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PubMedDate not supplied

Retiring physician.

Explore the source record for details and available documents.

Delivery of Health Care↗
PubMed1983

Economic impact of a botulism outbreak. Importance of the legal component in food-borne disease.

Legal expenses arising from food-borne outbreaks have not been reported in the medical literature, to the best of our knowledge. Expenses of an outbreak of food-borne botulism involving 34 victims in 1978 exceeded +5.8 million. These included outbreak investigation and control (3.2% of total), medical care for patients with botulism from April 1978 through October 1981 (12.3%), and settlements and legal charges (84.4%). Legal actions following food-borne outbreaks must be recognized for several reasons. First, the delay between the outbreak and the conclusion of legal activity (three years in this instance) mandates prompt and meticulous written documentation of investigation and control work. Second, legal expenses may make a large contribution to the total societal impact of food-borne disease outbreaks. Finally, awareness of the legal expense strengthens the rationale for public and private expenditures on food-borne disease prevention in this country.

Botulism↗
PubMed1991

Obstetrics and malpractice. Evidence on the performance of a selective no-fault system.

Most malpractice litigation in obstetrics could be replaced with an alternative insurance system based on "accelerated-compensation events," which are classes of medical injuries determined in advance by medical experts to be readily identifiable, normally preventable with good care, and nondistorting of medical decision making. This professionally derived system would help prevent injury and improve the resolution of injuries. Prior work on accelerated-compensation events was largely conceptual, so to study the likely effects of accelerated-compensation events, we applied the events to a large database of obstetrical malpractice claims. Results refute prior criticisms. Accelerated-compensation events (1) are definitely feasible to develop and apply, (2) would probably cover two thirds of currently paid claims and three quarters of indemnity dollars, (3) would likely involve substantial savings in time and expense per case, and (4) would probably not introduce an unmanageable number of large new claims.

Defensive Medicine↗
PubMed1998

Evaluation of narrative text for case finding: the need for accuracy measurement.

This article reviews the analysis of a narrative text electronic search technique being used in the insurance industry. We reviewed a previously published study of motor vehicle crashes in roadway construction workzones as well as additional data supplied by the authors with respect to the methods of keyword selection. The narrative text search technique was evaluated with decision statistics and was found to have a sensitivity of 92.3%, 95% confidence interval 67.5%-99.6%. This range of sensitivity, at its most extreme value, led to a 32.5% underestimation of claims prevalence. Furthermore, because the electronic search developed two classification categories from a limited text field (approximately 20 words), only half of the cases had at least one classification. Systematic error estimates were used to obtain true population proportions for crash characteristics, revealing significant underestimations in costs. This analysis highlights the need for investigators to apply decision statistics to narrative text searching techniques when they are used essentially as diagnostic test procedures on insurance claims datasets.

Accidents, Occupational↗
PubMedDate not supplied

Statistical models of outcome in malpractice lawsuits involving death or neurologically impaired infants.

The objective was to determine whether factors could be identified in medical and legal records that are associated with the successful defense of obstetrical malpractice cases involving the death or neurological impairment of infants. Obstetrical claims (169) closed by PROMUTUAL between January 1, 1990, and December 31, 1994, were retrospectively abstracted and analyzed to identify associations between medical and legal factors, and the medicolegal outcome. Multivariable analysis identifies that the use of pitocin, diagnosis of asphyxia, a delay in delivery, and the use of multiple defense expert witnesses decreased the chances of a successful defense. Two statistical models explaining indemnity payment were developed. The first, based on medical outcome, showed an increased indemnity payment when a case involved major neurological deficits, diagnosis of asphyxia, newborn seizures, later year of delivery, and participation of a particular defense firm. Perinatal or childhood death and the use of pitocin were indicators of a decrease in payment. The second model was based on long-term care requirements. In this model, indicators of increased indemnity payment were: nonreassuring intrapartum fetal heart rate tracing, later year of delivery, intensity of long-term care required, and participation of a particular defense law firm. Perinatal or childhood death, the use of pitocin, and settlement date increasingly removed from the occurrence date were the determinants of decreased payments in this model. Finally, the presence of major neurological deficits, the prolongation of a case, and the involvement of multiple law firms and defense witnesses increased the expense charged to and paid by the insurance company. Using the medical, legal, and financial data relevant to 169 obstetrical cases closed by one malpractice insurance carrier between 1990 and 1994, statistical models with potential predictive values for future malpractice claims involving neurologically impaired infants were constructed. These models may help determine in advance the chance a future case has for successful defense and the likely amount of expense and indemnity dollars that will be paid out to settle and defend it.

Adolescent↗
PubMed1995

Melanoma skin cancer screenings. A how-to approach.

Development of a workshop on skin cancer screening should begin with physicians who are able to best diagnose and treat skin cancer, that is, dermatologists who are board certified or board eligible. Local societies should then be involved as well as organizations that can offer ancillary help such as screening, clinics' location and assisting with personnel financial aid, and exposure to the public, such as advertising. Support groups then become essential to a good screening. The help of the American Cancer Society, local churches, clubs, and others is beneficial. The organization should have a central organizing body that sets the dates and locations for the clinics and that helps get supplies, such as tables, screens for privacy, and literature. Volunteers can help with sign-in and sign-out sheets for the screening and can act as traffic directors and assist the physicians. Media exposure then becomes important. A TV or radio show can get the public's attention, for example, by releasing the latest data on skin cancer or by presenting a solar meter project showing the local risk of ultraviolet radiation. The workshop itself should begin on time. Additionally, a cutoff time is also needed. In the final stage, the forms should be processed and a follow-up evaluation should be done on the number of patients seen, precancerous and cancerous lesions found, and the potential for future functions. Popular ancillary aids are good literature on the subjects discussed, and samples of sunscreens (SPF 15 or better) that are donated by pharmaceutical companies.

Administrative Personnel↗
PubMed1992

Could your hospital benefit from an owner-controlled insurance program?

In summary, underwriters are reaching out to consider some construction projects that are traditionally too small to qualify for an OCIP (under $80,000,000). A hospital system with an ongoing capital expenditures budget in excess of $100,000,000 over any three-year period can group its construction projects together to meet the minimum qualifying amounts generally required by underwriters for the OCIP. The approach of wrapping up the coverage for all the contractors on-site into one policy makes good economic sense and is administratively manageable with the computer support systems available from some brokers today. The concentrated effort of loss prevention, coupled with the control factor of knowing how much insurance is available and the security of the insurer providing it, makes for a winning combination in addressing the unknown risk brought on by large construction projects at the hospital.

Contract Services↗