Who’s going to be left delivering babies? Maybe foreign medical graduates, who still perceive themselves as having fewer options than the U.S.-born medical students who are increasingly steering clear of obstetrics as a specialty. Of course there’s also the option of departing a state like Maryland, where the prevailing insurance premium for an ob/gyn is slated to rise this year to $160,130, and starting up practice instead in a state like Wisconsin, where tough tort reforms keep the corresponding figure to an average of $45,000 to $50,000, according to Dr. Douglas Laube, head of an American College of Obstetricians and Gynecologists panel on obstetrics residency. (Jonathan Bor, “Obstetrics is failing to draw new doctors”, Baltimore Sun, Jul. 11).
Posts Tagged ‘medical’
Oft-sued Pennsylvania doctors
The litigation lobby has worked hard to advance the theme (accepted at face value in places like the New Republic) that a few bad apples in the medical profession account for most malpractice claims. On the other hand, some medical observers (see Apr. 10-13, 2003) have pointed out that if it’s true that five percent of doctors account for a majority of malpractice payouts, the most accurate description of that five percent would be not “incompetent M.D.s who should not be in practice” but rather “members of high-risk specialties in litigious localities”.
Reinforcing this latter view, a Pew Foundation project has surveyed 1,333 Pennsylvania specialists and drew responses from 824 physicians in high-risk fields including emergency medicine, general surgery, neurosurgery, orthopedic surgery, obstetrics/gynecology and radiology. “Eighty-six percent of specialists had been named in a malpractice suit at least once during their careers, and 47 percent had been sued in the three years prior to the survey.” Details today at Point Of Law, which also has new posts on Eliot Spitzer and on John Kerry’s Pennsylvania fund-raising.
No-fault medical liability proposals
…discussed at Point of Law today. Plus: Manhattan Institute launches new health policy site (more).
Panel says no malpractice, jury says $3 million
In South Portland, Maine, a jury has awarded Neil Maietta $3 million in a complicated medical malpractice claim against anesthesiologist Dr. Kenneth Blazier over an infection that set into Maietta’s spinal discs after a medical procedure. “The verdict was unusually large for Maine, where awards of more than a million dollars are rare. It was particularly surprising in this case because a medical malpractice review panel had unanimously found that the doctor and hospital were not at fault for Maietta’s injury. The panel’s finding was disclosed to the jury, but it found for Maietta anyway. ‘I’ll take my chances with a jury any day,’ said Maietta’s lawyer, Daniel J. Lilley of Portland.” (Gregory D. Kesich, “Man wins $3 million for injury by doctor”, Portland Press Herald, May 27)(via SickOfLawsuits.org).
Cleveland law firm breakup
Lurid allegations flew in a Cleveland courtroom after the breakup of medical-malpractice and personal-injury firm Kampinski & Mellino. A jury eventually ordered Charles Kampinski to pay almost $621,000 to Christopher Mellino, who had resigned from the firm. He can probably afford it: “Trial evidence indicated Kampinski earned about $36 million between 1997 and 2001 — $15.8 million in 2000 alone. Mellino, his longtime sidekick, raked in some $5.5 million over that span — peaking at $2.53 million in 2000 — under a pay scale that gave him 1 percent of the firm’s net fees for every year he worked there.” (Jim Nichols, “Ruling ends bad breakup of lawyers”, Cleveland Plain Dealer, Jun. 18) MedPundit (Jun. 18) comments. Despite the Cleveland paper’s description of the law firm as “one of Ohio’s most successful personal-injury and medical-malpractice firms”, it does not boast a particularly high Google profile, currently scoring only a dozen or so hits under its former name.
An expert witness’s fibs
What does it take to convict an expert witness of perjury? I ask that question this morning in a posting over at PointOfLaw.com, proceeding from a Ninth Circuit case handed down last week which demonstrated that some doctors, at least, fare well in court these days.
Scruggs watch
Last week lawyers associated with uber-tobacco lawyer Richard Scruggs fanned out across the country to file a dozen lawsuits against thirteen large non-profit hospitals in eight states. According to one press account, the lawsuits allege that “the institutions are not living up to their charitable missions, are overcharging uninsured patients and are using overly aggressive collection tactics.” (Rob Kaiser, “Class actions filed against non-profit hospitals,” Chicago Tribune, June 18) Scruggs characterizes the litigation as his attempt “to stop profiteering by nonprofit hospitals.” (Bill Lewis, “St. Thomas among hospitals accused of ‘profiteering,'” Nashville Tennessean, June 18)
The Tennessean article further explains:
“The lawsuit said Saint Thomas unfairly benefits from its long-held tax-exempt status, and the suit alleges a breach of contract, consumer fraud and deceptive business practices because Saint Thomas and the other nonprofits allegedly haven’t provided enough charity care in return for their tax exemptions….
“He criticized the hospitals named in the lawsuits for charging what he said were their highest rates to patients who do not have insurance, while giving discounts to big insurance companies. If the poor or uninsured patients cannot pay their bills, the hospitals garnishee wages and bank accounts, seize houses and force people into bankruptcy, he said.”
University of Chicago law professor Richard Epstein, quoted in the Tribune article, had this reaction: “Dicky Scruggs has got a lot of money, and he’s looking for a lot of trouble,” Epstein said. “The question is, what’s the law that’s being violated?”
Pediatric orthopedic surgeon driven out of spinal surgery
In the complicated surgery to correct scoliosis, screws and rods are inserted and bone added into the spine. The risk of nerve damage or paralysis is such that there is something called the Stagnara wake up test, whereby the patient is woken during surgery to ensure she can move her feet. In 1999, however, Joshua Terry was one of the unfortunate 0.1% who was paralyzed during surgery. And, according to the newspaper account, his lawyer, Jay Kelley, found four surgeons to testify against defendant Dr. Ernest Lindell that “paralysis was not a potential complication” from surgery on the spine to correct scoliosis. A Lucas County, Ohio jury awarded $8.4 million to Mr. Terry and another million to his parents. And Dr. Lindell will no longer perform spinal surgery. (“Paralyzed area man wins $10M judgment”, Toledo Blade, Jun. 16; P. Stagnara, et al., “Functional monitoring of spinal cord activity during spinal surgery”, Clin. Orthop., 1973; 93: 173?8).
Mammography under threat
Confirming the trend we reported on Oct. 3: “A worsening shortage of providers is threatening women’s access to mammograms, says a major new report that found long waits for the breast X-ray in parts of the country. …Fewer radiologists are specializing in breast imaging because of long hours, low reimbursement, heavy regulation and fear of lawsuits,” according to the Institute of Medicine study. In addition, as readers try to lean over backwards lest they be accused of overlooking an ambiguous result, the false-positive rate in mammogram results has nearly doubled since the 1980s, according to the report, which in turn “leads to costly, unnecessary repeat testing as well as the anxiety that women often cite for skipping mammograms.” (Lauran Neergaard, “Scientific advisers urge increased access to mammograms”, AP/San Francisco Chronicle, Jun. 10; “Advisers urge greater mammogram access”, AP/CNN, Jun. 10; report, “Saving Women’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis“).
The medical blogs have been all over the story: MedRants, Cut to Cure, MedPundit. Last month radiologist Thomas Boyle (“CodeBlueBlog”) deplored some of the economic and regulatory pressures working to kill mammography practice (“Mammactivists Killing the Mammogram”, May 12, see also Jun. 11), and was no less scathing about the legal pressures:
A mammogram is an inherently limited study with relatively low sensitivity and specificity. Unfortunately, the public does not understand these limitations because the exam has been oversold as a diagnostic modality (We are told this is for the public’s “own good?). As a result, people have a difficult time understanding why breast abnormalities are “missed” or “misinterpreted” during routine mammography. Personal injury lawyers ruthlessly take advantage of this dilemma by scavenging mammograms involved in breast cancer cases. They prey on this ignorance by holding radiologists to impossible standards bolstered with retrospective analyses of mammograms done by venal physicians in their stable of “experts”. As a result, mammography is the single highest liability risk for radiologists (and the second highest risk in all of medicine). For a $15 reading fee, radiologists can face multi-million dollar lawsuits.
More: PointOfLaw, Dec. 14.
Madison County medical malpractice numbers
Madison County has its deserved reputation as a “judicial hellhole” because plaintiffs recognize that its judges are friendlier to questionable class actions and asbestos cases, leading it to become a magnet jurisdiction for these actions. (See Apr. 15; Apr. 5; Jan. 5 and links therein; John Stockinger, “Advocates call for reform of Madison County legal system”, Alton Telegraph, Jun. 9.) Now, the Astroturf trial lawyers’ group “Victims and Families United” (Feb. 20) tries to defeat that perception by trumpeting some statistics about medical malpractice in the region. Previously, the group had tried to suggest there was no medical malpractice crisis, despite the fact doctors were leaving the area by the dozens, by pointing out the low number of verdicts in the area; of course, verdicts are a small fraction of payouts to lawyers in settlements. So the trial lawyers have responded by making up some numbers, and trusting that the press won’t delve too deeply into the claims.
By manipulating a couple of denominators, the trial lawyers’ group purports to show that settlement payouts are average for the state. The Madison-St. Clair region has 4.2% of ISMIE’s $270 million in payouts in 2003, they say, and 4.2% of the population; therefore, payouts are supposedly in line with the rest of Illinois. The St. Louis Post-Dispatch uncritically reports these numbers, as well as uncritically calling the trial lawyers’ group a “victims’ rights group.” (William Lamb, “Data do not justify Metro East’s malpractice reputation, group says”, Jun. 10).
But the numbers are bogus. ISMIE doesn’t insure “population”, it insures doctors, and doctors per capita are lower in Madison and St. Clair Counties than elsewhere in the state; off the bat, one would expect lower payout rates for these counties if they were typical for Illinois. Worse: the $270 million denominator is fictional. Using the actual denominator of $226 million (see 2003 ISMIE Annual Report at 25) or $234 million (John Stockinger, “Victims group disputes claims of insurance crisis”, Alton Telegraph, Jun. 11), and the Madison/St. Clair per capita number (a number that already understates the extent of the problem) turns out actually to be 116% to 120% of the statewide average–a number that can be found nowhere in the press coverage. (Patrick J. Powers, “Claims here mirror state”, Belleville News-Democrat, Jun. 12).
At least the Alton Telegraph balances it with other statistics that tend to show the fiction: average payment to plaintiffs in the area jumped from $276,000 to $495,000 between 2002 and 2003. In the past five years, ISMIE has paid out $33.5 million in verdicts, settlements and expenses, while earning only $29.6 million from Madison/St. Clair County-area premiums.