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    Thursday, January 02, 2003
    The Malpractice Conundrum

    As you may have heard, surgeons in West Virginia are walking off the job to protest skyrocketing malpractice insurance rates. I think it may have gotten to the point that almost all insurance carriers have pulled their malpractice coverage from West Virginia. I feel for these surgeons and their frustration, but this is worrisome:

    Four West Virginia hospitals cut staff hours and transferred more patients today because of a surgeons' walkout to protest malpractice costs. State officials planned an emergency program to ensure medical service to patients in the state's northern panhandle.

    Protesting surgeons want the state to make it harder to file malpractice lawsuits, which they say would eventually lower their insurance premiums. They also want the state to seek help from insurance companies and other third parties to pay a larger share of their costs.

    Two patients were moved late Wednesday and two others today, raising the number transferred in the two-day protest to five.

    The four affected hospitals also began reducing shifts of operating room nurses and other surgical support staff.

    "It's definitely generating worries within our staff, both about their own financial needs and about the health of the community," said Howard Gamble, spokesman for Ohio Valley Medical Center in Wheeling.

    A surgeon taking part in a job action said doctors' pleas for help have been ignored by state officials.

    Glenn Reynolds has some fantastic comments on the effects of malpractice insurance on the practice of medicine. Read the whole thing here, but an excerpt:

    Malpractice suits don't play a significant role in preventing bad medicine, or in compensating injured patients -- given that most patients never sue, it's essentially a lottery. Sometimes a particularly bad physician is brought to account, but just as often it's somebody who made an honest and forgivable error of judgment, or who did nothing wrong at all. And in some truly dreadful cases, trial lawyers won't bring suit because there's no money in it; I can think of one in particular I know of that would curl your hair, but that a major plaintiffs' firm turned down because they weren't sure they could make money.

    So the social value of malpractice suits is overrated: if you wanted to compensate people who were hurt by bad doctors, or if you wanted to police bad doctors, you wouldn't have a system like this one, where profitability to plaintiffs' lawyers -- which is at best only roughly correlated with severity of harm, and even more roughly correlated, if at all, with severity of malpractice -- is the major determinant of what cases get brought and what cases don't.

    Geez, I only wish I could write this clearly. I would never claim all doctors named in malpractice suits are martyrs; we've all heard the horror stories that make it into the news. And in the quarterly bulletins from the state medical board, the last section always consists of doctors who have had their licenses revoked or suspended - for some mind-bogglingly stupid things. But in the last six years I have had three notifications that I was being named in a malpractice suit - though I've been lucky; none of them went to court or even had to be settled (the suits had no merit and were dropped). The first time I freaked out. The second and third times I just cussed a couple times, picked up the phone and called our group's risk manager. Sound easy? Well, this stuff takes time, money and resources on the part of my malpractice carrier to investigate, as well as our risk manager. Every time we're cited in a suit, even if it's only a threat like the type I've mentioned above, it counts against us. Enough of those and our rates go up, even if the carrier never pays out a dime.

    This system is not an appropriate way to punish doctors who practice bad medicine, and it penalizes good docs who either have wacko patients (or wacko families of patients), or who make an honest mistake, or who did not make a mistake but were one of several doctors involved in a case that had a bad outcome caused by someone else, or who merely had communication problems with the patient... etc., etc.



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