The medical and legal landscapes are intertwined much more so than ever before. With the advent of this close relationship between the medical and legal fields, physicians have become involved in a multitude of legal proceedings. Physician involvement ranges from consultation on legal matters to testifying in open court to contesting malpractice lawsuits. In part 2 of our review of medicolegal issues, we are going to look at a few different types of legal cases that physicians are involved in, and what their roles are in those proceedings.
Social Security or Supplemental Security Disability Hearings
One of the major case types in which physicians are involved is for determination of an individual’s eligibility for Social Security or Supplemental Security Income Disability. Both of these programs provide financial assistance for those with disabilities. Social Security Income Disability pays benefits to people who are “insured”, meaning those who have worked for a certain number of years and have paid Social Security taxes. Supplemental Security Income does not have those restrictions, and pays benefits based on the financial requirements of the applicant.
Cases involving income disability center around a hearing, where citizens can appeal decisions made by the Social Security Administration (SSA) involving eligibility or specific monetary payouts. In these types of cases, physicians often testify for both the claimant and SSA. When physicians testify for the claimant, their purpose is usually to summarize key information about the claimant’s medical history and to provide the judge with evidence justifying the awarding of income disability. When physicians testify for the SSA, the purpose of their testimony remains to summarize key information about the claimant’s medical history. However, physicians are often called by the SSA to help support SSA decisions and prevent the case from being remanded or appealed again. Irrespective of which party the physician testifies for, they are also exposed to questioning by the other side involved in the hearing.
Another key case type that physicians testify in, and probably the one most notable to the public, is criminal trials. In criminal trials there are two notable roles that physicians may play. Physicians in the field of forensic pathology fill the first notable role. Forensic pathology is a sub-specialty of pathology and requires an additional year of fellowship training after completion of a pathology residency program. The role of forensic pathologists is multiple, with their primary objective being to analyze biological evidence. This analysis can include such things as performing autopsies on postmortem specimens to determine cause of death, examining wounds for possible etiology, inspecting histological slides to identify a disease process, or interpreting toxicology screens to determine drug exposure or impairment. Forensic pathologists are often called upon as expert witnesses to provide their testimony in open court, and they are subject to questioning by both parties involved in a case.
Forensic psychiatrists fill the second notable role for physicians in criminal trials. Forensic psychiatry is a sub-specialty of psychiatry, with an additional year of fellowship training after completing a psychiatry residency program. The responsibilities of a forensic psychiatrist include determining a person’s ability to stand trial in the context of mental competence. Further responsibilities include giving an opinion to the court about the mental state of a person during the commission of a crime. If a forensic psychiatrist determines that the party in question has some mental defect or illness, the party may be found “not guilty by reason of insanity.” The validity of these judgments are controversial, as many are suspicious of attorneys using “insanity defenses” when they are not typically warranted. Like forensic pathologists, forensic psychiatrists are subject to questioning by both parties involved in any legal case in which they testify.
Medical malpractice is defined as professional negligence by a health care provider where the treatment provided falls below, or deviates from, accepted standards of care. The specific course of action taken by the health care provider results in injury or death of the patient. In these types of cases physicians are the defendants, and they often employ legal advisors to aid in their defense. In order to further protect themselves from malpractice suits, physicians and hospital systems spend significant sums of money on malpractice insurance.
The statistics behind medical malpractice are both interesting and striking. In 2012, malpractice payouts totaled $3.6 billion from 12,142 claims. Cases involving death (31%) and significant permanent injuries (19%) encompassed 50% of all payouts. 5 states (New York, Pennsylvania, California, New Jersey, and Florida) had total payouts exceeding $200 million. The significant monetary burden of malpractice claims has created a controversy surrounding tort reform. Malpractice tort reform will be the topic of the next installment of the series, so stay tuned!