Quantifying the Economics of Medical Malpractice - A View from a Civil Law Perspective

Life is full of uncertainties. Legal rules should have a clear intention, motivation and purpose in order to diminish daily uncertainties. However, practice shows that their consequences are complex and hard to predict. For instance, tort law has the general objectives of deterring future negligent behavior and compensating the victims of someone else's negligence. Achieving these goals are particularly difficult in medical malpractice cases. To start with, when patients search for medical care they are typically sick in the first place. In case harm materializes during the treatment, it might be very hard to assess if it was due to substandard medical care or to the patient's poor health conditions. Moreover, the practice of medicine has a positive externality on the society, meaning that the design of legal rules is crucial: for instance, it should not result in physicians avoiding practicing their activity just because they are afraid of being sued even when they acted according to the standard level of care. The empirical literature on medical malpractice has been developing substantially in the past two decades, with the American case being the most studied one. Evidence from civil law tradition countries is more difficult to find. The aim of this thesis is to contribute to the empirical literature on medical malpractice, using two civil law countries as a case-study: Spain and Italy. The goal of this thesis is to investigate, in the first place, some of the consequences of having two separate sub-systems (administrative and civil) coexisting within the same legal system, which is common in civil law tradition countries with a public national health system (such as Spain, France and Portugal). When this holds, different procedures might apply depending on the type of hospital where the injury took place (essentially whether it is a public hospital or a private hospital). Therefore, a patient injured in a public hospital should file a claim in administrative courts while a patient suffering an identical medical accident should file a claim in civil courts. A natural question that the reader might pose is why should both administrative and civil courts decide medical malpractice cases? Moreover, can this specialization of courts influence how judges decide medical malpractice cases? In the past few years, there was a general concern with patient safety, which is currently on the agenda of several national governments. Some initiatives have been taken at the international level, with the aim of preventing harm to patients during treatment and care. A negligently injured patient might present a claim against the health care provider with the aim of being compensated for the economic loss and for pain and suffering. In several European countries, health care is mainly provided by a public national health system, which means that if a patient harmed in a public hospital succeeds in a claim against the hospital, public expenditures increase because the State takes part in the litigation process. This poses a problem in a context of increasing national health expenditures and public debt. In Italy, with the aim of increasing patient safety, some regions implemented a monitoring system on medical malpractice claims. However, if properly implemented, this reform shall also allow for a reduction in medical malpractice insurance costs. This thesis is organized as follows. Chapter 1 provides a review of the empirical literature on medical malpractice, where studies on outcomes and merit of claims, costs and defensive medicine are presented. Chapter 2 presents an empirical analysis of medical malpractice claims arriving to the Spanish Supreme Court. The focus is on reversal rates for civil and administrative decisions. Administrative decisions appealed by the plaintiff have the highest reversal rates. The results show a bias in lower administrative courts, which tend to focus on the State side. We provide a detailed explanation for these results, which can rely on the organization of administrative judges career. Chapter 3 assesses predictors of compensation in medical malpractice cases appealed to the Spanish Supreme Court and investigates the amount of damages attributed to patients. The results show horizontal equity between administrative and civil decisions (controlling for observable case characteristics) and vertical inequity (patients suffering more severe injuries tend to receive higher payouts). In order to execute these analyses, a database of medical malpractice decisions appealed to the Administrative and Civil Chambers of the Spanish Supreme Court from 2006 until 2009 (designated by the Spanish Supreme Court Medical Malpractice Dataset (SSCMMD)) has been created. A description of how the SSCMMD was built and of the Spanish legal system is presented as well. Chapter 4 includes an empirical investigation of the effect of a monitoring system for medical malpractice claims on insurance premiums. In Italy, some regions adopted this policy in different years, while others did not. The study uses data on insurance premiums from Italian public hospitals for the years 2001-2008. This is a significant difference as most of the studies use the insurance company as unit of analysis. Although insurance premiums have risen from 2001 to 2008, the increase was lower for regions adopting a monitoring system for medical claims. Possible implications of this system are also provided. Finally, Chapter 5 discusses the main findings, describes possible future research and concludes.

Is Inefficiency under control in the Justice Administration?

Efficiency in the administration of justice is found to increase over time, while the variation in the efficiency of the courts tended to remain low and fall over time. This would appear to be good news, at least for the case studied here: the civil courts of first instance in Spain between 2005 and 2009. Apart from the simple passing of time, the percentage of temporary judges in the system also determines some of the differences in efficiency between courts over time. Thus, we find that the greater the percentage of temporary judges, the lower is the efficiency of the courts. Overall, the average relative efficiency level for the period 2005 to 2009 was 97.46%, suggesting the matter is under control.

Responsabilidad de dar cuenta del desempeño de la función jurisdiccional (Tema Central)

En esta presentación abordaré tres asuntos, fundamentalmente. la primera cuestión a la que quisiera referirme es la de por qué dar cuenta, que en ocasiones puede considerarse obvia pero no lo es tanto, el segundo punto enfocará los contenidos respecto a los cuales quien ejerce una función jurisdiccional debe dar cuenta, finalmente, abordaré el asunto de la trascendencia o relevancia que socialmente alcanzan el cumplir y el incumplir con esta responsabilidad. Una puntualización aclaratoria: cuando me refiero a quienes ejercen función jurisdiccional, incluyo en ello tanto a jueces como a fiscales. Aunque en esta reunión se enfoca específicamente el caso de los jueces, dado que los integrantes del Ministerio Público también ejercen función jurisdiccional –especialmente en el caso de aquellos países donde se ha introducido el proceso penal reformado–, el abordaje del tema que propongo también los comprende.

Repensando o atendimento inicial nos Juizados Especiais Cíveis do Estado de Rondônia

Esta dissertação tem como objeto de análise o atendimento inicial prestado ao jurisdicionado, seja ele autor ou réu, no âmbito dos Juizados Especiais Cíveis do Estado de Rondônia. Destaca-se o tema em três partes: duas de cunho teórico e outra de predominância prática. Na primeira parte, estuda-se o acesso à justiça e a efetividade processual como premissas que permeiam os juizados. Na seqüência, numa abordagem prática, faz-se um retrato comparativo dos Juizados Especiais Cíveis carioca e rondoniense, explorando as singularidades e identificando as situações-problemas. Neste capítulo, situa-se o objeto principal do trabalho, que consiste na criação do Setor de Atendimento Inicial como fórmula destinada a atender o cidadão nos termos do artigo 9.º da Lei n.º 9.099/95 nas causas de até 20 (vinte) salários mínimos. Na terceira parte, volta-se a um estudo teórico, caracterizando o SAI como política pública obrigatória por parte do Poder Judiciário do Estado de Rondônia e apontando a ação civil pública e o termo de ajustamento de conduta como instrumentos hábeis a impô-lo. O trabalho seguiu um cunho interdisciplinar, analisando questões jurídicas e da Teoria Geral da Administração.

Apontamentos críticos à distribuição dinâmica do ônus da prova

O ônus da prova tem sido tradicionalmente distribuído no processo civil brasileiro segundo disposições legais prévias, contidas em geral no artigo 333 do Código de Processo Civil e que em geral seguem os brocados jurídicos onus probandi incumbit ei qui allegat, probatio incumbit asserenti e semper necessitas probandi incumbit illi quit agit. Nos últimos anos, no entanto, tem crescido na doutrina e na jurisprudência a tendência de atribuir o onus probandi à parte que supostamente tem mais facilidade em produzir a prova nos autos, independentemente da distribuição predeterminada pela lei. A inspiração para esta mudança vem da teoria argentina das cargas probatórias dinâmicas, introduzida pelo juiz Jorge Peyrano e que teria suas raízes, supostamente, no trabalho de Jeremy Bentham. O projeto de um novo Código de Processo Civil, que está sendo discutido no Congresso Nacional, muito provavelmente incluirá disposição autorizado expressamente que o juiz desloque o ônus da prova de uma parte para a outra quando entender que esta última tem melhores condições de produzí-la. Os riscos invocados contra esta teoria são o aumento da insegurança jurídica, da possibilidade de arbitrariedade do julgador e da dificuldade de estabelecer previsões sobre sucesso processual, impedindo que as partes possam tomar as melhores decisões sobre como se portar antes e durante um eventual processo. Também há crítica contra o enfraquecimento da imparcialidade do juiz, o que, segundo os defensores da teoria, não ocorreria. Uma análise dos argumentos contra e a favor da teoria do ônus dinâmico da prova, dos instrumentos já existentes no direito brasileiro para os problemas que esta teoria vida atacar, e das novas disposições legais a serem em breve introduzidas demonstra que existe uma linha tênue a ser traçada e seguida para que se atinjam os benefícios pretendidos, sem cair em novos problemas. É importante adotar e interpretar as novas normas processuais cuidadosa e atenciosamente, de modo a evitar prejuízo a garantias básicas dos jurisdicionados.

Giurisdizione ordinaria civile e autorità amministrative indipendenti nel sistema integrato di tutela dei diritti

L’elaborato si propone di analizzare i principali punti di contatto, nell’ordinamento domestico, tra le funzioni esercitate dalla giurisdizione ordinaria civile e le attribuzioni delle Autorità amministrative indipendenti, nel tentativo di delineare un quadro sistematico dei rapporti. Nella prima parte dell’indagine, ci si sofferma sui variegati strumenti di risoluzione delle controversie coniati in seno alle Autorità indipendenti, cercando di sviluppare un’essenziale classificazione per categorie omogenee, al fine di vagliare la compatibilità dei diversi modelli con il dato costituzionale. Successivamente, si sposta l’indagine sulle interferenze emergenti con riferimento a quelle attività delle Authorities assimilabili all’applicazione della legge al caso concreto nel contesto del pubblic enforcement. Tra queste, spicca la delicata questione del valore dei provvedimenti delle Authorities nei (correlati) processi civili risarcitori, soprattutto a seguito dell’entrata in vigore dell’art. 7, d.lgs. 3/2017, che ha plasmato un inedito «vincolo» per il giudice ordinario all’accertamento dell’AGCM. Alla previsione normativa si associa la tendenza giurisprudenziale a riconoscere una particolare “attitudine probatoria” anche ai provvedimenti di altre Autorità indipendenti, pur in assenza di specifica previsione normativa. Nel corso della trattazione, più che limitarsi ad esprimere una preferenza tra le diverse soluzioni già proposte dalla dottrina, si cerca di gettare le basi per un’interpretazione autonoma e sistematica del fenomeno. Adottando un approccio quanto più possibile interdisciplinare, si cercano di coniugare i punti di approdo della teoria generale dell’accertamento giuridico con quelli, gius-pubblicistici, della categoria dell’accertamento amministrativo. Si passa, infine, a vagliare le condizioni affinché tale ipotetico modello unitario possa ritenersi compatibile con altri valori di rilievo costituzionale e non solo, utilizzando quale parametro di riferimento l’art. 6 Cedu, come interpretato dalla Corte di Strasburgo.

Victims’ status at international and hybrid criminal courts : victims’ status as witnesses, victim participants/civil parties and reparations claimants

Bestraffning av internationella brott vid internationella och hybrida straffrättsliga domstolar har traditionellt och huvudsakligen grundat sig på principen om retributiv (vedergällande) rättvisa och ackusatorisk process snarare än återuppbyggande rättvisa och en inkvisitorisk modell. Därav har brottsoffrens ställning vid dessa straffrättsliga domstolar begränsat sig till den som innehas av vittnen vid Tribunalen som behandlar brott som begåtts i det forna Jugoslavien (ICTY), Internationella krigsförbrytartribunalen för Rwanda (ICTR) och Specialdomstolen för Sierra Leone (SCSL). Internationella brottmålsdomstolen (ICC), å sin sida, har medfört en viktig förändring gällande brottsoffrens ställning i internationella straffrättsliga fora, vilket innebär att de från att ha betraktats endast i egenskap av vittnen nu även har en rätt att delta och lämna sina synpunkter (i egenskap av brottsofferdeltagare) samt kräva gottgörelse. Denna trend har fortsatt inom området för internationell straffrätt, vilket manifesterats vid hybridtribunaler som tillsatts efter ICC såsom Kambodjadomstolen (ECCC) vid vilken brottsoffer kan agera civilrättsliga parter och Specialdomstolen för Libanon (STL) där brottsoffer kan inneha en deltagande roll. Den föreliggande studien behandlar två huvudsakliga frågeställningar, av vilka den första lyder: Vilken ställning tillskrivs brottsoffren vid internationella domstolar och hybridtribunaler? I detta hänseende argumenterar författaren, sammanfattningsvis, för att brottsoffrens ställning vid internationella straffrättsliga domstolar och hybridtribunaler huvudsakligen tar sig uttryck på tre sätt, d.v.s. som brottsoffer i egenskap av vittnen, som brottsoffer i egenskap av deltagande brottsoffer/civilrättsliga parter samt som brottsoffer som kräver gottgörelse. Den andra frågeställningen för denna studie lyder: På vilket sätt fungerar brottsoffrens ställning som vittnen, brottsofferdeltagande/civilrättsliga parter och gottgörelsekrävande vid internationella och hybrida straffrättsliga domstolar? -------------------------------------------------------------------------------------------------------------------------------------------------- Kansainvälisten rikosten rankaiseminen kansainvälisissä rikostuomioistuimissa ja hybridituomioistuimissa on perinteisesti enimmäkseen perustunut retributiivisen oikeuden ja akkusatorisen menetelmän soveltamiseen pikemmin kuin restoratiivisen oikeuden ja inkvisitorisen menetelmän soveltamiseen. Niinpä uhrien asema kansainvälisissä rikostuomioistuimissa ja hybridituomioistuimissa on rajoittunut todistajan asemaan entisen Jugoslavian kansainvälisessä sotarikostuomioistuimessa (ICTY), Ruandan kansainvälisessä sotarikostuomioistuimessa (ICTR) ja Sierra Leonen erikoistuomioistuimessa (SCSL). Kansainvälisen rikostuomioistuimen (ICC) perustaminen on kuitenkin merkinnyt tärkeää muutosta uhrien asemaan kansainvälisen rikosoikeuden alalla siten, että kun uhrit aiemmin nähtiin vain todistajina, heillä on nyt myös mahdollisuus tuoda esiin omat näkökantansa (osallistumisoikeus) ja vaatia hyvitystä. Tämä suuntaus on jatkunut kansainvälisen rikosoikeuden alalla ICC:n jälkeen perustetuissa hybridituomioistuimissa, kuten Kambodzhan erityistuomioistuimessa (ECCC), missä uhrit voivat olla asianosaisen asemassa, sekä Libanonin erityistuomioistuimessa (STL), missä uhrit voivat osallistua prosessiin. Tämä tutkimus käsittelee kahta keskeistä kysymystä. Ensinnäkin: Mikä on rikoksen uhrien asema kansainvälisissä rikostuomioistuimissa ja hybridituomioistuimissa? Tutkimuksessa päädytään mm. siihen, että uhrien asema kansainvälisissä rikostuomioistuimissa ja hybridituomioistuimissa voi koostua pääosin kolmesta ulottuvuudesta eli uhrit todistajina, uhrit prosessiin osallistujina/asianosaisina ja uhrit hyvityksen hakijoina. Tutkimuksen toinen keskeinen kysymys on: Miten uhrien asema todistajina, prosessiin osallistujina/ asianosaisina ja hyvityksen hakijoina toimii kansainvälisissä rikostuomioistuimissa ja hybridituomioistuimissa?

Law and economics in the civil law world: the case of Brazilian Courts

Conventional wisdom holds that economic analysis of law is either embryonic or nonexistent outside of the United States generally and in civil law jurisdictions in particular. Existing explanations for the assumed lack of interest in the application of economic reasoning to legal problems range from the different structure of legal education and academia outside of the United States to the peculiar characteristics of civilian legal systems. This paper challenges this view by documenting and explaining the growing use of economic reasoning by Brazilian courts. We argue that, given the ever-greater role of courts in the formulation of public policies, the application of legal principles and rules increasingly calls for a theory of human behavior (such as that provided by economics) to help foresee the likely aggregate consequences of different interpretations of the law. Consistent with the traditional role of civilian legal scholarship in providing guidance for the application of law by courts, the further development of law and economics in Brazil is therefore likely to be mostly driven by judicial demand.

Rules of civil procedure for the United States District Courts. : Hearing[s] Seventy-fifth Congress, third session, on S.J. Res. 281, a joint resolution to postpone the effective date of the Rules of civil procedure.

[pt.1] Hearing, April 18, 1938.--pt.2. Hearing, May 19, 1938.

Legal Services Corporation [microform] : activities of the chairman and replacement of the president : hearing before the Subcommittee on Courts, Civil Liberties, and the Administration of Justice of the Committee on the Judiciary, House of Representatives, One Hundredth Congress, second session, August 4, 1988.

"Serial no. 106."

The practice in civil actions and proceedings at law, in the courts where the common law practice is in vogue; with the amendments thereto necessary to incorporate the provisions of the statutes of Maine.

Spine title: Spaulding's practice.

Walker's errors in civil proceedings : being the errors in civil proceedings which were held by the Appellate court to be insufficient to justify reversal of the judgment rendered by the trial court, gathered from the printed decisions of all the state and federal courts /

Includes index.

The public records and the constitution; a lecture delivered at All Souls College, Oxford at the request of the Regius Professors of Civil Law and Modern History, with plan of evolution of the chief courts and departments of the government.

Mode of access: Internet.

The Maine register and United States' almanac for the year of our Lord 1820 ... containing civil, judicial, ecclesiastical and military lists in Maine, associations and corporate institutions ... names of the post towns and post masters ... : also, the constitution as reported by the convention, catalogues of the officers of the general government ... times of the sittings of the several courts, and a variety of other interesting articles.

Shaw & Shoemaker,