Medical Malpractice Trial Types

Understanding the Litigation Process

By Dr. Jay S. Grife; Esq, MAinsurance-book

There are two types of trials, trial by jury and trial by judge. It is the task of the judge to determine the law, while the jury determines the facts.  In a trial by judge—called a “bench” trial—the judge determines both the law and the facts.  The U.S. Constitution guarantees a trial by jury.  If a party does not request a jury trial, however, the right to a jury trial can be waived.

The Statistics

Most civil cases in the United States are tried by jury.  Of the 3 percent of all cases that go to trial, the Department of Justice reports about two-thirds are jury trials, and one-third are bench trials. Whether to try a case to the judge or to a jury is strictly a matter of choice by the litigants.  If either party timely requests a jury trial, however, the case must be tried to a jury.  Because of the constitutional implications, in most cases both parties must waive their right to a jury trial in order for the case to be tried to a judge.  In a few instances, such as trials for injunctions and family law matters, a jury trial is not an option and a judge must hear the case.  However, the majority of civil issues offer the litigants a choice between bench or jury trials.

Notions and Perceptions

So why would anyone choose to have a case heard by a judge as opposed to a jury, or vice versa?  The reasons are mainly based on preconceived notions about judge and juror biases.  Generally, most litigants favor a jury over a judge because the decision is put into the hands of many rather than in the hands of one.  Plaintiffs usually like juries because lay individuals are believed to be more sympathetic, and a plaintiff can appeal to the emotions of a jury.  Conversely, defendants usually prefer bench trials because a judge is thought to be more objective in deciding a case.  Requesting a bench trial can also result in a much quicker trial date.  Since court dockets in most large cities are becoming increasingly congested, the time difference between a jury trial date and a bench trial date can be literally years.

Assessment

None of the perceptions about the benefits of a jury trial or a bench trial apply to all situations—every case is different.  There is at least some empirical evidence that some of the commonly held conceptions about bench and jury trials are actually misconceptions.  For example, while it is almost universally believed that juries tend to favor plaintiffs and award much higher monetary amounts, a recent study by the Department of Justice suggests that judges favor plaintiffs and return higher verdicts.  Still, jury trials outnumber bench trials by about two to one [1].

Conclusion

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[1] See Civil Jury Cases and Verdicts in Large Counties, Civil Justice Survey of State Courts at: http://www.usdoj.gov/bjs/abstract/cjcavilc.htm.

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Introducing the ProPublica Patient Harm Community

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By Daniel Victor and Marshall Allen
ProPublica, May 21, 2012, 2:32 p.m.

On Facebook

You could fill a baseball stadium many times with the people who experts say die each year from an error [1], injury or infection [2] suffered while undergoing medical treatment. Many more are harmed.

Using Facebook, we’ve created a space to bring together those who have been harmed and others concerned about the problem. Join the community or follow the conversation here. [3]

Shared Stories

Group members have already shared stories of personal disability or the death of a loved one due to surgical mistakes, becoming infected with deadly drug-resistant bacteria and dental mishaps — including cases they claim were not properly addressed by health care providers.

For example, some of ProPublica’s past health-care reporting focused on gaps in nursing oversight [4], drug company payments to doctors [5] and abuses at psychiatric facilities [6]. With Facebook, we want to build a community of people — patients as well as doctors, nurses, regulators and health-care executives and others — who are interested in discussing patient harm, its causes and solutions. Among other things, we’ll post Q&As with experts and provide links to the latest reports, research and policy proposals. Your suggestions are welcome along the way.

Please Join Us

Share your story, ask questions and provide your perspective with other members. Your contribution may help shape our reporting.

The community is moderated by ProPublica reporters Marshall Allen [7] and Olga Pierce [8].

Marshall has covered patient harm since 2006. While at the Las Vegas Sun, Marshall’s series, “Do No Harm: Hospital Care in Las Vegas,” [9] won a Goldsmith Prize for Investigative Journalism and was a Pulitzer Prize finalist.

Assessment

Olga specializes in health policy, insurance issues and data journalism. She is a graduate of the Stabile Investigative Journalism Seminar at Columbia University and a finalist for the 2011 Livingston Awards.

Daniel Victor [10] and Blair Hickman [11], ProPublica’s social media team, try to also keep an eye on things.

Conclusion

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The Emerging Discipline of “Slow Medicine” and Professional Liability

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Examining the Heuristic Relationship between Face-Time and Medical Negligence Lawsuits 

By Dr. David Edward Marcinko MBA CMP™

www.BusinessofMedicalPractice.com

[Editor-in-Chief]

Our colleague and blogger Kent Bottles MD has been thinking and posting about the emerging philosophy of “slow medicine”. Of course, health economists realize how complex and difficult it is to transform American health care so that we will enjoy lower per-capita costs along with increased medical care quality in our lives. Unfortunately, grass root practitioners have done just the opposite these last two decades or so. In other words, practicing “faster medicine” with assembly line efficiency relegating office visits to 15, 10 or even 7 minute increments etc, in order to compensate for diminishing MCO/HMO reimbursement. And, this may have been a financially acute perspective for modernity until now!

Defining the Obvious

Slow medicine is practiced by a small, but growing subculture whose pioneer and spokesperson is Dr. Dennis McCullough, author of the book My Mother, Your Mother [Embracing “Slow Medicine,” The Compassionate Approach to Caring for Your Aging Loved Ones].

In other words, slow medicine is a philosophy and set of practices that believes in a conservative medical approach to both acute and chronic care. However, I believe there may be more to it than first perceived.

Link: http://www.thehealthcareblog.com/the_health_care_blog/2010/12/slow-medicine.html#comments

My Experiences

After serving as a medical expert witness in hundreds of malpractice cases [consulting, chart review, discovery depositions, trial appearances and sworn testimony] – both directly and indirectly and for both plaintiff and defendant doctors [predominately] – thru almost twenty year of private practice, my gut tells me the following:

“Patients do not sue doctors they personally like – they do sue doctors they do not like.”

In my opinion and experience, great clinical doctors are often sued while their lesser adept souls are not. Moreover, I believe this pleasing reduced liability relationships is enhanced by more patient face-time; not less. This is not a function of competency, but one of human relationships and “connectedness” with one’s caregiver. It will not be changed by eMRs, or more diagnostic tests [malpractice phobia] or procedures. It will be improved by intense physical examination, touching, eye contact, sympathy, empathy and time [aka: a TRUSTING relationship and pleasing bedside manner forged by TIME]. Period!

And so, for our business managers, CEOs and medical executive readers, let us compromise on terminology and call it “slower medicine.”

Assessment

Link: http://www.amazon.com/Insurance-Management-Strategies-Physicians-Advisors/dp/0763733423/ref=sr_1_3?ie=UTF8&s=books&qid=1275315795&sr=1-3

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Will eMRs Raise the Legal Standard of Care and Increase Malpractice Risk?

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Focus on Malpractice and Professional Liability

By Ann Miller; RN, MHA

By Dr. David E. Marcinko; MBA

[Executive Director]

We first postulated on this topic in our print book “Insurance Planning and Risk Management for Physicians and their Advisors.” Additional posts and comments are contained within this ME-P.

And now, Robert J. Mintz, JD wonders if medical provider liability increases with eHRs, even if the quality of care is vastly improved?

Related External Posts

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Medical Negligence and the “Burden of Proof”

Understanding the Malpractice Trial Process

By Dr. Jay S. Grife; Esq, MAinsurance-book

In all civil trials, the plaintiff, as the accuser, has the burden of proving his case.  Much like a criminal defendant, a civil defendant has no burden and is presumed “innocent” of any claim by the plaintiff.  As a result, if the plaintiff presents no evidence, or insufficient evidence to support his claim, the defendant wins without having to present his case.  The burden the plaintiff carries is that he must prove his case by what is called a preponderance of the evidence.  In other words, the plaintiff must prove it is more likely than not that he should win.  The best way to visualize this burden is to imagine a set of scales.  If the scales are even, or tipped in favor of the defendant, then the plaintiff has not carried his burden, and loses.  In order to prevail, the plaintiff must tip the scales in his favor.

Proving Medical Malpractice

To prove a case of medical malpractice, a plaintiff-patient must present evidence that the defendant-doctor was negligent, and the plaintiff does this by proving the treatment provided was below the applicable standard of care.  The “standard of care” is the care and skill that a reasonably prudent practitioner would provide in treating a patient.  It is established by the medical community at large, and is constantly evolving.  Care that violates the standard of care today may not necessarily violate the standard of care several years ago.  This distinction is an important one, since most cases take several years to get to trial.  The standard of care is never based on the outcome of the case; a bad result does not necessarily mean a violation of the standard of care.

The Medical Expert Witnesses

Expert medical testimony is required to establish a violation of the standard of care in virtually all medical malpractice cases.  A plaintiff who fails to present the required expert medical testimony in a medical malpractice case will lose.  The plaintiff must also produce expert medical testimony that the alleged negligence caused the injury.

For example, suppose that a patient’s widow brings a medical malpractice case against a surgeon who admitted the patient for removal of an AO plate embedded in bone.  The plaintiff-widow alleges that the surgeon should have done something to prevent a pulmonary embolism, which occurred three days after the patient was dismissed from the hospital, killing him.  The patient might have an expert who would testify that she would not have removed the AO plate, but left it in place.  Such testimony does not carry the burden of proving care below the standard required of the surgeon.  Indeed, in most cases, the standard of care allows a practitioner to choose from a variety of treatment options within an acceptable range.  Mere testimony by an expert witness that “I would have treated this patient differently” is insufficient to establish a breach of the standard of care.  The bad result also is not itself proof of any negligence.  Nor is there any evidence that the doctor caused the patient’s death (i.e., that the embolism would not have occurred without the alleged negligence of the surgeon). Therefore, doctor wins on all elements.

Assessment

Have you ever been involved in a medical malpractice trial; or other healthcare litigation process? The Medical Executive-Post readers are interested in hearing your story.

Conclusion

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Expert Witness Risks

A New Emerging Modern Peril

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

insurance-bookIn the past, a physician expert witness for the plaintiff was merely an opposing opinion by a learned and/or like colleague. Today, it is becoming a risk management minefield as the AMA and other groups are urging state medical licensing boards to police expert witnesses, which might require expert testimony be considered the practice of medicine.

The AANS

This seems especially true with the Rolling Meadows Illinois based American Association of Neurological Surgeons (AANS).

Feuding Members

Currently, a member of the AANS can file a complaint against any fellow member for testimony as either an expert witness for the plaintiff, or defense witness for the doctor. A committee of four then reviews the court records and requires the accuser to face the accused in a formal review. Sanctions range form three months to a year, to complete expulsion from the association. In the past twenty years, the program has reviewed 27 cases all involving plaintiff testimony. One led to expulsion and ten to suspension.

Assessment

Since 2001, the courts are beginning to take the AANS process seriously. After years of operations without strong legal backing, the program was upheld by the 7th Circuit Court of Appeals, in Chicago by a neurosurgeon whom the group suspended in 1997. So always remember, if you testify falsely, or too far from the norm, you may be at risk.

Conclusion

And so your thoughts, opinions and comments are appreciated?

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