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Lawsuits

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  • Lawsuits

    I debated (hah!) on where to put this but figured it was safer here.

    Limiting malpractice lawsuits can save big

    Limiting malpractice lawsuits can save big
    Fear of lawsuits makes some docs order costly tests that may be unneeded
    The Associated Press
    updated 4:55 p.m. CT, Fri., Oct . 9, 2009
    WASHINGTON - Limits on medical malpractice lawsuits would lead doctors to order up fewer unneeded tests and save taxpayers billions more than previously thought, budget umpires for Congress said Friday in a reversal that puts the issue back in the middle of the health care debate.

    The latest analysis from the nonpartisan Congressional Budget Office estimates that government health care programs could save $41 billion over ten years if nationwide limits on jury awards for pain and suffering and other similar curbs were enacted. Those savings are nearly ten times greater than CBO estimated just last year.

    "Recent research has provided additional evidence that lowering the cost of medical malpractice tends to reduce the use of health care services," CBO Director Douglas Elmendorf wrote lawmakers, explaining the agency's shift. Previously, CBO had ruled that any savings would be limited to lower malpractice insurance premiums for doctors, saying there wasn't clear evidence physicians would also change their approach to treatment.

    Defensive medicine
    On Friday, Elmendorf essentially acknowledged what doctors have been arguing for years: fear of being sued leads them to practice defensive medicine. Some doctors will order a $1,500 MRI for a patient with back pain instead of a simple, $250 X-ray, just to cover themselves against the unlikely chance they'll be accused later of having missed a cancerous tumor.

    Republicans immediately called for liability limits to be incorporated in the health care overhaul legislation advancing in Congress. The Senate Finance Committee bill now gives a nod of recognition to doctors' concerns, but little more. Heeding a call from President Barack Obama, the legislation calls for promoting state experiments with programs to resolve cases before they go to court.

    "The more federal health care programs spend on unnecessary tests, the less money is available for necessary patient care," said Sen. Charles Grassley of Iowa, the ranking Republican on the Finance Committee. "Cutting medical liability costs would help preserve patients' access to care. "

    Tens of billions of dollars in savings is "not chump change," added Grassley. "It's a no-brainer to include tort reform in any health care legislation."

    However, Republicans were unable to pass malpractice limits when they controlled Congress and the White House, and it's unlikely that Democrats would do so now.

    For one thing, trial lawyers have traditionally been heavy contributors to Democratic politicians.

    But also, patient advocates argue that fixed limits on jury awards as in California and some states are unfair to those who have suffered the most harm because of a doctor's negligence. A patient who was given the wrong drug and had to spend several days in the hospital recovering from a bad reaction would likely be able to collect adequate compensation. But a family whose youngster was left brain damaged by an anesthesiologist's mistake probably would not be able to offset all the costs of lifelong care.

    Obama has tried to straddle the argument, siding with the doctors on defensive medicine and agreeing with the lawyers who say limits on jury awards are the wrong remedy. He wants to promote alternatives to litigation; studies have shown anger over cover-ups by doctors is a principal reason that families sue.

    The CBO report means the malpractice issue will stay alive as the health care debate in Congress builds to a climax this year. The budget scorekeepers estimated the total effect of malpractice curbs could reduce the federal deficit by $54 billion over 10 years, once $13 billion in new tax revenues from economic ripple effects are taken into account.

    Even in the health care debate, that's real money.

    Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
    Wife to NSG out of training, mom to 2, 10 & 8, and a beagle with wings.

  • #2
    I don't really know what my opinion is - being in the field my husband is in I can see the major damage that can be done with a mistake but at the same time that is why some states have so few neurosurgeons because they can't afford to practice in some places because of the ridiculous lawsuits....

    ETA: My husband won't have to worry about it so much b/c his institution will pay for his insurance but we have a lot of friend in private practice that pay a LARGE part of their salary in malpractice insurance and therefore have to charge more to make money.
    Wife to NSG out of training, mom to 2, 10 & 8, and a beagle with wings.

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    • #3
      I was going to post the same thing. I think they are looking in the right direction as "defensive medicine" continues to grow. Although they are talking about it however, I am still cynical that much will come of it. I'm waiting for the opinions of our many attorney medical-spouse that are on here -- as they have a much broader understanding of the topic than I do.
      Wife to PGY4 & Mother of 3.

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      • #4
        It makes a lot of sense to me, but I'd also be interested in hearing what the legal professionals think.

        I know that when I was working in banking, we would spend a lot more time and use a lot more testers for things that could end up losing the bank money or causing regulatory fines.

        In that vein, it makes complete sense to me that doctors in often-sued fields would order more defensive tests to avoid lawsuits. I would... If I thought there was any chance a patient would sue me for millions of dollars, I wouldn't hesitate to make them spend a few extra hundred dollars for tests, but maybe that's just me.
        Laurie
        My team: DH (anesthesiologist), DS (9), DD (8)

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        • #5
          and that's yet another reason why my husband won't be practicing civilian medicine. I mean of course you CAN sue the Army. Anyone can sue anyone for anything... BUT- at least we're covered for legal stuff.

          Jenn

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          • #6
            I have a lot of thoughts on this topic, but I should begin by disclaiming that my legal insight in this regard is only very general. I’m not a trial lawyer; I have never handled a med mal case. (I hear enough gory hospital stories at the dinner table and have no interest in pursing those cases by day!) My observations are based in large part on anecdotes I hear from friends, colleagues and family members who have participated in this arena in various roles. My personal experience is very limited.

            I think caps on malpractice awards are not an effective solution to combat the costs of the practice of “defensive medicine.”

            First, it is my understanding that initial studies in states that have enacted caps are suggesting that caps simply don’t decrease spending on care. (It is worth noting that caps do decrease costs to doctors by lowering insurance premiums. These lower costs, however, are generally not passed on patients, and consumer’s health insurance premiums are not significantly lower in states with award caps).

            Second, caps hurt the most severely injured patients. The patients who traditionally recover big awards are (1) patients with significant brain damage; (2) quadriplegics; (3) infants with extensive injuries. Juries are most likely to be award these patient-plaintiffs the big “pain and suffering” awards. To tell these folks that $250,000 is fair recompense for spending the rest of their days with a severely compromised quality of life seems rather… cold.

            Third, caps discriminate. Caps make it harder for lower-income-earning individuals to bring lawsuits. The vast majority of patients cannot afford to pay a lawyer out-of-pocket for pursing a med mal action. As a result, most plaintiffs’ attorneys take these cases on a contingency fee basis, agreeing to litigate the action at no cost to the patient-plaintiff, with the agreement that the lawyer will be compensated a specified percentage of the verdict or settlement. If the plaintiff patient loses, the lawyer gets paid nothing. Obviously, this is a big risk for the lawyer. Med mal cases are notoriously costly and time consuming to litigate. As a result, lawyers are more likely to take cases with significant amounts of money at stake—i.e, those with the potential for a large “pain and suffering” award. Without significant money at stake, it may not be economically rational for the lawyer to take on the case. Patients in states with caps are having a harder time finding representation on a contingency-fee basis. Moreover, in states with caps, this has a discriminatory effect on whose cases are litigated. Even with caps on “pain and suffering,” some patients are still going to get big awards: those with big “economic damages”—i.e., patients who make a lot of money and will lose wages as a result of the injury. Lawyers will still be able to take those cases. However, low wage earners and individuals not employed outside the home are going to recover much less and have a harder time finding representation, than higher-earners with the same injuries. I think that’s an injustice.

            Nevertheless, I agree that the current malpractice system is bad for everybody. It’s economically wasteful and emotionally awful. Unfortunately, that’s the nature of our legal system. I would love to see physicians take some responsibility for improving the way mistakes are handled. I’m particularly interested in the “Sorry Works!” initiative and other systems for physicians/hospitals to internally ferret out and acknowledge mistakes, and work with injured patients on a fair settlement without resorting to legal action.

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            • #7
              Florida has had major malpractice reform and still there are claims that it isn't enough. I think what always makes me so fired up is accountability. As a lawyer, I have accountability to my clients. I must investigate all avenues, advise my client on my legal opinions and do my job. If I do not do my job....they have the right to come after me. If I cause a detriment to them - I must be held accountable. I have absolutely no problem with that. I knew that coming into my job. I do not think there should be a different guideline for doctors. Both lawyers and doctors are not good about policing their own - hence lawsuits. If FMA wanted to start getting a little stricter with investigating errors, pulling licenses until docs have taken CMEs on the error, financial fines, whatever - You would not have the same amount of lawsuits. If AMA/FMA started saying - doc - if you have more than __ amount of errors, you are out - you cannot practice in this state anymore - you wouldn't have the huge amount of unecessary deaths.

              I have a very good friend who does malpractice lawsuits. He says that if more doctors created relationships with their patients, if doctors said "I'm sorry" if they screwed up or offered a way to rectify the problem with no financial downside to the patient - it would cut lawsuits in half.

              As to premiums being tied to lawsuits, with all due respect - why is the insurance companies who insure the docs escape without even a 2nd look? One of the largest insurers for physicians in med mal arena here in Florida makes millions and millions of dollars EVERY YEAR. They skip off into the sunset without anyone looking at them. Several years ago - these companies were put into the spotlight in Fla. They squirmed and danced when posed with the same questions time and time again - if we curb and clamp down on med mal suits, will this lower docs premiums? YOu know what the answer was (once they were put under oath in front of the state legislature)? NO - we cannot guarantee that...

              Don't get me wrong - there is some riddiculous suits out there - but I think the climate these days with most juries is that - if you are going to be bring a med mal suit - it better be extremely eggregious.

              Just my .02 - for what it is worth.

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