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Watch this tragic charade for yourself!

Medical malpractice lawsuits, often described as "lawsuit abuse" or "frivolous lawsuits" are frequently described by the right as a serious problem.

For example, in the hearings today, I heard a number of calls to restrict medical malpractice awards.

Despite the huge amount of money and energy being spent by lobbyists and special interests to convince us that medical malpractice suits are to blame for the skyrocketing costs of healthcare,
nothing could be farther from the truth.

A new report: The 0.6 Percent Bogeyman: Medical Malpractice Payments Fall to All-Time Low as Health Care Costs Continue to Rise shows the depths to which the insurance, drug and hospital industries will go to deceive the American public and divert them from addressing the real causes of increases in health care costs.

The total cost of medical litigation and malpractice insurance premiums- of which damage awards are only a part, has fallen to AN ALL TIME LOW of 0.6%  as a percentage of total medical costs.


Please read on..

Number of Medical Malpractice Payments Made on Behalf of Physicians, 1991-2008

YearNumber of PaymentsNumber of Payments per 1 Million People (U.S. Population)

Frivolous? Hardly - even the most aggressive defense lawyers would not say that of almost all plaintiffs in malpractice cases:

"But even those who favor limiting patients’ rights, such as well‐known Washington lawyer Victor Schwartz, acknowledge that frivolous medical malpractice lawsuits are uncommon.

"There is no question that it is very rare that frivolous suits are brought against doctors. They are too expensive to bring," Schwartz said in 2004, when the fury over medical malpractice litigation was at its peak.2 In fact, the data thoroughly contradict myths about a prevalence of medical malpractice payoffs for inconsequential harms.

The vast majority of payments compensate victims or their families for injuries that no one would call frivolous. Nearly two‐thirds (65 percent) of medical malpractice payments in 2008 compensated for negligence resulting in "significant permanent injury," "major permanent injury," quadriplegia, brain damage or the need for lifelong care, or death.

More than four‐fifths (83 percent) of the total value of malpractice payments last year compensated for these very serious consequences. "Insignificant injury" and "emotional injury only," the two ostensibly least serious injuries, accounted for between 0.2 percent and 0.3 percent of dollars paid in 2008.  Not surprisingly, the four most serious categories posted the highest mean and median payments by significant margins."

Predictably, though...

"Yet despite the shocking frequency of serious
medical errors and the surprising infrequency with
which the victims or their families pursue redress in
court, Congress commits far more attention to the
mythical excess of lawsuits concerning medical
negligence than to the negligence itself. In the
current debate over health care reform, some are
calling once again to restrict patients’ legal
remedies even though medical malpractice
litigation has fallen to the lowest level on record.
The number of malpractice payments in 2008 was
the lowest since the creation of the federal
government’s National Practitioner Data Bank,
which has tracked medical malpractice payments
since 1990. This was not an aberration. Last year
was the third consecutive year in which the number
of medical malpractice payments sunk to an all‐time
low. The cumulative value of malpractice payments
(as distinct from the number of payments) in 2008
was either the lowest or second‐lowest on record,
depending on how one adjusts for inflation.
Medical malpractice litigation’s share of overall
health care costs, which always has been minuscule,
has fallen to less than 0.6 percent even under the
most liberal definition. This figure encompasses
insurance companies’ overhead and profits, as well
as their litigation costs and the sum of actual
payments made to victims. Actual medical
malpractice payments have fallen to less than 0.2
percent of all health costs – the lowest level on

Almost ten years ago, the Institute of Medicine published a groundbreaking study on medical errors

"To Err is Human". "To Err is Human" made a great number of recommendations for our healthcare system, Those recommendations have largely been ignored.

"State and federal policy makers should not take
comfort in the declines in medical malpractice
litigation. Rather than pointing to safer medical
care, the reduction in payments almost certainly
means that there are ever more malpractice victims
not receiving compensation – and fewer incentives
for doctors and nurses to reduce errors.
Despite the politically charged hysteria surrounding
medical malpractice litigation, the percentage of
malpractice victims who actually pursue damages is
incredibly small."

Both quotes are from: The 0.6 Percent Bogeyman: Medical Malpractice Payments Fall to All-Time Low as Health Care Costs Continue to Rise

Originally posted to Andiamo on Thu Jul 16, 2009 at 02:21 PM PDT.


Should we continue to blame "medical malpractice lawsuits" for the skyrocketing cost of health care in America, or are the REAL causes elsewhere?

18%10 votes
81%44 votes

| 54 votes | Vote | Results

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Comment Preferences

  •  Tip Jar (11+ / 0-)

    On health care: "nothing is settled until it's settled right"

    by Andiamo on Thu Jul 16, 2009 at 02:21:21 PM PDT

  •  Sometimes do a search on malpractice cases (3+ / 0-)

    Most of them are egregious, such as amputating the wrong limb or operating on the wrong side of the brain  or else a catastrophic outcome such as death or severe disability. It is merely the few outliers that are used for the terrible examples of malpractice insurance.
    here is one example from the pt's family's pov

    •  let me give you an example, though (2+ / 0-)
      Recommended by:
      VClib, Aranfell

      and believe me, I've been one who has always spoken out against the malpractice canard.

      But here's the situation I found myself in just a couple of days ago. I'm in a new job in a federally qualified health care center, dealing with a lot of uninsured patients. Some of these folks have some money, just not enough to afford health insurance (and that's another issue - but beyond this.)

      I can't go into a lot of details, but I saw a person the other day who had swelling in one leg and some risk factors for a blood clot, but it clinically didn't look like that. However, the clinical diagnostic utility for a blood clot is about 50% - in other words, useless. And this patient was uninsured - BUT also had a family member in health care who was saying this needed to be evaluated with an ultrasound. Problem was, I couldn't get an ultrasound. There's a blood test that can help detect blood clots, but it's not entirely reliable.

      So, the standard of care in this kind of situation is to get the ultrasound/doppler. The only way to do it in this situation was to send the patient to the ER, which would have generated huge amounts of costs, to the patient, to the system, and probably unnecessarily so. But the patient was concerned. And, frankly, given the fact that the patient had a family member in healthcare made me more concerned that if I acted on my clinical suspicion, which was about 90% or more that this was not a blood clot, but then it turned out to be one and the patient had a really bad outcome (say, oh, death) I would be liable for not following the standard of care. And the patient was worried.

      So, what would you do in this situation?

      Frankly, I can't remember a time where I felt so conflicted.

      In the end, after lots of discussion, we opted to get the blood test, which was okay, and the person will follow up later with the ultrasound to confirm that there is no clot.

      But here's the thing: I seriously wasn't just concerned about my potential liability, I was concerned whether I was doing the right thing for the patient. And I really do think that that's the concern for the majority of docs who order tests on the basis of, 'well, I don't think it is, but it might be, so I'm going to get the test/send the patient to the ED/whatever.'

      It's really never so very black and white, the shades of grey are absolutely infinite.

      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 Thu Jul 16, 2009 at 03:30:52 PM PDT

      [ Parent ]

      •  I hope physicians always treat to the (0+ / 0-)

        level of standard of care.

        Of course, standard of care is a lower threshold than reasonable care, which everybody, except docs, has to live up to.

        However, the problem with the standard of care liability test is that it discourages docs from trying new things.

        •  The problem with that is that many people (0+ / 0-)

          never get better because the insurance companies keep pushing that "standard of care" lower and lower.

          People who got care a few years ago now find that doctors don't consider it appropriate because other patients dont get it. The result is that people with chronic illnesses are having MAJOR problems and emergent diseases are COVERED UP.

          Even very common ones...

          On health care: "nothing is settled until it's settled right"

          by Andiamo on Thu Jul 16, 2009 at 05:27:09 PM PDT

          [ Parent ]

      •  I am not sure on this but purely as an aside (1+ / 0-)
        Recommended by:

        physicians employed by an FQHC are not subject to malpractice suits.  This sounds screwy but last year we employed a physician who had worked for an FQ for several years "bare" and our carrier was refusing to accept him until we presented the federal statute establishing his immunity.
        I wish I could provide the specific cite but FQHCs and RHCs tend to be different sorts of beasties than the run of the mill clinic.
        But I take your point

        •  there is some immunity, yes (0+ / 0-)

          and I've always previously been an employed doc for some organization that would work hard to get docs excluded from potential suits.

          After posting this, though, I was thinking about it a bit more. Yes, the suit thing was part of it, but the major think was wondering if I was really doing the right thing by the patient. The issue is that had the patient had insurance, I would have sent the patient to the ED if I couldn't arrange an outpatient doppler, no question about it. The fact that the patient had no insurance required me to rely more upon my clinical skills, not less.

          But in this day and age of "evidence based medicine," clinical skills have a very limited role because they can't be digitized.

          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 Thu Jul 16, 2009 at 03:57:29 PM PDT

          [ Parent ]

          •  even with insurance if you read the small print (0+ / 0-)

            preauthorization does not mean payment which means that the patient could have gotten the MRI and payment could still be denied for hundreds of different reasons. Also most carriers have a hold harmless clause so if the preauthorization does prove to be bogus, the charges all go back to the provider and you cannot balance bill the pt  

            •  like I said (0+ / 0-)

              you can't survive in primary care. Example/evidence provided by you, thanks.

              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 Thu Jul 16, 2009 at 04:21:16 PM PDT

              [ Parent ]

              •  tomorrow after 25 years (1+ / 0-)
                Recommended by:

                the last independent practice in the county will close its doors and in the future, all clinics are owned by the hospital system and all docs are hospital employees with a rubber stamp emasculated medical staff

                •  yeah, (1+ / 0-)
                  Recommended by:

                  and as soon as the hospital starts figuring out who and who does not make them money, i.e., doesn't order enough unneeded, expensive tests or doesn't refer for expensive, invasive surgeries or other procedures that might be done with more conservative measures, those docs will be out on their arses.

                  And yet part of the 'cost containment' of the reform bill will be about cutting reimbusement to providers, including primary care.

                  After many years of school and training, it's really not fun to keep getting it up the ass like this.

                  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 Thu Jul 16, 2009 at 06:05:07 PM PDT

                  [ Parent ]

                  •  It has already happened (1+ / 0-)
                    Recommended by:

                    For years we had argued that DNR orders should not consider hydration as "heroic measures" but that argument is now moot as the remaining physicians all accept the system's administration policy that DNR patients who are admitted are not to be hydrated if "in an irreversible or hopeless state"
                    BTW the policy is a collaboration between the CEO (BS in Business) and his DON (MSN but has never worked on the floor, having gotten her training in administration) and the policy has all sort of citations and footnotes proving this is the current standard of care.

                    We go out of community for healthcare but it is not much better elsewhere as the corporate octopus is everywhere  

                    •  don't even get me started (1+ / 0-)
                      Recommended by:

                      on administrative nurses. Even my 13 year old daughter said the other day, "why do nurses hate doctors so much?" She also said, "what do CEOs do, anyway?"

                      I hope this doesn't portend a career in hospital administration.

                      One of the things I have to say that I like about working in the FQHC is that it is all about primary care. However, we still have the put through isssues (plug and chug medicine) that limit the effective treatment that can truly be provided.

                      System is broke, FUBAR.

                      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 Fri Jul 17, 2009 at 04:12:43 AM PDT

                      [ Parent ]

                      •  I happened upon a copy of this one's resume (1+ / 0-)
                        Recommended by:

                        and under major career achievements she had listed  the Certificates of Need she had blocked in her career, preventing her employer's competitors from expanding services and facilities or implementing new facilities and services.  The insane thing was many of her sites of employment were in underserved areas

                        •  oh, gack (1+ / 0-)
                          Recommended by:

                          you have to wonder why people like that ever go into a career such as nursing. Yuck yuck yuck.

                          Unfortunately there are too many such people in careers that are supposed to be "helping" people, not just in nursing.

                          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 Fri Jul 17, 2009 at 07:19:42 PM PDT

                          [ Parent ]

  •  Just remember that when right-wingers call for (4+ / 0-)

    certain types of lawsuits to be restricted, they are the type of lawsuits where the little guy (you or I) is seeking compensation from multi-billion dollar industries (medical malpractice insurers).  They will not deny themselves their day in court (think Norm Coleman's abuse of three levels of the MN court system).

    Barack Obama in the Oval Office. There's a black man who knows his place.

    by Greasy Grant on Thu Jul 16, 2009 at 02:27:47 PM PDT

    •  and (0+ / 0-)

      look, I absolutely believe people need to have their day in court, and there are medical practitioners out there (doc and others) who frankly have no business doing so. The legal system is the only way to go about it.

      The problem is that it's not just going after the med mal insurers, it's actually going after the practitioners (docs and others) themselves. Just as a medical condition can preclude you from being able to get insurance, even if it's an error on a doc's form or something that is resolved, having been sued can render a doc (or other practitioner) uninsurable. And lots of insurers will simply settle so as to reduce the costs, because the litigation itself is expensive, and that  practitioner may be permanently unable to practice.

      The likelihood of finding a lawyer to represent a truly frivolous claim is very low, but even then costs can be high.

      As I said, I fully support the right of people to have their "day in court." Then again, I've never been sued. Could be I'd change my tune in that happenstance, which obviously I hope never happens.

      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 Thu Jul 16, 2009 at 03:36:43 PM PDT

      [ Parent ]

      •  Not all Doctors are Good, Honest People (0+ / 0-)

        Some are alcoholics and/or drug addicts who make horrible mistakes.... like amputating the wrong limb.

        Most doctors are good people who want to do the right thing and actually care about their patients so don't get me wrong.  However, I worked for a Personal Injury attorney (a famous one at that - shared in the tobacco settlement here) and he could pick and choose the cases he took in (he didn't need to take the questionable cases anymore).  

        Anyhow, after seeing what some doctors did, I do not believe in not allowing a person to sue for more than $250,000 (the limit in Texas now).  These were doctors who should not be practicing in the first place but there is no organization that polices their own (kind of like the Catholic Church and the sex-abuse scandals).

        -6.13 -4.4 Where are you? Take the Test!!!

        by MarciaJ720 on Thu Jul 16, 2009 at 04:14:44 PM PDT

        [ Parent ]

        •  For every case where somebody sues, there are at (0+ / 0-)

          least ten where the family doesn't or can't.

          The average amount of money in wrongful death lawsuits is very low, even lower than medical malpractice lawsuits.

          A human life is worth very little..

          If you don't earn a lot, or suffer a long time, almost nothing.

          On health care: "nothing is settled until it's settled right"

          by Andiamo on Thu Jul 16, 2009 at 05:37:36 PM PDT

          [ Parent ]

        •  No limit on actual damages (0+ / 0-)

          The $250,000 limit in Texas, California, and other states that have passed malpractice reform is the limit for non-economic damages. There is NO LIMIT on actual economic damages. For people with severe injuries it can include life time care and income totaling millions of dollars. Suggesting that in Texas there is a cap in malpractice cases of $250,000 is not correct.

          "let's talk about that"

          by VClib on Thu Jul 16, 2009 at 06:57:40 PM PDT

          [ Parent ]

  •  The solution to medical malpractice awards (1+ / 0-)
    Recommended by:

    that seem excessive is single payer. Juries are confronted with fact sets which are horrible and have no way to guess what the lifetime medical expense will be. If they pick a number which is too small the plaintiff and the plaintiff's family gets it in the shorts.

    Consequently they sometimes guess very high. Take out the medical expense and then it is back to punitive damages.

  •  I am currently in the middle of a (6+ / 0-)

    medical malpractice suit.  And believe that it is VERY difficult to file a medical malpractice suit.. most especially if you are sick/healing and trying to deal with all of the ramifications of what you already suffered.  To put oneself out into an environment that is unfriendly at best and subject oneself to go back over all of the events that caused them to lose their health, etc.. is not something MOST people would do on a lark.  

    Thank you for this diary.. their is a lot of covering up that doctors, medical personnel, insurance companies and hospitals take part in when an "error" occurs with a patient.. and it is continual.  I'm just saying.. unless a person walks through this fire, they ought to judge only on statistics.. and not pretend they really have a clue what a person loses when their health/finances/lifestyle..etc is taken by a doctor's mistake.  

    Because our individual salvation depends on our collective salvation.. Barack Obama, 5-25-08

    by sherijr on Thu Jul 16, 2009 at 02:31:52 PM PDT

    •  Spelling.. should be 'there'. nt (0+ / 0-)

      Because our individual salvation depends on our collective salvation.. Barack Obama, 5-25-08

      by sherijr on Thu Jul 16, 2009 at 02:33:32 PM PDT

      [ Parent ]

    •  Thank you for your perspective (1+ / 0-)
      Recommended by:

      The victims like yourself need to speak out.

    •  As a doctor, it is ironic to me (2+ / 0-)
      Recommended by:
      Caelian, stitchmd

      that some of the most egregious errors go unchallenged and some of the more "minor" errors are litigated. I personally am against caps on damages as some cases are horrible and do not fit into the cookie cutter $250,000 limit. But there must be some kind of review that avoids so called "frivolous" cases.

      BTW, most doctors are told to keep quiet by their malpractice insurance carrier. And often, lawyers often name anyone (doctors, nurses, therapists) who was involved in the care of the injured, regardless of their proximity or involvement in the "error".

      •  and yet, (0+ / 0-)

        there is plenty of information out there that suggests that if docs are honest with their patients, they are less likely to get sued.

        What is it they say? Affability, ability, availability? The one of those that is least like to get you sued is not ability but affability. And sometimes the most affable providers may not be the most able ones. (Actually, anecdotally, it seems like ability and affability are inversely related...)

        What's the other thing they say? The top third of the class goes into academics, the middle third makes the best docs, the bottom third makes the most money...

        and what do you call the person who graduates at the bottom of the medical school class?


        (and, frankly, someone is always going to graduate at the bottom of the class. We just need to raise the bar for the bottom.)

        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 Thu Jul 16, 2009 at 04:02:21 PM PDT

        [ Parent ]

      •  $250,000 limit (0+ / 0-)

        Just to be clear, as I am sure you know never forget, the $250,000 limit in states such as California, are for non-economic damages. Economic damages, including  loss of income, and in severe cases, life time care, have no limit.

        "let's talk about that"

        by VClib on Thu Jul 16, 2009 at 06:53:22 PM PDT

        [ Parent ]

      •  Though I appreciate your comment very (0+ / 0-)

        much- your honest.. I don't think I was clear in my comment.  When I say the medical community covers up- I mean that even after a person survives the 'error'.. when they seek medical attention for the "results, consequences" of the doctor's error.. even then unrelated doctors will cover up for each other.  Now this could just be where I live.. North Dakota is very small population.. in fact it is just like a medium sized city for the entire state.  The doctor who nearly killed me - clearly out of neglect- and what we believe was FEAR of acknowledging her error.. basically left me to die.. I was air lifted to another town within the state and after the doctor there operated- he tried to cover for her.. I saw multiple specialists after I left the hospital a month later- for two years I saw specialists.. and all but THREE of them admitted that my health problems were of course linked to her error.  

        It is very hard to survive something catastrophic now matter how it occurs.. because of the medical, financial and emotional hardship one goes through for LONG after the doctor goes home and puts it behind him or her.. but what adds a tremendous weight to even that burden is to be treated as if you are stupid by the medical profession.. because they are now afraid of the consequences.  I live with those consequences.. and I did nothing wrong.

        Because our individual salvation depends on our collective salvation.. Barack Obama, 5-25-08

        by sherijr on Thu Jul 16, 2009 at 06:56:40 PM PDT

        [ Parent ]

        •  I'm sorry- typing not good tonight.. It should (0+ / 0-)

          say- All but three of them refused to admit.  There have been only three doctors in a long long list that stood by the facts and the truth rather than feel more sympathy for their fellow doctor, than they felt for the person who suffered at her hands.  Their is no comparison here- I lost my health, I lost my lifestyle, my employability.. I suffered brain damage- and she was indeed sorry- but that does not fix all the problems I am faced with for life.  Also.. my bills are in the thousands- luckily $200 thousand of it was covered by the state (Medicaid).  My point is - I could not have foreseen in a million years what I see now- it is amazing the domino effect this sort of thing has on the survivor's life.  There is no aspect that is not affected- and every member of the family is also adversely affected.  This sort of thing is so much LARGER than the 'caps'.. or whatever.  After 3 years I am tired of all that was done and is being done to me and to my family.  Sorry-

          Because our individual salvation depends on our collective salvation.. Barack Obama, 5-25-08

          by sherijr on Thu Jul 16, 2009 at 07:03:34 PM PDT

          [ Parent ]

  •  thanks - all empirical data shows the same thing (2+ / 0-)
    Recommended by:
    doinaheckuvanutjob, wondering if

     that malpractice suits are not now - and never have been - an impetus to higher costs.

      In fact - the recent study - given wide play here of McAllen Texas as one of the most expensive cities for health care revealed that there are no - zero - nada - zilch suits yet the costs are rising -

     some would say that now that doctors are completely free of any market discipline that the net result of so called tort reform is worsening situation - damaged patients - increased costs due to medical errors and a handful of negligent doctors driving us all to the poor house -

    but hey alot easier to scapegoat lawyers

  •  IIRC (2+ / 0-)
    Recommended by:
    Boxer7, Sunspots

    The major force driving increase in health care costs are insurance companies ROI to their stockholders. Not malpractice, defensive medicine or technology.

    •  Here's how I think it works with some providers (0+ / 0-)

      First the provider checks what your insurance will cover, and then orders those procedures.  Whoever orders the most procedures gets a bonus from the hospital.

      Big Joe Helton: "I pay Plenty."
      Chico Marx: "Well, then we're Plenty Tough."

      by Caelian on Thu Jul 16, 2009 at 03:14:55 PM PDT

      [ Parent ]

      •  In 20 years of practice, I've never received a (2+ / 0-)
        Recommended by:
        Caelian, stitchmd

        bonus for ordering tests or procedures. Maybe I'm just not in the "in crowd" but no one I know ever has.

        •  well, (1+ / 0-)
          Recommended by:
          never forget 2000

          can I first say, after years of being an employed doc, that I'm sick of corporate health care, yet I also recognize I can't survive as a primary care doc outside of it?

          And I could tell you stories that could chill your blood. Like the doc who never should have graduated residency, but who admits tons of patients to the hospital, and when the administrators were asked "which would you rather have, this doc with all the potential liability for lawsuits or the loss of the doc's revenues but lower potential liability" the hospital of course said they'd rather have the former.

          Or another doc whose spouse was a resident who threatened to pull out and take patients to another hospital if said spouse did not get a fellowhip position. Guess what? Spouse got the fellowship.

          It's been a big gobsmack to me in the past couple of years. I guess I should be happy that I was well into my 40s before I had to deal with the ugly reality of the current practice of medicine.

          But can I open my yarn shop now, please?

          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 Thu Jul 16, 2009 at 04:07:30 PM PDT

          [ Parent ]

    •  A study identified major trigger for malpractice (4+ / 0-)

      crises -- you know, when insurers and doctors start complaining about the rising costs of malpractice insurance, declaring a crisis, and demanding tort reform.

      Crises weren't caused by the number of bad doctors increasing.

      Crises weren't caused by lowered standards for licensing doctors, nurses, hospitals, or other professionals.

      Crises weren't caused by plaintiff lawyers getting greedier, or getting higher publicity awards, or anything else in the legal system.

      "Crises" -- and I use quotes to indicate disdain for a word not meaning what it's supposed to mean -- were caused by health insurers' other investments taking a beating.

      Healthy Minds & Bodies, discussing outdoor adventures Tuesdays 5 PM PDT

      by RLMiller on Thu Jul 16, 2009 at 03:21:31 PM PDT

      [ Parent ]

  •  I just want to point out (0+ / 0-)

    that there is more to this issue than this story addresses.  The medical malpractice insurance premiums that doctors pay- which is directly related to malpractice payout risk assessments- is a hugely significant part of a doctor's or hospital's budget.  The problem is exacerbated by the incredible variability that leads to unforeseeable and unmanageable costs associated with practicing medicine.  

    I also want to point out that there is a VERY important difference between medical errors and medical malpractice.  Medical errors are an unfortunate but inevitable occurrence that we in the medical profession have a responsibility to minimize to the greatest possible extent, and victims of these errors are entitled to fair compensation by settlement.  No one questions that.  Malpractice must involve reprehensible negligence or criminal intent that is, in reality, exceedingly rare.  Disproportionate compensation creates an incentive to pursue these awards in the absence of malpractice, to the detriment of everyone.  

    •  Bit if awards are "insignificant" (0+ / 0-)

      Then shouldn't the cost of medical malpractice insurance be likewise "insignificant"?  Unless somebody's playing games with the numbers.

      Big Joe Helton: "I pay Plenty."
      Chico Marx: "Well, then we're Plenty Tough."

      by Caelian on Thu Jul 16, 2009 at 03:10:30 PM PDT

      [ Parent ]

    •  all due respect disagree with a point you make (2+ / 0-)
      Recommended by:
      Sunspots, RLMiller

       where you say that premiums are "directly related to malpractice payout risk assessments"  - were that it were true

        Reality seems to suggest that premiums charged are unrelated - and are charged in the absence of sound actuarial standards.

      •  There is data (0+ / 0-)

        showing a positive correlation between litigation costs and insurance premiums.  You are correct that this does not account entirely for the variability- actuarial cycles play a role, as do availability and investment returns.

    •  The liability premiums are 0.58% of total medical (0+ / 0-)


      here are the figures..

      Table 6, from Figure 6: Medical Liability Costs and Medical Malpractice Costs
      as Percentage of Total Health Care Spending, 1997-2006

      Total National
      Health Care
      (in billions)

      Sum of Direct
      Written for
      Physicians and
      (in billions)

      Value of
      Made on
      Behalf of
      (in billions)

      Premiums as a
      Percentage of
      Overall Health
      Care Costs

      Payments as a
      Percentage of
      Overall Health
      Care Costs
      1997 $1,124.92 $5.95 $3.08 0.53% 0.27%
      1998 $1,190.06 $6.21 $3.06 0.52% 0.26%
      1999 $1,265.16 $6.19 $3.35 0.49% 0.27%
      2000 $1,353.19 $6.43 $3.80 0.48% 0.28%
      2001 $1,469.36 $7.61 $4.39 0.52% 0.30%
      2002 $1,602.28 $9.64 $4.11 0.60% 0.26%
      2003 $1,734.93 $11.21 $4.42 0.65% 0.25%
      2004 $1,854.84 $11.96 $4.27 0.64% 0.23%
      2005 $1,980.60 $12.19 $4.08 0.62% 0.21%
      2006 $2,112.67 $12.31 $3.86 0.58%0.18%
      Sources: National Practitioner Data Bank, National Association of Insurance
      Commissioners, Centers for Medicare and Medicaid Studies

      On health care: "nothing is settled until it's settled right"

      by Andiamo on Thu Jul 16, 2009 at 03:23:29 PM PDT

      [ Parent ]

      •  Two observations (0+ / 0-)

        According to those last two columns, premiums collected are 2-3X the amount paid out.  Unless that omits out-of-court settlements, that's a whopping good profit.

        Second, if premiums are less than 1% of costs, why is it an issue at all?  Why do you hear of people leaving their practices because malpractice insurance is too expensive?  Or is it that certain areas (e.g., obstetrics and brain surgery) do have way above average rates?

        Big Joe Helton: "I pay Plenty."
        Chico Marx: "Well, then we're Plenty Tough."

        by Caelian on Thu Jul 16, 2009 at 04:05:14 PM PDT

        [ Parent ]

        •  Awards in malpractice cases 0.0018 of total! (0+ / 0-)

          that's almost two tenths of one percent of money spent on medical costs!


          Premiums for malpractice insurance, though is more than one half of one percent!

          0.0058 of money spent on health care...

          On health care: "nothing is settled until it's settled right"

          by Andiamo on Thu Jul 16, 2009 at 04:56:05 PM PDT

          [ Parent ]

      •  total health care costs (1+ / 0-)
        Recommended by:

        takes in a huge range of issues. But I bet if you looked at the operating and take home revenues for the physicans, not the total healthcare costs, the proportion would be higher.

        Lies, damned lies, and statistics. Isn't that how it goes? Pick your numbers, anyone knows.

        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 Thu Jul 16, 2009 at 04:10:13 PM PDT

        [ Parent ]

        •  Yep (0+ / 0-)

          The problem is that the financial impact of malpractice premiums isn't evenly distributed throughout the healthcare fields. The impact is minimal for some parties and enormous for others. It brings to mind the old saw about the statistician with his head in the freezer and feet in the oven; his body was at a comfortable average temperature.

          I should also point out that using the size of jury awards to determine malpractice payment costs is misleading to the point of dishonesty. Jury awards can be, and usually are, reduced drastically (by factors of at least 10) by judges. This reduction is not the result of an appeal; it represents the fact that jury awards are merely suggestions and that in many cases legislation limits the maximum damages that a judge can award.

          There is nothing so practical as a good theory—Kurt Lewin

          by ebohlman on Thu Jul 16, 2009 at 06:11:50 PM PDT

          [ Parent ]

  •  Their argument is that mal practice has more (1+ / 0-)
    Recommended by:

    pernicious effects. ie that many more tests are ordered than necessary as a preemptive response to the risk of lawsuit.

    "80% of Republicans want Palin to lead the Republican Party and 100% of Democrats want her to lead the Republican Party." Bill Maher

    by Dave from Oregon on Thu Jul 16, 2009 at 03:09:30 PM PDT

    •  "Preventative Medicine" (0+ / 0-)

      Right -- does the report address how many additional tests and procedures are performed to prevent lawsuits?

      And does the report address how many drugs and procedures are discontinued because of a few rare lawsuits?

      Big Joe Helton: "I pay Plenty."
      Chico Marx: "Well, then we're Plenty Tough."

      by Caelian on Thu Jul 16, 2009 at 03:13:05 PM PDT

      [ Parent ]

      •  There have been studies done (0+ / 0-)

        to try to determine the exact costs associated with defensive medicine that would not exist in the absence of liability threat, but there is no consensus on modeling or on estimates.

        It certainly exists, but the contribution is unclear.

      •  Press release for the report- which DOES address (0+ / 0-)

        This is the press release:

        "July 2, 2009

        Medical Malpractice Payments Fall to Record Low, Public Citizen Study Shows

        Medical Malpractice Epidemic Persists Even as Compensation to Victims Decreases

        WASHINGTON, D.C. - Medical malpractice payments were at or near record lows in 2008, but the decline almost certainly indicates that a lower percentage of injured patients received compensation, not that health safety has improved, Public Citizen reported in a study released today.

        Medical malpractice is so common, and litigation over it so rare, that between three and seven Americans die from medical errors for every one who receives a payment for any malpractice claim, Public Citizen’s analysis of medical malpractice payment data and the best available patient safety estimates indicate.

        For the third straight year, 2008 saw the lowest number of medical malpractice payments since the federal government’s National Practitioner Data Bank began tracking such data in 1990. The 11,037 payments in 2008 were 30.7 percent lower than the average number of payments recorded by the NPDB in all previous years. Ratios of payments per capita and per physician have fallen even lower compared to historical norms. There were 13.5 payments per million physicians in 2006 (the most recent year for which the number of physicians is available), which is 29.2 percent lower than the average in previous years. The value of payments in 2008 (as distinct from the number of payments) was the lowest or second lowest on record, depending on the method used to adjust for inflation.

        The cost of the medical malpractice liability system - if measured broadly by adding all malpractice insurance premiums - fell to less than 0.6 percent of the $2.1 trillion in total national health care costs in 2006, the most recent year for which the necessary data to make such comparisons are available. The cost of actual malpractice payments fell to 0.18 percent - one-fifth of 1 percent - of all health care costs in 2006. Annual malpractice payments have subsequently fallen from $3.9 billion in 2006 to $3.6 billion in 2008, but comparative data on total health care costs are not available.

        "Any way you measure it, medical liability accounts for less than 1 percent of the country’s health care costs, and the vast majority of victims receive no compensation whatsoever," said David Arkush, director of Public Citizen’s Congress Watch division. "These are people who died or were left with serious permanent injuries - out of work, with enormous medical costs for the rest of their lives - and they and their families are getting nothing from the doctors and hospitals responsible."

        The relatively small amount paid out for medical malpractice generally goes to patients with the most serious injuries. More than 80 percent of the money paid out for medical malpractice in 2008 was for cases involving "significant permanent injuries"; "major permanent injuries"; injuries resulting in quadriplegia, brain damage or the need for permanent care; or death, according to NPDB reporting.

        Despite the hysteria surrounding debates over medical malpractice litigation, experts have repeatedly concluded that several times as many patients suffer avoidable injuries as those who sue. The best known such finding was included in the Institute of Medicine’s (IOM) seminal 1999 study, "To Err Is Human," which concluded that between 44,000 and 98,000 Americans die every year because of avoidable medical errors. Fewer than 15,000 people (including those with non-fatal outcomes) received compensation for medical malpractice that year, and in 2008, the number receiving compensation fell to just over 11,000.

        There is no evidence that errors are any less rampant today. Most of the IOM’s safety recommendations have been ignored. Meanwhile, various safety indicators continue to raise alarms. For example, the Joint Commission, which accredits hospitals, learned about 116 occasions in which surgeons operated on the wrong part of a patient’s body in 2008 and 71 times in which foreign objects were left inside patients’ bodies. Health experts call these "never events," meaning that they simply should not happen at all.

        Proposals to limit patients’ legal rights have sprung up in the debate over health reform. The most popular idea this year is to establish special tribunals that would theoretically offer payments to more patients but in smaller amounts. Policy makers who wish to cut costs should steer clear of these proposals, Arkush said. The high volume of medical errors and the current infrequency of payments to victims ensure that proposals to increase the number of payments would inevitably cost far more than the current system.

        The only economically feasible and, indeed, humane way to improve the system is to reduce the number of senseless and tragic medical errors in our hospitals. In its report, Public Citizen calls on Congress to put safety measures in place that would set the nation on course to meet the IOM’s goal of cutting the number of avoidable deaths in half in five years.

        READ the report."

        On health care: "nothing is settled until it's settled right"

        by Andiamo on Thu Jul 16, 2009 at 03:30:00 PM PDT

        [ Parent ]

        •  I read the report (0+ / 0-)

          and I maintain my objection.  It's conflating medical errors with medical malpractice, but it seems to be collecting its data from only litigation payouts and not settlements, though I'm not sure and I don't have the time to study it in detail.  It's selling the idea that not only are the payouts associated with negative outcomes not a significant problem, but that victims are basically being fleeced in the process.  If that's the case, then why does a neurosurgeon in NY have to pay $300,000 a year in malpractice premiums?  

          I certainly don't have all the answers, I just think the way this data is being presented is very misleading.  On the other side, I will certainly grant that malpractice reform is certainly no panacea for our medical cost problems.

  •  You want tort reform? (0+ / 0-)

    Then limit the amount of fees that the attorney can collect.  In some cases, the client can recover after fees and expenses less than the attorney.

    But limit the attorney fees to say 15% or 20% of the total and you won't have all of these cases....

    However, what do you do when your family member dies under the knife of a surgeon who has a drinking problem and/or a serious drug problem?

    We have a doctor in the Houston area who left operating instruments in his patients that would then get infected....  Hello?  This man's license should have been taken away 10 deaths ago.

    Also, remember, somebody graduates First in their class but there is also the doctor who graduated last but they are still a doctor.

    -6.13 -4.4 Where are you? Take the Test!!!

    by MarciaJ720 on Thu Jul 16, 2009 at 04:05:20 PM PDT

    •  Serious injuries predominate.. (0+ / 0-)

      Table 7, from Figure 7: Percentage of Payments by Injury Type Compared
      All Payments, 2004-2008
      Injury Type 2004 2005 2006 2007 2008
      Emotional Injury
       Only 1.35% 1.63% 1.86% 1.86% 1.30%
      Insignificant Injury 1.67% 1.57% 1.75% 1.57%
      Minor Temporary Injury 9.93% 9.22% 10.50% 8.99% 9.52%
      Major Temporary
       Injury 9.02% 9.65% 8.81% 9.09% 10.03%
      Minor Permanent Injury 12.17% 12.59% 12.36%
       12.10% 12.03%
      Significant Permanent Injury 15.71% 16.70% 15.06% 15.90% 15.51%
       Permanent Injury 10.43% 10.93% 11.26% 10.23% 10.91%
      Quadriplegic, Brain Damage,
       Lifelong Care 5.13% 4.88% 4.99% 6.24% 5.27%
      Death 32.92% 32.06% 31.90% 32.89%
      Cannot Be Determined from Available Records 1.66% 0.76% 1.53% 1.12% 0.92%
       National Practitioner Data Bank

      Table 8, from Figure 8: Total Value of Payments
       by Injury Type, 2004-2008
      Injury Type 2004 2005 2006 2007 2008
      Emotional Injury
       $14,573,000 $22,547,250 $24,549,800 $23,021,350 $12,359,250
      Insignificant Injury
       $12,263,550 $12,121,400 $8,835,550 $8,363,450 $8,377,300
      Minor Temporary
       $101,059,050 $104,682,750 $130,721,900 $100,298,650 $103,843,400
      Major Temporary
       $197,722,800 $212,387,000 $190,869,100 $196,338,300 $205,103,050
      Minor Permanent
       $267,060,050 $314,644,650 $296,556,050 $284,256,900 $276,511,250
       Injury $656,728,250 $780,065,000 $728,582,250 $684,939,250 $659,952,800
      Injury $636,639,750 $754,976,250 $685,471,800 $618,161,250 $645,842,500
      Damage, Lifelong
      $541,849,750 $507,998,500 $507,809,500 $588,318,800
      Death $1,164,001,850 $1,321,016,450 $1,221,904,350 $1,171,621,150
      Cannot Be
      Determined from
      Available Records
      $47,192,100 $45,408,300
       $60,461,600 $34,616,000 $20,930,500
      Source: National Practitioner Data Bank

       9, from Figure 9: Average
      (Mean) Payment by Type of
      Injury, 2008
      Injury Type
      Emotional Injury Only $86,428
      Insignificant Injury $43,860
      Minor Temporary
       Injury $98,804
      Major Temporary Injury $185,278
      Minor Permanent Injury $208,216
       Permanent Injury $385,486
      Major Permanent Injury $536,414
      Quadriplegic, Brain
      Lifelong Care
      Death $325,268
      Cannot Be Determined from
      Source: National Practitioner Data Bank

      Table 10, from Figure
       10: Median
      Payment by Type of Injury, 2008
      in 2008
       Injury Only $42,500
      Insignificant Injury $17,500
      Minor Temporary Injury $37,500
       Temporary Injury $97,500
      Minor Permanent Injury $115,000
      Significant Permanent
       Injury $245,000
      Major Permanent Injury $375,000
      Quadriplegic, Brain Damage,
      Death $205,000
      Source: National Practitioner Data Bank

      On health care: "nothing is settled until it's settled right"

      by Andiamo on Thu Jul 16, 2009 at 05:05:57 PM PDT

      [ Parent ]

  •  Stunning. I was off by an order of magnitude. (0+ / 0-)

    I have friends who are OBs, and they pay about $60K per year in malpractice premiums.  For run the mill OBs, this amount is significant compared to their salaries, which are not as high as for other specialties.  So I am stunned to learn that the average premium is only about $4K.  This is truly a drop in the bucket.

    Thanks for posting this info.

    Consumption is not the answer.

    by Lexpression on Thu Jul 16, 2009 at 04:39:55 PM PDT

    •  US infant mortality increasing rapidly- now 29th (0+ / 0-)

      Childbirth has historically been very dangerous.. In pre-modern times, I think that a woman had a one in three chance of dying in childbirth rather than living into old age.

      its much lower now, obviously, but thats an area where the US is lagging further and further behind many other countries.. because many people here can't afford doctors any more..

      "U.S. lags other rich nations in infant mortality

      WASHINGTON (Reuters) - Infant mortality in the United States remains higher than in many other industrialized countries, with progress stalling this decade, the U.S. government said on Wednesday.

      The United States ranked 29th lowest in the world in infant mortality in 2004, the latest year for which comparative global figures were available, the U.S. Centers for Disease Control and Prevention said in a report.

      This extends a worsening trend for the United States in global infant mortality rankings. The 2004 ranking compares to 27th in 2000, 23rd in 1990 and 12th in 1960, the CDC's National Center for Health Statistics said.

      "Infant mortality is one of the most important indicators of the health of a nation, as it is associated with a variety of factors such as maternal health, quality and access to medical care, socioeconomic conditions and public health practices," the report said."

      On health care: "nothing is settled until it's settled right"

      by Andiamo on Thu Jul 16, 2009 at 05:19:59 PM PDT

      [ Parent ]

      •  Careful (0+ / 0-)

        An increase in the rank for infant mortality doesn't automatically an increase in the rate of infant mortality. It's perfectly compatible with our infant mortality rate actually decreasing, but some other countries' rate decreasing more than ours. The situation is similar to "leading cause of death for (group)" lists; if, say, suicide goes from number 5 to number 3 of the leading causes of death for young people, it doesn't necessarily mean that more young people are committing suicide. It could mean that fewer of them are dying of AIDS or being killed by drunk drivers.

        Dealing with "compositional data" (statistics where everything necessarily has to add up to a fixed amount) isn't very intuitive and most people tend to get it wrong. In the case of causes of death, everybody has to die of something and even if the number of young people dying declines, 100% of a smaller number is still 100%.

        There is nothing so practical as a good theory—Kurt Lewin

        by ebohlman on Thu Jul 16, 2009 at 06:27:16 PM PDT

        [ Parent ]

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