This is a priority for me, and I also want to prioritize arranging to have your child seen by the appropriate developmental pediatric specialist as soon as possible. Conclusions and Suggestions Disclosing medical error with an apology remains a thorny problem for physicians despite little disagreement about the ethical merit of such activity. The threat of medical malpractice litigation and its host of negative consequences clearly influence professional behavior and present a formidable social and structural barrier to opening better lines of honest and empathetic communication between stakeholders. There is increasing empirical evidence to suggest that genuine acknowledgments of mistake and regret, coupled with diligent efforts to compensate those harmed, offer a path forward that can mitigate the risk of legal liability. Liability claims and costs before and after implementation of a medical error disclosure program. Harm can also come to patients from getting unnecessary care, from poor or impaired medical judgment, or from a physician failing to put the good of the patient ahead of his or her own. Many errors of omission or commission are institutional or system failures, such as insufficient enforcement of standards for hand washing resulting in inappropriately high rates of health care-associated infections. This module will explore the individual and systems ethical responsibilities in the disclosure of iatrogenic events. Participants will discuss professional integrity, "duty to warn," and transparency. They will examine the moral and legal implications of the response to iatrogenesis. Participants will also review their response to colleagues involved in iatrogenesis. Finally, they will examine the role of apology after iatrogenesis has been disclosed. Participants may confidentially identify types/episodes of iatrogenesis and reflect on how they relate to their practice of medicine. Within this context other complementary ethical issues may arise: respect for people, professional integrity, fiduciary duties, truth telling, accountability, etc. Unfortunately, during the first 3 days of chemotherapy treatment, he had significant side effects, including high fever and neuropsychiatric symptoms. On day 4, the principal investigator was informed that the entire study drug had been administered, which did not match the protocol instructions. Subsequent investigation revealed that the pharmacy had received a new batch of the drug with the same appearance as the old lower-dose batch. She subsequently had a seizure and was transferred to the critical care unit, where she became comatose and died. Posthumously, it was discovered that she had consumed unpasteurized milk in Mexico. As he is scrubbing and getting ready, the nurse on the case notices that the attending surgeon is agitated and has alcohol on his breath. She now has to decide whether (and how) she will stop the attending surgeon from operating. Moreover, the situation is complicated by the power differential between the surgeon and the nurse. Gender, age, and ethnicity of the patients have been altered to avoid identification. Identify the ethical issues involved in the disclosure of iatrogenesis, give examples. Discuss fiduciary relationship, professional integrity, "duty to warn," transparency. Consider the need for assistance and solidarity with the professional involved in iatrogenesis. American Academy of Pediatrics- Resilience in the Face of Grief and Loss: A Curriculum for Medical Students, Pediatric Residents, and Fellows. Without trust, a civilization suffers and eventually, anarchy and disillusionment prevail. Hence, the ethical concept of a fiduciary relationship, one in which the interest of the patient or client be considered above that of the professional. The fiduciary obligation of the medical professional is based on the privilege of being granted permission to become intimately involved in the life of others as part of a curing and healing enterprise. Thus, from the perspective of professionalism, clinicians are expected to do their utmost to prevent errors, alert systems to actual or potential iatrogenesis, and disclose errors when they occur. This position has its grounding in the basic principles of autonomy and respect for people.
The continued instability in the south is considered with concern and Puntland will prevent an extension of instability to its territory. Convergences the respondents viewed the current situation in Somalia with mixed feelings. On the one hand, the end of the transition and the establishment of a new and recognised government provided reasons for some hope. On the other hand, the set-up of the government in Mogadishu and its actions in the first few months of its term were seen with suspicion. All agreed that developments in Puntland are promising and that the introduction of a multi-party system and democratic elections, as well as the exploitation of mineral resources, would provide a bright future for Puntland. A high-ranking member of the Ministry of National Security stressed that there was a need to stop foreigners from meddling in Somali affairs and that Somalis could make their own peace. Emerging discourse the main objective of the Galmudug state is to establish itself as a stable regional administration. The central strategy to reach these aims is reconciliation and negotiations within their region. Galmudug needs to expand its territory in order to be considered a full federal state under the constitution. Support from the federal government and the diaspora is expected to play a major role in its reconstruction. Convergences Galmudug leaders appreciated the positive change in Somali politics that began with the end of the transition and the establishment of the current government. They realised that there were still formidable challenges to overcome, particularly regarding security in the country. Divergences the only visible divergence between the old and the new president of Galmudug was the interpretation of the problem that al-Shabab posed to the nascent administration. While the former president stressed that al-Shabab controlled parts of the Galmudug state, the current president did not highlight this problem. Unaddressed issues the interviewees did not mention the political instability of Galmudug. In fact, the actual territory and boundaries of the regional state are unclear and disputed. There was also no word about the ongoing rivalry between Qavbdiid and Mahamud Abdi Ilmi aka Timokalajeeh. Saad-Saleban, Ayr-Saleban, Marrehan-Saleban, Saleban-Duduble, Marrehan-Ayr) were never mentioned. It was, however, indirectly mentioned that these conflicts exist when the two politicians repeatedly stated the need for extensive reconciliation in the region. Finally, President Abdi Qaybdiid did not mention the repeated attempts by al-Shabab to assassinate him. Both respondents consider that the region has sufficient resources to manage itself and face its challenges, and regard with suspicion attempts by external actors to meddle in their region. Convergences the respondents appreciated the positive change in Somali politics that began with the end of the transition and the establishment of the current government. They agreed that there were still formidable challenges to overcome, particularly regarding security in the country. Finally, there was convergence on the fact that traditional authorities should play a leading role in this process. Divergences the respondents disagreed on the role that the federal government should play in setting up the regional administration. The representative of the Juba Reconciliation Group stressed that the federal government should take the lead and provide the framework for the regional administration. The deputy leader of Ras Kamboni argued that the government should step back and let the local actors sort out their issues first. The respondents also disagreed on who has a legitimate stake in the leadership of the region. Unaddressed issues Respondents did not mention the fact that much of the region they plan to administer is either controlled by Kenyan forces or by al-Shabab.
This involves transforming the defined logical decomposition models and their associated sets of derived technical requirements into alternative solutions. These alternative solutions are then analyzed through detailed trade studies that result in the selection of a preferred alternative. This preferred alternative is then fully defined into a final design solution that satisfies the technical requirements. They include the system architecture models that define the underlying structure and relationship of the elements of the system. If the alternatives are precisely defined and thoroughly understood to be well differentiated in the cost-effectiveness space, then the systems engineer can make choices among them with confidence. It should be realized, however, that this illustration represents neither the project life cycle, which encompasses the system development process from inception through disposal, nor the product development process by which the system design is developed and implemented. These three products should be consistent with each other and will require iterations and design decisions to achieve this consistency. It is imperative that there be a continual interaction between the technology development process, crosscutting processes such as human systems integration, and the design process to ensure that the design reflects the realities of the available technology and that overreliance on immature technology is avoided. This interaction is facilitated through a periodic assessment of the design with respect to the maturity of the technology required to implement the design. Although the process of design concept development by the integration of lower level elements is a part of the systems engineering process, there is always a danger that the top-down process cannot keep up with the bottom-up process. Therefore, system architecture issues need to be resolved early so that the system can be modeled with sufficient realism to do reliable trade studies. As the system is realized, its particulars become clearer-but also harder to change. The purpose of systems engineering is to make sure that the Design Solution Definition Process happens in a way that leads to the most functional, safe, and cost-effective final system while working within any given schedule boundaries. The basic idea is that before those decisions that are hard to undo are made, the alternatives should be carefully and iteratively assessed, particularly with respect both to the maturity of the required technology and to stakeholder expectations for efficient, effective operations. This interaction is facilitated through periodic assessment of the design with respect to the maturity of the technology required to implement the design. After identifying the technology gaps existing in a given design concept, it is frequently necessary to undertake technology development in order to ascertain viability. Given that resources will always be limited, it is necessary to pursue only the most promising technologies that are required to enable a given concept. If requirements are defined without fully understanding the resources required to accomplish needed technology developments, then the program/project is at risk. Technology assessment should be done iteratively until requirements and available resources are aligned within an acceptable risk posture. Technology development plays a far greater role in the life cycle of a program/project than has been traditionally considered, and it is the role of the systems engineer to develop an understanding of the extent of program/ project impacts-maximizing benefits and minimizing adverse effects. Traditionally, from a program/ project perspective, technology development has been associated with the development and incorporation of any "new" technology necessary to meet requirements. However, a frequently overlooked area is that associated with the modification of "heritage" systems incorporated into different architectures and operating in different environments from the ones for which they were designed. If the required modifications and/or operating environments fall outside the realm of experience, then these too should be considered technology development. To understand whether or not technology development is required-and to subsequently quantify the Once it is understood what the system is to accomplish, it is possible to devise a variety of ways that those goals can be met. Sometimes, that comes about as a consequence of considering alternative functional allocations and integrating available subsystem design options, all of which can have technologies at varying degrees of maturity. When the bottom-up process is operating, a problem for the systems engineer is that the designers tend to become fond of the designs they create, so they lose their objectivity; the systems engineer should stay an "outsider" so that there is more objectivity. This is particularly true in the assessment of the technological maturity of the subsystems and components required for implementation.
Fraction pieces: Counters: + + the teacher should have been more specific in the instructions. Varies, but should include not only rounding, but also at least one other method, such as front-end, compatible numbers, or truncating. Michael began working on his division homework and his work on the first problem looked like this: 8 26 182 208 Explain where Michael got the 208. Varies, but should state something on the order of: "Michael estimated that 182 could be divided by 26 8 times, and when he tried it 8 x 26 was 208. I would try 7 because it is the next closest number (or I know that 6 x 7 = 42 and the dividend 182 also ends in a 2). Describe any that might be the same if you changed their orientation, that is any that would be the same if you moved them around. One day, in some haste, they left home with each wearing the hat and coat of one of the others. When Joyce joined the Army, she decided to give her boom box to Ron and Jim, her two high-school-age brothers. After she heard Ron and Jim quarrel over using her boom box, Joyce told them they had better figure out a fair method of division so that one of them would get the stereo and the other would get a fair payment. Alice, Bill, and Carl have jointly inherited a piano, a car, a boat, and $20,000 in cash. Decide which person receives each item, and what cash payments are made so that Alice, Bill, and Carl all feel they have received at least what each considers to be his or her fair share of the inheritance. Because of the high cost of living, Kimberly, Terry, and Otis each holds down two jobs, but no two have the same occupation. Consider a circle divided by n chords in such a way that every chord intersects every other chord interior to the circle and no three chords intersect in a common point. While three watchmen were guarding an orchard, a thief slipped in a stole some apples. On his way out, he met the three watchmen one after another, and to each in turn he gave half the apples he had and two besides. In windy cold weather, the increased rate of heat loss makes the temperature feel colder than the actual temperature. In a college mathematics class all the students are also taking anthropology, history, or psychology and some of the students are taking two or even all three of these courses. If (i) forty students are taking anthropology, (ii) eleven students are taking history, (iii) twelve students are taking psychology, (iv) three students are taking all three courses, (v) six students are taking anthropology and history, and (vi) six students are taking psychology and anthropology. Start the investigation by placing any two natural numbers in the first two rows of column one of the record sheet and then complete the column by adding the consecutive entries to obtain the next entry in the Fibonacci manner. Lastly, prove that your conjecture is correct by placing a and b in the first and second positions in the last column and then repeating the process as before. Use the fractions 2, 1, 1, 5, 1 and the whole number 1 to fill in 3 3 6 6 2 the spaces below so that each side of the triangle will have the same sum. Arrange four points on a plane so the distance between any two points is one of two possible lengths; for example, one possible solution would be to have the four points be the vertices of a square. They discovered that 27 members have visited Mexico, 34 have visited Canada, 12 have been to England, 18 have visited both Mexico and Canada, 6 have been only to England, and 8 have been only to Mexico. Some club members have not been to any of the three foreign countries and, curiously, and equal number have been to all three countries. Solve each of these problems and indicate the subtraction facts illustrated by each. The eighth grade class at Washington Middle School is raffling off a turkey as a moneymaking project. If a is to b as c is to d; that is, if a = d b a) show that b is to a as d is to c.
How does a physician balance the competing and sometimes conflicting goods of confidentiality, veracity, and fidelity When is it acceptable for a physician to deny a parent authority over what information to give a child What are the goals of medicine and are the goals of the child/parent/and physician the same The patient knows her mother died when she was a toddler and that those life circumstances meant her biological mother was unable to care for her, although she wanted the best for her child. The patient was recently in the hospital with respiratory problems and although she improved, she is asking questions. A 15-year-old female, the daughter of family friends, is a patient you are following for obesity and hypertension. Given her hypertension and the pregnancy, she is at some medical risk, but she promised to follow up on all her obstetric appointments and will tell her parents at some later time. You are caring for a child with asthma and his mother brings him in because he is wheezing. He was with his father over the weekend and he now has a cough and cold and has some wheezing. She accuses the father in front of the child and wants your help to get sole custody. Mom wants you to write to the court to inform them the father is medically negligent by continuing to smoke around their son and therefore putting the child at increased risk. A 12-year-old new patient is brought in by his parents with a past history of several episodes of wheezing. The father looks uncomfortable while you are asking about any family members with asthma and asks to speak to you in private. In private, the father tells you that the child was conceived via donor insemination and states he does not want his son to know. Discuss the basic of the duty of medical confidentiality, veracity, and fidelity and its application to the patient and family. Recognize situations in which these respective duties are potentially in conflict- for example, when a family wants information withheld from an older child or when a child and parents disagree on the course of action that should be taken. Suggested Reading and Resources for Instructor American Academy of Pediatrics, Committee on Bioethics. Communicating with children and families: from every day interactions to skill in conveying distressing information. Communicating about prognosis: ethical responsibilities of pediatricians and parents. Disclosure of a diagnosis to children and adolescents when parents object: a clinical ethics analysis. J Clin Ethics (special section) 2003;14:59-87 Case Discussion Analysis of the duties In this case, the duties to the parent for confidentiality are in potential conflict with the duty to tell the patient the truth. This highlights a challenge in pediatrics when the pediatrician has a legal obligation to the parents (or legal guardian) and a moral obligation to the patient. Middle school students as a group are known for their propensity to form cliques and exclude those who are different. Her parents have told her she has a blood disease, and she is compliant with treatment. Her biological mother died from the disease and although the daughter knows she is adopted and her mother is dead, the adoptive parents do not wish to discuss that the child 49 has the same disease as her mom or that it is fatal. The adoptive parents have tried to portray the biological mother as a caring woman who wanted what was best for the child, especially after she knew she was sick. Should physicians always tell the truth, the whole truth and nothing but the truth Physicians often inform patients of some, but not all, risks of a procedure or medication. In doing so, they make judgments about what information is essential for the patient to know and what ultimately they tell the patient. In this sense, withholding some information is common in the practice of medicine. Historically, physicians were regarded as ministers of hope and comfort to the sick. When diagnostic options were extremely limited and treatment options relatively nontoxic, doctors often believed that comforting and caring for the sick and suffering was more important than full disclosure and were known to withhold specific stressful information.
Alternative Case A 4-yearold is admitted with a 2day history of vomiting, diarrhea, fever, and mid abdominal pain. Laboratory tests and abdominal ultrasonography are normal in the emergency department, where the child is hydrated intravenously. During rounds with the attending physician, you mention your concern regarding the abdominal pain, but the attending physician reassures you that it is attributable to abdominal cramps and wants no further imaging performed. Are there times when it is not appropriate for a junior trainee to challenge the directions of a supervisor Be prepared to address disagreements with team members at more advanced levels of training and experience regarding important medical care decisions, even if doing so carries a risk to the junior trainee of appearing to challenge authority. Understand the role and obligations of mediators and other supervisory professionals to help resolve such disagreements. Suggested Readings for Instructor General materials on professionalism are listed as the first 3 references,1-3 in the final 134 section of this chapter. Discussion of a broad range of issues in ethics and professionalism that commonly challenge trainees can be found in the references by Bercovitch and Long 2009,4 Brody and Doukas 2014,3 Carrese et al 2011,5 McDougal and Sokol 2008,6 and Moon et al 2009. The relationship between a supervisor and junior trainee in the health care setting is one in which the trainee is both dependent on the supervisor for care oversight and education and obligated to deliver the best possible care to patients who are the joint responsibility of all involved. This is one of many sources of moral distress cited by health professionals, particularly nurses, who work in what have traditionally been considered to be subordinate roles. The more urgent or emergent the clinical situation, the less time there is for a trainee to question the directive of the supervisor. The more crucial the diagnostic or therapeutic conflict between supervisor and trainee to the wellbeing of the patient, the more important it is to take steps outlined below. What are the best actions to take in situations in which you have a dispute with a supervisor about treatment In order that your reasons for challenging their authority not be misunderstood or misinterpreted, you must strive to express your perspectives as clearly and respectfully as possible. If work within the clinical team is not experienced as taking place in a "psychologically safe environment,"10p842 trainees may feel inhibited asking questions or expressing differing viewpoints to their superiors. In many situations, engaging the supervisor in dialogue will largely resolve the conflict over appropriate patient management. All care teams need to have access to an outside party who can help mediate disagreements about care. This may be another senior 135 resident, a chief resident, another inpatient attending physician, or the chief of service. The duties of such mediators are to listen carefully to all considerations and be guided by the best interests of the patient. Challenging the authority of your supervisors can put you and your patients at risk. By virtue of their greater degree of experience and training, your supervisors may have taken additional considerations into account or been in similar clinical situations that put them in a good position to make what may be the most sound diagnostic and therapeutic decisions. At the same time, they may not have access to or appreciate all the information that you know by virtue of your close, current work "at the bedside" with the patient and family. Although engaging supervisors in respectful discussion about disagreements is an advanced professional skill worth fostering, you also run the risk of being viewed in an unfavorable light, depending on the dynamics of the process. Training programs are intimate social groups in which the reputations or perceived attributes of particular members endure. This may have a strong effect, together with other characteristics of their relationship, on help-seeking behavior by the trainee. There are times, such as lifethreatening emergencies demanding patient resuscitation, when the importance of maintaining a smoothly running, hierarchical team is critical to ensuring the best chance of favorable patient outcomes. In these instances, responsibilities for directing care tend to be shifted to the highest-level professionals available, and all impediments to carrying out treatment must be minimized. Even during patient resuscitation, however, any participating team member who feels that an error is being made, or is about to be made, should not remain silent. The second case scenario suggests the potential for harm resulting from delayed diagnosis of a condition, such as appendicitis, which could call for surgical intervention. The greater the likelihood that following instructions from your resident or attending may lead to harm to your patients, the more incumbent it is on you to argue for your own preferences in planning and delivering treatment. Interns face difficult decisions when supervising physicians disagree with their inclinations.
Electric companies over-capitalize and use excess capital to avoid labor and fuel expenditures (which are generally much cheaper than the additional capital) - nuclear generating plants are a good example of this of this type of planned inefficiency. Electricity is not something that is easily stored, and therefore the relevant demand for electricity is the peak demand on the system. Because public utilities must plan for peak load demands on the system, most of the time electric companies are operating at some fraction of total capacity. No description could exaggerate the evil which is in store for a society given hopelessly over to a regime of private monopoly. Under this comprehensive name we shall group the most important of the agencies which not merely resist, but positively vitiate, the action of natural economic law. Monopoly checks progress in production and infuses into distribution an element of robbery. It makes prices and wages abnormal and distorts the form of the industrial mechanism. Prices do not conform to the standards of cost, wages do not conform to the standard of final productivity of labor, and interest does not conform to the marginal product of capital. The system of industrial groups and sub-groups is thrown out of balance by putting too much labor and capital at certain points and too little at others. Every person who shall make any contract or engage in any combination or conspiracy hereby declared to be illegal shall be deemed guilty of a felony, and, on conviction thereof, shall be punished by fine not exceeding $10,000,000 if a corporation, or, if any other person, $350,000, or by imprisonment not exceeding three years, or by both said punishments, in the discretion of the court. Every person who shall make any such contract or engage in any such combination or conspiracy, shall be deemed guilty of a felony, and, on conviction thereof, shall be punished by fine not exceeding $10,000,000 1 Statutory material is current as of January 1997. Such proceedings may be by way of petition setting forth the case and praying that such violation shall be enjoined or otherwise prohibited. When the parties complained of shall have been duly notified of such petition the court shall proceed, as soon as may be, to the hearing and determination of the case; and pending such petition and before final decree, the court may at any time make such temporary restraining order or prohibition as shall be deemed just in the premises. If sections 1 to 7 of this title apply to such conduct only because of the operation of paragraph (1) (B), then sections 1 to 7 of this title shall apply to such conduct only for injury to export business in the United States. Critically evaluate the social optimum and fair rate of return theories of rate regulation of monopolies. Develop and explain the monopoly model, showing an economic profit, a normal profit, and an economic loss. Sample Questions: Multiple Choice: An unregulated monopolist when compared with a purely competitive industry will: A. Produce more, and charge more Produce more, and charge less Produce less, and charge more Produce less, and charge less Which of the following statements is true of an unregulated monopolist Price is less than marginal cost Price is more than average revenue Price is more than marginal revenue Price is set where the monopolist chooses regardless of cost 191 True - False Society would be unambiguously better-off without monopolists. The markets to be examined in this chapter are those where firms purchase productive resources (in other words, factors of production). Resource Market Complications Over the course of modern American economic history there have been market failures, serious social problems, and other difficulties that have resulted in certain resource markets becoming heavily regulated. In particular, capital and labor markets have been the focus of substantial regulation. Many of these scandals were from conflicts of interest, resulting in 2003 beginning to witness the regulation of financial markets in the U. The late 1990s witnessed the abuse of managerial trust by high ranking executives in awarding themselves very high compensation levels, while laying-off productive employees, and cutting wages and benefits for those who performed the work of the organizations. By 2003 these abuses have not yet been addressed by re-regulation, but as these becoming increasing problematic re-regulation will occur. The United States seems to go through cycles where regulation and deregulation ebb and flow. Resultant depressions and recessions, give way to more active government involvement in factor markets, and as things seemingly progress political pressure for de-regulation and the results of that political pressure set the stage for another round of economic difficulties. If history is instructive then market ups and downs are the natural order of things in a mixed economy. Because labor (human beings as a factor of production) and private property are involved in resource markets there tends to be more controversy concerning these markets than is true of normal product markets.
In the case of a large spill, the Oil Spill Liability Trust Fund would likely not provide sufficient backup. Thus, a significant portion of the injuries caused to individuals and natural resources, as well as government response costs, could go uncompensated. A realistic policy solution also requires an understanding of the host of complex economic impacts that could result from increases to liability caps and financial responsibility requirements. Recommendation F1: Congress should significantly increase the liability cap and financial responsibility requirements for offshore facilities. To address both the incentive and compensation concerns noted above, Congress should significantly raise the liability cap. Financial responsibility limits should also be increased, because if an oil company does not have adequate resources to pay for a spill, the application of increased liability has little effect: Should a company go bankrupt before fully compensating for a spill, its liability is effectively capped. If, however, the level of liability imposed and the level of financial responsibility required are set to levels that bear some relationship to potential damages, firms will have greater incentives to maximize prevention and minimize potential risk of oil spills30 and also have the financial means to ensure that victims of spills do not go uncompensated. Chapter Nine 285 285 Legislative attempts to raise the cap and financial responsibility requirements to significantly higher levels have been met with the argument that these changes will cause insurance carriers to drop oil pollution coverage, leading to an exodus of small and independent companies from the offshore drilling market. The counter-argument is that oil companies should bear the social costs of their activities, and if those costs are too large or unpredictable to be insurable, then it is appropriate that these companies exit the market. A company should not be able to cause billions of dollars of damage and walk away, simply because its operations contribute to the economy of the Gulf. Nor should smaller companies that can demonstrate the ability to drill safely and to pay for damages resulting from a large spill be forced out of the market. However, smaller companies that cannot demonstrate financial responsibility and meet risk requirements set and monitored by the Department of the Interior or a third party should not be allowed to make others pay for the costs of their accidents. One option for keeping competent independents in the market is a mutual insurance pool. Under such an arrangement, individual companies engaged in offshore drilling would pay premiums into a pool, which would pay out damages caused by a company as a result of a spill. This option would allow companies to demonstrate financial responsibility for the cost of spills, at least to the limit paid out by the pool. Another option would be to phase in increases in the liability cap and financial responsibility requirements, which would allow the insurance industry a period of adjustment. Although any increase in liability limits and financial responsibility requirements would test the capacity of the offshore drilling insurance market, over time such a change would almost certainly stimulate an increase in insurance capacity. A phased-in approach would allow Congress to re-assess any concerns about limited capacity in the insurance industry in light of actual experience. Finally, regardless of how insurance is provided, smaller firms could be encouraged to partner with firms with greater financial resources. It should be noted that "joint ventures" between larger and smaller companies already exist; thus a policy change may not be necessary to encourage such arrangements. The Need to Increase Limitations on Payments from the Oil Spill Liability Trust Fund If liability and financial responsibility limits are not set at a level that will ensure payment of all damages for spills, then another source of funding will be required to ensure full compensation. Therefore, Congress should raise the Oil Spill Liability Trust Fund per-incident limit because the current limits are clearly inadequate. Recommendation F2: Congress should increase the limit on per-incident payouts from the Oil Spill Liability Trust Fund. An alternative would be to increase the Trust Fund through a surcharge by mandatory provisions in drilling leases triggered in the event that there are inadequate sums available in the Fund. But raising the limit would help ensure that victims have access to compensation without the need to seek further specific funding from Congress, or otherwise burdening the taxpayer. The Need for Better Auditing and Monitoring of Risk the Interior Department currently determines financial responsibility levels based on potential worst-case discharges, as required by the Oil Pollution Act. This increased scrutiny would provide an additional guard against unqualified companies entering the offshore drilling market. Recommendation F3: the Department of the Interior should enhance auditing and evaluation of the risk of offshore drilling activities by individual participants (operator, driller, other service companies). The Department of the Interior, insurance underwriters, or other independent entities should evaluate and monitor the risk of offshore drilling activities to promote enhanced risk management in offshore operations and to discourage unqualified companies from remaining in the market. If liability and financial responsibility limits are raised, increased liabilities will be borne by insurance carriers, which will have a strong incentive to promote new safety techniques and methods, as well as to monitor risk. Insurance carriers might insist on certification of operators by an independent entity devoted to identifying best safety practices and monitoring risk, such as a self-policing safety organization for the oil and gas industry, as Chapter Nine 287 287 recommended in Chapter 8. Insurers or a self-policing safety organization for the industry also could provide a guard against unqualified companies entering the offshore drilling market.
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