Liability Risk Research Articles

DE-RISKING THE EMPLOYER-EMPLOYEE RELATIONSHIP WHEN WORKERS HAVE MILD COGNITIVE IMPAIRMENT OR YOUNG ONSET DEMENTIA

Abstract The employee-employer relationship is one that is well established in law and involves a contract between a worker who performs the work, and an employer who determines when, how and where the work is done. Many countries have introduced legislation that helps guide employee-employer behavior when workers’ performance of their duties is disrupted by illness or disability, such as mild cognitive impairment or young onset dementia (MCI|YOD). At any one time, about 8-12% of the workforce is off due to occupational or non-occupational work injury or illness with direct disability and absence costs projected about 7% of payroll in 2000. Drawing from data gathered in a systematic literature review and case study, this paper determined that uncertainty and risk influence employer-employee relationships when workers are identified with MCI|YOD. Employers’ industry context, size and corporate values influence their “integrated risk management” approach to workers with MCI|YOD, and early intervention is considered key to managing financial and liability risk. In contrast, progressive onset, delayed diagnosis, stigma, privacy concerns, workplace uncertainty, and lack of information may delay employee disclosure, a common employee risk mitigation strategy. We conclude by considering strategies to de-risk relationships between workers with MCI|YOD and employers using dual process theory to understand intuitive and rational decisions in the context of the disability management process.

Environmental Liability and Environmental Risks of Business

The paper considers the environmental liability of business organizations whose environmental activities are not only a legal obligation, but also a liability. Risk management approaches for solving environmental problems are considered, examples of environmental risks are given, key stages of environmental risk management are presented.

Water Asset Transition through Treating Water as a New Asset Class for Paradigm Shift for Climate–Water Resilience

Climate change is evident around the globe, which requires bold actions now to achieve UN-SDGs and Paris Agreement. The water sector is dominated by public finance and is almost subsidised. In addition, there is an increased risk perception surrounding climate investments in developing countries. Pricing climate risks is a daunting challenge for investors and the private sector, who must estimate the likelihood of various climate scenarios and their implications for physical, liability and transition risks at the firm, project, national, and regional scales. In addition, there is a building momentum to scale up global climate response. To translate this momentum into action will require significantly greater investments, investments in a different set of inclusive assets that address water security, mobilise the private sector and provides sector-based or economy-wide co-benefits to direct and indirect beneficiaries, e.g., job creation, health benefits, improved resilience and scaling knowledge and harmonise data and methodologies. Notably, climate–water finance is facing a dual challenge. It will have to both reduce the present water infrastructure financing gap and ensure that this new infrastructure/asset is low-carbon, resilient to climate change, and meets the goals of the UNFCCC and the Paris Agreement. Therefore, there is a need for a paradigm shift in the way how water asset is defined, developed, and financed. This paper presents this novel approach concept and its content and financial structure that enable treating water as a new asset class to enable private sector investment and ensure providing water for domestic, municipal, and industrial purposes and allows municipalities to scale their water reuse, sanitation, and desalination projects in partnership with the private sector and/or governments. It is increasingly important to treat water as a new asset class, particularly as nations around the world (particularly developing countries) are set to experience an anticipated 40% shortfall in water by 2030 due to climate change, economic recovery and growth, population growth and resource competition. Investment in water could be one of the ways of tackling this deficit by treating water as a new asset class.

Supply Chain Concerns and the Effect on Health Care Systems: Essential Considerations for Anesthesia Providers

Article| December 2022 Supply Chain Concerns and the Effect on Health Care Systems: Essential Considerations for Anesthesia Providers George Tewfik, MD, MBA, FASA; George Tewfik, MD, MBA, FASA Search for other works by this author on: This Site PubMed Google Scholar Samuel Mark Paschall Samuel Mark Paschall Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor December 2022, Vol. 86, 1–8. https://doi.org/10.1097/01.ASM.0000904200.47110.56 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation George Tewfik, Samuel Mark Paschall; Supply Chain Concerns and the Effect on Health Care Systems: Essential Considerations for Anesthesia Providers. ASA Monitor 2022; 86:1–8 doi: https://doi.org/10.1097/01.ASM.0000904200.47110.56 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: health care systems Health care workers, and anesthesia providers specifically, had likely never given much thought to supply chains until the start of the COVID-19 pandemic. As the world shut down, and we shifted our practices to emergency procedures, careful intubations, and ventilator management, our televisions were inundated with images of bare shelves in the supermarkets, with shoppers suddenly hoarding home essentials such as toilet paper and disinfectant wipes. Since that time, disruptions in the supply chain have affected consumer goods such as semiconductors, computer chips, and infant formula. Medical devices and medications have experienced supply chain issues that existed before the tumult of the last several years. A national shortage of propofol occurred in 2010 that caused anesthesia providers to quickly shift to alternate induction agents. This shortage was attributed to two major problems. The first was manufacturer hesitancy to make drugs with high liability risk, following a court ruling that held... You do not currently have access to this content.

Defensive versus evidence-based medical technology: Liability risk and electronic fetal monitoring in low-risk births

Technology-intensive birth practices are a hallmark of the overmedicalization of birth. For example, obstetricians routinely use continuous electronic fetal monitoring (EFM), even though this technology is not evidence-based, has a high rate of false positives, and does not improve outcomes in low-risk deliveries. Providers often argue that they must use EFM to protect themselves from malpractice liability, making it a form of defensive medicine. But does variation in actual liability risk contribute significantly to the use of non-evidence-based medical technology like EFM? This study uses multi-level logistic models to examine the effects of malpractice laws and lawsuits on EFM in low-risk births from 1995 to 2003. The models test the hypothesis that state-level variation in liability risk should influence the probability of EFM use. The models reveal that the probability of reporting EFM is higher when states artificially reduce liability risk by capping damage awards, suggesting that objective liability risk does not promote routine EFM and may deter it. In fact, caps on damages limit providers’ legal exposure without doing anything to encourage higher quality care. It is possible that states without tort reforms place greater emphasis on patient rights, safety, and quality of care. On the other hand, by reducing liability risk without encouraging improvements in quality, tort reform laws may inadvertently promote more technology use.

Climate Change Liability, Negative Emissions and Biodiversity Restoration

Abstract This article is about climate liability and the stimulation of negative emissions through nature restoration. Such a measure can contribute to the reduction of greenhouse gas emissions, but can also lead to a restoration of biodiversity and of ecosystem services. In order to finance measures aimed at achieving natural negative emissions, the European Commission is considering introducing a system of carbon credits as part of the ‘Fit for 55’ program. This contribution investigates the advantages and disadvantages thereof and wonders about the nature and extent of the liability risks if, for example, nature is destroyed that is financed with carbon credits and which results in the release of stored co2. In that respect, attention is given to the Environmental Liability Directive. If the stimulation of natural negative emissions is also aimed at restoring biodiversity, in the event of a loss of nature, merely recouping the market price of a ‘carbon credit’ is insufficient to compensate the public for the damage done.

Glaucoma-related malpractice litigation in the United States: A review of the WestLaw database

Purpose Gaining understanding of glaucoma-related malpractice litigation may highlight ways to improve patient care and minimize risk of litigation. This study aims to analyze the outcomes and characteristics of glaucoma-related malpractice litigation. Materials and Methods The Westlaw legal database (Thomson Reuters, New York, NY, USA) was used to identify cases regarding ‘malpractice’ AND ‘glaucoma’ or related terms. Cases were analyzed for characteristics such as alleged cause of malpractice, outcome, and demographics. Results The initial search terms yielded 498 results, 107 of which met further inclusion criteria. 38 (36%) were resolved via jury trial. Of these, verdicts in favor of the plaintiff were issued in 14 cases (34%), with median adjusted damages of $702,986. Of all 107 cases in the study reviewed, 65 (61%) resulted in verdicts in favor of the defendant. Ophthalmologists were named as defendants in 85% of the cases (with glaucoma specialists representing 7% of the ophthalmologists); optometrists in 24%. Sixty percent of the cases involved non-surgical treatment. The most common medical reasons for litigation were failure to diagnose (38%), and inappropriate/negligent treatment (36%). The most commonly litigated surgical procedures were cataract surgery (48%) and iridotomy/iridectomy (19%). Conclusion Glaucoma-malpractice litigation has increased, with medical mismanagement alleged in the majority of cases. Defendants are frequently successful in obtaining pre-trial dismissal, but the risk of liability increases in cases going to trial. A minority of cases involved glaucoma specialists. This historical analysis of glaucoma-related malpractice cases might provide perspective and aid physicians seeking to avoid litigation.

Abstract 15605: Underrepresentation of Cardiologist Demographics in Review of Medicolegal Cardiology Cases

Introduction: Cardiologists face an increased risk of medical professional liability (MPL) claims compared to physicians overall throughout their careers. Simultaneously, male physicians are over twice as likely to encounter medicolegal litigation than female physicians. Understanding the distribution of MPL claims across cardiologist demographics is vital to identify high risk areas and improve quality of patient care. Thus, we aimed to characterize current literature on the inclusion of demographic data in medicolegal cases against cardiologists. Methods: Searches were performed in the PubMed database. An initial search using a combination of the terms “cardiologist,” “cardiology,” “cardiac,” and “malpractice” yielded 802 results. Studies were screened by title and abstract for 1) relevance and 2) acquisition of data from a legal or insurance database. Data was manually extracted from eligible studies and categorized into 18 legal and demographic fields. Results: After applying eligibility criteria, 21 studies were analyzed. Comparison of key variables revealed an underrepresentation of cardiologist demographic data compared to patient data (Table 1). While two-thirds of medicolegal studies in cardiology described patient gender, no studies included gender of the defending cardiologist. Similarly, though two-thirds of studies mentioned patient age, none included cardiologist age. There was no mention of patient or cardiologist race in any of the 21 studies reviewed. Conclusion: In conclusion, knowledge of gender- and race-specific litigation patterns against cardiologists is absent from literature. Despite descriptions of patient characteristics, current studies on the medicolegal landscape of cardiology ignore key cardiologist variables. Incorporating demographics of prosecuted cardiologists could help elucidate the role of gender and race in medicolegal cases, minimize litigation risk, and enhance patient care outcomes.

Sistem Tanggung Renteng pada Keberlangsungan Usaha dalam Perspektif Ekonomi Islam

Financial institutions have now continued to expand, specifically the Islamic banking industry. Islamic banking offers various types of products, including financing for additional business capital. In the financing products offered, many risks are considered capable of affecting the health of the bank. Consequently, the banking sector has developed a mechanism to address the risk of default. For instance, the BTPN Syariah bank, which already has a mechanism for dealing with defaults through joint and several liability, where all members in a financing group are involved jointly or severally to be responsible for the loans they have. Apart from dealing with the risk of default, joint and several liability is also used to assist financing members who are having problems with their business being developed. Joint and several liability in muamalah fiqh is also referred to as kafalah.

What COVID-19 Can Teach Nurses About Liability Risks.

The COVID-19 pandemic has raised questions about professional liability risks for nurses tasked with caring for large numbers of severely ill patients while also challenged by resource shortages. This article will explore some key liability issues associated with the pandemic, including immunity, documentation, crisis standards of care, delegation and assignment, scope of practice, floating, travel nursing, telehealth, and misinformation and social media.

Stronger Together: Cross Service Media Recommendations

This article presents a way to use an individual’s entire media streaming history from all their providers to inform recommendations without any of the contributing services needing to process or hold the data. To enable this, the user’s personal data is held in a Solid pod, a secure personal web server designed to give the user greater control over their personal data supporting a more flexible approach to how it is used. We present an application and supporting architecture based around Solid pods that can process media consumption data in a way that is controlled by the user, generating a general-purpose “Media Profile” that media organizations can use to inform their recommendation services. This profile could form the basis of an open standard and would allow broadcasters to offer audiences more relevant content in a way that limits their data liability risk and safeguards their privacy. We will demonstrate the system in operation along with a platform and supporting application.

A Survey of Orientation and Mobility Specialist's Use of Telepractice During COVID-19.

Introduction: This survey sought to establish a baseline for the remote delivery of services (telepractice) by orientation and mobility (O&M) specialists nationwide, which became pervasive in 2020 as a result of the COVID-19 pandemic. Method: An online survey was distributed using professional email lists and then used snowball sampling to obtain a convenience sample. The survey was completed by 66 O&M specialists using telepractice at the time of the survey, the primary criterion for inclusion. Results: Engaging in telepractice was a direct result of the pandemic for 90.77% of the participants. Most professionals' caseloads remained relatively similar to the size they were prior to the pandemic (69.70%), and instruction used a one-on-one model (90.77%). For the most part, professionals were teaching conceptual knowledge rather than actual travel skills using video conferencing software. Most participants indicated they had not received training in telepractice (81.25%). Only 20.00% of participants found telepractice for O&M satisfactory, but 26.16% of participants indicated they would probably continue using telepractice after the pandemic. Most participants (72.13%) were unsure if they were covered by professional liability insurance. Discussion: Most participants were thrust into telepractice and very few received training in telepractice. It is likely that the tools used were tools of convenience. Despite a lack of preparation and lukewarm satisfaction levels, a noteworthy percentage of respondents intend to continue to use telepractice after the end of the pandemic. The liability risks associated with this new model have not been widely assessed. Implications for Practitioners: The most effective tools for O&M telepractice have not yet been identified. Practitioners and researchers can work together to develop and promote promising practices and tools for O&M telepractice. Professional liability should always be investigated before providing services. A tool for professionals to assess risk should be developed.

Building care amid navigating liability risks: The possibility of policy-driven care in China's drug-control arena

For Chinese policymakers, shouldering responsibility is often associated with high liability risk, thus resulting in low-level care for risky and stigmatized populations such as drug users. Therefore, it is crucial to explore ways to improve care access in such an uneasy policy environment. Based on long-term ethnographic fieldwork conducted in Yunnan province in southwestern China from 2013 to 2021, this paper traces the policy-making process of the Yunnan Province Methadone Oral Solution Take-Home Treatment Work Proposal. All stakeholders involved considered this policy attempt “impossible” at first, as the highly addictive methadone becomes an illegal drug once it is taken outside a clinical setting. By analyzing how a group of local government officials, together with medical practitioners and drug users, strive to legitimize and ultimately implement the policy, I argue that people's concern over liability risks strengthens the boundary between methadone as a “drug” and methadone as a “medicine,” between methadone solution drinkers as “drug users” and as “patients,” and between “inside the clinic” and “outside the clinic.” By utilizing a culturalist approach to explore the possibility of care in such a context, this paper reveals that a “heqing heli hefa worthy-of-being-cared-for” discourse is crucial in that it acts as symbolic capital to dissolve the above boundaries embedded in the dominant political culture. Moreover, it is the key cultural logic of the “building” of care. The findings also illustrate how local policymakers negotiate and balance responsibility and liability to create a potential policy space for enabling care practices. Additionally, this study sheds light on the inclusion of care for the most stigmatized and marginalized populations, and has broad implications for policy-making in other contexts.

Pragmatic Approaches to COVID-19 Related Ethics Dilemmas for Psychiatrists.

Psychiatrists face complex ethics dilemmas in the COVID-19 pandemic era when assessing dangerousness in patients or forensic evaluees who threaten to purposely infect others or spread the virus. Understanding local public health and medical quarantine laws for their jurisdictions can help guide treating psychiatrists in how to handle some of these situations; however, challenges occur when what is ethically best conflicts with the action that will confer the greatest protection against legal liability. Additionally, the calculus of weighing competing ethics considerations changes based on how relevant it is to the duties of a particular role (e.g., treatment, forensic, research, managed care, etc.) as well as the contextual factors of the situation. We present dialectical principlism as a framework to help psychiatrists resolve such ethics dilemmas related to the COVID-19 and future pandemics, illustrating how it can be applied in different roles (i.e., treatment versus forensic) and situations (i.e., when it is clear the danger of viral transmission is secondary to a delusion versus a delusion-like belief) to come to the best outcome that balances patient welfare, legal considerations, and societal safety. Occasionally, the most ethical action may entail small liability risks.

Ethical Considerations on Some Issues of Medical Artificial Intelligence Applications

Artificial intelligence has been widely applied in the medical field recently, such as medical imaging, pathological diagnosis, mental health, rehabilitation medicine, and home health support have progressed, which also triggered extensive ethical thinking. Under the perspective of medical ethics, this paper explores the controversial status of moral subjects of AI machines, the definition of multiple relationships arising from machine use, value judgments and trust considerations of AI technologies, data accessibility and privacy protection. It further points out the potential injustice, discrimination and risk liability arising from AI, and calls for the establishment of an ethical review and collaborative governance mechanism for AI that is deeply integrated with technology.

INDIRECT EXPROPRIATION AND THE PROTECTION OF PUBLIC INTERESTS

AbstractThis article analyses what is widely known as the police powers exemption found in modern international investment agreements, with a focus on mega-regional trade and investment agreements. It explores its legal nature and requirements, the burden of proof and issues of compensation. In an attempt to curb (indirect) expropriation claims, the exemption carves out non-discriminatory regulatory measures from the scope of indirect expropriation and in such situations no compensation needs to be paid. It follows that, as a rule, foreign investors are not protected against the adverse economic effects of regulatory measures. The key question addressed is whether host States can increase the level of protection given to public welfare objectives through the use of this exemption without having to compensate investors for the measures taken. The article argues that, under the proportionality test embodied in the exemption, States can provide the level of protection that they desire without incurring a risk of liability as regards expropriation claims.

Assessment of dependence potential and abuse liability of Δ8-tetrahydrocannabinol in mice

Delta-8-tetrahydrocannabinol (Δ8-THC) is a psychotropic cannabinoid produced in low quantities in the cannabis plant. Refinements in production techniques, paired with the availability of inexpensive cannabidiol substrate, have resulted in Δ8-THC being widely marketed as a quasi-legal, purportedly milder alternative to Δ9-THC. Yet, little research has probed the behavioral and physiological effects of repeated Δ8-THC use. The present study aimed to evaluate the effects of acute and repeated exposure to Δ8-THC. We hypothesized that Δ8-THC produces effects similar to Δ9-THC, including signs of drug tolerance and dependence. Adult male and female C57BL/6J mice were treated acutely with Δ8-THC (6.25–100 mg/kg, i.p.) or vehicle and tested in the tetrad battery to quantify cannabimimetic effects (i.e., catalepsy, antinociception, hypothermia, immobility) as compared with a non-selective synthetic cannabinoid (WIN 55,212–2) and Δ9-THC. As previously reported, Δ8-THC (≥12.5 mg/kg) induced cannabimimetic effects. Pretreatment with the CB1 receptor-selective antagonist rimonabant (3 mg/kg, i.p.) blocked each of these effects. In addition, repeated administration of Δ8-THC (50 mg/kg, s.c.) produced tolerance, as well as cross-tolerance to WIN 55,212–2 (10 mg/kg, s.c.) in tetrad, consistent with downregulated CB1 receptor function. Behavioral signs of physical dependence in the somatic signs, tail suspension, and marble burying assays were also observed following rimonabant-precipitated withdrawal from Δ8-THC (≥10 mg/kg BID for 6 days). Lastly, Δ8-THC produced Δ9-THC-like discriminative stimulus effects in both male and female mice. Together, these findings demonstrate that Δ8-THC produces qualitatively similar effects to Δ9-THC, including risk of drug dependence and abuse liability.

The Duty of Care and Business Judgment Rule in Austrian Company Law

The duty of care is a core instrument to incentivise managers to act diligently and in the best interest of the company. The following article highlights some key points under Austrian law and puts special emphasis on the business judgment rule, which aims to limit the liability risk of board members arising from the problem of judicial hindsight bias.

Enriching BIM with Unmanned Aerial Systems Data for Enhancing Construction Management Operations

The use of an unmanned aerial system (UAS) in construction project management (CPM) is an emerging methodology aimed at improving the performance of project management practices. Despite the different functions that an UAS offers, which are well covered in various sources ranging from isolated exploratory works to ad hoc case studies, construction practitioners still demonstrate little interest in UAS technology. The underwhelming interest is rooted in a lack of an understanding of the value of the data collected using UASs and their potential to enrich Building Information Modelling (BIM). This research presents the details of the UAS developed to check the accuracy of work performed, along with the generation of the corresponding progress payment reports as well as referencing and tracking information in real time, for a residential project. This study also discusses combining the data generated from the UAS and 5D BIM to develop a smart construction site. The UAS–BIM combination enables the project stakeholders to be fully informed of the work’s progress and quality to avoid mistakes that could lead to extra costs and delays. The paper identified the main obstacles to applying the UAS via interviews with the project managers and tradespersons involved in the selected project. Assuredly, a digital culture is essential for a smart construction site to shift the project team from a passive data user to a more proactive analyzer to improve performance and site safety. Other obstacles include ethical reservations, legal requirements, liability risks, weather conditions, and the continuation of using an UAS in non-open-air construction environments.

The Relationship of Attention-Deficit/Hyperactivity Disorder With Posttraumatic Stress Disorder: A Two-Sample Mendelian Randomization and Population-Based Sibling Comparison Study

BackgroundAttention-deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD) are associated, but it is unclear if this is a causal relationship or confounding. We used genetic analyses and sibling comparisons to clarify the direction of this relationship. MethodsLinkage disequilibrium score regression and 2-sample Mendelian randomization were used to test for genetic correlation (rg) and bidirectional causal effects using European ancestry genome-wide association studies of ADHD (20,183 cases and 35,191 controls) and 6 PTSD definitions (up to 320,369 individuals). Several additional variables were included in the analysis to verify the independence of the ADHD-PTSD relationship. In a population-based sibling comparison (N = 2,082,118 individuals), Cox regression models were fitted to account for time at risk, a range of sociodemographic factors, and unmeasured familial confounders (via sibling comparisons). ResultsADHD and PTSD had consistent rg (rg range, 0.43–0.52; p < .001). ADHD genetic liability was causally linked with increased risk for PTSD (β = 0.367; 95% CI, 0.186–0.552; p = 7.68 × 10−5). This result was not affected by heterogeneity, horizontal pleiotropy (Mendelian randomization Egger intercept = 4.34 × 10−4, p = .961), or other phenotypes and was consistent across PTSD datasets. However, we found no consistent associations between PTSD genetic liability and ADHD risk. Individuals diagnosed with ADHD were at a higher risk for developing PTSD than their undiagnosed sibling (hazard ratio = 2.37; 95% CI, 1.98–3.53). ConclusionsOur findings add novel evidence supporting the need for early and effective treatment of ADHD, as patients with this diagnosis are at significantly higher risk to develop PTSD later in life.