http://cgood.org/brochure-hcare.html

One of the difficulties I have had trying to discuss “malpractice reform” on this weblog is the tendency of many participants here to adhere to particular positions as articles of faith. (With, of course, the associated human tendency to accept without question anything which advances the preferred argument, while rejecting without reason anything which stands to the contrary – see, e.g., Curious JD’s response to the selective filtering of GAO reports in the prior discussion.)

Article of faith: special health courts. “I favor special health courts – Health Courts: A Better Approach to Malpractice Reform – as a way to increase the probability that victims receive compensation. Health Courts would do a better job of sorting out the facts – and likely generate less legal fees.”

What has been the evidence from states which effectivley already have “special health courts” – states which require the screening of cases by specially constituted medical review panels prior to litigation? How would these “special health courts” be constituted so as to ensure fairness for both sides? Why do you believe that the cost of litigation would be lowered? Given that you believe that special health courts would work to the benefit of both doctors and patients, while the evidence suggests that “damages caps” work to the near-exclusive benefit of insurance companies while causing measurable harm to the most severely injured malpractice victims, aren’t medical and insurance industry lobbying groups working harder for special health courts?

In the past you have appeared to advocate for evidence-based medicine – and I don’t recall any posts advocating that patients seek faith-based alternatives to allopathic care. Is it unreasonable to suggest that calls for reform of the legal system should also be backed by evidence?

Thanks for the well wishes.

I simply disagree with the physicians’ assessments, and the foundation for those assessments, of the legal system. And their proposed “reforms” of the system. I think I am qualified to comment on those.

Good luck on your boards.

One might very well wonder why you have such strong feelings about medicine … considering your qualifications as a lawyer.

First, the patient and /or family gets some amount of compensation for errors. Depending on the severity or the error, the compensation should increase. How impaired is the person is after the fact and how much pain did they suffer.

For instance my sister was given a TB diagnosis based on some lesions removed from her uterus. There was no biopsy done and she passed mulitple skin tests. No further diagnostic work was ever attempted-even though it is available. She was placed under house confinement and given TB antibiotics that permently damaged her vision. She couldn’t work for four months due to the severe side effects of the meds. She lost her house, her job, her car, and accumulated lots of debt. As it turns out the lesions were likely scars from endometriosis-later drs found many more when they did her hysterectomy. They were horrified at what she had been put through.

Somebody messed up a bit. Not 10 million dollars mess up but maybe 50 grand mess up. Was the first guy incompetent, overworked or just confused?

The second role a malpractice settlement plays is retribution. By punishing one dr for his mistake, hopefully other drs will see that and not make the same mistake. This role is pointless howver I think in the minds of the people they think it is maybe more important than the first role. Rather than punish someone for thier mistake, redesign the system so mistakes are easier to prevent. Retribution doesn’t prevent future occurances unless the occurances are intentional. medical mistakes aren’t.

On my most recent trip to thr ER I asked the nurse not to give me an antinausea med. She accidently did anyways. I could have gotton upset but she was at the end of a 16 hour shift and had an ER full of people from New Orleans. She had been volenteering at the local shelter for several days straight.

I think you guys try your best but still mess up sometimes. Taking any medication or any medical treatment requires risk-nothing is risk free.

Restructering the system so less hours are worked, longer time is spent with each patient, and drs are less arrogant would be a start. I don’t know how to do that. hmmmm…

We need to think beyond tort reform and into a whole new model. Reform of the current system can help, but will not address the fundamental flaws , the injustice to both physicians and patients, and the financial and emotional costs of that injustice.

See more at Patient Injury: An Ethical Partnership Approach ( on my website : http://www.ethicalhealthpartnerships.org/ethicalmalreform.html

Troyen Brennan , MD/JD, Michelle Mello of Harvard School of Public Health have written extensively about no-fault approaches: See:
Patient Safety and Medical Malpractice: A Case Study Troyen A. Brennan, MD, JD, MPH and Michelle M. Mello, JD, PhD, MPhil, 19 August 2003 | Volume 139 Issue 4 | Pages 267-273 Annals of Internal Medicine http://www.annals.org/cgi/content/full/139/4/267

Malpractice Liability and Medical Error Prevention: Strange Bedfellows? Paper Prepared for the Council on Health Economics and Policy Conference on Medical Malpractice Practice in Crisis: Health Policy Options March 2003 Michelle M. Mello, J.D., Ph.D., M.Phil. Article is linked on Kaiser’s site at: http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=796

Policies to Foster Patient Safety Michelle M. Mello, J.D., Ph.D., M.Phil. Assistant Professor of Health Policy and Law Department of Health Policy and Management Harvard School of Public Health http://www.cmwf.org/usr_doc/mello%20IOM%20meeting.pdf

Can the United States Afford a “No-Fault” System of Compensation for Medical Injury?
David M. Studdert, Eric J. Thomas, Brett I. W. Zbar, Joseph P. Newhouse, Paul C. Weiler, Jonathan Bayuk and Troyen A. Brennan.Ý Cited: 60 Law & Contemp. Probs. 1 (Spring 1997)
http://www.law.duke.edu/journals/lcp/articles/lcp60dSpring1997p1.htm

PS. I’m new in commenting although I have popped in and read various articles over the past months.

Indeed – explain to us what evidence you reviewed from the Scrushy case to come to the conclusion that it was decided wrongly?

It’s too bad you have such strong opinions on how the legal system works, considering you have no idea about how trial advocacy is practiced or taught, and you have no idea about what the evidence was in most if not all of the verdicts you disagree with. If you did know anything about trial ad, you would know that the number one rule is the KISS rule. And that every top tier trial lawyer will tell you that trying to trick the jury is the WORST thing to do.

“Some areas of the country have lost specialists due to malpractice costs.”

A claim the GAO could not link to malpractice premiums, but rather found them unsubstantiated or in rural areas that have always had a low number of specialists.

“but if malpractice insurance were that lucrative, we would see more competition in the marketplace. Insurance companies more likely leave the malpractice field than join it.”

That’s incorrect. With the economic turnaround, once again more companies are writing coverage. Do you do any investigation before you say these things?

“There are more profitable types of insurance.”

This claim is based on . . . .? Do you know the profit margin of your particular insurer over the last decade? Do you know how much surplus they are sitting on? Do you know what the rate of return on their investments are?

Dr. Centor, how do you reach all these conclusions with so little information? You determine the existence or lack thereof of malpractice without seeing the evidence, you determine the amount of damages without seeing the evidence, and you support ignoring the 7th Amendment to reform with something that you have no evidence will work? You even blame the legal system because the medical system doesn’t punish bad doctors!

You make all these unsubstantiated claims with impunity. The hubris is amazing. Or maybe I should just admire your faith.