Tyranny of the Minority: Rhode Island 2002 National Practitioner Data Bank Data
There is important Rhode Island-specific information contained in the National Practitioners Data Bank (NPDB) and the Healthcare Integrity and Protection Data bank (HIPDB) that is valuable in trying to create fair-minded and effective legislation and regulations that will actually improve the deteriorating statewide market for medical liability insurance.
This online data has been collected by the federal government since September 1, 1990 and is continuously updated as a public service at: http://www.npdb-hipdb.com. It is accessible to the public without cost, but does not currently allow the public access to the names of any physicians in the database.
The following link: http://www.publiccitizen.org/documents/RI_NPDB.pdf is a press release based on aggregate NPDB data that was published by the consumer advocacy group, Public Citizen on July 8, 2003. It provides a summary of key 2002 NPDB data for Rhode Island. To view it requires using the free Adobe Acrobat® Reader that can be downloaded from: http://www.adobe.com/products/acrobat.
As is typical in other states reported in the NPDB, between 1990 and 2002, a small minority of Rhode Island doctors (4.9%) was responsible for half (49.9%) of all malpractice payouts. This is also the case in Kentucky (4.7% for 50%), N.J. (6.1% for 54.8%), FL (6.2% for 52%), S.C. (3.9% for 61%) W.V. (10.2% for 60%) and Montana (8.7% for 53.3%).
Over that twelve-year interval, an even smaller physician minority in Rhode Island (1.5%) had made three or more malpractice payouts, amounting to 23.5% of all malpractice payouts in the state. Of the 52 doctors who made three or more malpractice payouts, only 12 (23.1%), have been disciplined by any disciplinary entity in the state.
The group of 84 doctors with 3, 4, 5, 10 or more payouts represents only about 2.4% of the 1997 RI doctor population of 3,481, and in this group, only 22 (26.5%) have had one or more reportable licensure actions.
As you can see from the tables in this July, 2003 news release, the numbers most directly related to our currently escalating premium increases and carriers leaving Rhode Island are the average amounts that have been paid out per case and per doctor. In Rhode Island, between 1990 and 2002, the average payout per case was $263,352 ($193,563,650/735) and the average payout per doctor was $367,992 ($193,563,650/526).
Public Citizen and trial attorneys may not acknowledge a real-time malpractice insurance cost and availability crisis in Rhode Island, but it's very real to me since I've seen my own General Electric Medical Protective premiums soar from $4,000 in 2000 to $20,000 in 2003 ($16,000 with my 20% discount based on zero claims since GE Medical Protective's coverage began in 1989). Even worse news for me, and about 129 of my Rhode Island colleagues using the same insurer, is the recent announcement that because GE Medical Protective is leaving the state as of July 1, 2004, my current policy will terminate on April 5, 2005.
Most of America’s more than 800,000 practicing physicians generally view the current professional liability cost and availability crisis from the perspective of the conservative/libertarian Association of American Physicians and Surgeons (AAPS.This viewpoint is expressed in its most recent newsletter entitled:"Doctors Fight Back on “Med Mal” (AAPS News Volume 60, No. 6 June 2004 at:http://www.aapsonline.org. Under “Departments” in the left frame click on: “AAPS News”.):
“What lawyers call “med mal” really refers to anything bad that happens to a patient for which a court might award money. It is a medical maloccurrence that might or might not involve malpractice—culpable neglect and negligence*---but certainly imposes liability on doctors, at least for insurance and defense costs.
The explosion in liability costs, like that in medical costs, is to a large extent sustained by an enormous pool of third-party “free money.” Everyone with the right ticket has access to the pool, which manifests the tragedy of the commons. When the pool is in danger of running dry, the third parties just extract higher premiums. But there is a limit, which is being reached with both professional liability and medical insurance. More and more states are nearing or reaching the tipping point**.”
On the other hand, the reality is that malpractice plaintiffs' trial lawyers and consumer and labor advocacy groups, like Public Citizen and Ocean State Action, will always believe that:
"The right approach to reducing lawsuits and insurance premiums is to reduce medical errors, improve oversight of physicians, stopping repeat offenders and encouraging other patient safety efforts".
In fact, Max Wistow, a prominent Rhode Island plaintiff's lawyer quoted in a Providence Journal article on May 21, 2004 parroted the Public Citizen and trial attorney mantra stating:
"The other part of the problem (in addition to malpractice insurance company fiscal irresponsibility) is that doctors have chosen to protect each other in ways that are scandalous. In Rhode Island, 4.8% of doctors were responsible for 52.7% of payouts. No one goes after those doctors".
Malpractice plaintiffs' trial lawyers and consumer and labor advocacy groups continue to scoff at the medical community’s argument that medical liability litigation constitutes a giant "lottery," in which lawsuits are purely random events bearing no relationship to the care given by a physician.
From their perspective, because a small percentage of doctors are responsible for the bulk of malpractice in the United States, better oversight by state medical boards could drastically reduce the damage they cause.
· Public Citizen’s analysis of the National Practitioner Data Bank, which covers malpractice judgments and settlements since September 1990, found that about five percent of the doctors in the United States are responsible for half the malpractice. Specifically, through September 2002, 4.8 percent of doctors (40,118) had paid two or more malpractice awards to patients. At that time, these doctors were responsible for 51 percent of all the reports made to the Data Bank, and had paid out nearly $21 billion in damages, more than 53 percent of the total damages paid.
· At the same time, 14,293 doctors, representing 1.7 percent of the doctors in the U.S., had made three or more payments, totaling $11 billion. These doctors were responsible for 27.5 percent of all malpractice awards reported up to that date.
To malpractice plaintiffs' trial lawyers, Public Citizen and other consumer and labor advocacy groups, rather than suggesting a random, lottery-like pattern, this distribution very much resembles the pattern of drunk driving recidivism. They point out that motor vehicle licensing bureaus have procedures in place to prevent or deter predisposed individuals from driving under the influence, such as mandatory counseling and license suspensions or revocations. Unfortunately, they believe, medical licensing boards do not use their statutory authority with nearly as much vigor.
This is why I personally believe that incremental malpractice liability market reforms(like those currently proposed to the Rhode Island General assembly), even if enacted into law, in the long term will not solve the underlying structural problems and thus will fail to improve the "old conditions".
What we need is a truly new order of things. If the silent majority of doctors, our hospitals and defense lawyers could ever initiate a coordinated, large scale attempt, using reasonable measures, to economically quarantine the most dangerous members of the Rhode Island doctor minority, I believe the escalating cost and availability crises could be improved significantly in both the short and long term.
Some of these types of measures are described in the September 23, 2002 Public Citizen News Release entitled: "Stopping Repeat Offenders: The Key to Cutting Medical Malpractice Costs."
(See: http://www.publiccitizen.org/congress/civjus/medmal/articles.cfm?ID=8308 ).
With adequate publicity and media coverage, I believe that, such an unprecedented good faith effort would provide the necessary leverage to at least start public and private discussions about combining:
(1) the patient safety effort with the other two components of the triad,
(2) California-style non-economic damages caps (i.e. the 4 principal provisions of MICRA (the California Medical Injury Compensation Reform Act of 1975). Similar damage caps are already in place in 24 states where they have been the only malpractice reform effort that has affected physicians' premiums, reducing them 17.1 %, and
(3) comprehensive liability market reform (between 1988 and 2001,the addition of California's 1988 " Proposition 103" to the MICRA provisions helped limit that state's cumulative medical malpractice premium increases to only 2%).
One thing is certain, Rhode Island’s one million citizens have no knowledge of these key statistics or the real scope of the crisis and its disastrous impact. And even worse, based on periodic news stories of medical negligence awards and settlements in PowerBall lottery amounts, many assume that medical negligence involves the majority of doctors both locally and nationally.
If Rhode Island's proposed new health insurance commissioner, consumers, the local media, the Governor, and our legislators and judges can appreciate the value of this integrated triad approach with its non-incremental, patient safety-centered features, meaningful reform legislation could be enacted and withstand any legal challenges.
Niccolo Machiavelli would have appreciated both the extreme barriers to innovative reform and the importance of introducing a coordinated approach that attacks all three root causes of the "med mal" problem. All we need now is the right medical, political and media leadership that can clearly explain this "new order of things" to all Rhode Island stakeholders and convince them that beneficial market reform will improve the status quo while serving the legitimate long term interests of all affected parties.
*In law: “failure to exercise the degree of care considered reasonable under the circumstances, resulting in unintended injury to another party.”
**an epidemiologic concept that small changes will have little or no effect on a system until a critical mass is reached. Then a further small change “tips” the system and a large effect is observed.
This online data has been collected by the federal government since September 1, 1990 and is continuously updated as a public service at: http://www.npdb-hipdb.com. It is accessible to the public without cost, but does not currently allow the public access to the names of any physicians in the database.
The following link: http://www.publiccitizen.org/documents/RI_NPDB.pdf is a press release based on aggregate NPDB data that was published by the consumer advocacy group, Public Citizen on July 8, 2003. It provides a summary of key 2002 NPDB data for Rhode Island. To view it requires using the free Adobe Acrobat® Reader that can be downloaded from: http://www.adobe.com/products/acrobat.
As is typical in other states reported in the NPDB, between 1990 and 2002, a small minority of Rhode Island doctors (4.9%) was responsible for half (49.9%) of all malpractice payouts. This is also the case in Kentucky (4.7% for 50%), N.J. (6.1% for 54.8%), FL (6.2% for 52%), S.C. (3.9% for 61%) W.V. (10.2% for 60%) and Montana (8.7% for 53.3%).
Over that twelve-year interval, an even smaller physician minority in Rhode Island (1.5%) had made three or more malpractice payouts, amounting to 23.5% of all malpractice payouts in the state. Of the 52 doctors who made three or more malpractice payouts, only 12 (23.1%), have been disciplined by any disciplinary entity in the state.
The group of 84 doctors with 3, 4, 5, 10 or more payouts represents only about 2.4% of the 1997 RI doctor population of 3,481, and in this group, only 22 (26.5%) have had one or more reportable licensure actions.
As you can see from the tables in this July, 2003 news release, the numbers most directly related to our currently escalating premium increases and carriers leaving Rhode Island are the average amounts that have been paid out per case and per doctor. In Rhode Island, between 1990 and 2002, the average payout per case was $263,352 ($193,563,650/735) and the average payout per doctor was $367,992 ($193,563,650/526).
Public Citizen and trial attorneys may not acknowledge a real-time malpractice insurance cost and availability crisis in Rhode Island, but it's very real to me since I've seen my own General Electric Medical Protective premiums soar from $4,000 in 2000 to $20,000 in 2003 ($16,000 with my 20% discount based on zero claims since GE Medical Protective's coverage began in 1989). Even worse news for me, and about 129 of my Rhode Island colleagues using the same insurer, is the recent announcement that because GE Medical Protective is leaving the state as of July 1, 2004, my current policy will terminate on April 5, 2005.
Most of America’s more than 800,000 practicing physicians generally view the current professional liability cost and availability crisis from the perspective of the conservative/libertarian Association of American Physicians and Surgeons (AAPS.This viewpoint is expressed in its most recent newsletter entitled:"Doctors Fight Back on “Med Mal” (AAPS News Volume 60, No. 6 June 2004 at:http://www.aapsonline.org. Under “Departments” in the left frame click on: “AAPS News”.):
“What lawyers call “med mal” really refers to anything bad that happens to a patient for which a court might award money. It is a medical maloccurrence that might or might not involve malpractice—culpable neglect and negligence*---but certainly imposes liability on doctors, at least for insurance and defense costs.
The explosion in liability costs, like that in medical costs, is to a large extent sustained by an enormous pool of third-party “free money.” Everyone with the right ticket has access to the pool, which manifests the tragedy of the commons. When the pool is in danger of running dry, the third parties just extract higher premiums. But there is a limit, which is being reached with both professional liability and medical insurance. More and more states are nearing or reaching the tipping point**.”
On the other hand, the reality is that malpractice plaintiffs' trial lawyers and consumer and labor advocacy groups, like Public Citizen and Ocean State Action, will always believe that:
"The right approach to reducing lawsuits and insurance premiums is to reduce medical errors, improve oversight of physicians, stopping repeat offenders and encouraging other patient safety efforts".
In fact, Max Wistow, a prominent Rhode Island plaintiff's lawyer quoted in a Providence Journal article on May 21, 2004 parroted the Public Citizen and trial attorney mantra stating:
"The other part of the problem (in addition to malpractice insurance company fiscal irresponsibility) is that doctors have chosen to protect each other in ways that are scandalous. In Rhode Island, 4.8% of doctors were responsible for 52.7% of payouts. No one goes after those doctors".
Malpractice plaintiffs' trial lawyers and consumer and labor advocacy groups continue to scoff at the medical community’s argument that medical liability litigation constitutes a giant "lottery," in which lawsuits are purely random events bearing no relationship to the care given by a physician.
From their perspective, because a small percentage of doctors are responsible for the bulk of malpractice in the United States, better oversight by state medical boards could drastically reduce the damage they cause.
· Public Citizen’s analysis of the National Practitioner Data Bank, which covers malpractice judgments and settlements since September 1990, found that about five percent of the doctors in the United States are responsible for half the malpractice. Specifically, through September 2002, 4.8 percent of doctors (40,118) had paid two or more malpractice awards to patients. At that time, these doctors were responsible for 51 percent of all the reports made to the Data Bank, and had paid out nearly $21 billion in damages, more than 53 percent of the total damages paid.
· At the same time, 14,293 doctors, representing 1.7 percent of the doctors in the U.S., had made three or more payments, totaling $11 billion. These doctors were responsible for 27.5 percent of all malpractice awards reported up to that date.
To malpractice plaintiffs' trial lawyers, Public Citizen and other consumer and labor advocacy groups, rather than suggesting a random, lottery-like pattern, this distribution very much resembles the pattern of drunk driving recidivism. They point out that motor vehicle licensing bureaus have procedures in place to prevent or deter predisposed individuals from driving under the influence, such as mandatory counseling and license suspensions or revocations. Unfortunately, they believe, medical licensing boards do not use their statutory authority with nearly as much vigor.
This is why I personally believe that incremental malpractice liability market reforms(like those currently proposed to the Rhode Island General assembly), even if enacted into law, in the long term will not solve the underlying structural problems and thus will fail to improve the "old conditions".
What we need is a truly new order of things. If the silent majority of doctors, our hospitals and defense lawyers could ever initiate a coordinated, large scale attempt, using reasonable measures, to economically quarantine the most dangerous members of the Rhode Island doctor minority, I believe the escalating cost and availability crises could be improved significantly in both the short and long term.
Some of these types of measures are described in the September 23, 2002 Public Citizen News Release entitled: "Stopping Repeat Offenders: The Key to Cutting Medical Malpractice Costs."
(See: http://www.publiccitizen.org/congress/civjus/medmal/articles.cfm?ID=8308 ).
With adequate publicity and media coverage, I believe that, such an unprecedented good faith effort would provide the necessary leverage to at least start public and private discussions about combining:
(1) the patient safety effort with the other two components of the triad,
(2) California-style non-economic damages caps (i.e. the 4 principal provisions of MICRA (the California Medical Injury Compensation Reform Act of 1975). Similar damage caps are already in place in 24 states where they have been the only malpractice reform effort that has affected physicians' premiums, reducing them 17.1 %, and
(3) comprehensive liability market reform (between 1988 and 2001,the addition of California's 1988 " Proposition 103" to the MICRA provisions helped limit that state's cumulative medical malpractice premium increases to only 2%).
One thing is certain, Rhode Island’s one million citizens have no knowledge of these key statistics or the real scope of the crisis and its disastrous impact. And even worse, based on periodic news stories of medical negligence awards and settlements in PowerBall lottery amounts, many assume that medical negligence involves the majority of doctors both locally and nationally.
If Rhode Island's proposed new health insurance commissioner, consumers, the local media, the Governor, and our legislators and judges can appreciate the value of this integrated triad approach with its non-incremental, patient safety-centered features, meaningful reform legislation could be enacted and withstand any legal challenges.
Niccolo Machiavelli would have appreciated both the extreme barriers to innovative reform and the importance of introducing a coordinated approach that attacks all three root causes of the "med mal" problem. All we need now is the right medical, political and media leadership that can clearly explain this "new order of things" to all Rhode Island stakeholders and convince them that beneficial market reform will improve the status quo while serving the legitimate long term interests of all affected parties.
*In law: “failure to exercise the degree of care considered reasonable under the circumstances, resulting in unintended injury to another party.”
**an epidemiologic concept that small changes will have little or no effect on a system until a critical mass is reached. Then a further small change “tips” the system and a large effect is observed.
posted by Bob Coli, MD at 12:36 PM
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