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The Committee
on Professional Liability’s activities involve
data gathering and analysis, education and responses
to medical liability issues.
Data Collection and Analysis
The committee’s primary efforts involve the
Closed Claims Project with additional data collection
by the Pediatric Perioperative Cardiac Arrest Registry
and the Postoperative Visual Loss Registry.
The Closed Claims Project depends upon the services
of its core staff as well as a hard-working group
of volunteer members from ASA. The Closed Claims Project
owes an enormous debt of gratitude to the 89 ASA members
who are currently on our list of active volunteer
reviewers. During 2003, 26 reviewers spent a total
of 68 days reviewing 709 claims. I would like to take
this opportunity to acknowledge those ASA members
who are on our list of active volunteers and have
submitted more than 100 claims each to the database:
James F. Black, M.D., Patrick K. Birmingham, M.D.,
John T. Bonner, M.D., Bruce R. Brookens, M.D., David
E. Byer, M.D., Michael G. Cassaro, M.D., Frederick
W. Cheney, M.D., Melvin A. Cohen, M.D., Karen B. Domino,
M.D., Richard M. Dsida, M.D., Peter L. Hendricks,
M.D., Robert E. Kettler, M.D., Helen T. O’Keeffe,
and Gary W. Welch, M.D., Ph.D. We continue to welcome
new closed claims reviewers. To obtain an application
form, please contact Project Manager Karen Posner,
Ph.D., at <posner@u.washington.edu>.
To date more than 6,500 closed claims have been acquired
from 35 insurance organizations. These companies currently
insure more than 14,500 anesthesiologists. Efforts
continue to expand the database by collecting claims
from participating companies at regular intervals
and by recruiting new companies that strengthen the
geographic distribution of the database. More than
300 new claims are entered into the database each
year. Ongoing data collection is crucial as the acquisition
of new claims improves the ability to study rare injuries
that may be difficult to understand as isolated events.
Ongoing data collection also leads to assessment of
the impact of changing patterns of practice on anesthesia-related
injury and allows us to identify new sources of liability
such as pain management and office-based anesthesiology.
Since the inception of the project in 1985, a total
of 21 papers have been published in the peer-reviewed
literature. A report on chronic pain management claims
was published in the January edition of Anesthesiology
(2004; 100:98-105). The proportion of claims and size
of payments related to chronic pain management by
anesthesiologists in the Closed Claims database increased
in the 1990s. Although nerve injury and pneumothorax
were the most common injuries in claims related to
chronic pain management, severe injuries involving
brain damage and death occurred with epidural steroid
injections and maintenance of implantable devices.
Two papers concerning injuries and liability associated
with central lines and regional anesthesia are currently
in press in Anesthesiology. A bibliography
of publications from the ASA Closed Claims Project
is maintained at the project Web site <www.asaclosedclaims.org>.
Educational Activities
The committee prepares articles on the topics of litigation
and liability for the June issue of the ASA NEWSLETTER.
Clinical lessons from the Closed Claims Project have
been discussed by committee members at multiple national
and international meetings. The Closed Claims Project
was highlighted at the Anesthesia Patient Safety Foundation
booth with posters on difficult airway management
and perioperative visual loss and a multimedia presentation
on important anesthesia safety issues. In 2003 Closed
Claims Project staff provided customized data reports
to 56 ASA members and participating companies for
use in educational, quality-improvement and risk-management
activities. Data requests may be obtained by contacting
Dr. Posner.
Malpractice Liability Issues
Committee on Professional Liability Survey:
This year the ASA Committee on Professional Liability
is again conducting a survey of a variety of medical
liability insurance carriers to assess changes in
availability and rates in various states in 2003,
which will be reported in the June ASA NEWSLETTER.
Last year we found that although premiums for anesthesiologists
increased an average of 28 percent, in most areas,
they were still below premiums in the mid-1980s.
Expert Witness Testimony: At the
ASA 2003 Annual Meeting, the House of Delegates approved
a new procedure permitting review of expert witness
testimony following a complaint by an ASA member.
The new procedure is patterned after a similar program
at the American Academy of Neurological Surgeons.
Review procedures were described in detail by ASA
Director of Governmental and Legal Affairs Michael
Scott, J.D., in the December 2003 ASA NEWSLETTER.
The Administrative Council considers the complaint
first, then refers it to the Judicial Council.
Task Force on Liability in Invasive Pain Management:
A task force chaired by Edward Michna, M.D., with
members Timothy R. Deer, M.D., and Robert P. Raggi,
M.D., was formed to investigate malpractice liability
premiums of interventional pain physicians.
Task Force on Professional Medical Liability Insurance:
A task force chaired by Rodney C. Osborn, M.D., with
members Vincent J. Degenhart, M.D., James W. Futrell,
Jr., M.D., and Larry D. Robbins, D.O., has been formed
to investigate the feasibility of Professional Medical
Liability Insurance Resolution No. 3. This resolution
addresses: 1) reporting of significant medical liability
insurance (MLI) issues annually to the Board of Directors
and House of Delegates, 2) ASA’s consideration
of maintaining comprehensive MLI information on a
state-by-state basis and 3) ASA’s consideration
of providing MLI brokerage services as a benefit to
members. Through the efforts of the Washington Office,
ASA is currently posting professional liability insurance
companies on the “Members Only” page of
the ASA Web site <www.ASAhq.org>
with names and contact numbers on a state-by-state
basis and updating these listings on a quarterly basis.
Please feel free to contact me <kdomino@u.washington.edu>
if you have any questions or concerns regarding the
committee’s activities.
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Karen
B. Domino, M.D., is Professor of Anesthesiology,
University of Washington, Seattle, Washington. |
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