What is Medical Malpractice Insurance?

• Medical malpractice insurance is a financial-based instrument available only to physicians or those individuals involved in healthcare. By purchasing a medical malpractice policy, the physician or medical professional is protected in the event of a judgment against them for medical negligence, malfeasance, or in general malpractice.

• The majority of states in America require that physicians have some form of medical malpractice insurance to protect them from a faulty or negligent action. In addition to a state mandate, the majority of hospitals or medical institutions will require physicians to be obtain a form of coverage—institutions will require the obtainment of a policy to protect them against costly settlements.

How Medical Malpractice Insurance Works

• A physician will purchase a medical malpractice policy from either a commercial insurance company or a mutual insurance company that is operated by a health care provider or medical professional. The physician can either choose individual coverage or be a part of a policy that incorporates the underlying practice or institution in which the doctor is employed.

• The form of coverage purchased is dictated by the individual physician’s employer. Those doctors or medical professionals employed by the United States Federal Government will not be required to purchase a medical malpractice insurance policy—any lawsuit against the federal government is self-insured.

How is the Medical Malpractice Premium Determined?

• The majority of physicians are rarely sued or sued infrequently. As a result, the data attached to a premium calculation is actuarially unsound. This characteristic makes it impossible for a physician to be “rated” or “classified” based on past history. In addition, the claims filed against a doctor are based on circumstance, making the issues concerning with a premium determinant difficult to gauge.

• As oppose to past histories, the premiums associated with medical malpractice insurance are determined based on specialty. All physicians are classified based on their medical field or their specialty.  Each classification is attached to a rate based on the probability of an occurrence of a medical malpractice issue. For example, orthopedic surgeons are more susceptible (as a result of the skill required to perform surgery) to negligent actions or mistakes, and as a result, are more likely to face a medical malpractice suit. As a result of this general susceptibility, orthopedic surgeons will face higher premiums for their medical malpractice insurance policies. In addition, the location of the physicians or medical professionals practice, will affect the premium level.

• As a result of the rising number of medical malpractice cases, insurance companies are realizing that the business of offering medical malpractice insurance is not indisputably profitable. This realization has increased premiums and placed a strain on the medical field.

What is a Medical Negligence Claim?

• A medical negligence claim is a direct legal action taken by a patient who falls victim to the negligent or wrongful actions of a medical provider or medical professional. All medical professionals work under a code of ethics. Considering the importance of their role, all physicians and medical professionals are required to provide suitable support and medical advice to their patients. These actions must be delivered in the patient’s best interest to accurately treat, diagnosis, or rehabilitate the individual. A failure to deliver this expected course of conduct may result in the filing of a medical negligence claim.

• To be considered medical negligence, the patient in question must suffer from an injury or some form of damage that arose from the medical professional’s actions.  These actions are not always direct; a misdiagnosis or a faulty prescription can result in long-term effects. Regardless of the specifics, all medical negligent claims are filed because the patient (who expected to receive suitable care) was injured, harmed, or suffered some form of loss as a result of the doctor’s negligent or wrongful actions.

• Medical negligent claims are filed through the civil court system of the particular jurisdiction in which the negligent or wrongful action took place. A medical negligent claim is filed by the patient to recoup finances from their injury. When an individual falls victim to a negligent or fraudulent medical action they will invariably suffer from sort of pain—emotional or physical pain must be present which results in the loss of wages or emotional distress.

• The laws associated with medical negligence claims–meaning the grounds for what constitute a medical negligent action—are dictated through state interpretation. Medical negligence is not always a direct issue; similar to other personal injury claims the negligent actions must be directly linked to the patient’s suffering.

• In addition to the varying interpretations, all states possess different statues of limitations that regulate when a medical negligence suit can be filed.

How to File a Medical Negligence Case

• To recoup finances lost from an injury or emotional distress caused by a doctor’s actions, you must gather all information regarding your particular case. A list of the doctor’s actions, all appointments with the underlying medical provider, prescriptions, diagnoses, and a proof of wages or time lost due to the injury must be presented at the medical negligence trial.

• After all information has been gathered and you understand your particular state’s interpretive laws regarding medical negligence, you must hire a medical malpractice attorney to facilitate your claim. Utilize all resources (the yellow pages, the Internet, word of mouth) before hiring a medical malpractice attorney.

• When an attorney is hired, develop a strategy that will give your case the best opportunity to reach a favorable settlement. The most important aspect of developing a strong case is the obtainment of information and evidence.

What is a Misdiagnosis?

• A misdiagnosis is an inaccurate diagnosis of a medical ailment. Medical professionals can misdiagnose an individual depending on a number of factors; however, in most instances a misdiagnosis is delivered through a negligent action taken by the medical provider or physician. An erroneous diagnosis can take on a number of forms—sometimes a medical problem is identified when the patient has no such ailments, or a diagnosis can be classified incorrectly. Examples of the latter include a doctor who diagnoses a tumor as benign when it is in fact malignant.

• A misdiagnosis is a medical error, and although it may be difficult to gauge given varying symptoms or the presence of inaccurate statistics, all forms of misdiagnoses will portray some form of externalities or adverse side effect.
 

Contact a medical-malpractice-lawyer to acquire legal advice and assistance.

Reasons for a Misdiagnosis?

• There are a number of reasons that will cause a misdiagnosis. People often times blame negligent actions or laziness for an inaccurate diagnosis; however, a misdiagnosis can arise for a number of medical reasons. That being said, the presence of a misdiagnosis may award an individual the right to file a medical malpractice suit.

• Reasons that would not necessitate or warrant a medical malpractice suit for a misdiagnosis include: faulty or malfunctioning medical equipment, a patient’s discretion to conceal critical information, a language barrier between the medical professional and the patient, or a situation in which the symptoms of the ailment did not match the universal diagnosis.

• Reasons that would necessitate or warrant a medical malpractice suit for a misdiagnosis: a negligent action taken by a doctor, a failure to adhere to the code of conduct necessary for all doctors to abide by, or a blatant wrongdoing that stems from laziness or the doctor’s inability to deliver a routine medical action.

Consequences of a Misdiagnosis

• The consequences of a misdiagnosis are variable; for example if a patient’s biopsied tumor is misdiagnosed as malignant when it is in fact benign, he or she will undergo unnecessary medical operations. This obviously would adversely affect the individual’s health and would invariably result in a medical malpractice suit.

• In order for the misdiagnosis to be considered malpractice, the individual must suffer a direct loss through a physical damage. Undergoing unnecessary surgery or chemotherapy will inevitably result in a negative effect in the form of unwarranted scars, sickness, and the loss of wages. These instances are grounds for medical malpractice suits; the individual will file a medical malpractice suit to obtain a recoupment for the losses suffered.

• In these instances, the individual must hire a medical malpractice attorney to facilitate their medical malpractice case. The individual must demonstrate to the local court system that the misdiagnosis directly lead to a loss in the form of finances, physical pain, or emotional distress.

New York courts specializing in the state’s 4,000 medical malpractice cases filed annually have begun expanding following the success of a Bronx judge in expediting the settlement process.

The approach, which has shown to save money by reducing court backlogs, has been extended to the other boroughs, through the implementation of training and educational programs. 

Starting December 1st, New York Chief Administrative Judge, Ann Pfau, will become the coordinating judge of the court system’s medical malpractice segment. The program is using a $3 million federal grant to train more judges in expediting the process. 

Bronx Justice Douglas McKeon, who has focused on malpractice cases for over 15 years, said he helped settle over 1,000 malpractice suits in his career. The efficacy in settling such cases is attributed to the city’s Health and Hospitals Corporation—an entity which runs 11 public hospitals and uses its own claims and law department to settle cases in a streamlined fashion. 

Courpration deputy counsel Suzzane Blundi stated that the entity revamped their commitment to patient safety, developing programs to manage claims, improve care and decrease payouts. The effort also investigates malpractice claims early on to help expedite settlements. 

Severe complications like kidney failure and heart attacks during and immediately after labor and delivery are rising nationwide, says a CDC report.  The report, published in the November issue of Obstetrics & Gynecology, has serious implications for pregnant women, attorneys in the malpractice field, obstetricians, midwives, and other birth professionals.

Because the study the report was based on was conducted by the Centers for Disease Control, it could examine a very large, nationwide sample of births.  The Nationwide Inpatient Sample, used by the study, includes information on over five million patients annually at approximately 1,000 hospitals.  According to these samples, having a baby is the single most common thing that Americans do in hospitals—labor and delivery accounted for more hospital intakes than any other single cause.

Out of about 50 million births recorded during the period from 1998 to 2009, about 600,000 involved severe complications in delivery or in the immediate period after delivery.  Women were recorded as having severe complications if they had to receive a blood transfusion or had a serious infection or other illness. 

Some of these events had seen a significant increase over the eleven year timespan.  For example, the rates of blood transfusion went up over 180 percent.  Embolisms were also more common, as were tracheotomies and heart attacks.

However, not all of the news was negative.  Maternal death rates are on the decline even as overall complication rates have gone up.  The rate of in-hospital maternal death is just over one in 10,000—a 37 percent reduction overall from what the maternal death rate was at the beginning of the study.

Several theories have been proposed to explain the increasing rates of complications.  One of the reasons for the increase may be that minority women are still unable to get equal access to healthcare.  They experience both fetal and maternal death more frequently than white women across the board.

Uninsured mothers are another component of the increase in complications, because the greatest risks for complications occur in women who have not received routine prenatal care.  Higher rates of obesity in the American population have also led to an increase in complications like high blood pressure and diabetes, which can make giving birth significantly more risky even with modern medical technologies.

Older women are also significantly more likely to experience birth related complications, especially women over the age of 40 who are giving birth for the first time.  In recent years, more women in this age group have been able to successfully conceive and give birth thanks to assisted reproductive technologies.  While these technologies have benefited many people, they also put more high-risk patients into obstetrics wards every year.

According to the CDC,  the best ways for women to avoid pregnancy related complications and maternal mortality involve taking good care of their bodies before getting pregnant.  Losing weight, stopping smoking, and getting untreated diabetes or hypertension under control before becoming pregnant is critical to a healthy mother and baby.

Source: cdc.gov

On October 19, 2012, the Food and Drug Administration approved the expanded use of the Sapien Transcatheter Heart Valve (THV).  Patients with aortic valve stenosis who can receive surgery but appear at risk of serious complications during surgery are now approved for the heart valve.  

The Sapien THV was first approved in 2011 for patients who could not undergo surgery for aortic valve stenosis.  The condition occurs when calcium deposits occur on the aortic valve and cause it to narrow.  The heart will eventually work harder to push blood through the reduced opening, and aortic valve stenosis can eventually lead to fainting, chest pain, heart failure, arrhythmias, or even cardiac arrest.  

The Sapien THV does not require a surgeon to open the chest or heart.  Instead, the THV is compressed into a small tube referred to as a delivery catheter.  The delivery catheter and the THV are then placed in the femoral artery in the leg and threaded to the bad valve.  Lastly, the THV is released from the delivery catheter and then increased to normal size with a balloon.  The inserted THV begins working right away.  

The use of the Sapien THV was expanded after a clinical study compared results between 348 patients who received the THV through the delivery catheter and 351 patients who received a valve replacement during open-heart surgery.  The groups experienced similar death rates during the first month, first year, and first two years.  THV recipients are at an increased risk of artery dissection or perforation, and the same patients are at risk of stroke during the first month after the procedure.  

Christy Foreman, the director at the FDA’s Center for Devices and Radiological Health, stated, “Any procedure to replace the aortic valve carries the risk for serious complications, but for some patients with coexisting conditions or diseases that risk may be especially high.  The THV serves as an alternative for some very high-risk patients.”

Source: U.S. Food and Drug Administration
 

Pediatricians should consider giving teenage girls a prescription for emergency contraception before they need it, according to a recent report released by the American Academy of Pediatrics.  The recommendation represents a significant shift in how the medication has been treated by pediatricians in the United States.

Although the popular emergency contraceptive, consisting of a combination of synthetic estrogens and progesterones, was made over the counter for women 17 years of age and older,  women under 17 still require a prescription to obtain the pills.

This presents a problem for girls under 16, who often have difficulty scheduling a doctor's appointment and obtaining a prescription within the 72 hour effective window for emergency contraceptives.  Making matters even worse for teenagers trying to get EC, the pill is at its most effective when it's taken as early as possible.

In repeated studies, physicians have found that emergency contraceptive drugs are safe for occasional use in adolescents.  Most of the objection to allowing girls under the age of 17 obtain the pills on their own came from people who had issues with the ways in which over the counter Plan B would diminish parental control over a child's medical treatment.

According to the American Academy of Pediatrics, giving girls pre-emptive prescriptions would solve several of the current issues with prescribing Plan B to teenagers.  For one, the pre-emptive prescription could be filled nearly immediately after an incident of unprotected sex or of a birth control method being compromised.  This makes the Plan B medications very likely to be effective. 

Another reason is that the doctor can evaluate any girls who are given a pre emptive Plan B prescription to ensure that they do not have any medical conditions that might make Plan B less safe for them to take.  Doctors can also go over side effect information with patients and help them understand that Plan B is not for use as a primary birth control method.

Anti abortion groups are likely to decry the statement by the American Academy of Pediatrics.  These groups also fought the approval of Plan B, as well as the recent change that made it over the counter for girls and women over 17 years of age.  According to these anti-abortion groups, because Plan B may be responsible for causing fertilized eggs not to implant in the uterus, they are tantamount to abortion.

However, according to the CDC and other government sources, these pills work primarily by blocking ovulation and are considered very safe.  There have been no major lawsuits as a result of Plan B being made available to consumers, either behind the pharmacy counter or over the counter.

It remains to be seen how many pediatricians will actually act in accordance with the new recommendations from the AAP.  Parental objections may make it difficult for some pediatricians, especially those in conservative or rural areas, to give pre-emptive Plan B prescriptions to younger female patients.

Sources: cdc.gov, aap.org