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Search results for "Legal and Policy Approaches"
- Legal and Policy Approaches
Journal Article > Study
Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, Bost P. JAMA. 2002;287:2951-2957.
This study examines the association between physicians’ patient complaint records and their risk management and malpractice experiences. A retrospective review of 645 physicians in a large U.S. medical group was performed. Both patient complaints and risk management events were higher for surgeons than nonsurgeons. Both complaint and risk management data were positively correlated with clinical volume. Risk management file openings, openings with expenditures, and lawsuits were significantly related to total numbers of patient complaints.
Journal Article > Review
Millenson ML. Qual Saf Health Care. 2002;11:57-63.
This article highlights the role of the news media in catalyzing the patient safety movement. The author maintains that the medical profession adopted an “ostrich-like attitude” toward medical errors prior to the intensified media coverage of high-profile mistakes. In the postwar era, trust in physicians was high, and the media profiled mainly scientific progress. In the past two decades, media coverage of medical mishaps has increased and changed the attitude toward patient safety. The author cites specific cases profiled in the media and the changes these cases prompted in the medical system, including a number of large-scale patient safety committees, projects, and landmark legislation.
Journal Article > Commentary
Studdert DM, Brennan TA. JAMA. 2001;286:217-223.
The authors from the Harvard School of Public Health describe a “no-fault” compensation system for medical injuries and errors, one that does not predicate compensation on proof of practitioner fault or negligence. They address cost concerns in implementing a no-fault system and the presumption that eliminating liability will dilute incentives to provide high-quality care. The authors describe the no-fault system in Sweden and outline its implementation in the United States. They postulate that such a system would encourage error reporting and could be linked to reforms that make institutions, rather than individuals, responsible for injuries to patients.
Learning from Bristol: The Report of the Public Inquiry into Children's Heart Surgery at the Bristol Royal Infirmary 1984–1995.
London, England: The Stationery Office; July 2001.
In June 1998, the Secretary for Health announced to Parliament the organization of a formal Inquiry into children's heart surgery at the Bristol Royal Infirmary between 1984 and 1995. Their objectives included understanding what happened in Bristol, assessing the quality of care and system failures that contributed to deaths, and generating lessons that could be learned for the entire National Health Service (NHS) in the United Kingdom. The inquiry was independent and not held as a legal proceeding, but provided a comprehensive investigation with interviews, expert panels, and a goal of driving improvement efforts. Section one of the report outlines pediatric cardiac surgical services in Bristol while section two focuses on recommendations to ensure high quality care across the NHS. Several publications resulted from the learnings of the Bristol inquiry, including a discussion of cultural entrapment and lessons for quality improvement.
Marx D. New York, NY: Columbia University; 2001.
Accountability is a concept that many wrestle with as they steer their organizations and patients toward understanding and accepting the idea of a blameless culture within the context of medical injury. Marx presents the concept from the legal perspective but does so for the non-barrister. Written prior to the acceptance of open disclosure or general policy support of it, the primer thoughtfully outlines the complex nature of deciding how best to hold individuals accountable for mistakes. Four key behavior concepts serve as the structure for the paper: human error, negligence, reckless conduct, and knowing violations. How they are applied to various situations in health care and how the individuals involved should be disciplined provide thoughtful reading.
Merry A, Smith AM. Cambridge, England: Cambridge University Press; 2001.
Merry, a New Zealand anesthesiologist, and Smith, a legal educator and a popular writer, explore the nature of medical errors. The authors suggest that most errors are due to systems factors, not moral lapses, and thus the tort system, which focuses on assigning individual blame, is an imperfect tool for dealing with these errors. The authors also summarize situations in which blame is appropriate and present concepts to help the reader discern the difference. This book will help readers understand the nature of medical error and the role of the legal system in patient safety.
Journal Article > Study
Studdert DM, Thomas EJ, Burstin HR, et al. Med Care. 2000;38:250-260.
The authors analyzed the relationship between negligent medical error and the filing of medical liability claims in a review of 15,000 hospital discharges in Utah and Colorado in 1992, a sample distinct in time and population from similar studies performed in California and New York. They reviewed each case for the presence of iatrogenic injury resulting from negligence and matched the set of cases against the medical malpractice claims filed in the two states. The authors find 97% of adverse events caused by negligence did not result in malpractice claims. Of the 18 malpractice claims in the sample, 14 were made in the absence of any negligence. Thus, the authors found almost no relationship between actual negligence and the filing of malpractice claims. The authors explore the relationships among poverty, advanced age, and a decreased likelihood of filing a claim and review options for comprehensive malpractice reforms.
Journal Article > Study
Kraman SS, Hamm G. Ann Intern Med. 1999;131:963-967.
This article reviews a humanistic risk management policy. The authors discuss principles of such a policy, including early injury review, maintenance of the hospital-patient relationship, full disclosure, and fair compensation for injuries. The experiences of one Veterans Affairs medical center are presented to illustrate the role a humanistic policy can play in controlling liability payments. The authors examine the complexity of embracing this proposed strategy while weighing the factors that lead to claims being filed. They conclude by suggesting that prioritizing patients’ interests may reduce expenses associated with malpractice claims.
The Girl Who Died Twice: Every Patient's Nightmare: the Libby Zion Case and the Hidden Hazards of Hospitals.
Robins NS. New York, NY: Delacorte Press; 1995. ISBN 0385308094.
Robins, an investigative journalist, recounts the story of Libby Zion, who died at New York Hospital in 1984 allegedly at the hands of under-supervised and overworked residents. The book is an interesting and engaging account of a case and its aftermath, including the highly publicized malpractice trial and the formation of the Bell Commission, which regulated resident work-hours for the first time. The book provides an important historical context for this case and the debate surrounding it, the implications of which are still being felt today in the wake of national regulations for resident duty-hours.
Journal Article > Study
Vincent C, Young M, Phillips A. Lancet. 1994;343:1609-1613.
The relationship between negligent care, malpractice claims, and adverse events does not tend to hold providers accountable for substandard care. In addition, a case study presented the tension between malpractice claims and patient safety initiatives with a series of proposed targeted reforms. This United Kingdom study surveyed 227 patients and relatives who were taking legal action and found that 70% were seriously affected by the incidents with long-term effects on work, social life, and family relationships. The respondents were also impacted by the unsatisfactory explanations from providers about their adverse event, including no assurance that it would be prevented in the future. The authors conclude that a "no fault" compensation system would fail to address all patient concerns involved in litigation decisions.
Journal Article > Study
Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III.
Localio AR, Lawthers AG, Brennan TA, et al. N Engl J Med. 1991;325:245-251.
Theoretically, the malpractice system is supposed to penalize substandard care. However, if the majority of claims brought against providers are filed for care that is not negligent, then the credibility of this system may be reduced. To address this issue, the Harvard Medical Practice Study examined the relationship between malpractice claims and true adverse events in patient care. The investigators linked clinical reviews of more than 30,000 inpatient records with statewide records of malpractice claims to determine the frequency with which negligent and nonnegligent medical care, as evaluated by physician reviewers, led to malpractice claims. They found that 1.53% of patients who had adverse events filed malpractice claims. The ratio of adverse events caused by negligence to malpractice claims was 7.6:1. The authors conclude that the malpractice system infrequently compensates patients injured by medical negligence and rarely holds providers accountable for substandard care.