1 REFORMING MALPRACTICE LAW THROUGH CONSUMER CHOICE by Clark C. Havighurst Prologue: The increasing frequency of physician liability claims and growth in size of awards prompted the American Medical Association s (AMA s) House of Delegates at its mid-winter 1984 meeting to characterize the situation as a matter of extreme importance and high priority. When organized medicine sought relief from its last malpractice crisis, which occurred in the mid-1970s, it sought reform of the nation s tort law system through state legislative action. Many legislatures did act, but the measures they approved provided only temporary relief For example, the St. Paul Companies, which provided professional liability insurance to 15 percent of the national medical market, reported 5,870 claims in ,757 more than in 1979, an increase of 88.6 percent. The AMA s Socioeconomic Monitoring Service reported in mid-1983 that the average incidence of claims per 100 physicians increased from 3.3 claims per 100 prior to 1978 to eight claims during the years Havighurst suggests in this essay that the time has arrived for medical care providers to recognize that longer lasting solutions may reside in private sector action, not simply in tort law reform. Havighurst is a professor of law at Duke University and a member of the National Academy of Sciences Institute of Medicine. Havighurst is a leading advocate of a medical care system that is based on decentralized, market-oriented solutions. He envisions a health sphere where individual consumers, armed with solid information, have the opportunity to select their medical care plans from an array of choices. Within Havighurst s preferred conceptual framework, he views government s proper place as rule-setter and referee of private sector action, not as the dictator of events.
2 64 HEALTH AFFAIRS After only a short absence from the policy agenda following the legislative and insurance reforms of the mid-1970s, the problems associated with medical malpractice litigation are once again the focus of national debate. This time around, however, if policymakers and industry observers are careful to view the situation in the context of overall health policy and in light of the new competitiveness of the health care industry, they will discover a promising new way in which the problem can be attacked. Specifically, the increased role of competition and consumer choice in health care, fostered through such federal policies as encouragement of prepaid health plans and aggressive antitrust enforcement, is opening exciting possibilities for private as opposed to judicial and legislative reform of the rules that govern liability for injuries suffered by patients in the course of medical treatment. Although law professors and economists have frequently suggested that health care providers and consumers should be allowed to enter into contracts creating rights and remedies that differ substantially from those established by courts and legislatures, this way of attacking the malpractice problem has remained largely an academic idea. 1 The time has now come, however, for the health care industry, and ultimately the courts, to recognize that tort law as laid down by courts and legislatures is not necessarily the final word. Instead, tort law should be seen as governing only in the absence of a negotiated arrangement. Questions would arise, of course, about the enforceability of particular contracts altering patients rights, and courts should certainly hesitate before enforcing a liability-limiting contract that a patient usually with the benefit of hindsight following some injury later regrets having entered into. Nevertheless, a court should avoid being too hard to convince that such a contract was fairly negotiated and served the interests of consumers as well as providers. Because the new competitive environment gives consumers new opportunities for informed choice of health plans and providers and new help in bargaining with provider interests, the need for judicial vigilance against provider overreaching is lessened. I have argued recently that courts should have an open mind when asked to enforce a private contract that purports to alter the liability rules prevailing between health care providers and their patients. 2 In this article, I will first show how changes in industry conditions have made it feasible and acceptable to contemplate private initiatives to redefine rights and responsibilities associated with medical accidents. Then I will summarize some reasons for thinking that the legal system has not found the best, or even a satisfactory, way to protect consumers against the risk of injury and to motivate providers to provide care of appropri- This article is adapted from testimony before the Senate Committee on Labor and Human Resources, July 10, It reflects work under Grant No. HS from the National Center for Health Services Research. DHHS.
3 REFORMING MALPRACTICE LAW 6 5 ate quality. Finally, I will suggest some ways in which health care providers and consumers might improve upon the legal system s effort. Competition In The Health Care Industry More than anything else, active competition in the health care sector is what makes it possible now to contemplate private solutions to the problems posed by tort law for medical care providers and their patients. In the era when the current law of medical malpractice took shape, consumers were seen as having. no real options in the marketplace and no capacity to exercise choice. It was therefore natural for the law to prescribe duties and for courts to be suspicious of attempts to set aside the law s prescriptions, Under the old assumptions, it was also natural for the law to look to the medical community for standards of care and to enforce professional norms of conduct without questioning their appropriateness or cost-effectiveness. Under the old circumstances, tort law was essentially prescriptive and regulatory, imposing substantial sanctions for departures from accepted processes whenever a bad result occurred. The old situation was, of course, essentially monopolistic. Health care was generally thought of as the product of a unitary system in which consumers had little choice, professionals set their own standards, thirdparty payers unquestioningly supported professional habits, and tort law rigorously enforced adherence to the system s norms. Recently, however, profound changes are occurring both in the structure of the industry and in our ways of thinking about health care. As we have begun to recognize that we live in an era of limits, even for medical care, alternatives to the previously dominant style and methods of practice have begun to seem acceptable. Although it is still hard to acknowledge it explicitly, we are gradually accepting the fact that we can t have it all, that the highest quality is not necessarily worth its high cost, and that trade-offs must be made. The belief that the same high standards should prevail everywhere, though still widely professed, is seen more and more as unrealistic, and emphasis is placed instead on raising standards where they are unacceptably low. Decision making is becoming decentralized, thus opening up new innovation possibilities. In these new circumstances, there is less reason to assume that there is one right way to treat patients. It should also appear that there may be more than one right way to redress medical injuries. Now that we have accepted alternatives to the dominant system of medical care, it seems a logical next step to look to health maintenance organizations (HMOs) and competitive medical plans of other kinds to offer consumers alternatives to the dominant legal system. Indeed, the key benefit of deregulating the health care industry, which more than compensates for the accompanying problems, is that it offers consumers a chance finally to escape the
4 66 HEALTH AFFAIRS burdens of professional monopoly not only the physicians monopoly over the making of costly medical decisions, but also the lawyers monopoly over the costly business of making and administering rules governing liability for medical injury. The Existing Legal System There are not many good things that can be said about the existing legal system for handling medical malpractice. Its most apparent virtue is that it gives patients an opportunity they would otherwise lack to call doctors and hospitals to account for harms they cause through poor practice. It is at least arguable that the availability of this powerful grievance mechanism causes health care providers to be more careful than they would otherwise be and more attentive to their patients as human beings. 3 Although the coming of competition has given consumers more opportunities for choice and effective complaint than they previously enjoyed, there is still a need for some public forum in which a patient can pursue his grievance to a decisive result and can see a meaningful sanction imposed on a negligent provider. Almost certainly, the reluctance of legislatures to make more than marginal changes in the law of medical malpractice has been attributable to a sense that patients should not be deprived of their basic right to seek redress for the serious harms that providers do, sometimes through culpable neglect. This is not to say, however, that consumers may not voluntarily surrender some of their rights under the tort system in a contract with a provider. But by serving as the starting point for negotiations, the tort system gives consumers substantial bargaining power with which to induce price or other concessions in return for surrendering certain rights. Everything else that can be said about the law governing medical malpractice is negative. The following brief specification of the legal system s faults, summarizing what others have observed, adds up to a powerful indictment. Although these objections may not justify legislation that repeals or greatly restricts patients right to sue, they certainly suggest that both providers and patients could benefit substantially by entering into private contracts creating liability rules which differ from the rules created and administered by the legal system. Very high legal and administrative costs. Judging negligence in the provision of medical care is often very difficult and expensive. As a result, much of the money paid as malpractice insurance premiums is absorbed, not in paying claims, but in deciding whether a particular loss should be shifted. Estimates of the portion of the premiums paid into the system that eventually goes to injured persons go no higher than 40 percent, meaning that at least 60 percent of the premiums collected go to pay lawyers and insurers for operating the system. (Costs of operating the
5 REFORMING MALPRACTICE LAW 6 7 courts are an additional and hardly negligible factor.) One might easily judge that these high operating costs are not justified by any benefits the system yields in overcoming economic hardships and enforcing good medical practice. A system of compensation that was simpler to administer that did not, for example, require a determination of fault in every case could benefit many more injured patients without costing any more. Patients and providers might see an opportunity to cut out the lawyers and to use the savings to cover more injuries, to reduce fees or premiums, or to improve quality. High psychic costs. The emotional toll taken on both providers and patients is unmeasurable but very high. The acrimony of trials, the tensions introduced into doctor-patient relationships, and the burdens on patients awaiting adjudication of their claims have been noted by many others. Many, though perhaps not all, individual providers and patients will see substantial value in escaping from such a system into one with fewer adversarial features. Haphazard compensation. Many injured patients go uncompensated even when their injuries were actually caused by negligence; a few patients are compensated extravagantly. A review of the numerous reasons why some potential lawsuits are brought while many others are not leaves the impression that the system is not serving any clear function well. Instead, like lightning, it seems to strike almost at random. There is a great deal of room for improving patients financial security by increasing the number of patients compensated while reducing the level of payment to more closely approximate real economic losses. Perverse incentives. Although the tort system is expensive to administer, there is always the possibility that its cost is justified by the behavior it induces. But there is good reason to believe that the liability system, whatever good it does, also promotes a great deal of uneconomic and undesirable behavior. Although defensive medicine is difficult to define and identify in practice, unnecessary testing and overutilization of health care resources do occur and in some degree seem to reflect providers desire to be protected against accusations of negligence. Moreover, tort law enforces a standard of care drawn primarily from customary practice did the doctor do what other doctors would do? Unfortunately, this standard of care is almost certainly an inefficient standard because it is derived by observing a market in which third-party payers unquestioningly foot the bills and physicians seek not only absolute safety for their patients but also protection against lawsuits for themselves. By using customary practice as a reference point for imposing liability, the legal system appears to restrict opportunities for even the most responsible economizing, thus forcing the public to bear unnecessarily high health care costs. Private agreements altering liability rules seem to have great potential for improving the climate for efficient behavior.
6 68 HEALTH AFFAIRS Altering The Rules By Private Contract Although the foregoing defects in the existing legal system are hard to compare to any benefits that the system may have in raising the quality of care to appropriate levels, they certainly provide a solid basis for thinking that there is room for improvement. Because legislative changes are inhibited by interest-group politics and uncertainty about precisely what to do, private avenues of change are worth exploring. Providers and consumers interacting in a competitive market appear to have an excellent opportunity to negotiate new arrangements that, by avoiding heavy legal and administrative costs and lifting the heavy penalties on responsible cost containment, could benefit everyone directly concerned. Only trial lawyers would have reason for complaint. Even patients who later suffer some injury that would have entitled them to a huge award may be seen as beneficiaries of the original decision to rule out such recoveries. The following paragraphs suggest some specific ways in which private health care plans and individual hospitals and physicians might agree with consumers on a different set of rules governing what happens when a patient suffers an injury in the course of treatment. Changing the forum. HMOs in California and elsewhere have already required arbitration of claims for medical malpractice. 4 Such arbitration agreements may be entered into before an injury occurs, and plaintiffs have been bound by arbitration clauses negotiated by their employers on their behalf even when they did not actually know that their right to a jury trial had been restricted. In such cases, it appeared important that the employee also had the option (through dual choice ) of choosing another form of financial protection which would have maintained his traditional legal rights. In addition to arbitration clauses, one can also imagine contractual provisions that would limit the initiation of malpractice suits that had not been previously approved by a screening panel of some kind. Such methods for foreclosing frivolous claims are similar to those adopted in some state legislations and would provide some protection to providers without preventing clearly meritorious actions. Limiting recoveries. Just as some states have sought to limit malpractice recoveries, private parties might do the same. Although the agreement might set a flat dollar limit, it is probably preferable to provide that a plaintiff could recover his full economic losses but not for pain and suffering or amounts reimbursed from collateral sources such as life, health, or disability insurance. A possible variation might provide an additional amount out of which the patient could pay his attorney s fees. Even though such limitations on recoveries might appear to benefit only the provider and not the patient, the provider s lesser exposure to liability risks might well translate into lower fees and health plan premi-
7 REFORMING MALPRACTICE LAW 6 9 ums. Because consumers do not customarily purchase insurance protection exceeding their potential out-of-pocket losses, it does not seem reasonable for courts to compel them, against their expressed will, to pay for duplicative or excessive protection through the tort system. Altering the standard of care. Because malpractice law appears to require that physicians adhere to customary practice in their community, opportunities for responsible economizing are restricted. As a result, a health plan or provider might wish to specify by contract a commitment to abide by a different standard. For example, an HMO might contract to be bound, not by community standards, but by the standards of other HMOs. Alternatively, the HMO s subscriber contract might preserve a right to depart from customary standards in good faith where medical literature supported the HMO s judgment and its subscribers were consulted on the decision to adopt different methods. Avoidance of dubious claims might also be accomplished by contracting to limit liability to those cases in which gross negligence or an intentional act or omission could be proved. No-fault alternatives. As a substitute for patients rights under the tort system, a provider or organized health plan might provide for automatic compensation for certain designated compensable events. Some years ago Laurence Tancredi and I proposed such a no-fault system that would be financed through provider-purchased insurance. 5 A subsequent study by a commission appointed by the American Bar Association confirmed the desirability and feasibility of such a compensation system. 6 Although a no-fault compensation system along these lines could be created by statute, it might also be implemented by private contract. In addition to protecting patients, a no-fault system can be structured to preserve strong incentives to avoid adverse outcomes. The Moore-Gephardt (O Connell) strategy. Private contracts might also provide for limitations on malpractice claims that are similar to those currently embodied in H.R. 5400, the Alternative Medical Liability Act introduced in the 98th Congress by Representatives Moore and Gephardt. This proposal, embodying ideas first advanced by Professor Jeffrey O Connell, would permit a provider to foreclose a lawsuit for medical injury by tendering the patient s net economic loss. 7 Whatever the desirability of legislation implementing this interesting idea, it is worth recognizing that it or something like it might also be implemented privately. Exculpatory clauses. The most extreme form of private agreement altering patients rights to compensation for medical negligence is an exculpatory clause, by which the patient entirely surrenders his right to sue. Although clauses of this type have been struck down by the courts from time to time, a case can be made for enforcing them. 8 In any event, it should be clear that judicial reluctance to enforce contracts of this extreme type does not control the enforceability of agreements of other kinds.
8 70 HEALTH AFFAIRS Conclusion This article has sought to highlight some new possibilities for relieving the serious burdens that are imposed on patients and providers alike by medical malpractice and the legal system s current methods for dealing with it. The new competitiveness of the health care industry makes private solutions to this problem thinkable for the first time. Innovative providers and creative lawyers should begin considering how the private sector might initiate some responsible reforms of its own in this difficult area; public officials should seek ways of encouraging such private initiatives; and courts should be receptive to them when they occur. NOTES 1. See, for example, Carl M. Stevens, Medical Malpractice: Some Implications of Contract and Arbitration in HMOs, Milbank Memorial Fund Quarterly 59 (1981):59-88; Richard A. Epstein, Medical Malpractice: The Case for Contract, American Bar Foundation Research Journal (1976):95-149; and Jeffrey O Connell, No-Fault Liability by Contract for Doctors, Manufacturers, Retailers and Others, Insurunce Law Journal (1975): Clark C. Havighurst, Decentralized Decision Making: Private Contract Versus Professional Norms, ed. Jack A. Meyer, Market Reforms in Health Care (Washington, D.C.: American Enterprise Institute for Public Policy Research, 1983), See, for example, Patricia M. Damon, An Economic Analysis of the Medical Malpractice System, Behavioral Smdies and the Law 1 (1983):39-54; William B. Schwartz and Neal K. Komesar, Doctors, Damages and Deterrence: An Economic View of Medical Malpractice, The New England Journal of Medicine 298 (1978): See, for example, Madden v. Kaiser Foundation Hospitals, 17 Cal. 3d 699 (1976); Doyle v. Giuliuci, 401 P.2d1 (1965). 5. Clark C. Havighurst and Laurence R. Tancredi, Medical Adversity Insurance A No- Fault Approach to Medical Malpractice and Quality Assurance, Milbank Memorial Fund Quarterly 51 (1973): ; see also Clark C. Havighurst, Medical Adversity Insurance Has Its Time Come?, Duke Law Journal (1975): American Bar Association Commission on Medical Professional Liability, Designated Compensable Event System: A Feasibility Study (Washington, D.C.: ABA, 1979). 7. See Jeffrey O Connell, Offers That Can t Be Refused: Foreclosure of Personal Injury Claims by Defendants Prompt Tender of Claimants Net Economic Losses, Northwestern University Law Review 77 (1982): See, for example, Emory University v. Porubiansky, 282 S.E.2d 903 (Ga. 1981); and Epstein, Medical Malpractice: The Case for Contract.
No-Fault Automobile Insurance By Margaret C. Jasper, Esq. Prior to the enactment of state no-fault insurance legislation, recovery for personal injuries sustained in an automobile accident were subject
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
Arizona State Senate Issue Paper June 22, 2010 Note to Reader: The Senate Research Staff provides nonpartisan, objective legislative research, policy analysis and related assistance to the members of the
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
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
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
Mailing Address: P.O. Box 34538 Seattle, WA 98124-1538 Maritime Injury Cases The following are the questions most frequently asked by our clients about Maritime injury cases. Obviously, the questions and
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
I. HISTORICAL BACKGROUND A. Common Law WORKERS COMPENSATION SUBROGATION AND THIRD PARTY SETTLEMENTS Before the advent of workers compensation statutes, the only protection afforded to victims of work place
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
Background Paper 79-5 PRODUCT LIABILITY PRODUCT LIABILITY Product liability refers to the legal responsibility by the manufacturer or marketer of a product for any bodily injury or property damage caused
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
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
Author: Attorney Dan A. Riegleman N63 W23965 Main Street Sussex, Wisconsin 53089 Prepared: 06/01/10 WHITE PAPER: DR2504 Addressing Abusive Lawyer Conduct in Relation to Litigation Proceedings 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
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
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
AMENDED IN ASSEMBLY APRIL 14, 2015 california legislature 2015 16 regular session ASSEMBLY BILL No. 597 Introduced by Assembly Member Cooley February 24, 2015 An act to amend Sections 36 and 877 of, and
MONTANA SELF INSURERS ASSOCIATION Executive Director Bob Worthington Board of Directors Rick Clark Plum Creek Timber Co Tim Fitzpatrick MT Schools Group Donna Haeder NorthWestern Corp Marv Jordan MT Contractors
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.
California Public Employees Retirement System Agenda Item 9 ITEM NAME: Proposition 46 Drug and Alcohol Testing of Doctors and Medical Negligence Lawsuits PROGRAM: ITEM TYPE: Legislation State Initiative
Province of Alberta LIMITATIONS ACT Revised Statutes of Alberta 2000 Current as of December 17, 2014 Office Consolidation Published by Alberta Queen s Printer Alberta Queen s Printer 5 th Floor, Park Plaza
This article first appeared in the October 2010 issue of The Corporate Counselor. Insurance Coverage In Consumer Class Actions John W. McGuinness and Justin F. Lavella The business world is an increasingly
Reed Armstrong Quarterly January 2009 http://www.reedarmstrong.com/default.asp Contributors: William B. Starnes II Tori L. Cox IN THIS ISSUE: Joint and Several Liability The Fault of Settled Tortfeasors
Proposition 46 Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits. Initiative Statute. Yes/No Statement A YES vote on this measure means: The cap on medical malpractice damages for such things
Commentary Refer to: Cooper JK, Egeberg RO, Stephens SK: Where is the malpractice crisis taking us? (Commentary). West J Med 127:262-266, Sep 1977 Where Is the Malpractice Crisis Taking Us? JAMES K. COOPER,
Making Amends the CMO s proposals for reforming the approach to clinical negligence in the NHS. Response to the consultation document by The Royal College of Surgeons of England OCTOBER 2003 Response of
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
Appendix I: Select Legislative Appendix I: Select Federal Legislative is and Mesothelioma Benefits Act H.R. 6906, 93rd 1973). With respect to claims for benefits filed before December 31, 1974, would authorize
CHBA Briefing Note on Liability in the Residential Building Industry Introduction Objectives The objective of this report is to present some recent developments in Canada on the topic of liability in the
FURR & HENSHAW 1900 Oak Street, P.O. Box 2909 Myrtle Beach, SC 29578 Phone: (843) 626-7621 and 1534 Blanding Street Columbia, SC 29201 Phone: (803) 252-4050 YOUR AUTOMOBILE ACCIDENT CASE The purpose of
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
osition Official Title and Summary Prepared by the Attorney General Requires drug and alcohol testing of doctors and reporting of positive test to the California Medical Board. Requires Board to suspend
UTAH Rick L. Rose Kristine M. Larsen RAY QUINNEY & NEBEKER P.C. 36 South State Street, Suite 1400 P.O. Box 43585 Salt Lake City, Utah 84111 Telephone: (801) 532-1500 Facsimile: (801) 532-7543 email@example.com
WikiLeaks Document Release February 2, 2009 Congressional Research Service Report RS20519 ASBESTOS COMPENSATION ACT OF 2000 Henry Cohen, American Law Division Updated April 13, 2000 Abstract. This report
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
UNDERSTANDING THE WORKERS COMPENSATION SYSTEM ADVANTAGES AND DISADVANTAGES Presented By: Sonia Lanteigne and Michael McGovern Legal Counsel, WorkSafeNB October 8, 2015 TODAY S AGENDA History of workers
HARDY MYERS Attorney General PETER D. SHEPHERD Deputy Attorney General DEPARTMENT OF JUSTICE GENERAL COUNSEL DIVISION John Shilts, Administrator Workers Compensation Division Labor & Industries Building
LIEN ON ME A Guide to Complying with Medicare s Secondary Payor Act and Pennsylvania s Act 44 April, 2009 HARRISBURG OFFICE P.O. Box 932 Harrisburg, PA 17106-0932 717-975-8114 PITTSBURGH OFFICE 525 William
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.
JURY INSTRUCTIONS PRELIMINARY INSTRUCTIONS 1. ANTITRUST CLAIMS 2. Elements of Monopoly Claim 2.1 Definition of Monopoly Power 2.2 Relevant Market 2.3 Existence of Monopoly Power 2.4 Willful Maintenance
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE March 10, 2003 H.R. 5 Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2003 As ordered reported by the House Committee on Energy and Commerce
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
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
HOLD HARMLESS, INDEMNITY, SUBROGATION AND ADDITIONAL INSURED INSURANCE IN TRANSPORTATION CONTRACTS By James W. Bryan Nexsen Pruet P.L.L.C. Greensboro, North Carolina 336-373-1600 firstname.lastname@example.org
February 20, 1978 ATTORNEY GENERAL OPINION NO. 78-81 Mr. Fletcher Bell Commissioner of Insurance Kansas Insurance Department 1st Floor - State Office Building Topeka, Kansas 66612 Re: Motor Vehicles--Insurance--Rights
Common Myths Associated With Georgia Workers Compensation Claims Ty Wilson 1-866-937-5454 www.tywilsonlaw.com Special Report COMMON MYTHS ASSOCIATED WITH GEORGIA WORKERS COMPENSATION CLAIMS Special Report
August 28, 2013 Hon. Kamala D. Harris Attorney General 1300 I Street, 17 th Floor Sacramento, California 95814 Attention: Ms. Ashley Johansson Initiative Coordinator Dear Attorney General Harris: Pursuant
California Senate Bill 474 Impact on Owners & Contractors Beginning January 1, 2013, project owners, general contractors ( GC ), construction managers ( CM ) and any lower tier contractor who employs subcontractors
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.
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.
Injured on the Job Your Rights under FELA Quick Facts: What To Do If Injured 1. Consult your own doctor for treatment. Give your doctor a complete history of how your injury happened. Make sure that the
Liability of Volunteer Directors of Nonprofit Corporations (10/02) This memorandum addresses the California and federal law protections that exist to shield volunteer directors of nonprofit corporations
Personal Injury Law: Minnesota Medical Malpractice Medical Malpractice Terms Statutes of Limitations Minnesota Medical Malpractice Laws Medical malpractice includes many forms of liability producing conduct
United States Workers Compensation/Indemnification Overview January 18, 2012 Jill Kirila email@example.com Kevin Hess firstname.lastname@example.org 36 Offices in 17 Countries Workers Compensation
9. Typical auto insurance benefits in both no fault and traditional States fall short of the needs of catastrophically injured victims. EXECUTIVE OFFICE INTER-COMMUNICATION From: KENNETH D. MERIN, DIRECTOR
Structured Settlements Application in Liability and Workers Compensation February 10, 2014 Noah S. A. Schwartz, CSSC J. Douglas Merritt, CSSC Richard Montarbo (Legal) Jack Blyskal (Moderator) Today Review
THE THREAT OF BAD FAITH LITIGATION ETHICAL HANDLING OF CLAIMS AND GOOD FAITH SETTLEMENT PRACTICES By Craig R. White SKEDSVOLD & WHITE, LLC. 1050 Crown Pointe Parkway Suite 710 Atlanta, Georgia 30338 (770)
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
MEDICARE AND LIABILITY CASES I. The Significant Statutory and Code Provisions A. The Medicare Secondary Payer Statute The Medicare Secondary Payer statute (MSP) has been the law for well over 25 years.
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
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
PRACTICAL ADVICE ON THE MOST EFFECTIVE WAY TO SETTLE YOUR CASE WITH THE GOVERNMENT This article is collaboration between the panel moderator Brian J. Alexander and panel participants, Richard Saltsman,
AUGUST 26, 2005 Plaintiff s Lawyers Bullish On Merrill Lynch: Brokerage Firm Agrees To Pay $37 Million To Settle Overtime Claims By Stockbroker By Dale A. Hudson In a settlement that may well be a harbinger
Key Concept 4: Understanding Product Liability Law Suppose that you are the president of a firm making products for sale to the public. One of your worries would be the company's exposure to civil liability
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
Pulitano v. Thayer St. Associates, Inc., No. 407-9-06 Wmcv (Wesley, J., Oct. 23, 2009) [The text of this Vermont trial court opinion is unofficial. It has been reformatted from the original. The accuracy
WHEN A CHILD MAY HAVE A TORT CLAIM: WHAT S THE CHILD S COURT- APPOINTED ATTORNEY TO DO? The Oregon Child Advocacy Project Professor Leslie J. Harris and Child Advocacy Fellows Colin Love-Geiger and Alyssa
CHAPTER 30: EMPLOYEE INJURIES INTRODUCTION TO JOB SAFETY Our legal system has developed three ways of handling employee injuries: A. NEGLIGENCE SUITS Was developed under common-law where the injured employee
Table of Contents Introduction 3 Why Not Settle With the Insurance Companies 4 What to do First 7 Hiring a Personal Injury Lawyer 11 How Much is My Claim Worth? 14 What if I have a Pre-Existing Condition?
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
ETHICAL CONSIDERATIONS IN ALTERNATIVE FEE AGREEMENTS FOR THE DEFENSE LAWYER BRIAN P. VOKE CAMPBELL CAMPBELL & EDWARDS ONE CONSTITUTION PLAZA BOSTON, MA 02129 (617) 241-3000 email@example.com
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
Information for Worker s Compensation Clients Overview of the Worker s Compensation Act Indiana Worker s Compensation cases are governed by a State law known as the Worker s Compensation Act. The legislature
Note: This document contains FAR Part 15 including Amendment 15-4 published in the Federal Register on September 4, 1997. PART 15--ADMINISTRATIVE CLAIMS UNDER FEDERAL TORT CLAIMS ACT Subpart A--General
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
LITIGATION OF PRODUCTS LIABILITY CASES IN EXOTIC FORUMS - PUERTO RICO By Francisco J. Colón-Pagán 1 I. OVERVIEW OF PUERTO RICO LEGAL SYSTEM A. Three branches of government B. Judicial Branch 1. Supreme
COLORADO REVISED STATUTES Title 13. Courts and Court Procedure Damages Regulation of Actions and Proceedings Article 20. Actions Part 8. Construction Defect Actions for Property Loss and Damage Construction