Darn right! That's why tort reform should have been part of health care overhaul! Until you relieve some of the concern for "am I going to be sued??", it's only natural that MDs will want to cover their butts and overtest.... We've got to get out from the pressure by special interest groups - plaintiff attorneys!!

Yep. The CBO estimates $54 billion could be saved via tort reform.

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/09/AR2009100904271.html

We don't need no stinkin tort reform. Especially not when trial lawyers contribute millions to Democrats, about 3 of every 4 dollars to be exact.

http://www.opensecrets.org/industries/indus.php?ind=K01

AMIRITE?

there will be a lawsuit filed today by the Trial Lawyers Bar asking for a ban on all studies that show that tort reform is an effective way to further decrease health care costs...

Ambulance chasing scumbags

tontosh,

27 states already have tort reform. In those states, medical malpractice premiums have gone up more and faster than in the states without tort reform. This is largely because very few cases of medical malpractice ever go to a court and become subject to tort reform. They are settled out of court. Why? Because, by settling out of court, the physician or pharmacist, or hospital gets to be free from any future criminal, civil, or disciplinary action. In other words, they settle so the malpractitioner is never punished.

Medical malpractice is the fifth leading cause of death in this country. It is not even in the top ten in any other country in the world.

And I find it extremely suspicious that ER's claim that they "over-test" because of fears of lawsuits, but they have no problem with letting people with insurance sit for hours and hours in a waiting room before they are seen. That would be an even more serious source of lawsuits than over-testing. The difference is that the over-testing is usually paid for by insurance, Medicaid, or Medicare and just leaving people in a waiting room is not. And "good samaritan" laws prohibit ER's from being sued if they haven't seen you yet, so if you die, you do so at your own risk.

The last time I went to an emergency room was for a large kidney stone. It was a Level II ER at a Tier 1 University Hospital (Emory in Atlanta). I had Blue-Cross Blue Shield insurance. My wife was on faculty at the Emory Medical School. I waited for six hours in extremely intense pain until my wife finally started making calls. Then I was suddenly seen. While I was there, I had the pleasure of watching people throw up, bleed from a compound fracture, pass out, faint, cry, and plead. And all of those people waited longer than I did and my guess would have been that most had insurance. BTW --- I wouldn't send a dog to that ER.

The other side of coin vs. this article is that doctors will request additional frivolous tests and charge Medicaid. Each time the patient comes into his office / practice and requests another test, the doctor gets an initial office fee for each and every visit.

this was all brought out in the health care debate. nearly 50% of all waste in medical costs comes from this problem. and the dems in congress blocked every effort for tort reform to be added to the bill. the reform law did nothing to control this largest culprit in health care costs.

The real problem is the number of people who get all their healthcare at the ER.

For what it's worth, "tort reform" as it is proposed by the Republicans isn't going to fix the problem. What's really needed is a way to both quickly compensate patients harmed by individuals or the system, while actually allowing the system to implement proper change. For example, there is already a National vaccine-injury fund that compensates those found by an independent panel to have been harmed by vaccination that Americans frequently get. If we set up state medical boards to do the same, and use that information to correct or remove improper providers or systems, then I'd argue that costs would SIGNIFICANTLY decrease.

Unfortunately, as this method completely bypasses the litigation system currently in use, Congress and the lawyers among them/supporting them will refuse to back such a plan.

This is what the republicans were saying over and over during HCR negotiations. The problem is that the trial lawyers own the democratic party.

Bottom line...no tort reform while Obama and the Democrats are in charge

@ Chris-749391

"And I find it extremely suspicious that ER's claim that they "over-test" because of fears of lawsuits, but they have no problem with letting people with insurance sit for hours and hours in a waiting room before they are seen. That would be an even more serious source of lawsuits than over-testing. The difference is that the over-testing is usually paid for by insurance, Medicaid, or Medicare and just leaving people in a waiting room is not. And "good samaritan" laws prohibit ER's from being sued if they haven't seen you yet, so if you die, you do so at your own risk."

Many academic centers are chronically short of patient care space. That wait is more often an effect of ER's being overloaded with less-critical patients than with the desire to avoid treatment. Besides, if they treated people with insurance faster (rather than intentionally letting them sit as you claim), they'd make more money. And for what it's worth, paramedics are covered by "Good Samaritan laws", not hospitals. And as that woman that died in LA's MLK-Harbor's waiting room showed last year, hospitals still are liable if that happens.

If tort reform did anything then in the states that have implemented tort reform (like Texas) you would see a statistically significant difference in malpractice insurance (you don`t), tests performed (you don`t) and possibly even outcomes (you don`t). These states show that tort reform is not the issue.

Can we just give tort reform a rest.

Plus look at the stats they provided.... 600 over two years for two thirds of the doctors in America..... so lets say 500 for all ER docs and that is out of 116,000,000 ER visits.

If it is your loved one that dies because some busy doctor blew them off when being seen in the ER you would be pretty angry. That doesn`t mean that I agree with any or all lawsuits but that sometimes they may be warranted. With women presenting with chest pains I would always want them to go overboard because we know statistically that women do not present with the same symptoms and are more likely to have them dismissed. ERs should be more cautious with them because they have proven they need to be.

By your logic then we shouldn't have health care for everyone because mass. has a big budget def. "some busy doctor"...I'm glad you bring up some busy doctor now, just you wait until the millions of others are added, same busy doctor, only now you gotta compete with countless more.

Chris and others-

All tort reform is not created equal. Defensive medicine definitely is a factor in me ordering tests or granting unnecessary referrals. And I am aware of frivolous lawsuits where I know nothing was done medically wrong, but the patient and lawyer were unhappy with the outcome, and so filed a lawsuit, hoping for compensation they think they deserve, rightly or wrongly.

People get sick, people have complications, people die. That's life. Not every bad outcome is a mistake. Not every mistake is malpractice. Lawyers benefit almost as much as the patient with their contingency fees, and the fact that loser doesn't pay, but win or lose the doctor still loses financially and emotionally (as well as the patients inconvenienced by the doc being sued having to take time away from the practice).

My malpractice bill for family practice works out to about $8 per outpatient seen in the office ($32K divided by 4000 patients per year). Insane!

Tort reform should not necessarily include caps on noneconomic damages - that is not the main point. Having a medical board of experts screen potential lawsuits prior to filing to see if the standard of care was deviated from would be most beneficial, with quick arbitration for settlements where obvious malpractice occurred (like operating on the wrong body part). Having lay people on a jury decide complicated cases where "experts" paid by both sides (neither of whom actually evaluated the patient) testify is a joke. Lawyers and lay people who criticize tort reform (that most doctors agree is necessary) is shortsighted. This is our industry, and we docs should have some say in the matter. And no, I am not suggesting tort reform will solve any more than a fraction of the high medical costs in this country - but it is definitely an important component that cannot be ignored.

Tontosh - exactly what I was going to say - not one Democrat will remember the constant request to consider tort reform as a means to rduce overall health care costs... Of course others will whine that ALL doctors are bad and need to be threatened to be sued in order to do a good job. Its always extreme arguments instead of careful consideration.

Tort Reform? A silver bullet? Those for it would be the first in an attoneys office if one of their loved ones died, or was crippled for life because of a "preventable mistake"! I'll be for a cap on malpractice when all those sealed settlements are open to public scrutiny! We still have interns treating people when they haven't slept in 36 hours! The reason behind large awards is to make it not profitable for those in healthcare to risk the patients lives in favor of profit! If the AMA spent their money on making sure hospitals and doctors were in keeping with the standards it sets itself, instead of on lobbying in Washington it would be better spent! Think about it! What's your husbands, wife's, or child's life worth? Or one, or a couple of your limbs? Or if you became a living vegetable because of a "preventable mistake"? They have tort reform in the military, you can't sue an incompetent doctor! A woman sergeant was to have one of her legs amputated, they amputated the "Wrong Leg"! You fools really think healthcare costs will go down with tort reform? There are 11,000,000 skilled jobs being held by illegal aliens. Do you really believe their employers have passed on their savings to the consumer, or put it in their pockets?

Chris-749391 & others- I've read what you've said about tort reform elsewhere. Thanks for the added info.

"Somewhere on the planet is the worlds worst doctor. What is scarrey is that someone is going to see them." Geo. Carlin

Hey William read the comment above yours. You are my prime example...

I say let the over testing begin!!!!!!! Better than being under tested- or NOT AT ALL!!!!! I think that the more info you have along w/ the more questions you ask your Dr., the better off you are.

what a friggin joke!!!!!!!!!!!!!!!!!!! they do more testing they make more money..........

This looks like another insurance company plant. The Physicians insurance assn represents insurers not doctors. Doctors are only liable if they do not follow established protocol.Insurance companies are reaping a fortune by overcharging on premiums. The average payout is under $25,000. Ask your doctor what he/she pays for protection.

What is tort reform? The reason I ask is this: My son passed out in early February, he was taken by ambulance to the ER. He was observed for 2 hours and sent home. He had right side weakness and could not stand on his own. The last thing he remembered was a sharp pain behind his eye before he passed out. We strongly questioned why he was being sent home with out a CT scan. We were told that they believed he had an epileptic seizure. However, no EEG was run and there was no family history. We were very concerned about his right side weakness and drooping face, but were sent home with anti seizure medicine. He seemed OK most of the night (except the right side), however, later in the evening he passed out again. He was taken by ambulance again to the ER and admitted to the epilepsy ward (against our wishes). We argued for another 6 hours before a scan was done on our unresponsive son. The result - you guessed it, a massive, multi clot stroke. 28 hours passed from his first visit to the hospital until the scan was finally done. The reason, it was a weekend and the CT/MRI staff are on call but not in the hospital and get overtime when they are called in.

My son will never fully recover, so please tell me again about all the wasteful tests and unwarrented lawsuits.

I'm gonna go ahead and call you out on this one. I don't buy the details of this story. Not for one second.

First of all, for a hospital not to have radiology techs (not radiologists) in house to perform a CT means it is a pretty small hospital. Pretty small hospitals certainly don't have a whole "epilepsy ward". Gimme a break, that small hospital may see one epilepsy patient every month and epilepsy patients generally don't get admitted to the hospital anyway. I also don't believe you had to argue for 6 hours with a physician to get a CT of the head done on an "unresponsive patient" either. It also would be quite rare for a ER physician to diagnose a patient with a seizure and send them home without a CT or MRI of the head, especially that patients first seizure.

I suspect this story is purely fabricated or severely embellished.

I suspect the same, jdmoore, since I literally just went through this with my son seven weeks ago - and what Lukeja describes is not even close to what happened.

The DNC sends out sob stories in emails, I know because I get them. They may or may not be true in the first place. Recipients are encouraged to re-tell the story, to emphasize the need for government run every-freaking-thing.

Like THAT's going to solve anything. Go to the post office, ffs.

I wish this was a fabricated story. The "ward" is 7900, the small hospital is United/Children's in St. Paul, MN (the largest is St. Paul). On weekend they do not have staff on site to run the MRI or CT machines. They are called in. They do have radiologist techs to run x-ray machines, that is it.

I am not calling for goverment take over, I am questioning the meaning of tort reform. You do not believe what happened to my son, and yet it happened.

Lukeja -

You would be compensated for a legitimate claim if tort reform occurred. The purpose of quality tort reform is to stop frivolous lawsuits, not condone malpractice where a new-onset seizure patient fails to have a CT scan ordered with obvious focal neurological signs. This is obvious malpractice. With tort reform, you likely would be compensated much quicker and with less insult to injury, and with less of the settlement going to the lawyer benefitting from your misfortune. The media and lay press often portray tort reform as letting doctors off the hook for injury sustained due to deviation from the standard of care, and nothing could be further from the truth.

medicine is an art and a science and the fact you think its simple shows how little you know about it; unlike working on a car, the human body is not a simple do your job correctly and it all works out right every time. You can work on the body and study it; but you can not explain what makes the heart beat? Some things in medicine remain a mystery. Expecting a doc to never make a mistake is absurd. Some errors deserve lawsuits but the fear of lawsuits should not dictate treatment decisions on every patient.

I certainly agree with you that mistakes will be made by doctors, as in any profession. However, If a doctor breaches the standard of care that all doctor's are held to and the patient is injured as a result, why is it so preposterous to hold the doctor accountable for his/her actions? Is it best to analyze and evaluate each case individually (and possibly in front of a jury), or is the best solution to completely immunize doctors from liability?

Tort reform would NOT remove the ability to sue in cases of negligence, nor would it immunize them from accountability. False straw man built out of extremes and it does NOT apply.

The fanatical insistence upon 'HOLDING PEOPLE ACCOUNTABLE makes the world suck and here's why:

You cannot, or will not, accept that sometimes there is no one to hold accountable and insist on going after people anyway. That there are situations in which a standard of care or a specific procedure was followed, and something bad STILL happened. Like the obese woman with high blood pressure in the article, for instance. All the bleeding hearts gave the family $1 million dollars because she had a heart attack - AFTER she wasn't having a heart attack, according to the ER tests.

Exactly how much time would have had to have passed between the ER saying she was NOT having a heart attack, and her having a heart attack, for you and apparently her family to NOT blame the ER doctor for NOT finding something that hadn't happened yet?

Medical degrees don't come with crystal balls, sorry about that.

Two words: Grow up. This is CENTRAL to why health care costs in this country are out of control.

Tort reform places a cap on damages. Medical malpractice litigation is extremely expensive, and costs about $30k just to get to the court room, and average 4.7 years in length. Most victims with a meritorious medical malpractice case cannot afford to hire a lawyer, and seek legal repair from lawyers who take cases on contingency basis.

These lawyers filter through the potential cases and make a business decision, a bet that the case is strong enough, and serious enough that it will pay off years down the line. Since lawyers typically are working 110%, only a very strong case with a big payout will get their attention. Medical malpractice caps in tort reform effectively prevents these lawyers from taking a bet in the victim's favor because they won't get much for their trouble. Tort reform would not affect doctors from being held accountable in a world where lawyers worked for free. In the real world, the purpose of tort reform is to protect bad doctors from being sued in the first place.

most of these tests are because the doctors are afraid of the lawsuits. ask any of them. most of the tests are unnecessary. i worked in health care fro 30+ years. sometimes a $7000 cat scan done daily on patients because famiolies demand to have all possible tests to save dying papa

"If they do their job correctly, they won't get sued. It's pretty simple"

If it's so simple then go to medical school and make the decisions yourself. You are extremely naive if you think doctors won't get sued for acting correctly. Nothing could be further from the truth. Doctors in this country get sued every day for bad outcomes, regardless of whether or not they did everything properly in trying to prevent the bad outcome. People want someone to blame and instead of blaming GOD they blame the doctor, because GOD won't pay them or their laywers anything. Humans are not machines...they are biologic organisms that don't always do what the textbooks say they're supposed to do. There is no such thing as 'perfect' or '100%' in medicine. One out of a thousand appendix operations will result in infection even though the procedure was done exactly the same in each one. People are quick to blame doctors because they think SOMEBODY must pay and doctors are 'rich.' Yes there are bad doctors out there but I'll wager anyone reading this that the percentage of bad ones is a hell of a lot less that the percentage in whatever field YOU work in.

See post 1.13.

Tort reform does NOT mean zero accountability. And all mistakes are not malpractice. Deviation from the standard of care that results in injury is malpractice. Many things in medicine are unclear, not "textbook." For example, did you know that a stomach ache can mean a heart attack (myocardial infarction)? So that means the doc has to decide which patients with stomach aches need the tests to rule out a cardiac problem, and which need CT scans to check for appendicitis or perforated stomach/duodenal ulcers.

And, we get sued all the time even if we do our job - most of my colleagues I have seen get sued were for frivolous illegitimate things. We docs can take responsibility for things that go wrong due to our poor judgement. But it absolutely kills us to get sued for B.S. reasons.

doctor jim59

"If they do their job correctly, they won't get sued. It's pretty simple"

If it's so simple then go to medical school and make the decisions yourself. You are extremely naive if you think doctors won't get sued for acting correctly. Nothing could be further from the truth. Doctors in this country get sued every day for bad outcomes, regardless of whether or not they did everything properly in trying to prevent the bad outcome. People want someone to blame and instead of blaming GOD they blame the doctor, because GOD won't pay them or their laywers anything. Humans are not machines...they are biologic organisms that don't always do what the textbooks say they're supposed to do. There is no such thing as 'perfect' or '100%' in medicine. One out of a thousand appendix operations will result in infection even though the procedure was done exactly the same in each one. People are quick to blame doctors because they think SOMEBODY must pay and doctors are 'rich.' Yes there are bad doctors out there but I'll wager anyone reading this that the percentage of bad ones is a hell of a lot less that the percentage in whatever field YOU work in.

O.K. doc. I read that only 5% of doctors are responsible for 95% of malpractice suits. If true the AMA is not doing a very good job, as state agencies that are supposed to monitor doctors have failed miserably. Also why don't malpractice carriers just increase the rates of those sued more often than other doctors? Like the auto insurance carriers do? No one in their right mind expects doctors to be God, even though many expect to be treated as one. How about unsealing all those medical malpractice settlements that were out of court? Would it show a pattern of preventable mistakes that others could use in court? If you can tell me how tort reform would reduce the number of "Preventable Mistakes" hospitals, and doctors have and are making. I'll jump on the bandwagon! By the way, many have said they'll go into another business if tort reform isn't passed. They can't be doing too badly to just start another career! I've checked out the physician parking sections in hospitals I've been to. Nice rides for financially strapped people! My doctor walks on water in my opinion. If he made a mistake and told me straight out, as I think he would. He'd have very little trouble from me. But if he lied to cover his backside as many do. And it took an attorney to get the truth from him in court. The last thing he would have to worry about is money!

Wow. You are grossly misinformed.

eab please explain why you think so?

I have been specifically told by a doctor that he won't prescribe a certain medicine because it has become "lawyer bait", (his term for it). This problem is universal.

Unless I am mistaken, we are the only country in the world that doesn't have "loser pays" as a policy. Since progressive socialists want us to be more like Europe, why not start with that?

I am PI attorney and often handle medical malpractice claims. First off, myself or any other lawyer have no effect whatsoever on treatment protocols. Those are set by the American Medical Association and other medical groups that have specialized knowledge in the particular field of medicine. Second, we “ambulance chasers” only file suits if a doctor deviates from a set protocol (also known as the standard of care) and some one is injured as a result. The truth is, the “lawsuit epidemic” that is constantly referred to is completely false and unfounded. In the state where I practice, over the last 15 years, a plaintiff bringing a medical malpractice lawsuit has been successful only 22.5% of the time. The cost of production for a Medical Malpractice suits is about $250,000 (almost always fronted by the attorney) and the average length in years is 5. The frivolous lawsuit agreement simply makes no sense. Why would a lawyer take a “junk” case that will take 3 to 7 years of his time, cost him/her hundreds of thousands of dollars, and only have less than ¼ chance of success?

Lawyers have become an easy target for animosity, but much of the blame for rising healthcare costs and doctor’s medical malpractice premium increases needs to be directed at the heath insurance industry. Who would stand to gain the most if patients were no longer able to bring a claim against a doctor/hospital?

I do agree with you though that term limits are needed.

EAB21 - you are full of sh**. Your profession has driven up insurance costs around the country to the point of driving doctors out of business or into corporation conglomerates, which limits competition and choice for medical services (more limited choice leads to increased costs). You have also driven up the need for doctors to perform unnecessary testing and procedures to safeguard themselves from liability, which ends up costing the consumer more money.

Let me ask you a few questions - if you answer yes to any of these and you or your firm still took the case, then you are actually a big part of the problem:

1) Did you ever exaggerate an injury or play it up for the courtroom?

2) Did you ever doubt the severity of injuries described or demonstrated by your client and still take the case?

3) Did you ever seek an amount for pain and suffering (damages above what would be required to fix the "injury") when the doctor's error didn't have serious and drastic impacts on the patient's quality of life?

4) Did you ever drive a doctor out of business who otherwise had a solid track record?

5) Have you ever thought to yourself that the damages your client received were unjustified and well above there earnings potential with or without the injury?

Like I said before, if you or your firm answered yes to any of these, in even one instance, then you are a major part of the problem and you need to accept responsibility for your contribution.

Lawyer never sue for testing to much, but if you send a heart attack patient home with out treatment and with out the test, you get sued. My Dr got sued for sending a patient with strep throat home with out treatment, the lab test was wrong, now he sends them to two labs, and start antibiotics until he get the lab results back. He was successful in defending the law suit, as he was following the standard practice, he has however change the standard of practice and the next DR. should be held liable for the same mistake. The child suffer severe brain damage.

Just a couple of thoughts. Do we need tort reform? Yes, but it is hardly the panacea that so many believe it is. Do lawyers set the standard of care? To some degree, yes. The medical profession is responding to legal issues in part when they set those standards.

Is the medical profession at fault? Yes, and in several ways. First, they are human and make mistakes. Some - amputating the wrong limb, for instance - are indefensible. Other medical problems/mistakes, as "girl terminated" points out, require years of training and experience simply to recognize much less treat.

However, to me, it seems the real problem tracks to the "success" of the A.M.A.'s PR machine. We have come to believe that the medical profession can cure all things. We have come to believe that they are gods, that they don't make mistakes. When they do, we are shocked.

Docs put their pants on just like the rest of us. They make mistakes. It is rather silly for us to expect perfection from human beings, don't you think?

While there are some minimal indefensible claims, there are also a lot of bogus claims that ambulance chasers help to bring to court for a quick buck.

I also agree that there should be some acceptable error level factored in, since everyone makes mistakes. Your doctor is there to help you, but he isn't perfect and isn't a miracle worker.

Finally, I find it incredible that people are allowed to sue for non-required procedures (e.g. unnecessary plastic and cosmetic surgery).

EAB forgot to mention a few things:

1) 27 states have already implemented medical malpractice reform. In those states medical malpractice rates are higher and rising faster than in the states without "tort reform"

2) It is the medical malpractice industry that has spend any, many millions of lobby dollars on tort reform. It is they who benefit.

3) Tort reform is irrelevant in the vast majority of medical malpractice cases because they are settled. The reason they are settled is that settlement results in an agreement with the injured party that he will not seek further civil, criminal, or disciplinary charges against the offender. This keeps a physician who has maimed or killed someone from losing his license.

4) Medical malpractice is the fifth leading cause of death in this country. It is not even in the top ten in any other country. This country may be Number 37 in health care delivery, but is #1 in medical malpractice.

5) There has never been any academic peer-reviewed study that has shown that "tort reform" lowers malpractice insurance rates, encourages physicians to move to a tort reform state, or any of the other claims are true. All studies, mostly by PhD health economists, say just the opposite --- tort reform has no beneficial effect and a small negative effect. There have been a number of studies recently that say that physicians, pharmacists and others who make errors can avoid as much as 80% of all malpractice suits by quickly admitting their error and taking responsibility, apologizing and telling the victim or family how badly they feel and what they are doing to prevent this error in the future, and offering restitution. Unfortunately, though the data is solid, this has not been easy to sell to medical professionals.

Tort reform is not as easy a fix as it sounds, but medical malpractice rates are something that can be fairly easily approved. I'll give you one good example. A few years back NIH funded a R01 proposal to study the use of checklists (such as the ones pilots are required to use) in surgery. The AMA, JCAH and a number of other groups came out against even doing the study, saying that it interfered with physicians' "rights." So the study was conducted in hospitals in The Netherlands and Spain, where surgical error rates are less than 1/10th of here. But even in these countries showed remarkable reductions in error rates, along with identification of numerous areas that could harbor potential errors. No hospital in the U.S. has ever even considered the use of checklists. In France, Britain, and Canada the use of checklists was validated with confirmatory studies and are in the process of being implemented nationwide. I don't know about other countries --- the EU tends to move together on this sort of thing, however. So in Europe and Canada, you have a refining of best practices and here physicians have malpractice insurance.

So if there is a victim whose injury or death was preventable through the use of documented best practices, and those procedures were ignored or even worse, willfully disallowed, then I have no problem with a victim or their family suing a malpracticing health professional. I would like to see some tort reform:

a) Ban all settlement conditions that preclude further civil, criminal, or disciplinary actions. Many more malpractitioners should be deprived of licensure or sent to prison in addition to bearing some joint liability with their insurance company.

b) Limit the insurance company's liability to 90% of the award. This would cause the medical professional to have some "skin" in the game.

c) Give judges in both settlements and verdicts the ability to refer the physician to criminal or disciplinary action as an additional judgment. This would let judges push appropriate offenders directly into the proper channel.

@ Chris-749391:

1) like I've posted above, payout caps are not equal to proper "tort reform". Proper tort reform would do both quicker compensation of those injured, and provide feedback or legal action to systems and individual practitioners outside of the court system.

2) "No hospital in the U.S. has ever even considered the use of checklists." For what it's worth, checklists are more common in the US than you think - I've been using one in the OR for years.

3) not all malpractice occurs at an individual level - what if a computer outage delayed the transmission of an important diagnosis, for example - yet we insist on punishing individuals for malpractice. Who do we punish in this example - the doctor who was not informed of the diagnosis and released the patient who wanted to go home? The IT specialist for the hospital, but who wasn't responsible for the failure? The computer manufacturer?

4) increasing "practitioner skin" in the risk pool will only increase the over-testing done by practitioners. If you're at-risk, you'll work even harder to be sure you're not missing something, which includes over-testing. Because humans aren't ever "100% like the textbook", you will wind up testing/treating for that 1% who aren't.

5) (@ EAB21) please, don't tell me lawyers aren't a part of designing medical care (however indirectly). The principle behind malpractice is "standard of care". There is no specific national standard for care beyond what "expert opinion" of the locality would render. And often enough, that "expert opinion" would recommend additional testing to be sure they'd be safe in the case of being wrong (and exposed to a lawsuit).

An example is the treatment of acute appendicitis prior to CT scanning. The original treatment paradigm in the 1950's was that you had to have a "negative appendectomy rate" of about 15% to be sure you're treating appendicitis early enough to avoid complications. That means being wrong 15% of the time on a clinical basis in order to avoid missing a more complicated and deadly perforated appendicitis in the other 85%.

Now, in the world of CT scanning which can improve accuracy to closer to 95-99% - who would not want a CT scan to be sure before you get what might be an unneccessary operation in that 15%? Hence it's now "standard of care" in some doctor's minds to get a CT scan in cases with abdominal pain, whether or not it's indicated by "clinical criteria", and without regard to the potential radiation risk to the patient.

Another example is the use of anti-inflammatory steroids in spinal-injury patients. The thought is that steroids might save some function from the injury - and therefore, the practice had spread to everyone who had a spinal cord injury. This despite the fact that the study that created this data was flawed to begin with, and wasn't meant to apply to everyone.

So for decades, we've given steroids to those who had spinal cord injuries because it was "standard of care" - and along the way exposed patients to the very real side effects (most notably severe infections) that the steroids brought with them - all for a quite controversial benefit for a rare few. This was so ingrained, that more recent data that suggested steroids didn't help came from Canada, and not the US - just because noone would do the study in the US for fear of lawsuit.

And yes, that's all driven by lawsuits - I mean, a typical Personal Injury attorney's claim is that they make the world safer by forcing companies to make safer products by the use of lawsuits. To think they don't want to work that way with the delivery of Medical care is facetious at best.

6) and one last question, Chris - are you advocating banning settlements altogether? What if the settlement was done "because it's cheaper than litigation"? Pay $50k now, to avoid spending $250k (per EAB21's estimates) over the next few years, yet admit no fault (even if none exists). Would you still recommend providers be prosecuted in criminal court for any case that might be settled, even ones with a finding of no-fault by the individual? Plus, unless you are not aware, with any settlement, there is no presiding judge. The point is to avoid the courtroom altogether. And settlements still currently go on a provider's permanent record.

eab i'll tell you why a lawyer takes a junk case......... because even if the lawsuit is baseless .........most docs will settle it, just to make it go away ;even though they did nothing wrong, it is such a worry that they'll pay money..."ie a lawyer sopranos shake down if you will" so they can get some sleep

Chris, that looks like one of those chain letters full of made up data that will end up on snopes soon.

Several of your facts are disproved after just looking up the CBO report on TORT reform. It took like 5 seconds to google it. http://www.cbo.gov/doc.cfm?index=5549&type=0&sequence=2

1) I don't see 27 states in there. I see way more than that. Made up #?
2) TORT Reform at a national level is different than multiple states doing it multiple different ways. It varies from state to state and does not mention all of the states have higher premiums.
3) They're settled because the clients agree to sign the settlement. That has nothing to do with TORT reform. It's greed. If it was really negligence and some Dr willfully did something horrible to a family member, they wouldn't rest until he was behind bars or no longer had a license. The fact that they take the $$ and drop the case says otherwise.
4) US #1 in medical malpractice. This is the first one I found to be correct. However, if you look it up, it's #1 in the number of people who sue doctors. Only 27% win and 83% of ALL of the lawsuits are in only 70 counties. It just so happens to be in areas with the most concentration of wealth as well. This deserves investigation and possible legislation (tort reform).
5) The fact that it varies from state to state means plaintiffs can choose their venue in which to place the lawsuit. They're choosing venues in states that do not have TORT reform and that should tell you something. It's in the CBO report listed above.

EAB21 - You must be one of the most ethical, wise, and perfect lawyers out there to have never filed a frivolous lawsuit. I see it all the time (family practice doc). I will never claim that tort reform is the solution to rising health care costs, but defensive medicine is definitely a component. See post 1.13. Whether malpractice occurred or not, the doctor ALWAYS loses.

Chris -

I've seen you erroneously claim in multiple posts over the past year that malpractice is the 5th leading cause of death in this country. Presumably, the basis for your claim is the 1999 IOM report that claims 98,000 deaths in the U.S. are caused by medical errors (or about 20 deaths per hospital per year). This and other "studies" have horrible flaws in methodology. And, errors are not the same as malpractice. I'm confident that the hospitals I've been on staff at have had nowhere near 20 deaths per year due to malpractice. People get sick, people die whether mistakes are made or not.

And, every hospital I've ever worked at does indeed have "checklists." On what basis do you claim otherwise? And even with "checklists," they amount to "cookbook medicine" which is hardly infallible in preventing patient injury due to deviation from standard of care (malpractice).

Less than 5% of health care money goes to insurance companies. You're premise is wrong.

I think your 5% figure is garbage. How many American families pay at least $12,000 a year in health insurance (while still paying a high deductible AND copay)? Most of these aren't having major medical issues annually, or every two years or even within five year spans. Most Americans see the vast majority of their health related money going to the Insurance companies and not to health care professionals or facilities.

Valhalla and TJ

"Of each dollar spent on health care in the United States 31% goes to hospital care, 21% goes to physician services, 10% to pharmaceuticals, 8% to nursing homes, 7% to administrative costs, and 23% to all other categories (diagnostic laboratory services, pharmacies, medical device manufacturers, etc."

This changes a bit if you remove Medicaid and Medicare from the picture because their administrative overhead is under 3.5%. My guess would be that about 15% or so goes to overhead in the private sector, and most of that would go to insurance companies since they ARE the administrative overhead in most cases.

I agree completely. They need a cap on torts and need to start penalizing law firms (not clients) that bring frivolous suits.

Lawyers getting sued? I like that.

I am always amazed by those who say the courts are clogged, but who advocate more lawsuits. Simply sub moronic!

What we need is real tort reform that is designed to address the needs of aggrieved patients, in an efficient manner. I attended Chicago-Kent College of Law (IIT) and we had a robust alternative dispute resolution program. If we were serious, we would convene panels comprised of doctors, lawyers, actuaries and experts in the fields of rehab and recovery and analyze claims for viability. If the claims are viable, the panel can then move the question of just how much it will cost to address the needs of the patient and make her whole, from a physical standpoint, and how to address the issue of non pecuniary (pain and suffering)damages from a formulaic perspective.

If we did this, litigation cost would plummet, patients who have been injured would be fairly compensated, doctors would be freer to practice medicine in a more efficient manner and insurance companies would have more certainty with respect to the amount of money they can be expected to pay out in claims.

Having said that, and knowing something about the tactics that insurance companies use to screw their health insurance customers, does anyone here think that the insurance companies are not gouging their medical malpractice insurance customers? When the stock market fell after the tech stock bubble burst, medical malpractice insurance premiums escalated. There was no event in the medical community that could justify the increase, but premiums went up. This was because the insurance companies need to replace that revenue, and the docs had the deep pockets, so they screwed them. The docs raised their fees to compensate, and health insurance companies raised their premiums.

That's how it works folks. One other thing that may help is legal insurance. Legal fees could be cut significantly if we had a viable legal insurance program in this country. Unfortunately, that is not all that marketable right now because most regualr people do not need legal services regularly enough to justify paying $50 a month to ensure they have representation.

The bigger picture is, why wasn't this story published BEFORE the health care bill was passed??

Oh that's right, the media is in the pocket of the progressives so they wait to post anything that would stop the bill until it's too late.

Now, too late, they can claim that they are "doing their job". Yea, right.

You are another one that doesn't have a @!$%#ing clue what you are talking about!!

Bernie-548913
You are another one that doesn't have a @!$%#ing clue what you are talking about!!

http://www.cbo.gov/doc.cfm?index=5549&type=0&sequence=2

Arguments For and Against Federal Tort Reform

Many legal scholars agree that tort liability has expanded over the past 30 years; the opportunity for victim compensation has increased, particularly in the area of product liability.

Since the mid-1980s, a large majority of states have enacted statutes to restrict tort lawsuits

I can tell you're a liberal Democrat by the way you argue. Name calling those who state facts without even bothering to look up whether or not it's true. You really shouldn't be going around telling people they don't have a clue in public venues if you're not going to clue your own self in.

I agree with you on that. If my parents would have taken me to the hospital every time I fell down or got bumps on my head I'd have spent 1/2 my childhood in them. I remember stepping on a nail that went in my foot about a quarter inch. I got sat down, foot put in hot water and epsom salt, and told to watch where I was walking. I haven't had any problems from that but if it happended in today's society, I'd have been taken to the ER, had my foot X-rayed, CT scans, and probably half a dozen blood tests before getting a shot of penicillen (if I needed one) and sent home to soak my foot in epsom salt. Parents today are way too overprotective and forget what happened to them as a child while playing.

Imagine the money saved if people knew about/utilized Urgent Care Centers. Maybe they should be next to every hospital ER, also, thus saving the ERs for TRUE emergencies.

vik2112: you don't have a @!$%#ing clue what you are talking about..

I think I do weekend @ bernie's. You must be a lawyer.

Bernie-548913

vik2112: you don't have a @!$%#ing clue what you are talking about..

You make the Democrats look more and more uninformed every time you post...*facepalm*. John Edwards was against TORT reform and made his living suing the crap out of Doctors before he went into politics. I believe the term used was "hot tub lawyer".

This is not only the fault of the DEMOCRATS....the REPUBLICANS were in charge for 6 years and did not change a thing. Tort reform did not happen under the republicans either. This is not a "party" problem, it is a political problem. All of them get too much money from outside interests, essentially "buying" their support.

Well Bighorn, I sure hope you're healthy, cause if you ever get sick and need a doctor you're F*CKED. I guess you'll have to ask the hospital janitor to diagnose your problem.

BIghorn's analogy is pretty accurate. There is being thorough and then there's being excessive. You have to be a careful patient and ask why a test is being performed and if it's necessary, and what will it cost. Since I have high deductible insurance, I'm paying the first few thousand dollars out of my own pocket. I will no longer allow a bunch of tests. I ask doctors for treatment to be handled in layers. I make sure we try the simplest and cheapest treatment first and see how it goes before trying something else. Before, it would be take this medicine, go have an x-ray, then go get some physical therapy. Now, I'll say - give me the prescription and make sure it's not one of those $100 ones either. I want something generic and proven. Usually that takes care of the problem and I don't proceed to the other treatments.

It's unfortunate that our healthcare system, for numerous reasons, causes any reasonable person (who has already paid thousands to insurance and thousands more to medical expenses) to force doctors to answer financial questions about treatment, and factor that in to the decisions.

As an example, I have one daughter with a health condition, who has been doing great on a generic med taken twice a day, that costs $4 a month at Target. During her last visit, the doctor thought it may be time to switch to a different med - but she'd need lab work first to make sure her kidneys were in good condition. And while taking the new meds, she'd have to be tested every 4 months or so to make sure no kidney damage was occurring. She drew the blood, and sent us home to decide if we wanted to make the switch, if labs came back ok. The labs came back find. The cost - $700! So, I can choose to keep her on a $4 a month RX that seems to be working, or switch and incur lab costs of $700 every 4 months. Hello? I only wish I'd asked what the lab work was going to cost up front.

Bighorn...that was the dumbest analogy I have ever heard. If you drive off without the new muffler and somehow wreck on the way back to your cave, you can't sue the mechanic for millions you bonehead.

Well, I'm glad your on-line reading and the fingers crossed approach work out for you and your daughter vs. that doctor with years of Med school and internship training Renee. I bet you don't ask the guy fixing your dryer if he knows what the hell he is doing because what, he had a 2 year apprenticeship at the local appliance store. Good luck.

Jon Jones - I would ask the guy fixing my dryer if he knew what he was doing! When you hire a professional, be it a mechanic or a doctor, you have to inform yourself and question "fixes" that are costly or seem out of line. Of course there are honest mechanics and honest doctors. But in the end, it's the consumer who pays and lives with the decisions. Whenever you are paying for services that involve knowledge and technology you know nothing about, you are at a disadvantage because you don't know if what they are telling you is true.

I like the doctor my daughter is seeing. I don't question her motives. But, she is not looking at the situation from a practical and realistic patient standpoint. For the uninsured and for people like me with high deductible insurance, unfortunately, cost has to be factored in to medical decisions. And for this daughter, she has a "condition-specific" deductible of $4000 which I have to pay out of pocket, before I meet the regular deductible of $2500, and then, insurance will pay 80%. That's the sad reality.

Well oh oh, start off by turning around in the parking lot of the hospital you went to first and drive to the next one down the road. Solve your problem right there.

Although I am buying pet insurance soon...

Any advice?

Vets don't get sued? Sure they do.

I would go to a veterinarian for treatment before I'd call a human doctor! Most vets are much more humane!

Vets get sued, but much more rarely. Malpractice insurance is only a fraction of what a human doctor's is. Let's hope it stays that way. It's better for doctors, better for patients, better for owner's pocketbooks.

I'm also a veterinarian and specialize in a specific area. As such, I deal with some pretty complicated cases and also review complaints filed against veterinarians. Complaints are lodged for the most ridiculous, petty reasons you can imagine. And the system drags even the most frivolous situations out as long as possible. In the only circumstance in which I was sued, I was advised to just settle because it would be easier. I refused to because the whole thing was just ridiculous. It was settled in my favor but only after a lot of time and money. No one in any area of medicine is immune.

As a college student I worked for a very good human orthopedic surgeon and he was routinely threatened with lawsuits before any sort of procedure was even performed! People seem to think they can ward off a bad outcome with threats of "or else...". No wonder MDs feel the need to cover their a**ses with a lot of testing and documentation.

Hey what do you do? I think your overpaid too... get my point? I love when people say other people are overpaid because it shows their ignorance. Who are you to say that anyone is overpaid? These people went to school for many years. Put in alot of blood and sweat to earn their degrees. Are plumbers overpaid? How about electricians or air conditioning maintainance? They on average make more than I do as a veterinarian.

I do agree with you on suing lawyers for malparactice. Remember this, lawyers would not be there if there wasn't someone looking to sue. Everyone hates lawyers until they need one. Then its "get the dirtiest, fiercest one."

DrX is a typical American who has succumbed to the propaganda disseminated by the AMA. The truth about lawsuits is that the court rooms are filled is because corporations fill them. Anyone who follows these matters knows that most legal maneuvering done in courtrooms is being done at the behest of the corporations.

Secondly, as much as I hat to say it, doctors are not overpaid. They do make a lot of money, especially neurosurgeons, interventional cardiologists, cardiac surgeons and other higher risk specialists. I work with trauma surgeons and interventional cardiologists, and they work their butts off to save peoples lives. They are at the hospital by 5 am many times. I go up a 3am to take an x-ray and an attending neurosurgeon is there too. They have very stressful lives. Mind you, it is very difficult for me to say these things, being a law school graduate studying for the bar, but it is true.

Sometimes, I hate doctors because they are arrogant, childish, pompous, dishonest, bullies who were the brunt of jokes as children who now get off on making the world pay by being total douches to the nurses, therapists, technologists and support staff that help them care for their patients, but they are not overpaid. Having said that, are there Drs who are only in for the money, of course. Just as there are nurses, therapists, technologists and other support specialists who are in it for the money. Even if they are in it for the money, only the nominal few make decisions in any manner that deviates from their motto, "Do no harm!" Mind you again, I speak as a person who is studying for the bar because I am sick to death of working with doctors, and nurses to for that matter.

Look, if you ask the mots(man on the street) if professional athletes are overpaid, they will say of course. If ask the mots if doctors are overpaid, most will say yes. If you ask the mots if lawyer are overpaid, most will say yes, and that they suck. If you ask the mots if they are overpaid, they will say hell no! I deserve more! So will the athletes, doctors and surprisingly, so will lawyers. Who cares what these people think. If they could do what lawyers and doctors do, and make that money, and more importantly, make the type of difference in people's lives they would. They're haters; period.

I had an opportunity to go to med school of law school. I chose to go to lawschool BECAUSE the mots hate them. If the mots hat lawyers, they must be doing something right because the mots are a terrible judge of character. Don't think so, look at the people they elect.

I'm lookig forward to getting into the Biz this winter and being despised!

PS,

Yes I know most elected officials are lawyers, but the MBA's are catching up and out cheating the lawyers by a long shot.

ckaybee: I worked with a team of doctors who were all teaching professors for about 2 years. The phenomenon that was taking place was the number of med students dropping of medical school to go to law school. While law is much more competitive, it certainly pays more for those who are willing to pay the price of giving up their lives with 70-80 hour weeks to practice.

I also know quite a few attorneys who married their secretaries, probably because they never met anyone else. They never leave the office!

Who should pay the cost of those tests? I know that's not a popular question but the money to cover all these tests has to come from somewhere. Why were you visiting an ER for a year? Did you see a different doctor every time? Did they have your history or just your word on what occurred at the previous visits?

You are ignoring the central question; Are ER's overtesting? In my opinion they aren't even close to testing enough.

Who paid for the tests is NOT at issue (but FYI in my case the tests were %100 paid for by me and my insurance). The need for the right tests at the right time IS the issue.

Not-part-of-the-issue-question 2), I was visiting the ER for a year because the right tests were not given at the right time. They could've diagnosed me with an ultrasound on my first visit to the ER.

Not-part-of-the-issue-question 3) Every single doctor who I presented to should've had the sense to have me screened right away in both cases.

Not-part-of-the-issue-question 4) Yes they had my history each and every time.

Can we now get back to whether testing is a good idea or not?

The need for the right tests at the right time IS the issue.

If your problem was ongoing for a year then by definition it was not an emergency and should not have been handled in an emergency room. From what you've described it sounds like it was nothing more that a way to circumvent the referral process to see specialist who would have been better qualified to make a request for those tests.

As for over testing, my guess is the zip code of the ER probably goes a lot further as to how much over testing is actually done.

You are not a medical professional, that much is quite clear. You aren't getting the point either. It is absolute luck that I didn't die. Patients who present in persistent severe abdominal pain should ALWAYS be screened/tested immediately. Gall stones can be very serious and fatal if not treated. A ruptured appendix is always fatal if untreated. You aren't thinking through this clearly if you expect Gall stones and appendicitis to only happen on weekdays during office hours and ONLY when the person's family physician is readily available (or the specialist who takes a month to get an appointment with and then another two weeks to get the testing scheduled and analyzed). As a matter of fact many family physicians have a strict policy of sending patients to the ER for persistent and severe abdominal pain due to the immediate need to treat problems like gall stones and appendicitis. Family practices also don't have the proper equipment to diagnose these things.

As for the ridiculous zip code theory; The zip code of the ER I went to is in a major city and is the most 'respected' one in that city.

Why do you have such a problem admitting that hospitals, ER's and Doctors are all fallible, and more to the point, a lack of information is dangerous?

I am a medical professional, and if your problem was on-going for a year, it was not emergent. If, after your first visit to the ER, you continued to experience problems, you should have followed up with a specialist.

Referral and follow-up information is given to every discharged patient in our ER. The fact that you kept following up with the ER rather than a specialist or your PHCP is evidence that you were the irresponsible one. Ultimately you are responsible for your own health. The ER doctor didn't give you a satisfactory answer? See your PHCP or a specialist. Think you're still experiencing an emergent condition? Try another ER. Everyone is entitled to a second (or third) opinion.

You clearly need to be educated about what an ER is for and what an ER does. An ER is not a follow-up clinic. Next time, go see a specialist. And, if after a year you still weren't dead, your condition was not emergent.

You make a lot of ignorant assumptions about me, what transpired with my medical history, what my doctors advised, what the ER told me to do, and what I do and don't know about ER's. Here's my assumption about you; You're possibly an administrator, an insurance shill, a lab tech, or a urine specimen collector but you certainly aren't a doctor, a nurse, or radiologist.

if after a year you still weren't dead, your condition was not emergent.

A medical professional who says appendicitis isn't emergent? or Gall stones? Know how long it takes a ruptured appendix to kill most people? Obviously you don't. According to your amazingly ridiculous logic, people who have heart attacks and strokes shouldn't bother going to an ER since it is sometimes survivable. They must not be emergent then to you. Thank God you aren't a doctor.

AGAIN, rather than attacking what you don't and never will know about my medical history, the point needing discussion here is whether ER's test enough and appropriately.

jmm - oh yeah I can see that to you everything in the world is Obama's fault. Health care, lawyers, deformed carrots, the weather, and oh just everything! No, to you Bush never screwed anything up did he? That's why you weren't foaming at the mouth back then were you?

and as for sneaking the word 'spade' into an Obama comment, you might think that's clever but to many it might be a neon sign for racist pig.

I was late to work this morning...... Obama's fault!!!!!

Hmm...... seems the tables have turned on you liberal lemmings! Remember when you all cackled about everything being George Bushs' fault? The only difference is that the mainstream media had coddled the annointed one so much that he was rarely blamed for anything. Now that even the liberal press has seen that the man is nothing more the an empty suit they finally cannot avoid calling him on the carpet anymore; to do so would make them look even more biased then they already are.

Damn right it's Obama's fault! If we just demagouge that point enough all of the Democrats's consituents (i.e. the undeducated) will start believing it!

Nibor,

Hospitals and doctors win 95% of their trials. The money is in corporate law. Big corporate law firms make millions because corporations litigate, sometimes knowing that it is not probable that they will win, and they have deep pockets. If an insurance knows that a physician has committed malpractice, they will usually settle by providing insurance for an aggrieved party that will care for them long term if necessary. They also set up annuities that pay a sum of money to a plaintiff every month and will draw interest that will continue to pay the monthly stipend, thus saving them money. Secondly, lawyers are paid on contingency in many med mal cases and fees are negotiated with the insurance companies during the settlement.

Corporate firms charge by the hour and corporations will pay. They will litigate hoping a key witness or plaintiff will die, some expert will be discredited or the law will change (if there is an issue before the appeals court). Don't get me wrong, med mal is very profitable, but if you want to get paid, get the corporate law firm money. Big time bankruptcy is the bomb. Even when the company goes under, the lawyers still get paid. Anti trust is HUGE; intellectual property is HUGE as well.

Peace

Of course it's a drop in the bucket, many of the individual line items Obama and the Democrats WON'T do are "drops in the bucket". However, when you have enough of them, you start to have a fairly full bucket.

Why WOULDN'T you do them?

Because are not ideologically in sync with the government tit-sucking this administration wants to encourage, or they piss off a key campaign contributor - like tort reform.

There is no reason not to do it.

My only point is that it's not that big of a deal, relatively speaking, and it will very possiby not reduce the cost of insurance one bit.

Other than that, it's great.

The $54 Billion did not consider savings from reducing defensive medicine costs, it only took in to account reduced liability insurance premiums and reduced legal awards. Two government agencies estimated defensive medicine costs at $200 billion per year ($2 trillion in 10 years). If tort reform would have reduced defensive medicine costs by 50%, health reform would have been paid for without reducing Medicare or increasing taxes. Of course that sounds too much like making sense.

Obama sucked his own d*** along with all you followers when he claimed that the HC bill would save us 120B, is that soooo much more than 54B?

That $120 billion is already gone, by the way, and then some and we're into deficit spending before the GD thing even goes into effect for the most part.

Doctor fix, not included in the law that passed = $250-$300 billion over 10 years. Their dealing with it piece-meal, google it if you have to. The Dems tried to attach it to a jobs bill most recently, and REFUSE to pay for it by cutting something else - like the nearly $400 billion left in the stimulus package their using as a slush fund to get themselves relected via road building.

Administrative costs, not included in the law that passed = $115 billion (so far).

Not to mention accross the board increases to insurance rates for people already insured of at least the same as last year, and more in most cases.

Not to mention the 9% increase in costs for medicine that pharma took, while STILL being protected from importation of medicine.

Yea, that law is going to destroy this country - unless it's already destroyed before it even kicks in in 2014.