PRACTICE GUIDELINES AND MALPRACTICE LITIGATION - A 2-WAY STREET

Citation
Al. Hyams et al., PRACTICE GUIDELINES AND MALPRACTICE LITIGATION - A 2-WAY STREET, Annals of internal medicine, 122(6), 1995, pp. 450-455
Citations number
24
Categorie Soggetti
Medicine, General & Internal
Journal title
ISSN journal
00034819
Volume
122
Issue
6
Year of publication
1995
Pages
450 - 455
Database
ISI
SICI code
0003-4819(1995)122:6<450:PGAML->2.0.ZU;2-M
Abstract
Objective: To understand how practice guidelines are used in malpracti ce litigation. Design: Review of the open and closed malpractice claim s of two medical malpractice insurance companies, and a mailed survey of attorneys who litigate malpractice claims. Setting: United States. Participants. Two insurance companies and 960 randomly selected malpra ctice attorneys. Measurements: Frequency and nature of the use of prac tice guidelines in litigation; understanding and frequency of the use of practice guidelines by attorneys in malpractice cases. Results: 259 claims opened in 1990-1992 at two insurance companies, including all obstetrics and anesthesia claims and a random sample of other claims, were reviewed. Seventeen of these claims involved practice guidelines, which were used as exculpatory evidence (exonerating the defendant ph ysician) in 4 cases and as inculpatory evidence (implicating the defen dant physician) in 12 cases. The only physician or patient factors ass ociated with use of a guideline was a longer physician-patient relatio nship (P = 0.021). Nine hundred and sixty surveys were mailed and 578 were returned (response rate, 60.1%). Attorneys reported that once a s uit is initiated, practice guidelines are likely to be used for inculp atory purposes (inculpatory in 54% of cases; exculpatory in 22.7% of c ases). However, guidelines that seem to offer exculpatory value induce attorneys not to bring suits. The only attorney factor associated wit h increased use of guidelines was a practice in which more than 50% of business was in medical malpractice. Conclusions: Guidelines are used both by plaintiffs' and defendants' attorneys in malpractice cases. T he emphasis in health reform proposals on guidelines as exculpatory ev idence should be carefully considered.