Medical Tort Liability: Red Herring

[MannyGoldstein]

The total cost of malpractice premiums is less than 2% of all medical spending:

http://www.cbo.gov/ftpdocs/49xx/doc4968/01-08-MedicalMalpractice.pdf

Thus, the impact of limiting suits would not do much to change health care costs, but it will sure cause a problem for those legitimately harmed by providers.

[flpoljunkie]

1. Doctors are also generally lousy at weeding out the incompetents among them.

[SharonAnn]

8. They know who the incompetents are, thy just won't "oust" them or report them.

Doctors and nurses and others in the medical profession know who the bad, dangerous doctors are.

Never trust any organization that "polices its own". They always cover up wrong-doing.

Doctors, police, dentists, etc.

[Princess Turandot]

12. That's not universally true..

it often depends on the issue. I'm familiar with a case where a doctor 'ratted out' a surgeon who took an emergency call after he'd been drinking at dinner, a big no-no relative to surgery, causing the guy to lose his surgical privileges. I'm also familiar with cases where MDs were suspended by their institutions for potential financial irregularities (ones that did not affect the institution.) My personal favorite was a case where a head surgical nurse called an MD's chief of service because the MD was about to do an operation which she did not think he was able to do at the time. The chief ran down to the OR and literally dragged the guy out of it, then yanked his privileges. (The operation had not yet started.) NYS subsequently yanked his license. (Ironically, the guy actually was an excellent surgeon; he'd come back to work too early following an operation of his own, out of greed.) I've known anesthesiologists who've dropped a word in the right ear about bad docs.

The bad, dangerous doctors historically often moved out of state, counting on communication snafus to keep their past covered up. Computers have helped clamp down on that now.

The bigger problem as far as I'm concerned are the state boards who have the responsibility for disciplining docs, not the docs who work with 'bad' ones and let them slide. Fortunately, that's improving.

[Thrill]

2. Obama made that clear

today.

[Doctor_J]

3. And, as pointed out in the current New Yorker, Texas quacks have no

malpractice liability and yet have the highest per capita health care cost and among the lowest quality.

[Bread and Circus]

4. I think you underestimate the cost to the system of practicing defensive medicine.

There is a culture of fear that is pervasive in medicine that we doctors won't outright admit to yet we are constantly reminded to check tests because if you "think about it, order it".

[MannyGoldstein]

5. According to the CBO, Those Practices Wouldn't Change Much

See the paper cited in the OP.

[Bread and Circus]

6. Well, those guys aren't doctors and don't work with doctors on a day to day basis...

and I can tell you most people don't understand how pervasive the fear of being sued is imbedded in your psyche from the moment you step into medical school.

Like one Internist told me, MRI is to headache as antibiotics are to a cold. In other words, you don't need it but it's what you get if you want to cover your you know what.

And let's not even start with how out of hand c-sections have gotten through the years and how a lot of that is driven by fear of lawsuits.

You can't be a bean counter at the CBO and quantify whether docs are getting tests because they need them or whether they are just CYA tests.

Only the doctors who order them know.

Do you think we call the CBO and tell them "hey yah...that MRI I just ordered, that's just a CYA test...so put that in the wasteful spending column"?/


No...that's not how it happens.

[ellacott]

7. Also certain specialties are hard hit with the cost of malpractice insurance

Ob/Gyn and Ortho pay an exorbitant amount on malpractice insurance. I know am Ob/Gyn who pays 50k a year for malpractice insurance. Some of these doctors have left the practice because the costs are too high.

The hospital that I work for has instituted safeguard measures to decrease the number of surgeries performed on the wrong body part. This sounds like a simple thing to avoid but it happens quite frequently and respresents many of the malpractice suits that are filed.

[SharonAnn]

9. To me, surgery "on the wrong body part" is malpractice.

[ellacott]

10. No question

In order to address the problem you can let it go through the court system or you can try and eliminate it from happening.

[Princess Turandot]

11. It's not a red herring in terms of certain medical practices...

even if it is not material to overall spending. It has a definite impact on the OBG profession as another poster mentioned and risks lowering their ranks. And while it may in some cases weed out bad practitioners, it also risks losing good practitioners. While this may have changed in recent years (it may not have: I'm just not sure), the statute of limitations for OB lawsuits in NYS was 18 years. I'm not at all sure how your kid could get to be 10, much less 18, w/o you noticing that something was wrong that was clearly the result of something that happened when they were born. But if you put the case in front of the right jury, the defendants are often just seen as 'deep pockets'.

I'm all for damages being paid to take care of a baby harmed by malpractice. I'm all for weeding out bad docs. But I'm a bit more skeptical about turning the case into a bonanza for the parents, which is something that actually does happen (beyond the award needed to take care of the baby, which can itself go into the 7 digits.)

In the interest of full disclosure, I used to work in hospital finance. But also in the interest of full disclosure, my family was awarded a settlement in connection with the death of my father several decades ago. The MD was in the early stages of dementia at the time he was taking care of my father. By the time the case was getting close to being put on a court docket, the insurance company realized that deposing the MD was going to be a disaster and settled it.

[MannyGoldstein]

13. Good Point

Thanks.