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PubMed2002

Compensation for victims of trauma in the United States.

The awarding of damages in civil litigation is a basic element of the civil justice system in the United States. The system is not free of problems and controversy. Cases in which Posttraumatic Stress Disorder (PTSD) is the basis for a claim of damages pose specific problems in quantifying the harm done and attributing causation. This paper will provide an overview of the American civil litigation system and address some of the challenges confronted when PTSD and other emotional distress claims are made. In addition, it will discuss alternative methods for compensating victims of trauma that do not utilize the traditional civil litigation system.

Adult↗

PubMed2003

[Conflict situations in a hospital in the case of a civil lawsuit].

In the case of possible malpractice the physician is threatened with various legal proceedings. These may range from civil lawsuits including out-of-court settlement, independent evidential procedures (sections 485 et seqq.), criminal litigation and proceedings at the labour court to the withdrawal of the registration as a panel doctor. The annual number of civil lawsuits for damages, pain and suffering is estimated as approximately 10,000. In 35% of all cases expert commissions decide on malpractice; 85% are settled out of court so that 15% of cases proceed with litigation in a civil court. Of special importance to the physician sued in malpractice litigation is his pre-trial strategy. The present paper names the most important basic rules. The physician's failure to comply with these rules may result in severe penalties including the loss of malpractice insurance.

Conflict, Psychological↗

PubMed2005

Fat and the law: who should take the blame?

The incidence of obesity in both adults and children is rising at a rapid rate in most developed countries, including in Australia. Some obese people are seeking to place the blame for their condition on the fast-food industry, as demonstrated by the recent litigation in the United States brought by two obese plaintiffs against McDonald's. This litigation was unsuccessful, and on existing Australian negligence principles any similar litigation commenced here is likely to suffer the same fate. Principles of personal responsibility, autonomy and free will should prevail to deny a negligence claim. The risk of obesity and concomitant health problems from eating fast food to excess is an obvious risk which the plaintiff should not have ignored and which he or she has voluntarily assumed. It is for the Australian Government, not the courts, to regulate the behaviour of the fast-food industry. The government should take action by requiring all major fast-food chains to label their products with nutritional information, and by imposing restrictions on the advertising of food to children.

Australia↗

PubMed2006

Medico-legal liabilities of anesthesia practice in Saudi Arabia.

OBJECTIVE: The aim of this paper is to reveal the anesthesia malpractice claims that were referred to the National Medico-Legal Committee (MLC) in Riyadh KSA, in order to evaluate the magnitude and underlying factors of its medico-legal litigations. METHODS: The official records-including incidence, location, and final resolution of each claim-of all anesthesia-related medico-legal malpractice claims over the period attending from 1420-1424H (1999-2003 AD), were critically analysed. RESULTS: A total 1765 cases were referred to the various MLC over the five-year period. An increasing trend of the total number of yearly claims was observed with a sharp increase between 1422-1424H (2001-2003 AD). The private sectors and Ministry of Health services both contributed 90% of the total number of claims. Of the total number of claims, referred anesthesia-related malpractice claims consisted of 76 cases (3.8%) of which legal action against anesthesiologists was taken in 7 cases (9.1%). CONCLUSION: Of the anesthesia litigation claims, 9.1% resulted in positive legal action. More than one anesthesiologist may be involved for a given claim, and anesthesiologist may share partial responsibility with the surgeon in claims primarily targeting surgery or an incident of resuscitation. It is concluded that adherence to the standards of medical practice, is by far, the best policy to avoid or reduce the incidence of litigation.

Anesthesiology↗

PubMed1988

Psychological reactions to medical malpractice suits and the development of support groups as a response.

For doctors to cope with litigation effectively, it is critical that they obtain accurate information about the current climate of litigation. Despite the considerable evidence that the core issue is not one of gross physician negligence, there is still no substitute for the feelings of competence and self-confidence that derive from adherence to the highest standards of medical knowledge and care. When a suit occurs, these feelings are often the best antidote for the hurt and depressed feelings that almost always arise. It behooves the doctor to try to deal as effectively as possible with the symptoms and behavioral responses to litigation because of the subtle impact such changes have on doctor-patient relationships and patient care.

Adaptation, Psychological↗

PubMed1987

Medico-legal consultation: an expanded role of the tertiary neonatologist.

Between January 1982 and December 1984, the neonatologists at the University of Michigan Medical Center were asked to render 115 consultations regarding potential medical litigation. Requests for consultation were made by attorneys representing plaintiffs in 36 per cent of cases and defendants in 64 per cent (hospitals, 32 per cent, physicians, 30 per cent, private industry, 2 per cent). A review of these cases indicates frequently recurring themes, especially fetal distress, postdate pregnancies, and birth trauma among obstetrical cases, and neurologic injury, birth asphyxia, meconium aspiration, and hypoglycemia among neonatal cases. In many instances, incomplete documentation in the medical record and poor physician-patient communications were the issues leading to litigation. In 49 per cent of plaintiff cases reviewed, outcomes were felt not be related to the medical care rendered. Sixty-one per cent of defendant cases were felt to be strongly defensible; in 30 per cent of cases significant doubt as to defensibility existed. The physician practicing perinatal or neonatal medicine must be aware of the areas of vulnerability to malpractice litigation and the need for adequate documentation and patient communication. The daily activities of the tertiary neonatologist support his credentials as an expert medical witness in his specialty.

Academic Medical Centers↗

PubMed1987

The liabilities and consequences of medical device development.

A large increase in medical products liability litigation during the past 40 years has resulted in a flood of litigation against drug and device manufacturers. The medical technology and chemical industries are prime targets for products liability litigation. Physicians and other health care providers are willing to accept a reasonable degree of risk associated with the use of a medical product when compared to the benefit to be achieved by that product but lay juries are less likely to tolerate the concept of an acceptable failure rate. Plaintiffs' lawyers believe that the medical products industry should be held to a standard of absolute liability and that anyone injured by a medical product is entitled to recover without regard for the circumstances. Large compensatory and punitive damage awards, the high cost of insurance, large defense costs, and low profit margins have forced some companies to remove their products from the market. The medical or biomaterials manufacturer can significantly reduce its exposure for products liability by adopting a successful product safety program. Manufacturers have significant control over the quality, safety, and reliability of their products through appropriate design, testing, manufacture, labeling, and sale of quality products.

Biotechnology↗

PubMed1981

The role of the defense psychiatrist in workmen's compensation cases.

Tomorrow's psychiatrist should be more cognizant, competent, and comfortable in forensic science matters. Psychiatric cases are increasingly the subjects of litigation, but justice in the court depends on able advocacy by all parties. Advocacy for patient-plaintiffs is more similar to customary clinical roles than is advocacy for defendant insurance companies, which nevertheless are as needful of competent psychiatric experts as patient-plaintiffs if justice is to be done. Ironically, defense psychiatrist can do much to help patient-plaintiffs if they understand their roles correctly. Since legal systems are designed to produce justice, not therapy, the forensic competence of future psychiatrists will help to make litigation more therapeutic and just for patients. This paper describes the peculiarities of psychiatric work in litigated workmen's compensation cases, focusing on the role of the defense psychiatrist. We will highlight the constructive and therapeutically gratifying potentials of this work. Greater familiarity with the process will help to enlist the interest and participation of psychiatrist in workmen's compensation cases for the ultimate benefit of the patients and improvement of the legal system.

Expert Testimony↗

PubMed1993

Medicolegal analysis of errors in diagnosis and treatment of surgical endocrine disease.

BACKGROUND: The medicolegal impact of adverse events in surgical endocrine disease has not been described previously. This study was undertaken to determine the causes, costs, and outcomes of endocrine malpractice litigation. METHODS: Jury verdict reports from the U.S. civil court system from 1985 through 1991 were reviewed. Sixty-two malpractice cases were identified from 21 states. RESULTS: The 62 cases were classified into three categories, totaling 63 adverse events: (1) complications (n = 34, 54%) from thyroid (n = 32, 51%) or parathyroid (n = 2, 3%) surgery; (2) delayed diagnosis (n = 22, 35%) of thyroid cancer (n = 11, 18%), adrenal tumors (n = 9, 14%), and hyperparathyroidism (n = 2, 3%); and (3) medical morbidity (n = 7, 11%) from radioactive iodine (n = 5, 8%) or from propylthiouracil (n = 2, 3%). Surgical injuries, mostly recurrent nerve injuries by general surgeons, accounted for the greatest number of cases and the highest cost of litigation. CONCLUSIONS: Medical malpractice involving endocrine disease results in expensive litigation, a result of serious harm. Technical misadventures account for most cases, followed closely by delays in diagnosis. These data may aid design of risk prevention strategies in endocrine disease.

Costs and Cost Analysis↗

PubMed1997

Implications of mandating amended reports following retrospective review of Papanicolaou smears.

The Clinical Laboratory Improvement Amendments of 1988 requires a 5-year retrospective review of negative or normal smears in patients with diagnoses of high-grade squamous intraepithelial lesions or cancer, and amended reports are required when discrepancies that would affect current patient care are found. Notwithstanding the requirements of the Clinical Laboratory Improvement Amendments of 1988, one laboratory has been required by a State Department of Health to issue amended reports even when the discrepancy did not affect current patient care. The implications of notifying the patient and her physician of any discrepancy in a Papanicolaou smear may lead to media attention and litigation. This paper outlines how amended reports and/or correspondence to patients and physicians can be utilized to generate media attention and litigation and what laboratories can do to combat the litigation.

Facility Regulation and Control↗

PubMed2026

Immune Checkpoint Inhibitor-related Adverse Events in Publicly Accessible United States Malpractice Records: A Systematic Legal Database Review, 2015 to 2026.

OBJECTIVES: By 2023, an estimated 56.7% of US patients with advanced or metastatic cancer were eligible for immune checkpoint inhibitor (ICI) therapy. Grade 3 to 4 immune-related adverse events (irAEs) occur in ∼14% to 21% of patients depending on regimen, yet publicly accessible malpractice records involving ICI administration or irAE management have not been systematically described. METHODS: We searched Lexis+ and Westlaw Advantage for publicly accessible US malpractice records filed from January 1, 2015, through March 31, 2026. Sources included jury verdicts and settlement databases, federal and state dockets, and briefs, pleadings, and motions databases. Cases were included only when ICI administration, indication selection, toxicity counseling, toxicity recognition, toxicity monitoring, or irAE management was causally central to the alleged negligence. RESULTS: Among 38 legal matters identified after cross-platform deduplication, 4 met eligibility criteria. These matters reflected 4 pleaded negligence theories: inappropriate ICI indication, toxicity counseling and informed-consent failure, irAE mismanagement, and treatment-related multiorgan toxicity. Publicly visible irAE-centered malpractice records were rare relative to the clinical burden, but the data do not support a national litigation incidence estimate. CONCLUSIONS: Publicly accessible irAE-centered malpractice records appear rare. As ICI use expands, litigation risk may increasingly focus on indication documentation, individualized toxicity counseling, and structured monitoring.

immune checkpoint inhibitors↗

PubMed1998

Effects of pediatrician characteristics on management decisions in simulated cases involving apparent life-threatening events.

OBJECTIVES: To study variations in the way pediatricians would evaluate and manage an infant with an apparent life-threatening event. SUBJECTS AND METHODS: A survey was mailed to the chief residents of all pediatric residency training programs in the United States in which respondents were presented with a simulated case and asked how they would manage an infant who had experienced an apparent life-threatening event that did not require resuscitation. The survey also explored each physician's tolerance of uncertainty, knowledge of apparent life-threatening events, experience, fear of litigation, responsiveness to parental demands, and propensity to order tests. MAIN OUTCOME MEASURES: Presumed decisions to prescribe antibiotics and/or order home apnea monitoring in a simulated case of an infant who had experienced an apparent life-threatening event not requiring resuscitation. RESULTS: Logistic regression analysis revealed 2 characteristics that made significant and independent contributions to respondents' presumed decision to prescribe antibiotics: (1) experience with an adverse outcome, and (2) propensity to order diagnostic tests. Presumed decisions to order a home apnea monitor were notably affected by fear of litigation. CONCLUSIONS: These findings suggest that differences in pediatricians' characteristics contribute to variations in care. Efforts to make management more uniform must consider that decisions are influenced by a host of different characteristics and experiences.

Clinical Competence↗

PubMed2003

The National Resident Matching Program and antitrust law.

In May 2002, a group of physicians filed a class action lawsuit alleging that the National Resident Matching Program (NRMP) violates antitrust laws. The plaintiffs contend that NRMP practices have stabilized lower-than-competitive wages and imposed exhausting working conditions on residents. They also maintain that NRMP procedures virtually force applicants for house officer positions to forfeit their right to negotiate for better wages and conditions. The plaintiffs also allege that the defendants have collectively fostered anticompetitive accreditation standards through the Accreditation Council for Graduate Medical Education. Jung v Association of American Medical Colleges could present antitrust law with some difficult challenges. Although the matching program on its face appears to limit competition in a manner that previous cases have found illegal, it operates in the context of important professional activities (medical education and quality improvement) that may generate some judicial deference. At this early stage, no confident prediction can be made about the outcome of the case if it goes to trial; however, the plaintiffs appear to have a plausible case under existing antitrust doctrine, and lengthy litigation is possible. Given the important questions that the litigation will not address, such as the potential costs of a finding of illegality to the government and other payers, and the impact of such a finding on the health care system as a whole, a legislative solution seems highly desirable.

Antitrust Laws↗

PubMed2005

Association between compensation status and outcome after surgery: a meta-analysis.

CONTEXT: Compensation, whether through workers' compensation or through litigation, has been associated with poor outcome after surgery; however, this association has not been examined by meta-analysis. OBJECTIVE: To investigate the association between compensation status and outcome after surgery. DATA SOURCES: We searched MEDLINE (1966-2003), EMBASE (1980-2003), CINAHL, the Cochrane Controlled Trials Register, and reference lists of retrieved articles and textbooks, and we contacted experts in the field. STUDY SELECTION: The review included any trial of surgical intervention in which compensation status was reported and results were compared according to that status. No restrictions were placed on study design, language, or publication date. Studies were selected by 2 unblinded independent reviewers. DATA EXTRACTION: Two reviewers independently extracted data on study type, study quality, surgical procedure, outcome, country of origin, length and completeness of follow-up, and compensation type. DATA SYNTHESIS: Two hundred eleven studies satisfied the inclusion criteria. Of these, 175 stated that the presence of compensation (workers' compensation with or without litigation) was associated with a worse outcome, 35 found no difference or did not describe a difference, and 1 described a benefit associated with compensation. A meta-analysis of 129 studies with available data (n = 20,498 patients) revealed the summary odds ratio for an unsatisfactory outcome in compensated patients to be 3.79 (95% confidence interval, 3.28-4.37 by random-effects model). Grouping studies by country, procedure, length of follow-up, completeness of follow-up, study type, and type of compensation showed the association to be consistent for all subgroups. CONCLUSIONS: Compensation status is associated with poor outcome after surgery. This effect is significant, clinically important, and consistent. Because data were obtained from observational studies and were not homogeneous, the summary effect should be interpreted with caution. Compensation status should be considered a potential confounder in all studies of surgical intervention. Determination of the mechanism for this association requires further study.

Compensation and Redress↗

PubMed2005

Defensive medicine among high-risk specialist physicians in a volatile malpractice environment.

CONTEXT: How often physicians alter their clinical behavior because of the threat of malpractice liability, termed defensive medicine, and the consequences of those changes, are central questions in the ongoing medical malpractice reform debate. OBJECTIVE: To study the prevalence and characteristics of defensive medicine among physicians practicing in high-liability specialties during a period of substantial instability in the malpractice environment. DESIGN, SETTING, AND PARTICIPANTS: Mail survey of physicians in 6 specialties at high risk of litigation (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) in Pennsylvania in May 2003. MAIN OUTCOME MEASURES: Number of physicians in each specialty reporting defensive medicine or changes in scope of practice and characteristics of defensive medicine (assurance and avoidance behavior). RESULTS: A total of 824 physicians (65%) completed the survey. Nearly all (93%) reported practicing defensive medicine. "Assurance behavior" such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents' lack of confidence in their liability insurance and perceived burden of insurance premiums. CONCLUSION: Defensive medicine is highly prevalent among physicians in Pennsylvania who pay the most for liability insurance, with potentially serious implications for cost, access, and both technical and interpersonal quality of care.

Defensive Medicine↗

PubMed1995

Neurotoxic complaint base rates of personal injury claimants: implications for neuropsychological assessment.

This study reports base rate data for 113 family practice patients with no history of head trauma or toxic exposure, 68 family practice patients with a history of head trauma or toxic exposure, and 156 personal injury claimants with no history of toxic exposure or head trauma who presented for a psychological evaluation due to emotional distress. Personal injury claimants reported suffering from significantly more neurotoxic and neuropsychologic symptoms than subjects with a reported history of head trauma and/or toxic exposure. The authors urge that evaluating psychologists consider the base rate of these symptoms in litigating populations and use caution in relying on self-reported symptoms as evidence of injury when patients are in litigation.

Adult↗

PubMed1984

Severe neurological impairment: legal aspects of decisions to reduce care.

Decisions to reduce care for patients with severe neurological impairment may raise legal questions. The laws of most states now authorize physicians to stop care for those who have suffered irreversible cessation of all functions of the brain ("brain death"). Where state law is not explicit, it is nevertheless probably lawful to regard brain death as death for legal purposes so long as currently accepted criteria are satisfied. Several courts have ruled that it is lawful to reduce care for patients in vegetative states, but have prescribed differing standards and procedures for implementing such decisions. The issue of whether parents can authorize physicians to reduce care for neurologically impaired children is the focus of current litigation. Implicit in this litigation is the question of how severe neurological impairment must be before parents and physicians may lawfully agree to reduce care. For severely impaired but not vegetative adults, there is some legal authority to justify certain decisions to reduce care. The issue of whether withholding feeding from a severely demented patient with life-threatening medical problems constitutes criminal behavior is now being considered by a state supreme court.

Alzheimer Disease↗

PubMed1999

Not to worry: directors and officers claims can be managed.

Directors and officers claims have become more prevalent due to the employment litigation surge in this country. This article provides examples of real claims, offers suggestions in managing claims, discusses trends in litigation and provides recommendations for loss prevention.

Administrative Personnel↗