Legal Considerations Legal Considerations for Health for Health

ProfessionalsProfessionals

Al Heuer, PhD, MBA, RRT, RPFTAl Heuer, PhD, MBA, RRT, RPFT

Professor & Program DirectorProfessor & Program Director

Rutgers – School of Health Related Rutgers – School of Health Related ProfessionsProfessions

Legal Disclaimer:Legal Disclaimer:The content of this presentation is The content of this presentation is

NOT NOT formal legal advice. Rather, it is formal legal advice. Rather, it is intended to help familiarize the intended to help familiarize the

audience with terminology and trends audience with terminology and trends in medical malpractice, as well as in medical malpractice, as well as

some discussion on how respiratory some discussion on how respiratory therapists and RN’s may be able to therapists and RN’s may be able to lessen their legal exposure “lessen their legal exposure “on the on the

jobjob.” .”

Learning ObjectivesLearning Objectives

►Discuss trends in medical malpractice as Discuss trends in medical malpractice as related to respiratory therapistsrelated to respiratory therapists

►Describe general legal concepts & termsDescribe general legal concepts & terms► Review a typical time-line for Med-Mal cases Review a typical time-line for Med-Mal cases ►Discuss where Clinicians tend to be exposed Discuss where Clinicians tend to be exposed

to being suedto being sued►Describe how clinicians may be able to limit Describe how clinicians may be able to limit

their legal exposure “on the job”their legal exposure “on the job”► Review a few cases (fictitious or closed) Review a few cases (fictitious or closed)

which illustrate the above points. which illustrate the above points.

Some Questions to Think Some Questions to Think About!About!

►Do you need do anything wrong to be Do you need do anything wrong to be sued?sued?

►Do you think you could ever be named Do you think you could ever be named in a Med-Mal suit?in a Med-Mal suit?

► Is malpractice insurance a waste of Is malpractice insurance a waste of money?money?

► If I’m named in a Med-mal suit, will the If I’m named in a Med-mal suit, will the hospital protect me?hospital protect me?

Some Myths & Some Myths & Myth-Myth-bustersbusters

► I’m covered by my hospital’s liability I’m covered by my hospital’s liability insurance. insurance. You may be indirectly if both you and the You may be indirectly if both you and the

hospital are co-defendants. If you are the lone hospital are co-defendants. If you are the lone defendant, you may well not be covered.defendant, you may well not be covered.

► If I’m going to be named in a malpractice If I’m going to be named in a malpractice (med/mal) lawsuit, I’ll know quickly.(med/mal) lawsuit, I’ll know quickly. Statute of limitations may be up to 3 years after Statute of limitations may be up to 3 years after

the incident.the incident.

► My “friend” the nurse (or RT or MD) would My “friend” the nurse (or RT or MD) would never try to blame me.never try to blame me. Happens all the time!Happens all the time!

More Myths… More Myths… BustedBusted► The less I document, the better. And, if The less I document, the better. And, if

they can’t read my writing, better yet!they can’t read my writing, better yet! Documentation often becomes the main focus Documentation often becomes the main focus

of a lawsuit. The lack of it (or poor/inaccurate of a lawsuit. The lack of it (or poor/inaccurate documentation) often works against the documentation) often works against the defendant.defendant.

►Having Malpractice insurance makes me a Having Malpractice insurance makes me a target in med/mal lawsuits!target in med/mal lawsuits! Malpractice Insurance has no effect, there is no Malpractice Insurance has no effect, there is no

central registry and often such info is only central registry and often such info is only revealed after the lawsuit is filed.revealed after the lawsuit is filed.

► If I’m sued, I’m in Trouble!!!If I’m sued, I’m in Trouble!!! Not necessarily so, There are things which you Not necessarily so, There are things which you

can do to minimize your exposure to being can do to minimize your exposure to being sued or an unfavorable outcome is you are.sued or an unfavorable outcome is you are.

Trends in in General Medicine Trends in in General Medicine Med/Mal.Med/Mal.

►General Medicine Med/Mal: (Studdert, et General Medicine Med/Mal: (Studdert, et al, NEJM, 2006)al, NEJM, 2006) Reviewed 1452 randomly selected, closed Reviewed 1452 randomly selected, closed

med/mal claims.med/mal claims. 72% of cases involved medical errors.72% of cases involved medical errors. 73% of cases involving both medical error and 73% of cases involving both medical error and

injury/death did result in a judgment or were injury/death did result in a judgment or were settled in favor of the plaintiff.settled in favor of the plaintiff.

54% of compensation went to administration of 54% of compensation went to administration of the lawsuitthe lawsuit►LawyersLawyers►Expert witnessesExpert witnesses►Courts Courts

More Trends in Med/Mal. More Trends in Med/Mal.

► Nursing and Respiratory Therapy Med/Mal: Nursing and Respiratory Therapy Med/Mal: (Sittig, AARC Times, 2001)(Sittig, AARC Times, 2001) RNs and MDs tend to be named as plaintiffs in RNs and MDs tend to be named as plaintiffs in

Lawsuits more often than RTS. Lawsuits more often than RTS. In recent years, RTs have begun being named In recent years, RTs have begun being named

more frequently in such cases.more frequently in such cases. The majority of cases involve airway management The majority of cases involve airway management

in an emergency or critical care setting.in an emergency or critical care setting.► IntubationIntubation►Code BlueCode Blue

An increasing number of med/mal cases involve An increasing number of med/mal cases involve breach of confidentiality (e.g., George Clooney).breach of confidentiality (e.g., George Clooney).

Relevant TermsRelevant Terms► Plaintiff:Plaintiff: The party making allegations of The party making allegations of

negligence and filing the suit.negligence and filing the suit. Has the burden of proofHas the burden of proof Judgment is based on the preponderance (51%) of the Judgment is based on the preponderance (51%) of the

evidenceevidence► Defendant:Defendant: The party(s) named/accused of The party(s) named/accused of

negligence and named in the suit.negligence and named in the suit.► Negligence:Negligence: A deviation (breach) from accepted A deviation (breach) from accepted

standards of carestandards of care that causes/contributes to that causes/contributes to injury/death of another.injury/death of another.

► Medical Error:Medical Error: Failure to perform an intended Failure to perform an intended diagnostic or therapeutic action that was correct, diagnostic or therapeutic action that was correct, given the circumstances and info available.given the circumstances and info available. Acts of commission: Acts of commission:

► Wrong patient, medication or time/frequency Wrong patient, medication or time/frequency ► Breach of confidentialityBreach of confidentiality

Acts of omission: Missed TreatmentActs of omission: Missed Treatment

More Terms/DefinitionsMore Terms/Definitions► Standard of Care:Standard of Care: What a person of the What a person of the

defendant’s profession would do under the defendant’s profession would do under the same/similar circumstancessame/similar circumstances ““What we expect a clinician to do in a given situation.”What we expect a clinician to do in a given situation.” Generally a national standard such as Clin. Practice Generally a national standard such as Clin. Practice

GuidelinesGuidelines► Causation: Causation: Where negligence by the RT or RN Where negligence by the RT or RN

caused or contributed to a patient’s injury or deathcaused or contributed to a patient’s injury or death► Statute of Limitations:Statute of Limitations: A time frame within which A time frame within which

a medical negligence lawsuit may be brought by the a medical negligence lawsuit may be brought by the plaintiff.plaintiff.

► Sovereign Immunity: Sovereign Immunity: Many state hospitals have Many state hospitals have limited exposure to being sued for negligence. limited exposure to being sued for negligence. Clinicians working there may Clinicians working there may not not have that have that protection.protection.

Burden of Proof Lies with the Burden of Proof Lies with the PlaintiffPlaintiff

►Plaintiff Must Prove Plaintiff Must Prove all Threeall Three of the of the FollowingFollowing Negligence: The Defendant breached the Negligence: The Defendant breached the

standard of care.standard of care. Causation: That the negligence caused Causation: That the negligence caused

damage, harm or death to plaintiff.damage, harm or death to plaintiff. Damage: How much the damages are Damage: How much the damages are

worth.worth.

How is a Breach of the Standard How is a Breach of the Standard of Care Proven?of Care Proven?

►Generally by “Expert” TestimonyGenerally by “Expert” Testimony Deposition: Answers to questions under oath. Deposition: Answers to questions under oath.

Become evidence in the case.Become evidence in the case. Testimony in court. Testimony in court.

► ““res ipsa loquiturres ipsa loquitur” : Negligence which so ” : Negligence which so profound, that it can be shown by profound, that it can be shown by circumstantial evidence.circumstantial evidence. Examples: Examples:

►Surgeon leaves a foreign object in a patient.Surgeon leaves a foreign object in a patient.►An MD connects an IV to oxygen tubing causing An MD connects an IV to oxygen tubing causing

an immediate gas embolism and death.an immediate gas embolism and death.►During an aerosol treatment., a young pediatric During an aerosol treatment., a young pediatric

patient aspirates the top of an albuterol unit patient aspirates the top of an albuterol unit dose, codes and dies!dose, codes and dies!

Defending Against the Breach of Defending Against the Breach of the Standard of Carethe Standard of Care

► The The Professional JudgmentProfessional Judgment Defense: Defense: A clinician can use his/her to choose one of A clinician can use his/her to choose one of

several actions that is within the several actions that is within the standard of standard of care.care.

Example: To ventilate during CPR, the clinician Example: To ventilate during CPR, the clinician can ventilate via a Mask w/manual resuscitator can ventilate via a Mask w/manual resuscitator bag or first intubate (depending upon the bag or first intubate (depending upon the institution) with MDs order. institution) with MDs order.

► Clinician’s Clinician’s Independent DutyIndependent Duty to the to the Patient: If the clinician disobeys and MD’s Patient: If the clinician disobeys and MD’s order that may hurt the patient.order that may hurt the patient. Example: Clinician does not implement an MD Example: Clinician does not implement an MD

orders a tidal volume of 1500 mls for a 12 YO orders a tidal volume of 1500 mls for a 12 YO patient or Control mode with a RR of 3.patient or Control mode with a RR of 3.

►Defense is generally also supported by Defense is generally also supported by Expert Testimony Expert Testimony

Two Other Relevant Terms: Two Other Relevant Terms: Assumption of Risk vs Assumption of LiabilityAssumption of Risk vs Assumption of Liability

► Assumption of Risk: Assumption of Risk: Generally applies to a plaintiff who knowingly Generally applies to a plaintiff who knowingly

assumes risk by consenting to a procedure assumes risk by consenting to a procedure with inherent risk. with inherent risk.

Is predicated on proper “informed consent” Is predicated on proper “informed consent” process.process.

► Assumption of Liability:Assumption of Liability: May apply to a clinician who makes a mistake May apply to a clinician who makes a mistake

due to a heavy assignment. If they accept the due to a heavy assignment. If they accept the assignment, they may be deemed to have assignment, they may be deemed to have accepted some of the liability for mistakes accepted some of the liability for mistakes linked to workload.linked to workload.

DamagesDamages► Types:Types:

Economic:Economic:►Actual medical expensesActual medical expenses►Future cost of care: Based on “Life Care Planner”Future cost of care: Based on “Life Care Planner”►Lost earnings: Based on earnings abilityLost earnings: Based on earnings ability

Punitive: Particularly egregious malpracticePunitive: Particularly egregious malpractice►Magnitude of Economic Damages:Magnitude of Economic Damages:

Wrongful death don’t necessarily result in the Wrongful death don’t necessarily result in the largest awardslargest awards

Those brought close to the brink of death, Those brought close to the brink of death, requiring custodial care for the rest of their requiring custodial care for the rest of their lives tend to generate exceptionally large lives tend to generate exceptionally large verdicts.verdicts.►Example: A clinician who intubates the Example: A clinician who intubates the

esophagus, resulting in an anoxic brain damage. esophagus, resulting in an anoxic brain damage. A $30 Mil. verdict is quite possible. A $30 Mil. verdict is quite possible.

Statute of Limitation: Statute of Limitation: Time during Time during which a lawsuit may be brought by a which a lawsuit may be brought by a

plaintiffplaintiffStatute Time FrameStatute Time Frame► 1 Year:1 Year:

► 2 Years:2 Years:

► 3 Years:3 Years:

► 4 Years:4 Years:

StateState► California, Kentucky, California, Kentucky,

Louisiana, TennesseeLouisiana, Tennessee► New JerseyNew Jersey, Oregon, , Oregon,

PennsylvaniaPennsylvania, Texas, , Texas, Alabama, Alaska, Alabama, Alaska, FloridaFlorida

► New York,New York, New New Hampshire, MarylandHampshire, Maryland

► Nebraska, Utah, Nebraska, Utah, WyomingWyoming

The Med/Mal. Lawsuit Timeline: The Med/Mal. Lawsuit Timeline: A Plausible ExampleA Plausible Example

9-5-019-5-01 9-30-9-30-0101

9/10/09/10/033

9-29-9-29-0303

1-5-041-5-04 6-6-046-6-04

Patient Patient Admitted Admitted to Hospto Hosp. . for CHF.for CHF.

Patient Patient Expires Expires due to due to failed failed CPR after CPR after repeated repeated intubatiointubation n attempts attempts by RT. by RT.

Lawsuit Lawsuit

Filed.Filed. RT, RT, RN and RN and MD MD named.named.

Statute of Statute of Limit. = 2 Limit. = 2 Yrs in Yrs in New New Jersey.Jersey.

DiscoverDiscovery Starts.y Starts. Plaintiff’s Plaintiff’s attorney attorney seeks seeks evidenceevidence..

DepositioDepositionsns

Begin: Begin: Sworn Sworn statement statement from from involved involved parties.parties.

Factors Which Influence Factors Which Influence Clinician’s Exposure to Med/Mal Clinician’s Exposure to Med/Mal

LawsuitsLawsuits► Setting: If Acute Care, exposure is higher!Setting: If Acute Care, exposure is higher!► Types of Cases: Types of Cases: Based on closed med/mal casesBased on closed med/mal cases

Airway Mgt.Airway Mgt. Medications (Atrovent & Narrow Angle glaucoma)Medications (Atrovent & Narrow Angle glaucoma) Vents/AlarmsVents/Alarms Infection Control Infection Control

► Other Potential Exposure:Other Potential Exposure: Improperly stored O2 Cylinder, you were in the roomImproperly stored O2 Cylinder, you were in the room Fall after you lowered the bedrail for ABGFall after you lowered the bedrail for ABG

► Both Acts of Omission & CommissionBoth Acts of Omission & Commission Omission: Missed Tx. Due to heavy workload.Omission: Missed Tx. Due to heavy workload. Commission: Gave albuterol to a pt allergic to it.Commission: Gave albuterol to a pt allergic to it.

Factors Which Influence Factors Which Influence Exposure (cont.) Exposure (cont.)

► System Error: System Error: Arise from multiple persons. Arise from multiple persons. Example: One clinician claims he told the other, nurse Example: One clinician claims he told the other, nurse

claims she left a message for the physician, who claims that claims she left a message for the physician, who claims that he was not informed.he was not informed.

Initially tend to be difficult to sort through. “Depos” tend to Initially tend to be difficult to sort through. “Depos” tend to contradict, one another. contradict, one another.

► Errors Related to Procedures: Errors Related to Procedures: Lack of a formal policy/procedure exposes the institution.Lack of a formal policy/procedure exposes the institution. Procedures should be evidence-based and not seemingly Procedures should be evidence-based and not seemingly

arbitrary.arbitrary. Failure to follow procedures exposes the clinician.Failure to follow procedures exposes the clinician.

► Product Liability: If product such as ventilator or Product Liability: If product such as ventilator or humidifier fails, clinician involved may well be humidifier fails, clinician involved may well be named.named. Example: Redfield v Beverly Health Services Inc. Home Example: Redfield v Beverly Health Services Inc. Home

ventilator company tried to blame malfunction on the RT. ventilator company tried to blame malfunction on the RT. Jury did not buy it. Jury did not buy it.

How to Reduce Med/Mal Risk How to Reduce Med/Mal Risk ► Prevention:Prevention:

Know and Follow the Standard of CareKnow and Follow the Standard of Care Keep current with Standard of Care (via CEUs)Keep current with Standard of Care (via CEUs) Know and Follow Hospital & Department Know and Follow Hospital & Department

PoliciesPolicies►Example: HIPAA as it relates to Patient Example: HIPAA as it relates to Patient

confidentialityconfidentiality Proper DocumentationProper Documentation Minimize Assumption of Liability: If you need Minimize Assumption of Liability: If you need

help, ask for it and document that you did so.help, ask for it and document that you did so. Obtain malpractice insuranceObtain malpractice insurance

How to Reduce Med/Mal Risk How to Reduce Med/Mal Risk (cont.)(cont.)

►Damage Control, if you are named.Damage Control, if you are named. Consider getting your own attorneyConsider getting your own attorney Review you charting before giving Review you charting before giving

testimony.testimony. Review your testimony before giving more Review your testimony before giving more

testimonytestimony Base your testimony on fact not opinions Base your testimony on fact not opinions

and suppositionand supposition

Malpractice Insurance for Malpractice Insurance for CliniciansClinicians

► A must have!!!A must have!!!► Is generally a great value!Is generally a great value!

Standard coverage ($1 million per incident) is Standard coverage ($1 million per incident) is generally less than $100 annually.generally less than $100 annually.

Supplemental coverage ($5 million per incident) Supplemental coverage ($5 million per incident) may only be another $25-$50 per year.may only be another $25-$50 per year.

►Generally the insurance company furnishes Generally the insurance company furnishes an attorney if you are named in a lawsuit.an attorney if you are named in a lawsuit.

► Is offered by several firms including Is offered by several firms including Princeton Insurance and Seabury-Smith.Princeton Insurance and Seabury-Smith.

Proper DocumentationProper Documentation

►Reasons for DocumentationReasons for Documentation BillingBilling CommunicationCommunication Create a legal recordCreate a legal record

►Always keep in mind: Documentation Always keep in mind: Documentation becomes the central focus of every becomes the central focus of every Med/Mal negligence caseMed/Mal negligence case What’s in your charting becomes the What’s in your charting becomes the

rationale for proceedingrationale for proceeding

Documentation (cont.)Documentation (cont.)► What/How should you document?What/How should you document?

SOAPSOAP► Subjective: What the Pt says.Subjective: What the Pt says.► Objective: What you observe and measureObjective: What you observe and measure► Assessment: What you assess & measureAssessment: What you assess & measure► Plan: What the planPlan: What the plan

SCALPSCALP► SimpleSimple► ClearClear► AccurateAccurate► LegibleLegible► PromptPrompt

► What not to DocumentWhat not to Document IrrelevantIrrelevant InflammatoryInflammatory Inaccurate/contradictoryInaccurate/contradictory

► Remember to read your own documentationRemember to read your own documentation Immediately after you write it.Immediately after you write it. If named in a suit: Prior to giving testimonyIf named in a suit: Prior to giving testimony

Case 1Case 1► Case Summary: An Clinician accepts an Case Summary: An Clinician accepts an

exceptionally heavy assignment. They complete exceptionally heavy assignment. They complete their assignment but do not chart on any of her their assignment but do not chart on any of her patients and just signs the MAR documenting the tx patients and just signs the MAR documenting the tx was given. Shortly after the end of her shift, one of was given. Shortly after the end of her shift, one of her asthmatic patients has a severe attack and dies. her asthmatic patients has a severe attack and dies.

► Outcome: Nine months later, the RT, the nurse and Outcome: Nine months later, the RT, the nurse and the hospital are named in a Med/mal lawsuit. In a the hospital are named in a Med/mal lawsuit. In a sworn deposition, the plaintiff’s attorney inquires sworn deposition, the plaintiff’s attorney inquires about their client’s respiratory status during that about their client’s respiratory status during that day. The RT and nurse say the patient was in no day. The RT and nurse say the patient was in no distress. However, there is no documentation distress. However, there is no documentation regarding the patient’s respiratory status nor how regarding the patient’s respiratory status nor how well she tolerated the therapy during that shift. It is well she tolerated the therapy during that shift. It is likely that the case was eventually settled in favor of likely that the case was eventually settled in favor of the plaintiff for several million dollars. the plaintiff for several million dollars.

► Discussion: What could have been done differently Discussion: What could have been done differently and where are clinicians exposed from a legal and where are clinicians exposed from a legal standpoint?standpoint?

Case 2Case 2

► Case Summary: Per MD order, clinician obtains a Case Summary: Per MD order, clinician obtains a blood sample from a 50 YO COPD patient but blood sample from a 50 YO COPD patient but accidentally leaves the bedrail down. Minutes later, accidentally leaves the bedrail down. Minutes later, the patient falls out of bed, hits his head, has and ICH the patient falls out of bed, hits his head, has and ICH and is rendered in a persistent vegetative state. and is rendered in a persistent vegetative state.

► Outcome: Eighteen months later, the RT, the nurse Outcome: Eighteen months later, the RT, the nurse and the hospital are named as defendants in a suit. and the hospital are named as defendants in a suit. The nurse was eventually dropped as a defendant The nurse was eventually dropped as a defendant and “testifies” that about two minutes after the RT and “testifies” that about two minutes after the RT left the room, she heard a “thud” and quickly found left the room, she heard a “thud” and quickly found the patient on the floor. The case was settled one the patient on the floor. The case was settled one year later for several million $ in favor of the plaintiff.year later for several million $ in favor of the plaintiff.

Case 3Case 3► Case Summary: Just after being brought to the ICU Case Summary: Just after being brought to the ICU

for CHF, 67 YO patient goes into cardiopulmonary for CHF, 67 YO patient goes into cardiopulmonary arrest. Per attending MDs verbal order, RT arrest. Per attending MDs verbal order, RT intubates the patient by first placing them in a intubates the patient by first placing them in a sniffing position. Intubation is successful, patient sniffing position. Intubation is successful, patient survives but patient is rendered a ventilator survives but patient is rendered a ventilator dependent quadriplegic due to dislodgment of dependent quadriplegic due to dislodgment of previously fused (5 years ago) C-3 to C-4 previously fused (5 years ago) C-3 to C-4 vertebrae. Nurse never told the RT about the vertebrae. Nurse never told the RT about the fused neck prior to or during the intubation. fused neck prior to or during the intubation.

► Outcome: One year later, the RT, MD, several Outcome: One year later, the RT, MD, several nurses and the hospital are named as defendants nurses and the hospital are named as defendants in a med/mal lawsuit. Case was settled two years in a med/mal lawsuit. Case was settled two years later in favor of the plaintiff for over $10 million. later in favor of the plaintiff for over $10 million.

Case 4Case 4► Case Summary: You are a homecare nurse or RT Case Summary: You are a homecare nurse or RT

and when visiting a apnea monitor patient, you and when visiting a apnea monitor patient, you notice that the alarm speaker is taped over. When notice that the alarm speaker is taped over. When you ask the caregiver about this, they complain you ask the caregiver about this, they complain that it is loud and wakes them up at night. You that it is loud and wakes them up at night. You remove the tape, reinstruct the caregiver not to do remove the tape, reinstruct the caregiver not to do this and leave. You do not document this activity, this and leave. You do not document this activity, follow up nor inform the prescribing physician. follow up nor inform the prescribing physician. One week later, you are informed that the infant One week later, you are informed that the infant died the prior night at home due to an apparent died the prior night at home due to an apparent apneic episode. apneic episode.

► Outcome: One year later, the nurse or RT, Outcome: One year later, the nurse or RT, homecare company and apnea monitor homecare company and apnea monitor manufacturer are named as defendants in a manufacturer are named as defendants in a med/mal lawsuit. med/mal lawsuit.

Take Home MessagesTake Home Messages► Anyone can be sued for almost anything…Anyone can be sued for almost anything…

it doesn’t mean you’ll loose.it doesn’t mean you’ll loose.► Almost anything can happen in a court of Almost anything can happen in a court of

lawlaw►Myths on this topic are just that!!!Myths on this topic are just that!!!► Roughly 70-80% of all med/mal cases Roughly 70-80% of all med/mal cases

ruled for the defendant.ruled for the defendant.► There are areas where clinicians may be There are areas where clinicians may be

more exposed to being sued.more exposed to being sued.► There are things that clinicians can do to There are things that clinicians can do to

minimize there exposure in a suit.minimize there exposure in a suit. Stay current with CPGs and policy/procedures.Stay current with CPGs and policy/procedures. Avoid common pitfalls on the job.Avoid common pitfalls on the job. Understand the process.Understand the process. Maintain malpractice insurance.Maintain malpractice insurance.

Selected ReferencesSelected References

►DeWitt, AL, DeWitt, AL, The Respiratory Therapist’s The Respiratory Therapist’s Legal Answer BookLegal Answer Book, Jones and Bartlett, , Jones and Bartlett, Sudbury, MA, 2006.Sudbury, MA, 2006.

► Settig, SE, Settig, SE, Preparation, management, and Preparation, management, and equipment for the difficult airwayequipment for the difficult airway, AARC , AARC Times, 32:41, 2001.Times, 32:41, 2001.

► Studdert, DM, et al, Studdert, DM, et al, Claims, errors and Claims, errors and compensation payments in medical compensation payments in medical malpractice litigationmalpractice litigation, New Eng J Med, , New Eng J Med, 354:2034, 2006.354:2034, 2006.