Tennessee Medical Malpractice Law Blog

SVMIC, the well-managed, physician-owned liability insurance company that insures an estimated 90% of the doctors in the state, publishes a newsletter called "Riskpoints." It is available on their website.

The Fall 2006 edition of the newsletter (article in on Page 2 of the newsletter). listed the top ten jury verdicts against SVMIC insureds in the six year period 2000-2005. Four of those verdicts were by out-of-state juries (SVMIC writes insurance in multiple states).

The largest verdict was the verdict in Hunter v. Ura, a Davidson County case, in the amount of $5.8M. The decedent, a six-figure wage earner, died as the result of an anesthesa error. He left a wife and two minor children behind.

The other Tennessee verdicts were $5.5M for the death of a child, $1.7M in a back fusion case for a 36 year old male, $2M for the death of a 46 year old male, $2.94M for what appears to be a brain injury to a child (judgement against doctor and hospital) and $1.8M for death of a 62 year old male in a failure to diagnose cancer case.

The article makes it clear that "[t]he amounts listed are the actual verdicts awarded by the court or jury. Keep in mind that a number of these cases subsequently were settled for significantly lesser
amounts during the course of post-trial negotiations."

Think about it folks. Six years of cases. Six adverse jury verdicts. Less than $20M in total verdicts, some of which were admittedly settled for substantially less that the original judgmnent.

This is why the industry fought for so long not to have to reveal this information. I have sought for years to find out not just numbers but facts - who is getting these multi-million dollar judgments?

Now we are beginning to learn.

The Legislature should mandate every malpractice insurer to reveal basic facts about every claim they pay over $100,000 so that it can determine whether juries are acting reasonably.

Read my post at www.dayontorts to learn when plaintiff's lawyers are required to report information to the Department of Commerce and Insurance about fees and expenses paid to them in medical negligence cases.

John Day has posted an article over on Day on Torts reporting on a recent study entitled "The Great Malpractice Hoax."  There are a number of interesting statistics cited in the post.

Click here to review the American Academy of Pediatric's Press Release regarding a new report in the peer reviewed journal Pediatrics which establishes guidelines for sedation of pediatric patients.  The guidlines are the result of a joint effort by the American Academy of Pediatrics and the American Academy of Pediatric Dentistry.

This article from the Washington Post  cites to an article published in the American Journal of Medical Quality that  in turn suggests that many hospital-acquired infections are preventable.

From the Post article:  "It's the process, not the patients," said David B. Nash, the journal's editor and chairman of the Department of Health Policy at Thomas Jefferson University in Philadelphia. "These three groups independently found that despite hospitals' claim that in the sickest patients it's inevitable that someone is going to get a hospital-acquired infection, that's just not the case."

The Post article goes on to say this:  "Hospital officials agree, said Nancy Foster, vice president for quality and patient safety at the American Hospital Association, which represents more than 4,800 hospitals and health-care systems nationwide.

"'The new wave of research is showing that our previous expectations around what was preventable underestimated what we could actually achieve,' Foster said. 'We can prevent more infections than we thought before. Lots of hospitals are striving to get to zero" infections.'"

I often find myself turning to the website of the Administrative Office of the Courts to access the Local Rules for particular Judicial Districts across the state in which we have cases filed. I wanted to let you know of this quick and easy resource for this essential information.  Click here  to link to the website. 

On December 20-21, 2006, Branham & Day will be holding our fifth annual Fundamentals of Civil Litigation in Tennessee seminar.  This year the seminar will be held at the Nashville School of Law.  The seminar is designed to help new lawyers grasp practical matters of civil litgation.  If you are within the first five years of your practice, you will especially enjoy this seminar.  To register visit our website: www.branhamday.com.

Senate Bill 2823 went into effect on July 1, 2006.  The Bill amends T.C.A. Title 24, Chapter 7, Part 1 by adding a new section which sets out a procedure for introducing medical records into evidence.  The statute provides that, when duly certified by their custodian, physician, physical therapist or chiropractor, medical records need not be identified at trial and may be used in any manner which records identified at trial could be used.  The statute requires giving the opposing party notice of the intent to introduce the records into evidence no later than 60 days before the trial.  This procedure seems to be akin to the procedure established by T.R.E. 902(11) for introducing business records into evidence without the need to call the custodian as a witness at trial. 

The Tennessee Supreme Court has requested comment on the proposed changes to the Rules of Procedure and Evidence.  Among the proposed changes is the following interesting proposed amendment to Rule 15.01 of the Tennessee Rules of Civil Procedure:

[Insert between the existing second and third sentences:]      

 "For amendments adding defendants pursuant to Tenn. Code Ann. §20-1-119, however, written consent of the adverse party or leave of court is not required."

T.C.A. 20-1-119 is the statute which allows a plaintiff  to sue a non-party in response to a comparative fault allegation notwithstanding any statutes of limitation.  

To review all the proposed changes visit the AOC website.

Check out this surgical procedure video of an anterior cervical fusion.  Click here to watch.

Two premature infants died in an Indiana hospital after being given adult doses of Heparin.  Four other children were also given incorrect doses.

Read more here.

 The coroner of Lake County, Illinois has ruled that the death of a woman of a heart attack while she waited for care in an emergency room was homocide.

ABC News reports that "'the definition of homicide that I give to the jury is either a willful and wanton act or recklessness on the part of someone, whether that's by their actions or by their inactions,' [the coroner] Keller said. "Certainly, by that definition, this is a homicide."

She apparently waited two hours for care after complaining of nausea, shortness of breath and chest pains,  but was found dead in a chair in the waiting area.

Law.com has posted an interesting article about destructive testing in products liability actions. The article was written by Michael Hoenig and was originally published in the New York Law Journal.  Of course, the potential for the need to conduct destructive testing exists in medical negligence actions as well, so I thought I would bring the article to your attention.

The article discussed the recent case of Mirchandani v. Home Depot, U.S.A., Inc., 235 FRD 611 (D. Md. 2006), in which the court was faced with a request to permit destructive testing of a bolt that allegedly failed on a ladder. The court sought to achieve a "balance between the 'costs of irreversibly altering the object and the benefits of obtaining the evidence sought in the case.'" In doing so it weighed these four factors:

"(1) whether the proposed testing is reasonable, necessary and relevant to proving the movant's case;

(2) whether the non-movant's ability to present evidence at trial will be hindered, or whether the non-movant will be prejudiced in some other way;

(3) whether there may be any less prejudicial alternative methods of obtaining the evidence sought; and

(4) whether there are adequate safeguards to minimize prejudice to the non-movant, particularly the non-movant's ability to present evidence at trial. "

The Court allowed the testing to procedure, subject to certain safeguards designed to reduce any prejudice to the defendant. Specifically, the court said that "defendant will be allowed to attend the testing; all test procedures will be photographed; and plaintiff will produce a detailed protocol of the intended testing, explaining all procedures."

Recall that in Tennessee Rule 34A of the Tennessee Rules of Civil Procedure provides that "[b]efore a party or an agent of a party, including experts hired by a party or counsel, conducts a test materially altering the condition of tangible things that relate to a claim or defense in a civil action, the party shall move the court for an order so permitting and specifying the conditions. Rule 37 sanctions may be imposed on an offending party."

The Mirchandani case and the other cases cited in this article will be helpful to a trial court in determining the circumstances under which testing should be conducted.

The Archives of Surgery has a new article that discusses the rate and type of errors that occur during laparoscopic cholecystectomies particularly  injuries to the extrahepatic biliary tree.  The rate of injury to the extrahepatic biliary tree is twice as high in LC cases as it is in open procedures.

The article reports the results of  a " retrospective review of a public malpractice database was compared with previously published reviews of LC litigation by K. A. Kern, MD, and the Physician Insurers Association of America. "  The authors report that "[i]n Kern's study, injuries triggering litigation involved the bile duct in 61%, bowel in 16%, vascular system in 9%, and miscellaneous events in 14%; in the present study, injuries involved the bile duct in 78%, bowel in 2%, vascular injury in 7%, and miscellaneous injuries in 13%. Missed injuries occurred in 86% in the present study and 83% of the Physician Insurers Association of America cases. Although 15% of cases in the present study were converted to open procedures, in 53% of these cases conversion was performed to repair an injury."

The authors conclude that "[d]espite residency training, injuries triggering litigation after LC remain largely unchanged. The nature of the bile duct injuries suggests that routine intraoperative cholangiography is unlikely to make LC safer. To minimize the risk of litigation after LC, it is recommended that the threshold for conversion to open procedures be lowered. "

An RFID chip has been developed to reduce the risk of sponges being left in surgical patients.  Simliar technology is being used to prevent theft of goods in retail stores.

 Read more here.

John Day posted on Day on Torts about an expert witness who sued three doctors and the Florida Medical Association. The lawsuit stems from a disciplinary proceeding alleging that the expert's testimony in a medical malpractice case against the three doctors fell below reasonable professional standards. Read more details over on Day on Torts.

Frank Thomas, the former White Sox first baseman and designated hitter, has filed a medical negligence claim against two orthopedic doctors who were hired by the Sox. According to SI.com, the suit claims the White Sox doctors misdiagnosed the Big Hurt's broken foot as a bruise. Thomas continued playing, leading to a second bone break and his "eventual departure" from the team.

On a completely separate note... Go White Sox.

I recently came across a website for healthgrades.com. This business, among other things, appears to provide background information on hospitals and medical professionals for a fee. The website says they can provide information such as quality ratings, board certification and disciplinary action for specific hospitals, nursing homes and individual medical professionals. I have not tried their service and am not sanctioning it, just thought it was interesting and decided to pass it along.

Left.

Right.

My patient.

Someone else's patient.

My patient.

One of my other patients.

These really are not difficult concepts. Except that in 1 out of 112,994 surgeries (not including spine surgeries) surgeons perform "wrong site" surgery.

Eighty-fours such errors were reported last year - and reporting is not mandatory in all states.

Spine surgeries were excluded because "surgical sites on the spine are verified with X-rays...." True - but surgeons still operate on L-3 L-4 when they are supposed to operate on L-2 L-3.

Read about it in USA Today. For the complete study from Archives of Surgery click here. One interesting set of stats from the article: "Surgery on the wrong patient occurred in 13% of cases, using the wrong procedure in 11%, and on the wrong body part or site in 76%."

If you represent plaintiffs in medical malpractice cases you are probably already a member of your local trial lawyer association and hopefully ATLA as well. If you are not a member, join. If you have not attended the annual convention/seminar programs of these organizations I strongly recommend that you consider doing so. There is a wealth of knowledge to be gained from these educational programs. I also get a great re-charge of my batteries by spending a few days each summer with folks who do the same work I do. Visit www.ttla.org and www.atla.org to learn more about their conventions coming up this summer.

In order to improve patient safety, the FDA recently announced a revision to the format of medication package inserts. The new format will be easier to read, and will highlight the most important parts of information regarding the medication, making the inserts easier for the prescribing physicians (and patients) to use. The new format will include a "Highlights" section which will provide prescribing information about risks and benefits, warnings, indications, dosages, etc. There will also be a "Table of Contents" section for easy reference regarding safety and efficacy, a section regarding the date of initial product approval, and a section regarding how to report suspected adverse events. There is also a section entitled "Patient Counseling Information" to help with communication between the patient and health care provider. Read more about the new format here.

The Journal of the American Medical Association published an article criticizing conflicts of interest that may exist due to the close ties between drug manufacturers and doctors. According to the Washington Post, the JAMA article attacks the current voluntary guidelines to limit conflicts of interest have failed. The WaPo article points to numerous means by which physicians receive benefits from drug manufacturers:

From their first rounds as residents, doctors travel in a world increasingly dominated by drug company salespeople proffering meals, office supplies, entertainment and even cash to speak at conferences or sit on advisory boards.

Some physicians have been paid lucrative consulting retainers for no specific work; others are paid to put their names on articles ghostwritten by industry employees. One congressional inquiry cited in the report found that pharmaceutical executives steer research grants to doctors and schools that promote their firms' drugs.

The JAMA authors, including the president of the Association of American Medical Colleges, urge a number of steps to curtail actual or perceived conflicts of interest within the medical profession. An abstract of the article is available here at the JAMA website, with the full text available to subscribers.

Illinois has now joined three other states in requiring hospitals to report the occurence of certain "adverse events." Each event must be reported to a state agency; the facility is then required to perform a root cause analysis of the event and take corrective action (or explain why none is being taken."

The reportable information is "not be available to the public and shall not be discoverable in any civil, criminal or administrative proceeding against a health care facility or health care professional."

Read more about the new statute here.

Read the new statute itself here.

Here is a good neonatology resource I found on the internet. This website, Neonatology on the Web, is very useful, both for parents and health care providers. It provides a list of various conditions and disorders with links to other websites where you can research information about the specific condition or disorder. It also provides you with a list of various treatments and procedures with the same type links to other websites. There is also a list of databases for neonatologists that I found helpful.

Read today's post at dayontorts for an interesting study on medical error rates (and other health care information) in the United States and five other countries.

In any case where a large volume of documents will be exchanging hands during discovery, we find it helpful to begin a list of all documents produced. Make sure to include who produced the documents, the date of production, and a detailed description of the documents including bates numbers. By keeping this list updated, you will know at a glance what documents have exchanged hands.

When you are gathering itemized billing statements from the medical providers who treated your clients, you typically request the billing statements from the treating physicians and hospitals. Don't forget to also request billing statements from providers such as the emergency medicine groups, the radiology groups, and the anesthesiology groups. Often times, these physicians are not employed by the hospital and bill separately. If you are having difficulty determining the names of these other groups, ask your client if they can provide you with copies of the Explanation of Benefits statements they received from their health insurance provider. These EOB statements show what medical providers have been paid and often help fill in the blanks.

On October 11, 2005, the Wall Street Journal published two letters to the editor from doctors regarding holes in the peer review process. The two doctors suggest that problems with the medical profession's internal checks allow bad doctors to continue practicing medicine despite a history of medical errors. One of the two physicians who wrote in to the Journal is an orthopedic surgeon in Tennessee.

The Tennessee Hospital Association's motion for a temporary injunction to block doctors from performing surgery in their offices has been denied, according to the Nashville City Paper. This is still just at the temporary injunction stage, so we will see where the case goes from here.

When preparing interrogatories to propound to the defendant doctor in a medical malpractice case, don't forget to ask for listings of all previous cases in which the doctor has been named and cases in which the doctor has served as an expert witness. Make sure to get specifics regarding these cases such as the attorneys who handled each case and whether a deposition was given. Once you have this information, you can then attempt to locate the prior depositions of the defendant doctor for review. This prior deposition testimony can be extremely helpful when preparing for your deposition of the doctor, especially when the cases are similar.

The Tennessee Hospital Assocation filed a lawsuit yesterday to prevent doctors from performing major surgeries in their own offices, rather than in hospitals. The THA's argument is apparently that doctors' offices are not subject to the same requirements as hospitals, and therefore public safety would potentially be compromised by not holding offices to the same standard. I have not read the complaint, but the Nashville City Paper reports that THA's complaint states “the community standard of care is for major surgery to be performed at regulated facilities.”

This interesting article discusses how flat-fee medical clinics are moving into the rural south. This trend, which is believed to have started in the Seattle area, once was only available to those who could afford to pay as much as $10,000 per year for unlimited medical treatment. The clinics featured in this article and located in Georgia are providing their services for only $500 per year.

The Wall Street Journal has an article about doctors suing to stop their patients from posting criticism online. These cases are obviously teeming with legal issues, but those are nothing new. (The extent to which the First Amendment protects potentially defamatory statements on the internet is a first year law school topic). The larger question is how patients can go about finding information about a doctor's history. Unfortunately, the answer to a large extent is that patients cannot.

The Supreme Court filed an Order September 12, 2005 soliciting comments on proposed changes to the Tennessee Rules of Civil Procedure, Juvenile Procedure, Evidence and Appellate Procedure. Comments must be submitted by November 14, 2005. To review the Order and proposed changes visit the Administrative Office of the Courts website.

The subpoena is one of the most powerful tools in the lawyer's arsenal. It is important, however to remember the limitations of the tool. For example, don't forget that, under T.C.A. 24-9-101, physicians, psychologists, chiropractors, dentists, custodians of medical records (so long as the custodian has complied with the procedure for producing medical records set forth in T.C.A. 68-11-401 et seq)are among those subject to a subpoena to a deposition but exempt from subpoena to trial in Tennessee state court. On the other hand, other medical professionals (such as nurses and nurse practitioners)not specifically identified in the statute are not exempt from subpoena to trial. I know of more than one attorney who has run into trouble because the attorney planned to use the deposition of a medical professional at trial and the medical professional was not on the list of professionals exempt from subpoena, thus making the deposition inadmissible hearsay.

In this article, state Attorneys General comment on their concerns regarding rising medical malpractice insurance premiums despite evidence that claims payments are down. The comments follow the state Attorneys General review of a study by Consumer Federation of America, Public Citizen's Congress Watch and U.S. PIRG regarding rising medical malpractice insurance premiums. The study examined data in Annual Statments filed by medical malpractice insurors with state insurance departments.

Earlier this year the South Carolina Legislature passed laws limiting a patient's recovery for pain and suffering in a medical malpractice case to $350,000 for an individual defendant or up to $1.05 million for multiple defendants. Now South Carolina is looking at the possibility of further changes to their medical malpractice law, including adopting an "I'm Sorry" law which is intended to encourage doctor's to apologize and offer a settlement to families before cases go to court. According to this article, "I'm Sorry" laws have been passed in other states and are encouraged by a group of doctors, patients, and lawyers known as Sorry Works. This concept of investigating and working to resolve claims before litigation is filed sounds good, but I am concerned by a quote in the article from a Sorry Works spokesperson in which he apparently explained that, as part of the "I'm Sorry" process, families are made an offer of settlement and told that any effort to take the case to court will be fought "to the end." I would be very concerned about any firm policy that encouraged parties to litigation, or potential parties, to make a one-time offer and otherwise to fight the case "to the end." Even though the "I'm Sorry" law process apparently anticipates an investigation procedure, it is certainly possible that all parties involved may not have all of the information they need to make an informed decision about settlement at the time this preliminary offer is made. This is particularly true if the investigation is one-sided and the family is not given an equal opportunity to have their own representatives review the medical provider's investigation results. The point is, litigants should always try and keep an open mind to resolution. Encouraging any litigant to draw a line in the sand before a case is even filed seems like a bad idea.

Earlier this week a Massachusetts jury awarded an eight year old boy approximately $23 million in damages and another $16 million in interest. The eight year old was severely injured at birth due to a delay in delivery. He now has the mental capacity of a three-four year old, must wear leg braces and has hearing and vision impairment. The family entered into a high-low agreement before the jury returned its verdict so they will not actually receive the entire amount of the award. Click here for more from the Boston Herald.

Branham & Day will be hosting two seminars this fall. Fundamentals of Civil Litigation in Tennessee on December 14 and 15 will focus on helping new lawyers grasp practical matters of civil litigation. Topics include initiating and responding to a lawsuit, written discovery and depositions, motion practice, client communication and case management. Attendees will be provided useful forms, checklists and other documents to help in daily practice. Beyond the Fundamentals of Civil Litigation in Tennessee on December 19 is geared toward lawyers who have already attended the Fundamentals seminar or who have been in practice for several years. This seminar addresses many of the same topics covered in the Fundamentals course but in much greater depth and assumes a basic understanding of the Rules of Civil Procedure and Rules of Evidence. Both seminars will be held at the Cool Springs Conference Center in Franklin Tennessee. For more information visit our website at www.branhamday.com or email me at rblair@branhamday.com.

There are many ways to locate a medical expert willing to review your potential medical malpractice case and provide an opinion regarding the care given to the patient. Of course you can turn to expert finder services or other resources that provide names of potential experts, but we have had great success locating potential experts while performing medical research. Often times the physicians who author medical journal articles are passionate about the topic(s) they have written about and are willing to speak to you regarding your potential case. Finding an expert in this manner can be very beneficial. For example, we had a case years ago where we found our nurse expert witness after reading one of her articles on how to use a particular medical device during an emergency. In our client's situation, the device was present, however no one but the treating surgeon knew how to use it. When we obtained the list of nursing continuing education provided by the defendant hospital, we discovered the hospital had provided training to their nurses using our expert's article. Keep this in mind when you are reviewing medical journal articles.

Why wait for the opposing party to send you discovery requests? In those instances when you know what the relevant issues are and you have the information in hand, why wait for the other side to request it? Often we will send our client's pertinent medical records and expenses as soon as we learn the identity of defense counsel in a personal injury or medical malpractice case. In a vehicle accident case we may send the police report. At least one lawyer in our office has even been known to send the defendant completed discovery responses before the defense lawyer got around to serving any discovery requests. The point is, if you want to keep the case moving, and you know eventually you will be sharing the information anyway, why not do it sooner rather than later?

What is wrong with people? Spurred on by greedy lawyers, people will sue for anything! Every little mistake seems to end up in some courtroom.

This case is a fine example. This family filed a lawsuit just because a neurosurgeon operated on the wrong side of a 15 year old's brain.

I mean, can you imagine the nerve of some testimonial harlot saying that a neurosurgeon is supposed to know the difference between left and right? The defendant is chief of neurosurgery at a children's hospital. If he doesn't know the difference, how could the standard of care possibly require knowledge of the difference?

By the way, did you know that "wrong site surgery" is one of the leading sources of payouts for State Volunteer, Tennessee's bedpan mutual for certain specialities? Here is a quote from 3 years ago:

"Despite all the warnings about wrong-site, wrong person, and wrong procedure surgery, the problem persists. A review of SVMIC claims data finds that “operation performed at incorrect site” continues to rank in the top five complications for our insured physicians in general surgery, orthopedic surgery, neurosurgery and ophthalmology. It is also a significant problem for our gynecologists and vascular surgeons. "

Blue Cross Blue Shield has a new site that allows consumers to evaluate and compare the outcomes from various procedures at Tennessee hospitals.

For example, Vanderbilt has a "worse than average" mortality rate for C-sections. However, its "length of stay" for craniotomies is "better than average" (meaning that on the average you are out of the hospital quicker).

The site promises to offer information about the quality of physican care in the future.

The Agency for Healthcare Research and Quality (AHRQ) along with the American Medical Association and the American Association of Health Plans (America’s Health Insurance Plans) have created a website called National Guideline Clearinghouse. The website contains evidence-based clinical practice guidelines for use by nurses, physicians, other health care providers, etc. Among other things, you can easily search the site for guidelines related to specific diseases, organizations, or treatment. You can also compare guidelines and check out guidelines that have been added each week.

Rebecca Blair and I are at the ATLA Convention in Toronto. Over the next few weeks we will be sharing with you information we learned about medical negligence litigation from our attendance at the seminar programs in Toronto.

One of the wonderful traditions of ATLA is the willingness of ATLA members to share. A rising tide truly lifts all boats, and we are fortunate that we get to further that fine tradition by sharing what we learn with you via this blog.

The American Association of Critical Care Nurses has issued a new study concerning medical malpractice in our nation's hospitals.

This is scary stuff. The reports says that each year "one in twenty in-patients will be given the wrong medication, 3.5 million will get an infection from someone who did not wash his or her hands or take appropriate precautions, and 195,000 will die because of mistakes made while they're in the hospital." The study goes on to say that 60% of medication errors are caused by mistakes in interpersonal communication.

The study explains that the majority of health care providers break rules, make mistakes, or apppear to behave incompetently, but less than 1 in 10 say anything about it.

The study is fascinating and speaks volumes about the need for reform in our health care system in an effort to protect patients from injury or death.

Too busy to read the 19 page study? Read the Executive Summary.

A study of the healthcare cost of 30 nations in the Organization for Economic Cooperation and Development reports that the United States spends more on health care costs per capita but does not receive more services. The study found:
 The nations examined spend a median of $2,193 per capita on health care;
 The United States spent $5,267 per capita for prescription drugs, hospital stays and physicians visits in 2002, compared with $3,446 per capita for Switzerland, the next highest spender;
 Health care spending accounted for 14.6% of the U.S. gross domestic product in 2002, a time when only two other nations -- Switzerland and Germany -- spent more than 10% of their GDP on health care;
 The United States has 2.9 hospital beds per 1,000 residents, compared with a median of 3.7 beds per 1,000 residents among the other nations examined;
 The United States had 2.4 physicians per 1,000 residents in 2001, compared with a median of 3.1 physicians per 1,000 residents among the other nations examined in 2002;
 The United States had 7.9 nurses per 1,000 residents in the United States in 2001, compared with a median of 8.9 nurses per 1,000 residents among the other nations examined in 2002;
 The United States has 12.8 CT scanners per one million U.S. residents, compared with a median of 13.3 scanners per one million residents among the other nations examined;
 The United States appears to have more magnetic resonance imaging machines per capita than many of the other nations examined, but the machines are used only 10 hours daily in the United States, compared with a median of 18 hours daily in other nations.

Interestingly, the study also found that the average medical malpractice payment, which included both settlements and judgments, was $265,103 in the United States in 2001, compared with $309,417 in Canada and $411,171 in Britain.
Thanks to Medical News Today and the KaiserNetwork.org for bringing this our attention. Click here to review the report online.

Former Supreme Court Justice Penny White, former Court of Criminal Appeals Judge Joe Riley and I have started offered CLE programs in the Fall. We have expanded the program to allow you to earn all 15 hours of CLE in two days, including your 3 E & P hours. If you wish, you can attend just one day. In addition, we are having a 3 hour E & P program only in several cities around the state. Click here for the dates and the cities.

We had a great turnout last year and hope for an even better turnout this year. In addition to an unpdate on the law of torts and comparative fault I will be giving an extended lecture on the law of depositions. When you leave the seminar you will know what there is to know about law in Tennessee concerning taking depositions and the use of them at trial.

We hope to see you there. You may register here.

Despite what you read in the paper, lawyers don't cause medical malpractice. Doctors and hospitals cause malpractice. Stop malpractice and you not only help patients but you get lawyers out of the picture.

Here is a profile of a company that is trying to actually do something to stop errors from injuring or killing patients. This company is trying to change "the 'John Wayne' style of hospital management, [where] surgeons run the operating room [and e]verybody else has the good sense to keep quiet."

The Company reports that "the results are pretty dramatic. One of our biggest clients was running a wrong surgery once every 60 days." After adopting the program, the error rate is now one every 619 days, 10 times better than the national average, which is 15 wrongs per 100,000 procedures.

That's right. If doctors and hospitals would spend their money to reduce errors rather than trying to pass legislation that restricts the rights of patients with legitimate claims they would improve their relationship with patients.

In 2003, legislative attorney Henry Cohen prepared a chart of the standards for proving punitive damages in medical malpractice cases in each of the 50 states and the District of Columbia. It is now available online here. According to the report, Iowa's burden of proof for punitive damages is a "preponderance of clear, convincing, and satisfactory evidence." They also drive cars with 6 cylinder V-8s.

Would you think that a doctor who has had 33 medical malpractice payouts in the last decaded would still be practicing medicine?

Dr. Michael Sachs in Manhattan is. His record became news after a 42 year old mother died after a nose job performed in his office. The cause of death was "cardiac arrest." He also has two malpractice cases pending against him alleging breathing difficulties stemming from botched nose jobs. Read the article here.

James' vasectomy did not go as planned. His wife Corrine became pregnant. They filed suit against his urologist.

The Maryland Court of Special Appeals held that Corrine could not file suit against the doctor because there was not a physican-patient relationship. In short, the Court ruled that Corrine did not establish that her husband's doctor owed her a duty of care.

The dismissal of James' claim on the ground of contributory negligence was also affirmed. (In Maryland, contributory negligence is still an absolute bar to recovery.) The basis for the claim of contributory negligence included the failure to follow doctor's orders.

Read the opinion here.