Category Archives: National

Innovation Stifled by Defensive Medicine

Washington Millions of dollars that could be used for innovation in health care delivery often are funneled toward medical liability costs, a panel representing private health systems told a Senate committee on May 23. The witnesses said boosting quality through innovative health system reforms would do a great deal to tamp down the defensive medicine practices that result from the heightened liability climate. “With the very visible impact and the efforts around the health system on quality and the pursuit of quality, my anticipation is that quality of care will go up and the whole issue around defensive medicine will become much more mitigated,” Richard Migliori, MD, executive vice president for health services for UnitedHealth Group, told the Senate Finance Committee. The hearing was held to address the progress of private-sector systems to reduce costs and improve quality, but the discussion quickly turned to defensive medicine. Sen. Orrin Hatch (R, Utah), the top Republican on the Finance panel and a former medical liability defense lawyer, asked the witnesses what they were spending to protect against medical liability. “What is the percentage of cost of doing business that’s caused by many of these suits? And how serious are they in your…

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Defense Costs of Medical Malpractice Claims

To the Editor: Despite research on the overall costs of the U.S. medical liability system,1 national data are limited on the costs associated with resolving medical malpractice claims2 — defense costs — and how they vary according to physician specialty. The frequency of malpractice claims and the size of awards vary considerably across specialties,3 yet the degree of variation in defense costs across specialties is unknown. Defense costs constitute an important expense for insurers, and they affect physicians and patients by raising the costs of malpractice premiums and medical care, respectively. We analyzed defense costs associated with 26,853 malpractice claims closed between 1995 and 2005 among 40,916 physicians covered by a nationwide professional liability insurer. We have used claims from this insurer elsewhere to study malpractice risk according to physician specialty.3Each claim contained information on whether or not a payment was made to a patient, the specialty of the physician involved, and the defense cost associated with the claim. Defense costs included factors that were directly associated with the cost of defending an individual claim, such as filing and expert-witness fees, but they did not include items that could be spread across multiple claims. The mean (±SD) defense cost associated with claims was…

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President should back up his rhetoric with real reform

In his State of the Union address, President Obama urged Congress to set aside politics and work with the White House on passing legislation. But the president neglected to mention that Republicans in Congress have been doing just that. Unfortunately, our efforts to expand the economy and create jobs for American workers have been rebuffed by the White House. If the president is serious about working across party lines to tackle the tough issues facing America today, I urge him to support common-sense proposals from the House Judiciary Committee. Rein in regulations: The House of Representatives passed three Judiciary Committee bills last year to help lessen the strain of burdensome regulations on business owners. More than once this year, the president has talked about the dangers that excessive regulations pose to our economy. But unfortunately, his actions speak louder than his words. Federal regulations already cost our economy $1.75 trillion per year. But rather than reduce the number of regulations, the Obama administration has only added to the burden. The administration counted 410 new major rules in its regulatory agendas for 2010 and 2011. That’s four times the number of major rules than during the first two years of the…

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Defensive medicine seeping into physician training, study says

Practicing defensive medicine to avoid medical liability lawsuits may not be a formal part of medical school curriculum, but it’s still being taught to medical students and residents, a study shows. A survey of 202 fourth-year medical students and third-year residents at Northwestern University Feinberg School of Medicine in Chicago found that 94% of students and 96% of residents have seen examples of defensive medicine in their clinical training. Nearly two-thirds of students and three-quarters of residents said their attending physician implied that they take medical liability concerns into consideration when making clinical decisions. Nearly half of respondents said their attending directly instructed them to do so, says the study in the February Academic Medicine (www.ncbi.nlm.nih.gov/pubmed/22189882/). Educators should reframe such conversations to focus on reducing liability risk by improving patient safety and communication, said Kevin O’Leary, MD, lead study author and associate professor and associate chief of Northwestern’s Division of Hospital Medicine. “At its core, medical malpractice is about preventable injury to patients,” he said. “I think we lose track of that and focus on the potential risk to ourselves when we should focus on the potential risk to our patients. We can help trainees with clinical decision-making without having to…

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When the Doctor Faces a Lawsuit

Within months of completing my training, I received the call that every doctor dreads. “You’ve been named in a malpractice lawsuit,” said the hospital administrator on the other end of the line. The family of a patient I had seen briefly a year before believed that a colleague’s decision not to operate hastened her demise. Now their lawyers, combing through the medical records, believed that a single sentence in my note brought that doctor’s decision into question. As a second or maybe even third opinion, I had written that the woman was a “possible candidate” for surgery. The truth was that when I saw her she was a possible candidate, but only tenuously so. In fact, her health deteriorated so rapidly that by the time she finished seeing all the specialists and returned to her original surgeon, the chances of her surviving any treatment, no matter how heroic, were almost nil. Though I knew all that, in the weeks after that telephone call I couldn’t help questioning myself, going over the case in my mind as soon as I woke up, then again and again late into the night. I froze with fear every time I was asked for my…

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Fear of lawsuits, little time with patients lead to more aggressive care

Nearly half of primary care physicians say patients receive too much medical care. In a study of 627 such physicians, 42% said patients in their practice get too much treatment, and 6% said patients receive too little care. Fifty-two percent of doctors said the amount of care was just right, according to the study published Sept. 26 in Archives of Internal Medicine. Three in four doctors listed medical liability concerns as the primary reason they practice more aggressive medicine. Forty-percent said inadequate time with patients is a factor in practicing more aggressively. About one in four physicians practices medicine more aggressively by ordering more tests and making more referrals than they would like to do. The results are not surprising, said internist Calvin Chou, MD, a professor in the Dept. of Medicine at the University of California, San Francisco, Veterans Affairs Medical Center. He wrote an editorial that accompanied the study. “I run into problems myself when a patient is very demanding of a particular test that I don’t think is particularly warranted,” Dr. Chou said. “I think I’m pretty good at discussing it with them, but I know that I’m not perfect. There are times when it’s easier to…

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Lobby Battle Over Loans for Lawsuits

WASHINGTON — Companies that advance money to plaintiffs involved in personal injury lawsuits are campaigning in state capitals for legislation making clear that their growing industry is not subject to usury limits on interest rates or other state laws that protect borrowers. Instead, the lawsuit lending companies want to adopt a separate and less rigorous set of protections. Since February, they have persuaded legislators in at least five states, including New York, to introduce bills based on the industry’s own proposals. The campaign is drawing strong opposition from chambers of commerce, insurance companies and others who worry that lawsuit loans encourage litigation by emboldening plaintiffs. These critics also argue that the bills would strip protections from borrowers. “They are coming in under the guise of accepting regulation when in fact what they are trying to do is to legalize lawsuit lending and to explicitly exempt themselves for consumer lending requirements,” said Lisa A. Rickard, president of the Institute for Legal Reform, an arm of the United States Chamber of Commerce. These clashes reflect both the uncertain legal status of lawsuit lending and the growing debate over its social value: Should third-party investment in lawsuits be encouraged, tightly restricted or banned…

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Obama, GOP should avoid a standoff on malpractice reform

PRESIDENT OBAMA announced in his State of the Union speech that he would deal with Republicans on one of their pet issues, reform of medical malpractice. But nothing is likely to get done because congressional Democrats oppose the GOP’s trademark solution to high liability costs — a federal law capping damages that malpractice victims can receive. They are right that a cap is too arbitrary, limiting awards even for the most egregious mistakes. But the debate shouldn’t end there. Both parties should find common ground on innovative approaches that not only reduce jury awards but also help doctors and hospitals correct underlying problems. Those approaches — now being tested in more than 20 locations — start with the recognition that the current system has several flaws. The most obvious is that the threat of frivolous lawsuits drives up doctors’ insurance costs, which get passed on to patients. Fear of suits also causes doctors to practice “defensive medicine,’’ ordering unnecessary tests just to prove that they covered all the bases. Meanwhile, the current system fails to provide any relief to many patients who suffer from medical mistakes but are never informed of them or cannot find lawyers to represent them. Finally,…

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Study: Doctors order tests out of fear of lawsuits

SAN DIEGO (AP) — CT scans, MRIs and other pricey imaging tests are often more for the doctor’s benefit than the patient’s, new research confirms. Roughly one-fifth of tests that bone and joint specialists order are because a doctor fears being sued, not because the patient needs them, a first-of-its-kind study in Pennsylvania suggests. The study comes a day after President Barack Obama began a push to overhaul state medical malpractice laws as a way to reduce unnecessary tests that drive up health care costs. “This study is a glimpse behind the curtain of what’s happening in a doctor’s mind,” said its leader, Dr. John Flynn of Children’s Hospital of Philadelphia. If doctors sense you might second-guess them or cause trouble, “you could potentially be risking more tests being done.” Results were reported Wednesday at an American Academy of Orthopedic Surgeons conference in California. Patients expect the highest level of care and think this means the most advanced technology, Flynn said. Many patients feel better when a doctor orders lots of tests — until they get the bill. Besides hurting your wallet and adding to health care costs, unnecessary tests can expose people to radiation that accumulates over a lifetime…

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Medical liability: Lawsuit chances take a toll

Our actions are influenced even when the odds are in our favor. So we save receipts (tax audit risk, 1 in 100), change the smoke detector battery (fire-related fatality odds, 1 in 1,235), and think twice about standing in the rain (chance of being struck by lightning, 1 in 6,250). When it comes to the chances physicians face in terms of being sued, a new AMA report shows they can expect a lawsuit not as matter of possibility, but of probability. More than half — almost 61% — of physicians older than 55 report having been sued. The behaviors that result from those odds should come as no surprise — such as defensive medicine and practice decisions to shield the doctor from risk. And those actions can significantly affect the cost of care and patient access. The AMA found that overall, 42.2% of the 5,825 surveyed physicians had been sued, with nearly a quarter of them hit with lawsuits twice or more. Obstetrician-gynecologists were among the most likely to be sued, and the measures they have taken as a result are predictable. In a 2009 survey, nearly a third of ob-gyns reported cutting back on high-risk obstetric patients, one of…

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