This document discusses respondeat superior tort liability and surgical errors in low-income countries. It begins with an overview of how hospitals can be held liable for employee malpractice under respondeat superior. It then reviews literature on health care legal structures, licensure, accreditation, and liabilities. The document recommends that hospitals in low-income countries minimize liability by implementing evidence-based practice guidelines for surgery, addressing nursing shortages, and pursuing accreditation to strengthen quality and safety standards.
The issue of fraud in health care has become a serious problem that every participant in the health delivery system must remain aware of in terms of potential and consequences. Managers in the health care system are tasked with ensuring that their staff members know the various fraud schemes as well as making sure that providers are not committing fraud themselves. A key way to accomplish this task is through education and training for fraud detection and prevention by and of health care stakeholders. The stakeholders in health care include providers, patients, organizations and institutions, the government, and the public. Also included are non-health care entities that may steal patient data for fraudulent claims and billing. Managers, therefore, are strongly advised to seek the services of health care compliance agencies to train staff, including doctors and nurses, on how to detect fraud and prevent fraud themselves. These agencies are also adept at helping to improve billing and payment functions to mitigate the risk of lost revenue through fraud and avoidance of criminal liability for the actions of providers and patients. The well-coordinated efforts of all stakeholders of health care assist in preserving the integrity of the system and make available quality services at reasonable prices for all.
The issue of fraud in health care has become a serious problem that every participant in the health delivery system must remain aware of in terms of potential and consequences. Managers in the health care system are tasked with ensuring that their staff members know the various fraud schemes as well as making sure that providers are not committing fraud themselves. A key way to accomplish this task is through education and training for fraud detection and prevention by and of health care stakeholders. The stakeholders in health care include providers, patients, organizations and institutions, the government, and the public. Also included are non-health care entities that may steal patient data for fraudulent claims and billing. Managers, therefore, are strongly advised to seek the services of health care compliance agencies to train staff, including doctors and nurses, on how to detect fraud and prevent fraud themselves. These agencies are also adept at helping to improve billing and payment functions to mitigate the risk of lost revenue through fraud and avoidance of criminal liability for the actions of providers and patients. The well-coordinated efforts of all stakeholders of health care assist in preserving the integrity of the system and make available quality services at reasonable prices for all.
What's the difference between fraud, waste and abuse when it comes to health care? What is the government doing to prevent fraud, waste and abuse from happening? Learn the definitions and differences in these legal terms and how CMS has worked to prevent these from happening since its inception in 1965.
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
Medical reimbursement issues push physicians to flee hospitals triggering a r...Medical Billers and Coders
For over a decade, US healthcare has seen hospitals integrating with primary healthcare physicians across all the states of the US, challenging the traditional notion of primary care as a separate set of services from hospital healthcare.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
Healthcare QualityPolicy and LawChapter 121ChaSusanaFurman449
Healthcare Quality
Policy and Law
Chapter 12
1
Chapter Overview
(1 of 2)
Discusses licensure and accreditation in the context of healthcare quality
Describes the scope and causes of medical errors
Describes the meaning and evolution of the medical professional standard of care
Identifies and explains certain state-level legal theories under which healthcare professionals and entities can be held liable for medical negligence
Chapter Overview
(2 of 2)
Explains how federal employee benefits law often preempts medical negligence lawsuits against insurers and managed care organizations
Describes recent efforts to measure and incentivize high-quality health care
Quality Control Through
Licensing and Accreditation
(1 of 3)
Licensing of healthcare professionals and institutions is an important function of state law, as it filters out those who may not have the requisite knowledge or skills to practice medicine
State licensure laws define the qualifications required to become licensed and the standards that must be met for purposes of maintaining and renewing licenses
Quality Control Through
Licensing and Accreditation
(2 of 3)
Historically, licensing has been used in the promotion of healthcare quality in only the bluntest sense. This is because the only method by which to promote quality through licensure is the granting or denial of the license to practice medicine—no real middle ground.
Private professional and industry ethical and practice standards exist, though their effect on day-to-day quality is debatable.
State licensing schemes were designed not with healthcare quality per se in mind, but rather with an eye toward protecting the medical professions from unscrupulous or incompetent providers and bad publicity.
5
Quality Control Through
Licensing and Accreditation
(3 of 3)
Licensure plays an important role in defining the permissible “scope of practice” of the various types of healthcare providers.
It is one thing for state legislators to define the meaning of practice for various broad medical fields, but quite another for legislators to define, for example, the lawful activities of doctors as compared to physician assistants as compared to nurses.
6
Medical Errors
(1 of 3)
Although medical errors are not a new problem, framing the issue as a public health problem is a relatively new phenomenon.
Overall, more people die each year from medical errors than from motor vehicle accidents, breast cancer, or AIDS.
Medical Errors
(2 of 3)
Causes of medical errors may include the failure to complete an intended medical course of action, implementation of the wrong course of action, use of faulty equipment or products in effectuating a course of action, failure to stay abreast of one’s field of medical practice, health professional inattentiveness, the fact that optimal treatments for many illnesses are not yet known, and the culture of medicine itself.
Medical Errors
(3 of 3)
Policy makers have begun shifting their ...
Running head U.S. HEALTH CARE SYSTEM AND GOVERNANCE1U.S. HEA.docxtoltonkendal
Running head: U.S. HEALTH CARE SYSTEM AND GOVERNANCE 1
U.S. HEALTH CARE SYSTEM AND GOVERNANCE 6
Health care administrator’s role and patient protection
Student’s Name:
Course Name and Number
Instructor
Institutional Affiliation
Date:
Abstract
More rules and regulations have been proposed by government and various organizations in order to improve the overall health care system of the country. There is increasing compliant and requirement for high-quality health care system which can be provided only using the proper law, regulation and health care administrator. There are many issues faced by the people due to non-compliance and negligence which can be reduced only through proper governance. Health care administrator has more concern over the legal, ethical and code of conduct of the medical professionals. Effective laws governing the health care system cannot bring any changes in the entire system; it is the administrator who ensures that this system is performing as per the requirement of law. In this paper we will first discuss the role of health care administrator in the health care system and a brief discussion about the penalties in case of any violations. In the later part of paper, we will discuss about the basic elements required by the patients to prove the medical negligence and a brief discussion about non-compliance by the medical professionals.
Health care administrator’s role and patient protection
Health care administrator’s role:
Healthcare system of the country compared with the other organization or any other community which is governed by various rules, regulations, principles, laws and ethics. Administrator must be aware of all the governing laws, ethical behavior, what are the roles and responsibilities, so that the entire system will get benefitted. About health care system, patients are given priority as a health care administrator one has to ensure that patients are not facing any difficulty at any point of time. Must immediately address any concerns of the patients, and any violation must immediately report.
There are some problems identified in the governance of health care system, there are more gaps in the corporate and clinical governance, and they are not effectively managed (The Dowton Consulting International, 2011). The corporate side mainly concern with the rules, regulations, policies, laws, people and professionals. Next is a clinical side that mainly deals with the safety and security of the patient, patient care standards and creating an excellent environment for the patient (The Dowton Consulting International, 2011).
As an administrator, it is essential to bridge the gap between these two in order to accomplish the desired result. As an administrator it is essential to governing the relationship between both the medical professional and patient, for providing the best service to the patients. Relationship with the patients, gaining their confidence, discharging the duty a ...
November 1999I N S T I T U T E O F M E D I C I N E S.docxIlonaThornburg83
November 1999
I N S T I T U T E O F M E D I C I N E
Shaping the Future for Health
TO ERR IS HUMAN:
BUILDING A SAFER HEALTH SYSTEM
Health care in the United States is not as safe as it should be--and can be. At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have
been prevented, according to estimates from two major studies. Even using
the lower estimate, preventable medical errors in hospitals exceed attributable
deaths to such feared threats as motor-vehicle wrecks, breast cancer, and
AIDS.
Medical errors can be defined as the failure of a planned action to be
completed as intended or the use of a wrong plan to achieve an aim. Among
the problems that commonly occur during the course of providing health care
are adverse drug events and improper transfusions, surgical injuries and
wrong-site surgery, suicides, restraint-related injuries or death, falls, burns,
pressure ulcers, and mistaken patient identities. High error rates with serious
consequences are most likely to occur in intensive care units, operating rooms,
and emergency departments.
Beyond their cost in human lives, preventable medical errors exact
other significant tolls. They have been estimated to result in total costs (in
cluding the expense of additional care necessitated by the errors, lost income
and household productivity, and disability) of between $17 billion and $29
billion per year in hospitals nationwide. Errors also are costly in terms of loss
of trust in the health care system by patients and diminished satisfaction by
both patients and health professionals. Patients who experience a long hospi
tal stay or disability as a result of errors pay with physical and psychological
discomfort. Health professionals pay with loss of morale and frustration at
not being able to provide the best care possible. Society bears the cost of er
rors as well, in terms of lost worker productivity, reduced school attendance
by children, and lower levels of population health status.
A variety of factors have contributed to the nation’s epidemic of medi
cal errors. One oft-cited problem arises from the decentralized and frag
mented nature of the health care delivery system--or “nonsystem,” to some
observers. When patients see multiple providers in different settings, none of
whom has access to complete information, it becomes easier for things to go
Errors…are costly
in terms of loss of
trust in the health
care system by pa
tients and dimin
ished satisfaction
by both patients
and health profes
sionals.
Types of Errors
Diagnostic
Error or delay in diagnosis
Failure to employ indicated tests
Use of outmoded tests or therapy
Failure to act on results of monitoring or testing
Treatment
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or method of using a drug
Avoidable delay in treatmen.
What's the difference between fraud, waste and abuse when it comes to health care? What is the government doing to prevent fraud, waste and abuse from happening? Learn the definitions and differences in these legal terms and how CMS has worked to prevent these from happening since its inception in 1965.
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
Medical reimbursement issues push physicians to flee hospitals triggering a r...Medical Billers and Coders
For over a decade, US healthcare has seen hospitals integrating with primary healthcare physicians across all the states of the US, challenging the traditional notion of primary care as a separate set of services from hospital healthcare.
Managed Care within Health Care covers a variety of information from nursing homes, policies, Medical, Medicare, out of pocket, and partial payment, management, contracts, government, and the Social Security State Fund. Within this working paper I will discuss a few of these mechanisms that are applied and utilized within ‘Managed Care’ today. A system within a system that brings in 25% of the United States debt.
Healthcare QualityPolicy and LawChapter 121ChaSusanaFurman449
Healthcare Quality
Policy and Law
Chapter 12
1
Chapter Overview
(1 of 2)
Discusses licensure and accreditation in the context of healthcare quality
Describes the scope and causes of medical errors
Describes the meaning and evolution of the medical professional standard of care
Identifies and explains certain state-level legal theories under which healthcare professionals and entities can be held liable for medical negligence
Chapter Overview
(2 of 2)
Explains how federal employee benefits law often preempts medical negligence lawsuits against insurers and managed care organizations
Describes recent efforts to measure and incentivize high-quality health care
Quality Control Through
Licensing and Accreditation
(1 of 3)
Licensing of healthcare professionals and institutions is an important function of state law, as it filters out those who may not have the requisite knowledge or skills to practice medicine
State licensure laws define the qualifications required to become licensed and the standards that must be met for purposes of maintaining and renewing licenses
Quality Control Through
Licensing and Accreditation
(2 of 3)
Historically, licensing has been used in the promotion of healthcare quality in only the bluntest sense. This is because the only method by which to promote quality through licensure is the granting or denial of the license to practice medicine—no real middle ground.
Private professional and industry ethical and practice standards exist, though their effect on day-to-day quality is debatable.
State licensing schemes were designed not with healthcare quality per se in mind, but rather with an eye toward protecting the medical professions from unscrupulous or incompetent providers and bad publicity.
5
Quality Control Through
Licensing and Accreditation
(3 of 3)
Licensure plays an important role in defining the permissible “scope of practice” of the various types of healthcare providers.
It is one thing for state legislators to define the meaning of practice for various broad medical fields, but quite another for legislators to define, for example, the lawful activities of doctors as compared to physician assistants as compared to nurses.
6
Medical Errors
(1 of 3)
Although medical errors are not a new problem, framing the issue as a public health problem is a relatively new phenomenon.
Overall, more people die each year from medical errors than from motor vehicle accidents, breast cancer, or AIDS.
Medical Errors
(2 of 3)
Causes of medical errors may include the failure to complete an intended medical course of action, implementation of the wrong course of action, use of faulty equipment or products in effectuating a course of action, failure to stay abreast of one’s field of medical practice, health professional inattentiveness, the fact that optimal treatments for many illnesses are not yet known, and the culture of medicine itself.
Medical Errors
(3 of 3)
Policy makers have begun shifting their ...
Running head U.S. HEALTH CARE SYSTEM AND GOVERNANCE1U.S. HEA.docxtoltonkendal
Running head: U.S. HEALTH CARE SYSTEM AND GOVERNANCE 1
U.S. HEALTH CARE SYSTEM AND GOVERNANCE 6
Health care administrator’s role and patient protection
Student’s Name:
Course Name and Number
Instructor
Institutional Affiliation
Date:
Abstract
More rules and regulations have been proposed by government and various organizations in order to improve the overall health care system of the country. There is increasing compliant and requirement for high-quality health care system which can be provided only using the proper law, regulation and health care administrator. There are many issues faced by the people due to non-compliance and negligence which can be reduced only through proper governance. Health care administrator has more concern over the legal, ethical and code of conduct of the medical professionals. Effective laws governing the health care system cannot bring any changes in the entire system; it is the administrator who ensures that this system is performing as per the requirement of law. In this paper we will first discuss the role of health care administrator in the health care system and a brief discussion about the penalties in case of any violations. In the later part of paper, we will discuss about the basic elements required by the patients to prove the medical negligence and a brief discussion about non-compliance by the medical professionals.
Health care administrator’s role and patient protection
Health care administrator’s role:
Healthcare system of the country compared with the other organization or any other community which is governed by various rules, regulations, principles, laws and ethics. Administrator must be aware of all the governing laws, ethical behavior, what are the roles and responsibilities, so that the entire system will get benefitted. About health care system, patients are given priority as a health care administrator one has to ensure that patients are not facing any difficulty at any point of time. Must immediately address any concerns of the patients, and any violation must immediately report.
There are some problems identified in the governance of health care system, there are more gaps in the corporate and clinical governance, and they are not effectively managed (The Dowton Consulting International, 2011). The corporate side mainly concern with the rules, regulations, policies, laws, people and professionals. Next is a clinical side that mainly deals with the safety and security of the patient, patient care standards and creating an excellent environment for the patient (The Dowton Consulting International, 2011).
As an administrator, it is essential to bridge the gap between these two in order to accomplish the desired result. As an administrator it is essential to governing the relationship between both the medical professional and patient, for providing the best service to the patients. Relationship with the patients, gaining their confidence, discharging the duty a ...
November 1999I N S T I T U T E O F M E D I C I N E S.docxIlonaThornburg83
November 1999
I N S T I T U T E O F M E D I C I N E
Shaping the Future for Health
TO ERR IS HUMAN:
BUILDING A SAFER HEALTH SYSTEM
Health care in the United States is not as safe as it should be--and can be. At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have
been prevented, according to estimates from two major studies. Even using
the lower estimate, preventable medical errors in hospitals exceed attributable
deaths to such feared threats as motor-vehicle wrecks, breast cancer, and
AIDS.
Medical errors can be defined as the failure of a planned action to be
completed as intended or the use of a wrong plan to achieve an aim. Among
the problems that commonly occur during the course of providing health care
are adverse drug events and improper transfusions, surgical injuries and
wrong-site surgery, suicides, restraint-related injuries or death, falls, burns,
pressure ulcers, and mistaken patient identities. High error rates with serious
consequences are most likely to occur in intensive care units, operating rooms,
and emergency departments.
Beyond their cost in human lives, preventable medical errors exact
other significant tolls. They have been estimated to result in total costs (in
cluding the expense of additional care necessitated by the errors, lost income
and household productivity, and disability) of between $17 billion and $29
billion per year in hospitals nationwide. Errors also are costly in terms of loss
of trust in the health care system by patients and diminished satisfaction by
both patients and health professionals. Patients who experience a long hospi
tal stay or disability as a result of errors pay with physical and psychological
discomfort. Health professionals pay with loss of morale and frustration at
not being able to provide the best care possible. Society bears the cost of er
rors as well, in terms of lost worker productivity, reduced school attendance
by children, and lower levels of population health status.
A variety of factors have contributed to the nation’s epidemic of medi
cal errors. One oft-cited problem arises from the decentralized and frag
mented nature of the health care delivery system--or “nonsystem,” to some
observers. When patients see multiple providers in different settings, none of
whom has access to complete information, it becomes easier for things to go
Errors…are costly
in terms of loss of
trust in the health
care system by pa
tients and dimin
ished satisfaction
by both patients
and health profes
sionals.
Types of Errors
Diagnostic
Error or delay in diagnosis
Failure to employ indicated tests
Use of outmoded tests or therapy
Failure to act on results of monitoring or testing
Treatment
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or method of using a drug
Avoidable delay in treatmen.
Disaster Contact a disaster preparedness person at either a loca.docxlynettearnold46882
Disaster
Contact a disaster preparedness person at either a local hospital, or local city or county emergency services agency. NORTHEAST OHIO
1. Blackout 2003
2. Chardon Highschool shooting 2012
3. Great blizzard 1978
Interview your contact, asking the following questions:
1) "What do you consider to be the top three disasters for which you prepare?"
2) "What would you say are your top three lessons learned about managing a disaster?"
What Would the Best Future for Health Care Look Like?
Introduction
The one thing the debate over reforming health care taught us all is that there are as many opinions as there are interested groups, and all of them differ in meaningful ways. To look at the views on improving the systems of care delivery, it is important to note where they have points of agreement and where they differ. They are all driven by the values and principles of the constituencies and what they hope to achieve from changes in the delivery system. This module will explore points of agreement and differences between important groups that will influence the direction health care will go in the next decade.
Patients
It is an interesting point that all constituencies, in their public statements, emphasize that a strong health care system should focus on getting the best outcomes for patients. What would that be, from the perspective of patients? Typically, patients relate that they want top quality in their care and the latest technology, along with immediate and unrestricted access to care, at the lowest possible cost. This triad has become the stumbling block of change initiatives, since to date, no one has figured out how to deliver all three. However, when patients' views are explored and probed, some interesting facts emerge. When patients say they want top quality care, in general, they tend to define that as achieving a cure or return to health. They certainly do not want to leave the system feeling worse than when they came in. Patients have been heavily lobbied in the media by pharmaceutical and medical technology companies to convince them that the latest (and most expensive) technology will deliver the desired outcomes. However, very little real research on the true effectiveness of treatments and technology makes its way to most patients, and patients in general do not shop for their medical care as carefully as they would if they were purchasing new cars, for example. The language of research and medicine is difficult for patients to understand and is frequently not well-explained by providers.
So, the nuances of top quality care in terms of being able to deliver a cure or return to health are not well understood by the constituency with the most at risk. What patients do understand is whether they feel better or see improvement in their health and whether care was rendered without errors and in a compassionate way. The best health care system, from a patient's point of view, is one that can consistently deliver the good.
1Running Head CRITICAL THINKING NEW HOSPITAL PROPOSALCR.docxfelicidaddinwoodie
1
Running Head: CRITICAL THINKING: NEW HOSPITAL PROPOSAL
CRITICAL THINKING: NEW HOSPITAL PROPOSAL 2
Introduction
The system of healthcare in most of the countries is national based healthcare system whereby the government offers health care services to the public using governmental agencies. In Saudi Arabia for example, there are some growing private healthcare facilities. The government of many nations remains the full controller of the healthcare sectors both private and public. The private hospitals are both non-profit and profit for example in Saudi Arabia, most of these private hospital attracts several expats. Both the standards of both private and government hospitals are of more similarity. Some of the private healthcare facilities are of the world class but with poor health service delivery (Penm,2015).
Comparing and Contrasting the Legal Structure and Governance of the Profit and Non-profit international entities
Differences
The selected international entities include the Joint Commission International (non-profit), International Hospital Federation (non-profit) and the Kaiser Permanente (non-profit and profit). The legal structure of the Joint Commission International (JCI) follows the certification and accreditation of the hospital. The hospital must be evaluated first to see if the hospital complies with the standards and meets the activities needed by this entity. There are accreditation programs that any hospital must go through. This is then followed by the certification which can either be based on associated health care organization (Joint Commission, 2016). On the other hand, the International Hospital Federation requires a formal and documented request addressed to the Chief Executive Officer for one to be a member. The legal structure of Kaiser Permanente is consisting of two or three independent legal entities in each region of California (Finz, 2012). The applying employee must have been hired as a new Kaiser Permanente for an award-eligible post.
The governance of the International Hospital Federation is consisting of three organs i.e. the general assembly, governing council, and the executive committee. There are also the designated positions which consist of the president, chairman designate, immediate past president, treasurer, and the chief executive officer (International Hospital Federation, 2015). On the other hand, Kaiser Permanente is consisting of entities with each entity having its management and governance structure. There are regional entities and twelve Permanente Medical groups which were created by the Permanente Federation. The role of the Permanente is to standardized patient care as well as the performance (Finz, 2012). The governing of JCI is under the leadership of the President and the chief executive officer (Matt, 2011).
Advantages of the Entities
Join Commission International provides a wide variety of health care programs l ...
Running Head MEDICAL MALPRACTICE LAWSUIT1 MEDICAL MALPRACTICE .docxglendar3
Running Head: MEDICAL MALPRACTICE LAWSUIT 1
MEDICAL MALPRACTICE LAWSUIT 5
Term Paper “The Lawsuit of Medical Malpractice”
Marilyn Diaz
Professor George Ackerman
PLA4522 Health Care Law
July 17th, 2019
Abstract
This paper explores “Medical Malpractice” in the field of law in detailed explanation. The paper begins with an introduction to medical malpractice giving statistics and data. Data from the European Union is used to give a detailed illustration. The introduction is followed by elements of medical malpractice lawsuit, defenses to a medical malpractice lawsuit, ways of avoiding a medical malpractice lawsuit and the policy of medical insurance. The method used to gather information was reading of various articles on the subject. The results of the study revealed an increase in the number of medical malpractice cases. Results also revealed that some medical practitioners are using the defenses available in medical malpractice lawsuit to evade penalties. The study emphasizes on ways in which physicians can avoid malpractice by way of precautionary measures.
The Lawsuit of Medical Malpractice
Introduction
Medical malpractice is a precise kind of negligence defined as an act of omission by a physician during treatment of a patient that departs from accepted standards of practice in the health sector and causes an injury to the patient (Bal, 2009). In the last decade, medical malpractice has increased in Europe to double-digit percentage i.e. >50% in Eastern States, Great Britain and the Baltic, a maximum three-digit percentage i.e. 200-500% in Mediterranean area, Germany, the Iberian countries and Italy. France and Scandinavian counties have seen reduction in malpractice because of simplification of procedures and exemplary innovations.
The Special Eurobarometer on Medical Error in 2006 revealed that 80% of EU citizens view medical error as a key issue and close to 50% believed they would be tangled in a case of medical malpractice. This revealed that the public has become aware that claims of medical malpractice against health practitioners can be successful. In Sweden and Denmark between 2005-2010, the ratio of approval for compensatory claims rose to 40%, the average settlement of around €30,000 per case in EU countries. The European Hospital and Healthcare Federation Standing Committee estimates cost of coverage to be in excess of 200%. Costs fluctuated between 9 and 15 euros per capita with Britain exhibiting the highest figures (Ferrara, 2013).
Elements of a Medical Malpractice Lawsuit
The burden of proof in a Medical Malpractice Lawsuit lays on the plaintiff. The plaintiff needs to prove all the elements of medical malpractice in order to stand chance of success in a courtroom.
Existence of physician-patient relationship. Breach of duty of cared owed to patient by physician. Duty upheld at a professional standard of care. Duty of the physician to the patient established by the relationship. Patient sust.
Running Head MEDICAL MALPRACTICE LAWSUIT1 MEDICAL MALPRACTICE .docxtodd581
Running Head: MEDICAL MALPRACTICE LAWSUIT 1
MEDICAL MALPRACTICE LAWSUIT 5
Term Paper “The Lawsuit of Medical Malpractice”
Marilyn Diaz
Professor George Ackerman
PLA4522 Health Care Law
July 17th, 2019
Abstract
This paper explores “Medical Malpractice” in the field of law in detailed explanation. The paper begins with an introduction to medical malpractice giving statistics and data. Data from the European Union is used to give a detailed illustration. The introduction is followed by elements of medical malpractice lawsuit, defenses to a medical malpractice lawsuit, ways of avoiding a medical malpractice lawsuit and the policy of medical insurance. The method used to gather information was reading of various articles on the subject. The results of the study revealed an increase in the number of medical malpractice cases. Results also revealed that some medical practitioners are using the defenses available in medical malpractice lawsuit to evade penalties. The study emphasizes on ways in which physicians can avoid malpractice by way of precautionary measures.
The Lawsuit of Medical Malpractice
Introduction
Medical malpractice is a precise kind of negligence defined as an act of omission by a physician during treatment of a patient that departs from accepted standards of practice in the health sector and causes an injury to the patient (Bal, 2009). In the last decade, medical malpractice has increased in Europe to double-digit percentage i.e. >50% in Eastern States, Great Britain and the Baltic, a maximum three-digit percentage i.e. 200-500% in Mediterranean area, Germany, the Iberian countries and Italy. France and Scandinavian counties have seen reduction in malpractice because of simplification of procedures and exemplary innovations.
The Special Eurobarometer on Medical Error in 2006 revealed that 80% of EU citizens view medical error as a key issue and close to 50% believed they would be tangled in a case of medical malpractice. This revealed that the public has become aware that claims of medical malpractice against health practitioners can be successful. In Sweden and Denmark between 2005-2010, the ratio of approval for compensatory claims rose to 40%, the average settlement of around €30,000 per case in EU countries. The European Hospital and Healthcare Federation Standing Committee estimates cost of coverage to be in excess of 200%. Costs fluctuated between 9 and 15 euros per capita with Britain exhibiting the highest figures (Ferrara, 2013).
Elements of a Medical Malpractice Lawsuit
The burden of proof in a Medical Malpractice Lawsuit lays on the plaintiff. The plaintiff needs to prove all the elements of medical malpractice in order to stand chance of success in a courtroom.
Existence of physician-patient relationship. Breach of duty of cared owed to patient by physician. Duty upheld at a professional standard of care. Duty of the physician to the patient established by the relationship. Patient sust.
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
Journal of Legal Nurse Consulting • Summer 2006 • Volume 17, Number 3 • 3
Despite ongoing efforts to educate nurses on the law and
their professional responsibilities through nursing programs
and continuing education courses, the number of nurses
named as defendants in malpractice actions continues to
increase (Croke, 2003; Guido, 2006; National Practitioner
Data Bank (NPDB) Annual Report, 2004). In 1986, The
Health Care Quality Improvement Act, Title IV of P.L.
99-660, authorized the Secretary of Health and Human
Services to establish and monitor a national practitioner data
bank (NPDB). The mission of the NPDB is to protect the
public by “restricting the ability of unethical or incompetent
practitioners to move from State to State without disclosure
or discovery of previously damaging or incompetent
performance”(NPDB, 2004, p.10).
The NPDB is a central repository receiving information
from private and governmental agencies under U.S.
jurisdiction. Information received by the NPDB is accessible
to registered entities, such as state licensing boards and
professional societies, which are eligible to query. Although
patients cannot access the NPDB, health care providers
listed in the NPDB can access their own information to
check for misinformation. The NPDB collects information
on physicians, dentists, nurses, and other health care
practitioners who, as a result of judgments in malpractice suits,
have entered into settlements, had disciplinary action taken
against them that resulted in their licenses being revoked or
suspended, had their privileges to practice limited, or had
to pay monetary awards (Croke, 2003). According to the
National Practitioner Data Bank 2004 Annual Report, since
its inception in 1990 and continuing through 2004, there
have been approximately 5,001 malpractice claims assessed
against all types of registered nurses (RNs). The NPDB
established the following malpractice reason categories for
reporting numbers of nursing malpractice payments:
Anesthesia related
Behavioral health related
Diagnosis related
1.
2.
3.
Equipment or product related
IV or blood products related
Medication related
Monitoring related
Obstetrics related
Surgery related
Treatment related
Miscellaneous
The NPDB classifies RNs into five categories:
nonspecialized RNs, nurse anesthetists, nurse midwives,
nurse practitioners, and clinical nurse specialists/advanced
practice nurses. Nonspecialized RNs were responsible for
the most malpractice payments (3,131 or 62.7%), followed
by nurse anesthetists (1,035 or 20.7%), nurse midwives
(459 or 9.2%), nurse practitioners (368 or 7.3%) and clinical
nurse specialists/advanced practice nurses (8 or 0.2%). The
majority of payments for malpractice claims were based upon
monitoring, treatment, and medications problems, as well as
obstetrics and surgery-related problems (NPDB, 2004).
Today’s health care environment poses even greater
liability risks for nurses. L ...
Legal PrinciplesNon- Malfeasance- Do n.docxsmile790243
Legal Principles
Non- Malfeasance- Do no harm
The legal principles are rules of human behavior that used to be considered as just, before the law started being written.
The ethical category of Non-Malfeasance represents the doctor’s try to avoid any act or treatment plan that would hurt the patient or violate the patient’s trust, and has been popularized in the phrase “first, do no harm.” Non-Malfeasance is supported through discretion and avoidance. It is critically important that the specialist provider of highly persistent treatments uphold Non-Malfeasance.
(Rodak, 2012)
Beneficence- Promote the welfare of others
Beneficent actions and motives have usually occupied a middle place in morality. Ordinary examples today are found in social welfare programs, policies to improve the welfare of animals etc.
Distributive Justice- All involved should have equal entitlements
The economic structure that each society has its laws, institutions, policies, etc. results in different distributions of economic benefits and burdens across members of the society. These economic frameworks are the result of human political processes and they continually change both across societies and within societies over time.
Autonomy- non influenced decisions for both patients and physicians
The term “autonomy” has appeared more and more often in the medical literature. According to this interpretation of autonomy, the goal for an autonomous person is to decide on his or her own, without undue manipulation by others.
One of the first empirical papers in medical decision making on patient autonomy thus linked autonomy to the question of whether patients wanted to make decisions themselves. In the descriptive medical decision making literature, this meaning has become the default.
The patient described in the informative model from the well known paper of Emanuel and Emanuel corresponds with an autonomous patient in this sense.
Healthcare Rights
Non- Discrimination- race, religion, sexual orientation
In human social affairs, discrimination is treatment or consideration of, or making a difference in favor of or against, a person or thing based on the group, class, or category to which that person or thing is apparent to belong to rather than on individual merit. This includes treatment of an individual or group, based on their real or perceived membership in a certain group or social group.
(Lamont, 2016)
Credentialing/ Scope of Practice
When you go for health care, identity matters a lot. You need to verify certain proofs. Following are the things that you need:
Verification of identity
(NAMSS, n.d.)
Legal Employment Qualifications
The Immigration Reform and Control Act of 1986 (IRCA) required employers to verify that all newly hired workers present "facially valid" documentation verifying the employee's identity and legal authorization to accept employment in the United States. The I-9 form or more properly ...
This research paper outlines the idea of cost-effective health care, which minimizes 'unnecessary' patients tests and procedures that do not improve patient outcomes. The analysis focused on examining current trends in cost-effective health care, the rise of modern medical technologies involved in cost-effective health care, and the benefits of the U.S. implementing a cost-effective health care system. Mrs. McCallister and Dr. Pahwa were instrumental in the formation of this paper.
In the coming years the United States will find themselves going through a number of changes within the Social Security Administration which will affect the Health Care Industry as we know it “Hospital size has long been an area of discussion and debate in the U.S. healthcare industry. Questions have consistently focused on cost management or efficiency in large versus small hospitals. A persistent question among researchers is whether efficiencies are associated with larger facilities through economies of scale, or if there are alternate scenarios that play a significant part in hospital cost and efficiency” (2009, JHM). Since the Affordable Health Care Act was established it made obtaining health care much more affordable and accessible, but at the same time there has to be some cut back.
5 The Physician–Patient Relationship Learning Objectives After.docxalinainglis
5 The Physician–Patient Relationship
Learning Objectives
After completing this chapter, you will be able to:
· 1. Define the key terms.
· 2. Describe the rights a physician has when practicing medicine and when accepting a patient.
· 3. Discuss the nine principles of medical ethics as designated by the American Medical Association (AMA).
· 4. Summarize “A Patient’s Bill of Rights.”
· 5. Understand standard of care and how it is applied to the practice of medicine.
· 6. Discuss three patient self-determination acts.
· 7. Describe the difference between implied consent and informed consent.
Key Terms
Abandonment
Acquired immune deficiency syndrome (AIDS)
Advance directive
Against medical advice (AMA)
Agent
Consent
Do not resuscitate (DNR)
Durable power of attorney
Human immunodeficiency
virus (HIV)
Implied consent
Informed (or expressed)
consent
Incompetent patient
In loco parentis
Living will
Minor
Noncompliant patient
Parens patriae authority
Privileged communication
Prognosis
Proxy
Uniform Anatomical Gift Act
THE CASE OF DAVID Z. AND AMYOTROPHIC LATERAL SCLEROSIS (ALS)
David, who has suffered with ALS for 20 years, is now hospitalized in a private religious hospital on a respirator. He spoke with his physician before he became incapacitated and asked that he be allowed to die if the suffering became too much for him. The physician agreed that, while he would not give David any drugs to assist a suicide, he would discontinue David’s respirator if asked to do so. David has now indicated through a prearranged code of blinking eye movements that he wants the respirator discontinued. David had signed his living will before he became ill, indicating that he did not want extraordinary means keeping him alive.
The nursing staff has alerted the hospital administrator about the impending discontinuation of the respirator. The administrator tells the physician that this is against the hospital’s policy. She states that once a patient is placed on a respirator, the family must seek a court order to have him or her removed from this type of life support. In addition, it is against hospital policy to have any staff members present during such a procedure. After consulting with the family, the physician orders an ambulance to transport the patient back to his home, where the physician discontinues the life support.
· 1. What were the primary concerns of the hospital?
· 2. What was the physician’s primary concern?
· 3. When should the discussion about the patient’s future plans have taken place with the hospital administrator?
Introduction
Few topics are as important as the physician–patient relationship. This relationship impacts the entire healthcare team. All healthcare professionals who interact with the patient must understand their responsibilities to both the patient and the physician. The patient’s right to confidentiality must always be paramount.
The first physicians were “medicine men,” witch doctors, or sorcerers. The physician–pa.
Code of ethics and legal practices has been very old element in the professional management of the doctor’s behaviour. The ethical practices or code shows a commitment to act with honesty in extreme situations. At the time patients seek medical treatment they are not just entering a normal social relationship, they often feel vulnerable but required to share and expose important aspects of their lives. Codes of ethical conducts provide some tangible safety to both doctors and patients in such circumstances. In the below report, the researcher is explaining ethical, legal and
professional guidelines and principles for health care as well as its implications in the healthcare sector of the United Kingdom. After reading this report, the reader would be able to understand how healthcare adopts ethical practices at the workplace and ensures protection of patients in their medical treatment.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Respondeat superior tort liability and surgical errors in low income countries an overview
1. Journal of Biology, Agriculture and Healthcare www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.8, 2013
131
Respondeat Superior Tort Liability and Surgical Errors in Low
Income Countries: An Overview.
John Adwok
Consultant General and Endocrine Surgeon, Nairobi Hospital, P.O. Box 21274, 00505, Nairobi, Kenya
Email of the author: jadwok52@gmail.com
Disclosures: This paper is an extract from a course project during a PhD program at Capella University,
Minneapolis, MN.
Abstract
A hospital can be held liable under the general doctrine of respondeat superior in a case when an employee
commits malpractice. This tort liability is applicable even when the employer is without fault because the
employee was acting in the scope of his or her employment when the negligent act or omission allegedly
happened. Attending physicians working in hospitals are considered independent contractors rather than
employees in some situations, making the theory of respondeat superior inapplicable, and the physician has to
bear full liability when sued for malpractice while treating a patient in a hospital. More often than not, hospitals
are implicated for negligently granting privileges to an unlicensed or incompetent physician. Hospitals in
developing countries are increasingly implicated in malpractice litigation following the doctrine of respondeat
superior. Due to the dramatic circumstances that surround them, surgical malpractice cases are a cause for
concern to hospital administrators as well as the surgical staff. The legal programs covering surgical services at
health care institutions in low income countries need strengthening to preempt increasing litigation activities as
their populations become more aware of their medico-legal rights.
Key Words: Respondeat Superior, surgery, malpractice, tort liability, negligence, low income countries,
hospitals.
1. Introduction
With the increasing use of information technology and the internet, the average citizen in low and middle income
countries is more aware today of health care issues than a decade ago. This knowledge about health matters, in
tandem with economic, educational, and social development has created a more educated citizenry who are very
much aware of their legal rights. All these changes have impacted on the medico-legal landscape, as there have
been an increasing number of malpractice law-suits in recent years especially in surgical and ob-gyn services.
This trend is clearly indicated by the medical liability insurance for physicians which has exponentially increased
in recent years in many African countries.
Hospitals are implicated in these suits either directly for not meeting standards of service or as respondeat
superior--a doctrine in tort law that makes a master liable for the wrong of a servant--when employees are sued
for malpractice cases occurring during hospital admissions. The lack of specific guidelines for clinical practice in
many of the mushrooming private and public hospitals in low income countries has allowed physicians with
varying backgrounds to practice independently with little supervision. We posit that hospitals in many low
income countries are complacent in their legal programs and recommend accreditation of health care services to
improve the quality and safety of health care delivery to minimize tort liability incidents.
2.0 Literature Review
2.1 Legal Structure of Health Care Organizations
The legal system in many Anglophone countries has parallels with that of the United States as they were both
influenced by British law in their inception. The function of the legislative branch is to enact new laws and
amend existing ones, the executive is to enforce and administer laws, and the judiciary adjudicates - deciding
disputes in accordance with the law (Miller, 2006). The legislative creates and funds health programs and
balances policy with other policy domains (Longest, 2006). The executive branch proposes, approves, or vetoes
legislation, promulgates rules and regulations. The role of the Judiciary concerns the interpretation of
constitutional and statuary law, develops body of case law, preserves rights, and resolves disputes (Longest).
Health care organizations have governing bodies, often referred to as boards, which wield ultimate authority and
legal responsibility for operations.
The board appoints the CEO and organized medical staff who also have minor governance roles. “Board
members have a duty to exercise reasonable care and skill in the management of the entity’s affairs and to act at
all times in good faith and with complete loyalty to the entity” ( Miller, 2006, P. 44). Hospitals are regulated by
all levels of government besides being occasionally confronted with conflicting mandates. Many private groups
develop standards, focused mainly on the quality and safety of services, and accredit institutions who meet their
2. Journal of Biology, Agriculture and Healthcare www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.8, 2013
132
standardization criteria.
Accreditation is not legally mandated in contrast to licensure which is a government regulation without which a
hospital cannot operate. Health maintenance organizations (HMOs), nursing homes, ambulatory surgery centers,
hospices, home health agencies, and clinical laboratories require a license to operate and must comply with
licensing standards (Pozgar, 2011). Nonprofit hospitals do not generally operate to generate profit for
distribution. Any profit must instead be used to improve the hospital environment, quality of care, and
remuneration of employees.
Health care administrators need to be conversant with legal mandates in order to anticipate and avoid the
inevitable legal tussles arising from civil liability suits. Today in the United States, health care services are
among the most highly regulated industries and health care administrators are expected to correctly interpret the
rules and regulations to avoid legal pitfalls (Miller, 2006). Recognition by an accreditation body usually
indicates the standards of care are of good quality and compliant with the published guidelines. Limited
compliance with health care regulations and inconsistent accreditation system are still a source for concern in
low income countries.
2.2 Licensure and Accreditation of Health Care Organizations
Accreditation is a process by which a recognized body, usually an NGO, assesses and recognizes that a health
care organization meets applicable pre-determined and published standards. Accreditation is a private function
that is not legally mandated. On the other hand licensure is a governmental regulation which is established to
ensure that an organization meets minimum standards to protect public health and safety. Various units in a
hospital like the laboratory, pharmacy, and x-ray departments as well as individual health care providers may
require different licenses. Accreditation standards are usually regarded as optimal and achievable, and are
designed to encourage continuous improvement efforts within accredited organizations. Key components of the
initiative that are currently part of the accreditation process by The Joint Commission on Accreditation of
Healthcare Organizations (JCAHO) include: Periodic Performance Review (PPR), Tracer methodology, Priority
Focus Process (PFP), and unannounced survey (formerly announced). “The standards focus on important patient,
client, or organization functions that are essential to providing quality care in a safe environment” (JCAHO,
2013). Compliance for these surveys is voluntary and the emphasis is on evaluation funded by provider fees
focusing on identifying what the organization is doing right and how it could be improved. Accreditation
systems are well developed and widely used in high income countries like the United States, Canada, and Europe.
In the United States, licensure surveys are mandatory, annual, use tax funds, with an emphasis on inspection
focusing on what the organization is doing wrong. Non-compliance has harsh punitive implications including
withdrawal of the license. The licensing requirements are more stringent as licenses are only granted when
facilities meet defined levels of quality certification. This is often a complex process as hospitals and other
health care entities are among the most extensively regulated institutions by all levels of government and by
numerous agencies within each level (Miller, 2006). It is possible to satisfy the requirements of one entity, just to
be frustrated by another arm of government. This logistical problem has received more attention in recent times
with relief provided in some areas (Miller), but conflicting mandates are likely to continue considering the
intricate American legal system. Licensure and accreditation systems in low and middle income countries do
exist on the same lines as the American system but are at best very limited in scope and application. This has
medico-legal implications as it encourages unregulated substandard care that leads to serious recurrent errors.
2.3 Liabilities and Malpractice
Errors in the course of providing health care services lead to criminal law and civil penalties to health care
professionals and entities. According to Miller (2006), the most common liability of health care professionals
and institutions is the negligent tort. Negligence must however cause injury to establish liability. The less
common criminal penalties relate to all health care decisions regardless of outcome, deaths or significant injuries
associated with health care, and intentional end-of-life decisions (Miller). Not withstanding the rights of the
patient, this trend is impacting negatively on the provision of health care.
The allocation of huge awards for frivolous or otherwise claims in the health insurance industry has created a
backlash in some specialties. Forty four states are cited by the American Medical Association to have varying
degrees of problems, if not crisis, pertaining to liability coverage for physicians(Larkin, 2007). High risk
specialties like OB-GYN are avoided by insurers or have to pay unaffordable high premiums. Early retirements
and curtailing of practices by physicians due to the unrealistic escalating liability insurance costs, and
demoralization, has restricted the public’s access to essential health services, notably delivery and trauma
services (Larkin). With the current globalization of health care, there is empirical evidence that developing
health care systems are increasingly experiencing medico-legal liability suits. Although respondeat superior
applies only for negligent acts by hospital employees, it is not unusual for the plaintiff lawyers to enjoin the
hospital with charges of faulty equipment or for allowing negligent physicians to use its facilities.
3. Journal of Biology, Agriculture and Healthcare www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.8, 2013
133
3. Minimizing Respondeat Superior Liability in Developing Countries
3.1 Using Evidence-Based Practice Guidelines in Surgical Services
Performing procedures without adequate training is a liable act and hospitals need to protect themselves from
such a liability by controlling access to and use of its facilities. Hospitals in developing countries can reduce
liable surgical errors by introducing clinical guidelines derived from evidence-based practice for the surgical
division.
An understanding of the quality continuum is essential for health care managers in order to acquire the skills
necessary to achieve quality health care. A guiding philosophy for the entire organization from the leadership is
required to achieve success at continuous quality improvement projects and defining clinical practice guidelines
(Kelly, 2003). The quality continuum provides tools and techniques to help managers, health care providers, and
organizations to do things right the first time and every time. The introduction of clinical guidelines would foster
good practice and improve the quality of care. This translates to fewer mistakes and less litigation of physicians,
nurses and hospitals. The results of the care provided also need continuous monitoring and auditing and the
information used to improve the care of all patients. However, change initiatives need effective leadership able
to manage the inevitable resistance to change which could be detrimental to organizational success.
Physicians are known to resist changes introduced by hospital managers especially when the changes are
perceived to impact ‘negatively’ on their practice and/or put their performance under the microscope. Health
care managers need to accept resistance as the norm recognizing and welcoming it as a healthy response and an
opportunity to open debate possibilities. According to Atkinson (2005), a major problem in driving change in
organizations is dealing with and managing the resistance encountered during all change initiatives. It should be
treated as a powerful ally in facilitating the learning process (Atkinson). Senior members of the surgical staff are
more often than not affixed to their routines and tend to view change initiatives with suspicion. Failure t to
accept evidence-based practice guidelines opens up the likelihood of tort liability for negligence and failure to
provide the expected due care.
3.2 Addressing the Nursing Shortage
A threat to many surgical services in low income countries is the shortage of experienced OR nurses. A shortage
of more than 4 million healthcare workers in 57 developing countries – most of them in Africa – is hampering
efforts to combat HIV/AIDS, malaria and Tuberculosis (World Health Report, 2006). Performing complicated
surgical procedures with inexperienced OR nurses and assistants often results in poor outcomes. The shortage of
nurses translates to overwork and fatigue lowering the quality of care. The nursing shortage affecting high
income countries in recent years comes as a blessing for third world nurses but is considered a major tragedy for
their health care systems.
There is an urgent need to stop the exodus of nurses by offering them better remuneration and living conditions
in low income countries. Nurses in general are central to the production of a safety culture system in a healthcare
organization (Groves, Meisenbach, & Scott-Cawiezell, 2011). “Nurses intercept 86% of all medication errors
made by physicians, pharmacists, and others prior to the provision of those medications to patients.....
Insufficient monitoring of patients, caused by poor working conditions and the assignment of too few RNs,
increases the likelihood of patient deaths and injuries” (Liape, et al, 1995). Surgical services have to retain
experienced nurses especially OR nurses as this is vital to the provision of effective and safe health care in the
surgical department.
Instruments and swabs left in body cavities may sound the stuff of newspapers, but do actually happen in
environments where there is inexperience, ongoing training, and fatigue from overwork. According to Rappaport
and Haynes (1990).the retained surgical sponge after intra-abdomen operations is a continuing problem with a
grossly underestimated incidence despite precautions. Working in a high income country with optimal facilities
the authors had four incidents of retained abdominal sponges in a 10 year period. Similarly, a Jordanian group
found 11 cases of retained sponges over a 13 year period (Bani-Hani, Gharaibeh, & Yaghan, 2005). It does not
take a lot of imagination to realize that such incidents would be manifold in a poor resource surgical
environment as is usually seen in public hospitals in low income countries. Yet, adoption of criteria for
performance excellence available through accreditation organizations can go a long way in minimizing errors in
the surgical service irrespective of geographical location or wealth status.
3.3 Accreditation of Services
It has been shown in developed health care systems that accreditation strengthens community confidence in the
quality and safety of care, treatment, and services. It also provides a competitive edge in the market place and
improves risk management and risk reduction (JCAHO, 2013). An organization can benefit from conducting
self-assessment using the appropriate criteria for performance excellence and taking action for improvement
(Kelly, 2003). Health care criteria are designed to help organizations use an integrated approach to
organizational performance management that results in delivery of ever-improving value to patients, other
customers, and stakeholders, contributing to improved health care quality and organizational sustainability
4. Journal of Biology, Agriculture and Healthcare www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.8, 2013
134
(BNQP. 2013). In Sub-Saharan Africa, only some hospitals in South Africa have successfully applied for
accreditation from bodies in Europe and the United States in an effort to improve their services and standards of
care. Fewer mishaps would happen in the OR and other departments of a hospital if internationally accepted
clinical guidelines are used in appointments of staff, conduct of invasive procedures, use of anesthetic equipment,
application of appropriate nurse ratios, and regulation of working hours. These are usually stressed by
accrediting bodies in their health care criteria.
The power of accreditation to compel hospitals to adhere to guidelines and regulations and therefore stay clear of
legal mishaps is often underestimated. The model of accreditation in both low income and high income countries
strives to promote improvements, standardization of processes, and providing feedback (Braithwaite, Shaw,
Moldovan et al., 2012). The general logic is the same and the difference lies in specialized features. The
introduction of accreditation in low income countries often meets resistance from health care managers due to
the associated costs and the lack of immediate incentives. The fact that accreditation is voluntary and not legally
required also makes it unattractive to the average hospital in low income countries.
4.0 Summary and Recommendations
Care should not vary illogically from clinician to clinician or from place to place. The benefits of evidence-based
medicine in enhancing the overall quality of healthcare are tremendous (Institute of Medicine, 2001). This has
directed medical practice away from consensus to scientifically proven methods in the management of patients.
There are now clear guidelines and check-lists to follow for the management of most conditions which are
backed by evidence based results from controlled studies. The guidelines are readily available in medical
manuals, books, and journals as well as the internet. There is growing evidence that this combined with other
tools like reminder systems can improve patient care. Evidence-based medicine can be used to minimize
malpractice litigation during adverse surgical incidents in low income countries.
Firstly, hospitals can strengthen their criteria for the admission of surgical, anesthetic and ob-gyn staff to use
hospital facilities; with emphasis on the system used to determine whether the applicants have the required
qualifications, experience and practice licenses. The scope of procedures a surgeon should be allowed to perform
is to be limited by experience and training as well as adherence to evidence-based guidelines for particular
procedures. More efficient modalities of reporting errors to the ‘legal department’ and communication with
patients and family need to be enacted and emphasized. An institutional annual review of the admitting staff
performance and complications rate should be more stringent. Withdrawal of admission rights could be enforced
more vigorously for negligent or incompetent practice while avoiding victimization of physicians by competing
colleagues.
Secondly, the OR Users Committees which is usually composed of senior OR Nurses, Obstetricians and
Gynecologists, Surgeons, and Anesthesiologists should regularly advise the management on the importance of
resolving any concerns about the standards of care in the OR functions and their medico-legal implications.
CMEs for all OR staff and surgeons should be held regularly and focus on standards of care issues, especially the
ones which could lead to mistakes and possible liability suits.
Thirdly, the administration can, through financial and professional rewards attempt to retain experienced OR
nurses. Simple measures like appropriate work loads, appreciation, emotional support, and sensitivity to their
needs could yield positive results. These efforts to retain nurses usually fail when they get lucrative offers from
hospitals in high income countries with promises of large pay checks and better standards of living. Moreover,
there is an inherent risk in giving preferential treatment to OR nurses as it demoralizes nurses in other
departments provoking further dissatisfaction and departures to competing hospitals. Proven conflict resolution
techniques and models can help resolve these staff issues.
Finally, the main solution which stresses the introduction of evidence-based clinical practice to the surgical
management of patients may be frustrated by various constraints. The nursing administration might not
encourage the preferential treatment of OR nurses for the reasons mentioned earlier on both financial and
logistical grounds. The CEO may find it difficult or risky to interact negatively with influential senior surgeons
who might decline to use evidence-based guidelines for the management of surgical conditions. Yet, these issues
should all be resolved as there are no other pathways to quality, effective, and safe healthcare provision.
References
Atkinson, P. (2005). “Managing resistance to change”. Management Services 49(1),14-19.
Baldrige Performance Excellence Program. (2013). “2013–2014 Health Care Criteria for Performance
Excellence” Retrieved June 1, 2013, from http://www.nist.gov/baldrige/publications/hc_criteria.cfm
Bani-Hani, K., Gharaibeh, K, &Yaghan, R (2005). “Retained surgical sponges (gossypiboma)”. Asian J
Surg. 28(2), 109-15
5. Journal of Biology, Agriculture and Healthcare www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
Vol.3, No.8, 2013
135
Braithwaite, J., Shaw, C., Moldovan, M., et al. (2012). “Comparison of health service accreditation programs in
low- and middle-income countries with those in higher income countries: a cross-sectional study”, Int J Qual
Health Care first published online October 30, 2012 doi: 10.1093/intqhc/mzs064
FindLaw. (2013). Medical malpractice in-depth. Retrieved June 3, 2013 from
http://public.findlaw.com/LCsearch.html?restrict=consumer&entry=Respondeat+superior
Groves, P., Meisenbach, J., & Scott-Cawiezell, J (2011) “Keeping patients safe in healthcare organizations: A
structuration theory of safety culture”, Journal of Advanced Nursing 67(8) 1846-1855.
Available at: http://works.bepress.com/jill_scott-cawiezell/1
HMO Lawsuits. (2003). Retrieved on July 23, 2007, from
http://www.brytonlaw.com/practiceareas/hmoliability_ptr.htm
Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century. Washington,
D.C.: National Academy Press.
Joint Commission on Accreditation of Health Care Organizations. Retrieved June 1, 2013, from
http://www.jointcommission.org/performance_measurement.aspx
Kelly, D.L. (2003). “Applying quality management in healthcare: A process of Improvement”. Chicago, IL:
Health Administration Press.
Larkin, H. (2004, March). “Homegrown Liability insurance”, Hosp Health Netw.78(3):44-8, 50,
PMID:15061070 [PubMed - indexed for MEDLINE]
Longest, B.B., Jr. (2006). Health policymaking in the United States (4th
ed.) Chicago: Health Administration
Press.
Lucian, L Leape et al., (1995) “Systems Analysis of Adverse Drug Interactions” JAMA. 274(1):29-34.
doi:10.1001/jama.1995.03530010043033
Miller, R. (2006). Problems in health care law (9th
ed.). Sudbury, MA: Jones and Bartlett
World Health Report (2006), WHO. Retrieved June,1 from http://www.who.int/whr/2006/en/
Pozgar,G.D.(2011). Legal Aspects of Healthcare Administration(11th
ed.). Sudbury, MA. Jones and Bartlett.
Rappaport, W; Haynes, K. (1990) “The retained surgical sponge following intra-abdominal surgery. A
continuing problem”, .Arch Surg, 125(3), 405-7
Author: John Adwok, MBBS, MMED(Surg.), FCS (ECSA), FRCS (Edin), FACS, Ph.D. Consultant General
and Endocrine Surgeon, Nairobi Hospital, Nairobi, Kenya. Formerly Associate Professor of Clinical Surgery,
University of Nairobi, Kenya.
6. This academic article was published by The International Institute for Science,
Technology and Education (IISTE). The IISTE is a pioneer in the Open Access
Publishing service based in the U.S. and Europe. The aim of the institute is
Accelerating Global Knowledge Sharing.
More information about the publisher can be found in the IISTE’s homepage:
http://www.iiste.org
CALL FOR PAPERS
The IISTE is currently hosting more than 30 peer-reviewed academic journals and
collaborating with academic institutions around the world. There’s no deadline for
submission. Prospective authors of IISTE journals can find the submission
instruction on the following page: http://www.iiste.org/Journals/
The IISTE editorial team promises to the review and publish all the qualified
submissions in a fast manner. All the journals articles are available online to the
readers all over the world without financial, legal, or technical barriers other than
those inseparable from gaining access to the internet itself. Printed version of the
journals is also available upon request of readers and authors.
IISTE Knowledge Sharing Partners
EBSCO, Index Copernicus, Ulrich's Periodicals Directory, JournalTOCS, PKP Open
Archives Harvester, Bielefeld Academic Search Engine, Elektronische
Zeitschriftenbibliothek EZB, Open J-Gate, OCLC WorldCat, Universe Digtial
Library , NewJour, Google Scholar