Systemic Misunderstanding: Public Citizen versus The Doctor's Company*
In a September 23, 2002 publication, Public Citizen, a "national, non-profit public interest organization", proposed that the real problem is not medical malpractice lawsuits. Instead, Public Citizen believes that improving oversight of physicians and stopping repeat offender doctors are the keys to cutting medical malpractice costs. (http://www.citizen.org/congress/civjus/medmal/articles.cfm?ID=8308).
In its July, 2003 press release, it used 2002 federal National Practitioner Data Bank (NPDB) records to dispute the presence of a malpractice lawsuit "crisis" in Rhode Island (http://www.citizen.org/documents/RI_NPDB.pdf).
On April 14, 2004, Public Citizen released its annual ranking of serious disciplinary actions in 2003 by state medical boards (http://www.citizen.org/publications/release.cfm?ID=7308).
Based on data from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2003 against doctors, Public Citizen’s Health Research Group has calculated the rate of serious disciplinary actions, including license revocations, surrenders, suspensions and probation/restrictions per 1,000 doctors, in each state and compiled a national report ranking state boards by the rate of serious disciplinary actions per 1,000 doctors for the year. Physicians are typically disciplined for negligence, incompetence, sexual misconduct, and breaking criminal laws.
There were 2,992 serious disciplinary actions taken by state medical boards in 2003 (3.55 actions per 1,000 physicians), up 4.5% from the 2,864 serious actions taken in 2002 (3.56 actions per 1,000 physicians). State rates ranged from a low of 1.46 serious actions per 1,000 physicians in Rhode Island, which was ranked 51st of all states and the District of Columbia, to 11.58 actions per 1,000 physicians in Kentucky, a 7.9-fold difference between the best and worst states.
* A systemic misunderstanding arises when your framework and the other person’s framework are so fundamentally different that it cannot be corrected by providing more information.” (Thomas Friedman NY Times 1/28/00 Page A28)
DEFENDING THE PRACTICE OF MEDICINE:
According to Richard E. Anderson, MD, Chairman of The Doctor's Company, a leading medical malpractice insurer based in Napa, California: "There is little doubt about the following facts: Physicians across the United States have been confronted with alarming increases in the cost of malpractice insurance, and access to critical medical services imperiled in many states." Mutual or reciprocal insurance companies, like The Doctor's Company, are owned by the physician policyholders themselves, not outside shareholders and dominate the national market, currently insuring more than 60% of America's practicing physicians.
His commentary in an article entitled: "Defending the Practice of Medicine:" reviews the extent of the malpractice insurance dilemma as it exists today, compares it with historical antecedents, analyzes the root causes and suggests practical solutions that are available now. (Archives of Internal Medicine Vol. 164, June 14, 2004 1173-1178: http://www.archinternmed.com). AMA Members and subscribers to the Journal have online access to the article. Others can purchase and print it online for $12.
Main sections in the article include:
(1) The Crisis Today: Loss of Capacity
(2) Earlier Crises
(3) Unique Aspects of Today's Malpractice Arena (Frequency, Severity, The HMPS and IOM Reports)
(4) Allegations of the Plaintiff's Bar (Flat claims losses, Making up for stock market losses)
(5) Solutions
(6) Costs
(7) Conclusions
Dr. Anderson notes the 4 principal provisions of the Medical Injury Compensation Reform Act (MICRA) which was passed by a special session of the California legislature in 1975. These are:
(1) A $250,000 limit on noneconomic damages that limits only payments for pain and suffering, not actual damages.
(2) Periodic payment of awards in excess of $50,000 (damages are paid over the period they are intended to cover rather than as a lump sum).
(3) Collateral source rule (prevents duplicate collection of damages already paid by a third party).
(4) A sliding scale limitation which controls the size of on attorney contingency fees (For example, for a $1 million jury award, an attorney is limited to $221,000 plus expenses)
He concludes that "There are 27 years of evidence that the MICRA statutes can contribute significantly to a solution for the current crisis by facilitating sustainable insurance markets while still providing full indemnification for injured patients."
According to Gerald B. Hickson, MD, director of the Center for Patient and Professional Advocacy at Vanderbilt University in Nashville, Tennessee (http://www.mc.vanderbilt.edu/cppa), the current tort-based system is slow to act, expensive to operate, unpredictable in outcome—and it fails the vast majority of patients injured by poor medical care. (Internal Medicine News March 15, 2004).
“Empirical studies reveal that although adverse events due to medical negligence are common, errors appear to play only a limited role in decisions to sue. Perhaps 1% to 6% of hospitalized patients are injured due to care. Yet only 2% of families with valid claims ever sue. On the other hand, up to seven times as many families with adverse outcomes that are not due to negligence file suit as well. Stated another way, 80% of claims may not be valid.
Studies have also shown that neither patient characteristics nor complexity of care explains suit variation. Not even technical competence discriminates physicians who have never been sued from those in the highest risk group. But the existing court system is neither sensitive nor specific in awarding compensation of which only about 28% is received by the injured individual.
Examination of physician claims experiences reveal that most physicians are never sued or experience only a “random hit.” On the other hand, in any target period, a minority of 2% to 8% of physicians, by discipline, generate a disproportionate share of suits accounting for 70% to 80% of all dollars paid in settlements and awards. Researchers have also found that physicians who are in the ’high risk” group today remain there for years. Physicians who attract a disproportionate share of claims do not seem to relate well to their patients. Poor rapport between physician and patient appears to drive many decisions to sue. Families report that they perceive the doctors they sue as being unresponsive and uncaring. An adverse outcome, the declarations of subsequently treating professionals, and poor relationships—not negligence---appear to drive most decisions to file suit.”
In its July, 2003 press release, it used 2002 federal National Practitioner Data Bank (NPDB) records to dispute the presence of a malpractice lawsuit "crisis" in Rhode Island (http://www.citizen.org/documents/RI_NPDB.pdf).
On April 14, 2004, Public Citizen released its annual ranking of serious disciplinary actions in 2003 by state medical boards (http://www.citizen.org/publications/release.cfm?ID=7308).
Based on data from the Federation of State Medical Boards (FSMB) on the number of disciplinary actions taken in 2003 against doctors, Public Citizen’s Health Research Group has calculated the rate of serious disciplinary actions, including license revocations, surrenders, suspensions and probation/restrictions per 1,000 doctors, in each state and compiled a national report ranking state boards by the rate of serious disciplinary actions per 1,000 doctors for the year. Physicians are typically disciplined for negligence, incompetence, sexual misconduct, and breaking criminal laws.
There were 2,992 serious disciplinary actions taken by state medical boards in 2003 (3.55 actions per 1,000 physicians), up 4.5% from the 2,864 serious actions taken in 2002 (3.56 actions per 1,000 physicians). State rates ranged from a low of 1.46 serious actions per 1,000 physicians in Rhode Island, which was ranked 51st of all states and the District of Columbia, to 11.58 actions per 1,000 physicians in Kentucky, a 7.9-fold difference between the best and worst states.
* A systemic misunderstanding arises when your framework and the other person’s framework are so fundamentally different that it cannot be corrected by providing more information.” (Thomas Friedman NY Times 1/28/00 Page A28)
DEFENDING THE PRACTICE OF MEDICINE:
According to Richard E. Anderson, MD, Chairman of The Doctor's Company, a leading medical malpractice insurer based in Napa, California: "There is little doubt about the following facts: Physicians across the United States have been confronted with alarming increases in the cost of malpractice insurance, and access to critical medical services imperiled in many states." Mutual or reciprocal insurance companies, like The Doctor's Company, are owned by the physician policyholders themselves, not outside shareholders and dominate the national market, currently insuring more than 60% of America's practicing physicians.
His commentary in an article entitled: "Defending the Practice of Medicine:" reviews the extent of the malpractice insurance dilemma as it exists today, compares it with historical antecedents, analyzes the root causes and suggests practical solutions that are available now. (Archives of Internal Medicine Vol. 164, June 14, 2004 1173-1178: http://www.archinternmed.com). AMA Members and subscribers to the Journal have online access to the article. Others can purchase and print it online for $12.
Main sections in the article include:
(1) The Crisis Today: Loss of Capacity
(2) Earlier Crises
(3) Unique Aspects of Today's Malpractice Arena (Frequency, Severity, The HMPS and IOM Reports)
(4) Allegations of the Plaintiff's Bar (Flat claims losses, Making up for stock market losses)
(5) Solutions
(6) Costs
(7) Conclusions
Dr. Anderson notes the 4 principal provisions of the Medical Injury Compensation Reform Act (MICRA) which was passed by a special session of the California legislature in 1975. These are:
(1) A $250,000 limit on noneconomic damages that limits only payments for pain and suffering, not actual damages.
(2) Periodic payment of awards in excess of $50,000 (damages are paid over the period they are intended to cover rather than as a lump sum).
(3) Collateral source rule (prevents duplicate collection of damages already paid by a third party).
(4) A sliding scale limitation which controls the size of on attorney contingency fees (For example, for a $1 million jury award, an attorney is limited to $221,000 plus expenses)
He concludes that "There are 27 years of evidence that the MICRA statutes can contribute significantly to a solution for the current crisis by facilitating sustainable insurance markets while still providing full indemnification for injured patients."
According to Gerald B. Hickson, MD, director of the Center for Patient and Professional Advocacy at Vanderbilt University in Nashville, Tennessee (http://www.mc.vanderbilt.edu/cppa), the current tort-based system is slow to act, expensive to operate, unpredictable in outcome—and it fails the vast majority of patients injured by poor medical care. (Internal Medicine News March 15, 2004).
“Empirical studies reveal that although adverse events due to medical negligence are common, errors appear to play only a limited role in decisions to sue. Perhaps 1% to 6% of hospitalized patients are injured due to care. Yet only 2% of families with valid claims ever sue. On the other hand, up to seven times as many families with adverse outcomes that are not due to negligence file suit as well. Stated another way, 80% of claims may not be valid.
Studies have also shown that neither patient characteristics nor complexity of care explains suit variation. Not even technical competence discriminates physicians who have never been sued from those in the highest risk group. But the existing court system is neither sensitive nor specific in awarding compensation of which only about 28% is received by the injured individual.
Examination of physician claims experiences reveal that most physicians are never sued or experience only a “random hit.” On the other hand, in any target period, a minority of 2% to 8% of physicians, by discipline, generate a disproportionate share of suits accounting for 70% to 80% of all dollars paid in settlements and awards. Researchers have also found that physicians who are in the ’high risk” group today remain there for years. Physicians who attract a disproportionate share of claims do not seem to relate well to their patients. Poor rapport between physician and patient appears to drive many decisions to sue. Families report that they perceive the doctors they sue as being unresponsive and uncaring. An adverse outcome, the declarations of subsequently treating professionals, and poor relationships—not negligence---appear to drive most decisions to file suit.”
posted by Bob Coli, MD at 3:05 PM
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