Re: Medical Liability System

[Guest guest]

Ray, I'm sorry your family will have to move because of the high insurance

premium rates for malpractice. I read an interesting article in the paper

this morning concerning why the insurance premiums are running so high,

particularly the last couple of years. We hear that most of the blame is put

on trial lawyers and " frivolous lawsuits. This maybe part of the problem, but

I truly believe it is many faceted. The article that I read said that for the

last 30 years the number of claims filed against doctors has remained flat

and the amount of the average recovery has also remained flat for that same

time period when adjusted for inflation. It goes on to say....Why are these

cyclical events where malpractice rates skyrocket? Their answer was that the

insurance industry has been a poor shepherd of the doctor's premiums, or like

us, they were duped into thinking their investments were secure or safer that

they were. There is an inverse relationship between the stock market returns

and the premiums charged to physician. When the market was getting

double-digit returns during the go-go times of the 90's, the insurance

companies were writing insurance for all the doctors regardless of their

claim history because they were getting such fantastic returns on their

investment. As a result, there was competition for insuring physicians for

their premiums, which resulted in keeping the doctors' rates lower.

Consequently, when the market returns are high, the amount charged to doctors

stays low, and the inverse is also true: When the market returns are poor,

the rate charged to the doctors for malpractice insurance inflates.

According to this article, it also stated that putting a cap on noneconomic

damages, say at $250,000 (which is the figure that some are talking about)

helps...but they also should put a cap on what the insurance companies can

charge to the doctors. Calif has done this...put a 3 percent per year or the

insurance company would have to open their books to justify a higher

increase. To date, there has never been a crisis in Calif severe enough to

warrant opening their books to the world to see. Until there is insurance

reform there will never be any true " fix " to the problem. Just thought this

article was interesting....not in anyway justifying what poor doctors have to

pay....just adding further point of view. Best regards, Connie (granny)

[Guest guest]

Medical malpractice jury awards are up 76% from 1996-1999. Although the

number of cases has remained constant. I have read the majority of insurance

companies are over 80% invested in bonds. There are a number of sites that

blame the malpractice crisis on the insurance companies and their investing.

Every single one of them was associated with a law firm or the ABA. No

insurance company can expect to get 76% returns on their money in a 3 year

period. To not blame the lawyers for this crisis would be like not blaming

criminals for crime. The lawyers want to save their plush lifestyles at the

expense of the patients, hospitals, insurers and medical profession. They are

desperate and in my opinion, they have no ethics. Their latest ads on TV now

say even if you don't think you have a case we may be able to get you money.

Why do you think they run so many ads on TV? The jury verdicts are outrageous

and the money has to come from somewhere. Sorry for the tone of this letter

but the lawyers actions are indefensable.

Dave in NC

[Guest guest]

Multiple links and sources for the malpractice crisis. Dave in NC

<A

HREF= " http://www.ama-assn.org/sci-pubs/amnews/pick_02/prl10415.htm " >http://www.a\

ma-assn.org/sci-pubs/amnews/pick_02/prl10415.htm</A>

<A

HREF= " http://www.psychiatrictimes.com/p021101a.html " >http://www.psychiatrictimes\

..com/p021101a.html</A>

<A

HREF= " http://www.cbsnews.com/stories/2002/07/13/health/main515080.shtml " >http://\

www.cbsnews.com/stories/2002/07/13/health/main515080.shtml</A>

<A

HREF= " http://www.ama-assn.org/sci-pubs/amnews/pick_02/gvsc0701.htm " >http://www.a\

ma-assn.org/sci-pubs/amnews/pick_02/gvsc0701.htm</A>

[Guest guest]

In a message dated 2/18/03 12:45:13 PM Eastern Standard Time, dsgolf9@...

writes:

> There are a number of sites that

> blame the malpractice crisis on the insurance companies and their

> investing.

> Every single one of them was associated with a law firm or the ABA.

Dave,

Much of this debate is politically motivated. I think both political view

points have merit. Maybe, if you put a cap on damages as well as limit what

the insurance company can charge the doctor (like Calif. did).....that might

be a good solution. FL is going through this same debate (as many other

states are doing) and they want to just limit damages. Why would they not

want to limit insurance premiums also? That's all I was trying to say. Before

I read the article this morning...I too, blamed it all on the lawyers. But we

can't demonize one aspect of the crisis and not the other, can we? My fear is

that any laws that are made now, without taking all aspects into

consideration, will be swayed to the insurance companies benefit. Below is

one link that is not linked to a law firm or the American Bar Assoc. Some of

these senators are lawyers, but not all. I suppose if you looked hard enough,

most in political office have been lawyers. Best regards, Connie (granny)

<A HREF= " http://www.senate.gov/~leahy/press/200302/021103b.html " >Statement of

Senator Leahy On The " Medical Malpractice Insurance

Antiturst Act of 2003 " </A>

[Guest guest]

Thanks, Peggy. We will have to move. My wife has been interviewing with

practices in Knoxville, TN, her " hometown " which is about two hours away by car.

We're 95% sure we will be going. She is waiting on her license from TN, and a

contract offer from the practices. THey are working with the hospital to come

up with an appropriate contract. Wheels grind slowly, though everyone keeps

saying they want it done quickly.

My wife's partner has also been hit with the same increase and plans to leave

within a year or so, possibly sooner. He was out interviewing this weekend with

a hospital practice in Iowa.

It looks like our small town will lose four of its eight

obstetrician/gynecologists this year, mostly due to the malpractice insurance

increase. That's going to put a strain on the doctors that are left, and cause

many patients to seek care at nearby hospitals. That's sad because regionally,

our hospital has the best reputation for obstetrical care and delivery, and the

highest patient count in that specialty. I'm not sure everyone in hospital

administration realizes how this will devastate the hospital's income.

The CEO of our hospital offered to try to go to bat for my wife and her partner

to get the hospital to help in some fashion with the malpractice increase. Too

little, too late. It might help others, but it will take months to work out.

Time we no longer have, since every day she keeps seeing patients here, is

another several hundred dollars in debt.

Ray Neal

[Guest guest]

I would rather be apolitical about this debate and just look at the facts.

California's system of caps on jury awards and insurance premium increases

may work. However, Granny your link was from 4 senators all from one party,

who's major source of campaign contributions is lawyers, as one of their top

three contributors to their party. Therefore I find their statement self

serving and biased on the senators part. However, the AMA, Hospitals and

other Medical organizations don't necessarily have a political motivation for

the call to malpractice reform, they are just tring to stay in business and

practice medicine. Granny, because you are bright and persuasive you were

able to provide me with facts and sway me to understanding the Canada drug

price argument and I agreed with you as I usually do. However, I believe the

facts are irrefutable that the lawyers are to blame. For instance, taking the

lawyers excuse that the insurance companies invested the premiums poorly and

that it is not the doubling of jury verdict awards that caused premiums to

increase, then if you were running an insurance company you would sell the

insurance and invest differently, not get out of the business of malpractice

insurance. The reason they are getting out of the business is they are paying

a $1.40 out for every $1.00 of premiums in.

Sorry about my obsession with this but numerous conversations with those

effected by this, and with some doctors fleeing states because of this issue,

the ability for all these people to get quality health care must not be held

hostage by the trial lawyers.

Have a great day,

Dave in NC

[Guest guest]

Hi Ray,

I'm SO sorry to hear of your wife's predicament. That is SO sad. This is the

last thing you need, it really is. I will pray for you and your wife.

Take care,

Dawn

[Guest guest]

Dave--

At 12:43 PM 2/18/2003 EST, you wrote:

>Medical malpractice jury awards are up 76% from 1996-1999. Although the

>number of cases has remained constant.

I can't seem to work the links to the websites you sent. Which one says

that about jury awards?

I think perhaps I should give a little background about myself before I say

more. I always try to keep personal stuff out of my posts because I am not

the spondy-sufferer in the family--it is my adult son who needs to know

what you all are saying, but is " too busy " to get involved himself.

Anyway, I am a former plaintiffs' personal injury lawyer. I have worked on

(when I worked for a law firm) medical malpractice cases and considered

(when I worked for myself) malpractice cases for clients.

Now, I do some work for a low-income-client legal services organization and

handle adult guardianships for the court. I make from $35--$50/hr on most

cases. The point: I am not a rich lawyer defending a " plush lifestyle. "

I quit doing personal injury work, which IS better paid, mainly because I

did not want to work so hard any longer--that is extremely intense,

demanding, stressful work, especially malpractice. On each malpractice

case, the lawyers have quickly learn as much about that area of medicine as

doctors know. Otherwise, there is no way to know if it is a " real " case or

only a disgruntled patient for whom the doctor could not achieve--even when

meeting the accepted standard of care--the result the patient wanted.

Also, you can't prove what happened if you don't understand it yourself.

In malpractice cases, any conscientious attorney does not want to " harm "

the doctor involved. But, there are doctors who shouldn't be practicing,

for various reasons--temperamentally unsuited, emotionally affected by

outside pressures, drug- or alcohol-abusing, or just plain " burned out. "

And, even the most rational, conscientious doctor makes mistakes--doctors

are human, as they keep reminding us. (I think that's pretty close to a

quote from the transplant surgeon at Duke who just " forgot " to check the

patient's and donor's blood types!)

Unfortunately, doctors have chosen a profession where their mistakes can

have serious, life-threatening or even life-ending, repercussions for their

patients. That's why they carry insurance. Doctors should be respected

and applauded for accepting the risk of making such a mistake (where did

the cliche " it's dirty work but somebody has to do it " come from??) but

insurance companies should not be " rewarded " when that happens.

Insurance companies, whatever the risk they are insuring against, are in

business to make money. As Connie pointed out, when the companies' profit

margins start shrinking--whether it's because of bad judgment about whom to

insure, or a bad gamble on what investments will earn--they raise their

rates to the people they insure. In the currently-publicized situation,

it's the doctors who are told they must pay higher rates. Doctors really

are getting squeezed. They are also seeing less income in the first

place--again caused by insurance companies, who do not want to pay what the

doctors' services are worth because the insurers want to make huge profits.

In my experience, insurance companies (whether in malpractice, auto

accident, product liability or employment cases) will pay huge sums to

their lawyers to fight paying anything--at all--to injured people. On

numerous occasions, when a case has ended (98% of the time without going to

trial), I've commented to the lawyers on the other side that I thought the

result was fair to all and been told, " of course--there was clear liability

here. " This has been after years of dragging out the case with legal

maneuvering and silly, " low ball " offers of settlement. How much fairer it

would have been if the insurance company--and their defense

attorneys--would have evaluated the case at the beginning and agreed to a

reasonable settlement right away! In many years of practice, I ran into

one defense lawyer who did that. I also commented to him about his

refreshing attitude when the case was over (took a total of maybe two

months). He noted that he lost a couple of jobs with law firms that

represent insurance companies who won't take that approach before he

finally went into business for himself and hooked up with a couple of

companies willing to be realistic.

I've also been told (again, by their own lawyers) that one reason the

insurance companies drag out a case for so long is that they DO evaluate

their risk when they first learn of a case, then invest funds to " cover "

what they think it is worth. They simply refuse to settle until the

invested funds have made enough so they have no " real " loss. I've always

wondered why the companies then scream and want to raise premiums when they

pay out the money they've made for that purpose.

I share your contempt for lawyer advertising, though. I'm from an era when

lawyers did think it was unethical. And, no ethical lawyer would offer to

" get you money " if there really is no case. I think the advertising you

were referring to simply means that people with little medical

knowledge--and a huge emotional investment--really aren't able to evaluate

their own cases. But, any ethical attorney will not pursue a case without

merit. Conscientious lawyers thoroughly investigate a case before they do

anything.

When I said I had " considered " malpractice cases when working on my own,

that's what I meant. In each case, I did investigate and concluded that

there was not sufficient evidence to proceed. In addition, in my state

(one of those where there is supposedly a " malpractice crisis " ) the

attorney's conclusion isn't enough. We are required to get an opinion from

a doctor who actually practices in the same field as the defendant-doctor.

That other doctor must agree that there was a mistake made which should not

have been made if the doctor had done his/her job. Then, the attorney has

to file an affidavit with the court when filing the case that the opinion

exists and is that the case has merit. We do not have to have that doctor

at trial, but we do have to have an " expert " at trial who spends at least

75% of his/her time in the specialty involved in the case. Few practicing

specialists will publicly testify against another one, no matter how bad

the mistake. (It's the " blue wall " rule, alive and well.)

Also, the " runaway jury " phenomenon that someone has referred to almost

never exists. I'm not going to make this a lot longer, but there are rules

in court about what can be presented and what the lawyers can say to a

jury. Also, you can be sure the insurance company's lawyer is there

fighting to keep out anything that could be damaging to the doctor (or any

defendant). (Interestingly, one of the things that can't be said is that

the defendant has insurance and that the defendant's lawyer is actually

being paid by the insurance company.) The point, however, is that the

plaintiff's lawyer can't simply " make up " a case--there have to be facts

given to the jury, and the insurance company's lawyer is there to be sure

those facts are interpreted in the doctor's best interest.

So, rather than stating so definitely that " the facts are irrefutable that

the lawyers are to blame, " perhaps there is plenty of blame to go around.

Insurance companies (especially HMO's) pressure doctors to increase patient

loads, therefore decreasing the time spent with each patient and increasing

the likelihood of error. Other insurance companies, also with an eye on

profits, take unreasonable positions and then howl when they eventually

have to pay up, even though they have invested funds and made enough on

them to cover the pay-out. Some lawyers, and many clients, are

unreasonable and greedy, as well. It isn't a perfect world. But, is the

answer really to say that a person who has been left a paraplegic, or will

never regain consciouness, or never see again, or . . . . is only entitled

to $250,000, forever, for his/her suffering? How far down the list of

big-insurance-company executives do you suppose you have to go to reach the

level where the individuals are making less than $250,000 EACH YEAR?

Ray, I greatly sympathize with your family's situation. Perhaps a

small-ish town? I visited my OB/GYN yesterday, and she said she is

thinking about getting out of the OB business, but only because she doesn't

think she is needed to deliver babies any more--there have been three OB's

here (a town of about 50,000) for many years, but now there are four, and

two more scheduled to come next month! There must be something good

happening, and maybe the same thing is occurring in other similar places.

I apologize to all for the length of this message. I actually wrote

another one when this subject first came up, then deleted it, thinking it

was " too political. " But, the topic doesn't seem to want to go away, so

here I am again. I'll try to be good and keep my mouth shut again for

awhile, though. Thanks for listening! --bc

[Guest guest]

Betty, thank you for your thoughtful and professional input on this very

difficult situation. I had no idea that we had an attorney amongst us.

(Although, I believe someone's husband is). It is, as you say, political, but

I believe that it affects all of us on this list....either through personal

events with negligence or through our medical charges, availability of

doctors, etc. After seeing the current episode of organ transplant

negligence, I find it hard to believe that this little girl's suffering and

pain is not worth more than $250,000! (That is, if she lives...God have mercy

for her.) If she does live, I am now hearing that she may have brain damage

beyond repair. I know that the doctor and any others involved in the

negligence are sincere and dedicated, but human. This is exactly why there

is such a thing as malpractice insurance and good lawyers (like yourself) for

the victims, as well...as lawyers for the alleged offending doctors (feel

sorry for him, too). There has to be an ethical answer to the problem and

much thought has to be given to the doctor's plight, victim's plight, and the

ability of the providing insurance company to make a fair profit or to break

even, as is the case where some doctors have opened insurance companies for

nonprofit....just to cut their premium rates. Do you know, if they should

decide to put a cap on malpractice cases, would this little girl be an

exceptional case....and be provided more for her suffering and pain? I can

think of many such cases that would seem to require more compensation than a

$250,000 cap. Like a leg that was cut off...and they had to return and cut

the real diseased leg off, leaving the victim a paraplegic. Or an operation

on someone's back that left the person in terrible pain the rest of their

life. These are real problems our congress has to think about before they

glibly make these kind of decisions. They can't be one sided...but they have

to think of the whole complex problem. Boy, I wish we had a King to

solve all our looming problems.

You mentioned that some of the insurance companies may have made bad

investments. Well, while I was going through different sites, I came across

the fact that St. Insurance Co., one of the largest malpractice

insurance companies, had lost almost $900 million dollars just before it said

it was not going to take on malpractice anymore and dropped many

doctors...leaving them high and dry. They told the public that it was all due

to malpractice verdicts. It came out later that they had lost $108

million....in just Enron stocks. Who knows what else was in their portfolio.

I believe if the truth were known, many of our insurance companies did the

same. In the 90s, almost every company, including banks, young and old

people, put their money....where they could make the most. After many years

of good stock growth, caution was thrown to the wind and we all are reaping

the great rewards.

Best regards, Connie (granny)

PS There are bad apples in every barrel....bad eggs in every profession.

Because there are a couple of bad apples, doesn't mean that the whole barrel

is bad.

[Guest guest]

In a message dated 2/21/03 8:06:08 AM, dommer@... writes:

<< How about the government checking into

some insurance reform? They're the ones collecting premiums that

never seem to be there for dispersement when needed.

>>

I think eventually that no insurance companies will be in business if this

keeps up. The government would have to supply insurance and charge the

taxpayers huge amounts, as the lawyers get richer and richer, and the poor

get poorer..

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[Guest guest]

I just wanted to comment on a similar situation I was involved in.

A number of years ago, I was involved in a product liability case.

A grocery store near me had been grinding sausage when the grinder

broke, shredding pieces of metal. They knew they were missing some

of the pieces, but chose to put the meat out for sale anyway. Since

it was sausage links, the meat was enclosed, and the metal couldn't

be seen. I found it, though! When I bit into it! Of all of my

family, I was glad it had been me instead of one of my children. I

chew thoroughly, and if one of them had swallowed it, it potentially

could have done some real damage to their esophagus or stomach. It

was only about 1/2 " long, but was severely cork-screwed in shape. My

molar cracked open all the way up to my jaw...very painful.

When I went to the store next day to tell them, they refunded the

money for the sausage...$2 and something. I asked if they would

agree just to pay any medical costs involved, and they agreed.

Well, had I known up-front all the work that was going to be

involved in trying to save that tooth, I would have opted for an

extraction. But, you know how that goes...first they say you need

only have this done, then they keep adding more " necessary " steps,

and, before you know it, you're stuck with " their " decisions. Like I

said, I should have just had them pull it out.

Anyway, they sent their insurance rep over to my house to talk and

see what I would settle for. I told her that I just wanted the

medical costs, since it didn't seem fair that my insurance should

have to foot the bill for something THEY were responsible for.

(that's why rates keep going up, right?) She stated that since I'd

gone through such H**l, I should be compensated for pain and

suffering...her idea, not mine. And that is what she recommended to

the store. $2200 for dental/medical bills, and $5,000 for pain and

suffering...a total of $7,200. The store didn't like that, and

offered me only $500 to cover my deductible...that's it. So, I

sought out a lawyer.

Months later, after a jury trial that cost you and I as taxpayers,

I was awarded $41,000. Now, most of that, (more than half), went to

the lawyer, the court costs, and various depositions. All of the

expense could have been avoided for a mere $2,200, what I feel they

owed. Instead, we all lost. I know I certainly didn't enjoy all the

aggravation it caused.

I think that fairness has lost it's place in favor of large

settlements. Everywhere you look on TV, there are law firms

soliciting your business to take the people for " what they deserve " .

Common decency somehow loses out.

With doctors, of course they make mistakes, they're only human like

the rest of us. But, on the other hand, we hold them up to use their

better knowledge to aid us, not hurt us. I know of a current case

where the guy went in for a routine sinus cleaning, and was dead

within two weeks. Seems they " forgot " to change his bandages for the

first 72 hours he was in the hospital, didn't know they'd punctured

through to his brain, and the resulting infection completely shut

down his brain. He was in a coma for a week before he finally

succumbed, leaving a wife and two small children. What's a fair

amount for them? I don't know. I would sugggest that his income be

matched until they reach adulthood. And the wife? They would have

had a pension plan and insurance to last BOTH of them for their old

age, and now she'll be on her own to provide all of it.

Something needs to be done, but I don't necessarily think it should

be on the doctors' backs. How about the government checking into

some insurance reform? They're the ones collecting premiums that

never seem to be there for dispersement when needed.

CelticJade