Compensation for medical injury in New Zealand: does "'no-fault" increase the level of claims making and reduce social and clinical selectivity?

The issues of patient safety and quality of care have gained policy attention with a growing appreciation of the scale and impact of medical injury in health systems. While the focus is clearly on the prevention of iatrogenic injury, the question of patient compensation is now also considered important, if only because in fault-based tort systems the fear of litigation may itself be a barrier to the disclosure and open discussion of medical error. No-fault systems, by contrast, do not require proof of culpability, and thus may both reduce barriers to compensation and increase disclosure of error. Little evidence, however, is available on the performance of such systems. This article reports on the analysis of two data sources-a sample of hospital admissions and a complete set of compensation claims for medical injury. Both are for the same year and region of New Zealand, a country that has maintained a no-fault system of accident compensation for a quarter of a century. Just over 2 percent of hospital admissions were associated with an adverse event that was potentially compensable under scheme criteria. While the claims process was well targeted, the level of claims making and receipt was low, with the ratio of successful claims to potentially compensable events being approximately 1:30. Comparison of social and clinical characteristics of the two data sets revealed a degree of selectivity. Compared with the hospital events, the typical successful claimant was younger and female and was much more likely to have experienced a surgical adverse event that, while unexpected, was not due to substandard care. It is concluded that, in interpreting these results, account needs to be taken of a number of features unique to the New Zealand system. These include: the limited payoff for a compensation claim (no pain and suffering or lump sum, free hospital care); the relative complexity of the grounds for claim (either rarity and severity or practitioner error); and a history of limited litigation for medical error. This suggests that, while the New Zealand system is well targeted, cheap, and free of financial and legal barriers, a change in legal doctrine alone has not in itself been sufficient to remove completely the selective and low level of claims making traditionally associated with patient compensation under tort.     

Analysis of human fecal material for autosomal and Y chromosome STRs

Human stool samples from eight volunteers were stored under various conditions and extracted by three different procedures. Fecal material and tissue paper soiled with fecal material obtained from a crime scene were also extracted. Extracted DNA was amplified using the AmpFlSTR Profiler Plus, AmpFlSTR COfiler, and the AmpFlSTR Identifiler PCR amplification kits for the detection of the autosomal STR allelic patterns. DNA extracted from the male volunteers and from the soiled tissue paper evidence sample was also amplified using the Y-PLEX 6 and Y-PLEX 5 amplification kits. Analysis of the amplified products was carried out by capillary electrophoresis on the ABI PRISM 310 Genetic Analyzer. Autosomal and Y-STR profiles obtained from the fecal material were concordant with the results from the donors' buccal swabs.     

The direct detection and identification of staining dyes from security inks in the presence of other colorants, on currency and fabrics, by laser desorption mass spectrometry

Laser desorption mass spectrometry (LDMS) is useful for the direct desorption and MS analysis of dyes off materials such as paper. Here it is shown that staining dyes, produced by currency degradation devices, such as those used by financial institutions or armored transport companies, can be detected by LDMS. These staining dye packs are commonly used in bank security programs to deter theft or unauthorized removal of currency from teller stations or from ATM cash cassettes. Working automatically, these technologies release a security dye to degrade the surface of the notes and possibly mark the assailant involved in the attack. These dyes can be characterized and identified directly from paper currency, and from fabrics, and uniquely identified in the presence of other dyes that are used in the printing and dying of such materials, by LDMS. In these experiments, no extraction step is required. A pulsed UV laser directly irradiates a paper or fabric sample--colorants are desorbed, ionized and detected using time-of-flight MS. Results shown here suggest that dyes such as Basic Red 1:1 and Basic Violet 11:1 are used in such devices.     

The influence of personal history of abuse and gender on clinicians' judgments of child abuse

Two extra-legal factors were examined for their influence on professionals' decisions to report child abuse: having been abused as a child oneself, and the gender of the child, the parent, and the professional. One hundred and one men and women who worked regularly with children in mental health settings rated a series of scenarios presented as cases from a protective service agency. Participants made several judgments regarding the case including the severity of the parent's behavior, the likely effect on the child, whether the situation was abusive, and whether the case should be reported to a social service agency. Despite some interpretive limitations, the results generally support the hypothesis that extra-legal factors influence the perceptions of professionals who are mandated to report a suspected incident of abuse.     

Children rearing children: A study of reportedly maltreating younger adolescents

This ex post facto study of officially reported child abuse and neglect incidents examined the demographic and dynamic variables associated with reportedly maltreating adolescent mothers of differing ages. A sample of one half of all the incidents reported within Maricopa County, Arizona, was drawn for the period January 1, 1976, through December 31, 1978 (N =5,098). Adolescent mothers were compared on the basis of their age at the time of the incident, and were categorized as younger adolescents (less than 16 years of age) and older adolescents (16 to 19 years of age). It was found that this total sample of adolescents was faced with pressures such as those found within the general, non-age-specific maltreating population. However, the younger adolescent was faced with the greatest financial stress, yet was less likely to be receiving any income supplement. Additionally, the younger adolescent was more likely to be a minority group member, was less likely to be married, and the maltreating situation involved neglect of children. In sum, the reported situation was likely to have been a direct result of the financial, educational, employment, and life experience limitations found in the adolescent's environment. Discussion of the findings reported that the younger adolescent parent's problems were rooted in basic survival and environmental stabilization needs. Implications and suggestions for further research are also presented.