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By C. Ramon. Sonoma State University.

Anderson discount emsam 5mg visa anxiety symptoms memory loss, MD discount emsam 5 mg with amex anxiety leg pain, FACP SUMMARY The rising cost of claims has fueled a dramatic rise in the cost of medical malpractice insurance in the United States. Increasing severity has driven malpractice tort costs beyond $20 billion per year. A significant percentage of America’s doctors are defendants in malpractice litigation and more than 600 new claims are initi- ated daily. In high-risk specialties, virtually all physicians are potential litigation targets. Other factors contributing to the increased cost of malpractice insurance include falling interest rates, higher costs for reinsurance, shrinking capacity, and judicial nullification of existing legal reforms. More than a quarter century’s experience with California’s Medical Injury Compensation Reform Act (MICRA) statutes pro- vides ample evidence that reforms are well defined and effective. In the absence of these reforms, it is predictable that the current crisis will worsen and access to fundamental medical services will be increasingly imperiled. Key Words: Legal reform; tort reform; Medical Injury Compen- sation Reform Act (MICRA); premiums; frequency; severity; “bad” doctor; Harvard Medical Practice Study; Institute of Medi- cine; collateral source; periodic payments; caps; contingency fee; defensive medicine. Many physicians have been forced to curtail their practices, move to other venues, or even retire from the practice of medicine (2–5). The issue has been extensively discussed and debated in the medical and legal press, the media in general, a number of state legislatures, and nationally by both Congress and the president. This chapter reviews the nature and extent of the problem, the relevant attributes of medical malpractice insurance, and the evidence that legal reforms can ameliorate the problem. EXTENT OF THE PROBLEM The expansion of tort law into new arenas of potential liability grew throughout the 20th century, particularly the latter half. But until quite recently it was a backwater of the legal system, of little importance in the wider scheme of things. For all practical purposes, the omnipresent tort tax we pay today was conceived in the 1950s and set in place in the 1960s and 1970s by a new generation of lawyers and judges. In the space of twenty years they transformed the legal landscape, proclaiming sweeping new rights to sue. Some grew famous and more grew rich selling their services to enforce the rights that they themselves invented. But the revolution they made could never have taken place had it not had a component of idealism, as well. Tort law, it is widely and passionately believed, is a public- spirited undertaking designed for the protection of the ordinary con- sumer and worker, the hapless accident victim, the ‘little guy. No other country in the world administers anything remotely like it” (6). Peter Huber, author of a seminal treatise on the expansion of liability law, refers to the attendant costs as the tort tax: “It is one of the most ubiquitous taxes we pay, now levied on virtually everything we buy, sell and use. The tax accounts for 30 percent of the price of a stepladder and over 95 percent of the price of childhood vaccines. It is responsible for one-quarter of the price of a ride on a Long Island tour bus and one-third of the price of a small airplane. It will soon cost large municipalities as much as they spend on fire or sanitation services” (6). Chapter 15 / The Case for Legal Reform 203 Responding to the same issues, Philip Howard has referred to “the death of common sense” (7). He founded an organization named Com- mon Good, which is dedicated to reforming America’s legal system (http://cgood. Common Good has this to say about the expansion of medical liability and the provision of health care in the United States: “The lawsuit culture in modern America is creating a crisis in Ameri- can healthcare. The broad perception that anyone can sue for almost anything has fundamentally altered the practice of medicine, eroding the quality and availability of healthcare. Catherine Crier, lamenting the explosion in litigation wrote: “Trial work has become a major stand-alone business within the legal com- munity. What was once the place for good advice about the worthiness of a claim has become a gristmill for expanding rights and remedies. Tradi- tionally, lawyers were officers of the court who zealously represented clients within legal and ethical boundaries.

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Lawyers can make outrageous claims against physicians in malprac- tice cases generic 5 mg emsam visa anxiety upon waking. As long as they make it in the setting of a court or deposition discount emsam 5mg with mastercard anxiety reduction techniques, they are immune against claims of defamation. TYPES OF PLAINTIFF ATTORNEYS AT DEPOSITION One author has aptly described plaintiff attorneys as “pals,” “freight trains,” “butterflies,” “time bombs,” or “ignoramuses”(8). Also, attorneys may be casually dressed, joking with each other, often including your lawyer in this banter before the deposition starts. Remember that the deposition is adversarial and that their role is to make you look bad. Do not let the “pal” plaintiff attorney disarm you with his or her friendliness. Freight Train The “freight train” plaintiff attorney will barrel along with rapid-fire questions, trying to make you speak before you think. The best way to handle this type of attorney is to hesitate before answering each question Chapter 5 / Discovery and Deposition 59 and to respond in complete sentences, which will slow down the process and ruin the timing of the plaintiff attorney. Butterfly The “butterfly” plaintiff attorney flips from one line of questioning to another in an attempt to confuse you. The goal of the plaintiff attor- ney is to make you give conflicting testimony. He or she will ask the same question in multiple ways over different points of time in the deposition, hoping for inconsistent answers. Do not worry about the apparent con- fusion in terms of the line of questioning. Concentrate on the questions at hand, and answer in a consistent manner. Time Bomb The “time bomb” plaintiff attorney saves the most difficult questions for the end of the deposition when you are most tired. You can ask for a break if you are tired or if you need to use the restroom. Just make sure that this discussion is out of earshot of the plaintiff attorney. Ignoramus The apparently ignorant plaintiff attorney tries to get you to volunteer information that you otherwise would not. Assume the opposing attor- ney is well-versed in the subject and do not overly educate him or her. OBJECTIONS RAISED DURING DEPOSITION Your attorney can object for many different reasons. Some of these include if the plaintiff attorney has already asked you the same ques- tion multiple times. When your attorney objects, take a second to think about why the objection is occurring. However, do not be overly concerned about the objections so that you lose your concentration. After an objection has been raised, you can still answer the question if your attorney says so. POSTDEPOSITION You will be offered the opportunity to read your deposition and to correct any errors in how the transcriber heard you. If you want to 60 Epstein make substantial changes, then ask your attorney. In general, any changes made to the deposition that are substantial will look damag- ing. Some jurisdictions will allow such substantial changes to the deposition and others will not. If there are any discrepancies in what you said in the deposition, as opposed to what you will say at trial, then prepare how to explain them. You should have a postdeposition meeting to assess the case and your ability to defend it successfully. You should also ask your attorney about reading other depositions in the case.

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The vertebral region the body on the axillary region because of the possibility of damag- extends the length of the back discount 5mg emsam overnight delivery anxiety symptoms 5 year old, following the vertebral column cheap emsam 5mg online anxiety gas. Easily identified surface landmarks are helpful in assessing the condition of these organs. Centered on the front of the abdomen, the umbilicus (navel) is an obvious land- mark. Body Organization and © The McGraw−Hill Anatomy, Sixth Edition Organization, and the Anatomical Nomenclature Companies, 2001 Human Organism Chapter 2 Body Organization and Anatomical Nomenclature 37 Cephalic (head) Cranial Frontal (forehead) (surrounding the brain) Nasal (nose) Orbital (eye) Buccal Occipital Oral (mouth) Posterior (back of head) (cheek) thoracic Cervical (neck) Mental (chin) Posterior neck Shoulder Sternal Shoulder Axillary (armpit) Pectoral region Vertebral Mammary (breast) (chest) (spinal column) Anterior Brachial (arm) Brachial (arm) cubital Abdominal (cubital Antecubital fossa) Posterior (front of elbow) cubital (elbow) Inguinal Abdominal (groin) (abdomen) Lumbar Coxal (lower back) Antebrachial (hip) (forearm) Sacral Gluteal (buttock) Carpal (wrist) Dorsum of Palmar (palm) the hand Digital (finger) Perineal Femoral Pubic Femoral (thigh) (thigh) region Knee Popliteal fossa (back of knee) Anterior crural (leg) Posterior crural (leg) Tarsal (ankle) Dorsum of the foot Plantar (sole) (a) (b) FIGURE 2. The center of the back side of the abdomen, cating the sites of pains, tumors, or other abnormalities. The sacral region is located further down, at the point where the Pelvic Region vertebral column terminates. This region is a common injection The pelvic region forms the lower portion of the trunk. Body Organization and © The McGraw−Hill Anatomy, Sixth Edition Organization, and the Anatomical Nomenclature Companies, 2001 Human Organism 38 Unit 2 Terminology, Organization, and the Human Organism Right Epigastric Left hypochondriac region hypochondriac region region Right Umbilical Left lateral region lateral abdominal abdominal region region Right Hypogastric Left inguinal region inguinal region region FIGURE 2. The upper vertical planes are positioned lateral to the rectus abdo- minis muscles, the upper horizontal plane is positioned at the level of the rib cage, and the lower horizontal plane is even with the upper border of the hipbones. The cubital fossa is the depressed anterior portion of the cubital region. The shoulder is the region be- The manus has three principal divisions: the carpus, con- tween the pectoral girdle and the brachium that contains the taining the carpal bones (see fig. The shoulder is also referred to as the omos, or ing the metacarpal bones; and the five digits (commonly called deltoid region. The cubital region is the area between the arm fingers), containing the phalanges. The front of the hand is re- ferred to as the palmar region (palm) and the back of the hand is cubital: L. Body Organization and © The McGraw−Hill Anatomy, Sixth Edition Organization, and the Anatomical Nomenclature Companies, 2001 Human Organism Chapter 2 Body Organization and Anatomical Nomenclature 39 Right upper quadrant Left upper quadrant Right lower quadrant Left lower quadrant FIGURE 2. The perineal region can be divided into a urogenital triangle (anteriorly) and an anal triangle (posteriorly). Body Organization and © The McGraw−Hill Anatomy, Sixth Edition Organization, and the Anatomical Nomenclature Companies, 2001 Human Organism 40 Unit 2 Terminology, Organization, and the Human Organism Cranial cavity (contains brain) Vertebral cavity (contains spinal cord) Thoracic cavity (contains heart, lungs, Diaphragm and esophagus) (respiratory muscle) Abdominal cavity (contains stomach, liver, spleen, pancreas, and intestines) Pelvic cavity (contains certain reproductive organs, especially in female) Paras FIGURE 2. The lower extremity consists of the hip, thigh, knee, leg, and pes (foot). The thigh is commonly called the upper leg, or Knowledge Check femoral region. The knee has two surfaces: the front surface is the patellar region, or kneecap; the back of the knee is called the 12. The shin is a prominent bony ridge face landmarks that help distinguish their boundaries? Distinguish the pubic area and perineum within the The pes has three principal divisions: the tarsus, contain- pelvic region. Identify the joint between the following regions: the the metatarsal bones; and the five digits (commonly called toes), brachium and antebrachium, the pectoral girdle and containing the phalanges. The ankle is the junction between the brachium, the leg and foot, the antebrachium and hand, leg and the foot. The heel is the back of the foot, and the sole of and the thigh and leg. Explain how knowledge of the body regions is applied in a clinical setting. Body Organization and © The McGraw−Hill Anatomy, Sixth Edition Organization, and the Anatomical Nomenclature Companies, 2001 Human Organism Chapter 2 Body Organization and Anatomical Nomenclature 41 Mediastinum (contains esophagus, major vessels, and certain nerves) Thoracic Pleural cavities cavity (surround lungs) Pericardial cavity (surrounds heart) Abdominal cavity (contains abdominal viscera) Abdominopelvic Pelvic cavity cavity (contains pelvic viscera) Paras FIGURE 2. The For functional and protective purposes, the viscera are compart- coelom is lined with a membrane that secretes a lubricating fluid.

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