The impact of malpractice lawsuits on patient care

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G-Man

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A show on Fox News tonight at 9 pm ET called "Breaking Point". All should watch and post your thoughts in the lounge thread under same title.
 

JohnHolmes

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G-Man said:
A show on Fox News tonight at 9 pm ET called "Breaking Point". All should watch and post your thoughts in the lounge thread under same title.
thanks man. :thumbup: I don't have fox (in cville so not much here), but can you or do you know where to get a transcript?

JH
 
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Moocow2011

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It's troubling, but a doctor doesn't have to make a mistake to lose a malpractice case. If the lawyer is good enough, the lawyer can make a strong emotional appeal to the jury and back his story up with some other doctor ("expert witness"). The lawyer may not win every time, but if there are many lawsuits, good doctors will eventually lose. California has a malpractice cap, and it works (relative to, say, Pennsylvania).
 

Zweihander

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Moocow2011 said:
It's troubling, but a doctor doesn't have to make a mistake to lose a malpractice case. If the lawyer is good enough, the lawyer can make a strong emotional appeal to the jury and back his story up with some other doctor ("expert witness"). The lawyer may not win every time, but if there are many lawsuits, good doctors will eventually lose. California has a malpractice cap, and it works (relative to, say, Pennsylvania).
My understanding is that in the vast majority of cases, the jury decides in favour of the doctor. Also, there are statistics regarding how doctor-patient interactions affect malpractice, and it turns out that doctors who spend more time interviewing patients and doctors who are viewed as "caring about the patient" are less likely to get sued, regardless of outcome.

Personally, I don't think caps on malpractice are the way to go, although they might help. What really needs to happen is caps on insurance premiums -- I honestly don't think insurance companies need to be charging as much as they do to turn a profit. Also, capping insurance premiums takes money out of the system, and if there is less money to be had, people will not sue as much. Just look at EMS.
 

vtucci

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As an attorney, I have no problem stating that the legal profession is destroying the fabric of american medicine.

I agree that doctors should be held accountable for gross negligence or recklessness. The problem is that in many cases, good physicians, ones who have made no mistakes and who did not deviate from the standard of care are sued by patients trying to hit the jury lotto. I support caps on malpractice cases- particularly on the pain and suffering portion of the award. I do think it is necessary, however, to ensure that the actual and future medical costs be covered by such awards so that society does not have to shoulder those costs. Also, keep in mind that in states without caps, many doctors are leaving higher risk specialties (e.g., OB-GYN, cardiology etc.) or relocating to states with malpractice caps (generally reducing the cost of malpractice insurance).

Many patients will sue or threaten to sue if the outcome is not perfection. Medicine is an art as well as a science and many times, the best outcome achievable is not satisfactory to the patient. It is true that doctors who spend more time with their patients and who discuss things with them in a respectful manner are less likely to be sued. However, it is not just actual lawsuits that have changed the medical profession but the threat of being sued. Now many doctors will order thousands of dollars worth of tests to avoid missing the 1 in million rare disease (which granted, if you were that 1 in million case, you would need).

There was an article in Newsweek in December about this as well. It is worth checking out. US News and World report also had an article in the last year.
 

MacGyver

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There are lies, damned lies, and statistics.

Med mal is colored by which statistics you use. There are only about 3,432 statistics related to med malpractice issues.

What we need is a measure of what percentage of doctors get sued. I know that 100% of all neurosurgeons in Mississippi have been sued at least once. I'm sure there are high numbers depending on specialties across the country.

I know the lawyers like to point out that 5% of docs are responsible for like 90% of all med mal payouts. That number is meaningless unless you also know the percentage of all doctors sued.
 

juddson

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MacGyver said:
There are lies, damned lies, and statistics.

Med mal is colored by which statistics you use. There are only about 3,432 statistics related to med malpractice issues.

What we need is a measure of what percentage of doctors get sued. I know that 100% of all neurosurgeons in Mississippi have been sued at least once. I'm sure there are high numbers depending on specialties across the country.

I know the lawyers like to point out that 5% of docs are responsible for like 90% of all med mal payouts. That number is meaningless unless you also know the percentage of all doctors sued.
yes yes. It's all statistics-any one of which is open to debate, twisting, etc. But the AMA seems particularly disgusting in this regard, right? $3.5 average jury award when the median is only about $1 million. THAT gives the wrong impression. Not only that, it includes (most dishonestly) awards against large corporations like hospitals and medical device manufacturers, and not just doctors (no doubt the reason why the average is skewed so high upwards - there would have to be some HUGE awards neer the top). And ONLY using Jury Verdict to report data. Dishonest.

The reality is the AMA is an interest groups with doctors as beneficiaries. Public Citizen is NOT a lawyers group.

It's time somebody starts directing attention to the numbers behind the mindless tirades on these forums.

medicine is a HIGH RISK, HIGH PAY occupation. What's the average pay for a nuerosurgeon on Mississippi? I'm guessing close to $400k or more - EVEN THOUGH they've all been sued (which I doubt, but who knows).

It's simply not enough to post stories about cases that seem to have gone wrong (most of which don't contain enough facts to make an informed opinion anyway.

Judd
 

juddson

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beastmaster said:
One ought to listen to a diverstity of opinion and make up their own mind.
Couldn't agree more. You need to see BOTH sides of this issue. Unfortunatetly, we only get one side on these forums (for obvious reasons).

BTW, it simply is not enough to merely accuse Public Citizen of being 'Liberal'. The word along can't make your arguments for you.

Judd
 
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beastmaster

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I'm not here to make big arguments and enter debates.

The group very openly advocates hugely increased government regulation of practically every bailiwick they discuss. There are even copies of petition letters stating their position available for all to mail to their congressmen. The selectively post news releases to support only their point of view. I won't start posting links, as that gets cumbersome, but it is not difficult to carve out their agenda amidst the guise of purported "public interest." That's not to say they are wrong on all issues, but on several (not necessarily med malpractice; I'm evaluating them on issues I'm more intimately familiar with).

If I don't get a chance to reply to your comment please excuse me. I don't have very much time to peruse these forums. Regards.
 

WyldeWolf1

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I've discussed this issue at length with my father, a lawyer, and I live in a state (Florida) where malpractice award caps have been introduced. In the end, doctors' insurance premiums are not dropping significantly. It's terribly obvious that the only beneficiaries of these measures are the insurance companies. Essentially, they are now able to screw both doctors and patients. What is needed are premium caps; most other businesses are prevented from price gouging; why aren't they?

Also, it's important to remember that 1) most of the "ridiculous" lawsuit stories you hear on, say, the radio, are untrue urban legends and 2) most of the astronomical jury awards are reduced by the judge. So don't jump on anecdotal evidence, but attack the problem as a broad issue.
 

MacGyver

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I think we should open up the NPDB. However, I also think that new information should be added to the NPDB. It should have all of the following:

Total number of lawsuits FILED against that doctor.

Total number of lawsuits that WENT TO TRIAL against that doctor

Total number of lawsuits SETTLED against that doctor

Total settlement PAYOUTS by that doctor

Total legal fees SPENT by the doctor/insurance company

Total amount and number of TRIAL AWARDS against the doctor

Listing of all state medical board actions regarding the doctor (all states included, not just current state of practice)

The NPDB should also have summary tables to compare that doctor against his colleagues. It should have national, regional, state, and county, and city breakdowns.
 

Goober

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The problem with getting sued and winning or having the case dropped against you is you still lose. Every time you get sued your insurance rates will go up regardless of the outcome. If you don't think that is a big deal consider that in many states doctors in high risk specialites are paying 100-150k/year to be insured. If they raise it 20% you have to pay another 20-30K

If you get sued enough times your insurance will drop you even if you never have a judgement against you. In almost all states you do not have recourse if this happens. If you get dropped by an insurance company, you will find it incredibly difficult to find another one that will take you.
 

juddson

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beastmaster said:
I'm not here to make big arguments and enter debates.

The group very openly advocates hugely increased government regulation of practically every bailiwick they discuss. There are even copies of petition letters stating their position available for all to mail to their congressmen. The selectively post news releases to support only their point of view. I won't start posting links, as that gets cumbersome, but it is not difficult to carve out their agenda amidst the guise of purported "public interest." That's not to say they are wrong on all issues, but on several (not necessarily med malpractice; I'm evaluating them on issues I'm more intimately familiar with).
Well, agreed that you need to evaluate each issue individually. Not asking anybody to agree with every issue (nor, i would hope, would we be asked to agree with every issue on some conservative group's agenda). Look at the data, read the analysis, decide for yourself.

BTW, the med mal issue seems to contradict your main reason for charging this group with liberal regulation hysteria. Public Citizen would like congress to NOT regulate the medical malpractice scene. Couldn't agree more. Now where are my Federalist Papers?

judd
 

juddson

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MacGyver said:
I think we should open up the NPDB. However, I also think that new information should be added to the NPDB. It should have all of the following:

Total number of lawsuits FILED against that doctor.

Total number of lawsuits that WENT TO TRIAL against that doctor

Total number of lawsuits SETTLED against that doctor

Total settlement PAYOUTS by that doctor

Total legal fees SPENT by the doctor/insurance company

Total amount and number of TRIAL AWARDS against the doctor

Listing of all state medical board actions regarding the doctor (all states included, not just current state of practice)

The NPDB should also have summary tables to compare that doctor against his colleagues. It should have national, regional, state, and county, and city breakdowns.
Agreed. Awesome idea. No complaints from me or the trial lobby, I am guessing. Doctors would HATE to have this opened up EVEN WITH the data you are suggesting. For god's sake, only like 15 state medical boards list meaningful information on disciplinary actions against thier doctors.

Judd
 

juddson

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Goober said:
The problem with getting sued and winning or having the case dropped against you is you still lose. Every time you get sued your insurance rates will go up regardless of the outcome. If you don't think that is a big deal consider that in many states doctors in high risk specialites are paying 100-150k/year to be insured. If they raise it 20% you have to pay another 20-30K

If you get sued enough times your insurance will drop you even if you never have a judgement against you. In almost all states you do not have recourse if this happens. If you get dropped by an insurance company, you will find it incredibly difficult to find another one that will take you.
This is the kind of "common wisdom" that seems evident on its face. It's not clear to me that it is true, though. I think premiums are set by risk class, and while a loss will affect that class significantly, I don't think a win has that much effect. Some doctors have been sued 15 times or more and they still have insurance (because they win). Your scenario would price them out of the market completely.

BTW, with all this talk about how every doctor is sued at least once (or twice or 20 times) in a life-time, what are the stats on the average person being sued in a life-time? What about people who engage in risky occupations (like owning a grocery store or greeting card company - or any company with employees)? Just curious. Are doctors REALLY sued more than other people?

Judd
 

FoughtFyr

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juddson said:
Oh that sucks. Must have screwed up the link.

Try this one.

http://www.citizen.org/documents/Briefing_Book.pdf

Judd
I read the Nader document you reference. It is bunk. It contradicts itself all over...

Example -

In the executive summary, "According to experts at the Medicare Payment Advisory Commission (MedPAC), liability insurance premiums make up just a tiny part of a physician?s expenses and have increased by only 4.4 percent over the past year."
then on page 17 their chart demonstrates 9.5% and 8.7% increases over the past two years respectively. Oops.

Besides, this is from Ralph Nader's citizen watchdog group. They have supported 1000s of tort claims, usually against major industries. Nader himself practically invented regulation by tort. And you are holding this drivel out as an "unbiased" look. Please. In my town seven attendings in the past year moved their practices to differing states, four had been dropped by their med mal carriers completely - without a single successful suit against them (the insurance companies were no longer covering trauma neurosurgeons in our area - historic awards were just "too high"). Like it or not, regardless of the cause, skyrocketing med mal premiums exist, and without relief larger and larger areas of the country are without coverage for "high risk" specialites.

MEDICAL MALPRACTICE INSURANCE REFORM IS A PATIENT ACCESS ISSUE!

As long as we are posting links. Read this:
http://www.isms.org/realmedicine/ga...multimedia.html download the powerpoint pres. and read it. Or go here,
http://www.isms.org/realmedicine/info/book/dear.html and read the presentation.

Or for a completely unbiased look find and read "Confronting the New Health Care Crisis: Improving Health Care Quality and Lowering Costs By Fixing Our Medical Liability System, U.S. Department of Health and Human Services, July 24, 2002"
http://aspe.hhs.gov/daltcp/reports/litrefm.pdf
 

Goober

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juddson said:
This is the kind of "common wisdom" that seems evident on its face. It's not clear to me that it is true, though. I think premiums are set by risk class, and while a loss will affect that class significantly, I don't think a win has that much effect. Some doctors have been sued 15 times or more and they still have insurance (because they win). Your scenario would price them out of the market completely.



Judd

Judd do you actually have any experience in dealing with malpractice companies or are you just making stuff up as you go along? There have been plenty of doctors I know personally and many who are written up about in the many medical magazines who have been dropped from Insurance comapanies for being sued far less than 15 times even if they never lost a case. Typically the reason they give is "excessive claims".

Since you are planning on becoming a doctor you may actually want to spend sometime talking to them so you know what you are getting into.
 

ZekeMD

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juddson said:
Oh that sucks. Must have screwed up the link.

Try this one.

http://www.citizen.org/documents/Briefing_Book.pdf

Judd
If you'll notice, that article was written by lawyers and politicians! Go figure that it goes on to say that medical malpractice suits are not frivolous.

IMHO, the main problem with medical malpractice suits is that they result in an increase of healthcare costs for patients. Doctors are more likely to order expensive tests that may not be required, just to cover their asses. Also, malpractice insurance premiums are skyrocketing. That is causing hospitals and doctors to increase charges. In the end, all these lawsuits come back to hurt the public.

Another important point is that doctors can refuse to care for a patient. Most likely to occur if the doctors specialty does not "exactly" match the current case. For instance, a surgeon may refuse to operate on a child since he is not a "pediatric surgeon." The liability increases for doctors since if something goes wrong, they could easily be sued and it could be argued that they had no place operating on the patient since it was not their specialty...even though they were fully capable. If doctors begin refusing to treat some patients, valuable time could be wasted trying to find a doctor who will and transporting the patient to them. In the end, these suits are hurting the patients the most. When will people realize this???
 
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