Later On

A blog written for those whose interests more or less match mine.

More on medical malpractice

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An interesting article by Darshak Sanghavi at Slate. From that article:

… But there’s a major problem with seeing malpractice reform as a quest to reduce bogus lawsuits: Doctors make huge, negligent mistakes quite regularly—and they usually get away with it. In a landmark 1991 study, Harvard researchers reviewed the hospital records of tens of thousands of New Yorkers and estimated that almost 27,000 patients were harmed by negligent medical care—yet only 3,500 actually filed claims. The system, the report concluded, "rarely holds providers accountable for substandard care." In 2006,another Harvard study concluded that only about 15 percent of malpractice litigation costs involved claims without errors—and only 3 percent of all claims involved no patient injury. Further, about four in five claims were adjudicated properly. In 2006, a study in Health Affairs concluded there was no crisis in doctors’ malpractice costs, since inflation-adjusted premiums were lower in 2000 than in 1986; another study last year found most doctors in Massachusetts (declared a "crisis state" by the American Medical Association) paid lower premiums in 2005 than in 1990.

And while doctors hate to admit it, lawsuits can save lives. Motivated in part by liability suits, anesthesiologists dropped the risk of death in surgery from one in 5,000 to one in 250,000 over two decades, and their premiums have dropped from being the highest among doctors to some of the lowest. At the hospital where I trained in pediatric cardiology, a publicized malpractice case in which a child died led quickly to critical improvements in patient safety throughout the hospital.

So here’s the dilemma: On one hand, doctors believe—despite some evidence to the contrary—that there are too many frivolous lawsuits, and they respond by ordering a lot of unnecessary testing and treatment. It’s probably impossible to change their perception, which arises from some well-publicized, if uncommon, bad decisions. As a result, their solution is to make it harder for patients to sue. (That’s the general position taken by Republicans.) On the other hand, patients often get harmed by negligent medical care, and lawsuits are their only way to fight back. Doctors are already getting away with lots of negligence, so making it harder to sue seems unfair. (That’s the Democrats’ view.)

There’s a more constructive way to frame the debate about medical liability: How can we design a system in which more patients harmed by negligence get timely, reasonable compensation, but in a manner that also protects doctors and encourages them to learn from their mistakes? In this regard, the current system fails miserably and is best compared to a casino. A tiny number of injured patients win huge jackpots while the majority gets nothing, in a gaming process rife with outrageous overhead costs (roughly half of all malpractice costs go to lawyers, experts, and the court system).

Damage caps may protect doctors from lawsuits, but they do little to help patients. There are other, much better, ideas out there, and they deserve bipartisan support since they allow everyone—doctors, patients, and taxpayers—to win. Michelle Mello, a health law professor at the Harvard School of Public Health and a leading researcher on medical liability, outlines three examples: promoting "disclosure-and-offer" programs in which health providers are incentivized to fess up quickly to mistakes and offer prompt compensation; creating neutral tribunals that evaluate evidence and recommend damages; and proclaiming federal "safe harbors" where doctors are immunized from lawsuits if they adhere to evidence-based practices, as Dr. Merenstein did…

Written by LeisureGuy

9 November 2009 at 12:31 pm

Posted in Daily life, Law, Medical

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