Caps on malpractice

[whitecobra]

I guess with the number of docs like myself and the others on the forum this wasn't the best topic for a wood forum but what the heck it is in the "anything allowed section"

I to agree that premiums are WAY to high
My brother is one of the top anesthesiologists in the USA his group pays over 5 MILLION a year. My last year in surgery which was in the 90's was over $100K an I was PART TIME this is NONSENSE

Who pays? EVERYONE. Sure a few might collect some nice sums but do you ALL want to pay for that suit agreement?

I hear DAILY about the outrageous costs of health care but then I see guys looking to take docs to the cleaners for a bad outcome. Bad outcomes happen and there should be some compensation for them but not millions and millions

As for the instance cited that is absolutely the rare extreme case and we had better NOT be making precedent based on the impaired doc doing bad work. FAR more "bad outcomes" occur by GREAT docs who get a tough case then bad outcomes from bad docs. Interesting enough unless the Patient is in a locked in HMO or the like the bad docs get weeded out in most areas of the US. One thing about the free enterprise system is people talk and bad talk kills bad docs so they move (another topic)

Higher premiums do NOT filter down to the patient AT ALL. Higher premiums are absorbed by the docs to the point that they simply say ENOUGH I WON'T PLAY. MOST patients have insurance and most docs "participate with them" so they can ASK for more money but we never get it we simply write off the difference in what we WANT and what they pay. MP premiums go up our fees go up and the write offs get bigger each eyar. Eventually the write off is more then the collected amount.

In the meantime they limit the services that they COULD render simply by saying it is to risky to do so I will play safe

Had the cardiac catheterization worked perfectly you would have praised the doc to the world as saving your life. I find it INTERESTING that your neurologist was able to point a finger 6, yes SIX; OH YEAH SIX years later that it was the fault of the cath that you stroked out. Hum so lets see had they not gone in and opened the other side up you would have lasted 8 MINUTES now you are upset for them buying you 6 YEARS.

Here in Orlando we lost ALL of the trauma surgeons for 3 years. YES we had NOT ONE in the Central Florida area for 3 YEARS the closest was Jacksonville (3 hour drive or helocopter away). Why? EASY they wanted to make a living and since most trauma cases are not compensated for (anyone who ocmes to an ER must be treated regardless of whether or not he or she can pay)and since the liability for trauma surgeries are the highest of all the surgeries they were paying more to the MP carrier then to themselves

So as a society do we want good healthcare or limited healthcare the answer is directly related to caps.

We have cap limits in Florida and now we have trauma docs at LOCAL hospitals

I wouldn't go back into surgery again for a million dollars a year in my pocket after taxes. Simple enough I treat patients NOT insurance company rules and thanks to the layers and their ease in winning big suits for nonsense issues (coffee spilled at McD's etc...) I can't help you when you are REALLY in need of my help the most

Dr D

[JR]

In the meantime they limit the services that they COULD render simply by saying it is to risky to do so I will play safe

I remember a similar argument being raised in the presidential debate two years ago. Although the argue-er's case (let's not name him to keep partisanship out of it) was more like, "Too many services are being prescriped in order to mitigate the risk of litigation by having done too little."

I don't doubt the doctors' situation is problematic. Dr. D's point about the trauma centers is mind-boggling. Here in California we have a similar problem, particularly in the inner city. This part of the problem is complicated by the fact that so many people have no insurance, so they use the emergency room for primary care. I think this is where the lion's share of the problem lies.

I heard a statistic the other night that I can't properly dredge up right now, but basically it said that up to 40% of Americans have no health insurance. That leaves another portion "benefitting" from HMO coverage. That leaves a minority of Americans who are in a position to get bad the medical care complained about so far in this thread (too many treatments, too few treatments, mistakes, or whatever).

If you've ever been treated within an HMO you know it is frequently barely better than no coverage. Some times HMO's are worse than no coverage because patients are not getting specialist treatment they need. Primare care physicians in HMOs are flogged to see X number of patients daily and are dinged if they refer them to specialists. Or, in other words, the gatekeeper to your health is too busy to help.

It's a goofy system. People who can afford care are being accused of abusing the system. People who can't afford care are being accused of abusing the system. And many people who need care can't get it.

JR

[Jeffrey Schronce]

Dr. D, I agree with you on most of your statements. Here in NY/NJ/PA we have been in a medical liability crisis for a long time. One thing that should not be confused in this discussion is the fact that medical malpractice has caused minimal increase in the cost of healthcare today. It has become a huge hindrance to the profitability of good doctors in many states. The high costs of health insurance can be attributed to incredible and substantial increases in medical technology, prescription drug costs, demand on medical services by an aging population, charging more to those who have coverage to support those who don't and the fact that so many of us are fat with sedentary lifestyles.

[BigguyZ]

This whole conversation reminds me of a discussion I had with a coworker. We were talking about the cost of healthcare, and the effects on it. Then, later on, she was talking about her future goals to become a lawyer. I asked her what kind of law she would want to practice, and she responded "Personal injury- because it's a guaranteed payout even if you settle". I stopped talking right then. I was at work and if I would have said what initially entered my head I could very well have been fired.

[Warren]

I believe that unless the doctor's actions were egregious that the victim should only be awarded enough to cover repairing the damage or, in the case of death or incapacitation, projected earnings or, to cover loss to family members. It is complicated. And, I would never find myself on a jury based on my philosophy. I simply don't believe in windfall awards. Make the injured party whole if possible, punish malpractice when proved and move on.

An honest mistake should not be punished. There's a huge difference between an honest mistake and malpractice. Juries usually look only to the deep pocket and often fail to consider the difference between a mistake and malpractice. A doctor convicted of malpractice should have his license revoked. A cop guilty of malpractice, the same and some jail time. As with a lawyer in the same circustances. Plumbers, contractors, teachers, etc, the same. Penalize the incompetent and criminal; and let the competent carry on unfettered and unconcerned.

With regard to the uninsured statistic. Remember that they count indiginous peoples, who receive free government medical care, in these numbers to inflate them. They also count the people, and their children, who pay their own way and have the funds to do so. Also counted are those, and their children, who have the ability to pay, but prefer to let the government (taxpayer) pay for them. That total is very, very suspect. This is not to say that there is not a portion of the population without the means to pay for health costs or insurance.

It's kind of similar to the so called "homeless" population. Many of the people in this total are homeless by choice. Many of those counted have left a home of their own free will and have one to return to should they desire.

I refer to government as the "great enabler," spreading money to one and all regardless of need. It is slowly sucking the life's blood out of a formerly strong and independant people. Many children no longer see the care and comfort of their aging parents as a responsibility. Many parents see government subsidized child care as a right. Those that work see a large part of their salary going to support those that won't, not just to those that can't and need the assistance.

[jerrye]

Warren,

You have so eloquently stated what I meant by my post. According to a former vascular surgeon friend the high medical cost issue is due to several things but mostly due to increased costs for diagnostics and meds. In addition, and also as has been stated, it's due to Dr.'s loss of income from MedInsurance. My friend dropped a few insurers because they would only reimburse him 40-50% of his cost for certain procedures. His cost! No business can stay in business without a profit; with MP insurance hitting on one side, lowered MedIns payments on another, and forced writeoffs on the third, the Dr. today is getting squeezed and hosed.

If any of the Dr.s on this forum disagree with the above statement, I welcome correction.

Still my .02, still humbly submitted.

[gjat]

How can one justify 'no caps' when we are discussing compensation for two different things?

There shouldn't be a 'cap' when it is money to make someone 'as whole as possible', paying for their actual loss or real damages. You have to realize, you can only repair somebody so much. If you are in an auto accident and dent another vehicle, are you responsible to repair just the fender (knowing it will never be exactly the same paint as the rest of the vehicle) or replace the entire car so it has fenders that have never been repaired?

There absolutely should be a 'cap' when it comes to 'punitive' damages. That is payment to 'punish' the offender. What's obvious from this discussion, is that substantial payment for punitive damage does not sufficiently damage the offender, but damages the entire medical communinty and the average person seeking affordable medical care.

[Tom J]

I am somewhat hesitant to weigh in on this topic, because I tend to go back and forth. I tend not to like the idea of caps, but I also do not like running adequate doctors off because of high premiums.

Rather than try to address all the points made, let me point out what I think is another problem--judges and the way we select judges.

I have not done any research on this, but I suspect if you went back 30 or more years you find more cases thrown out before they went to the jury because of the plaintiff's failure to state a cause of action. Additionally, there were probably more cases in which there was a reduction in the jury award when the judge thought the amount was the product of sympathy for the plaintiff rather than the proof set forth in the case.

Judges still have the power to do this, but I think are less likely to exercise it, because of wanting to retain their jobs. It varies from state to state, but in Illinois circuit court judge run in an election against an opponent the first time. If elected the judge will run for retention every six years thereafter. I.e. he/she does not run against an opponent. The question given to the voters is whether he/she should be retained. If 60% say yes, the judge get another six years. This system was adopted as a type of compromise between outright elections and appointment of judges.

In my limited experience, most judges are retained absent a strong campaign against them. In the times there are been such campaigns, many times these campaigns are championed by plaintiff's lawyers who are upset at what they see as adverse actions against their interests by the judge.

Judges usually like their jobs and don't relish a return to private practice. I thinki to avoid campaigns against their retention they are less likely to go against plaintiff's attorneys. This leads to some cases getting to juries when they should not and some unduly high awards. This has a snowball effect, these inflated awards then become the norm, thereby giving less grounds for other judges to lessen awards in cases they are presiding over.

My solution is to appoint judges either for life or a set term after which they will be reviewed by an appointed panel. Just has been pointed out by some of the doctors on this site, the electorate is not particularly knowledgable about what makes a good judge. The federal system of appointed judges while subject to the political pressures nonetheless usually results in a highly qualified jurist and one that is not scared to make the unpopular ruling.

[Ed62]

This is for all the docs

Hum so lets see had they not gone in and opened the other side up you would have lasted 8 MINUTES now you are upset for them buying you 6 YEARS.

That couldn't be further from the truth. I'm very happy with the medical care I received. If I wasn't, I would have filed a lawsuit, which I didn't do. Why would I want to run him out of a job, when I might need him again in the future?

How does this sound? Since it's true that the average person has very little knowledge on medical issues, let's have juries made up only of the medical community (who would have the power to void someone's license) for a trial period to see if it helps weed out the bad seeds. If, after a certain time, it doesn't seem to be helping, we go back to a citizen's jury. Let's face it, it's not unheard of for people of one prefession to cover for others in the same profession. This includes doctors, cops, you name it. This is the world we live in. A system like this could allow us to get the best of both worlds (maybe).

The subject of this thread is a subject that means something to everyone. With all the intelligent people we have representing us in Congress, they should be able to come up with a plan that works!

Ed

[gjat]

With all the intelligent people we have representing us in Congress, they should be able to come up with a plan that works!

Ed

When did we get some of THOSE "intelligent" people in Congress? I thought we elected politicians.

[Ed62]

Yeah, you have a very solid point.

Ed

[JSUPreston]

I've been reading all of this, and I have to put my $.02 in. This story is very personal, so I am leaving out the names of the people.

5 years ago today, SWMBO gave birth to #2. After about a month, she spoke with her OBGYN about a certain shot that she had heard about that would act as birth control. She was just trying to get information to make a decision. Dr. told her that she could come in for the shot. Wife assumed that the shot was safe.

Within a week of the shot, wife went off the deep end. She went to the hospital psych ward at least 4 times that year. All told, she has spent several months worth of time in the hospital in the past 5 years.

Now the backstory...wife has a history of depression in the family. Well documented by numerous doctors. As a matter of fact, the OB prescribed Prozac during the pregnancy (in consultation with her psychologist), so he knew about the problem. The shot he gave her was Depo Provera. According to all the information we found in the months after she was given the shot, the doctor should have never even considered it for her. One of the warnings was specifically directed to people who had a history of depression. A quick google search today states that depression is one of the most serious side effects.

In the past 5 years, my wife has gone through 2 counselors and two psychologists. We have spent thousands of dollars in doctor bills, hospital bills and prescriptions. She has been on SSI disability and just now appears to be getting back to normal. We nearly divorced during this time due to the stress and irrational behavior. I have personally missed hundreds of hours of work due to this. My sons have seen their mother act in ways no one should see anyone act. Fortunately, things have been going much better in the past 10-12 months, and she has come off a lot of medications. Is she getting better? Yes. I am still worried $#!^less about her? You better believe it!

We thougth about suing the OB for MP. It was obviously a case of neglect on his part. We weren't looking to get rich, just to recover all the money we have spent, and in all honesty, we should get some extra for pain and suffering. Should it bankrupt this doctor? I don't think so, but he should definately be made to suffer. In the end, we decided it wasn't worth the emotional strain on my wife to actually take this to court. BTW: I estimate the costs over the years to be at least $40k.

Are the MP limits too high? Most likely yes. Doctors shouldn't be sued for MP for the least little problem, but there are cases like my wife's when it is obvious the doctor was in the wrong.

[jerrye]

How does this sound? Since it's true that the average person has very little knowledge on medical issues, let's have juries made up only of the medical community (who would have the power to void someone's license) for a trial period to see if it helps weed out the bad seeds. If, after a certain time, it doesn't seem to be helping, we go back to a citizen's jury. Let's face it, it's not unheard of for people of one prefession to cover for others in the same profession. This includes doctors, cops, you name it. This is the world we live in. A system like this could allow us to get the best of both worlds (maybe).
Ed

Isn't this the true definition of "a jury of your peers"?

[MilDoc]

Malpractice insurance costs:

1977 (first year in practice) - $700 per year

1996 (after I left the university) - $13,000 per year

2006 - $21,000 per year

and I'm a pediatrician who does no serious procedures, I don't do in hospital work or newborn work anymore (but did up to 2001).

As many have stated, juries know nothing about medicine. If a doc or other healthcare worker is called for jury duty (or if you have a doc relative), and it's a MP case, you can bet you WON'T be chosen.

On top of that courts admit way too much "junk science." Most cases of newborn cerebral palsy have now been shown to be primary, NOT due to the OB's "mistakes," but they still get sued and lose. And that's just one example.

Other coutries send all such cases to a panel of experts FIRST. If they decide there is no MP and you sue anyway, if you lose YOU pay all court costs, lawyers fees (including the docs), etc. If a lawyer does this too often he may well be disbarred.

Now THAT's intelligent!

[25]

Isn't this the true definition of "a jury of your peers"?

Thats what I would think. Unfortunately lawyers disagree.