Medical malpractice claims and quality improvement program as viewed by a forensic pathologist.

This is a review article dealing with the half-century evolution of the quality assurance program to improve patient care in the United States. The author attempted to point out some differences in approach to solving the medical error and medical malpractice problems between Japan and the U.S. In the 1970s, an increase in the medical malpractice claims resulted in such high premiums for medical liability insurance that it threatened the healthcare system in the U.S. Urgent legislative remedy, the Medical Injury Compensation Reform Act (MICRA) was put into place in the State of California. This act was the beginning of the definitive quality improvement in our health care system. It was followed by other improvement programs, such as the National Practitioner Data Bank (NPDB) for tracking physicians with malpractice judgments or settlements against them, or who have problems with the medical licensing Board or other impairments. By comparison, in recent years, in Japan, there has been a rash of medical malpractice claims, similar to the situation in the U.S. in the 1970's. The two pronged approach to maintaining and assuring quality health care are: (1) Set standards by inspection and accreditation of hospitals and healthcare facilities and (2) by credentialing and peer review program to assure the competency of the physicians and other healthcare personnel. Clinical medicine has made a major effort in setting up a quality assurance program and so has forensic medicine. Similar approaches have been used in both programs. The current emphasis in forensic medicine is on inspection and accreditation of the medical examiner and coroner's offices by the National Association of Medical Examiners (NAME) and re-certification for the medical license and specialty board and credentialing and peer review activities.