Client Information

This article is a comparative overview of the American Bar Association’s Model Rule 1.6(b) before and after the issuance of the ABA’s Formal Opinion 473, issued on February 17, 2016, which was an attempt to restate and revise the rule’s ethical expectations and to help settle several questions that had plagued the rule’s practical application. A lawyer’s duty of confidentiality to his or her client, and the public policy favoring judicial efficiency and fair disclosure during the discovery phase of litigation, often places lawyers in precarious ethical positions. This article attempts to provide guidance on this issue through an analysis of the rule and the context in which a lawyer’s overarching duty to keep his or her client’s information confidential can be precluded by the lawful compulsion to disclose such information without incurring malpractice liability.

Effect of an Educational Intervention on Medical Student Scripting and Patient Satisfaction: A Randomized Trial.

IntroductionEffective communication between clinicians and patients has been shown to improve patient outcomes, reduce malpractice liability, and is now being tied to reimbursement. Use of a communication strategy known as “scripting” has been suggested to improve patient satisfaction in multiple hospital settings, but the frequency with which medical students use this strategy and whether this affects patient perception of medical student care is unknown. Our objective was to measure the use of targeted communication skills after an educational intervention as well as to further clarify the relationship between communication element usage and patient satisfaction.MethodsMedical students were block randomized into the control or intervention group. Those in the intervention group received refresher training in scripted communication. Those in the control group received no instruction or other intervention related to communication. Use of six explicit communication behaviors were recorded by trained study observers: 1) acknowledging the patient by name, 2) introducing themselves as medical students, 3) explaining their role in the patient’s care, 4) explaining the care plan, 5) providing an estimated duration of time to be spent in the emergency department (ED), and 6) notifying the patient that another provider would also be seeing them. Patients then completed a survey regarding their satisfaction with the medical student encounter.ResultsWe observed 474 medical student-patient encounters in the ED (231 in the control group and 243 in the intervention group). We were unable to detect a statistically significant difference in communication element use between the intervention and control groups. One of the communication elements, explaining steps in the care plan, was positively associated with patient perception of the medical student’s overall communication skills. Otherwise, there was no statistically significant association between element use and patient satisfaction.ConclusionWe were unable to demonstrate any improvement in student use of communication elements or in patient satisfaction after refresher training in scripted communication. Furthermore, there was little variation in patient satisfaction based on the use of scripted communication elements. Effective communication with patients in the ED is complicated and requires further investigation on how to provide this skill set.

What Happens When the Patient ‘Fires’ the Psychiatrist and Then Needs a Refill?

Back to table of contents Previous article Next article Professional NewsFull AccessWhat Happens When the Patient ‘Fires’ the Psychiatrist and Then Needs a Refill?Moira Wertheimer,J.D., R.N., C.P.H.R.M.Moira Wertheimer,Search for more papers by this authorJ.D., R.N., C.P.H.R.M.Published Online:1 Mar 2018https://doi.org/10.1176/appi.pn.2018.3a3AbstractIf you prescribe a medication for a patient after a doctor-patient relationship ends, you may have to repeat the termination process.Moira Wertheimer, J.D., R.N., C.P.H.R.M., is aassistant vice president of the Healthcare and Psychiatry Group of AWAC Services Company, a member company of Allied World.In previous Psychiatric News articles, we shared with you best practices to consider when either the psychiatrist terminates the doctor-patient relationship with a patient or the patient terminates the doctor-patient relationship with the psychiatrist.As discussed, in either of these scenarios, the psychiatrist must take steps consistent with state law to avoid a claim for patient abandonment, including providing a “reasonable” period of time for emergent care and providing written notification of the termination. Moreover, when the psychiatrist prescribes medication, the termination correspondence should include the importance of continuing the medication as directed until the patient sees the new psychiatrist, any risks of abruptly discontinuing prescribed medication and, if relevant, instructions for tapering the medication to avoid harm. All too frequently in these situations, however, the patient runs out of his medication, needs a refill, and contacts you—the former psychiatrist—for assistance. These circumstances become particularly problematic in situations where it would be harmful to the patient to discontinue the medication abruptly. Do not assume that because you are “technically” no longer the patient’s physician of record that you do not have any remaining obligations to the patient. At the same time, however, keep in mind that if you refill a prescription for the patient after termination of the relationship, the clock for termination may reset and you may need to start the termination process again. So given this tension, what are your options in these circumstances?In these situations, it is important to consult with a local attorney or a risk management professional. Some options to discuss, depending on the specific circumstances, may include the following:Prescribing the needed medication and providing the patient with a tapering schedule. Note: this will likely re-establish the psychiatrist-patient relationship and require the termination period to begin anew, including sending the patient another letter containing the new termination effective date.Obtaining consent from the patient to speak with his primary care provider to discuss having that individual prescribe the medication in consultation with the psychiatrist until the patient establishes a relationship with a new psychiatrist.In circumstances in which threatening or abusive behavior toward the psychiatrist is a consideration, directing the patient to the emergency department to obtain the medication may be indicated. Keep in mind that if the patient or family member exhibits threatening, abusive behavior or there is a safety concern to you or your staff, simply because you prescribe medication does not mean you have to continue to see the patient. Safety is always the priority, and the patient can be referred to a local emergency department for treatment in these instances.Without a doubt, these complicated situations require careful consideration of the specific circumstances. Even in situations in which the patient “fires” you, your obligations to the patient may not end immediately or even upon the termination “effective date” when patient safety is an issue or when you are prescribing medications. Consult with attorneys experienced in medical malpractice liability or a risk management professional to assist you through the process and help limit your liability exposure and promote patient safety.This information is provided as a risk management resource and should not be construed as legal, technical, or clinical advice. This information may refer to specific local regulatory or legal issues that may not be relevant to you. Consult your professional advisors or legal counsel for guidance on issues specific to you. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, GmbH, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. ■“What Happens When the Patient ‘Fires’ the Psychiatrist?” can be accessed here. “Risk Management Considerations When Terminating With Patients” is available here. ISSUES NewArchived

Changes in liability claims, costs, and resolution times following the introduction of a communication-and-resolution program in Tennessee

Objective To investigate whether a malpractice reform known as collaborative communication resolution program can improve transparency after an adverse outcome without resulting in higher malpractice liability costs, relative to traditional “deny and defend” approaches. Methods Collaborative communication resolution program started at Erlanger Health System in January 2009. We compare liability outcomes before and after collaborative communication resolution program implementation. Annual liability measures evaluated were the number of filed claims, time interval to resolve an event, defense costs, settlement costs, and total liability costs. We describe the process through which events were resolved under collaborative communication resolution program. Results One percent of adverse events when there was no medical error received compensation under collaborative communication resolution program; no medical error occurred in 65% of adverse events; 43% of events with injury from medical error were resolved with apology alone. Compared to pre-implementation levels, there was a decrease in the average number of new claims filed (CF) (1.07 to .36, p=.004), defense costs ($41,950 to $20,623 p=.004), settlement costs ($19,480 to $14,228 p=.510), and total liability costs ($61,430 to $34,851, p=.022) under collaborative communication resolution program all measured per 1000 hospital admissions. The median time interval to resolve a claim decreased from 17 months to 8 months, a reduction of 53% ( p&lt;.001). Conclusion Collaborative communication resolution program implemented at Erlanger had a reduced time interval to resolve events and lower defense and total liability costs. The improved liability outcomes and the total of 43% of events with medical error resolved by apology alone, even though 60% of these patients had legal representation, may encourage physicians to support CRP.

Informing Consent: Medical Malpractice and the Criminalization of Pregnancy

Since the early 1990s, jurisdictions around the country have been using civil child abuse laws to penalize women for using illicit drugs during their pregnancies. Using civil child abuse laws in this way infringes on pregnant women's civil rights and deters them from seeking prenatal care. Child Protective Services agencies are key players in this system. Women often become entangled with the Child Protective Services system through their health care providers. Providers will drug test pregnant women without first alerting them to the potential negative consequences stemming from a positive drug test. Doing so is a breach of these providers' duties to obtain informed consent from their patients before administering medical tests. Malpractice liability can deter providers from forcing women into the Child Protective Services system and forestall the use of civil child protective laws to criminalize pregnancy.

Empathy among undergraduate medical students: A cross-sectional study in one Malaysian public medical school.

Background:Empathy is one of the cardinal components for physician–patient relationships, optimal outcomes in patient care, improved patient satisfaction, greater adherence to therapy, and lower malpractice liability. It is also considered an essential quality for health-care professionals to practice medicine. The aim of the present study was to assess the empathy level of medical students of Universiti Pertahanan Nasional Malaysia (UPNM) National Defense University of Malaysia, Kuala Lumpur, Malaysia.Methods:This was a cross-sectional study conducted in 2017 which recruited medical students of UPNM. The Empathy Quotient, a self-reported questionnaire, was utilized for data collection. The total empathy score of the questionnaire is 80.Results:Majority of the respondents were male (60.9%), year-V students (26.6%), Malay (70.5%), and cadet officer (69.6%). The overall mean score achieved by the respondents was 36.76 ± 9.18, and 74.4% of the respondents scored more than 30. The empathy scores of the students were significantly affected by the gender (t = 2.371; df = 205; P < 0.05), year of study (F = 2.553; df = 4/202; P < 0.05), and examination grades (F = 3.488; df = 2/204; P < 0.05). The findings showed that female students are more empathetic than their male counterparts. Further, the post hoc Tukey test analysis revealed that Year-V students are more empathetic than their junior counterparts and students who got highest grade are more empathetic.Conclusions:To improve the empathy level of the UPNM medical students, appropriate educational strategies and interventions should be designed and implemented in the curriculum to inculcate, maintain, and enhance empathy.

Medical Malpractice Liability Exposure and OB/GYN Physician Delivery Decisions.

This study examines the effect of physician medical malpractice liability exposure on primary Cesarean and vaginal births after Cesarean (VBACs). Secondary data on hospital births from Florida Hospital Inpatient File, physician characteristics from American Medical Association Physician Masterfile, and physician malpractice claim history from Florida Office of Insurance Regulation. Our study estimates the effects of physician malpractice liability exposure on Cesareans and VBACs using panel data and a multivariate, fixed effects model. We merge three secondary data sources based on unique physician license numbers between 1994 and 2010. We find no evidence that the first malpractice claim affects primary Cesarean deliveries. We find, however, that the first malpractice claim decreases the likelihood of a VBAC (conditional on a prior Cesarean delivery) by 1.2-1.9 percentage points (approximately 10 percent relative to mean VBAC incidence). This finding is robust to focusing on obstetrics-related malpractice claims, as well as to considering different malpractice claims (first report, first severe report, and first lawsuit). Given the increase in both primary and repeat Cesarean deliveries, our results suggest that physician malpractice liability exposure is responsible for a relatively small share of the VBAC decrease.

Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015

ImportanceRecognizing malpractice trends in the field of dermatology is important for establishing safeguards for patient care and minimizing liability. However, there is a lack of published data on malpractice claims against dermatologists.ObjectiveTo determine characteristics of medical professional liability claims in the field of dermatology and to compare these claims with those against all physicians.Design, Setting, and ParticipantsWe examined malpractice liability data collected on dermatologists and other physicians insured by companies that report data to the Physician Insurers Association of America Data Sharing Project (PIAA-DSP), a nationally representative liability claims registry. Data analyzed spanned the years 1991 through 2015.Main Outcomes and MeasuresDemographic characteristics of dermatologists subject to claims, characteristics of closed claims, medical errors associated with closed claims, and patient outcomes leading to closed claims.ResultsData on a total of 90 743 closed claims were analyzed, 1084 (1.2%) against dermatologists and 89 659 (98.8%) against nondermatologists. More lawsuits were brought against male (n = 753, 69.5%) than female dermatologists (n = 270, 24.9%); 5.6% of claims (n = 61) did not identify the physician’s sex. Full-time practitioners (n = 1035, 95.5%) and those in solo practice (n = 600, 55.4%) were more likely to be sued than those in group practices (n = 429, 39.6%) and institutions (n = 31, 2.9%). Most claims against dermatologists were abandoned, withdrawn, or dismissed (n = 735, 67.8%). Between 2006 and 2015, trial verdicts favoring defendants exceeded trial verdicts favoring plaintiffs by a factor of 7. Errors that occurred during a procedure spawned the most claims (n = 305), of which 102 were paid. Misdiagnoses comprised the second-highest number of claims (n = 192), of which 62 were paid. The average recovery per claim was $238 145. The most common procedure leading to claims was skin operations (420 claims, of which 130 were paid). The most common adverse patient outcome associated with claims was dyschromia, resulting in 171 claims, of which 40 were paid.Conclusions and RelevanceMale dermatologists were sued more often than female dermatologists. Overall, alleged errors in procedures and misdiagnosis gave rise to the most lawsuits. Dyschromia was the most common adverse outcome alleged in lawsuits.

Legal quality criteria of expert opinions in liability for medical malpractice

In litigation regarding to liability for medical malpractice the court itself for lack of medical expert knowledge cannot judge a claimed error in treatment. That applies too for the question if there is causation between the error in treatment and claimed damage to patient's health. In this respect, the court is dependent on a medical expert and is bound to his assessment, unless there is no quality deficit in respect of medical and/or legal criteria. The more the medical expert knows the legal background of physician's liability for medical malpractice, the less is the risk of legal quality deficits in his expert opinion and thereby also of judicial errors by court.

TEISMINIS PACIENTŲ PATIRTOS ŽALOS ATLYGINIMO MODELIS

Straipsnyje, atsižvelgus į pastaraisiais metais Lietuvoje vykstančias diskusijas dėl pacientų patirtos žalos atlyginimo reguliavimo taikymo, svarstomus esamos sistemos pakeitimus, analizuojamas Lietuvoje veikiantis teisminis ieškinio modelis, pagrindiniai su jo taikymu susiję aspektai. Taip pat svarstoma, ar Lietuvoje įgyvendintas teisminis ieškinio modelis yra neefektyvus ir kaip galėtų būti tobulinamas pacientų patirtos žalos atlyginimo institutas.

Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability.

Funding policy and medico-legal climate are part of physicians' reality and might permeate clinical decisions. This study evaluates the influence of maternal age and government funding on obstetrician/gynecologist recommendation for invasive prenatal testing (i.e. amniocentesis) for Down syndrome (DS), and its association with the physician's assessment of the risk of liability for medical malpractice unless they recommend amniocentesis. Israeli physicians (N=171) completed a questionnaire and provided amniocentesis recommendations for women at 18weeks gestation with normal preliminary screening results, identical except aged 28 and 37. Amniocentesis recommendations were reversed for the younger ('yes' regardless of testing results: 6.4%; 'no' regardless of testing results: 31.6%) versus older woman ('yes' regardless of testing results: 40.9%; 'no' regardless of testing results: 7.0%; χ2=71.55, p<.01). About half of the physicians endorsed different recommendations per scenario; of these, 65.6% recommended amniocentesis regardless of testing results for the 37-year-old woman. Physicians routinely performing amniocentesis and those advocating for amniocentesis for all women ≥ age 35 were approximately twice as likely to vary their recommendations per scenario. Physicians who perceived risk of liability for malpractice as large were nearly one-and-a-half times more likely to vary recommendations. The results indicate physicians' recommendations are influenced by maternal age, though age is already incorporated in prenatal DS risk evaluations. The physician's assessment of the risk that they will be sued unless they recommend amniocentesis may contribute to this spurious influence.

Malpractice Laws and Incentives to Shield Assets: Evidence from Nursing Homes

Empirical research on medical malpractice liability has largely ignored incentives to restructure to protect assets. This study provides evidence on asset shielding in the nursing home industry. There was a rapid increase in lawsuits alleging patient neglect or abuse in states with plaintiff‐friendly tort environments beginning in the second half of the 1990s. We document two apparent asset‐shielding trends in these states during the 1998–2004 period: (1) sales of homes by large chains to smaller, more judgment‐proof owners; and (2) a reduced propensity to “brand” chain‐owned units with names that linked them directly to the central corporation or sister units. Twelve states enacted tort reforms during the 2003–2006 period that placed caps on noneconomic damages. Using a difference‐in‐differences (DD) methodology, we find that the trends in asset‐shielding behavior abated or reversed in the states that enacted tort reforms. These findings suggest that tort law affects ownership and other organizational choices in this industry.

Learning from an analysis of closed malpractice litigation involving myocardial infarction

ObjectiveTo examine the epidemiologic data, identify the pattern of dispute, and determine clinical litigious errors by analyzing closed malpractice claims involving myocardial infarction (MI) in Taiwanese courts. MethodsA retrospective descriptive study was performed to analyze the verdicts pertaining to MI from the population-based database of the Taiwan judicial system between 2002 and 2013. The results of adjudication, involved specialists, primary dispute leading to lawsuits, and litigious errors were recorded. ResultsA total of 36 closed malpractice claims involving MI were included. The mean interval between the incident and litigation closure was 65.5 ± 28.3 months. Nearly 20% of the cases were judged against clinicians and the mean payment was $100639 ± 49617, while the mean imprisonment sentence was 4.3 ± 1.8 months. Cardiologists and emergency physicians were involved in 56.3% of cases, but won 92.6% of lawsuits, while other specialists lost nearly 25% of lawsuits. The most common dispute was misdiagnosis (38.9%), but this dispute had the lowest percentage of loss (7.1%). Disputes regarding delayed diagnosis were judged against the defendants in 50% of claims. Clinicians lost the lawsuit in the following conditions: 1) misdiagnosis of MI in patients with typical chest pain and known coronary artery risk factors; 2) failure to perform thoughtful evaluation and series investigations in patients suspicious of ischemic heart disease; 3) failure to perform indicated treatment to avoid disease progression. ConclusionsMedical practitioners should keep a high index of MI suspicion, especially if the diagnosis and treatment of MI are beyond their daily practice. Prudent patient reevaluation, serial ECG and cardiac enzyme testing, and early consultation are suggested to reduce malpractice liability.

Don't overlook malpractice liability in medical marijuana states

It is an untapped frontier of case law that likely won't go untested much longer, now that more than half of the states allow for some medical uses of marijuana. Are physicians being exposed to significant malpractice liability when certifying patients to receive marijuana for medical purposes?

Analysis sees malpractice liability as overlooked in medical marijuana states

Analysis sees malpractice liability as overlooked in medical marijuana states

IMPACT OF MEDICAL LIABILITY REFORM ON CORONARY ARTERY DISEASE TESTING AND INTERVENTION

Background: Physicians often report practicing “defensive medicine,” including ordering marginally beneficial tests and interventions to reduce their malpractice liability risk. Yet, most economic studies find no decrease in spending after malpractice reform. Methods: This study uses a random 5