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.
The Jacksonville, Fla. paper runs a dramatic photo from a lawyer’s office arising from a medical malpractice lawsuit. White Coat finds evidence that the circumstances of the photo-taking were less than ideally spontaneous [EP Monthly]
New research by Michael Frakes of Cornell: “I estimate a small and statistically insignificant relationship between malpractice forces and two metrics of healthcare quality emphasized by the Agency for Healthcare Research and Quality: avoidable hospitalization rates (reflective of outpatient quality) and inpatient mortality rates for selected medical conditions.” [SSRN]
On July 12 New York Times columnist Jim Dwyer wrote an extensive story about the death of a 12-year-old boy who had been brought to an emergency room with fever and rapid pulse, sent home, and died of septic shock. Lab test results and other indicators of distress allegedly went unheeded, and the boy’s family is represented by Thomas Moore, perhaps the city’s premier medical malpractice lawyer. Some legal blogs had a field day citing Dwyer’s article as an example of flagrant medical malpractice, as they depicted it; other reactions, some gathered in a Dwyer follow-up column, were more mixed.
White Coat, the blog at Emergency Physicians Monthly, has been resistant to the Dwyer-Moore narrative of the case. Its blog posts can be found here,
here, here, and here.
I’ve got a piece in today’s New York Post on why doctors and medical providers should be interested in New Hampshire’s first-in-the-nation “early offers” experiment in malpractice reform. Earlier here, etc. Note also that Christopher Robinette at TortsProf has added to his illuminating series of posts on the idea with new contributions here and here (& Allen McDuffee, Washington Post “Think Tank”.)
Overriding a veto from Gov. John Lynch, the New Hampshire legislature on June 27 enacted SB 406, establishing the nation’s first “early offer” system for medical malpractice claims. The law establishes incentives for defendants to make offers early in the litigation process that cover plaintiff’s economic losses such as medical bills and lost wages. The early-offer process is at claimants’ option only; claimants are free not to request such an offer. [Kevin Pho; supportive website; trial lawyers' opposition website]
Importantly, the new procedure also contains pioneering elements of loser-pays in both directions. If a claimant chooses to accept a defendant’s early offer of economic-loss expenses, the defendant will pay an additional sum to reflect a scheduled assessment of pain and suffering, plus the reasonable costs of attorney representation. However, if the claimant invokes the early-offer process but then turns down the offer as inadequate, there is a real risk of a fee shift in the opposite direction:
XII. A claimant who rejects an early offer and who does not prevail in an action for medical injury against the medical care provider by being awarded at least 125 percent of the early offer amount, shall be responsible for paying the medical care provider’s reasonable attorney’s fees and costs incurred in the proceedings under this chapter. The claimant shall certify to the court that bond or other suitable security for payment of the medical care provider’s reasonable attorney’s fees and costs has been posted before the court shall consider the case.
At TortsProf, Christopher Robinette explains in some detail (contrary to an error-filled screed in a Litigation Lobby outlet) why this adds up to a generally good deal for claimants (who, of course, are free not to trigger the process if they disagree) as well as making the system fairer. “Early-offer” proposals have been championed over the years by Jeffrey O’Connell, the distinguished University of Virginia torts scholar, and by Philip K. Howard of Common Good, among others. More on loser-pays here.
[Research assistance: Cato Institute intern Byron Crowe; cross-posted at Cato at Liberty]
More from John Steele Gordon at Commentary: “This looks like a big step in the right direction.”
Covered it in a roundup a couple of weeks back, but as a reader favorite it may as well have its own post: “A jury has awarded a Georgia woman $3 million over her husband’s heart attack, finding that his doctor should have warned the Atlanta cop against strenuous activity like the three-way sex he was having at the time he died, WXIA-TV reports.” The deceased was not married to either of the other participants in the fatal motel-room encounter. [USA Today/Freep]
Which of course will die in the Senate as usual [TortsProf] I discussed the federalism problems with this class of bills last year.
According to what seems to be the sense of many in the Florida legal profession, doctors and their patients should not have the right to enter enforceable arbitration agreements before the fact to resolve disputes, but lawyers and their clients should have the right to enter enforceable agreements before the fact to limit liability for excessive charging of legal fees. Thanks for clarifying! [White Coat, scroll; earlier]