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In 21 U.S. States, Medical Standards Locally Determined

Rule dating back to 1880 allows standard of care to be decided by what is the local norm

THURSDAY, June 21 (HealthDay News) -- In contrast to medical school training, licensing and board certification, which are determined according to national requirements, standards of medical practice are locally determined in 21 U.S. states, creating uncertainty over what constitutes medical malpractice, according to a commentary published in the June 20 issue of the Journal of the American Medical Association.

Michelle Huckaby Lewis, M.D., J.D., of the Johns Hopkins Berman Institute of Bioethics in Baltimore, and colleagues explain that the locality rule was created in the 1880s, and arose from the lack of educational opportunities for rural doctors compared to their urban counterparts. In small communities with only one or two doctors, the law in effect created immunity from malpractice suits.

The authors argue that in the context of modern medical education and practice, the locality rule is becoming harder to justify because it allows substandard doctors to set the level of acceptable care, education is now standardized and all physicians can upgrade their knowledge using modern technology.

"Whereas this rule protected rural physicians in the 1800s who didn't have access to the kind of medicine available in larger cities, it now works to create uncertainty for physicians, especially those who practice in more than one legal jurisdiction, which can translate to less than adequate patient care," said Huckaby Lewis, in a statement.

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