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View Diary: Medical Error, Liability, and Murtha (322 comments)

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  •  Tort reform is BS. It has done nothing to (33+ / 0-)

    lower the costs here in Colorado for malpractice insurance. I believe the same is true for California. Only the patients end up with less. The profits went straight to the insurers bottom line.

    •  Texas has the strictes tort reform (25+ / 0-)

      laws in the country and some of the highest medical costs. The patient's body becomes an unguarded money pit, totally at the mercy of unscrupulous doctors, hospitals, pharmaceutical companies and insurers.

      Deoliver47 was right and deserves some apologies.

      by beltane on Wed Feb 10, 2010 at 07:57:41 AM PST

      [ Parent ]

      •  In Texas, the cost to physicians (3+ / 0-)
        Recommended by:
        TX Unmuzzled, elfling, Clarknt67

        for malpractice insurance originally went down slightly, but then began rising again, even though the Texas "tort reform" that passed limits punitive damages for malpractice to $250,000.  Tort reform did not affect the cost of health insurance at all - actually, it was not expected to, although that's the way it was sold to voters.  Also, tort reform did not reduce the number of tests or repeat appointments ordered by physicians (studies proving this were conducted only for Medicare and Medicaid billing), because physicians continued to be paid on a fee-for-service basis.  The more tests the doctor ordered and the more follow-up appointments he scheduled, the more payments he received.

        In the end, tort reform saves no one money.  It simply adds to the insurance companies' bottom line.

        "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

        by SueDe on Wed Feb 10, 2010 at 08:32:48 AM PST

        [ Parent ]

        •  THE TRUTH ABOUT TEXAS "TORT REFORM" (4+ / 0-)

          If any journalist wants background for reporting on this issue, or if you have a major medical malpractice case (major), then call the firm Abraham Watkins in Houston, TX, the leading firm in Texas for plaintiffs, and you should ask to speak with someone in the partner Randy Sorrels's group - he was profiled in a recent magazine. They can tell you about how special interests pushed through "tort reform" in Texas a few years ago by scaring the public about rising costs and evil trial lawyers so that the voters would even approve a constitutional amendment to put a liability cap in place so that no matter if a negligent hospital breaks your toe nail or if they paralyze or kill you, the non-economic damages caps at $250,000. So now the multi-billion dollar medical industry has a very simple number to plug into their spreadsheets.

          And now all med mal lawsuits are limited to a maximum of $250,000 plus actual economic damages only that result from the negligent actions (when hospitals/clinics are found liable by a court/jury). Multi-billion dollar private hospital companies and clinics know in Texas and other states they're on the hook for basically nothing when they negligently injust a patient, so what's the incentive to put safeguards in place?

          The corporate medical actuaries know exactly the probability of these lawsuits, they can quantify them, and executives make cost tradeoff decisions. It's not a matter of when these horrible things happen to people or even how often, it's a just a matter of who it's going to happen to. Will it be you or your family member?

          "Tort reform" is about turning medical care at for-profit institutions into a giant game of Russian Roulette for patients.

          In Texas, a jury of 12 people are trusted to decide whether a guilty person lives or dies. But a jury of the same 12 people are not allowed to decide what a wronged injured patient deserves when a medical provider is found guilty of causing the injury. Pretty sick huh?

          This is a major CIVIL RIGHTS ISSUE and I wish civil rights leaders would wake up to it.

          This is what happens when corporate special interests are allowed to pour money into the political system for their profitable gains. This is why the Gang of 5 on the SCOTUS has threatened our common welfare and our entire democracy. Just look at what happened in Texas. Med mal law is state law, so these "tort reform laws" have mostly been pushed through quietly state by state.

          I am not an attorney, FYI.

          It's time to speak truth to crazy.

          by TX Unmuzzled on Wed Feb 10, 2010 at 09:46:48 AM PST

          [ Parent ]

    •  As malpractice decreases malpractice insurance (10+ / 0-)

      costs decrease.

      Doctors need to take responsibility for their errors and stop whining about lawyers.

      •  In Texas, the malpractice premiums (16+ / 0-)

        continued to rise in spite of caps on malpractice claims. Turned out that the insurance companies were trying to make up for failed investments.

        You can no more win a war than you can win an earthquake. Jeannette Rankin

        by RustyCannon on Wed Feb 10, 2010 at 08:11:00 AM PST

        [ Parent ]

      •  We should all have access to a doctors (3+ / 0-)

        database like a BBB for docs. If I need a plumber, I'm able to find a reputable one via BBB. But how do I find a good doc? They should be forced to publically post every complaint and the resolution.

        What do you call the guy who graduated last in class at med school?

        Doctor.

        Now, who would you rather have treating your child?

        "Two things are infinite, the universe and human stupidity, and I'm not sure about the universe." Albert Einstein

        by GrannyOPhilly on Wed Feb 10, 2010 at 08:23:51 AM PST

        [ Parent ]

        •  Not complaints but reporting of quality measures (1+ / 0-)
          Recommended by:
          GrannyOPhilly

          Google 'hospital compare' and 'nursing home compare'.
          Over the next few years this type of reporting will become more comprehensive and include individual physicians.

          •  This seems like a great idea (2+ / 0-)
            Recommended by:
            wvhillrunner, stitchmd

            but in practice, it isn't really working.  the "quality" measures are chosen becasee they are easy to measure, not becasue they represent the most important measures of quality.

            For instance, the current measures for anesthesiologists- whose care determines whether you live or die- are 1) the timing of the pre-op antibiotic (really a surgical, not an anesthetic issue) and 2) the temperature of patients having colon cases upon arrival in the recovery room- regardless of the blood loss, length of procedure, or the method of temperature measurement.  
            Hosp[ital measure that which is easy to measure.  

            Qualtiy is a very difficult thing to measure, especially with rare events.  I could be twice as likely to kill a patient through inattention as a colleague- but it would take our entire careers to show that statistically- and he might have a death in the first year, and I might have both of mine at the end of my career.

            I'm not against quality measurement at all, but the curent attempts are like the drunk looking for his lost keys under a lamp post- not because he lost them there, but because the light is better.  Hosptials and JACHO measure what is easy to measure.

            •  disagree that its not working (0+ / 0-)

              Most of the processes being measured are improving.  
              You are correct that the current set won't tell you anything about anesthesiologists, but improved compliance with evidence based guidelines saves real lives and money.
              Public reporting of PQRI should be coming soon with a variety of measures relevant to many specialties.

            •  It doesn't work like that in life. (0+ / 0-)

              doctors who are screwups do it early  and often.

              We are in a time where it is risky NOT to change. Barack Obama 7-30-08

              by samddobermann on Thu Feb 11, 2010 at 03:31:21 AM PST

              [ Parent ]

          •  The HCR bill requires hospitals to report (0+ / 0-)

            infection rates and maybe error rates (but I'm not sure about the last.).

            But the HCR bill has a lot of good things in it.

            We are in a time where it is risky NOT to change. Barack Obama 7-30-08

            by samddobermann on Thu Feb 11, 2010 at 03:29:21 AM PST

            [ Parent ]

        •  Academic success does not correlate (0+ / 0-)

          with being a good or not good doctor.

          The top students usually go into research anyway.

          We are in a time where it is risky NOT to change. Barack Obama 7-30-08

          by samddobermann on Thu Feb 11, 2010 at 03:27:13 AM PST

          [ Parent ]

      •  A third of all malpractice suits. (4+ / 0-)
        Recommended by:
        freelunch, elfling, J M F, BPARTR

        I have heard that a third of all malpractice suits are simply to find liability so that treatment can proceed. A genuine Health Care Reform plan can be seen as "no fault" driver's insurance--it would pay for these cases without having it go to trial.

        Greg McKendry, Linda Kraeger, Dr. George Tiller, Steven Johns. Victims of Wingnut violence

        by Judge Moonbox on Wed Feb 10, 2010 at 08:27:04 AM PST

        [ Parent ]

        •  Single payer make this much less an (2+ / 0-)
          Recommended by:
          freelunch, Judge Moonbox

          issue. Same for Workmen's Compensation which is exorbitant. The payer could simply negotiate with the Dr or hospital to be reimbursed the ongoing costs of treatment and even lifetime benefits, if required. Much simpler and direct.

          Single payer is all of a piece, reducing cost across the board - if done correctly.

        •  you have to have something like trial (0+ / 0-)

          to establish if the treatment was below the minimum standard of care and what and how much the damages are.

          You don't want to put an injured and maybe ailing patient or even a recently bereaved and shocked family up against a fast talking hospital or doctor's representative (otherwise known as a lawyer).

          What is your kid was say, being treated for a treatable cancer and got a dose of radiation 6 times as much as he should have gotten and now can't speak, hear or see.

          Hey, no fault, no hassle. Sorry kid.

          Where you heard

          I have heard that a third of all malpractice suits are simply to find liability so that treatment can proceed.

          I don't know. That makes no sense at all. Someone was shitting you. Malpractice cases frequently take years.

          We are in a time where it is risky NOT to change. Barack Obama 7-30-08

          by samddobermann on Thu Feb 11, 2010 at 03:40:31 AM PST

          [ Parent ]

      •  costs yes. (0+ / 0-)

        The costs of malpractice awards would decrease as malpractice decreases.
        The premiums paid by doctors might not decrease. We're talking insurance companies, you know.

        If "con" is the antonym of "pro," what is the antonym of "progress"?

        by Frank Palmer on Wed Feb 10, 2010 at 08:35:34 AM PST

        [ Parent ]

        •  Most doctors own their own insurance companies (0+ / 0-)

          It's routine for them to use a mutual insurance company that was set up by medical societies or a risk retention group that might save money for a particular practice or group of medical providers. Malpractice insurance prices are adjusted to meet expected claims.

          •  no, look at the Kaiser Foundation's (0+ / 0-)

            expose. The med-mals are not publicly traded so don't have to show profits.

            But they're a scam. The doctors don't care cause it allows them to whine.

            And it gives them an excuse to order lots and lots of extra treatment and tests which is making them rich.

            We are in a time where it is risky NOT to change. Barack Obama 7-30-08

            by samddobermann on Thu Feb 11, 2010 at 03:50:01 AM PST

            [ Parent ]

      •  The question needs to be Why Protect Bad Doctors (3+ / 0-)
        Recommended by:
        freelunch, stitchmd, Abra Crabcakeya

        I made this same comment recently. It needs to be about Truly Bad Doctors and the Medical Review Boards that Protect them.

        Here's a headline that is pretty scary - "Report: Pa. Medical Oversight Board among worst."

        In PA, a "Doctor accused of trying to bribe a member of the State Board of Medicine." - After a lawsuit settled in death of 18 yr old girl - "State records indicate Glunk renewed his medical license about five months later."

        And this Nurse to Stand Trial for Reporting Doctor

        In a surprise inspection last September, state investigators found several violations by Dr. Arafiles and concluded that the hospital had discriminated against the nurses by firing them for "reporting in good faith."

        So Doctor has violations but they are still going the to put the reporting nurse on trial.

        It's not about malpractice lawsuits - it's about keeping the secret about bad doctors - who can continue to practice. Stop Protecting Bad Doctors!

        "People ask, is there one word that you have more faith in than any other word, ...I'd say its Participation." - Pete Seeger

        by PAbluestater on Wed Feb 10, 2010 at 08:54:41 AM PST

        [ Parent ]

        •  The hospital knew of his really, really bad (0+ / 0-)

          record but you see, it was hard to get a doctor out there in West Texas so the administrator was thinking over what to do.

          So the nurse filed the complaint. But the doc had treated the sherif for a heart attack and he lived and just loves his doc so he is helping him out.

          We are in a time where it is risky NOT to change. Barack Obama 7-30-08

          by samddobermann on Thu Feb 11, 2010 at 03:43:48 AM PST

          [ Parent ]

      •  Actually the premium costs (1+ / 0-)
        Recommended by:
        samddobermann

        seem to track more tightly to the performance of the stock market than to anything that physicians do or don't do.

        Fry, don't be a hero! It's not covered by our health plan!

        by elfling on Wed Feb 10, 2010 at 08:57:12 AM PST

        [ Parent ]

      •  Actually, no, they won't (0+ / 0-)

        unless the anti-trust exemptions for malpractice insurance are removed.

        Without that, malpractice insurance rates will continue to be pegged to what doctors can be squeezed for -- not to actual risks or costs.

      •  Screw tort lawyers (0+ / 0-)

        they are bottom-feeders and exploit injured people.

        •  and if you or your kid is grievously (0+ / 0-)

          injured and has to suffer the rest of their life?

          Go it alone.  Have fun.

          Yeah there are some that are bad but the damage bad doctors and systems do is horrendous.

          Go to the New you times and click on their health section and read a few articles, particularly the one on radiation errors. Do a search for it there.

          We are in a time where it is risky NOT to change. Barack Obama 7-30-08

          by samddobermann on Thu Feb 11, 2010 at 03:59:35 AM PST

          [ Parent ]

      •  Wrong. Medical Malpractice insurance (0+ / 0-)

        is a scam. They are over charging doctors, claiming a need for huge reserves they don't actually need.  They lurk beneath notice and I think many are not publicly traded firms. That keeps their doings private.

        The scams have been investigated and discussed by the Kaiser Health Foundation, which does a lot of health care related work.

        It has been demonstrated, time and again that most clear cases of malpractice do not even give rise to a complaint. A detailed study of case records looking to see if malpractice claims were legit and how many were not found that there was way more malpractice than they imagined and very little was prosecuted.

        Malpractice is not merely a doctor or nurse making a mistake. It is where the level of practice falls below the minimum standard of care and causes injury or damage to the patient.

        You want to cut malpractice suits? You want to cut malpractice in half or more?

        The answer is simple.

        Most malpractice is caused by a relatively few doctors (nurses, hospitals, ...). In study after study researchers find that 80%, 90% and more of all malpractice cases are caused by fewer than 10% of all doctors. The first study I read, back when Ob-gyn malpractice insurance fees shot up so high in California, found that 93% of the claims were due to just 7% of the doctors.

        In fact med-mal insurance corporations know all that. Their own studies show that the best predictor of who will cause a malpractice claim is....

        A previous malpractice claim!

        So a quick remedy is to audit a MM insurers books and establish a legitimate cost structure. That will reduce prices.

        Second is change the rules. After the first malpractice claim found to be legitimate (either admitted or by a neutral panel) the insurance rates for that doctor rise 50% for three years. If he stays clean they revert. For a second offense within three years they double for a further three years. For a second offense later they double for three years.

        For a third offense the rates go to 500% of the normal rate. They double for every subsequent offense.

        In each case notice is sent to the employer if any, to associated hospitals, and to the medical licensing board of the jurisdiction.

        Reports of all legitimate claims should go into a publicly available data base.

        All hospital must publish the number of infections patients have gotten inside the hospital and the number of legitimate malpractice claims against the hospital and all employee staff as well as the number against doctors practicing at the hospital.

        That will reduce the problem to manageable proportions.

        Many disastrous situations can be prevented by the use of check lists. Failures are frequently due to system errors that allow the doctors to get away with sloppy work. To some extent it is because medicine has become so complex with so many ways to do so much more and often do it better that a doctor, even a team, can't hold it all in their head at one time.

        Poor Murtha is a case study of a disaster.

        He is one of the over 198,000 who die in hospitals each year from PREVENTABLE medical errors.

        I will elaborate soon.

        We are in a time where it is risky NOT to change. Barack Obama 7-30-08

        by samddobermann on Thu Feb 11, 2010 at 03:24:31 AM PST

        [ Parent ]

    •  Well, that's what it is all about. (8+ / 0-)

      GOP wants to deregulate and maximize business profitability.  That is their calling card.

      "It is a serious thing to live in a society of possible gods and goddesses." - CS Lewis, Weight of Glory

      by Benintn on Wed Feb 10, 2010 at 08:11:08 AM PST

      [ Parent ]

    •  Well, that's too broad of a statement (12+ / 0-)

      Malpractice lawsuits add only a small increment to the cost of medical care, but that doesn't mean there aren't good reasons to reform our system.  Most actual malpractice, in fact, does not result in lawsuits at all; and conversely most people who are injured by medical intervention don't really have grounds for a lawsuit because the physicians were not negligent.  Mistakes and bad outcomes happen in medicine, as in every other endeavor, but doctors are human, just because they err doesn't necessarily constitute malpractice. So most people with injuries have no means of getting compensation.

      What we need to do is divorce compensation for iatrogenic injury from policing of the profession for negligence and incompetence.  They are really two separate problems and ought to be handled separately.  Lawsuits and litigation are a bad way of dealing with both problems.  This is probably too complicated an issue for a comment here, but on the other hand, what's the use of writing a diary, 99% of them sink like a rock.  

      Anyway, it's a more complex issue than it is usually presented to be.

      •  Here's a blog post I wote a while back (15+ / 0-)

        Medical errors -- particularly medication errors -- obviously can happen outside of hospitals, but we don't have good data on errors and adverse events in ambulatory care. For hospitals, however, there is a commonly accepted range of estimates, that from 44,000 to 98,000 Americans die every year from avoidable errors made in hospitals. The number who are injured, including many serious injuries (e.g., amputating the wrong leg) is obviously much higher.

        You can see where those estimates come fromhere, which is the first page of the E-book version of the Institute of Medicine's report "To Err Is Human: Building a Safer Health System." The E-book format is kind of dodgy: access to the publication is free, but you can't download it and print it out, you have to look at it on your computer one page at a time. In other words, they're still hoping you'll pay for the printed version. But it's there if you're really interested.

        Okay, to kick off this discussion, let me make some basic observations:

        Medical intervention, like flying an airplane, is inherently dangerous. You have a long way to fall from the sky, and you also can do a lot of damage by cutting people open, sticking tubes in them, or pumping in or feeding them powerfully bioactive chemicals.

        Everybody makes mistakes. If I make a mistake at work (not that it would ever happen), the most dire consequence might be that somebody is sitting around in a conference room wondering where the hell I am, or a questionnaire goes out with an embarassing typo. If a doctor, nurse or pharmacy technician makes a mistake, well .. .

        Modern medicine is a very complex undertaking. There are new drugs, new tests, new procedures all the time. New information about risks and counterindications for existing drugs, tests and procedures comes out all the time. It's nearly impossible for anybody to keep track of all the information that might affect patient safety, even in a narrow field. Take my post yesterday about sodium phosphate: most gastroenterologists apparently don't know that it's dangerous for people with kidney failure. That seems pretty basic, but it's also a different specialty.

        Historically, the principle method by which medical providers have been made accountable for errors has been malpractice litigation. This does not efficiently discourage errors because:

           Mistakes are not the same as malpractice, which requires a finding of negligence. You can make a mistake without being negligent.

           Malpractice litigation is an adversarial procedure. It encourages doctors to fight the allegations rather than trying to figure out how to make sure it doesn't happen again. That means trying to suppress information, or interpret it in the most favorable possible light. It means not coming forward in the first place if you know you did something wrong, hoping nobody will notice. It drives physicians to stick together like thieves, creating a culture of cover-up and avoidance.

           Malpractice litigation is mostly directed at finding fault in individuals, and getting them and/or their insurance companies to pay up. It doesn't encourage analyzing systems to find ways of making them mistake proof.

        So, there is growing interest in systems approaches to medical errors. Try to figure out where the points of vulnerability are that lead to mistakes, and fix the physical environment, the procedures, the job descriptions so that mistakes are impossible to make. For example, people used to be injured by getting hooked up to the wrong kind of gas. Now the fittings for oxygen and anaesthesetics are incompatible. And have you noticed how they always ask your birthday before handing you your prescription? That's to make sure you are the right Pemberton G. Throckmorton.

        We'll get into more depth on this later. But in the meantime, remember, even without mistakes, medical intervention is dangerous -- and as a matter of fact, it can be hard to draw the line between mistakes and bad luck. There is an awful lot of judgment involved in trying to trade off risks and benefits. There are deep psychological and philosophical issues in deciding what is appropriate and what is just plain nuts. Hospitals are always going to be very dangerous places.

        •  The line between mistakes and malpractice has, (8+ / 0-)

          unfortunately, been beaten all to hell.

          More and more, it seems like juries want to punish bad outcomes instead of bad behavior.

          Free speech? Yeah, I've heard of that. Have you?

          by dinotrac on Wed Feb 10, 2010 at 08:22:28 AM PST

          [ Parent ]

          •  If mistakes harm, they need to be compensated (0+ / 0-)

            Does the victim of a hospital's mistake care that it was routine incompetence rather than malpractice?

            •  It is not a binary issue. "Mistakes" in medicine (4+ / 0-)
              Recommended by:
              stitchmd, virgomusic, eyesoars, Gravis

              do not require incompetence.  The only way to prevent them is to refuse treatment when treatment is difficult.

              Free speech? Yeah, I've heard of that. Have you?

              by dinotrac on Wed Feb 10, 2010 at 11:26:26 AM PST

              [ Parent ]

              •  I'm talking about financial recovery (1+ / 0-)
                Recommended by:
                dinotrac

                If there was a mistake, the victim should receive recompense. If it wasn't malpractice, I wouldn't expect any sort of exemplary damages, but the patient cannot be expected to control the competence or quality of care of the medical staff.

                •  Then let's lose the word mistake for a moment. (0+ / 0-)

                  I agree that compensation for incompetence or negligence is appropriate, but, let me offer a terrible scenario that actually happened to my family:

                  My sister-in-law was diagnosed with a very aggressive late-stage cancer of the brain stem near the end of a pregnancy.

                  I don't know why it wasn't caught sooner, but the symptoms we did notice -- she was somewhat pale and easily tired -- could easily be attribute to her pregnancy.  The tumor was discovered only after she suffered a terrible headache.

                  My nephew was delivered by Caesarian, and my sister-in-law's surgery took place two days later.  The surgeon was unable to safely remove the tumor, and my sister-in-law suffered a stroke on the operating table.  She never woke up.

                  Things don't get much worse than that:
                  Young woman dead,
                  husband widowed,
                  children left without a mother, one having spent only a day with her.

                  So, who's at fault here? The obstetrician who didn't catch her cancer because he was paying attention to her pregnancy?

                  She might have been better off not getting the surgery, and possibly living a few days longer, but she and my brother agreed to take a risk on life and the surgeon was willing to try to save her.

                  Who should be punished for that?

                  Free speech? Yeah, I've heard of that. Have you?

                  by dinotrac on Wed Feb 10, 2010 at 11:43:27 AM PST

                  [ Parent ]

            •  What is a mistake? (1+ / 0-)
              Recommended by:
              Gravis

              Sometimes there are no good choices, and anything one does will to some degree have a bad outcome.  Should medicine be on the hook for those?

              Sometimes there are good and bad choices, but they can only be determined after the fact.  How about then?

              Medicine is highly organic: diseases and conditions occupy a very large, continuous (in the mathematical sense) space.  Much of that space is unknown; medicine in such situations is necessarily experimental.  How then?

              If we go by that method, then how does one ever run a substantial study?  Any study that has a control group will necessarily have people who were harmed, either by action or inaction.  Traditional medical protocols do their best to minimize the amount of hurt, but they necessarily can't be perfect.  How then?

              You're trying very hard to push and enormous amount of grey into two little squares of black and white.  It won't fit.

        •  These are important comments. (4+ / 0-)
          Recommended by:
          elfling, nightsweat, stitchmd, BPARTR

          My husband is hospitalized for infections periodically at a teaching hospital. The hospital attending doctors are always different. At our first conversation, I always tell them "We don't expect miracles from anyone. You are human. All we ask is that you do your best." I think knowing we're reasonable people helps them. You say "Hospitals are always going to be very dangerous places". This we have learned, once when he picked up an infection within the hospital and once when an unnecessary line was placed down his arm when, in fact, an antibiotic was available in pill form. Both times, the resident has admitted the problem. Hospitals aren't perfect. But when a fever suddenly rages and blood pressure drops, they are an the most important place to be. People have to have reasonable expectations.

          "It does not require many words to speak the truth." -- Chief Joseph, native American leader (1840-1904)

          by highfive on Wed Feb 10, 2010 at 08:53:25 AM PST

          [ Parent ]

        •  excellent comment (3+ / 0-)
          Recommended by:
          stitchmd, highfive, erush1345

          I think both doctors and patients forget that any intervention can create risk, and that there's value in treading carefully.

          I would far prefer a system that sent every mistake through a medical review board for investigation and appropriate corrective action, and where patients simply got the care that they needed without having to find someone at fault first.

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Wed Feb 10, 2010 at 09:42:56 AM PST

          [ Parent ]

          •  exactly (1+ / 0-)
            Recommended by:
            highfive

            I think both doctors and patients forget that any intervention can create risk, and that there's value in treading carefully.

            We've come to this idea in this country that if some health care, i.e., treatment is good, more is better. That is not always true, and all potential treatments have risks.

            Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

            by stitchmd on Wed Feb 10, 2010 at 03:16:37 PM PST

            [ Parent ]

        •  This is true. Have you read Gawande's (0+ / 0-)

          new book, Check lists. It's all about fixing the problems.

          But none of that helps the few doctors that cause most of the malpractice claims. Most are arrogant.

          Doctors still don't wash there hands between patients. Won't. There was one doc on DKos who said it made his hands too chapped and he wasn't going to do it.

          We are in a time where it is risky NOT to change. Barack Obama 7-30-08

          by samddobermann on Thu Feb 11, 2010 at 04:10:34 AM PST

          [ Parent ]

      •  Is there any reporting of the actual costs that (0+ / 0-)

        they add, and the cost of threatened lawsuits?

        Most things I see report on judgments, but the vast majority of civil suits -- on the order of 95% -- never go that far.  Most are either dropped or settled. There is also another category of dispute that doesn't go to lawsuit.  That would be cases where settlements are negotiated without a lawsuit even being filed.  Not that common, but the right fact scenario with the right (feared) attorney can make it happen.

        Free speech? Yeah, I've heard of that. Have you?

        by dinotrac on Wed Feb 10, 2010 at 08:20:17 AM PST

        [ Parent ]

        •  Try this interview (2+ / 0-)
          Recommended by:
          freelunch, dinotrac

          Very good overview of the issues within the system.

          http://prescriptions.blogs.nytimes.c...

          Q. A lot of people seem to have taken up the cause of tort reform. Why isn’t it included in the health care legislation pending on Capitol Hill?

          A.
          Because it’s a red herring. It’s become a talking point for those who want to obstruct change. But [tort reform] doesn’t accomplish the goal of bringing down costs.

          Q.
          Why not?

          A.
          As the cost of health care goes up, the medical liability component of it has stayed fairly constant. That means it’s part of the medical price inflation system, but it’s not driving it. The number of claims is small relative to actual cases of medical malpractice.

          Q.
          But critics of the current system say that 10 to 15 percent of medical costs are due to medical malpractice.

          A.
          That’s wildly exaggerated. According to the actuarial consulting firm Towers Perrin, medical malpractice tort costs were $30.4 billion in 2007, the last year for which data are available. We have a more than a $2 trillion health care system. That puts litigation costs and malpractice insurance at 1 to 1.5 percent of total medical costs. That’s a rounding error. Liability isn’t even the tail on the cost dog. It’s the hair on the end of the tail.

          Q.
          You said the number of claims is relatively small. Is there a way to demonstrate that?

          A.
          We have approximately the same number of claims today as in the late 1980s. Think about that. The cost of health care has doubled since then. The number of medical encounters between doctors and patients has gone up — and research shows a more or less constant rate of errors per hospitalizations. That means we have a declining rate of lawsuits relative to numbers of injuries.

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Wed Feb 10, 2010 at 09:00:23 AM PST

          [ Parent ]

          •  That interview doesn't answer the question. (0+ / 0-)

            I didn't understand this part:

            For gray areas where awards and settlements
            are typically (but not always)
            excluded, such as punitive damages

            but I do understand that they didn't include any defensive actions against legal action.

            I also think that comparing $30 billion against a $2Trillion health system understates reality, if only because parts of that system -- like Worker's comp -- greatly restrict the ability to file malpractice suits.

            As it is, the reported cost is about $250-300 per family per year.  Not a fortune, but not nothing, especially to those at the low end of the wage scale.

            Free speech? Yeah, I've heard of that. Have you?

            by dinotrac on Wed Feb 10, 2010 at 09:19:52 AM PST

            [ Parent ]

          •  Wrong title on above comment - sigh (0+ / 0-)

            Getting too old to keep. ;0)

            Free speech? Yeah, I've heard of that. Have you?

            by dinotrac on Wed Feb 10, 2010 at 09:20:30 AM PST

            [ Parent ]

      •  Completely agree (1+ / 0-)
        Recommended by:
        PAbluestater

        Tort reform is no more the solution to health costs than torts themselves are the solution to medical errors.

        I do think the AMA in particular needs to get more reasonable in accepting oversight - right now, any sort of legislative attempt to force simple things like 'checklists' onto practicing physicians is going to cause the AMA to blow a gasket... and that's a PR war that will IMPOSSIBLE to win.

        Either the AMA needs to take a stronger hand in development medical error preventive guidance, or, it needs to hold its fire and let someone else do it... Right now - I don't see either in the cards.

        I guess everyone's got their own blog now.

        by zonk on Wed Feb 10, 2010 at 08:42:29 AM PST

        [ Parent ]

    •  It's a tax on victims of malpractice... (4+ / 0-)
      Recommended by:
      JanL, mariva, J M F, output

      and a subsidy for incompetent doctors. The Repubs don't mind the new tax because they see doctors as winners and malpractice victims as losers.

      Greg McKendry, Linda Kraeger, Dr. George Tiller, Steven Johns. Victims of Wingnut violence

      by Judge Moonbox on Wed Feb 10, 2010 at 08:23:40 AM PST

      [ Parent ]

    •  They can have tort reform when... (6+ / 0-)

      ... we have universal health coverage for every living human in the US. If a doctor amputates the wrong kidney, the patient needs every cent of a $3 million settlement to cover their healthcare for the rest of their lives. The patient with no working kidneys would have a "pre-existing condition" that would prevent them from ever getting health insurance again.

      Get rid of "pre-existing conditions" and then talk about tort reform. They are tied together.

      "As God is my witness, I thought turkeys could fly."- Arthur Carlson

      by bobinson on Wed Feb 10, 2010 at 08:31:21 AM PST

      [ Parent ]

      •  Agreed (2+ / 0-)
        Recommended by:
        freelunch, bobinson

        One reason we see people going for enormous judgments, is because these people know if they don't get cash immediately, they'll be screwed and in the poor house for the rest of their lives because the secondary support systems (e.g. government health insurance) are totally inadequate. People maimed medical malpractice have no rational choice except to try for a huge settlement.

      •  What if someone looses her arm (0+ / 0-)

        from preventable medical error. So she gets medical costs one way or another.

        But she was a music teacher. Violin. Her whole life was music.

        You would cover medical costs.

        Goody.

        We are in a time where it is risky NOT to change. Barack Obama 7-30-08

        by samddobermann on Thu Feb 11, 2010 at 04:26:23 AM PST

        [ Parent ]

    •  The question that nobody answers. (0+ / 0-)

      If a doctor orders tests to protect himself from lawsuits that might arise if some unlikely condition exists, doesn't thoat test also protect the patient if that unlikely condition exists.

      If "con" is the antonym of "pro," what is the antonym of "progress"?

      by Frank Palmer on Wed Feb 10, 2010 at 08:33:21 AM PST

      [ Parent ]

      •  Not always (1+ / 0-)
        Recommended by:
        stitchmd

        Tests especially imaging studies can show things that when you chase them turn out to be non-harmful. Medicine is a very subjective specialty.

        •  exactly (2+ / 0-)
          Recommended by:
          freelunch, samddobermann

          Pre-op chest x-rays wused to be standard for everyone.  Then it was studied, and it turned out that the inevitable complications of following up abnormal x-rays caused more morbidity than was prevented by finding abnormalities pre-op.

          These are averages- some cancers were found unexpectedly and those lives may or may ot hae been saved.  The extra operations biopsying  shadows which turned out to be benign caused my morbidity, and even deaths.

          So now, pre-op xrays are not routine.  Are the people with unknown lung cancer harmed- yes.  But more people are helped.

          •  pre-op evaluations are a good example (1+ / 0-)
            Recommended by:
            samddobermann

            we now have to do them on everyone, and there is little data that this widespread use does anything to reduce risks but lots to increase costs.

            Again, though, studies are always done on populations and the results may, or may not, apply at the individual level.

            Take, for example, the situation of Congressman Murtha. Outpatient cholecystectomy is generally a safe procedure; even according to the statistics quoted in the diary, 985 to 99.3% of patients, even elderly, will survive the surgery. The flip side, of course, is that of every 1000 procedures performed, 7 to 20 people will die.

            Does, then, the fact that Rep. Murtha died make this a case of malpractice? Not in and of itself. But it's still, at the individual level, the most negative outcome possible.

            It's often hard to distinguish between the two.

            Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

            by stitchmd on Wed Feb 10, 2010 at 03:23:29 PM PST

            [ Parent ]

            •  to true. (1+ / 0-)
              Recommended by:
              stitchmd

              I am an anesthesiologist- what do you stitch?

              •  Primary care internal medicine (0+ / 0-)

                so I'm the one doing the pre-ops! Hey, it's good income and easy in most cases.

                But as an example, let's take colonoscopies. The best data, btw, for reducing colon cancer is the most simple test: a yearly fecal occult blood test. Data for colonoscopy, apart from the recent furor over CT colonography, is not as strong.

                And it requires a prep, which is taxing to the patient; and it requires sedation, which now requires a pre-op eval in the hospitals where I work. Since, for screening, these patients are over 50 by definition, that means getting lab work, EKG, usually a chest xray.

                So the best data is for the $50 - $100 test, the FOBT.

                Colonoscopy is, what, $500? Minimum? Add to that the cost of the pre-op, and you now have something that is going to be over $1000. Now, is that cost effective? Really?

                The other thing, it seems to me that anesthesiologists used to do a fair amount of low-level pre-op eval themselves. But there's a lot of risk shifting going on. Thoughts from the inside?

                I never say someone is "cleared" for surgery. I assess the risk and say whether there are contraindications are not. Because there are always. risks.

                Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                by stitchmd on Wed Feb 10, 2010 at 04:15:09 PM PST

                [ Parent ]

                •  But few doctors are doing the (0+ / 0-)

                  yearly fecal occult blood test now.

                  That's why I am switching doctors.

                  We are in a time where it is risky NOT to change. Barack Obama 7-30-08

                  by samddobermann on Thu Feb 11, 2010 at 04:32:54 AM PST

                  [ Parent ]

                •  Interesting observation. (0+ / 0-)

                  We have a nurse run pre-op clinic where by criteria they call the anesthesiologist for direction.  When further evaluation is necessary, we order it. no cxr unless specifically indicated, no ekg unless indicated for patients under 55, and 6 mo is ok if there was no abnormality on the last one. Minimal pre-op labs unless specifically indicated.

                  I am glad you do not "clear" patients for surgery.  That is one of my pet peeves. What we want, as anesthesiologists, is exactly what you describe: characterize the disease, and tell me whether the patient is optimized or whether  additional treaatment could make the risk lower.  No patient is too sick for surgery.  All patients are cleared for surgery- it is just a matter of relative risks.

      •  at what cost. that is why US costs are 2 (0+ / 0-)

        times those in other companies. And our health is worse.

        But our doctors are richer.

        We are in a time where it is risky NOT to change. Barack Obama 7-30-08

        by samddobermann on Thu Feb 11, 2010 at 04:28:13 AM PST

        [ Parent ]

      •  tests have costs. Some are invasive. Should (0+ / 0-)

        people be tested for a 1 in 100k risk at a time when the doctor might ignore what is actually happening? What about the high rate of false positives?

        The areas in which testing was most lavish outcomes overall were not better than areas where testing was far less.

        Reality driven medicine is best.  

        We are in a time where it is risky NOT to change. Barack Obama 7-30-08

        by samddobermann on Sat Feb 13, 2010 at 03:27:34 AM PST

        [ Parent ]

    •  same surgery, similar complication (0+ / 0-)

      I had the same surgery back in 1992 and my surgeon nicked my bile duct. He thought something was wrong, fortunately, and kept me in the hospital.

      After two major surgeries, including an 8+ hour surgery at a major medical center, several bouts with antibiotic-resistant infections, and about a year, I was finally back to normal health. It helped that I was otherwise healthy and in my 30s.

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