Controlling large malpractice claims: the unexpected impact of damage caps.

Indiana's comprehensive malpractice reforms, inaugurated in 1975, include a cap on damages, a mandated medical review before trial, and a state insurance fund to pay claims equal to or greater than $100,000. We have found that the amount of compensation going to claimants with such large malpractice claims in Indiana is, on average, substantially higher than in Michigan and Ohio. Indiana's mean claim severity between 1977 and 1988 was $404,832, while the means for Michigan and Ohio were $290,022 and $303,220, respectively, with the difference between these three means being highly significant. Although data on claim and claimant characteristics reveal considerable interstate variation, the results of regression analyses show that Indiana claim payment amounts are higher than Michigan or Ohio payments, independent of the effect of factors such as sex, age, severity of injury, allegations of negligence, and year of settlement.     

Variation in the growth and incidence of medical malpractice claims

This study analyzes the incidence of medical malpractice claims since 1976, using data drawn from the 1982 core survey of the American Medical Association's Socioeconomic Monitoring System. The data show that, on average, physicians incurred twice as many claims per year in the years 1976 to 1981 as they did during their careers prior to that period. Using Tobit analysis, we find the annual frequency of claims to be greater among surgeons, obstetricians and gynecologists (OBGs), physicians in group practice, and physicians in states which apply the legal doctrine of informed consent. In addition, we find that the number of years since medical residency is positively related to physicians' claims incidence during the first 27 years of practice, and that OBGs and medical specialists who spend more time with their patients per office visit incur fewer claims.     

Effects of tort reforms on the value of closed medical malpractice claims: a microanalysis

Tort reforms enacted by state legislatures mainly seek to reduce the rate of increase in medical malpractice insurance premiums and other costs of the professional liability system, such as "defensive medicine." We examine the effects tort reforms enacted during the 1970s have had on the probability that a claim will be paid, the amount of payment, and the speed with which the claim is resolved. Claims frequency is not used as a variable in this analysis, but findings from other studies pertaining to frequency are noted. This study uses two closed claims databases--one from the National Association of Insurance Commissioners, and one from the U.S. General Accounting Office. We merged the two data sets for purposes of this analysis. The observational unit was the individual claim. Data on tort reforms came from our own analysis of statutory changes by state. Dollar ceilings on recoveries ("caps") are shown to be the strongest reforms in terms of their impact on paid claim size. Most caps limit recovery for noneconomic loss, though some limit dollar awards. Other reforms that reduced payments per claim were costs awardable provisions and mandatory collateral offsets.     

Research malpractice and the issue of incidental findings.

Human subject research involving brain imaging is likely to reveal significant incidental findings of abnormal brain morphology. Because of this fact and because of the fiduciary relationship between researcher and subject, board-certified or board-eligible radiologists should review the scans to look for any abnormality, the scans should be conducted in accordance with standard medical practice for reviewing the clinical status of the whole brain, and the informed consent process should disclose the possibility that incidental findings may be revealed and what consequences will follow. In the event such findings are revealed, qualified physicians should explain to the subject the significance of the findings and the alternatives available.     

美国企业犯罪的审前转处协议研究

美国针对企业犯罪建立了特殊的审前转处程序,办案检察官可以与涉罪企业签署暂缓起诉协议和不起诉协议,如果企业能够在考察期限内完成协议下的义务,则不会被审判和定罪。在美国经济危机时期,该制度较好地为企业的生存和社会公共利益的维护提供了保障。该制度以美国司法部内部的政策性文件为依据,赋予了办案检察官较大的自由裁量权,法院基本无权干预。美国理论界的争论主要围绕三对冲突关系:社会公共利益维护与企业“大到不用判刑”特权的冲突、检察官的转处裁量权与程序正义的冲突、司法部内部行为与立法/司法管辖权的冲突。在我国面临企业犯罪处理困境的当下,该制度及其相关理论能够为我国“司法行政部门帮扶企业”政策的践行提供经验借鉴。