The Midwest Medical Legal Advisor provides legal information for healthcare providers and administrators, malpractice insurance professionals, and attorneys.

9 Jul, 2013

Should I Stay or Should I Go Now (to the E.R.)?

2018-04-23T23:52:20-05:00July 9th, 2013|Midwest Medical Legal Advisor|

America's healthcare system has been no stranger to controversy over the years.  A large piece of the current debate pertains to the cost of healthcare – with the finger often pointed at the rising expense of emergency medicine and unnecessary treatments.  One of the goals of the new healthcare overhaul is to lessen this burden with more access to primary care physicians.  Another proposed solution is to make patients front the [...]

5 Jul, 2013

Key requirement of the Affordable Care Act delayed

2018-04-23T23:57:56-05:00July 5th, 2013|Health Care Law, Midwest Medical Legal Advisor, Tort Reform|

On Tuesday, the U.S. Treasury Department announced a one-year delay in a key provision of President Barack Obama's sweeping health care law, the Affordable Care Act.  It postponed the provision that required businesses with more than 50 employees to provide their workers with health insurance or face fines.  The Treasury Department explained in its blog that the government needs time to simplify reporting requirements, and businesses need breathing room to adapt [...]

28 Jun, 2013

Is this the end or just the beginning?

2018-04-23T23:52:20-05:00June 28th, 2013|Health Care Law, Midwest Medical Legal Advisor|

Today marks my husband’s last day of residency.  As he walks out of his last call shift, he says a bittersweet farewell to not only his on call pager (the sound of which will likely trigger a nervous twitch for many years to come) - but to an army of mentors and a group of colleagues bonded through three years of work with little sleep.  The topic of residency has [...]

25 Jun, 2013

The Impact of Unnecessary Surgery

2018-04-23T23:57:56-05:00June 25th, 2013|Health Care Law, Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Nebraska Hospital-Medical Liability Act, Risk Management, Tort Reform|

A recent article in USA Today posits that doctors perform thousands of unnecessary surgeries every year.  It claims that unnecessary surgeries might account for 10% to 20% of all operations in some specialties, including a wide range of cardiac procedures.  It generally cites three reasons as the cause of the problem: - doctors who enrich themselves by bilking insurers for operations that are not medically justified; - doctors who simply lack the competence [...]

18 Jun, 2013

Protecting Emergency Services Providers from Communicable Diseases

2018-04-23T23:52:20-05:00June 18th, 2013|Health Care Law, Midwest Medical Legal Advisor, Risk Management|

It’s a scene straight from a movie – someone is injured and you rush to render aid.  Of course, there’s blood – and with blood comes the potential exposure to communicable diseases.  So, what should you do if you do not know whether the person you have been assisting may have placed you at risk? The Nebraska statutes and regulations provide some protection to emergency services providers (including individuals rendering [...]

14 Jun, 2013

The National Practitioner Databank

2018-04-23T23:57:56-05:00June 14th, 2013|Disciplinary Actions, Health Care Law, Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management|

No doctor wants to be the target of a medical malpractice lawsuit.  Nor does any doctor want to be reported to the National Practitioner Databank.  I recently argued before the Eighth Circuit Court of Appeals in an attempt to remove a doctor’s name and report from the Databank. My main take-away from this experience: if and when you receive notice that you are the subject of a disciplinary proceeding where [...]

7 Jun, 2013

Doctors-in-Training Have Only 8 Minutes Per Patient

2018-04-23T23:52:20-05:00June 7th, 2013|Health Care Law, Medical Malpractice, Midwest Medical Legal Advisor|

How much time should a physician spend with their patient? In an ideal world, the answer would be as much time as needed.  Yet, according to a new study conducted by researchers from the John Hopkins University and the University of Maryland, gone are the days where new physicians had the time to truly get to know the individuals they treat.   This new study found that physicians-in-training spend about eight minutes per day [...]

28 May, 2013

Going Gently Into that Good Night: Physician Distrust on End of Life Care and a Few Musings from the Wife of a Resident Physician

2018-04-23T23:52:20-05:00May 28th, 2013|Midwest Medical Legal Advisor|

My husband - Tony (left) with his twin brother Adam. Both are internal medicine residents at the University Nebraska Medical Center. A backyard bar-b-q this Memorial Day weekend with two third year resident physicians - one being my husband and another my brother-in-law (twins who coincidentally (or by design?) have chosen the same career path - see inset picture) prompted a somewhat unique although not unusual conversation considering the company involved: [...]

24 May, 2013

Omaha and Lincoln area hospitals shorted $1 million

2018-04-23T23:57:56-05:00May 24th, 2013|Health Care Law, Midwest Medical Legal Advisor, Nebraska Hospital-Medical Liability Act|

In an interesting article this morning in the Omaha World Herald, it reports that nine Omaha and Lincoln area hospitals had approximately $1 million in Medicare payments withheld due to the number of patients returning to the hospitals within a month of being released. Medicare has recently targeted these types of readmissions, which cost roughly $17 billion dollars a year.  The government is penalizing hospitals with high readmission rates within [...]

22 May, 2013

Is the Patient’s/Plaintiff’s Expert Witness Qualified to Testify Against You?

2018-04-24T00:00:15-05:00May 22nd, 2013|Health Care Law, Medical Malpractice, Midwest Medical Legal Advisor, Tort Reform|

Many years ago, in a Nebraska gynecological case alleging medical malpractice, an oncologist testified favorably as to the applicable standards of care relating to the defendant physician.   After the jury returned a verdict for the defense, the plaintiff appealed this inclusion of this expert witness’ opinions to the jury.  The Nebraska Court of Appeals upheld the decision in Hoffart v. Hodge, M.D, 9 Neb. App. 161, 609 N.W.2d 397 (2000).  [...]

17 May, 2013

Monetary Value of Malpractice Claims is Steadily Declining

2018-04-23T23:52:20-05:00May 17th, 2013|Health Care Law, Medical Malpractice, Midwest Medical Legal Advisor, Tort Reform|

Last week I discussed a new study published by the journal BMJ Quality and Safety that analyzed malpractice claims since 1986 and found errors in diagnosis to be the worst offender for malpractice claims.  This week, my discussion centers on a similar analysis performed by Diedrich Healthcare.  Analyzing data gathered by the National Practitioner Data Bank, Diedrich Healthcare found that out of the $3.6 billion paid out for malpractice lawsuits in [...]

14 May, 2013

EMTALA and the “appropriate medical screening.”

2018-04-23T23:57:56-05:00May 14th, 2013|Midwest Medical Legal Advisor|

Congress enacted the Emergency Medical Treatment and Labor Act (“EMTALA”) in 1996 in response to claims that hospital emergency rooms were refusing to treat patients with emergency conditions but no medical insurance.  EMTALA imposes duties on covered facilities, hospitals which accept Medicare funding with an emergent care department, to: (a) provide an “appropriate medical screening examination” for those who come to an emergency room seeking treatment, and (b) provide, in [...]

10 May, 2013

The Quality Improvement/Peer Review Privilege: It’s Not Automatic

2018-04-24T00:10:53-05:00May 10th, 2013|Health Care Law, Midwest Medical Legal Advisor, Privileges|

The need for Quality Improvement and Peer Review Activities to remain confidential and to be protected from discovery in a lawsuit has long been recognized.   Historically, Nebraska’s quality and peer review statutes have provided very limited privilege protection.  Many hospitals performed quality and peer review activities that staff and administrators believed to be privileged but likely were not.  In 2011, the Nebraska Legislature passed The Health Care Quality Improvement Act [...]

7 May, 2013

Diagnostic Errors Account for the Most Malpractice Claims

2018-04-23T23:52:20-05:00May 7th, 2013|Midwest Medical Legal Advisor|

A new study published by the Journal BMJ Quality and Safety sought to characterize the frequency, health outcomes, and economic consequences of medical malpractice claims within the United States.  The study’s authors analyzed closed, paid malpractice claims from the National Practitioner Bank, with claims dating back to 1986.  In total, 350,706 paid claims were analyzed.  Errors in diagnosis accounted for the most medical malpractice claims with 28.6% of paid medical [...]

3 May, 2013

Nebraska Supreme Court rules that Physical Therapists are professionals

2018-04-23T23:57:56-05:00May 3rd, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management|

Earlier, we discussed whether Physical Therapists are professionals and whether a slip and fall can implicate professional negligence.  Last week, the Nebraska Supreme Court, in Churchill v. Columbus Community Hospital, agreed with my unofficial poll where a full 100% of the therapists polled considered physical therapists to be professionals (full disclosure: my polling sample size was one) and found that a slip and fall at a therapist’s clinic implicated professional negligence. The Churchill [...]

30 Apr, 2013

Hospital Policies: Will They be a Burden or a Benefit to You in Litigation?

2018-04-24T00:10:53-05:00April 30th, 2013|Health Care Law, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management|

Hospital policies are adopted for the purpose of providing a safe environment and quality care to patients.  They are also adopted as a means of preventing liability.  It is becoming increasingly common, however, for policies to be used against health care facilities and providers when litigation arises.  By applying a literal interpretation to a policy that does not provide any flexibility in its terms, the plaintiff is able to argue [...]

26 Apr, 2013

The Debate Over Work Hour Restrictions for Doctors in Training

2018-04-23T23:52:20-05:00April 26th, 2013|Health Care Law, Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management|

Time magazine recently published an article highlighting the controversy surrounding work hour restrictions placed upon doctors in training.  Work hour restrictions were initially enacted by the state of New York in 1987 in response to the death of an 18 year old female, caused by a medication prescribing error made by a resident in the middle of a 30 hour work shift.   As a result of the 18 year old’s death, [...]

16 Apr, 2013

Nebraska’s Good Samaritan Law and the Duty to Rescue

2018-04-23T23:52:20-05:00April 16th, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor|

Does anyone remember the last episode from Seinfeld where Jerry, Elaine, George and Kramer end up in jail for failing to help an individual being held up at gunpoint? The arresting police officer cites the town’s “Good Samaritan” law as grounds for the arrest, which purports to impose upon citizens a duty to rescue. Unlike this fictionalized episode from Seinfeld, laws generally do not impose a duty to rescue.  In [...]

12 Apr, 2013

Nevada’s Runaway Jury

2018-04-23T23:57:56-05:00April 12th, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Tort Reform|

A Nevada jury says the state’s largest health management organization is liable for $24 million in compensatory damages to three plaintiffs in a negligence lawsuit stemming from a hepatitis C outbreak that became public in 2008. That was not all.  Unlike Nebraska, Nevada allows punitive damages.  The plaintiffs’ lawyer asked the jury to hold Health Plan of Nevada and Sierra Health Services responsible for another $1 billion in punitive damages [...]

5 Apr, 2013

Understanding Physician Liability Under Nebraska’s So Called “Captain of the Ship” Doctrine

2018-04-23T23:52:20-05:00April 5th, 2013|Midwest Medical Legal Advisor|

With all of the recent cruise ship debacles, I was reminded of a doctrine often applied in malpractice cases informally referred to as the "Captain of the Ship" doctrine.  This doctrine suggests that a surgeon has the ultimate responsibility for the care of the patient, and has a non-delegable duty to ensure that proper care is given while in the operating room.  Simply put, the physician is the captain of the ship during the operation being performed [...]

3 Apr, 2013

Independent Medical Examinations

2018-04-23T23:57:56-05:00April 3rd, 2013|Litigation Tips, Midwest Medical Legal Advisor|

Independent medical examinations are a “hands on” way to evaluate the injuries claimed by a plaintiff.  With the ability (with some limits) of hand-picking the examiner, an IME is a great way to strengthen the defense of a given case. When a plaintiff has placed his medical condition in controversy, and the defending party has good cause, an independent medical examination of the claimant should be allowed. According to Rule [...]

29 Mar, 2013

Missouri Moves to Reinstate Cap on Malpractice Damages

2018-04-24T00:10:06-05:00March 29th, 2013|Health Care Law, Midwest Medical Legal Advisor, Tort Reform|

On a 93-62 vote, the Missouri House passed a measure yesterday to reinstate that state's cap on non-economic damages in medical malpractice cases.  The cap had been declared unconstitutional by the Missouri Supreme Court last summer.  In that decision, the Missouri Supreme Court held that the cap violated the right to trial by jury found in the Missouri Consititution.  The Court found that, because there was a common law right [...]

26 Mar, 2013

Expanding Physician-Patient Confidentiality

2018-04-23T23:52:20-05:00March 26th, 2013|HIPAA, Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management|

On December 20, 2012, the Florida Supreme Court expanded the already far reaching scope of doctor-patient confidentiality.  In the case of Hasan v. Garvar, 2012 WL 6619334 (Fla.), a patient sued a dentist (referred to as Dentist #1 for purposes of this post) after the dentist failed to diagnose and treat a dental condition resulting in a bone infection. The patient subsequently sought treatment from a second dentist.  (Dentist #2).  Dentist [...]

22 Mar, 2013

Oregon passes law allowing presuit mediation of malpractice claims

2018-04-23T23:57:56-05:00March 22nd, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management, Tort Reform|

Oregon recently passed a law, Senate Bill 483, creating a new mediation process for patients injured by medical mistakes.  The law allows injured patients to confidentially discuss, at a mediation, their claim and a possible settlement with the medical provider where the alleged negligence occurred.  What is the upside to this bill?  Participation is obviously voluntary.  Most significantly, the discussions would not be admissible in court if a lawsuit is [...]

12 Mar, 2013

Kansas: 1 Missouri: 0. The score on the constitutionality of non-economic damage caps

2018-04-23T23:57:56-05:00March 12th, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Tort Reform|

Kansas recently became the eighteenth state to hold that statutory caps on non-economic damages are constitutional.  The court in Miller v. Johnson, No. 99,818 (Kan. Oct. 5, 2012) held that a Kansas statute did not violate the plaintiff's right to a trial by jury, due process, or equal protection, nor did it violate the separation of powers. The Miller court cited a number of familiar reasons for upholding the statutory cap [...]

8 Mar, 2013

Overtreatment and MRI’s

2018-04-23T23:52:20-05:00March 8th, 2013|Health Care Law, Midwest Medical Legal Advisor|

The Omaha World Herald published a thought provoking article on the topic of overtreatment and the use of MRI’s in last week’s paper, written by World Herald Columnist Matthew Hansen.  In it, Dr. Thomas Tape from the University Nebraska Medical Center discusses how the health system in this country pushes people into hospitals, rather than out, with unnecessary medical tests, including the overuse of MRI’s, becoming the norm.  According to [...]

5 Mar, 2013

A Few Do’s and Dont’s of Prescribing Medicine

2018-04-23T23:52:20-05:00March 5th, 2013|Health Care Law, Midwest Medical Legal Advisor, Risk Management|

This topic hits close to home.  I am married to a third year resident who is starting his career as a hospitalist in August.  Friends and family frequently ask my husband to write them a prescription for various ailments rather than visit their primary care physician.  His response? "Sorry, unless you come visit me in my clinic and we establish a physician - patient relationship, the Statutes and Regulations in [...]

1 Mar, 2013

Issues with high-low agreements in the medical malpractice context

2018-04-23T23:57:56-05:00March 1st, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management|

Should a high-low agreement waive the right to appeal?  Waiving the right to appeal, and the finality that this brings, is a potential benefit.  However, giving up the right to challenge any error or impropriety in the proceedings has its own risks, including dealing with an overzealous opposing attorney, who may be more willing to push the envelope at trial, knowing that an appeal has been waived.  It is at [...]

26 Feb, 2013

Hospital Employed Physicians May Face Conflicts of Interest

2018-04-24T00:10:06-05:00February 26th, 2013|Health Care Law, Medical Malpractice, Midwest Medical Legal Advisor|

Between 2000 and 2010, the number of doctors employed by hospitals grew by 32 percent, to 212,000.  This unmistakeable trend raises serious questions about potential conflicts of interest that such employment arrangements may create.  For example, some physicians have reported that their hospital employer requires them to use in house lab facilities when the physicians have received better results or better service from an outside lab.  Others have reported that [...]

22 Feb, 2013

The Failure to Pass Board Examinations as Evidence in a Medical Malpractice Trial

2018-04-23T23:52:20-05:00February 22nd, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor|

So, you didn't pass your medical boards?  Or you didn't pass your medical boards on your first try?  Worried how it might affect your career as a physician?  Well, you can rest easy when it comes to malpractice suits.  Generally, a defendant physician's failure to pass board certifications is not admissible as to whether a physician complied with the standard of care.  While performance on a board certifying examination might [...]

18 Feb, 2013

Don’t Let Your Medical Record Invite Litigation

2018-04-24T00:10:06-05:00February 18th, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management|

The medical record can be your best friend or your worst enemy in litigation.  More than that, a well documented record can prevent a lawsuit altogether.  In order to see how, one must understand the process of how a lawsuit comes to pass.  Whenever there is an unexpected or untoward outcome, the patient or the patient's family will have many questions.  The first and best source to answer those questions [...]

15 Feb, 2013

High-low Agreements in the Medical Malpractice Context

2018-04-23T23:57:57-05:00February 15th, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Nebraska Hospital-Medical Liability Act, Risk Management|

In negotiating a high-low agreement in the medical malpractice context, there are any number of issues to consider, including whether a settlement pursuant to such an agreement is reportable to the National Practitioner Data Bank (“NPDB”), whether to waive post-trial motions and the right to appeal, how to deal with comparative fault, taxation of costs, and a hung jury. Generally speaking, a high-low agreement is a contract used to limit [...]

8 Feb, 2013

Court Hears Argument on Whether Physical Therapists are Professionals

2018-04-23T23:57:57-05:00February 8th, 2013|Midwest Medical Legal Advisor|

"Eyes and ears are poor witnesses when the soul is barbarous."  This is the quote that stares down at those presenting oral argument before the Nebraska Supreme Court.  In a dimly lit room, with wood paneled ceiling, concrete walls, seemingly ancient tapestries, and seven learned judges just waiting for their opportunity to test the merits of a position, this quote completes the ambience of this hall of higher jurisprudence. In [...]

7 Feb, 2013

Would Streamlining the Malpractice System Reduce Defensive Medicine?

2018-04-24T00:10:06-05:00February 7th, 2013|Health Care Law, Medical Malpractice, Midwest Medical Legal Advisor, Tort Reform|

Dr. Robert Glattner posted a very interesting article on Forbes.com yesterday that discusses the need for malpractice reform.  It is well worth the read.  I do have a couple of criticisms of his thesis, however. First, Dr. Glattner cites a recent RAND Corporation study for the proposition that "waiting for the resolution of [malpractice] claims can take up more than 10 percent of the average medical career."  While the study [...]

5 Feb, 2013

Stolen Laptop Costs Idaho Hospice $50,000

2018-04-24T00:10:06-05:00February 5th, 2013|Health Care Law, HIPAA, Midwest Medical Legal Advisor|

Last month the U.S. Department of Health and Human Services announced a first-of-its-kind settlement involving a breach of unsecured electronic protected health information.  The Hospice of North Idaho agreed to pay HHS $50,000 to settle potential violations of the HIPAA security rule.  The case arose when the hospice reported to HHS that an unencrypted laptop computer containing the electronic protected health information of 441 patients had been stolen.  During its investigation, [...]

2 Feb, 2013

Falling on Your Scalpel: Admitting Fault in Medical Malpractice

2018-04-24T00:10:06-05:00February 2nd, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor, Risk Management|

In a previous post, I discussed the potential use of an apology to head off medical malpractice litigation.  In this post, I will discuss situations where a complete admission of fault may help bring about a more favorable outcome in such litigation.  Before I do so, however, I want to direct you to a superb article on the subject of physician apologies that was published last week by the Boston [...]

29 Jan, 2013

What is Malpractice?

2018-04-23T23:57:57-05:00January 29th, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor|

What constitutes “malpractice?”  If a patient slips and falls while at the doctor’s office, does that implicate professional negligence?  Generally speaking, malpractice is defined as treatment by a doctor in a manner contrary to accepted standards of care which results in injury to the patient.  In Nebraska, medical malpractice and professional negligence are defined as follows: "Malpractice or professional negligence shall mean that, in rendering professional services, a health care provider [...]

25 Jan, 2013

Surcharge Under Nebraska Hospital-Medical Liability Act Continues to Decline

2018-04-24T00:10:07-05:00January 25th, 2013|Health Care Law, Midwest Medical Legal Advisor, Nebraska Hospital-Medical Liability Act|

The Nebraska Excess Liability Fund provides excess coverage for medical malpractice claims against qualified health care providers in Nebraska.  The provider is responsible for the first $500,000 in coverage, and the Excess Fund provides coverage from $500,000 up to the maximum amount recoverable of $1,750,000.  The Excess Fund is paid for by a surcharge levied on qualified health care providers.  The surcharge is expressed as a percentage of the premium charged for [...]

18 Jan, 2013

HHS Releases Final HIPAA Omnibus Rule

2018-04-24T00:10:07-05:00January 18th, 2013|Health Care Law, HIPAA, HITECH, Midwest Medical Legal Advisor|

The U.S. Department of Health and Human Services yesterday unveiled long awaited changes to the Health Insurance Portability and Accountability Act of 1996 ("HIPAA").  The release is comprised of four final rules combined into a single omnibus rule designed to reduce the impact and number of times certain compliance activities need to be undertaken by regulated entities.  Important provisions include: An expansion of HIPAA's scope to apply many HIPAA provisions [...]

16 Jan, 2013

Are Physical Therapists Professionals?

2018-04-23T23:57:57-05:00January 16th, 2013|Litigation Tips, Medical Malpractice, Midwest Medical Legal Advisor|

According to the U.S. Bureau of Labor Statistics, there were 198,600 physical therapists in 2010.  Over the next 10 years, that number is expected to grow by 39%.  If you ask any physical therapist if he or she consider themselves to be a professional, the vast majority would likely answer in the affirmative.[1]  In my unofficial poll, a full 100% of the therapists polled considered physical therapists to be professionals.  [...]

15 Jan, 2013

Does It Pay To Say You’re Sorry?

2018-04-24T00:10:07-05:00January 15th, 2013|Midwest Medical Legal Advisor, Risk Management|

In the third hour of her deposition, and after over a year of litigation, a plaintiff who was suing over the death of her daughter said, “Nobody ever came to talk to us about what happened.  Nobody ever explained it to us.  It’s like they didn’t care.  We had to file this case to learn the truth.”  We hear these words, or words like them, over and over again in [...]

Go to Top