This Makes Me Sick

Doctors group's cartoon blames the greedy lawyers

In this corner, weighing in at.... In the increasingly contentious battle over medical liability, lawyers and doctors too often find themselves in separate corners. We don't think it should be this way. A web-cartoon by Protect Patients Now (a project of a 230,000-strong medical specialist outfit) calls out lawyers as the reason that malpractice rates skyrocket, doctors flee and health care options deteriorate. Is it really this simple? Watch and decide for yourself. These sentiments stir the pot, but they don't cure what makes us sick. Watch [Protect Patients Now]

Liability fears and a patient’s false hopelessness

Life is filled with stories of near-fatal diseases and injuries followed by miraculous recoveries. A doctor’s words the springboard for the hope and inner strength that keys survival. But what happens if hope never takes root? What happens if a doctor paints a bleaker picture than necessary to stave off liability should the worst occur?

Dr. David Spiegel, a psychiatrist at Stanford medical school, believes that the fear of malpractice litigation after a bad outcome drives doctors to be stunningly explicit from the outset. Couple this with many patients desire for frankness and the “language of hope” becomes a tricky issue in modern medical care.

Can today’s doctor be both honest and supportive without liability issues clouding a relationship? It’s just one more challenge in American health care. This solid article looks at all of the angles of a doctor’s balance to keep hope alive. Read [The New York Times]

Top Pennsylvania malpractice carrier freezes rates

'Tis the holiday season as PMSLIC Insurance Co. has begun writing new policies after three years of restricting sales and six years of double-digit rate hikes. Pennsylvania actually has an innovative approach to dealing with the medical liability crisis and the stream of doctors fleeing the state.  PMSLIC provides coverage for claims totaling $500,000. MCARE Fund, a state program created in 2002, pays claims ranging between $500,000 and $1 million, and most of the state's 34,000 doctors are required to contribute to the fund. Hospitals generally provide additional coverage for doctors practicing in medical facilities, where claims exceeding $1 million most often occur. It's all a step in the right direction. But don't break out the champagne just yet. There's still the issues of a history of wildly fluctuating malpractice rates and the lack of a medical error reporting system. Read [Pittsburgh Business Times]

Calls for more doctor oversight

On the heels of a solid investigative series in the Baltimore Sun on masking malpractice cases, Maryland lawmakers are seeking tighter oversight of the state's doctors, including greater disclosure of malpractice claims histories and other information by the Board of Physicians. "'It's very disconcerting that a conservative state such as Virginia is far ahead of Maryland'" in publishing doctors' malpractice histories online, said Senate President Thomas V. Mike Miller. "'It's shocking to me that... the same information is not available to people who need to make life-and-death medical choices.'" The Sun series noted that the Board's monitoring system has a four year backlog of physician disciplinary cases for quality of care. Yikes! What's going on here? Read [Baltimore Sun]

Dr. Eric Novack: Keys to a successful medical liability system

In his previous posts, Dr. Novack--host of “The Eric Novack Show” on KKNT960 AM Phoenix--stressed the importance of embracing the legal system and began dissecting the underlying legal concepts of medical liability. Today, he continues to uncover the keys to a successful medical liability system.

The “corrective justice” theory of tort law states that the person harmed ought to receive compensation for the losses incurred by the injury. Those losses fit into two categories. The first is “lost wages.” If the harm kept a person out of work for 2 weeks then the compensation for lost wages should equal 2 weeks pay. Lost wages also would include the money spent on the extra care required to pay for the harm. Wheelchairs or other assist devices that were purchased, travel expenses, nursing care, other doctor opinions, etc., should be reimbursed.

On the face this seems simple. Just add up the above, get the total, and, if harm was found to have occurred, reimburse that amount. But, of course, even this is not that easy. The economic calculations must also include the amount to cover future expenses that will be incurred due to the injury. For example, if someone injures his hip in a car accident, the expenses can include the possible costs of a future hip replacement and associated rehabilitation. Since these are estimated future expenses, in many cases possibly years later, it is difficult to accurately estimate.

In the current, very adversarial world of medical liability, this is a major area of dispute when damages are discussed and argued. But at least the numbers can be generated using some kind of calculations.

The other category of losses falls into “non-economic damages” or “pain and suffering.”

The Economist weighs in

We're happy to see the gamut of media outlets giving front page space to the real medical liability crisis. This week the venerable Economist lays it down in  "Doctors and drug firms in the dock." Though we're a little bothered by the tired reference to former trial lawyer and vice-presidential candidate John Edwards as "smooth," the piece is chock full o'Economist-worthy facts and figures and they give support to the innovative solution of health courts being pushed by Common Good. Here's a sampling of the numbers:

• 76% of American obstetricians have been sued at least once



• $228,396 ~ The average malpractice insurance premium paid by neurosurgeons in St. Clair County, Illinois in 2004. That's five times more than their colleagues in Wisconsin.



• From 1975--2003 the cost of medical malpractice lawsuits has risen more than 2,000% to $26.5 billion, according to Tillinghast, an actuarial consultancy.

After the knockout figures, they breakdown the tangled financial mess this creates--from a family's soaring health care costs to General Motors' own financial woes. Read [The Economist]

Patients 'dumped' from Florida ERs

An increasing shortage of doctors willing to treat emergency patients in Palm Beach County sometimes means dicey treatment options for the injured. And, surprise, surprise, the nation’s liability mess is to blame. Let’s say that a plastic surgeon from Wellington Regional Medical Center refuses to come to the hospital's ER to treat a man with facial injuries from a car accident. The patient waits hours for treatment before he’s “dumped” and sent to another hospital. Why the lack of hand surgeons, orthopedic surgeons, ophthalmologists, plastic surgeons and obstetricians in the area’s ERs? Well, Florida law allows doctors to practice without medical malpractice insurance. And as malpractice insurance rates rise, some do opt to ‘go bare.’ But in Palm Beach County there's no large public hospital at which doctors in the ER have sovereign immunity from lawsuits. So docs practicing there face an increased liability risk. Especially those sans malpractice insurance. They stay home and the lineup grows thin. And the people suffer. Discuss. Read [Palm Beach Post]

It's a broken system driven by fear

The ER doc arrived for his usual shift at a hospital in Washington. The problem was that it WAS a typical day where another patient would be subjected to a litany of tests--"The cost of this young man’s head, neck, face and abdominal CAT scans, ambulance ride, and extensive evaluation was likely in the range of $20,000"--that weren't needed. But the doc's colleagues ordered them to cover their collective derrieres. We'll let the doc's story speak for itself. Read [The Olympian]

Dr. Eric Novack: The legal concepts of medical liability

We should examine arguments in favor of embracing modifications of the legal system by the medical community.  In the original post, I laid out six components of a successful medical liability system. Before explaining in greater detail those components and deciding whether the current system is satisfactory or deficient, we need to look at some underlying legal concepts of medical liability. This examination should matter to healthcare providers and doctors, as it serves as the basis of the current system, much in the same way that understanding basic anatomy and physiology is essential to understanding diseases.

More after the jump.

Enjoy the Silence

There’s been plenty written on the Merck lawsuit saga and it’s recalled pain-reliever Vioxx that may or may not have caused heart attacks. But now comes the charge that cardiologist Dr. Eric Topol lost his title as chief academic officer of the Cleveland Clinic's medical college.   All because he took the stand and took it to Merck (he’s a longtime critic), charging they committed scientific misconduct when it marketed the drug. A hospital spokeswoman said the doc’s allegations that he was demoted are nonsense: "The organization made the decision that that position was no longer needed.” Ah, but Dr. Topol begs to differ: "The hardest thing in the world is just trying to tell the truth, to do the right thing for patients, and you get vilified. No wonder nobody stands up to the industry." Is this purported nonsense a fact of medicine? Read [New York Times] and respond.