MICRA, approved by California voters in 1974, limits noneconomic damage payouts in medical malpractice cases and has been the main reason medical liability insurance rates in the state are only in the middle of the pack nationally despite the state’s long-earned reputation as one of the most litigious in general. Focus-group research led trial lawyer advocates to tack on a provision prescribing drug testing for doctors to improve the measure’s chances [James Hay, San Diego Union-Tribune; Legal NewsLine and more; ABA Journal] Some predict that the impending lawyers-vs.-doctors battle, with various allies brought in on both sides, will be the most expensively fought ballot measure in history. Earlier coverage of MICRA here.
The charts in this Washington Post article get steadily more interesting as they go along, and the most informative is the last: the top nine states or state-equivalents for per-capita medical malpractice outlays are, in order, New York, Pennsylvania, New Jersey, Massachusetts, Connecticut, the District of Columbia, Maryland, Rhode Island, and New Hampshire. Basically, that describes the Boston-Washington corridor with the exception of Delaware (Vermont makes for an even more notable break in the pattern because its outlays are among the lowest.) Most states outside the Northeast have reformed their malpractice law; most states in the Northeast have too powerful a trial lawyers’ lobby to let that happen.
Fortunately for residents of the rest of the country, the inconveniences of an unreformed high-litigiousness system — things like $100,000 premiums for doctors with good records who practice high-risk specialties — seem mostly to be borne by residents of the states in question. Overall, incidentally, as the chart previous to that shows, national payouts went through a decade-long decline but now have resumed climbing.
Until recently, Florida would have been a likely pick when enumerating states with the highest medical malpractice exposure, but the Sunshine State legislature finally got tired of being a target of the derision of the national medical profession and reformed its malpractice system. Or perhaps the better phrase would be, “thought it reformed”; the Florida Supreme Court, dominated by justices cozily allied with the plaintiff’s bar in re-election campaigns, just annihilated that reform. No one will be particularly surprised if Florida vaults up to top-ten status in future payout lists.
In the season’s highest-profile case of alleged medical negligence, 13-year-old Jahi McMath, described as suffering from sleep apnea, went in to Oakland Children’s Hospital for surgery. After the surgery she began bleeding profusely, went into cardiac arrest and suffered brain death.
A hundred press accounts have described the procedure McMath underwent as a “routine tonsillectomy.” Not so, according to Brandon Peters, M.D. at About.com:
There is a paucity of known facts in this situation. The family and their lawyer have released few specific details. Oakland Children’s Hospital, bound by the privacy restrictions of the Health Insurance Portability and Accountability Act (HIPAA), has offered even less. Jahi underwent three surgical procedures for the treatment of her sleep apnea. This included a tonsillectomy, uvulopalatopharyngoplasty (UPPP), and removal of nasal turbinates. Though initially described as a “routine tonsillectomy,” this degree of surgery in children is not routine. It is extensive. When performed on a child, the risk is high.
More here and on uvulopalatopharyngoplasty (or “UP3″) and its indications and risks here. It should be apparent that with the sparsity of facts agreed on it is still extremely early to begin speculating what went wrong in McMath’s case and what kind of medical negligence if any might have been involved. (& Alkon)
“A federal appeals court has shot down a Massachusetts consumer protection case against two doctors, a medical journal and its publisher over an allegedly flawed article cited by defendants in birth-injury medical malpractice cases. That means plaintiffs’ attorneys will have to challenge the article’s validity in each case in which the defense wishes to cite it.” The First Circuit did not reach the issue of constitutional free speech, but upheld a lower court’s ruling that the plaintiff had not shown adequately that expert testimony reliance on the allegedly faulty article had resulted in the loss of the litigation in question. [Sheri Qualters, NLJ] Earlier on A.G. v. Elsevier here.
A plaintiff’s lawyer is suing a medical journal and two doctors for publishing a case report that makes it harder to win some birth-injury lawsuits.
Here are the details, as reported by Sheri Qualters of the National Law Journal. Some newborns are found to be suffering from brachial plexus injury, a type of harm to a child’s shoulder, arm, or hand that in a minority of cases results in permanent disability (so-called Erb’s palsy or a number of related conditions). A large volume of birth-injury litigation goes on as a result, in part because courts have tended to accept the idea that the only medically recognized cause of those conditions in newborns is excessive or traumatic use of physical force by clinicians (“traction”). In 2008, however, the American Journal of Obstetrics & Gynecology published a case report of a delivery in which an infant was found to be suffering such injury although the physician by her own account had not applied any excessive traction during the birth. If instead natural forces of labor could cause the dislocation resulting in the condition, many lawsuits might rest on shakier ground. Since then, defense lawyers have cited the report — by Henry Lerner of Harvard Medical School and Eva Salamon of the Bond Clinic in Winter Park, Fla. — in litigation.
A Boston lawyer who claims to have debunked the Lerner-Salamon case study has proceeded to sue its two authors, Elsevier — which publishes AJOG and many other medical and scientific journals — and Dr. Salamon’s clinic for publishing and refusing to retract it. The damages are said to be $3 million each to two families of infant plaintiffs whose lawsuits did not succeed allegedly because of the case report. The lawsuit invokes a Massachusetts consumer protection law which allows treble damages, and also asks for a court order forbidding the report to be entered as evidence in future litigation. A trial court dismissed the case, in part on the grounds that the plaintiffs had not shown that the article was a material cause of the families’ failure to prevail in the suits. Now the case is on appeal to the First Circuit, where defense lawyers are arguing, inter alia, that if there are weaknesses in the article the remedy for plaintiffs is to introduce evidence to that effect to counter it in trials. “As for its own role, Elsevier argued that applying a state consumer protection law to its published material would violate its free-speech right under the First Amendment.”
First Amendment? Let’s not go to extremes. If we start applying the First Amendment, how are lawyers supposed to silence publications that inconvenience them?
Our “watch what you say about lawyers” tag — which perhaps we should rename as “watch what you say about lawyers or their cases” — is here (cross-posted at Cato at Liberty; & welcome readers from Jesse Walker, Reason, Prof. Bainbridge).
That’s former Obama Administration budget director Peter Orszag’s view [Bloomberg]:
Most of the costs in the U.S. health-care system are incurred in a small number of expensive cases. The top 25 percent of Medicare beneficiaries ranked by cost, for example, account for 85 percent of total spending. And the expenses in those cases are driven significantly by the recommendations that doctors make to pursue one treatment path and not another.
In making these choices, doctors are influenced by various things, including medical-school training, traditions among their peers, financial incentives (which are distorted by fee- for-service payments) and, yes, the medical-malpractice system. Improving the criteria for what constitutes appropriate care could significantly change doctors’ behavior and also save money, recent research by Michael Frakes of Cornell Law School suggests.