P
Premedtomed
I have an interview at a med school this thursday ( u of Lou) and this question might be asked. I am doing an online search too.
5
51487
Premedtomed said:
Well, it looks like even more Americans are uninsured now...I just read an article on that the other day--like 45 million now, is it?
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anyone know why malpractice lawsuits have become more of a pain in recent years? i'm not sure why it's any different now than it has been in the past, but i've heard that it is because it's more complex and expensive now or something along those lines.
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i think its a function of how society has changed in the past decade when it comes to jumping at the chance to getting some easy $$. especially in the us. also, i remember reading somewhere that medical malpractice was the 3rd leading cause in the states, so i dont know...are we just now uncovering all these mistakes that have been happening all along? who knows, but lord knows sneaky lawyers have found their niche!
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constructor said:
yah, good question, does anyone have any sources on this?
i keep hearing that malpractice has gone through the roof, but now i realized that i have no understanding of why!
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When it comes to problems with the rising cost of malpractice insurance, many of the problems occur because in various specialties there are high risks. For example infertility doctors are one of the specialties suffering from rising malpractice costs. This comes from the fact that with the procedures and the drugs involved there is alot of risk for the mother and the children. Sometimes people have a baby born with a defect or cerebral paulsy say, and there isn't a known cause for this defect yet so the family blaims the physician for a bad delivery. Now this is entirely possible that is COULD be the cause, but because people don't know often the doctor takes the blaim. These are just some hypothetical examples.
The long and the short of it is that people are looking for someone to blaim alot. True some doctors make mistakes they should be punished for, and true some families do deserve compensation for the pain they've suffered (for example, say the hospital mislabels the xray and the surgeon opperates on the wrong leg. I think we all agree that this person has grounds for a lawsuit).
But alot of times, people are unhappy that after an accident, despite the best care possible, they can't live the way they want or are used to. A large number of these cases are based on second opinions obtained after the fact.
Also There is not a national cap on pain and suffering, or emotional distress (I don't think). Some states have caps, but some don't and this means people are getting awarded exorbatant amounts of money. Some doctors who have experienced this rise in malpractice insurance (simply due to their specialty, and not necessarily due to any mistake they made) are finding it's just not financially possible to continue practicing medicine.
I hope that helps. I'm sure this isn't everything, but from the research I've done this is what I found to be some of the basics.
The long and the short of it is that people are looking for someone to blaim alot. True some doctors make mistakes they should be punished for, and true some families do deserve compensation for the pain they've suffered (for example, say the hospital mislabels the xray and the surgeon opperates on the wrong leg. I think we all agree that this person has grounds for a lawsuit).
But alot of times, people are unhappy that after an accident, despite the best care possible, they can't live the way they want or are used to. A large number of these cases are based on second opinions obtained after the fact.
Also There is not a national cap on pain and suffering, or emotional distress (I don't think). Some states have caps, but some don't and this means people are getting awarded exorbatant amounts of money. Some doctors who have experienced this rise in malpractice insurance (simply due to their specialty, and not necessarily due to any mistake they made) are finding it's just not financially possible to continue practicing medicine.
I hope that helps. I'm sure this isn't everything, but from the research I've done this is what I found to be some of the basics.
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Caesarsgrl said:
hey....stop blaiming blaim...
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The expensive price of medications. How drug companies push new drugs that aren't really that much more effective than cheaper alternatives just to make a profit (case in point: COX-2 inhibitors vs. NSAIDs, or Nexium/Protonix/Aciphex/Prevacid vs. OTC Prilosec).
I think a lot of doctors prescribe certain drugs just because they get pretty pens or free samples or something. I don't think this issue is as pressing as the insane number of people without health insurance, however. Obesity seems like a bigger problem too.
I think a lot of doctors prescribe certain drugs just because they get pretty pens or free samples or something. I don't think this issue is as pressing as the insane number of people without health insurance, however. Obesity seems like a bigger problem too.
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calstudent said:
There is an excellent article on the malpractice crisis and the need for tort reform on the AMA website. It gives tons of alarming statistics and really dissects the problem, which is not only an increasing number of lawsuits for high-risk procedures but also a huge increase in the average settlement. The article also relates malpractice costs to defensive medicine and how this affects the rate of increase in overall cost of healthcare.
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Great answer! In addition, the malpractice insurance is kind of based on how much they expect the legal suits to cost for that particular specialty. So in Texas, after Proposition 12 was passed and there is now a cap on pain and suffering damages, so the malpractice insurance can stop rising...a local doc said he doesn't think that the cost of the insurance will decrease, but at least it will stop rising so rapidly.Caesarsgrl said:
It was good that Prop 12 passed last September, but it may have been a little late....a lot of physicians left Texas b/c they couldn't afford the insurance. In Corpus Christi, a lot of specialists left and they are experiencing a great lack of healthcare access there.
That's the big thing with malpractice insurance and these suits...Caesarsgrl said it well, but in addition, the big thing is that it leads to lack of access in states where there are no caps on legal suits. Or at least, that is my understanding. If you want more info and Texas' cap on legal suits, search Prop 12.
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SFAJess said:
A cap on the reward amount is only half the solution. A system must also be set up to discourage lawyers from being able to push so many lawsuits into the courts. If the doctor wins suit before the case is heard by jury, it only costs the doc $12,000 average in costs. However, if the case is heard by jury and the doc ends up winning (which happens the vast majority of the time), the doc is charged an average of $91,000 in costs. So the other part of the problem with increase in malpractice insurance is that so many illegitimate suits are being pushed into the courts by lawyers that, even when the doctor wins, costs a TON of money.
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Good point...hadn't considered that b/c I didn't know about those costs. Thanks! Is there anyway to discourage that or are there any current ideas that law and policy-makers want to put into effect?DocMizzle said:
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SFAJess said:
I don't know...I think California might have policy in place, but I'm not sure. Viable solutions to this problem are given in the AMA article on tort reform, but I didn't read through them just because trying to follow legal mumbo-jumbo gives me a headache!
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this is slightly off-topic, but here's some websites i've found helpful:
background info:
http://www.publicagenda.org/issues/frontdoor.cfm?issue_type=healthcare
http://www.kff.org/
also, try this link for bioethics:
http://eduserv.hscer.washington.edu/bioethics/topics/index.html
for sample interview questions:
http://www.smsu.edu/bms/programs/medinterview.html
background info:
http://www.publicagenda.org/issues/frontdoor.cfm?issue_type=healthcare
http://www.kff.org/
also, try this link for bioethics:
http://eduserv.hscer.washington.edu/bioethics/topics/index.html
for sample interview questions:
http://www.smsu.edu/bms/programs/medinterview.html
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SFAJess said:
Make the plaintiff(and their lawyers) pay for the legal fees if they lose.
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great stuff guys nice link on interview questions.
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okay, doctors in general grossly misunderstand the nature of medical malpractice insurance premiums. Dr. WIlliam Sage, M.D., J.D. is heading up a huge research project in Pennsylvania (yes, one of the worst med mal states in the nation) for the Pew Charitable Trust. His research so far clearly indicates at least one major thing: caps on damage awards do not in any way lower or slow the increase of med mal insurance premiums. Docs see their insurance rates go up and they hear of so-and-so who got sued on some bogus claim, and they put two and two together, but end up with five.
the problem is multi-faceted, that's for sure, but there seems to be one major cause, and it isn't litigious patients. insurance companies. they are fiscally irresponsible in a way that would destroy any legitimate business dealing with a tangible product. they operate in a cyclical manner, which i will explain. first, only a few insurance companies exist in a state, and provide the med mal coverage for all the docs in the state. then, more spring up in an attempt to get some market share. now, realize that insurance companies charge more than what they need to actually cover their costs each year--they build up a reserve in order to protect them from a year wherein their actuaries miscalculate and they take a big hit. rather than use the reserves for this purpose (i.e., emergency financial circumstances), they use the reserves to overcompete with the other insurance companies that are around, and they drive each other out of business. once most of them are out of business, and the remaining companies have depleted their reserves, what do they do? they raise the cost of their insurance to the consumer (the docs) incredibly high. yep, YOU pay for their fiscal irresponsibility and their massive and unethical overcompetition. and how do the docs handle it? they (and the hospitals) raise prices, which transfers the burden to the individual who needs medical attention, for which purpose they have health insurance, so the health insurance companies pick up the tab and that means anyone with health insurance ends up eating the cost of (1) negligent physicians and hospital staff, (2) litigious patients with frivolous or minor claims, and (3) med mal insurance companies' ridiculous overcompetition. a freaking MRI costs 2,000.00 or more, not because of the tech development costs, but because it's a quick and dirty way for the hospital to snag some much-needed funds from the health insurance providers.
as far as lawsuits go (by the way, i am graduating from law school in july and med mal and health law are my specialties), the big problem there, as the research data consistently shows, is NOT the mythical and uncommon multi-million dollar award, it's the incredible amount of out of court settlements that take place every day. why do they happen that way? for one main reason--cost. it is cheaper to settle out and lose 90% of cases than it is to litigate and win. the cost to defend a doc or hospital in court is around $80,000.00 if it is as short as possible. the average out of court settlement ranges from 30-50k.
realize that, statistically, only 1 of every 10,000 people who gets injured through the negligence of a doctor or hospital actually ever gets the money awarded to them by the courts for their injuries. that means that most negligently injured patients never know that they were injured, and those who figure it out rarely sue, and those who sue rarely walk away with an amount of money sufficient to pay their medical costs, attorney fees, and lost work.
solutions:
(1) single-payer system. that means the gov't would pay all health care costs, and that all taxpayers would pay into that pot. i'm not talking "basic" coverage, i'm talking coverage for everything that is not truly experimental (the legal definition of experimental is a whole nother story i can share some other time...crazy how lawyers will mindf*ck the simplest thing to death and take 50 pages to do it). canada does it with 10% of their GNP. we spend 17% of our GNP in the usa and cover the elite and the very very poor. the middle class bears the burden. restructure the system, big time (yes, very very huge task...it's what i want to work on), and make the gov't the health insurance provider. then, the government can create administrative regulations to govern when suits can be filed and in what situations and against whom and for how much without running afoul of congressional deadlock.
(2) AMA and AOA need to get on the damned ball. i forget the stat, but in michigan like 17% of docs are responsible for 80% of the med mal suits filed. why is that? some would argue that they are in very delicate lawsuit-prone specialties. no, the specialties are all across the board; it's just crappy docs who practice irresponsible medicine. the 'good old boys' club needs to break up and docs need to start rooting out those who are damaging the reputation of the profession. cut them out like a tumor, because that's what they are, and you can focus on the outside causes with much less public opposition. wait too long and then it will be nothing more than a political, forced 'witch hunt' with good doctors getting the shaft during a panic.
(3) tort reform needs to happen, but not by capping damages. if i go in for lap gall bladder surgery and someone screws up and i wake up with my testicles removed, how can you put a price tag on that? you paralyze me or my child or my wife for life, and how can you tell me that $500,000 is sufficient? that's just asinine. i definitely don't advocate allowing emotional jury awards to run trainwrecks through hospitals, but that is the exception, not the rule. good people with real injuries from truly negligent docs get screwed into living not only a crippled life, but one in poverty, too. lame. proper tort reform, which is still a question mark and pretty much an experiment in many forms in many states, could involve things like a pretrial screening panel, where an apolitical group of experts and laymen evaluate each case and determine whether it should be allowed to go to trial. the plaintiff can disregard their findings and go to trial, but if they lose in trial after being told by the review panel that they have no case, the plaintiff pays the court costs. the main problem with that system is that the panels thus far created suck at determining what cases have and what cases lack merit. i'm not sure if i am in favor of making the loser just flat-out have to pay court costs, with or without a screening panel. they do it that way in great britain, but the argument (and reason why america does it differently) is that poor people get screwed by that system. try to sue IBM, or blue cross. and just try to afford the lawyer bills--literally in the millions of dollars at the end of years of inane litigation. see, BC/BS or IBM or <insert megacorporation here> can afford to pay 20 mil for a team of attorneys to crush you. but you can't afford the same thing. for a person living with 18,000.00 a year, they simply cannot afford to sue. that is considered ethically unacceptable as a means to limit lawsuits--to make it so only the rich can sue. another form of tort reform, and this one i strongly favor, is that of JUDICIAL reform. court rules need to be changed to mitigate emotional verdicts awarded by juries of idiots. just because a child died doesn't mean a doctor did something wrong. and that's something that juries don't always grasp.
there is a lot of work that needs to be done in this field. the best thing you can do as aspiring physicians is to STAY EDUCATED about the situation, and do so by reading/listening to sources that are from MULTIPLE sources (rather than just listening to the AMA and other physician-friendly sources), and make your own decisions. my girlfriend will be a surgeon in a couple more years, and i'm not sure yet if i want in on med school for myself or not (i'm already 30), but i see an MPH in my future and then a whole buttload of work trying to understand this problem better and then lobbying for the right changes. the other thing you all can do is to BE POLITICALLY ACTIVE. don't just vote, and don't just vote or make decisions based on your pocketbook. what's good for your income this year may turn out to screw you in 5 years. again, educate yourselves and make your own decisions, but don't trust any solution that sounds like a quick fix or a single-step solution, because they are never that easy. remember throughout that you are physicians, and that this entails a certain healthy respect for life and the quality of life, and try to make your decisions about this issue with that in mind. it's very easy to see the plaintiff and his or her lawyer as a pair of evil scuts trying to steal your money through moral turpitude, but realize that these people are everywhere, but they really are the minority, and most folks who sue for an injury have a legitimate claim. reform needs to happen at all levels, in all aspects of american society to correct this huge issue.
sorry for the length and the preachy ending, but it's something i'm really passionate about and i have encountered too many who have a partial or incorrect understanding of the situation.
--jason
the problem is multi-faceted, that's for sure, but there seems to be one major cause, and it isn't litigious patients. insurance companies. they are fiscally irresponsible in a way that would destroy any legitimate business dealing with a tangible product. they operate in a cyclical manner, which i will explain. first, only a few insurance companies exist in a state, and provide the med mal coverage for all the docs in the state. then, more spring up in an attempt to get some market share. now, realize that insurance companies charge more than what they need to actually cover their costs each year--they build up a reserve in order to protect them from a year wherein their actuaries miscalculate and they take a big hit. rather than use the reserves for this purpose (i.e., emergency financial circumstances), they use the reserves to overcompete with the other insurance companies that are around, and they drive each other out of business. once most of them are out of business, and the remaining companies have depleted their reserves, what do they do? they raise the cost of their insurance to the consumer (the docs) incredibly high. yep, YOU pay for their fiscal irresponsibility and their massive and unethical overcompetition. and how do the docs handle it? they (and the hospitals) raise prices, which transfers the burden to the individual who needs medical attention, for which purpose they have health insurance, so the health insurance companies pick up the tab and that means anyone with health insurance ends up eating the cost of (1) negligent physicians and hospital staff, (2) litigious patients with frivolous or minor claims, and (3) med mal insurance companies' ridiculous overcompetition. a freaking MRI costs 2,000.00 or more, not because of the tech development costs, but because it's a quick and dirty way for the hospital to snag some much-needed funds from the health insurance providers.
as far as lawsuits go (by the way, i am graduating from law school in july and med mal and health law are my specialties), the big problem there, as the research data consistently shows, is NOT the mythical and uncommon multi-million dollar award, it's the incredible amount of out of court settlements that take place every day. why do they happen that way? for one main reason--cost. it is cheaper to settle out and lose 90% of cases than it is to litigate and win. the cost to defend a doc or hospital in court is around $80,000.00 if it is as short as possible. the average out of court settlement ranges from 30-50k.
realize that, statistically, only 1 of every 10,000 people who gets injured through the negligence of a doctor or hospital actually ever gets the money awarded to them by the courts for their injuries. that means that most negligently injured patients never know that they were injured, and those who figure it out rarely sue, and those who sue rarely walk away with an amount of money sufficient to pay their medical costs, attorney fees, and lost work.
solutions:
(1) single-payer system. that means the gov't would pay all health care costs, and that all taxpayers would pay into that pot. i'm not talking "basic" coverage, i'm talking coverage for everything that is not truly experimental (the legal definition of experimental is a whole nother story i can share some other time...crazy how lawyers will mindf*ck the simplest thing to death and take 50 pages to do it). canada does it with 10% of their GNP. we spend 17% of our GNP in the usa and cover the elite and the very very poor. the middle class bears the burden. restructure the system, big time (yes, very very huge task...it's what i want to work on), and make the gov't the health insurance provider. then, the government can create administrative regulations to govern when suits can be filed and in what situations and against whom and for how much without running afoul of congressional deadlock.
(2) AMA and AOA need to get on the damned ball. i forget the stat, but in michigan like 17% of docs are responsible for 80% of the med mal suits filed. why is that? some would argue that they are in very delicate lawsuit-prone specialties. no, the specialties are all across the board; it's just crappy docs who practice irresponsible medicine. the 'good old boys' club needs to break up and docs need to start rooting out those who are damaging the reputation of the profession. cut them out like a tumor, because that's what they are, and you can focus on the outside causes with much less public opposition. wait too long and then it will be nothing more than a political, forced 'witch hunt' with good doctors getting the shaft during a panic.
(3) tort reform needs to happen, but not by capping damages. if i go in for lap gall bladder surgery and someone screws up and i wake up with my testicles removed, how can you put a price tag on that? you paralyze me or my child or my wife for life, and how can you tell me that $500,000 is sufficient? that's just asinine. i definitely don't advocate allowing emotional jury awards to run trainwrecks through hospitals, but that is the exception, not the rule. good people with real injuries from truly negligent docs get screwed into living not only a crippled life, but one in poverty, too. lame. proper tort reform, which is still a question mark and pretty much an experiment in many forms in many states, could involve things like a pretrial screening panel, where an apolitical group of experts and laymen evaluate each case and determine whether it should be allowed to go to trial. the plaintiff can disregard their findings and go to trial, but if they lose in trial after being told by the review panel that they have no case, the plaintiff pays the court costs. the main problem with that system is that the panels thus far created suck at determining what cases have and what cases lack merit. i'm not sure if i am in favor of making the loser just flat-out have to pay court costs, with or without a screening panel. they do it that way in great britain, but the argument (and reason why america does it differently) is that poor people get screwed by that system. try to sue IBM, or blue cross. and just try to afford the lawyer bills--literally in the millions of dollars at the end of years of inane litigation. see, BC/BS or IBM or <insert megacorporation here> can afford to pay 20 mil for a team of attorneys to crush you. but you can't afford the same thing. for a person living with 18,000.00 a year, they simply cannot afford to sue. that is considered ethically unacceptable as a means to limit lawsuits--to make it so only the rich can sue. another form of tort reform, and this one i strongly favor, is that of JUDICIAL reform. court rules need to be changed to mitigate emotional verdicts awarded by juries of idiots. just because a child died doesn't mean a doctor did something wrong. and that's something that juries don't always grasp.
there is a lot of work that needs to be done in this field. the best thing you can do as aspiring physicians is to STAY EDUCATED about the situation, and do so by reading/listening to sources that are from MULTIPLE sources (rather than just listening to the AMA and other physician-friendly sources), and make your own decisions. my girlfriend will be a surgeon in a couple more years, and i'm not sure yet if i want in on med school for myself or not (i'm already 30), but i see an MPH in my future and then a whole buttload of work trying to understand this problem better and then lobbying for the right changes. the other thing you all can do is to BE POLITICALLY ACTIVE. don't just vote, and don't just vote or make decisions based on your pocketbook. what's good for your income this year may turn out to screw you in 5 years. again, educate yourselves and make your own decisions, but don't trust any solution that sounds like a quick fix or a single-step solution, because they are never that easy. remember throughout that you are physicians, and that this entails a certain healthy respect for life and the quality of life, and try to make your decisions about this issue with that in mind. it's very easy to see the plaintiff and his or her lawyer as a pair of evil scuts trying to steal your money through moral turpitude, but realize that these people are everywhere, but they really are the minority, and most folks who sue for an injury have a legitimate claim. reform needs to happen at all levels, in all aspects of american society to correct this huge issue.
sorry for the length and the preachy ending, but it's something i'm really passionate about and i have encountered too many who have a partial or incorrect understanding of the situation.
--jason
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wow, good to know that there are people out there to try to fix this broken system the right way. i really think that every med student should take a health law class to find out where they will stand with the law in the future. that way more people will be educated on what their rights/options/solutions are to health care problems. in the mean time, it looks like future docs will be paying even higher premiums, patients getting less healthcare at a higher cost, while insurances are making like bandits out of the whole thing.
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i would highly recommend that every med student, as a part of their core curriculum, study some med mal cases, hear a few lawyers speak on the topic (and judges), and also study public health policy.
in the meantime, i'll sit around and hope buffalo grow wings, lol.
still, the best thing any physician can do is to be politically aware and politically active.
in the meantime, i'll sit around and hope buffalo grow wings, lol.
still, the best thing any physician can do is to be politically aware and politically active.
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delchrys said:
This is very interesting; thanks for giving a different point of view.
Just a few questions/comments:
1) how do you explaing the success of MICRA in keeping mal premiums down in California? Do you think similar legislation will work in other states?
2) Please read the AMA article before you knock it. True, it is a secondary source, but it pulls its info from dozens of studies, reports, and other primary sources.
3) Remember that even good docs make mistakes. Your argument for solution #2 needs clarification...do these 17% of docs have recurring mal suits year after year or is this stat for only 1 year? Also, who is to say what doc is "good" and what doc is "bad"?
4) Data shows that the AVERAGE liability award in 2001 was $3.9 million, and the AVERAGE award in 2002 was $6.2 million. How can you say that these high awards do not have a significant effect on mal premiums docs pay? Why will a lawsuit cap not partially fix the increase in mal premiums when the average award is increasing at such an incredible rate?
5) How can you say that "most folks who sue for injury have a legitimate claim" when almost 70% of claims do not result in ANY payment to patients?
6) Remember that the tort system is a flawed system to begin with. It is meant to correct the doctors who make mistakes by hitting their pocketbook so that they will no longer make that mistake, and the injured patient then is rewarded for the suffering and lost wages. However, the reality of the system is that it does not encourage open discussion of medical mistakes between docs and between docs and patients due to the fear that this info can be used in court in a suit. How can other docs learn from one docs mistakes when open discussion does not occur? Sure the doc making the mistake is punished, but how does this help to ensure the same mistake is not repeated a month later by another doc?
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Let me propose to everyone a different solution to the medical malpractice dilemma by first asking the question: who is the party ultimately winning in tort cases? Answer: lawyers. The fact is almost 60 cents on every dollar spent in the tort system is absorbed by administation fees, and legal fees are the primary component of this expense. Or, to put it another way, when a malpractice case goes to jury and the doctor wins, the patient gets little or no compensation and the doctor pays an average of $91,000 out of pocket on expenses. Who gets the rest of the money? Lawyers.
Therefore, I propose a solution that will take away the incentive for lawyers to push so many cases into the courts, especially those that are illegitimate: if a case goes to court and the doctor wins, the lawyer gets no compensation and splits the court fees with the plaintiff. Right now there is little control over the number and/or legitimacy of malpractice lawsuits taken to trial...if the lawyers are forced to assume risk and responsibility in the tort system, they will no longer be pushing frivolous mal suits to get rich.
Therefore, I propose a solution that will take away the incentive for lawyers to push so many cases into the courts, especially those that are illegitimate: if a case goes to court and the doctor wins, the lawyer gets no compensation and splits the court fees with the plaintiff. Right now there is little control over the number and/or legitimacy of malpractice lawsuits taken to trial...if the lawyers are forced to assume risk and responsibility in the tort system, they will no longer be pushing frivolous mal suits to get rich.
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first, to docmizzle's suggestion...logically extend the consequences of your suggestion to what would happen in society. lawyers can no longer charge contingent fees (fees that are payable only on winning). lawyers then have to charge every client an amount sufficient to cover their costs. this can be anywhere between $50.00 and $150.00 or even more. before you jump on that and say "well, there's the problem, the lawyers are getting 'too much money'", let me remind you that a fair analogy would be for me to say that doctors charge too much for an MRI ($2,000.00-3,000.00). we both know the doc isn't getting that money. same goes for lawyers. so, lawyers now charge every client $50.00-$150.00+ per hour of work on the case, which does what? causes most poor clients to not sue, even with valid claims, because many, many people cannot afford to litigate a personal injury suit by paying out of pocket costs. that's the reason that contingent fees are even in existence in the first place. so, if you want to abolish contingent fees, then you need to either accept and acknowledge that you are willing to screw those who cannot afford to pay for legal representation, or you need to find another way to get lawyers who spend quite a lot of money and time to get their educations (and expose themselves to malpractice suits themselves!) the money they will need/demand to make the economics work.
one part of the solution i advocate is to have the ABA impose serious penalties on attorneys who act like 'vultures' and bring frivolous suits against dr.s and hospitals.
now, to the other points (1-6) brought up by docmizzle:
1) i don't know yet. i haven't had the time as of yet to investigate the fact that CA has succeeded in preventing med mal insurance rates from going up any more than about 176% in the past 20 years. it's impressive. my statements regarding the ineffectiveness of tort reform in the form of caps on damages are based on my experiences here in michigan, as well as the detailed data collection and analysis Dr. Sage has done for Pew in PA, plus many, many articles on the subject. i still have a long way to go, trust me, lol...
2) if i came across as knocking the AMA article, i take that back. i DO mean to say, though, that very often the sources physicians most commonly reference, and the "common knowledge" amongst health care professionals, is that tort reform via damage caps is a holy grail in the world of med mal, and the root cause of the problem is bad lawyers and greedy patients who "just don't understand" what goes into every decision in a hospital.
3) the stat reflects that 17% of all doctors in michigan are responsible for the lion's share of the med mal suits. the stat was for only one year, but first, a person who makes a mistake borne of negligence (see below) four times more than another person in the same field for a year, you can bet that is a long-term situation, and not a one-year isolated event. data over a number of years would be VERY interesting to review, though! now, to negligence...negligence does not mean "a mistake". it means a mistake that deviated from the standard of ordinary care as would be followed by the average professional doing the same job. judgment calls are not considered negligence unless the judgment was a decision that no doc in that specialty/subspecialty in their right mind would have made. it is very important to nail that distinction down (mistakes vs. negligence), because one means you have a successful lawsuit and the other means you don't. emotional juries screw this up (hence my desire for court rule reform), but you would not BELIEVE how many idiots are in medicine. the idiots are, by FAR, a minority, but they are there. everyone in medicine has met more than their share of docs who they consider bad, who they personally would never send a loved one to. i'm not on a witch hunt, but i do want irresponsible, unethical, or just plain stupid docs and lawyers OUT OF BUSINESS.
4) the average liability award is calculated based on TRIAL RESULTS. out of court settlements are not included in that figure, so my statements are unaffected by this. i am NOT challenging you, but i am asking where you got that data--any new info i can find is valuable to me! the issue isn't whether caps will slow or stop premium increases, the issue is more whether the way to do that will end up screwing a lot of people who are injured through negligence. still, insurance companies (of all groups!) and the folks who are investigating the impact of damage caps are in agreement that there is a negligible (or zero) impact on med mal insurance premiums. i won't swear by it, and any data that's out there that proves/disproves this is welcomed...the last thing i want to do is to ascribe to a set of theories on this that are flawed. but so far the data demonstrates that high damage awards are not a significant factor in med mal cost increases.
5) if i actually said "most folks who sue for injury have a legitimate claim" (i think i did say that), then i must correct myself to say "most people who are injured through negligence never receive any compensation and most never even sue". and to your point, a lot of the reason there is such little payout is that the statue of limitations has been tweaked to make it harder to bring suits for med mal, and that the standard of proof is actually prety hard to meet, despite common lore to the contrary.
6) your statements here confuses me. someone who steals a million dollars will never be encouraged to discuss this by having the laws against theft removed. in the same way, doctors who make mistakes out of NEGLIGENCE have harmed a person by virtue of being crappy at their job, and the punishment should not be taken away to encourage dialogue. a doc who makes a mistake, a true mistake of a compotent professional, should definitely talk about it and be open to that fact. they should have nothing to fear. i udnerstand that people get jacked in an imperfect, human legal system, but the fact that doctors will choose to act in their own financial self-interest rather than in line with their hyppocratic oath and work on trying to improve the system by reporting errors openly is not the fault of the fact that there is a punishment system in place to help injured parties recover their losses. reporting errors is part of a physician's ethical, moral, and professional responsibility, just as is the expectation that physicians will do their "best" when working with a human life. when the doctor negligently fails to do the latter, the requirement of the former is not eliminated as some kind of 'bonus'.
if my tone comes across as sarcastic, i apologize in advance. it often does, but i do not intend it to be so. where i ask for sources for stats, i'm not being a dick and challenging you, i'm genuinely wanting them so i can add them to my resource list. (and i'm interested in the 70% figure for claims that don't result in any payment.). i am rushed at the moment, but will re-check this thread for a link to the AMA article. if it's not here, would you mind posting it?
--jason
one part of the solution i advocate is to have the ABA impose serious penalties on attorneys who act like 'vultures' and bring frivolous suits against dr.s and hospitals.
now, to the other points (1-6) brought up by docmizzle:
1) i don't know yet. i haven't had the time as of yet to investigate the fact that CA has succeeded in preventing med mal insurance rates from going up any more than about 176% in the past 20 years. it's impressive. my statements regarding the ineffectiveness of tort reform in the form of caps on damages are based on my experiences here in michigan, as well as the detailed data collection and analysis Dr. Sage has done for Pew in PA, plus many, many articles on the subject. i still have a long way to go, trust me, lol...
2) if i came across as knocking the AMA article, i take that back. i DO mean to say, though, that very often the sources physicians most commonly reference, and the "common knowledge" amongst health care professionals, is that tort reform via damage caps is a holy grail in the world of med mal, and the root cause of the problem is bad lawyers and greedy patients who "just don't understand" what goes into every decision in a hospital.
3) the stat reflects that 17% of all doctors in michigan are responsible for the lion's share of the med mal suits. the stat was for only one year, but first, a person who makes a mistake borne of negligence (see below) four times more than another person in the same field for a year, you can bet that is a long-term situation, and not a one-year isolated event. data over a number of years would be VERY interesting to review, though! now, to negligence...negligence does not mean "a mistake". it means a mistake that deviated from the standard of ordinary care as would be followed by the average professional doing the same job. judgment calls are not considered negligence unless the judgment was a decision that no doc in that specialty/subspecialty in their right mind would have made. it is very important to nail that distinction down (mistakes vs. negligence), because one means you have a successful lawsuit and the other means you don't. emotional juries screw this up (hence my desire for court rule reform), but you would not BELIEVE how many idiots are in medicine. the idiots are, by FAR, a minority, but they are there. everyone in medicine has met more than their share of docs who they consider bad, who they personally would never send a loved one to. i'm not on a witch hunt, but i do want irresponsible, unethical, or just plain stupid docs and lawyers OUT OF BUSINESS.
4) the average liability award is calculated based on TRIAL RESULTS. out of court settlements are not included in that figure, so my statements are unaffected by this. i am NOT challenging you, but i am asking where you got that data--any new info i can find is valuable to me! the issue isn't whether caps will slow or stop premium increases, the issue is more whether the way to do that will end up screwing a lot of people who are injured through negligence. still, insurance companies (of all groups!) and the folks who are investigating the impact of damage caps are in agreement that there is a negligible (or zero) impact on med mal insurance premiums. i won't swear by it, and any data that's out there that proves/disproves this is welcomed...the last thing i want to do is to ascribe to a set of theories on this that are flawed. but so far the data demonstrates that high damage awards are not a significant factor in med mal cost increases.
5) if i actually said "most folks who sue for injury have a legitimate claim" (i think i did say that), then i must correct myself to say "most people who are injured through negligence never receive any compensation and most never even sue". and to your point, a lot of the reason there is such little payout is that the statue of limitations has been tweaked to make it harder to bring suits for med mal, and that the standard of proof is actually prety hard to meet, despite common lore to the contrary.
6) your statements here confuses me. someone who steals a million dollars will never be encouraged to discuss this by having the laws against theft removed. in the same way, doctors who make mistakes out of NEGLIGENCE have harmed a person by virtue of being crappy at their job, and the punishment should not be taken away to encourage dialogue. a doc who makes a mistake, a true mistake of a compotent professional, should definitely talk about it and be open to that fact. they should have nothing to fear. i udnerstand that people get jacked in an imperfect, human legal system, but the fact that doctors will choose to act in their own financial self-interest rather than in line with their hyppocratic oath and work on trying to improve the system by reporting errors openly is not the fault of the fact that there is a punishment system in place to help injured parties recover their losses. reporting errors is part of a physician's ethical, moral, and professional responsibility, just as is the expectation that physicians will do their "best" when working with a human life. when the doctor negligently fails to do the latter, the requirement of the former is not eliminated as some kind of 'bonus'.
if my tone comes across as sarcastic, i apologize in advance. it often does, but i do not intend it to be so. where i ask for sources for stats, i'm not being a dick and challenging you, i'm genuinely wanting them so i can add them to my resource list. (and i'm interested in the 70% figure for claims that don't result in any payment.). i am rushed at the moment, but will re-check this thread for a link to the AMA article. if it's not here, would you mind posting it?
--jason
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In clarification of and response to the #6 posted earlier...
I agree that physicians should speak openly with other docs and their patients if a medical mistake occurs. I was simply stating that the tort system as it is set up today greatly discourages this openness. Theoretically and ethically it shouldn't, but realistically it does. And not that docs completely lie or cover up mistakes; there are ways of wording things and avoiding certain details so as not to condemn one's self in a court of law. It happens.
All of the stats I gave are in the AMA article I have been referring to entitled "Medical Liability Reform - NOW!" Here's the link: http://www.ama-assn.org/ama1/pub/upload/mm/450/mlrnowjune112004.pdf
The citation for the almost 70% of claims in 2002 were closed without payment to plaintiff is:
PHYSICIAN INSURERS ASS'N of AM., PIAA CLAIM TREND ANALYSIS: 2002 ed. (2003), exhibit 1-2.
The citation for the average claim award in 2001, 2002 is:
JURY VERDICT RESEARCH, CURRENT AWARD TRENDS IN PERSONAL INJURY: 43rd ed. (2004), 18.
I agree that physicians should speak openly with other docs and their patients if a medical mistake occurs. I was simply stating that the tort system as it is set up today greatly discourages this openness. Theoretically and ethically it shouldn't, but realistically it does. And not that docs completely lie or cover up mistakes; there are ways of wording things and avoiding certain details so as not to condemn one's self in a court of law. It happens.
All of the stats I gave are in the AMA article I have been referring to entitled "Medical Liability Reform - NOW!" Here's the link: http://www.ama-assn.org/ama1/pub/upload/mm/450/mlrnowjune112004.pdf
The citation for the almost 70% of claims in 2002 were closed without payment to plaintiff is:
PHYSICIAN INSURERS ASS'N of AM., PIAA CLAIM TREND ANALYSIS: 2002 ed. (2003), exhibit 1-2.
The citation for the average claim award in 2001, 2002 is:
JURY VERDICT RESEARCH, CURRENT AWARD TRENDS IN PERSONAL INJURY: 43rd ed. (2004), 18.
