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Cecchi R, Haja TM, Calabrò F, Fasterholdt I, Rasmussen BSB. Artificial intelligence in healthcare: why not apply the medico-legal method starting with the Collingridge dilemma? Int J Legal Med 2024; 138:1173-1178. [PMID: 38172326 DOI: 10.1007/s00414-023-03152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
Technology has greatly influenced and radically changed human life, from communication to creativity and from productivity to entertainment. The authors, starting from considerations concerning the implementation of new technologies with a strong impact on people's everyday lives, take up Collingridge's dilemma and relate it to the application of AI in healthcare. Collingridge's dilemma is an ethical and epistemological problem concerning the relationship between technology and society which involves two approaches. The proactive approach and socio-technological experimentation taken into account in the dilemma are discussed, the former taking health technology assessment (HTA) processes as a reference and the latter the AI studies conducted so far. As a possible prevention of the critical issues raised, the use of the medico-legal method is proposed, which classically lies between the prevention of possible adverse events and the reconstruction of how these occurred.The authors believe that this methodology, adopted as a European guideline in the medico-legal field for the assessment of medical liability, can be adapted to AI applied to the healthcare scenario and used for the assessment of liability issues. The topic deserves further investigation and will certainly be taken into consideration as a possible key to future scenarios.
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Affiliation(s)
- Rossana Cecchi
- Laboratory of Forensic Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Tudor Mihai Haja
- Laboratory of Forensic Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Calabrò
- Laboratory of Forensic Medicine, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Iben Fasterholdt
- CIMT - Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Program for Health System and Technology Evaluation, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Benjamin S B Rasmussen
- Department of Radiology & CAI-X - Centre for Clinical Artificial Intelligence, Odense University Hospital, Odense, Denmark
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Morales-Ferrero JI. Economic and social perspective of healthcare professional liability. Med Clin (Barc) 2024; 162:e15-e19. [PMID: 38448297 DOI: 10.1016/j.medcli.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 03/08/2024]
Affiliation(s)
- Juan Ignacio Morales-Ferrero
- Área de Praxis, Servicio de Responsabilidad Profesional, Colegio Oficial de Médicos de Barcelona, Consejo de Colegios de Médicos de Cataluña, Barcelona, España; Cátedra de Medicina Legal, Responsabilidad Profesional Médica y Seguridad Clínica, Universidad de Barcelona, Barcelona, España.
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Li H, Li L, Liu T, Tan M, He W, Luo Y, Zhong X, Zhang L, Sun J. Risk management and empirical study of the doctor-patient relationship: based on 1790 litigation cases of medical damage liability disputes in China. BMC Health Serv Res 2024; 24:521. [PMID: 38664671 PMCID: PMC11044444 DOI: 10.1186/s12913-024-10952-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/04/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Compensation for medical damage liability disputes (CMDLD) seriously hinders the healthy development of hospitals and undermines the harmony of the doctor-patient relationships (DPR). Risk management in the DPR has become an urgent issue of the day. The study aims to provide a comprehensive description of CMDLD in China and explore its influencing factors, and make corresponding recommendations for the management of risks in the DPR. METHODS This study extracted data from the China Judgment Online - the official judicial search website with the most comprehensive coverage. Statistical analysis of 1,790 litigation cases of medical damage liability disputes (COMDLD) available from 2015 to 2021. RESULTS COMDLD generally tended to increase with the year and was unevenly distributed by regions; the compensation rate was 52.46%, the median compensation was 134,900 yuan and the maximum was 2,234,666 yuan; the results of the single factor analysis showed that there were statistically significant differences between the compensation for different years, regions, treatment attributes, and trial procedures (P < 0.05); the correlation analysis showed that types of hospitals were significantly negatively associated with regions (R=-0.082, P < 0.05); trial procedures were significantly negatively correlated with years (R=-0.484, P < 0.001); compensat- ion was significantly positively correlated with years, regions, and treatment attributes (R = 0.098-0.294, P < 0.001) and negatively correlated with trial procedures (R=-0.090, P < 0.01); regression analysis showed that years, treatment attributes, and regions were the main factors affecting the CMDLD (P < 0.05). CONCLUSIONS Years, regions, treatment attributes, and trial procedures affect the outcome of CMDLD. This paper further puts forward relevant suggestions and countermeasures for the governance of doctor-patient risks based on the empirical results. Including rational allocation of medical resources to narrow the differences between regions; promoting the expansion and sinking of high-quality resources to improve the level of medical services in hospitals at all levels; and developing a third-party negotiation mechanism for medical disputes to reduce the cost of medical litigation.
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Affiliation(s)
- Hui Li
- School of Health Care Management, Anhui Medical University, 230032, Hefei, China
| | - Limin Li
- School of Health Care Management, Anhui Medical University, 230032, Hefei, China
| | - Tong Liu
- School of Health Care Management, Anhui Medical University, 230032, Hefei, China
| | - Meiqiong Tan
- The Second Clinical Medical College, Anhui Medical University, 230032, Hefei, China
| | - Wanwan He
- The Second Clinical Medical College, Anhui Medical University, 230032, Hefei, China
| | - Yuzhu Luo
- The Second Clinical Medical College, Anhui Medical University, 230032, Hefei, China
| | - Xuerong Zhong
- The Second Clinical Medical College, Anhui Medical University, 230032, Hefei, China
| | - Liping Zhang
- School of Marxism, Anhui Medical University, 230032, Hefei, China.
| | - Jiangjie Sun
- School of Health Care Management, Anhui Medical University, 230032, Hefei, China.
- School of Management, Hefei University of Technology, 230039, Hefei, China.
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Levy MJ, Wend CM, Flemming WP, Lazieh A, Rosenblum AJ, Pineda CM, Wolfberg DM, Jenkins JL, Goolsby CA, Margolis AM. Bleeding Control Protections Within US Good Samaritan Laws. Prehosp Disaster Med 2024; 39:156-162. [PMID: 38572644 DOI: 10.1017/s1049023x24000268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
INTRODUCTION In the United States, all 50 states and the District of Columbia have Good Samaritan Laws (GSLs). Designed to encourage bystanders to aid at the scene of an emergency, GSLs generally limit the risk of civil tort liability if the care is rendered in good faith. Nation-wide, a leading cause of preventable death is uncontrolled external hemorrhage. Public bleeding control initiatives aim to train the public to recognize life-threatening external bleeding, perform life-sustaining interventions (including direct pressure, tourniquet application, and wound packing), and to promote access to bleeding control equipment to ensure a rapid response from bystanders. METHODS This study sought to identify the GSLs in each state and the District of Columbia to identify what type of responder is covered by the law (eg, all laypersons, only trained individuals, or only licensed health care providers) and if bleeding control is explicitly included or excluded in their Good Samaritan coverage. RESULTS Good Samaritan Laws providing civil liability qualified immunity were identified in all 50 states and the District of Columbia. One state, Oklahoma, specifically includes bleeding control in its GSLs. Six states - Connecticut, Illinois, Kansas, Kentucky, Michigan, and Missouri - have laws that define those covered under Good Samaritan immunity, generally limiting protection to individuals trained in a standard first aid or resuscitation course or health care clinicians. No state explicitly excludes bleeding control from their GSLs, and one state expressly includes it. CONCLUSION Nation-wide across the United States, most states have broad bystander coverage within GSLs for emergency medical conditions of all types, including bleeding emergencies, and no state explicitly excludes bleeding control interventions. Some states restrict coverage to those health care personnel or bystanders who have completed a specific training program. Opportunity exists for additional research into those states whose GSLs may not be inclusive of bleeding control interventions.
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Affiliation(s)
- Matthew J Levy
- Johns Hopkins School of Medicine, Baltimore, MarylandUSA
| | | | | | - Antoin Lazieh
- Rutgers New Jersey Medical School, Newark, New JerseyUSA
| | | | | | | | | | | | - Asa M Margolis
- Johns Hopkins School of Medicine, Baltimore, MarylandUSA
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Gil-Hernández E, Carrillo I, Tumelty ME, Srulovici E, Vanhaecht K, Wallis KA, Giraldo P, Astier-Peña MP, Panella M, Guerra-Paiva S, Buttigieg S, Seys D, Strametz R, Mora AU, Mira JJ. How different countries respond to adverse events whilst patients' rights are protected. Med Sci Law 2024; 64:96-112. [PMID: 37365924 DOI: 10.1177/00258024231182369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Patient safety is high on the policy agenda internationally. Learning from safety incidents is a core component in achieving the important goal of increasing patient safety. This study explores the legal frameworks in the countries to promote reporting, disclosure, and supporting healthcare professionals (HCPs) involved in safety incidents. A cross-sectional online survey was conducted to ascertain an overview of the legal frameworks at national level, as well as relevant policies. ERNST (The European Researchers' Network Working on Second Victims) group peer-reviewed data collected from countries was performed to validate information. Information from 27 countries was collected and analyzed, giving a response rate of 60%. A reporting system for patient safety incidents was in place in 85.2% (N = 23) of countries surveyed, though few (37%, N = 10) were focused on systems-learning. In about half of the countries (48.1%, N = 13) open disclosure depends on the initiative of HCPs. The tort liability system was common in most countries. No-fault compensation schemes and alternative forms of redress were less common. Support for HCPs involved in patient safety incidents was extremely limited, with just 11.1% (N = 3) of participating countries reporting that supports were available in all healthcare institutions. Despite progress in the patient safety movement worldwide, the findings suggest that there are considerable differences in the approach to the reporting and disclosure of patient safety incidents. Additionally, models of compensation vary limiting patients' access to redress. Finally, the results highlight the need for comprehensive support for HCPs involved in safety incidents.
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Affiliation(s)
- Eva Gil-Hernández
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Sant Joan d'Alacant, Spain
| | - Irene Carrillo
- Health Psychology Department, Miguel Hernández University, Elche, Spain
| | | | - Einav Srulovici
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Kris Vanhaecht
- Department of Public Health, Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium
| | - Katharine Ann Wallis
- General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, Australia
| | - Priscila Giraldo
- Head Patient Advocacy, Hospital del Mar, Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
| | - María Pilar Astier-Peña
- Primary Care Quality Unit, Territorial Health Authority, Camp de Tarragona. Health Institut of Catalonia, Barcelona, Spain
- Patient Safety Group of SemFYC (Spanish Society of Family and Community Medicine) and Quality and Safety Group of Wonca World (Global Family Doctors), Barcelona, Spain
| | - Massimiliano Panella
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale, Novara, Italy
| | - Sofia Guerra-Paiva
- Public Health Research Centre, National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Sandra Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Deborah Seys
- Department of Public Health, Leuven Institute for Healthcare Policy, KU Leuven-University of Leuven, Leuven, Belgium
| | - Reinhard Strametz
- Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Germany
| | - Asier Urruela Mora
- Department of Criminal Law, Philosophy of Law and History of Law, University of Zaragoza, Zaragoza, Spain
| | - José Joaquín Mira
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Sant Joan d'Alacant, Spain
- Health Psychology Department, Miguel Hernández University, Elche, Spain
- Alicante-Sant Joan Health District, Alicante, Spain
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Campini M. [Criminal liability of practitioners. Patient consent as a justification ?]. Rev Med Suisse 2024; 20:611-613. [PMID: 38506465 DOI: 10.53738/revmed.2024.20.866.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
The medical world brings together the divergent interests of healthcare professionals and patients, and a balance between the two is always necessary to establish and maintain a relationship of trust and to ensure that the healthcare system functions properly. Conflicts do arise, however, particularly when patients feel that their rights have not been respected by health professionals, in which case the latter may be held liable, particularly under criminal law. However, there are justifications that practitioners can use to avoid any liability : in particular, the patient's consent, and it is up to the professional to prove this.
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Affiliation(s)
- Marika Campini
- Avocate-stagiaire, Nexus Avocats SA, Rue des Communaux 14, 1800 Vevey
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Kaye AD, Barrie S, Kelkar RA, Shekoohi S. Anesthesia Liability Related to Pre-existing Conditions. Anesthesiol Clin 2024; 42:33-40. [PMID: 38278590 DOI: 10.1016/j.anclin.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
In 1985, the American Society of Anesthesiologists initiated a quality improvement closed claims analysis project for anesthetic injury to elevate patient safety. To date, there have been a total of 8954 documented claims, describing injuries contracted under sedation, regional anesthesia, or failure to attend to a patient's post-operative needs. The Closed Claims database reveals that the most highly documented health care complications were a loss of life at 2%, nerve injuries at 2%, and damage to the brain at 9%. The highest documented cases of damage from anesthesia involved regional-block-related events at 20%, followed by respiratory-related adverse effects at 17%, cardiovascular-related events at 13%, together with apparatus-linked events at 10%. Injury may result from several causes. First, multiple techniques and interventions are used during surgery, and all have potential adverse effects. Additionally, many patients scheduled for surgery have extensive past medical histories and medical comorbidities, thereby increasing their baseline risk for injury. From the Closed Claims database, improved evaluation of clinical-related implications linked to injuries within the handling of airway, sedation, non-operational room locales, obstetric anesthesia, along with chronic pain management. In summary, anesthesia departments should review outcomes of their patients on a routine basis. Assessing factors when an adverse outcome occurs may allow for changes in techniques or other anesthesia considerations to help lessen or prevent future complications.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA; Department of Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA.
| | - Sonnah Barrie
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA
| | - Rucha A Kelkar
- School of Medicine, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA 71103, USA
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8
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Riva L. The Physician-Assisted Suicide Pathway in Italy: Ethical Assessment and Safeguard Approaches. J Bioeth Inq 2024; 21:185-192. [PMID: 37831290 PMCID: PMC11052828 DOI: 10.1007/s11673-023-10302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/02/2023] [Indexed: 10/14/2023]
Abstract
Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified.
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Affiliation(s)
- Luciana Riva
- Bioethics Unit, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162, Roma, Italia.
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9
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Lamadé A, Beekmann D, Eickhoff S, Grefkes C, Tscherpel C, Meyding-Lamadé U, Bassa B. [Quality indicators artificial intelligence]. Nervenarzt 2024; 95:242-246. [PMID: 38085285 DOI: 10.1007/s00115-023-01573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 03/06/2024]
Abstract
The ability of some artificial intelligence (AI) systems to autonomously evolve and the sometimes very limited possibilities to comprehend their decision-making processes present new challenges to our legal system. At a European level this has led to reform efforts, of which the proposal for a European AI regulation promises to close regulatory gaps in existing product safety law through cross-sectoral AI-specific safety requirements. A prerequisite, however, would be that the EU legislator does not only avoid duplications and contradictions with existing safety requirements but also refrains from imposing exaggerated and unattainable demands. If this were to be taken into consideration, the new safety requirements could also be used to specify the undefined standard of care in liability law. Nevertheless, challenges in the context of provability continue to remain unresolved, posing a risk of rendering the legal protection efforts of the aggrieved party ineffective. It remains to be seen whether the EU legislator will address this need for reform with the recently proposed reform of product liability law by the Commission.
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Affiliation(s)
| | - Dustin Beekmann
- Philipps-Universität Marburg, Marburg, Deutschland
- Watson Farley & Williams LLP, Hamburg, Deutschland
| | - Simon Eickhoff
- Institut für Neurowissenschaften und Medizin, Jülich Forschungszentrum, Jülich, Deutschland
| | - Christian Grefkes
- Zentrum der Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Caroline Tscherpel
- Zentrum der Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Uta Meyding-Lamadé
- Klinik für Neurologie, Nordwestkrankenhaus in Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Burc Bassa
- Klinik für Neurologie, Nordwestkrankenhaus in Frankfurt am Main, Frankfurt am Main, Deutschland
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10
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Chazal RA, Kusumoto FM, Wilson BH, Anderson RE. Professional Liability: The Problem That Will Not Go Away. J Am Coll Cardiol 2024; 83:869-872. [PMID: 38383102 DOI: 10.1016/j.jacc.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
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11
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Shachar C, Baruch S, King LP. Whose Responsibility Is It to Define Exceptions in Abortion Bans? JAMA 2024; 331:559-560. [PMID: 38252432 DOI: 10.1001/jama.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
This Viewpoint evaluates Texas’ proposals to define the scope of the life exception for the state’s abortion ban and argues that these approaches do not allow physicians to follow the national standards of care, avoid criminal liability, or have sufficient notice of what the law permits.
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Affiliation(s)
- Carmel Shachar
- Health Law and Policy Clinic, Harvard Law School, Harvard University, Cambridge, Massachusetts
| | - Susannah Baruch
- Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Harvard University, Cambridge, Massachusetts
| | - Louise P King
- Harvard Medical School, Harvard University, Boston, Massachusetts
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12
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Iacobucci G. Leading climate scientist Mann wins $1m in defamation lawsuit. BMJ 2024; 384:q401. [PMID: 38355147 DOI: 10.1136/bmj.q401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
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13
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Hendriks AC, Verhagen CFB. [Is agression a valid reason to end the therapeutic relationship with a patient?]. Ned Tijdschr Geneeskd 2024; 168:D7914. [PMID: 38319311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
It regularly occurs that a physicians is abused by a patient. For physicians this may be a reason to consider to end the relationship with such patients, particularly if patients become violent. But is this permitted? The Dutch law and professional standards restrict physicians from doing so, unless there are 'serious reasons' to do so and only after having investigated all possibilities to restore the treatment relationship, including a discussion with the patient. We argue that these restrictions are too strict. Physicians should be able the end the relationship with patients that fail to respect the physical or mental integrity of physicians or their colleagues.
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Affiliation(s)
- A C Hendriks
- Universiteit Leiden, Faculteit der Rechtsgeleerdheid, departement Publiekrecht, Leiden
- Contact:
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14
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Tollefson J. Climatologist Michael Mann wins defamation case: what it means for scientists. Nature 2024; 626:698-699. [PMID: 38337053 DOI: 10.1038/d41586-024-00396-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
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15
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Mello MM, Guha N. Understanding Liability Risk from Using Health Care Artificial Intelligence Tools. N Engl J Med 2024; 390:271-278. [PMID: 38231630 DOI: 10.1056/nejmhle2308901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Affiliation(s)
- Michelle M Mello
- From Stanford Law School (M.M.M., N.G.), the Department of Health Policy, School of Medicine (M.M.M.), the Freeman Spogli Institute for International Studies (M.M.M.), and the Department of Computer Science (N.G.), Stanford University, Stanford, CA
| | - Neel Guha
- From Stanford Law School (M.M.M., N.G.), the Department of Health Policy, School of Medicine (M.M.M.), the Freeman Spogli Institute for International Studies (M.M.M.), and the Department of Computer Science (N.G.), Stanford University, Stanford, CA
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16
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Allman CJ. Case law update. J Healthc Risk Manag 2024; 43:39-46. [PMID: 38180389 DOI: 10.1002/jhrm.21564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
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17
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Morrill CC, Haffar A, Ditton T, DiCarlo HN, Gearhart JP, Crigger C. Bladder exstrophy-epispadias complex related litigation: A legal database review. Med Leg J 2023; 91:210-217. [PMID: 37032596 DOI: 10.1177/00258172231160593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVE To review the nature and extent of bladder exstrophy-epispadias related malpractice litigation in the United States. METHODS Two legal databases (Nexis Uni, WestLaw) were reviewed for state and federal cases using the terms "bladder exstrophy", "cloacal exstrophy", "epispadias", in combination with "medical malpractice", or "negligence", or "medical error", or "complication", or "malpractice", or "tort". Databases were queried from 1948 to 2022 and reviewed for medical and legal details. RESULTS Our search yielded 16 unique legal cases with 6 fitting established criteria for analysis. Urology and paediatric urologists were named in 50% of cases as were community medical systems. Cause for lawsuit included negligence in surgical performance (50%), primary closure of exstrophy (33%), and post-operative care (50%). Settlement agreement was reached in one case (17%). Outcomes favoured the physician in 60% of trials. Lawsuits alleging negligent surgical performance and/or post-operative care exclusively named urologists with outcomes favouring the surgeon in 66% of cases. The settlement payment (n = 1) was $500,000 and monetary damages (n = 1) equated to $1.3 million. CONCLUSIONS Malpractice litigation related to BEEC treatment is rare. Trial outcomes favour the medical provider. Cases that resulted in financial liability successfully alleged avoidable negligence resulting in irreversible physical damage. The authors recommend families with BEEC seek board-certified paediatric urologists experienced in treating this complex and/or Bladder Exstrophy Centers of Excellence. Further, we recommend surgeons treating BEEC properly educate patients and families on the severity of this major birth defect including its lifelong implications and need for surgical revisions.
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Affiliation(s)
- Christian C Morrill
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, USA
| | - Ahmad Haffar
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, USA
| | - Thomas Ditton
- J. Reuben Clark Law School, Brigham Young University, Provo, USA
| | - Heather N DiCarlo
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, USA
| | - John P Gearhart
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, USA
| | - Chad Crigger
- James Buchanan Brady Urological Institute, Division of Pediatric Urology, Douglas A. Canning MD Exstrophy Database Center, Charlotte Bloomberg Children's Hospital, The Johns Hopkins Medical Institutions, Baltimore, USA
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18
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Nolan P, Matulionyte R. Artificial Intelligence in Medicine: Issues When Determining Negligence. J Law Med 2023; 30:593-615. [PMID: 38332598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
The introduction of novel medical technology, such as artificial intelligence (AI), into traditional clinical practice presents legal liability challenges that need to be squarely addressed by litigants and courts when something goes wrong. Some of the most promising applications for the use of AI in medicine will lead to vexed liability questions. As AI in health care is in its relative infancy, there is a paucity of case law globally upon which to draw. This article analyses medical malpractice where AI is involved, what problems arise when applying the tort of negligence - such as establishing the essential elements of breach of duty of care and causation - and how can these can be addressed. Product liability under Australian Consumer Law is beyond the scope of this article. In order to address this question, the article: (1) identifies the general problems that black box AI causes in the health care sector; (2) identifies the problems that will arise in establishing breach and causation due to the "black box" nature of AI, with reference to the Civil Liability Act 2002 (NSW) and common law through two hypothetical examples; and (3) considers selected legal solutions to the problems caused by "black box" AI.
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19
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Nolan P. Artificial intelligence in medicine - is too much transparency a good thing? Med Leg J 2023; 91:193-197. [PMID: 36659838 DOI: 10.1177/00258172221141243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Some encouraging uses for AI in medicine will lead to potentially novel legal liability issues. Complex algorithms involve an opacity that creates problems for the medical and legal professions alike. As iatrogenic injury is common in medical malpractice, the medical profession is understandably concerned when AI is introduced in diagnostic and therapeutic devices and events and outcome cannot be fully explained due to the "black box" effect.A concern about machine learning algorithms is the black box issue and understanding how conclusions or outcomes are reached. The deployment of AI devices in healthcare will require an increase in a clinician's understanding of AI to increase the transparency of their use.An important aspect of medical treatment is the notion of "therapeutic privilege". This will only arise in limited circumstances and requires the clinician to make a judgment, based on reasonable grounds, that the patient's physical or mental health might be seriously harmed by providing the information.Given the complexity of AI and the black box effect, could too much AI transparency possibly overwhelm a patient, such that it may dissuade them from giving consent in circumstances where treatment is necessary and essential? In other words, too much AI transparency and information may inadvertently hinder treatment and progress.
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Affiliation(s)
- Paul Nolan
- Barrister-at-Law, Australian Bar Association
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20
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Stewart C, Freckelton I. Lessons from Re Teo: Unconventional Practice and the National Law. J Law Med 2023; 30:520-537. [PMID: 38332593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
This section explores the decision of the New South Wales Professional Standards Committee, in Re Teo [2023] NSWMPSC 2. The case provides insights into how the Health Practitioner Regulation National Law Act 2009 (Qld) regulates practitioners who practise outside of conventional practice. The section compares the decision to similar cases and then concludes with a proposal that an express policy on unconventional practice is needed in Australia.
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21
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Margolis I. Who Is a Health Care Provider?: Statutory Interpretation as a Middle-Ground Approach to Medical Malpractice Damage Caps. Am J Law Med 2023; 49:493-510. [PMID: 38563270 DOI: 10.1017/amj.2024.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Debates over the effectiveness, constitutionality, and fairness of medical malpractice damage caps are as old as the laws themselves. Though some courts have struck down damage caps under state constitutional provisions, the vast majority hesitate to invalidate malpractice reform legislation. Instead, statutory interpretation offers a non-constitutional method of challenging the broad scope of damage caps without fully invalidating legislative efforts to curtail "excessive" malpractice liability. This Note examines the term "health care providers" in construing malpractice reform laws and identifies two predominant forms of statutory interpretation that state courts apply. In doing so, this Note offers recommendations for courts and legislatures to best balance the goals of the malpractice reform movement with patients' interests in recovery for medical injuries.
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22
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Jones C, Thornton J, Wyatt JC. Artificial intelligence and clinical decision support: clinicians' perspectives on trust, trustworthiness, and liability. Med Law Rev 2023; 31:501-520. [PMID: 37218368 PMCID: PMC10681355 DOI: 10.1093/medlaw/fwad013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Artificial intelligence (AI) could revolutionise health care, potentially improving clinician decision making and patient safety, and reducing the impact of workforce shortages. However, policymakers and regulators have concerns over whether AI and clinical decision support systems (CDSSs) are trusted by stakeholders, and indeed whether they are worthy of trust. Yet, what is meant by trust and trustworthiness is often implicit, and it may not be clear who or what is being trusted. We address these lacunae, focusing largely on the perspective(s) of clinicians on trust and trustworthiness in AI and CDSSs. Empirical studies suggest that clinicians' concerns about their use include the accuracy of advice given and potential legal liability if harm to a patient occurs. Onora O'Neill's conceptualisation of trust and trustworthiness provides the framework for our analysis, generating a productive understanding of clinicians' reported trust issues. Through unpacking these concepts, we gain greater clarity over the meaning ascribed to them by stakeholders; delimit the extent to which stakeholders are talking at cross purposes; and promote the continued utility of trust and trustworthiness as useful concepts in current debates around the use of AI and CDSSs.
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Affiliation(s)
- Caroline Jones
- Hillary Rodham Clinton School of Law, Swansea University, Swansea, UK
| | - James Thornton
- Nottingham Law School, Nottingham Trent University, Nottingham, UK
| | - Jeremy C Wyatt
- Wessex Institute, University of Southampton, Southampton, UK
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23
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Blumstein JF, McMichael BJ, Storrow AB. Developing Safe Harbors to Address Malpractice Liability and Wasteful Health Care Spending. JAMA Health Forum 2023; 4:e233899. [PMID: 37991781 DOI: 10.1001/jamahealthforum.2023.3899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
This Viewpoint discusses the feasibility of developing safe harbors that account for the role of medical malpractice liability and go beyond generic guidelines discouraging the overuse of health care resources.
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Affiliation(s)
- James F Blumstein
- Vanderbilt University Law School and Vanderbilt University Medical School, Nashville, Tennessee
| | | | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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24
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Brous E. Legal Issues 101: Malpractice and Licensure Discipline. NASN Sch Nurse 2023; 38:316-319. [PMID: 37403483 DOI: 10.1177/1942602x231183940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
This article is part of a series of articles titled "Legal Issues 101." The purpose of this series is to address common questions and misconceptions regarding the law and school health. Nurses frequently conflate malpractice or negligence with professional licensure discipline and it is important to understand the difference. To reduce liability exposure, school nurses must understand what their risks are and what they are not, for both civil lawsuits and for nursing board discipline.
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Affiliation(s)
- Edie Brous
- Nurse Attorney, New York and Pennsylvania
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25
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Montisci R, Licciardi M, Cecchi R, Kondo T, Gerosa G, Casula R, Cecchetto G, Montisci M. Malpratice claims in cardiology and cardiac surgery: A medico-legal issue. Leg Med (Tokyo) 2023; 65:102319. [PMID: 37696211 DOI: 10.1016/j.legalmed.2023.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
Medical liability has become a challenge in every physician's modern practice with the consequent loss of the physician's autonomy and an increase in "defensive medicine". From this perspective, the role of Legal Medicine in assessing medical liability has become increasingly specific and a homogenization of the methods of ascertainment is increasingly necessary, since such a process can contribute to strengthening the guarantees in professional liability procedures. Focusing on malpractice claims in the field of cardiology, the complexity of the management of cardiac pathologies and the frequency of severe adverse events implies the importance of a multi-disciplinary approach, together with the application of a shared ascertainment methodology. In particular, it is essential for the forensic pathologist to collaborate with experts in cardio-pathology, cardiology and/or cardiac surgery in cases of alleged medical liability in the cardiologic field and to follow the guidelines which have been produced to assist the expert dealing with deaths reflecting cardiac disease, in order to prevent criticism of case analysis in medico-legal environments and to promote the standardization of the structure of the juridical-legislative medical malpractice lawsuits.
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Affiliation(s)
- R Montisci
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Licciardi
- Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - R Cecchi
- Institute of Legal Medicine, Department of Medicine and Surgery, University of Parma, Italy.
| | - T Kondo
- Institute of Legal Medicine, Wakayama Medical University School of Medicine Graduate School of Medicine, Japan
| | - G Gerosa
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - R Casula
- Clinical Cardiology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - G Cecchetto
- Legal Medicine and Toxicology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - M Montisci
- Legal Medicine and Toxicology Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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26
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Haftenberger A, Dierks C. [Legal integration of artificial intelligence into internal medicine : Data protection, regulatory, reimbursement and liability questions]. Inn Med (Heidelb) 2023; 64:1044-1050. [PMID: 37861724 DOI: 10.1007/s00108-023-01598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/21/2023]
Abstract
Artificial intelligence (AI) opens up new opportunities to improve medical care in internal medicine; however, legal uncertainties in the application of AI impede its integration into the daily practice of internal medicine. To clarify the situation this paper gives an overview of the legal aspects related to AI and shows which frameworks must be adhered to in order to exploit the benefits of AI without neglecting the rights and protection of patients. The paper first addresses data protection issues which arise when sensitive health data are processed by AI. This is followed by a discussion of the key regulatory requirements for the use of AI in internal medicine. As the establishment of AI in practice also depends on sufficient funding, legal issues of reimbursement are additionally examined. Finally, the specific features that need to be considered when using AI to avoid medical liability consequences are highlighted.
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Affiliation(s)
- Anna Haftenberger
- Dierks+Company Rechtsanwaltsgesellschaft mbH, Invalidenstr. 113, 10115, Berlin, Deutschland.
| | - Christian Dierks
- Dierks+Company Rechtsanwaltsgesellschaft mbH, Invalidenstr. 113, 10115, Berlin, Deutschland.
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Morena D, Di Fazio N, Scognamiglio P, Delogu G, Baldari B, Cipolloni L, Frati P, Fineschi V. Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey. Medicina (Kaunas) 2023; 59:1928. [PMID: 38003977 PMCID: PMC10673589 DOI: 10.3390/medicina59111928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75-7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50-3.46, p < 0.001). Prioritizing protection from professional liability over patients' actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a 'risk management culture' and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine.
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Affiliation(s)
- Donato Morena
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
| | - Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
| | | | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
| | - Benedetta Baldari
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
| | - Luigi Cipolloni
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy;
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185 Rome, Italy; (D.M.); (N.D.F.); (G.D.); (B.B.); (V.F.)
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28
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Dyer C. Lucy Letby case: Police investigate hospital for corporate manslaughter over baby deaths. BMJ 2023; 383:2299. [PMID: 37797968 DOI: 10.1136/bmj.p2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
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29
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Allman CJ. Case law update. J Healthc Risk Manag 2023; 43:48-56. [PMID: 37653678 DOI: 10.1002/jhrm.21556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023]
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30
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Sittig DF, Wright A. A guide to mitigating audit log-related risk in medical professional liability cases. J Healthc Risk Manag 2023; 43:37-47. [PMID: 37486791 DOI: 10.1002/jhrm.21553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/13/2023] [Indexed: 07/26/2023]
Abstract
Following the American Recovery and Reinvestment Act in 2009, use of electronic health records (EHRs) has become ubiquitous. Accordingly, one should expect most medical professional liability cases to involve review of patient records produced from EHRs. When questions arise regarding who was involved in care of a patient, what they knew and when, or the meaning, completeness, integrity, validity, timeliness, confidentiality, accuracy, or legitimacy of data, or ways that the EHR's user interface or automated clinical decision support tools may have contributed to the alleged events, one often turns to the EHR and its audit log. This manuscript discusses lines of defense incorporated into the design, development, implementation, and use of EHRs to ensure their integrity and the types of EHR transaction logs (e.g., audit log) that exist. Using these logs can help one answer questions that often arise in medical malpractice cases. Finally, there are "best practices" surrounding EHR audit logs that health care organizations should implement. When used appropriately, EHRs and their audit logs provide another source of information to help hospital risk managers, legal counsel, and EHR expert witnesses to investigate adverse incidents and, if needed, prosecute or defend clinicians and/or health care organizations involved in the patient's care.
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Affiliation(s)
- Dean F Sittig
- Center for Healthcare Quality & Safety, McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Informatics-Review LLC, Lake Oswego, Oregon, USA
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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31
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Springer S, Bochis J. [Law of emergency representation by spouses in matters of healthcare-Practical implementation of a controversial norm]. Anaesthesiologie 2023; 72:677-684. [PMID: 37558827 DOI: 10.1007/s00101-023-01324-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/11/2023]
Abstract
The scope of the German law of emergency representation by spouses ("Ehegattenvertretungsrecht"), which has been in effect since 1 January 2023, is currently being described as uncertain, fuzzy and insufficiently defined in many aspects. Treating physicians are confronted with a long legal text characterized by references to other norms and in need of interpretation. The law itself is not limited to representation in emergency measures sensu stricto, although the right of representation should only be based on treatment that is "necessary from a medical point of view and cannot be postponed". Pending established case law, this article attempts to present guidelines for the practical application of the law of emergency representation by spouses. Special aspects such as medical liability, the central register of lasting powers of attorney and the inclusion of the represented spouse in studies are discussed.
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Affiliation(s)
- Sebastian Springer
- Abteilung für Anästhesiologie, Intensivmedizin & Notfallmedizin, Klinikum Hochrhein GmbH, Waldshut-Tiengen, Deutschland
| | - Julia Bochis
- , Hauptstr. 78-80, 79761, Waldshut-Tiengen, Deutschland.
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32
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Kuersten A. Health Digital Twins, Legal Liability, and Medical Practice. Am J Bioeth 2023; 23:66-69. [PMID: 37647488 DOI: 10.1080/15265161.2023.2237462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Andreas Kuersten
- American Law Division, Congressional Research Service, Library of Congress
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33
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Wang X. Legal Theories, Disability Models and Principles of Disability Assessment. Fa Yi Xue Za Zhi 2023; 39:329-336. [PMID: 37859470 DOI: 10.12116/j.issn.1004-5619.2023.230307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
In the personal injury compensation system, the protection and relief of the injured people's rights to life, rights to health, and body rights are generally based on the results of disability assessment. Over the years, with the increased number of personal injury compensation cases, the practice of disability assessment have been greatly developed, and the development of disability assessment standards tends to be mature. However, the lack of basic theories for disability assessment has seriously affected the construction and unification of standards. Starting from the tort legal system of personal injury compensation, this article systematically analyzes the legal theories of disability assessment, and holds that the loss of labor ability is the legal basis for disability assessment in China, and the essence of disability assessment should be understood as the quantitative assessment of an individual's permanent loss of labor ability. This article combines the international disability assessment models and the primary concepts of American Medical Association's Guides to the Evaluation of Permanent Impairment to refine the basic concepts of disability assessment in China, such as impairment, disability, handicap, disabled people and self-care ability, etc. At the same time, it sorts out the critical issues of identification time, promotion principles and compound calculation of multiple injuries in disability assessment. It is expected to be beneficial to the theory and practice of disability assessment in personal injury compensation.
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Affiliation(s)
- Xu Wang
- Key Laboratory of Evidence Science, Ministry of Education, China University of Political Science and Law, Beijing 100088, China
- Felony Procuratorial Evidence Research Center, China University of Political Science and Law, Beijing 100088, China
- Forensic Science Standards Research Center, China University of Political Science and Law, Beijing 100088, China
- Center of Cooperative Innovation for Judicial Civilization, Beijing 100088, China
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34
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Martin-Fumadó C, Benet-Travé J, Arimany-Manso J. Wrong-Site Surgery in Spain and Professional Liability Claims. J Patient Saf 2023; 19:e63. [PMID: 37306520 DOI: 10.1097/pts.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Carles Martin-Fumadó
- Praxis Area College of Physicians of Barcelona Chair of Legal Medicine Medical Professional Liability and Clinical Safety Hospital Clínic of Barcelona University of Barcelona Barcelona, Spain
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35
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Orlandi E, Nardi E, Siodambro C, Massi D, Pinchi V. Professional liability subsequent to the Cartabia Reform: implications for pathologists. Pathologica 2023; 115:217-220. [PMID: 37711037 PMCID: PMC10688249 DOI: 10.32074/1591-951x-878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 11/11/2023] [Indexed: 09/16/2023] Open
Abstract
The Cartabia Reform modifies the standard used by the Public Prosecutor for the submission of requests for filing or referral for trial. The standard has shifted to the "reasonable prediction of conviction" by moving the principle of in dubio pro reo to the investigation phase. The scope of the legislative amendment is focused on protecting the rights of investigated individuals, who are too often brought to trial without adequate supporting evidence. The implications that this reform has on legal proceedings concerning the criminal liability of healthcare professionals, including pathologists, is discussed.
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Affiliation(s)
- Edoardo Orlandi
- Section of Anatomic Pathology, department of health sciences, University of Florence, Florence, Italy
| | - Eleonora Nardi
- Section of Anatomic Pathology, department of health sciences, University of Florence, Florence, Italy
| | - Chiara Siodambro
- Departmental Section of Legal Medicine, University of Florence, Florence, Italy
| | - Daniela Massi
- Section of Anatomic Pathology, department of health sciences, University of Florence, Florence, Italy
| | - Vilma Pinchi
- Departmental Section of Legal Medicine, University of Florence, Florence, Italy
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36
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Stewart C, Kim P. The Standard of Care Test Revisited: Competing Approaches to Defining Competent Profession Practice in Australia. J Law Med 2023; 30:278-285. [PMID: 38303615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
This section examines the recent decision of the New South Wales Court of Appeal in Dean v Pope [2022] NSWCA 260. The decision settles a long-running dispute in New South Wales about the test for the standard of care under s 5O of the Civil Liability Act 2002 (NSW). That provision was introduced following the medical indemnity crisis of the early 2000s and provided for a modified Bolam test to protect professionals from claims in negligence when they had acted in accordance with a standard of "competent professional practice". In recent years there has been controversy regarding whether that section required the practice to be one already established to satisfy the section. This section examines the decision, how it fits into the history of the Ipp reforms and what it means for other jurisdictions in Australia.
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37
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Feldman SL, Johnston C. Legal Liability of Clinical Ethics Services in Australia: "Should I Be More Worried Than I Am?". J Law Med 2023; 30:345-357. [PMID: 38303619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
A key function of clinical ethics services (CESs) is to provide decision-making support to health care providers in ethically challenging cases. Cases referred for ethics consultation are likely to involve diverging views or conflict, or to confront the boundaries of appropriate medical practice. Such cases might also attract legal action due to their contentious nature. As CESs become more prevalent in Australia, this article considers the potential legal liability of a CES and its members. With no reported litigation against a CES in Australia, we look to international experience and first principles. We consider the prospects of a claim in negligence, the most likely legal action against a CES, through application of legal principles to a hypothetical case scenario. We conclude that, although unlikely to be successful at this time, a CES could face answerable claims in negligence brought by patients (and families) who are the subject of ethics case consultation.
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Affiliation(s)
- Sharon L Feldman
- PhD Candidate, University of Melbourne Department of Paediatrics
| | - Carolyn Johnston
- Research Fellow University of Tasmania, Honorary Senior Fellow (Law), University of Melbourne
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Toomey JW. The Causes of Minor Suicide: How the Restatement Approach to Foreseeability & Scope of Liability Fails to Act as a Deterrent. Am J Law Med 2023; 49:396-413. [PMID: 38344789 DOI: 10.1017/amj.2023.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Suicide is one of the most common causes of death among individuals younger than eighteen years old. While psychological and social sciences continue to study the causes of the increasing prevalence of suicide in children and teens, the law largely continues to treat suicide as an isolated event. This Note tracks the historical treatment of suicide both under tort and criminal law, supporting the shift away from the traditional view of suicide towards one that more closely aligns with the growing understanding of the many factors that can contribute to a minor's suicide. Ultimately, this Note argues that many minor suicides should be treated as foreseeable, allowing actions in tort.
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Safrin S. The Impact of Malpractice Damage Caps on C-section Rates and Alternative Approaches. Clin Obstet Gynecol 2023; 66:278-292. [PMID: 37036792 DOI: 10.1097/grf.0000000000000780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
About half of the states in the United States have had noneconomic damage caps in place for at least 8 years. National aggregate data shows that women are just as likely to give birth by cesarean section (C-section) in states with damage caps as in ones without. For the most recent year studied, the national C-section rate for births in states with damage caps was 33.04% compared with a 32.10% ratefor births in states without caps. Other initiatives (malpractice insurance reform, accessible public disclosure of hospital C-section rates, and improved compensation for vaginal delivery) should be considered to reduce C-section rates.
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Sundel MH, Blackburn KW, Seyoum N, Morton C, Swartzberg A, Bafford AC. Lessons in liability: Examining medical malpractice suits against general surgeons in Maryland. Am J Surg 2023; 225:748-752. [PMID: 36414471 PMCID: PMC10033332 DOI: 10.1016/j.amjsurg.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/14/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although medical malpractice lawsuits pose a significant burden, there is a paucity of research on physician-specific characteristics influencing lawsuits against surgeons. Our objective was to identify factors associated with general surgeons being named in malpractice cases. METHODS This was a cross sectional study of Maryland general surgeons, using malpractice data from a publicly accessible judiciary database. Case number per decade and lifetime lawsuit status were modeled with linear and logistic regression. RESULTS Male surgeons had a higher average lawsuit volume (p = 0.002) and were more likely to be named in a malpractice case (p < 0.001). In regression analysis, a second graduate degree was a predictor of average cases per 10 years (p = 0.008) and male gender predicted lifetime lawsuit status (OR = 1.73, p = 0.046). CONCLUSIONS Male gender was associated with increased odds of being named in a malpractice lawsuit. Identifying this difference is a preliminary step in developing interventions to reduce lawsuits amongst surgeons.
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Affiliation(s)
- Margaret H Sundel
- University of Maryland, Department of Surgery, 22 South Greene Street, Baltimore, MD, 21201, United States.
| | - Kyle W Blackburn
- University of Maryland, Department of Surgery, 22 South Greene Street, Baltimore, MD, 21201, United States
| | - Nahom Seyoum
- University of Maryland, School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, United States
| | - Claire Morton
- University of Maryland, School of Medicine, 655 West Baltimore Street, Baltimore, MD, 21201, United States
| | - Allyson Swartzberg
- Wake Forest University, College of Arts and Sciences, 1834 Wake Forest Road, Winston-Salem, NC, 27109, United States
| | - Andrea C Bafford
- University of Maryland, Department of Surgery, 22 South Greene Street, Baltimore, MD, 21201, United States
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41
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Gaidzik PW. [Assessor liability DGOU]. Unfallchirurgie (Heidelb) 2023; 126:366-372. [PMID: 36929037 DOI: 10.1007/s00113-023-01299-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/18/2023]
Abstract
The legal liability risks in assessments are often overestimated, but also sometimes underestimated. In fact, lawsuits for incorrect assessment are rarely successful, but they are nevertheless annoying and require considerable time for those affected as defendants. In the following, the legal principles of expert opinion liability within and outside of formal court proceedings are presented.
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Affiliation(s)
- Peter W Gaidzik
- Fakultät für Gesundheit, Institut für Medizinrecht, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland.
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Li L, Chen Y, Gao H, Li C. How to Regulate the Infringements of Geographical Indications of Agricultural Products-An Empirical Study on Judicial Documents in China. Int J Environ Res Public Health 2023; 20:4946. [PMID: 36981856 PMCID: PMC10049200 DOI: 10.3390/ijerph20064946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
Under the background of China's strategy of becoming a powerful agricultural country, geographical indications (GIs) of agricultural products, as an important intellectual property right to enable Chinese agriculture to develop with high quality, have a strong effect of strengthening and promoting agriculture. However, there are a large number of infringements of GIs among agricultural products in judicial practice, which not only greatly damage the economic and social values of GIs of agricultural products, but also bring huge food safety hazards to consumers and hinder the overall protection of intellectual property rights in China. On this basis, this paper, with the help of a quasi-case research method, integrates the facts of relevant cases, the focus of disputes, the application of law, and other case elements to realize the case similarity judgment based on the legal argumentation model. With the help of the retrieval tool of "Peking University Magic Weapon", this paper provides statistics on the civil cases of infringement of GIs of agricultural products in China from 1 January 2014 to 31 July 2022 and sets different retrieval conditions for two searches. After two screenings, 245 valid samples were obtained, and the judicial patterns of infringement disputes over GIs of agricultural products in China were systematically sorted out from the distribution of plaintiff and defendant, the distribution of infringement types, the basis of adjudication, and the standard of compensation. It was found that the plaintiff types showed double simplification, the infringement types took edge infringement as the basic form, and the general trademark provisions occupied the main position in legal applications. Then, the main litigation points, such as the dispute over the identification of GIs of agricultural products, the dispute over the use of geographical names, and the dispute over tort liability, are summarized, so as to dig out the characteristics of the implicitness of infringement, the expectation of implementation, and the concreteness of aspects. On this basis, the regulatory path of the infringement of GIs of agricultural products is put forward, such as introducing procuratorial public interest litigation, multi-agents cooperating to implement all-round supervision, and reasonably determining the amount of damages.
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Affiliation(s)
- Lingling Li
- School of Humanities and Social Development, Northwest A & F University, Yangling, Xianyang 712100, China; (L.L.); (Y.C.); (H.G.)
| | - Yingzi Chen
- School of Humanities and Social Development, Northwest A & F University, Yangling, Xianyang 712100, China; (L.L.); (Y.C.); (H.G.)
| | - Haoran Gao
- School of Humanities and Social Development, Northwest A & F University, Yangling, Xianyang 712100, China; (L.L.); (Y.C.); (H.G.)
| | - Changjian Li
- School of Law, Huazhong University of Science and Technology, Wuhan 430223, China
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Sittig DF, Wright A. Identifying a Clinical Informatics or Electronic Health Record Expert Witness for Medical Professional Liability Cases. Appl Clin Inform 2023; 14:290-295. [PMID: 36706791 PMCID: PMC10033222 DOI: 10.1055/a-2018-9932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/21/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The health care field is experiencing widespread electronic health record (EHR) adoption. New medical professional liability (i.e., malpractice) cases will likely involve the review of data extracted from EHRs as well as EHR workflows, audit logs, and even the potential role of the EHR in causing harm. OBJECTIVES Reviewing printed versions of a patient's EHRs can be difficult due to differences in printed versus on-screen presentations, redundancies, and the way printouts are often grouped by document or information type rather than chronologically. Simply recreating an accurate timeline often requires experts with training and experience in designing, developing, using, and reviewing EHRs and audit logs. Additional expertise is required if questions arise about data's meaning, completeness, accuracy, and timeliness or ways that the EHR's user interface or automated clinical decision support tools may have contributed to alleged events. Such experts often come from the sociotechnical field of clinical informatics that studies the design, development, implementation, use, and evaluation of information and communications technology, specifically, EHRs. Identifying well-qualified EHR experts to aid a legal team is challenging. METHODS Based on literature review and experience reviewing cases, we identified seven criteria to help in this assessment. RESULTS The criteria are education in clinical informatics; clinical informatics knowledge; experience with EHR design, development, implementation, and use; communication skills; academic publications on clinical informatics; clinical informatics certification; and membership in informatics-related professional organizations. CONCLUSION While none of these criteria are essential, understanding the breadth and depth of an individual's qualifications in each of these areas can help identify a high-quality, clinical informatics expert witness.
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Affiliation(s)
- Dean F. Sittig
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, Texas, United States
- Informatics-Review LLC, Lake Oswego, Oregon, United States
| | - Adam Wright
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Kim H, Lee A. How patient autonomy drives the legal liabilities of medical practitioners and the practical ways to mitigate and resolve them. Postgrad Med J 2023; 99:83-88. [PMID: 36827969 DOI: 10.1093/postmj/qgad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/13/2022] [Accepted: 11/05/2022] [Indexed: 02/26/2023]
Abstract
This paper discusses the rapidly evolving healthcare risk landscape and considers how emerging trends-such as advancement of medical technology, cyber security, pandemic risks, increasing prevalence of noncommunicable health conditions, and the shift towards patient autonomy-are shaping the nature of liabilities faced by doctors and healthcare professionals. Then it discusses practical ways to mitigate clinical risks and resolve the medico-legal claims or inquiries that arise while addressing the role that indemnity providers should play.
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Affiliation(s)
- Hwan Kim
- Asia Pacific Healthcare Division, Allied World Assurance Company, Ltd, 079914, Singapore
| | - Albert Lee
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Jerstad CA, Haukalid C. Feilbehandling må kunne medføre personlig ansvar. Tidsskr Nor Laegeforen 2023; 143:23-0029. [PMID: 36811435 DOI: 10.4045/tidsskr.23.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Tan J, Ross JM, Wright D, Pimentel MPT, Urman RD. A Contemporary Analysis of Closed Claims Related to Wrong-Site Surgery. Jt Comm J Qual Patient Saf 2023; 49:265-273. [PMID: 36925434 DOI: 10.1016/j.jcjq.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Wrong-site surgeries are considered "never events" and continue to occur despite the implementation of the Universal Protocol by The Joint Commission in 2003. METHODS The authors reviewed closed claims data on wrong-site surgery between 2013 and 2020 from a medical malpractice company. The claims were classified by allegations made by claimants, the responsible services, the types of procedures, the injuries, and contributing factors. Researchers performed a descriptive analysis of the available variables and reviewed the clinical summary of each case. RESULTS Between 2013 and 2020, there were 68 wrong-site closed claims cases. The mean age of the patients was 55.7 (standard deviation 16.21) years, and 51.5% were female. The services most frequently responsible for these were Orthopedic (35.3%), Neurosurgery (22.1%), and Urology (8.8%). The most common types of procedures were spine and intervertebral disc surgery (22.1%), arthroscopy (14.7%), and surgery on muscles/tendons (11.8%). The severity of claims was higher in the inpatient setting compared to the ambulatory setting. The most common alleged injuries included the need for additional surgery (45.6%), pain (33.8%), mobility dysfunction (10.3%), worsened injury (8.8%), death (7.4%), and total loss (7.4%). The top contributing factors to wrong-site surgery were failure to follow policy/protocol (83.8%) and failure to review the medical records (41.2%). The mean closed claim value was $136,452.84, and 60.3% of cases were settled. CONCLUSION The risk of wrong-site surgeries is increased with spine surgeries, likely due to unique technical challenges. Further research is required to identify effective methods of prevention of these events.
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Kumari D, Ahmed O, Jilani S, Funaki E, Funaki B. A Review of Professional Liability in IR: Sweeping the Mines. J Vasc Interv Radiol 2023; 34:157-163. [PMID: 36241149 DOI: 10.1016/j.jvir.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
Abstract
Medical professional liability (MPL) is becoming a substantial issue in interventional radiology (IR), with both impact on health care costs and negative psychological effects on physicians. MPL presents special challenges within IR because of the field's complex and innovative therapies that are provided to a diverse group of patients and complicated by the off-label use of devices and drugs that is pervasive in the field. This review discusses the principles and practices to avoid and manage MPLs that are specific to the field of IR.
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Affiliation(s)
- Divya Kumari
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois.
| | - Osman Ahmed
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
| | | | | | - Brian Funaki
- Department of Radiology, University of Chicago Medicine, Chicago, Illinois
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Pallocci M, Treglia M, Passalacqua P, Tittarelli R, Zanovello C, De Luca L, Caparrelli V, De Luna V, Cisterna AM, Quintavalle G, Marsella LT. Informed Consent: Legal Obligation or Cornerstone of the Care Relationship? Int J Environ Res Public Health 2023; 20:ijerph20032118. [PMID: 36767485 PMCID: PMC9915667 DOI: 10.3390/ijerph20032118] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 06/02/2023]
Abstract
The topic of informed consent has become increasingly important in recent decades, both in the ethical-deontological field and as a duty of law. The review covered all sentences issued by the 13th section of the Civil Court of Rome during the period January 2016-December 2020. During this period, 156 judgments were found in which a breach of consent was required; in 24 of these, specific liability was proven, and the corresponding compensation liquidated. Moreover, 80% of the cases concerned the lack of information provided. The most involved branches were those related to surgical areas: general surgery, plastic surgery and aesthetic medicine and orthopaedics. The total amount of compensation paid was EUR 287,144.59. The research carried out has highlighted how, in a broad jurisprudential context, the damage caused by the violation of the right related to informed consent is considered, and how it impacts on the economic compensation of damages. Additionally, it showed that the areas most affected by the information deficit are those related to the performance of surgical activities, which are characterized by greater invasiveness and a higher risk of adverse events. The data reported underline the exigency to consider informed consent not as a mere documentary allegation but as an essential moment in the construction of a valid therapeutic alliance, which is also useful for avoiding unnecessary litigation that is becoming increasingly burdensome for healthcare systems all over the world.
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Affiliation(s)
- Margherita Pallocci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Michele Treglia
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Pierluigi Passalacqua
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Roberta Tittarelli
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Claudia Zanovello
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Lucilla De Luca
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Valentina Caparrelli
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Vincenzo De Luna
- Department of Clinical Science and Translational Medicine, Section of Orthopedics and Traumatology, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | | | - Luigi Tonino Marsella
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Abstract
This Viewpoint discusses recent legal directives by the DHHS and FDA that could increase health care entities’ liability for possible discriminatory biases of clinical algorithms and the need for additional legal clarity to avoid adverse effects on algorithm development and use.
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Affiliation(s)
- Katherine E Goodman
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- VA Maryland Healthcare System, Baltimore
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50
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Sang T, Zhang L. The Institutional Positioning of Environmental Tort Remedy in China: Executive-Led or Judicial-Led? Int J Environ Res Public Health 2023; 20:1443. [PMID: 36674199 PMCID: PMC9858980 DOI: 10.3390/ijerph20021443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
There are two options for environmental tort remedy in China: resorting to environmental administration or environmental justice, with an ongoing debate over which of the two should lead. Firstly, it compares the structure of China's environmental tort remedy system and the two types of power: administrative power and judicial power, concluding that administrative power is dominant. Then, it argues for the indispensability of judicial power, attempts to find a clear boundary between the two sides, and justifies their mutual division of labor and collaboration. Through sufficient demonstration, it clarifies why the dominant position of environmental administrative power must be guaranteed. Then, it summarizes the experience of other countries and the practice of environmental protection in China; and provides three innovative paths of the future environmental rights remedy system. These three aspects are setting up a review procedure for administrative priority judgment before filing an environmental lawsuit, establishing the independent position of experts in environmental litigation, advocating a risk communication mechanism other than litigation, and providing a richer institutional guarantee for the relief of environmental rights.
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Affiliation(s)
| | - Lijun Zhang
- Koguan Law School, Shanghai Jiaotong University, Shanghai 200030, China
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