In the first study of its kind, the RAND Institute for Civil Justice (ICJ) found that as adverse events in hospitals decreased, medical malpractice claims decreased as well.

While the study may seem to prove the obvious, no evidence affirming such a correlation had previously been documented.

In principle, improvements in health care quality, and in safety outcomes and practices in U.S. facilities, ought to have a positive impact on the volume of malpractice claims against physicians and institutions. Malpractice claims are supposed to spin out of legitimate injuries to patients, so reducing the occurrence of those injuries ought to have a corresponding effect on the volume of litigation. In practice, however, this association has not previously been demonstrated.

Despite its putative status, the link between safety outcomes and malpractice claims in U.S. hospitals and facilities is nevertheless potentially very important to policy. Such a link suggests that providers could improve their own malpractice risk by making health care safer; that the interests of patients and providers are potentially well aligned when risk is addressed in this way; and that policymakers might enact a new set of tools for reducing malpractice risk, focused on facilitating new patient safety interventions, quality-improvement activities, rootcause analysis efforts, and the like.

The results?

Our results showed a highly significant correlation between the frequency of adverse events and malpractice claims: On average, a county that shows a decrease of 10 adverse events in a given year would also see a decrease of 3.7 malpractice claims.

The study indicated the policy implications of the results;

From a policy perspective, the idea of a direct link between safety outcomes and the malpractice claims that spin out of them has several major implications. First is the premise that new safety interventions potentially can reduce the volume of malpractice litigation--a desirable result to seek out, even beyond the immediate impact of medical injuries avoided. Stated another way, improvements in safety performance have the potential to benefit both patients and providers and to align their interests while reducing litigation. A second implication is that the relationship between safety and malpractice is complex and not fully described by the simple notion of deterring acts of negligence through civil liability. Third is the observation that malpractice laws that place providers at risk for engaging in peer review risk-management activities, root-cause analysis, and the like, could have the perverse effect of detracting from broader patient safety efforts. In turn, that could increase the frequency of adverse events and preventable injuries and, indirectly, increase the volume of malpractice litigation itself.

These kinds of relationships and concerns represent an entirely different set of levers for policymakers to consider in regard to malpractice, quite apart from more conventional statutory tort interventions, such as caps on damages in tort claims.

For the full report, click here.

In Posas v. Hortan, 126 Nev. Adv. Op. No. 12 (April 15, 2010), the Nevada Supreme Court addressed when it is appropriate for a sudden emergency instruction to be given to a jury.

The case arose from an automobile accident. Nicole Horton rear-ended Amelia Posas when Posas stopped suddenly for a jaywalking pedestrian pushing a stroller. Horton, who was driving about three to four behind Posas, admitted that she was following Horton too close.

Posas filed suit against Horton as a result of the accident. At trial, the jury was given a sudden emergency instruction, despite Posas' objection, and the jury returned a verdict for Horton.

The sudden emergency instruction stated that "A person confronted with a sudden emergency which he does not create, who acts according to his best judgment or, because of insufficient time to form a judgment fails to act in the most judicious manner, is not guilty of negligence if he exercises the care of a reasonably prudent person in like circumstances."

The Court concluded that the jury instruction was given inappropriately. First, the Court concluded that Horton wasn't faced with a sudden emergency because she was not suddenly placed in a position of peril through no negligence of her own. Instead, the Court concluded that she placed herself in a position of peril through her own negligence. Further, the Court stated that in order to request the sudden emergency instruction, the requesting party must have been affected by the emergency. The Court noted that if an emergency situation had been created by the pedestrian, it would have been an emergency that confronted Posas, not Horton.

The Court clarified that the sudden emergency instruction is only appropriate when (1) unexpected conditions confront the actor requesting the instruction and (2) the actor was otherwise exercising reasonable care.