Healthcare: News and Commentary: MedWatch

Doctors cannot rely on the law to protect sensible decisions. Legal fear is eroding the quality and availability of healthcare in America. Common Good's MedWatch collects recent news and commentary reflecting on this trend.

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Wasted Medical Dollars
Kevin Pho, USA Today, April 23, 2008

More than half the dollars in America’s $2.2 trillion health care system are wasted each year, according to a recent PricewaterhouseCoopers analysis.  Factors contributing to this waste include medical errors, poor use of information technology, and badly managed chronic diseases.  Dwarfing these factors is a phenomenon called “defensive medicine,” in which physicians order unnecessary tests to avoid even the threat of lawsuits.  This can result in wasteful spending such as unneeded CT scans, MRIs, and cardiac testing.  More than nine in ten physicians, on average, reported practicing defensive medicine, according to a 2005 survey in the Journal of the American Medical Association.  However, in the experience of Dr. Kevin Pho, “patients don’t seem to mind the extra testing, and they often equate defensive medicine with ‘more thorough’ care.  After all, if one test is good, wouldn’t more be better?”  Not necessarily – every test can result in a “false positive,” which is a positive test despite the absence of disease.  This can lead to yet more testing, such as advanced imaging scans or biopsies, which carry risks of serious complications.  “How do we tackle this problem?” asks Dr. Pho.  The malpractice system needs to be more reliable in its ability to differentiate between cases of negligence and those in which a patient simply suffered a bad outcome.  “Until the system is perceived as being fairer, physicians will do all they can to avoid being sued,” writes Dr. Pho.  “That involves ordering unnecessary tests, which is a shame, because those billions of dollars can be put to much better use.” » article  

South Florida medical malpractice cases difficult for both sides
Patty Pensa, South Florida Sun-Sentinel, April 20, 2008

Nine years ago, Rita Wax’s son died during surgery, yet the lawsuit alleging malpractice continues.  “I was devastated,” said Rita Wax, 72, of Boca Raton.  “I really still haven’t recovered.  It’s something that will never go away.”  Medical liability cases can last for years, taxing emotionally both plaintiffs and defendants.  Regardless of the outcome, lawyers say, “neither side really feels like the winner.”  The average length of a malpractice case is three to five years.  Furthermore, adverse outcomes, deaths, or injuries do not automatically equate with wrongdoing by a physician.  Many families file lawsuits simply because they want to know what happened, according to Lindsey Chepke, a researcher at Duke University.  Several years ago, in response to the escalating costs of the system, the Florida Legislature enacted caps on damages for pain and suffering.  Chepke says, however, that “reforms often are a tug of war among trial lawyers, medical groups, and insurers.  They ignore patient safety, which should be the focus.”  The current system fails both doctors and patients.  Even when a case ends, physicians see their reputations tarnished, their decisions questioned, and they practice medicine defensively, seeing patients as potential plaintiffs.  Patients are ill-served as well.  “I’ve had $300 million in settlements over my career,” said Gary Cohen, a veteran trial lawyer, “but I never see anyone walk out happy.  They feel they’ve stood up and gotten justice but they’re very rarely happy.  If they lose, they’re no more devastated than when they win.” » article  

Health Care Reform II
Senator Robert O'Leary, Barnstable Patriot, April 17, 2008

The Massachusetts Senate is considering health care reform legislation, specifically to reduce costs, to increase access to primary care, and to improve transparency and efficiency.  Among other things, the bill addresses issues surrounding medical education and primary care.  However, writes Senator O’Leary, “we must do more work to control the growing cost of health care for our first-in-the-nation approach to work. . . . I think that we can do more, especially in the area of malpractice reform.”  The current process for handling medical injury cases “takes a long time, is very inefficient, and does little to promote system-wide enhancements in patient safety.”  Physicians can no longer afford exorbitant premiums for malpractice insurance; many are abandoning certain specialties, such as obstetrics, or are leaving Massachusetts altogether.  Further inflating medical costs is the practice of defensive medicine – in which doctors order unnecessary tests out of legal fear.  Moreover, the legal environment inhibits patient safety and learning because doctors are afraid to talk about mistakes.  In addition, the present court system fails patients – studies suggest that less than 5 percent of injured patients seek compensation.  Reforms like caps on damages have been suggested, but they do not address fundamental problems with the current tort system and do nothing to enhance patient safety.  “We must find a better option for reform,” mandates Senator O’Leary.  “An alternative approach could help to correct these failings, while also potentially reducing adversarialism in the system – benefiting both patients and health care providers.” » article 

More South Florida Obstetricians Stop Delivering Babies, Cut Services
Patty Pensa, South Florida Sun-Sentinel, April 14, 2008

In South Florida, pregnant women have fewer options for medical care as more physicians cease delivering babies and avoid taking high-risk patients.  As more patients head to fewer doctors, two corollaries are longer waits to see a physician and a break in doctor-patient relationships.  Projections show that in three years there will be 30 percent fewer obstetrician-gynecologists in Palm Beach County, despite an estimated 7 percent growth in the demand for such doctors.  Part of the problem is the medical liability system.  Ob-gyns and others like neurosurgeons and family practitioners are caught between exorbitantly high malpractice insurance premiums and low reimbursement for their services.  “Obstetrics is a very important part of medicine,” said Dr. Jay Trabin, head of Florida’s chapter of the American College of Obstetrics and Gynecology.  “But it’s not what it used to be.  I love delivering babies but I can’t do it anymore.”  In addition to losing established doctors, it is very difficult to recruit new physicians because of the high cost of malpractice insurance – around $100,000 per year, according to Dr. Anne Honebrink.  And the situation especially affects patients.  “To go to your gynecologist is one of the most personal things a person does,” said Stephanie Tomasini, 33, of Delray Beach.  “It’s a shame if the doctors aren’t there.  I don’t know how you would get the care you need.” » article 

Report: US Wastes More Than Half of Health Spending
Anna Matthews, Wall Street Journal, April 10, 2008

Further chronicling the inefficiency of the U.S. health care system is a new report by the Health Research Institute at PricewaterhouseCoopers.  The new analysis puts the price tag of waste in the health care system at a gigantic $1.2 trillion per year.  This “wasteful spending” could account for over half the $2.2 trillion spent annually on health care in America.  One of the biggest parts of the waste is “defensive medicine” – unnecessary medical tests driven by legal fear.  Defensive medicine weighs in at $210 billion per year, dwarfing the waste in many other categories, such as the $22 billion tied to badly-managed diabetes. » article

Lawyer, Insurance Industry, Doctors and Officials Need to Work Together
Arnold Ghitis, South Florida Sun-Sentinel, April 8, 2008

Beginning in the last five years, Florida physicians started opting out of ER call as medical malpractice insurance rates climbed higher and higher.  High-risk fields such as neurosurgery were particularly affected.  Now, new doctors have little interest in relocating to Florida because of the infamous liability environment.  And as baby boomers continue to age, more people will need medical attention, and the health care system will face mounting pressure – especially worsened if the liability trends continue.  “Only a collaborative effort between the medical community, legal entities, the insurance industry and our officials can bring a fair solution to cure our health system,” writes Dr. Arnold Ghitis. » article 

Make Health Courts Central to Medical Reform
William Reider, South Florida Sun-Sentinel, April 7, 2008

“[ Florida] will continue to drive away the best and brightest [doctors] from considering practicing,” quotes this editorial addressing the state’s critical medical malpractice situation.  Physicians are leaving Florida at an “alarming rate,” due much in part to skyrocketing malpractice insurance premiums.  Further complicating the situation is the practice of defensive medicine, which is the over utilization of tests out of a fear of lawsuits.  Health courts could be the solution, and the proposal has been supported by experts at the Harvard School of Public Health, the Robert Wood Johnson Foundation, and the Progressive Policy Institute.  Moreover, AARP has called for health court pilot projects.  Such a system could utilize special judges with health care expertise and neutral medical experts to achieve more reliable verdicts.  “The health courts concept has been around for many years,” writes the author.  “The time has come for our legislators to consider this reform.” » article 

Medical Liability Worries End Free School Physicals
Carolyn Casey, Rocky Mount Telegram, April 6, 2008

An increase in medical liability will end a more than 30 year old program in some North Carolina schools.  Administrators at Nash-Rocky Mount public schools have eliminated school site physicals for student athletes because of legal concerns.  Physicians who volunteer each year at the schools thought it wise to move the physicals off site because of an increase in malpractice lawsuits, said Wayne Doll, the system-wide athletics director.  “We just can’t put ourselves at that liability anymore,” said Dr. Nicholas Patrone, head of the Boice-Willis Clinic.  Off site physicals can allow for more exam time, and the school-based exams were a “potentially huge legal liability for us if anything does happen to that child,” commented Dr. Patrone.  And this problem is not exclusive to North Carolina; school districts across the nation are encountering similar medical liability troubles. » article 

Conference Looks at Ways to Reduce Medical Errors, Boost Openness
Allison Rupp, Billings Gazette, April 4, 2008

This recent article highlights a conference in Laramie, Wyoming cosponsored by Common Good and the University of Wyoming.  The keynote speaker, past president of the Joint Commission Dr. Dennis O’Leary, described how medical errors continue to be a serious challenge facing providers and administrators.  Speakers from across the country, in many fields of expertise, discussed ways to improve patient safety and reduce errors through both medical and legal programs.  While some advocates noted the need for transparency and disclosure, others noted that the current legal system discourages those very practices.  Moreover, the legal system links compensation with provider accountability, according to Ed Dauer of Common Good Colorado.  "A patient can't get compensation if the doctor doesn't lose," said Dauer, who is currently president of the Colorado branch of Common Good, a bipartisan legal and health care reform coalition. "It creates an adversarial posture."  Common Good General Counsel, Paul Barringer, suggested voluntary compensation pilot projects which would take medical malpractice claims out of the court system for faster, more equitable resolution with robust linkages to patient safety.  » article  » more coverage of the Wyoming event

Health Care Reform Comes Down to Cost Efficiency
Richard Lamb, News Journal, April 1, 2008

 In this editorial, Dr. Richard Lamb, a hospital-based anesthesiologist since 1955, offers a prescription to the health care mess.  To make the medical system more efficient and economical, America should try to control the outrageously expensive legal costs.  Defensive medicine wastes billions of health care dollars annually.  Because of the costs stemming from legal fear and other problems, “this country is bankrupt,” and “it’s time to come to our senses.” » article

Righting Healthcare Reform
Christopher Anderson, Boston Globe, March 31, 2008

In a 2005 letter to the state legislature, more than 20 Massachusetts business associations affirmed their support for measures that would rein in health care expenses.  They wrote that “cost, after all, is the single biggest problem we face today in the delivery of health care.”  Unfortunately, the price of health care is just as big an issue today, and “ Massachusetts has reached a crisis point,” according to Christopher Anderson, president of the Massachusetts High Technology Council.  One idea is to reform the state’s medical malpractice laws.  “Creating a system that minimizes frivolous lawsuits and provides protections to doctors,” writes Anderson, “would greatly stabilize skyrocketing malpractice premiums, which are driving many good doctors out of state.”  Furthermore, a federal report showed that reforming the medical malpractice system would save the nation over $100 billion in annual health care costs.  According to Charles Baker, head of Harvard Pilgrim Health Care, the Senate President is “doing us a big favor by throwing the gauntlet down” on cost reform.  The stakeholders in the health care debate must work together to ensure it is done right. » article 

An Unhealthy Situation for Patients
Cathleen Crowley, Albany Times Union, March 30, 2008

Dr. Joseph Sellers works as a primary care physician at Bassett Healthcare Cobleskill.  He lives in Cobleskill, New York, where his son is mayor.  Nineteen years ago, Sellers was lured to the county because New York State promised to repay part of his medical school loans if he practiced in an underserved area.  However, the area is still suffering from a health care shortage.  According to the Annual Physician Workforce Profile, the county has only 68 physicians per 100,000 residents – in stark contrast with Albany County’s 406 per 100,000 – and the number is falling.  A new loan forgiveness program has been proposed, but many in the medical community say that it will not be enough.  “Exorbitant malpractice insurance premiums [and] flat Medicare reimbursement rates” are among the central issues affecting access to health care in the region.  Over one-quarter of New Yorkers live in underserved areas, according to the state Department of Health.  And eight counties have no practicing obstetrician.  “If I want to refer someone to a dermatologist or child neurologist, there is nobody available for miles and miles and months and months,” Sellers said. » article 

Health Care Costs Trends Still Cause for Concern
Steve Sink, Rochester Democrat and Chronicle, March 30, 2008

The cost of health care is a pressing issue in Albany, Washington, and on the presidential campaign trail.  Being especially hard hit are small businesses.  “When your income is going up somewhere between 2 and 5 percent a year and your health care costs are rising 10 to 15 percent, that [gap] falls directly to the bottom line,” lamented Gerald Archibald, a small business leader in Rochester, New York.  Archibald cited prescription drug prices and lawsuits as two of the primary problems.  Among suggested solutions, Archibald addressed the tendency of Americans to file a lawsuit “every time things don’t go [their] way.”  Malpractice insurance rates for physicians have skyrocketed due to “our litigious society.”  Another effect is that doctors practice “defensive medicine,” meaning that they often order high-priced, unnecessary exams and procedures out of legal fear.  Meanwhile, because of the high cost of health care, “it’s a safe bet that some of the 2.2 million non-elderly New Yorkers without health insurance are small business workers, maybe even owners.” » article 

Hospitals Learn to Say Sorry
Maura Lerner, Minneapolis Star Tribune, March 29, 2008

Minnesota hospitals have quietly been changing the way they approach medical errors.  For years hospitals and providers have been encouraged not to reveal any information about a mistake or acknowledge that something had gone wrong.  Yet research shows that malpractice claims can often be deterred if the patient and their family are offered an apology and an explanation.  Beginning in 1999, two Minnesota children’s hospitals revised their policies to require the immediate disclosure of adverse events and near-misses.  Without this kind of openness, patients often feel abandoned and betrayed by trusted caregivers.  Moreover, the silence surrounding errors means physicians and hospitals do not discuss what went wrong and take steps to prevent the same incident from recurring.  "As a whole state, I think the culture has shifted," said Dr. Phil Kibort, vice president and chief medical officer at Children's Hospitals. "In the last five, six years, we've been telling the truth." » article 

Study Finds Many Patients Dissatisfied with Hospitals
Robert Pear, New York Times, March 29, 2008

Recent data on patient satisfaction with hospital care shows that patients are often unhappy with some aspect of their care.  Many patients described a lack of courtesy and respect, feeling that they had not received adequate pain medication, and many said they received unclear instructions from their caregivers.  Nationwide, an average of 67% of patients would recommend a hospital to a friend or family member.  But the results provide cause for concern, said Dr. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality, a unit of the Public Health Service. “Poor communication is a major source of medical errors,” Dr. Clancy said. “If doctors are not listening carefully, patients may not bring up important information. Patients who do not understand discharge instructions are more likely to be readmitted to the hospital or end up in the emergency room.” » article

Abington Hospital Starts Mediation Effort
Sandra Moyer, The Intelligencer, March 28, 2008

A new mediation program at Abington Memorial Hospital in Pennsylvania hopes to bring quick, fair resolution to patients injured in the course of treatment, as well as encourage patient safety improvements.  The program, run by the Hospital, the Montgomery County Medical Association and the Montgomery County Hospital Association, will attempt to resolve malpractice claims without the lengthy and exhausting process of going to trial.  The program was first promoted by the State Supreme Court in 2002 as one of a series of reform measures that could lower liability costs and keep hospitals in business.  Three years in the making, the program hopes to bring patients and doctors to the table before moving to trial in order to resolve claims amicably, fairly and quickly.  Patients retain the ability to go to trial, but often patients want to hear an apology and see that the providers are taking steps to make sure the same error is not repeated.  “But the process gives patients and doctors a chance to communicate with each other before each side has a chance to harden their positions,” noted the chair of the mediation program.  “There is healing through mediation.”  » article

Thousand of Michigan Doctors Likely to Hang Up Their Stethoscopes
Diane Ivey, MLive, March 28, 2008

More than 6,000 Michigan doctors will be retiring or quitting in the next 10 to 12 years.  Among them is John Dircks, a doctor of pulmonary medicine.  Dircks, 65, founded his pulmonary care group in 1976, and says he looks forward to a diminished workload.  “It’s really just not feasible to keep doing what I'm doing,” Dircks said, referring to increased overhead and reduced reimbursements.  Many primary care, family, and internal medicine physicians will also be retiring – approximately 38 percent by 2020.  The growing exodus of physicians is due to several factors, according to David Fox of the Michigan State Medical Society.  Between problems such as declining income, high medical malpractice insurance rates, and greater exposure to lawsuits, doctors are inclined to quit sooner.  Political and other governmental leaders need to address this problem.  “People will need doctors, and who’s going to take care of them?” asked Fox. » article 

Obstetricians May Avoid Births Due to Lawsuits
Frank Donnelly, Times-Picayune, March 27, 2008

 Several years from now, many infants could be delivered by physicians who are total strangers to their mothers.  Medical malpractice insurance could become so costly that only hospitals could afford birth coverage.  This would mean that ob-gyns would have to transfer the care of expectant mothers to hospital staff doctors, who would likely be unknown to the mothers.  Obstetricians say exceedingly high medical liability premiums – around $200,000 per year – have resulted in many of their colleagues ceasing baby delivery or quitting the field altogether.   “All too often, doctors are held liable for less-than-perfect outcomes,” said Dr. Ralph W. Hale of the American College of Obstetricians and Gynecologists.  Yet a number of of those injuries – cerebral palsy, brain damage, or other problems – can be a result of circumstances beyond the physician’s control, such as congenital or genetic abnormalities, or intrauterine strokes.  “I think [the medical malpractice crisis is] going to compromise the care," said Dr. David Herzog, an attending physician at Richmond University Medical Center.  A baby's birth will become “a sterile procedure instead of a beautiful experience; it’s inevitable if the current system continues as is.” » article

Primary Care Needs Fixing Before Universal Care Can Work
Benjamin Brewer, Wall Street Journal, March 26, 2008

In a recent editorial, Dr. Benjamin Brewer describes how the promise of universal healthcare hinges upon the availability of a large group of well-trained primary care physicians able to provide continued care.  Yet recent numbers from the American Academy of Family Physicians show that 40,000 new primary care physicians will have to join the workforce in the next 12 years to meet the nation’s demand.  Primary care physicians face many challenges with high overhead costs and lower reimbursement payments than other specialists.  These crunches have put some seasoned doctors out of practice and are deterring new students from entering the field.  With fewer physicians and more patients, liability costs will rise and the chances will increase that a physician makes an mistake.  “We won't see better health outcomes or any cost savings from improvements in quality unless there are broadly trained primary care doctors available and willing to practice where they're needed…Medical insurance coverage without a doctor to see is another big health problem -- not a solution.” » article
 

Defensive Medicine

Price is High for Preventing Medical Lawsuits
Alexander Strasser, Democrat and Chronicle, March 21, 2008

In this editorial, Dr. Alexander Strasser, a New York internist, describes one of the negative effects the current legal system has had on health care.  The omnipresent threat of a lawsuit has forced doctors to practice “defensive medicine” – the ordering of unnecessary tests and procedures out of legal fear.  In particular, radiologists have become vague in their reports out of fear of being sued.  This often leads to overuse of diagnostic procedures such as CT scans, which are “not medically indicated, but legally necessary.”  When medically necessary, further testing should be done.  “But who decides what is medically indicated?” asks the author.  “Is it the insurance company, the malpractice attorney or the attending physician?”  Because of the current system, doctors have left New York or are refusing to settle there in the first place.  Legal reform is necessary, because the “price for this [current system] is too high and one that society cannot afford.”  » article

Many Doctors, Many Tests, No Rhyme or Reason
Dr. Sandeep Jundahar, New York Times, March 11, 2008

“I recently took care of a 50-year-old man who had been admitted to the hospital short of breath.  During his month long stay he was seen by a hematologist, an endocrinologist, a kidney specialist, a podiatrist, two cardiologists, a cardiac electrophysiologist, an infectious-diseases specialist, a pulmonologist, an ear-nose-throat specialist, a urologist, a gastroenterologist, a neurologist, a nutritionist, a general surgeon, a thoracic surgeon and a pain specialist.”  So begins an article by a New York cardiologist about the problems associated with over testing.  The 50-year-old patient underwent a total of 12 procedures, including a pacemaker implantation and a bone-marrow biopsy, and when he was discharged, follow-up appointments were scheduled with seven specialists.  This case is not atypical in America’s health care system, “where doctors are paid piecework for their services, [and] if you have a slew of physicians and a willing patient, almost any sort of terrible excess can occur.”  Overutilization is caused by many factors such as doctors trying to avoid lawsuits (i.e., “defensive medicine”).  While precise data is lacking, the overuse of medical services likely cost hundreds of billions of dollars last year – a huge portion of the approximately $2 trillion that Americans spent on health care.  And “[a]re we getting our money’s worth?” asks Dr. Jauhar.  “Not according to the usual measures of public health. The United States ranks 45th in life expectancy, behind Bosnia and Jordan; near last, compared with other developed countries, in infant mortality; and in last place...among major industrialized countries in health care quality, access and efficiency.”  » article

Broken Legal System Chasing Doctors Away
Carlos Muhletaler, South Florida Sun-Sentinel, February 26, 2008

A representative from Florida Stop Lawsuit Abuse describes how the current medical malpractice system is ineffective and expensive for all patients, not just those who have experienced medical injury. Physicians, fearful of liability, practice costly defensive medicine and those costs are passed on to the consumers. In Florida, the "three strikes" law - in which physicians' licenses are revoked after three malpractice verdicts - has discouraged doctors from practicing in the state or entering high risk specialty fields. The medical society predicts a 65% shortage of on-call neurosurgeons by 2011. In one doctor's words, "This [law] opened the door to every bogus lawsuit possible. With the sense that we all had bulls-eyes on our back, we left." The author urges common sense liability reform that encourages and protects patient safety, while attracting physicians. Health courts would have significant linkages to patient safety mechanisms and would encourage consistent and fair liability decisions.  » article

Besieged by Scourge of Medical 'Malpractice'
John Maxfield, Naples Daily News, February 16, 2008

In this editorial, an emergency physician in Ohio describes the current affliction of defensive medicine (unnecessary medical tests stemming from legal fear).  “Why not obtain a CT scan on every patient with back pain or, for that matter, perform every test known to medical science on every patient who is ill?  After all, peoples’ lives are at stake,” questions the doctor.  There are two main reasons, he explains.  First, many medical tests are inaccurate to at least some degree.  Furthermore, a test that comes back positive often leads to additional testing.  These tests and procedures are sometimes invasive and many carry the potential for dangerous complications or side effects.  Because of this, “the search for extremely unlikely diagnoses would kill more patients than would missing those diagnoses,” writes the author.  Dartmouth University researchers have shown that “more care is often worse care.”  The second major reason is the sheer cost of defensive medicine.  We must choose where to spend our money, and if we spend it on frivolous tests, we will need to decrease spending in other areas (e.g., national defense and public education).  “[S]ome of my younger colleagues, paralyzed by the fear of being sued, regularly spend $2,000 to diagnose a cold,” notes the writer.  Our nation has to make a choice when it comes to our medical malpractice system, “[a] chance for good and efficient medical care for the many or a stacked lottery for the few.” » article 

Medical Testing, Dealing with Uncertainty
Joe Pellicer, The Olympian, January 28, 2008

One physician describes how the fear of liability is affecting the way doctors practice medicine.  Many patients believe more testing leads to better care, and physicians have responded by ordering up expensive tests to satisfy patients and protect themselves from liability claims.  Medicine is not always an exact science and there is always the possibility that a diagnosis is wrong, despite all the symptoms or tests.  Physicians now rely heavily on testing and defensive medicine has become a costly and ubiquitous feature in the field. » article

Biggest Factor in Rising Health Costs are the Doctors Themselves
Steve Cole, Dallas Morning News, December 17, 2007

Dr. Steve Cole, a staff physician at Baylor University Medical Center, writes that a primary factor involved in the rising costs of health care is the doctors themselves.  This is because physicians are “ordering more tests, prescribing more medications and requesting more consultations with specialists.”  The problem is exacerbated by the fact that many of these procedures and medications can lead to expensive and potentially dangerous complications (e.g., surgical complications, side effects from drugs).  One major reason cited is that doctors possess “an intense fear of litigation.”  Medical students are often reminded about the potential for lawsuits in response to a missed diagnosis.  In order to avoid such litigation, doctors have a propensity to practice “defensive medicine, ordering [many tests] and requesting a multitude of additional consultations.” » article 

Defensive Medicine: Cautious or Costly?
Wyatt Andrews, CBS News, October 22, 2007

Recently, a sophomore at the University of Richmond went to the hospital with a simple stomach ache and came out with an $8,500 bill for a barrage of expensive imaging tests.  Doctors found a harmless cyst, something that could have been diagnosed for a fraction of the cost.  This is yet another example of what many physicians term “defensive medicine” – needless procedures driven by legal fear.  Some experts estimate the annual cost to the nation is over $100 billion.  These costs are passed on to patients, even those with insurance, often through rising deductibles and co-payments.  “Defensive medicine is bad medicine,” says Dr. Kevin Pho.  “There’s no doubt in my mind this is a significant driver in health care costs today.” » article

Report: Americans Get Too Much Treatment
David Schepp, The Journal News, October 13, 2007

Medical technology has made great improvements to both quality and length of life.  However, a new report says some of these tests are overused.  “Unfortunately, much of what is spent on health care is for services that are not needed or, worse, are harmful," said Dr. Janet Sullivan, chief medical officer at Hudson Health Plan.  “One of the reasons for that...stem[s] from liability insurance,” said Dr. Michael E. Rader, medical director at Nyack Hospital.  Health care providers are apt to order unnecessary tests and procedures out of legal fear.  These costly tests result in needless medical expenses.  One physician who did not concur with all of the studies findings still agreed that there is “tremendous waste” in the nation’s health system. » article

We're Beating Ourselves in the War on Germs
Lauren Myers, The Arizona Daily Wildcat, September 25, 2007

Antibiotics have saved countless lives since the discovery of penicillin in 1928.  However, overuse has facilitated the evolution of drug-resistant strains of microbes.  In 1995, 70 percent of the 1.7 million hospital-acquired staph infections were caused by drug-resistant bacteria.  Many doctors routinely prescribe antibiotics in inappropriate circumstances.  This misuse contributes to the growth of germs that are impervious to treatment.  One reason that doctors unnecessarily prescribe antibiotics is defensive medicine.  Legal fear motivates doctors to “insulate themselves from potential lawsuits,” bringing us closer to a “post-antibiotic age.”  » article

Med Student Struggles to Preserve Her Idealism
Emily Breidbart, CNN, August 16, 2007

One medical student describes the new era of healthcare, one in which costs dictate the way doctors practice medicine and temper enthusiasm.  Students are taught how to keep patient visits brief and efficient, and how to use defensive medicine to protect themselves from litigation.  “We are trained what kind of patients to be wary of. Basically, we are taught that we can't trust our future patients, which is confusing to first-year medical students. How can we expect our patients to trust us if we can't trust them?” writes the student.  The author further describes how the preceding generation of physicians advised her and her fellow students against pursuing a career in medicine.  The costs, bureaucratic challenges, and struggles with insurance companies all mean that doctors are practicing less medicine and spending more time dealing with administrative issues. » article

A Trip to the Hospital Shouldn't Leave the Patient with "Bill-itis"
Mike Wilkes, Sacramento Bee, August 4, 2007

One young teacher’s emergency room experience is an unfortunate example of how the fear of liability is directly influencing patients. Following the advice of her doctor, the young woman went to the ER to seek treatment, imagining her health insurance would cover her needs. After several hours, a battery of tests and procedures (many deemed unnecessary), she left the hospital without a diagnosis after filling out several medical malpractice liability waivers. What she did leave with was a mammoth $11,000 bill. Next time she gets sick she says she’ll need to be on death’s door before even thinking about a trip to the emergency room. Some estimate that defensive medicine costs billions each year, and patients often foot the bill. » article

Caesareans are Used in a Quarter of All Births
Daniel Martin, Daily Mail, June 26, 2007

A recent study indicates that 23.5% of births in the United Kingdom were by caesarean section in 2005-06.  The reasons cited incldue, “[t]he compensation culture [which] may also be to blame. A recent survey indicated that many doctors carry out more caesareans than in the past because of fear of litigation if a natural birth goes wrong.” » article

What's Up, Docs?
Robert Kolker, New York Magazine, June 18, 2007

A panel of top New York physicians sat down with a New York magazine author to discuss aspects of the medical profession. The doctors discussed everything from mistakes they have made to what makes a good doctor or patient, to the real effects of defensive medicine for patients.  The doctors describe defensive medicine and the fear of liability as being one of the greatest problems doctors face today in practicing good, accurate medicine.  “Overall, malpractice has made good doctors worse rather than bad doctors better because of the fear that you’re missing something and you may be sued for missing a diagnosis. So someone has back pain. You could diagnose a stiff neck with 95 percent certainty, but there’s a 5 percent chance that he could have cancer or a serious infection, and instead of going with your gut, you order a bunch of extensive tests to rule out the improbable,” said one physician in the interview. » article

More Doctors Return to Old Philosophy on Caesareans
Jennifer Boen and Nic Pyle, News-Sentinel, April 20, 2007

Hospitals continue to tighten their policies on VBACs (vaginal birth after a previous cesarean section) due to liability concerns.  article » 

Fear of Lawsuits Means Fewer Radiologists Read Mammograms
Diane Cochran, Billings Gazette, March 18, 2007

In a growing trend, radiologists across the country are refusing to read mammograms, and fewer medical students are opting to specialize in mammography, in part because of legal fear.  Dr. Leonard Berlin, a medical school professor in Illinois, said: "[t]here's no question the fear of malpractice litigation does dissuade many radiologists from reading mammograms.”  According to the Physician Insurers Association of America, a trade group of medical malpractice insurance carriers, missed breast cancer is the most common basis for medical malpractice lawsuits in the United States, and it is also among the most expensive kind of malpractice cases. “In a seven-year period ending in 2002, PIAA members spent almost $200 million on breast cancer malpractice cases. That was $30 million more than was spent during the previous six years.”  According to some, part of the problem is that mammography has been “oversold” as a perfect diagnostic technique, when in reality it is not a foolproof test. article »

Risk, Malpractice Fears Push Bay State C-Section Surgeries
Jessica Fargen, Boston Herald, January 24, 2007

The Massachusetts Department of Public Health reports that use of C-sections continues to increase in the state.  Almost one third of Massachusetts’ births in 2005 were by C-section.  Dr. Dale Magee, president-elect of the Massachusetts Medical Society, said that “doctors are under pressure to exhaust every delivery option available, often including C-sections, because of malpractice worries.”   article »

What’s Making Us Sick Is an Epidemic of Diagnoses
H. Gilbert Welch, Lisa Schwartz, and Steven Woloshin, New York Times, January 2, 2007

A New York Times essay bemoans that an epidemic of diagnosis is the biggest health threat facing most Americans. Our legal environment, which punishes physicians for failure to diagnose, is feeding this epidemic. “While failing to make a diagnosis can result in lawsuits, there are no corresponding penalties for overdiagnosis. Thus, the path of least resistance for clinicians is to diagnose liberally — even when we wonder if doing so really helps our patients.” Physicians are prescribing medicine for physical or emotional symptoms that used to be considered part of everyday life, and there is a trend of diagnosing disease early before the onset of symptoms. “Most of us assume that all this additional diagnosis can only be beneficial. And some of it is. But at the extreme, the logic of early detection is absurd. If more than half of us are sick, what does it mean to be normal?” More importantly, the epidemic of diagnoses creates an epidemic of treatments, and we know that almost all treatments involve risks for patients’ health. article »

Ariz. ERs Face Patient Crunch, Staff Shortages
Jodie Snyder, Arizona Republic, August 14, 2006

Jodie Snyder of the Arizona Republic recently shadowed Dr. Todd Taylor on his last emergency room shift at Phoenix’s Banner Good Samaritan Medical Center.  She writes: “The Arizona Republic has identified at least 15 doctors who left this year or who say they’re leaving.  Todd Taylor is one of them, fed up with employee shortages and too many liability-driven precautions and delays.”  These liability-driven precautions become evident with Dr. Taylor’s first patient – a female diabetic with high blood pressure, complaining of a severe headache.  After examining the woman, Dr. Taylor heads to the nurses’ station to write out orders, implementing what he calls "the most expensive instrument in medicine: the doctor's pen."  The orders that he writes total more than $500 for the visit.  While "Taylor worries that he orders tests that are unnecessary, costly and time-consuming . . . every patient who comes into the emergency department is a pop quiz, with huge consequences for the patient and Taylor, if he doesn't find the right answers."  Taylor tells Snyder that although multimillion-dollar verdicts against ER physicians are not common, "hearing about them makes emergency doctors nervous." article »

Malpractice Lawsuits Spurring Growth in 'Defensive Medicine'
Tracey Birkenhauer, Ann Arbor Business Review, June 22, 2006

“Even though medical malpractice filings are down [in Michigan],” writes Tracey Birkenhauer of the Ann Arbor Business Review, “the litigious environment in which doctors operate has tempered the way they practice medicine.”  “[D]efensive medicine,” one Michigan doctor tells her, “dictates much of today’s standard of care.”  The Michigan State Medical Society, Birkenhauer notes, has put forward several proposals to reform the state’s malpractice system, including the idea of instituting a system of special health courts. article »

Doctors Order Needless Tests, Say Experts
Lee Bowman (Scripps Howard News Service), Seattle Times, May 20, 2006

According to a new study, “[n]eedless medical tests,” possibly prompted by fear of malpractice lawsuits, “are costing the U.S. healthcare system potentially billions of dollars a year and are adding unnecessarily to patient stress.”  The study found that “at least one of three common exams -- urinalysis, electrocardiogram and X-rays -- was inappropriately ordered for 43 percent to 46 percent of the patients.”  The cost of these unnecessary procedures is projected at $47 to $194 million annually.  Dr. Dan Merenstein, an assistant professor of family medicine at Georgetown University Medical Center and lead author of the study said that "[m]any physicians, as well as their patients, appear to believe that a routine health exam should include a number of tests they feel can screen for unknown diseases, but the evidence shows that some of these tests are less than beneficial when used in this way."  The study cites malpractice fears as one reason why physicians may be ordering the extra tests. article »

NJ Among Highest in C-sections
Jessica Adler, Herald-News, May 9, 2006

“This is all fueled by an absolute paranoia of being sued," explains Dr. Roger Kierce, chairman of the department of Obstetrics and Gynecology at St. Joseph's Regional Medical Center in Paterson, commenting on the rising rate of C-section births both in New Jersey and nationwide.  The rise, he relates, is the result of doctors practicing defensively: "It's terrible.  Things we would have sat on 10 years ago and (performed vaginal births for) – kids who end up doing great – will go to C-Section these days because of the lawsuits."  C-sections accounted for 29.1% of all births in 2004, up 40% over eight years.  At over 33%, New Jersey had the highest national rate in 2004 – since 1999, the statewide rate has increased by 6% a year. article »

Doctor Says Big Medicine at Core of Health-Care Crisis
Kim Trigilio, Beverly Citizen, April 20, 2006

In a new book, A Pediatrician’s Journal: Caring for Children in a Broken Medical System, pediatrician Dr. Brian G. Orr “takes aim at … practicing medicine under the constant threat of malpractice lawsuits.”  “What people want and need is a connection with their doctor,” he states.  “Yet there are pressures in the healthcare system, that decrease the value of that."  One such pressure is doctors’ need to practice “’defensive medicine.’”  Orr argues: “It is one of the biggest costs in medicine that no one ever talks about.  We have to order an MRI just to prove they don’t have a brain tumor, even though we know they don’t."  He relates how he was once sued by the mother of an autistic child for allegedly providing her poor breast-feeding counseling – and even though he won the suit, he explains that “[i]t is a horrible thing to go through.  You doubt yourself and practice more defensively. …  It was five weeks of torture defending myself, all because of the power of the people bringing the suit."  Moreover, he explains, our current medical justice system stymies communication between providers, endangering patient safety:  "Nobody wants to admit that they made any mistakes.  It is not an environment where you can talk about what works and what failed.  Practices become more secretive.  You don’t want to open yourself up to criticism that can lead to a lawsuit."

Don't Take This Lying Down
Sarah Bilston, New York Times, March 24, 2006

In an opinion piece questioning the wisdom of prescribing bed rest to women with complicated pregnancies, Sarah Bilston, a professor of English at Trinity College, relates that “doctors in other counties are far less likely to prescribe it.”  Judith Maloni, a professor of nursing at Case Western, theorizes that part of the reason 92% of U.S. doctors prescribe some form of bed rest is because of legal fear.  Bilston writes, “Bed rest convinces patients and doctors alike that everything possible is being done to sustain a difficult pregnancy.  And it is, after all, cheap to prescribe.” opinion »

Placentas Taken, but Moms Were Not Told
Susan Goldsmith, Oregonian, February 12, 2006

According to a recent report in the Oregonian, legal fear drove some hospitals in Oregon, Washington, and California to take the drastic – and some say unethical – step of registering placentas with “a Portland institute created and financed by the insurance industry, in part to help health care providers defend against birth-injury lawsuits.”  Between 1996 and 2003, around 700 placentas from difficult births were sent – often without the mothers’ knowledge – to the Cascadia Placenta Registry for analysis.  Legal experts argue that the practice did not violate state or federal laws, but leading ethicists criticize the fact that many providers did not seek explicit permission to analyze the placentas, and that the registry was maintained by an organization financed by the insurance industry.  “‘If you're going to take things from patients – extract DNA or use them as potential sources of defense in litigation – subjects have an absolute right to know that and must consent or not,’” argues one medical ethicist.  “‘To have insurance companies collecting this stuff is very problematic.’”  It was done, a former executive of one of the registry’s primary underwriters argues, because birth-injury cases have become “‘a huge lottery.’”  “‘Errors are made, and families should be compensated,’” he explains.  “‘But there are other cases where it’s quite clear – particularly with cerebral palsy – that they are not due to malpractice.  But you have such a sympathetic witness with the damaged child that emotional awards are made out of proportion to fault or the damage done.’” article », editorial »

Doctors' Delicate Balance in Keeping Hope Alive
Jan Hoffman, New York Times, December 24, 2005

In an article examining doctors’ use, or lack thereof, of “[t]he language of hope” when dealing with the critically ill, the New York Times relates that legal fear may be contributing to some doctors’ preference for painting the bleakest picture possible for their sick patients: “Now, whether a patient comes in complaining of a backache, a rash or a lump in the armpit, many doctors interpret informed consent as the obligation to rattle off all possibilities, from the best-case to worst-case situations.”  The article goes on to quote a Stanford medical school psychiatrist who states, “’There are doctors who paint a bleaker picture than necessary so they can turn out to be heroes if things turn out well, and it also relieves doctors of responsibility if bad things happen.’” article »

More Women Choosing Caesarian Births
Jacob Goldstein, Fort Wayne News Sentinel, December 9, 2005

The threat of lawsuits is cited by many South Florida doctors as “the most important factor driving local C-section rates above national averages.”  While the national average reached a new high last year, with 29% of newborns being delivered by C-section, the percentage in South Florida was an all time high as well – at 37%.  And while C-sections, generally, can result in greater complications during birth, it is because those complications “tend to be associated with the mother, not the baby” that lawsuits arise.  “‘When the expectations for the outcomes are so high that anything less than the perfect outcome is unacceptable, the tendency is always to want to go back and say, ‘If a C-section had been performed …’,’” says one Hollywood, FL obstetrician.  He adds, describing why many doctors, despite the risks to the mother, opt for performing C-sections over vaginal births, “In South Florida we are obviously in a very litigious environment. … The thing that makes a difference here is the fear of litigation.”

Specter of Medical Liability Creates Enormous Cost
Op-ed, Olympian, November 28, 2005

Illustrating how the practice of “defensive medicine” raises the cost of health care, a recent piece in the Olympian recounts the case of a construction worker who went to a Washington State hospital complaining of jaw pain, after falling 20 feet from scaffolding, and did not leave until after an estimated $20,000 worth of tests had been performed on him.  The man's attending physician (the author of the piece) confirmed a diagnosis of a broken jaw, and says that the ensuing CAT scans and additional tests performed after the diagnosis – and over his objections – were the result of “a broken system driven by fear.”  He writes, on the additional tests and our current medical liability system, “I am certain no one thought that these tests would add to this patient’s care, but everyone felt relieved of their liability risk.  The shroud of medical liability is strangling all of society in more ways than most anyone knows.  This case is an example of what occurs daily in every ER and doctor’s office throughout our country."

C-Sections in the U.S. Are at an All-Time High
Associated Press, Arizona Republic, November 15, 2005

The rate of Caesarean sections in the U.S. has climbed to an all-time high, in part due to malpractice concerns, according to a recent report by The National Center for Health Statistics.  In 2004, 29.1% of all births were Caesarean up from 27.5% in 2003.  This increase comes despite efforts by public health authorities to bring down the number of such deliveries.  Liability concerns have led some hospitals to ban vaginal births for mothers with previous C-sections.  Tonya Jamois, president of the International Cesarean Awareness Network, said "Women are struggling to avoid unnecessary surgery, but the medical system has abandoned them. For many, they have to submit to major surgery in order to get medical care."

ANA: CT Advice From NCI Ignored in the ER
Ed Susman, MedPage Today, September 27, 2005

Research presented at the 2005 annual meeting of the American Neurological Association reveals that despite a National Cancer Institute memorandum advising caution in the use of CT scans for children in the ER, their use has increased, possibly due to malpractice concerns.  Reviewing data from a hospital in West Virginia, researchers found a three-fold increase in the use of CT scans on children in the ER.  The authors posit that the increase may be due to physicians practicing "defensive medicine.” article »

Battle Lines Drawn Over C-Sections
Rita Rubin, USA Today, August 23, 2005

At more and more hospitals, women are being forced to undergo unnecessary c-sections just because they have already had one in the past. Doctors and hospitals say that they fear lawsuits if they allow a patient to have a vaginal birth after a previous c-section--known as a VBAC--and something goes wrong.

"'We think the risk is more of a legal risk than a medical risk,' acknowledges Bob Wentz, CEO of California's Oroville Hospital, which banned VBACs two years ago"

The trend is visible around the country:

• In Flagstaff, Ariz., an obstetrician/gynecologist says she was reprimanded by her colleagues for arranging to do what her own patients could not: have a VBAC at her own hospital.
• In North Platte, Neb., a mother of five delivered baby No. 6 at home after the local hospital suggested that because she had had one C-section, she temporarily relocate to Denver or Omaha--each nearly 300 miles away--if she wanted to deliver vaginally.
• In Oklahoma, most OB/GYNs won't allow patients to attempt a VBAC because their malpractice insurance no longer will cover claims resulting from such births.

article »

Medical Malpractice Concerns Lead to More Breast Biopsies
Radiologoical Society of North America, Press Release, July 28, 2005

Compared to their colleagues in other parts of the world, radiologists in the United States have "higher recall and false-positive rates, possibly due to heightened concern about medical malpractice." In fact, a new survey of radiologists found that "more than half (58.5 percent) indicated that this concern moderately to greatly increased their number of recommendations for breast biopsies, and 72.4 percent reported their concern moderately or greatly increased their number of recommendations for diagnostic mammography or ultrasound. ... 'The majority of women who are called back for additional testing after a screening mammogram do not have any evidence of breast cancer on subsequent evaluation.'"

"Women are extremely anxious about breast cancer. More testing leads to more anxiety among women," said Joann G. Elmore, MD, MPH, associate professor of medicine at the University of Washington School of Medicine and lead author of the new study. "Failure or delay in breast cancer diagnosis is one of the most prevalent and expensive conditions in malpractice claims leveled against physicians. ... A related study published in Radiology found that one-third of radiologists considered withdrawing from interpreting mammograms because of malpractice concerns."

Related: Defensive Medicine Widespread, with Serious Consequences

Fear of Lawsuit Could Put You in Hospital
Angela Stewart, New Jersey Star-Ledger, July 13, 2005

When an emergency room physician is faced with the decision to admit or not admit a patient, the fear of being sued can have a significant impact on that decision. This according to a new study that rated 33 physicians as having a "low, medium or high fear of malpractice suits," and then examined records involving those physicians to determine their treatment of patients with "symptoms suggestive of heart disease." "Overall, the survey found that emergency physicians who had the most fear of malpractice suits were less likely to discharge low-risk patients when compared with emergency physicians with less fear. Patients seen by physicians with high fear of being sued also were more likely to be admitted to an intensive care or observation unit. These doctors were also more likely to order additional testing. ... Of the 7 million people who seek emergency department care for chest pain or other cardiac symptoms like shortness of breath, about half end up hospitalized or admitted to observation units. The majority of those admitted, however, are subsequently found not to be experiencing a heart attack or to have any heart problems. ... This kind of "defensive" medicine only increases health care costs, maintained lead study author David A. Katz."

26% of Births in City are Caesarean Deliveries, Study Says
Marc Santora, New York Times, July 13, 2005

New York City's Public Advocate, Betsy Gotbaum, is taking aim at the high Caesarean rate at some city hospitals. City-wide, the Caesarean rate is 26.4%, about equal to the national average, but nine hospitals report Caesarean rates of over 30 percent. "There is a tremendous risk," in conducting such surgeries unnecessarily," Gotbaum told the Times. The Centers for Disease Control and the World Health Organization recommended Caesarean sections be used "only in cases in which a vaginal birth would put the health of the mother or baby at risk. Such a standard, the groups said, would help reduce the rate of Caesarean sections to the 15 percent they recommend." But as Maureen Corry, executive director of the Maternity Center Association pointed out, "[M]alpractice has a lot to do with [high Caesarean rates]. ... Nobody ever sues a provider for doing an unnecessary C-section." article »

Malpractice Fears Color Mammogram Readings
Kathleen Doheny, Forbes, June 28, 2005

In a recent survey of radiologists, a full 72.4 percent said "their malpractice fears moderately or greatly increased the number of recommendations they made for mammography or ultrasound. More than half (59 percent) said concerns about medical malpractice also moderately or greatly increased the number of recommendations they made for breast biopsy." Among the radiologists who had been sued--about half of those surveyed--81 percent said the experience was "very" or "extremely" stressful. article »

Is Bed Rest Bunk?
Dina Roth Port, Baby Talk, June 2005

"Though 90 percent of obstetricians prescribe bed rest to women with complications that increase the risk for preterm labor, such as high blood pressure, carrying multiples, and vaginal bleeding, no solid studies have ever shown that it's an effective treatment. In fact, according to the American College of Obstetricians and Gynecologists (ACOG), 'bed rest does not appear to improve the rate of preterm birth and should not be routinely recommended.' And yet, doctors continue to do so to nearly 700,000 expectant patients--about one in five--each year. ... Liability and fear of medical malpractice play a role too. 'Obstetrics is a field often subject to inertia--doctors have to be conservative because we're dealing with two patients and there's that much more risk,' explains Charles Lockwood,M.D., chairman of the department of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine in New Haven, Connecticut."

Malpractice Fears Put Doctors on Defense
Alan Bavley, Kansas City Star, June 1, 2005

"When Geoffrey Blatt went to medical school, he was taught not to order unnecessary tests for his patients. Now, even some patients with headaches get brain scans. 'You're afraid of the one-in-10,000 patient that may have a brain tumor,' the Kansas City neurosurgeon said. And afraid that the patient may sue for malpractice. ... '[Defensive medicine] is so prevalent at this point that it is verging on becoming the standard of care,' Blatt said." Be sure to read about the study on defensive medicine published in the Journal of the American Medical Association. Ninety-three percent of Pennsylvania physicians reported practicing defensive medicine.

Defensive Medicine Widespread Among Physicians in High-Risk Specialties
News-Medical.Net, May 25, 2005

Do doctors practice defensive medicine, and what is the harm if they do? According to a new study published in the Journal of the American Medical Association, "[m]ore than 90 percent of surveyed physicians in Pennsylvania reported defensive medicine practices, such as over-ordering diagnostic tests, unnecessary referrals and avoidance of high-risk patients. ... 'Assurance behavior' such as ordering tests, performing diagnostic procedures, and referring patients for consultation was very common (92 percent). ... Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious."

The authors write, "The most frequent form of defensive medicine, ordering costly imaging studies, seems merely wasteful, but other defensive behaviors may reduce access to care and even pose risks of physical harm. Because both obstetrics and breast cancer detection are high-liability fields, women's health may be particularly affected." article »

Defensive Medicine
Daniel Fisher, Forbes, April 15, 2005

Aspect Medical Systems has created a device that may help prevent anesthesia awareness--the rare but terrifying experience of waking up during surgery to find oneself "[p]aralyzed by powerful drugs yet aware of everything going on." But not all doctors are rushing to embrace Aspect's Bispectral Index Monitor. Some "fear the machine is yet another example of a technological advance that gives doctors useless or ambiguous information in the operating room but can provide a treasure trove of evidence in the courtroom. ... [Doctors] remember the fetal heart monitor, introduced with great enthusiasm in the 1970s as a way to cut down on birth injuries by alerting doctors to fetal distress in time to remove the baby via Caesarean section. Subsequent research has shown the device doesn't reduce the incidence of cerebral palsy, which results in some of the most costly malpractice judgments against obstetricians. The paper record it produces, however, is a virtual script for trial lawyers seeking to convince jurors that somebody screwed up."

Edward Richards, director of Louisiana State University law school's program in public health, told Forbes that the monitor would help physicians, but courts should adopt "a simple change": "Paid experts should see the record as the treating physician did, bit by bit in time order. 'It's actually impossible to judge the physician's behavior fairly when you know the outcome.'"

Doctors Worry Video of Baby's First Moments Could be Legal Weapon
Associated Press, March 21, 2005

Many parents cherish videotapes of their baby's first moments, but worried about lawsuits, some doctors and hospitals are putting restrictions on videotaping in the delivery room. "What once used to be really fun and warm and cozy and so forth is now a potential nail in the coffin from a liability perspective," said John C. Nelson, a Salt Lake City obstetrician. article »

Lawsuit Could Change Pediatric Practice
Michelle Paynter, WTOC-11 (Savannah, GA), March 16, 2005

Doctors at Pediatric Associates of Savannah say they are now "very hesitant" to call in prescriptions without first seeing a child in person--something they used to do regularly for minor ailments like diaper rashes and runny noses. The change in their prescription policy comes after a jury "awarded more than $3 million to a boy who sued Pediatric Associates ... for malpractice," claiming among other things that "his doctors prescribed him medication without seeing him in person." But the change will be hard on some parents. "Especially being a working mom," said Rachel New. "It's difficult to take off and bring them to the doctor, so it would be hard and irritating to not be able to [have the doctor call in a prescription without seeing the child]." And time isn't the only cost to parents: Doctors "will also be referring many of their patients to specialists as an added safeguard. That will cost parents more money." article »

Jersey Delivers Wide Range of C-section Rates
Carol Ann Campbell, Star Ledger, March 5, 2005

Some hospitals in New Jersey have a C-section rate of more than 40 percent, contributing to the statewide average of 33.1 percent--the nation's highest. "Many in the field blame litigation. Doctors fearful of being sued, and already hit with high malpractice premiums, may be quicker to perform the surgical procedure than in the past." The national average C-section rate is 27.6 percent--far too high, according to some activists. "A Caesarean section is major abdominal surgery to deliver the baby. The procedure requires anesthesia and several days in the hospital. A release by the American College of Obstetrics and Gynecology cited a study that found a woman's risk of dying in childbirth was 'significantly' higher with Caesarean, or 35.9 deaths per 100,000 deliveries, compared with 9.2 deaths per 100,000 vaginal deliveries."

A Prescription for Retirement
Jason Main, Newark (OH) Advocate, February 1, 2005

After 32 years as a pediatrician, Dr. John Adams of Newark, OH, is retiring because the cost of liability insurance has "risen to the point that continuing to practice is untenable." Dr. Adams told the Newark Advocate about the troubling realities of unreliable law and defensive medicine: "With the potential of lawsuits hanging over their heads with every patient they see, Adams contends, doctors have become more cautious and conservative in their treatment plans. They are more likely to order lab work or seek the advice of specialists than in the past in order to minimize the risk that patients will suffer unexpected ailments. Any time a patient has an unfavorable result during the course of treatment, there is the potential of a suit being filed, whether the physician is at fault or not, he said. 'It's like holding you to a standard of absolute perfection, which no one can achieve.'"

The Horror of Medical Lawsuits
Thomas Sowell, Human Events, January 25, 2005

Thomas Sowell writes about a two-part test for cancer he underwent several years ago: "The first part was uncomfortable but not painful or with any great risk of infection. After a young doctor had put me through this part, an older specialist took over and examined the results--and he decided not to proceed with the second part of the test. ... [T]he chance that I had cancer was sufficiently small, and the danger of infection from the test itself was sufficiently large, that the best choice was not to go any further." Sowell appreciated the doctor's decision, but he notes, "[H]ow many doctors feel free to make such choices in today's legal climate? ... After so many megabucks awards grew out of claims that babies born with cerebral palsy could have been spared if only the doctor had delivered them by Caesarean section, C-section births rose sharply. But it did not reduce cerebral palsy."

In addition to highlighting how legal fear can sometimes turn the course of treatment away from a patient's best interests, Sowell also notes that our unreliable system of justice is damaging the doctor-patient relationship. "Trust between doctor and patient is not a small thing. Sometimes it can be the difference between life and death. Our laws recognize the enormous importance of that relationship by exempting doctors from having to testify to what a patient has told them, even if it is a murder case. To go to these lengths to protect the doctor-patient relationship -- and then blithely throw it away with easy access to frivolous lawsuits makes no sense." article »

Overuse of Medical Scans Is Under Fire
Vanessa Fuhrmans, Wall Street Journal, January 12, 2005

Medicare is joining the effort of private insurers to "curb the sharply escalating costs of MRIs and other scans"--now "approaching $100 billion a year" nationwide. Among the changes that a Medicare advisory panel will recommend to Congress are reducing payments for some scans and reducing the number of imaging centers that "meet certain quality criteria in order to bill Medicare for services." But vital legal reforms are not mentioned among the panel's recommendations. We need a system of medical justice that defends the reasonable decision not to order an expensive scan. There must be a standard of care that doctors and patients can rely on, rather than a (non-)standard that changes from one jury to the next.

"There were a remarkable 45.4 million CT procedures performed in 2002 nationwide ..., compared to 39.6 million in 2001. ... National Imaging Associates estimates from its own experience that about one-third of advanced imaging tests are either inappropriate for the medical problem at hand, or don't contribute to a doctor's diagnoses or a patient's outcome."

Related: IN DEPTH: CT Scans and the Fear of Being Sued.

Report: Lawsuits Limit Cancer Tests
Carrie Johnson, St. Petersburg Times, December 21, 2004

In Florida, a governor-appointed task force reports that lawsuits are "discouraging radiologists from offering mammograms." Radiologists have good reason to be afraid. As many as 17 percent of tumors are "missed during at least one exam." And in 2002, a study of 25 insurance companies conducted by the Physicians Insurers Association of America found that "radiologists accounted for 33 percent of all claims and the most common allegation against radiologists was 'mammogram misread.'" Six seats are available in breast-imaging fellowship programs across the state of Florida, but none are filled. In fact, "a recent survey of 211 radiology residents showed that 63 percent of students wouldn't accept a fellowship in breast imaging." "Why would they jeopardize their lives and their careers if it's not absolutely necessary?" said Dr. Ada Patricia Romilly, a member of the Florida task force. article »

Take Two Torts and Call Me in the Morning
Lawrence K. Altman, M.D., New York Times, December 14, 2004

Trial lawyers need doctors too, but how does the patient's profession impact the doctor-patient relationship? Some doctors act defensively, ordering "extra tests to be sure they do not miss something and become one of their patient's next victims. And a small number of doctors--no one knows exactly how many--have refused to treat lawyers." For their part, some lawyer patients "try to avoid identifying themselves as lawyers on doctors' intake forms. ... [They worry] they might be subjected to overtesting because of their profession, and thus risk having unnecessary procedures. But other lawyers are emphatic in letting the doctor know their occupation: They believe the extra tests they may get will lead to better care."

Increase in C-sections Spurs Ethical Debate
Michael Flynn, Asheville Citizen Times, November 15, 2004

The number of births by Caesarean section increased by seven percent between 2001 and 2002, in part because of liability concerns. "They now account for more than one in four births, the highest rate ever reported in the United States. ... Defensive medicine has resulted in C-sections being performed earlier in labor or with less definitive medical indications, [Dr. William Brannan of Ashville's Mission Hospitals] said. 'Once a woman mentions C-section as a possibility, physicians are reluctant to encourage her to continue laboring because any problem with the delivery or the child will be blamed on the physician not doing a C-section in a timely fashion,' he said."

Related: IN DEPTH: Law and the Realities of Medicine

Studies Raise Questions on Value of Intensive Care
Ceci Connolly, Washington Post, October 8, 2004

New studies conducted by Dartmouth Medical School have found that more intensive medical care "does not necessarily translate into longer life or better health and may in fact leave patients worse off. ... Elderly patients with chronic illnesses who stay in the intensive care unit longer, receive more diagnostic tests or are treated by numerous specialists do not fare better than those who receive less intensive care." Unfortunately, our unreliable legal system often does not protect the decision to provide less-intensive care.

The Dartmouth studies "lend support to a growing movement in health policy circles toward 'evidence based medicine' in which doctors adhere to scientifically proven treatments and providers are paid for results rather than procedures." To read more about how the legal system can be hostile to evidence based medicine, see "Winners & Losers" by Dr. Daniel Merenstein.

IN DEPTH: CT Scans and the Fear of Being Sued
Comments on "CT Scans May Get Overused"
Joe Pellicer, Olympian, August 18, 2004

Last year alone, over 60 million CT scans were performed in the United States. Are CT scans overused? It's a complex social and medical question that doctors must wrestle with in their daily practice. More than a social and medical question, however, for doctors it is also a legal question. With CT scans, as in other areas, a pervasive fear of being sued has become a sizable hurdle to finding the right answers--and the right balance--for our society and for our health.

more »

Doctors Spell Out Risks of Childbirth on Consent Forms
Carol M. Ostrom, Seattle Times, August 9, 2004

Seven Seattle obstetricians are drafting a consent form that details "in graphic terms the dangers [patient's] babies face coming into the world, including death, 'permanent severe brain damage,' and other lifelong disabilities." Such a detailed form departs from the usual approach, but the doctors say they need to "force patients--particularly highly educated, perfection-seeking professionals who have never accepted 'bad outcome' as an option--to face a stark reality: In pregnancy, there are no guarantees." While juries typically side with doctors and hospitals in medical malpractice cases, Jury Verdict Research indicates that in cases involving "a childbirth gone wrong, . . . juries sided with patients 60 percent of the time in 2002, up from 34 percent two years earlier." (Most medical malpractice cases do not go to trial, ending in settlement instead.) article »

Health Care Costs

May I Say: Band-Aids Won't Fix Health Crisis
Debbie Griffin, River Falls Journal, February 15, 2008

This Wisconsin editorialist discusses the myriad reasons why healthcare in the US is reaching crisis level.  Insurance companies and pharmaceutical industries dictate the care people receive more and more, and at ever greater cost.  More individuals are forgoing regular checkups or insurance coverage altogether so that they pay off other expenses - like mortgages or groceries.  Moreover, pharmaceutical companies send the message that there is a pill for everything - resulting in more medicating, more testing, and ultimately more spending.  Physicians are paid for performing costly, and often unnecessary, procedures and are sued for failing to do so, and those costs are passed on to the consumer.  "How much less could care cost without that overhead? If it came with a deep discount on care, patients would line up to sign a release waiver on their way in." » article 

Health Insurance Costs Stymie Small Businesses
James Arvantes, AAFP News Now, January 29, 2008

The escalating cost of health insurance has made it hard for owners of small businesses to provide health benefits for themselves and their employees.  “Between 2003 and 2008, the cost of a single policy has increased 80 percent, an average of 16 percent a year,” testified Dr. Stephen Eby in front of the House Committee on Small Business.  “I suppose when these people become ill, they will have to go to the emergency room and pray the hospital bills don’t drive them into bankruptcy.”  A ranking committee member asked if the U.S. legal system and frivolous lawsuits have played a role in driving up insurance costs.  Dr. Eby commented that medical malpractice laws are a “significant problem” that increase both insurance premiums and medical costs in general.  Emergency room doctors have to practice defensive medicine to avoid lawsuits.  “From the ER doctor’s perspective, they don’t know the patient, and they cannot afford to miss anything,” he said. “If you walk into the ER with a headache, you are going to get a CT scan, almost guaranteed.  If you walk in with a sore throat, you will probably get a blood test.” » article

Pennsylvania's Crisis is not Over
Lewis Sharps, The Bulletin, January 11, 2008

While Pennsylvania’s malpractice environment has improved recently, there is still much work to be done, according to Dr. Lewis Sharps, an orthopedic spine surgeon and president of Pennsylvania’s physician-driven malpractice insurance company.  Several years ago, a deluge of lawsuits caused a surge in malpractice insurance costs that threatened the state’s supply of doctors.  Access to medical care was endangered as prohibitive liability premiums coerced many specialists and practices to either close or move to other states.  Trauma centers were left struggling, further jeopardizing patient care.  However, legislation in the form of government subsidies (state-signed checks serving as a band-aid for larger system deficiencies) helped reverse the problematic situation.  But more fundamental flaws in the medical malpractice system still exist.  “Defensive medicine” – unnecessary treatment used out of legal fear – is an epidemic pushing general health care expenses even higher.  Moreover, the injured patients are badly served by the current system: only $0.28 from every settlement dollar goes to a plaintiff (the rest goes towards administrative costs such as attorney fees).  However, Dr. Sharps does have some advice: improve the quality of care and stem the flow of patients injured by medical treatment.  “Remember, no one wins a malpractice claim,” writes Dr. Sharps.  “It’s only a matter of how much it costs.  It is cheaper to prevent a claim than defend and win one.” » article 

Doctor Shortage Pushes Health Costs Up, Queen's Experts Say
Webwire, November 20, 2007

A recent Canadian study highlights how many patients are unable to receive continuity of care because primary care physicians are in short supply.  This trend is driving up the overall cost of health care, as patients with the most need are not able to see their physicians.  Elderly patients are the biggest users of the health care system, and access to continuous care from a single physician would help improve quality and reduce costs, say researchers.  “Citing new evidence that a strong relationship with their family doctor can result in fewer trips by Canadians to the emergency department and hospital admissions, two Queen’s researchers are calling on provincial governments to strengthen health-care delivery models that promote continuity of care.” » article

A Costly Remedy
Alan Wechler, Albany Times Union, September 16, 2007

In an effort to save money, New York hospitals and health care facilities have been ordered to consolidate.  However, the administrative challenges and unexpected costs may prove significant.  As hospitals close in order to merge with other facilities, they are required to purchase “tail” insurance, a large malpractice policy to cover any claims that may arise after the hospital closes its doors.  These multi-million dollar policies, along with the challenges of closing or relocating facilities could drive costs into the billions.  New York State’s annual health care bill is about $45 billion, one of the highest in the country, and these changes were initiated in an effort to save money.  It seems, however, that the changes may not prove financially worthwhile. » article

City Takes Its Lumps: Pays $496M in Claims
Maggie Haberman, New York Post, August 24, 2007

Last year New York spent $496.4 to resolve liability claims, with the majority of those claims arising from hospital malpractice cases.  Despite an overall decrease in the number of malpractice claims filed, costs continue to rise, and remain some of the highest in the country.  Settlements against the city’s hospitals went up to $152 million, a 20 percent increase from the previous year, and malpractice claims alone accounted for $155.2 million, a 6 percent increase.  The Insurance Commissioner recently announced a 14 percent increase in malpractice premiums for the coming year due to the highly litigious market.  Governor Spitzer has formed a task force to investigate solutions to the problem. » article

Health-Care System's Critical Condition
Wayne King and James Toole, Winston-Salem Journal, August 11, 2007

Health care is a hot-button issue in the 2008 presidential campaign. But despite all the attention given to the subject, we are not focusing enough on some of the reasons why our health care is so expensive in the first place. The cost of medical malpractice insurance continues to climb. In an effort to protect themselves from malpractice, doctors order scores of tests and procedures, many of which they acknowledge are not medically necessary. Though more patients would be compensated under the health court system, overall malpractice costs would decrease and doctors could practice medicine without fear of liability. » article

An Unhealthy Burden
The Economist, June 28, 2007

A recent study examining our health care system shows a system burdened by cost and lacking in benefits.  The Duke University study separates health care costs into five categories: medical torts; the Food and Drug Administration (FDA); insurance regulation; and the certification of both health professionals and health facilities.  The figures for medical torts show net expenses that run near $80 billion and benefits of less than half that figure - just one example of how our system fails to deliver for the amount of money we pay. » article

Dealing with Medical Malpractice in Court
Sarah Starr, Register Citizen, May 22, 2007

A Connecticut newspaper details how our current medical liability system hurts both patients and providers.  Though thousands are injured each year in hospitals, less than 2% ever take their claims to court, often because the rewards are deemed to low to make the case worth pursuing.  Defensive medicine drives up the cost of care by 10%, according to a 2006 study by PricewaterhouseCoopers.  Additionally, high liability premiums can force doctors to relocate, cut services or leave the profession altogether.  In fact, in some states, some physicians practice without liability insurance to be able to continue practicing.  "The whole system is upside down," William Plested, President of the American Medical Association said. "It goes after the most qualified people we have." » article

Most Support U.S. Guarantee of Health Care
Robin Toner and Janet Elder, New York Times, March 2, 2007

According to a New York Times/CBS News poll, “[a] majority of Americans say the federal government should guarantee health insurance to every American, especially children, and are willing to pay higher taxes to do it.” At present, more than 15 percent of Americans go without health insurance – and increase of 6.8 million since 2000. The poll also relates that “an overwhelming majority … said the health care system needed fundamental change or total reorganization,” but that a consensus as to what should replace it did not exist. Common Good has garnered a wide array of support for its efforts to improve one area of the current system – how it adjudicates claims of malpractice. Common Good believes that by restoring reliability to the medical justice system – through the establishment of health courts – health care costs can be contained and insurance made more affordable. article »

Medical Care Hikes Prompt Increase in Consumer Prices, Report Finds
Kaiser Daily Health Policy Report, February 22, 2007

An increase in medical prices drove up consumer prices in January 2007, according to a report by the Department of Labor. Analysts attributed the increase in medical costs to increased costs for prescription drugs and physician services. According to David Wyss, chief economist at Standard & Poor's, "We got a nasty little surprise from the health care sector. This is definitely a worrisome inflation report." In addition, analysts said that medical prices in January increased by 4.3% from the previous year and likely will continue to increase as baby boomers age and require more health care. article »

A Dog's Breakfast
Daniel L. McFadden, Wall Street Journal, February 16, 2007

Wall Street Journal columnist Daniel McFadden argues that in order to control our healthcare costs, "[f]irst, we need to wring out some of the inefficiencies" permeating our healthcare system. "We spend $6,102 per person on health care each year, nearly 17% of GDP," while Canada's single-payer system costs $3,165 per person per year, about half our expenditure, or 10% of their GDP, and both countries achieve similar health outcomes. McFadden writes that "[s]omething like 30% of our health costs come from administrative overhead, legal costs and defensive medicine." article »

Guest Commentary: For Doctors, Patients, Malpractice Trials Should Change
Scott Ross, M.D., Napes Daily News, January 17, 2007

In an op-ed in the Naples Daily News, Dr. Scott Ross examines the indirect costs of our medical liability system on doctors and patients. “[His] presence in the courtroom removes the doctor from the office, creates havoc with his practice and can devastate him financially. Staff must still be paid, lest they move on to greener pastures. And the patients still have needs. Who will treat them while the trial continues? And when can the doctor see his or her patients?” Dr. Ross proposes a new system somewhat similar to Common Good’s proposal for special health courts, in which expert judges would decide medical malpractice cases. article »

Consumer Unease With U.S. Health Care Grows
Julie Appleby, USA Today, October 16, 2006

A new survey by by USA Today, ABC News and the Kaiser Family Foundation reveals that “80% of respondents said they were dissatisfied with the total tab the nation spends on health care, estimated to hit $2.2 trillion, or $7,129 a person, this year. The survey, based on a national sample of 1,201 adults, has a margin of error of plus or minus 3 percentage points.”  When asked what was primarily? contributing to the increase costs “37% blamed too many medical malpractice lawsuits.” article »

New Harvard Study Finds Current Medical Justice System Inefficient
Study: Four out of 10 Medical Malpractice Cases Are Groundless
Alicia Chang, Associated Press, May 11, 2006

A new study by researchers at the Harvard School of Public Health reveals that about 40% of medical malpractice lawsuits involve either no evidence of injury to plaintiffs (3% of all claims) or no medical error by providers (37% of claims where an injury occurred).  And while 72% of claims with no evidence of provider error are either “thrown out or otherwise resolved without a payout to the patient,” the study also reveals that the average cost of litigating a claim is $52,521, which represents about 54% of a plaintiff’s compensation, and that it takes, on average, five years to resolve a claim.  Addressing the inefficiency and cost of our current system, Michelle Mello, one of the study’s co-authors, recommends that “[f]inding ways to streamline the lengthy and costly processing of meritorious claims should be in the bullseye of reform efforts." article »,  press release »

Report: Malpractice Claims Dip, Costs Up
Carol M. Ostrom and Ralph Thomas, Seattle Times, October 5, 2005

Reflecting the high costs of our current system of medical justice, a new report by the Washington State Insurance Commissioner’s office reveals that the average cost to defend medical malpractice cases in Washington has continued to increase sharply for each of the past three years, even while the number of malpractice claims filed has fallen.  From 1996 to 2005, the average cost to defend each claim has more than doubled. article »

National Education Campaign Reveals Americans' Concerns About Lawsuit Abuse
SickofLawsuits.org, PR Newswire, September 12, 2005

A national survey reveals that “seventy-nine percent of Americans are concerned that frivolous lawsuits make it harder for them and their families to get affordable healthcare.” article »

Maryland Probes Doctors' Extra Administrative Fees
Marguerite Higgins, Washington Times, July 21, 2005

In Maryland, some doctors are taking the controversial--some say illegal--step of imposing a surcharge on patients to cover escalating malpractice insurance costs. "Drs. Esposito, Mayer, Hogan and Associates PA, a Columbia, Md., obstetrics/gynecology practice, in May began asking for a $25-per-patient annual fee. 'Recently, medical malpractice rates have skyrocketed out of control and will have a major impact on our practice ...," the practice said in a letter informing patients of the surcharge." The fee is voluntary and "not applicable to patients on government insurance programs," and "[t]he practice will not turn away patients who refuse to pay the extra charge." But the Maryland State Medical Society has "cautioned doctors that a surcharge could ... [cause] patient alienation," and the Maryland Citizen's Health Initiative says it is "concerned the office fees could limit patient access to care." The Maryland Attorney General's Office has said that "such a charge violates the state HMO law's prohibition against balance billing of HMO members." Malpractice insurance rates have increased 128 percent for Esposito and Associates over the past three years. article »

Medical Malpractice Cap Measure Causing Flood of Lawsuits
Tawney Saylor and Brian Nanos, Northwest Indiana Times, July 6, 2005

A typical large hospital in Chicago must "set aside about $60 million a year to pay for jury verdicts," according to Danny Chun, a spokesman for the Illinois Hospital Association. "This means less money for nurses, less money for new technology, less money for doctors," Chun said. The current legal system fails to balance the interests of everyone. A few injured patients receive enormous jury verdicts, but all patients face rising costs and diminished access. article »

Health Care Costs, Spending Up
Ceci Connolly, Washington Post, June 21, 2005

Medical costs grew four times faster than wages in 2004, marking the eighth-consecutive year that "the growth in medical costs [has] far outpaced the growth of wages," according to a new study by the nonpartisan Center for Studying Health System Change. This means more Americans "will be unable to afford their health insurance," said the Center's president, Paul Ginsburg. "As health costs have risen over the past decade, more businesses have scaled back or dropped coverage entirely. The first group hit were poor workers, but Ginsburg said the trend is continuing into higher-wage groups." About 45 million Americans were uninsured in 2003. Costly defensive medicine contributes to escalating costs. article »

Malpractice Insurance Crisis Affects Everyone
Elizabeth M. Orsay, M.D., Chicago Tribune, May 25, 2005

The University of Illinois at Chicago "spent $28 million last year alone on malpractice premiums, a 33 percent increase over the previous year," according to an Associate professor at the College of Medicine. Earlier this month, the dean of the College of Medicine, Joseph A. Flaherty, called for the re-examination of medical malpractice "in a manner that differentiates medical neglect and incompetence from the horrendous personal burden resulting from the limits of medical science and the random occurrence of tragedies like birth trauma." In a Chicago Sun-Times op-ed, Flaherty argued that medical liability reforms should accompany larger reforms of the healthcare system. He wrote, "[The United States is] paying far more per capita for health care than other Western countries, yet rank[s] 37th in overall health performance. Health care is now consuming more than 15 percent of the gross domestic product."

Mammography Sites Face Big Bills, Taxes
Kristin Boyd, Asbury Park Press, May 2, 2005

"Before radiology centers can make a profit or even break even, they must surmount some major financial obstacles." Radiology equipment is expensive, reimbursement rates are low and the cost of malpractice insurance is soaring. "Malpractice insurance for physicians at University Radiology [in New Jersey] increased four times during the past four years, according to Tom Dunlap, the company's chief executive officer. Now the group must pay nearly $50,000 a year for each of its 66 radiologists, almost $3.3 million, Dunlap said." Dr. Judy Destouet, chairwoman of the American College of Radiology's Mammography Accreditation Commission, expects a "lack of mammography-certified radiologists to hit home [in the next five to 10 years]."

Med-mal Costs PA Hospitals $636M in 2004, Study Says
Pittsburgh Business Times, May 2, 2005

Following a March report that malpractice payouts in Pennsylvania reached a record high of $448 million in 2004, a report from the Pennsylvania Health Care Cost Containment Council, an independent state agency, says the state's 182 general acute-care hospitals spent $636 million for medical liability coverage in 2004, with "many hospitals choosing to self-insure." In fact, the $636 million figure understates the problem, according to Roger Mecum, executive vice president of the Pennsylvania Medical Society. The report, he said, "did not include data from independent physicians and nurse midwives. It also did not include liability insurance costs for nursing homes. And, let's not forget costs associated with defensive medicine and extensive risk management." article »

A Final Malpractice Warning
Steve Foreman, Philadelphia Inquirer, April 6, 2005

Disturbing news from Pennsylvania: "[M]edical malpractice payouts jumped 14 percent to an all-time high in 2004. ... [E]qually significant: The number of awards did not increase in 2004 and was 13 percent below the all-time high of 1,566 in 2001." Says Steve Foreman, an associate professor of economics and allied health at Robert Morris University, "This clearly shows the role of growing jury awards in the continuing crisis. ... The $447 million paid by insurance companies representing Pennsylvania physicians in 2004 was exceeded only in New York. ... Pennsylvania's average payout per case ($500,000) was exceeded only by Illinois' ($512,000)."

Foreman outlines "four underlying facts" that need to be addressed by "a major overhaul" of the medical justice system: "[1] The current system rewards patients with large injuries and denies money to those with smaller ones because lawyers won't take the cases of the latter. [2] So-called administrative costs, of which lawyers' fees are a large part, use more than half the system's resources. [3] The fault-based system encourages doctors to hide errors, and the system fails to recognize patterns. [4] Jury sympathies and bad outcomes produce awards that may not be justified." Foreman endorses a new system of medical justice with similarities to the health courts proposed by Common Good.

Malpractice Payouts in Pennsylvania Rose in 2004
Mark Levy, Associated Press, March 23, 2005

Insurance companies in Pennsylvania paid out $448 million for malpractice claims against physicians in 2004. That amount represents a 13.5 percent increase over the $394.5 million paid out in 2003, and it breaks the previous record, set in 2001, of $423.7 million. Unfortunately, while a few patients win multi-million dollar verdicts or settlements, most people injured by a medical mistake get nothing. article »

Cost Concerns Have Many Florida Women Forgoing Breast Exams
Mark Hollis, South Florida Sun-Sentinel, March 15, 2005

Experts say that regular mammograms can "substantially reduce [women's] risk of dying from breast cancer. But new studies find that thousands of Florida women, particularly low-income blacks and Hispanics without health insurance, are going without annual tests. High out-of-pocket medical costs, low Medicaid reimbursements, long wait times at radiology centers and a shortage of doctors conducting the exams are making this basic health screening off limits to Florida women without standard insurance coverage." Lawsuits are partly responsible for the shortages, according to a task force appointed by Florida Governor Jeb Bush. As many as 17 percent of tumors are "missed during at least one exam," and in 2002, a study of 25 insurance companies conducted by the Physicians Insurers Association of America found that "radiologists accounted for 33 percent of all claims and the most common allegation against radiologists was 'mammogram misread.'"

Florida isn't the only state facing shortages; the Institute of Medicine reports a "serious decline" in access to mammograms nationwide. IOM also says that an increase in "false-positive" mammogram readings "may be due partly to radiologists practicing 'defensive medicine' in hopes of avoiding lawsuits."

Related: "Report: Lawsuits Limit Cancer Tests," Carrie Johnson, St. Petersburg Times, December 21, 2004

City Paid Millions in Personal Injury Lawsuits in 2004
Associated Press, February 20, 2005

New York City "paid a record $570 million in 2004 on personal injury cases that range from medical malpractice to traffic accidents. The cases cost the city $12 million more than last year. Medical malpractice cases made up nearly a third of the jury verdicts and settlements paid out."

Healthcare Costs Demand Attention
Kristen Gerencher, CBS MarketWatch, February 17, 2005

A study by the Health Reform Program at the Boston University School of Public Health concludes that healthcare spending in the United States is growing beyond sustainability, and that costs will be reduced only by enlisting doctors "as a first step in fighting waste, which now accounts for about half of each health-care dollar spent. ... Physician decisions account for 87 percent of personal health spending, the report said." Yet unnecessary spending will continue until we have a reliable system of medical justice that protects reasonable decisions--like prescribing aspirin instead of a CAT scan for a headache. Said Dr. Alan Sager, a co-author of the Boston University study, "[W]e need to demand that health care gets reshaped in ways that encourage and persuade doctors to take charge of spending money more carefully [and] ... weed out clinical waste." Sager also noted that "waste comes from unnecessary care, defensive medicine, excessive paperwork born of mistrust between insurers and doctors, as well as theft and fraud."

"[H]ealth-care spending is projected to have absorbed 25 percent of all economic growth in the last five years, [the report said]. ... Health-related expenditures will consume 15.5 percent of the total U.S. economy in 2005, up from 13.2 percent of the gross domestic product in 2000. Yet the number of uninsured Americans rose to 45 million in 2003 from nearly 40 million in 2000. Health-care spending dwarfs defense spending and is twice that of education. Each person in the United States spends on average twice the amount on health care compared with other industrialized countries." article »

U.S. Tort Costs Increased in 2003
Towers Perrin, Business Wire, January 12, 2005

According to new data released by Towers Perrin, medical malpractice tort costs reached $27 billion in 2003, an amount equal to $91 per person. "The growth in these costs--11.8% per year on average since 1975--continues to outpace that of total tort costs, which has averaged 9.2% per year." article »

Nation's Health Spending Slows, but it Still Hits a Record
Robert Pear, New York Times, January 11, 2005

"The torrid pace of growth in national health care spending cooled a bit in 2003, but the spending, at $1.7 trillion, topped 15 percent of the gross domestic product for the first time, the government said on Monday. ... [T]he United States devotes a much larger share of its economic output to health care than other industrial countries do. Among the 30 members of the Organization for Economic Cooperation and Development, the countries with the next largest shares, Switzerland and Germany, spend less than 12 percent of G.D.P. on health care." It is difficult to talk about reducing health care costs without a reliable system of medical justice; until such a system exists, doctors will continue to order unnecessary tests and procedures to protect themselves in the event of a lawsuit.

Medical Liability Problem Affects Everyone
Gerald Harmon, The State (South Carolina), January 2, 2005

Gerald Harmon, Chairman of the South Carolina Medical Association Board of Trustees, points to some disturbing facts about the current medical justice system: "[One-sixth] of all American doctors report a claim against them each year. ... [A]bout 70 percent of all these suits find no fault with the doctors, yet each one costs about $23,000 to successfully defend. ... Furthermore, an important study in the New England Journal of Medicine found no relationship between physician negligence and the outcome of medical malpractice litigation. Astonishingly enough, the impact of the patient's injuries ... on the jury and the skill of the plaintiff's attorney is what count for high awards, not the negligence of the doctor." Discussing the issue of patient safety, Harmon adds, "We [the South Carolina Medical Association] believe that doctors and hospitals should be able to review errors and take corrective action without fear of being sued or having the discussion become part of a lawsuit."

Higher Costs, Less Care
Ceci Connol