Person:

Weiler, Paul

The first version of this article appeared on the Social Science Research Network more than five years ago. At the time, Andrea Carska-Sheppard, Paul Weiler, and Jim Medford suggested an interdisciplinary debate to bring about solutions urgently needed in the area of performance enhancing malpractice in sports. This was before the Congressional investigations on steroid use, which brought public scrutiny to professional sports. While our society deals (with varying success) with other types of offenses by providing perpetrators with means of support and rehabilitation, we noted there is very little systematic support available to athletes who are suspended for performance enhancing malpractice. The article offered a debate on the legal model that would provide corrective justice and rehabilitation for these types of wrongdoing. In order to create a legal model the authors turned to Professor Weiler’s proposed medical malpractice theory and applied it to performance enhancing malpractice. The World Antidoping Agency (WADA) has now adopted its revised Anti-Doping Code and the time has come to revisit our article and the proposed model. What the authors found is that, despite of the passage of time, their proposal is still timely and calls for the attention of all stakeholders. Though the new Anti-Doping Code sheds light on various aspects of doping prosecution and education, it is silent as to the rehabilitation and assistance provision to athletes implicated in doping. The concept of offering a systematic assistance model to the wrongdoers relates to the morality of current and future generations, which cannot be ignored. Instead it is time for the stakeholders to review and examine the model proposed in this article, which would assist athletes and enhance corrective principals in doping malpractice management.

One of the key issues separating US critics of a no-fault alternative to the tort system for compensating victims of medical injury from supporters is its anticipated cost. Results from a study are presented that estimate the costs of a no-fault system, one that is similar to the system now in operation in Sweden, within the context of the US health care system.

METHODS We reviewed 30,121 randomly selected records from 51 randomly selected acute care, nonpsychiatric hospitals in New York State in 1984. We then developed population estimates of injuries and computed rates according to the age and sex of the patients as well as the specialties of the physicians.

RESULTS Adverse events occurred in 3.7 percent of the hospitalizations (95 percent confidence interval, 3.2 to 4.2), and 27.6 percent of the adverse events were due to negligence (95 percent confidence interval, 22.5 to 32.6). Although 70.5 percent of the adverse events gave rise to disability lasting less than six months, 2.6 percent caused permanently disabling injuries and 13.6 percent led to death. The percentage of adverse events attributable to negligence increased in the categories of more severe injuries (Wald test χ2 = 21.04, P<0.0001). Using weighted totals, we estimated that among the 2,671,863 patients discharged from New York hospitals in 1984 there were 98,609 adverse events and 27,179 adverse events involving negligence. Rates of adverse events rose with age (P<0.0001). The percentage of adverse events due to negligence was markedly higher among the elderly (P<0.01). There were significant differences in rates of adverse events among categories of clinical specialties (P<0.0001), but no differences in the percentage due to negligence.

CONCLUSIONS There is a substantial amount of injury to patients from medical management, and many injuries are the result of substandard care.

Background: In a sample of 30,195 randomly selected hospital records, we identified 1133 patients (3.7 percent) with disabling injuries caused by medical treatment. We report here an analysis of these adverse events and their relation to error, negligence, and disability.

Methods: Two physician-reviewers independently identified the adverse events and evaluated them with respect to negligence, errors in management, and extent of disability. One of the authors classified each event according to type of injury. We tested the significance of differences in rates of negligence and disability among categories with at least 30 adverse events.

Results: Drug complications were the most common type of adverse event (19 percent), followed by wound infections (14 percent) and technical complications (13 percent). Nearly half the adverse events (48 percent) were associated with an operation. Adverse events during surgery were less likely to be caused by negligence (17 percent) than nonsurgical ones (37 percent). The proportion of adverse events due to negligence was highest for diagnostic mishaps (75 percent), noninvasive therapeutic mishaps ("errors of omission") (77 percent), and events occurring in the emergency room (70 percent). Errors in management were identified for 58 percent of the adverse events, among which nearly half were attributed to negligence.

Conclusions: Although the prevention of many adverse events must await improvements in medical knowledge, the high proportion that are due to management errors suggests that many others are potentially preventable now. Reducing the incidence of these events will require identifying their causes and developing methods to prevent error or reduce its effects.