Source: http://ispub.com/IJLHE/5/1/5237
Timestamp: 2019-04-18 15:12:24+00:00

Document:
E Monico, R Kulkarni, A Calise, J Calabro. The Criminal Prosecution of Medical Negligence. The Internet Journal of Law, Healthcare and Ethics. 2006 Volume 5 Number 1.
Historically, the medical malpractice lawsuit stood alone within the four corners of any description of liability arising out of the practice of medicine. Now, criminal sanctions against medical personnel for medical acts that result in harm to patients represent a new page in the book on professional liability. This paper discusses traditional medical malpractice juris prudence, reviews criminal counts against medical personnel and discusses arguments for and against criminal charges resulting from medical acts.
In Waukegan, Illinois, 49 year old Beatrice Vance died of a heart attack after waiting two hours in a hospital waiting room.1 A Lake County coroner's jury had declared her death a homicide. Over the past two decades, medical personnel have faced criminal charges for medical acts that resulted in harm to patients. Angst within the medical community, turmoil among legal scholars, and shock within the lay press followed each occasion. This paper discusses traditional medical malpractice juris prudence, reviews criminal counts against medical personnel and discusses arguments for and against criminal charges resulting from medical acts.
Traditionally, redress for patients harmed during the course of medical therapy has been sought in civil court. “Civil” in the legal sense refers to private rights and remedies that are sought by action or suit.2 Civil cases, therefore, involve individuals and organizations seeking to resolve legal disputes. In a civil case the victim brings the suit. Persons found liable in a civil case may only have to give up property or pay money.
The efficacy of other modes of quality oversight has also been called into question. Through their policing power, state licensing boards have the authority to regulate the quality of medicine.12These boards may revoke a physician's license to practice medicine for gross negligence,13 professional incompetence,14or similar acts.15 Despite this power, state licensing boards rarely revoke a health care provider's license for incompetence.9 This may be, in part, because these boards are under-staffed and under-funded, receive incomplete information, and usually forego disciplinary actions in return for the physician's promise never to practice in the state again. In the past, this allowed incompetent physicians to simply continue their practices in another state.
In theory, peer review provides oversight of the care rendered by medical professionals and should be well situated to monitor the quality of health care. However, lack of compensation for peer review committee members9 and a perceived prohibition against passing judgment against one's colleagues9 limits the usefulness of these committees. Also, despite the immunity provided to peer review committee members by the Health Care Quality Improvement Act (HCQIA), fear of litigation continues to dissuade physicians from serving on peer review committees.9 Whether real or perceived, these failures have stimulated a search for an alternative way to ensure the quality of health care. As a result, the general public remains skeptical of this form of internal policing and views peer review as having only a limited role in weeding out incompetent health care providers.
A legal duty to act may arise out of other laws such as statutes (a law passed by a legislative body),2 or contract ( a binding agreement between two or more bodies enforceable by law).2 Health care providers are subject to both. For instance, physicians are legally prohibited from refusing to treat patients because the patients are seropositive for the human immunodeficiency virus (HIV).20 Similarly, hospitals, HMO's and nursing facilities have physician employment contracts creating a legal obligation to treat all patients admitted to the facility.
Criminal prosecution of health care providers for medical errors is not novel to American jurisprudence. Courts in Japan, New Zealand, Saudi Arabia, and India also see their health care providers on trial as criminal defendants for medical acts. Although no single answer adequately explains what drives criminal prosecution for medical mistakes in other countries, culture and lack of alternative forms of redress probably have a hand on the wheel.
The overwhelming predominance of civil liability cases makes head-to-head comparison difficult. However, enough criminal cases have surfaced over the last twenty years to make some observations possible. For instance, two distinct layers of behavior settle out of the emulsion of criminal cases arising from medical acts. One layer contains cases which so closely resonate with the mens rea or guilty mind embodied in criminal statutes that no controversy can legitimately exist. These include attempts to defraud the Medicare program32 and illegally prescribing medication.33 The other layer involves purely medical acts and is more difficult to rationalize. The following case is used to exemplify the difference between these layers.
It may be too early to tell if criminal prosecution of health care professionals for medical acts represents a new legal threat to health care for the coming decade. The fear emerging from these cases is that the general public may grow to expect criminal charges should follow every bad outcome or medical misadventure.44 Before this happens, those making prosecutorial decisions should keep two things in mind.
One way to reduce this treat is to draft legislation reserving criminal prosecution for acts possessing the gross, wanton, and deliberate misconduct, with an accompanying mens rea, that truly deserves punishment. Another is for regulatory agencies and peer review boards to be more proactive in uncovering negligent practices and weeding out incompetent physicians. Only when these mechanisms are exhausted or when the negligent act amounts to more than human mistake should criminal sanctions be sought.
Criminal sanctions against health care personnel should be an extraordinarily rare event in clinical medicine. Although cases are sparse, the number of medical professionals facing criminal prosecution is increasing. Clearly, the time to address this problem is now. Complacency might be all it takes to transform aberrant behavior into common occurrence.
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