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medical malpractice

Medical roundup

by Walter Olson on September 10, 2014

  • ObamaCare challenge: D.C. Circuit vacates Halbig decision for en banc rehearing [Roger Pilon, earlier]
  • ACLU and SEIU California affiliates oppose trial lawyers’ higher-damages-plus-drug-testing Proposition 46 [No On 46, earlier] As does Sacramento Bee in an editorial;
  • Rethinking the use of patient restraints in hospitals [Ravi Parikh, Atlantic; legal fears not mentioned, however]
  • Certificate of need regulation: “I didn’t know the state of Illinois had a standard for the maximum permissible size of a hospital room.” [John Cochrane]
  • In China, according to a study by Benjamin Liebman of Columbia Law School, hired malpractice mobs “consistently extract more money from hospitals than legal proceedings do” [Christopher Beam, The New Yorker]
  • Overview of (private-lawyer-driven) municipal suits on painkiller marketing [John Schwartz, New York Times, earlier] More: Chicago’s contingency deal with Cohen Milstein on opioid lawsuit [LNL]
  • “So In The End, The VA Was Rewarded, Not Punished” [Coyote]

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Medical roundup

by Walter Olson on July 9, 2014

  • Congress responds to Veterans Administration health care scandal by throwing huge new sums at care [Nicole Kaeding, Chris Edwards, Cato] “Every Senior V.A. Executive Was Rated ‘Fully Successful’ or Better Over 4 Years.” [NYT via Instapundit] “VA Hospitals aren’t included on the federal government’s Hospital Compare web site” [White Coat]
  • Canadian judge quashes as vexatious suit over non-admission to medical school [Winnipeg Free Press]
  • Brain-damaged child cases: “14.5 Million Reasons Physicians Practice Defensive Medicine” [White Coat, Cleveland] “North Carolina Jury Deadlocks in John Edwards’ Malpractice Trial Against Doctor” [Insurance Journal, emergency medicine]
  • “Medical Licensing in the States: Some Room for Agreement — and Reform” [Charles Hughes, Cato]
  • “NY Launches Statewide Med Mal Settlement Program” [NYDN via TortsProf]
  • “Unlucky Strike: Private Health and the Science, Law and Politics of Smoking” [John Steddon and David Boaz, Cato program] Here’s the long-awaited segue to complete prohibition: British Medical Association recommends banning tobacco permanently for persons born after 2000 [WaPo]
  • Sneaky: California ballot language undoing MICRA liability limits “buried in an initiative titled The Troy and Alana Pack Patient Safety Act of 2014.” [Yul Ejnes, KevinMD]

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.

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Medical roundup

by Walter Olson on April 17, 2014

  • Academics have underestimated sensitivity of medical system to liability pressures [Michael Frakes, SSRN via TortsProf]
  • “Nobody has gone out and bought a new home” — Mark Lanier talks down his verdict knocking $9 billion out of Takeda and Lilly after two hours of deliberation by a Lafayette, La. jury [Reuters] Japanese drugmaker says it had won three previous trials [ABA Journal]
  • Nursing home in living-up-to-its-name town of West Babylon sued over hiring male strippers to entertain residents [NYP, more (wife of complainant attended display), ABA Journal]
  • “Reining in FDA regulation of mobile health apps” [Nita Farahany, Volokh/WaPo]
  • Another setback for plaintiffs as Arkansas tosses $1.2 billion Risperdal marketing case against Johnson & Johnson [AP/Scottsbluff Star-Herald, Eric Alexander/Drug and Device Law, earlier here and here]
  • “Spacecraft collision injuring occupant”: docs scratch their heads at new revamp to billing codes [Steven Syre, Boston Globe via Future of Capitalism]
  • FDA preclearance, drug litigation: “Most [patients] never know they were harmed, because we never know what we might have had.” [John Stossel]

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Medical roundup

by Walter Olson on March 31, 2014

  • Latest don’t-blame-the-regulators shortage of a generic medical supply is nitroglycerin for acute cardiac care [New York Times, ACSH]
  • “Does Medical Malpractice Law Improve Health Care Quality?” Maybe not so much [Michael Frakes and Anupam Jena, SSRN via Tyler Cowen]
  • “Affordable Care Act opening doors to IT security attacks” [Ponemon via Fierce CIO] “States Barred from Requiring Obamacare Navigators Carry Error and Omission Insurance” [Craig Gottwals, Benefit Revolution] On suspension of statutory dates, Rule of Law has scanty constituency [Ramesh Ponnuru]
  • “Video Debate: Richard Epstein and Ryan Abbott on FDA, Off-Label Drug Use” [Bill of Health]
  • “Trial lawyers helped FDA with rule opening generic drug firms to lawsuits” [Paul Bedard, Washington Examiner]
  • Everyone including the agency itself discontented with FDA’s handling of new sunscreen ingredients [WaPo via Alex Tabarrok]
  • Does writing up a more careful patient chart help keep a doctor from getting sued? [White Coat]

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.

Medical roundup

by Walter Olson on March 14, 2014

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Medical roundup

by Walter Olson on February 10, 2014

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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)

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Medical roundup

by Walter Olson on November 13, 2013

  • Pressure from HHS leads day cares to ban practice of baby-swaddling, and not everyone’s pleased about that [Abby Schachter, Reason]
  • “If Big Pharma likes your healthcare plan, you can keep it” [Tim Carney]
  • For “those of us with polycystic kidney disease… stringent FDA regulation seems to be taking away hope” [Bill Brazell, Atlantic] And: speaking of the FDA, “Dallas Buyers Club Is a Terrific Libertarian Movie” [David Boaz, Cato] Also: New Peter Huber book, “The Cure in the Code: How 20th Century Law Is Undermining 21st Century Medicine” [Basic/Manhattan Institute, Wired]
  • $7,440 annual expected loss per hospital bed in Florida vs. $810 in Minnesota, and other med-mal loss statistics [Becker's Hospital Review via TortsProf]
  • Charge: black lung defense firm finds ways to conceal medical expert reports from adversaries [Center for Public Integrity via Joe Patrice, Above the Law]
  • Prescribing drugs for off-label uses is perfectly legal, but Johnson & Johnson will pay $2.2 billion for promoting the practice [Ann Althouse]
  • Jury awards $4 million legal malpractice verdict against prominent D.C.-based plaintiff’s firm [Richmond Times-Dispatch via White Coat]
  • “Can You Secretly Record the Medical-Legal Exam?” [Eric Turkewitz]

Medical roundup

by Walter Olson on October 25, 2013

  • Sen.-elect Cory Booker (and Mayor Bloomberg too) on liability reform and fixing health care [NJLRA] How plaintiff’s lawyers get around caps [Alex Stein, Bill of Health] Missouri protects health volunteer workers [John Ross]
  • Like an Ayn Rand novel: Massachusetts ballot initiative pushes confiscation of private hospital profits [Ira Stoll, NY Sun]
  • Advice: plan now to lower your 2014 income to get valuable ObamaCare subsidies [San Francisco Chronicle]
  • Medicare comes off poorly: “Quality Of Care Within Same Hospital Varies By Insurance Type” [Tyler Cowen]
  • Revisiting a panic over alleged mass drug injury: “Avandia’s posthumous pardon” [David Oliver, earlier here and at Point of Law]
  • Louisiana lawmakers use malpractice statute to discourage abortion [Alex Stein, Bill of Health]
  • Georgia committee looks at plan to replace med-mal suits with administered compensation [Georgia Report via TortsProf, Daily Report Online (constitutionality), Insurance Journal]
  • Uwe Reinhardt on professional licensure and doctors’ monopoly [David Henderson]

“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).

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Medical roundup

by Walter Olson on August 22, 2013

  • No, ma’am, I’m not going to diagnose your kids with PTSD after your low-speed auto accident, but I’m sure some other doc will [White Coat]
  • In time to avert catastrophe? “FDA reboot of antibiotic development” [David Shlaes] Role of price controls in shortages of sterile injectables [ACSH]
  • Trial lawyers launch campaign to roll back MICRA, law that has limited California med-mal payouts [KPBS, L.A. Times]
  • DNA panopticon beckons: “Mississippi law requires cord blood from some teen moms” [Emily Wagster Pettus, AP, earlier]
  • Dear N.Y. Times: please make up your mind whether it’s OK to break health privacy laws [SmarterTimes]
  • Committee of AMA decides on schedules by which doctors are paid. And you were expecting it to be done how? [Arnold Kling]
  • “The more your doctor worries about getting sued, the more you’ll end up spending on medical tests” [MarketWatch on Michelle Mello study in Health Affairs] Oklahoma high court used strained rationale to strike down certificate of merit law [Bill of Health]

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Medical roundup

by Walter Olson on July 16, 2013

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Medical roundup

by Walter Olson on June 6, 2013

  • New ACA regulations from the feds restrict employer wellness programs [Jon Hyman; Leslie Francis, Bill of Health]
  • Frequent-flyer defense medical examiner comes to grief in New York [Eric Turkewitz]
  • Fecal transplants (that’s not a misprint) appear to hold out hope of saving a lot of lives, except for the mountain of FDA paperwork blocking them [Amar Toor/The Verge, Maggie Koerth-Baker] Enter the grey market [Beth Skwarecki]
  • Why can’t the FDA catch up with Europe on sunscreens? [Alex Tabarrok]
  • “The banning of catastrophic-only plans infuriates me the most…. the only plans that are actually financially sensible for a healthy individual to purchase.” [MargRev comments section]
  • More on the recent study of malpractice suits by a group of Johns Hopkins researchers [Christopher Robinette]
  • For all his public health pretensions, Michael Bloomberg “has no idea what he’s talking about” on medical marijuana [Jacob Sullum]
  • Another look at asylums? [James Panero, City Journal]
  • Feds’ war on Google pharma ads reflects no credit on D.C. [Brian Doherty]

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Medical roundup

by Walter Olson on May 15, 2013

  • Hit by stray bullet, wakes from anesthesia fighting, hospital told to pay $17 million [Georgia; Insurance Journal]
  • Study: physician’s previous paid claims history has no impact on odds of catastrophic med-mal payout [Bixenstine et al, JHQ via PoL] Overall, med-mal payouts have fallen steadily in past decade; $3.6 billion figure last year follows strongly regionalized pattern with top per capita figures all in Northeast [Diederich analysis of annual payouts via TortsProf] Florida law now requires that testifying medical witness be in same specialty as defendant [Business Week]
  • In lawsuits alleging “wrongful birth,” what’s the measure of damages? [Gerard Magliocca, Concurring Opinions]
  • ObamaCare exchanges in D.C., California and Connecticut declare smoking “pre-existing condition,” say insurers can’t base higher rates on it [Kevin Williamson, NR]
  • “The Crime of Whitening Teeth with Over-the-Counter Products” [Caleb Brown, Bluegrass Institute]
  • How not to die: Jonathan Rauch on end-of-life overtreatment [The Atlantic]
  • “I’m going to start a rumor that Sudafed is an abortifacient. Then the feds will finally have to allow reasonable access to it.” [me on Twitter]

Medical roundup

by Walter Olson on April 8, 2013

  • “It Didn’t Feel Like a ‘Win’” ["Birdstrike, M.D."/White Coat]
  • Federal ban on long shifts by hospital residents may have harmed safety, in part because it drove up number of patient handoffs [USA Today]
  • N.J. bill would narrow chance for suits against first aid, ambulance and rescue squads [NJLRA]
  • Bill in Georgia legislature aims to apply workers’-comp-like principles to med-mal [Florida Times-Union]
  • I mostly agree that med-mal reform is for states to decide, but Ramesh Ponnuru may underrate Washington’s legitimate role in prescribing legal consequences when it pays for care [Bloomberg/syndicated]
  • Shift burdens through price control: NJ assemblyman’s bill would prohibit insurers from considering docs’ claims experience except for cases that result in actual court findings [NJLRA]
  • Someone’s hand stuck in the sharps box again? Sixth time this month [Throckmorton]

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