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.     

Questioning mandatory sentencing efficiency: A case study of persistent felony offender rapists in Kentucky

This policy analysis explores the incapacitative efficiency of Kentucky’s career criminal statute in averting the recidivism of offenders convicted of rape. The study utilizes a 1985 cohort of Kentucky persistent felony offenders with at least one rape conviction (n = 62) and tracks recidivism rates up to fifteen years later. The results question the efficiency of mandatory sentencing. In general, mandatory minimum sentences (where offenders are not eligible for statutory good time or parole) kept these offenders incarcerated beyond the time necessary to avert future crimes.     

Comparative study of postmortem barbiturates, methadone, and morphine in vitreous humor, blood, and tissue

With the introduction of radioimmunoassay (RIA) techniques, it has become toxicologically possible to determine drug concentrations in postmortem vitreous humor. This study demonstrates and confirms this toxicological feasibility. In 49 medical examiner's drug related cases, postmortem tissue levels of morphine, barbiturates, and methadone were compared to the vitreous humor.     

A Test of Two Methods of Recall for Violent Events

This project took advantage of an opportunity to test the comparability of two different methods for collecting self-reports of violent incidents. Using a life events calendar (LEC) approach, we collected data from individuals about violent incidents that occurred within a 1–3-year prior time period. These individuals had been research participants in a previous study that collected information about violent incidents using prospective, weekly interviews. Results using the LEC method were compared with the weekly self-reports of violence for an overlapping recall period. This allowed us to see how well the recall of violent incidents at a later date mapped onto reports obtained within seven days of any incidents. Overall results show a significant amount of under-reporting using the life-event calendar methodology compared to the weekly interview approach, but some higher concordance of reporting was found for serious rather than minor violence.     

A friend in need: the role of friendship quality as a protective factor in peer victimization and bullying

This study examined friendship quality as a possible moderator of risk factors in predicting peer victimization and bullying. Children (50 boys and 49 girls, ages 10 to 13 years) reported on the quality of their best friendship, as well as their bullying and victimization tendencies. Parents reported on their child's internalizing and externalizing behaviors, in addition to bullying and victimization tendencies. Results indicated that externalizing problems were related to bullying behavior; however, friendship quality moderated this relation such that among children with externalizing behaviors, a high-quality friendship significantly attenuated bullying behavior. Internalizing problems and low friendship quality were significantly related to victimization; however, friendship quality did not moderate the relation between internalizing problems and victimization. Implications for interventions based on these findings are discussed.