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Malpractice myths and coverups.

Mention the subject of medical malpractice, and the debate will most likely focus on money-hungry patients exaggerating their frivolous injuries, evil insurance companies squeezing money from hard-working doctors, or a corrupt cabal of reckless physicians leaving wristwatches and sponges inside of every third patient.

A study published in the May 11, 2006 issue of New England Journal of Medicine (354:2024-2033) showed the results of research to investigate how much of the blame frivolous malpractice suits deserve. The study centered on five large malpractice insurers that offered their records for review. The records came from 1,452 cases settled between 1984 and 2004 in the areas of obstetrics, surgery, missed or delayed diagnoses, and medication errors.

The results showed that in 563 cases (39 percent), either the plaintiff was not culpable, or the blame fell on the defendants. Of those cases, only 151 cases (27 percent) resulted in payment. Contrast those results with the 889 cases (73 percent) that resulted in payment after it was noted that the doctor or physician in question was found to be at fault. The amount of payment in cases where there was no error on the part of the doctor was, on average, also 40 percent less.

These numbers--when translated--indicate that frivolous (or even false) claims of malpractice contribute little to the volume of medical litigation and the drain on malpractice insurance companies.

In fact, reports about skyrocketing medical malpractice insurance rates are mostly untrue. According to Public Citizen, a national nonprofit public interest organization, the total cost of medical malpractice premiums increased by 18.9 percent--less than four percent a year--between 1996 and 2000. These numbers keep pace with the rate of medical inflation, which increased by 17.6 percent in the same years. In 1997, doctors paid 25 percent less of their average annual incomes to malpractice insurance agencies than they did in 1985.

Although it is true that there was a spike in malpractice insurance premiums between the years 2000 and 2001, when premiums rose 10 percent for the three riskiest fields, these numbers kept pace with other premium costs from other fields. For example, automobile insurance premiums rose by 8.4 percent in the same time period. The same was true for homeowner's insurance and health insurance premiums, which rose 8 percent and 11 percent in that time period, respectively.

Even with the gradual increase of premium costs, the number of claims of malpractice per 100 doctors has remained remarkably constant. In 1991, the number was 16.8 percent; in 1996, it was 16.7 percent. More recent data are not readily available, because many of those claims have not yet been closed. In 1991, the average malpractice payout was $29,093. In 1996, that number rose slightly, to $29,504.

It is the recidivists who are the problem--doctors who repeatedly practice bad medicine and who are consistently let back into hospitals and clinics to do it all over again.

In Texas, for example, 322 physicians made four or more payments for malpractice between the years 1990 and 2003. Of those 322, only 50 had been disciplined. Medical boards--most of which are quite aware of who the repeat malpractice offenders are--routinely fail to weed out the bad doctors who harm their patients.

One look at the National Practitioner Data Bank shows 45 doctors who are licensed in Texas and have six or more malpractice payments. Their names have been removed from public record, but they are referred to by numbers. They include:

* Physician 35749: settled eight malpractice lawsuits between 1991 and 2001. His offenses involved a lack of informed consent to perform surgery, delayed diagnosis, four incidents of improper surgical performance, and improper management of a surgical patient. Total payments: $347,250.

* Physician 35846: settled nine malpractice lawsuits between 1992 and 2002. Payments included improper management of course of treatment, one treatment-related problem, and failure to supervise treatment. Total payments: $1,995,000.

* Physician 36243: settled six malpractice lawsuits between 1990 and 1999. Included were improper performance of surgery, one treatment problem, an anesthesia problem, failure to diagnose, and improper management of medication regiment. Total payments: $1,640,000.

* Physician 36270: settled eight malpractice lawsuits between 2002 and 2002 for two incidents of wrong diagnosis, surgery on the wrong body part, a treatment problem, and unnecessary surgery. Total payments: $2,925,000.

* Physician 36361: settled eight malpractice lawsuits between 1991 and 2001 for four incidents of improper surgical performance, unnecessary surgery, and others. Total payments: $2,571,250.

* Physician 36396: settled six malpractice lawsuits between 1991 and 2001 for failing to diagnose, two incidents of delay in diagnosis, improperly performed C-section, failure to treat fetal distress, delay in delivery, improperly managed labor, and an obstetrics-related problem. Total payments: $1,132,500.

None of the physicians has been disciplined by the state of Texas.

The problem here may lie with state medical boards. These governing bodies are responsible for licensing and disciplining physicians and health care workers. These organizations have the power to fine the doctors with the worst malpractice records and punish them or remove them from practice entirely.

According to the Reno Gazette-Journal, 476 doctors in Nevada made a total of $217.2 million in malpractice payments since 1996. Of those doctors, 50 were responsible for $99.7 million, or 46 percent of the payments. Only four of those 50 doctors were subject to formal complaints by the Nevada medical board. The most-sued doctor, who has 24 malpractice settlements totaling almost $15 million dollars, moved to California to avoid discipline and never missed a day's practice.

Certification by the states' medical boards is no guarantee against malpractice. If patients do their research and find a doctor on the list of state board-certified doctors, there is no guarantee of the quality of care that physician will provide. This is because certification is a one-time process that lasts a lifetime. Continuing education is not mandatory of for doctors or physicians. A doctor who received certification in 1960 would not be required to prove his or her knowledge of current procedures and technology in the year 2006. This could lead to any number of problems.

Another "solution" offered for frivolous malpractice lawsuits is to install a cap on the amount of money a wronged patient can receive per case. In reality, total malpractice premiums as a percent of the total cost for health care accounted for just $.56 out of every $100 in the year 2000. If the government took the cap solution to the extreme and removed any rights of consumers to hold their doctors and other health care providers responsible for monetary damage, the savings would amount to one-half of 1 percent of every dollar spent on health care.

PricewaterhouseCoopers, a national auditing and assurance company, stated in a report that while health insurance premiums increased an average of 13.7 percent from 2001 to 2002, less than 1 percent of that increase is attributable to the cost of litigation and malpractice.

The only true solution to these, problems is transparency and accountability at the medical board level. Until those doctors who commit serial malpractice are singled out and disciplined, patients will continue to be in danger.

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Title Annotation:medical malpractice
Publication:Nutrition Health Review
Geographic Code:1USA
Date:Jun 22, 2005
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