Medical Liability: Review of a Whole Year of Judgments of the Civil Court of Rome

Background: Complaints about medical malpractice have increased over time in Italy, as well as other countries around the world. This scenario, perceived by some as a “malpractice crisis”, is a subject of debate in health law and medical law. The costs arising from medical liability lawsuits weigh not only on individual professionals but also on the budgets of healthcare facilities, many of which in Italy are supported by public funds. A full understanding of the phenomenon of medical malpractice appears necessary in order to manage this spreading issue and possibly to reduce the health liability costs. Methods: The retrospective review concerned all the judgments drawn up by the Judges of the Civil Court of Rome, XIII Chamber (competent and specialized section for professional liability trials) published between January 2018 and February 2019. Results: The analysis of data concerning the involved parties showed that in 84.6% of the judgments taken into account, one or more health facilities were sued, while in 58.2% of cases, one or more health workers were present among the defendants. When healthcare providers are the only ones to be summoned, it is dentists and aesthetic doctors/plastic surgeons who undergo most of the claims. In the overall period analyzed, the amount paid was 23,489,254.08 EUR with an average of 163,119.82 EUR. Conclusion: The evidence provided by the reported data is a useful tool to understand medical malpractice in Italy, especially with regard to the occurrence of the phenomenon at a legal level, an aspect still hardly mentioned by existing literature.

Ensuring successful implementation of communication-and-resolution programmes

BackgroundCommunication-and-resolution programmes (CRP) aim to increase transparency surrounding adverse events, improve patient safety and promote reconciliation by proactively meeting injured patients’ needs. Although early adopters of CRP models reported relatively smooth implementation, other organisations have struggled to achieve the same. However, two Massachusetts hospital systems implementing a CRP demonstrated high fidelity to protocol without raising liability costs.Study questionWhat factors may account for the Massachusetts hospitals’ ability to implement their CRP successfully?SettingThe CRP was collaboratively designed by two academic medical centres, four of their community hospitals and a multistakeholder coalition.Data and methodsData were synthesised from (1) key informant interviews around the time of implementation and 2 years later with individuals important to the CRP’s success and (2) notes from 89 teleconferences between hospitals’ CRP implementation teams and study staff to discuss implementation progress. Interview transcripts and teleconference notes were analysed using standard methods of thematic content analysis. A total of 45 individuals participated in interviews (n=24 persons in 38 interviews), teleconferences (n=32) or both (n=11).ResultsParticipants identified facilitators of the hospitals’ success as: (1) the support of top institutional leaders, (2) heavy investments in educating physicians about the programme, (3) active cultivation of the relationship between hospital risk managers and representatives from the liability insurer, (4) the use of formal decision protocols, (5) effective oversight by full-time project managers, (6) collaborative group implementation, and (7) small institutional size.ConclusionAlthough not necessarily causal, several distinctive factors appear to be associated with successful CRP implementation.

The Status of Construction Safety in Bangladesh: Challenges, Benefits, Effects and Suggestions

Construction industry is an important part of the economy in many countries and often seen as a driver of economic growth especially in developing countries. As construction industry is less mechanized and more labor intensive, construction workers are backbone of this industry. So the major consideration is ensuring workers safety during construction. This paper is aimed to examine the current safety status, identify the main causes for not practicing safety measures which termed as challenges of construction safety, identify the benefits of considering safety measures, effects for not practicing safety measures and suggestions to overcome the challenges in the construction sites in Bangladesh. The study was conducted in three stages. Firstly the existing rules and regulations of construction safety were studied. Secondly physical survey was conducted among the ongoing construction sites. Thirdly 20 causes and 14 effects for not practicing safety measures that influence the safety performance in construction sites, 16 benefits for practicing safety measures were identified from literature review and ranked them based on Factor Index (FI) by conducting questionnaire survey. According to the physical survey data, it was obvious that workers were working without PPE and fall protective system. From the data analysis, the main causes for not practicing safety rules and measures are lack of enforcement of safety rules and regulations, lack of safety awareness among the construction stakeholder and lack of safety training respectively. The main benefits for practicing safety measures and rules are reduced administrative costs, the potential for reduced insurance and liability costs and improving safety is usually a competitive advantage, because of reduced costs respectively. The main effects for not practicing safety measures and rules are payment for settlement of injury/death claims, negative impact on reputation of firms and increase in project cost respectively. Finally significant suggestions to overcome the challenges were identified from the stakeholder of this industry. The survey results may help the authorities to increase the awareness of practicing safety measures and enforce the construction safety rules in the next project approach.

Reasonable, Adequate and Efficient Allocation of Liability Costs for Automated Vehicles: A Case Study of the German Liability and Insurance Framework

In general, a functioning liability and insurance framework should ensure an adequate level of third party claimant protection and a reasonable and adequate final allocation of liability costs for the involved parties. This research examines whether the liability and insurance framework resulting from the amendment to German Road Traffic Act meets these two central objectives. The article shows that a reasonable and adequate allocation of liability costs is inhibited because of several barriers that hinder the shift of liability costs from the owner of the vehicle to the manufacturer. In particular, it is highly dependent on the practical application of subrogation claims. The ability and the motivation of motor insurers to conduct subrogation claims could be negatively affected because of a lack of required technical and engineering know-how and because a market-wide conduction of subrogation claims would erode the business model of motor insurance. This article proposes changes to the current framework particularly by removing specific exclusions of product liability and by easing the burden of proof of a product defect.

Changes in liability claims, costs, and resolution times following the introduction of a communication-and-resolution program in Tennessee

Objective To investigate whether a malpractice reform known as collaborative communication resolution program can improve transparency after an adverse outcome without resulting in higher malpractice liability costs, relative to traditional “deny and defend” approaches. Methods Collaborative communication resolution program started at Erlanger Health System in January 2009. We compare liability outcomes before and after collaborative communication resolution program implementation. Annual liability measures evaluated were the number of filed claims, time interval to resolve an event, defense costs, settlement costs, and total liability costs. We describe the process through which events were resolved under collaborative communication resolution program. Results One percent of adverse events when there was no medical error received compensation under collaborative communication resolution program; no medical error occurred in 65% of adverse events; 43% of events with injury from medical error were resolved with apology alone. Compared to pre-implementation levels, there was a decrease in the average number of new claims filed (CF) (1.07 to .36, p=.004), defense costs ($41,950 to $20,623 p=.004), settlement costs ($19,480 to $14,228 p=.510), and total liability costs ($61,430 to $34,851, p=.022) under collaborative communication resolution program all measured per 1000 hospital admissions. The median time interval to resolve a claim decreased from 17 months to 8 months, a reduction of 53% ( p<.001). Conclusion Collaborative communication resolution program implemented at Erlanger had a reduced time interval to resolve events and lower defense and total liability costs. The improved liability outcomes and the total of 43% of events with medical error resolved by apology alone, even though 60% of these patients had legal representation, may encourage physicians to support CRP.