Overlawyered: Chronicling The High Cost Of Our Legal System

Posts Tagged ‘obstetric’

One less Illinois doctor

“Dr. Eileen Murphy has been delivering babies for 18 years, including Governor [Rod] Blagojevich’s daughter, Anne. But on April 30 she’ll see her last patient. She just can’t afford to do it anymore. … The problem’s not her $170,000 a year salary. It’s her insurance premium which jumped to $138,000 this year. Without insurance she can’t get hospital privileges. ‘If anything goes wrong, even if it’s a possible complication, a possible natural outcome, you can almost guarantee that you are going to be sued,’ Murphy said.” (“Doctors Protest Malpractice Rates”, CBS 2 Chicago, Mar. 24). Murphy plans to become a junior high school teacher instead, according to news reports. “I am going on strike for tort reform,” she wrote in a letter to her patients. More: Spoons Experience, Capitol Grilling bulletin board. Even more: Chicago Tribune on state’s crisis (“The doctors are leaving”, Apr. 18) (editorial); Maureen Martin, Heartland Institute, Mar. 26; Patrick J. Powers, “Doctor laments loss of friends to other states”, Belleville News-Democrat, Jan. 14.

The Hartford Courant on Apr. 4 (reg) ran a guest commentary by an attorney named Henry Kopel (“My Colleagues Are Wrecking Health Care”) who is married to an obstetrician/gynecologist and who begins his column: “I am an attorney, and I am ashamed of what my profession is doing to health care in America.” (reprinted: Connecticut College of Emergency Physicians). And here are a couple more medical-liability sites we haven’t previously noted: Doctors for Medical Liability Reform (various physician specialty groups), Protect Access to Care & Treatment (American Academy of Orthopedic Surgeons).

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Senate nixes OB relief

State medical societies have expressed considerable ambivalence about proposals to proceed specialty by specialty on malpractice reform, starting with the hardest-hit areas such as obstetrics and emergency medicine, fearing that such measures might serve to divide the profession and allow politicians to say that they had “done something” after addressing only the most obvious crisis areas (“AMA vows united voice in battle for tort reform”, American Medical News, Jan. 5). At any rate, it seems the choice of such a compromise won’t be available at the federal level, since opponents have no seeming interest in it. This week the Senate’s Republican leadership brought back malpractice reform in a pared-down version intended just to address obstetric litigation, but no go: the 48-45 vote was pretty much the same as that by which omnibus reform had failed, falling far short of the 60 needed to overcome an expected filibuster by Democrats.

The Associated Press report on the vote (Jesse Holland, AP/DailyNews.com, Feb. 25) reported that “some conservatives” opposed the bill, but the conservative it quoted turned out to be Ken Connor, former head of the religious-right Family Research Council. What AP didn’t add is that Connor is not exactly your typical conservative, having made his fortune in Florida as a plaintiff’s lawyer suing nursing homes and having served as a tenacious legislative advocate for the interests of the trial bar before his stint at FRC (see Mar. 2-4, 2001).

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“In Trial Work, Edwards Left a Trademark”

Good New York Times page-one article investigating the Senator’s legal work, and in particular his big-ticket lawsuits over cerebral palsy. (Adam Liptak and Michael Moss, Jan. 31). See our earlier coverage Jan. 20 and Jan. 26. Alex Tabarrok, Sydney Smith, Charlotte Hays and Wayne Eastman comment.

Meanwhile, a theme has developed among several lawyer and law-professor bloggers that Edwards should not be held up to reproach even if it turns out that he employed dubious expert testimony to extract fortunes from innocent obstetricians, on the grounds that a trial lawyer is just doing his job when he seeks to introduce all admissible evidence on behalf of his client; in fact, he may even be obliged to do so as an ethical matter of “zealous advocacy”. (It should be stressed that Edwards strongly disputes the idea that his cases were in any way scientifically dubious.) We ourselves aren’t buying this line of reasoning, but it has some articulate advocates, including Peter Nordberg (who also defends Edwards here, while acknowledging that some details in the new Times piece “may supply grist for Edwards’ critics”), Franco Castalone, and David Bernstein. For our views of what constitutes proper “zeal” on lawyers’ part, see Jul. 17.

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Edwards’ persuasive powers

Having long taken an interest in the career of North Carolina Sen. John Edwards (see Sept. 16, Aug. 27 (talk about bad predictions!), Aug. 5, earlier posts), we are not entirely surprised that the silver-tongued trial lawyer/politician did so well among Iowa Democrats, not to mention charming such commentators as Mickey Kaus (scroll to second “P.P.S.” item) and Andrew Sullivan (second item). As we’ve had occasion to note, before entering politics Sen. Edwards had some of his greatest success representing families of kids with cerebral palsy against the doctors who’d allegedly botched their deliveries — this despite a steadily mounting pile of research (see Feb. 27, 2003) tending to refute the popular theory that cerebral palsy is commonly caused by obstetricians’ conduct during labor and delivery. Last March, in a letter to the editor printed at this site, Mississippi physician S.W. Bondurant wondered whether the press would look into the question of whether Edwards’s trial wins were based on sound science. Now reporter Marc Morano of the conservative CNSNews.com takes on that assignment (“Did ‘Junk Science’ Make John Edwards Rich?”, CNSNews.com, Jan. 20). Just to clarify my own views, which are quoted at some length: I don’t assert that every lawsuit blaming obstetricians for infant brain damage is unfounded. The problem is that our system gives wide leeway for cases of debatable scientific merit to be filed and then, after a battle of the hired experts, decided by appeals to jury emotion. (& welcome visitors from sites including Kaus (Jan. 20), Sullivan, MedPundit, Rangel M.D., Blog 702, MedRants, and many others)

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Med-mal roundup

Lack of malpractice insurance is threatening to close the only obstetrics practice in Virginia’s rural and economically depressed Northern Neck region. The closure of Rappahannock General Hospital’s OB unit, which delivers about 250 babies a year, would be “absolutely devastating” to community health, says Albert C. Pollard Jr., who represents the region in the Virginia House of Delegates: “we’d lose a lot of babies if somebody has to drive to Richmond or Newport News.” (Frank Delano, “Crisis presses OB docs”, Fredericksburg (Va.) Free Lance-Star, Dec. 21). “While the governor and Legislature dither over fixing the state’s medical malpractice system, the [Philadelphia] region’s doctors have been voting with their feet,” reports the Philadelphia Daily News. “And they are choosing states that cap damages in malpractice lawsuits — or have other strong reforms to keep malpractice insurance premiums low.” (Michael Hinkelman, “Pa. docs are moving to ‘cap’ states”, Philadelphia Daily News, Dec. 8). Hard numbers on malpractice payouts are often in short supply, but the Missouri state department of insurance has some: it says insurance companies operating in the state “reported paying $135 million to cover 524 claims closed last year”. Self-insured entities, mostly hospitals, “reported paying $6.6 million to close 42 claims, but the actual number of claims and the amount paid may be understated in the data, department spokesman Randy McConnell said. … The average malpractice claim takes more than four years to reach resolution, so the 2002 claims data capture injuries sustained over a period of years. Only 15 of the 566 claims went to a court verdict.” Most of the paid cases involved claims that medical misadventure led to permanent injury or death. (Judith Vandewater, “566 medical malpractice claims were settled in Missouri in 2002”, St. Louis Post-Dispatch, Dec. 4). The American Medical Association rates Missouri a “crisis” state. (M. Steele Brown, “Malpractice ‘crisis’ drives docs from Missouri”, Kansas City Business Journal, May 5).

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Disappearing Australians

Lifeguards: “One of Victoria’s most popular surf beaches may be unpatrolled this summer as its lifesaving club struggles to pay the huge public liability insurance costs. The Torquay club will not put lifesavers on the beach this season if the State Government does not pass legislation protecting members and the club from litigation.” (Stephen Moynihan, “Popular beach may have no lifesavers this season”, Melbourne Age, Nov. 2). Pediatric surgeons: “Eighteen orthopedic surgeons and obstetricians have quit public hospitals in Sydney in the past week because of the Government’s medical indemnity charge.” (Ruth Pollard, “Children’s surgeons quit, more will follow”, Sydney Morning Herald, Oct. 2). Rural obstetricians (Lucy Beaumont, “Insurance fear on rural births”, Melbourne Age, May 6). See David Little, “Left untreated, the indemnity system will cause more suffering”, Sydney Morning Herald, Oct. 9; Richard Ackland, “In a row between doctor and lawyer, you know who the politician will call”, Sydney Morning Herald, Oct. 31)

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Midwives disappearing in NYC

New York City may soon be left with only a single independent center for natural childbirth: “The Brooklyn Birthing Center says its insurance company has stopped covering midwives, and a costlier new policy could push them out of the baby-birthing business as well. The news comes less than a week after the highly regarded Elizabeth Seton Childbearing Center, which delivers more than 400 babies a year, announced it will shut down its West 14th Street [Manhattan] birthing rooms on Sept. 1 because of malpractice insurance costs it says have quadrupled.” All three independent midwifery centers in New Jersey closed in recent years; one remains in the Bronx which receives federal funding and insurance. (Susan Edelman, “Midwife Strife Hits Moms in Brooklyn”, New York Post, Aug. 17; Dan Mangan, “Midwife Crisis”, New York Post, Aug. 12). And in Tallahassee, Fla., a doubling of insurance rates has contributed to the closing of Full Circle Women’s Health, a nonprofit midwifery agency whose efforts have been credited with helping reduce the county’s high rate of neonatal mortality. (Jeff Burlew, “Area midwifery agency closing after 20 years”, Tallahassee Democrat, Aug. 13)(more on obstetric liability)(& update Sept. 3, letter to the editor Sept. 18)

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“Once a C-section, always a C-section” policy blamed on legal risks

Oregon: “Women who have delivered a baby by Caesarean section must deliver their next child the same way if they give birth at Merle West Medical Center. The hospital’s board of directors today announced a new policy that supports a decision by local obstetricians to not deliver a baby vaginally if the mother has had a previous Caesarean section, a surgical procedure that delivers the baby by making an incision in the abdomen and uterus. The decision is based more on legal implications related to the potentially high-risk procedure than on medical statistics, said Dr. Rick Zwartverwer, vice president for medical affairs at Merle West Medical Center.” (Marcia McGonigle, “Hospital alters C-section policy”, Klamath Falls (Ore.) Herald & News, Jul. 8)(see Feb. 5, 2001). Update Nov. 29, 2004: New York Times covers the story.

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Archived medical items, pre-July 2003

“Texas’s giant legal reform“, Jun. 18-19, 2003.

Malpractice suit crisis, 2003: “Letter to the editor“, Jun. 20-22; “Docs leaving their hometowns“, Jun. 12-15; “Juggling the stats“, Jun. 4-5; “Malpractice studies“, May 12; “Public Citizen’s bogus numbers“, Apr. 10-13; “Malpractice crisis hits sports-team docs” (& general roundup), Apr. 7-8; “Would you go into medicine again?“, Mar. 18; “‘Public deceit protects lawsuit abuse’“, Mar. 15-16; “One solution to the malpractice crunch“, Feb. 19; “Feinstein set to back Bush malpractice plan“, Feb. 12; “State of the Union“, Jan. 29; “Malpractice-cost trends“, Jan. 24-26; “ATLA’s hidden influence“, Jan. 21-22; “Playing chicken on malpractice reform“, Jan. 9; “‘Doctors strike over malpractice costs’” (W.Va., Pa.), Jan. 3-6.  2002: “Campaign roundup“, Nov. 4-5; “Pennsylvania House votes to curb venue-shopping“, Oct. 11-13; “Rumblings in Mississippi“, Oct. 9-10 (& Sept. 9-10); “Let ’em become CPAs“, Oct. 7-8; “Tour of the blogs“, Sept. 24; “You mean I’m suing that nice doctor?“, Aug. 1; “‘Bush urges malpractice damage limits’“, Jul. 29; “‘Trauma center reopens doors’“, Jul. 18; “Malpractice crisis latest” (Pa., Tex.), Jun. 11-12; “Sick in Mississippi?  Keep driving“, Jun. 3-4 (& Apr. 5-7); “‘Rocketing liability rates squeeze medical schools’“, May 28-29; “‘The trials of John Edwards’“, May 20-21; “Ob/gyns warn of withdrawal“, May 17-19; “‘The Tort Mess’” (Forbes, etc.), May 13; “Texas doctors’ work stoppage“, Apr. 11 (& Mar. 15-17); “No more ANZAC Day marches?” (Australia), Apr. 1-2; “Scenes from a malpractice crisis“, Mar. 5; “Med-mal: should doctors strike?“, Jan. 21-22.  2001:  “Soaring medical malpractice awards: now they tell us“, Sept. 11; “‘Valley doctors caught in “lawsuit war zone”‘“, May 3; “Pennsylvania MDs drop work today“, Apr. 24; “Philadelphia juries pummel doctors“, Jan. 24-25.  2000: “Trial lawyers’ clout in Albany“, Oct. 4; “Malpractice outlays on rise in Canada“, Oct. 2. 

Ob/gyn, 2003: “Juggling the stats“, Jun. 4-5; “Malpractice studies“, May 12; “‘Edwards doesn’t tell whole story’“, Mar. 4 (& letter to the editor, Mar. 31); “‘Delivering Justice’“, Feb. 27.  2002: “Ob/gyns warn of withdrawal“, May 17-19 (& see Jun. 11-12); “‘Support case hinges on failed sterilization’” (Ind.), Apr. 26-28; “Med-mal: should doctors strike?“, Jan. 21-22.  2001: “Fleeing obstetrics, again“, Dec. 21-23; “‘Wrongful life’ comes to France“, Dec. 11 (& updates Jan. 9-10, May 20-21, Jul. 1-2, 2002); “Meet the ‘wrongful-birth’ bar“, Aug. 22-23 (& letter to the editor, Sept. 3; more on wrongful birth/life: Nov. 22-23, Sept. 8-10, June 8, May 9, Jan. 8-9, 2000); “Pennsylvania MDs drop work today“, April 24; “Caesarean rate headed back up“, Feb. 5.  2000: “Birth cameras not wanted“, Oct. 18; “Plastic surgeons must weigh patients’ state of mind, court says” (roundup: anti-abortion suits), Aug. 15.  1999: “‘Trial lawyers on trial’” (Norplant, etc.), Dec. 23-26; “‘Your perfect birth control…blocked?’“, Aug. 11 (Norplant) (& update Aug. 27; company to settle 36,000 suits); “Yes, this drug is missed” (hospital admissions for hyperemesis tripled after lawyers drove Bendectin off market), Jul. 21. 

“Malpractice studies“, May 12, 2003; “Radiologists: sue them enough and they’ll go away“, Nov. 2, 2000 (& see Sept. 24, 2002).

Nursing homes, geriatrics, 2003: “Florida: ‘New clout of trial lawyers unnerves legislators’“, Mar. 20; “$12,000 a bed“, Mar. 19.  2001: “Soaring medical malpractice awards: now they tell us“, Sept. 11; “‘Doctor liable for not giving enough pain medicine’“, Jun. 15-17; “‘Nursing homes a gold mine for lawyers’“, Mar. 13-14.  2000: “‘Litigation grows in ailing nursing home industry’“, Jun. 20 (& see Mar. 2-4, 2001). 

“Incoming link of the day“, Mar. 5-7, 2003.

Emergency medicine: “‘Trauma centers warn lives could be at risk’” (Orlando), Feb. 28-Mar. 2, 2003; “Ambulances, paramedics sued more“, Oct. 28-29, 2002; “Let ’em become CPAs“, Oct. 7-8; “Avoid having a medical emergency in Mississippi“, Apr. 5-7; “Scenes from a malpractice crisis” (closure of trauma centers), Mar. 5, 2002  (& see Jun. 11-12); “That’ll teach ’em” (Chicago EMS), Dec. 26-28, 2000; “Highway responsibility” (ambulance, hospital sued in Derrick Thomas crash), Nov. 28, 2000. 

“The jury pool he faced“, Feb. 25, 2003.

“Take care of myself?  That’s the doc’s job“, Feb. 14-16, 2003; “Claim: docs should have done more to help woman quit smoking and lose weight” (Pa.), Sept. 18-19, 2002.

“Medical mistakes” estimates, 2001:  “Report: ‘medical errors’ study overblown“, July 27-29.  2000: “‘Report on medical errors called erroneous’“, July 11; “Medical mistakes, continued“, March 7; “‘Medical errors’ study“, Feb. 28; “Against medical advice” (Clinton proposals), Feb. 22 (& see malpractice law section below). 

“Mercury in dental fillings“, Jul. 16-17, 2002 (& Nov. 4-5, 2002). 

Psychiatry and allied fields, 2002: “‘Mom who drugged kids’ ice cream sues’“, Nov. 1-3; “‘Patient sues hospital for letting him out on night he killed’” (Australia, psychiatric case), Oct. 16-17; “‘After stabbing son, mom sues doctors’“, May 31-June 2; “Counseling center may face closure” (Okla.), May 24-26.  2000: “Killed his mother, now suing his psychiatrists“, Oct. 2; “Not my fault, I” (woman who murdered daughter sues psychiatrists), May 17; “Legal ethics meet medical ethics” (lawyers advise schizophrenic murder defendant to go off his medication for trial), Feb. 26-27 (update, Mar. 2: he’s reported to have punched a social worker twice since going off medication; Mar. 29: jury convicts him anyway); “Latest excuse syndromes” (“Internet intoxication”, etc.), Jan. 13-14; “Warn and be sued” (clinical psychologist loses confidentiality suit after warning of patient’s dangerousness), Jan. 12.  1999: “Doctor sues insurer, claims sex addiction“, Oct. 13; see also personal responsibility. 

“Artificial hearts experimental? Who knew?“, Oct. 23, 2002.

“U.K.: ‘Dr. Botch’ sues hospital for wrongful dismissal“, Oct. 18-20, 2002; “Let them sue us!” (hospitals get sued if they withdraw privileges from questionable doctors), Mar. 23, 2000. 

“Lawyers fret about bad image” (lawyers’ own poll finds public has much more confidence in doctors than in lawyers), Oct. 3, 2002.

“‘Patient pays price for suing over cold’” (U.K.), Sept. 20-22, 2002.

“‘Doctors hope fines will curb frivolous lawsuits’“, Sept. 6-8, 2002; “The doctor strikes back” (neurosurgeon countersues), June 14-15, 2000; “‘Truly egregious’ conduct” (court cites misconduct by attorney Geoffrey Fieger in suit against cardiologist), Sept. 14, 1999. 

“Accident medicine”, 2002: “‘How to spot a personal injury mill’“, Aug. 19.  2001: “Lawyers (and docs) block cleanup of Gotham crash fraud“, April 2.  2000: “‘How do you fit 12 people in a 1983 Honda?’“, Aug. 23-25; “His wayward clients“, May 25; “Less suing = less suffering” (NEJM whiplash study), Apr. 24 (& update Jun. 26). 

“‘The NFL vs. Everyone’” (medical privacy laws could restrict sports teams from commenting on players’ injuries), Jun. 13, 2002; “Promising areas for suits” (sports medicine), Dec. 7, 2000; “Doctor cleared in Lewis cardiac case“, May 15, 2000. 

“‘Remove child before folding’” (AEI-Brookings study on defensive medicine), Jun. 5, 2002. 

Managed care/HMOs, 2002: “‘Bad movie, bad public policy’” (John Q), Mar. 19; “Washington Post blasts HMO class actions“, Jan. 30-31.  2001: “Managed care bill: Do as we say…“, Sept. 7-9 (& Dec. 6, 1999); “Contrarian view on PBR“, Aug. 17-19; “Chapman, Broder, Kinsley on patients’ rights“, June 28; “Managed care debate“, June 26; “Columnist-fest” (Morton Kondracke), June 22-24; “Docs and Dems“, June 19; “Roundup“, May 21.  2000: “Patients’ Bill of Wrongs” (Richard Epstein), Oct. 27-29; “Fortune on Lerach“, Aug. 16-17; “Arm yourself for managed care debate“, April 20; “Employer-based health coverage in retreat?“, March 31-April 2.  1999: “Weekend reading: columnist-fest” (John McCarron), Dec. 11-12; “Actions without class” (Wash. Post editorial: “extortion racket”), Dec. 2; “Who’s afraid of Dickie Scruggs?“, Dec. 2; “Aetna chairman disrespects Scruggs“, Nov. 18-19; “World according to Ron Motley” (world’s richest lawyer plans to sue HMOs, nursing homes, drugmakers), Nov. 1; “Deal with us or we’ll tank your stock” (managed care stock prices plunge), Oct. 21; “‘Health care horror stories are compelling but one-sided’“, Oct. 16-17; “After the HMO barbecue“, Oct. 12; “Power attracts power” (Boies joins anti-HMO effort), Sept. 30; “Impending assault on HMOs“,  Sept. 30; “Rude questions to ask your doctor” (why are you helping trial lawyers make it easier to sue health plans?), Sept. 4-6; “From the fourth branch, an ultimatum” (leading trial lawyer vows to “dismantle” managed care), July 16. 

“Hospital rapist sues hospital“, May 22-23, 2002 (& Mar. 5-7, 2003: court dismisses case). 

“Bush’s big mistake on mental health coverage“, May 13, 2002. 

“‘Big government ruined my long weekend’” (tide-over weekend prescribing), May 7, 2002. 

“Lawyers stage sham trial aimed at inculpating third party“, Mar. 22-24, 2002. 

“All things sentimental and recoverable” (veterinarians), Jan. 30-31, 2002. 

Public health follies: “Infectious disease conquered, CDC now chases sprawl“, Nov. 9-11, 2001; “Letter to the editor” (activist doctors vs. gun ownership), May 18, 2001; “‘P.C., M.D.’“, Feb. 23-25, 2001. 

“Bioterrorism preparedness” (laws hobble hospitals), Oct. 30, 2001. 

“Letter to the editor“, Sept. 3, 2001 (can/should doctors avoid lawyers as patients?) (responses, Oct. 22). 

“Clinical trials besieged“, Aug. 27-28, 2001; “Bioethicist as defendant” (Arthur Caplan, Jesse Gelsinger case), Oct. 6-9, 2000. 

“‘Doctor liable for not giving enough pain medicine’“, Jun. 15-17, 2001. 

“The unconflicted Prof. Daynard” (British Medical Journal and tobacco lawyer), April 21-23, 2000 (& update: letters, Jan. 2001, June 2001). 

“To destroy a doctor” (lawyer’s campaign against laparoscopic surgeons), June 6, 2001. 

“Mommy, can I grow up to be an informant?“, July 30, 2001; “A case of meta-False Claims” (overzealous prosecution of hospitals), Sept. 9, 1999. 

“Updates” (Lawyers’ cameras in trauma ward), Dec. 26-28, 2000 (& Oct. 18). 

“Promising areas for suits” (laser eye surgery), Dec. 7, 2000. 

Plastic surgery: “Plastic surgeons must weigh patients’ state of mind, court says“, Aug. 15, 2000 (& June 11, 2001: she loses); “Strippers in court“, Jan. 28, 2000; “No spotlight on me, thanks” (leading breast-implant lawyer obtains gag order against lawyers for dissatisfied clients), August 4, 1999; “Never saying you’re sorry” (implants), July 2, 1999. 

“Turn of the screw” (pedicle screw lawsuits), Oct. 24, 2000. 

“Disabled rights roundup” (obligatory sign interpreters at doctor’s offices), Sept. 29-Oct. 1, 2000; “From our mail sack: ADA enforcement vignettes” (interpreters, guide dog allergy case), May 31, 2000. 

“Embarrassing Lawsuit Hall of Fame” (intimate injury; misdiagnosis charge), Aug. 14, 2000. 

“Senator Lieberman: a sampler” (cost of defensive medicine), Aug. 8-9, 2000. 

“And don’t say ‘I’m sorry’” (nurse’s first-person account), June 21, 2000. 

“Can’t sue over affair with doctor” (court rules it was consensual), June 13, 2000. 

“Jumped ahead, by court order” (residency), May 31, 2000.

“‘Case’s outcome may spur more lawsuits’” (Mississippi fen-phen trial), Dec. 10, 1999; “‘Dieters still want fen-phen’“, August 18, 1999. 

“Rhode Island A.G.: let’s do latex gloves next“, Oct. 26, 1999. 

“Michigan high court upholds malpractice reform“, August 6, 1999. 

Other resources on medicine and litigation:

Good general links pages on health law are provided by the St. Louis University Center for Health Law Studies and by the whimsically named but highly useful Health Hippo. 

The Litigation Explosion, the 1991 book by Overlawyered.com editor Walter Olson, was excerpted in two parts by Medical Economics [part one] [part two] 

Marc Arkin, “Products Liability and the Threat to Contraception” (Manhattan Institute Civil Justice Memo, February 1999). 

L. William Luria, M.D., and Dennis G. Agliano, M.D., “Abusive Medical Testimony: Toward Peer Review“, describes efforts under way in Hillsborough County, Florida, to apply principles of peer review to the control of irresponsible or unqualified forensic testimony by medical professionals. 

Walter Olson, “Lawyers with Stethoscopes: Clients Beware” (Manhattan Institute Civil Justice Memo, 1996) (abusive litigation is also bad for the medical prognosis of claimants) 

Breast implants: see separate page

Vaccines: 

Health Hippo vaccines section. 

Peter Huber, “Dan Quayle, the Lawyers and the AIDS Babies“, Forbes, October 28, 1991 (liability and an AIDS vaccine). 

Peter Huber, “Health, Death, and Economics“, Forbes, May 10, 1993 (“investment in vaccines remains far lower than it should be, given the huge benefits that vaccines provide”) 

Walter Olson, “California Counts the Costs of Lawsuit Mania“, Wall Street Journal, June 3, 1992 (liability slowing research on AIDS vaccine). 

Malpractice law:

Daniel Kessler and Mark McClellan of Stanford won the Kenneth Arrow Award in Health Economics in 1997 for their article “Do Doctors Practice Defensive Medicine?”, which “found that when states reformed malpractice laws to put caps on damages for pain and suffering, or to eliminate punitive damages, hospital expenditures for heart disease patients were reduced by about 5 percent, yet did not leave the patients with worse health outcomes.” 

Richard Anderson, M.D., “An ‘Epidemic’ of Medical Malpractice?  A Commentary on the Harvard Medical Practice Study“, Manhattan Institute Civil Justice Memo, July 1996 (shortcomings of famous study of medical care in New York hospitals). 

Forbes columns by Peter Huber on the issue include “Malpractice Law: A Defective Product” (1990) and “Rx: Radical Lawyerectomy” and “Easy Lawsuits Make Bad Medicine” (1997). 

Walter Olson, “A Story That Doesn?t Have a Leg To Stand On,” Wall Street Journal, March 27, 1995 (the famous “wrong-leg amputation” case). 

In 1993, in a paper given at the annual meeting of the Association for Health Services Research, Daniel Mendelson and Robert Rubin estimated that defensive medicine practices in three areas alone — pre-surgical testing, fetal monitoring and skull x-rays — probably exceeded $2 billion a year, and estimated likely savings from “aggressive malpractice reform” at more than twice that amount.  Perhaps in contrast (or perhaps not), a 1995 study of obstetrics in Washington state by L. Baldwin et al found no differences in practice between doctors who had been named in suits and those who had not. And Mark Hauser et al, “Fear of Malpractice Liability and its Role in Clinical Decision-Making” studied doctors’ reaction to hypothetical cases in which a patient’s file did or did not reveal a history of having sued physicians.  They found that in cases where an earlier suit had been reported the doctors were modestly more likely to call in other doctors, to recommend hospital admission, to document a case “by the book” rather than rely on judgment, and to predict a bad outcome.  Surprisingly, they did not order more tests or withdraw from cases more often when informed that a patient had a record of suing.  The Hauser paper notes one possible cost of an over-hasty resort to hospitalization: “In psychiatry a defensive response might include a needlessly low threshold for involuntary hospitalization, where the patient’s liberty and autonomy are, in essence, sacrificed in favor of conservative practice for the sake of self-protection.” 

The Michigan law firm of Garan, Lucow, Miller & Seward, P.C., which has a specialty in medical malpractice defense, maintains a comprehensive links page of resources in the field. 

Among reform groups, the Health Care Liability Alliance is a nationwide advocacy group whose website offers a variety of useful materials on the case for lawsuit reform. Californians Allied for Patient Protection defends the Golden State’s MICRA limits on malpractice liability.  CLYSIS is a Minnesota group working for medical liability reform.  State medical societies, such as the Medical Society of the State of New York, often maintain law-related information at their websites.

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