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Malpractice Cases (malpractice + case)
Selected AbstractsPlacing "Standard of Care" in Context: The Impact of Witness Potential and Attorney Reputation in Medical Malpractice LitigationJOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 3 2006Catherine T. Harris Previous empirical studies have speculated about the role that factors other than negligence play in the resolution of medical malpractice claims. The present study identifies and evaluates the impact of three "strategic variables" in the medical malpractice litigation process: the witness potential of the defendant physician, the witness potential of the plaintiff, and the reputation of the plaintiff's attorney. These factors, unrelated to standard of care, make a difference in the outcome of medical malpractice cases. Data were collected from insurance company files on cases filed in the North Carolina state courts between 1991 and 1995. Analyses revealed that when the insurers' outside (physician) reviewers rated liability as probable, based on standard of care, settlement occurred in most of the cases. However, when liability was rated as uncertain or unlikely, strategic variables such as perceived witness potential and the reputation of the plaintiff's counsel were significant predictors of case outcome. Cases in which the defendant physician had a strategic advantage were much less likely to settle, while cases in which the plaintiff had a strategic advantage were much more likely to settle. [source] Idealized design of perinatal careJOURNAL OF HEALTHCARE RISK MANAGEMENT, Issue S1 2006Faith McLellan PhD Idealized Design of Perinatal Care is an innovation project based on the principles of reliability science and the Institute for Healthcare Improvement's (IHI's) model for applying these principles to improve care.1 The project builds upon similar processes developed for other clinical arenas in three previous IHI Idealized Design projects. The Idealized Design model focuses on comprehensive redesign to enable a care system to perform substantially better in the future than the best it can do at present. The goal of Idealized Design of Perinatal Care is to achieve a new level of safer, more effective care and to minimize some of the risks identified in medical malpractice cases. The model described in this white paper, Idealized Design of Perinatal Care, represents the Institute for Healthcare Improvement's best current assessment of the components of the safest and most reliable system of perinatal care. The four key components of the model are: 1) the development of reliable clinical processes to manage labor and delivery; 2) the use of principles that improve safety (i.e., preventing, detecting, and mitigating errors); 3) the establishment of prepared and activated care teams that communicate effectively with each other and with mothers and families; and 4) a focus on mother and family as the locus of control during labor and delivery. Reviews of perinatal care have consistently pointed to failures of communication among the care team and documentation of care as common factors in adverse events that occur in labor and delivery. They are also prime factors leading to malpractice claims.2 Two perinatal care "bundles", a group of evidence-based interventions related to a disease or care process that, when executed together, result in better outcomes than when implemented individually , are being tested in this Idealized Design project: the Elective Induction Bundle and the Augmentation Bundle. Experience from the use of bundles in other clinical areas, such as care of the ventilated patient, has shown that reliably applying these evidence-based interventions can dramatically improve outcomes.3 The assumption of this innovation work is that the use of bundles in the delivery of perinatal care will have a similar effect. The authors acknowledge that other organizations have also been working on improving perinatal care through the use of simulation training and teamwork and communication training. IHI's model includes elements of these methods. The Idealized Design of Perinatal Care project has two phases. Sixteen perinatal units from hospitals around the US participated in Phase I, from February to August 2005. The goals of Phase I were identifying changes that would make the most impact on improving perinatal care, selecting elements for each of the bundles, learning how to apply IHI's reliability model to improve processes, and improving the culture within a perinatal unit. This white paper provides detail about the Idealized Design process and examines some of the initial work completed by teams. Phase II, which began in September 2005, expands on this work. This phase focuses particularly on managing second stage labor, including common interpretation of fetal heart monitoring, developing a reliable tool to identify harm, and ensuring that patient preferences are known and honored. [source] Defense of Breast Cancer Malpractice ClaimsTHE BREAST JOURNAL, Issue 2 2001FACOG, Samuel Zylstra MD Abstract: The goal of this study was to determine whether factors associated with the successful defense and cost of malpractice cases involving the failure to diagnose breast cancer could be identified in medical and legal records. Secondary goals were to develop a multidisciplinary clinical algorithm utilizing National Comprehensive Cancer Network (NCCN) practice guidelines with practitioner risk management strategies. Physician deviations from these guidelines were tracked to identify high-risk areas in the diagnosis of breast cancer. A multidisciplinary clinical algorithm was introduced and practitioner risk management issues were addressed. In this study specific medical, legal, and cost factors were retrospectively abstracted and analyzed to identify associations between medical and legal factors and medicolegal outcome. ProMutual handled 156 malpractice cases involving breast cancer between January 22, 1986, and November 20, 1997. Of the total, 124 cases involving 212 defendants were closed. The closed cases were analyzed, using multivariable stepwise logistic and linear regression, to identify associations between clinical factors and case outcome. Women's health practitioners (WHPs), including obstetrician-gynecologists (OB-GYNs), family medicine, and internal medicine clinicians, were the largest group of defendants (97). Others included radiologists (43), surgeons (33), and pathologists (3). OB-GYNs accounted for 31% of these defendants, with a cost of more than $16 million. The greatest number of specialists represented in the open cases were radiologists, with 38% of the total. The defense model predicts that the probability of successful defense is lessened with inadequate record keeping, a patient that has metastasis and is alive, and a delay in diagnosis of 12 months or more. The overall indemnity model predicts a higher indemnity with the spread of disease at the time of evaluation, a patient who has metastasis and is alive, and a date of occurence closer to the present. Indemnity is less in patients who have had a lymph node dissection, who have died, or who are alive without metastasis. The WHP model predicts an increased overall indemnity with the spread of disease at the time of evaluation and the presence of a mass without pain. Indemnity decreases with a history of pregnancy, absence of presenting symptoms, or presentation with pain with or without a mass, and the performance of a lymph node dissection. [source] AN AUDIT OF OPERATIVE NOTES: FACTS AND WAYS TO IMPROVE,ANZ JOURNAL OF SURGERY, Issue 9 2008Liviu P. Lefter Background: Accurate operation record keeping is an important element of risk management. Handwritten surgical notes are often produced as evidence in medico-legal malpractice cases and incomplete and illegible notes may be a source of weakness in a surgeon's defence. Therefore, we audited the surgical notes in a teaching hospital surgical department. Methods: During 1 week 190 operative notes were audited for patient identity details, preoperative diagnosis, operation title and details, CMB code, postoperative instruction and author of the note. The operative notes were assessed by a medico-legal lawyer and a medical expert to establish level of legibility and usefulness in a virtual court case. Results: Several operative notes were found incomplete (51.57%) missing important information as CMB code (13.68%), patient details (6.8%) preoperative diagnosis (6.31%), operation title (6.31%) and postoperative instruction (14.73%). Overall, only 92 notes were complete. Conclusion: This audit suggests that handwritten surgical notes generate several errors that could lead to confusion when notes are reviewed for further follow up or are produced as evidence in medico-legal disputes. [source] | ||||||||||