Medical Malpractice Reform

I.      DEFINITIONS a.     Safety – freedom from accidental injury b.     Error – the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim c.     Adverse Event – an injury resulting from a medical intervention (not due to the underlying condition of the PTs) d.     “cook book” medicine – quality improvement techniques (evid-based treatment guidelines, computerized diagnostic and risk-assessment tools) e.     Iatrogenic Injuries – “brought forth by the healer”; caused by the DR                                                i.     negligent injuries that result in valid claims f.      Frivolous Litigation – claims that lack evid of injury, substandard care, or both g.     “no odds yet” – when the needed info is genuinely unavail thru informal discovery h.     “don’t know yet” – PTs have good reason to believe their injuries were caused by negligence, but has insufficient info to determine which of their h/c providers is responsible i.      Framing Bias – the human tendency to favor low odds gambles when they are framed as possible gains, rather than as possible losses j.      Customary Skill and Care – failure to exercise the customary skill and care for your profession k.     Sentinel Event – unexpected occurrence of serious injury/death or “risk thereof”. l.      Benevolent Gesture – [rsmo 538.229] – actions which convey a sense of compassion or commiseration emanating from humane impulses

I.      GENERALLY          a.     Three MM crises:                   i.     1975                   ii.     1986                   iii.     2001 (MO passed statute in 2005)          b.     Issues:                   i.     each involved increasing MM ins premiums                   ii.     reduced access to MM ins                           1.     result - some MM ins became DR-owned                           2.     reduced specialty DR’s                   iii.     justice is random                           1.     innocent DR’s are drug thru the system                          2.     PT’s who are harmed do not always get redress           c.     Areas of Possible Reform:                   i.     (1) Claims Frequency and Cost                   ii.     (2) Overhead Costs                   iii.     (3) Liability Costs                   iv.     (4) Defensive Medicine                   v.     (5) Supply (access to DR’s)                   vi.     (6) Quality of Care          d.     Facts/Problems:                                                i.     2/3 of all MM claims are dismissed or abandoned                                              ii.     potential Ps considering filing a lawsuit do not know whether the hosp/DR was negligent or not                                             iii.     in order to learn about care quality, they must file a lawsuit and proceed w/ the discovery process                                             iv.     the need for formal discovery differentiates MM cases from other types of torts                                              v.     High Damage claims are prime candidates for litigation despite poor evidence of negligence (due to high return)                                             vi.     minimum threshold of damages (generally $250k) to justify the significant costs associated w/ pursuing even the clearest cases of MM                                           vii.     Ps atty’s often say that they are often precluded from doing substantial investigation b/4 filing suit b/c they are faced w/ SOL 1.     could be caused by Atty delay could be caused by delay in PT seeking legal representation

definitions

Generally