A message to all physicians from Ardis Dee Hoven, MD, chair of the AMA Board of Trustees. In the past few weeks, a lot of people in Washington have been talking about medical liability issues. This is a good thing, and I hope it means we are about to see significant and meaningful reform in this important area. Because I, for one, am very tired of practicing defensive medicine and constantly looking over my shoulder when I should be concentrating on what is best for my patients. This situation is also creating a bad climate for American medicine and costing our patients and the country a lot of money that doesn’t need to be spent. On Jan. 20, I testified before the House Judiciary Committee in one of the first hearings of the new Congress. In my testimony, I encouraged Congress to move forward. On Jan. 24, the American Medical Association was among those who announced support for a newly introduced bill: the Help Efficient, Accessible, Low-cost, Timely Healthcare Act of 2011. The bipartisan bill includes what sponsors Rep. Phil Gingrey, MD (R, Ga.), Rep. David Scott (D, Ga.) and Judiciary Committee Chair Rep. Lamar Smith (R, Texas) say will fix the broken medical liability system, reduce health care costs and preserve patients’ access to medical care. The HEALTH Act would reduce costs while ensuring that patients who have been injured due to negligence receive just compensation. At the same time, it would promote speedier resolutions to disputes and maintain access to courts. In addition, the HEALTH Act protects effective state medical liability reform laws. On Jan. 25, during his State of the Union address, President Obama again indicated that he is willing to pursue medical liability reforms other than caps on noneconomic damages. You may recall that Obama reprogrammed federal funds for a new medical liability grant program to explore alternative reforms such as health courts, processes for early disclosure of and compensation for adverse events, and safe harbors for the practice of evidence-based medicine. One reason medical liability reform is in the public eye is because of the costs incurred by physicians who feel forced to practice defensive medicine. We all do it; it is one of the only ways we can — hopefully — avoid being brought into unnecessary lawsuits. It can be demoralizing when all of a sudden you’re confronted with a lawsuit over which you have no control — or you are confronted with something else in the lawsuit process. It devastates you. And you probably know the statistics. Fully 64% of medical liability claims in 2009 were dropped or dismissed — at a cost averaging more than $25,000 each. Moreover, according to a 2006 New England Journal of Medicine article, no error was involved in more than a third of medical liability claims. Among physicians age 55 and older, more than 60% of us have been sued. Nearly half of medical students report that their choice of specialty is dependent on the potential for liability issues. This is simply not healthy for our profession, much less the American people. Money, of course, is a big part of the equation: The Dept. of Health and Human Services estimates that the practice of defensive medicine costs us all between $70 billion and $126 billion per year. And a Harvard School of Public Health Study found that defensive medicine costs were $45.6 billion in 2008 — not including $5.7 billion in liability claims payments or $4 billion in administrative and other expenses. Thirteen months ago, the nonpartisan Congressional Budget Office estimated that nationwide implementation of medical liability reforms, including caps on noneconomic damages, would have reduced total U.S. health care spending by about $11 billion in 2009, and that these reforms would reduce federal budget deficits by $54 billion over the next 10 years. Similarly, this past December, the National Commission on Fiscal Responsibility and Reform released its report on recommendations to bring federal spending and the deficit under control, including medical liability reforms as part of the solution. Medical liability reforms have made a difference in both California and Texas. Physician premiums have risen more slowly than in the rest of the country, and the number of lawsuits has dropped. Equally important, in Texas, the growth rate of newly licensed physicians in the state was 59% higher in the past two years than the two years preceding reform. Texas also has added 218 obstetricians in the past six years. Both the Texas law, which was enacted in 2003, and the 1975 California law are held up as examples for the rest of the country, and the California law is seen as a road map for what Washington should do. Doctors have talked for a long time about having to practice defensive medicine and the price of doing so. Now we are being heard. Today the public recognizes just how costly our medical liability system is — and that they are footing the bill through taxes, higher health insurance premiums and higher medical costs. We must redouble our efforts to keep medical liability reform in the news and on the minds of our representatives in Washington. Stay in touch with your senators and members of Congress on this one — for the good of the medical profession, our patients and our nation. Dr. Hoven is an internal medicine and infectious disease specialist in Lexington, Ky. Learn more about Dr. Hoven at the AMA’s bio page or contact her by e-mail.
