1 Dealing with Medical Errors What should I say? R Singh MB BChir MA (Cantab) MBA MD (SUNY) Department of Family Medicine Associate Professor and Associate Director, UB Patient Safety Research Center Presented in 2010 by gurdev Singh, Director, UB Patient Safety research Center Patient Safety Research Center
2 Dealing with Medical Errors What should I say? R Singh MB BChir MA (Cantab) MBA MD (SUNY) Department of Family Medicine Associate Professor and Associate Director, UB Patient Safety Research Center Health Warning: This talk may raise more questions than it answers!! Presented in 2010 by gurdev Singh, Director, UB Patient Safety research Center Patient Safety Research Center
3 The Six ACGME Core Competencies Communication Knowledge Professionalism Patient Care Practice Based Learning System Based Practice Safety Transcends all Competencies Singh 07
4 Safety is a fundamental system property. Without safety there can be no quality of care IOM Patient Safety Is freedom from accidental injury due to medical care or medical error Gurdev Singh 2007
5 National Burden of Systemic Errors in the Health Care The(US) TheUS Healthcare 2-5 Jumbo jets of the Health Care Industry drop out of the sky every day (Analogy after Leape: the Safety Guru of USA) 1.5 Million/year Incidents of Harm And then there are other adverse Events!! Gurdev Singh 2007 Singh 07
6 International Rankings and National Health Expenditure (Through Patient s Lens) AUS CAN GER NZ UK USA Overall Ranking Patient Safety Effectiveness ? Patient-centeredness Timeliness Efficiency Equity Health Expend./Capita $ $5,635 $7600 Source: The Commonwealth Fund : Singh 07
7 Our Goal Congressional Budget Office Head, Peter Orszag: Times Nov 08 Singh 08
8 Our Goal If this is not a MAJOR National Disaster my name is not gurdev Congressional Budget Office Head, Peter Orszag: Times Nov 08 Singh 08
9 Singh 07 Singh: Jan 09
10 Singh 07 This constitutes nearly 50% of the surgical Never Events Wrong body part : 30% Wrong procedure : 16% Wrong patient: 4% COST About 20Billion/yr CMS press release 2006 (Minnesota Study) Singh: Jan 09
11 Patient Safety Awareness Week March 7-13 March 7-13
12 Currently we live in Fear R and G Singh Scherkenbach s Cycle of Fear, 1991
13 Currently we live in Fear Kill the messenger (denial; shift the blame) R and G Singh Scherkenbach s Cycle of Fear, 1991
14 Currently we live in Fear Kill the messenger (denial; shift the blame) Filter the data (game the system) R and G Singh Scherkenbach s Cycle of Fear, 1991
15 Currently we live in Fear Micromanage (Barking up the wrong tree) Kill the messenger (denial; shift the blame) Filter the data (game the system) R and G Singh Scherkenbach s Cycle of Fear, 1991
16 Currently we live in Fear Micromanage (Barking up the wrong tree) Kill the messenger (denial; shift the blame) Filter the data (game the system) R and G Singh Scherkenbach s Cycle of Fear, 1991
17 From January to May, I work for the government to pay for my income tax and from May to October to pay for my malpractice insurance Singh
18 There are increasing calls for Error Disclosure from various directions with increasing disclosure protection Singh
19 Overview Background Current culture of blame and non-disclosure Ideal culture of safety with open disclosure Ethical principles What do patients want? What do physicians think? Risks and Benefits of Disclosure A practical approach to disclosure Conclusions
20 Background1/3 Errors are common Harm sometimes occurs it is preventable System problems are usually at the root Humans are often unfairly blamed To err is human Current culture is conducive to hiding errors to avoid repercussions When errors are hidden we cannot learn from them
21 Example: System for ordering labs and obtaining results (a small sub-system!) Doctor Test Log Doctor s In-Box Lab Slip Lab Report Clerk Doctor Patient To be filed Patient Specimen collection Chart
22 Background2/3 When errors are hidden we cannot learn from them We need to change the culture!! In a Culture of Safety: Micromanage (Barking up the wrong tree) Fear Filter the data (game the system) Kill the messenger (denial; shift the blame) Scherkenbach s Cycle of Fear, 1991 People are able to discuss errors openly without fear of repercussions Attention is focused on faulty systems rather than blaming individuals for all problems This includes disclosing errors to patients and families where appropriate R and G Singh Currently we live in
23 Background3/3 Disclosing errors to patients and families How can we decide whether it is appropriate to disclose or not?
24 Ethical Principles that can guide our disclosure decisions *Beneficence act in the best interests of the patient *Nonmaleficence - do no harm *Patient Autonomy protect and foster a patient's free, uncoerced choices *Justice fairness of healthcare in society
25 If it s often the right thing to do why not just do it?
27 From January to May, I work for the government to pay for my income tax and from May to October to pay for my malpractice insurance Singh
28 What do patients want?1/3 Gallagher et al JAMA (8) Patients wanted disclosure of all harmful errors and information about: *What happened *Why the error happened *How the error's consequences will be mitigated *How recurrences will be prevented. NOTE: they don t want to know who s fault it is Patients also desired emotional support, saying that they would be less upset if the physician: *Talked honestly *Showed compassion *Apologized Qualitative study (13 focus groups of patients/physicians)
29 What do patients want?2/ Schwappach Int J Qual H Care (4): Internet survey 1017 citizens of Germany In cases with a severe outcome, if the physician was: Honest Empathic Accountable Then, there was a 59% decrease in support for strong sanctions (e.g., lawsuits) against the physician
30 What do patients want?3/3 Witman et al Arch Int Med : outpatients at an academic medicine clinic 98% wanted to be informed, even of a minor error For errors of various severities, patients reported that if they were informed of the error by the physician (vs. finding out from another source) then they were: Error of Moderate Severity Less likely to change doctors (60 vs. 92%) Less likely to report the physician (23 vs. 52%) Less likely to file a lawsuit (12 vs. 20%)
31 Why do people sue?1/2 Of course, every case is different. Studies have shown that there is little, if any, correlation between quality of care and likelihood of malpractice claims. Many suits are filed even when no lapse in quality has take place. In cases where medical negligence has taken place, only a small minority of patients or families file suit (perhaps as low as 3%) So, why do people sue??
32 Why do people sue?2/2 Hickson et al JAMA 1992;268(11): Interviewed 127 mothers who had sued due to perinatal injuries to their infants. Reasons for filing suit included: Advised to sue by knowledgeable acquaintance (33%) Recognized a cover-up (24%) Needed money (24%) Needed information (20%) Wanted to protect others from harm (19%) Respondents believed that their physician(s): Tried to mislead them (48%) Did not talk openly (32%) Did not listen (13%)
33 What do physicians think? Gallagher et al JAMA (8) Qualitative Study Physicians agreed that harmful errors should be disclosed but "choose their words carefully" when telling patients about errors. often avoided stating that an error occurred, why the error happened, or how recurrences would be prevented. Physicians were upset when errors occurred and expressed a desire to apologize but worried that an apology might create legal liability.
34 Benefits and Risks of Disclosure1/2 Benefits to the Patient *Opportunity to receive corrective treatment *Helps them to make informed decisions *Promotes trust in the physician *Alleviates worry why did that happen to me? *Acknowledges fallibility encourages patient to take greater responsibility for their own care *Opportunity to receive fair compensation Benefits to the Physician May be less likely to be sued *If sued, the fact that you disclosed may help your case *May help alleviate stress *Fulfills your moral obligation to tell the truth
35 Benefits and Risks of Disclosure2/2 Risks to the Patient Anxiety / Confusion (but pt s in Gallagher s study did not report this) Loss of trust in the system These risks may justify non-disclosure of inconsequential errors Risks to the Physician Risk of being sued (if the patient wouldn t otherwise know about the error) Risk of disciplinary action Possible loss of reputation Loss of patients
36 Joint Commission Requirement (Endorsed by most Patient Safety and Risk Management organizations) As a requirement of Joint Commission certification, hospitals must develop policies on disclosure of unanticipated outcomes to patients/families. Disclosure only required for unanticipated outcomes ie when there is harm Don t have to disclose an error if no harm results But: Does this meet the ethical standard? Who is to decide what harm is?...
37 Was there harm? Differing perceptions of harm. Is it harm if Treatment is delayed slightly? Hospital stay is prolonged? Patient undergoes unnecessary tests? Patient has to incur additional costs? Hospital or health plan has to incur additional costs? Harm may not be apparent until after discharge. Therefore the patient may need to be informed of warning signs for potential harm. These and other practical issues need to be resolved
38 What should I say? As a student do nothing by yourself! If you discover an error: Inform your supervisor(s) Discuss possible disclosure options Ultimately the physician has to decide whether to disclose and what to say
39 What should I say? As a physician If no or mild harm Consider informing (weigh the risks and benefits) If significant harm Consult with risk management / malpractice carrier Consider informing (weigh the risks and benefits) If you decide to disclose: What should you say?
42 Error disclosure protocol:1/6 Consider doing the following (in a timely fashion): (after weighing up the risks and benefits) 1. Acknowledge the error 2. Apologize and empathize 3. Accept some responsibility 4. Commit to investigate & prevent 5. Set the tone 6. Address adverse consequences 7. Address any other concerns 8. Arrange follow-up
43 Error disclosure protocol:2/6 1. Set the tone in person eye-level private & respectful consider participants check comfort allow time for the patient/family to react to what you say listen
44 Error disclosure protocol:3/6 2. Acknowledge the error Be direct Use words such as error or mistake I think you received the wrong medication by mistake You are right - you were supposed to get the MRI today. Sounds like an error was made.
45 Error disclosure protocol:4/6 3. Apologize and empathize I m sorry that this happened to you is not an admission of guilt it s not a true apology either! I certainly understand your anger about the unnecessary delay in your discharge an expression of empathy I m sorry I made a mistake is a true apology however, it is an admission of guilt may create legal liability in some states may be premature (most harm is multi-factorial and involves system failures)
46 Error disclosure protocol:5/6 4. Accept some responsibility for the error and its consequences If you are sure it was your error, consider saying so: It was my mistake. I forgotten to write the order. [Note that this can create legal liability] If it is possible you may have contributed to the error, consider saying so: I m not sure how this happened. I may have written the wrong order, or maybe it was illegible, or maybe someone else made a mistake in following the orders. Don t be too sure about your personal responsibility without some pause for reflection and supervision. Guilt can influence your words.
47 Error disclosure protocol:6/6 5. Commit to investigate and prevent Commit to investigate the error to find its causes Commit to inform the patient of the findings Commit to attempt to prevent the error from happening again 6. Address adverse consequences Screen & work up as needed Educate/advise patient as needed 7. Address any other concerns 8. Arrange Follow-up
48 Tips for safe disclosure Don t t be evasive *Make yourself available *Don t t say No comment Don t t jump to conclusions prematurely some questions require further investigation before they can be answered. Say that you are not sure rather than blaming someone else or denying responsibility immediately. Don t t use jargon the patient may think you are trying to confuse them. Don t t promise something unless you can deliver.
49 Conclusions - Theory Ethical arguments in favor of full and honest disclosure of all errors, regardless of harm caused, are widely recognized. JC requires that errors be disclosed if harm occurs. Most patients desire full disclosure and an apology. Fear of litigation makes many physicians feel uncomfortable disclosing information and apologizing. The desire to find out what happened, and to prevent recurrence are the cause of many lawsuits. Disclosure may decrease the risk of litigation since it helps to meet these needs further studies are needed.
50 Conclusions - Practice Don t despair (it s not all doom and gloom!) Most errors have relatively mild effects as a physician, errors will happen in your practice but you can manage them effectively if you communicate well with your patients For errors that cause serious harm you are not alone help is available
51 Final Thought Treat other people the way you would want to be treated.
Disclosing Medical Errors: 2008 and Beyond Wendy Levinson, MD Professor of Medicine University of Toronto Goals 1. To describe physicians attitudes and experience re disclosure. 2. To describe changing
Improving open disclosure in Dutch hospitals Kiliaan van Wees and Lodewijk Smeehuijzen/VU University, Amsterdam Introduction Previous research project Open Communication and Compensation following adverse
Disclosing Medical Errors to Patients: Developing and Implementing Effective Programs Thomas H. Gallagher, MD University of Washington School of Medicine Accelerating Interest in Disclosure Growing experimentation
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
Georgene Saliba MBA, CPHRM Administrator, Risk Management & Patient Safety Lehigh Valley Health Network Allentown, PA Objectives Define Enterprise Risk Management(ERM) and its application when managing
APHA 33 rd National Congress Open Disclosure Workshop with Case Studies Presented by Dr Chris Beck, Prof Rick Iedema, Dr John Wakefield, and Shane Evans 25 March 2014 ME_112150592 A. Overview and Framework
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
Ghazala Sharieff MD, MBA Medical Director, Quality and Medical Management, Scripps Health Scott Buchholz Esq Dummit, Buchholz & Trapp Ana Jackson RN, MSN Senior Director, Risk Management, Scripps Health
Disclosing Medical Errors to Patients: International Developments and Future Directions Thomas H. Gallagher, MD University of Washington School of Medicine Accelerating Interest in Disclosure Growing experimentation
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
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.
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
ADMITTING MISTAKES: ETHICAL CHOICES AND REASONING Mark S. Hochberg, M.D. Department of Surgery New York University School of Medicine GOALS AND OBJECTIVES What is a medical mistake? Ethical choices when
Guide To Patient Counselling page - 1 - GUIDE TO PATIENT COUNSELLING Communication is the transfer of information meaningful to those involved. It is the process in which messages are generated and sent
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
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,
Tort Reform in Utah: Disclosure, Apology and Resolution Intermountain Healthcare Healthy Dialogues Series Greg Bell President/CEO Utah Hospital Association Who is UHA? NFP trade association established
Medical Malpractice VOIR DIRE QUESTIONS INTRODUCTION: Tell the jurors that this is a very big and a very important case. Do a SHORT summary of the case and the damages we are seeking. This summary should
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,
Statutory duty of candour with criminal sanctions Briefing paper on existing accountability mechanisms Background In calling for the culture of the NHS to become more open and honest, Robert Francis QC,
CHAPTER 24 DEPOSITION GUIDANCE FOR NURSES I. INTRODUCTION With the number of personal injury and healthcare-related lawsuits increasing each year, at some time in your professional career as a nurse, you
Jun 1, 2003 Contemporary Pediatrics The difficult duty of disclosing medical errors By Steven M. Selbst, MD Few tasks are harder than telling a patient and family that they have fallen victim to a medical
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
CLINICAL CASE 2 Disclosure and the Retrospectoscope Commentary by Thomas H. Gallagher, MD, and R. James Brenner, MD Mrs. Lee is a busy, working mother. She has raised three children, all of whom are successful
Should We Disclose Harmful Medical Errors to Patients? If So, How? Thomas H. Gallagher, MD, and Mary Hardy Lucas, RN, MA Abstract Objective: To assess the strength of the evidence for disclosing errors
Activities for MANAGERS Australian Safety and Quality Framework for Health Care Putting the Framework into action: Getting started Contents Principle: Consumer centred Area for action: 1.1 Develop methods
Your Personal Guide To Your Personal Injury Lawsuit Know How To Do Things Right When You ve Been Wronged You have questions. And most likely, you have a lot of them. The good news is that this is completely
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
Virtual Mentor American Medical Association Journal of Ethics April 2007, Volume 9, Number 4: 300-304. Health law I m sorry laws and medical liability by Flauren Fagadau Bender, JD Mrs. G. arrived at the
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
How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB, ChB, FRCP, FACG ACG Annual Meeting 2013 How to Professionally and Personally Survive a Malpractice Suit John Baillie, MB,
Disclosure & Early Offer: How it Started, where it is Going. Steve Kraman, MD* Professor, Pulmonary, Critical Care and Sleep Medicine University of Kentucky, USA firstname.lastname@example.org *Former chief of staff,
PFSP Dealing with adverse events, complaints, and medical legal litigation PFSP The first steps... The information in this brochure is intended to provide immediate and useful information for physicians
Learning when things go wrong Marg Way Director, Clinical Governance Alfred Health, Melbourne Safety and Quality Management in hospitals Things have changed a lot over the last 10 years.. HOSPITAL catastrophes
Mitigating Legal and Ethical Risks Patrick O Rourke, JD Julie Altmix, RN, BSN University of Colorado Denver School of Medicine Conflict of Interest We have no conflicts of interest, commercial or otherwise,
Document Information Board Library Reference Document Author Assured By Review Cycle P033 Head of Risk & Compliance Quality & Healthcare Governance 3 Years Note: This document is electronically controlled.
TESTIMONY OF WILLIAM M. SAGE, MD, JD PROFESSOR COLUMBIA LAW SCHOOL BEFORE THE COMMITTEE ON HEALTH, EDUCATION, LABOR, AND PENSIONS UNITED STATES SENATE June 22, 2006 Mr. Chairman and Members of the Committee,
EXECUTIVE SUMMARY Compliance Program and False Claims Recovery INTRODUCTION: The Federal Deficit Reduction Act of 2005, also known as the DRA, requires that providers give their employees, medical staff,
Mock Trial Examining Elements to Prepare the Pediatric Practitioner Brian G. Wilhelmi M.D./J.D., Eric V. Jackson M.D./M.B.A., Robert S. Greenberg M.D., Brian J. McNamara J.D. 1 Educational Objectives Upon
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
Responding to Complaints in Your Practice Contents Frontline and formal complaints 3 Why do patients complain? 3 How doctors respond to complaints 4 Your responsibilities 4 Avoiding complaints 5 Avoiding
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
AAFP Reprint No. 281 Recommended Curriculum Guidelines for Family Medicine Residents Risk Management and Medical Liability This document was endorsed by the American Academy of Family Physicians (AAFP).
Code of conduct for Healthcare Support Workers Working to standard: a code of conduct for support workers in health care 1. Introduction 1.1 Welcome to this code of conduct for support workers in health
TRIAL IS DEFINED AS, A FAILURE TO SETTLE The Mediator s Perspective By Professor John Burwell Garvey Franklin Pierce Law Center For the typical case involving insurance defense, mediation should be the
SUPERIOR COURT OF THE COUNTY OF LOS ANGELES If you are a subscriber of Kaiser Foundation Health Plan, Inc. and you, or your dependent, have been diagnosed with an autism spectrum disorder, you could receive
Quality of care series Number 1: Medical error Extract from Addressing global patients safety issues. An advocacy toolkit for patient organisations. International Alliance of Patient Organizations. 2008.
Judgment & Comprehension in Nursing Situations Subtest This test was designed by psychologists to identify someone who will make appropriate decisions in the nursing role Because a nurse often finds himself/herself
Crisis Management Guide The Crisis Management Guide has been designed to help your company effectively respond to a crisis situation. Crises, large and small can be minimized if a thorough Crisis Management
After the Error: Disclosure Responsibilities and Controversies Sue Evans, M.D., M.P.H. June 15, 2012 S L I D E 0 Disclosures I have no financial disclosures. Relationships: ASTRO multidisciplinary Quality
Great Bay Mental Health Associates, Inc. Notice to Clients and Consent to Mental Health Treatment Agreement Courtney A. Atherton, MA, LCMHC, MLADC Patient Name (please print): Welcome to the therapy services
MODULE 4 QUIZ Legal Issues in Documentation 1. From a legal standpoint, failure to document client care means which of the following? a. The care provider made errors b. Care provider forgot to document
Consumer Awareness Guide to Choosing a Personal Injury Lawyer Provided as an educational service by: Anthony D. Castelli, Esq. Concentration in Auto and Work Related Injuries (513) 621-2345 Read this guide
Communication to Prevent and Respond to Medical Injuries: WA State Collaborative Thomas H. Gallagher, MD Professor of Medicine, Bioethics & Humanities Director, UW Medicine Center for Scholarship in Patient
49th Annual Meeting Preventing Medication Errors in a Just Culture Environment Disclosure I do not have a vested interest in or affiliation with any corporate organization offering financial support or
AIDET Overview: Why, What & How TRAINING OBJECTIVES By the end of this training session you will be able to: 1 Explain what AIDET means and understand the use of Key Words as a tactic to: Improve Operational
Free Legal Consumer Guide Series Brought To You By Meeting All Your Legal Needs For 50 Years 2 What You Need To Know About Workers Compensation HOW TO USE THIS GUIDE If you read this guide, you will discover
1. Q: Will the transition log be sent to the counties and care systems electronically? A: It will be available on each health plan s Web page. If a website is not available, the plan will send the form
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,
Policy and Procedure for Claims Management RESPONSIBLE DIRECTOR: COMMUNICATIONS, PUBLIC ENGAGEMENT AND HUMAN RESOURCES EFFECTIVE FROM: 08/07/10 REVIEW DATE: 01/04/11 To be read in conjunction with: Complaints
Vexical s Solution to the Patient Responsibility Conundrum Abstract: Providers are drowning in bad debt to the sum of $65B annually 1. A significant portion of the bad debt is due to the fact that patients/families
KNOW THE FACTS Medical Review Panels are Constitutional in Kentucky SUMMARY Medical review panel legislation very similar to the process supported by the Care First Kentucky Coalition in Senate Bill 119
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
Chapter 35. Error Reporting and Disclosure Zane Robinson Wolf, Ronda G. Hughes Background This chapter examines reporting of health care errors (e.g., verbal, written, or other form of communication and/or
Page 1 Listen, Protect, and Connect PSYCHOLOGICAL FIRST AID FOR CHILDREN, PARENTS, AND OTHER CAREGIVERS AFTER NATURAL DISASTERS Helping you and your child in times of disaster. Page 2 As a parent or adult
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
10 things sued 2010-11 A publication of Texas Medical Liability Trust TEXAS MEDICAL LIABILITY TRUST 901 Mopac Expressway South Barton Oaks Plaza V, Suite 500 Austin, TX 78746-5942 P.O. Box 160140 Austin,
IN THE HIGH COURT OF JUSTICE IN NORTHERN IRELAND PROTOCOL FOR CLINICAL NEGLIGENCE LITIGATION 1. Practitioners are reminded of the need to bear in mind the overriding objective set out at Order 1 rule 1(a)
Risk Management Advice in Dealing with the Unhappy Financial Disclosure: OMIC: Immediate Past-Chairman of the Board Member, Board of Directors Richard L. Abbott, M.D. Thomas W. Boyden Health Sciences Clinical
Dale C. Godby, Ph.D., ABPP, CGP 6330 LBJ Suite 150 Dallas, Texas 75240 972-233-0648 Problems in love and work, as well as troubling symptoms like depression and anxiety, often lead people to seek therapy.
Medical Malpractice Legal Problems!!! Aaron G Hill CCP Sentara Careplex Hampton Va VCU Medical Center Richmond, Va Estimated Deaths Due to Medical Error Source The Philadelphia Inquirer Total lives lost
Hip Transplant Detailed Study INTRODUCTION This case involves four patients who underwent hip replacements with a "metal-on-metal" device designed and manufactured by "Replacement Manufacturer." The patients
Your Guide to Recovery PERSONAL INJURY LAWYERS Committed to Your Future We will: Ensure all necessary notices are provided to maintain your claim and commence the action within the limitation period. Work
Deborah Issokson, Psy.D. Licensed Psychologist HEALTHCARE PRIVACY AND SECURITY POLICIES PSYCHOTHERAPIST-PATIENT SERVICES AGREEMENT Welcome to my practice. This document (the Agreement) contains important
The Perils of Practice Staying Out of the Courtroom and Off Social Media Miriam (Mimi) Clemons, JD, MBA Asst. Vice President - Claims and Director of Memphis Operations SVMIC Claims With A Loss By Location
DORCHESTER COUNTY, MARYLAND Fiscal Policies and Procedures Fraud, Waste & Abuse Adopted August 11, 2009 SECTION I - INTRODUCTION The County Council of Dorchester County, Maryland approved on August 11,
Law and Veterinary Medicine Malpractice November 30, 2006 Paul Waldau, D.Phil., J.D. a little refreshment Making sure you re clear on the contract-tort distinction and why it is so important in the legal
Facing Legal Action: An Employee's Guide An information leaflet for employees of: Cambridgeshire & West Norfolk PCTs/PCP Cambridge & Peterborough Mental Health Partnership NHS Trust Anglia Support Partnership
Quality measures in healthcare Henri Leleu Performance of healthcare systems (WHO 2000) Health Disability-adjusted life expectancy Responsiveness Respect of persons Client orientation Fairness France #1
Title: Duty of candour and the disclosure of adverse events to patients and families Author: Yvonne Birks Professor of Health and Social Care Social Policy Research Unit University of York YO10 5DD email@example.com