Overlawyered: Chronicling The High Cost Of Our Legal System

Location, Location, Location

Opponents of medical malpractice tort reform often argue that malpractice premiums are on the rise because insurance companies made bad investments, not because of out-of-control jury awards. But, if that’s so, then why do premiums vary so widely by geography? Consider the rates in Cleveland, Ohio, a city that can lay claim to some of the most aggressive trial lawyers in the state, as well as some of the most generous juries:

A comparison of standard, non-discounted rates the American Physicians Assurance Corporation charges in Ohio, Illinois and Michigan shows doctors in Cuyahoga County paying the highest rates in almost every category, and nearly double the Columbus tariff.

For instance, neurosurgeons in Cuyahoga County paid $212,000 annually, while their colleagues in Columbus paid $118,000 in malpractice premiums. Doctors in the high-risk specialties also paid about $20,000 less in Chicago and Detroit than their counterparts in Cuyahoga County.

‘The fact is, a day doesn’t go by when a Northeast Ohio doctor doesn’t get sued for multimillions of dollars,’ says Myers.

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They Mind Very Much If You Smoke

Retired history professor, and former smoker, Robert Zangrando is suing his next door neighbor for smoking. The neighbor, who isn’t allowed to smoke inside her rented condominium, smokes outside on her patio, where the fumes evidently waft into the professor’s condo. The lawsuit, filed in January, was slated to begin this month, but has been delayed until September. In those intervening months, his neighbor has agreed to smoke in her backyard during only the first fifteen minutes of every hour. She’s also decided to move her family to a new neighborhood. Conflict resolved, right? Wrong. Zangrando is still pursuing his case. He’s charging her with battery and trespass and wants $50,000 in damages. The former smoker blames his neighbor’s smoking, not his own, for his declining lung capacity.

The report in the The Cleveland Plain Dealer notes that there has been an increase in these second-hand smoke lawsuits:

Secondhand smoke often leads to conflicts, and more than 420 lawsuits involving secondhand smoke have been filed in the last 25 years, according to research by Edward Sweda Jr., senior attorney for the Tobacco Control Resource Center at the Northeastern University School of Law in Boston.

“There have been an increasing number of lawsuits in recent years that corresponds to people’s increased awareness of secondhand smoke and the physical harm it can cause,” he said, “and the gradually increasing societal disfavor of tolerating such exposure.”

Well, it’s not just due to an increased awareness, it’s also due to the work of legal activist groups like this one.

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A 1 in 1.09 quintillion chance

A North Carolina woman sued a hospital for failing to correctly diagnose her husband’s cancer. Except they did diagnose it correctly:

…Linda Brown alleged that Charlotte Regional contaminated tissue samples during a lung biopsy in 2000 which resulted in the wrong cancer diagnosis of small cell lung cancer. … Brown’s attorneys argued that due to hospital technicians not wearing gloves or due to unsanitary conditions, Gerald Brown’s tissue was contaminated with someone else’s DNA.

The defense argued that’s nearly impossible because someone would have had to actually have lung tissue containing the cancer cells on his fingertips while when he handled the sample.

The hospital’s attorneys argued during opening statements last week that the chances of Gerald Brown’s DNA being contaminated was 1 in 1.09 quintillion. In fact, the chances of that happening may be even greater since that one-in-a-quintillion person would have to be in Punta Gorda, inside Charlotte Regional, having a lung biopsy at the same time and have small cell lung cancer. But no one else in the hospital was undergoing a lung biopsy at the same time as Gerald Brown on March 22, 2000.

The jury ruled in favor of the hospital, but the case took four years and several hundreds of thousands of dollars to defend. That’s OK with Mrs. Brown, because now she knows “the truth.” Apparently, neither she nor her lawyers, thought of having an autopsy to discover the truth. But then, autopsies cost money, with nary a chance of making money. Not even a 1 in 1.09 quintillion chance. (More: letter to the editor Aug. 16).

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Non-Partisan Report on Tort Reform

Point of Law points to the latest Congressional Budget Office report on tort reform, which concludes that non-economic damage caps do result in lower malpractice insurance premiums. They also decreased the practice of defensive medicine, at least when it comes to treating heart disease, without increasing mortality:

The authors found that the adoption of direct reforms led to a 6 percent drop in hospital expenditures for heart attack patients and a 9 percent decline for heart disease patients, with no significant change in mortality rates or cardiac complications.

They defined direct reforms as such measures as caps on punitive damages. Although it did take a few years to see the change in behavior and the reduction of malpractice insurance premiums, it appears from the report of this nonpartisan arm of the government, that tort reform works. Now can we give it a chance?

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Suffer the Poor

The practice of obstetrics is not easy. Doctors who deliver babies face long, late hours, life-threaatening complications that can spring up in a split second without warning, and the constant threat of litigation for events beyond their control. Now, the malpractice crisis is making it even harder, with doctors in crisis states like Pennsylvania finding themselves in a manpower crunch thanks to the exodus of obstetricians from the state. Not only are doctors leaving, but hospitals are shutting down their obstetrics departments:

According to the 2003 American College of Obstetricians and Gynecologists Survey on Medical Liability, 12.5 percent of OB/GYNs in Pennsylvania have stopped practicing OB and 57.5 percent have made some change in their practice because of issues with affordability or availability of liability coverage, including relocating, retiring, dropping OB, reducing number of deliveries, reducing amount of high-risk OB care, or reducing gynecological surgical procedures.

Those statistics, however, do not come close to revealing the extent of the current problem of obstetrician supply in the five-county Philadelphia region, which lost 25 percent of its staffed OB beds between 1993 and 2003, according to Delaware Valley Healthcare Council President Andrew Wigglesworth. Within the past 18 to 24 months, he says, the region lost 10 hospital OB departments, including those at MCP, Methodist, Nazareth, Warminster, Mercy Fitzgerald, Episcopal and Elkins Park; while OB services were also lost from hospital closures including City Line, Sacred Heart in Norristown and Community Hospital in Chester.

That means longer hours and a greater proportion of riskier cases for the hospitals and doctors who remain. Which means they’re more prone to errors. It also means that they can no longer spread themselves as thinly as they once did. Hospitals that once staffed inner city public health clinics are can no longer spare the staff to do so, leaving the poor without easily accessible prenatal care. Remember that the next time you hear John Edwards say that he has spent his career helping the down and out.

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The “litigatory equivalent of road rage”

Regarding a dispute between a townhouse owner and his homeowners’ association: “Their quarrel, which began over a basketball hoop and a parking space, has resulted in at least four separate actions, with an intimation of more to come. At a loss as to why so little has generated so much conflict, we can only surmise that we are in the middle of what may be the litigatory equivalent of road rage. The number of actions, the sheer ferocity with which they have been pursued, and the inconsequential nature of what has been sought offer us little hope that we are wrong in this assessment.” — Maryland Court of Special Appeals in Campbell v. Lake Hallowell Homeowner’s Association (PDF) (via Dave Stratton, Insurance Defense Blog, Jul. 19).

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Victory in St. Louis (again)

“Saying a newly revised Missouri law bars such legal action, a state appeals court refused Tuesday to reinstate the city’s [St. Louis’s] lawsuit that sought compensation from gunmakers, distributors and related trade groups for gun-related injuries. … Tuesday’s decision upheld a St. Louis County judge’s dismissal last October of the city’s 1999 lawsuit. In that ruling, Circuit Judge Emmett O’Brien said such lawsuits would open ‘a floodgate to additional litigation,’ and that ‘issues of both logic and fairness’ favored throwing out the case.” (Jim Suhr, “Appeals court rejects St. Louis city’s lawsuit against gunmakers”, AP/Kansas City Star, Jul. 27)(via Conservative Contrarian)(see Oct. 29).

More: One of the few bright spots for the anti-gun side has been a decision by the Indiana Supreme Court allowing the city of Gary’s suit to stay alive. The victory however was not exactly a famous one: “Although Indiana’s high court ruled that the city’s pleadings were legally sufficient, the unanimous panel expressed skepticism that Gary’s counsel could connect all of the links in the causal chain from manufacturer to injured party.” (Andrew Harris, “Court reinstates Indiana gun suit”, National Law Journal, Jan. 5).

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One Man’s Not So Unusual Experience

One of the most frustrating aspects of the medical malpractice business from the physician’s perspective is the seeming carelessness with which malpractice attorneys launch suits. It usually works like this: Someone has a bad outcome, say, in the hospital. The attorney gets the medical record, but he doesn’t use it to determine who is at fault. He uses it to collect all the physician names within it, from the doctor who saw the patient in the ER to the resident who ordered a Tylenol for a fever. The suit is then filed, naming every last doctor with a legible name. It’s only after the suit has been filed – and defense attorneys get involved – that the names are whittled down to who is deserving of being sued – a process that often takes months and thousands of dollars. In some cases, the lawyers don’t even make an attempt to determine if they have the right doctor, as in the case of this family physician from rural Oklahoma who was willing to share his story with Overlawyered:

I was served at my university job (where I was an academic fellow at the time) with papers for a lawsuit that at first blush looked absolutely horrific.? I think that there in fact were material questions of possible physician negligence that resulted in a patient’s death.? I was devastated, and began racking my brain trying to recall the specifics of this case (I had been an attending physician for a residency at the time I practiced there so it could have been any of a number of patients I had passing involvement in).? I went home and called my fiance and began to get very depressed.? Then I noticed something…the dates of the alleged incidents.? I HAD BEEN GONE FROM THAT HOSPITAL FOR OVER A YEAR AND A HALF BEFORE THIS PATIENT WAS EVER ADMITTED!!!? Apparently the order in question read “telephone order from Dr. A”.? It hadn’t been signed off, and the lawyer for some reason decided that I must be the “Dr. A” in question.?

Now here is where I think that he was negligent (defined by me as not taking reasonable measures to ensure he was naming people appropriately).? He had to ask the hospital’s medical staff office for a forwarding address, since I was gone.? Had he only asked, “When did this guy leave here?” he would have known he had the wrong doctor.

I called an attorney friend whose partner does medmal defense, and they managed to fire off a letter to the filing attorney and the court.? I was removed within a few weeks.?… Had I not called my friend first, but rather relied on the malpractice insurance carrier to do this for me, I would have had an open claim with costs incurred.? I would have had my insurance premium go up, and I would have had to forever list in credentialing documents that I had been sued.? As it is, multiple sources have advised me to not list this incident as I was ultimately “no suited”.?

When I asked multiple friends in the legal field about what possible complaint or discipline could be brought to bear, I was repeatedly told “nothing”.? I would have been thrilled if a letter apologizing for their error had been sent to me, but apparently apologizing (i.e. taking responsibility for ones incorrect actions) is not something that trial lawyers do.? Apparently, reckless behavior by an attorney in the name of “protecting the rights of his client” is allowed, no matter how negligent and regardless of its effect/potential effect on innocent third parties.

I have long past put this incident in perspective and resigned myself to the fact that the game as it is set up is inherently unfair.? To this day, though, I carry a small scar and a huge amount of fear/loathing for a system that allows bullies to run rough-shod over people with no chance of reining in their bad behavior.? Oh…by the way.? My attorney friend said that me having obtained the name of the actual Dr A involved (by way of asking the hospital risk manager, “who WAS the Dr. A who gave that order”…they found a signed note by him four pages away in the chart) and her giving it to the plaintiffs attorney was key in them dropping me without further question.

I’d like to reiterate, had I not done things the way I had, but rather called my insurer and had them handle it, it would have probably cost tens of thousands of their dollars to figure this out. Further, I would have had an open claim on my record and my rates would have been jacked up for several years…all because a lawyer wasn’t held accountable up front for reckless behavior.

There were about a dozen docs named in that suit initially. All but two were dropped within two months of the intial filing. My experience was apparently not unique.

Unfortunately, it isn’t unique, but all too commonplace. It is, in fact, the “standard of care” for plaintiff’s attorneys. When asked about the practice, even defense attorneys shrug and explain it’s a necessary evil. If a plaintiff’s attorney fails to name someone in the original suit, they can’t go back and add him. No one wants to explain to an angry client that they overlooked the person truly responsible.

And yet, this strikes us as a poor excuse for actions that have such far-reaching consequences for so many innocent bystanders. Prosecutors have to have fairly good evidence that they’re charging the right person before they file a criminal case. They don’t bring charges against everyone who ever encountered the crime victim. Shouldn’t malpractice attorneys have to live by the same standards?

MORE: Fellow medical blogger and Georgian surgeon Bard-Parker notes that doctors with illegible signatures get sued, too – as Dr. John Does (scroll down to “Itinerant Blogging”.

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Cerebral Palsy Turn Around

Michigan’s Supreme Court overturned a $21 million verdict in the kind of case that made John Edwards the man he is today. The Court ruled 6-1 that the basis of the jury’s decision in the original 1997 trial was faulty, because the expert witness testimony was faulty. Not that this means that the courts now recognize that cerebral palsy is rarely caused by birth injuries. Rather, the lower court failed to allow the defense an opportunity to object to the admission of the expert’s testimony. (An expert that they maintained had “novel” theories about the origin of cerebral palsy.) Still, it might be a step in the right direction toward correcting much that’s wrong with today’s malpractice litigation – “experts” who aren’t really experts.

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Honor to Be Here

I’m honored to have been asked by Walter Olson to guest blog here at Overlawyered this week. For those of you who aren’t familiar with me, I’m a family physician in solo practice in Northeast Ohio. I usually blog at Medpundit on all topics medical. I’ll be confining my guest blogging here to ways in which the law touches the practice of medicine, which in this day and age of soaring malpractice insurance premiums and litigation is a touch too much.

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