SEARCH · PubMed Health

Results for “Litigation”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,639 records · Page 91Linked to original sources

PubMed2005

Professional liability claims and Central Association of Obstetricians and Gynecologists members: myth versus reality.

OBJECTIVE: The purpose of this study was to survey members of the Central Association of Obstetricians and Gynecologists about professional liability claims. STUDY DESIGN: A survey was mailed to Central Association of Obstetricians and Gynecologists members regarding medical liability experience. RESULTS: Of the 897 surveys mailed, 73% were completed. The responding 658 clinicians had been in practice for 17,136 years and had 1507 closed claims. The respondents had a claim every 11 years of practice and a trial every 69 years. Matched for years of practice, a case control comparison indicated that the litigation is significantly lower for female physicians (1.5 +/- 1.8) than for male physicians (2.2 +/- 2.0; P = .019) although the mean cases that were dropped or dismissed were higher for men (1.3 +/- 1.7 vs 0.8 +/- 1.4; P = .022). However, the mean number of trials, defense trial verdicts, and the settlement amounts were similar for both genders. CONCLUSION: We found that professional liability claims are uncommon and that the gender of the obstetrician-gynecologist influences the litigation profile.

Adult↗

PubMed2005

Brachial plexus injury: a 23-year experience from a tertiary center.

OBJECTIVE: The purpose of this study was to analyze the data on brachial plexus injury and its relationship with shoulder dystocia from a tertiary center for a 23-year period. STUDY DESIGN: A review of the logbooks on labor and delivery and the nursery and the International Classification of Diseases codes identified all newborn infants with brachial plexus injury who were delivered at our center. RESULTS: During the 23 years (1980-2002), there were 89,978 deliveries, of which there were 85 cases of brachial plexus injury (1/1000 births) with vaginal delivery. The injury was permanent (> or =1 year) in 12% of the cases, and only 2 cases have been litigated. Newborn infants that weighed > or =4 kg were significantly more common among those infants who had shoulder dystocia and brachial plexus injury than those infants without injury (odds ratio, 6.55; 95% CI, 2.30, 18.63). The rate of permanent brachial plexus injury was similar between the 2 groups. CONCLUSION: A case of brachial plexus injury occurs 1 time in every 1000 births, is permanent in 1 of every 10,000 deliveries, and is litigated 1 time for every 45,000 deliveries. The infrequent nature of injury may preclude prevention.

Adult↗

PubMed2005

A plaintiff attorney's candid view of medical malpractice.

The human dynamics of medical malpractice litigation is more nuanced than many doctors suspect. The purpose of this article is to provide some candid insights into the process. The article presents three subjects that doctors are not likely to learn on their own, even if they read all of the law books or had the misfortune of running the gauntlet of their own medical malpractice lawsuit. Those subjects are: (1) the top five reasons why doctors get sued, (2) avoiding less than optimal legal representation, and (3) the importance of nonmedical issues in litigation.

Humans↗

PubMed2004

The relationship of workers' compensation to the Americans with Disabilities Act and Family and Medical Leave Act.

This article examines the intersection of workers' compensation laws with the Americans with Disabilities Act (ADA) and the Family and Medical Leave Act (FMLA). Much ADA and FMLA litigation stems from work-related injuries or illnesses. Knowledge of the ADA and FMLA may help prevent workers' compensation cases from resulting in costly employment litigation. Employees who are absent from work for a work-related condition often have rights under other laws, besides workers' compensation laws, such as the ADA and FMLA. Employers need to be cognizant of this while addressing these cases. First, the goals of state workers' compensation laws and the ADA and FMLA are reviewed. Then specific issues involving the intersection of workers' compensation, ADA,and FMLA are discussed.

Employment↗

PubMed2006

Screening mammography, public perceptions, and medical liability.

PURPOSE: To outline the most common sources of raising malpractice claims in screening mammography and to discuss the related medical litigation issues in the light of the evidence-based medicine. METHODS AND MATERIAL: Electronic and manual search of the relevant literature. RESULTS: The most common cause of malpractice is the delayed diagnosis of breast cancer. The plaintiff must establish that the radiologist was negligent and the delay in diagnosis caused injury to the patient. Literature shows that mammography does not always detect breast cancer, and even skilled radiologists may periodically miss malignant lesions. Also, delay in diagnosis does not always affect treatment and prognosis. Over-promotion of screening mammography has made disproportionately difficult for a defendant radiologist to prevail in a malpractice lawsuit. Thus, screening mammography is at stake, although it saves lives. The public and legal system should be educated about biological processes, medical practice, and the limitations of screening mammography. CONCLUSION: If mammography is to survive medical litigation and continue to save lives a major reform in public perception, in the stance of the mass media, and in the ability of legal system to understand medicine is required. Physicians and medical associations have an important role to play.

Attitude to Health↗

PubMed2006

Emergency contraception, abortion and evidence-based law.

Courts and legal tribunals increasingly decline to serve as religious or moral guardians, and require social evidence to support litigants' claims. Recent cases on emergency contraception and abortion are examined to show how judicial interpretations can take account of evidence of the impact that different understandings of the law will have for how ordinary people can plan their lives and reproductive choices. In an emergency contraception case, an interpretation was rejected that would have criminalized choices that millions of decent, law-abiding physicians, pharmacists and women routinely make. In an abortion case, three judges unanimously rejected a government ministry's defence of compliance with the law because the ministry had failed to investigate the needs within its jurisdiction for legal clarity, lawful services, and its responsibility to women returning from having lawful procedures elsewhere. In both cases, litigants prevailed who showed factual evidence that their claims better promoted reproductive health and choice.

Abortion, Induced↗

PubMed2005

Medical negligence: Can doctors and nurses still rely on the doctrine that they know best?

It is questionable today as to whether doctors know what is in the patient's best interest when it comes to delivering health care. This is further highlighted by changes in English law where the previously sound Bolam test has come under scrutiny as expert witness testimony is being contested in terms of its defensibility. Hence the Bolitho case has questioned the authenticity of expert knowledge in view of the Bolam test to the extent that opinion amongst expert groups may not in fact be based on sound current knowledge. As such this then has implications on the outcome of future litigations because expert opinion may well be open to scrutiny and logicality. Therefore, this article will discuss the development of medical negligence litigation since the inception of the Bolam test as a defence in medical law. It will also discuss Lord Woolf's warning to medical professionals that the courts would no longer apply a deferential 'Doctors knows best' doctrine in negligence cases. It will particularly look at the Bolam test and discuss whether this standing alone is a good enough defence in medical negligence.

Attitude of Health Personnel↗

PubMedDate not supplied

Presurgical biopsychosocial factors predict multidimensional patient: outcomes of interbody cage lumbar fusion.

BACKGROUND CONTEXT: Interbody cage lumbar fusion (ICLF) has been advanced to improve arthrodesis; however, little attention has been given to quality of life and functional outcomes. Studies suggest that psychosocial factors may be important modifiers of low back surgical outcomes. PURPOSE: To depict outcomes of ICLF surgery across multiple dimensions and to investigate presurgical biopsychosocial predictors of these outcomes. STUDY DESIGN/SETTING: A retrospective-cohort research design was used that involved completion of presurgical medical record reviews and postsurgical telephone outcome surveys at least 18 months after surgery. Presurgical variables included in a regression model were age at the time of surgery, spinal pathophysiology rating, smoking tobacco, depression, and pursuing litigation. PATIENT SAMPLE: Seventy-three patients received ICLF, and of those 56 patients completed the outcome survey an average of 2.6 years after surgery. OUTCOME MEASURES: Outcome measures consisted of arthrodesis status, patient satisfaction, back-specific functioning, disability status, and quality of life. RESULTS: Although arthrodesis occurred in 84% of the patients, nearly half were dissatisfied with their current back condition. Functional status was worse than expected, and 38% were totally disabled at follow-up. Regression analyses revealed tobacco use, depression, and litigation were the most consistent presurgical predictors of poorer patient outcomes. CONCLUSIONS: Overall, despite a high rate of arthrodesis, ICLF was not associated with substantial improvements in patient functioning. Presurgical biopsychosocial variables predicted patient outcomes, which may help improve patient selection and possible targeted interventions.

Arthrodesis↗

PubMed2003

The presentation of scaphoid non-union.

A retrospective study of 30 patients presenting with scaphoid non-union was performed. The results showed that eight had been treated in plaster for a mean of 6 weeks and discharged from follow-up. They presented with established non-union at a mean of 60.3 months after the original fracture. Three of these cases have resulted in litigation against the surgeon. A total of 27 patients underwent bone grafting and Herbert's screw fixation achieving in union in 24. The natural history of scaphoid non-union has been examined in some detail in the literature. These studies have shown that scaphoid non-union is inevitably associated with arthritic changes that become worse with time and that freedom from symptoms is not protective from these changes. Therefore, prompt diagnosis and treatment of scaphoid non-union is vital, whether symptomatic or not, to prevent osteoarthritis developing in the future. Inadequate follow-up of treated scaphoid fractures will result in delayed diagnosis and treatment of non-union with a potentially impaired outcome and even litigation against the surgeon. It is the authors' advice that all scaphoid fractures treated in a plaster cast are reassessed clinically and radiologically 6 months post-injury.

Adolescent↗

PubMed2003

Legal aspects of psychiatric nursing.

In attempting to practice within legal limits, psychiatric nurses must demonstrate safe and acceptable clinical practice. Clinical standards and legal standards change over time, and it can be difficult to be aware of all the changes that occur. Ways exist to minimize the risk of litigation, however. Keeping focused on the patient and attempting to provide the best clinical care possible should guide practice, not fear of litigation. It is wise to be familiar with the law, institutional policies, and professional standards, but nothing can replace sound clinical judgment.

Forensic Psychiatry↗

PubMed2003

Reduced medicolegal risk by compliance with obstetric clinical pathways: a case--control study.

OBJECTIVE: To estimate whether guideline compliance affected medicolegal risk in obstetrics and whether malpractice claims data can provide useful information on guideline noncompliance by focusing on the claims experience of a large health system delivering approximately 12000 infants annually. METHODS: We retrospectively identified 290 delivery-related (diagnosis-related groups 370-374) malpractice claims and 262 control deliveries at the health system during the period from 1988 to 1998. Clinical pathways for vaginal and cesarean delivery implemented in 1998 were used as a "standard of care." We compared rates of noncompliance with the pathways in the claims and control groups, calculated an odds ratio for increased risk of being sued given departure from the guideline standards, and calculated the elevated risk of litigation introduced by noncompliance. We also compared the frequencies of different types of departures across claims and control groups. RESULTS: Claims closely resembled controls on several descriptive measures (mother's age, location of delivery, type of delivery, and complication rates), but noncompliance with the clinical pathway was significantly more common among claims than controls (43.2% versus 11.7%, P <.001; odds ratio = 5.76, 95% confidence interval 3.59, 9.2). In 81 (79.4%) of the claims involving noncompliance with the pathway, the main allegation in the claim related directly to the departure from the pathway. The excess malpractice risk attributable to noncompliance explained approximately one third (104 of 290) of the claims filed (attributable risk = 82.6%). There were no significant differences in the types of deviation from the guidelines across claims and control groups. CONCLUSION: In addition to reducing clinical variation and improving clinical quality of care, adherence to clinical pathways might protect clinicians and institutions against malpractice litigation. Malpractice data might also be a useful resource in understanding breakdowns in processes of care.

Adult↗

PubMed2001

Medicolegal aspects of testicular torsion.

OBJECTIVES: Testicular torsion is an active area of medical malpractice litigation because of the diagnostic uncertainty, delays in diagnosis and treatment, diagnostic errors, and resultant testicular loss. We reviewed this topic to determine the nature of patient claims and their clinical and legal outcomes. METHODS: All closed case files of a large medical malpractice insurance company based in New Jersey involving testicular torsion from the years 1979 to 1997 were retrospectively reviewed. The following data were collected: patient demographics, timing of presentation, initial complaints, diagnosis given, consultations obtained, radiographic studies, treatment provided, outcomes, and indemnity payments. RESULTS: Thirty-nine cases consisting of 58 individual claims were reviewed. Indemnity payments were made in 26 cases (67%), of which 25 (96%) were settlements, and 13 cases (33%) ended in favor of the physicians. Five cases went to trial, with only one verdict in favor of the plaintiff. The median indemnity payment was $45,000. Urologists were named most frequently (48%), and a misdiagnosis of epididymitis (61%) was most commonly cited. The mean patient age was 24.3 years. Atypical initial complaints were common (46%). Late presentation (greater than 8 hours) did not affect the medicolegal outcome. The major liabilities for paid claims were an error in diagnosis (74%), a delay in or lack of referral (48%), lack of radiologic examination (19%), failure to explore (13%), error in surgical technique or judgment (13%), and falsified records (10%). CONCLUSIONS: Testicular torsion litigation most often focuses on the urologist. Claims are more common in older patients and those with atypical complaints. Settlement is the most common outcome, with a fairly standard indemnity payment rewarded. The initial treating physician must have a high index of suspicion for the diagnosis and refer promptly. In lieu of a definitive radiologic study, or when the diagnosis is in question, the urologist should strongly consider exploration and should perform contralateral exploration when torsion is found.

Adult↗

PubMed1979

Common misconceptions.

Certain misconceptions about the law are common among physicians. The purpose of the legal system is to resolve disputes rather than dispense "justice." The rules of law are neither stable nor clear. Truth cannot be recovered for purposes of litigation; therefore, the evidence alone must determine the merit of a case. Many factors other than merit may also contribute substantially to the outcome of litigation.

Humans↗

PubMed2002

Toxicogenomics and toxic torts.

One of the first practical applications of toxicogenomics will probably be in the context of toxic tort personal injury litigation. Gene expression changes that'fingerprint' exposure to particular classes of toxic substances can potentially be used to demonstrate exposure, prove causation and support novel damage claims in lawsuits brought by citizens injured by toxic exposures. Although the potential use of toxicogenomic data in toxic tort litigation is immense, there is a danger of premature use of such data before they have been adequately validated and characterized.

Causality↗

PubMed1988

Post-traumatic neck pain: a prospective and follow-up study.

Three hundred fifty-one alert emergency department patients with post-traumatic neck pain were evaluated prospectively. Seven (2%) had proven fractures or ligament disruptions. The immediate onset of neck pain and the presence of posterior midline cervical tenderness each had 100% sensitivity, with specificity of 65% and 48%, respectively. Discharged patients were followed up by telephone or letter at a mean of 25 +/- 20 weeks. Of this group, 63% saw another physician, and 43% had persistent moderate-to-severe neck pain or neurologic symptoms at a mean follow-up time of 24 weeks after injury. Of those who had not had a cervical radiograph while in the ED, 52% later obtained one. In addition, 66% of the discharged patients were pursuing litigation. The results suggest that it may be possible to identify alert patients with cervical spine injury by means of history and examination only; however, a larger study confirming these results is required. The high frequency of post-ED radiography, the high prevalence of persistent symptoms after injury, and frequent involvement in litigation are factors to be considered when evaluating ED patients with post-traumatic neck pain. These factors may support the validity of obtaining cervical spine radiographs on many more of these patients than high-yield criteria would dictate.

Adult↗

PubMed1996

Analysis of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act.

STUDY OBJECTIVE: To identify the incidence of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act (COBRA). METHODS: Under the Freedom of Information Act, we retrieved a copy of any document related to fines imposed on, settlements made by, or litigation against physicians or hospitals as a result of COBRA violations from the Office of the Inspector General. Under a separate inquiry, also under the Freedom of Information Act, we requested and received from the central office of the Health Care Financing Administration the National Composite Log showing the status of all complaint investigations pursuant to COBRA since the inception of the law. RESULTS: One thousand seven hundred fifty-seven complaint investigations were authorized. Of the 1,729 investigations completed, 412 (24%) were found to be out of compliance with federal regulations. Of these, 27 cases resulted in fines imposed on hospitals. These fines ranged from $1,500 to $150,000 with a mean of $33,917, a median of $25,000, and standard deviation of $35,899. The six fines that were imposed against physicians ranged in value from $2,500 to $20,000 with a mean of $8,500, a median of $7,500, and an SD of $8,612. Seven hospitals but no physicians were terminated from the Medicare program for COBRA violations. CONCLUSION: The incidence of federally imposed penalties for COBRA violations is low given the multitude of patient transfers that have occurred since the enactment of COBRA. The growing concern regarding this issue may be related to current litigation efforts to broaden the scope and applications of these laws.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2003

Immunization of pregnant women: reproductive, medical and societal risks.

Establishing successful vaccine programs for pregnant women would be the quintessence of preventive medicine when you realize the preventive potential for reproductive problems of many of the new and old vaccines. The development of vaccines to prevent maternal, fetal and newborn disease is actually in its infancy. The risks and benefits are discussed in detail as well as the most appropriate and inappropriate time to immunize women of reproductive age and pregnant women. The great majority of risks are theoretical, but the problem is that birth defects and other developmental and reproductive problems are in the group of "diseases of affliction" which means that there are tremendous emotional upheavals in families affected with serious reproductive problems. The failures in reproduction are so common that immunization of a pregnant women has potential deleterious consequences. A consortium of government, academia and industry must work together and an appeal to the more responsible members of the law profession to solve the problem of non-meritorious litigation has be in place before manufacturers of vaccines will be willing to initiate the development of new vaccines. The potential for reducing the incidence of birth defects, prematurity and neonatal infectious disease exists, but it will be difficult to initiate these programs because vaccine makers may be unwilling to assume an additional burden of negligence litigation. Certainly, it is clear that we could provide a safe vaccine for Group B streptococcus and infant botulism that would be of immediate benefit and the potential for reducing other diseases is realistic. This is not going to be an easy task.

Adult↗

PubMed2001

Financial compensation for radiotherapy-related adverse events in a judicial system where proof of medical negligence is not required.

PURPOSE: To examine the frequency of adverse events related to radiation therapy that lead to financial compensation in a judicial system that is not based on litigation in court but on statutory insurance where proof of medical negligence is not required for obtaining compensation. METHODS AND MATERIALS: In Finland, an injured patient does not sue through the courts, but submits an insurance claim to the Patient Insurance Association. Proof of medical negligence is not required for obtaining compensation. We reviewed all filed claims associated with radiotherapy presented to the Patient Insurance Association from May 1987 to January 1999. During this time period, 1,732,000 patient visits to radiation therapy units were made, and the estimated number of radiotherapy treatments was 86,600. The data collected included descriptions of the adverse events, examination of the radiation therapy procedures followed, assessment of the causal relation of the event to radiotherapy by the therapists involved and by independent reviewers, and the sums used for compensation. RESULTS: Only 102 patients (about 0.1%) had filed a claim for financial compensation, and in 18 (0.02%) cases the claim led to compensation. The mean national annual expenditure used for compensation was $35,200, and the sums paid in single cases ranged from $310 to $287,430 (median, $1,970). The expenditure used for compensating adverse radiation events was about $4 per treated patient, which is about 0.3% of all radiation therapy costs. CONCLUSIONS: The frequency of radiation therapy injuries that are financially compensated can remain low in an insurance-based judicial system where no litigation or attorneys are involved.

Adult↗