America's first medical malpractice crisis, 1835-1865

Prior to the early 1800's, medical malpractice was almost unknown in the United States. However, a large number of malpractice law suits inundated the courts between 1835 and 1865. About 70 to 90 percent of the litigation involved fractures and dislocations with imperfect results or deformities such as shortened or crooked limbs. Lawyers alleged that the physicians did not provide due proper care, skill and diligence despite the fact that the better surgeons tried to save limbs rather than follow the common practice of amputation, especially for compound fractures. While a number of texts dealt with medical jurisprudence, it was not until 1860 that a text on the subject intensively delved into the issue of medical malpractice. Coincidentally, the attitudes and behaviors of patients, lawyers, physicians and judges during the first medical malpractice crisis were surprisingly similar to those currently held.     

Dental malpractice: practical tips on avoiding a dental malpractice claim

With a few simple strategies, dentists can avoid the expensive trauma of malpractice litigation. Sometimes it's just a matter of maintaining good records.     

Revision of the medical malpractice law--legal aspects

Since the beginning of this century, modifications of the criminal law regarding medicine have been outlined frequently. The focus of these modifications was to eliminate the circumstance that each medical procedure is a criminal offense even if it was performed correctly and was successful. Treatment without consent was supposed to be punished. The draft recently submitted to the ministry of justice seems to be a failure. The prerequisites of an effective consent remain unclear. An incorrect information of the patient would be classified as intent and, thus, be punishable. By application of uncertain criteria, medical experiments and treatment procedures might be followed by excessive punishment.     

Stroke and malpractice claims

We describe 15 malpractice claims that were filed after the patients had strokes. Both embolic and thrombotic, sterile and infected strokes led to claims. Ten of the claims alleged physician failure to protect the patient, two alleged physician failure to react as called for by symptoms, and three were related to medication. We conclude that physicians should advise patients of the possibility of stroke when circumstances warrant it, as well as documenting their judgment and suggested preventive practices. These cases further suggest that treatment decisions supported by documented second opinions may reduce the number of malpractice claims for strokes.     

Expert testimony in malpractice suits

As part of his professional activities, every physician has the right, and--if he is appointed by a court of law as an expert witness according to sec. 407 ZPO, 75 StPO--even the duty to write expert opinions. An expert witness has the same privileges not to testify as any other witness. The expert opinion has to contain only information about the basics and the standards of the expert's field as well as informing about the necessity of each step of the medical treatment. He is not up to the expert to answer legal questions or decide the question of negligence. In case of a culpable violation of the duty to provide a correct expert opinion, there may result a liability for a wrong expert opinion.     

Individual malpractice insurance decisions revisited

Nurses' professional obligations to their patients include financial accountability. Whether nurses best provide this through self-insurance, coverage by an employer's insurance policy, or by purchase of an individual policy remains a personal decision. Changes in law and the health care market, however, should prompt a revisiting of this decision because the relative costs and benefits of each option may have changed. The pace of these changes, the unexpected consequences of some of the legal changes, and the individual differences in each nurse's situation may require seeking legal counsel to identify and evaluate the risk/benefits in that situation. The cost of that counsel may well exceed the cost of the policy premium.     

Pulmonary embolism and malpractice claims

BACKGROUND: Deep venous thrombosis (DVT) with pulmonary embolization (PE) often occurs as an unexpected event with fatal consequences. This provides a setting for malpractice claims. METHODS: We reviewed 160 consecutive malpractice claims submitted by attorneys for medical expert review during the 11-year period ending in 1997. Seven cases involved DVT with PE. RESULTS: Alleged failure to anticipate and reduce the chance of PE was the basis for six of the claims. All six patients were at risk for lower extremity DVT, and one had a history of DVT 6 months earlier. The PE was manifested by sudden death in three cases. The seventh case represented a complication of heparin therapy for PE. CONCLUSIONS: We conclude that risk management for PE should focus primarily on DVT. Physicians should perform and document an examination for DVT whenever there is a history of lower extremity stasis or it is likely to occur. They should also consider documenting a concurring second opinion when making anticoagulant-related decisions.     

The malpractice controversy and the quality of patient care

The widespread doctor strikes of 1975 stimulated belated attention to a crisis in malpractice insurance. Most state legislatures responded only to a shadow crisis in insurance as they rallied to the defense of health care providers. The smouldering substantive crisis--the reality of malpractice--is now galvanizing institutions and professions into aggressive activities for quality assurance and renewal of trust between patient and doctor. New procedural experiments offer prospects for preserving economy and equity by containing the causes of malpractice suits within the health care system itself.     

Arbitration agreements and your malpractice coverage

With new legislation and favorable case law developments, many providers of health care services are turning to binding arbitration agreements as a partial solution to the medical malpractice crisis. Existing data indicate tremendous advantages can be gained from the use of such agreements, if they are carefully drawn to comply with new law, tailored to the particular situation in which they will be used and coupled with appropriate procedures to secure the intended benefits. Arbitration is not a substitute for insurance, but if a provider has taken the calculated risk of forgoing insurance he should not be without a carefully drawn binding arbitration agreement.     

Tort of outrage in medical malpractice

Rats born of mothers fed a low protein diet (8% casein versus a normal 25% casein diet) starting 5 weeks prior to mating showed a 50-100% increase in protein synthesis in the brain and kidney on the day of birth. This effect was due to a 50-100% increase in the uptake of IP injected 14C-leucine in the malnourished rats. The proportion of total tissue radioactivity in the trichloroacetic acid-protein precipitates was the same in the 8% and 25% casein groups. For the most part, there were no significant diet related changes in uptake or incorporation of 14C-leucine in the brain, liver or kidney in the 8% and 25% casein groups on Days 5, 10-11 and 21. While the physiological basis of the diet related changes seen on the day of birth is unknown, the present data represent a previously undescribed effect of prenatal protein malnutrition.