Medical Malpractice

Kristy Carey

Akiea Wilson

Katherine Bishop

Samuel Locoh-Donou

HLTH207 Dr. Angela Johnson

Definition

Classified as an act of neglect or omission of a patient by his or her health care provider going against their accepted standards of practice.

Neglect or omission would be the cause of injury and sometimes death of a patient.

History

44,000 to 98,000 patients may have died as a result of medical malpractice mistakes that could have been prevented in hospitals alone each year

Hospitals pay $17 billion to $29 billion annually for mistakes made

History (continued)

Tort Law Categories include: Negligence, nuisance,

defamation, intentional torts, statutory torts, competition law, and economic torts.

“In law, malpractice is a type of tort in which the misfeasance, malfeasance or nonfeasance of a professional, under a duty to act, fails to follow generally accepted professional standards…” (Currie and Cameron)

History (continued)

The average amount of money paid to a malpractice patient winning his or her trial is $125,000

4% of patients injured who go to trial win

Malpractice insurance costs the physician 3.2 percent of his or her average revenue

Current Structure

When claims are filed:

The plaintiff is the patient, or a legally designated party acting on behalf of the patient.

The defendant is the health care provider (dentists, nurses, pediatricians and sometimes whole hospitals, clinics and medical corporations)

Current Structure (continued)

A plaintiff must prove that a legal duty was owed, as is the case whenever a hospital or health care provider undertakes care or treatment of a patient.

Current Structure (continued)

Then the plaintiff must prove that the duty was breached the provider failed to conform to the

relevant standard of care.

Current Structure (continued)

It must next be proved that the breach caused an injury, and that damages occurred in a financial, physical or emotional manner damages constitute the basis for the

claim

Current Structure (continued)

A lawsuit is filed by the plaintiff (or the plaintiff's attorney) in a court with appropriate jurisdiction

Current Structure (continued)

Between filing of suit and trial, the parties are required to share information

Either both parties agree and the case may be settled early or they don’t and the case goes to trial

Current Structure (continued)

In court, both parties will usually present experts to testify as to the standard of care required, and other technical issues during trial,and the judge or jury must then weigh all the evidence and determine which is the most credible

Current Structure (continued)

A verdict will then be rendered for the prevailing party, and compensatory and punitive damages will be assessed and assigned

Current Structure (continued)

Expert witnesses – “sufficient knowledge, education, training, or experience regarding the specific issue”

The qualifications of the expert are not the deciding factors

Importance of Malpractice Insurance

Reduces the rate of patient injuries Ensures the patient’s access to fair

compensation for legitimate medical injuries

Protects the health care provider Promotes open communication

between the health care provider and the patient

Importance of Malpractice Insurance (continued)

Studies show that the most important factor of a customer’s decision to file lawsuits is not negligence but the ineffective communication between customer and provider

Importance of Malpractice Insurance (continued)

Lawsuits are also filed because of the lack of empathy from the health care provider because the customer feels as though he or she may be withholding essential information

By not providing information, you take away a patients right to make their own decisions, which leads to lawsuits.

Importance of Malpractice Insurance (continued)

Who benefits? Customer (Patient)

By being protected by the policy purchased by the care provider

In case a protocol goes wrong in a surgical procedure and it is due to the negligence of the doctor, monetary compensation becomes available in an attempt to repair the mistake

Sometimes law suits result in the dismissal of incompetent health care providers, and this may help the next customer by ensuring a satisfactory level of integrity and professionalism

Importance of Malpractice Insurance (continued)

Who benefits? (continued) Healthcare Provider

Protects them from frivolous claimsThere is a money (pay out) cap on the

damage charges that could potentially be pressed against the care providers covered under the malpractice insurance policies

Insurance CompanyCash flow from the payment of the doctor’s

premiums

Malpractice Crisis

50% of the United States is in what the American Medical Association (AMA) calls a malpractice crisis

Malpractice Crisis

AMA defines a crisis as "when patients lose access to care as a result of a broken medical liability system…that causes physicians’ insurance premiums to skyrocket forcing them to restrict their practice" (Henley, 706).

Malpractice Crisis (continued)

Increase in Insurance Premiums Poor marketing strategies by the insurance

companies, which led to decreased profitability has caused insurance premiums to increase

Many practitioners could not afford these high rates, the demand decreased and many malpractice insurance companies left the market

With less malpractice insurance carriers, the insurance has become less available

Malpractice Crisis (continued)

Rising insurance rates are balanced with the rising rates providers charge or collect for their services

Malpractice Crisis (continued)

Current health insurance regulations surrounding Medicare and Medicaid reimbursement, along with discounted fee contracts, has prevented providers from increasing their revenue to offset the increasing malpractice rates

Malpractice Crisis (continued)

Providers are left uninsured and some of them out of business

Malpractice Crisis (continued)

Who is at fault?

Physicians, insurers, and hospitals state that the litigation system and lawyers are to blame due to the high average payouts on claims and allowing the large number of claims to be filed

Malpractice Crisis (continued)

Who is at fault? (continued)

Consumer groups and attorneys claim that there is a natural cycle that malpractice insurance goes through and that poor pricing decisions by insurers and decreased investment returns are to blame

Malpractice Crisis (continued)

WHO IS RIGHT?

BOTH ARE!!!

The cause of the crisis is a combination of the two, along with other factors

Possible Solution

To ensure adequate and professional medical care for patients by way of Peer Review Organizations Peer Review is having physicians’ peers review

procedures, medical records, etc. and give feedback

Work to interface privacy and necessary disclosure to provide practice guidelines that protect both the patient and the provider.

Possible Solution (continued)

Three states (Maine, Minnesota, and Vermont) have enabled legislation that allows practice guidelines to be used as a defense in malpractice actions under certain conditions

This legislation makes defense lawyers’ appeals more complex and difficult to carry out

Possible Solution (continued)

Medical malpractice suits are one method of regulating the quality of care

Expensive

Unfair

Possible Solution (continued)

Developing the occurrence of both peer review practices and medical practice guidelines

Conclusion

Whether we want to face it or not, it’s obvious that medical malpractice is occurring in the United States.

Conclusion (continued)

All of those claims can’t be frivolous and it’s fairly shocking that only 4% of patients win their trials.

Conclusion (continued)

To help prevent medical malpractice, providers have malpractice insurance, which is at the center of the current crisis

It is such a hot commodity since EVERYONE benefits from it. So insurance companies can charge as much as they want for it!

Conclusion (continued)

Providers and the care they provide to patients is suffering as a result of those high costs though

Conclusion (continued)

So, what’s the answer? More highly qualified physicians to reduce the

instances of malpractice Peer Review Organizations Restraints on insurance companies that limit

their abilities to charge such high rates Developing the occurrence of both

peer review practices and medical practice guidelines

Conclusion (continued)

To solve the problem, it might take a combination of all of these!

THE END