Medical malpractice: Fiction or crisis? And what to do-

[lil-petunia]

Truth- Malpractice suit rates and recoveries in suit are lower today than in the last 8 years, adjusted for inflation.
Truth - Most malpractice occurs in hospitals, and is never reported, many times, not even to the patient.
Truth - Many most outrageous cases of malpractice are hidden by ye olde "Transfer the patient to another facility" game.
Truth - insurance rates for doctors are high, but not because of payments. The insurers' investments were lousy and they are making up for lost profits.
Truth - Health care costs and insurance are rising faster than inflation for the past 7 years.

Do we have a crisis? Yes, but not the one you may think. Many health problems in the US would be solved with more preventative care. That was the original (now abandoned) theory behind HMOs. Anyone recall health MAINTENANCE as the plan? The problem is two-fold.
First, there are severe shortages in rural areas. (GPs are the lowest paid, and these guys aren't dummies. They go to where the money is - specialization is the answer)
Second, overspecialization always results in higher costs. Fewer general practitioners mean little or no competition.

Let's not even get into the corrupt relationship between drug companies and MDs thinking that chemistry is the answer to all problems. That whole situation stinks as bad as today's FDA.

One easy, cheap and fast solution. Open up medical schools to twice as many students. Increase the number of licenses by a factor of 2-3 over the next four years.

With many more doctors practicing, the economics of medicine would radically change.
You'd have a larger pool of MDs for rural areas. You'd have true competition. You'd have the opportunity to seek alternate care, the kind that saves the knife and the drugs for those actually in need of those last resorts.


We must also beware the Bushista approach to malpractice. They claim that phony suits drive up costs. Untrue. Most states have panels or requirements of doctor affidavits supporting the allegation of malpractice. Many states have caps. Some even penalize those who file unsupported suits. The crisis is one of perception, not reality.

They mix "phony" suits with real life damages. When malpractice occurs, it can be devastating to an individual. Juries - our fellow citizens, our peers - make the decisions about what to award, not some scheming, plotting lawyers. By seeking tort reform, what they want to do is absolve companies and hospitals of any repercussions due to their malpractice. In other words, the big companies get protection, the little guy gets screwed.

[plcdude]

1. site?

Do you have a site for this?

[lil-petunia]

4. No, I'm a lawyer and pick these tidbits up from lots of sources

The Illinois Bar publishes some of the data, as does the ABA. It is all there, but finding each one would be a massive headache.

Of course, the AMA is sitting on a statistical study about malpractice because they really did not like the results. But try to get them to admit that in public.

[trotsky]

2. Your fourth truth is the one I'd like to see hammered home.

People should realize that malpractice payouts have declined the last few years, yet the insurers have raised their rates anyway. Clearly it's not the cost of the suits forcing the rate increase, and the only other income/loss that insurers have is their INVESTMENTS.

[Wapsie B]

3. Make it easier

to strip an incompetant doc of their license. As it is now, how many people does an incompetent doc get to kill before that happens? Strip their license, and all assets. Then prison time.

[lil-petunia]

6. great point.

There are estimates that 2% of the MD population is involved in 70% of the malpractice committed each year. But MDs are notoriously protective of their own.
There is an infamous story about the head of Neurosurgery in a world reknown Chicago hospital.

The guy was brilliant at diagnostics. As a treater, well, let's say an epileptic in the midst of a seizure had better results. At one point he had 14 active cases pending. An example, he correctly diagnosed an operable brain tumor as the cause of pain, weakness and other neuro disorders. Despite the nurses telling him that he was operating on the wrong side of the brain, he completed cryosurgery (removal of brain material with small, controlled stream of liquid nitrogen). Not only did he miss the tumor, but he lobotomized the poor 35 yr old, leaving him totally incompetent. Father of three. Sole breadearner for the family.

The State of Illinois refused to yank his license. Luckily, the hospital made it known that his surgical days were over (they were about to lose their malpractice coverage) so he eventually returned to Iran. I hope some of the radical mullahs there get treated by him.

[sandnsea]

5. States with caps? Oregon ballot measure

I need to write an LTTE, we've got a cap measure on the ballot. I want to write a letter about states with caps and how it hasn't helped. Also I understand California has done something different on malpractice that's been more successful. Do you have some quick info that I could fit into a short LTTE? Save me alot of time if you've got it off the top of your head.

[lil-petunia]

7. Indiana, I believe Florida as well.

The key author for the medical liability reform act in Indiana lost his wife to malpractice several years after passage. He went on the air with this mea culpa. But the hospitals and MDs funded a huge attack and I believe he lost his re-election campaign. Can't remember his name, though.

[ProfessorGAC]

8. The Crisis Is Based Upon 2 Things

Lack of supply of medical care due to the physicians' groups hyperregulating the credentials for 75 years, resulting in lower supply of doctors. It's way too hard to get credentialed to do ANYTHING in medicine. Hence, brilliant MRI technicians, who could do all the interpretation of the spectra, are left just running the machine so a radiologist can come to the exact same diagnosis.

Secondly, the insurance companies are actively creating the supply problem by raising rates to exorbitant levels to maintain a constant return on total assets, rather than accept their own mistakes. Everyone pays for their financial blunders, rather than just their stockholders. Ford didn't get to raise the cost of every other model because they screwed up on Edsel. They just ate the losses and so did their stockholders. Insurance companies don't feel the need to accept the same risks that every other business accepts.

The result of these two things have driven medical prices up at 3x inflation for over 20 years. Lawsuits have almost nothing to do with any of it, and there is not one tort reformer i've ever seen on TV, or read in any newspaper or magazine that has data that says otherwise.

It's the ultimate con job.
The Professor

[lil-petunia]

9. insurers also fail to charge the repeat offenders more

If they did, pure economics would help force the mistake-prone ones out of practice.

[PsN2Wind]

15. Perhaps Professor

The Dems should start saying that they might sign on to "tort reform" if insurers are required to roll back their rates and have any future increases tied to the CPI.

[ProfessorGAC]

19. I Concur

There is a point of compromise that must be made. Tort reform as it relates to medical mistakes is jsut another medical mistake.

But, if the liability falls, so should the risk taken by insurers.

However, i would exclude medical mistakes from any caps on damages.

I do have a proposal for a solution to tort rewards, that i've discussed here before. Even if my solution were accepted and implemented whole cloth, however, i'd STILL exclude medical mistakes from the system. Injured parties need to get maximum recompense for such injuries.
The Professor

[meow2u3]

10. Another common-sense solution

Lower premiums for good doctors, those who haven't filed a claim in two years, while raising the premiums for docs who've filed malpractice claims. Repeat offenders belong in a high-risk pool, much like insurers calculate auto insurance rates.

Don't make the good doctors pay for the actions of the bad ones, nor make all doctors pay for the bad investments of insurance companies.

[Mend]

11. Medical Malpractice

I have been a practicing physician for over thirty years, and, by the grace of God, I have never been sued. There are negligent doctors but there are also extremely difficult patients. The guy who needs surgery who weighs over 400 pounds, smokes, drinks, and has complications from his life-style. He needs surgery and of course it doesn't go perfectly fine and he sues and wins. Actual case. Many of us survive by being very selective as to whom we will see....the brave ones do the hardest cases. In our town, the ob-gyn's pay $250,000 a year for liability insurance for $250,000 in coverage. Managed care dictates how much they can charge for a delivery so they can't pass the cost on to the patient....so they quit doing ob. You can open up medical schools and change the financial picture....that makes me laugh. As someone who actually walked the walk and lived the incredibly challenging life of a doctor, I can assure you, the best and brightest simply won't do it. Most doctors, including myself, have had flat incomes for over ten years. Our abilities would allow us to choose another profession without the pain and suffering. I love my work but I strongly advised my own kids from following in my footsteps and if I had to do it over again, I would not choose medicine, no matter how much I love it.

[ProfessorGAC]

12. Huh?

You wouldn't do it over again, yet you love it. Then it's not about the money, right? So, if it's not about the money, and you love it, why wouldn't you do it again? Sorry, but your statement fails the logic test.

Also, in countries with very high standards of medical care, getting into and through med school and residency is far less rigorous. Yet, the situations you describe don't occur as often. Apparently, a liberalization of supply does help. Again, your anecdotal evidence aside, the greater body of data would suggest your logic is flawed.
The Professor

[lil-petunia]

13. Mend, you make some decent points, but

not every OB/GYN is being sued. There are a few who truly are horrendous, as I have seen in my daily experience.

For decades, docs in this country created an aura of "magic", "invincibility", and created an almost separate class between themselves and the patient. By proclaiming that they SAVE LIVES and therefore should be above the rest of us, many docs created today's problem. This is compounded by their almost uniform refusal to clean out their own outhhouse. You know how many docs in Illinois have lost their licences due to repeated foul-ups in the past 8 years? Zip. Nada. Not A One. OK, there were a few who raped their clients, and lost them for that reason. I also represented one who was suspended because of a serious mental illness, but not one for repeated acts of malpractice.

Would you dare suggest that malpractice does not exist in Illinois? To the contrary, a year ago, an independent study found that in 5% of all hospital admissions, malpractice was found to be present. Missed diagnoses, the wrong drugs, operating on the wrong limbs, just to name a few of the top mistakes. A few years back, I represented one hospital in which the nurses were so sick of surgical mistakes that without doctor orders, they themselves started marking the non-surgical limb with magic markers, saying "NO, WRONG LEG!" in huge letters all over the healthy limb. Try ignoring or explaining away that kind of evidence in court.

At least lawyers don't maintain that silly aura of invincibility. We know some of our own make mistakes, but we actively do something about it. State disciplinary commissions are frequently called on to investigate the potential wrong-doing by an attorney. Each advance sheet has the status of pending investigations and lists disbarments. It is a shame that it happens, but it also needs to be done - in order to protect the clients and the legal system. Just what are today's docs doing to protect the health and safety of their patients from high incidence of malpractice?

Heck, in Illinois, if you see wrongdoing by another attorney YOU have the obligation to report him/her. If you don't, then your license is at risk. In Re Himmel.

Only recently did the AMA recognize that client relations are as important (in treatment success, preventing malpractice actions and even getting paid timely) as the treatment rendered. Several recent studies show that treating a patient with respect will do more to prevent malpractice claims than any other step.

[Francine Frensky]

14. Sorry, there's a bunch of mistakes here:

first, unless someone is an idiot, why would you pay $250,000 a year for an insurance policy of $250,000???? As a business person, I know doctors have a reputation of being bad businesspeople, but I also know doctors aren't THAT stupid.

Second, you ruin your argument about "loving your job" by saying you wouldn't do it again because there isn't enough money in it. Artists struggle, and wonder if it's worth it. Doctors play golf and buy yachts. Everybody in America knows this.

Bottom line: malpractice costs are 1% of healthcare costs, republicans are using this as a smokescreen, and docs who pay high premiums are simply poor business people who are being taken advantage of by unscrupulous insurance agents.

When doctors are living in MY neighborhood, THEN I'll know that the healthcare system is reformed.

[PsN2Wind]

16. My thoughts too

Why doesn't the doctor just take the money out of one pocket and put it in the other. Then if there is no suit they are ahead the $250,000/year. A good doctor (one that isn't sued) could then retire in pretty good comfort after ten years practice.

[lil-petunia]

17. No offense, but Docs are body mechanics. Not god.

some just think they are god.
great points, Francine.

[Susang]

18. Cases rarely go to court

The insurance companies and lawyers usually insure an out of court settlement because they fear that if the case went to court, the patient would actually win a judgement and it would be significantly more than the insurance company offers. The insurance companies walk away still making a profit, the lawyers walk away with their fees and the doctor retains his or her license, does not have to admit fault and ends up paying a helluva lot more in premiums, as do all other doctors, 'cause somebody's gotta pay for the insurance company's costs.

Who we should be regulating is the insurance companies, not instituting caps or limits on jury awards. Frivolous lawsuits have actually gone down, so why do doctor's insurance premiums continue to be so disproportionately high? Insurance industry greed, pure and simple.

I'm not even going to get into the managed care argument, as you can probably guess how I feel about that. And as far as salaries go, I know several physicians, my brother is actually a surgeon, not one of their incomes have remained static for the past ten years. All of them have increased, though probably not as much as they would have liked. :-)

[lil-petunia]

20. most cases never go to trial. In fact, trials civil are becoming rare

I read a statistic that only 1 in a thousand do in the larger states and court systems.