Bawa-Garba ruling is not good news for doctors.

Although some doctors celebrated when the Court of Appeal overturned Hadiza Bawa-Garba's erasure from the medical register, it is argued here that in many ways the ruling is by no means good news for the medical profession. Doctors' interests are served by transparent professional tribunals but the Court of Appeal's approach to the GMC Sanctions Guidance risks increasing opacity in decision-making. Close attention to systemic factors in the criminal trial protects doctors yet the Court of Appeal states that the structural circumstances surrounding Bawa-Garba's failings were only of peripheral relevance to her conviction. Public confidence in the profession is undermined when convicted doctors return to work because the public de facto do not understand the nuance of gross negligence manslaughter law. Rather than changing the law to make the regulator more lenient towards doctors, it would be better to ensure that doctors are only convicted of gross negligence manslaughter when their conduct is so serious that they ought to be struck off.

Doctor in court: what do lawyers really need from doctors, and what can doctors learn from lawyers?

Doctors and lawyers are usually well-educated, thoughtful people. Both groups have to assimilate large amounts of information and use it to make decisions. But the way that they do it is very different. Doctors have a better chance of helping courts to make good decisions if they understand exactly what courts need from them.

The high cost of clinical negligence litigation in the NHS.

John Tingle, Reader in Health Law at Nottingham Trent University, discusses a consultation document from the Department of Health on introducing fixed recoverable costs in lower-value clinical negligence claims.

Association between anesthesiologist age and litigation.

BACKGROUND: : The threat of being sued is a concern for many anesthesiologists. This paper asks whether litigation brought against anesthesiologists is associated with the age of the anesthesiologist. METHODS: : Institutional research ethics approval was granted. We obtained billing data for all procedures performed by specialist anesthesiologists stratified into three age groups (less than 51, 51-64, and 65 and older) from British Columbia, Quebec, and Ontario for the 10-yr period from Jan. 1, 1993 to Dec. 31, 2002. We also obtained all litigations (including disability weighted claims) handled by the Canadian Medical Protective Association during the same time period in which the Canadian Medical Protective Association experts considered the anesthesiologist cited to be at least partially responsible for the adverse event leading to the complaint. RESULTS: : In univariate analysis with the less than 51 age group as the reference category, the litigation rate ratio for the 51-64 age group was 1.14 (95% CI: 0.99-1.32) and for the 65 and older age group was 1.50 (95% CI: 1.14-1.97). Our analyses using disability weighted claims showed the 51-64 group to have 1.31 (95% CI: 0.95-1.80) and 65 and older group to have 1.94 (95% CI: 1.41-2.67) relative increase in disability compared to the less than 51 age group. CONCLUSIONS: : We found a higher frequency of litigation and a greater severity of injury in patients treated by anesthesiologists in the 65 and older group. The reasons for these findings should become an active field of research.

Practical strategies for defense in malpractice lawsuit: a case illustration.

UNLABELLED: This report describes an unprecedented malpractice litigation on a neurology case. A young woman developed multiple complications after a simple hysterectomy: pan-peritonitis, post-op deep coma with hypotension, generalized anasarca, hyponatremia, hemolysis, cerebral hypoxia and renal shutdown requiring dialysis and multiple-unit blood transfusions. She survived 43 days in Neuro-ICU, and was transferred to a regular ward where she developed status epileticus lasting for 17 hours. On examination, she had cortical blindness, which the plaintiff believed it was caused by prolonged seizures but actually hypoperfusion/hypoxia of the brain did it. Plaintiff's attorneys jumped to a lawsuit for $80+ millions, accusing defendant for failure to stop her seizures. They took the plaintiff to Honolulu and San Diego to confirm brain injury. RESULTS: On the top of calcarine infarct, she has pseudoseizures or malingering. To inflate the claim for compensation, they cleverly included three guardians ad litem as co-plaintiffs who live in U.S. Mainland. The first court battle was denied at Guam Superior Court on the ground of exceeding one year of Statute of Limitation. Cunningly they manipulated clinical course to stretch the date of discovery of damages in order to move the statute of limitation within one year of filing to the court. They then went on to Guam Supreme Court, where it was struck down. Unconvinced, they went on all the way to the Federal Ninth Circuit Court in California where again it upheld the original decision. The plaintiff lost and never reached the trial court. After two years' legal combat, I have learned hard way defense strategies: (1) Practice defensive medicine, to keep informed consent and tracks of timing of diagnosis and treatment; (2) Avoid factors that may provoke dissatisfaction, anger, or frustration on outcome of treatment; (3) Keep ledger of ambulance chasers and good defense lawyers; (4) Never surrender at the notification from court; (5) Settle out of court, if this can be done reasonably to save time and stress; (6) Keep cool and study carefully the allegations; (7) Consultation with experts in the area involved; (8) Set up trust fund for children; (9) Buy liability insurance and take CME in medicolegal classes.

Laudo médico e a sua utilização em ações judiciais de fornecimento de medicamentos / The use of medical reports in lawsuits for the supply of medicines

O artigo discutiu os requisitos ínsitos do laudo médico e receituário decorrentes do julgamento do Recurso Especial n. 1.657.156/RJ, no qual o Superior Tribunal de Justiça fixou as bases de observância obrigatória por todos os juízes brasileiros para determinação de fornecimento de fármacos não constantes das listas oficiais do Sistema Único de Saúde. Foi feita pesquisa bibliográfica e documental, com abordagem qualitativa e exploratória, a partir do acórdão disponibilizado pelo portal do Superior Tribunal de Justiça; seguiu-se, então, para consultas às demais fontes bibliográficas, dentre as quais Google Scholar, Biblioteca Virtual em Saúde, Scientific Electronic Library Online e Biblioteca Digital Brasileira de Teses e Dissertações do Instituto Brasileiro de Informação em Ciência e Tecnologia. Por fim, passou-se à análise dos achados e, com embasamento teórico e empírico, buscou-se compreender e justificar as exigências relativas a laudo médico utilizado em ações judiciais, em uma tentativa de contribuir para a gestão da política sanitária e dos próprios processos judiciais, bem como para a popularização do precedente. Concluiu-se que o precedente do Superior Tribunal de Justiça levara à exigência de laudos médicos com mais informações, demandando nova atuação dos médicos, e à expectativa de priorização dos protocolos clínicos, das diretrizes terapêuticas e dos medicamentos constantes das listas oficiais do Sistema Único de Saúde.

The article discussed the requirements of medical reports and prescriptions resulting from the judgement of Special Appeal nº 1.657.156/RJ, in which the High Court of Justice established the compulsory adoption measures that all Brazilian judges must follow to decide on the supply of drugs that are not listed in the official Brazilian Unified Health System. This is a bibliographic and documentary research, with a qualitative and exploratory approach, based on the electronic document availability of the judgement trough the High Court of Justice portal. This research followed a critical approach, and entailed searches in various bibliographic sources, including: Google Scholar, Virtual Health Library, Scientific Electronic Library Online and the Brazilian Digital Library of Dissertations and Theses of the Brazilian Institute of Information in Science and Technology. Finally, we proceeded to the analysis of the findings, and, with a theoretical and empirical basis, we sought to understand and justify the requirements related to the medical report used in the lawsuits. This had the purpose of contributing to both the management of the health policy and the legal processes themselves, and the popularization of the requirements. It is concluded that these requirements will conduct to having medical reports with more information, doctors aware of important actions, and prioritization of clinical protocols, therapeutic guidelines and medications included in the official lists of Brazilian Unified Health System.