Malpractice courts rather than tort reform

Problem is, a “malpractice court” turns multimillion-dollar trial lawyers like John Edwards into Worker’s Comp lawyers cranking out cases for a fixed fee.

Even if more patients are compensated but for less money per judgement (read: more justice to more people), the trial bar would not want it, as they no longer face the prospect of the big windfall.

I’d think about reforming a medical system where only 57% of doctors follow elementary hygiene practices and 100,000 patients die of hospital infections each year before I’d think about reforming our malpractice system.

I clipped this editorial from Family Practice News, July 15, 2000.

Dr. A. E. Miller is a physician in solo practice in Blackfoot, Idaho. He said something that I wish more of our medical leadership would say. He was happy to allow me to reproduce this, with attribution.

More common sense from a country doc in Idaho than from our own medical “leadership”.

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I really don’t understand it: Physicians just love to nitpick the printed word. In fact, we thrive on it. If you publish a study on diabetes, thousands of doctors across the country will tear it apart, mercilessly, word by word, line by line, chapter and verse. That’s what keeps the science valid.

Yet if you publish a study accusing the medical profession of killing hundreds of thousands of patients, the same physicians will react with a collective yawn. Never – not once – do they ask, “Where’s the beef?”

In November 1999, the “prestigious” Institute of Medicine reported that medical errors killed between 44, 000 and 98,000 citizens each year. According to the IOM, physicians are America’s eighth leading cause of death. The major media, in concert, trumpeted the story across the land. News analysts trembled in outrage; cartoonists lampooned the bumbling killers. And on December 1 – scarcely 2 weeks later – President Clinton announced urgent new legislation to combat the dreaded epidemic of medical mistakes.

Today – before Congress is swept away on a tidal wave of emotion – we must ask, “Where’s the beef?” Here’s what I’ve found.

The IOM report was delivered in book form: “To Err is Human: Building a Safer Health System” (National Academy Press, 2000). Before the book was published in March of 2000, Dr. Lucian L. Leape had appeared in numerous TV interviews representing the IOM. Dr. Leape, a principal investigator in the Harvard Medical Practice Study (N. Engl. J. Med. 324 [6]: 370-376, 1991), has lectured widely on medical errors, medical malpractice, and adverse medical outcomes.

The figure, “98,000 deaths from medical errors,” is taken directly from Dr. Leape’s 1991 Harvard study. The figure, “44,000 deaths from medical errors,” was extrapolated from a record review of hospital discharges in Utah and Colorado. The Utah-Colorado Study, scheduled for publication this year, has not yet reached the open scrutiny of the printed page.

The Harvard study was based on a chart review of 1984 hospital records from New York State. One might ask: Has the standard of documentation changed in those 16 years? The conclusion that a patient had been killed by medical errors was reached by a handful of trained physician chart reviewers, based solely on the paperwork. The reviewers never saw nor touched the living, breathing patients.

So here’s the beef: The Harvard Medical Practice Study mentions – almost as an afterthought – that some of the patients (whose lives were cut short by iatrogenic errors) were critically ill with terminal disease. The study describes one example:

Many patients who died after an adverse event had very serious underlying disease, and several surely had shortened life expectancies independent of their iatrogenic injury. [The reviewers] could not, and were not asked to, estimate the number of days of life lost as a result of the adverse event. This is a critical issue, particularly in the case of a terminally ill person. For instance, a pneumothorax injury sustained during the insertion of a central venous catheter may have been the immediate cause of death in a comatose patient with metastatic lung cancer who was undergoing mechanical ventilation because of respiratory failure. Although this patient might have lived only a few more hours or days had the adverse event not occurred, the death was judged to have resulted from the medical injury.

Any honest-to-God physician who actually treats sick folks will need to read no farther. To imply that a patient with metastatic cancer – comatose and on a ventilator – died because of his doctor’s mistakes is like saying the Titanic sank because someone dropped an oar from one of the lifeboats.

I know not how things are done at prestigious Ivy League medical centers, but those of us in the western territories, when faced with the unpleasant task of filling out death certificates, recognize the subtle difference between a “cause of death” and a “terminal event.”

Medicine is not easy. We search for truth, always trying to get it right. Sometimes we don’t. Bad stuff happens, and always will.

The IOM conclusions are now carved into the stone of public perception. But why do we allow a double standard, giving no scrutiny to those who criticize our profession so loudly, so smugly, and so publicly?

Reducing errors is a laudable goal, but overstating the problem only drives further the wedge of mistrust between doctors and their patients, ultimately paving the way for more government intervention into the practice of medicine.

Then again, perhaps that’s what the folks at the Institute of Medicine intended in the first place.

Dr. A. E. Miller is in solo practice in Blackfoot, Idaho.

Reputable news site?

Geez, I know you don’t have any scientific background but come on.

Since someone brought up that Harvard study, should we also mention that in 80% of the cases where suits were filed there was no damage to the plaintiff nor medical negligence.

For those of you that truly believe the medical system is “broken”, how do we fix it? I’d LOVE to hear a legitimate answer to that one.

I say to Nida,Have you lost A loved one to Medical neglect??If someone walked up & shot your Husband,Mother,Brother Ect. & killed them wouldn’t you be angry??Wouldn’t you be devastated,in shock,expecting them to be there with you in the mornings,evenings,At the dinner table Family gatherings,To hug & say I love you & hear them say it back in return.Well Nida,Yes I miss all that & more my Brother lived with me 8 Years.He was in the Hospital in 2003 he came home with MRSA We wasn’t told the infection was antibotic resistant,& overtime he got sick trouble breathing & Jan.25Th.2005 he had a heart attact Respitory failure,He was sent to another Hospital to put Stences in some blocked Arteries,Dr. said he would be like a new man.Well he came home{Feb 11Th.} sicker than he went into the Hospital.Early Morning March 1St. He didn’t have enougth breath to fog up a pair of glasses.He was taken to the hospital in an ambulance,His airways were swolen off from a new case of guess what Nida?? MRSA His heart in a weakened State & lungs suverly damaged from not one but two cases of MRSA My Brother never had a chance to recover,To top it off they didn’t tell us or My Mom of age 95[My Brother was dying} who also lives with me.She looks for my Brother every day & crys all day & snubs all night.Two days before his Death they took him from ICU put Him in a room ,They said he was doing better,He couldn’t even talk,His records say he had mild hoarseness.He couldn’t even whisper,He was home 19 days with Mrsa Stence Procedure Trouble Breathing{Both cases were in his lungs} No…….Antibotics,No Oxygen,No Breathing Med.’s His release said he came through the Procedure fine could go back to his normal routine. I tried to nourish Him back to Health he was bleeding internal blood pressure bottoming out then very high blood pressure The Dr. said he was having Anexity Attacts,Wonder why??Anyone would,Yes I have A Lawyer I hope he gets both Hospitals & every Dr. Nurse Even the Aids.For being so careless & for their negligence.My Bro to you & Dr.’s may just be a # or Statistic…..Nida he was my Bro. & my Mothers Son He has two children & four Grand Children.God Bless You Nida,”Just passing through thios World on my way Home,”Ruthie!!!!