Medical Malpractice Liability Exposure and OB/GYN Physician Delivery Decisions.

OBJECTIVE: This study examines the effect of physician medical malpractice liability exposure on primary Cesarean and vaginal births after Cesarean (VBACs). DATA SOURCES/STUDY SETTING: Secondary data on hospital births from Florida Hospital Inpatient File, physician characteristics from American Medical Association Physician Masterfile, and physician malpractice claim history from Florida Office of Insurance Regulation. STUDY DESIGN: Our study estimates the effects of physician malpractice liability exposure on Cesareans and VBACs using panel data and a multivariate, fixed effects model. DATA COLLECTION: We merge three secondary data sources based on unique physician license numbers between 1994 and 2010. PRINCIPAL FINDINGS: We find no evidence that the first malpractice claim affects primary Cesarean deliveries. We find, however, that the first malpractice claim decreases the likelihood of a VBAC (conditional on a prior Cesarean delivery) by 1.2-1.9 percentage points (approximately 10 percent relative to mean VBAC incidence). This finding is robust to focusing on obstetrics-related malpractice claims, as well as to considering different malpractice claims (first report, first severe report, and first lawsuit). CONCLUSIONS: Given the increase in both primary and repeat Cesarean deliveries, our results suggest that physician malpractice liability exposure is responsible for a relatively small share of the VBAC decrease.

U.S. State Driving Regulations Relevant to Foot and Ankle Surgeons.

The effect of lower extremity pathology and surgery on automobile driving has been a topic of contemporary interest, because these conditions can be associated with impaired driving function. We reviewed the U.S. driving laws relative to foot and ankle patients, for the 50 U.S. states (and District of Columbia). We aimed to address the following questions relative to noncommercial driving regulations: does the state have regulations with respect to driving in a lower extremity cast, driving with a foot/ankle immobilization device, driving with acute or chronic lower extremity pathology or disability, those who have undergone foot and/or ankle surgery, and those with diabetes? Full state-specific answers to the preceding questions are provided. Most states had no explicit or specific regulations with respect to driving in a lower extremity cast, a lower extremity immobilization device, or after foot and/or ankle surgery. Most states asked about diabetes during licensing application and renewal, and some asked specifically about lower extremity neuropathy and amputation. Most did not require physicians to report their patients with potentially impaired driving function (Pennsylvania and Oregon excepted) but had processes in place to allow them to do so at their discretion. Most states have granted civil and/or criminal immunity to physicians with respect to reporting (or lack of reporting) of potentially impaired drivers. It is our hope that this information will be useful in the development of future investigations focusing on driving safety in patients with lower extremity dysfunction.

[Delayed appendectomy because of diagnostic malpractice: Experiences of the Arbitration Board of the North German Medical Associations]. / Die durch Diagnosefehler bedingte Verzögerung der operativen Behandlung der akuten Appendizitis - Erfahrungen der Norddeutschen Schlichtungsstelle für Arzthaftpflichtfragen.

From 2000 to 2012, 447 panel proceedings concerning acute appendicitis were evaluated. 271 cases (57 %) were related to alleged diagnostic malpractice. This was confirmed in 176 cases (67 %). The following medical specialities were involved (m = quote of malpractice): general surgery 33 %, m = 51 %; paediatric surgery 3 %, m = 44 %; general practitioner and prehospital emergency services 24 %, m = 62 %; internal medicine 19 %, m = 70 %; paediatrics 13 %, m = 57 %; gynaecology 3 %, m = 91 %; urology 2 %, m = 17 %. The most frequent misdiagnosis was gastroenteritis (43 % in adults, 69 % in children), obviously based on the concomitant symptom of diarrhoea. Surgery revealed all stages of advanced appendicitis up to peritoneal sepsis, organic failure and death (n = 5). The evaluation of the files and the experts' reports of the 176 cases of diagnostic malpractice allowed to define the following basic failures, which led to unjustified delay of operation: careless history-taking, no or incomplete physical examination, no follow-up investigations, incorrect interpretation of the patient's complaints and clinical findings, no or incomplete documentation. Conducting a thorough investigation is essential to avoiding diagnostic malpractice. Internal analysis of failures or near failures may contribute to reducing the number of future cases of malpractice.

Obstructive sleep apnea: strategies for minimizing liability and enhancing patient safety.

OBJECTIVE: To characterize malpractice litigation regarding obstructive sleep apnea (OSA) and educate physicians on frequently cited factors. STUDY DESIGN AND SETTING: Analysis of the Westlaw legal database. METHODS: Jury verdict and settlement reports were examined for outcome, awards, patient demographic factors, defendant specialty, and alleged causes of malpractice. RESULTS: Out of 54 identified cases, 33 (61.1%) cases were resolved in favor of defendants, 12 (22.2%) via settlement, and 9 (16.7%) through jury award. Median settlement and jury awards did not significantly differ ($750,000 vs $550,000, P > .50). Age and gender did not affect outcome. Otolaryngologists and anesthesiologists were the most frequently named defendants. Forty-seven cases (87.1%) stemmed from OSA patients who underwent procedures with resultant perioperative adverse events. Common alleged factors included death (48.1%), permanent deficits (42.6%), intraoperative complications (35.2%), requiring additional surgery (25.9%), anoxic brain injury (24.1%), inadequate informed consent (24.1%), inappropriate medication administration (22.2%), and inadequate monitoring (20.4%). CONCLUSION: Litigation related to OSA is frequently associated with perioperative complications more than nonoperative issues such as a failure to diagnose this disorder. Nonetheless, OSA is considerably underdiagnosed, and special attention should be paid to at-risk patients, including close monitoring of their clinical status and the medications they receive. For patients with diagnosed or suspected OSA with planned operative intervention, whether for OSA or an unrelated issue, a comprehensive informed consent process detailing the factors outlined in this analysis is an effective strategy to increase communication and improve the physician-patient relationship, minimize liability, and ultimately improve patient safety.

Physician Liability and Social Responsibility Related with Medical Certificates / 이화의대지

Medical certificate, post-mortem examination or certificate guarantee their authenticity of the content through the article 233 of the criminal act. The article 233 of the criminal act states that if a medical or oriental medical doctor, dentist or midwife prepare false medical certificate, postmortem examination or certificate life or death, one shall be punished. To constitute the crime of issuance of falsified medical certificates, it is necessary for the contents of the certificate to be substantially contrary to the truth, as well as it is needed the subjective perception that the contents of the certificate are false. On the article 17 of the medical service act, no one may prepare a medical certificate, a report or certificate of postmortem examination to a patient or public prosecutor in a district public prosecutors' office, who conducts a medical service and has given the medical treatment or conducted the postmortem examination by him/herself: Provided that, such certificate or report may be issued for a patient without giving any medical treatment, if the patient has died within 48 hours after his/her last medical treatment, while if the medical doctor, dentist or oriental medical doctors who examined a patient or conducted a postmortem examination of the dead patient is unable to issue such certificate or report due to an inevitable cause or event, any other medical doctor, dentist or oriental medical doctor who works for the same medical institution, may issue such certificate or report based on the medical records of the patient.

Physician liability: the next big thing for personalized medicine?

Liability is likely to be a major driver for the future direction and implementation of personalized medicine, spurring the adoption of genetic tests and other pharmacogenomic technologies, in some cases appropriately, and in other cases prematurely or as inefficient defensive medicine. While all entities in the personalized medicine chain will face liability risks, physicians will be at the greatest risk owing to their lack of defenses, limited experience in dealing with genetics and the growing disparities within the profession in implementing new medical technologies. The history of liability for genetic testing, primarily in the prenatal testing context, suggests that liability will often be both unpredictable and influential in changing medical practice. It is critical to anticipate and attempt to prevent such liability risks in a proactive manner so to minimize the disruptive impact that liability can cause.

Out of court settlement of malpractice claims relating to the treatment of fractures in children: experience of the arbitration board of the North German Medical Associations.

BACKGROUND: The medical peer-review committees and arbitration boards of the Medical Associations of the individual German federal states assess claims for damages arising from alleged medical malpractice. METHODS: 189 panel proceedings concerning alleged malpractice in the treatment of fractures in children were evaluated on the basis of the available documentation and decisions. The proceedings were evaluated with respect to the involved medical specialties and treatment facilities, the types of fracture and particular allegations in each case, the actual malpractice found to have been committed (if any), and the harm resulting from malpractice. The cases were derived from the nine German states for which the North German arbitration board is responsible. RESULTS: An actual malpractice was found to have been committed in 64% of cases, or about twice as frequently as the average rate among all cases going before an arbitration board in Germany. Most of the medical errors involved inaccurate diagnostic evaluation, misinterpretation of radiological findings, inappropriate treatment for the particular type of fracture involved (conservative rather than operative, or vice versa), or inadequate follow-up of the fracture (or none at all). The highest rate of a positive finding of malpractice involved fractures in the elbow region (77%). A mild or moderate degree of permanent injury due to malpractice was found in 37 cases (31%) and severe permanent injury in 16 cases (13%). CONCLUSIONS: The appropriate treatment of fractures in children requires experience in clinical examination as well as knowledge of radiological anatomy and of the problematic fracture types and localizations. The results reported here should raise consciousness of the possibilities for medical error and thus help prevent future instances of malpractice.