Errors litigation

Medication errors are costly to both the patient (direct costs such as additional treatment and increased hospital stay) and to society (indirect costs such as decreased employment, costs of litigation) [1,5]. The cost of medication errors in a 700-bed teaching hospital based on a study in eleven medical and surgical units in two hospitals over a six-month period, was estimated to be 2.8 million dollars annually [2]. The increased length of stay associated with a medication error was estimated to be 4.6 days [2]. In a four-year study of the eosts of adverse drug events (ADEs) in a tertiary care center, 1% of these events were elassified as medication errors. The excess hospital costs for ADEs over the study period were almost 4,500,000 with almost 4,000 days of increased hospital stay [12]. 

Realizing that the decisions of accident victims to litigate and of litigants to settle are not random yields several insights. First, few litigated cases involve facts that lie far from the decision standards that courts use to render judgments. Plaintiffs and defendants make errors about the relationship between the facts of their particular cases and the rules used by courts to separate successful from unsuccessful torts, but large errors are uncommon (Priest and Klein 1984 Priest 1985, 220). 

Safety and risk considerations are often at the center of mistake proofing. Imagine the risk associated with unveiling new investment software, or with implementing a new surgical procedure. Both the financial and health care industries have a host of mistake-proofing measures in place to avoid costly errors and litigation. 

In toxic tort and product liability litigation, the admissibility of new risk assessment methods and data must be approved by the trial judge before being presented to the jury. The U.S. Supreme Court announced a new standard for the admission of scientific data in 1993 in its Daubert decision (Daubert 1993). Under this new standard, federal judges must serve as a gatekeeper to ensure that scientific evidence is reliable and relevant, which includes an assessment of whether the evidence (i) has been empirically tested, (ii) has a known rate of error, (iii) has been peer-reviewed and published, and (iv) is generally accepted within the relevant scientific field. Many state courts have adopted a similar standard, although some still apply the earlier standard on admissibility (Frye 1923), which is whether the evidence is... 

Studdert, D.M., Mello, M.M., Gawande, A.A. etal. (2006) Claims, errors, and compensation payments in medical malpractice litigation. The New England Journal of Medicine, 354(19), 2024-2033. 

Disclosure enhances learning for the clinician and institution. Disclosure enables the patient to obtain appropriate treatment/understanding. Disclosing errors and harm does not result in increased litigation. 

The risk of litigation increases when patients or families sense deception. Some clinicians believe that medical errors or unanticipated outcomes can appear as a negligent disclosure of error or the error it could create liability risks (Table 13.7). 

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