Recent lawsuits against HMOs are challenging decisions based on corporate policies. In Detroit, Michigan, Blue Care Network settled a lawsuit based on negligent corporate policies. According to the lawsuit, 12-year-old Kimmietta Branch suffered permanent brain damage after being denied medical treatment by a Blue Care Network pediatrician because of an outstanding $40 bill. She died four years later. Although Kimmietta Branch’s mother, Cassandra Branch, offered to pay the bill, she was told she could not pay and could not see a physician. Two days later the child became disoriented and was admitted to a hospital, where she was diagnosed with viral encephalitis. According to the lawsuit, Blue Care Network had a bad-debt policy that prohibited patients from seeing a physician if there was an outstanding bill.

In another case, the parents of a two-day-old girl who died a day after she went home in 1995 are suing Aetna U.S. Healthcare, Blue Bell, Pennsylvania, for damages caused by the insurer’s former policy of discharging newborns from hospitals after 24 hours. The, previous testimony of the parents, Steve and Michelle Bauman, to Congress and the New Jersey legislature led to a Federal law and many state laws requiring a minimum 48-hour stay for newborns and their mothers. The U.S. Supreme Court set a precedent in June 2000 when it upheld a Federal appeals court ruling that the couple could sue the HMO for malpractice in state court. A lawsuit has been filed, and the trial is expected to take place next summer.

Previously, state malpractice lawsuits against HMOs were moved to Federal courts, where plaintiffs could recover only the cost of care denied them. Now HMOs face pending Federal class-action lawsuits challenging how HMOs manage care and potential Federal and state laws giving patients the right to sue their HMOs.

IN 1787, 11 YEARS after penning the Declaration of Independence, Thomas Jefferson wrote, “without health there is no happiness. An attention to health, then, should take the place of every other object.” (1)

Jefferson’s words ring even more true today. As a society, Americans attend to health in ever increasing amounts. Health care spending accounts for nearly 15 percent of the U.S. gross domestic product.

Multiple factors account for this:

* Technological innovation

* Physician-induced demand

* Insurance-generated consumer price insensitivity

* Governmental regulation

Some maintain that the fear of medical malpractice litigation plays a significant role as well. This fear of liability, also called defensive medicine, is defined as “objective measures taken to document clinical judgment in case there is a lawsuit.” (2)

Indirect costs to the health care system secondary to defensive medicine are estimated to run $15 billion to $35 billion per year. (2,3)

Many researchers and policy analysts, like Wennberg and Eddy, (4,5) recommend analyzing physician practice patterns and small area variations in practice to promote cost-effective, high quality clinical policies. They advocate development of clinical practice guidelines to assist and standardize practitioner treatment of particular medical conditions.

As the movement toward guidelines gains momentum, questions arise about the role guidelines will play in medical malpractice litigation. How will they affect the current status of a malpractice tort? What will the implications for public policy be?

What are clinical practice guidelines?

Clinical practice guidelines - also known as practice parameters, clinical protocols, critical pathways and treatment algorithms - serve five major purposes in medicine, according to the Institute of Medicine.

1. Assist patients and practitioners in clinical decision-making

2. Educate individuals or groups

3. Assess and ensure quality of care

4. Allocate health care resources

5. Reduce the risk of legal liability for negligent care (6)

The very explicit guideline development that emerged in the 1990s weighs potential benefits, harms and costs of treatment for each individual treatment option with the patient preferences for outcomes. (7)

WITH HEADLINES proclaiming another medical malpractice crisis, it’s a good idea to take stock of how physicians conduct business with patients.

Let’s face it, in malpractice cases the trouble doesn’t begin with lawyers, it begins with doctors’ interactions with patients. Patients who feel well cared for and have an amicable relationship with their physicians rarely sue, even when there may be a poor outcome to some element of a care plan.

In medical practice for 38 years, I’ve seen the malpractice concerns of physicians rise from minimal to, sometimes, almost hysterical. The scope of our problems accelerated in the early 1970s.

I believe our risks for litigation grew as individuals dispersed away from their core family groups after World War II. The close, long-term contacts with which many of us grew up in our well-defined communities were disrupted. Trust became a victim of that dispersion. People did not have the family ties and, due to frequent moves, did not develop new ones.

That mobile pattern continues to increase today. In addition, the highly publicized scientific developments in medicine began to make the public believe that medicine could cure almost anything and expectations became unrealistic in many cases.

This combination of lost trust in physicians and publicity surrounding miracle cures played a large part in the development of the litigious society in which we live. Of course, this litigious attitude is not limited to physicians, but it hits us hard when we see our insurance premiums rise each year and our coverages reduced.

Cost of doing business

Involved in medical malpractice crisis since the early 1970s with the Nebraska Medical Association committee on malpractice, I later served as a co-author in a group that helped write the Nebraska medical malpractice statute that still exists today.

In the mid-1980s while a professor of family medicine at the University of Cincinnati, I took a sabbatical at the University of Cincinnati College of Law as a scholar in residence to study the basic elements of tort law and how they affect the medical profession. That sojourn led to continued activity in the area of malpractice for the past 16 years.

Worried about breast cancer, AIDS or fatal traffic accidents? Maybe you should be more concerned about your medical treatment.

A new study has reported that one in every five hospital patients experienced adverse events–due to inadequate follow-up medical care–after leaving the hospital and returning home.

In fact, medical errors in the United States account for more deaths than breast cancer, AIDS or highway accidents combined.

Prescription drugs accounted for the most problems after discharge, affecting 66 percent of the 400 patients involved in the study.

Antibiotics were responsible for 38 percent of the problems, corticosteroids (used in hormone replacement therapy) for 16 percent, cardiovascular drugs for 16 percent and pain relievers for 10 percent. Three percent of patients suffered permanent disabilities.

If doctors performed more thorough examinations of patients while the patients were still in the hospital, monitored their patients more closely after their release, and informed them of possible drug side effects and interactions, many of these post-discharge problems could be avoided, said the researchers.

Results of the study were published in the February 4, 2003 issue of the Annals of Internal Medicine.

Medical malpractice premiums are rising, and angst and recriminations abound. The insurance industry claims premium hikes are largely due to an increase in lawsuits by injured patients. The American Trial Lawyers Association claims the insurance industry is to blame for premium increases, arguing that insurers often present suspect data in support of their actions. State lawmakers are being challenged to weigh opposing arguments and find a way to equitably reform the regulation of medical malpractice insurance coverage and claims adjudication

Meanwhile, the American Medical Association cites a dozen states–Florida, Georgia, Mississippi, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Washington, and West Virginia–as experiencing a full-blown crisis because of rising medical malpractice insurance premiums, and predicts that 30 other states soon will be under a similar crisis.

How are state officials and legislators addressing this challenge to avoid loss of critical services and protect the rights of patients? Here are a few examples.

Florida. In November 2002, the Florida House appointed a work group to study the issue of rapidly rising medical liability insurance premiums. The work group is continuing research on medical liability performed by another House-appointed work group.

Mississippi. Mississippi House Bill 2 (HB 2), enacted in 2002, limits noneconomic damages to $500,000 for actions filed on or after the bill’s passage but before July 1, 2011; actions filed between July 1, 2011, and July 1, 2017, are limited to $750,000; and actions filed after July 1, 2017, are limited to $1 million.

Willie Shoemaker (1993): The former jockey filed a $50 million lawsuit against Glendora Community Hospital and the seven doctors who treated him after he drove his Ford Bronco oft a 30-foot embankment. The accident rendered him a paraplegic. His suit against the California Highway Department for not having a guardrail was ultimately dropped. In 1997, he settled with Ford Motor Co. for $2.5 million and negotiated a confidential settlement with the doctors and the hospital.

Hank Gathers (1990): The family of the Loyola Marymount University basketball star sued the school’s coach, trainer and athletic director, seven doctors and three medical practices after Gathers collapsed on court and later died from a heart disorder. Eleven defendants settled, including Gathers’ cardiologist, for $1 million. Loyola’s insurance carrier settled for $1.4 million. The case was ultimately dismissed against Kerlan-Jobe Southern California’s recent history. Orthopedic Group of Inglewood and two doctors who treated Gathers that night.

Ashley Hughes (1987): The family of newborn Hughes sued the doctor at Pomona Valley Community Hospital who twisted her spinal cord with forceps during her delivery, rendering her a quadriplegic. The hospital settled early in the case. In 1991, a Los Angeles jury awarded Hughes’ family $21 million, or $460 million paid over her lifetime, the largest malpractice award in California at the time.

Harry Jordan (1982): The owner of an insurance agency was awarded $5.2 million three years after doctors removed his healthy left kidney instead of his cancerous right one. He and his wife sued six doctors, two medical groups and Long Beach Community Hospital, where the surgery occurred. The jury verdict was awarded against four of the doctors and Grobert-Sawyer Medical Corp.

Research and Markets  has announced the addition of The Guide To Distributors of Medical Equipment & Supplies Worldwide 2006 to their offering.Over 1,450 detailed and fully verified profiles of specialist distributors in more than 115 countries around the globe.

Whatever your sales representation needs this essential guide will help. Unlike simple address listings, each profile has been researched and verified directly with the company by our researchers, and details provided include, where available:

Sales success in export markets requires local business and cultural knowledge - knowledge that can effectively be found via sales agents and distributors.

Full contact details

Years established

Number of employees, including sales/servicing split

Turnover

Product areas represented

Potential new product areas

Companies represented

Summary

The information you need in the format you want

The Guide is provided in two formats to meet the needs of customers.

Print edition: Published November 2005, the print edition is available in 4 regional volumes (Europe, Middle East/Africa, Americas and Asia/Pacific).

Web edition: Updated and maintained on a daily basis, the web edition provides fast and easy access to all the data in the Guide. A simple search facility allows you to identify representatives by different criteria (eg. country, product type etc.)

Easily find and evaluate medical sales agents and representatives in….

Volume I: Europe - Over 525 specialist medical sales companies in 41 countries

Volume II: Middle East/Africa - Over 250 specialist medical sales companies in 28 countries

Volume III: Americas - Over 325 specialist medical sales companies in 27 countries

Research and Markets (http://www.researchandmarkets.com/reports/c28996 ) has announced the addition of The Guide To Distributors of Medical Equipment & Supplies Worldwide 2006: Europe to their offering.** Please note this report is a subset of The Guide to Distributors of Medical Equipment & Supplies Worldwide 2006. For more information please search our site.

The Guide to Distributors of Medical Equipment & Supplies Worldwide 2006 contains 1,450 detailed and fully verified profiles of specialist distributors in more than 115 countries around the globe.

Whatever your sales representation needs this essential guide will help. Unlike simple address listings, each profile has been researched and verified directly with the company by our researchers, and details provided include, where available:

Sales success in export markets requires local business and cultural knowledge - knowledge that can effectively be found via sales agents and distributors.

Full contact details
Years established
Number of employees, including sales/servicing split
Turnover
Product areas represented
Potential new product areas
Companies represented

Summary

Volume I: Europe

Over 525 specialist medical sales companies in 41 countries

Armenia - Austria - Azerbaijan - Belarus - Belgium - Bosnia and Herzegovina - Bulgaria - Croatia - Cyprus - Czech Republic - Denmark - Estonia - Finland - France Germany - Greece - Hungary - Iceland - Ireland - Italy - Latvia - Lithuania - Macedonia - Malta - Moldova - Netherlands - Norway - Poland - Portugal - Romania - Russia - Serbia - Slovakia - Slovenia - Spain - Sweden - Switzerland - Turkey - Ukraine - United Kingdom

Research and Markets  has announced the addition of The Guide To Distributors of Medical Equipment & Supplies Worldwide 2006: Americas to their offering.** Please note this report is a subset of The Guide to Distributors of Medical Equipment & Supplies Worldwide 2006. For more information please search our site.

The Guide to Distributors of Medical Equipment & Supplies Worldwide 2006 contains 1,450 detailed and fully verified profiles of specialist distributors in more than 115 countries around the globe.

Whatever your sales representation needs this essential guide will help. Unlike simple address listings, each profile has been researched and verified directly with the company by our researchers, and details provided include, where available:

Sales success in export markets requires local business and cultural knowledge - knowledge that can effectively be found via sales agents and distributors.

Full contact details

Years established

Number of employees, including sales/servicing split

Turnover

Product areas represented

Potential new product areas

Companies represented

Summary

Volume III: Americas

Over 325 specialist medical sales companies in 27 countries

Argentina

Bahamas - Barbados - Bermuda - Bolivia - Brazil - Canada - Chile - Colombia - Costa Rica - Cuba - Dominican Republic - Ecuador - El Salvador - Grenada - Guatemala - Honduras - Jamaica - Mexico - Panama - Paraguay - Peru - Puerto Rico - Trinidad & Tobago - United States - Uruguay - Venezuela

The American Medical Association (AMA) has agreed to supply its files on 650 000 doctors to a company specialising in databases to create a joint venture called HealthCareProConnect. The association will earn about $18.8m (13.4m [pounds sterling]) from the deal.

Three years ago, the association was criticised for its commercial deal with the Sunbeam Corporation that would have allowed the association seal to be placed on the company’s home health care products in exchange for royalties (BMJ 1997;315:502).

Critics are now worried that drug and medical supply companies will use HealthCareProConnect–set up through the association’s deal with Acxiom Corporation–to solicit doctors with controversial marketing practices that violate the association’s own ethical standards.

Dr Arthur Caplan, director of the Center for Bioethics, University of Pennsylvania, Philadelphia, said, “It is a very common practice for professional organisations and groups to sell mailing lists to others. But many will not do so in order to protect their members from unwanted marketing. Still others will not do so since they believe that the kind of advertising their members will be subjected to is too commercial or skewed.

“The AMA wants the American people to respect the professionalism of medicine, but the road to the respect does not run through the sale of membership lists to for-profit marketing entities.”

Richard Corlin, the association’s president elect, said earlier this month: “The American Medical Association strongly objects to certain media reports today that mischaracterise the intent and potential benefits offered by its new joint venture with Acxiom Corporation–HealthCareProConnect. Today, physicians are bombarded with information and solicitations from medical marketers. While many marketers provide needed and useful information to physicians, not all do. HealthCareProConnect seeks to address this situation.”

He added: “Mistakenly, some articles today said that HealthCareProConnect was formed to promote increased access by pharmaceutical companies to physicians. On the contrary, HealthCareProConnect helps improve the quality and accuracy of physician information while enabling physicians to screen out unwanted and unnecessary solicitations.

“It simply does not follow logically, as some media reports suggest, that creating a much better physician database increases the incidence of unethical gifts.”