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Medical Malpractice Reform Measures And Their Effects, Robert Leflar Jun 2013

Medical Malpractice Reform Measures And Their Effects, Robert Leflar

Robert B Leflar

New rules and methods for medical injury dispute resolution have been launched in New Hampshire and New York, and demonstration projects are underway elsewhere. This article describes major medical malpractice reforms undertaken and proposed in recent years. Reforms are classified as (1) liability-limiting initiatives favoring health-care providers; (2) procedural innovations promoted as improving dispute resolution processes, such as patient compensation funds, “sorry” laws, disclosure and early offer laws, health courts, and safe harbor laws; and (3) major conceptual reforms to move liability away from physicians to hospitals or administrative no-fault compensation systems. Empirical evidence about the practical effects of already-implemented ...


"Unnatural Deaths," Criminal Sanctions, And Medical Quality Improvement In Japan, Robert B. Leflar Apr 2013

"Unnatural Deaths," Criminal Sanctions, And Medical Quality Improvement In Japan, Robert B. Leflar

Robert B Leflar

A worldwide awakening to the high incidence of preventable harm resulting from medical care, combined with pressure on hospitals and physicians from liability litigation, has turned international attention to the need for better structures to resolve medical disputes in a way that promotes medical safety and honesty toward patients. The civil justice system in the United States, in particular, is criticized as inefficient, arbitrary, and sometimes punitive. It is charged with undermining sound medical care by encouraging wasteful expenditures through defensive medicine; by driving information about medical mistakes underground where it escapes analysis, undercutting quality improvement efforts; and by forcing ...


Reform Of The United States Health Care System: An Overview, Robert B. Leflar Dec 2012

Reform Of The United States Health Care System: An Overview, Robert B. Leflar

Robert B Leflar

This essay, written for readers unfamiliar with the details of American health law and policy, portrays the essential features of the battle for health reform in the United States and of the law that survived the battle: the Patient Protection and Affordable Care Act (PPACA). The essay summarizes key aspects of the U.S. health care system and how it compares in terms of costs and results with other advanced nations’ systems. The political and legal conflicts leading up to and following PPACA’s enactment are described. The major features of the law, attempting to address problems of access to ...


Reform Of The United States Health Care System: An Overview, Robert B. Leflar Dec 2012

Reform Of The United States Health Care System: An Overview, Robert B. Leflar

Robert B Leflar

This essay, written for readers unfamiliar with the details of American health law and policy, portrays the essential features of the battle for health reform in the United States and of the law that survived the battle: the Patient Protection and Affordable Care Act (PPACA). The essay summarizes key aspects of the U.S. health care system and how it compares in terms of costs and results with other advanced nations’systems. The political and legal conflicts leading up to and following PPACA’s enactment are described. The major features of the law, attempting to address problems of access to ...


The Law Of Medical Misadventure In Japan, Robert B. Leflar Dec 2011

The Law Of Medical Misadventure In Japan, Robert B. Leflar

Robert B Leflar

This paper offers a comprehensive overview of Japanese law and practice relating to iatrogenic (medically-caused) injury, with comparisons to other nations’ medical law systems. The paper addresses criminal sanctions for Japanese physicians’ negligent and illegal acts; civil law principles of substantive law and related issues of procedure, practice, and liability insurance; and administrative measures including health ministry programs aimed at expanding and improving the quality of peer review within Japanese medicine, and a recently implemented no-fault compensation system for birth-related injuries. Among the paper’s findings are these. Criminal and civil actions increased rapidly after highly publicized medical error events ...


Human Flotsam, Legal Fallout: Japan's Tsunami And Nuclear Meltdown, Robert B. Leflar, Ayako Hirata, Masayuki Murayama, Shozo Ota Dec 2011

Human Flotsam, Legal Fallout: Japan's Tsunami And Nuclear Meltdown, Robert B. Leflar, Ayako Hirata, Masayuki Murayama, Shozo Ota

Robert B Leflar

We report on our field research in Fukushima Prefecture in July 2011. We interviewed legal professionals and community leaders in Fukushima City and in towns inundated by the March 2011 tsunami and within a few kilometers of Fukushima No. 1 nuclear reactor. We catalogued many of the extensive variety of problems faced by Fukushima residents, both evacuees and those who remained in their homes. Many of these problems, both legal and non-legal, arose from government actions as the disaster unfolded and afterwards, including the administration of the initial program for provisional compensation for disaster victims. We learned that in the ...


Public And Private Justice: Redressing Health Care Harm In Japan, Robert B. Leflar Dec 2010

Public And Private Justice: Redressing Health Care Harm In Japan, Robert B. Leflar

Robert B Leflar

Japanese legal structures addressing health care-related deaths and injuries rely more on public law institutions and rules than do the common-law North American jurisdictions, where private law adjudication is predominant. This article explores four developments in 21st-century Japanese health care law. The first two are in the public law sphere: criminal prosecutions of health care personnel accused of medical errors, and a health ministry-sponsored “Model Project” to analyze medical-practice-associated deaths. The article addresses a private law innovation: health care divisions of trial courts in several metropolitan areas. Finally, the article introduces Japan’s new no-fault program for compensating birth-related obstetrical ...


Medical Malpractice (Book Review), Robert B. Leflar Dec 2010

Medical Malpractice (Book Review), Robert B. Leflar

Robert B Leflar

This is a review of Medical Malpractice, by Frank Sloan and Lindsey Chepke. This superb book provides a balanced, comprehensive, factual overview of the structure, flaws, and merits of the U.S. legal system relating to malpractice; the causes of cyclical insurance pricing and availability difficulties; ameliorative initiatives both implemented and proposed; and the political considerations affecting the achievability of leading reform proposals. The authors' evidence-based stances will discommode many participants in the malpractice debate, physicians and trial lawyers alike. The book debunks widely-held "myths of medical malpractice" propounded by medical tort reformers. However, the authors also conclude that "no ...


Reasons To Pass Health Reform, Robert B. Leflar, Hershey Garner Md Mar 2010

Reasons To Pass Health Reform, Robert B. Leflar, Hershey Garner Md

Robert B Leflar

Column 5 (of 5) on the health reform debate


Health Reform: Arkansas Impacts, Robert B. Leflar Feb 2010

Health Reform: Arkansas Impacts, Robert B. Leflar

Robert B Leflar

Column 4 (of 5) on the health reform debate


Medical Malpractice Reform?, Robert B. Leflar Dec 2009

Medical Malpractice Reform?, Robert B. Leflar

Robert B Leflar

Column 3 (of 5) on health reform: Medical malpractice reform proposals


Health Bills: What's At The Core, Robert B. Leflar Nov 2009

Health Bills: What's At The Core, Robert B. Leflar

Robert B Leflar

Column 2 (of 5) on the health reform debate: explanation of the legislation.


Health Care: Yellow Lights, Red Flags, Robert B. Leflar Nov 2009

Health Care: Yellow Lights, Red Flags, Robert B. Leflar

Robert B Leflar

Column 1 (of 5) on the health reform debate


The Regulation Of Medical Malpractice In Japan, Robert Leflar Dec 2008

The Regulation Of Medical Malpractice In Japan, Robert Leflar

Robert B Leflar

How Japanese legal and social institutions handle medical errors is little known outside Japan. For almost all of the 20th century, a paternalistic paradigm prevailed. Characteristics of the legal environment affecting Japanese medicine included few attorneys handling medical cases, low litigation rates, long delays, predictable damage awards, and low-cost malpractice insurance. However, transparency principles have gained traction and public concern over medical errors has intensified. Recent legal developments include courts' adoption of a less deferential standard of informed consent; increases in the numbers of malpractice claims and of practicing attorneys; more efficient claims handling by specialist judges and speedier trials ...


Medical Error As Reportable Event, As Tort, As Crime: A Transpacific Comparison, Robert B. Leflar, Futoshi Iwata Dec 2004

Medical Error As Reportable Event, As Tort, As Crime: A Transpacific Comparison, Robert B. Leflar, Futoshi Iwata

Robert B Leflar

All nations seek to reduce the human toll from medical error, but variations in legal and institutional structures guide those efforts into different trajectories. This article compares legal and institutional responses to patient safety problems in the United States and Japan, addressing developments in civil malpractice law (including discoverability of internal hospital documents), administrative practice (including medical accident reporting systems), and - of particular significance in Japan - criminal law. In the U.S., battles over rules of malpractice litigation are fierce; tort law occupies center stage. The hospital accreditation process plays a critical role in medical quality control, and peer review ...


Informed Consent And Patients' Rights In Japan: 2001 Epilogue, Robert B. Leflar Dec 2001

Informed Consent And Patients' Rights In Japan: 2001 Epilogue, Robert B. Leflar

Robert B Leflar

Japan is on a steeper trajectory toward the incorporation of informed consent principles into medical practice than the “gradual transformation” observed in a 1996 article, Informed Consent and Patients’ Rights in Japan. Among the most significant recent developments from 1996 to 2001 have been these seven: (1) the 1997 enactment of the Organ Transplantation Law permitting the use of brain death criteria in limited circumstances in which informed consent is present; (2) the strengthening of patients’ rights in clinical drug trials; (3) the continued trend toward increasing disclosure to patients of cancer diagnoses; (4) initiatives by the health ministry toward ...


The Reform Of Ethics Rules In Arkansas Government, Robert B. Leflar Dec 1999

The Reform Of Ethics Rules In Arkansas Government, Robert B. Leflar

Robert B Leflar

This essay outlines existing conflict-of-interest rules in Arkansas government, particularly for state agencies, boards and commissions. The essay identifies weaknesses in the rules, and suggests disclosure requirements and certain restrictions on voting by board members with conflicts.


The Preemption Pentad: Federal Preemption Of Products Liability Claims After Medtronic [V. Lohr], Robert B. Leflar, Robert S. Adler Dec 1996

The Preemption Pentad: Federal Preemption Of Products Liability Claims After Medtronic [V. Lohr], Robert B. Leflar, Robert S. Adler

Robert B Leflar

Taking the language of the federal consumer protection statutes out of historical context and inattentive to those laws' original purposes, judges dissatisfied with the expansion of state products liability law have in recent years read preemption provisions of these federal statutes to bar a wide range of claims that would otherwise be viable under state law. In Medtronic v. Lohr, the Supreme Court (per Justice Stevens) severely constrained the scope of the federal preemption defense in the context of the federal medical device law. But the implications of the Medtronic decision for cases involving products in other regulatory categories remain ...


Informed Consent And Patients' Rights In Japan, Robert B. Leflar Dec 1995

Informed Consent And Patients' Rights In Japan, Robert B. Leflar

Robert B Leflar

This article analyzes the development of the concept of informed consent in the context of the culture and economics of Japanese medicine, and locates that development within the framework of the nation's civil law system. Part II sketches the cultural foundations of medical paternalism in Japan; explores the economic incentives (many of them administratively directed) that have sustained physicians' traditional dominant roles; and describes the judiciary's hesitancy to challenge physicians' professional discretion. Part III delineates the forces testing the paternalist model: the undermining of the physicians' personal knowledge of their patients that accompanies the shift from neighborhood clinic ...


Public Accountability And Medical Device Regulation, Robert B. Leflar Dec 1988

Public Accountability And Medical Device Regulation, Robert B. Leflar

Robert B Leflar

In enacting the Medical Device Amendments of 1976, Congress instituted a flexible system of regulatory controls over a vast array of health care products. Analyzing the complex statute and its legislative history, Professor Leflar finds at the law's core a structure designed to ensure the Food and Drug Administration's accountability to the public for its regulatory actions. Reviewing the history of FDA's implementation of the medical device law, however, the author demonstrates that FDA has strayed widely and, he contends, illegally from the congressionally mandated structure of public accountability. In particular, in its review of new-model medical ...