We’ve posted four more letters from readers on our letters page. Topics this time include Nevada’s trial-lawyer-sponsored Question 5, which should alarm not only doctors but anyone who gets sued; the widely disseminated myth that patients suffer bedsores only when medical care is substandard; the risks of being a soldier; and DirecTV’s campaign against owners of hardware capable of intercepting its satellite signal.
Posts Tagged ‘medical’
Michigan malpractice
Striking numbers: “Despite statewide reforms designed to lower the cost of medical malpractice insurance, the most expensive annual premium for a general surgeon in Wayne County [Detroit] reached $194,000 for $1 million of coverage — a 60 percent increase over last year, according to a survey released last week by Medical Liability Monitor, a trade journal. A doctor in Grand Rapids would pay $63,000 for the same coverage.” Both are doing better than general surgeons in Dade County, Fla., where the comparable figure is $277,000. (Sheri Hall, “Malpractice rates drive off doctors”, Detroit News, Oct. 25). More: MichMedMal blog, Oct. 25.
Med-mal: new at Point of Law
Our sister website has published numerous posts this month on medical malpractice issues, including a modest proposal for doctors to make money by suing each other; certificates of merit, done right; what kind of insurance premiums one law prof doesn’t find shocking; more and yet more on anonymous medical experts; a Flash animation game on med-mal; in search of a few bad ob/gyns; and commentaries by Ted Frank and Jim Copland on Maryland’s crisis.
Criminalizing pain treatment
The New York Times has a short piece on how medical disputes over proper forms of pain treatment have effectively been criminalized by a phobic and overzealous DEA. Reason Magazine has a longer piece on the subject, and has been covering this topic for quite some time.
“We are unable to refer patients to doctors who will treat pain, if only because once a name gets out there, patients understandably flock, and then the doctor is targeted,” said Siobhan Reynolds of Pain Relief Network, a patient advocacy group based in New York. The Association of American Physicians and Surgeons, based in Tucson and dedicated to the concerns of private practitioners, has gone so far as to warn doctors against managing chronic pain, lest they face of years of harassment and legal fees, even prison. “If you do,” the association enjoins, “first discuss the risks with your family.”
Scattered evidence confirms these impressions. A 1998 survey of more than 1,300 physicians by the New York State Medical Society found that 60 percent were moderately or very concerned about the possibility of being investigated by regulatory authorities for prescribing opiates for noncancer pain.
A third said they prescribed lower quantities of pills and lower dosages “frequently” because of the possibility of eliciting an investigation. When asked how often they avoided prescribing a preferred drug for noncancer pain, because doing so required triplicate forms, half said “frequently.”
(Sally Satel, M.D., “Doctors Behind Bars: Treating Pain Is Now Risky Business”, New York Times, Oct. 19; Maia Szalavitz, “Dr. Feelscared”, Reason, Aug/Sep.; Jacob Sullum, “Pill Stoppers”, Reason Online, Aug. 20).
Update: Hollins v. Jordan
American Medical News has additional details on the Ohio cerebral palsy medical malpractice case of Hollins v. Jordan, which we covered Aug. 31. Interesting new and previously unreported details include: Hollins was an intrauterine growth-retarded baby, yet the plaintiff sought to blame his medical problems on a decision to hold a C-section in two hours instead of one; plaintiffs asked for triple the damages they had disclosed in an expert report; Geoffrey Fieger would regularly interrupt lawyers for the other side as if “to emulate TV trials in which lawyers can do and say whatever comes to mind.” Though Fieger wouldn’t talk to the American Medical News, the two lawyers gave an interview to an Illinois newspaper that seems to be unaware that the judge overturned the May verdict. (Tanya Albert, “Judge: Mega-verdict spawned by passion”, Oct. 11; Mark Samuels, “Difficult Questions: Who Should Pay And How Much?”, The Southern Illinoisan, Sep. 2; James F. McCarty, “Disabled boy gets $30 million”, Cleveland Plain Dealer, May 25). You may or may not be disturbed to learn that there is a Geoffrey Fieger fan club that was unhappy with the Ohio court’s decision, though don’t expect to find much in the way of reasoned analysis there. (Update, Nov. 20: verdict reinstated.)
In other cerebral palsy litigation news, the Wall Street Journal tells the tale of Brenda Stoltz. The lawyers she retained were excited about the prospect of a multi-million-dollar case involving future lifetime medical care of a brain-damaged baby, but when the child died shortly after, the attorneys dropped the case. (Rachel Zimmerman and Joseph T. Hallinan, “As Malpractice Caps Spread, Lawyers Turn Away Some Cases”, Oct. 8 ($), reprint; Grunt Doc blog, Oct. 8; Brad Parker, Galen’s Log blog, Oct. 8). The Journal article notes one side effect with non-economic damages caps; people without income–the elderly, the young, homemakers–who suffer wrongful death can be left without real recourse, though this is true for many types of untimely death.
U.K.: “Medics slam ‘money for referrals'”
Following a rules change this spring which for the first time allowed solicitors to share fees with third parties, law firms across England have begun offering money to doctors for the referral of injury cases. “Lawyers Higgins and Co, from Birkenhead in Wirral, has been offering GPs ?175 for every patient they refer to their firm. … The British Medical Association said it believed doctors being offered money for compensation referrals was ‘inappropriate and gives the appearance of a conflict of interest.'” One danger, for example, is that doctors in cases of unclear diagnosis will be given an incentive to diagnose a malady for which compensation can be sought rather than one for which there is no one to blame. “But the Law Society said there was nothing wrong with this practice, as long as all parties were aware that money had been exchanged.” (BBC, Aug. 27) (& letter to the editor, Jan. 17).
Medical education constricted
Symptoms of the medical liability crisis are less severe in North Carolina than in many other states; “Dr. Edward Halperin, vice dean of Duke’s medical school, said the issue is not cited as a major factor in Duke students’ decisions to pick a medical specialty,” which is not the case in some other parts of the country. “The malpractice issue has had a negative influence, however, in the kinds of learning opportunities medical schools offer. In years past, Halperin said, schools routinely let students do training stints at hospitals around the country. Now this practice is being curtailed, because medical schools are leery of carrying the liability for students working outside their hospitals.
“Such subtle problems seldom get mentioned in the debate, but Halperin said the effect is long term. ‘It’s inhibiting access to educational opportunities,’ he said.” (Sarah Avery, “Malpractice debate hides subtleties”, Raleigh News & Observer, Sept. 7) (via Common Good).
Pennsylvania malpractice roundup
The IssuesPA/Pew Poll has found that a remarkable 26 percent of Pennsylvanians polled “said rising malpractice insurance costs have forced their family to change doctors in the past year”, and that state residents polled also favored a constitutional cap on pain and suffering damages by a margin of 68 percent to 24 percent. (The state legislature has refused to allow such a measure to reach the ballot.)(doctor availability survey, Sept.; caps survey, Aug.). The Scranton Times Tribune, a newspaper heretofore known for skepticism about the extent of a malpractice crisis, now credits reports that the number of local doctors practicing in key specialties “has declined sharply in recent years” and that specialties with high legal risk are disproportionately affected (Jeff Sonderman, “Area losing its specialists”, Sept. 12). And in a Sept. 3 speech in Scranton, President Bush “cited the tale of Carbondale physician Neal Davis … Dr. Davis, a longtime family practitioner, stopped delivering patients’ children in January because he could no longer afford obstetrics insurance.” The result, said Bush, was that “then-expectant mother Mary Coar of Honesdale [was] out in the cold”; she wound up driving 50 miles each way to see different doctors. (Chris Burk, “Bush stresses liability reform by tale of Carbondale doctor”, Scranton Times Tribune, Sept. 4). More on Pa. malpractice: Jul. 16, May 20, Jan. 18, 2004; Sept. 12 and Jul. 23, 2003, etc.
Wrongful birth (cont’d)
Yorba Linda, Calif.: The basic fact pattern underlying this wrongful-birth suit will be familiar to longtime readers of this site (Aug. 22-23, 2001, Jul. 1, 2003, etc.): little Leilani Duff’s parents say they love her, but also say they’d have aborted her if they’d realized she was at risk of spina bifida, so they’re suing their obstetrician, Dr. William Dieterich, for unspecified damages. (Claire Luna, “If Only We’d Known, Parents Say”, Los Angeles Times, Sept. 9). The L.A. Times’s account includes the following comment about the incentives this burgeoning field of litigation may be sending to doctors practicing in the field:
The rise in wrongful-life suits and the threat of legal responsibility for a child’s defects puts obstetricians in the uncomfortable position of recommending, if not insisting on, abortion when there is the slightest doubt, said one physician.
“On one side you have a liability mess that puts you on the hook for the rest of the child’s life,” said Dr. T. Murphy Goodwin, chief of maternal-fetal medicine at USC’s Keck School of Medicine [and also, as the article notes, a member of the American Assn. of Pro-Life Obstetricians and Gynecologists].
“The other side, you have carte blanche to avoid the potential for these kinds of problems by shading the discussion to advocate abortion. There’s almost no adverse reaction if a doctor tells someone to terminate a pregnancy based on faulty information.”
Ritter family’s malpractice suit
The family of John Ritter has sued Burbank’s Providence St. Joseph Medical Center, charging failure to diagnose and treat the late comedian’s aortic dissection in timely fashion, and medblogger Galen reacts in a less than sympathetic manner (Sept. 9, strong language; “Ritter family files wrongful death lawsuit”, SignOnSanDiego, Sept. 9). KevinMD (Sept. 10), Sydney Smith (Sept. 10) and Chris Rangel (Sept. 11) also weigh in, and the latter adds thoughts about the hospital death of Bee Gees member Maurice Gibb.