Reform: Medical Mistakes or Tort Law?
By Montag | Related entries in General Politics, Ideas, Smart Things Said By Smart PeopleRoss Eisenbrey has a piece at The American Prospect online edition on the medical malpractice issue. He suggests that rather than focus on tort reform, it may be more useful to look at…
…the way doctors and hospitals practice medicine and the millions of things some of them do wrong each year that lead to bad, sometimes fatal, results. Cutting medical errors by 25 percent would save far more than any tort-law change Congress has considered, all without doing damage to our system of justice or the rights of victims.
He points to an example of this type of approach in practice:
Happily, there is at least one success story in the fight against medical errors that is so dramatic that it ought to inspire every interested party to duplicate it. The only wonder is that it has received so little attention. On June 21, 2005, The Wall Street Journal reported on the remarkable improvement in the safety of anesthesia over the last 20 years, which has been transformed from a frighteningly perilous procedure into something much less risky. “Over the past two decades,� the Journal reported, “patient deaths due to anesthesia have declined to one death per 200,000 to 300,000 cases from one for every 5,000 cases.� You read that right: Anesthesia is 40 times safer today than it was 20 years ago.
As the standard of care improved, medical errors, malpractice, and malpractice litigation have all declined. Anesthesiologists have cut their share of all malpractice claims in half, and the share of claims involving serious injury has also fallen. In the 1970s, more than half involved death or permanent brain injury; today, it is less than one-third. The effect on insurance premiums is another cause for celebration. As malpractice premiums for every other specialty have skyrocketed over the last two decades, they have fallen 37 percent for anesthesiologists, to an average of $22,572 per year.
American Prospect Online: Malpractice Made Perfect
Doesn’t this seem like a reasonable alternative to tort reform? I’m not sure the government even has to do any legislating or creating of complex regulations or bureaucracies. They could address this the same way they addressed steroid use in baseball: put pressure the medical industry to correct themselves. And maybe throw out some grants to medical organizations to help fund the work.
If tort reform actually has the effect of lowering malpractice insurance premiums, wouldn’t that take away some of the incentive for doctors to address the problem of medical mistakes in a meaningful way?
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August 3rd, 2005 at 11:27 am
I say fix both problems. Too many people see a trip to the hospital as a chance to get rich at someone elses expense. Push the tort-reform through, and give more reasonable settlements. At the same time, if
the doctor makes a mistake, let him pay a hefty fine. His malpractice rates should go down (hopefully), but his attention to detail would improve.
August 3rd, 2005 at 1:00 pm
Yes, there are medical mistakes.
Problem is, the studies (IOM for example) that product many of our statistics look very suspicious, and it is difficult to get two studies to match.
We need better definitions, leading to better research, leading to better answers, then we can reduce medical errors.
August 3rd, 2005 at 1:13 pm
Yeah – I don’t understand why the two approaches should be mutually exclusive. I also think there’s a third area that needs attention: medical malpractice insurance.
The costs of malpractice insurance are simply passed along to the consumer/taxpayer, along with the other increases in medical care cost. In all but the most egregious cases, this arrangement isolates doctors and medical institutions from the financial consequences of mistakes and/or outright malpractice.
Doctors and hospitals can afford to be sloppy as long as their malpractice insurance covers the cost of the resulting lawsuits. (Like a car company paying civil damages as long as it’s less expensive than retooling for a gas tank design problem.) They remain in practice or in business unless they do something bad enough to lose their license, with no real incentive to improve. So in the current scenario, the classical economic forces – the ones that would tend to reduce errors by bankrupting the really sloppy practitioners and institutions – are confounded.
This isn’t much different from the way medical costs in general are allowed to soar: there’s an insurance company “middleman” confounding the classical economic forces that are normally in control of the service provider / consumer relationship. The consumer has no direct economic influence over what the provider charges, unlike other markets where the provider competes via lower prices.
Justin (if you’re checking in here) – check this out vis-a-vis our previous discussion regarding group medical insurance:
http://tinyurl.com/9p5gb
August 3rd, 2005 at 1:15 pm
Step one could be requiring six hours sleep for interns in every 24 hour period before letting them work on patients. But that would actually mean treating new hires as professionals instead of slaves, so the AMA would resist.
August 30th, 2006 at 4:11 pm
Across the United States people act as if they have won the lottery whenever their car gets tapped from behind or if a doctor, dentist, employer, or whoever, makes a mistake, big or small. As the number of lawsuits in this country skyrockets, the cost on our system has become outrageous. The price of America’s tort system is now over $200 billion annually, which is over two percent of the gross domestic product. In fact, the cost of tort claims has grown four times faster than the US economy.
Nowhere is this legal free spending more rampant than in healthcare. Lawsuits have forced malpractice premiums for MD’s as high as $200,000 a year, and even higher for surgeons. In medical malpractice cases, plaintiffs receive average awards of $1.2 million.
Sometimes, it is more than just money. Take Putnam County. Putnam is a small, rural county of 55,000 residents in West Virginia. Until recently, this county was served almost exclusively by Putnam General Hospital, which is owned by national health care provider Hospital Corporation of America, Inc. (HCA). Yet the hospital is scheduled to shut its doors for good soon. In fact, they’ve already stopped admitting parents. Why? There is only one reason. Well, more like hundreds of reasons – the number of predatory lawsuits filed by local lawyers.
What happened you ask? The issue surrounds the strange case of Dr. John King, who allegedly mishandled dozens of surgeries during his six-month stint at Putnam. Clearly, something went wrong here, and no one is arguing for anything less than a full airing of the facts and for any injured parties to be made as whole as possible. But that is not what local lawyers had in mind, and instead came a barrage of lawsuits for billions of dollars! Not millions, but billions!!!
Here’s the bottom line: Whatever happened at Putnam related to Dr. King, whatever role there is for the courts in this circumstance, the litigation has gone too far, because more than 55,000 West Virginians will soon live without nearby doctors, nurses, trauma centers or emergency rooms. This is a triumph for justice?
If trial lawyers really want reform then they’ll call on the state of West Virginia and dozens of other states to change the way they license their doctors, because Dr. King was fully licensed to practice medicine in West Virginia. Further, Putnam General Hospital revoked Dr. King’s privileges after just 7 months and before a single lawsuit was filed.