1 THE MEDICAL MALPRACTICE MYTH THOMAS BAKER (University of Chicago Press, Chicago, Illinois, 2005), 214 pages, $ Reviewed by Mary Coombs, J.D., Miami, Florida.* Professor Thomas Baker s new book, The Medical Malpractice Myth, consists largely of a deconstruction of the beliefs that undergird the call for tort reform and impede the ability of the polity to focus on, and respond constructively to, the real problems of health care in twenty-first century America. This deconstructive project is very persuasively carried out. Professor Baker also offers some positive proposals for reform, designed to open a dialogue. Rising to this invitation, I suggest below some modifications to his proposals that might make them more politically feasible. DECONSTRUCTING THE MALPRACTICE MYTH The primary strands of the malpractice myth are the following: that many malpractice lawsuits are frivolous; that many plaintiffs obtain large judgments or settlements although the defendants did nothing wrong; and that, as a result of these lawsuits, doctors have been driven to waste substantial resources on defensive medicine, insurance premiums have skyrocketed, and good doctors have been driven out of the practice of medicine. The overall result: worse care for patients, demoralized doctors, higher costs of medical care, with no one
2 benefiting but a few greedy plaintiffs and the favored villain for this Administration, apart from terrorists trial lawyers. 1 Baker proceeds systematically, persuasively, often eloquently, to dismantle each of these myths, showing either that the alleged problem does not exist or its severity is overblown. Sometimes the alleged causal link between medical malpractice litigation and the problem is false or wildly exaggerated. The evidence cited in support of the myth is generally far weaker than its proponents acknowledge or is countered by other data. As for frivolous lawsuits, Baker concedes that many suits are dismissed by the plaintiff before trial but argues that such suits are not frivolous but, rather, are a consequence of health professionals refusal to meet their obligation when things go wrong to discuss with the patient or his family what happened. Patients may believe the best way to pierce the white wall of silence is through use of the discovery processes permitted when a lawsuit is filed. 2 If the facts thus unearthed indicate that there was no malpractice, the suit is dropped. Furthermore, multiple studies have indicated that the number of adverse events and even of malpractice 3 far outweigh the number of malpractice lawsuits. 4 Baker concludes the real problem is one of too much malpractice rather than too much malpractice litigation. When lawsuits do reach trial, malpractice plaintiffs are relatively less successful than plaintiffs in other kinds of litigation, undermining the claim that juries and judges unduly favor them. When plaintiffs do recover, through trial or by settlement, the amount of the recovery is best predicted by two factors: the
3 seriousness of the injury and the assessment by the malpractice insurance company s experts of the quality of the plaintiff s case. 5 The legal system, then, works as it should in most cases. 6 Its apparatus for truth-finding is different from that of the healthcare system so that doctors are often angered or discomfited by the process 7 -- but the outcomes are generally consistent. 8 With regard to defensive medicine, Baker first notes the difficulty of defining this term. Changes in medical practice in response to malpractice litigation are most clearly a problem if they provide no medical benefit to the patient. 9 As Baker points out, the Office of Technology Assessment informed Congress that they could not distinguish in any quantitative way between the good and bad effects of medical malpractice lawsuits.  Only two studies seemed to indicate that states tort law was significantly related to additional treatment that did not lead to improved health care outcomes in the relevant population. But, Baker argues, there are reasons to think that the benefits of tort reform found by Professors Kessler and McClellan, the authors of the most widely cited study, 10 are relatively slight and short-lived; and, more important, the attempt to generalize the result to other treatments and other populations is an implausible extension of the study results. More broad-based studies did not find evidence that the malpractice litigation system induces defensive medicine -- perhaps because the shift from fee-for-service to managed care provides a strong counter-force by restricting payment for practices that cannot be justified by the patient s health needs. Baker notes that, to the extent there is a problem with the use of tests and procedures that have little or no benefit, the right
4 solution is evidence-based medical management, not curtailment of patients rights to seek redress for iatrogenic incidents. [130-32] Professor Baker provides a particularly careful and nuanced study of the malpractice insurance market. 11 He notes that the periodic appearance of hard markets, in which insurance rates rise rapidly, is an artifact of the inherent volatility of those markets. Insurance regulations require companies to adjust their reserves annually to reflect their assessment of predicted losses. The long tail (the lengthy time from an act of alleged malpractice to final resolution), the relatively large amounts at stake in many claims, and the inflation in health care costs that can increase the potential damages going forward make it difficult for insurance companies to accurately predict their ultimate exposure. These uncertainties, coupled with the need for actuarial conservatism, periodically lead to sharp increases in required reserves and a consequent spike in premiums. The supply of doctors in general responds much more to focused incentives, such as financial support for medical school education, than to indirect effects of the litigation system. [142-43]. There is a problem of too few doctors in rural areas because the potential income for such doctors is so much lower than elsewhere. Any significant cost, including malpractice premium increases, will exacerbate this problem. There may be a similar marginal effect for those, such as older doctors, whose commitment to continuing in practice is less strong in any event, or younger doctors making choices of location and practice specialty. The one area, Baker acknowledges, where malpractice seems to affect substantially physician s practice decisions is obstetrics. Some
5 doctors leave obstetrics, concentrating the practice in the hands of a smaller number of physicians. However, this may improve the quality of care, since the remaining physicians will be more experienced.  As Baker notes, there is anecdotal but little hard evidence of any significant decrease in access to care as a result of malpractice litigation. 12 As with malpractice insurance premiums and defensive medicine, there is a real problem, though less severe than presented by the proponents of the myths. More important, changing the rules for medical malpractice litigation is, at best, a highly inefficient way of responding to these problems and distracts from the need to find and develop political support for real solutions. None of this is likely to be news to the readers of this journal. But readers of this journal are not the primary audience for the book. Rather, Baker describes his goal as reframing the public discussion about medical malpractice lawsuits by shin[ing] so much sunlight on the.. myth that doctors and other people who care about health care cannot help but see what a misleading picture it presents.  Thus it would seem that one significant audience is those politicians and opinion leaders who have simply accepted the myths that he challenges. IS BAKER S PROJECT LIKELY TO SUCCEED? It is difficult to predict what effect this book might have in the real world of policy development. I sense a tension between two Tom Bakers. One, an earnest optimist, writes this book in the hope that those pushing misdirected tort
6 reforms might be turned around by the truth. The other, more realistic and cynical, whom I find more persuasive, recognizes that politicians and the leaders of special interest groups propagate and use these myths knowingly. 13 I also doubt that many in the general public will read this book, be shaken out of their strong but erroneous beliefs, 14 and pressure the politicians to abandon their tort reform agenda. Nor does it seem likely that the medical profession can be moved. Physicians, too, have entrenched views that are unlikely to be changed merely by the provision of contradictory facts. 15 However, if fact-based argument were combined with proposed reforms that resonate better with the concerns of the medical profession, it might be possible to displace the bad reforms that the institutional medical profession has been supporting. 16 As Professor Baker recognizes, there are a number of reasons why the medical profession has accepted so much of the myth. First, malpractice litigation itself is experienced as upsetting in ways that are not true for other forms of litigation. [D]espite its veneer of scientific precision, medicine is a field in which success depends largely on experience and judgment. 17 Physicians find it difficult to acknowledge the uncertainties of medical choices and the unavoidability of what turn out to be bad choices or true mistakes. 18 Baker terms the processes that project these anxieties outward onto the tort system blame displacement and fear displacement. [15-16] Perhaps because of this hostility, physicians readily believe the myths about the harms that malpractice litigation causes. These beliefs are reinforced by their colleagues and their professional associations; and doctors, like the rest of us, tend to absorb most readily from the
7 media those stories that confirm their worldview. While Baker acknowledges that doctors fear and anxiety deserve our attention, even if they are out of proportion to what the research shows,  I think we need to pay more attention to the genuine, if not wholly rational, reasons for physicians hostility if we are to get traction for more effective reform. THE CONFUSIONS OF TERMINOLOGY Among the most difficult, but important, issues we must confront, both to make the patient safety movement effective and to reduce physician hostility, is terminology. Numerous writers have recognized the difficulty of carefully defining and distinguishing among such concepts as bad outcome, adverse event, medical error, and negligence. 19 Failure to do so makes it very difficult to collect the kind of data that allows for effective change or to compare the results of different studies, as Baker notes in discussing the various studies on which he relies to demonstrate the extent of the problem of medical error. Despite his care to speak precisely, 20 Professor Baker sometimes uses the term malpractice as his shorthand for this congeries of issues or otherwise writes in ways that are likely to evoke the ire of physician readers, such as when he asserts that [t]he problem is not that there are too many claims; the problem is that there are too few.  There is no simple answer here; the concepts for which we seek descriptive language are inherently slippery. One problem is that we generally consider an adverse event to be an error only if it is preventable. However,
8 hindsight bias makes it difficult to determine if a bad outcome was reasonably foreseeable and thus preventable. Second, we use the same terminology to talk about a series of actions prospectively, for purposes of possible corrective action, and retrospectively, to decide if a particular outcome was the result of error. Finally, concepts like adverse event are statistical, yet lay readers may translate them to proof that this particular bad outcome could have been avoided. I have no answer to these problems; I only note that we should be sensitive to the potential for misuse of such language as mistake or error or adverse event by the media and others, 21 and to the foreseeable and not unreasonable sensitivity of the medical profession to the conflation of different concepts through the confusions of terminology. MAKING BAKER S REFORMS MORE PALATABLE In light of the above concerns, I want to briefly examine three of the reforms that Professor Baker proposes and suggest how they might be modified to increase their acceptability to the medical profession (and thus their political plausibility), their effectiveness in advancing patient concerns, or both. 22 Professor Baker s reform proposals include mandatory disclosure of medical misadventures to patients and to state agencies. Baker tends to blend the two, using the same standard to define what should be disclosed in both contexts. I think, however, that for both substantive and political reasons, they should be carefully distinguished.
9 Mandatory Disclosure to Patients Baker s proposed disclosure obligation to patients is extensive and the sanctions for failure severe. Every adverse or possibly adverse healthcare event must be disclosed to the patient orally and in writing, including: what happened, what the preferred outcome would have been, how what happened differed from this, and what the provider making the disclosure or others could have done differently to increase the chance of getting the preferred outcome. Any provider who does not disclose or get written proof that another person had done so and that the patient received and understood the disclosure would be deemed negligent in any subsequent lawsuit. [159-60] Baker correctly notes that his mandate for full disclosure is consistent with and reinforces the medical profession s ethical edict to inform the patient of all the facts necessary to ensure understanding of what has occurred, [regardless of] legal liability which might result following truthful disclosure. 23  He also recognizes that the disclosure may provide the basis for the patient, presumably together with his or her attorney, to decide what steps to take.  As Baker and others have noted, effective communication between physician and patient is essential, at all stages of the relationship. Indeed, key predictors of whether someone will bring a malpractice claim are patient dissatisfaction with physicians communication and interpersonal skills. 24 Apart from the normal human reluctance to admit error or to talk about things that go wrong for which one feels some responsibility, physicians have understandable reason to avoid any obligation to disclose. Many of them lack the natural ability
10 or the training to effectively communicate difficult, complex information, especially to patients who are likely to be both medically unsophisticated and under stress. 25 Partly because of the complexities of terminology noted above, there is a legitimate concern that the communication will be misunderstood. Might patients misconstrue their expressions of concern as apologies for error? Might they misconstrue the term adverse event as a synonym for negligence, even if the complication experienced resulted from an inherent risk of a reasonable treatment choice? Before we reach for the heavy stick of presumptive liability, we should provide health care workers with the communication tools to minimize such misunderstandings, through special training or the support of hospital staff who are themselves better able to avoid these linguistic landmines. Mandatory Disclosure to State Agencies Professor Baker would require that the same data be disclosed to whatever state agency is, in effect, the patient safety organization, including a serious auditing requirement to ensure such disclosure. [160-61] He calls for strong enforcement measures on the reasonable assumption that disclosure will not occur simply from the good will of providers or a desire to improve the accuracy of claims of medical malpractice. 26 . However, effective disclosure for patient safety purposes cannot be defined ex post by the consequences. The key is risk-creating behavior, not harm-causing behavior.
11 Patient safety advocates realize that evidence-based analysis of systems failures requires consideration of near-misses as well as adverse events. 27 Furthermore, confidentiality and insulation from discovery not mentioned by Professor Baker -- are needed to induce such disclosure. Steps have been taken, including the recent Patient Safety and Quality Improvement Act of 2005, 28 to provide such protection. Baker is correct that disclosure will not reliably occur without a positive obligation of some sort, 29 but I believe that it also will not reliably occur without the carrot of confidentiality. The widespread belief among health care professionals and institutions that such disclosures are dangerous is itself a fact that must be taken into account. 30 Enterprise Liability Professor Baker also proposes the adoption of enterprise insurance, a scaled-down version of enterprise liability. He argues that the health care facility should provide liability insurance that would cover the physicians who practice there, as well as its own employees. This would directly affect only the insurance market (by providing the benefits of larger pools of insureds and experience rating), not the structure of subsequent tort litigation. 31 [67, 164] However, enterprise insurance will also almost surely create an incentive for hospitals (who are paying the premiums) to control physician behavior that threatens to increase the number and severity of compensable events. Indeed, Professor Baker recognizes this when he mentions that his proposal might make hospitals choosier about which doctors they allow to use their facilities. That
12 would be a very good thing. . It is unlikely to signficantly reduce the intense resistance of the medical profession to enterprise liability. 32 This might suggest that the only politically feasible position would be to oppose both enterprise liability and enterprise insurance. I think, however, that there may be an opportunity to move the medical profession by persuading them of how different tort litigation might be, with the shift to an enterprise liability system as the first step in such a transformation. 33 There has been a presumption that the patient safety movement and the medical malpractice system are conflicting cultures. As David Studdert presents the received wisdom, the punitive, individualistic, adversarial approach of tort law is antithetical to the systems-oriented, non-punitive, cooperative strategies of the patient safety movement. 34 If one assumes this conflict is inevitable, the question becomes deciding which system is best. But the choice is not this stark; the two approaches share some common ground. Perceptive proponents of the tort system recognize that its deterrence effects are necessarily indirect and rely on system changes of the sort the patient safety movement promotes, while perceptive proponents of patient safety acknowledge that the changes they advocate have often come in response to malpractice litigation. 35 The received wisdom assumes that the current structure of medical malpractice, with its focus on individuals, is inevitable. Consider, however, what malpractice litigation might look like if the defendants were healthcare institutions. The plaintiff s claim in most lawsuits would be not that doctor X
13 harmed me by failing to behave as a competent doctor should, but that institution Y failed to take the steps that a reasonable institution would take to train its staff or to institute systems (that the patient safety movement has shown are practicable) to sever the link between inevitable mistakes and harm to patients. Refocusing litigation on the institution largely eliminates the challenge to the reputation of individual physicians and thus can reduce the hostility of the medical profession generally and the resistance by individual physiciandefendants to the current system. 36 It would also reinforce the patient safety system. Such a modified malpractice system, focused largely on challenging failures to implement patient safety systems, 37 might better advance all the goals of the tort system: to provide compensation for those who have been injured by medical error, to induce changes in the health care system (the deterrent effect of tort law), and to provide corrective justice between the injured patient and the system that failed him or her. It also can draw on deep parallels to another area of tort law, products liability, in which the focus is not on individuals and frequently not on particular, blameworthy behavior but, rather, on the institutional decisions that unreasonably risk the safety of consumers. CONCLUSION The debates over what to do about medical malpractice are complex andlongstanding. I hope that Professor Baker s analysis and proposals, and my own responses to them, will be seen as offering some fresh ideas and perspective, but the problems will not readily be solved and the debate will go on.
14 The key value of Professor Baker s book, in my view, is that it can elevate the debate and make it more rational and reality-based by chipping away at the myths that obscure understanding and block meaningful collaboration on solutions. If we can move toward debates in which lawyers, doctors, insurance professionals, economists, scholars, and others with a genuine interest in improving the system talk among ourselves rather than shouting impossibly conflicting positions at each other, perhaps some real progress can be made. Not only will the medical and legal systems be improved but, more important, patients who come in contact with these systems will benefit. It is a goal both Professor Baker and I share. * * * * * * Professor of Law, University of Miami School of Law, Coral Gables, Florida. Address correspondence to Professor Coombs at P.O. Box , Coral Gables, FL , or via at 1 While a variety of groups have promulgated these myths, Baker uses as a framing device a speech by President Bush in January 2005 presenting a number of these myths as facts and citing them as the basis for the need to fix a broken medical liability system.  [Ed. Note: Numbers in brackets herein refer to pages in the Baker text.]
15 2 [81-87] Baker here relies significantly on Henry Farber & Michelle White, Medical Malpractice: An Empirical Examination of the Litigation Process, 22 RAND J. ECON. 199 (1990). 3 See note 19 infra and accompanying text. 4 See DON HARPER MILLS, ED., REPORT ON THE MEDICAL INSURANCE FEASIBILITY STUDY (1977); Troyen Brennan et al., HARVARD MEDICAL PRACTICE STUDY, PATIENTS, DOCTORS, AND LAWYERS: MEDICAL INJURY, MALPRACTICE LITIGATION AND PATIENT COMPENSATION IN NEW YORK (1990); Ross Wilson, William Runciman et al., The Quality in Australian Health Care Study, 163 MED. J. AUSTRALIA 458 (1995); Lori Andrews, Studying Medical Error in Situ: Implications for Malpractice Law and Policy, 54 DEPAUL L. REV. 357 (2005). 5 Recoveries in cases where the defense experts believed care was appropriate were generally small and, thus, cheaper than the costs of litigation, while even in cases assessed as strong on the evidence, insurance companies generally settled only after plaintiffs hired lawyers and pressed for such compensation. [78-81] 6 Baker persuasively demonstrates the defects in the one contrary study. See Thomas Baker, Reconsidering the Harvard Medical Malpractice Study: Conclusions about the Validity of Medical Malpractice Claims, 33 J. L., MED. & ETHICS 501 (2005).
16 7 The negative reaction is not irrational. Legal practice, unlike medicine, does not purport to be a search for abstract truth but, rather, for a plausible, supportable story that is consistent with one s client s position. See, e.g., Professor Baker s recounting that the visiting lawyers in a medical malpractice case told his torts class that, for strategic reasons, they had constructed their case as one in which the hospital, not the delivering doctor, was liable but, if we had to prove she caused the harm, we could have. Baker, supra note 1, at Academic studies have shown a high degree of agreement between juries and medical experts presented with the same information. See Catherine Struve, Doctors, The Adversary System, and Procedural Reform in Medical Liability Litigation, 72 FORDHAM L. REV. 943, (2004). 9 A practice is also undesirable, defensive medicine, if the costs clearly outweigh the potential benefits, but this calculation is still more complicated. 10 Daniel Kessler & Mark McClellan, Do Doctors Practice Defensive Medicine?, 111 Q TLY. J. ECON. 353 (1996)(describing a study of treatments for heart disease in elderly patients in states with and without tort reform). There was also some evidence of a modest effect on C-section rates from perceived malpractice litigation risks. A. Russell Localio et al., Relationship between Malpractice Claims and Cesarean Delivery, 269 J.A.M.A. 366 (1993).
17 11 His analysis here draws on his excellent and more detailed article, Thomas Baker, Medical Malpractice Insurance and the Insurance Underwriting Cycle, 54 DEPAUL L. REV. 393 (2005). 12 Baker relies here on an earlier version of Katherine Baicker & Amitabh Chandra, Defensive Medicine and Disappearing Doctors?, 28 REGULATION 24 (2005). 13 This is, after all, an Administration that faulted its critics for living in the realitybased community, because, it asserted, when we act, we create our own reality. Ron Suskind, Without a Doubt, N. Y. TIMES MAG. 44 (Oct. 17, 2004) (available at last visited Mar. 8, 2006).. 14 Baker notes part of the problem is the phenomenon of cognitive dissonance. [42-43] Once we believe something is true, we tend to perceive and believe those things that reinforce what we already know and overlook, dismiss, or undervalue contradictory inputs. See LEON FESTINGER, A THEORY OF COGNITIVE DISSONANCE (1957). 15 See, e.g., William Sage, Reputation, Malpractice Liability and Medical Error, in VIRGINIA SHARPE, ED. ACCOUNTABILITY: PATIENT SAFETY AND POLICY REFORM 159, 159 (2004). Professor Sage observes: [O]pposition to malpractice litigation has been a litmus test for membership in the medical profession... Eliminating malpractice suits takes precedence over every other political objective for the
18 AMA and state medical societies. No contradictory belief, however well-reasoned, empirically based, or sincerely held, succeeds in crowding out antipathy toward malpractice from physicians minds. 16 Such a shift is particularly important, given the ways in which politicians and special interests -- as Baker recognizes, when he describes President Bush as speaking surrounded by doctors in white coats -- are using the medical profession as a front group, to rally public support for protecting not just doctors, but also pharmaceutical companies, medical device manufacturers and business in general from effective accountability through the tort system.  17 Sage, supra note 15, at 165. Physicians sense of being unfairly targeted may be exacerbated by the recognition that one factor driving increased malpractice litigation over time has been precisely the improvements in health care that make it easier to prove that a particular action caused harm, that increase economic damages, and that create rising expectations that, when disappointed, can lead to litigation. See David Studdert, Michelle Mello, & Troyen Brennan, Medical Malpractice, 350 NEW ENG. J. MED. 283, 286 (2004); Sage, supra note 15, at He relies in part on the insights of ATUL GAWANDE, COMPLICATIONS: A SURGEON S NOTES ON AN IMPERFECT SCIENCE (2002).
19 19 See, e.g., Maxine Harrington, Revisiting Medical Error: Five Years After the IOM Report, Have Reporting Systems Made a Measurable Difference?, 15 HEALTH MATRIX 329 (2005); Troyen Brennan, The Institute of Medicine Report on Medical Errors Could It Do Harm? 342 NEW ENG. J. MED (2000). 20 I think Baker s failures in this regard are somewhat overstated in the review of his book by Peter Hammer, Slaying Dragons: Malpractice Beyond Myth, 25 HEALTH AFFAIRS, 289 (2006). 21 Harrington, supra note 19, at 344: [M]any people, including professionals, equate medical error with negligence. Insofar as our focus is prospective, we need a broad concept that will encourage development of tools that would make bad outcomes that appear to be the inevitable risks of appropriate medical care preventable. Cf. David Leonhardt, Why Doctors So Often Get it Wrong, N.Y. TIMES (Feb. 22, 2006) (http://www.nytimes.com/2006/02/22/business/22leonhardt.html, last visited Mar. 8, 2006) (describing a computer system that allows diagnosis of rare conditions that even well-trained physicians might otherwise overlook). 22 Baker also includes two other proposals, which I do not deal with here. First, he suggests an administrative, no-fault compensation system, modeled on worker s compensation. The proposal is attractive in some ways, but its acceptability to the medical profession may be undermined by the same characteristic that makes it acceptable to the trial bar: It is consciously designed to minimize interference with
20 the current tort approach (164). He also proposes a variation of the early offer procedure in which a health care provider who believes he or she is at fault can acknowledge that fault and offer restitution within a reasonable time after he or she is aware of the extent of the patient s injuries. There are financial consequences that make both offer and acceptance attractive. Baker stresses, however, the therapeutic benefits to all parties of apology and restitution [171-72], citing Lee Taft, Apology and Medical Mistake: Opportunity or Foil?, 14 ANNALS OF HEALTH L. 55 (2005). Here, as in his disclosure requirements, Baker would permit use of the physician s statements in subsequent litigation. 23 American Medican Association Council on Ethical and Judicial Affairs, Code of Medical Ethics Studdert et al., supra note 17, at Consider the literature examining parallel problems in the context of informed consent. See, e.g, Alan Meisel & Lorne Roth, Toward an Informed Discussion of Informed Consent: A Review & Critique of the Empirical Studies, 25 ARIZ. L. REV. 265 (1983); JESSICA BERG ET AL., INFORMED CONSENT: LEGAL THEORY & CLINCIAL PRACTICE, 2D ED. (2001). These problems are often exacerbated by the need of both physician and patient to see the doctor as infallible. See JAY KATZ, THE SILENT WORLD OF DOCTOR AND PATIENT (1986), Lucian Leape, Can We Make Health Care Safe? in ACCELERATING CHANGE TODAY, REDUCING MEDICAL ERRORS AND
Medical Malpractice BAD DOCTORS G. Randall Green, MD, JD St. Joseph s Hospital Health Center Syracuse, New York The nature of the crisis US not in a medical malpractice litigation crisis US in a medical
Malpractice Reform: In Search of an Approach that is Rational, Fair, and Promotes Quality Improvement Joshua B. Murphy, JD Mayo Clinic Legal Department Rochester, MN Presenter Disclosures Joshua B. Murphy,
Virtual Mentor American Medical Association Journal of Ethics January 2013, Volume 15, Number 1: 46-50. HEALTH LAW Medicine, the Law, and Conceptions of Evidence Valarie Blake, JD, MA Evidence-based medicine
MRT MEDICAL MALPRACTICE SUBCOMMITTEE: MALPRACTICE COVERAGE COSTS October 17, 2011 1 GNYHA AND GOALS With respect to the health care system With respect to the tort system Improve quality, efficacy, and
PROCEDURAL PROVISIONS IN NEVADA MEDICAL MALPRACTICE REFORM Carl Tobias* In late July 2002, a special session of the Nevada Legislature passed medical malpractice reform legislation. 1 The expressly-stated
A REASONABLE PERSPECTIVE ON RECREATIONAL INJURY LIABILITY James C. Kozlowski, J.D., Ph.D. 1988 James C. Kozlowski Driving an automobile is probably the most dangerous activity in our daily lives. Certainly,
Virtual Mentor American Medical Association Journal of Ethics September 2011, Volume 13, Number 9: 637-641. HEALTH LAW The Jury Is Still Out on Health Courts Valarie Blake, JD, MA In many physicians minds,
IT S OK TO SAY I M SORRY Anything you say can and will be used against you in a court of law. We are all familiar with this phrase from the Miranda warning. It essentially advises a person accused of a
PRODUCT LIABILITY Product Liability Litigation The Effect of Product Safety Regulatory Compliance By Kenneth Ross Product liability litigation and product safety regulatory activities in the U.S. and elsewhere
ANNALS OF HEALTH LAW ADVANCE DIRECTIVE VOLUME 19 SPRING 2010 PAGES 306-315 The Effect of Medical Malpractice Jonathan Thomas * I. INTRODUCTION: WHAT IS MEDICAL MALPRACTICE Every year, medical malpractice
Common Myths About Personal Injury and Wrongful Death Cases 1 By B. Keith Williams There are several myths about accident cases and the attorneys that handle them. It is important to keep these myths in
Physicians on Medical Malpractice Reform Options Survey Methodology This survey was conducted online from August 31 October 31, 2012. Invitations for the survey were emailed to physicians who have been
9 THE AMERICAN LAW INSTITUTE Continuing Legal Education Third Party Litigation Funding: Pros, Cons, and How It Works November 1, 2012 Telephone Seminar/Audio Webcast Alternative Litigation Funding Conference
CONGRESSIONAL BUDGET OFFICE U.S. Congress Washington, DC 20515 Douglas W. Elmendorf, Director October 9, 2009 Honorable Orrin G. Hatch United States Senate Washington, DC 20510 Dear Senator: This letter
The Malpractice Lawsuit: Process and Prevention Advocate Health Care 7 th Annual Advocate Trauma Symposium Wyndham Lisle - Chicago November 18, 2010 Rogelio Lasso The John Marshall Law School BACKGROUND
ANNALS OF HEALTH LAW ADVANCE DIRECTIVE VOLUME 19 SPRING 2010 PAGES 297-305 The Defensive Medicine Debate: Driven by Special Interests Jill Fairchild * I. INTRODUCTION Tort reform is a contentious issue
MEDICO/LEGAL ASSOCIATION ALICE SPRINGS 2002 MEDICAL NEGLIGENCE The World Changes In considering what some have called the crisis in medical negligence we need to bear in mind that there has been a large
I. Synopsis WASHINGTON COLLEGE OF LAW, AMERICAN UNIVERSITY MEDICAL LIABILITY & PUBLIC HEALTH PROFESSOR STEVEN M. PAVSNER SYLLABUS The objective of the seminar, Medical Liability and Public Health, is to
THE EFFECT OF SETTLEMENT IN KAPLOW S MULTISTAGE ADJUDICATION Abraham L. Wickelgren Professor Louis Kaplow s article, Multistage Adjudication, presents an extremely useful framework for thinking about how
Advocate Magazine March 2011 Why medical malpractice still matters. Despite MICRA limitations, medical-negligence claims still have a crucial role in society BY BRUCE G. FAGEL We all know the statistics
William Gallagher Associates Introduction to Medical Malpractice Insurance What is Medical Malpractice Insurance? Insurance, in general, is the practice of sharing your risk with a large number of individuals
ISSUE In line with the overall tort system, the purpose of medical malpractice liability is to compensate patients who suffer an injury as a result of medical negligence. However, an effective tort system
Proposed Apology Legislation: from the Medical Perspective Dr David Dai JP Consultant Physician Member of the Working Group on Apology Legislation Of the Steering Committee on Mediation 11 July, 2015 The
Question 5 Attorney mailed a professional announcement to several local physicians, listing his name and address and his area of law practice as personal injury. Doctor received Attorney s announcement
Expert Medical Evidence: The Australian Medical Association s Position The Australian Medical Association and its members have had an increasing interest in this field for many years, with the level of
Board for Physician Workforce Spotlight on National Tort Reform & Reform in the Surrounding States August 2010 Tort reform continues to be a highly debated issue at both the state and national level. In
STATEMENT OF CHERYL NIRO Incoming Member, Standing Committee on Medical Professional Liability Member, House of Delegates On Behalf of the AMERICAN BAR ASSOCIATION Before the Committee on Health, Education,
Buyers Up Congress Watch Critical Mass Global Trade Watch Health Research Group Litigation Group Joan Claybrook, President S. 1784 Encourages Providers and Insurers to Voluntarily Report Medical Errors,
LEGAL ISSUES Why should I learn about legal issues? School administrators are typically the only personnel to receive training in classroom liability issues, yet teachers have the most responsibility for
Cooper Hurley Injury Lawyers 2014 Granby Street, Suite 200 Norfolk, VA, 23517 (757) 455-0077 (866) 455-6657 (Toll Free) YOUR RIGHTS WHEN YOU ARE INJURED ON THE RAILROAD Cooper Hurley Injury Lawyers 2014
STABILITY, NOT CRISIS: MEDICAL MALPRACTICE CLAIM OUTCOMES IN TEXAS, 1988-2002 Bernard Black, University of Texas Charles Silver, University of Texas David A. Hyman, University of Illinois William M. Sage,
SRJ 35: Study of Health Care Medical Malpractice: Montana's Approach to Limiting Liability by Sue O'Connell, Research Analyst Prepared for the Children, Families, Health, and Human Services Interim Committee
QUESTION NO. 3 Amendment to Titles 1 and 3 of the Nevada Revised Statutes CONDENSATION (ballot question) Shall Title 1 of the Nevada Revised Statutes governing attorneys, and Title 3 of the Nevada Revised
The Accuracy of the Medical Malpractice System: What the Evidence Tells Us Michelle Mello, JD, PhD Harvard School of Public Health 1 Today s discussion 1. The MIMEPS study 1. Methodology 2. Descriptive
Virtual Mentor American Medical Association Journal of Ethics March 2009, Volume 11, Number 3: 242-246. HEALTH LAW Difficult Patient-Physician Relationships and the Risk of Medical Malpractice Litigation
Medical Liability Task Force Report and Recommendations Oregon Health Policy Board November 9, 2010 1 The Board s Charge to the Task Force Investigate the current medical liability system Suggest opportunities
February 2011 Bracing for change Medical professional liability (MPL) insurance costs at a crossroads At a glance The effects of the healthcare reform law, changing market conditions, emerging societal
the compensation myth The Compensation Myth It is common to hear stories of the Compensation Culture or claims that Britain is becoming Risk Averse as a result of people claiming compensation. The truth
Working with the Physician s Counsel in Defending Off-Label Use Litigation By Gerald P. Schneeweis Morris Polich & Purdy LLP Working with the Physician s Counsel in Defending Off-Label Use Litigation By
Econ 149: Health Economics Problem Set IV (Extra credit) Answer Key 1. Your utility function is given by U = ln(4c), where C is consumption. You make $30,000 per year and enjoy jumping out of perfectly
ATTORNEY HELP CENTER: MEDICAL MALPRACTICE The healthcare industry has exploded over the last thirty years. Combined with an increasing elderly population, thanks to the Baby Boomer generation, the general
Testimony Before: Senate Codes, Health & Insurance Committees Tuesday, December 1, 2009 10:00 a.m. Hearing Room B, Legislative Office Building Albany, NY Presented By: Dr. William Doscher, MD, FACS Legislative
Do You Have a Case? Truck Accident ebooklet Andrew Miller 201 South 3rd Street Logansport, IN 46947 P: (574) 722-6676 www.starrausten.com Disclaimer No attempt is made to establish an attorney-client relationship
CHAPTER 34 INFORMED CONSENT FOR THE NURSE I. INTRODUCTION The goal of informed consent is patient autonomy or self-determination. To be autonomous, individuals must be able to control their bodies by controlling
FULL DISCLOSURE OF MEDICAL ERRORS Helen Gulgun Bukulmez, J.D. Josie s Story QuickTime and a decompressor are needed to see this picture. . There is a current and important transformation towards full disclosure
IMPROVING SETTLEMENT SAVVY Kathy Perkins Kathy Perkins LLC, Workplace Law & Mediation www.kathy-perkins.com In these difficult economic times, parties may be looking to reduce litigation costs and risk
Medical Malpractice Litigation What to Expect as a Defendant Being named as a defendant in a malpractice suit may be your first exposure to civil litigation. You will probably wish it would just go away.
The legal framework for patient safety in Switzerland Prof. Olivier Guillod Institut de droit de la santé Université de Neuchâtel Ascona / 20.11.13-2 - 2 What are the relevant facts? Hospitals save lives
N.J.L.J. N.J.L. Opinion 699 Advisory Committee on Professional Ethics Collaborative Law Advisory Committee on Professional Ethics Appointed by the Supreme Court of New Jersey This inquiry involves application
ABA Section of Litigation Corporate Counsel CLE Seminar, February 11-14, 2010 Winning The Settlement Keys to Negotiation Strategy Winning The Settlement Keys to Negotiation Strategy Thomas A. Dye Carlton
Series: Malpractice From A-Z First of a Series of Five Medical Malpractice Insurance: The Implications and Complications By Philip R. Dupont & Maggie L. Nigro You ou should be aware that the new Missouri
21 st Annual Health Law Institute 2015-8635 March 13, 2015 Session #2 10:30 am 12:00 noon The End of Malpractice Litigation? Improving Care and Communications to Reduce Risk Charles J. Chulack, III, Esq.
-xiii- SUMMARY Thirteen states currently either mandate no-fault auto insurance or allow drivers to choose between no-fault and tort insurance. No-fault auto insurance requires individuals to carry personal
SUBMISSION OF THE BAR COUNCIL OF IRELAND TO THE JOINT COMMITTEE ON HEALTH AND CHILDREN ON THE CHALLENGE OF RISING COSTS IN PROFESSIONAL MEDICAL INDEMNITY INSURANCE 1. INTRODUCTION (a) General Remarks 1.
February 15, 2016 Professional Practice 544 Tort Law and Insurance Michael J. Hanahan Schiff Hardin LLP 233 S. Wacker, Ste. 6600 Chicago, IL 60606 312-258-5701 firstname.lastname@example.org Schiff Hardin LLP.
LEGAL AID ADVISORY COMMITTEE REVIEW INTO ESTABLISHING A CONTINGENCY LEGAL AID FUND IN NORTHERN IRELAND WRITTEN SUBMISSIONS OF THE ASSOCIATION OF PERSONAL INJURY LAWYERS 1. The Association of Personal Injury
Making Sure The Left Hand Knows What The Right Hand Is Doing Representing Health Care Providers In Medical Negligence Cases by: Troy J. Crotts, Esq. Florida Continues as National Leader in Disciplinary
1 of 6 8/25/2010 5:22 PM Main Page Search August 25, 2010 Association News Features/Substantive Law Spotlight/Profiles Departments Classifieds The Hennepin Lawyer Kenneth Ross August 24, 2010 Headlines
Ooopps : Medical Errors and the Ethical Landscape Thalia Arawi, PhD Founding Director, Salim El-Hoss Bioethics & Professionalism Program Clinical Bioethicist Vice Chair, Medical Center Ethics Committee
STATEMENT OF KAREN IGNAGNI, PRESIDENT, AMERICAN ASSOCIATION OF HEALTH PLANS Source: U.S. House. Committee on Commerce, Subcommittee on Health and Environment. 1997. Managed Care Quality. 28 October 1997.
Over the last 25 years, injured and ill workers rights have been rolled back in many states. At the same time, employers are emboldened by today's economy to pressure workers not to exercise the few rights
What the Jury Hears in Products Liability Litigation The View From Both Sides and the Middle Theresa Zagnoli, Communications Expert and Jury Consultant Susan T. Dwyer, Defense Lawyer Jeffrey A. Lichtman,
AMERICAN BAR ASSOCIATION STANDING COMMITTEE ON CLIENT PROTECTION SECTION OF FAMILY LAW NATIONAL ORGANIZATION OF BAR COUNSEL STATE BAR OF NEW MEXICO VIRGINIA STATE BAR WASHINGTON STATE BAR ASSOCIATION STANDING
IN THE SUPREME COURT OF FLORIDA CASE NO. SC05-1150 IN RE: PETITION TO AMEND RULE 4-1.5(F)(4)(B) OF THE RULES OF PROFESSIONAL CONDUCT / COMMENTS OF DAN CYTRYN, ESQUIRE OF LAW OFFICES CYTRYN & SANTANA, P.A.
Consultation Response Consultation on Recommendations for No-Fault Compensation in Scotland for Injuries Resulting from Clinical Treatment The Law Society of Scotland s response November 2012 The Law Society
FREQUENTLY ASKED QUESTIONS ABOUT MEDICAL MALPRACTICE INSURANCE FEBRUARY 2005 Are high insurance rates driving obstetricians and gynecologists out of business or reducing access to health care? The Congressional
Tort Reform - Medical Malpractice Country: USA Partner Institute: The Commonwealth Fund, New York Survey no: (3)2004 Author(s): Robin Osborn Health Policy Issues: Political Context, Quality Improvement,
Legal Reform Agenda Ensure that Georgia s tort and contract laws do not discourage the development of business in the state Ensure that Georgia s procedural laws are appropriate for the equitable distribution
CHAPTER 7 NURSING LIABILITY INSURANCE We have all read many articles on and heard seminar speakers advocate why nurses should not buy professional liability insurance. However, in our opinion, there are
Special Report Physician medical malpractice by Jean LeMasurier Malpractice insurance premiums for physicians have increased at an average rate of over 30 percent per year. This rate is significantly higher
McLAUGHLIN & ASSOCIATES GEORGIA PHYSICIAN SURVEY DECEMBER 11, 2013 1. ARE YOU A CURRENT MEMBER OF THE MEDICAL ASSOCIATION OF GEORGIA, ALSO KNOWN AS MAG? YES 46.5 NO 48.4 DK/REFUSED 5.1 2. HAVE YOU EVER
Virtual Mentor American Medical Association Journal of Ethics January 2012, Volume 14, Number 1: 31-34. HEALTH LAW The National Childhood Vaccine Injury Act and the Supreme Court s Interpretation Valarie
Limitation of Liability Submission to the Attorney-General (Western Australia) July 2000 The Institution of Engineers, Australia Institution of Engineers, Australia 11 National Circuit, Barton, ACT, 2604
RESOLUTION 108-2011 Albert L. Fisher, MD 1 2 3 4 5 6 7 Whereas, Wisconsin physicians have paid billions of dollars into the Injured Patients and Families Compensation Fund over the last 35 years, for which
Defenses in a Product Liability Claim written by: Mark Schultz, Esq. COZEN O CONNOR Suite 400, 200 Four Falls Corporate Center West Conshohocken, PA 19428 (800) 379-0695 (610) 941-5400 email@example.com
This article originally appeared in The Colorado Lawyer, Vol. 25, No. 26, June 1996. by Jeffrey R. Pilkington TORT AND INSURANCE LAW REPORTER Informal Discovery Interviews Between Defense Attorneys and
)LQDQFLDO$VVXUDQFH,VVXHV RI(QYLURQPHQWDO/LDELOLW\ ([HFXWLYH6XPPDU\ %\ 3URI'U0LFKDHO*)DXUH//0 DQG 0U'DYLG*ULPHDXG Maastricht University and European Centre for Tort and Insurance Law (ECTIL) Final version
Medical Malpractice Insurance and Health Reform Bernadette Fernandez Analyst in Health Care Financing Baird Webel Specialist in Financial Economics Vivian S. Chu Legislative Attorney April 15, 2010 Congressional
LVM: Session 5 Author: Paul Waldau, D.Phil., J.D. We begin with this fundamental question, What is malpractice? We discuss the basic issues and the legal standard (this subject will be raised again later
Congressional Memo Potential Impacts of Federal Medical Malpractice Interventions An assessment based on available evidence Arthur L. Kellermann, James N. Dertouzos RAND Health WR-966 May 2011 RAND working
Policy Forum About Medical Malpractice Liability Reform in Illinois: First, Do No Harm by Lorens A. Helmchen More than two years after medical malpractice liability reform first took effect in Illinois,
If you have been in an automobile accident that is not your fault and your vehicle is damaged, you do have certain rights. If total property damage from the wreck to all damages appears to be over $1,000.00,
Chapter 11 Auto Insurance in the United States (continued) Overview Compensating innocent motorists who have been injured in auto accidents is an important issue for society. Private insurers are not anxious
Your consent to our cookies if you continue to use this website.