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Biomedical subjects

V R Scarano

Publications and source records attributed to V R Scarano.

10 recordsLinked to original sources
PubMed2000

The state of electroconvulsive therapy in Texas. Part I: reported data on 41,660 ECT treatments in 5971 patients.

The Texas Legislature in 1993 mandated a quarterly reporting requirement for hospitals and physicians performing electroconvulsive therapy (ECT) in the state (United States Government hospitals were excluded). The Texas Department of Mental Health and Mental Retardation (TDMHMR) was designated as the agency responsible for collecting and maintaining the data. This paper reviews the ECT data from 16 quarterly reports (09/01/93 through 08/31/97). The reports contained data on 41,660 ECT treatments in approximately 5971 patients. The results of this study support the proposition that ECT is an extremely safe and effective treatment for those individuals suffering from a serious mental illness. In Texas, ethnic groups other than non-Hispanic Anglo-Americans appear to be underserved in regards to ECT. Those patients without appropriate insurance or adequate personal finds are also underserved as a result of the few county and state hospitals performing ECT and the relatively small number of patients treated with ECT at those hospitals. Recommendations are suggested to improve the quality of the database and in informing the public as to the safety and efficacy of this valuable treatment modality. What, at first, was seen as an unwarranted legislative foray into the practice of medicine, has, in the end, become a source of valuable data supporting the use of ECT as an important treatment modality.

Adolescent↗
PubMed2000

The state of electroconvulsive therapy in Texas. Part 2: contact with physicians, hospitals, medical liability insurance companies, and manufacturers of stimulus generating equipment.

Since mid-1993, all ECT treatments performed in the state of Texas (except for United States government hospitals) must be reported every quarter to the Texas Department of Mental Health and Mental Retardation (TXMHMR) on a data collection form provided by the Department. Part 1 of this paper reviewed that data. This paper reviews the responses to questionnaires and contacts made with physicians, hospitals, medical liability insurance companies, and manufacturers of stimulus generating devices regarding their experience with ECT in Texas. Questionnaires were sent to physicians and hospitals that had not performed ECT during the final two quarters of the review period. Medical liability insurance companies and the manufacturers of the stimulus generating equipment used in ECT were contacted regarding their experience with liability claims. The results indicate that medical liability in regards to the performance of ECT is extremely low. Physicians and hospitals that stopped performing ECT did so for reasons other than medical liability.

Adult↗
PubMed1999

Tarasoff in Texas.

Texas physicians do not have a statutory duty to warn potential victims of their patients' violent conduct but may warn medical or law enforcement authorities if the patient is a danger to himself, to the treating physician, or to others. Moreover, the Medical Practice Act of Texas does not authorize even permissive exceptions to confidentiality, thereby preventing physicians from legally warning victims. Nonetheless, 5 Texas appellate courts already have addressed a clinician's duty to issue protective warnings to reasonably identifiable victims. The approaches of these 5 courts have been similar, but important differences warrant attention. In 1998, the Supreme Court of Texas, in a fact-specific decision, did not adopt a duty for physicians to protect third persons from their patients' violent acts. All Texas physicians should become familiar with the emerging jurisprudence of professional protective responsibilities and liabilities to third persons who can be harmed physically by their patients' violent conduct.

Duty to Warn↗
PubMed1998

Post-traumatic movement disorders: effect of the legal system on outcome.

Since patients with post-traumatic, neurologic, movement disorders often seek legal counsel and become involved in litigation, we used this group of disorders as a model for testing the hypothesis that an interaction with the legal system may influence its outcome. We reviewed 100 consecutive medical records of patients with post-traumatic movement disorders from the Movement Disorders Clinic at the Baylor College of Medicine. Additionally, 40 patients completed a detailed questionnaire and a health survey. Nineteen of the 40 respondents had obtained legal representation in regards to compensation for their medical problems. The group of patients with attorneys differed from those without legal representation in that they were significantly younger and a significantly higher percentage of these patients were disabled as compared to the group without attorneys. While most were dissatisfied with the legal system, 68% were satisfied with services provided by their attorneys. Although the patients with legal aspects of their movement disorders seemed to have more severe and persistent disability, we could not definitely conclude that the legal system had adversely affected the outcome of the post-traumatic movement disorders.

Adolescent↗
PubMed1998

Beyond tort reform.

Organized medicine has spent a great deal of time, energy, and money attempting to revise the legal tort system. Yet, change, if any, has been incredibly slow. There are many reasons for this. Tort law has been a part of American jurisprudence for hundreds of years. In addition, most state legislatures are populated with large numbers of attorneys. This paper explores the economic factors that underlie the litigation process in medical negligence/malpractice cases. It suggests that the current tort system is not as antimedicine as physicians commonly believe, rather, it is physician-friendly. Presented here is a more efficient and cost-effective method of addressing medical negligence/malpractice cases. An exclusive relationship between the liability insurance carrier and a defense law firm is proposed. Rather than using the old billable hours system to charge for its services, the defense law firm negotiates a yearly retainer based upon a percentage of the annual liability insurance premiums paid. How this relationship would result in a more efficient and cost-effective approach to the present tort system is examined.

Humans↗
PubMed1997

Beyond tort reform.

Organized medicine has spent a great deal of time, energy, and money attempting to revise the legal tort system. Yet, change, if any, has been incredibly slow. There are many reasons for this. Tort law has been a part of American jurisprudence for hundreds of years. In addition, most state legislatures are populated with large numbers of attorneys. This paper explores the economic factors that underlie the litigation process in medical negligence/malpractice cases. It suggests that the current tort system is not as antimedicine as physicians commonly believe; rather, it is physician-friendly. Presented here is a more efficient and cost-effective method of addressing medical negligence/malpractice cases. An exclusive relationship between the liability insurance carrier and a defense law firm is proposed. Rather than using the old billable hours system to charge for its services, the defense law firm negotiates a yearly retainer based upon a percentage of the annual liability insurance premiums paid. How this relationship would result in a more efficient and cost-effective approach to the present tort system is examined.

Accounting↗
PubMed1996

Rationale for a medical society sponsored expert witness program.

The medical profession has many avenues by which to improve the present tort system as it regards medical negligence cases. One such avenue is a medical society sponsored expert witness program through which medical societies can assure that each case is being evaluated properly by an ethical and responsible physician. This effort will assist attorneys in weeding out medical negligence cases that are without merit and shepherding meritorious cases towards appropriate settlement. Such a program would be a positive step in discouraging the legal profession's use of the "professional expert." Finally, such a program might also provide funds for other worthwhile medical/legal projects.

Expert Testimony↗
PubMed1977

Congenital atresia of the colon.

Atresia of the colon is a rare congenital anomaly. In 1673, Binninger reported the first case of colonic atresia and Gaub reported the first survival of a patient with this anomaly in 1922. Since that time there have been 97 successfully managed patients described in the literature.

Colon↗