William M. McDonnell

Medical diagnoses commonly associated with pediatric malpractice lawsuits in the united states

In this article we discuss the medical diagnoses underlying the most common lawsuits involving pediatricians in the United States. Where applicable, specific and general risk-management techniques are noted as a means of increasing patient safety and reducing the risk of medical malpractice exposure.

Policy statement - Expert witness participation in civil and criminal proceedings

The interests of the public and both the medical and legal professions are best served when scientifically sound and unbiased expert witness testimony is readily available in civil and criminal proceedings. As members of the medical community, patient advocates, and private citizens, pediatricians have ethical and professional obligations to assist in the administration of justice. The American Academy of Pediatrics believes that the adoption of the recommendations outlined in this statement will improve the quality of medical expert witness testimony in legal proceedings and, thereby, increase the probability of achieving outcomes that are fair, honest, and equitable. Strategies for enforcing guidance and promoting oversight of expert witnesses are proposed.

Lights, camera, action… spotlight on trauma video review: an underutilized means of quality improvement and education.

Background: Trauma video review (TVR) is an effective method of quality improvement and education. The objective of this study was to determine TVR practices in the United States and use of TVR for quality improvement and education. Methods: Adult and pediatric trauma centers identified by the American College of Surgeons (n = 102) and the National Association of Childrens Hospitals and Related Institutions (n = 24) were surveyed by telephone. Surveys included questions regarding program demographics, residency information, and past/present TVR practices. Results: One hundred eight trauma centers (86%) were contacted, and 99% (107/108) completed surveys. Of the surveyed centers, 34% never used TVR; 37% previously used TVR and had discontinued at the time of the survey, with most reporting legal/privacy concerns; 20% were currently using TVR; and 9% were planning to use TVR in the future. Nineteen percent (14/73) of general trauma centers are using or planning to use TVR compared with 50% (17/34) of pediatric centers (P = 0.001). One hundred percent of current TVR programs report that TVR improves the trauma resuscitation process. Most pediatric emergency medicine (87%), emergency medicine (89%), and surgery (97%) trainees participate in trauma resuscitation at trauma centers. Fifty-two percent of centers using TVR report trainee attendance at TVR process/conference; 38% specifically use TVR for resident education. Conclusions: All current TVR programs report that it improves their trauma processes. More pediatric trauma centers report planning future TVR programs, but the implication of such plans remains unclear. Opportunities exist for expanded use of TVR for resident education.

Judicial outcomes of child abuse homicide.

OBJECTIVES To determine whether convictions and sentencing differ between child abuse homicide cases and adult homicide cases and to identify characteristics of the victim, suspect, or crime that influence conviction and sentencing results. DESIGN Retrospective case review. SETTING Homicide data abstracted from the National Violent Death Reporting System in Utah. PARTICIPANTS All deaths classified as homicide in Utah between January 1, 2002, and December 31, 2007. MAIN EXPOSURE Judicial processing of homicide cases for conviction and sentencing results. MAIN OUTCOME MEASURES Conviction rate, level of felony conviction, and severity of sentencing for suspects of child abuse homicide vs adult homicide. RESULTS Utah had 373 homicide victims during the study period; 52 cases were child abuse homicide. Among 211 homicide cases with an identified suspect, conviction rates for child abuse homicide (88.2%) and adult homicide (83.0%) were similar (risk ratio, 1.0; 95% confidence interval [CI], 0.8-1.4). There were no significant differences in level of felony conviction (adjusted risk ratio, 0.8; 95% CI, 0.4-1.3) or severity of sentencing (adjusted risk ratio, 0.8; 95% CI, 0.5-1.5) for suspects of child abuse homicide vs adult homicide. Among child abuse homicide cases, no demographic factor was significantly associated with felony conviction results. CONCLUSION Suspects of child abuse homicide are convicted at a rate similar to that of suspects of adult homicide and receive similar levels of felony conviction and severity of sentencing.

Expert Witness Participation in Civil and Criminal Proceedings

The interests of the public and both the medical and legal professions are best served when scientifically sound and unbiased expert witness testimony is readily available in civil and criminal proceedings. As members of the medical community, patient advocates, and private citizens, pediatricians have ethical and professional obligations to assist in the civil and criminal judicial processes. This technical report explains how the role of the expert witness differs in civil and criminal proceedings, legal and ethical standards for expert witnesses, and strategies that have been employed to deter unscientific and irresponsible testimony. A companion policy statement offers recommendations on advocacy, education, research, qualifications, standards, and ethical business practices all aimed at improving expert testimony.

Disclosure of adverse events in pediatrics

Despite increasing attention to issues of patient safety, preventable adverse events (AEs) continue to occur, causing direct and consequential injuries to patients, families, and health care providers. Pediatricians generally agree that there is an ethical obligation to inform patients and families about preventable AEs and medical errors. Nonetheless, barriers, such as fear of liability, interfere with disclosure regarding preventable AEs. Changes to the legal system, improved communications skills, and carefully developed disclosure policies and programs can improve the quality and frequency of appropriate AE disclosure communications.

Relative Productivity of Nurse Practitioner and Resident Physician Care Models in the Pediatric Emergency Department

Objectives Duty hour restrictions limit the use of resident physicians in pediatric emergency departments (PEDs). We sought to determine the relative clinical productivity of PED attending physicians working with residents compared with PED attending physicians working with nurse practitioners (NPs). Methods In a tertiary care PED with multiple care models (PED attending physicians with residents and/or fellows, PED attending physicians with NPs, PED attending physicians alone), we identified periods when care was provided concurrently and exclusively by a PED attending physician with 1 to 2 residents (resident pod) and a PED attending physician with 1 NP (NP pod). Billing records were reviewed to determine relative value units (RVUs) generated and patients seen by each PED attending physician. Emergency Severity Index (ESI) triage scores were used to compare patient acuities. Results The NP pods generated 5.35 RVUs per hour and the resident pods generated 4.35 RVUs per hour, with a significant difference of 1.00 RVUs per hour (95% confidence interval, 0.19–1.82). The NP pods saw 2.18 patients per hour, whereas the resident pods saw 1.90 patients per hour. This difference of 0.28 was not statistically significant (95% confidence interval, −0.07 to 0.62). Patient acuity was similar. Thirteen percent of the NP pod patients had the highest triage severity levels of ESI-1 and ESI-2, whereas 19% of the resident pod patients were ESI-1 and ESI-2 (P = 0.06). Conclusions Pediatric emergency department attending physicians in an NP care model had greater clinical productivity, measured by RVUs, than PED attending physicians in a resident care model while treating similar patient populations.

Policy statement - Professional liability insurance and medicolegal education for pediatric residents and fellows

The American Academy of Pediatrics believes that pediatric residents and fellows should be fully informed of the scope and limitations of their professional liability insurance coverage while in training. The academy states that residents and fellows should be educated by their training institutions on matters relating to medical liability and the importance of maintaining adequate and continuous professional liability insurance coverage throughout their careers in medicine.

Challenging assumptions about uninsured children in the pediatric emergency department

Objective Emergency departments (EDs) are experiencing increased volumes and crowding problems. Although crowding is often blamed on uninsured patients, the role of uninsured children is unclear. We compared ED use by insured and uninsured children. Methods Parents of children presenting at a tertiary care pediatric hospital ED were surveyed to determine health insurance coverage and frequency of ED use. Hospital billing records were reviewed separately to validate our survey results. Results were compared with Census Bureau data on the prevalence of uninsured children. Results We enrolled 2024 participants in the survey arm. Of all children 48.4% (n = 972) were privately insured, 42.1% (n = 846) have government insurance, and 9.5% (n = 191) were uninsured. Billing records showed that 10.2% (n = 3825) of pediatric ED patients during the previous year were uninsured. Census data showed that 13% of children statewide were uninsured. Among survey subjects, uninsured children were more likely than privately insured children (53% vs 42%), but less likely than children with government insurance (67%), to have moderate ED use (≥1 additional ED visit in 12 months; P < 0.001) or frequent ED use (≥5 visits in 12 months; 4% vs 2% vs 8%; P < 0.001). When private and government insurance categories were combined, uninsured children showed no greater likelihood of moderate ED use (53% vs 53%, P = 0.89) or frequent ED use (4% vs 5%, P = 0.71) than insured children did. Conclusions Uninsured pediatric patients were not disproportionately represented in the ED population. Moreover, uninsured children were not more likely than insured children to be moderate or frequent ED users.

Bruesewitz v Wyeth: Ensuring the Availability of Children's Vaccines

On February 22, 2011, in the case of Bruesewitz v Wyeth ,1 the US Supreme Court preserved the crucial role of the National Childhood Vaccine Injury Act (NCVIA) in ensuring the continuing availability of childrens vaccines in the United States. Although at first glance the Bruesewitz case may seem to be simply a technical decision that addressed the legal intricacies of products liability law, the case has important implications for pediatricians, their patients, and the continuity of our vaccine supply. By the 1980s, vaccines had become so successful at preventing many infectious diseases that the public was becoming much less alarmed by those diseases2 and much more concerned with the risk of injury from the vaccines themselves.3 As a result, the number of lawsuits alleging vaccine-related injuries exploded, driving manufacturers from the market and producing vaccine shortages. In 1986, the US Congress enacted … Address correspondence to Gary N. McAbee, DO, JD, Department of Neuroscience, New Jersey Neuroscience Institute, 65 James St, Edison, NJ 08818. E-mail: gmcabee{at}solarishs.org