Medical roundup

  • Med mal something of a regional problem: nearly half of payouts are in Northeast, with New York alone paying out more than the entire Midwest [New Jersey Civil Justice Institute on Diederich Healthcare analysis] “Neurosurgeons were 50% more likely to practice defensive medicine in high-risk states compared with low-risk states” [Smith et al., Neurosurgery via NJCJI]
  • New Paul Nolette book on state attorneys general Federalism On Trial includes history of suits led by New York’s Eliot Spitzer to redefine as “fraud” widely known drug-pricing practices that Congress had declined to ban or otherwise address. The resulting lucrative settlements also earmarked money to fund private critics of the pharmaceutical industry;
  • City of Chicago signs on to one of the trial bar’s big current recruitment campaigns, suits seeking recoupment of costs of dealing with prescription opioid abuse [Drug & Device Law; earlier here, here, here]
  • We here in Washington, D.C. take very seriously any violations of HIPAA, the health privacy law. Just kidding! If a union supporter pulls information from an employee medical database to help in an organizing drive, that might be overlooked [Jon Hyman on National Labor Relations Board administrative law judge decision in Rocky Mountain Eye Center]
  • “Preferred Care defendants respond to New Mexico Attorney General’s lawsuit, argue it was filed at urging of Cohen Milstein law firm” [Legal NewsLine]
  • Philadelphia police run warrant checks of hospital visitor lists, and as a result many persons with outstanding warrants avoid going to hospitals. So asserts sociologist Alice Goffman in her book On the Run, but the evidence is disputed [Sara Mayeux last August, Steven Lubet in review challenging the book more broadly on ethical and factual grounds, Goffman’s response]
  • Making contraceptive pill available over the counter without prescription should please supporters of birth control access, right? Funny you should ask [Elizabeth Nolan Brown, Reason, earlier]


  • Hi Walter, thanks for linking to my post. I should say I wouldn’t classify myself as disputing Goffman’s evidence on this point, per se. Rather, I found the book vague about what exactly its claim is about how pervasive/consistent this practice is and the mechanics of the practice, and thought it would have been helpful to have more specifics (and perhaps a hospital’s official line on the matter, even if just as a data point), both to be able to evaluate the claim and to address the practice.

    Interestingly, in Goffman’s response to Lubet, she seems to suggest that hospital staff themselves run visitor lists for warrants, in addition to the police doing so: “Many hospitals in Philadelphia require visitors to show ID at the registration desk and register as a visitor; some, like the Children’s Hospital of Pennsylvania, selectively run the names of these visitors in criminal databases.” If so, that seems like a separate and equally (perhaps more) troubling issue from police coming in to check warrants.

    In any event, in related news- I learned of the following article about policing in urban ERs that may also be of interest to you and/or readers:

  • “Med mal something of a regional problem”

    Actually, it becomes a national problem, possibly with serious second and third order consequences. Many of the most prominent teaching hospitals and medical schools are in the northeast. The providers in that area of the nation practice defensive medicine. Their practice standards are picked up by teaching hospitals and medical schools in that area of the country and are taught as the applicable standards of care in various specialties. Then those standards of care become the national standards, thereby ratcheting up the national standards to reflect the practice of defensive medicine. Individual and smaller providers and hospitals and clinics (and some medium and large ones) must then either raise their rates to increase revenues to cover the added costs (which is difficult when the government and insurers set rates for procedures), or limit their services so that they do not provide services subject to the new standards of care (which is usually easier). It is debatable whether the quality of care improves, since as individual and small providers either leave the practice, or go to work for larger hospitals or group practices, and small hospitals and clinics close, so that the availability of medical care is reduced, and increasingly is available only in larger towns and cities. Given the inconvenience, some will skip checkups and care which would have revealed conditions and illnesses when they were readily treatable (i.e., precancerous conditions and Stage 1 cancers), and await until those conditions and illnesses require significant treatment and may be terminal. In other instances, because the local provider or hospital has ceased providing care in a specialty, the patient must be transported to a larger facility. This results in a delay in treatment, which is especially worrisome for acute care situations.

    One of the justifications for torts arising from professional services is that it will force the professionals in that field to become better, and so the general public will benefit. Whether that is, in fact, true as to medical malpractice, is debatable, as second and third order effects appear to cross state lines and can have significant adverse impacts.

  • The data on defensive medicine because of rear of malpractice claims is very poor and it presupposes a stunning selfishness that I think is very rare in doctors.