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Evidence-Based Pathology and Tort Law: How Do They Compare?

Chapter

Abstract

All physicians, including pathologists, work in an environment where most diagnostic problems can be resolved using the certainty of widely accepted facts, and therefore major diagnostic disagreements are uncommon. However, some degree of uncertainty is inevitable when dealing with complex biological systems, and this uncertainty is one factor leading to disagreements. It has increasingly been accepted that an evidence-based approach to both scientific investigation and medical practice is the best approach to reducing uncertainty. Unfortunately, due to deficiencies in current knowledge, some areas of uncertainty cannot be resolved scientifically, and pathologists must rely on the ad hoc use of factors such as authority, consensus, experience, and best judgment to resolve disagreements.

When the tort system addresses allegations of malpractice, it too deals in medical certainty anduncertainty. Disagreements are both routine and contentious, but in contrast to medical practice, the methodology for resolution is highly structured. This methodology leads the tort system to its own conclusions about what is established medical knowledge, what is an area of legitimate medical uncertainty, and what actions by physicians are “standard of care” in these settings. Because the legal system and medicine employ quite different methodology to evaluate physician’s actions, the tort system’s resolution of cases can differ from scientifically-based medical opinion. It has been suggested that improving the scientific quality of physician expert opinion would improve the scientific quality of the decisions reached by tort system. However, efforts aimed at closing the gap between admissible expert testimony and generally accepted medical opinion are in direct conflict with the right of the opposing sides to present their strongest case. In certain jurisdictions, judges now have the power to exclude “outlier” testimony, and undoubtedly, in some instances this has helped jurors to better understand cases.

Physicians would welcome more effective efforts to improve the scientific validity of decisions rendered in malpractice cases, but currently, reform requires that the legal profession itself comes to a consensus that reform is needed. In the absence of this consensus, making even minor changes in legal procedures is extremely difficult. However, when malpractice cases require pathology expert testimony, pathologists themselves have the power to elevate the tort system’s scientific standards. By agreeing to provide expert opinion, and by committing to providing only testimony that is clear, honest, and credible, pathologists enable tort proceedings to function more scientifically, and at the same time they protect their colleagues from the damaging effects of scientifically shabby opinions..

Keywords

Evidence-based pathology Tort law in medicine Evidence-based pathology in the legal system Medical malpractice and evidence-based medicine 

References

  1. 1.
    Hyman DA. Medical malpractice and the tort system: what do we know and what (if anything) should we do about it? Published as part of a symposium on civil justice in the Texas Law Review, Vol. 80, No. 7, June 2002. Available at http://www.law.umaryland.edu. Accessed 2 Oct 2005.
  2. 2.
    Malpractice mythology (Editorial). The New York Times. January 9, 2005. Available at http://www.nytimes.com. Accessed 9 Jan 2005.
  3. 3.
    Berenson A. Jury finds Merck liable in the Vioxx death and awards $253 million. The New York Times. August 19, 2005. Available at http://www.nytimes.com. Accessed 19 Aug 2005.
  4. 4.
    Olson W. The next Sandra Day. The Wall Street Journal. July 7, 2005. p. A12.Google Scholar
  5. 5.
    Olson W. Justice served, sometimes. The Wall Street Journal. September 8, 2005. p. D10.Google Scholar
  6. 6.
    Wick MR, Adams RK. Medical malpractice actions: procedural elements. Semin Diagn Pathol. 2007;24:60–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Foucar E, Wick MR. Evidence-based medicine and tort law. Semi Diagn Pathol. 2005;22:167–176.PubMedCrossRefGoogle Scholar
  8. 8.
    Feld AD, Carey WD. Expert witness malfeasance: how should specialty societies respond? Am J Gastroenterol. 2005;100:991–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Cecil JS. Ten years of judicial gatekeeping under Daubert. Am J Public Health. 2005;95:S74–80.PubMedCrossRefGoogle Scholar
  10. 10.
    Rosenbaum S. The impact of United States law on medicine as a profession. JAMA. 2003;289:1546–56.PubMedCrossRefGoogle Scholar
  11. 11.
    Steinbrook R. Science, politics, and federal advisory committees. N Engl J Med. 2004;350:1454–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Huber PW. Galileo’s revenge: junk science in the courtroom. New York: Basic Books; 1991.Google Scholar
  13. 13.
    U.S. Supreme Court, Tanner v United States, 483 U.S. 107 (1987). Available at http://caselaw.lp.findlaw.com. Accessed 12 Aug 2004.
  14. 14.
    Vidmar N. Expert evidence, the adversarial system, and the jury. Am J Public Health. 2005;95:S137–43.PubMedCrossRefGoogle Scholar
  15. 15.
    Miller JF. Should juries hear complex cases? Duke Law & Technical Review. April 2, 2004. Available at http://www.law.duke.edu. Accessed 11 Jan 2005.
  16. 16.
    Bal R, Bijker WE, Hendriks R. Democratisation of scientific advice. BMJ. 2004;329:1339–41.PubMedCrossRefGoogle Scholar
  17. 17.
    Ezrahi Y. Nature as dogma. Book review of: politics of nature: how to bring the sciences into democracy. Bruno Latour. Harvard University Press; 2004. Am Sci. 2005;93:89–90.Google Scholar
  18. 18.
    Foucar E. Diagnostic decision making in anatomic pathology. Am J Clin Pathol. 2001;116(Suppl):S21–33.PubMedGoogle Scholar
  19. 19.
    McDougal L. I trust juries – and Americans like you. Newsweek. December 22, 2003. p. 16.Google Scholar
  20. 20.
    Olson W. Stop the shakedown. The Wall Street Journal. October 29, 2004. p. A14.Google Scholar
  21. 21.
    Mohr JC. American medical malpractice litigation in historical perspective. JAMA. 2000;283:1731–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Murray I. The malpractice economist: liable to suffer. The American Enterprise. September 2003. p. 50–1.Google Scholar
  23. 23.
    Zhang J. How much soy lecithin is in that cookie? The Wall Street Journal. October 13, 2005. p. D1.Google Scholar
  24. 24.
    Simon R. Payback time for dot-com investors. The Wall Street Journal. February 1, 2005. p. D1.Google Scholar
  25. 25.
    Crossen C. A thirties revelation: rich people who steal are criminals, too. The Wall Street Journal. October 15, 2003. p. B1.Google Scholar
  26. 26.
    Martinson BC, Anderson MS, de Vries R. Scientists behaving badly. Nature. 2005;435:737–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Saks MJ, Koehler JJ. The coming paradigm shift in forensic identification science. Science. 2005;309:892–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Junghans C, Feder G, Hemingway H, Timmis A, Jones M. Recruiting patients to medical research: double blind randomized trial of “opt-in” and ­“opt-out” strategies. BMJ. 2005;331:940–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Judge declares mistrial in case of Ohio highway shootings. The Associated Press. May 9, 2005. Available at http://www.nytimes.com. Accessed 9 May 2005.
  30. 30.
    Fridman DS, Janoe JS. Judicial gatekeeping in New Mexico. From The Judicial Gatekeeping Project. 1999. Available at http://cyber.law.harvard.edu/daubert/nm.htm. Accessed 15 June 2005.
  31. 31.
    Michaels D. Scientific evidence and public policy. Am J Public Health. 2005;95:S5–7.PubMedCrossRefGoogle Scholar
  32. 32.
    Silicosis, Inc. (Editorial). The Wall Street Journal. October 27, 2005. p. A20.Google Scholar
  33. 33.
    Tesoriero HW, Brat I, McWilliams G, Martinez B. Merck loss jolts drug giant, industry. In landmark Vioxx case, jury tuned out science, explored coverup angle. The Wall Street Journal, August 22, 2005. p. A1.Google Scholar
  34. 34.
    Halpern SD. Towards evidence based bioethics. BMJ. 2005;331:901–3.PubMedCrossRefGoogle Scholar
  35. 35.
    Lipton P. Testing hypotheses: prediction and prejudice. Science. 2005;307:219–21.PubMedCrossRefGoogle Scholar
  36. 36.
    Albert T. Expert witness sues critics. American Medical News. June 28, 2004. p. 1.Google Scholar
  37. 37.
    Milunsky A. Lies, damned lies, and medical experts: the abrogation of responsibility by specialty organizations and a call for action. J Child Neurol. 2003;18:413–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Petroski H. Technology and the humanities. American Scientist. 2005;93:304–7.Google Scholar
  39. 39.
    Mawer S. Science in literature. Nature. 2005;434:297–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Byatt AS. Fiction informed by science. Nature. 2005;434:294–6.PubMedCrossRefGoogle Scholar
  41. 41.
    Jacobson PD, Bloche MG. Improving relations between attorneys and physicians. JAMA. 2005;294:2083–5.PubMedCrossRefGoogle Scholar
  42. 42.
    Andrews M. Making malpractice harder to prove. The New York Times. December 21, 2003. Available at: http://www.nytimes.com. Accessed 21 Dec 2003.
  43. 43.
    Victoroff MS. Peer review of the inexpert witness, or…Do you trust the chickens to guard the coop? Managed Care, September 2002. Available at http://managedcaremag.com. Accessed 7 Aug 2003.
  44. 44.
    Begley S. Ban on “junk science” also keeps jurors from sound evidence. The Wall Street Journal. June 27, 2003. p. B1.Google Scholar
  45. 45.
    Troxel DB. Error in surgical pathology. Am J Surg Pathol. 2004;28:1092–5.PubMedCrossRefGoogle Scholar
  46. 46.
    Sandlin S. Unser malpractice lawsuit is settled. ABQ Journal.com online edition, October 4, 2005. Available at http://abqjournal.com. Accessed 25 Oct 2005.
  47. 47.
    Hupert N, Lawthers AG, Brennen TA, Peterson LM. Processing the tort deterrent signal: a qualitative study. Soc Sci Med. 1996;43:1–11.PubMedCrossRefGoogle Scholar
  48. 48.
    Budetti PP. Tort reform and the patient safety movement. Seeking a common ground. JAMA. 2005;293:2660–2.PubMedCrossRefGoogle Scholar
  49. 49.
    Gold JA. Malpractice. Book review of: Medical malpractice: a physician’s source-book. Anderson RE, editors. Humana Press; 2005. JAMA. 2005;293:1393.Google Scholar
  50. 50.
    The Publisher’s Editorial Staff, Nolan JR, Nolan-Haley JM. Black’s law dictionary (Centennial Edition). 1990. St. Paul: West Group.Google Scholar
  51. 51.
    Reay DT, Davis GJ, and the members of the CAP Forensic Pathology Committee. Legal basis for civil claims ( Chapter 6). In: The pathologist in court. A Publication of the College of American Pathologists; 2003. p. 27–33.
  52. 52.
    Sunstein CR. Courting division. The New York Times. October 6, 2005. Available at http://www.nytimes.com. Accessed 6 Oct 2005.
  53. 53.
    Epstein JI. Pathologists and the judicial system: how to avoid it. Am J Surg Pathol. 2001;25:527–37.PubMedCrossRefGoogle Scholar
  54. 54.
    Rylander E. Negative smears in women developing invasive cervical cancer. Acta Obstet Gynecol Scand. 1977;56:115–8.PubMedCrossRefGoogle Scholar
  55. 55.
    Wick MR. Medicolegal liability in surgical pathology: a consideration of underlying causes and selected pertinent concepts. Semin Diagn Pathol. 2007;24:89–97.PubMedCrossRefGoogle Scholar
  56. 56.
    Dalrymple T. Trial by human beings. The jury system and its discontents. Natl Rev. 2005;25:30–1.Google Scholar
  57. 57.
    Balko R. Justice often served by jury nullification. July 28, 2005. Fox News Channel. Available at http://foxnews.com. Accessed 28 July 2005.
  58. 58.
    Be prepared (Professional Issues). Interview with Sara C. Charles and Paul Frisch. American Medical News. July 11, 2005. p. 14–5.Google Scholar
  59. 59.
    Reay DT, Davis GJ, and the members of the CAP Forensic Pathology Committee. Courtroom etiquette ( Chapter 11). In: The pathologist in court. College of American Pathologists; 2003. p. 56–9.
  60. 60.
    Petroski H. Daubert and Kumho. American Scientist. 1999;87:402–6.Google Scholar
  61. 61.
    US Supreme Court, 509 U.S. 579. Daubert v Merrell Dow Pharmaceuticals, Inc. 1993. Available at http://supct.law.cornell.edu. Accessed 10 Sep 2003.
  62. 62.
    US Supreme Court, 522 U.S. 136. General Electric Co v Joiner. 1997. Available at http://supct.law.cornell.edu. Accessed 10 Sep 2003.
  63. 63.
    U.S. Supreme Court, 526 U.S. 137. Kumho Tire Company v Patrick Carmichael. 1999. Available at http://supct.law.cornell.edu. Accessed 10 Sept 2003.
  64. 64.
    Jasanoff S. Law’s knowledge: science for justice in legal settings. Am J Public Health. 2005;95: S49–58.PubMedCrossRefGoogle Scholar
  65. 65.
    Faigman DL. Is science different for lawyers? Science. 2002;297:339–40.PubMedCrossRefGoogle Scholar
  66. 66.
    Foucar E. Pathology expert witness testimony and pathology practice: a tale of two standards. Arch Pathol Lab Med. 2005;129:1268–76.PubMedGoogle Scholar
  67. 67.
    Kassirer JP, Cecil JS. Inconsistency in evidentiary standards for medical testimony. Disorder in the courts. JAMA. 2002;288:1382–7.PubMedCrossRefGoogle Scholar
  68. 68.
    Gutheil TG, Hauser M, White MS, Spruiell G, Strasburger LH. The “whole truth” versus the “admissible truth”: an ethics dilemma for expert witnesses. J Am Acad Psychiatry Law. 2003;31:422–7.PubMedGoogle Scholar
  69. 69.
    Appelbaum PS. Law and psychiatry: policing expert testimony: the role of professional organizations. Psychiatr Serv. 2002;53:389–99.PubMedCrossRefGoogle Scholar
  70. 70.
    “Expert” witness gets booted from ACR. Diagnostic imaging online. July 8, 2004. Available at http://­diagnosticimaging.com. Accessed 31 Oct 2004.
  71. 71.
    Neufeld PJ. The (near) irrelevance of Daubert to criminal justice and some suggestions for reform. Am J Public Health. 2005;95:S107–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of PathologyUniversity of Virginia Medical SchoolCharlottesvilleUSA

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