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Post 20

Saturday, September 25, 2004 - 5:11pmSanction this postReply
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Andrew:

In order:

1. Cite me one case or one official source for your ridiculous statement that Edwards consulted with 40 or 50 doctors on ANY case. Hell, I'd even settle for one case where he consulted with 4 or 5 of a particular specialty before he got the desired opinion. Do you understand how much money he would have wasted solicitng those opinons on a weak case, likely a loser? Do you think he got rich by gambling on bad cases? Or getting recoveries in good ones? My guess is you cannot cite a single credible source. You have some gall making a claim like this and then criticizing ~my~ cited sources.

2. As I clarified, no other group receives this sort of blanket protection across the board. Show me one that does.

3. Read the discussion above about noneconomic damages. No one is misleading anyone, and I resent your suggestion that I am being misleading. And BTW, dont you think I, as a plaintiff's attorney, would LOVE to give juries information about how much other cases of a similar type got at trial? Listen, if you can convince the defense bar to go for it, I'm all for it. As if barring this type of information is the Plaintiff's idea...uh huh. Having the burden of proof, helping a jury to understand the value of the human losses if the hardest part of a plaintiff's lawyer's job.

4. Again, you slam my conclusions and method of arriving at them, but fail to refute mine, you ignore the cited GAO report which addresses this ~precise~ issue, and then come up with malpractice premium figures out of thin air. Who is being misleading here?

5. Malpractice lawsuits overall are not as costly as physicians and insurance companies would have you believe.

6. Again, try reading the article. Malpractice cases are down 14.1%. That means in 2002, there were 14.1% FEWER filings in med mal than in 1992. This borders on willful misrepresentation and evasion of the basics. How is anyone supposed to take you seriously?

It's clear you don't have time right now. In fact, you didn't seem to even have time to read the actual article. Your comments are welcome and appreciated. But please do not accuse me of dishonesty when your own post is rife with unsubstantiated supposition.

Post 21

Sunday, September 26, 2004 - 10:44amSanction this postReply
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Scott--

On my question, at least, you've given a fair reply and given me something to think about, so thanks for putting the effort into it.


Post 22

Sunday, September 26, 2004 - 1:31pmSanction this postReply
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Scott,

You have my admiration and respect for stating your case transparently and comprehensively. I do have two objections to the current state of things in liability law:

1. The idea that members of the jury should disregard their own professional knowledge seems wacko. If an "expert witness" says something that I know from my professional experience to be false, should I treat it as true? Especially when justice depends on what is true and what is false? Any professional epistemologist, or ethicist, or psychiatrist will tell you that the very idea is certifiably insane.

2. Preemptory challenges do not, as far as I know, have any grounding in a rational understanding of objective reality. Even if very few lawyers use preemptory challenges to exclude educated people from juries, justice is adversely affected in the specific cases tried by those lawyers. One of the changes I would require, in the conversion of our current legal system into a system of justice, is the elimination of preemptory challenges.

I thank you for your considered answers to previous questions, and I look forward to reading more.

Post 23

Sunday, September 26, 2004 - 4:51pmSanction this postReply
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Earlier I wrote: "In Los Angeles, where there are caps, an obstetrician pays about $65,000 per year in medical malpractice premiums. In Miami, Florida, where there are no caps, an
obstetrician pays about $250,000 per year.”

DeSalvo: But you provide no support for these contentions. First, I have twice cited
the fact that malpractice premiums in non-cap states are lower than in capped states, which would seem to cast some doubt on your position. Where do you get your geographic malpractice premium numbers from?
 
Those premium numbers are from the record of a Society of Actuaries session that took place about a year ago on the subject of medical malpractice insurance. It's on the web at:
http://library.soa.org/library-pdf/rsa03v29n3118ts.pdf  Florida very recently passed cap legislation, but the effect on premiums and claims are delayed.

I have not claimed that premiums in a state with caps are necessarily lower than in another
state w/o caps, so you try to attribute a position to me that I do not hold. I only gave the Los
Angeles-Miami numbers that favor that position and are contrary to the position you hold based on (I assume) national data. It is obvious that introducing caps (if low enough) in a given state will have some effect on subsequent claim costs, especially long-term. However, differences in premium rates in different places depend on many factors. You say premiums in non-cap states are lower than in capped states. So what? That does not imply that caps are ineffective or should not exist.

This is yet another case of your using statistics to make or suggest bogus inferences. You
compare apples and oranges." I will explain. Suppose there are two states X and Y. Neither has caps. In X claims and premiums are much higher in than in Y, so X legislates caps to "fight the crisis." Enough time passes such that the caps slightly reduce premiums and claims or slow their growth, but X with caps continues to have higher premiums than Y. That in no way proves that caps are ineffective. Indeed, I expect my example of X and Y by analogy explains the national situation, based on averages. States with high premiums impose caps; states with low premiums don't.

Another case is your saying that the number of medical malpractice cases fell 14.1% between 1992 and 2002. So what? That could be due to lots of things -- the effect of caps, medical providers practicing defensive medicine, doctors withdrawing from high-risk specialties, possibly more. Yet you seem to leap to the conclusion it is a conspiracy of insurers, and worse, accuse Andrew of willful misrepresentation and evasion.

You direct us to websites like that of the Illinois Assn of Trial Lawyers. This is clearly an
organization whose main purposes are to promote the self-serving interests of plaintiff-side
trial lawyers (often using govt as means) and demonize insurance companies. You direct us to the website of another organization whose purposes are to demonize insurance companies and advocate the use of govt force to harm them. It rationalizes itself with unsubtantiated
allegations, false assertions, and "junk science" statistics. This is like directing us to Arab-only websites for info on the Israeli-Palestinian conflict.

DeSalvo: You are correct that insurers are contractual providers with doctors– they can
negotiate whatever terms they desire. As a practical matter though, we both know this is not the case. Insurers are monstrous, monolithic entities who offer insurance ‘packages’–and you take them or leave them. I do not think doctors would buy a policy that did not afford them complete protection, but they might, if the policy were offered at a substantial discount. My personal feeling is that most doctors are ‘sleeping with the enemy’–it is the insurers who have sold doctors a bill of good about why premiums are going up, and doctors have bought it."
 
I doubt that what I say next will have any effect on Mr. DeSalvo, whose obvious vitriol for
insurance companies shows again -- they are "liars", "dishonest" (for which he gives no
evidence) and "monsters offering 'packages'", not a business that offers customers options and faces stiff competition and under extensive govt control. Ralph Nader would love him. However, other readers might come to a more objective evaluation of the matter. Insurers face price controls (they must get premium rates approved by states before implementing them and states often deny requested increases), the same for policy provisions, rollbacks (the state forcing insurers to reduce premiums), and they are forced to pay for poor risks they don't underwrite via state-run assigned risk pools. If others want to know if insurers have made profits in this market in the last 25 years, they can look here, especially the first graph on page 3:  http://tinyurl.com/5xw43

Milliman is a very highly regarded insurance consulting firm. I suspect that the variability of
loss experience by year shown by the graph is much aggravated by price controls and rates of
inflation, especially of medical costs. It's easy to see that medical malpractice insurance is generally a losing business. Recent years have been very bad. The largest company in that market withdrew recently because states denied it premium levels sufficient to cover expected claims and expenses. Insurance companies do not exit profitable markets.

If Mr. DeSalvo's sole point was that there should be no caps on non-economic damages in
malpractice suits, I'd agree  -- if there were no govt controls on an insurer putting dollar
limits on the same in their policies or pricing. However, he has also made numerous attempts to demonize insurance companies and doesn't demonize doctors or other medical providers.
It's far more plausible that medical providers want caps more and have more political pull than insurers. The former, not the latter, are the ones guilty of any malpractice . If insurers had
the right to put in their policies whatever dollar limits on damages they wish and could sell,
they'd have no need for govt-imposed caps. I am glad to see that DeSalvo approves of that right, if he truly means it. If a jury came to a judgment in excess of the policy limits, that would be the problem of the medical provider, not the insurer. Considering the larger picture, there
seems little reason for insurers wanting caps. DeSalvo and others want us to believe that
legislating caps simply adds to insurer profits. Not so. Caps invite competitive pressure that
push *premiums* lower, too. Also, states that have adopted caps at the same time have *forced* insurers to make big reductions in premium levels. I expect the insurers end up losing. But I can give one solid reason why they would want caps, one of self defense. They are *forced* to take on unacceptable risks as dictated by state governments via assigned risk pools.

DeSalvo says I misunderstand advice given juries re anyone’s insurance status -- they aren't
advised. Not being a lawyer, I don't know the rules. Regardless of what the legal rules are,
there is nothing to prevent jury members from assuming that the medical practitioner is fully
insured and an insurance company will have to pick up the tab for whatever damages the jury
decides. Ah, the "deep pocket theory."

DeSalvo: If they [insurers] know they must pay 20 or 30 million, is there an incentive for them to keep that money in their investments rather than to pay out quickly?

Yes, a very slight one these days, but there are disincentives, too. They may suffer fines or punitive damages for "bad faith" claims handling.

DeSalvo pleads his case for unlimited non-economic damages by pleading for sympathy for a girl seriously harmed by medical malpractice, paralyzed and unable to live a normal life. It's awful and she has my sympathy. But does that justify DeSalvo's apparent desire to give juries a legal blank check on the assets of an insurer? No; his vitriol and remedy are misdirected. His argument is as morally and logically flawed as that of a politician who wants to tax us in order to fund his favorite welfare schemes. He ends his plea: Can you so little understand humanity that you question that, while money is a blunt tool and poor substitute for a life ruined, it is all we can and ~must~ give to those who have been wrongfully robbed of that which we all take so much for granted?

We? Be honest; you mean insurers. And by what standard, by what code?  I did believe that this forum is for people who rejected the notions of unchosen duty, unearned guilt, and coerced altruism! My doubt begins.


Post 24

Monday, September 27, 2004 - 6:51amSanction this postReply
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Merlin:

First, your cite to malpractice premium amounts comes from an AMA spokeman's speech, which does not cite where he gets his numbers from. So, heck, its double hearsay. Worse than my research, even!

Second, if you read the entirety of the articles you cite, there is some disturbing (for you) information in there--like the loss ratio in the med mal insurance industry was ~higher in the early 1990's~ than it is now, and that the ratio is cyclical in the industry. I did some more digging based on the numbers in the report you cited and found "...that annual investment returns for the nation's 15 largest malpractice insurers dropped by an average of 1.6 percentage points from 2000 to 2002--enough to account for a 7.2 percent increase in premium rates, which corresponds to almost half of the 15 percent increase in rates estimated by the Centers for Medicare and Medicaid Services. (http://www.cbo.gov/showdoc.cfm?index=4968&sequence=0). These hurt your argument about a current tort crisis causing an increase in premiums.

Third, insurers and the AMA make claims that the number of medical malpractice cases are skyrocketing. The 14.1% figure debunks this myth, so citing it serves a purpose. If you are just going to ignore my cited materials and cite double hearsay yourself, you will do nothing to clarify these issues, and will only further obfuscate them.

But I end with this: None of your positions make legislative meddling in the legal system acceptable, even if you personally can accept the idea of a completely arbitrary number to award to injured people. You position is full of contradictions. You voice no criticism of the insurance industry's exemption from anti-trust laws, but lament other government regulation. You lament the 'arbitrary' damages awards of juries, but prefer a government-mandated ~arbitrary~ cap on those damages, to be imposed by a legislature who has no idea of particular harms in a particular case. Why are you and your kind so afraid of the jury system? Because your company isn't making enough profit? So you advocate more government involvement to keep insurance risk management mistakes from knocking a player out of the industry?

I am not going to respond to the rest of your post, because it is repetitious, and I think I made my position and reasons for them pretty clear previously. You seem to be accusing me of personal dishonesty, and I do not think you have supported that argument, either.
(Edited by Scott DeSalvo on 9/27, 8:28am)


Post 25

Monday, September 27, 2004 - 7:32pmSanction this postReply
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Scott,

 

You wrote: First, your cite to malpractice premium amounts comes from an AMA spokeman's speech, which does not cite where he gets his numbers from. So, heck, its double hearsay. Worse than my research, even!

 

Heresay evidence can be true or false. If you have evidence that the numbers are erroneous, then prove it. Here is another site which compares premiums in Los Angeles and Dade County, where Miami is: http://www.calphys.org/assets/applets/micra_savings_chart.pdf

The numbers in the two sources are very close.

 

I did not question the veracity of the premium data you gave, but assumed it was true and tried to interpret it rationally. If you believe I erred, then please explain how.

Second, if you read the entire articles you cite, there is some disturbing (for you) information in there--like the loss ratio in the med mal insurance industry was ~higher in the early 1990's~, which pretty much hurts your argument about a current crisis.

 

Wrong (disturbing for you). Look again. The graphs clearly show higher loss ratios in 2000-02 than 1991-93.

Third, insurers and the AMA make claims that the number of medical malpractice cases are skyrocketing. The 14.1% figure debunks this myth, so citing it serves a purpose. If you are just going to ignore my cited materials and cite double hearsay yourself, you will do nothing to clarify these issues, and will only further obfuscate them.

 

You again make assertions that are false and/or give no evidence. Also, looking at number of cases is very misleading, which you not surprisingly try to take full advantage of. The main statistic for an insurer setting premium levels is aggregate claims in dollars, or frequency times severity. Number of cases affects only the numerator of frequency. Also, like the Milliman article said, severity is the biggest problem

But I end with this: None of your positions make legislative meddling in the legal system acceptable, even if you personally can accept the idea of a completely arbitrary number to award to injured people. You position is full of contradictions. You like that the insurance industry is exempt from anti-trust, but lament the other state controls. You lament the 'arbitrary' damages awards of juries, but prefer a government-mandated ~arbitrary~ caps on those damages, to be imposed by a legislature who has no idea of particular harms in a particular case.

 

Are you trying to say the current system has no room for improvement? Since my previous post, I’ve looked at some web pages about MICRA, the medical practice reforms California enacted in 1975. Medical providers generally approve of the effects it has had. It doesn’t surprise me that trial lawyers are against MICRA-like legislation. I suggest readers interested in this issue do a Google search on MICRA and “malpractice”, read some of the hits, and come to their own conclusions about whether MICRA-like legislation is an improvement. It seems to have not limited awards of *economic damages* in the least. Again, caps are only about non-economic damages.

 

About “full of contradictions”, again you make unproven and even false allegations. I’d also appreciate your not assuming I’m in full agreement with the political ideas of what you regard as the prevailing mind of the insurance business. Yes, the insurance industry is exempt from anti-trust law because that is a federal govt matter, and regulation of the insurance business is a state govt matter. (That fits with Article X of the Bill of Rights.) Do you wish to impose anti-trust laws on the insurance industry? If so, I’d be very surprised to hear such a thing on this forum and I’d like to hear why.

 

I don’t prefer an arbitrary anything, but a govt’s court system as a practical matter needs rules about what people can do within it. That includes people on juries. There are many rules about what they can do or not do, including in deciding penalties and such. Caps on *non-economic* damages would merely be only one more such rule. Also, people serving on juries are temporarily *acting on behalf of govt*, so the idea that they should be allowed to decide *anything* they want re a defendant (not part of the govt) is in effect another form of arbitrary govt power.

 

As for legislated dollar caps on non-economic damages, I have no personal stake in the matter and the insurance industry is quite capable of adapting to caps or no caps as long as aggregate damage award amounts are fairly predictable and they don’t have their hands tied on pricing and policy provisions.

 

Why are you and your kind so afraid of the jury system? Because your company isn't making enough profit? So your insurance company pals want to get the government involved ~again~ to keep your risk management mistakes from knocking a player out of the industry?

 

Why the unwarranted personal attacks? I am not afraid of the jury system. I do not work for an insurance company and never did work for one that sold medical malpractice coverage. As for your remark about risk management mistakes, you give no evidence for it. I suspect you uncritically swallow the smear jobs and lies of those who want insurers persecuted by the govt, such as those who own the websites you have referred to.


I am not going to respond to the rest of your post, because it is repetitious, and I think I made my position and reasons for them pretty clear previously. You seem to be accusing me of personal dishonesty, and I do not think you have supported that argument, either.

 

Yes, I did repeat some, but not entirely in the rest. I repeated some because I thought it worthwhile to again expose your unfair demonizing of  some businessmen, the fallacies in your position and some of your arguments in support of it. The last includes misleading statistics and relying on misrepresentation by others. I have not accused you of personal dishonesty, but of what I just said. But I do accuse your fellow trial lawyers of dishonesty and using “junk math.”  I have provided strong support for that.

 

You have given your and trial lawyers’ side of the matter as if it was beyond question and a defense of insurers could not possibly have any merit.  Well, we sort of have a jury here comprised of our readers. I hope you will trust their decision to be a rational one when they decide against you on this matter.  :-)

 

As for your choosing to not respond to the rest of my post: Darn! I was looking forward to your reply to the Rand-like question I asked at the end of my last post. It seems your answer is Rand-like, too: “Blank out.”

 

Hmm, DeSalvo. One of the definitions I found for “salvo” in a dictionary was:

Something resembling a release or discharge of bombs or firearms, as: a. A sudden outburst, as of cheers or praise. b. A forceful verbal or written assault.

 

How fitting!


Post 26

Tuesday, September 28, 2004 - 9:29amSanction this postReply
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Let's be clear of something right now. I never personally attacked you, or, for example, made sport of your last name (as you did with mine). I have also been as honest as possible, barring mistakes or oversights, which are always a possibility. I think all of this is pretty clear, especially in my "Part 2" post, of which Adam complimented me for being absolutely transparent in my position and explanation. Having some feel for Adam based on his other SOLO contributions, I assume he meant that comment as a compliment--that I was being completely honest, and doing a decent job of explaining my position and why I held it.

There is literally nothing new to address in your post, other than its tone. Your position is still contradictory and circular, and without factual support. You still haven't addressed the core concept of the article--that it is inappropriate to infringe on the province of the jury to provide economic assistance to a private industry.

If you want a response to the end of your last post, how about this: Rand was against accepting unearned guilt. But personal responsibility means that you take responsibility for your actions, rather than lobbying Congress to change the law so that you can avoid personal responsibility. And, two wrongs don't make a right (more government involvement in a private industry is not a good thing).

Post 27

Wednesday, September 29, 2004 - 4:58amSanction this postReply
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I am not replying to Scott’s last post, but I have done some more Google searching about the medical malpractice controversy and wish to report on it.

 

It’s very clear that medical providers are the leading advocates of legislating caps on non-economic damage awards, i.e. for “pain and suffering”, in medical malpractice cases. That’s common sense; they clearly benefit from lower insurance premiums. Some lawyers advocate caps, too. See for example American Tort Reform Association, with website: http://www.atra.org/show/7827  

 

Scott asserts that insurance company lobbying is the driving force for imposing non-economic caps - for which he supplies no good evidence – but he doesn’t demonize doctors or the lawyers that support tort reform. When I searched the Internet for evidence of such lobbying, it was confined to the pages of personal injury trial lawyers. This tells me insurers are an easy scapegoat or red herring for them in the battle against legislated caps (and other tort reforms) that would affect the incomes of personal injury trial lawyers. They demonize insurers to divert attention from themselves. These trial lawyer groups usually do not demonize doctors per se, only occasionally the AMA or HMOs.

 

Experience has shown that caps have worked in reducing and/or slowing the rate of growth of medical malpractice premiums and aggregate dollar claims against insurers that sell the coverage. Los Angeles and Miami were both high rate locations in 1975. California passed MICRA; Florida didn’t. Now Los Angeles offers affordable rates and medical malpractice insurance is a competitive market. In contrast Miami has the highest rates in the country and insurance availability is poor. That’s pretty good evidence. Yet trial lawyers claim that caps don’t work when they do their lobbying and spew their propaganda using “junk math.” Also, if caps (and other reforms) do not work, i.e. they are ineffective or irrelevant, then why should the trial lawyers be against them?  This indicates the big contradiction in their double-speak.

 

I grant Scott’s point that a simple dollar amount cap on non-economic damages is arbitrary. Maybe caps would better be some percentage of the economic damages. Maybe the percentage should differ for different kinds of medical treatment and/or degree of negligence of the medical practitioner. Such specifics are well beyond my expertise. In any case, percentages would obviate his complaint about leaving juries with no discretion.

 

Trial lawyers lobby like crazy against legislated tort reform and make huge contributions to political candidates to promote their cause. We don’t hear Scott complaining about this. He doesn’t even mention it. Maybe he doesn’t know about it, but I find that hard to believe. The trial lawyers’ cause is clearly exploiting the current tort system for their own self-enrichment. See for example:

 

http://www.triallawyersinc.com/html/part01.html

http://www.triallawyersinc.com/html/part06.html

http://www.cfif.org/htdocs/freedomline/current/in_our_opinion/john_edwards.htm

http://www.nationalreview.com/comment/copland200407080820.asp

http://www.objectivistcenter.org/navigator/articles/nav+ehudgins_doctors-shrug.asp

 

I recommend members of this forum read these sources, and then decide how accurate is Scott’s portrayal of the truth about medical malpractice lawsuits. He contends that tort reform affecting medical malpractice suits is wrong because it is more government intervention. That’s true with respect to juries. However, such reform would result in *massively less* government intervention in the lives of the general public. The defense rests.


Post 28

Wednesday, September 29, 2004 - 8:17pmSanction this postReply
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The reason I oppose "Tort Reform" (i.e., diluting the jury system by arbitrarily limiting its power to protect one interest over another) is the same reason I do not support, for example, a "percentage of economic damages" cap, as Mr. Jetton suggests.

1. The average high school graduate can understand any well-presented evidence well enough to responsibly sit on any jury in any trial and give a fair verdict. Since the plaintiff has the burden of proof, any evidence, especially complicated evidence, that is not broken down well, and explained clearly and fully, cuts against the plaintiff, not the defendant, who has ~no duty under the law to prove anything.~

2. We entrust juries to interpret complicated contracts in lawsuits between businesses in which millions or billions of dollars hang in the balance; and in the criminal context, whether someone will spend the rest of their life in jail, or be executed. How many billions have changed hands, and how many men have wasted in jail or had their lives ended by the decision of these juries that we now so revile? All it has taken is the right anti-jury marketing campaign, and we are ready to give up a Constitutionally-mandated (Amendment VII) protection of freedom and fairness?

3. We have Appeals Courts who can review any decision of a jury and reverse it if it is excessive or incorrect--the word of the jury is hardly the last word.

4. Insurance companies and doctors are lobbying at the State and Federal level to substitute the blanket judgment of a legistor for that of a chosen (and accepted by ALL parties to suit) jury of 12 who has heard all the facts of a particular case; in other words, the people who know the most about the doctor's actions, and the harm it has caused, and have who have been extensively questioned about their ability to be fair.

4. If we do not support a system where personal responsibility is fostered by making negligent medical providers pay for the exact harm they caused, then the laws of economics mean that we are blunting the self-regulatory effect that losing a big lawsuit has; in effect, giving doctors and hospitals less of a reason to check, and double check, to make sure their treatment is of the highest quality. If we do not have a system that compensates people for what they have really lost, you risk a reversion to the rule of man, not of law. Isn't this really what a monied interest preventing a fair hearing based on the facts is all about? It's no different from a Baron asking the King's permission to seize a peasant's pig. Because the Baron is a Baron, he is given permission to take the pig, not because he is entitled to it as compensation, not because the law was applied to the facts and he is owed the pig, but because, as a Baron, he has the King's ear, and the King does favors for the Baron. What a transparent and tragic step backwards for this country and the world.

That's it, pretty simple. If you do not like the jury system, then why not do away with any measure of damages altogether, and we'll just give everyone injured by a doctor $5,000.00, even if they were crippled or killed, because this will protect doctors and insurance companies more effectively. After all, that should be the Justice System's main concern, right? Protecting private industry and wealthy doctors from the consequences of their mistakes? Protecting them against those rotten blue-collar people who went and died after surgery? How inconsiderate.

But be warned, if you choose the rule of man over the rule of law, be prepared for some people to take the law into their own hands. An aggrieved father may not take kindly to a doctor killing his son or crippling his little girl with no real recourse sitting down--there will likely be a reprisal in that doctor's future. I understand that in the Old West, doctors who didn't save the patient often ~did~ get shot.

Post 29

Wednesday, September 29, 2004 - 10:32pmSanction this postReply
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Since I am neither a doctor, lawyer or insurance professional, I dropped out of this thread as it grew into a tit for tat of statistics compiled from various industry studies and government reports.  I lack the time and energy to delve too deep into that sort of debate, and Merlin, by nature of his profession, was more qualified to speak on the pro tort reform side than myself.

Nonetheless, I feel I ought to offer a few comments at this point.

Scott writes:

If we do not support a system where personal responsibility is fostered by making negligent medical providers pay for the exact harm they caused, then the laws of economics mean that we are blunting the self-regulatory effect that losing a big lawsuit has; in effect, giving doctors and hospitals less of a reason to check, and double check, to make sure their treatment is of the highest quality.

You raise a good point here, and have gotten me to rethink some of my current biases and prejudices on the matter.  Nonetheless, I still have a hard time grappling with the subjective nature of non-economic damages.  If I was a victim of egregious malpractice and had to live the rest of my life in a catastrophically different state than I currently am in now, I could understand wanting some compensation beyond the mere medical expenses.  However, if a loved one of mine was killed or maimed, I would not feel right about cashing in on that for my 'pain and suffering'.  No amount of money would ever bring them back, and that money would just seem tainted to me.  It's a tricky issue.

Scott also earlier alluded to the fact that he expected many on this website would have an initial reaction to defend the insurance companies, as we 'correctly revere' capitalism.  This is true.  Furthermore, I would go so far as to suggest that there might also be a bias amongst many of the same people against plaintiff's lawyers, viewing them (right or wrong) as being 'looters' more than they are 'producers'. 

And I'll be the first to come out and admit it: this bias clouds my own view to a certain degree.  As I look inward to the source of it, I think it comes as a reaction to the victimization culture festering in our society, which is perhaps nowhere more apparent than in frivolous lawsuits.  Whether it's a $50+ million settlement from Denny's because some black guys got shitty service, or a plaintiff naming the NFL in a drunk driving suit because the perpetrator had been drinking at a football game, or one of the many perversions of the Americans with Disabilities Act, the examples are numerous and well known. 

Now obviously, not all lawsuits are frivolous, and most of the really bad ones (hopefully) get thrown out and never see the light of day.  Nonetheless, when we the public see the extremely bad cases, and the self-righteous manner in which the attorneys prosecute them in search of the big pay-out, it's understandable that we might be a bit suspicious of trial lawyer interest groups who oppose tort reform.

I just wish there was a better way to allow individuals to prosecute civil suits other than the contingency basis, but I can't think of any, so I'll shut up for now.


Post 30

Thursday, September 30, 2004 - 6:59amSanction this postReply
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Pete, I have a ton of respect for you. You are an honest and upstanding fellow. Sure, we disagree on some things, like tort reform, but we ~do~ agree that there is nothing wrong with considering changes that might positively impact justice. Obviously, I am not a 'celebrity lawyer'--I am in the trenches. I hate when these spectacular, ridiculous cases get so much play in the media. They represent a statistically insignificant percentage of everything going on in the system, but because it is what everyone sees, opinions get formed based upon them.

As for lawyers bringing frivolous suits--I can tell you that the time for that is passed. I talk to some old timers in the industry, and they speak with nostalgia about the 'good old days' of the 70's and even 80's, where almost everything settled without any investigation--even the bad injury cases. Then the pendulum had swung so far in favor of plaintiff's lawyers that insurance companies ~were~ giving away more money than was deserved, based on unscrupulous presentation by the plaintiff lawyers, and failure to investigate by the insuracne companies.

The pendulum has swung very much the other way now. We are at the point now where companies lowball people--offer them less than their medical bills, especially on the small cases, because they know the economics of the practice of law. If we are talking about a simple leg fracture with closed reduction, the medical bills may only be $5,000, but for blue-collar laborers, there will almost certainly be lost time from work for between 4 and 8 weeks. Insurance companies do not want to pay lost time. It can be a painful injury with alot of ongoing problems afterwards, and an almost certain early onset of oesteoarthritis. They are pretty hesitant about offering anything for this, either. It is a time of real scepticism in the industry, and in fact, it hurts the insurance companies, too, because with a 'zero offer' mentality, they are letting meritorious cases that could be settled cheaply go to trial at the risk of a much bigger verdict. And, they are paying a defense lawyer about $200/hour to defend the case on top of whatever the plaintiff wins. To some degree, some of these companies are cutting off their noses to spite their faces. Long story short, anecdotally, I can tell you that unless you are one of the very few privileged few, this is a tough job, alot of work, especially for guys like me that actually care about their clients. Maybe a few more years of practice will dull my compassion, but I doubt it.

Anyway, thank you for your insights and honesty.

Post 31

Friday, October 1, 2004 - 8:14amSanction this postReply
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Scott writes: The average high school graduate can understand any well-presented evidence well enough to responsibly sit on any jury in any trial and give a fair verdict.  . . . We entrust juries to interpret complicated contracts in lawsuits between businesses in which millions or billions of dollars hang in the balance.

 

The issue is about caps on non-economic damages. The jury’s right to award economic damages would remain fully intact.

 

[Are we] ready to give up a Constitutionally-mandated (Amendment VII) protection of freedom and fairness?

 

I have seen, and you have provided, no evidence of lobbying to repeal Amendment VII. If you can’t produce the evidence, then this is irrelevant.

 

We have Appeals Courts who can review any decision of a jury and reverse it if it is excessive or incorrect--the word of the jury is hardly the last word.

 

If appeals courts knock down awards for non-economic damages that juries award, isn’t that evidence of jury errors or extravagance?

 

But how likely is that appeals courts will knock down awards when courts have judges hand-picked and financially supported by trial lawyers, as in Trial Lawyers, Inc.?

 

http://www.ilcampaign.org/press/news/judicial/articles/2004/2004-7-12Courtelection.html

http://www.atra.org/

 

And these are only “the tip of the iceberg.”

 

Insurance companies and doctors are lobbying at the State and Federal level to substitute the blanket judgment of a legislator for that of a chosen (and accepted by ALL parties to suit) jury.

 

Trial lawyers lobby legislators and make huge campaign contributions to political candidates to support their side of the controversy.

 

If we do not have a system that compensates people for what they have really lost, you risk a reversion to the rule of man, not of law.

 

“Really lost” is fairly ascertainable for economic damages. It’s arbitrary for non-economic ones. If X has lost, that does not automatically mean some Y is responsible for compensating for X’s loss. Rule by men versus rule by law is hardly a black-and-white issue here. Men write and apply the laws; they pick judges who will interpret the law.

 

If we do not support a system where personal responsibility is fostered by making negligent medical providers pay for the exact harm they caused, then the laws of economics mean that we are blunting the self-regulatory effect that losing a big lawsuit has; in effect, giving doctors and hospitals less of a reason to check, and double check, to make sure their treatment is of the highest quality.

 

In my view we don’t have that now. Medical practitioners as a rule buy insurance. An effect is that the many practitioners who are not guilty of malpractice pay for the few ones who are guilty. Also, at least in some cases, with “victim-hood” and “junk science” having a role, they pay when the alleged negligence is absent or very questionable.

 

Doctors say much of this checking (defensive medicine) is unnecessary, costly, we all pay for it, and the money could be better spent on other medical care. They say the cost of medical malpractice insurance affects access to healthcare and adversely impacts the quality of that care. Hospitals, nursing homes and other healthcare facilities are being forced to close or reduce the range of services they can offer to the communities they serve.

 

Where is your proof that big lawsuits raise quality? Doctors maintain the opposite – they lower quality because “doctors shrug.” They leave or don’t enter high-risk specialties and go where they can get lower malpractice insurance premiums. See, for example:

http://www.fightingdocs.com/information_lincolnInstitute.htm   It’s simple economics, although the decision is likely based on gross income minus malpractice insurance cost.

(Pennsylvania doesn’t have caps, a state-run assigned risk pool, and Pennsylvania’s Supreme Court ruled that limiting attorney contingency fees recoverable in medical malpractice actions is unconstitutional.) It seems you consider only the *intended* consequences of lawsuits and not the unintended ones.

 

Maybe doctors could do more to weed their ranks of the guilty, at least repeat offenders not convicted on “junk science”. I know nothing about the factst. Have lawsuits contributed to weeding them?

 

Isn't this really what a monied interest preventing a fair hearing based on the facts is all about?

 

In part, yes, and one of those moneyed interests is Trial Lawyers, Inc.

 

That's it, pretty simple. If you do not like the jury system, then why not do away with any measure of damages altogether, and we'll just give everyone injured by a doctor $5,000.00, even if they were crippled or killed, because this will protect doctors and insurance companies more effectively. After all, that should be the Justice System's main concern, right? Protecting private industry and wealthy doctors from the consequences of their mistakes? Protecting them against those rotten blue-collar people who went and died after surgery? How inconsiderate.

 

This is absurd and sounds like demagoguery to support the special interests of Trial Lawyers, Inc. No one is advocating such a thing. The issue is non-economic damages.

 

But be warned, if you choose the rule of man over the rule of law, be prepared for some people to take the law into their own hands.

 

Sure, like Trial Lawyers, Inc.

 

In reply to Pete, you wrote:

 

Then the pendulum had swung so far in favor of plaintiff's lawyers that insurance companies ~were~ giving away more money than was deserved, based on unscrupulous presentation by the plaintiff lawyers

 

Thanks for once admitting that insurers have been victims with plaintiff lawyers the demons.

 

If we are talking about a simple leg fracture with closed reduction, the medical bills may only be $5,000, but for blue-collar laborers, there will almost certainly be lost time from work for between 4 and 8 weeks. Insurance companies do not want to pay lost time.

 

Is this a realistic malpractice case? Why would a non-economic cap of $0.5-$1 million be relevant here?  How about justifying some multi-million awards for “pain and suffering” that have been made and are a big part of the rapid rise in average amount of damage awards?

 
I’ve read several places that lost wages are economic damages, none saying they are non-economic damages. What about income from other sources like sick pay or workmen’s comp? In California a jury is required to hear about such collateral source payments. This allows defendants to argue that damages be limited to what the plaintiff actually paid out, if e.g. the plaintiff is covered by  health insurance. This reduces the severity of claims, helping to keep down the cost of health care for all. Notice of collateral source payments is typically included with tort reform that puts caps on non-economic damages. Hmm, I wonder why this is a part of it. Have trial lawyers conspired to make it inadmissible evidence? And why should insurance companies pay for lost wages if the plaintiff has other replacement income?

I close with a question. Would you defend the right of an insurer to sell medical malpractice coverage with limits on payments for *non-economic* damages? Ignore the side issues of whether or not state governments would permit it and the difficulty the insurer would have in selling such coverage to prospective buyers. This is a question of principle. I am confident the personal injury trial lawyers of Trial Lawyers, Inc. would try to take the law into their own hands and outlaw such provisions.

 


Post 32

Saturday, October 2, 2004 - 7:59amSanction this postReply
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Merlin, I have to tell you that I am dangerously-close to writing you off as just being evasive, since you are, again, sort of ignoring already-addressed points, But here we go again:

1. Damage caps infinge on a jury's decision, so it ~IS~ primarily an issue of whether we want a jury to perform its COnstitutionally-mandated function, or whether we arbitrarily want an uninformed legislator make jury-type decisions.

2. Have you seen the composition of uber-conservative members of the Supreme Court? Don't you think the insurance industry has had something to do with the politics of who gets appointed? You greatly, greatly misapprehend the power of plaintiff's lawyers.

3. The insurance industry lobbys legislators and makes huge campaign contributions to elected officials to try to get them to pass laws which INFRINGE ON A CONSTITUTIONAL RIGHT and defeat the purpose of an injury lawsuit (compensating the injured, not protecting a company or wrongdoer). Plaintiff lawyers exert what power they can to protect the right to a jury for the little guy, as well as big corporations (like insurance companies)--you'll note that insurance companies ~always~ want a jury when charged with illegal conduct or when sued by another company--the same right to a jury they want to deny to individuals.

4. Why is an arbitrary award of $5,000 any more absurd that a elgislated cap? Because the amount is lower? WEll, you seem convinced that all of these cases are frivolous, so better to pay 5k for the frivolous than the $250k, no? I used the $5k example to demonstrate how utterly indefensible it is to draw an arbitrary line for compensation when we have a perfetly effect means of doing so--trusting the senses and mind of man. You, evidently, find this to be absurd. Hmmmm.

5. The context of my response to Pete shifted to general injury work, so the leg fractrure example was just a simple, let's say, car accident, not necessarily medmal. But, show me ~any~ multimillion dollar award for a simple fracture case as described in any jurisdiction, at any time. Go ahead, find one of this 'omnipresent' frivolous suits. I dare you. Why I am I being so cocky? Because there are none. In favor of reason and evidence, the insurance industry relies on fear and supposition to try to beat down resistance to their un-American and unconstitutional perversions of justice.

6. Similar to your knowledge of whether juries are informed of insurance status, your suppositions about collateral source payments are so mistaken that they boot you not. And, unlike earlier, I dont feel like giving you a free lesson on how it works, because then you'll just come back and make another ridiculous assumption about another area of the law, and waste another hour of my time trying to straighten you out.

7. Insurers and their insureds can agree to whatever contracts they like. I do not know of a single PI lawyer who would be so bold as to try to interfere with a private contract betwween and insured and an insurer.

Post 33

Saturday, October 2, 2004 - 7:59amSanction this postReply
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Merlin, I have to tell you that I am dangerously-close to writing you off as just being evasive, since you are, again, sort of ignoring already-addressed points, But here we go again:

1. Damage caps infinge on a jury's decision, so it ~IS~ primarily an issue of whether we want a jury to perform its Constitutionally-mandated function, or whether we arbitrarily want an uninformed legislator to make jury-type decisions, with none of the facts to make the decision reasoned or rational.

2. Have you seen the composition of uber-conservative members of the Supreme Court? Don't you think the insurance industry has had something to do with the politics of who gets appointed? You greatly, greatly misapprehend the power of plaintiff's lawyers.

3. The insurance industry lobbys legislators and makes huge campaign contributions to elected officials to try to get them to pass laws which INFRINGE ON A CONSTITUTIONAL RIGHT and defeat the purpose of an injury lawsuit (compensating the injured, not protecting a company or wrongdoer). Plaintiff lawyers exert what power they can to protect the right to a jury for the little guy, as well as big corporations (like insurance companies)--you'll note that insurance companies ~always~ want a jury when charged with illegal conduct or when sued by another company--the same undiluted right to a jury they want to deny to individuals.

4. Why is an arbitrary award of $5,000 any more absurd that a legislated cap? Because the amount is lower? Well, you seem convinced that all of these cases are frivolous, so better to pay 5k for the frivolous than the $250k, no? I used the $5k example to demonstrate how utterly indefensible it is to draw an arbitrary line for compensation when we have a perfetly effective means of doing so--trusting the senses and mind of man--12 men, actually. You, evidently, find this to be absurd. Hmmmm.

5. The context of my response to Pete shifted to general injury work, so the leg fractrure example was just a simple, let's say, car accident, not necessarily medmal. But, show me ~any~ multimillion dollar award for a simple fracture case as described in that post, in any jurisdiction, at any time. Go ahead, find one of these 'omnipresent' frivolous suits. I dare you. Why I am I being so cocky? Because there are none. In favor of reason and evidence, the insurance industry relies on fear and unsupported supposition to try to beat down resistance to their un-American and unconstitutional perversions of justice.

6. Similar to your knowledge of whether juries are informed of insurance status (and how beyond-policy cases are (or aren't) paid), your suppositions about collateral source payments are so mistaken that they boot you not. And, unlike earlier, I dont feel like giving you a free lesson on how it works, because then you'll just come back and make another ridiculous assumption about another area of the law, and waste another hour of my time trying to straighten you out.

7. Insurers and their insureds can agree to whatever contracts they like. I do not know of a single PI lawyer who would be so bold as to try to interfere with a private contract betwween and insured and an insurer.

Post 34

Monday, October 4, 2004 - 4:51amSanction this postReply
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Scott wrote: Merlin, I have to tell you that I am dangerously-close to writing you off as just being evasive.

 

Now that is a great example of “the pot calling the kettle black.”

 

With one exception, I’m not going to reply to the rest of his post, which is repetitive and has little more than his usual evasion, obfuscation, and demonizing. I’m tired of it and don’t have time to continue it. I only hope that other readers have learned from my posts that there is far more to this controversy than the obviously narrow and biased one Scott has given.

 

The exception is collateral source rules. Per a source I found there are at least 5 states – GA, MD, NC, SC, and TX – that prohibit reduction of damages due to collateral source payments. In some other states they may or must be deducted, or there is a more complex rule.

 
He and I might agree on some topics, but one of them is not medical malpractice lawsuits. I do thank him for raising the topic. I probably would not have investigated it otherwise.


Post 35

Monday, October 11, 2004 - 5:48pmSanction this postReply
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          I apologize for my tardiness in responding to the Scott DeSalvo Post #20 on 9/25.  Being a forum neophyte, the entire second page of this thread managed to evade me until yesterday.  I’d like to note that my first post was responding to the Mr. DeSalvo’s article.  Despite being positioned below “Part 2,” it was actually written beforehand (11:00 vs. 11:32). 

 

1) Cite me one case or one official source for your ridiculous statement that Edwards consulted with 40 or 50 doctors on ANY case. Hell, I'd even settle for one case where he consulted with 4 or 5 of a particular specialty before he got the desired opinion . . . My guess is you cannot cite a single credible source. You have some gall making a claim like this and then criticizing ~my~ cited sources.

          In the 1/31/04 edition of The New York Times, two (non-conservative) faculty members of the Columbia University Graduate School of Journalism Adam Liptak, J.D. and Michael Moss (author of a series re: how poorly physicians read mammograms) wrote an article re: Edwards’ trial work: 

          “In building his career, Mr. Edwards…sifted through several dozen expert witnesses to find one who would attest to his claims”…“In 1985 he handled his first cerebral palsy case, for Jennifer Campbell…whose voice he recreated at trial. In his book ''Four Trials,'' Mr. Edwards described the case as an uphill battle. The doctor was esteemed and worked at a prestigious teaching hospital. Mr. Edwards's associate interviewed 41 obstetricians before finding one local doctor who would make a good witness.” 

          I remembered reading this article in January and, admittedly, don’t know where else to look for corroborative information.  I did, however, look up several other articles by these authors and saw no evidence of bias or other reasons to discredit their information.

 

2) As I clarified, no other group receives this sort of blanket protection across the board. Show me one that does.

          I was referring to your initial claim, which was incorrect, not to your clarification.  Nit-picking aside, your argument is clearly valid – that the procedure involved in suing one’s physician differs from other types of litigation.  I, personally, feel that uniqueness of the physician-patient relationship & medical setting, and the complexity of medical science warrant such procedural differences.   “Standard of care” is not necessarily a black & white issue.  This is only my opinion and is not an objective argument.

 

3) Read the discussion above about noneconomic damages. No one is misleading anyone, and I resent your suggestion that I am being misleading. And BTW, dont you think I, as a plaintiff's attorney, would LOVE to give juries information about how much other cases of a similar type got at trial? Listen,…


 

          In your original article you present the steps in which the prosecution tallys medical bills, lost future wages, and other future care-related expenses. Then you discuss the determination of guilt, followed by…  “Instead of allowing the twelve people with the most information and knowledge of the case (the jury) to fix a precise amount which is necessary to compensate the wrongfully injured person, the insurance industry is lobbying hard for caps on damages”…. “Caps only affect the cases in which a jury of twelve people heard all the facts of the case and decided the injury was so severe and life-altering and the misconduct so blatant that a patient injured by the errors of a health care provider should receive more than $250,000.”

          I felt that, despite all of the detail provided, the true nature of the caps being debated was not at all clear.  You did not once mention non-economic caps by name and did not describe them conceptually.  If one did not know anything about the debate at hand, your article would leave him/her with the impression that the total settlement would be capped.  Nobody argues against providing the economic damages you describe in detail, and I do not believe that any state caps economic damages.  Later on you go as far as to say, “The 2003 Weiss Report found that despite caps on economic damages in 19 states…”  The report, in reality, discusses non-economic damages.  There is no doubt that your article was misleading on this crucial point.  Whether or not it was intentional is not provable. 

          Regarding the second portion of #3, I don’t know which side would be favored were it permissible to present to the jury information regarding legal precedent and suggestions of methods to determine non-economic damages.  Your point that it may favor the prosecution seems very reasonable.  I offered that detail because a medical malpractice defense attorney expressed to me his frustration with the current gags on non-economic damage-related information.

 

 

4) Again, you slam my conclusions and method of arriving at them, but fail to refute mine, you ignore the cited GAO report which addresses this ~precise~ issue, and then come up with malpractice premium figures out of thin air. Who is being misleading here?

          I did not “slam your conclusions” on this issue, mislead, or concoct figures “out of thin air.”  I was clear in stating that certain anecdotal evidence leads me to hold off in my acceptance of your assertions/evidence re: physicians not actually leaving and causing regional shortages.  I also qualified that I did not personally see your cited articles.  And many statistics on this matter do, in fact, count a state’s ~licensed~ physicians as ~practicing~ physicians.  I don’t expect my anecdotal evidence (or testament to the neurosurgeon’s credibility) to change your mind, so here are data regarding average neurosurgery premiums as stated in the Chicago Tribune (3/12/2004): Illinois $228,396, Wisconsin $46,803, Indiana $70,472, Missouri $129,519, California $74,660.  F.Y.I., WI, IN, CA, and MO all have non-economic damage caps, although Missouri’s $565,000 cap currently has a loophole in which the cap may be applied more than one time per patient.  More premium stats from ISMIE (malpractice insurance provider):

OB/Gyn- Illinois 2000: $78,880; 2003: $139,696 (+77.1%)

OB-GYN- Wisconsin: 2000: $27,466; 2003: $30,304 (+10.3%)

Gen. Surgery- Illinois 2000: $52,364; 2003: $92,576 (+76.8%)

Gen. Surgery- Wisconsin 2000: $16,661; 2003: $19,641(+17.9%)

Int. Medicine- Illinois 2000: $19,604; 2003: $35,756 (+82.4%)

Int. Medicine- Wisconsin 2000: $5,993; 2003: $5,612 (-6.4%)

          Clearly, there have been very significant changes in Illinois malpractice premiums in the past 3 yrs.  The ramifications are still evolving, and there is certainly no evidence to suggest that existing regional shortages won’t exacerbate in the near future.  There are already areas in southern Illinois lacking 24 hour neurosurgical coverage.

 

5) Malpractice lawsuits overall are not as costly as physicians and insurance companies would have you believe.

          Perhaps not… I assume that you are referring to the <2% of total health care expenditures figure you quoted.  I agree that the overall healthcare savings to the country would probably not be as high as some insurance companies and physicians would have you believe.  However, I think that the “defensive medicine” argument is valid to a point, particularly with respect to the overuse of imaging and diagnostic studies.  I think that this is especially the case when the decision does not also include a financial incentive for the physician, one way or the other.  Behavior, unfortunately, may change less when such incentives do exist.  I would respond to your point, however, by saying that if one chooses to argue that the risk of litigation significantly influences physician behavior (as you do), he/she should also admit that the potential overall savings to the health care system would be, indeed, greater than the 2% figure.

 

6) Again, try reading the article.  Malpractice cases are down 14.1%.  That means in 2002, there were 14.1% FEWER filings in med mal than in 1992.  This borders on willful misrepresentation and evasion of the basics.  How is anyone supposed to take you seriously?

          The first article did not contain such a figure.  Okay, 14.1% fewer filings in 2002 than 1992.  The 70.4% increase in the median reward is a more telling statistic.  And as previously mentioned, the mean would be even more telling.  The Weiss report also uses the median rather than the mean. 

 

Here’s the link to the CBO article (http://www.cbo.gov/showdoc.cfm?index=4968&sequence=0).  Interesting points therein:

*“Evidence from the states indicates that premiums for malpractice insurance are lower when tort liability is restricted than they would be otherwise.”

*“A 2003 study that examined state data from 1993 to 2002 found that two restrictions--a cap on noneconomic damages and a ban on punitive damages--would together reduce premiums by more than one-third (all other things being equal).”

*“Payments of claims are the most significant costs that malpractice insurers face, accounting for about two-thirds of their total costs. The average payment for a malpractice claim has risen fairly steadily since 1986, from about $95,000 in that year to $320,000 in 2002. That increase represents an annual growth rate of nearly 8 percent--more than twice the general rate of inflation.”

*“malpractice insurers who buy reinsurance to protect themselves from large losses have seen that part of their underwriting costs rise significantly over the past decade. (Those increases are not related solely to medical malpractice but reflect a general tightening of the reinsurance market in the wake of such catastrophic events as Hurricane Andrew in 1992, the Northridge earthquake in 1994, and the terrorist attacks of September 11, 2001.)”

 


(Edited by andrew barkmeier on 10/14, 5:39am)

(Edited by andrew barkmeier on 10/14, 3:18pm)


Post 36

Tuesday, November 16, 2004 - 2:13pmSanction this postReply
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Andrew:

"The doctor was esteemed and worked at a prestigious teaching hospital. Mr. Edwards's associate interviewed 41 obstetricians before finding one local doctor who would make a good witness.” "

Interviewing doctors and choosing one who you believe is the best communicator before a jury is a heck of alot different that 'shopping' a case until you find an expert witness who will give you an opinion that a case is malpractice when the others have not. It is the latter, not the former, that I believed you were alluding to. Still, I find it pretty hard to believe his Associate spoke with more than a few doctors in any one specialty.

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Post 37

Monday, May 2, 2005 - 6:27amSanction this postReply
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And this, from the Washington Post, written by a neurosurgeon:

Washington Post
Sunday, April 24, 2005; Page B02

How Malpractice Suits Keep My Profession Honest
By Bernard Sussman

Most medical malpractice litigation is frivolous. That's what defense
attorneys, insurance companies and even the U.S. president would have
you believe. Some 80 percent of cases are, after all, resolved in favor
of the defendant doctor.

But little is made of the advantages that doctors take into a courtroom.
Physicians are apt to prevail in these cases because of their
professional culture of silence, which can make it difficult for injured
patients to secure reliable expert witnesses who will testify on their
behalf. Nor is there any acknowledgement of the countless people who are
unaware that injuries they have sustained in the hospital should rightly
be blamed on medical negligence or error. As a neurosurgeon with some 50
years of clinical experience, I can say from first-hand observation that
it's often not the patients' claims that are frivolous, but rather the
manner in which those claims are treated.

During the 36 years I spent as a professor at Howard University College
of Medicine, I witnessed and testified in instances of medical
malpractice that should give even the most forgiving patient pause:
There were failures to locate a tumor simply because the surgeon
operated on the wrong side of the head; and there were patients rendered
mute or otherwise disabled because tissue was removed from inappropriate
areas of the brain. In cases like these, the medical experts who
testified on behalf of the patients risked being ostracized or suspended
by their professional organizations. I know, from personal experience.

Even in the most egregious cases of medical negligence, those few
physicians who argue against their colleagues are often denied
opportunities to present or publish their scientific papers. That's just
what happened to me. In 1980, I was invited to present a paper at a
professional meeting in California. Two other members of the panel took
exception to my presence because I was known as a plaintiff's witness,
and I subsequently received a letter withdrawing the invitation to
present my paper.

Little did I realize what I was getting into in the late '60s when I
volunteered to testify on behalf of a young black man who had been shot
through the mouth and then denied admission to a primarily white
hospital. We lost that civil rights era case, but it gave me a
reputation -- for being willing to stand up to members of my own
profession.

I remember a Detroit neurosurgeon calling me in desperation to ask what
to do after he had testified against a surgeon who had operated on the
wrong side of a patient's head. The Detroit doctor worried that he was
being needlessly scrutinized by the American Association of Neurological
Surgeons. It reminded me of a case in which I had been an expert witness
here in Washington that led to complaints from the professor who had
performed the surgery and unrelenting nit-picking from the association.
My advice to the Detroit doctor? Resign from the association. That's
what I did.

The vast majority of the cases in which I have taken part have been
settled out of court. In cases that do get to court, medical experts who
testify for plaintiffs have sometimes been countersued by defendant
doctors claiming defamation of character. And there have even been
situations in which the defendant doctor has countersued the injured
patient in order to force a withdrawal of the complaint.

These closings of the professional ranks continue to be common practice
because the medical profession -- not just neurosurgery -- has no set
standards of practice. With no standards for medical behavior, no one
can be faulted, and doctors have a free hand in what they choose to do
or not to do. That's why one neurosurgeon could argue in his own defense
that he had operated on the wrong side of the brain because the
technician had hung the X-ray backward. My argument was that his excuse
was no excuse; indeed, that the surgeon's actions were absolutely
inexcusable. But it still amazes me, living as we do in a society with
governing standards for almost everything imaginable, that the human
endeavor that affects us the most seriously goes more or less
unregulated.

After years of encountering medical tragedies of this sort and
representing patients in court in more than 75 cases, I believe in
putting the blame where it properly lies -- not just on individual
doctors but on the profession as a whole for failing to come up with and
adhere to proper professional standards.

Instead though, as injured patients continue to seek remedies in the
courts, they are scoffed at by defense attorneys alternately charging
that their claims are "frivolous" and that any awards they might come by
for noneconomic damage need strict "capping." That is the kind of
thinking that has prompted President Bush and his allies in Congress to
embark upon their campaign to limit malpractice litigation.

In any civil lawsuit, the jury's decision often comes down to the number
and the credibility of each side's expert witnesses. Jurors weigh their
credentials, experience and demeanor. In some malpractice cases the
plaintiff's charge cannot be sustained because he or she cannot even
recruit a doctor who will counter the defense expert's testimony even if
all it amounts to is a farcical recitation of unverifiable
pseudoscientific assertions.

Whom then might a jury believe? Certainly not the minimally supported
plaintiff. Instead, the jury is led down the garden path by a
conjuration of medical fictions. There are deserving lawsuits that can't
even be filed because the odds are stacked so high against obtaining
solidly corroborative expert opinions.

The medical community also succeeds in projecting a pervasive sense of
invulnerability. Just being a physician carries with it a certain aura
of self-confidence and knowledgeableness.

Even if certain ostensibly caring physicians know full well that they
are the direct and only cause of some medical tragedy, they are unlikely
to let their patients in on that fact. By closing ranks, the medical
community has shielded itself from the effects of meritorious
litigation.

I have a long view of what has sometimes happened in America's operating
rooms -- and gone unpunished by America's courts: Blood vessels of the
brain that should be considered inoperable are nevertheless tackled
surgically with serious consequences. Other blood vessels that have bled
and require immediate surgery go untreated until they bleed a second
time, sometimes with fatal results. Doctors prescribe drugs haphazardly.

It wouldn't be hard to devise a set of standards for practice in my own
specialty -- insisting, for example, that a patient even briefly
unconscious from a blow to the head be observed for at least 24 hours in
a hospital; requiring that patients be told that for certain kinds of
tumors radiation therapy offers as much chance of benefit as surgery but
that an operation carries a greater risk of brain injury; monitoring
elderly patients who are found to have a benign tumor of the brain
rather than operating on them. These would be useful standards to adopt.

I know my critics will say this is just old-fashioned cookbook medicine.
I know they will point to some of the great achievements of modern
neurosurgery and to the lives that are being saved. But as injured
patients continue to seek remedies in America's courtrooms, I know that
many of these men and women do not deserve to be scoffed at by defense
attorneys charging that their claims are trifling.

Author's e-mail : bjsuss@aol.com

Post 38

Wednesday, July 13, 2005 - 9:14amSanction this postReply
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And, here is some more grist for the mill:

From Marketwatch.com

U.S. health costs highest; malpractice no factor: study
By Kristen Gerencher, MarketWatch
Last Update: 7:18 PM ET Jul 12, 2005

SAN FRANCISCO (MarketWatch) -- Americans pay more for health care per person than citizens anywhere else in the world, doling out half again as much in medical expenses each year as the second-highest-cost country, according to a new study.

And contrary to popular belief and political rhetoric, malpractice lawsuits have little impact on those high costs in this country. Nor does the fact that people elsewhere end up on waiting lists for care that is in short supply do anything to hold costs down, according to the study published in the July/August edition of Health Affairs.

U.S. citizens paid $5,267 per person for health care in 2002, the study found, 53% more than any other industrialized country and $1,821 more than Switzerland, the nation with the second highest per-capita spending.

"What we said three years ago and still reiterate is, it's prices, stupid," said Dr. Gerard Anderson, lead author of the report and a professor at the Johns Hopkins Bloomberg School of Public Health.

"We pay for drugs, hospital stays and doctor visits 2 to 2 1/2 times as much as other countries pay."

While medical malpractice is a problem, its costs account for less than 1% of spending. And defensive medicine, where doctors run tests or do procedures to lower their chances of being sued, makes up no more than 9% of total spending, the study of spending in 30 nations found.

"The finding that litigation and waiting lists do not explain most of the higher U.S. health spending is perhaps not surprising considering previous research showing that the prices of care, not the amount of care delivered, are the primary difference between the United States and other countries," the authors wrote.

In 2001, the average malpractice award in the U.S. was $265,100. That was lower than Canada's $309,417 and the United Kingdom's $411,171 but higher than Australia's average payment per settlement or judgment of $97,014. All four nations had malpractice payments that represented less than 0.5% of total health spending.

But Canada, Australia and the U.K. are getting more litigious, and at a faster rate, Anderson said. Australia's average annual total malpractice payments from 1997 to 2001 increased by 28%, Canada's grew 20% and the U.K. rose 10% compared with a 5% increase for the U.S, the study said.

The presence of waiting lists for medical services didn't appear to account for much of the difference in spending either.

Spending in 12 countries with waiting lists for elective surgery was $2,366 per person compared with $2,696 per person in seven nations, not including the U.S., that said they didn't have substantial waits -

Medical services that require waiting lists comprise only 3% of U.S. health spending.

Drug costs and hospital stays

Americans also pay twice as much for prescription drugs than other countries that benefit from collective bargaining, Anderson said.

"They have a more uniform approach where all the insurers or all the purchasers of care get together and negotiate with the hospitals, with the pharmaceutical industry or the physicians," he said. "They have one block that's the negotiator whereas in the U.S. every insurance company is negotiating individually. It's not as powerful a negotiation."

Despite a widespread belief that Americans make frequent use of some of the best medical care in the world, they see doctors less often and spend 20% fewer days in the hospital than most other countries, Anderson said.

Americans checked in for 4.8 hospital days on average in 2003, down from 5 days in 1999 and 7.3 days in 1980, according to the Centers for Disease Control and Prevention.

"Our whole policy focus for the past 10, 15 years has been trying to reduce encounters, especially hospitalizations," Anderson said. "Why we're still focused as a country on reducing hospital days makes no sense to me."

Doctors' economic expectations after attending medical school also are vastly different in the U.S. compared with other nations because they begin their careers with a much bigger financial burden.

"In virtually no other country do you leave with an average $100,000 of debt," Anderson said. "In most other countries the debt a medical student has is either zero or very small."

"It's both a real difference and a perceived difference," he said. "A doctor feels like he or she is entitled to a very high salary because of this debt, but the reality is doctors make anywhere from $150,000 to $200,000 on average.... In no other country do they make more than $100,000."

Economic impact

Most industrialized countries saw their health spending increase more quickly than their total economic activity. Health spending rose to 14.6% of gross domestic product in the U.S. in 2002 from 13% in 1992 even as analysts credited managed care and cost sharing with holding it down, according to the study.

The gain of 1.6 percentage points was twice the median increase of other developed nations during that time.

Only two other countries spent more than 10% of their GDP on health care in 2002: Switzerland spent 11.2% and Germany spent 10.9% on medical expenditures.

Post 39

Wednesday, July 13, 2005 - 2:00pmSanction this postReply
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And if you fasctor in the subsidies, I daresay the numbers change...

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