Overview of Medico-legal Issues

  • I. W. FongEmail author
Part of the Emerging Infectious Diseases of the 21st Century book series (EIDC)


Medical malpractice litigation is usually the result of an unexpected and undesirable outcome in our customers (patients) and when the affected individual or family perceives the outcome as being due to carelessness or poor clinical care. In the present era of modern medicine, the management of any given patient involves many layers of physicians and health care professionals from encounter to completion of care, for any specific condition. With this complexity of medical care, there is an increased risk of some error along the route towards the end result of cure or achieving relief and patient satisfaction. As a result, each health professional owes a separate duty to the patient within his or her area of practice. Although an individual health professional is not directly liable for the mistakes of others, in complex cases with multiple encounters by several health professionals, it is often difficult to determine the individual responsible for the outcome. However, in many of the cases, despite checks along the way involving multiple layers of health care workers, errors are often overlooked and missed by several health professionals.


Medication Error Adverse Drug Event Diagnostic Error Permanent Disability Cognitive Error 
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  1. 1.
    Schiff GD, Kim S, Abrams R, Cosby K, Lambert B, Elstein AS, Hasler S, Krosnjar N, Odwazny R, Wisniewski MF, McNutt RA (2003). Diagnosing diagnostic errors: lessons in patient safety: From Research to Implementation, vol. 2. Rockville, MD. Agency for Health Care Research and Quality p255–278. AHRQ Publication No. 050021.Google Scholar
  2. 2.
    Golodner L (2004). How the public perceives patient safety. Newsletter of the National Patient Safety Foundation. 1997:1–6.Google Scholar
  3. 3.
    Shojania KG, Burton EC, McDonald KM, Goldman L (2003). Changes in rates of autopsy-detected diagnostic errors over time. A systematic review. JAMA 289:2849–2856.PubMedCrossRefGoogle Scholar
  4. 4.
    Sato L (2001). Evidence-based patient safety and risk management technology. J Qual Improv 27:435.Google Scholar
  5. 5.
    Phillips R, Bartholomew L, Dovey S, Fryer GE Jr, Miyoshi TJ, Green LA (2004). Learning from malpractice claims about negligent adverse events in primary care in the United States. Qual Saf Health Care 13:121–126.PubMedCrossRefGoogle Scholar
  6. 6.
    Graber ML, Franklin N, Gordon R (2005). Diagnostic error in internal medicine. Arch Intern Med 165:1493–1499.PubMedCrossRefGoogle Scholar
  7. 7.
    You Gov Survey of Medical Misdiagnosis (2005). Isabel Healthcare – Clinical Decision Support System. Available at:
  8. 8.
    Burroughs TE, Waterman AD, Gallagher TH, Waterman B, Adams D, Jeffe DB, Dunagan WC, Garbutt J, Cohen MM, Cira J, Inguanzo J, Fraser VJ (2005). Patient concern about medical errors in emergency departments. Acad Emerg Med 23:57–64.CrossRefGoogle Scholar
  9. 9.
    Elstein AS (1995). Clinical reasoning in medicine. IN: Higgs JJM (ed). Clinical reasoning in the Health Professions. Butterworth-Heineman Ltd, Oxford, England, p49–59.Google Scholar
  10. 10.
    Berner ES, Graber ML (2008). Overconfidence as a cause of diagnostic error in medicine. Am J Med 121: S21–S23.CrossRefGoogle Scholar
  11. 11.
    Croskerry P (2003). Cognitive forcing strategies in clinical decision making. Ann Emerg Med 142:110–120.CrossRefGoogle Scholar
  12. 12.
    Redelmeier DA (2005). The cognitive psychology of missed diagnosis. Ann Intern Med 142:115–120.PubMedGoogle Scholar
  13. 13.
    Brennan TA, Leape LL, Laird NM, Herbert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH, (1991). Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med 324:370–376.PubMedCrossRefGoogle Scholar
  14. 14.
    Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, Etchells E, Ghali WA, Hėbert P, Majumdar SR, O’Beirne M, Palacios-Derflingher L, Reid RJ, Sheps S, Tamblyn R (2004). The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 170:1678–1686.PubMedGoogle Scholar
  15. 15.
    Wilson RM, Runciman WB, Gibberd RW, Harrison BT, Newby L, Hamilton JD (1995). The quality in Australian Health Care Study. Med J Aust 163:458–471.PubMedGoogle Scholar
  16. 16.
    Davis P, Lay-Yee R, Briant R, Ali W, Scott A, Schug S (2002). Adverse events in New Zealand public hospitals 1: occurrence and impact. N Z Med J 115:U271 (1167).PubMedGoogle Scholar
  17. 17.
    Vincent C, Neale G, Woloshynowych M (2001). Adverse events in British Hospitals: preliminary retrospective chart review. BMJ 322:517–519.PubMedCrossRefGoogle Scholar
  18. 18.
    Schiǿler, T, Lipczak H, Pedersen BL, Mogensen, TS, Bech RB, Stockmarr A, Svenning AR, Frolich A (2001). Danish Adverse Event Study. Incidence of adverse events in hospitals. A retrospective study of medical records. Ugeskr Laeger 163:5370–5378.PubMedGoogle Scholar
  19. 19.
    Thomas EJ, Brennan TA (2000). Incidence and types of preventable adverse events in elderly patients: population based review of medical records. BMJ 320:741–744.PubMedCrossRefGoogle Scholar
  20. 20.
    Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, William EJ, Howard KM, Weiler PC, Brennan TA (2000). Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 38:261–271.PubMedCrossRefGoogle Scholar
  21. 21.
    Zed PJ, Abu-Laban RB, Balen RM, Loewen PS, Hohl CM, Brubucher JR, Wilbur K, Wiens MO, Samoy LJ, Lacaria K, Pursell RA (2008). Incidence, severity and preventability of medication-related visits to the emergency department: a prospective study. CMAJ 178:1563–1569.PubMedGoogle Scholar
  22. 22.
    Leape L, Brennan TA, Laird N, Lawthers AG, Localio R, Barnes BA, Hebert L, Newhouse JP, Weiler PC, Hiatt H (1991). The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 324:377–384.PubMedCrossRefGoogle Scholar
  23. 23.
    Fisher G, Fetters MD, Munro AP, Goldman EB (1997). Adverse events in primary care identified from a risk-management database. J Fam Pract 45:40–46.Google Scholar
  24. 24.
    Wilson T, Sheikh A (2002). Enhancing public safety in primary care. BMJ 324:584–587.PubMedCrossRefGoogle Scholar
  25. 25.
    Elder NC, Dovey SM (2002). Classification of medical errors and preventable adverse events in primary care: a synthesis of the literature. J Fam Pract 51:927–932.PubMedGoogle Scholar
  26. 26.
    Flynn EA, Barker KN (2007). Research on errors in dispensing and medication administration. IN: Cohen MR (ed). Medication Errors, 2nd Edition, American Pharmacists Association: Washington DC, p15–41.Google Scholar
  27. 27.
    Leape LL (2007). Systems analysis and redesign: the foundation of medical error prevention. IN: Cohen MR (ed). Medication Errors, 2nd Edition, American Pharmacists Association: Washington DC, p3–14.Google Scholar
  28. 28.
    Cohen MR (2007). Causes of medication errors. IN: Cohen MR (ed). Medication Errors, 2nd Edition, American Pharmacists Association: Washington DC, p55–66.Google Scholar
  29. 29.
    Kohn LT, Corrigan JM, Donalson MS (eds) (2000). To Err is Human: Building a Safer Health System. National Academics Press, Washington DC.Google Scholar
  30. 30.
    Teagarden JR (2007). The clinical bioethics of safe medication practice. IN: Cohen MR (ed). Medication Errors, 2nd Edition, American Pharmacists Association: Washington DC, p587–604.Google Scholar
  31. 31.
    Hepler CD, Strand LM (1990). Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm 47:533–543.PubMedGoogle Scholar
  32. 32.
    Bartlett G, Blais R, Tamblyn R, Clermont RJ, MacGibbon B (2008). Impact of patient communication problems on the risk of preventable adverse events in acute care settings. CMAJ 198:1555–1562.Google Scholar
  33. 33.
    WHO (1972). International drug monitoring: the role of national centers. Tech Rep Ser. WHO no. 498.Google Scholar
  34. 34.
    Edwards IR, Aronson JK (2000). Adverse drug reactions: definition, diagnosis and management. Lancet 356:1255–1259.PubMedCrossRefGoogle Scholar
  35. 35.
    Lazarou J, Pomeranz BH, Corey PN (1998). Incidence of adverse drug reactions in hospitalized patients. JAMA 279:1200–1205.PubMedCrossRefGoogle Scholar
  36. 36.
    Khong TK, Singer DRJ (2002). Adverse drug reactions: current issues and strategies for prevention and management. Expert Opin Pharmacother 3:1289–1300.PubMedCrossRefGoogle Scholar
  37. 37.
    Wasserfallen J, Livio F, Buclin T, Tillet L, Yersin B, Biolaz J (2001). Rate, type and cost of adverse drug reactions in emergency department admissions. Eur J Int Med 12:442–447.CrossRefGoogle Scholar
  38. 38.
    Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, Small SD, Sweitzer BJ, Leape LL (1997). The costs of adverse drug events in hospitalized patients. JAMA 277:307–311.PubMedCrossRefGoogle Scholar
  39. 39.
    Classen DC, Pestotnik S, Evans RS, Lloyd JF, Burke JP (1997). Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA 277:301–306.PubMedCrossRefGoogle Scholar
  40. 40.
    Poon EG, Keohane CA, Yoon CS, Ditmore M, Bane A, Levtzion-Korach O, Moniz T, Rothschild JM, Kachalia AB, Hayes J, Churchill WW, Lipsitz S, Whittemore AD, Bates DW, Gandhi TK (2010). Effect of bar-code technology on the safety of medication administration. N Engl J Med 362:1698–1707.PubMedCrossRefGoogle Scholar
  41. 41.
    Gallaher TH, Studdert DM, Levinson W (2007). Disclosing harmful medical errors to patients. N Engl J Med 356:2713–2719.CrossRefGoogle Scholar
  42. 42.
    Kraman SS, Hamm G (1999). Risk management: extreme honesty may be the best policy. Ann Intern Med 131:963–987.PubMedGoogle Scholar
  43. 43.
    Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldman DA, Sharek PJ (2010). Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 363:2124–2134.PubMedCrossRefGoogle Scholar
  44. 44.
    Kachalia A, Kaufman SR, Boothman R, Anderson S, Welch K, Saint S, Rogers MA (2010). Liability claims and costs before and after implementation of a medical error disclosure program. Ann Intern Med 153:213–221.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.St. Michael’s HospitalUniversity of TorontoTorontoCanada

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