Medical malpractice 965553 226026166 2008-07-16T14:26:28Z Nbauman 2419261 rv edit no reason given in edit summary. Injury is a necessary component of malpractice. {{POV|date=December 2007}} {{globalize/USA}} {{TortLaw}} '''Medical malpractice''' is an act or omission by a health care provider which deviates from accepted standards of practice in the medical community and which causes injury to the patient. Simply put, medical [[malpractice]] is [[professional negligence]] (by a healthcare provider) that causes an injury. At the outset it is important to remember that virtually every country in the world operates its own unique legal system, and within some countries (e.g. the [[USA]], the [[United Kingdom]]), there is more than one system operating within the same national borders. While much of this article mentions US law, it is important to remember that US law is not applicable world-wide, including when it comes to medical malpractice. Medical malpractices may hide medical murders. When Japanese nurse [[Daisuke Mori]] was arrested, it was suspected because there were many medical malpractices in Japan.<ref>{{cite web|url=http://www.time.com/time/asia/magazine/2001/0122/japan.nurse.html|title=Very Questionable Care |publisher=Time |author=Tim Larimer |date=2001-01-22 |accessdate=2008-03-22 }}</ref><ref>{{cite web|url=http://www.japantoday.com/jp/shukan/5|title=Sendai's killer nurse|publisher=[[Japan Today]]|date=2001-01-26|accessdate=2008-03-22}}</ref> At common law, the issue of [[Professional liability insurance]] is a subset of the law of negligence. ==The medical malpractice claim== ===The parties === The [[plaintiff]] is or was the patient, or a legally designated party acting on behalf of the patient, or -- in the case of a wrongful-death suit -- the executor or administrator of a deceased patient's estate. The [[defendant]] is the health care provider. Although a 'health care provider' usually refers to a physician, the term includes any medical care provider, including dentists, nurses, and therapists. As illustrated in ''Columbia Medical Center of Las Colinas v Bush (122 S.W. 3d 835, Texas, 2003)'', "following orders" may not protect nurses and other non-physicians from liability when committing negligent acts. Relying on [[vicarious liability]] or direct corporate negligence, claims may also be brought against hospitals, clinics, managed care organizations or medical corporations for the mistakes of their employees. ===Elements of the case=== A [[plaintiff]] must establish all four elements of the tort of negligence for a successful medical malpractice claim.<ref>{{cite web | last = | first = | year = 1997 | url = http://info.med.yale.edu/caim/risk/malpractice/malpractice_2.html | title = The Four Elements of Medical Malpractice | format = | publisher =Yale New Haven Medical Center: Issues in Risk Management | accessyear = 1997}}</ref> # A duty was owed - a [[legal duty]] exists whenever a hospital or health care provider undertakes care or treatment of a patient. # A duty was breached -- the provider failed to conform to the relevant [[standard of care]]. The standard of care is proved by expert testimony or by obvious errors (the doctrine of [[res ipsa loquitor]] or 'the thing speaks for itself'). # The breach caused an injury -- The breach of duty was a [[proximate cause]] of the injury. # Damages -- Without damages (losses which may be pecuniary or emotional), there is no basis for a claim, regardless of whether the medical provider was negligent. ===The trial=== Like all other tort cases, the [[plaintiff]] (or the plaintiff's attorney) files a lawsuit in a court with appropriate [[jurisdiction]]. Between the filing of suit and the trial, the parties (or their attorneys) are required to 'share information' through a process known as [[Discovery (law)|discovery]]. Such information includes [[interrogatories]], requests for documents, and [[deposition]]s. If both parties agree, the case may be settled early on negotiated terms. If the parties cannot agree, the case will proceed to trial. The plaintiff has the [[burden of proof]] to prove all the elements by a preponderance (51%) of evidence. At trial, both parties will usually present experts to testify as to the standard of care required, and other technical issues during trial. The fact-finder (judge or jury) must then weigh all the evidence and determine which is the most credible. The factfinder will render a [[verdict]] for the prevailing party, and assesses the compensatory and punitive damages, within the parameters of the judge's instructions. The verdict is then reduced to the [[judgment]] of the court. The losing party may move for a new trial. In a few jurisdictions, a plaintiff who is dissatisfied by a small judgment may move for [[additur]]. In most jurisdictions, a defendant who is dissatisfied with a large judgment may move for [[remittitur]]. Either side may take an [[appeal]] from the judgment. ===Expert testimony=== [[Expert witness]]es must be qualified by the Court, based on the prospective experts qualifications and the standards set from [[legal precedent]]. To be qualified as an expert in a medical malpractice case, a person must have a sufficient knowledge, education, training, or experience regarding the specific issue before the court to qualify the expert to give a reliable opinion on a relevant issue. The qualifications of the expert are not the deciding factors as to whether the individual will be qualified, although they are certainly important considerations. Expert testimony is not qualified "just because somebody with a diploma says it is so" (''United States v. Ingham'', 42 M.J. 218, 226 [A.C.M.R. 1995]). In addition to appropriate qualifications of the expert, the proposed testimony must meet certain criteria for reliability. In the United States, two models for evaluating the proposed testimony are used: The more common (and some believe more reliable) approach used by all federal courts and most state courts is the 'gatekeeper' model, which is a test formulated from the US Supreme Court cases ''[[Daubert v. Merrell Dow Pharmaceuticals]]'' (509 U.S. 579 [1993]), ''[[General Electric Co. v. Joiner]]'' (522 U.S. 136 [1997]), and ''[[Kumho Tire Co. v. Carmichael]]'' (526 U.S. 137 [1999]. Before the trial, a [[Daubert]] hearing<ref>{{cite web | last =Reeg and Bebout | first = | year = 1993 | url = http://www.mobar.org/journal/1997/novdec/bebout.htm | title = What's It All About, Daubert? | format = | publisher =Journal of the Missouri Bar | accessyear = 1993}}</ref>will take place before the judge (without the jury). The trial court judge must consider evidence presented to determine whether an expert's "testimony rests on a reliable foundation and is relevant to the task at hand." (Daubert, 509 U.S. at 597). The Daubert hearing considers 4 questions about the testimony the prospective expert proposes: * Whether a "theory or technique . . . can be (and has been) tested" * Whether it "has been subjected to peer review and publication". * Whether, in respect to a particular technique, there is a high "known or potential rate of error" * Whether there are "standards controlling the technique's operation".<p> Some state courts still use the Frye test that relies on scientific consensus to assess the admissibility of novel scientific evidence. Daubert expressly rejected the earlier federal rule's incorporation of the Frye test. (Daubert, 509 U.S. at 593-594) Expert testimony that would have passed the Frye test is now excluded under the more stringent requirements of [[Federal Rules of Evidence]] as construed by Daubert. In view of Daubert and Kuhmo, the pre trial preparation of expert witnesses is critical.<ref> Preparing Plaintiff's Expert in the Post Kuhmo Era, [[Anthony H. Gair]], [[New York State Bar Association]], [[1999]]</ref> A problem with Daubert is that the presiding judge may admit testimony which derives from highly contested data. The judge may expand the limits contained in the "school of thought" precedent. Papers that are self-published may be admiited as the basis for expert testimony. Non-peer reviewed journals may also be admitted in similar fashion. The only criterion is the opinion of a single judge who, in all likelihood, has no relevant scientific or medical training. <ref> LR Tancredi, AJ Giannini.The admissability of scientific evidence in psychiatric malpractice:Daubert. Journal of Clinical Forensic Medicine (UK).1:145-149,1994.</ref> ===Damages=== The plaintiff's [[damages]] may include compensatory and punitive damages. Compensatory damages are both economic and non-economic. Economic damages include financial losses such as lost wages (sometimes called lost earning capacity), medical expenses and life care expenses. These damages may be assessed for past and future losses. Non-economic damages are assessed for the injury itself: physical and psychological harm, such as loss of vision, loss of a limb or organ, the reduced enjoyment of life due to a disability or loss of a loved one, severe pain and emotional distress. [[Punitive damages]] are only awarded in the event of wanton and reckless conduct. ==Statistics on malpractice and preventable medical error== {{Main|Medical error}} Medical malpractice claims can help identify areas where primary health care in the United States needs improvement, according to the American Academy of Family Physicians. The Academy refers to a study entitled "Learning from Malpractice Claims about Negligent, Adverse Events in the United States", in suggesting that the medical community can learn from tort claims. In that study, researchers looked at primary care malpractice claims settled between 1985 and 2000 in the United States. The study focused on a subset of 5,921 claims that were clear errors. The researchers found: * 68 percent of the errors were in outpatient settings and resulted in more than 1,200 deaths. * Negligence was more likely to have severe outcomes when they occurred in hospitals, but the total number of high severity outcomes and death was larger in the outpatient setting. * Of the 10 most prevalent medical conditions with error-related claims, no single condition accounted for more than five percent of all negligent claims. * Diagnostic error accounted for more than one-third of the claims.<ref>{{cite web | last = | first = | year = 2004 | url = http://www.aafp.org/online/en/home/press/aafpnewsreleases/april/malpractice.html | title = Malpractice Claim Reports Can Help Direct Prevention of Medical Errors | format = | publisher =American Academy of Family Physicians | accessyear =2004}}</ref> A recent study by [[Healthgrades]] found that an average of 195,000 hospital deaths in each of the years 2000, 2001 and 2002 in the U.S. were due to potentially [[preventable medical errors]]. Researchers examined 37 million patient records and applied the mortality and economic impact models developed by Dr. Chunliu Zhan and Dr. Marlene R. Miller in a study published in the Journal of the American Medical Association (''[[Journal of the American Medical Association|JAMA]]'') in October of 2003. The Zhan and Miller study supported the Institute of Medicine’s (IOM) 1999 report conclusion, which found that medical errors caused up to 98,000 deaths annually and should be considered a national epidemic. <ref>{{cite web | last = | first = | year = 2004 | url = http://www.medicalnewstoday.com/medicalnews.php?newsid=11856 | title = In Hospital Deaths from Medical Errors at 195,000 per Year in USA | format = | publisher =Medical News Today | accessyear =2006}}</ref>Some researchers questioned the accuracy of the 1999 IOM study, reporting both significant subjectivity in determining which deaths were "avoidable" or due to medical error and an erroneous assumption that 100% of patients would have survived if optimal care had been provided. A 2001 study in ''[[Journal of the American Medical Association|JAMA]]'' estimated that only 1 in 10,000 patients admitted to the hospital would have lived for 3 months or more had "optimal" care been provided.<ref>{{cite journal |author=Hayward R, Hofer T |title=Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer |journal=JAMA |volume=286 |issue=4 |pages=415–20 |year=2001 |pmid=11466119 |doi=10.1001/jama.286.4.415}}</ref> A 2006 follow-up to the 1999 Institute of Medicine of the National Academies study found that medication errors are among the most common medical mistakes, harming at least 1.5 million people every year. According to the study, 400,000 preventable drug-related injuries occur each year in hospitals, 800,000 in long-term care settings, and roughly 530,000 among Medicare recipients in outpatient clinics. The report stated that these are likely to be conservative estimates. In 2000 alone, the extra medical costs incurred by preventable drug related injuries approximated $887 million -- and the study looked only at injuries sustained by Medicare recipients, a subset of clinic visitors. None of these figures take into account lost wages and productivity or other costs.<ref>{{cite web | last = | first = | year = 2006 | url = http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=11623 | title = Medication Errors Injure 1.5 Million People and Cost Billions of Dollars Annually | format = | publisher = The National Academy of Science | accessyear =2006}}</ref> == Criticism of medical malpractice lawsuits == Doctors' groups, patients, and insurance companies have criticized medical malpractice litigation as expensive, adversarial, unpredictable, and inefficient. They claim that the cost of medical malpractice litigation in the United States has steadily increased at almost 12 percent annually since 1975.<ref>[http://www.towersperrin.com/tp/getwebcachedoc?webc=TILL/USA/2006/200603/2005_Tort.pdf#searc%20h=%22Tillinghast%20Towers%20Perrin%2C%20U.S.%20Tort%20Cos%0Ats%20and%20Cross-Border%20Perspectives%3A%202005%20Upda%0Ate%22] Towers Perrin, Tillinghast, U.S. Tort Costs and Cross-Border Perspectives: 2005 Update, (New York, NY: Towers Perrin, March 2006). Tillinghast/Towers Perrin is an interested party in the politics of tort reform with its operations as a major consultant to the insurance industry and as an insurance company itself with its reinsurance business. Previous studies by Tillinghast/Towers Perrin study have been [http://www.epi.org/content.cfm/bp157 criticized] by the Economic Policy Institute as unverifiable: "Although TTP's estimate is widely cited by journalists, politicians, and business lobbyists, it is impossible to know what the company is actually measuring in its calculation of tort costs, and impossible to verify its figures, because TTP will not share its data or its methodology, which it claims are 'proprietary.'" </ref>Jury Verdict Research, a database of plaintiff and defense verdicts, says awards in medical liability cases increased 43 percent in 1999, from $700,000 to $1,000,000. <p> These critics assert that these rate increases are causing doctors to go out of business or move to states with more favorable tort systems.<ref>[http://www.business-journal.com/archives/20040611MedicalMalpracticeInsuranceRoundtableDoctorsPrescribeRemediesforCrisis.asp Medical Malpractice Insurance Roundtable: Doctors Prescribe Remedies for Crisis]. The Business Journal, Jun 11, 2004, accessed August 3, 2006.</ref> Not everyone agrees, though, that medical malpractice lawsuits are solely causing these rate increases. A 2003 report from the [[General Accounting Office]] found multiple reasons for these rate increases, only one of which was medical malpractice lawsuits.<ref>[http://www.gao.gov/new.items/d03702.pdf GAO-03-702 Medical Malpractice Insurance: Multiple Factors Have Contributed to Increased Premium Rates] General Accounting Office, June 2003, accessed August 3, 2006.</ref> Despite noting multiple reasons for rate increases, the report goes on to state that the "GAO found that losses on medical malpractice claims-which make up the largest part of insurers’ costs-appear to be the primary driver of rate increases in the long run." <p> [[Tort reform]] advocate [[Common Good (organization)|Common Good]] has proposed creating specialized medical courts (similar to distinct tax courts) where medically-trained judges would evaluate cases and subsequently render precedent-setting decisions. Proponents believe that giving up jury trials and scheduling noneconomic damages such as pain and suffering would lead to more people being compensated, and to their receiving their money sooner. This approach has been criticized for treating medical malpractice differently from other areas of tort law and for depriving Americans of their right to a trial by jury. Still, a number of groups and individuals have supported this proposal.<ref>[http://www.law.com/jsp/nlj/PubArticleNLJ.jsp?id=1114798472362 National Law Journal], [http://www.usatoday.com/news/opinion/editorials/2005-07-04-our-view_x.htm 'Health courts' offer cure] USA Today, July 4, 2005, accessed Aug. 3, 2006; and [http://cgood.org/healthcare-newscommentary-inthenews-252.html Health Courts Endorsed in Wall Street Journal] by Betsy McCaughey The Wall Street Journal, August 24, 2005, accessed Aug. 2, 2006.</ref> Other tort reform proposals, some of which have been enacted in various states, include placing limits on noneconomic damages and collecting lawsuit claim data from malpractice insurance companies and courts in order to assess any connection between malpractice settlements and premium rates.<ref> [http://www.ncsl.org/standcomm/sclaw/medmaloverview.htm Medical Malpractice Tort Reform], National Conference of State Legislatures, May 1, 2006, accessed Aug. 3, 2006.</ref> Most (73%) settled malpractice claims involve medical error. A 2006 study published in the New England Journal of Medicine concluded that claims without evidence of error "are not uncommon, but most [72%] are denied compensation. The vast majority of expenditures [54%] go toward litigation over errors and payment of them. The overhead costs of malpractice litigation are exorbitant." Physicians examined the records of 1452 closed malpractice claims. Ninety-seven percent were associated with injury; of them, 73% got compensation. Three percent of the claims were not associated with injuries; of them, 16% got compensation. 63% were associated with errors; of them, 73% got compensation (average $521,560). Thirty-seven percent were not associated with errors; of them, 28% got compensation (average $313,205). Claims not associated with errors accounted for 13 to 16% percent of the total costs. For every dollar spent on compensation, 54 cents went to administrative expenses (including lawyers, experts, and courts). Claims involving errors accounted for 78 percent of administrative costs.<ref>[http://content.nejm.org/cgi/content/short/354/19/2024 Claims, Errors, and Compensation Payments in Medical Malpractice Litigation], [[New England Journal of Medicine]],May 11, 2006.</ref><ref>[http://www.law.com/jsp/nlj/PubArticleNLJ.jsp?id=1151658318847 Medical Malpractice Study, Disproving Frivolous Myth] , Jeffrey B. Bloom, Gair, Gair, Conason, Steigman & Mackauf, [[The National Law Journal]], July 3, 2006 </ref> ==Medical Malpractice and [[Medical Tourism]]== Medical malpractice interfaces with [[medical tourism]] (the practice of travelling overseas for the purpose of acquiring healthcare) at a number of levels. Medical malpractice suits and the damages awarded are one reason why healthcare costs have spiralled in the USA and in some other developed countries, and it is in turn these high costs which are persuading some people requiring or desiring healthcare services to travel overseas and become [[medical tourism|medical tourists]]. The costs of surgery etc. are often lower outside of the USA and Europe. Also, in 1998 The Institute of Medicine released a report highlighting that 44,000 - 98,000 Americans die each year of medical errors. [http://www.iom.edu/CMS/8089.aspx] On the other hand, [[medical tourism|medical tourists]] may find it difficult to take effective legal action if they run into difficulties overseas because of different legal systems, ethical standards, and local customs. In some countries active in [[medical tourism]], hospitals and their legal teams will work hard to avoid civil cases being heard in US courts. [http://www.sofiha.co.uk/page16.htm] In 2006, the group CEO of [[Bumrungrad Hospital]] in Thailand, stated "If there's a mistake, we fix it..... But the idea of suing for multimillions of dollars for damages is not going to be something you can do outside the U.S." In fact, this particular hospital requires all doctors within their group to carry malpractice insurance. [http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2006/11/02/national/a083252S07.DTL&type=health] ==References== {{reflist}} ==External links== [[Category:Medical malpractice| ]] [[Category:Health law]] [[Category:Healthcare law]] [[Category:Tort law]] [[Category:Healthcare quality]] [[de:Arzthaftung]] [[es:Negligencia médica]] [[he:רשלנות רפואית]] [[ja:医療事故]] [[pl:Błąd lekarski]] [[zh:医疗事故]]