This Makes Me Sick

The Insurance Company Gets a Patient's Right To Sue?

Jeffrey Segal, M.D, a board-certified neurosurgeon and the founder and president of Medical Justice Services, Inc., offers a potential cure to the nation's healthcare blues:

What if we all stopped and looked at healthcare in America? Would we like what we saw?

Think about it. Millions are uninsured – and the cost of their care drives up the cost of healthcare for those that can pay.  Health insurance rates are high, driven by the increased costs of defensive medicine, which is primarily practiced, after all, not to provide care but to provide a defense to a lawsuit.

Medical malpractice premiums have increased, in some areas, to the point where specialists in trauma neurosurgery and high-risk ob/gyn are leaving for better climes, which leaves some patients without access to the care that they need. And patients have reasonable expectations, that they’ll receive quality care, that they’ll be safe, that they’ll be made whole again if they are injured through the negligence of others.

What if there was a better way? I have a suggestion. It’s called HealthCare 2.0™. And it would work like this:

Guest Blogger Greatest Hits

We thought it was a good a day to thank a few of the many smart minds who have contributed guest pieces to ThisMakesMeSick over the past six months. They've helped bring a personal voice to uncovering—and overcoming—the liability mess.

We’ve gotten great support since the beginning from Philip Howard and the crew at Common Good who are helping bring special health courts to states across the nation. Howard wrote a powerful piece about hospitals’ fear of lawsuits helping allow a nurse, Charles Cullen, to kill at least 29 patients in New Jersey and Pennsylvania. Read

Doug Wojcieszak first asked when he joined the TMMS squad: "What if you could lower lawsuits and litigation costs without any politics?" Read

Dr. Eric Novack started the first of his many guest columns by flatly stating: “Solving the medical liability crisis will require medicine embracing the legal system. That sounds like complete heresy coming from an actively practicing surgeon!” Read

We got the real political deal of trying to clean up the medical liability mess from U.S. Congressman Mac Thornberry. He watched the wind blowing the special health court sails disappear like magic as a fellow congressman’s support for the solution vanished: “the Association of Trial Lawyers caught wind of his interest in the bill and they quickly changed his mind by threatening to cut off all campaign contributions.” Read

Muriel in Seattle, an 87-year old grandmother, detailed the nonsense of having to sign liability wavier after wavier while facing a frightening hospital stay over Thanksgiving in 2005: "They stick it right in front of you." Watch

We bet you have something to say. Maybe a sad or chilling experience from the frontlines. A solution that might help ease the liability mess. Or maybe just your two cents. Let it out, here.

Senate to Debate Med-Mal Caps

Next month, the U.S. Senate will take another swing at medical malpractice reform. The medical liability bill (S 1955) would cap total non-economic damages in malpractice lawsuits at $750,000 and would cap such damages at $250,000 per defendant. These bills have been debated before and the fact we’re still writing about it tells you about the past results.

But it’s a new year and Sen. Frist, M.D., is charged up and so are people on both sides of the issue. Learn about docs pushin’ here and opponents shoutin’ here.

Can you, the reader, offer some reasons for and against capping non-economic damages? We still don’t know if this is a real solution.

Medical Malpractice Caps Affecting Healthcare?

Hat tip to PointofLaw.com for an interesting post comparing the latest rankings by HealthGrades on relative safety of hospitals across America versus states with caps on malpractice rewards. Simplified, yes, but interesting nonetheless. They also sum up the cap fight in a tidy way:

"Recall that reform opponents argue that caps reduce the quality of care because doctors no longer fear malpractice awards. Reformers argue that malpractice litigation is so random that it deters the practice of medicine without any real effect on quality of care, because good doctors are almost as likely as bad doctors to be sued."

The findings:

What does this prove?

Docs Living Fat Off of Malpractice 'Suits

"This isn’t doctors against lawyers,” said Dan Kopen, M.D., an independent general surgeon in Kingston, PA. “It’s people who have a vested interest in the current system versus people who want something better for the population in general…. There are doctors who are becoming very wealthy as part of the current system because they provide expert testimony on a regular basis,”

Alright, we knew that, but this is what was news to us: “One of the biggest national brokers for expert medical testimony — Berkeley, Calif.-based American Medical Forensic Specialists Inc. — said it has a nationwide network of about 7,500 expert doctors and they bill hourly rates of $400 to $500, depending on the type of doctor needed.” Read [Scranton Times]

I want a slick corporate lawyer and a stethoscope-sportin’ med expert to arm wrestle on pay-per-view.

There is simply too much money involved in the medical liability world. Scrap the high-paid experts. Do away with the 40% cut-getting attorneys. Give us a better way. Someone. Somewhere. PLEASE!

Double Dipping Medical Directors

Guest blogger Jeffrey Segal, M.D., a board-certified neurosurgeon and the founder and president of Medical Justice Services, Inc., says a physician abuses the system—and his fellow doctors.

I think that one thing is not negotiable:You shouldn’t be allowed to work “both sides” at the same time for personal gain.

Introducing ethics into the debate seems obvious enough. But it isn’t.

As long as there has been managed care, there have been medical directors of managed care organizations (MCO). These are physicians who review confidential medical records and, among other things, make determinations of “medical necessity.” This includes determining whether to pay for specific procedures, and if so, how much.

When such records are reviewed, the physician who sends the information to the MCO assumes that the information will remain confidential, and it will be reviewed solely on its own merits.

Imagine the surprise when a physician learned that the Medical Director for one of the larger MCOs in the Northeast was wearing two hats.

By day, he was reviewing confidential charts, as expected.

By night, he was serving as a plaintiff’s expert witness to medical malpractice attorneys.

Spring Has Sprung

Hear ye, hear ye. ThisMakesMeSick sports a new look for all those stopping by to get to the bottom of America's medical liability mess. Information is now easier to find, as are opportunities to get something off your chest and to share your own stories and experiences in this arena.

So if you are a lawyer, a doctor, an insurance maverick, a patient, a spouse of the aforementioned, or just a concerned citizen worried about what’s happening to our health care system and how nefarious parties are abusing it, SPEAK UP.

Contact ThisMakesMeSick.

The System Defended

A few days ago we noted some moves down in the great state of Massachusetts to make malpractice payouts predictable and consistent with the injury. One reader, Matt, responded otherwise.

"Why should payouts be based on the type of injury? Wouldn't it be more equitable to base them on the person's circumstances in terms of their pre-injury quality of life, or their lost earnings? Why should the injury to an 80 year old in a wheelchair have the same value as the same injury to a 20 year old college football star?

Of course, evaluating those factors is what juries do already, and there is no statistical evidence that they aren't already consistent, is there?"

Bothered? Interest piqued? Do you too agree and think the system is fine how it is?