MedMal...a few thoughts.

<p>Curious: Malpractice is a topic broad enough to constitute no less than a good semester's work for a motivated student. In short, from the docs' perspective, it is a complex phenomenon that results from:
1) A change in society's values, where fault necessarily must be assessed any time the outcome is unfavorable.
2) A failure to recognize that ever-shrinking reimbursements to physicians by insurance companies (lead by the gov't-controlled Medicare system) will always lead to less time-per-patient and therefore to necessarily inferior care.
3) An abundance of attorneys, the excess percentage being by nature scavengers (though these are not the bedrock of the legal profession).
4) The Lottery Mentality that exists in America today. This mindset infers that everyone is entitled to at least one large cash settlement in a lifetime. </p>

<p>Okay, I'm ranting, so let me stop here.</p>

<p>I'm writing a research paper on this very subject ironically :p</p>

<p>I agree PSerdishMD. I have a cousin who is in med school. He is in his 3rd year doing rotations. He says that if he didn't like medicine he would never be doing it because of all the stress associated with it and all the sacrifices he has made. Since he plans to be a surgeon :), he is very aware of committing malpractice due to negligence which could stem from many factors, such as lack of sleep from the horrific working hours, or being falsly charged.</p>

<p>Maybe I'll stir things up a bit here by offering a lawyer's perspective. (Disclosure - I work in-house for a corporation now, but I did work as a plaintiffs' personal injury lawyer in my younger days, and filed two medical and one dental malpractice case, out of the twenty or so I was asked to consider taking.)</p>

<p>Keep in mind that there are a lot of urban legends on the subject, so a healthy skepticism is probably warranted for some of the anecdotal evidence you might come across (perhaps even in my posting). I'll start with a few observations.</p>

<li><p>Plaintiffs' attorneys aren't actually that anxious to handle medical malpractice cases. They're very expensive to prosecute; you can't win one without paying another physician (and sometimes several) to testify as an expert witness. Your own witness fees will run you thousands of dollars; when you're deposing the defendants' experts, you have to pay their customary rates. In neither case are they constrained by the cost restraints associated with managed care. Moreover, something like 2 out of 3 juries in medical malpractices cases find for the defense. (Legal malpractice cases, by contrast, are much more likely to result in plaintiffs' verdicts; they're also far more commonly filed, by the way.) Plaintiffs' attorneys generally advance all the costs for these cases, and they're almost always an expensive gamble. The number of attorneys that have the capital or willingness to gamble $50,000 or $100,000 on a single case is not high. (Granted, there are some, but not many.) </p></li>
<li><p>In California, where I practice, damages and attorneys fees in medical malpractice cases are limited by statute. (The limit for pain and suffering awards is $250,000, for example, and hasn't been raised since the statute was enacted 20 or more years ago.) </p></li>
<li><p>If you look behind the headlines that talk about the "malpractice crisis" in some state or other, you may well find that there has been a large (perhaps collusive) increase in insurance rates without any corresponding increase in the number of claims made or settled.</p></li>
<li><p>A large jury award in a malpractice case doesn't necessary mean a lot of money in the pocket of the plaintiff (or the plaintiff's attorney, for that matter). In a lot of cases, the parties have already agreed to a settlement with a ceiling and a floor, and are relying on the jury's verdict to set the specific number. Large jury awards are frequently set aside by the trial judge; they're also typically appealed, which can delay things for years.</p></li>
<li><p>I don't minimize the distress occasioned by being the defendant in a lawsuit. I can tell you from personal experience that the stress is higher when the claim is justified than when it's frivolous. </p></li>

<p>By the way, Doctor, I've long enjoyed your posts.</p>

<p>Thanks Grey, and aside from your far left-leaning politics, I'm a fan of yours too ;)
I think all of your points above are valid. I would add though that while there a few attys looking to sue docs, there a few in every city who make up for the rest.
I would also mention that reviewing many of these cases over the years, I have found they are, in the main, (and I'm talking about a 95% main) totally frivolous.
In my own case, 14 years of practice with 2 silly claims, both dismissed, and I found my premiums in suit-happy Mississippi tripled last year, resulting in my having to close my office and leave the state.
Now to be fair, there are some horrendous malpractice atrocities committed out there and we need a way to deal with them. There are also a handful of totally incompetent docs in every community and we need a way to get rid of them. But most important is the fact that we need a way to bring affordable and reasonably good medical care to everyone who needs it, anywhere they happen to be.</p>


<p>My gues is that the tripled premiums had little to do with the cost of providing insurance in the state. It sounds like another manufactured crisis to me.</p>

<p>Far left-leaning? I'll cop to being a card-carrying member of the American Civil Liberties Union (just like Bob Barr, i might add.) But there was a time when I just as proudly carried a membership card in Young Americans for Freedom, and my friends used to call me William F. Buckley III.</p>

<p>Well I'm a Ronald Reagan Republican, but also a card carrying ACLU member. God bless us all, eh?</p>

<p>Amen to that!</p>

<p>Is there a website with information on how much medmal insurance costs per specialty per state?</p>

<p>Probably not. The cost varies from doctor to doctor (depending on fwhether there have been prior claims as well as other factors), and from insurance carrier to insurance carrier.</p>

<p>I see, thanks anyways. :)</p>

<p>Some excerpts from a New York Times article on medical malpractice insurance rates
The link (registration required):
<a href=""&gt;;/a&gt;&lt;/p>

<p>"But for all the worry over higher medical expenses, legal costs do not seem to be at the root of the recent increase in malpractice insurance premiums. Government and industry data show only a modest rise in malpractice claims over the last decade. And last year, the trend in payments for malpractice claims against doctors and other medical professionals turned sharply downward, falling 8.9 percent, to a nationwide total of $4.6 billion, according to data compiled by the Health and Human Services Department...</p>

<p>"The recent spike in premiums - which is now showing signs of steadying - says more about the insurance business than it does about the judicial system...</p>

<p>"Costs for most doctors last year rose between 6.9 percent and 24.9 percent compared with increases of between 10 percent and 49 percent in 2003, according to The Medical Liability Monitor, a newsletter published in Chicago.</p>

<p>"The most expensive place in the country is South Florida, where some obstetricians and general surgeons paid nearly $280,000 for coverage last year, according to The Monitor. Obstetricians in Illinois paid as much as $230,428, The Monitor said, while in Nebraska, the least expensive place in the country for malpractice insurance, obstetricians paid $16,194. Florida adopted a cap on awards of $500,000 to $1 million in 2003. Illinois has no cap and Nebraska has a cap of $500,000...</p>

<p>"Mr. Weiss of Weiss Ratings and researchers at Dartmouth College, who separately studied data on premiums and payouts for medical mistakes in the 1990's and early 2000's, said they were unable to find a meaningful link between claims payments by insurers and the prices they charged doctors. </p>

<p>"We didn't see it," said Amitabh Chandra, an assistant professor of economics at Dartmouth. "Surprisingly, there appears to be a fairly weak relationship."</p>

<p>From today's New York Times:</p>

<p>"A study to be released today by the Center for Justice and Democracy, a consumer advocacy group in New York, ... finds that net claims for medical malpractice paid by 15 leading insurance companies have remained flat over the last five years, while net premiums have surged 120 percent. </p>

<p>"From 2000 to 2004, the increase in premiums collected by the leading 15 medical malpractice insurance companies was 21 times the increase in the claims they paid, according to the study. (The net totals in the study are calculated after accounting for reinsurance.)"</p>

<p>So you mean we've been getting screwed? Who knew?? ;)</p>

<p>Everybody knew you've been getting screwed, but it's getting clearer that it's not the usual suspects (i.e. the trial lawyers) who have been most adept with the Phillips heads.</p>

<p>And yet trial lawyers don't want to get rid of frivoulous lawsuits. Hmmm.... I think the title of the lawsuit says it all, yet they still decided to sue for stupid things while other more deserving people get screwed out of money because there isn't as much money to be made from their case.</p>

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