My main point is that malpractice is a poor way to increase health care quality. Malpractice has a negative effect on the quality movement.

The purpose of a civil lawsuit is not to reform the practice of medicine. Its purpose is to compensate an injured party for the loss they have suffered at the hands of another. Reform of medical practice might be a secondary result, but it is not the primary purpose.

another result the malpractice environment is the dwindling supply of doc’s who wan’t to provide comprehensive care.

below is from todays NPR segment underscoring the fact that future doc’s are specializing.

http://www.npr.org/templates/story/story.php?storyId=4106713

can you blame the debt burdened student? why work brutal hours to provide comprehensive care when one can work regular hours by limiting practice to one organ?. although suits affect all specialties, it is easier to accept a lawsuit if one does not sacrifice so much personal time in her/his carreer.

It is never a good sign when you start out by getting your facts wrong. It is not “the trial lawyer lobby” that says malpractice premiums represent only 1% of health care costs. It was President Bush, getting his facts wrong in last night’s debate. Perhaps you are thinking of Senator Edwards’ reference to the bipartisan Congressional Budget Office figures (which, obviously, are not figures manufactured by trial lawyers), which express that the cost of malpractice liability (not just insurance costs, but all associated costs) represent “less than 2 percent of overall health care spending.”

In terms of a percentage of physician income, the question becomes different. When you complaint that malpractice premiums can be as much as 25% of physician income, you create an implicit analogy with the cost of health insurance for a typical family of four – it would eat about 25% of their household income. The question then becomes not whether that cost is reasonable, but whether the cost is being placed on the appropriate party. If the weight is presently unduly on individual physicians, perhaps there should be some cost-shifting to the parties which presently pay less than their ostensible share based upon the distribution of health care revenues.

Is it unreasonable, by the way, for an internist to be paying $8,000.00 per year for malpractice insurance? How does that compare to other professionals who have to carry malpractice insurance – lawyers and accountants, for example? Or don’t you care?

As for “defensive medicine”, I have consistently pointed out in the comments that damages caps (and the various other “tort reform” proposals advanced by your lobbyists and insurance companies) will most certainly *not* impact “defensive medicine”. Why? As I have repeatedly pointed out, because your so-called “tort reform” efforts are directed at the most meritorious cases, with the most serious damages. Defensive medicine is directed at avoiding non-meritorious litigation, which is completely unaffected by damages caps.

If you want to do something about “defensive medicine” you need to do a better job of establishing standard of care. After all, as anybody who is even slightly informed on the issue of malpractice knows, you can only be liable for malpractice if the care you provide falls below the governing standard. Who defines that standard? Physicians do. Not lawyers, not judges, and not juries – physicians. If a physician won’t testify to establish a standard, and won’t testify that the standard was violated by the defendant, there is no malpractice case.

An RN, who is also a certified lactation consultant, I know was recently contacted by a defense firm over a malpractice matter – a tragedy involving the death of a baby. She was first asked if she would have followed the same approach as the doctor who, rather than having the mother bring the baby in for an examination, assured the mother that it wasn’t a big deal that the baby was refusing to nurse. She responded that her background in a NICU would have caused her to want to examine the baby. Wrong answer. The defense lawyer informed her that she was only supposed to answer as a nurse and lactation consultant, and that her background in the NICU wasn’t relevant. (You know – matching qualification for qualification between the defendant and the expert witnesses.) The defense lawyer asked her how much she would charge if she were hired as an expert. “I don’t know. I’ve never done this before. I guess $50 per hour.” Wrong answer. The defense lawyer told her that experts in this area charge at least $75-100 per hour. (And as you know, if your expert doesn’t charge enough… the jury might think she’s not greedy? I never did get that one, but a lot of law firms won’t hire an expert who is “too cheap.) Needless to say, she wasn’t hired.

What a silly game. What a waste of time, money and energy. And that wheel of “standard of care”, with the matching of credentials between the defendants and the experts, is played in every malpractice case. That is the system that your “tort reform” lobbyists and insurance companies have created, and they lobbied very hard for the legislation that forces that type of matching, and to prevent any generalized standards of care which could be applied from case to case. You want to do something about “defensive medicine”? The place to start is with your own lobbyists.

(And your lobbyists will probably tell you that simple, clear standards of care are a plaintiff’s lawyer’s dream. That it is better to keep complicating the system, as they have successfully done for decades, by preventing such standards from emerging.)

I am not clear on how “decreasing the size of punitive damages” will decrease malpractice premiums. Michigan does not permit “punitive damages”, and permits what it calls “exemplary damages” in only the most egregious of circumstances. (You know – like the surgeon who was so pleased with his work that he “signed” it by carving his initials into his patient. But that’s not really a malpractice case – it’s an intentional tort.) Michigan also has the much ballyhooed damages caps, and has had them for many years. And Michigan’s obstetricians pay… high malpractice premiums.

You know what? I have no problem with the elimination of punitive damages for ordinary negligence cases (a category which includes malpractice, but not carving your initials into your patient). I just don’t think it will help, and cite Michigan as a (well documented) example.

Whinging about how trial lawyers point out that your industry’s so-called “tort reform” efforts are directed at the victims with the most egregious of injuries doesn’t change the facts. Damages caps *are* about preventing the most seriously injured victims of malpractice from recovering fair compensation for their injuries. It is astonishing that some of you pretend otherwise.

In terms of juries, the jury system has both costs and benefits. Your lobbyists probably like juries, despite your misgivings, because juries return defense verdicts in 75% of medical malpractice cases. Juries also, on the whole, significantly undercompensate tort victims.

I am not sure how you would create “expert panels”, or who would be on them. Do you envision a system of doctors who essentially serve as administrative law judges, serving on these panels as a substantial part of their practice? Do you propose that most doctors would rotate on and off panels, sort of like laypersons performing jury duty, as part of their service to the profession? I am interested to hear your proposal.

Also, what of the studies which indicate that only 12% of medical malpractice victims even seek compensation? (Figures which I have never heard challenged by the malpractice insurance industry or medical lobbies.) As it seems, the medical lobby has no interest in advancing the limited experiments with liability pools for certain birth injuries on a national basis – whatever the merits of those pools, and despite the benefits they offer to injured babies and to obstetricians. Why not?

(And anybody who suggests that medical malpractice liability cannot improve the practice of medicine has been sleepwalking through the debate. By way of example, lawsuits over bad anaesthesiology practices spurred improvements in that profession which have had profound benefits to patients.)

There is so much I would care to reply to this rhetoric line by line, from the view of an injured patient, thrust into our legally system unwillingly. But I shan’t for the moment. With the breath of my being, I do my utmost to speak out for the people that have been or may be in the future, victims of negligent doctors, lives taken or destroyed, by those we are conditioned to trust.

First, my case is fast approaching 100K to bring to court. In the business of law, how can anyone argue, an attorney his wage? In my case 32 %.
Of which I will be happy to pay, given the extent of work and effort that goes into a medical malpractice suit. And indeed, drug out more and complicated legal ploys by the physician’s insurance to not only wear the victim down, but it behooves them to invest in these cost adding maneuvers, to save potential in the long run.
I would challenge you this.
You are due a surgical procedure. Your physician must upfront the costs of everything first. The OR, the nurses, the hospital room, the tests, everything.
When all is said and done, the physician is compensated only when and IF the patient is 100% satisfied with every aspect of their care.
Yet that is what we expect from our attorney’s.
I know, especially in the throes of traumatic injury, further hospital bills, the average person would not be able to front the 100k needed to file a case.
Thus, with a cap law in place, it has been proven, that negligent physicians ‘get away’ with grievous harms, when the patient is a child, homemaker, retired person. As they have “no economic value’ as dictated my our bureaucrats.
And proven so in Ca, where there is currently legislation being considered to repeal the caps law for this very reason. A child died, from blatant negligence, yet a case could not be filed. I for one, am ready to have my day in court, and the legalities there is another issue.
Here, you are talking about caps laws, which do nothing more than negate my value as a human being, while a professional athlete, given the same circumstance of injury, would be worth millions.
All it does, is take away a persons right to their day in court. As dictated by some far removed politician who has not one idea of me, nor my case.
Yes there are good doctors, it was one who saved me. But to give those less than stellar of the physicians comrades carte blanche to harm with no recourse, only adds to even more a cavalier attitude in their responsibilities to their patients.

As far as winning the lottery. I faced Sen. Frist head one and let him know, I could never be more insulted by an attitude. Again, these doctors have forgotten the patients in their stead.
To even suggest, I would trade my spinal cord for a lottery ticket is infuriating.
Or other victims who have lost limbs, lungs, and lives, Ask them what kind of lottery they won.
I see in these words the physicians again, turning their back on the patients with a hardened heart and disregard to the Hippocratic oath by both them and their brethren. Again, you exhibit, it isn’t the blame of the doctor, it is the patient for filing.
Spend one day in My wheelchair and tell me I won a lottery.
250 is merely a pittance of which I am to be grateful along with the condescending pat on the head.
While no measure can be made in the pain and suffering, most all know these awards go to pay for needs or adaptations not covered under the medical costs award.
The driving system I need, in order to get the doctors, is 60k, and needs to be replaced every few years. Oh yes, I’ve won some lottery.

defensive medicine is a
costly reality

http://netec.mcc.ac.uk/WoPEc/data/Articles/tprqjeconv:111:y:1996:i:2:p:353-90.html

despite the denial of trial lawyers ..it is a huge national cost approaching 100 billion dollars annually.

defensive medicine.
defensive school board actions.
defensive teaching.
defensive vaccine makers.
defensive fast food restauraunts….

the shadow of trial lawyers is here….time to vote for a change:

http://www.cgood.org