Risk management issues related to the use of contrast agents.

The authors reviewed retrospectively 2,100 claims filed over an 11-year period in 12 hospitals in a large metropolitan area covered by a single insurance carrier. One hundred cases (5%) involved radiologists, and 10 of these were related to the use of contrast media. Four of the cases reached financial settlement before trial, three were dropped with no financial settlement before tribunal or trial, one was dropped after a tribunal finding for the defendants, and two were decided in favor of the defendants at trial. Multiple issues were raised by the plaintiffs in all 10 cases. The questions of quality of care and of informed consent were raised in 10 and nine cases, respectively. In the four cases that reached a financial settlement, quality of care was thought to be an important issue in three, whereas informed consent was not a key issue in any. Conversely, adequate informed consent was an important consideration in three of the six cases that were dropped. Screening of patients and documentation of risk factors, adverse events, treatment, and follow-up were also important factors in determining outcome. The authors conclude that legal claims relating to use of contrast agents are unusual, most often involve non-life-threatening outcomes, and in most cases do not result in trial or a financial settlement.

The advent of clinical standards for professional liability.

The development of clinically based written standards to reduce the frequency and severity of medical malpractice loss appears to be gaining in popularity among provider specialty groups and professional liability underwriters. To date, such standards have addressed problems in specialties such as obstetrics and anesthesia where dollar losses associated with malpractice claims have been high. Guidelines can be developed and used by providers on a purely voluntary basis or mandated on an involuntary basis by third parties such as malpractice insurance companies or legislators. Because the advent of risk-control standards is a relatively new phenomenon, formal scientific studies on the long-term benefits of such guidelines have not yet been published. However, it appears that sharp reductions of malpractice losses in specialties such as anesthesia have coincided with the implementation of formal written standards specifically designed for liability control. This has led some liability insurance carriers to decrease premiums associated with specialists following such standards. Many providers are understandably concerned about the potential use of written standards by plaintiff attorneys in medical malpractice suits. Although it is possible that such policies and guidelines could be admitted into evidence to show that a provider breached the legal duty or standard of care owed to a patient, it is uncertain whether these risk-control standards could ultimately pass the evidentiary rules of relevancy or materiality in a given lawsuit. It is clear, however, that the consensus-based process of creating clinical standards and guidelines specifically for controlling professional liability losses is itself a powerful and emerging standard for health care risk management programs.

An analysis of the Edelin case.

PIP: On February 15, 1975, Kenneth C. Edelin was found guilty of manslaughter after he performed an abortion on an patient who was 20 weeks pregnant. One of the biggest public issues was whether the subject of abortion was on trial. The verdict sent shock waves to various sectors of the medical and health care professions, with many medical professionals voicing support of Edelin. The Massachusetts Hospital Association, however, issued a memorandum stating that hospital administrators may wish to place new emphasis upon the limitations of abortion procedures and stated that hospitals may be more cautious about performing abortions after the first 20 weeks of pregnancy. A fear that both the medical community and the judiciary share is the growing and complex interwining of the law and medicine.^ieng