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The Wall Street Journal’s health blog asks “How much are CT scans increasing cancer risk?” A recent article in the New England Journal of Medicine claimed that the scans could be causing 1.5 to 2 percent of all cancers. The WSJ blog found other medical experts who questioned the study.
Arl Van Moore, chairman the American College of Radiology’s board, told the WSJ that “there are scans performed that may well be unnecessary,” But he called the authors’ conclusions about the possible 2% rate of future cancer diagnoses “a reach.” And he told the AP “there are some serious concerns about the methodology used” in the paper.
It is tough to estimate the risk of developing cancer from radiation risk. As the authors (two Ph.D.s from Columbia’s Center for Radiological Research) point out, most such estimates are based on studies of survivors of the atomic bombs dropped on Japan in 1945.
Still, what if the “62 million CT scans every year” in America were the cause of only .1 percent of all cancers in the country? That would still be a significant number.
Kevin MD has blogged twice on the subject this week (here and here). He thinks defensive medicine has a lot to do with the high number of CT scans. The articles he quotes don’t explicitly mention defensive medicine as a reason, but one does speak of catching possible problems early and keeping down expenses. I have a hard time believing that there aren’t medmal concerns lurking in the background.
It is great to see this kind of commitment in the face of overwhelming odds:
The measure, sponsored by Sen. Carolyn Allen, R-Scottsdale, would require patients to prove “by clear and convincing evidence” that the care they received did not meet professional standards. That is more difficult to prove than the current requirement that a plaintiff show it is more likely than not the doctor committed malpractice, a standard that would remain in place for virtually all other types of medical claims.
The measure, sponsored by Sen. Carolyn Allen, R-Scottsdale, would require patients to prove “by clear and convincing evidence” that the care they received did not meet professional standards. That is more difficult to prove than the current requirement that a plaintiff show it is more likely than not the doctor committed malpractice, a standard that would remain in place for virtually all other types of medical claims.
Allen pushed wording identical to that through the Legislature in 2006, only to have it vetoed by the governor. Napolitano said then that she saw no evidence that making the change would cure the problem of doctors being unwilling to work in emergency rooms.
Since then, a task force appointed by the governor has come up with a list of recommendations for ways to ensure there are doctors – and specialists in particular – available when patients are brought to hospital ERs. Altering the standard of proof for malpractice cases is only one of the items on that list.
The whole article is interesting (and seems biased to me, but I’m probably biased also). But the main thing that stands out is the thought that there is no possibility that people required in emergency situations cannot be expected to make mistakes. Even if other means were created to produce better results, wouldn’t these also produce a shortage? I mean, what do you think it takes to make an emergency worker able to handle emergencies without ever making a mistake? I’m thinking years of special-forces-type training and a selection process that only allows the people in the program who have the best reflexes and the best ability to handle pressure and make the right decisions.
In other words, less affordable care and more shortages.
Most trial lawyers point to the statistic that malpractice comprises of less that 1 percent of health care costs.
However, they are missing the fact that the threat of malpractice litigation raises costs by encouraging defensive medicine, as well discounting the significant amount of cases that are settled prior to trial.
The link points to this story: “Malpractice curbs hailed, faulted.” In my opinion, the article raises some strong possibilities that the Texas form of tort reform could be improved. But it doesn’t at all convince me that tort reform is unnecessary or inconsequential. And it most certainly that John Edwards is being accurate when he fends off calls for it by pointing to a completely irrelevant comparison:
But Democratic hopeful John Edwards, a former trial lawyer, has said that the changes hurt the victims of medical errors while doing little to reduce the cost of healthcare. Edwards recently said that “insurance company-driven hysteria” has created the false impression that malpractice insurance rates are significantly driving up healthcare costs.
“I think the reality is that the cost associated with legal cases is well under 1 percent of our [medical] system,” said Edwards, a former senator from North Carolina.
If this low single digit figure has any basis in reality, Kevin is right to point out that it is certainly overlooking the cost of defensive medicine.
But what about the doctors? Is there any doctor who only pays one percent of his income to medical malpractice insurance? Sure, if you add up every single aspect of the medical “system”–the pharmaceutical companies, the hospitals, the office personnel, etc.–perhaps medmal costs seem relatively low.
But the costs of medical malpractic are not distributed evenly throughout the system. They are paid by doctors. In fact, there are whole areas of medicine that are disappearing due to medmal rates. And this means that one very important part of “the medical system”–namely, the doctor–bears a huge burden. For one thing, he is constantly tempted to find a way to shift from the part of the healthcare system that is constantly getting sued and has to pay for insurance that reflects that fact, to a relatively less risky place in administration.
So in addition to the expense that can be counted monetarily, there is also the problem of scarcity–shortages caused by economic and other kinds of stress related to the medmal lottery. An essential part of the system is bearing the weight. Comparing the cost to the whole system completely misses the point.
Medical justice has posted a few frivolous lawsuit stories. My favorite was the neurosurgeon sued for a man who died who never was his patient.
Neurosurgeon received a letter of intent to sue from a patient whose name he could not recall. There was no medical record or billing statement to support that this mystery person had ever been a patient. Suit was filed and an attorney had to be hired to answer the allegation that the patient developed paraplegia from a spinal mass. The neurosurgeon was named because “he was the only neurosurgeon in the community.” The case was not dropped until the plaintiff was deposed and stated under oath he had never heard of this doctor and had no complaints with him.
I hope that none of you are involved in anything so horrible of as a medical malpractice lawsuit. But whatever your circumstances, I hope you had time to give thanks today and are able to put the bad out of your mind and enjoy this weekend with friends and family.
Sad news for doctors and patients:
Doctors Worry About Ill. Lawsuit Caps
SPRINGFIELD, Ill. — A court ruling last week that tossed out the caps on some malpractice awards has left some doctors in Illinois worried that insurance rates could rise again and force them to leave state.
A Cook County judge tossed the caps, saying they unconstitutionally limited victims’ rights to recovery for their injuries. Now the Illinois Supreme Court will decide the fate of the caps.
“We lose this, it’s going to be devastating,” said Sen. Dave Luechtefeld, R-Okawville.
Soaring malpractice insurance rates hit doctors hard in 2003 and 2004. By 2005, dozens were closing their practices, unable to afford the higher rates.
Patients were left scrambling to find doctors, especially in specialties like brain surgery and gynecology, and the losses threatened to drive up health care costs throughout the state.
The Democrat-controlled Legislature and Gov. Rod Blagojevich gave in to pressure from doctors, despite complaints from trial lawyers _ some of their biggest political supporters _ that they were interfering with victims’ rights to compensation.
The 2005 law included a $500,000 cap on non-economic damages, such as pain and suffering, that victims can receive in malpractice cases against doctors, and a $1 million cap in awards against hospitals.
One of the main things that should be emphasized about this story was that the medmal caps were bringing doctors to Illinois:
State data show 5,000 more doctors are licensed in Illinois now than two years ago, three new insurance companies are providing coverage for doctors and 10 existing insurers have dropped their rates by 5 percent to more than 30 percent.
But we’re supposed to believe that was all coincidence and that “malpractice lawyers are more cautious about cases they try to take to court.” That last claim would be genuinely good news. But I doubt it is true and, if it is, I doubt even more it will last. The motivations inherent in the system go the other way; the “lottery” temptation will be too great.
Pretty amazing story. After Dr. Jan Adams operated on Donda West for a “tummy tuck” and breast reduction, she stopped breathing the next day and was declared dead upon arrival at the hospital.
Allegedly, Adams is handling this by assuring people that the outrage will just blow over. It is also telling that he reportedly does not have medical malpractice insurance. I’m not surprised. With his DUI and malpractice record no one would want to touch him.
In a lot of ways, there are signs here that something broke down in terms of public safety and accountability.
But there are also clear signs here that this was a bizarre situation. Most doctors working in most hospitals are doing more necessary medicine than most forms of plastic surgery. They don’t dream of being a “celebrity doctor” and can’t afford that sort of medmal record (or DUI record).
I don’t want to make a case for mandatory insurance, but it is pretty obvious that Adams is better evidence for that and other thing than he is an argument against tort reform.
Here is something interesting, found thanks to Kevin MD and the Point of Law blogs: “Canada’s legal culture will prevent “excesses” of U.S. legal system.” The three reasons that I found most compelling were these:
- Canadian judges are appointed, not elected, and therefore Canadian courts are somewhat insulated from pressure to make decisions that will appeal to the electorate (i.e. policyholders).
- The outside limit for punitive damages against an insurer in Canada is thus far about Cdn$1 million. To approach this kind of award, the defendant’s conduct would have to be demonstrably “vindictive,” “reprehensible,” and “malicious.”
- There is more of an emphasis on bench trials in Canada, as opposed to jury trials in the United States.
The first item is interesting, but I don’t know enough about the legal system to comment. The second is easy to understand because it basically says that Canada has capped medmal awards. The third reminds me of the proposal for “Health Courts.” It seems to me that, when Doctors are found liable, we would all be much better off with an explanation for the decision that was written in a way to provide precedent and, thus, guidance.
Kevin MD pointed out this story: “No liability for doctor who revived newborn.”
A doctor can’t be held liable for resuscitating a baby who was born without a heartbeat and survived with severe disabilities, the state Supreme Court says.
The baby’s parents filed a malpractice lawsuit after the baby’s 2004 birth. They claimed doctors in Vancouver, Wash., were negligent when they continued to resuscitate the baby for almost half an hour, after he was born without a heartbeat.
The parents also said the medical team should have gotten their consent before continuing to revive the baby.
But the Supreme Court justices say the doctor can’t be held liable for failing to stop resuscitation efforts on a baby.
It is pretty insane when a doctor can be sued if he fails to save a baby’s life and also if he saves the baby’s life. While the Supreme Court did the right thing, the first commenter at Overlawyered made a great point that the doctor or the insurance company had to shell out a lot of money for his defense before the case reached the state’s Supreme Court.
(And as long as I’m mentioning comments, this response to the story at Kevin MD’s blog is really sad.)
Here is a headline and a story that contains some pretty good news.
But four of the seven largest insurers have filed to lower their rates in 2007, although Continental Casualty Co.’s filing excluded South Florida. The other three didn’t change their rates, despite paying fewer claims per earned premium.
The largest insurer, Jacksonville-based First Professionals Insurance Co. (Nasdaq: FPIC), asked the state insurance office for an 11.7 percent decease on top of the 8.5 percent decrease it passed on last year. Its rates would be just below 2003 levels, says President Bob White.
And premiums will continue falling for the next two years, then stabilize as more years of lower claim data are factored into the rate formula, White says.
Of course, the headline is rather mild and the quotation I selected is a few paragraphs down. As you can see by following the links, the story begins with several paragraphs that are filled with pretty negative spin about medical malpractice insurance rates and tort reform.
It is great when results are dramatic, as they have been in some states, but there are many factors affecting medmal rates, including the need to recover from previous bad years.
The fact that rates that were surging upwards are now headed in the opposite direction is still good news.
The Medinnovation Blog pointed out this report that’s been circulating since Halloween (to point out a completely irrelevant coincidence that still seems ominous). It is funny how wishful thinking can affect one’s ability to read. When I first read the blog entry I thought he said that “medical malpractice rates are lower than they have been in years.”
Wouldn’t that be nice?
Well, the news is still good, just not that good. Increases in medmal insurance rates are lower than they have been in years.
But notice that this news, though positive, is almost overwhelmed by a negative context: “Costs Rise Faster Than Revenue In Many Medical Group Practices.” While this is discouraging, it also poins to another reason why it is so imperative to make sure that liability issues are not a factor in making it too expensive to practice medicine. Once we get that issue out of the way, then we can move on to investigate and find other reasons why the cost/revenue ratio is getting worse.
There are a lot of issues affecting doctors. But since we have pretty good evidence from examples like Texas and Mississippi that tort reform can deal with one of them, that is all the more reason to make sure such reform is carried out everywhere so that we can concentrate on other problems.
