With the depenalization of professional conduct of the physician in case of adherence to the guidelines proposed by L. 189/2012 the discussion on the quality of the available guidelines in the literature has led the authors to a review with particular regard to stakeholder involvement in the elaboration process. Evident critical points arise in the accessible studies that have used as an assessment tool a scientifically validated questionnaire (Appraisal of Guidelines for Research and Evaluation – AGREE). As a result the solution of the legislature, although useful to contain the phenomenon of defensive medicine, may be useless and ineffective in criminal cases where fundamental and absolute rights, as the right to life and health of patients, are involved.
[Law is jurisprudence: "there is no certainty of tomorrow". Comment to: judgment of the Court of Milan, July 17th 2014]Today, more and more evidence is perfected a peculiar creation process of law: law is jurisprudence!The judgment of the Court of Milan, here under review, sets out a direction completely contrasting with the well-established theory of liability of "social contact" in the health sector.The point at issue? The same for some time, now: the Decree Balduzzi revived the responsibility model in force before the landmark ruling in 1999, or only represented a failure of the Legislator?The jurisprudential debate arises from the interpretation of Article 3 of Law 189 of November 8, 2012, the conversion of D.L. September 13, 2012 n. 158, the notorius "Decree Balduzzi".The Court of Milan promotes the interpretation that the second part of Article 3 of Law n. 189/2012, would change the "living law", making a choice in line with the purpose of containing the costs of compensation of public health and to remedy the phenomenon of so-called "defensive medicine", "throwing to the nettles" the usability in practice of the theory of social contact.The position taken by the Court of Milan cannot be shared: the reference to art. 2043 of the Civil Code must be interpreted as a failure of the Legislator, too worried about reducing health care costs. We must therefore continue to apply the model of liability of art. 1218 of the Civil Code, and then the theory of social contact. Anyway: posterity will judge!
This abrupt increase in demands to a physician and his legal responsibility was not preceded by a related increase in his abilities and resources necessary to adapt to the change in law. This caused the set off of unintended side-effects, which arise from doctors' intent to defend themselves from probable legal prosecution and which brought about a decrease of the quality of health care. Multiple manifestations of defensive medicine and its consequences for health care are reviewed. Ways and prospects for solutions to the problem of "defensive medicine" (especially, ensuring feasibility of related legal provisions) are examined.
This abrupt increase in demands to a physician and his legal responsibility was not preceded by a related increase in his abilities and resources necessary to adapt to the change in law. This caused the set off of unintended side-effects, which arise from doctors' intent to defend themselves from probable legal prosecution and which brought about a decrease of the quality of health care. Multiple manifestations of defensive medicine and its consequences for health care are reviewed. Ways and prospects for solutions to the problem of "defensive medicine" (especially, ensuring feasibility of related legal provisions) are examined.
The paper's authors aim to elaborate on the innovations brought by law n. 24/2017, issued by the Italian Parliament with a close focus on art. 5, which pertains to the drafting of guidelines and the adoption of best practices. The guidelines constitute in fact an element of innovation brought by the above-mentioned law, and compliance with them can shield from possible liability those health care professionals who find themselves embroiled in professional accidents while in the fulfillment of their duties. Besides, there are several critical aspects within the law that need to be highlighted as well. As far as best practices are concerned, the lawmakers who drafted the legislation make no mention as to the standards of evidence needed in order to characterize any given professional behavior as "best practice". The reform appears unlikely to be effective in providing doctors with clear behavioral standards, thus reducing the margin for liability claims against them.
To correctly appreciate the place of the MD in modern French society, 3 points must be made clear: (a) the composition of the med profession, (b) its activities during the past 150 yrs, & (c) the participation of MD's in pol'al life. For several yrs, persistent efforts have made it possible to estimate quite accurately the actual number of practicing MD's in France. In contrast, an ignorance of the way in which the soc action of the group has evolved has been detrimental to the members themselves. Professional org's have ordinarily been limited to defensive activities & have been incapable of furthering any organized med program. Estimates of the number of MD's in local elected groups, in the Assembly & in the ministries leaves little doubt concerning the importance of their pol'al role. However, no systematic res has yet been attempted in this area. Tr by J. A. Broussard from IPSA.
We describe an exemplary case of inadequate health legislation and defensive medicine, regarding umbilical cord tissue collection for personal "private" use.
Any military expeditionary force, whether deployed for offensive or defensive purposes, must be prepared to manage the major and expected by-products of military action—wounded and diseased personnel.
In the first essay, ``Does Government Health Insurance Reduce Job Lock and Job Push?'', I estimate the extent that job mobility is affected by the link between health insurance and employment. Workers holding employment-contingent health insurance (ECHI) are often thought to stay in jobs that are otherwise inferior matches out of fear of losing their ECHI, while those without insurance may leave employment states that are otherwise good matches seeking access to ECHI. These two phenomena are known as job lock and job push, respectively. During the late 1980s and early 1990s, Medicaid expansions resulted in many working class households gaining Medicaid eligibility for one or more family members, an alternative source of health insurance that is not contingent on employment. Using this eligibility as a measure of variation in the dependence on ECHI for health insurance coverage, I find large estimates of job lock and job push for men. Medicaid eligibility for one household member results in an increase in the likelihood of a voluntary job exit for men over a four-month period by approximately 34%. Similarly, moves into jobs with ECHI fall by approximately 25% in response to Medicaid eligibility. For women, I do not find evidence consistent with job lock. For the case of job push, some of my estimates suggest large effects, though these estimates have interpretive difficulties.The second essay, titled ``Does Regulation of Physicians Reduce Health Care Spending?'', examines the fear among physicians that legal liability increases health care spending. Theoretically, the effect of legal risk could be positive or negative on spending, and empirical evidence has supported both cases. Previous empirical work, however, has ignored that physicians face risk from centralized regulators -- industry oversight groups like medical boards -- in addition to civil litigation risk. This paper addresses this omission by incorporating previously unused data on punishments by oversight groups against physicians, known as adverse actions, along with malpractice payments data to study state-level health care spending. My analysis suggests that health care spending does not rise in response to higher levels of risk. An increase in adverse actions equal to 16, the mean year-to-year change within a state, is found to be associated with statistically significant average spending decreases of approximately 0.11% to 0.21%. Malpractice payments were generally estimated to have smaller, statistically insignificant effects.The final essay, ``Preliminary Results On The Effect of Specialist Cost Information on Primary Care Physician Referral Patterns'', reports early results on a field experiment designed to test whether primary care physicians (PCPs) would use information on specialist costs in allocating their patient referrals between doctors within the specialty. The experiment was performed in partnership with a private-sector group of medical practices organized as an Independent Practice Association (IPA). Randomly chosen PCP practices within the IPA were provided with a report listing average cost information for Ophthalmology practices within the IPA. The response of the PCPs is compared to a control group of PCP practices within the IPA to see if the information influenced which Ophthalmology practices received PCP referrals. Analysis of experimental data so far available does not find any effects that are statistically significant at conventional levels. These results, however, are based on data from a very short post-period, and are not considered final. The experiment is ongoing at the time of the writing of this essay.
The principle of precaution, a fundamental, essentially legalistic, rule underpinning health care legislation in France, basically arose from environmental protection policies. This principle became the topic of a good deal of well-publicized debate following the decree concerning HIV contamination rendered in 1993 by the Conseil d'Etat, the supreme jurisdiction on legislative matters in France. This translation of a fundamental principle from one domain to another is not devoid of significance and could have an unexpected impact on the nature and meaning of health care itself. When applied to medicine, the principle of precaution must be confronted with the notion of risk, inherent in all acts of health care. This risk certainly implies patients' rights and informed consent to medical care, but also, in a reasonable search for an acceptable balance between risk and benefit, the freedom of biomedical research from overly-restrictive regulations. Consequently, in accordance with an ethical approach to medical care, legislative and judicial bodies must take into consideration the practical reality of medicine in order to integrate the scientific, economic, social, and psychological aspects of everyday medical practice into health care laws and regulations. Once faced with the reality of health care, the principle of precaution could appear contradictory to the fundamental principles of medicine. Indeed, every physician, every health care worker, makes daily evidence-based decisions that are never devoid of risk. Unrestricted application of the principle of precaution to a growing number of public domains, including medicine, as advocated by a large number of opinion leaders, could lead to an inextricable situation, in total contradiction with the goal of health care itself. In order to develop new truly ethical and adapted health care regulations, we must break down the barriers confining judges and legal representatives to a purely legalistic vision of health care and equally confining physicians to a purely ...
The principle of precaution, a fundamental, essentially legalistic, rule underpinning health care legislation in France, basically arose from environmental protection policies. This principle became the topic of a good deal of well-publicized debate following the decree concerning HIV contamination rendered in 1993 by the Conseil d'Etat, the supreme jurisdiction on legislative matters in France. This translation of a fundamental principle from one domain to another is not devoid of significance and could have an unexpected impact on the nature and meaning of health care itself. When applied to medicine, the principle of precaution must be confronted with the notion of risk, inherent in all acts of health care. This risk certainly implies patients' rights and informed consent to medical care, but also, in a reasonable search for an acceptable balance between risk and benefit, the freedom of biomedical research from overly-restrictive regulations. Consequently, in accordance with an ethical approach to medical care, legislative and judicial bodies must take into consideration the practical reality of medicine in order to integrate the scientific, economic, social, and psychological aspects of everyday medical practice into health care laws and regulations. Once faced with the reality of health care, the principle of precaution could appear contradictory to the fundamental principles of medicine. Indeed, every physician, every health care worker, makes daily evidence-based decisions that are never devoid of risk. Unrestricted application of the principle of precaution to a growing number of public domains, including medicine, as advocated by a large number of opinion leaders, could lead to an inextricable situation, in total contradiction with the goal of health care itself. In order to develop new truly ethical and adapted health care regulations, we must break down the barriers confining judges and legal representatives to a purely legalistic vision of health care and equally confining physicians to a purely ...
