Duncan MacCourt

Lecturer on Law

2016-2017

Hauser 400

617-495-3124

Assistant: Teresa Cyr / 617-496-2392

Biography

Duncan MacCourt is currently an associate psychiatrist at McLean Hospital, the associate medical director at McLean Hospital SouthEast, and an instructor in Psychiatry at the Harvard Medical School. He is a graduate of Harvard College and Harvard Law School. After HLS, he clerked for the Honorable Conrad K. Cyr on the United States Court of Appeals for the First Circuit. He then attended the University of Pennsylvania School of Medicine, the Harvard/Cambridge Hospital Psychiatry Residency program, and he completed a fellowship in cancer psychiatry/psychosomatic medicine at the Dana Farber/Brigham and Women’s Hospitals. Research and teaching interests include law and psychiatry, ethics, death and dying, law and literature, psychiatric education methodologies, medical error reduction and emerging technologies. In addition, he has a special interest in the developmental path of law students during their education and lawyers in their careers. Current projects include the relationship of neuroscience to informed consent doctrine and the role of reading in the law. His clinical work focuses on helping individuals suffering from depression, anxiety and psychosis.

Areas of Interest

Joseph L. Bernstein, Duncan MacCourt, Dan M. Jacob & Samir Mehta, Utilizing Information Technology to Mitigate the Handoff Risks Caused by Resident Work Hour Restrictions, 468 Clinical Orthopaedics & Related Res. 2627 (2010).
Categories:
Health Care
,
Technology & Law
Sub-Categories:
Health Law & Policy
,
Science & Technology
,
Medical Technology
Type: Article
Abstract
Resident duty hours have been restricted to 80 per week, a limitation thought to increase patient safety by allowing adequate sleep. Yet decreasing work hours increases the number of patient exchanges (so-called "handoff") at the end of shifts. WHERE ARE WE NOW?: A greater frequency of handoff leads to an increased risk of physician error. Information technology can be used to minimize that risk. WHERE DO WE NEED TO GO?: A computer-based expert system can alleviate the problems of data omissions and data overload and minimize asynchrony and asymmetry. A smart system can further prompt departing physicians for information that improves their understanding of the patient's condition. Likewise, such a system can take full advantage of multimedia; generate a study record for self-improvement; and strengthen the interaction between specialists jointly managing patients. HOW DO WE GET THERE?: There are impediments to implementation, notably requirements of the Health Insurance Portability and Accountability Act; medical-legal ramifications, and computer programming costs. Nonetheless, the use of smart systems, not to supplant physicians' rational facilities but to supplement them, promises to mitigate the risks of frequent patient handoff and advance patient care. Thus, a concerted effort to promote such smart systems on the part of the Accreditation Council for Graduate Medical Education (the source of the duty hour restrictions) and the Association of American Medical Colleges (representing medical schools and teaching hospitals) may be effective. We propose that these organizations host a contest for the best smart handoff systems and vigorously promote the winners.
Duncan MacCourt & Joseph Bernstein, Medical Error Reduction and Tort Reform Through Private, Contractually-Based Quality Medicine Societies, 35 Am. J.L. & Med. 505 (2009).
Categories:
Civil Practice & Procedure
,
Health Care
Sub-Categories:
Torts
,
Torts - Negligence
,
Health Law & Policy
Type: Article
Abstract
The current medical malpractice system is broken. Many patients injured by malpractice are not compensated, whereas some patients who recover in tort have not suffered medical negligence; furthermore, the system's failures demoralize patients and physicians. But most importantly, the system perpetuates medical error because the adversarial nature of litigation induces a so-called "Culture of Silence" in physicians eager to shield themselves from liability. This silence leads to the pointless repetition of error, as the open discussion and analysis of the root causes of medical mistakes does not take place as fully as it should. In 1993, President Clinton's Task Force on National Health Care Reform considered a solution characterized by Enterprise Medical Liability (EML), Alternative Dispute Resolution (ADR), some limits on recovery for non-pecuniary damages (Caps), and offsets for collateral source recovery. Yet this list of ingredients did not include a strategy to surmount the difficulties associated with each element. Specifically, EML might be efficient, but none of the enterprises contemplated to assume responsibility, i.e., hospitals and payers, control physician behavior enough so that it would be fair to foist liability on them. Likewise, although ADR might be efficient, it will be resisted by individual litigants who perceive themselves as harmed by it. Finally, while limitations on collateral source recovery and damages might effectively reduce costs, patients and trial lawyers likely would not accept them without recompense. The task force also did not place error reduction at the center of malpractice tort reform -a logical and strategic error, in our view. In response, we propose a new system that employs the ingredients suggested by the task force but also addresses the problems with each. We also explicitly consider steps to rebuff the Culture of Silence and promote error reduction. We assert that patients would be better off with a system where physicians cede their implicit "right to remain silent", even if some injured patients will receive less than they do today. Likewise, physicians will be happier with a system that avoids blame-even if this system placed strict requirements for high quality care and disclosure of error. We therefore conceive of de facto trade between patients and physicians, a Pareto improvement, taking form via the establishment of "Societies of Quality Medicine." Physicians working within these societies would consent to onerous processes for disclosing, rectifying and preventing medical error. Patients would in turn contractually agree to assert their claims in arbitration and with limits on recovery. The role of plaintiffs' lawyers would be unchanged, but due to increased disclosure, discovery costs would diminish and the likelihood of prevailing will more than triple. This article examines the legal and policy issues surrounding the establishment of Societies of Quality Medicine, particularly the issues of contracting over liability, and outlines a means of overcoming the theoretical and practical difficulties with enterprise liability, alternative dispute resolution and the imposition of limits on recovery for non-pecuniary damages. We aim to build a welfare enhancing system that rebuffs the culture of silence and promotes error reduction, a system that is at the same time legally sound, fiscally prudent and politically possible.
Joseph Bernstein, Duncan MacCourt & Bruce D. Abramson, Topics in Medical Economics: Medical Malpractice, 90 J. Bone & Surgery Am. 1777 (2008).
Categories:
Civil Practice & Procedure
,
Health Care
Sub-Categories:
Torts
,
Health Law & Policy
Type: Article

Education History

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