Medical malpractice reform and insurer claims defense: unintended effects?

In response to recent and past medical malpractice insurance crises, most states have implemented reforms meant to stabilize premiums and coverage availability. The importance of understanding whether these reforms implicitly affect the behavior and incentives of plaintiffs, attorneys, medical providers, and malpractice insurers in the intended way is crucial to policy makers, if they are to achieve their goal. This study specifically examines the effect of reforms on the claims defense efforts of insurers, given that defense expenses account for approximately 30 percent of malpractice premiums. Using state data for the period 1998-2002, we regress claims defense expenses against a variety of reform variables. These include seven tort reforms (noneconomic damage caps, punitive damage limits, attorney fee limits, modified collateral source rule, modified joint and several liability doctrine, mandatory pretrial screening, and statute of limitations) and two government-sponsored insurance mechanisms (joint underwriting associations and patient compensation funds). Claims defense expenses are found to be higher in the presence of noneconomic damage caps, punitive damage limits, and attorney fee limits--an unintended and counterproductive effect of reform--but are lower with mandatory pretrial screening and patient compensation funds.     

Uncertainty of calculation results in vehicle collision analysis

In the analysis of road accidents two types of calculation result uncertainty can be distinguished: modelling uncertainty and uncertainty in calculation results [R.M. Brach, M. Brach, Vehicle Accident Analysis & Reconstruction Methods, SAE International Publisher, Warrendale, 2005]. The problem becomes very important first of all when minor modifications of input parameters or application of different models of the phenomenon lead to a fundamentally different answer to the question posed by the court. The aim of the paper was to prove the necessity of including the problem of uncertainty in calculations related to vehicle collision mechanics and to justify the application of different error analysis methods recommendable in vehicle collision reconstruction. The data file from crash test No. 7 [H. Burg, M. Lindenmann, Unfallversuche, Verlag Information Ambs, Kippenheim, 1982] was used, the selection restricted to the range typical of average police records of collision place. Collision speeds were calculated using two methods: reconstruction and simulation. The analysis of uncertainty was carried out. Maximum and mean square uncertainty were calculated by means of total differential of relevant forms. Since the reconstruction resulted in very broad error intervals of uniform distribution, additional calculations were performed by the Monte Carlo method using algorithm described in [W. Wach, J. Unarski, Determination of vehicle velocities and collision location by means of Monte Carlo simulation method, Special Publication Accident Reconstruction SP-1999, SAE Paper No. 2006-01-0907, 2006].     

Unexpected Serotonin Syndrome,Epileptic Seizures,and Cerebral Edema Following 2,5‐dimethoxy‐4‐bromophenethylamine Ingestion

4‐bromo‐2,5‐dimethoxyphenethylamine (2C‐B) is a designer drug. In Europe, 2C‐B is easily obtained and used for recreational purposes. It is known for its stimulating effects similar to those of 3,4‐methylenedioxymethamphetamine, although in higher doses it has more hallucinogenic effects. Here, we report a case of 2C‐B ingestion, confirmed by liquid chromatography‐tandem mass spectrometry, in an 18‐year‐old man. The neurological consequences were severe, including the development of serotonin syndrome and severe brain edema. Supportive therapy resulted in a stable condition, although, after several months, the patient still suffered from severe neurological impairment due to the drug‐induced toxicity. This case showed that 2C‐B could not be identified with the drugs of abuse screening routinely used in Dutch hospitals. The use of 2C‐B carries many risks, with potentially profound neurological damage, that both consumers and healthcare physicians are unaware of.     

Predictors of re-offending in German substance-abusers in legal detention: a prospective population-based cohort study

This study aimed to evaluate whether the elapsed time after release to first re-offense is longer for those who complete coerced forensic addiction treatment than for those who fail to complete the treatment. It is also aimed to identify predictors of re-offending for both those who complete such treatments as compared with those who do not. Two hundred and sixty-one patients discharged from five German forensic addiction clinics were investigated on 65 anamnestic, socio-demographic, and therapeutic process variables. One hundred and fifty-one patients were prematurely discharged and returned to prison (group A; time at risk [TAR] = 58.7 months), 110 finished treatment successfully (group B; TAR = 44.2 months). Federal Criminal Register data were used for follow-up. Univariate survival analyses and multivariate stepwise Cox-regression models were computed. Twelve predictors in group A revealed a four-factor model: age at admission to treatment, duration of concurrent prison sentence, number of entries in the criminal register, and attendance at prior substitution programs. The model for group B covered five out of eight predictors: regular working activities before first diagnosis of mental illness, type of main offense, (secondary) traffic offenses, outpatient rehabilitation treatments, and escapes during treatment. Successful completers of forensic addiction treatment are slower to re-offend than non-completers.     

How does organizational task matter for the reputation of public agencies?

The study of organizational task for understanding how organizations behave and evolve has been one of the classic topics in organization theory and public administration. Reputation scholarship has appeared as a promising perspective to understand internal and external organizational dynamics. Reputation scholars, too, emphasize the critical importance of task. Despite this recognition, the literature is characterized by a lack of theorization, and large-scale comparative analyses on how task characteristics are related to reputational dynamics. This study aims to address these concerns, relying on an extensive longitudinal dataset on the media reputation of 40 agencies in two countries to explain organizations' likelihood of attracting reputational threats (both in general and targeting specific reputational dimensions) through different task characteristics. Our main finding is that as agencies perform tasks of a more coercive and authoritative nature (regulatory tasks and, to a lesser extent, redistributive tasks), they are more likely to attract reputational threats (both in general and to all dimensions).