Warning: the legal system may be hazardous to your health.

The Bush administration's initiative to reform medical malpractice laws should raise the larger question about the consequences of a legal system that bestows astonishing awards for pain and suffering. While the economic impact of these payments is obvious, the health consequences to those involved in litigation resulting from injury in an accident is an issue that policymakers should study carefully. There is evidence that injured parties who get involved in the legal system are at greater risk for poor medical outcomes than those who don't litigate, and any debate on the issue of tort reform should take this information into account.

In 1995 Saskatchewan, Canada, switched to a no-fault legal system for personal injury while increasing medical and income-replacement benefits for injured parties. To study the impact of the elimination of payments for pain and suffering in the province's tort-compensation system, Canadian researchers compared the number of whiplash injuries that came to medical attention in the period immediately preceding the change in the law (3,046) to two comparable periods following the change. [In the two six-month periods following reform there were 2,230 and 2,186 claims, respectively.] They also looked at the time from the date of injury to closure of a claim, intensity of neck pain, level of physical functioning, and the presence or absence of depressive symptoms.

For the injured parties in the study, the duration from injury to closure following tort reform was significantly less than was the case in the previous year. They also had less neck pain, a higher level of physical functioning, and fewer depressive symptoms. The authors concluded that the type of insurance system had a major effect on the number of claims and duration of symptoms for whiplash injuries and that injured parties recover faster if lavish awards for pain and suffering aren't available.

This study, based on a research design that the scientific community holds to be inferior to prospective studies, doesn't prove that litigation causes prolonged recovery from whiplash. It does, however, reveal a thought-provoking association between financial compensation and adverse therapeutic results. Other studies have noted similar findings. A paper published in the journal Rheumatology found that the involvement of financial compensation for patients with neck pain that traveled down one arm resulted in a negative effect on treatment compared to those who chose to forego litigation.

As a physician who has dealt with personal injury cases, I can say that the above-cited research resonates with my impression of the consequences of patients' involvement in the legal system. It also makes me wonder if the availability of gargantuan awards for medical malpractice cases affects peoples' health. Though the paper on whiplash doesn't directly address the effect of litigation on patients who suffer a suboptimal outcome from medical care, comparisons are obvious. Malpractice litigation involves a form of personal injury and, in our society, victims in either case can receive virtually limitless monetary awards. It isn't a stretch to think that the risk to health for injured patients seeking legal redress is entirely analogous to people injured in a nonmedical setting.

This type of research has sparked a view of pain that transcends the purely biological analysis. The statement of a prominent physician on back pain provides insight into this school of thought. Richard Deyo, a respected and frequently published investigator of back pain, has written that it seems reasonable to assume that biological factors alone are insufficient to explain prognostic factors in the recovery of an injured party. He says that social influences, especially in the form of legal and economic incentives, also appear to be critical.

It is clear that the current malpractice insurance crisis is having a profound effect on the cost, and even the availability, of health care. In 1996 the median award (the award value ranked in the middle of awards listed by value) to plaintiffs in medical malpractice cases was $503,000. By 2000 this rose to $1 million. Moreover, reports of physicians leaving practice due to their inability to obtain either reasonable malpractice insurance rates or any malpractice insurance are becoming commonplace.

There is now evidence, however, that the tort-compensation system can also have an adverse effect on health. The national debate on medical malpractice reform should include acknowledgement that our system of injury compensation can provide the setting for suboptimal recovery from injury. This possibility, and the fact that legal costs are an increasingly large part of our nation's health care bill, could result in the judgment that the combined economic and medical costs of our current tort-compensation system may now outstrip any benefit to society that the prevailing system may provide.

Jim Whalen is a freelance medical writer who can be reached at [e-mail].