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    by Published on 11-14-2011 07:53 AM     Number of Views: 1657 
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    An agency within the U.S. Department of Health and Human Services that maintains a discipline and medical-malpractice database reopened it for public access yesterday, two months after the agency had first taken the database offline.


    The National Practitioner Data Bank contains information used by hospitals, insurers, and licensing boards to track doctors' records, check prospective hires, and make other decisions. ...
    by Published on 11-02-2011 08:02 PM     Number of Views: 2521 
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    Nurse anesthetist told state board only after his third trip to treatment.

    Nurse Jerold L. Mullins was good at stealing drugs from hospitals or other employers and never getting punished by state regulators -- even though the state knew he had a problem.


    Over a period of at least 15 years, Mullins endangered patients by treating them while he was high on drugs he pilfered during the course of his work as a nurse anesthetist, according to a consent order ...
    by Published on 10-31-2011 07:51 PM     Number of Views: 2411 
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    Editor's note: This article by Tony Mira, president and CEO of Anesthesia Business Consultants, an anesthesia & pain management billing and practice management services company, originally appeared in Anesthesia Business Consultants eAlerts, a free electronic newsletter. Sign-up to receive this newsletter by clicking here.

    When Physicians Must, and Must Not, Say Something Negative About Each Other
    Two recent court decisions combine ...
    by Published on 10-27-2011 08:36 PM     Number of Views: 2128 
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    Plattsburgh, New York - October 27, 2011


    A Plattsburgh anesthesiologist has been found guilty of medical malpractice after a patient in his care died. ...
    by Published on 10-25-2011 05:51 PM     Number of Views: 3222 
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    Duty to Disclose Drug Use Arose from Recommendation


    Kadlec Medical Center v. Lakeview Anesthesia Associates, ---F.3d---, 2008 WL 1976591 (C.A. 5, May 8, 2008)
    Kadlec Medical Center and its insurer, Western Professional Insurance ...
    by Published on 10-14-2011 06:28 PM
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    Attorney General Jack Conway says Lee Adam Balaklaw was indicted on 20 counts of Medicaid fraud following an investigation into his billing practices at Anesthesia Associates of Louisa.
    ...
    by Published on 10-12-2011 06:34 PM
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    “It only took two atomic bombs to force the Japanese to surrender.“


    Saber rattling from a military leader or despotic strongman? Nope, a pithy quote by Nevada plaintiffs’ lawyer Will Kemp to a Bloomberg reporter (full story here) in the wake of his clients being awarded $162.5 million ...
    by Published on 10-11-2011 05:44 PM
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    Question


    I am a physician who has been bullied (maligned) by nursing and other staff. The result has seriously damaged my career and reputation. What legal recourse do I have?

    Response from Carolyn Buppert, NP, JD
    Attorney, Law Office of Carolyn Buppert, PC, Bethesda, ...
    by Published on 10-10-2011 06:53 PM
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    Units of Teva Pharmaceutical Industries Ltd. (TEVA) and Baxter International Inc. (BAX) must pay $14 million over sales of reusable vials of the anesthetic Propofol that a colonoscopy patient blamed for his hepatitis, a jury ruled.


    Jurors in state court in Las Vegas deliberated about six hours before finding Teva Parenteral Medicines Inc. and Baxter Healthcare Corp. improperly sold Propofol in vials large enough to be used on multiple patients. Michael Washington contends he was diagnosed with Hepatitis C in 2007 after getting the ...
    by Published on 10-07-2011 11:31 PM
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    No one likes to make mistakes.

    But in the meticulous world of medicine, making a mistake can be especially serious – potentially fatal. A medical error resulting in death is probably every patient's and health professional’s worst nightmare.
    So ...
    by Published on 09-29-2011 08:08 PM
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    Dr. Bruce Liberman believes he can be remediated for what happened to Krista Stryland. But he still doesn’t accept what he’s done wrong.


    The anesthesiologist, who was found to be unprofessional and incompetent by Ontario’s College of Physicians and Surgeons in the wake of Stryland’s death following her liposuction procedure, testified at his penalty hearing Wednesday.

    ...
    by Published on 09-28-2011 04:00 PM
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    Law Med was a little bored, and a little curious after hearing the prosecution in the criminal trial of Michael Jackson’s physician, Conrad Murray, tell the jury in opening statements that Murray was ordering GIGANTIC monthly supplies of propofol and other medications which he used to ‘sedate’ his patient on a nightly basis.


    ...
    by Published on 09-27-2011 04:06 PM
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    STUNNING Propofol Evidence In Jackson Physician Manslaughter Trial


    In the prosecution’s opening statement on the first day of Dr. Conrad Murray’s Voluntary ...
    by Published on 09-27-2011 09:56 AM
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    3. General News
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    NLRB report raises questions about social media use at practices


    The National Labor Relations Board has answered yes to the question of whether a physician can fire an employee for complaining about the practice on social media.


    But that's only if a single employee is doing the complaining. If multiple employees are talking online, particularly to one another, and have legitimate gripes, no one can get fired, according to the NLRB. So for physicians, ...
    by Published on 09-20-2011 06:33 PM
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    3. Politics
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    UPDATE OF IANA LEGAL PROCEEDING


    "On Friday, September 9, 2011, a hearing was held before Judge Reis in the
    Polk County District Courthouse from 9 AM to noon. The hearing related to
    the Motion for Summary Judgment which had been filed by the Iowa Medical
    Society and the Iowa Society of Anesthesiologists, and the state of Iowa's
    Cross-Motion for ...
    by Published on 09-19-2011 04:24 PM
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    Two area doctors could have their medical licenses suspended or revoked after allegations of gross negligence were recently filed with the Medical Board of California.

    Accusations of unprofessional conduct were filed Sept. 8 against Dr. ...
    by Published on 09-14-2011 05:11 PM
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    Anesthesiologists may hesitate to report adverse events or errors because they fear blame from colleagues, according to a study published in the Sept. 2011 issue of Anesthesia ...
    by Published on 08-31-2011 09:57 AM
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    $4.7 M Awarded Ruptured Esophagus During Intubation


    4 years ago, 62 y/o Susan Kalitan was working as a dental hygienist when she decided ...
    by Published on 08-25-2011 10:36 PM
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    Karen Heild/Albuquerque Journal
    Dr. Christian R. Schlicht used to inform prospective patients that he had invented a surgical procedure for chronic back pain that would turn "the clock back by decades."


    The key: a cement-like substance he would inject between discs in the spine to act as a cushion and stop pain.


    What he didn't mention was that the procedure was experimental, unproven and untested, and neither safe nor effective, according to dozens of personal injury lawsuits filed against Schlicht and others in state district court in Alamogordo.


    One of the 47 lawsuits pending against Schlicht contends that the surgery with what is commonly known as plexiglass wasn't an approved treatment in humans and didn't work when used in experiments on pigs.


    After the injections, patients were left in more pain, with more debility and, some, with paralysis or loss of bowel or bladder functions, the lawsuits allege.


    Schlicht, who is 46, is alleged to have botched other back surgeries, because he wasn't qualified or properly certified to perform them.


    He is an anesthesiologist but was negligently allowed to perform spine and neurosurgery at Gerald Champion Regional Medical ...
    by Published on 08-18-2011 09:31 PM
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    Malpractice Risk According to Physician Specialty

    Anupam B. Jena, M.D., Ph.D., Seth Seabury, Ph.D., Darius Lakdawalla, Ph.D., and Amitabh Chandra, Ph.D.
    N Engl J Med 2011; 365:629-636August 18, 2011

    Despite tremendous interest in medical malpractice and its reform,
    1-10 data are lacking on the proportion of physicians who face malpractice claims according to physician specialty, the size of payments according to specialty, and the cumulative incidence of being sued during the course of a physician's career.11-13 A recent American Medical Association (AMA) survey of physicians showed that 5% of respondents had faced a malpractice claim during the previous year.14 Studies estimating specialty-specific malpractice risk from actual claims are much less recent,15,16including a Florida study from 1975 through 1980 showing that 15% of medical specialists, 34% of obstetricians and anesthesiologists, and 48% of surgical specialists faced at least one claim that resulted in an associated defense cost or payment to a claimant (an indemnity payment) during the 6-year study period.17

    Each of these earlier studies has limitations, including the use of older data15-17 with limited geographic coverage,17 reliance on self-reports with limited sample size and low response rates,14limited information on physician specialty,13,14 and a lack of information on the size of payments.14Although the National Practitioner Data Bank includes most cases in the United States in which a plaintiff was paid on behalf of a licensed health care provider,18 it does not report the specialties of physicians and does not record information on cases that do not result in a payment.

    Using physician-level malpractice claims obtained from a large professional liability insurer, we characterized three aspects of malpractice risk among physicians in 25 specialties: the proportion of physicians facing a malpractice claim in a given year, the proportion of physicians making an indemnity payment, and the size of this payment. In addition, we estimated the cumulative career risk of facing a malpractice claim for physicians in high- and low-risk specialties.

    METHODS

    Malpractice-Claims Data

    We obtained physician-level data on malpractice claims from a large, physician-owned professional liability insurer that provided coverage to physicians in every U.S. state and the District of Columbia. The procedures for safeguarding these data were approved by the institutional review board at RAND. The data included records on closed malpractice claims for 40,916 physicians who were covered for at least one policy year from 1991 through 2005. The number of physicians grew steadily from 12,498 in 1991 to 17,376 in 2005. We identified 24 specialties that had at least 200 physicians represented in our sample. Physicians belonging to other, smaller specialties were grouped together in an “other specialty” category. Across specialties, there were 233,738 physician-years of coverage, with an average duration of coverage of 5.7 years (range, 4.6 in pediatrics to


    7.3 in thoracic–cardiovascular surgery). The most common specialties in our data were anesthesiology, family general practice, and internal medicine (Table 1TABLE 1

    Summary Statistics for Physician Specialties.).
    Claims were available for all years during which a physician was covered by the insurer. Claims that were not yet closed by the insurer were not available. Indemnity payments that were associated with a claim reflected payments to a claimant that arose from either a settlement with the claimant or a jury verdict.

    Although the data included physicians from all 50 states, California was overrepresented in our data, accounting for 16,076 physicians (39.3%). We corrected for this oversampling by weighting each physician in our data by the relative number of physicians who are not employed by the federal government reported in the Area Resource File of the Department of Health and Human Services. After weighting, the share of physicians in California was 12.2%, which by construction matches the share reported in the Area Resource File. Because we relied on data from a single insurer, we verified that the average number of indemnity claims per physician and payment levels in our data matched similar numbers in the National Practitioner Data Bank. In a previous study, investigators also relied on claims from a single insurer.19

    We included physicians between the ages of 30 and 70 years in the study. The average age of physicians in all specialties was 49.0 years (range, 43.2 for emergency medicine to 53.0 for gynecology). Data on other demographic characteristics (e.g., sex and race) were not available.

    Describing Malpractice Risk

    For each specialty, we began by calculating the proportion of physicians who faced a malpractice claim in a given year. We distinguished between claims leading to indemnity payments versus overall claims (those with a defense cost but not necessarily a payment). In sensitivity analysis, we adjusted for physician age, year, and state to examine whether these adjustments would affect our reported estimates.

    Given the long period studied, we separated our sample into three periods (1991–1995, 1996–2000, and 2001–2003) in order to investigate how claims rates varied over time for high- and low-risk specialties, which were defined as the five specialties with the highest and lowest proportions of physicians with a claim in a year, respectively. We did not include 2004–2005, since many claims that had been filed during that period might not have been closed by the end of 2005.

    We then characterized the size of malpractice payments for each specialty by computing mean and median annual payments. We also determined how many payments exceeded $1 million to characterize specialties with outlier awards. Payments were normalized to 2008 dollars on the basis of the Consumer Price Index.

    Finally, we analyzed data on physician age to estimate the cumulative career malpractice risk of being sued at least once by a given age for both high- and low-risk specialties. We first estimated a multivariate regression model of the probability of facing at least one claim in a given year as a function of physician age, physician random effects, physician specialty, state of practice, and county–year demographic variables (per capita income, age distribution, and the proportions of residents who were white or male). We allowed the effect of age to vary according to specialty. Physician random effects were included to account for unobserved differences among physicians that might have led some physicians to have been sued more frequently than others. This estimation yielded predicted annual rates of facing a claim at every age of a physician's career and for each specialty. These estimated lifetime risk profiles were then used to compute cumulative career malpractice risks for physicians in high- and low-risk specialties, as well as in each of the largest specialties in our data (internal medicine and its subspecialties, general surgery and surgical subspecialties, anesthesiology, obstetrics and gynecology, and pathology).

    Our model assumes that the probability of being sued was unrelated to the duration of coverage by the insurer and that the probability of being sued at a given age was independent of being sued at an earlier age (after adjustment for physician random effects). To ensure that estimates of the cumulative risk of being sued in each specialty were not determined by the experience of a few idiosyncratic physicians, we conducted two sensitivity analyses: we excluded physicians after their first claim (consequently ignoring the subsequent experiences of physicians who were sued repeatedly) and estimated fixed-effects specifications that allow for correlation between physician characteristics (such as age) and unobserved propensities to be sued.



    RESULTS

    Malpractice Claims According to Specialty

    Figure 1FIGURE 1


    Proportion of Physicians Facing a Malpractice Claim Annually, According to Specialty. shows the proportion of physicians who faced a malpractice claim in a year according to specialty. Across specialties, 7.4% of physicians annually had a claim, whereas 1.6% made an indemnity payment. There was significant variation across specialties in the probability of facing a claim, ranging annually from 19.1% in neurosurgery, 18.9% in thoracic–cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. Specialties in which physicians were most likely to face claims were not always specialties in which indemnity claims were most prevalent. Our estimates of rates of overall and paid claims were unaffected by adjustment for physician age, year, and state of practice.

    Another measure of risk is the likelihood of a payment conditional on a claim. The payment rate can be inferred as the proportion of physicians making a payment divided by the proportion facing a claim. The proportion of physicians with a claim was not well correlated with the payment rate (Pearson's correlation, 0.17; P=0.42). For example, gynecology alone had the 12th highest average annual proportion of physicians with a claim, but it had the highest payment rate (>38%).

    Trends in Claims

    The proportion of physicians facing a malpractice claim varied moderately across the study period (Figure 2FIGURE 2


    Trends in Overall Claims and Claims with an Indemnity Payment, According to Risk of Specialty.). Between the 1991–1995 and 2001–2003 periods, the average annual proportion of physicians in low-risk specialties with a claim decreased from 8.3% to 5.8%. Among high-risk specialties, the proportion of physicians with a claim was highest during the 1996–2000 period. Claims with an indemnity had similar patterns, and the differences between periods were significant (P<0.001 for all comparisons). Differences in overall and indemnity claims were stable between high-risk and low-risk specialties over time.

    Size of Malpractice Indemnity Payments

    Figure 3FIGURE 3


    Amount of Malpractice Payments, According to Specialty. shows mean and median indemnity payments per physician for each specialty after the exclusion of claims that did not result in an indemnity payment. Across specialties, the mean indemnity payment was $274,887, and the median was $111,749. The difference between the mean and median payment reflects the right-skewed payment distribution. Specialties that were most likely to face indemnity claims were often not those with the highest average payments. For example, the average payment for neurosurgeons ($344,811) was less than the average payment for pathologists ($383,509) or for pediatricians ($520,924), even though neurosurgeons were several times more likely to face a claim in a year. The estimated correlation between the proportion of physicians with a claim and the average payment amount was 0.13 (P=0.52). The correlation between the proportion of physicians with an indemnity payment and the average payment was similar and was not significant. This suggests that factors driving the likelihood of a claim are largely independent of factors that drive the size of a payment.

    Outlier awards, which were defined as those exceeding $1 million, were infrequent, in part because the full size of outlier awards would not have been recorded if they had exceeded individual policy limits. Among all physician-years, 66 payments exceeded this amount, accounting for less than 1% of all payments. Obstetrics and gynecology accounted for the most payments (11), followed by pathology (10), anesthesiology (7), and pediatrics (7).

    Cumulative Career Malpractice Risk

    The projected proportion of physicians facing a malpractice claim by the age of 65 years was high (Figure 4FIGURE 4


    Cumulative Career Probability of Facing a Malpractice Claim or Indemnity Payment, According to Risk of Specialty and Age of Physician.). Among physicians in low-risk specialties, 36% were projected to face their first claim by the age of 45 years, as compared with 88% of physicians in high-risk specialties. By the age of 65 years, 75% of physicians in low-risk specialties and 99% of those in high-risk specialties were projected to face a claim. The projected career risk of making an indemnity payment was also large. Roughly 5% of physicians in low-risk specialties and 33% in high-risk specialties were projected to make their first indemnity payment by
    ...