Medical Malpractice Now

The annual statement of fire safety recently issued covers the period 1 January 2011 to 31 December 2011 and is due for completion by 24 February 2012. A letter sent to Chief Executives reminds them of the need to complete, sign and return the 2011 annual statement.

The purpose of the annual statement is to assure the Department of Health and the Care Quality Commission that the risk to patients, visitors and employee’s arising from the threat of fire is being effectively managed.

Read the letter on the annual statement of fire safety management 2011 and view the annual statement.

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Article source: http://www.dh.gov.uk/health/2012/01/statement-fire-safety/

The discussion was like some kind of malpractice bazaar, with lawyers blurting out terrible facts and big numbers.

“Our offer of $500,000 is more than we’ve ever had on a dead baby case,” said Margaret Sherman, a lawyer for the New York City Health and Hospitals Corporation, which runs 11 public hospitals.

The patients were not there, but the lawyers and Justice McKeon — who has better-than-average medical knowledge — were. Cajoling, flattering and arguing, Justice McKeon, of State Supreme Court, worked to bring about settlements long before the cases moved toward trials.

The approach, known as judge-directed negotiation, is seen by the Obama administration as offering states a way to curb liability expenses that have sharply increased health care costs nationally. Getting judges involved earlier, more often and much more actively in pushing for settlements, is its crucial ingredient — evident in the recent session watched by this reporter, one of many that are usually not attended by the public.

New York officials say the program bypasses years of court battles, limiting legal costs while providing injured patients with compensation that is likely to be less than a jury would award but can be paid out years earlier, without lengthy appeals.

Under a $3 million federal grant, the city courts are now expanding the program beyond the Bronx, where it started in cases against city hospitals, to courts in Brooklyn and Manhattan, as well as to cases against private hospitals. It is to begin in Buffalo courts in the fall.

“We would hope that other states across the country would look at this as a model they might want to replicate,” said James B. Battles, the official overseeing the grant at the federal Agency for Healthcare Research and Quality. By some estimates, the program could save more than $1 billion annually if state courts adopted it nationally, Dr. Battles said. The city’s public hospitals say the program, along with other changes, like sharply increased attention to safety, has helped save $66 million in malpractice costs a year. During the recent session in Justice McKeon’s chambers, the lawyers seemed more relaxed than they would be with patients watching. After he agreed to take $1.5 million for a child with cerebral palsy, a plaintiffs’ lawyer, Louis G. Solimano, seemed disappointed. “I didn’t get a grand slam,” he said.

Malpractice costs have been at the center of the debate about health care expenses for decades, with some states enacting legislation to limit awards. But the lawsuits have been difficult for judges to control, partly because the cases can go on with little judicial involvement for years, pushing up legal expenses and solidifying positions.

Michelle M. Mello, a Harvard professor of law and public health who is evaluating the New York experiment, said the program represented a major cultural change in malpractice cases. “Ordinarily when the parties come to a settlement conference, it’s late in the game,” she said. “It’s often a pro forma exercise rather than an attempt to grapple with the tricky issues in the case.”

Under the New York program, cases are assigned from their earliest stages to a judge with training in medical issues who holds frequent settlement conferences, often after months, rather than years. A nurse with legal training helps the judge. Lawyers are required to have the authority to settle. Justice McKeon, who started the approach when handling cases against public hospitals in the Bronx, said settlement became more difficult the longer a case lingered. State court officials say statistics indicate he settles about 20 percent more cases than other judges.

Article source: http://www.nytimes.com/2011/06/13/nyregion/to-curb-malpractice-costs-judges-jump-in-early.html?partner=rssnyt&emc=rss

Amitabh Chandra, a Harvard economist, is a leading expert on medical malpractice, and his work does not fit neatly into either the American Medical Association’s camp or the trial lawyers association’s camp. Sometimes it comforts one side. Sometimes, it comforts the other. I used Mr. Chandra’s research extensively in writing an overview of malpractice in 2009.

DAVID LEONHARDT

Thoughts on the economic scene.

Now he and three other researchers have a new paper, published in The New England Journal of Medicine. Among its findings is that a large majority of malpractice claims do not lead to any payment from a doctor to a patient. Either the patient drops the case, or a court dismisses it.

In every medical specialty the researchers studied, at least three out of four claims led to no payment. In many specialties, about 9 out of 10 claims led to no payment.

Over all, about 7 percent of doctors faced a claim in a given year, and fewer than 2 percent made any payment relating to a claim.

©2011 The New England Journal of Medicine; not for resale or commercial use

These patterns, the authors note, may help explain why doctors’ concern over malpractice suits is very high even in states that limit such suits, like Texas. As the paper notes, doctors’ self-reported worries about malpractice vary little across states, even though malpractice laws vary greatly. The researchers write:

Our results may speak to why physicians consistently report concern over malpractice and the intense pressure to practice defensive medicine, despite evidence that the scope of defensive medicine is modest. … Although these annual rates of paid claims are low, the annual and career risks of any malpractice claim are high, suggesting that the risk of being sued alone may create a tangible fear among physicians.

The perceived threat of malpractice among physicians may boil down to three factors: the risk of a claim, the probability of a claim leading to a payment, and the size of payment. Although the frequency and average size of paid claims may not fully explain perceptions among physicians, one may speculate that the large number of claims that do not lead to payment may shape perceived malpractice risk. Physicians can insure against indemnity payments through malpractice insurance, but they cannot insure against the indirect costs of litigation, such as time, stress, added work, and reputational damage.

These findings seem consistent with earlier research suggesting that malpractice reform is nothing like a magic bullet for high medical costs. But malpractice does weigh heavily enough on doctors’ minds that a more efficient accountability system for doctors — one in which avoidable errors were more likely to be punished and decent care was less likely to be subject to lawsuits — could both improve care and have some effect on costs.

In addition to Mr. Chandra, the paper’s authors are Anupam B. Jena, Seth Seabury and Darius Lakdawalla.

Article source: http://economix.blogs.nytimes.com/2011/08/17/malpractice-anxiety/?partner=rssnyt&emc=rss