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"Drawing on an unusually rich trove of data, the authors have refuted more politically convenient myths in one book than most academics do in a lifetime." —Nicholas Bagley, professor of law, University of Michigan Law School "Synthesizing decades of their own and others’ research on medical liability, the authors unravel what we know and don’t know about our medical malpractice system, why neither patients nor doctors are being rightly served, and what economics can teach us about the path forward." —Anupam B. Jena, Harvard Medical School Over the past 50 years, the United States experienced three major medical malpractice crises, each marked by dramatic increases in the cost of malpractice liability insurance. These crises fostered a vigorous politicized debate about the causes of the premium spikes, and the impact on access to care and defensive medicine. State legislatures responded to the premium spikes by enacting damages caps on non-economic, punitive, or total damages and Congress has periodically debated the merits of a federal cap on damages. However, the intense political debate has been marked by a shortage of evidence, as well as misstatements and overclaiming. The public is confused about answers to some basic questions. What caused the premium spikes? What effect did tort reform actually have? Did tort reform reduce frivolous litigation? Did tort reform actually improve access to health care or reduce defensive medicine? Both sides in the debate have strong opinions about these matters, but their positions are mostly talking points or are based on anecdotes. Medical Malpractice Litigation provides factual answers to these and other questions about the performance of the med mal system. The authors, all experts in the field and from across the political spectrum, provide an accessible, fact-based response to the questions ordinary Americans and policymakers have about the performance of the med mal litigation system.
n January 2005, President Bush declared the medical malpractice liability system out of control.The president's speech was merely an echo of what doctors and politicians (mostly Republicans) have been saying for years - that medical malpractice premiums are skyrocketing due to an explosion in malpractice litigation. Along comes Baker, direct...
Medical malpractice has been at the center of recurring tort crises for the last quarter-century. In 1960, expenditures on medical liability insurance in the United States amounted to about $60 million. In 1988, the figure topped $7 billion. Physicians have responded not simply with expensive methods of "defensive medicine" but also with successful pressure upon state legislatures to cut back on the tort rights of seriously injured patients. Various reforms have been proposed to deal with the successive crises, but so far none have proved to be effective and fair. In this landmark book, Paul Weiler argues for a two-part approach to the medical malpractice crisis. First, he proposes a thorough revision of the current tort liability regime, which would concentrate available resources on meeting actual financial losses of seriously injured victims. It would also shift the focus of tort liability from the individual doctor to the hospital or other health care organization. This would elicit more effective quality assurance programs from the institutions that are in the best position to reduce our current unacceptable rate of physician-induced injuries. But in states such as New York, Florida, and Illinois, where the current situation seems to have gone beyond the help of even drastic tort reform, the preferred solution is a no-fault system. Weiler shows how such a system would provide more equitable compensation, more effective prevention, and more economical administration than any practical alternative.
Books such as this one are deceptively difficult to create. The general subject is neither happy, nor easy, nor most anyone’s idea of fun. M- practice litigation, however, has become a central fact of existence in the practice of medicine today. This tsunami of lawsuits has led to a high volume of irreconcilable rhetoric and ultimately threatens the stability of the entire health care system. Our goal has been to provide a source of reliable information on a subject of importance to all who provide me- cal care in the United States. The book is divided into four sections. Part I gives an overview of insurance in general and discusses the organization of professional - ability insurance companies in particular. Part II focuses on the litigation process itself with views from the defense and plaintiff bar, and the physician as both expert and defendant. Part III looks at malpractice litigation from the viewpoint of the practicing physician. Some of the chapters are broadly relevant to all doctors—the rise of e-medicine, and the importance of effective communication, for example. The other ch- ters are constructed around individual medical specialties, but discuss issues that are of potential interest to all. Part IV looks ahead. “The Case for Legal Reform” presents changes in medical-legal jurisprudence that can be of immediate benefit. The final two chapters take a broader perspective on aspects of our entire health care system and its interface with law and public policy.
How safe are hospitals? Why do some hospitals have higher rates of accident and errors involving patients? How can we accurately measure and assess staff attitudes towards safety? How can hospitals and other healthcare environments improve their safety culture and minimize harm to patients? These and other questions have been the focus of research within the area of Patient Safety Culture (PSC) in the last decade. More and more hospitals and healthcare managers are trying to understand the nature of the culture within their organisations and implement strategies for improving patient safety. The main purpose of this book is to provide researchers, healthcare managers and human factors practitioners with details of the latest developments within the theory and application of PSC within healthcare. It brings together contributions from the most prominent researchers and practitioners in the field of PSC and covers the background to work on safety culture (e.g. measuring safety culture in industries such as aviation and the nuclear industry), the dominant theories and concepts within PSC, examples of PSC tools, methods of assessment and their application, and details of the most prominent challenges for the future in the area. Patient Safety Culture: Theory, Methods and Application is essential reading for all of the professional groups involved in patient safety and healthcare quality improvement, filling an important gap in the current market.
In the past 50 years the development of a wide range of medical devices has improved the quality of people's lives and revolutionized the prevention and treatment of disease, but it also has contributed to the high cost of health care. Issues that shape the invention of new medical devices and affect their introduction and use are explored in this volume. The authors examine the role of federal support, the decision-making process behind private funding, the need for reforms in regulation and product liability, the effects of the medical payment system, and other critical topics relevant to the development of new devices.
A Measure of Malpractice tells the story and presents the results of the Harvard Medical Practice Study, the largest and most comprehensive investigation ever undertaken of the performance of the medical malpractice system. The Harvard study was commissioned by the government of New York in 1986, in the midst of a malpractice crisis that had driven insurance premiums for surgeons and obstetricians in New York City to nearly $200,000 a year. The Harvard-based team of doctors, lawyers, economists, and statisticians set out to investigate what was actually happening to patients in hospitals and to doctors in courtrooms, launching a far more informed debate about the future of medical liability in the 1990s. Careful analysis of the medical records of 30,000 patients hospitalized in 1984 showed that approximately one in twenty-five patients suffered a disabling medical injury, one quarter of these as a result of the negligence of a doctor or other provider. After assembling all the malpractice claims filed in New York State since 1975, the authors found that just one in eight patients who had been victims of negligence actually filed a malpractice claim, and more than two-thirds of these claims were filed by the wrong patients. The study team then interviewed injured patients in the sample to discover the actual financial loss they had experienced: the key finding was that for roughly the same dollar amount now being spent on a tort system that compensates only a handful of victims, it would be possible to fund comprehensive disability insurance for all patients significantly disabled by a medical accident. The authors, who came to the project from very different perspectives about the present malpractice system, are now in agreement about the value of a new model of medical liability. Rather than merely tinker with the current system which fixes primary legal responsibility on individual doctors who can be proved medically negligent, legislatures should encourage health care organizations to take responsibility for the financial losses of all patients injured in their care.
Examines the newest scientific advances in the science of safety.