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Public Health Law Map - Beta 5 - Medical and Public Health Law Site

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2. Implementing ADR<br />

The major benefit of ADR is not as an alternative to disputes that have already<br />

ripened to the point that a lawsuit is about to be filed. ADR should been seen as part<br />

of a general strategy of avoiding disputes rather than just a more expeditious method<br />

of resolving them. ADR is most effective when it is incorporated in all business<br />

transactions. Many Fortune 500 companies are putting ADR provisions in their<br />

contracts with suppliers <strong>and</strong> corporate customers. In addition to requiring ADR<br />

should a formal dispute arise, the unavailability of litigation encourages the quick,<br />

informal resolution of disputes.<br />

All states allow ADR for medical business disputes, <strong>and</strong> most allow it for medical<br />

malpractice claims, but only if the choice of ADR is voluntary. For example, an MCO<br />

might require persons who choose to subscribe to agree to the binding arbitration of<br />

potential medical malpractice claims. Although most states would accept this, there<br />

is growing trend to require that the ADR agreement be signed after the patient is<br />

injured so that it is really a free choice. The courts would likely reject an agreement<br />

with a private physician who allowed a patient to schedule an appointment <strong>and</strong> arrive<br />

at the office, but then required the patient to agree to arbitration before treatment.<br />

ADR agreements are not allowed as a condition of emergency care or in other<br />

situations where the patient cannot exercise free choice.<br />

In many cases, it is the malpractice insurance companies that resist ADR agreements<br />

because ADR has the potential to increase the overall payments to claimants. An<br />

efficient system for resolving disputes will allow patients with small claims to be<br />

compensated. Studies of the incidence of medical malpractice find that many more<br />

patients are injured by negligent medical care than file medical malpractice lawsuits.<br />

[Compensation in New York. Report of the Harvard <strong>Medical</strong> Malpractice Study to the<br />

State of New York. 1990.] Some of these patients do not realize that they were the<br />

victims of malpractice, some intentionally choose not to sue their medical care<br />

providers, but most are unable to secure representation because their claim is too<br />

small. If the cost of these small claims exceeds the savings in limiting large claims<br />

<strong>and</strong> attorney’s fees, then ADR will only increase the cost of insurance.<br />

3. References - ADR<br />

Adelman SH. Alternative forms of dispute resolution—we must be clear on what we<br />

want. Mich Med. 1991;90:55–56.<br />

Bachman J. Alternative dispute resolution: facilitating new dispute resolution<br />

systems. Aspens Advis Nurse Exec. 1997;12:1,4–7.<br />

Barton HM. Alternative dispute resolution of medical-legal issues. Tex Med.<br />

1991;87:58–61.<br />

B-Lynch C, Coker A, Dua JA. A clinical analysis of 500 medico-legal claims<br />

evaluating the causes <strong>and</strong> assessing the potential benefit of alternative dispute<br />

18

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