Litigation involving medical faculty and academic medical centers, 1950-1991.

An analysis is presented of 240 cases of litigation involving medical faculty, medical schools, and academic medical centers reported over the period 1950-1991. The number of reported cases increased dramatically over the study period in association with the expansion of the national medical educational enterprise. These cases can be conveniently divided by the issues they dealt with into three broad areas: general administration (89 cases), clinical affairs (108 cases), and research issues (43 cases). Cases of litigation related to general administration were most often concerned with the hiring, promotion and/or tenure, and discharge of faculty, with nearly half of these alleging discrimination. General administrative disputes also arose over allocation of departmental resources and responsibilities, faculty conduct, Veterans Affairs, relationships, employee benefits, system-wide discrimination, and collective bargaining. Courts generally supported the exercise of administrative discretion, yet examined procedures carefully. Litigation related to clinical affairs increased dramatically in recent years. Issues litigated reflect the complexity of the existing academic health care system and environment: sovereign immunity and/or malpractice, practice plans, staff privileges, indemnification, access to peer review records or other records, and conduct of practice. Outcomes of clinically related litigation through 1991 indicate substantial leeway for medical faculty, medical schools, and academic medical centers to innovate and advance their patient mission. Litigation related to medical research also accelerated recently. Issues litigated involved grants and/or personnel management, research risks, commercialization, research funding, ethics, and research animals. Litigation has paralleled (1) federal policy initiatives designed to stimulate collaboration between industry and academia and (2) the growth of regulations designed to monitor policy areas affecting research. The exposure of academic medical administrators and faculty to litigation has increased in the last 40 years. Medical schools and academic medical centers should take active steps to reduce future risks of litigation.