New York City may soon be left with only a single independent center for natural childbirth: “The Brooklyn Birthing Center says its insurance company has stopped covering midwives, and a costlier new policy could push them out of the baby-birthing business as well. The news comes less than a week after the highly regarded Elizabeth Seton Childbearing Center, which delivers more than 400 babies a year, announced it will shut down its West 14th Street [Manhattan] birthing rooms on Sept. 1 because of malpractice insurance costs it says have quadrupled.” All three independent midwifery centers in New Jersey closed in recent years; one remains in the Bronx which receives federal funding and insurance. (Susan Edelman, “Midwife Strife Hits Moms in Brooklyn”, New York Post, Aug. 17; Dan Mangan, “Midwife Crisis”, New York Post, Aug. 12). And in Tallahassee, Fla., a doubling of insurance rates has contributed to the closing of Full Circle Women’s Health, a nonprofit midwifery agency whose efforts have been credited with helping reduce the county’s high rate of neonatal mortality. (Jeff Burlew, “Area midwifery agency closing after 20 years”, Tallahassee Democrat, Aug. 13)(more on obstetric liability)(& update Sept. 3, letter to the editor Sept. 18)
Posts Tagged ‘medical’
Doctor slang? Think twice
“The inventive language created by doctors the world over to insult their patients – or each other – is in danger of becoming extinct,” according to one expert. “The increasing rate of litigation means that there is a far higher chance that doctors will be asked in court to explain the exact meaning of NFN (Normal for Norfolk), FLK (Funny looking kid)”, CTD (Circling the Drain, expected to die soon) or GPO (Good for Parts Only). (“Doctor slang is a dying art”, BBC, Aug. 18; Roger Dobson, “Doctors issue warning over misuse of slang”, British Medical Journal, Aug. 16). MedPundit (Aug. 18) also weighs in, and an Iain Murray commenter has compiled EMS acronym slang. (& welcome Law.com readers)
The cerebral palsy law machine
It grinds on inexorably, for all that the medical establishment may cast aspersions on it (see also Feb. 27). In June a San Jose jury voted $38 million to a family in a case in which an earlier Caesarean section would allegedly have prevented a child’s cerebral palsy; the medical defendants strenuously denied any such causal link (Barbara Feder Ostrov, “Baby, family win $38 million verdict”, San Jose Mercury News, Jun. 18). The Palm Beach Post traces the history of a $10 million verdict which “sank one of Florida’s largest physician-run malpractice insurers … While the award pays for Kenan’s care, it also pays for legal fees that leave [mother Priscilla] Davis wondering at times whether she should have taken her chances with the state Medicaid plan.” Causation, you ask? “It remains unclear whether any doctor could have prevented Kenan’s cerebral palsy.” It was a Willie Gary case (Sanjay Bhatt, “Boy’s case illustrates malpractice crisis”, Palm Beach Post, Jun. 15). And a federal judge in East St. Louis, Ill. has awarded $19 million in a lawsuit which ascribed a child’s cerebral palsy to a doctor’s improper use of a vacuum extractor during labor. No word from the newspaper report on whether the defendants disputed this causal theory, but the choice of defendants was an interesting one: the federal Treasury. “The doctor, Charles L. Davis, was considered a federal employee because his employer, the Southern Illinois Healthcare Foundation, receives funding from the U.S. Department of Health and Human Services. The government was named as a defendant, but he was not.” (William Lamb, “Botched birth nets verdict of $19 million”, St. Louis Post-Dispatch, Jul. 31).
Employment Policy Foundation finds med-mal system lacking
“The Employment Policy Foundation?s (EPF) analysis of data comparing states with and without limitations on damage awards in malpractice cases found that capped damage awards could save $54.8 billion to $97.5 billion annually — 7.2 percent to 12.7 percent of the $764.8 billion spent on hospital and physician services each year. … In 2001, the gap between premiums collected and underwriting losses amounted to $4,033 per physician, assuming that all 744,000 full-time physicians in the U.S. were covered. … Plaintiffs eventually receive only 38 percent of the total dollars that flow through the malpractice litigation system.” (“Medical Malpractice Litigation Raises Health Care Cost, Reduces Access and Lowers Quality of Care”, EPF Issue Backgrounder, Jun. 19 (PDF); news release, Jun. 13).
Time is money
Already squeezed by litigation-driven hikes in medical liability insurance premiums, Nevada doctors may be facing a new type of lawsuit. Fed up with having to wait three hours to see his doctor, patient Aristotelis Belavilas filed suit for $5,000, explaining “My time is worth something just like his is.” A Las Vegas small claims court awarded Belavilas $365 in damages and court fees. Dr. Ty Weller, understandably “appalled” by the case, said he plans to appeal. “Even more important than the money is that now I have to worry about other patients doing this to me,” he said. (“Impatient patient sues doctor for waiting time,” Assoc. Press, July 30).
Addendum: RangelMD has more (Jul. 30, Jul. 31) as does MedRants and Cut to Cure. Update: case settled in Sept. 2003 for doctor’s apology and payment to charity, see Sept. 16, 2005.
GAO: legal costs drive med-mal rates
Congress’s General Accounting Office confirms what the Department of Health and Human Services and Joint Economic Committee (PDF) have found before it: “Increases in medical malpractice insurance rates in some states, including Pennsylvania, were due largely to high payoffs on legal claims, according to a congressional survey released yesterday. …’Losses on medical malpractice claims appear to be the primary driver of increased premium rates in the long term,’ the report states. ‘Such losses are by far the largest component of insurer costs.'” (Lara Jakes Jordan, “Malpractice insurance rise tied to legal claims”, AP/Pittsburgh Post-Gazette, Jul. 29). Study: “Medical Malpractice Insurance: Multiple Factors Have Contributed to Increased Premium Rates”, Jun. (PDF format).
P.S. In August 2003 the GAO released a further look at medical malpractice problems, “Medical Malpractice: Implications of Rising Premiums on Access To Health Care“. Congress’s Joint Economic Committee later (Dec.) published a policy brief offering perspective on the GAO findings.
Pa. malpractice insurers lost $18M last year
“Medical-malpractice insurance underwriters in Pennsylvania lost $18 million last year, according to a new analysis by the state Department of Insurance that appears to underscore industry claims that Pennsylvania’s tort system is driving insurers out of the state. … Medical-malpractice insurance underwriters in Pennsylvania paid out $345.4 million in claims last year, about 31 percent less than the $499 million that insurers received in premiums from doctors, the department said. But while insurers earned $46.4 million in investment income, they also paid $136.9 million in legal costs and $81.1 million for taxes and other operating expenses.” The actual loss figure attributable to 2002 may come in a good bit higher than $18 million when all accounts finally come to reckoning: “The insurers also put away $209.4 million in reserves for future claims.” (Marc Levy, “State analysis shows Pa. malpractice insurers lost $18M last year”, AP/Doylestown (Pa.) Intelligencer, Jul. 15).
More: reader James Ingram writes, “So what do these numbers show? Insurers collected $499 mm in premiums and paid $345 mm in claims and $137 mm in legal costs. If we assume that 1/3 of the amount paid in claims went to plaintiffs’ lawyers (actually a pretty conservative figure, many charge more) that amounts to another $115 mm going to legal costs. Add $137 mm and $115 mm and you have $252 mm of the $499 mm that doctors, hospitals and other providers paid in premiums (more than half) going to legal expense while a maximum of $230 mm (46%) went to claimants. Great system, if you are a lawyer!”
“Once a C-section, always a C-section” policy blamed on legal risks
Oregon: “Women who have delivered a baby by Caesarean section must deliver their next child the same way if they give birth at Merle West Medical Center. The hospital’s board of directors today announced a new policy that supports a decision by local obstetricians to not deliver a baby vaginally if the mother has had a previous Caesarean section, a surgical procedure that delivers the baby by making an incision in the abdomen and uterus. The decision is based more on legal implications related to the potentially high-risk procedure than on medical statistics, said Dr. Rick Zwartverwer, vice president for medical affairs at Merle West Medical Center.” (Marcia McGonigle, “Hospital alters C-section policy”, Klamath Falls (Ore.) Herald & News, Jul. 8)(see Feb. 5, 2001). Update Nov. 29, 2004: New York Times covers the story.
Australia: “Doctor must pay to raise boy”
“The High Court stunned doctors yesterday with a landmark finding that a surgeon who bungled a woman’s sterilization is liable for the cost of bringing up her child to the age of 18.” Kerry Melchior’s son Jordan is perfectly healthy, but she sued Queensland ob/gyn Dr. Stephen Cattanach and the state health department because the tubal ligation he had performed had not prevented pregnancy as intended. (Cynthia Banham, Sydney Morning Herald, Jul. 17). Dr. Andrew Pesce, who chairs the Australian Medical Association’s professional indemnity task force, said “the decision was a part of a pattern where doctors’ liability was gradually increased over time, so that ‘nobody actually knows what their obligations are'”. For similar American cases, see Apr. 26-28, 2002.
Escalating liability had already provoked an insurance crisis for ob/gyns Down Under, as in the States; especially hard hit are women practitioners who often maintain less than a full-time practice but must pay hefty flat-rate premiums anyway (Wendy Tuohy, “A labour of love becomes labour too hard, and too risky”, Melbourne Age, Jul. 5). Among those quitting is Dr. Denise Koong, though some of her patients have “begged her to reconsider, saying things like: ‘Give me the paper and I’ll sign it, I will promise not to sue you!'” Trouble is, the courts (certainly in the U.S., and we presume in Australia these days as well) toss out such written promises as unenforceable.
Kinsley: GOP is right on malpractice
“The current arrangement delivers justice at random, in widely varying amounts or not at all, depending on whether you’re feeling litigious, how good your lawyer is, or what a judge or a juror had for breakfast that day. … It is a society with an odd sense of justice that awards millions of dollars to every 25th victim of what may or may not have been a botched operation, but doesn’t guarantee basic health care to anyone.” (“The lawsuit lottery”, Slate, Jul. 10).
The Senate’s failure to invoke cloture on medical litigation reform proceeded on strict party lines, with no Democrats voting for and only two Republicans voting against, Shelby of Alabama (no surprise there) and Lindsey Graham (R-S.C.). (Helen Dewar, “Medical Malpractice Bill Dies in Senate”, Washington Post, Jul. 10). What’s with Graham? — wonders Wyeth Wire.
MedPundit Sydney Smith as usual offers omnibus coverage of the malpractice debate, including a new column of her own (“The Threat to Medical Innovation”, TechCentralStation, Jul. 11); a new study from researchers at the Agency for Healthcare Research and Quality finding that states with liability caps “experienced a more rapid increase in their supply of physicians” than states without; a funny Scrappleface satire on how doctors should start prescribing cash as a remedy for pain and suffering since that’s what the government considers suitable (Jul. 8, and read the comments); a critique of a typically benighted treatment of the subject in The American Prospect; and more (scroll down, too).