From: russ@wpg.com (Russell Lawrence)
Newsgroups: sci.med
Subject: Re: Questions for MDs
Date: 27 Jul 92 21:31:40 GMT
Organization: WP Group


In article <Brz49F.GDt@wpg.com> russ@wpg.com (Russell Lawrence) writes:
rl> If this problem [ growing malpractice awards ] is expanding in 
rl> the US, as you say, it seems to me that it would be reflected in 
rl> the statistical figures.  Have the payouts increased over the 
rl> past thirty years or so?  evidence please].  Incidently, is it 
rl> true that the cost of liability insurance for doctors and 
rl> hospitals in the US is less than 1% of the total US health care 
rl> budget?  

From article <1992Jul26.204051.15161@newstand.syr.edu>, by mdkline@rodan.acs.syr.edu (Mark D. Kline):
mk> The problem is not the cost of liability insurance;  the problem 
mk> is that doctors are so worried about getting sued that they order 
mk> more diagnostic procedures more often...such "defensive medicine" 
mk> is how the malpractice crisis really drives up the cost of 
mk> medical care.  The malpractice situation also contributes to 
mk> choices medical students are making in terms of what specialty 
mk> they'll train in and in what settings they will ultimately 
mk> practice.  Imagine the future obstetrician graduating from a 
mk> private medical school perhaps $70,000 in debt, and finishing 
mk> their residency and confronting a malpractice premium of $60,000+ 
mk> per year.  Are they going to go practice in an inner city, where 
mk> their patients are going to be at higher risk of obstetrical 
mk> complications, for example, and have little or no private 
mk> insurance?  Probably not.  Then we wonder why our infant mortality 
mk> among minorities in the inner city is so high...  

I'm skeptical.  Back in the early-to-mid-70's, when consumers 
began to complain about a dramatic increase in hospital room 
rates, the American Medical Association and the American Hospital 
Association launched a series of PR campaigns blaming tort 
litigation for the rising costs of health care.  A subsequent
investigation conducted by the US Department of Health, 
Education, and Welfare showed that the claims were groundless.  
Still, the idea lingered in the minds of many concerned citizens 
that hospital costs would be significantly lower if the right 
to sue were curtailed or eliminated.  

Is it true that ob-gyn specialists are giving up the profession 
because of malpractice insurance rates?  Or, is it possible that 
any departure trends might be correlated with a decrease in birth 
rates?  According to federal statisticians, there were 18,900 
ob-gyn specialists working in the US in 1970.  There were 
3,731,000 births in that year which works out to 197.4 
births/physician.  In 1975, there were 21,700 ob-gyn men and and 
3,144,000 births (144.8 births/specialist).  In 1980, there were 
26,300 ob-gyn specialists and 3,612,000 births (137.3 
births/specialist).  When 1985 rolled around, there were 30,900 
physicians and 3,761,000 births which works out to one specialist
for every 121.7 births.   It's reasonable to conclude that there
are too many obstetricians, not too few, and that the decision
to search out greener pastures may have more to do with birth
control that the threat of litigation.

[Incidently, one might assume that a greater number of practitioners
would enhance competition and lower the cost of health care.  Not 
really.  Moreover, there's quite a bit of evidence to show that an 
excessive number of practitioners in a given field often creates 
problems by stimulating the marketing of creative treatment 
modalities that may not serve the best needs of the patient.] 

mk> Malpractice is not only a potent economic force but an extremely
mk> cynicizing one that works against medical idealism.  People certainly
mk> need redress for medical incompetence, but there's gotta be a better way.

No doubt.  For starters, it might be a good thing if physicians
and dentists would pressure licensing boards to do their job
to eliminate fraudulent and incompetent practitioners from the
ranks.  It would also be useful if more doctors would have the
guts and integrity to speak the truth vis-a-vis incompetence
and malfeasance, instead of adopting an "it's us vs. them" attitude
in response to trouble reports.

Consider the case of obstetrician, Dr.  James Burt, for example.  
Burt was a popular physician in Akron, Ohio, who was considered 
to be the doctor-of-choice in the mid-80's among affluent 
pregnant women in Akron who could afford his high fees.  What 
Burt's patients didn't know was that he was in the habit of 
sexually mutilating many of them, in grotesque and bizarre ways, 
when they were under the influence of the general anesthesia that 
he typically recommended.  [It's tough to carve-up epidural 
patients without attracting their attention].  

One of Burt's patients was outraged, as we might expect, when she 
discovered the manner of her mistreatment.  She filed a 
malpractice suit, but was unable to find a single specialist in 
Ohio willing to testify that Burt had violated the standard 
of obstetrical care.  Lacking expert testimony, the attorney 
handling the case had no choice but to let it drop, and Burt 
continued to mutilate women.  

In the end, Burt was obliged to give up his license volontarily,
not because of an initiative on the part of the licensing board
or other obstetricians, but because the media got wind of the
coverups and began publishing some of the atrocity stories.

Incidently, several years previously the Cleveland Plain Dealer 
had published a weeklong expose of the Ohio's board's failure in 
disciplining doctors.  According to Charles Inlander, et al, 
_Medicine on Trial_ (Pantheon Books: NY, 1988, p. 186), the 
board's motives for granting leniency in cases brought to its 
attention included the following: 

  -- a doctor's confession of wrongdoing
  -- a doctor's inability to make a living outside his practice
  -- the embarrassment that a doctor might suffer if disciplined  
  -- the belief that an appearance before the board was sufficient
     punishment   

-- 
Russell Lawrence, WP Group, New Orleans (504) 443-5000
russ@wpg.com   uunet!wpg!russ
Newsgroups: sci.med,talk.politics.drugs,pnw.general