Just got my first lecture on malpractice in med school...

[NNguyenMD]

And apparently the rising costs of malpratice insurance isn't from awards given to patients who suffered bad outcomes from their doctors, its from massive number of settlements made by the mappractice lawyers b/c its cheaper to settle a case than fight it out in a court of law. And the the guys who always win no matter what the outcome are the LAWYERS.

I do not support the capping awards to patients who win malpractice lawsuits. But I am for laws tightening the validity required to sue your doctor, because when surgeons and OB/GYNs refuse to practice in states that have few of either because the malpractice insurance is too high, everybody loses patients and doctors. And if you think its just rich doctors whining about nothing, imagine coughing up $183,000 costs a year from your own business to just one place, the malpractice insurance. There really needs to be a system to throw out malpractice suits that have no merit, where the lawyers soak up the cost burdens. There should also be more protections for doctors so that they don't have to practice with the fear of getting sued over their heads all of the time.

Did you know that the statute of limitations for an OB/GYN is friggin 18 YEARS!!! Every kid they delivered in the OB ward has 18 years to find a reason to sue their doctor! Doesn't that bother anyone?

[sir_captain]

1. I agree with you

though I doubt you'll get much sympathy around here. Doctors don't seem to be too popular on DU...

[Tandalayo_Scheisskopf]

2. Sure.

More regulations just as soon as the medical associations do a far better job of policing incompetant doctors.

The situation needs a little give and take. There are clearly incompetant doctors out there, like the surgeon who allowed my friend's father to bleed out into his peronteneal cavity, with all the usual signs of this happening.

This was not the first time he had killed anyone, either. That's right: killed. It all came out in court. The plaintiffs won, but not some princely sum.

[iamjoy]

14. My Mom Was ALMOST Killed

I mean, everytime we think about this, we know she is lucky to be alive. But because there was no permanant damage, no lawyer would take her case.

The doctor definately made some mistakes, her insurance company may have too. After a procedure, her doc released her from the hospital. When she voiced concerns about some of her vital signs to him, he said the insurance co wouldn't pay for another day. She wound up back in the emergency room a few days later and was in the hospital for 3 weeks which put her into the next plan year (try spending Christmas and New Years Eve in a Progressive Care Unit) which meant she had a new deductible, etc. She pitched a fit saying if the doctor had treated her properly the first time (and the insurance had let her stay) she never would have been back in the hospital. The bill disappeared. Some one knew they fucked up big time, you know how insurance companies and medical providers are about their bills. I've fought improper billing before and it took three years to get it corrected. Hers got fixed in a snap.

[Throckmorton]

49. Effectively my wife was killed by malpractice,

Her esophageal cancer went undiagnosed for over a year, despite over 20 visits to the doctor.

[RUDUing2]

52. my sisters colon cancer did too..

she complained for years to her doc that she had bowel probs..constipation, upset stomach, etc...
she complained for 6 mths that she had blood in her stools..
then she started having respiratory probs that would not clear up..doc told her they were allergy's..then that they were bronchitis..
she finally scheduled a colonoscopy on her own..
she was diagnosed with stage 4 colon cancer that has spread to 4 lung nodules and 12 lymph nodes..she was given a 22 mth survival probability the same week my mom died of ovarian cancer...
she turned 45 a month later....

[elehhhhna]

100. that's horrible. I'm so sorry.

[Throckmorton]

154. So typical.

A simple barium swallow series would have shown the tumor, it was huge when it was discovered. But no, the doctor just kept prescribing one pill after another, with minimal effect.

He never did find the tumor, it was discovered after she was hospitalized with a hemocrit value of 5. The gastro guy thought she had a bleeding ulcer, but the endoscope proved that wrong.

She lived just 14 months after her diagnosis, leaving me with a 7 and 9 year old to raise on my own. She died in March and I'm still trying to come to grips with suing, I suspect that I will never get anywhere with the suit, but I really should talk to a lawyer I guess.

[RUDUing2]

156. lawyer told my sister she doesn't have a case cause

her type of colon cancer is 100% terminal..and earlier detection would not have changed the outcome...

[JanMichael]

3. As soon as we have 100% coverage fine.

Until then, as the money battles are forged, sorry.

[SmokingJacket]

54. YES -- this is the issue

When, for example, a child is born with massive birth injuries requiring possibly a LIFETIME of medical bills, the money has to come from somewhere.

This issue is partly about incompetence -- I do believe that the vast majority of doctors are competent, but human -- but mostly about inadequate health coverage.

[politicat]

228. in cases of incompetant health coverage, we should be suing the insurers.

Not the doctors.

But I seem to recall that we're not allowed to sue our insurers. Some little recent change in the law...

I'm fighting Cigna right now to get them to cover what our policy says they cover - labs and imaging...

Grr...

Pcat

[papau]

4. true - but "massive number of settlements" reason for cost is a lie

the price increases are related to casulty insurance company investment portfolio investment loss

claims have been stable or decreasing

[NNguyenMD]

6. Physicians Insurers Association of America 2003

61% of mal practice suits dropped or dismissed cost on average FOR THE DEFENSE $16,743

32% of mal practice cases that are settled cost on average FOR THE
DEFENSE $39,891

Only a marginal amount ever go to trial in which a defense verdict (6% of cases) cost $85,718. And a verdict in favor of the plantiff costs $91,423

Believe me, sueing people costs money. And when all doctors can expect to be sued at least once in their careers on average, it comes out to a lot of money to lawyers.

[papau]

13. All true - and mostly unchanged as to $'s over the years - yet the

premiums charged MD's over last few years have doubled - in some case are 3 times.

If claims and claim settlement cost have not gone up what has happen?

For one - the illustrations of the sad state of the ins company re mal-practice ins now include a lot more allocated over-head, and less investment earnings on the very long tail, so as to show less profit.

The SOCIETY OF ACTUARIES HAS THE VARIOUS INDUSTRY wide studies over the years -

Lawters and plantiffs have not suddenly become better paid/compensated.

Indeed the GOP is now reduced to selling an awards cap as a way to stop defensive medicine extra lab/tests/mri etc - and not because of the actual mal-practice claims/claims serttlement expense.

[texastoast]

25. Yes, but

isn't it amazing that insurers haven't lost a dime? If the insurance companies' profit margins get too slim, they cry to the legislatures.

I would like to see a cap on premiums (or how about a refund when a doc goes a year without suit?--like that idea?) when tort reform measures are passed to cap patients' recovery. Don't bother me with the insurers' pool argument. Instead, look to their profits.

And why can't patients waive a doc's liability? Where is the freedom to do that? A minor skin cancer removal that first cost $125, then $200, up to $275 in a doc's office now costs $3,000 plus the "operating room" fee. Defensive medicine? I can hardly buy that in many instances. More likely is the insurers and the health care industry (not docs necessarily) are as deeply in bed as the oil and gas industry and the auto makers.

[papau]

59. true - and a waiver seems reasonable - as well as self insurance

many md's in mass do self insurance via a doc owned company they own and fund.

[sendero]

195. Insurance in this county....

... is like a casino. The house always wins, always. It is not a business, where there is a risk and a possibity of failure, it is like organized crime - everyone gets the shakedown.

Doctors ought to organize their own insurance system and send the sorry piece-of-sh*t insurance companies packing. They provide no value to the situation, they are merely leeches.

As is commercial health insurance in general.

[merh]

219. Go check out the GOA's report that came out last year

that states there is no correlation between the cost of medical malpractice insurance and the litigation. If I find the link, I will glady post it for you. Basically the GOA found that it is a myth to believe that the insurance rates increased as a result of litigation.

INSURANCE COMPANIES lost investments so they continue to show profits by increasing the rates.

Doctors need to start their own insurance pools like many casinos have done. Pay into your own associations, watch the investments, be able to intelligently see how your insurance rates are used and at the same time, be in a position to see which members of your profession are the greatest risk (most negligent or totally incompetent) and then discipline them by suspicion of privileges, suspension of licenses, mandatory education and revocation of licenses if necessary.

It is the insurance companies and the medical professionals refusal to take care of its own by means of discipline as opposed to protection.

imho

Here ya go - this is by that kooky conservative group that did the fact checking during the campaign.

Read the article and the discussion of the studies on this then go read the studies. Link are all provided at the end of the article.

DON'T DRINK THE KOOLAIDE - http://www.factcheck.org/article133.html

[Somawas]

15. Exactly. Been that way for a long time.

eom

[signmike]

5. You're only in Med School and already you did a malpractice and

all you got was a LECTURE? Damn, you rich kids get all the breaks.

[NNguyenMD]

7. I'm sure most of the learning will come from having to fill out all the

stupid paperwork to protect yourself from this nonsense.

And when I said lecture I meant a CLASS LECTURE, that you get from an instructor standing in front of a crowd in a big lecture hall.

[sir_captain]

11. See what I mean?

About how popular docs are around here?

Keep your chin up...

[NNguyenMD]

16. I hear ya brother, but I do appreciate the support though =)

[iamjoy]

8. Reform Is Needed On Both Sides

I agree. But any type of tort reform must go hand-in-hand with medical reform. Doctors do not do a good enough job of "policing" their own. Some ideas in tort reform that don't compromise the patient:

1. A review process to make sure only those cases with merit made it to court. If it sounds familiar it is because John Edwards advocated it.

2. The "expert witnesses" the plaintiff attorney calls must be presented with a similar case, not given the outcome & asked for an expert medical opinion. Hindsight is all too easy.

3. Different regulations regarding torts apply to certain fields deemed high risk - such as obstetrics and trauma rooms. How the heck is a doctor who has a patient come in bleeding, unconscious, etc. needing critical care supposed to get the medical history needed to make the best decision?

4. Don't cap non-economic damage awards completely, but have any amounts over a certain limit go somewhere other than the pocket of the attorney or the injured. For example, punitive damages could go to a fund to help pay medical bills for the uninsured or to educate the public about health issues.

WHAT DOCTORS MUST DO
Regulate your own! When a doctor messes up, yank his damn license! And medical boards must be more careful about granting licenses to doctors suspended in other states.

Doctors should be educated in bedside manner. I have no statistics, but I am willing to bet doctors with a good bedside manner get sued less than rude doctors because people have confidence and think the doctor cares about them.

[NNguyenMD]

9. I think you make a good point about accountability and there is

physician profiling adopted by more states, like New York where I go to school, where you can look up the history of a physician's practice or how many times they have been sued all online. That doesn't solve all the problems of accountability, but like all professions this "look after your own" mentality needs to be dropped.

But I really wish it were only the bad doctors who got sued, b/c good doctors get sued too, and most physicians (no statistics just anecdotal) I've spoken to in all seriousness expect to get sued at least once in their careers of practice. Thats a lot of money getting shoveled into litigation. Doctors are not perfect, we try as best we can but we cannot promise perfection, and its getting too expensive for both of us to expect perfection from our profession.

[iamjoy]

22. Easy For The Educated

to go online and look that stuff up, but not enough people know about it. The poor and uneducated don't know how to do this.

And I think they are the most suseptible to some attorney persuading them to sue.

Doctors should have something in their office, or in the consent for treatment that tells people how to look this stuff up. Some poor and uneducated people may still not understand, but as long as we have a for profit medical system we are going to have discrepancies in treatment based on income.

I wish there were a way to distinguish in these cases between human error and gross negligence and limit awards on the former, but not the latter. I don't know how to distinguish, but I know that doctor who forgot the metal rod for his patient's spine, didn't realize it until the in the operating room and inserted a screwdriver... forgetting the rod was human error. Using a screwdriver was inexcusable negligence.

http://www.usatoday.com/news/health/2003-07-16-spine-screwdriver_x.htm

[gbwarming]

24. Pubic Citizen.org has payouts/doc for 1990-2003.... 83% of docs had none

It's an interesting paper. See fig 12, p29: http://www.citizen.org/documents/PA_MedMal_Rpt.pdf

Just 0.4% of doctors (3243/736,000) made 5 or more payouts during that time period which amounted to 12%(23,000/192,000) of all payouts.
16.4%(123k/736k) of all doctors made 100% of the payouts...
That leaves 83.6% of docs between 1990 and 2003 with 0% of payouts. zip, nada. Don't freak out bro. Lots of people get sued at least once in their careers or personal lives.

BTW, what are the median malpractice premiums for various specialties? 183k is probably not typical.

[Skidmore]

47. Not only yank the offending physician's license, but make

it impossible for doctors to go to another state and resume practicing because they can get a license there. Make that list of physicians public.

And as for the insurance companies--what a racket. If doctors and lawyers would both buy a vowel and get a clue, they would gang up on the insurance companies. Insurance is a ponzi (sp?) scheme, and those suckers are laughing all the way to the bank.

[RuleofLaw]

48. Let me comment on your fourth point

"4. Don't cap non-economic damage awards completely, but have any amounts over a certain limit go somewhere other than the pocket of the attorney or the injured. For example, punitive damages could go to a fund to help pay medical bills for the uninsured or to educate the public about health issues."

The way the American tort system is set up, there is a financial incentive for suing bad people. Every person is a potential General Attorney. Financial incentives makes it profitable to go after people who commits wrongs. That is why you have punitive damages being paid to the people who have been wronged. If you cap the damages, as we did here in Florida via the constitutional amendment, you will take away the financial incentive for lawyers to take on complicated and costly cases, and therefore those cases will not be pursued.

What you are suggesting is what is common in Europe, where the whole concepts of contingency fees and punitive damages are unheard of. There it is the governments job to police the various professions. If you as a patient gets hurt by a doctor, the state will assign you a disability rating and pay you accordingly.

The same people who call for tort reform will call this socialism.
What is really at stake is the average persons right to have his case heard before a court. Yes, medical malpractice can be a profitable business for lawyers (on both sides), but that is how the system is designed.

In Florida, the new cap is that a lawyer can only receive 10% of the award if it is over $250,000. Imagine a complicated medical malpractice case, with costs of $400,000 (not uncommon). How many lawyers do you think will take on a case of that magnitude, if the financial reward is minuscule? And who do you think that ultimately will hurt?

If people truly want to reform this area of the law, the only solution is national health care. Imagine if you wouldn't have to sue anybody, to be able to go to the hospital. Remember that in most tort cases it is a basic question of who should pay for the medical bills?

[iamjoy]

155. Any Cap Shouldn't Apply To Expenses

I am talking about separate from court costs.

And I would see nothing wrong with stricter govt regulation & penalties instead of lawsuits. To me, less govt regulation & lawsuits are the ultimate in free market...but that's just me

[Patiod]

97. You're right - there have been studies about bedside manner

and perceived physician honesty. The sued MD is not necessarily a worse doctor, just a ruder doctor.

From a WSJ article: "But studies show that a majority of malpractice suits are brought not necessarily because of a bad outcome in treatment but because patients and their families felt medical staff either lied about it or tried to stonewall them afterward.

[YNGW]

10. 6x2=12

>Just got my first lecture on malpractice in med school and apparently the rising costs of malpractice insurance isn't from awards given to patients who suffered bad outcomes from their doctors, its from massive number of settlements made by the malpractice lawyers b/c its cheaper to settle a case than fight it out in a court of law.

To me, that's six of one and a half dozen of the other. Either way, the insurance is high because of all the money they pay out.

>I do not support the capping awards to patients who win malpractice lawsuits.

Should we ever move to universal healthcare, I would be in favor of a cap. The gov't would negotiate with the drug companies what they're willing to pay, the doctors would be told by the gov't what would be paid for medical procedures, and lawyers would not be permitted to represent patients for medical procedures gone wrong. Any cases would be left up to an arbitrator. If you didn't like the outcome, you could appeal one more time to a Senior arbitrator. But regardless, everyone is going to have to forfeit something in order to keep costs down.

If insurance companies are paying out large sums of cash for things that went wrong, that will cause them to increase malpractice insurance to cover the costs of those settlements, which means the gov't will have to increase what it pays for medical procedures to doctors so they, in turn, can pay the increased premiums, which means the gov't will have to collect more money from those of us who pay taxes. Ultimately, the taxpayer bears the cost of these large settlements. So, you cap the settlements. The insurance companies know that no matter what, the maximum they will have to pay out is $X, they can budget and keep down the cost of malpractice insurance, which keeps down the cost doctors have to pay for premiums, which lowers the cost required for them to be paid for procedures, which means less tax money required to run the healthcare system.

I say a good cap would be $1 million. You die on the operating table as a result of a doctor's error, your estate gets $1 million, that's it. No reason that we the taxpayer should have to annie up a bunch of cash to the gov't to cover the cost of some large payout because of some doctors mistake.

[NNguyenMD]

12. I think Oregon has actually adopted something similar for economical

punitive damages and mal practice costs for physicians has actually stabilized. So maybe there's hope after all.

[papau]

18. true and true - but not related.since economical punitive damages

is not a major driver of the premium rate.

[Hippo_Tron]

38. I don't think that it's paid with tax money, just insurance premiums...

Which I suppose causes your premiums to go up.

[Festivito]

17. Would truth trump a Republican president.

Not in the American media.

So, settling costs more than big-dollar suits. Interesting.

Will need better proof. Very nice to hear. Thank you NNgyuenMD.

[mom-mad-about-bush]

19. Just wondering.......

Can you be a doctor and NOT have malpractice insurance???? If the patient is aware the Dr. does not have insurance....could they still choose to be treated????

[gratuitous]

20. Uhm . . . No

Here's what it takes, at least in Oregon, to bring a medical malpractice lawsuit:

First, heueueuege damages. If the patient isn't dead or debilitated for life, forget it. That's mostly because of . . .

Number two, the large expense of bringing a suit against a doctor. None of the attorneys that I work for or that I know of in the legal community can easily afford to spend the thousands of hours necessary to prosecute a med mal claim (not to mention the other business necessarily turned away to concentrate on one case), AND be out the six figures it's going to require to bring a case to trial for two, three or four years. During which time, of course, the attorney is liable for taxes on those costs advanced, which the tax system treats as a "loan" to the debilitated client, who is usually in no position to pay costs as they're incurred. Why are costs so high? Well, that's . . .

Reason number three: Doctors are incredibly reluctant to testify against their professional colleagues, even in a case of extreme negligence. The nearest doctors we can contact even to render an opinion (but not testify) are in Seattle or San Francisco. Most likely, if we hire a medical expert to testify against an Oregon doctor, he's coming from at least a couple of states away, Colorado or Minnesota. Not only does the expert's time cost, but his transportation, housing, deposition, cross-examination, and trial testimony all necessitate at least four figures every time. Why are these costs necessary? That brings us to . . .

Fourth, the insularity of the medical community, and its hardball tactics in defending even the worst butchers. Getting a fair assessment of a doctor's treatment (Was it negligent? Did it meet the standard of care? Was the evidence of the x-ray so blindingly obvious that a fourth grader could see it?) without engaging high-priced experts just doesn't happen.

As for "finding a reason" for an 18-year-old to sue his or her OB/GYN, you'd have to cite some case law before I'd believe that that happens on anything more than a one in a billion chance. First, the effects of the malpractice would have to be directly and positively atributable to something that happened two decades previously, and nothing else. There would have to be a sound medical reason for the damage to remain latent for over a decade. Those two facts alone would eliminate virtually any claim after that long a period of time.

However, if you're talking about a kid who's the victim of some botched procedure, and the lawsuit being held in abeyance or the statute of limitations tolled until the full dimensions of whatever deficits he's going to experience become a little clearer, then I'd say that that happens not only for medical professionals, but also for any other potential tortfeasor who injures an infant (e.g., the owner of a building where an infant crawls out an unobstructed floor level window on the third floor; see Troller-Renfree v. University of Portland). I see no compelling reason to grant doctors deserve preferential consideration.

[texastoast]

27. And docs aren't so bad

as long as they are open-minded to alternative medicine and augmentative whole life approaches. I can't stand a pill doctor when a life style change is called for.



:beer:

[onecitizen]

21. You know what would stop this stuff?

If the Doctors would police their own. But they will never do it. It's a few BAD docs out there that repeatedly have incidents. Then the good docs(and most are good and caring)have to pay the price too.

My Neurologist talked to me about this recently. He has to leave the area because of sky rocketing insurance here. I asked who was to blame and he said it is NOT Lawyers. It was more the greed of the insurance companies as well as what I mentioned above.

I heard today that the average cost of employee health care insurance is now $465/mo (that's the employees' share)! Unbelievable! Then later I heard that Medicare payments are soon to be slashed(the payments made to Hospitals and Docs). Which means the Docs and Hospitals will quit taking Medicare patients. Soon, it will be only the really rich that will be allowed to live here. I'm telling you something: A REVOLUTION IS GONNA COME!! It will happen.:mad:

[Hippo_Tron]

34. But see, the religious leaders tell their congregations...

That voting for somebody because they will give you healthcare assistance from the government is greedy and anti-christian. And besides you need to vote for the guy who will make sure that those faggots can't get married. That's #1 priority.

[OhioChick]

36. I couldn't agree with you more...

Doctors should 'weed' out their colleagues who are 'causing' their insurance rates to climb. I understand that CA has had 'tort reform/caps' since the 70's and their malpractice insurance is just as high as other states......"Maybe" medical malpractice isn't the #1 problem...

[RPM]

23. 18 years makes sense...

If a child were to be delivered with issues, 18 years is an appropriate amount of time for the child to come to the age of majority and bring suit (without the parents being involved).

Actually, I am a bit surprised its not 18 years and 1 (day, month, 6 months). Either way - It seems to be a Statute of Limitations that allows latent issues to be discovered and/or a chance for the child to sue of his own standing.

[Kitka]

26. The 18 year SOL is necessary.

They can't just conjure up any old reason to sue the OB, it has to be related to a problem at birth that is documented. Sometimes the full extend of damage can't be proven until the child has fully grown.

In Illinois we have a statute where a doctor in the same field as the doctor being sued has to sign an affidavit that the case has merit. I believe that's quite fair. I work for a medical malpractice attorney, and we only have about 5 active cases, because he is so selective about the cases he takes.

Personal injury, on the other hand, can be quite frivolous. If only PI cases were required to have validity!

[NNguyenMD]

29. but the extended length is one of hte major reasons why OB/GYNs

are grouped into high risk specialties, and are charged one of the highest mal practice insurance premiums out there.

Its not just that though, but the very thought of an 18 year statute of limitation has got to affect the way an OB practices and ultimately eat up your pocket book in health care costs. No one is perfect, physicians are far from it, but when society singles us out and necessitates the demand of perfection from OB's with the threat of litigation, its almost always going to up with defensive medical practice.

If most American are willing to accept those costs, then fine. But they shouldn't forget that putting a physician's feet under constant fire will dramatically affect the way healthcare is delivered.

Medicine is a very fluid profession that changes by the day, its not like launching a space shuttle or building a safe airplane. We deal with high volumes of patients with very limited time for each one. Mistakes will happen, as a society we have to be reasonable with what we deem gross malpractice and legitimate acceptable mistakes.

[RPM]

33. ahhhhh, the price of professionalism.

It's a bitch - but after a semester of legal ethics and the related discussion of malpractice and how to protect against it (as an attorney), the only justifications I can find are:

1) to whom much is given, much is expected...

AND

2) in order to accept a higher rate of return, one must accept a greater risk - rare and fleeting are the opportunities to earn a higher rate of return at a lesser amount of risk.

So much for degrees in finance and law.

For what its worth, I'll buy you a beer and we can bitch about insurance companies and our malpractice premiums. :toast:

[NNguyenMD]

40. I might take you up on that beer sometime. Here's to starving students!

[RPM]

41. heres to starving students...

... and the wives who support them.

cheers! :toast:

[Kitka]

50. Of course that’s how you see it from your POV, but keep in mind

that although medicine cannot be an exact science, it deserves to be singled out. Your profession affects whether human beings live or die more than any other. Of course the rules are going to be different.

As for the 18 year statute, it’s unfortunate that OB’s are charged more, but the reality is that some doctors do make mistakes that are due to negligence at birth. The extent of damage caused by those mistakes may not be fully obvious until that baby is fully grown. How could a baby who was injured at birth get fair compensation at 2 years old? Say we pay them based on the worst possible outcome of their current condition. Then the doctor is paying out more than possibly is necessary. If we pay them based on the best possible outcome of their current condition, we may screw over a child who will grow up to be non-functioning, but whose parents were forced to sign a release when they were 2 years old. What suggestion do you have to replace this 18 year SOL? What type of fair system do you propose that could accurately predict the level of handicap an adult will suffer due to an injury at birth?

[elehhhhna]

105. You said it ! If you're in Cook County the jurors are Lotto Balls! $$$$$

[AP]

28. Insurance companies rip off everyone with money. Drs are a big target.

Insurance co's have profit margins of something like 50%.

You know that one of the canadian provinces insures drivers. They pay out everything they take in, and adjust year over year to make up the difference. Legislators are committed to making roads and cars safe since they pay if they aren't.

Insurance costs were cut in half.

[elehhhhna]

106. Wow. We shoudl start a Best Practices Party and adopt these laws!

[Maddy McCall]

30. Keep in mind that your lecture on malpractice ins. came from a physician.

And physicians historically HATE doctors. It is hard for a physician to give an unbiased lecture on this topic, because I am he or his colleagues have faced a lawsuit or two.

Plus, there is a movement in this nation by physicians to introduce federal tort reform, and almost all doctors are politically active on this topic.

Basically, you got an inculcation lecture tonight, to bring you into their political fold. I hope you are wiser than believeing this.

[NNguyenMD]

31. came from a professor who heads our Bioethic course, who is a practicing

NON-physician lawyer in Syracuse.

[central scrutinizer]

64. What do they call the person who graduates dead last from medical school?

Doctor.

A college classmate thirty years ago was the first black woman ever admitted at a certain midwestern medical school. Her stories of med school were horrific. She said most of the lectures were about money and how much money you would make in this specialty versus the amount of money you would make in that specialty. There was a lot of competition for grades and many of the students were ruthless cutthroats who would purposely try to sabotage other student's learning. For example, the school had boxes of microscope slides of tissue samples. She said that some students would peel off the identifying labels on the slides and mix them up so the students who came after them would get those answers wrong on the next exam. Maybe she was targeted because of her race and gender. That was pre-internet(s) so maybe now students hack into the med school's computer and switch the information that way these days.

[NNguyenMD]

94. ever try to apply to medical school?

if you have I think you'd know that its extremely hard to get into one. And not to blow my own horn, but we are among some of the best of most undergraduate colleges. Being last in your class doesn't make you some dummy.

[central scrutinizer]

133. no, all of my degrees are in mathematics

but you're right - my students who are pre-med are usually the ones who work the hardest since it so competitive to get into med school. The subject title of my post was just an old joke and wasn't meant to be taken personally. I have a great doctor and my mother in law is a retired pediatrician.

[politicat]

229. Physicians hate DOCTORS? What are you smoking?

Unless you're talking Doctors of letters - and most of that type don't use the Doctor title - you just said that physicians hate themselves.

Unless you're trying to draw a distinction between doctors who practice and physicians who teach?

:WTF?:

Pcat

[republicansareevil]

233. Maddy obviously meant to say LAWYERS, not doctors.

Maddy's post was exactly right.

[SharonAnn]

32. Did you know that a small percentage of the doctors cause most

of the malpractice awards? And they're not removed from practice?

Did you know that doctors don't police their ranks very well and that causes a lot of problems?

I grew up in a medical family and can remember the fights my dad would have with the local and then the state organization to get someone's license suspended because they were bad doctors and patients were dying. It hasn't really improved.

[atre]

42. Doctors and allied fields also cover for one another

I've had to spend an extra $5000 or so because of an error by a medical care provider early in treatment. I've never thought about suing; that sum simply isn't worth the effort. But what amazes me is how all the other such medical care providers have attempted to give me such ridiculous explanations for how it happened, ignoring the obvious explanation.

[kayleybeth]

35. Malpractice Lawyers didn't cause my daughter's brain damage

The medical staff did. And if it were up to me, those people would be in PRISON now, but criminal charges were not an option. Suing them was.

What a lot of people don't realize is that unless you have a solid case it is very difficult to get a lawyer to represent you. The law firm we went to spent 3 months and over $10,000 of their own money researching the facts before they would even agree to represent us. It wasn't until they were certain that malpractice had in fact ocurred that they took my daughter's case.

There are not nearly as many "frivolous" medmal cases as you might think. And hospitals rarely ever settle just to make a case go away. Defendants will fight in court for years upon years, regardless of the merits of the case, and they never run out of money or lawyers or time.

I sympathize with the "good doctors" who have to pay such high rates, but they are going after the wrong targets. They should be going after the insurance companies, not the victims or the lawyers. Insurance companies should charge according to individual risk instead of spreading the risk among all doctors. The doctor who caused my daughter's injuries, for instance, SHOULD pay through the nose for medmal insurance, but she pays the same rate as the doctors who have never committed malpractice. That should bother you.

[deek]

83. very true

Hard to endure the process, even in obvious cases. Medical records are written as to avoid implication in the future/changed.

I know of quite a few families, including myself, that have children with disabilities because of doctor/hospital error, but were unable to win a lawsuit because of society's misconception over the prevelance of frivolous lawsuits and the medical industry's illegal complicity in covering up their mistakes.

[NNguyenMD]

37. I'm going to recant some of my previous statements b/c

I think papau and a lot of your guys made some great points, and I have done a little bit of research from http://www.consumerwatchdog.org and other articles online to realize hte error of my ways. Because I cannot find one statistic that justifies the rising rates of malpractice insurance by insurance companies. The # of claims and costs of awards has not moved in most states, with a few exceptions such as a state like Mississippi which has recently given a lot malpractice awards over $1 million dollars but is a marginal amount of the total costs, there really hasn't been an increase in the amount of money that mal practice insurance companies are giving to patients or paying out in physician legal fees.

So, I was probably overreacting in blaming lawyers. If anything, lawyers are one of the few outlets for people to seek social justice. To all lawyers at DU, I apologize.

In any event, regulation is probably the best course of action. If the huge sums of money physicians give insurance companies ultimately does nothing more than to beef up their profit margins, and goes nowhere to helping patients or other physicians with their legal fees, then they must fight back and demand tighter regulation by the states and federal government.

The insurance lobby, and sadly the physician lobby as well, are both turning physicians and patients against each other. In a lot of ways, this reminds me of how the auto industry tried duping Americans to "buy quality american" as a way to protect American automotive jobs, when the only people they were seriously concerned about were their share holders. Ultimately they shipped their jobs overseas anyways, while still making record profit margins.

Here's an informative report on how California learned its lesson when it caved into the insurance company in '75, but fought back and regulated rates to appropiate levels twelve years later in '88. http://www.consumerwatchdog.org/healthcare/rp/rp003103.pdf
Thanks everyone for all the information and help.

[charlie]

39. Another data point to ponder

Nation's Largest Medical Malpractice Insurer Declares Caps on Damages Don't Work, Raises Docs' Premiums

Santa Monica, CA -- The nation's largest medical malpractice insurer, GE Medical Protective, has admitted that medical malpractice caps on damage awards and other limitations on recoveries for injured patients will not lower physicians' premiums.

The insurer's revelation was made to the Texas Department of Insurance (TDI) in a regulatory filing obtained by FTCR. The revelation was contained in a document submitted by GE Medical Protective to explain why the insurer planned to raise physicians' premiums 19% a mere six months after Texas enacted caps on medical malpractice awards. In 2003, Texas lawmakers passed a $250,000 cap on non-economic damage compensation to victims of medical malpractice caps after Medical Protective and other insurers lobbied for the change.

According to the Medical Protective filing: "Non-economic damages are a small percentage of total losses paid. Capping non-economic damages will show loss savings of 1.0%." The company also notes that a provision in the Texas law allowing for periodic payments of awards would provide a savings of only 1.1%. The insurer did not even provide its doctors that relief and eventually imposed a rate hike on its physician policyholders.

http://www.consumerwatchdog.org/insurance/pr/pr004692.php3

[elehhhhna]

107. THANK YOU!

[eridani]

241. Insurance companies talk out of both sides of their mouths

http://releases.usnewswire.com/GetRelease.asp?id=38849
To: National Desk, Health Care Reporter

Contact: Douglas Heller of the Foundation for Taxpayer and Consumer Rights,
310-392-0522 ext. 309

SANTA MONICA, Calif., Oct. 26 /U.S. Newswire/ -- The nation's largest medical malpractice insurer, GE Medical Protective, has admitted that medical malpractice caps on damage awards and other limitations on recoveries for injured patients will not lower physicians' premiums.

The insurer's revelation was made to the Texas Department of Insurance (TDI) in a regulatory filing obtained by the Foundation for Taxpayer and Consumer Rights (FTCR). The revelation was contained in a document submitted by GE Medical Protective to explain why the insurer planned to raise physicians' premiums 19 percent a mere six months after Texas enacted caps on medical malpractice awards. In 2003, Texas lawmakers passed a $250,000 cap on non-economic damage compensation to victims of medical malpractice caps after Medical Protective and other insurers lobbied for the change.

According to the Medical Protective filing: "Non-economic damages are a small percentage of total losses paid. Capping non-economic damages will show loss savings of 1.0 percent." The company also notes that a provision in the Texas law allowing for periodic payments of awards would provide a savings of only 1.1 percent. The insurer did not even provide its doctors that relief and eventually imposed a rate hike on its physician policyholders.

The Medical Protective document can be downloaded from: http://www.consumerwatchdog.org/insurance/rp/rp004689.pdf

According to a St. Paul Insurance company study provided to the Florida Department of Insurance at the time:

"The conclusion of the study is that the noneconomic cap of $450,000, joint and several liability on the noneconomic damages, and mandatory structured settlements on losses above $250,000 will produce little or no savings to the tort system as it pertains to medical malpractice."

"Time after time insurers present caps as the panacea for high insurance rates only to argue that caps actually have a negligible impact when it comes time to send doctors the bill," concluded Heller.

[dpibel]

181. This post deserves respect and congratulation

I compliment you on your willingness to do your own thinking.

The facts are out there, for those, like you, willing to look them up.

But, even amongst doctors who, as you note, must satisfy rigorous requirements for academic success, it seems that many are willing to take the easy way, and blame the victims.

It's surpassing strange that, in all the insurance-industry generated hoo-hah over tort law, no one looks at the fact that the only people in the tort system who never show a loss are the insurance companies. Anyone who thinks that all tort lawyers are rich predators should meet more tort lawyers. But insurance companies? They always win.

[Swamp Rat]

43. Next lecture you can bring up ethics in medicine and Frist the Cat Killer

[atre]

44. If you think med schools trash lawyers, ask a pharmacist about your field

Physicians are, from what I hear, the most "corrupt profession in America," particularly in regards to their practices pimping pharmaceuticals for profit while harming patients, Hippocrates and his Oath be damned.

The problems with health care are considerably more complex than you think. I understand the temptation is always great to single out one profession for the blame (and particularly lawyers; easy target, rigth?), but it's hardly accurate.

Personally, I think there should be a multi-pronged attack on the health care dilemma: Price caps on pharaceuticals along with absolute restrictions on advertising; Shorter IP rights to hasten the availability of generic substitutes; Extensive reporting requirements for insurance companies as to their premiums and pay-outs (I strongly suspect price-gouging in most areas of the country); Rule 11 sanctions for lawyers who bring frivolous med mal claims; lower contingency fee availability for personal injury lawyers; socialized health care (which would virtually eliminate most of the sting of a malpractice verdict because of the collateral source rule).

[Sgent]

45. 18 years is short

In some states its 28 years after the birth.

Are OB/GYN's and Neurosurgeons the worst doctor's? Sued every 3rd year on average. Or is there a bigger issue going on here? Anyone who thinks the tort system is good for either the medical profession or the patients has a gaint chip on their sholder -- it is good for neither.

I'm not sure what the solution is, but the MP system is a disaster for all parties, and some sort of reform needs to come about. It should provide reimbursement to the patient for economic expenses -- without the need to resort to court cases. Ideally, it would be no-fault so that doctors are encouraged to come forward with issues, at least to their Q/A committees and the Medical Board.

As for better policing of bad doctors, I am not against it, but there aren't that many of them out there. Every board already uses the NPDB which will tell them if a doctor's license has ever been suspended, restricted, or if the doctor has been thrown off a hospital staff. I would like to see some additional measures, but personally I am more worried about the expansion of mid-level care which is poorley supervised (or not at all) than I am bad doctors.

[sangh0]

65. That's what the repukes tell us

but the insurance industry has been having record profits.

Funny how you repeat EVERY repuke argument on DU.

[NNguyenMD]

75. well then why don't you address the issue of

how a lengthy statue of limitations is the insurance company's justification for higher premiums for OB/GYNs, Neurosurgeons, Orthopedic Surgeons, and Psychiatrists. Or how it ultimately leads to defensive medical practice, and how that affects the way patients are treated. Or do you not acknowledge that any of that happens and think its just made up imaginary fluff from the media.

You're quick to accuse the physicans on DU of whining and bitching, but share no ideas of your own concerning the problems of these issues.

[sangh0]

78. HAHAHAHA!!!

Dude, YOU started the thread. YOU made claims about settlements. The burden of proof is on YOU!!

I'm not going to address your fantasies merely because you pretend they're an "issue"

You claimed it's a problem, now PROVE IT!!! At the very least, provide SOME EVIDENCE to support the RNC's lie that the SOL is a problem.

C'mon "doctor" You claim to have diagnosed a problem. Show us the EVIDENCE!!!

[Name removed]

86. Deleted message

Message removed by moderator. Click here to review the message board rules.

[sangh0]

88. YOU made claims about settlements, but wont' defend them

I hope you didn't think I would be distracted into debating something irrelevant to your claims. YOu said that malpractice insurance rates are rising due to settlements.

Prove it.

Provide EVIDENCE.

[sangh0]

91. And you link is a JOKE

Do you really think an article by a JOURNALIST proves anything about medical insurance?

[sangh0]

46. You teacher is full of repuke propoganda

The reason why malpractice insurance is high has nothing to do with frivolous lawsuits, which haven't been increasing in frequency of increasing in size. The problems are medical errors, and the losses the insurance industry experienced in the stock market

Here's a thread that shows that frivolous lawsuits are not the problem:

http://www.democraticunderground.com/cgi-bin/duforum/duboard.cgi?az=show_thread&om=688&forum=DCForumID31

And here's a link showing how the RNC is behind all this BS

http://www.democraticunderground.com/cgi-bin/duforum/duboard.cgi?az=show_thread&om=35849&forum=DCForumID35&archive=

[RUDUing2]

51. nope, doesn't bother me at all.

and it is harder to file a medical malpractice then is claimed.

For instance my son was misdiagnosed as having bronchitis and then double pneumonia instead of the asthma it really was at 10 mths of age...and he was being given aspirin (1981 it was still used for babies, etc)...which turns out he is severely sensitive too...it sets off asthma in him. He spent 7 days in an oxygen tent. Getting sicker..his doctor finally called a pedi pulmo 90 miles away at a children hospital who said he would see him..but the hospital did not transfer him, and we had to sign a paper saying we were checking him out against their recommendation. The pedi pulmo diaged asthma..took him off the antibiotics, started him on asthma meds and switched him to tylenol...3 days later he went home..
But we had no cause to file a malpractice suit because there was not *permanent* harm to our son...we even had to pay the doctor and hospital which would have killed him if we hadn't went against their *recommendations* and removed him...

My mom is dead because of doctor incompetance..she died of ovarian cancer...two months after she was declared a *survivor* (5 yr mark)the doctor found another mass...doctor told her they were just going to watch it cause it didn't *feel* like cancer to her...3 mths later when they finally did surgery it was cancer and had spread to her colon and bowel..a year later she died following surgery to remove scar tissue causing a blockage in the colon due to surgery that had to remove part of her colon...but my dad refuses to sue for malpractice cause the doctor is *nice*....

so sorry..cry me a river...docs should be held to the highest level of responsibility...

[Sgent]

53. I Don't Know Enough

To comment on the two cases you mention -- but its entirely possible in both of them, based on the info given, that no malpractice was committed in either case. Without looking at your son's x-ray's and labs its entirely possible that an incorrect dx was made, but is supported by the physical exam and other findings. An incorrect dx does not mean malpractice -- the doctor is human, not a god.

As for the cancer case, without looking up suggested lump follow-up and immediacy issues from a professional society, I have absolutely no idea if what the doctor did was standard practice or not. It is dangerous and bad medicine to perform unnecessary surgery. The fact that in hindsight it should have been done doesn't mean a bad call was made given the information available at the time.

[Bridget Burke]

55. So, what's your background?

Medical, legal?

Insurance company PR?

Why don't you let us know how malpractice insurance premiums were lowered & medical care was made more available after "tort reform" was introduced in Texas? Happy hunting!

[RUDUing2]

56. that is the point though...that this belief that frivolous medical

malpractice suits are running rampant...it is harder to file a medical malpractice suit then complaining docs would like people to know...

[ret5hd]

57. Disagree with many things here...

Insurance company profit margins at all time highs.

Insurance companies claiming hard times all around: home owners
insurance, malpractice, etc etc etc.

Yet, insurance company profit margins at all time highs.

If the number of settlements made by malpractice (corporate hack insurance company) lawyers is the cause, FIX THE CAUSE! TAKE EVERY CASE TO COURT! yeah, it might cost more in the short term, but the problem (if you think this is the real problem) will fix itself.

If a personal protection lawyer, knowing he will only get paid if he wins a court case, knowing that the case WILL GO TO COURT, is presented with a case he can't win, HE WON"T TAKE IT.

Of course, there is another explanation for the situation: The insurance companies are ripping us off. As evidence i present the attorney general of new york and the cases he has been bringing against the insurance companies.

Also, the medical industry refuses to police itself AND refuses to give the public access to the information that would allow us to make informed decisions: information on past lawsuits against doctors.

So, you go ahead and spout the typical line that plaintiffs are the problem, refuse to look at the complex issues involed.

[MadHound]

58. There are a number of factors driving up the cost of malpractice insurance

But malpractice settlements and lawsuits really aren't one of them. The number of malpractice lawsuits have actually gone down over the past decade, as have the amount of damages/settlements awarded.

One of the major reasons that malpractice(and other) insurance rates have gone up is that the vast bulk of money an insurance company makes comes not off of the premiums paid, but from the investments that the insurance companies make with those premiums. And quite frankly, not only has the insurance industry taken a bath in the markets, along with other investors, but the insurance industry makes a great number of very shaky investment decisions. Their investment monies were a big force in the dotcom mania, they have a weakness for hedge funds, lots of shaky overseas investments, etc. And instead of eating the losses like a normal individual investor would be forced to do, they are passing along their losses to you and I in the form of higher premiums.

Another reason that rates have gone up across the board is the increasing number of disasters that they are having to make payouts on. Not just the disasterous hurricane season this year, but the ever increasing damage during the fire season out west, the greater number of tornadoes in the midwest, etc. etc. Global warming induced natural disasters might actually kill the insurance industry within the next thirty years if the number of disasters continues to climb at the rate that it is climbing.

Another factor to consider is that both the AMA and the insurance companies are heavy hitters amongst the Republican donors. And they expect something in return for all of that money that they're giving. Tort reform benefits the insurance industry because it will boost their profits, and it will benefit the AMA because it will make the bad physicians that are in practice even less accountable than they are now. Tort reform also benefits the Republicans, since trial lawyers are heavy hitting donors for the Democrats, and if they have a revenue stream cut off, then the Democratic party will have that much less money coming in.

So before you going buying the party line from your instructors, go do some research of your own. There are probably enough checks and balances within our justice system that tort reform is as pressing a matter as it has been increasingly portrayed. What is much more urgently needed is for regulation of the insurance industry to make it's investments more accountable, less risky, and not passing on their losses to their customers. Also, the AMA needs to go after the bad apples in it's own profession before it worries about others. Doctors who are clearly a threat are routinely allowed to keep their license, are if it is pulled, they simply jump to another state. Accountability and full disclosure are something that the AMA has fought tooth and nail, despite their knowledge of life threatening physicians in their midst. This attitude has got to change. Let them clean out their own house before they start worrying about others. I imagine that in the long term if the AMA did do some reform and better policing, premiums would go down, as there would be fewer dangerous doctors practicing.

I'm not saying that malpractice lawyers, suits and settlements aren't abused, they are. But the lecture you're being fed is standard AMA propaganda, and you shouldn't fall for it. We would all, doctors and patients, be much better served if we concentrated on insurance regulation and getting rid of dangerous doctors than by going after tort reform. Sadly though, both the insurance companies and the AMA are looking out for the bottom line, not the patients life, so therefore they are pushing for tort reform. I predict that even if the most draconian tort reform is passed, if the insurance companies' and AMA's wildest wet dreams were to come to pass, your rates would continue to go up. The medical industry is no longer about saving lives friend, it is all about the money.

[NNguyenMD]

66. very informative but...

I resent your accusation that my lecturer was a "repuke". The gentlemen is an attorney and a bioethicist, and has spent the greater part of the last decade training medical students in handling issues such as confidentiality, patient autonomy, duty to treat, physician accountability, and being a patient's advocate. Maybe I should have been more clear on what he said, but I don't think that its so outrageous a thought to think that legal costs to defend physicians each year contributes to higher malpractice premiums.

The basic conclusions I came to, if you've been reading what I've been writing were basically these points

1) Lengthy statue of limitations results in defensive medical practice. More costly labs, xrays, and expensive tests. Is that neccesarily bad? Maybe not, does it cost more, it absolutely does.

2) You cannot demand perfection from physicians. We are not perfect, and every misdiagnoses or wrong choice we make resulting in a bad outcome does not negate years of experience or immediately deem us permanently incompetent. I challenge you to take a peak into what it takes to become a physician, it is a continuously changing profession that demands continuous education and adaptation. Most specialties require recertification examinations every few years, and even physicians who have practiced for decades have to go back to thousands of pages of updated material to pass them. The point is we try the best we can to provide the best treatment thats availiable based on the most current evidence that supports it.

3) I agree that physicians should be held more accountable for their actions, patients should be more informed about the history of a physician's legal bouts, and perhaps a mal-practice insurance rate modeled after the auto insurance industry's is in order. But if physicians want to make it difficult for people to yank their lisences then I hope you understand why that is. If you had invested thousands of dollars in tuition costs, and years upon years of education and training, then I'm sure you can understand why physicians would get edgy when it comes to lisence suspension. They are protective of their profession just as professors, lawyers, teachers, and unions are of their own. They have invested a lot to be where they are, their lisences are their livelihoods. We are human guys. And we don't believe that bad outcomes necessarily make it your fault, and mean that you're a bad doctor.

4) Regulation of malpratice insurance premiums is in order. Proposition 103 in California demanded that malpractice insurance companies justify rate hikes to the state insurance commisioners under very strict guidelines, and rates since then have increased along side the national rate of inflation. So it seems that what California did looks like a viable solution to a national problem.

STOP ACCUSING ME OF BEING A REPUKE!!! For the most part, people have been coming on here for a genuine discussion, but there have been a lot of knee jerk, reactionary accusations that my instructors and school is full of RNC thugs has disheartened me about DU, and bears semblance to the kind of hate you'd find at places like "Freerepublic.com". I'm not here to tout a party line, but to talk about an important issue with anyone here interested. Maybe my post # is too low for you guys to trust me. But I'm not here to spew the republican party line, and attacking one another like this is a real turn off for newcomers to DU like myself.

[Name removed]

71. Deleted message

Message removed by moderator. Click here to review the message board rules.

[MadHound]

98. LOL friend, I'm not accusing either you or your prof of being a 'Pug OK

So settle down, take a deep breath and relax. I am saying that it sounds like your prof is giving the standard AMA position lecture. You are reading more into my post than what I've written. Read, then respond, don't go flying off half cocked when you've only half read a post.

Secondly, I know exactly what it takes to become a doctor, I come from a very medical family, parents, siblings, in laws, all doctors or nurses(RN, with advanced degrees). I know the road your traveling all too well OK, so please don't assume that I'm uninformed.

I also realize that doctors can't be perfect, and that they will make mistakes. I also realize that there are doctors out there whose mistakes go far beyond what is normal, yet they are still allowed to practice. It is the dirty little secret that the AMA keeps, but thankfully it is starting to become a bit more public. You mentioned that this was your first malpractice lecture, so I'm assuming that you haven't gone into residency yet. When you do, go hang out in the doctors' lounges, and keep your ears open. You will be suprised at the number of doctors' name brought up in conjunction with the words "bad doctor", "poor performance", and "dangerous".

And yes, anybody in any profession would be edgy about license suspension, especially when they've invested as much time and money into attaining the position as doctors do. However, lawyers usually invest just as much, and there are not only laws on the books concerning dishonest lawyers, but most bar associations are quite vigorous about getting rid of such bad lawyers. In addition, most professions are quite stringent about policing themselves, and having outside agencies police them. Even in professions such as plumbing and electric, there are laws on the book concerning work performance, and under what circumstances a person's license is to be pulled. I work at a nuclear reactor(not a power one, a research reactor, making radio-pharmaceuticals). There are four different sets of rules and laws that I have to follow, and if I make a mistake, it costs me $50,000. If I make a second mistake, then I'm out of a job, and permanently out of the nuclear industry.

Yet the AMA shields doctors from that kind of scrutiny. A doctor with a track record of poor, or even dangerous work, is allowed to continue in their practice. And when the lid finally does blow off, and a doctor who has gotten by with completely outrageous, life threatening or even deadly practices is finally called on the carpet for their mistakes, they are slapped on the wrist fine wise, have their license yanked in that particular state, and simply move to another one where they can continue to harm their patients.

Your faith in your profession is touching, expected, and somewhat misplaced. I suggest that you use a critical eye on your profession, and let experience and the real world teach what really goes on behind the curtain. All isn't sweetness and light in the medical profession, the AMA just writes out the propaganda so it seems like it is.

[NNguyenMD]

101. now that is a response that I appreciate greatly. Thanks =)

[MadHound]

104. You're welcome. And stock up on sleep now,

Because you're not going to get any as soon as you go on rotation. I don't know why, but it seems that every resident has to go through the "trial by fire" of 24hr, 36hr, 48hr or even longer on duty rotations. The general feeling I get is that the old boys who make the rules had to do it, so they figure it is only far to inflict it on the next generation.

And good luck with school. Medicine is a very rewarding career, both personally and professionally. And please, I don't know what specialty you're going into, but keep in mind that folks out in the rural areas are literally dying for the want of a doctor close by. I know that you won't make as much by becoming a rural doctor, but hey, money isn't everything, and living out in the country is richly rewarding.

[sangh0]

109. Still have NO EVIDENCE to post?

I'm not surprised, seeing as how very little you've said is actually true

[NNguyenMD]

113. lets see some evidence countering what I've said then.

Show me data demonstrating that higher liability does not lead to higher costs in health care and does not change behavior of practitioners.

Show me data of the national costs of malpractice claims unchanging in the last 30 years.

Show me that most mal practice claims are legitimate, and not tossed out because of poor validity. And that every single one of them is justified because the doctor was bad and evil.

[sangh0]

117. You're backpedaling now

YOU are the one who made a claim, and so YOU are the one who has to provide support for your claim. Unless you're a believer in faith-based arguments, I have no obligation to prove you wrong. You have an obligation to support your claims with something more than personal attacks on those who question your claims.

[NNguyenMD]

123. I hope you realize that you've got nothing to say about this whole issue

[sangh0]

128. I hope you realize the same about yourself

http://www.democraticunderground.com/cgi-bin/duforum/duboard.cgi?az=show_thread&om=35849&forum=DCForumID35&archive=

[NNguyenMD]

131. you know how to cut and paste, very nice...

[sangh0]

134. Still afraid to respond with evidence

How many dishonest tactics will you try instead of just backing your claims with evidence? So far, you've tried:

1) Claiming I have to prove you wrong

2) Claiming you don't have to post any evidence

3) Claiming I havent posted any info, when I've posted far more than you

4) personal insults

How about posting some facts that support your claims?

[NNguyenMD]

136. this is exhuasting...look I cited several source justifying whatever it

was we were originally talking about. I cited several sources justifying my claims about defensive medicine, and malpractice costs NOT changing. I said I supported rate regulation not caps. I'm not really sure what else there is you want to know.

[sangh0]

140. You said rates increased due to settlements

Now you're trying to hide your ridiculous claims (which coincidentally, the repukes also make) behind the straw man that "there's such a thing as defensive medicine".

NO ONE said there's no defensive medicine. YOU SAID rates are rising becuase of settlements, but after dozens of posts from you, you STILL have posted NO EVIDENCE to support that claim

I'm not really sure what else there is you want to know.

Right!!

After a dozen posts from me pointing out that you've claimed that settlements are causing malpractice insurance rates to rise, you're trying to pretend that I haven't been clear about what I want from you.

I'm sure everybody was fooled by that

[LSdemocrat]

60. Actually its the INSURANCE COMPANIES who are pocketing the money

Awards (including settlements) aren't going up, but insurance company profits are.

[Catchawave]

61. Read John Edwards' "Four Trials" n/t

[Jose Diablo]

62. Yes, make the attorneys pay for frivolous lawsuits.

And never settle just because it is easier. There is a principle involved. Namely, settling a lawsuit that claims a Doctor was negligent is more than just about money, it is about the Doctors professionalism. The Doctor should have the final say on if to settle or not. If the lawsuit then is determined the Doctor was not at fault, the Doctor should be able to counter sue the plaintiffs attorney. Let the attorneys start to pay exorbitant malpractice insurance. I think this would solve the problem. I am sure many attorneys are little more than ambulance chasers.

No insults to the legal profession, but I think its true that attorneys are those that during premed school decided to shift to legal after realizing the grind it would take to become medical doctors.

[GumboYaYa]

63. There would not be so many malpractice suits if there were not so

much malpractice. Doctors are the worst of all the learned professions at policing the members of their profession. Much like the police, there is often a circle the wagons approach when addressing claims of bad conduct by a doctor.

On the other hand, lawyesr are fully aware that they can bring suits and force settlment b/c of the cost of defense, regardless of the merits of the case.

I think the solution is for the medical profession to become more proactive in policing itself. You then establish medical review boards who certify malpractice cases before they can be submitted to the courts. Anyone who submits a case without medical certification would be required to bear the costs of the defense and pay a fine if the case ultimately loses.

[Sgent]

68. Ever tried

To sue an attorney for legal malpractice?
To fire a tenured professor for just about anything?

To posit the idea that physicians are in a class by themselves when it comes to the ability to sue or pull licenses is extreme.

The reality is that our current malpractice system is broke. Those with 5, or even 50k of damages will not find an attorney to take the ccase. Conversely, attorney's take "bad" cases all the time because they will sell well to a jury (think any type of pediatrics).

One final note -- just because a doctor is sued a lot does not mean they are a bad doc. On average a family practitioner has a 5% chance per year of a law suit.

A OB/GYN or Neursurgeon has a 33% or higher per year.

These numbers indicated that the system is very biased in one way or another -- if it weren't, the FP would be sued as often as the OB/GYN. The fact is that a dead or severely damaged child makes for a better case in front of a jury -- it has nothing to do with malpractice, or correctly compensating vitims.

I don't like tort reform (caps), but to stubbornly say there is no tort problem is intellectual dishonesty of the first order. The reality is that the entire system is screwed up and it needs to be overhauled from top to bottom (think workman's comp type system). Today, more money goes to the attorneys and insurance companies than goes to the patients -- by a wide margin.

[sangh0]

72. More repuke lies

Today, more money goes to the attorneys and insurance companies than goes to the patients -- by a wide margin.

Care to post some EVIDENCE to back that up?

[NNguyenMD]

80. He's trying to explain how a cap on damage awards won't

solve the problem of reducing costs to physicians.

http://www.consumerwatchdog.org/insurance/nw/nw004696.php3

[sangh0]

82. Please don't use right-wing astro-turf sites to support your argument

and the poster is NOT telling the truth about where the money goes.

But you'll defend that untruth

[NNguyenMD]

89. correct me if I heard you wrong but...

are you insinuating that consumerwatchdog a repuke source of evidence?
Did you even read it? Or know what it says in there?

[sangh0]

92. I know who funds them

repukes

[NNguyenMD]

102. yeah but you ever read what htey have to say about health care issues?

or do you just exclude anything that seems even remotely contrary to your stubborn beliefs.

[sangh0]

111. Still NO EVIDENCE from you?

Gee, I wonder why someone who feels so certain is SO unwilling to provide ANY EVIDENCE to support their claims.

Instead, you keep dishonestly implying that *I* have to provide evidence for something, even though I haven't made claims the way you have.

[NNguyenMD]

114. lets see some counter evidence then, you've called me a liar so show me

the data demonstrating that higher liability does not lead to higher costs in health care and does not change behavior of practitioners.

Show me data of the national costs of malpractice claims unchanging in the last 30 years.

Show me that most mal practice claims are legitimate, and not tossed out because of poor validity. And that every single one of them is justified because the doctor was bad and evil.

[sangh0]

118. So you WON'T provide ANY EVIDENCE?

You're the one who claimed that settlements are driving up the cost of malpractice insurance. Instead of defending your ridiculous claim, you continue to dishonestly claim that *I* have to disprove your claims.

[NNguyenMD]

125. yup...still nothing meaningful or interesting from you yet.

I can't wait too much longer you know.

[sangh0]

130. Still NO EVIDENCE?

Why are you afraid to post a link showing that malpractice insurance rates have risen due to settlements?

You said it in your OP, so why complain when someone asks you to support your claim?

[NNguyenMD]

138. still no point to this discussion with you...

[sangh0]

158. What "discussion"???

YOu haven't discussed ANTHING. You've merely made some outrageous claims, and then refused to discuss or even defend them

[NNguyenMD]

162. a woman here earlier made some statement that

juries are reluctant to give out large sums to plantiffs! Dozens of people here have made repeated claims that mal practice suits are hard to prove and that lawyers are reluctant to take them up. You ignored every baseless statement they have made, but you go after me! Is this seriously something personal? I remember dealing with you before, and it was the same situation, do making demands on me that you don't make on anyone else.

If I am guilty of making outrageous claims then you have failed to refute them. You're dismissing the evidence and links I've provided b/c they don't suit your standard of unbiased sources. Have you even looked at hte methodology of how the data is collected? Do you have any other reason to suspect that the evidence is flawed other than personal feelings against who the source is?

If anyone is guilty of being outrageous and ridiculous its you my friend.

[sangh0]

166. What a cowardly response

"But, but officer...they were speeding too!!"

YOU started a thread based on ridiculous claims, and you're wondering why I'm challenging YOUR claims.

This reminds me how you asked me what I wanted AFTER I had told you more than a dozen times that I wanted you to support your claim about settlements

If I am guilty of making outrageous claims then you have failed to refute them.

I have no obligation to refute you, but you have an obligation to support your claims.

You're dismissing the evidence and links I've provided b/c they don't suit your standard of unbiased sources.

1) It's wrong for you to use the plural when only one of the links you posted supported your claim about how settlements are driving the increase in premiums

2) An industry-funded group is not an unbiased source by any standard. It's dishonest of you to imply I'm making an unreasonable demand here. I'm merely applying standards that are common. Interested parties in a dispute are NOT considered credible unless there's INDEPENDENT (ie unbiased) corroboration

[NNguyenMD]

168. if you're can't refute it then you're too lazy and have nothing to add to

this discussion

[sangh0]

175. I bet even you could do better than that

if you're can't support it then you're too lazy and have nothing to add to this discussion

[NNguyenMD]

174. the only thing that I have repeated is the assertion that

premium hikes are unjustified in many states, and must be because the companies are greedy. How that translates into a pro-business Republican argument by you baffles me.

[sangh0]

143. So you continue to refuse to post EVIDENCE?

Why are you so unwilling to back up your own claims?

[NNguyenMD]

151. I gave you evidence, but you've not happy with it

so how about next time you write me up a dissertation on the whole issue from unbiased source that only I approve. And maybe we'll find common ground.

[sangh0]

159. That is not true

You have yet to post info showing that settlements are the cause of increases in malpractice insurance premiums. The only points you have supported are the straw men you raised which no one has contested.

[politicat]

232. Prove it. Show the me the money trail.

Because I don't see it.

Pcat

[Sgent]

192. Response

Sure... I assume that Public Citizen is an acceptable source.

http://www.citizen.org/documents/MedMalBriefingBook08-09-04.pdf

Page 32 states...

"the average doctor-owned medical malpractice insurer spends 32
percent of premiums on defense costs"

Assuming EVERY OTHER PENNY went to plantiffs, and an average of 33% total fees taken by the plantif attorney, you have 56% of all malpractice premiums eaten by the system before it touches a plantiff.

Of course, there are administrative costs, profits, etc. in insurance, as there are court costs and other costs assessed to any award on top of the contingency percentage. This probably brings it up to the 70% number (or close to it) that I cited earlier. So out of every 1 dollar paid by a physician, at the most 44% goes to a wronged indiviudal, and it is probably much less than that -- especially if a trial is involved.

[NNguyenMD]

193. Thanks Sgent

[GumboYaYa]

73. Attorneys are regularly disciplined and even disbarred for bad

conduct. Not that the system is perfect, but Bar Associations actually police their members. The AMA is an advocay group for physicians. It is a very rare event when a doctor loses his or her license for bad conduct.

Q. What do you call the doctor who graduated last in his class?

A. Doctor.

In the legal profession, the marketplace frequently self-selects the people at the bottom of the class out of the profesion.

I'm not saying that there are not plenty of problems with attorneys as well, but there is no question that physicians engage in virtualy no self-policing of their profession. It is disingenuous for the medical profession to lay the problems solely at the feet of the legal profession. There is plenty of blame to go around.

Of course, I in no way implied that there are not problems with malpractice system as currently constitueted. I actually posited a solution that is very close to the workers comp system you chose as an analogy.

[sangh0]

76. And that's why those who repeat repuke lies

don't post ANY EVIDENCE to support their claims.

[NNguyenMD]

69. if you believe that it were only bad doctors who got sued then...

fine. But medical malpractice doesn't always mean negligience or that we're just bad people.

I think that their is a big disconnect between what people think our job is, and what it actually entails.

If by policing ourselves, you mean yanking more lisences and issuing more suspensions, I think that you have to understand that general mistakes made by physicians are accepted by the profession. And if we seem lax in policing ourselves then it is because we all know that sometimes even if you do everythign right, things can still go wrong, and its not always your fault.

[sangh0]

85. WHen will you defend your claims with proof?

You keep repeating about how malpractice insurance rates are rising due to settlements, but with more than a dozen posts in this thread, you still haven't posted ONE BIT OF EVIDENCE to support that claim

[ArkDem]

67. Lawyers are the most moral people in America. They only

want to help the 'little man'. There is no finer example of caring human beings than Accident and Injury Attorneys. All doctors and insurance companies are evil and are in health care only to get rich.

[NNguyenMD]

70. you're kidding me right?

[sangh0]

74. You are being very hypocritical

making all sorts of ridiculous claims without ANY EVIDENCE to support it, and then pretending surprise when someone else does the same.

[NNguyenMD]

77. lets hear what you have to say about this issue. What are your ideas and

what is your evidence? Otherwise you're not really contributing to this discussion.

[sangh0]

79. The 1st rule for debating freepers is MAKE THEM PROVE IT!!!

Until you provide some EVIDENCE for your ridiculous claims, there is no issue besides the insurance industry's record profits

[NNguyenMD]

81. now you're the one repeating the same argument. Why

don't you contribute more to this discussion? What do you know of the reasons why the premiums are going up? Where's your evidence of what that is?

[sangh0]

84. So you won't defend your ridiculous assertions?

You've made many claims in this thread, so why won't you provide EVIDENCE for any of them?

Instead, you try to personally attack me about my "contribution"

Where's your evidence of what that is?

HAHAHAHAHAHAHAHAHAHAHAHAHAHA!

*YOU'RE* asking for evidence? Do you even know what evidence is, because YOU haven't posted any.

Why won't you defend your own assertions?

[NNguyenMD]

87. ok, so which one of my claims do you take issue with?

what kind of evidence are you lookign for? What's suitable evidence for you? A national study? One from a journal only you approve of? What specific kind fo evidence do you want to see to assuage your fears from my dangerous "lies".

[sangh0]

90. All of them

Did you think it was OK to post baseless claims that had NO EVIDENCE to support them, as long as one of your claims was true?

You have to support ALL of your claims. Otherwise, don't make them if you can't support them.

[Name removed]

93. Deleted message

Message removed by moderator. Click here to review the message board rules.

[NNguyenMD]

95. defensive medicine, one example here

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9017954

from UConn's dept of Eonomics.

http://ideas.repec.org/p/nbr/nberwo/5466.html

I dont' even know why I'm entertaining this.

[sangh0]

112. Still no evidence from you

Your link doesn't show that the costs of defensive medicine have risen due to increased settlements.

[NNguyenMD]

116. you've called me a liar, and tried to debunk what I've said with

accusations and no evidence of your own countering my arguments.

Show me data demonstrating that higher liability does not lead to higher costs in health care and does not change behavior of practitioners.

Show me data of the national costs of malpractice claims unchanging in the last 30 years.

Show me that most mal practice claims are legitimate, and not tossed out because of poor validity. And that every single one of them is justified because the doctor was bad and evil.

[sangh0]

124. So you're sticking with the dishonest argument

that *I* Have to prove you wrong, but you don't have to prove yourself right?

Go right ahead! You can ignore me, but I am not going to stop responding to your disinformation.

[NNguyenMD]

126. enjoy doing it then...

just curious, plenty of people have made declarative statements on this thread without any evidence at all. Why are you singling me out?

[sangh0]

132. You're repeating the repuke arguments

as you've done on several occassions.

And, like the repukes, you refuse to provide ANY EVIDENCE to support your ridiculous claims.

http://www.democraticunderground.com/cgi-bin/duforum/duboard.cgi?az=show_thread&om=35849&forum=DCForumID35&archive=

[NNguyenMD]

165. repuke arguments? Repeated?

You're something else.

OK this is what I've said, insurance is expensive. It costs money to pay lawyers, and insurance companies or greedy, regulate their rates. HOw are those repuke arguments?

[sangh0]

167. Yes, you repeated repuke arguments

and the link I posted has links to those repuke funded orgs that make the very same arguments that you repeat here.

That's why you don't make any effort to refute anything that's said in my link.

OK this is what I've said, insurance is expensive. It costs money to pay lawyers, and insurance companies or greedy, regulate their rates. How are those repuke arguments?

The way you left out the various unsupportable claims you've made is very similar to the way Repukes lie about their past claims.

[NNguyenMD]

171. so let me get this straight...

its repuke to demand government regulation of insurance rates?

[sangh0]

176. Very poor

Now you've lowered yourself to inventing things that I haven't ever said

[NNguyenMD]

188. READ MY POSTS!!!!

The only thing I've repeated is the necessity for REGULATION OF INSURANCE RATES!!!!

[Forkboy]

210. Dont get sucked in by this poster

seriously,you'll never "win" whether you're right or not.

(For the record I dont agree with you....but still feel you need a heads up regarding your sparring partner here.)

[NNguyenMD]

213. yeah you can tell I'm new to this

but thanks for the advice anyways.

[NNguyenMD]

108. litigation costs between a decade ago and now

http://www.amda.com/caring/march2004/liability.htm

[sangh0]

119. An AMA website - they also support partial birth abortion bans

please research the corporations that fund them

[NNguyenMD]

129. yeah thats great except I cited consumer watchdog, not AMA

whats the point of this?

[sangh0]

135. You posted a link to org that is run by the AMA

check out the links I provided. They show that this group is ASTROTURF

[NNguyenMD]

141. are you talking about http://www.consumerwatchdog.org or what?

never mind I ass, the amda. Ok fine, they are apart of the AMA. And they supported bans on partial birth abortions. Great. So they supported a conservative stance on a totaly unrelated issue. WHats your point?

[sangh0]

144. no, your consumerwatchdog link was irrelevant

it did not say that settelements have been the cause for the rising malpractice insurance rates.

[NNguyenMD]

149. look I said it costs money. I even said in an earlier post

points that were in line with yours. That the insurance companies were profiteering off physician pocketbooks. What the hell else do you want to hear? Yeah, the number and costs of claims haven't changed. I said somethign else in the original post that I wrote yesterday night! I found out something else. Praise me for learning the truth. Why do you insist on being like this? Just chill out dude.

[sangh0]

160. You said the rising rates were caused by settlements

and even though you haven't posted any info to support that claim, you continue to insist that you have.

I found out something else. Praise me for learning the truth. Why do you insist on being like this? Just chill out dude.

Then why are you still insisting there is a problem?

[NNguyenMD]

163. a problem with what? Insurance is expensive! Right? Do you need a

comprehensive independent study by the Brookings institute to believe that one? Its expensive. Part of the reason its expensive because it costs money to pay for lawyers, MOST of the reason of why it is expensive is because insurance companies are greedy and overcharging policy holders. Regulation is the solution.

[sangh0]

169. "Regulation is the solution"???

To what problem? How does regulation solve that problem?

MOST of the reason of why it is expensive is because insurance companies are greedy and overcharging policy holders

Really?

Care to provide some EVIDENCE for this new claim?

[NNguyenMD]

173. yeah sure, look at California's malpractice premium rates after

MICRA was passed in 1975, and did nothing to stabilze rates. But when they implemented tighter justifications by the state insurance commissioner in 1988 with Prop 103, the rates SURPRISE! went down. There, do alittle research and see for yourself.

I recommend taking a look at Texas, and seeing how caps did absolutely nothign to stabilizeing premiums

http://www.consumerwatchdog.org/healthcare/rp/rp003103.pdf

[sangh0]

177. You're getting incoherent

I asked for evidence to support your claim that the high rates are due solely to insurance corps seeking profits. Instead of posting evidence for that, you revert back to posting straw men, such as the high costs in CA (which no one mentioned until now) as if anyone disputed that CA had high rates.

My understanding is that there are a number of factors, and that the relative stregnth of the various factors depends on which state one is talking about.

[NNguyenMD]

185. you asked what I meant as regulation as the solution...

and I gave you California as an example. I even gave you a link of the study done by consumerwatchdog detailing every nook and cranny of how the issue was taken cared of.

This I said he said BS is getting old and stale. Look at my previous post from yesterday, I clearly stated the regulation of insurance rates was the answer to this problem.

[NNguyenMD]

110. look 'em up read them all to your heart's desire, and enjoy!

Until you have someone meaningful to say, something do bring to the disucssion with YOUR evidence to back it up. I've really not no other reason to dignify your comments.

[sangh0]

115. Your evidence is irrelevant

You still have provided NO EVIDENCE tht a rising number of settlements is causing malpractice insurance to rise, the point of your OP.

Instead, you are dishonestly trying to imply that someone on this thread has claimed that there's no such thing as defensive medicine.

[NNguyenMD]

122. I wrote earlier in a previous post that...

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=104&topic_id=2775438&mesg_id=2775983&page=

the insurance company raising premium rates at the amounts that they do is unjustifiable. And that government regulation of rate control, like the do in California, is the solution not caps on awards for damages.

You didn't bother to read what I said. Instead you continued to call me a liar and demand evicence for my arguments without offering anything of your own. You have also singled me and Sgent out for your attacks, and not demanded similar evidence from other posters making claims against my own. This has been a really dissapointing experience on DU. I thought the people here wanted to discuss issues and ideas. But you just seem to want to start fights.

You're closed minded and impossible to talk to. Its people like you, not willing to respect and openly discuss other people's ideas who caused us to lose this election so badly.

[sangh0]

137. You said that malpractice ins. rates were rising due to settlements

but you havent provided any EVIDENCE to support that.

Raising straw men won't distract me from trying to get you to post EVIDENCE to support your claims.

ANd you can't talk oout of both sides of your mouth - either the rate increases are fair (ie due to settlements) or unfair.

[NNguyenMD]

139. for CHRIST sakes!

I wrote in the damn post that regulation was the answer. I said claims and settlements COST MONEY. And its not cheap. That was from the stat from the www.thepiaa.org. What else hte hell do you wnat? It cost money! Does that surprise you so much that its expense to sue someone?!! Dear god!

[sangh0]

142. ANOTHER INSURANCE PAC link??

Do you actually believe that the INSURANCE INDUSTRY is unbiased on this subject?

[NNguyenMD]

157. give me a detailed rebuttal of how the methodology

of their data gathering and calculations of that stat is flawed and skewed and I'll join your chorus and accusing it of being a baised unreliable source.

[sangh0]

170. Cowardly argument

YOU made the claim, so it's YOU who has the burden of proof, not I.

[NNguyenMD]

172. if you can't prove me wrong, then you must accept it as truth b/c you're

too lazy to figure it out on your own.

[sangh0]

178. And you're going to be a doctor??

I guess one doesn't have to be intelligent enough to know "you must accept it as truth" is BS in order to get into med school.

No wonder they get sued so often.

[NNguyenMD]

184. nice attack, thanks for officially lowering the bar of decency on here

You haven't proven jack on here for the entirety of the day. Look back at what you accomplished today, NOTHING. ALl you did was whine and bitch about why you're not satisfied with my answers without offering any real opinions of ideas of your own.

[Name removed]

189. Deleted message

Message removed by moderator. Click here to review the message board rules.

[ArkDem]

120. Stating the 'official' DU position.

:hurts:

[NNguyenMD]

96. claims and settlement costs

from the Physician Insureres of America 2003

61% of mal practice suits dropped or dismissed cost on average FOR THE DEFENSE $16,743

32% of mal practice cases that are settled cost on average FOR THE
DEFENSE $39,891

Only a marginal amount ever go to trial in which a defense verdict (6% of cases) cost $85,718. And a verdict in favor of the plantiff costs $91,423

Believe me, sueing people costs money. And when all doctors can expect to be sued at least once in their careers on average, it comes out to a lot of money to lawyers.

[sangh0]

121. So now you're citing Medical INSURANCE PAC's??

and you expect people to believe you?

[NNguyenMD]

127. where else are you going to get the data on how much they pay out?

Go to the GAO or Health and Human services and findout yourself them. Then I get to accuse you of using a source sanctioned by a repuke republican administration.

[sangh0]

147. I guess you never heard of INDEPENDENT STUDIES??

Go to the GAO or Health and Human services and findout yourself them. Then I get to accuse you of using a source sanctioned by a repuke republican administration.

And once again you resort to the discredited tactic of trying to shift the burden of proof onto me.

*YOU* Made the claim. *YOU* prove it.

[NNguyenMD]

152. you tell me why its so outrageous and impossible to conceive that it

happens.

I dont' know why I get singled out by you and you alone. I make claims and arguments on this board just like everybody else does, with or without evidence or claims and you go ahead and attack me only. What the hell is your problem?

[sangh0]

161. So now you're issuing orders?

SOrry, but you're not the boss of me.

YOU made a claim, so YOU have the burden of proof here, not me.

I make claims and arguments on this board just like everybody else does, with or without evidence or claims and you go ahead and attack me only. What the hell is your problem?

If you had read the links *I* posted, you'd have seen that I've done a lot of research in this area. Unlike you, I don't make claims I can't back up.

[NNguyenMD]

164. then back it up, in YOUR words. Lets see if you've even read what you dug

up on the net. THe only opinion I've heard out of you is that insurance companies are making record profit. Well fine, I could agree with that, but lets hear some evidence huh? Where are you basing that claim from? What are your opinions?

And how about more than just a flurry of cut and pastes. I'm not going to go through a blob of random exerpts. What is YOUR opinion and why is it true?

[sangh0]

180. YOU said rising rates were caused by settlements

Now YOU are saying it's because the insurance corps are making record profits.

SO it's YOU who has something to prove, not me.

And how about more than just a flurry of cut and pastes.

I posted a link that has about ten pages of text that I wrote, in addition to dozens of links.

[NNguyenMD]

186. then you must be an expert, let hear you sum it all up right here

[NNguyenMD]

190. You really have no clue what anyone here is talking about do you?

[NNguyenMD]

145. so where would massa like ta see this data come from?

[sangh0]

148. How about an unbiased source?

or is that incomprehensible for someone who's every link is to either a right-wing group, or a medical industry group?

[NNguyenMD]

150. well find me an unbaised source that suits you and

makes you feel like sugar and bubble gum and I'll promise to take a look at it sometime.

[elehhhhna]

99. 10 years ago it was 40K to settle suits against OB's & techs who

told pregnant patients the wrong sex of their babies when using ultrasound. At the time, they could only "sex" the baby with a sense of accuracy of about 80%, and they told the patients so...
Ridiculous.

JK & JE had an excellent plan to implement review boards for this stuff before it goes to trial.

[Kitka]

103. Also, it's untrue that the only ones that win "no matter the outcome" are

lawyers. Because of misconceptions regarding lawyers like this, juries are very weary to award damages in med mal cases. Many cases, valid ones too, bring in NO money or very little because of this. However, a medical malpractice case is EXTREMELY expensive to bring to trial. We're about 25/75 for making money off med mal cases. Usually we don't.

[Outrider]

208. Lawyers do get paid no matter the outcome

Defense lawyers. Win or lose they go home with a paycheck. The plaintiff's lawyers loses, they have bills waiting for them from the costs of taking the case to court.

[Kitka]

225. Yes, but it's obvious defense lawyers weren't the group the OP was

speaking of. At least, it was to me. When one talks of the evil lawyers who bring frivolous lawsuits, one isn't referring to defense lawyers.

[AngryAmish]

146. Not going to flame you, just some disagreements

In IL, the statute of limitations is 2 years. However, the statute is tolled until age 18. So, here it is 20 years from date of birth. Or even longer if the child is disabled, theoretically until 2 years after the child's death.

There was med mal reform in IL for more than 15-20 years. One needs a doctor to review your case and state that it has merit. Attorneys fees are limited. You need an expert in court to say there was malpractice.

In my experience, a much higher percentage of med mal cases are tried than other types of cases with equal damages. Many MDs have clauses in their insurance policies that give them the right to refuse to settle. And many of them exercise that right.

The high number of doctors getting their cases dismissed is because attorneys are obligated to sue as many providers as possible because if an attorney misses a party at fault is guilty of malpractice himself. So 5 docs get sued, and it turns out 3 of them did nothing. Not fair, but it is hard to tell who to sue until you get everyone's deposition.

It costs b/w $50k to $150k to bring a case to trial. So most attorneys are very careful about the cases they select.

How can one tell whether or not malpractice is killing docs? The Bureau of Labor Statistics keeps tabs on incomes by profession (and specialty IIFC). I have looked at the numbers lately, but the incomes are going up. (However, I acknowledge that if people are leaving a state the remainder would make more $ as their specialty become more rare and they can charge more (or work more).

Becoming a doctor is a noble thing. Good luck. Nevermind the flames.

One more thing - just have insurance. I have NEVER heard of a plaintiff's lawyer going after a doctor for personal assets. The fears of impoverishment may exist, but in practice not real.

[Outrider]

201. Doctors leaving

Actually the myth of doctors leaving Illinois is just that. What has happened is that there are doctors that are moving there practices within IL, most towards higher population areas were there is more money to be made. The doctors that have left Illinois are for the most part leaving for a very reasonable reason, they went and got married to someone outside of Illinois and are moving their instead of their new spouse moving here.

[gaia_gardener]

153. OBs in the US do not practice

evidence based medicine and most are just lucky they haven't caused damage.

I was at a birth where the resident came in and broke the water without checking the baby's station. OOPS, the baby wasn't engaged. She's lucky the cord didn't prolapse. Then they gave the patient pitocin without getting consent (of any kind). We didn't even know she had it until the nurse said something about turning it off. The 3 of us turned and said "when was pitocin ordered?" She was in labor less than 6 hours total (for a first time mom) and they ordered pitocin at the 3 hour mark (about 30 minutes after they broke her water). I walked out later the residents were talking about "saving her". They didn't save her, neither she or the baby were ever in danger, her labor was normal. Yet these residents believe in the myth of birth being a major danger that they reacted by using medicine and procedures that weren't warranted.

Women are getting c-sections are ever increasing rates. I can't count the number of women that submitted to an induction (and subsequent c-section) because the doctor thought 40 weeks was long enough and any longer would be dangerous (never mind that the average gestation for a first time white mom is 41w3d). We still have doctors using cytotec to induce labor (cytotec is an ulcer drug that has a side effect of uterine contractions). Because cytotec only causes uterine contractions (and not cervical dilation) women are at an increased risk of major labor complications (including ful uterine rupture) and fetal distress.

OBs think that the only way to prevent being sued is to use all the interventions they have - never thinking about the complications of the interventions. There is a risk/benefit to every medical procedure. Sometimes the benefits far outweigh the risks and sometimes they don't. In some situation, the risks so far outweigh the benefits that they shouldn't even be considered, but in the OB field these interventions are used regardless.

A major problem is that the malpractice rates aren't related to the individual provider. A midwife in town lost her practice because she couldn't afford the malpractice insurance. She had never even so much as had a complaint made against her, nevermind been sued. The costs to the patient for her care were a fraction of the traditional OB cost and considerably safer.

[DS1]

179. "Loser pays" anyone?

:shrug:

[Outrider]

198. Never

Very bad idea. Juries are becoming ever more biased towards doctors (In my area the local insurance giant gives people paid time off for jury duty, so the juries tend to be filled by their employees) It is becoming hard to get a decision for a plaintif even in cases were the doctor was obviously wrong the jury. The jury will instead excuse it as just a mistake and find for the doctor. This along with the fact that the defense attorneys have no reason to limit their costs (most are paid an hourly rate as opposed to percentage pay for the plaintiffs attorneys) would result in plaintiff's attorneys being driven from their profession after they lose what should have been an easy case and are presented with a bill for all of the costs that the defense has run up which could be into the realm of tens of millions.

[samtob]

182. NNguyenMD, here is an interesting

study. I worked in the insurance industry for years, I share some of your postions. (not all)

I found this study which supports some of what you heard in the lecture. Of course this is a very limited study in a very small region in Illinois, but it is a common story in many states.

http://www.icjl.org/TheMedMalStudy.pdf

[Endangered Specie]

183. How about price caps on lawyer salaries?

;)

[Sgent]

194. See my above post

I supported my earlier claim regarding most malpractice money going to the attorneys -- with data from Public Citizen.

Sorry to blow up your preconcieved notions of fairness.

As for not settling, most physicians won't do it because it affects the rest of their career. If you want to put someone out of business or take their job away from them, they will fight tooth and nail. An entry of a settlement in the NPDB is equivalent to many credentialing boards to a lost lawsuit. Therefore, doctor's usually never settle -- since there is no immediate risk to forcing a trial, and a large risk to settleing.

[AngryAmish]

243. For many lawyers there is

In injury lawsuits the rate paid by insurance companies has been going down for many years. This creates many incentives that screw up the system (discourage settlements because the many hours of getting ready for trial raise the bill) and screw up the lawyers life (have to work more to make same money, discourage increasing the size of partnerships where real money is made).

But cap lawyer fees? Well, that is un-American.

[Book Lover]

187. I'd like to shed a different light on the thinking here

Practicing medicine is an art and a craft, not a science. Before anyone starts screaming at me, please think about this. I am not saying that doctors should be held blameless for errors that impact a patient's health - on the contrary, as the daughter of a nurse who both worked the floor and in public health, I hold physicians to the highest workman's standard. However, they are not scientists, per se. It is not always possible to give a patient an absolute answer; however, physicians have a duty to recognize that and frame discussion of diagnoses in those terms. Doctors are not gods, and patients are not ignorant masses waiting for the word from on high. We all need better health education to make informed decisions for ourselves as patients, and not be so willing to take the doctor's word as the last word.

Now, all that said, bringing suit is the only method a wronged patient has to remedy an injury. The system is broken so that the insurance companies win and mostly everyone else loses; after all, will your disease remit because the judge banged her gavel in your favor?

[NNguyenMD]

191. I couldn't agree with you more

[Cattledog]

196. Blaming lawyers is

a lame excuse. The real reason for MP increases is based on the insurance Co's profits. When their profit margin is low rates go up. Has
very little to do with lawsuits. Also MD's are notorious when it comes to protecting the BAD doctors who commit the most of the cases. MD's are now in it for the money. What was once an honorable profession is now just a business.

CD

[sendero]

197. On a slightly tangential note...

... I have had my share of health problems over the years and my diabetic wife has had more than her share.

Doctors are just like everyone else. Just like auto mechanics, just like pro athletes - some are better than others, and some just plain suck.

I've learned to spot the sucky doctors most of the time, and I waste no time in replacing them. If I (or wifey) gets a diagnosis, we ask why and if I don't find the answer convincing, I go elsewhere.

People have way to much reverence for doctors. Remember, half of all doctors perform below average for a doctor. Make sure you get one in the upper half if you want to live. :)

[Outrider]

199. One way to fix the problem

There is only one way to fix the problem of ever increasing malpractice insurance rates. This is even more important than getting rid of the 5% of doctors that are causing 95% of the malpractice awards. The states that have the fairest malpractice insurance rates are those states that have strong regulation of the insurance industry. California for example placed caps on damages but the insurance rates kept going up at the same rate. Then as soon as they put in place a strong regulatory body that has policed the insurance rates the rate of increase while not stopped has been cut back to a managable level.

Of course this would all be moot, if we would be reasonable and adopt a state run malpractice fund that would be funded by either a yearly fee to all doctors or a small fee placed on all doctors visits, ER visits, etc.

[NNguyenMD]

200. the california example is an excellent point

and should be looked at as a potential national model to controlling premium rates.

[Outrider]

202. One problem

When you bring up the case of California, conservatives will unfailingly ceredit a delayed response to the damages cap as the reason for success.

Wisconsin is also has a system that should be looked at. Up there they have a state run fund that pays damages over a 1 million dollar cap on insurance paid damages. The fund is currently running something in the range of $100 million in the black and has never paid out more in a year than it has taken in.

[NNguyenMD]

203. yeah I know what you mean, kind of when the conservatives tried to

spin the causes of the economic boom of the mid to late nineties toward Bush I and Reagan's way instead of Clinton's. Damn them!!!

[frustrated_lefty]

204. Doesn't bother me one bit.

M.D.s tend to be sloppy and/or over-stretched.

That freaking girl died a few years ago because a M.D. tried to do a transplant with the wrong goddamned blood type. I was in a hospital and a nurse tried to give me an injection which was intended for another patient.

No, I don't have sympathy. M.D.s tend to be arrogant pricks who do sloppy work and just shrug it off when their patient dies due to their incompetence. Piss off if you disagree, I work with these incompetent bastards routinely. I have NO respect for them. You want to lower your insurance rates? Do your fucking job the way it's supposed to be done.

[NNguyenMD]

205. you certainly do seem to be frustrated

stop suing b/c we can't cure your head cold in time for the prom and we'll think about it

[frustrated_lefty]

207. For the record

I don't sue. I just avoid the incompetent bastards as much as I can.

The last time we went, my wife was bleeding from her nose for no apparent reason. The sink and toilets were soaked in blood and we still don't know why. We went to the ER, they shot saline up her nose and left a few pieces of plastic is her sinal cavities. The bleeding stopped, after she came home and fixed it herself. The plastic is now causing what appears to be a sinus infection.

We DON'T sue. BUT, we have NO respect for MDs. Learn to do your job, and teach your fellows.

[NNguyenMD]

209. could be vwf syndrome. If you're a health care professional ask your

wife if her menstrual bleeds are heavy or how many pads she has to go through, and if spontaneous nose bleeds have happened frequently before. VWF is von willebrand factor is a clotting factor, and people genetically deficient of it are frequently in the population. If it was an ER in Louisiana, I'm afraid I can't speak for how they run things over there, I wouldn't know how to teach medicine over there. But I can tell you that you wouldn't see conditions like that in the hospital I train at in NY.

I figure you're probably working in the healthcare field. If you don't like that doctors you work with then give them a piece of your mind. You know that they wouldn't hesistate to complain about you if they were upset with your work.

[frustrated_lefty]

242. To be fair,

not all MDs are incompetent morons. Some are very dedicated people who DO their very best for their patients. You seem to be one of that kind, so please don't take my vitriol personally. Thank you for the suggestion, I'll check with my wife about vwf.

I'm not a health care professional. I'm a gene therapist. My most recent work with an MD involved a viral vector I made. Basically, it was a lentiviral vector pseudotyped with a Hantaviral envelope (or glycoprotein). I infused the vector into the animal through a catheter, flushed the catheter with saline, threw the syringe and eppendorf which originally held the vector into a biohazard box. The MD said I was free to leave while he sutured the animal. Somehow, while cleansing the catheter, the man got a drop of its contents in his eye (despite the fact the man wears glasses!). My first response is: How the hell do you manage that?!

What is this guys response? He goes to a general practitioner. How many general practitioners do you know that know a thing about lentiviral vectors? The general practitioner hears two words: "HIV" and "Hanta." He immediately contacts BOTH the CDC and the NIH and all hell starts to rain down.

Why does this bother me? This guy who was scared about his health was careless enough to get a drop of fluid in his eye when he thought the shit was that dangerous to begin with, and managed to do it around his glasses. He contacted another doctor who knows shit about gene therapy or vectors. And, we end up with a fiasco with the CDC, NIH, and head of Infectious Diseases crashing down on a promising research project which had been idiot-proofed.

Another anecdote. A MD put me on depakote at 1,000 mg/day and didn't check in for 3 weeks. It put me in convulsions for 12 hours straight and had many other nasty side effects. When I spoke with her again, she THOUGHT she had put me on 250 mg/day. Her response: "ooops, sorry."

I realize not all MDs are incompetent fuckwads. Some are actually devoted workers who care for their patients. But some...well, they're incompetent and do things which are detrimental to their patients. Some lack common sense. And some just do inexplicable things, without any apparent reason.

That's why, generally speaking, I don't like MDs. It would be great if I could call them on mistakes, but I lack seniority. I'm just a lowly, lowly post-doc.

[Forkboy]

211. Stop leaving instruments inside of patients

:silly:

[NNguyenMD]

212. Its actually the OR nurse who is responsible for

the sponge and instrument counts during operations. Unless you prefer your surgeons to keep track on counting sponges and instruments than fixing your insides, you should direct your anger at the nurses responsible for those occurences.

And when the OR nurses do screw up the counts, its the surgeon who has to go back in to pull the damn thing out, and who has to worry about getting sued for something that is clearly the nurse's responsibility.

But almost all lawsuits are directed at the doctors b/c guess what, Doctors have deeper pockects than nurses!

[Outrider]

215. He's responsible

The surgeon is the person in charge in the OR and therefore he is responsible for what occurs. Easy as that, and if he does need to double check the sponge count then he is doing a thorough job instead of a half assed do it as fast as possible job.

[NNguyenMD]

217. really now? So do you think its ok to leave the nurse who screwed up

unaccountable for their actions? Doesn't sound just to me. If its the nurse unbagging all of the surgical instruments and tools for the operation, they're they ones who know whats going in the patient, and as far as I'm concerned they should be responsible for knowing how much went in before the surgeons sew up the patient. Trust me, you're better off with your surgeons focusing on repairing whats inside of your than keeping conut of sponges. Thats why its the nurse's duty to do it and they should be responsible when instruments get left inside of patients afer surgery.

[Outrider]

220. Yes but,

the doctor is in a supervisory position and is resposible for their actions. I'm just stating things based on the fact that the surgeon is the individual who is responsible for what occurs in the OR. Also, remeber that the doctor is the one putting most of those instruments into the patient. Anyways, most hospitals have malpractice insurance themselves to cover them in cases were nurses screw up.

[NNguyenMD]

221. fair enough, but practically speaking its a job nurses are responsible for

and should take dead seriously instead of leaving the responsibility totally to the surgeon. They should be held more accountable for those sorts of happenings. Most people it seems throw the blame squarely on the surgeon.

[Outrider]

222. Truth be told

This is not much of a problem anymore. It is rare for this to happen today because hospitals got their acts together and fixed the problem. The days of people going home with the doctors wristwatch in their gut are fast ending.

[NNguyenMD]

223. well then now thats something that I think I could drink to

[OhioChick]

206. Bravo! n/t

[Outrider]

214. Do you know why they are now saying settlements.

Do you know why they are now saying that settlements are the cause for increasing insurance rates instead of the old mantra of jury awards. It is simple, people have looked up the data on jury awards and called the insurance industry and doctors liars because the data does not show what they claimed. Settlements on the other hand, are not a matter of public record and the amount of money that the plaintiff receives is unknown so doctors and insurance companies are free to say that settlements are the cause because no one can look at the number and call them liars.

[merh]

216. Young doc to be, the malpractice INSURANCE crisis

is not the lawyers fault, it is the fault of the insurance companies and the medical profession. Insurance companies invest their monies and when the stock market started to have problems, so did the insurance companies. In order to maintain their profits, they increased the rates. It is really rather simple. Insurance companies have done this for years, in to all sorts of professions that require insurance (contractors, transportation companies, home owners and even lawyers).

The medical community does not properly regulate and discipline its own. Complaints made against doctors are rarely acted upon, and if they are, it rarely results in suspension or revocation of licenses.
Doctors cover their fellow doctors arses, as do hospitals.

Also, keep in mind, medical malpractice insurance is a business expense which can be claimed at tax time, thus the doctors pay less taxes and are able to see more money in the pockets of their white coats. And, I hate to be blunt, but why is it that doctors feel they are entitled to drive fancy cars and live in fine, expensive houses? Yes, the went to college longer than most and they have to do their intership and residencies, but so. There are thousands of folks who put in as much hard work and time in the "real world" who will never be able to live at the standard doctors feel they are entitled to. What ever happened to the practice of medicine for the purposes of helping people and not for the sake of living well above the middle class?

I don't get it, please explain it to me. I have to pay car insurance and health insurance out of my salary and those are not tax right offs, they are a must (well, sadly now health insurance is a luxuary, a lot of folks can't afford it). Those premiums are huge chunks out of my salary - I do without luxuries and necessities to pay those. I

Get the message right and not what the medical profession and insurance companies want you to believe - INSURANCE RATES are as a result of insurance companies wanting to continue to make profits. If you don't believe me, go look and see which industry in our lovely land has continually shown a profit over the last 30 years.

As to the OB/Gyn having to deal with an "18 year statute of limitations" - the minor has the right to bring suit once he/she reaches legal age if the doctors negligence caused that child harm. You would have no problem with this if it was your child with ceberal palsy caused by the negligence of the doctor and your child sued in the hopes of being able to obtain some money that will help him/her deal with his handicaps during his/her adult life. Try to put yourself in the shoes of those nasty plaintiffs. Then try to learn all of the facts. When you have time, I will gladly explain to you the expenses that those nasty trial lawyers foot to pursue the litigation. They can be astronomical and they do it out of pocket, they only recover if the plaintiff recovers.

[NNguyenMD]

218. this might shock you but...

I agree that physicians need to be more accountable for each other, when there is clearly a history of a physician being negligent and incompetent in their practice.

I'm inclined to believe you're right in the gross profitability of the insurance companies as the reason for high costs, versus costs in claims and settlements.

If you don't like the fact the doctors complain about business losses they incurr due to their insurance premiums, I'm with you there. Consider taking your family to an academic university hospital for care. Their insurance rates don't affect how much they get paid.

I still think 18 year statute of limitation is excessive. But if there is a system in place, such as suggested by Sen. Edwards and Kerry, where the insurance company couldnt' use it as a justification for jacking the premium so high, then I woudln't have a problem with it.

Thanks for your input!

[merh]

224. It is not a business loss, it is a business right off and thus

more money in the pocket (more profit) for the doctor, less taxes to pay. Who pays the medical mal for the the doctors at the academic university hospitals? Against, cost of doing business, tax cuts, yadayadaya!

I really think the medical associations and professionals so create self insurance pools. They can make the profits that the insurance companies make, they can insurance those small town doctors that can't affort the rates as tax right offs and they can see where the money is going. They can also see to it that those that hurt the profession and the profits either improve their skills through education and additional "residencies" or lose their licenses. The profession will be in a poster to protect itself from its own, not just protect its own. If regulating hours worked (you and I both know that the hours a resident must put in is dangerous to the resident and to the patients) and patients seen by the physician is necessary and wise, then the profession can do that too.

Stop given to the insurance companies. Create your own insurance pools and regulate the members and profit from the premiums or put the premiums to good use by further improving the profession.

BTW, ask that professor or doctor that gave you the lecture if he/she ever testified as an expert witness. If he/she says yes, then ask them what hourly rate did they charge. The hourly rate that doctors charge to testify or give depositions or review records are outrageous. (anywhere from $450.00 an hour to $2000.00 an hour).

[NNguyenMD]

227. There are physician run mal-practice insurance companies and they're

a disaster.

Medical mal-practice at academic instutions are paid at a group rate by the hospital, thats why the doctors there make a whole lot less than private practicing ones. No costs for overhead, or staff.

The instructor was a professor at the local Law school and also heads our Bioethics course. Not all medical school instructors are doctors. We have lawyers, PhD's in philosophy, and even an english professor who give us lectures on bioethics.

The system of precurring an expert witness seems flawed. 9 out of ten physcians could give the same opinion for a certain situation, but all an attorney needs to do is find the one willing to testify on their favor, plantiff or defense.

I have zero experience in running a small business much less a private practice, only 2 years out of college, so I'll take your word for it about the tax write off/business loss physicians get for their mal-practice premiums. If you personally leave out potential tax write-offs for the good of mankind, then you should pat yourself on the back, good for you. Otherwise private practicing medicine is very much a business. There is cost for rent, staff, nurses, accounting, insurance, blah blah blah blah blah. If private practitioners are guilty of having a $ sign business mentality b/c they chose to work in that sector, then I suppose they are no different from the millions of other small business owners of America. Shame on them

[merh]

230. You are so wrong about the testimony and proof required

relative to a medical mal case. It is standard of care for the community. If you get a New York hired gun lawyer to testify that the a Louisiana doctor's action or inaction is beneath the standard of care that he is familiar with, his testimony will not be given the weigh necessary (if it is allowed at all) because he is not testifying to the standard of care for Louisiana. Medical malpractice cases are very difficult and expensive. The cost of the medical records alone can be staggering, then the records have to be evaluated and put in laymen terms, then finding a doctor to testify is difficult and often impossible. Doctors protect their own.

The failure of the physician run mal-practice companies is because they are run by physicians. The egos don't provide for the obvious, hire competent administrators to run them, doctors (elected boards like the board of directors for any corporation, including insurance companies) control the business. There is a difference between control and running, smart folks in any industry recognize their limitations and hire experts to operate the industry, while they maintain control. Doctors tend to have egos (like lawyers) and the question is do medical schools breed a**holes or are a**holes attracted to the profession (just like lawyers). What comes first, the chicken or the egg?

Ask your lawyer instructor to explain to you the costs to the plaintiffs associated with litigating a malpractice claim. Ask him if the plaintiff has to come up with that money or is it an out of pocket cost footed by the lawyer. Ask him who is paying the medical expenses. Ask him what are the average charges for expert testimony, for reviewing the records, for deposition testimony. Just ask him to be fair across the board and to give you both sides of the argument.

From personal experience, I know that malpractice cases have improved the medical treatment provided to patients and have limited the exposure of doctors. Imagine in the '80s a woman who goes in to have a small boil removed from her breast. It could have been done on an outpatient basis, but she was a nurse that trusted her doctors and the hospital. When the anesthesia was administered, the hoses to the oxygen and the nitric-oxygen were crossed, thus she was killed instantly. The lawsuit proved that the man that administered the anesthesia was not paying attention but it also proved a design flaw that was deadly, the couplings were interchangeable. The corporation that designed the couplings were aware of the flaw, but decided that it was not cost effective to alter the couplings so that they could not be mistakenly switched. As a result of the litigation, the coupling manufacturer corrected the problem and now you cannot mistakenly switch the hoses. So the death of the 42 year old nurse, the mother of 2 young children under the age of 8 who was married to a blue collar guy, though tragic, was not in vein, something good came out of it. The couplings were corrected and others will not accidentally die because of inattention and because the corporation didn't want to spend the extra pennies to install couplings on the tanks that could not be accidentally interchanged.

[NNguyenMD]

231. ok, sure

I guess you're right, thanks.

[sangh0]

226. How hypocritical

Earlier, you admitted that lawsuits aren't why the premiums are so high, and that it's due to the insurance companies greed, so why are still defending medical malpractice, discouraging legal action, and calling for changes to malpractice law?

It doesn't make sense to change the law if it's not causing any problems, and you don't identify any problem with the statute of limitations.

[Princess Turandot]

234. Even though my dad died because of an incompetent physician,

who was already in dementia when it came time to depose him - we obviously didn't go to court in the end but were offered a settlement - I don't believe most MDs are incompetent. The insurance companies are also bad actors in this area, just as they are in health insurance. Every dollar they rack up in cost is charged to the doctor or hospital, so their perspective in these lawsuits are a bit murky.The premiums go to the insurance companies, and as they ratchet up the cost of OBG policies, they ignore the fact that many of the other types of physicians rarely have malpractice awards against them.

In NYS, unless things have changed, there is a process by which cases are reviewed by a committee to determine whether cases can go forward. In reality, the OBG cases are the main problem, and in that case, you not only have possible malpractice, insurance companies spending willy-nilly, those evil trial lawyers, you also have juries. I've worked in a hospital in a past life which inherited several OBG malpractice cases from a hospital it had merged with years before, and we were desparate to settle them before they went to a jury trial. In NYS, the case can be adjudicated where the baby was born or where the baby's family lived, and depending on the borough, there were juries who looked at these cases as lottery windfalls, awarding amounts into the 8 digit level, on punitive damages. (9-11 proved the difficulty of placing a value on an adult's life.)

I also know of another case, though not at a place that employed me, where a jury awarded an immense verdict against a hospital for the mental retardation of a child they treated. The mental retardation was a form that was genetically caused, and the place was not involved in pre-natal care of the child which might have counseled the mother to have an abortion. Yet, the jury ignored the facts and awarded the parents a multi-million dollar settlement, which was later reversed upon appeal.

I don't know what the comprehensive answer is to the medical malpractice dilemma. At a minimum, I think it should be separated out from the usual discussion of 'tort reform', because the failure of Car Company X to knowingly omit a $1.20 part from a car which causes significant numbers of accidents is not the same thing as a human being making a mistake. The situation would also be vastly improved if state medical boards took their responsibility more seriously and not be so reluctant to punish MDs who are bad actors. I recently worked at a place where an MD had a number of claims made against him by a prior employer, and while investigating the claims, most of which were frivolous, the board investigators discovered that he had falsified his record-keeping (beyond a shadow of a doubt) to cover up one of the incidences. They revoked his license to practice medicine in NYS permanently; 10 years ago, that would not have happened. He's probably practicing in Kentucky now: information like that needs to be shared and respected. And last but not least, MDs should stop closing ranks every single time a physician is accused of a problem, be it malpractice or an ethical issue. You're still in medical school,but after you've been on a staff at a hospital for 10 years or so, you will have a pretty good idea of who the relatively limited number of incompetent MDs are. (The last time I had surgery, my first call was to the Chief of Anesthesiology to find out what his folks thought abt the relatively new and young MD who was going to operate on me, because they would know.) MDs need to support the good MDs and not the ones who bring down the profession. The good news is that I think younger MDs see
problem doctors as bringing down both themselves and their institution and don't want to stand behind them. Unfortunately, a lot of old school guys are still running most hospital's medical committees.

It's a complicated issue and there is no one solution to it nor is there only one class of 'villain.'

Just some thoughts.

[NNguyenMD]

235. they are much appreciated.

and I can promise you that your thoughts will be part of a discussion that I'll bring to my other colleague student doctors, so that we take a better look at cleaning up our own house.

[drbtg1]

236. From one doctor to another...

I guess you can tell from this thread that your degree may get you some respect, but a lot of enemies as well.

I'm tempted to add my two cents on my experience on this side of the field, but I doubt it'll do any good. Not sure anyone really cares.

I'm sure you know, unlike any other field, that perfection is expected every day. It's also warranted more than any other field and I'm sure you'll do all you can to get there. After that, probably the best advice I can give is this: whenever possible, after your patient calls you "doctor" for the first time, get them comfortable enough to call you by your first name. The doctorate brings an awful lot of ego. Consumes some folks. But if you can keep that ego contained in your American Express Gold Card and away from your patients, you'll be better than most of the kids in your class.

No one knows your shoes. Good luck walking in them.

[NNguyenMD]

238. haha thats great advice, thanks Dr. btg1

I'm in just hte second year, and I'm sure what you said will really come to life during the clinical years when I actually have to see patients live. But I think you're right, that ego gets more doctors in trouble than they otehrwise should be. I'll try to remember that down the road, thanks.

[Ladyhawk]

237. My father was killed by malpractice.

His colon cancer went undiagnosed despite his complaint to the doctor of blood in his stool. The doctor said it was due to hemorrhoids and left it at that.

[NNguyenMD]

239. I really don't know what to say...I'm very sorry about your father.

In middle aged to older men especially, heavy blood loss in stool with anemia could be highly suspicious for gastrointestinal malignancy. I'd have to know more about the case to know precisely where this physician went wrong down the road in the treatment of your dad, normally by the time someone reaches their late thirties, colonoscopies should become rather regular for early detection of colon cancer. There are genetic tests to measure how susceptible you dad might have been to developing colon cancer of course, but those are usually done after the first daignoses. He really should have started referring your dad to a Gastroenterologist much earlier in the course of his treatment. Colonoscopies every 5 years typically become part of the standard care of colon cancer screening for middle aged men and women by the time they reach their forties.

[proudbluestater]

240. We had the "tort reform" discussion on the old Kerry site

It suddenly came to a screeching halt when I asked the good doctors "What percentage of the health care dollar goes to malpractice insurance?" Never got a response. That's because it's like 1/2 of 1%!!

Tort reform is NOT needed. The Repukes want it because there aren't enough lawyers donating to the Repuke party. But most of the insurance companies donate to Repukes!

[NNguyenMD]

244. are you talking about how much goes to awards and settlements?

b/c I think that you're right, very little goes to actual patients. Most is probably kept by the insurance company, and some bit else is kept by lawyers in legal fees, namely the defense attorneys who represent the mal-practice physician.