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Medical malpractice

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Medical malpractice

  1. 1. Medical Malpractice Sheldon F. Kurtz University of Iowa Percy Bordwell Professor of Law Professor of Medicine (Department of Surgery)
  2. 2. The Nature and Extent of Medical Error <ul><li>How rampant is medical error? </li></ul><ul><ul><li>3-jumbo jet crashes a day </li></ul></ul><ul><li>Is there too much medical litigation? </li></ul><ul><li>Does the data suggest reasons for physicians to be frustrated over malpractice litigation? </li></ul>
  3. 3. The Nature and Extent of Medical Error <ul><li>How rampant is medical error? </li></ul><ul><ul><li>3-jumbo jet crashes a day </li></ul></ul><ul><li>Does the data make your nervous about your doctor? </li></ul><ul><li>Is there too much medical litigation? </li></ul><ul><li>Does the data suggest reasons for physicians to be frustrated over malpractice litigation? </li></ul>
  4. 4. The Nature and Extent of Medical Error <ul><li>How rampant is medical error? </li></ul><ul><ul><li>3-jumbo jet crashes a day </li></ul></ul><ul><li>Does the data make your nervous about your doctor? </li></ul><ul><li>Is there too much medical litigation? </li></ul><ul><li>Does the data suggest reasons for physicians to be frustrated over malpractice litigation? </li></ul>
  5. 5. Extent of Suits <ul><li>28% for diagnostic errors </li></ul><ul><li>27% for surgical errors </li></ul><ul><li>26% for improper medical treatment </li></ul>
  6. 6. Who Gets Sued Most <ul><li>Surgeons </li></ul><ul><li>Anesthesiologists </li></ul><ul><li>Obstetricians </li></ul><ul><li>Emergency Medical Docs </li></ul>
  7. 7. Saks Study <ul><li>A negligent doctor who causes injury has a 3 out of 100 chance of being sued </li></ul><ul><li>A non-negligent doctor has a probability of being sued for a non-negligent injury of 13 out of 10,000. </li></ul><ul><li>Thus, for every malpractice claim in response to a negligent injury there are 15-30 malpractice victims who bring no suit but there are 4-5 claims brought by non-negligently injured patients. </li></ul>
  8. 8. How the Law Effects Quality of Care <ul><li>Medical malpractice </li></ul><ul><li>Licensure </li></ul><ul><li>Certification </li></ul>
  9. 9. Medical Malpractice Defined <ul><li>Medical malpractice occurs when a physician fails to act as a reasonable physician would have acted under the circumstances </li></ul>
  10. 10. The Liability Formula <ul><li>Duty (Did a physician-patient relationship exist) + </li></ul><ul><li>Breach of duty (Did the physician fail to meet the required standard of care) + </li></ul><ul><li>Causation (Did the physician’s breach cause the patient’s injury) + </li></ul><ul><li>Damages (Did the patient incur medical expenses, pain, suffering, lost wages as a result of the breach) = </li></ul><ul><li>LIABILITY </li></ul>
  11. 11. Proof of Malpractice-Experts <ul><li>Generally, expert witnesses required </li></ul><ul><li>Battle of experts </li></ul><ul><li>Local vs. National standard </li></ul><ul><ul><li>Locality rule: </li></ul></ul><ul><ul><ul><li>Historic </li></ul></ul></ul><ul><ul><ul><li>Unfair to patients if “conspiracy of silence” </li></ul></ul></ul><ul><ul><ul><li>Fails to recognition “nationalization” of medicine </li></ul></ul></ul><ul><ul><li>National </li></ul></ul><ul><ul><ul><li>Literature </li></ul></ul></ul><ul><ul><ul><li>Professional organizations </li></ul></ul></ul><ul><ul><li>Local standard (same locality or community of similar nature) still applicable for GPs, residents </li></ul></ul>
  12. 12. Proof of Malpractice-Experts <ul><li>Generally, expert witnesses required </li></ul><ul><li>Battle of experts </li></ul><ul><li>Local vs. National standard </li></ul><ul><ul><li>Locality rule: </li></ul></ul><ul><ul><ul><li>Historic </li></ul></ul></ul><ul><ul><ul><li>Unfair to patients if “conspiracy of silence” </li></ul></ul></ul><ul><ul><ul><li>Fails to recognition “nationalization” of medicine </li></ul></ul></ul><ul><ul><li>National </li></ul></ul><ul><ul><ul><li>Literature </li></ul></ul></ul><ul><ul><ul><li>Professional organizations </li></ul></ul></ul><ul><ul><li>Local standard (same locality or community of similar nature) still applicable for GPs, residents </li></ul></ul>
  13. 13. Proof of Malpractice-Experts <ul><li>Generally, expert witnesses required </li></ul><ul><li>Battle of experts </li></ul><ul><li>Local vs. National standard </li></ul><ul><ul><li>Locality rule: </li></ul></ul><ul><ul><ul><li>Historic </li></ul></ul></ul><ul><ul><ul><li>Unfair to patients if “conspiracy of silence” </li></ul></ul></ul><ul><ul><ul><li>Fails to recognition “nationalization” of medicine </li></ul></ul></ul><ul><ul><li>National </li></ul></ul><ul><ul><ul><li>Literature </li></ul></ul></ul><ul><ul><ul><li>Professional organizations </li></ul></ul></ul><ul><ul><li>Local standard (same locality or community of similar nature) still applicable for GPs, residents </li></ul></ul>
  14. 14. Proof of Malpractice-No Experts <ul><li>Common knowledge exception </li></ul><ul><li>Res ipsa loquitur </li></ul>
  15. 15. Malpractice Defenses <ul><li>Conformed to the standard of care </li></ul><ul><li>Alternative methods of treatment </li></ul><ul><li>Clinical innovation </li></ul><ul><li>Contributory Fault </li></ul><ul><li>Assumption of the risk </li></ul><ul><li>Waiver </li></ul>
  16. 16. Malpractice Defenses <ul><li>Conformed to the standard of care </li></ul><ul><li>Alternative methods of treatment </li></ul><ul><li>Clinical innovation </li></ul><ul><li>Contributory Fault </li></ul><ul><li>Assumption of the risk </li></ul><ul><li>Waiver </li></ul>
  17. 17. Malpractice Defenses <ul><li>Conformed to the standard of care </li></ul><ul><li>Alternative methods of treatment </li></ul><ul><li>Clinical innovation </li></ul><ul><li>Contributory Fault </li></ul><ul><li>Assumption of the risk </li></ul><ul><li>Waiver </li></ul>
  18. 18. Liability for acts of Others <ul><li>Vicarious liability </li></ul><ul><li>Captain of the Ship Doctrine </li></ul><ul><ul><li>Particularly for surgeons </li></ul></ul><ul><li>Borrowed servant doctrine </li></ul><ul><li>Referring physicians </li></ul><ul><li>Covering docs </li></ul><ul><li>Physician assistants </li></ul>
  19. 19. Liability for acts of Others <ul><li>Vicarious liability </li></ul><ul><li>Captain of the Ship Doctrine </li></ul><ul><ul><li>Particularly for surgeons </li></ul></ul><ul><li>Borrowed servant doctrine </li></ul><ul><li>Referring physicians </li></ul><ul><li>Covering docs </li></ul><ul><li>Physician assistants </li></ul>
  20. 20. Liability for acts of Others <ul><li>Vicarious liability </li></ul><ul><li>Captain of the Ship Doctrine </li></ul><ul><ul><li>Particularly for surgeons </li></ul></ul><ul><li>Borrowed servant doctrine </li></ul><ul><li>Referring physicians </li></ul><ul><li>Covering docs </li></ul><ul><li>Physician assistants </li></ul>
  21. 21. Hospital Liability for Acts of Doctors <ul><li>Employee Doctors </li></ul><ul><li>Sovereign and Charitable immunity </li></ul><ul><li>Medical Staff Doctors (non-employees) </li></ul><ul><ul><li>Ostensible agency </li></ul></ul><ul><ul><ul><li>Typically emergency room doctors </li></ul></ul></ul><ul><ul><ul><li>Implied agency (HMO’s watch out) </li></ul></ul></ul><ul><ul><li>Control test </li></ul></ul><ul><ul><ul><li>Negligence in granting privileges </li></ul></ul></ul><ul><ul><ul><li>Oversight </li></ul></ul></ul><ul><ul><li>Inherent or essential functions doctrine </li></ul></ul><ul><ul><ul><li>Emergency room; pathology; anesthesia </li></ul></ul></ul>
  22. 22. Statute of Limitations <ul><li>Date of occurrence </li></ul><ul><li>Date of discovery </li></ul><ul><li>Continuous treatment doctrine </li></ul>
  23. 23. Statute of Limitations <ul><li>Date of occurrence </li></ul><ul><li>Date of discovery </li></ul><ul><li>Continuous treatment doctrine </li></ul>
  24. 24. Information about Malpractice <ul><li>Boards of Medical Examiners </li></ul><ul><li>National Practitioner Data Bank </li></ul><ul><li>Operational Oversight </li></ul><ul><li>Who reports </li></ul><ul><li>Who has access </li></ul><ul><li>Who does not have access </li></ul>
  25. 25. Information about Malpractice <ul><li>Boards of Medical Examiners </li></ul><ul><li>National Practitioner Data Bank </li></ul><ul><li>Operational Oversight </li></ul><ul><li>Who reports </li></ul><ul><li>Who has access </li></ul><ul><li>Who does not have access </li></ul>

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