Republicans in the Oregon Legislature are getting their first look at what they won in exchange for their support for Democratic Gov. John Kitzhaber’s health care transformation plan. It’s not the overhaul of rules for medical malpractice lawsuits the Republicans hoped for, but it’s significantly more than nothing. For a few tense days in February, it looked as though a dispute over malpractice would keep lawmakers from allowing Kitzhaber’s health care plan to move forward. Republicans, who with Democrats jointly control the House of representatives, wanted tough malpractice reforms, including a $570,000 cap on damages awarded in lawsuits against doctors and other health care providers. The Republicans were in a strong position. The state’s current budget is built on an expectation that the health care transformation will achieve significant savings. By withholding their support Republicans threatened to derail the central achievement of Kitzhaber’s current term while also throwing the budget out of balance, with consequences for state programs favored most strongly by Democrats. But in the end, the Republicans dropped their opposition. What they got in return was a promise by Kitzhaber to appoint a work group that would bring proposals for malpractice reform to the Legislature in 2013. The Republicans could have held out for more, but they showed why Salem is a more productive place than Washington, D.C. Oregon Republicans have a stake in both the health care plan and the budget. In addition, Kitzhaber’s¬ promise still carries weight — when the governor said he’d take a hard look at malpractice, the Republicans believed him. Kitzhaber’s recommendations, released last week after discussions with members of the work group, show that the Republicans’ trust was not misplaced. The governor isn’t calling for a cap on damages — no one would expect him to, given the fact that twice in the past dozen years voters have rejected ballot measures limiting malpractice damage awards. Instead, Kitzhaber proposes placing a series of speed bumps and exit ramps in front of the courthouse. First, patients or health care providers who believe a “serious event” has occurred would have to file notice, triggering a process of discussions that could result in an apology, an offer of compensation or both. If those discussions don’t prove fruitful within a defined period, the matter then goes to mediation. A lawsuit would result only if mediation fails to resolve a malpractice dispute. Kitzhaber’s recommendations now go to the work group, which consists of legislators, a lawyer and a physician. The work group will hold public meetings to prepare proposals for consideration by the Legislature in 2013. The governor has provided the group with a good starting point and a solid set of goals: to improve medical performance and patient safety, to devise a more effective system of compensation for medical errors, and to reduce overall costs. The work group should consider other possible reforms of a system that currently inflates the cost of health care by encouraging the practice of defensive medicine, compensates relatively few people who suffer as a result of medical mistakes or negligence, and produces malpractice awards that are sometimes too big or too small. But so far, legislative Republicans can be at least provisionally satisfied with the bargain they made earlier this year.
