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INTRODUCTION

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  • Many medical errors are preventable

  • Most medical malpractice claims can be avoided

  • Patient safety & quality must remain highly intentional

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I recently retired from my position as medical director of Denver Health, a regional level I trauma center and academic safety net hospital. My career spanned nearly 30 years at Denver Health. Prior to my final job as medical director, I also spent many years as chief of internal medicine and chief medical officer.

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During the last 15 or so years of my tenure at Denver Health, I became very involved in the formalization and growth of Denver Health’s Patient Safety and Quality Department. This was around the time that the Institute of Medicine seminal report, “Crossing the Quality Chasm,” was published. Concurrent with that, I also became closely involved with risk-management-type issues at Denver Health. Thus, my ability to reflect back on those experiences helped me to author this chapter.

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MONETARY CAPS ON DAMAGES

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From the outset, it is worth noting that Denver Health is fortunate to be included in the shelter provided by “governmental immunity,” and thus there was a relatively low maximum financial cap that lawsuits could achieve if they prevailed against Denver Health. This relatively small monetary cap definitely dissuaded attorneys from pursuing lawsuits against Denver Health. As a result, thankfully, I was somewhat limited in my exposure to medical malpractice claims, notwithstanding my long-term experience as a medical hospital executive.

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This reality for me is worthy of deliberation because it does strongly support a need for tort reform in order to help rein in exploding healthcare costs. Statutory caps on damages are essential because liability premiums grew rapidly during the last 2 decades even though they recently have stabilized. Of note, as the monetary cap for damages from institutions covered by governmental immunity increases, medical malpractice suits also tend to increase. This also supports an overall need for statutory caps on damages as part of long-overdue tort reform in order to avert the expensive cost of defensive medicine.

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What Is Defensive Medicine?

Defensive medicine is medical practice driven by a fear of litigation, resulting in increased diagnostic testing, increased referral rates, and a reticency to treat certain conditions or perform certain procedures.

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Fear of malpractice is often cited as a strong driver of overuse of healthcare services and high healthcare spending. The cap on awards engendered by governmental immunity likely limited malpractice claims. The cap in Colorado was $250,000 whereas the mean payment amount for paid claims that were adjudicated in court approached $600,000 over the last 5 years. Moreover, almost half of claims judged in court resulted in payments greater than $1 million.

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TWO CATEGORIES: ERRORS OF COMMISSION, ERRORS OF OMISSION

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The epidemiology of the malpractice claims that I was involved in helping to resolve, in very ...

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