Discussion in 'Emergency Medicine' started by southerndoc, 05.31.12.
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This will never ever happen.. Loser pays is surely ideal for us but flawed for society.
I disagree. We have far too much litigation, not just in medicine. Society would be well-served by getting rid of some of it.
I dont disagree; we have far too much litigation but a full on loser pays system in this country would lead to much abuse.
Regarding malpractice, A wise old ER doc once told me "You never see the bullet that hits you".
I sat next to a lawyer on a plane a few months back (I give him a little credit - his firm won't defend DWI offenders - but will sue people injured by drunk drivers); he said it was a $300K breakpoint to bring a case to trial (i.e., if the return is less than that, it's not cost-effective to bring the suit). Loser pays will, at least in the short term, become onerous on the true victims, along with the fakes. (And I didn't notice EF's post just above mine.)
A not-so-old timer told me the same thing: the patient that sues is NOT the one you are sure would, the one you think would never sue WILL, and the doc that gets sued is the last one on a list you might make of who is most likely to get sued, not the first.
Disagree. For people who were truly wronged, it's unlikely to change their ability to sue. For people who were slightly inconvienced, or worse, just had outcomes that weren't perfect, they shouldn't be able to file a suit just to have us settle for less than 300K. And honestly, if someone wanted to file a legitimate suit with damages that aren't that, I still think they would go if their lawyers thought it reasonable that they would win.
This lawyer doesn't practice in TX. As such, "loser pays" doesn't apply. As such, I'm saying how it is elsewhere in the US. If it brings in less than 300K, it's not cost-effective, and, no matter how clear-cut is the result, how do you make a lawyer take the case? You can't.
If "loser pays" becomes law, in the short term, as I said, all victims (true and false) will suffer, because the attorneys will take only the cases that are beyond a "reasonable" chance of winning.
Your point would be correct after the whole system cools down and settles a bit, and everyone can see the lay of the land.
Lawyers should be able to vet cases and say to a client: "You don't have a case I'm not going to pursue it".
You think the legal climate we're in now is reasonable, where anyone can sue anyone else for anything, and in the process cost them thousands of dollars and ruin their lives even if the suit is completely frivolous?
I thought they did that already??
No, I do not, and I have no idea why you might think that I do. Doctors win 5/6 malpractice cases, which, in itself, tells me we're doing a pretty good job, and it's borderline desperation for the scumbag lawyers who spin the wheel of "jackpot justice". 99% of lawyers make all the rest of them look bad.
And, just because I'm posting, I'll add the codicil which I've mentioned frequently: "People say lawyers are scumbags/trash/garbage/filth/worthless until they need one. Then, their tune changes. I disagree; when I need a lawyer, they're still pieces of ****. What I need, though, is the biggest, scummiest, dirtiest, filthiest one. When I get my result, that doesn't change the human garbage which they are, and I wash my hands of them and their pathetic sewage."
Sure, the few "ethical" lawyers who are out there may do that. At the end of the day if they think they can settle and get an easy payout, they'll pursue it even if there's no case.
I don't care about the win rate. I don't want to be sued at all. The mental anguish, time, and money that goes with getting sued is intolerable, even if you win the case.
Lawyers are not sewage. They are a necessary evil of an open, free, democratic society. Do they overstep what is fair and decent? Yes. Can we fix the system? Yes.
See the thing about lawyers is they view the system differently than us. They dont choose to take cases based on their level of ethics, its simply based on money. They arent stupid and believe me dont want to waste their time since they work on contingency since most plaintiffs couldnt afford an attorney.
Just had a case here, scumbag patient goes to lawyer with some bs case. Lawyer tell patient there is no money here, patient insists on suit. Lawyers insists on 5k retainer.. Case over.
The lawyers are business people first, once they smell the money then they move into scumbag mode.
Lawyers are scum.. They arent scum inherently but learn some bizarre thought processes in law school. My wife and I cant agree on the problems with med mal. Now keep in mind she is more conservative than me, relies on my income for our livelihood (now), and is typically a sensible lady.
The other lawyers I met are the same. I often tell my wife that if I met her while she was in law school or later I probably would have never married her. We met as undergrads and at that time she had no plana on being an attorney.
99% of lawyers make all the rest look bad. Yes, sewage. Turds. Flushable. Foul, nasty, and offensive. Sociopaths with the narcissistic personality disorder. "Necessary evil"? How about made necessary by their own hand? That is, although out of context, as Shakespeare said 400 years ago, "first, kill all the lawyers". Would you even notice a difference? 95%+ of society would not. Law is a make-work job.
And I know EF's wife is a lawyer. Never met her. And, out of the lawyers I've met, I've liked the prosecutors best. Most of the others, not at all.
How does the state level statute of limitations play into this discussion? It seems that tort reform could, in theory, have many dimensions with a reduction in the window to file suit being one of them. A pattern I have seen is that legitimate suits tend to happen more quickly since lawyers working on contingency are quick to take up an open and shut lucrative case. There is probably much more shopping around for lawyers for the more frivolous cases.
There are other reasons for lawsuits to be delayed in filing, including the fact that the longer the amount of time that has passed between the patient encounter and lawsuit the less you remember. Documentation tends to suck (very few people document bullet-proof charts with a high degree of consistency and even these doctors are betrayed by contradictory or non-existing nursing charting) and if it's 3 years between patient and the stand you're unlikely to remember much detail of the encounter. It's not the aortic dissection that took too long to go to the OR that sues, it's the BS chest pain that was smote by Jehovah prior to seeing another doctor or the wound you stitched up that ends up getting infected and the patient doesn't seek medical care for weeks.
And I didn't see EF's post right above mine (I was posting on my phone).
Is there a law against counter-suing the patient for lost time, emotional stress, etc? I guess insurance companies handle the legal aspect of most cases...but it seems like if the pt knew they stood a chance to lose a decent amount money they wouldn't file ridiculous lawsuits.
If the stress associated with a "wrongful birth" involving a kid with downs is "worth " 2.9M. Surely, the stress of a long drawn out lawsuit is worth at least 1M (based on the above standard)...
They have no money.. they dont care.
I found out the deceased guy is a cop, and he and his male buddy were having a threesome with another girl. I'm sure the wife loved that one.
Actually Obama does want tort reform. Read it.
Since that was from his 2011 SotU address, what has he done in the year and a half since then? Anything?
Tort reform was left out of ACA, and was apparently the only thing, since it's almost as long as the tax code.
It might be in there. No one knows for sure what is contained in the arcane code of the ACA. Now that we've passed it, the American people can find out what's in it.....
-It has caused doctors to practice defensively ordering more diagnostics and consults than are medically necessary resulting in greatly increased costs and morbidity.[/QUOTE]
Defensive medicine is difficult to quantify. However, estimates range from 0-3% of overall health spending in the US. Nothing to sneeze at, but greatly exaggerated by most physicians. Tort reform will not bend the cost curve. Read Health Affairs September 2010.
[/QUOTE]-It has resulted in a jackpot mentality on the part of patients who feel no imperative to be responsible for their own actions or to be active participants in their health care. They assume that if anything bad happens they will get a big pay off.[/QUOTE]
As the great philosopher Herman Cain once said, "I don't have facts to back this up..." but my guess is that this sentiment is also greatly exaggerated. There are bad apples, but most people want to be treated with respect and, if harmed, an apology.
[/QUOTE]-It has resulted in greatly increased documentation requirements at every step in healthcare causing huge decreases in productivity.[/QUOTE]
This is true. But, again, the overall costs are fairly insignificant when tossed on top of a 2.7 trillion denominator.
I still think we need tort reform for the psychological aspect and because the current system doesn't work. 98% of patients who are harmed do not sue and many of those who do sue were never harmed. There needs to be more overlap for the tort system to be effective.
up to 8%.. Look further.. Estimates are all over the map. 0 of course is not the answer. If it is please find and link that article.
Long story short the estimates are all over the place. Much depends on how broadly or narrowly this is defined.
Where do you pull this from? You need to overlap this with Duty, negligence, and harm,
The actual number is higher. Take for example end-of-life care. 80% of Medicare dollars are spent in the last year of life. We all know it's futile, so why do we do it? Because if Granny who's 90 with dementia dies one second too early, family can sue us.
If we really want to fix our medical system, tackling the futile end-of-life care is the only way to do it.
... and in the vast majority of brains out there "too early" means "ever". Because miracles happen all the time, you know. The Bible says so.
No idea what this means.
Exactly, which is why patients/families should not make end-of-life decisions when they are spending taxpayer money. They lack the necessary scientific understanding of the issues.
I'm sure one of my Left-wing fans will now cry out that I'm proposing "rationing" and isn't that against what I stand for?
The answer is that I'm against the government being involved in ANY healthcare, but since it's a settled issue and Medicare (or some form of it is here to stay), then we have to do what's right and keep it viable. Unfortunately the only way to do that is rationing, because when you make a product or service free, demand becomes infinite.
I sincerely agree - what our health care system needs is rationing of care and death panels.
I'll volunteer to sit on one of these "death panels". My shop is in the middle of at least 8 nursing homes. Each ambulance ride back and forth costs YOU (the taxpayer) between 3,000 - 4,000 bucks. And we all know how "worthless" these visits are.
The intended meaning was this:
Medical-malpractice litigation infrequently compensates patients injured by medical negligence and rarely identifies, and holds providers accountable for, substandard care. (N Engl J Med 1991; 325:24551.)
This puts it close to, but not exactly, zero:
Malpractice isn't meant to hold providers accountable for substandard care.
That's what the medical board is for. You damn sure want a jury of other doctors who practice in your state deciding if what you do is acceptable. You damn sure don't want a jury of people who think all doctors are rich and born with a silver spoon in their mouth.
Tort is meant to take money from those that have, to give to those that don't. That's why people sue corporations and not employees. That's why people don't sue the driver, they sue the insurance company, the city, etc.
You can't get blood from a turnip.
I agree with you but lately it's been the right wing who has been scaremongering about rationing and death panels as a way to fight Obamacare. I understand why but I think it will be a set back in the long run when we as a society really do have to come to terms with how to curtail this wasteful spending.
I don't agree with everything Conservatives espouse. There are a lot of reasons they lost this election, but one of them is their outdated message. If they could stick to a pragmatic, fiscally-responsible, pro-Constitution platform, they could probably still win elections. They need to get rid of the insane Christian, anti-abortion, anti-science agenda that still permeates a lot of their candidacies.
Amen! Err... I mean, I agree!
Yes, I absolutely agree.
I agree as well. I am much more of a staunch fiscal conservative and a social moderate. However we need to know what will happen politically if we cut out that part of the bloc, i.e. will we pick up enough moderates/independents to make up for the loss of the religious right. I just don't know if we would. I agree we need to do something. We may have lost for good on this one. By the end of this administration we are likely to have so many more people who consume more from the government than they contribute that they become a permanent and overwhelming constituency.
As noted above flawed studies. The one regarding defensive medicine costs is blocked to me but if you have ever practiced a day in the ED you know its not 1%. A huge portion of our scans and lab work is med mal related. I am a low utilizer in my group of 40 docs and I would guess way over 8% of the costs I run are med mal related. Cautious admission, CT scan etc.
I would definitely be considered "the religious right" - even still, I would happily vote for a fiscal conservative that is a social moderate. I think the two (fiscal and social issues) should not be inherently coupled, instead I think people should run on their fiscal platform and allow social issues to either be a states' rights issue (preferred) or govern based on the will of the people.
I am the king of the "cautious admission." I have no incentive to send anyone home, and when your average patient age is 63... forget about it. I softball EVERYTHING.
Separation of church and state FTW. That'd be state, at all levels.
I'll cross swords with you on this one. "Will of the people" is proving to be an unsustainable position these days.
See also: The majority of people who can vote... can't demonstrate an understanding of the issues or process.
Me too, and I CT like crazy. If there is even a remote suspicion of something, I CT. I've been very surprised at the number of atypical symptoms of very serious pathology.
Med mal laws vary tremendously between states and procedure/diagnostic testing/admission rates don't seem to correlate with Med mal laws. If all the Med mal is driving costs why aren't costs drastically lower in Texas vs, for example, Illinois?
Because Residency training is relatively standardized, so ordering patterns are taught based on the worst case scenario. Training programs are right to do this because they don't know if their graduates will end up in high or low med mal states.
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