By Brenda Fitzgerald
The risk of medical injury due to physician negligence is the same today as it was 30 years ago. Medical liability awards have greatly increased, medical insurance rates have greatly increased, but the risk of injury due to negligence has remained the same.
Even the best health care in the world cannot prevent all bad outcomes. Many medical procedures involve the risk of complications or injury, even when the highest standard of care is meticulously followed. There is a clear difference between bad outcome and bad care.
The purpose of our medical liability system is to provide compensation to the victims of medical errors and to create an incentive for health care providers to take steps to reduce medical errors. At the same time, these goals cannot be allowed to undermine access to good medical care because a liability system that becomes too expensive can cause health care providers to leave the market, particularly in rural areas and in high-risk professions.
Unfortunately, it is clear our current medical liability system is increasingly inefficient and ineffective at balancing these objectives. Not only have negligence rates not changed, but many charge that the system has become so expensive that access, especially in high-risk specialties such as obstetrics, has been reduced.
A permanent solution must address the legal system, the medical liability insurance system and the health care system.
The System is Broken
Compensation to victims is neither timely nor efficient.
In the current system, fault must be established to obtain compensation. This process is adversarial, difficult and long, with average cases lasting two to three years and some lasting five or more years. This process takes up the time of the court, the health care provider(s) and the attorneys representing both sides. It also takes up the time of the injured party – time that could be critical in speeding their recovery.
Studies have shown that the majority of patients who suffer malpractice do not sue.[1] The Harvard Medical Practice Study found that only one malpractice claim was filed for every eight negligent medical injuries.[2] In fact, another Harvard study found that “physicians were more likely to be sued for rendering non-negligent care.”[3] This certainly appears to hold true in Georgia, where health care providers win 82 percent of malpractice lawsuits.[4]
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Only 42 percent of the money awarded in medical tort cases ever reaches the patients or their families. |
For those who sue and win, only 42 percent of the money awarded in medical tort cases ever reaches the patients or their families: 33 percent goes to lawyers and 25 percent goes to administrative costs.[5] Emory University health care expert Kenneth Thorpe notes in a recent study that “program administration – defense and underwriting costs – accounts for approximately 60 percent of total malpractice costs … These costs are high even when compared with other tort-based systems, such as automobile litigation or airplane crashes, that determine fault and compensate victims.”[6]
Costs are rising.
Medical liability awards have been growing steadily. According to Jury Verdict Research data from 1994 to 2000, the median jury award rose by 176 percent. In 1996, 34 percent of all jury awards exceeded $1 million. Four years later, the number of these large awards increased to 52 percent.
Medical liability costs are increasing at a far more rapid rate than medical costs generally. According to the Insurance Information Institute, from 1990 to 2000, medical liability costs rose 140 percent, which is more than double the 60 percent rise in general medical costs during the same period. From 1975 to 2000, medical liability costs exploded by 1,642 percent, as compared to a 449 percent increase for general medical costs.[7] Median malpractice awards (including both jury awards and settlements) per paid claim doubled in real terms between 1990 and 2001.[8] In Georgia, the number of medical malpractice claims of $500,000 or more have doubled since 1995, and claims of $1 million and $2 million or more have tripled.[9]
A July 2002 report prepared for the U.S. Department of Health and Human Services identified the average cost to defend a malpractice as was over $24,000, even though the majority of cases were dropped or dismissed. Countersuits to regain these monies have been for the most part unsuccessful since the courts are reluctant to discourage plaintiffs from utilizing the judicial system for meritorious claims.
| Claims Disposition and Defense Costs Average Share of Share of Claim Disposition Claims DefenseDropped or Dismissed 61% $16,743 Settled 32% $39,891 Trial Verdict Defense verdict 6% $85,718 Plaintiff verdict 1% $91,423 Source: Physician Insurers Association of America |
There are enormous additional costs in the medical system because of the current system of handling adverse medical events. The estimated cost of defensive medicine (when doctors order expensive tests and procedures even when the odds of finding disease are very low) in the United States is $15 billion per year.[10] At the Loyola University Chicago Institute for Health Law annual health policy forum in November 2003, law professor Barry Furrow reported that other health care costs associated with medical errors are $17 billion per year. These costs include providing additional care for the patients, disability costs, lost income and productivity costs.
Despite increased costs, medical error rates have not improved.
The results of several studies indicate that statistically you are just as likely to be a victim of medical malpractice today as you were 30 years ago. In a 1974 study of adverse medical events in California, 1 percent was found to be due to negligence. In a New York study of adverse medical events in 1984, 1 percent was found to be due to negligence. In a 1992 study of adverse medical events in Utah and Colorado, 1 percent was found to be due to negligence. In spite of the increasing amounts of money spent, the incidence of negligence has been unchanged for almost 30 years. We are not getting rid of “bad” doctors. Some patients are being compensated, but the current system is not improving.
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The results of several studies indicate that statistically you are just as likely to be a victim of medical malpractice today as you were 30 years ago. |
The Institute of Medicine’s 2000 report focused attention on the principal factors that feed the problem of medical error and related injury. It estimated that there are 1 million errors in American medicine each year and that between 44,000 and 98,000 people die each year due to medical error. It cites the main problem as a failure by medical providers to observe and learn from errors and a continued focus on individual rather than systematic causes of error. It finds epidemiologic research in recent years shows that “modern medicine’s increasing capacity to alleviate disease, injury and disability comes with significant risks to independently cause harm.” It also notes, “Data on the supposed deterrent effect of medical malpractice suits alone has not been sufficient to address the problem.” It concludes that most of the preventable injuries in our hospitals are not due to bad medical professionals but rather to the imperfect systems in which these professionals work.
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There is a reluctance to openly discuss or reveal problems because of the fear of a malpractice claim. Mistakes or bad outcomes are not the learning opportunity they should be and therefore the current system is actually a hindrance to improved quality of care over time. |
Medicine can extend or improve life, but it can never guarantee that you will live always without disease or defect. Because doctors know this, most, or perhaps all, firmly believe that the tort system is capricious and malpractice claims rarely reflect quality of care. There is a reluctance to openly discuss or reveal problems because of the fear of a malpractice claim. Mistakes or bad outcomes are not the learning opportunity they should be and therefore the current system is actually a hindrance to improved quality of care over time.
Medical training programs have always emphasized non-punitive, vigorous review of outcomes. This results in open and honest evaluation of medical care. It also results in changes in medical decision-making. However, once doctors leave the training environment, the current legal system encourages defensive medicine, (i.e. more C-sections) without open review. This results in increased costs with no improvement of care.
For the family with a baby with cerebral palsy, there are enormous medical and emotional costs. These are present whether the doctor who delivered the baby was a “good” or a “bad” doctor. The bottom line is that errors occur. Only a small number, 1 percent, are due to negligence. Medical professionals who are negligent or inadequate should be retrained or lose their license to practice medicine, but costs could be reduced and quality of care improved if the system also encouraged learning from these errors.
Access to quality medical care is being endangered in many areas of the state.
The American Medical Association currently lists Georgia as one of the 19 states with a malpractice crisis.[11] In Georgia, the number of medical malpractice claims of $500,000 or more has doubled since 1995 and the claims over a million dollars have tripled.[12] The clearest example of the effect of this statistic is that 12 percent of Georgian obstetricians were expected to have stopped delivering babies between 2002 and 2005.
Obstetricians Who Will Stop or Have Already Stopped Delivering Babies
|
| Albany 2 | Alpharetta 1 |
| Athens 9 | Atlanta (city) 17 |
| Augusta 4 | Bainbridge 2 |
| Brunswick 1 | Carrollton 2 |
| Columbus 4 | Dalton 1 |
| Dublin 4 | Eastman 2 |
| Elberton 1 | Gainesville 6 |
| Griffin 1 | Kingsland 1 |
| Lawrenceville 5 | Macon 9 |
| Marietta 4 | Newnan 1 |
| Norcross 2 | Riverdale 1 |
| Rome 2 | Roswell 3 |
| Royston 1 | Sandersville 1 |
| Savannah 3 | Statesboro 2 |
| Smyrna 1 | Tifton 1 |
| Toccoa 1 | Valdosta 1 |
| Vidalia 1 | Woodstock 1 |
| Total Stopping Delivery Services: 98 |
Ob/Gyns Who Have Already Left or Are Leaving Practice
| Alpharetta 1 | Americus 1 |
| Athens 2 | Atlanta (city) 4 |
| Augusta 2 | Canton 1 |
| Cartersville 2 | Columbus 3 |
| Covington 1 | Dalton 1 |
| Demorest 1 | Douglasville 1 |
| Eastman 1 | Elberton 1 |
| Gainesville 5 | Lawrenceville 2 |
| Macon 4 | Marietta 2 |
| Monroe 1 | Riverdale 1 |
| Rome 1 | Roswell 1 |
| Savannah 1 | Thomasville 1 |
| Toccoa 1 | Total Leaving Practice: 44 |
These positions may not be easily filled. The American College of Obstetricians and Gynecologists reports a significant decrease in the number of obstetricians being trained. Only 66 percent of new residency training positions were filled in the United States in 2003 and fewer students are choosing to go into Ob/Gyn. For example, Common Good, a legal reform coalition, reports that in 2003 in Maryland, which has been hard hit by lawsuits, no medical graduates of the University of Maryland chose residencies in obstetrics. In 2004, only one student out of 150 chose obstetrics. Johns Hopkins Medical School is also in Maryland. Of 115 medical graduates at Johns Hopkins Medical School in 2004, only three students chose obstetrics.
In the four Georgia medical schools, Emory, Medical College of Georgia, Mercer and Morehouse, there were 359 medical graduates in 2004, but only 20 planned to go into Ob/Gyn. The current statistic is that 50 percent of obstetricians trained in Georgia leave the state. Thirty percent of practicing Ob/Gyns are over age 55. With earlier retirement and fewer students entering the field, potential loss of services looms large.
| An Illustration of the Crisis: Athens, Georgia
The main reason cited by doctors for stopping needed services is medical malpractice costs. Although one large claim may not necessarily impact access to health care statewide, its impact in a community can be tremendous. For example, in Athens, Georgia, one group of obstetricians was forced to stop delivering babies in 2004 after serving Athens for 35 years. The total number of doctors in this practice has varied from a high of 11 doctors to the recent count of seven doctors – more than 173 years of combined experience. They have provided care for the most complicated obstetric patients in Athens. In the entire 35 years of the practice, there have been three malpractice suits. (The national average is three suits in the life of every obstetrician.) The fourth suit, this year, closed their obstetric practice – they could no longer purchase adequate malpractice insurance. The suit was brought after an Emory University-trained obstetrician in this group delivered a baby by C-section who had cerebral palsy. The best data suggest that cerebral palsy babies develop the problem during the pregnancy and method of delivery does not affect outcome. The doctor was nevertheless sued and the suit resulted in an out-of-court settlement for a large sum. The group’s malpractice insurance was not renewed even though the doctor had been in practice for 12 years and had never been previously sued. Another insurance company agreed to insure the involved doctor, but for a price that was greater than her entire annual salary. She left the group and is no longer delivering babies. As an additional result of this case, the rest of the group could no longer get obstetric insurance coverage at an adequate level. One younger partner left to join another group and the rest stopped obstetrics entirely. Athens now has lost a third of its obstetricians. Perhaps more importantly, it has lost the experienced doctors who had been treating the high-risk, more difficult pregnancies in Athens. |
A March 2003 study conducted by the American Medical Association reports that 65 percent of America’s high-risk specialists such as those in neurosurgery, trauma surgery, emergency medicine and obstetrics, have made changes to their practices including no longer providing certain services, referring complex cases and closing their practices. Of these, a fourth have completely stopped needed services such as emergency and trauma care and delivering babies. The majority, 92 percent, of these physicians say liability pressures were important in their decision to stop these services.
Trauma surgeons, obstetricians, neurosurgeons and emergency physicians have all been faced with career-ending increases in malpractice costs. This has resulted in closing of hospital emergency departments, trauma centers and critical care medicine. Soon, only elective, low-risk surgical cases and routine medical care may be readily available.
The market for medical malpractice insurance is very volatile, leading to cyclical changes in premiums.
The current malpractice insurance crisis is the third in 30 years. In the mid-1970s, and again in the mid-1980s, medical malpractice markets experienced rapid increases in the frequency of claims, rising premiums, and in some places, decreasing options for professional coverage.
In 2003, many states averaged premium increases of 25 percent. The Georgia Ob-Gyn Society reports that 70 percent of respondents to their survey have had over a 40 percent increase in their malpractice rates in the last two years, with 38 percent reporting a 70 to over 100 percent increase. Board-certified emergency medicine groups in Georgia with no malpractice suits against them have experienced a 50 percent increase in the last two years.
The largest malpractice insurer in the country and in Georgia, The St. Paul Company, declared in December 2001 its plan to discontinue its services to the medical community. Twenty out of 40 insurance carriers in Florida have withdrawn from the market in the last 10 years. In addition to St. Paul, MIXX, PHICO, Frontier Insurance Group and Doctors Insurance Reciprocal have all stopped medical malpractice coverage.[13]
The National Academy for State Health Policy describes the role of insurance in the health care system: “Insurance underwriting practices are cyclical, with periodic adjusting of rates after the fact to reflect actual losses during a given period. The premiums are invested and the return on investments is factored in as a part of a company’s profit and losses. During times of high interest rates or a strong stock market, companies keep their premiums low to remain competitive. During these times, new companies enter the market and the resulting price wars cause companies to sell malpractice insurance at rates too low to cover costs of subsequent claims. When the boom stock market went bust, exacerbated by the September 11th attacks, many companies suffered large losses and either drastically raised premiums or stopped offering malpractice insurance.”
The Solution Must Be Comprehensive
To finally solve this recurrent problem, a thorough discussion and comprehensive understanding of all the systems involved is needed. Medical care, liability insurance and tort law all play a role in costs and consequences. Any solution that only deals with one of the components is doomed to failure.
The Medical System
Separating bad outcomes and bad care with mandatory malpractice review panels.
Practicing medicine often involves risk and judgment, and bad outcomes can and do occur. Studies show that less than one-third of these bad outcomes are due to negligence on behalf of the medical provider.[14] Unfortunately, in many cases a physician is labeled a “bad” doctor even when the highest standard of care is followed. It is critical that we separate medical providers who are guilty of negligent care from those who have met the expected standard of care and should not be held legally liable for a bad outcome.
To accomplish this goal, the state should require medical professionals to serve on statewide medical malpractice review boards that would determine whether the care given in a case where there was a bad outcome met the expected standard of care. These professionals should be chosen, like jury duty, from another area of the state than the case in question. To insure fairness and accuracy, these boards should be composed of three board-certified doctors in the specialty involved in the case, and two members not from the medical community. These two could be from the legal community, patient advocates or community members appointed by a grand jury.
Once created, the panel should review only written evidence, such as the medical chart, affidavits and depositions. This process would work to focus the inquiry on objective evidence and prevent potentially excessive costs. Upon completion of its review, the panel would decide if the doctor provided the standard of care and if the doctor should have additional medical training required before his license is renewed. Importantly, if either party is dissatisfied with the panel’s conclusion, it may move for trial after a 30-day waiting period. As in many other states, the panel’s finding regarding liability should be admissible at trial, and fairness dictates that panel members should be available to testify.
Fairness would also dictate that at trial the dissatisfied party must obtain a reversal of the liability decision or be assessed the fees of the panel, court costs and reasonable attorney’s fees.
The mandatory medical malpractice panel system works. Of the 21 states that enacted such a system, only three (14 percent) are considered crisis states by the AMA. Conversely, 66 percent of the 12 states that repealed their system are listed as crisis states.
Although some review panels in other states have been ruled unconstitutional, this system is likely to pass constitutional muster in Georgia. Currently, the Fulton County Superior Court requires litigants in non-medical malpractice cases involving alleged damages of $25,000 or less to submit to non-binding arbitration. The Georgia Supreme Court has upheld that requirement over claims that it denies a party’s access to courts, violates separation or powers and infringes on litigants’ rights of equal protection.[15]
This proposal differs from other states because it will be directly linked with the physician licensing process. If care were inadequate, the physician must complete the additional training recommended by the medical review panel before the medical license can be renewed. The recommendation to require additional updates could be made even if the standard of care were met. Medicine is a field with new treatments and new procedures constantly being introduced. This system would continually improve and update doctors while taking swift action to address negligence.
The Insurance System: More disclosure and transparency
There has been great debate concerning the relationship between jury awards and medical malpractice premiums. Medical malpractice insurance premiums are influenced by multiple factors: the size and number of paid claims, investment returns, the level of competition in the market between insurance carriers and other unforeseen impacts such as the impact of 9-11 on the reinsurance market.
Unfortunately, these debates are rarely settled because much of the data necessary to analyze the situation are difficult to obtain or unavailable. Many significant paid claims are the result of settlements and this information remains confidential. Other data, such as jury verdicts and investment income, are either not required to be disclosed by insurance companies or are only available in a form that is very difficult or time consuming for researchers, much less the public, to access.
Better disclosure and transparency of this information would not only help policy-makers identify the true drivers of medical malpractice premiums, but would also provide insurance carriers with better information to gauge the Georgia market. This would lead to more accurate pricing, would limit the profit taking we have seen in the Georgia market due to a lack of information and would provide better data to track the impact of reforms.
The Tort System: Balancing compensation and access
There is no dispute that medical injuries occur, and that they can often be heartrending and tragic. As discussed above, medical injuries occur due to medical negligence as well as when medical providers have followed all accepted standards of care. It is equally tragic if Georgians are harmed by a lack of access to health care services caused by excessively expensive malpractice costs.
Limiting non-economic damages
Physicians do not wish to restrain the right of patients to obtain compensation for the economic costs of their injuries – both those that are caused by negligence and even those that are not. There is significant debate concerning whether limiting non-economic damages is an effective solution to limit the increase in malpractice premiums and ensure access to health care.
The General Accounting Office (now the Government Accountability Office) conducted a study on medical malpractice insurance rates in 2003. While citing many factors (investment losses, reinsurance rates, market concentration, etc.), the study found that “losses on medical malpractice claims – which make up the largest part of insurers’ costs – appear to be the primary driver of [medical malpractice] rate increases in the long run.”[16]
The Georgia Trial Lawyers Association argues that caps on non-economic damages do not reduce malpractice premiums.[17] However, Emory University health care expert Kenneth Thorpe studied data from 1985-2001 and found that “premiums in states with a cap on awards were 17.1 percent lower than in states without such caps.”[18]
According to a July 2003 study by the U.S. Department of Health and Human Services, states that have passed legislation that caps non-economic damages in medical liability cases have more doctors.[19] In 1970, before any cap legislation, all states had virtually identical levels of physicians per 100,000 citizens. In 2000, states with caps averaged 11 percent more physicians per 100,000 compared to those states without caps. A study in May 2003 conducted by the U.S. Congressional Joint Economic Committee also found that higher malpractice premiums reduce the number of practicing physicians in a state.[20]
In the early 1970s, California, with bipartisan support, passed the Medical Injury Compensation Reform Act (MICRA). The provisions were:
- Full compensation for all economic damages including medical bills, lost wages, future earnings, custodial care and rehabilitation
- A limit of $250,000 on non-economic damages, such as pain and suffering
- A fair and reasonable statute of limitations
- Periodic payment of damages and ensuring that the bulk of any award goes to the plaintiffs
From 1976 to 2000, medical liability premiums for physicians in California have risen only 167 percent as compared to a 505 percent increase for the entire United States. The awards in California have outpaced inflation, but because the increases have been only in economic damages, insurance companies have been better able to predict future costs and stability has been brought to the health care delivery system. The difference is even more dramatic in high-risk specialties. In a nationwide survey of neurosurgeons from 2000 to 2002, the average rate of increase of malpractice insurance in non-reform states was 143 percent. In Los Angeles, California, the rate of increase for neurosurgeons was just 8 percent.[21]
Studies of the California system have concluded that the most effective part of the legislation in controlling costs has been the $250,000 cap on non-economic damages. In 1993, the U.S. Office of Technology Assessment concluded that caps on damages consistently lowered medical liability insurance premiums.
No-fault compensation: Moving toward a better balance
Tort cases have not improved negligence rates and many believe they have hindered improvements in error rates. The costs of the system are enormous and increasing, while only 42 percent of the money awarded ever makes it to the damaged party. If our goal is to compensate patients when bad things happen, we need a more efficient system. If our goal is to improve medical care and get rid of bad doctors, we need a more efficient system. If our goal is to improve access to good medical care for all Georgians, we need a more efficient system. An improved system requires fundamental reform rather than changes around the edges.
Bad outcomes have significant consequences for patients even if the doctor rendered the best care. A perfect system would provide swift no-fault compensation for every patient who suffers a significant, permanent, adverse medical event coupled with a professional review of each questioned case – similar to the mandatory medical malpractice review panels discussed previously.
The review should be admissible in court and it should clearly state whether there was negligence or below-standard care. Doctors should be required to take training courses before their licenses are renewed if inadequate care were given. Doctors who did not complete the required training or have too many poor-care cases would lose their license. If a patient or family wanted to reject the compensation and take the case to the current tort system, they certainly should be able to, with the caveat that the loser pays costs. Lawyers working on a contingency fee basis could be required to purchase a bond to pay for court costs if they lost the case.
Patients and families who need help would get money in a timely manner, and doctors who are inadequate would be subject to mandatory retraining or lose their medical license. Trust would be restored to the healing profession. Access to the courts would be preserved. Insurance companies would have better data to determine costs. Juries would know that adequate money was available to a family to cover costs. Theoretically, only those doctors who were actually negligent would be taken to court.
Conclusion
A compensation system for all patients who have a bad outcome is ideal. This is an insurance system for patients, not doctors. We have an insurance system for automobile mishaps and we deserve an insurance system for “human mishaps.” This is a new idea for Georgia, but we should begin to think about how to achieve compensation for all who need it and not just compensation for those who happened to have a bad doctor.
Georgia, however, must act this year. In other states, reasonable caps on non-economic damages have most consistently insured medical access and controlled costs.
Whichever compensation method we choose, we should couple it with a mandatory medical review panel to increase patient safety and provide for the continuing improvement of Georgia’s entire medical system. Georgia deserves no less.
References
[1] Harvard Medical Practice Study, “Patients, Doctors and Lawyers: Studies of Medical Injury, Malpractice Litigation and Patient Compensation in New York,” 1990, 7-37; and David M. Studdert, Eric J. Thomas, Helen R. Burstin, Brett I.W. Zbar, E.J. Orav, and Troyen A. Brennan, “Negligent Care and Malpractice Claiming Behavior in Utah and Colorado,” Medical Care 38 (2000): 253.
[2] P.C. Weiler et al., “A Measure of Malpractice: Medical Injury, Malpractice Litigation, and Patient Compensation,” Harvard University Press, 1993.
[3] Harvard School of Public Health, Brigham and Women’s Hospital, http://www.brighamandwomens.org/publicaffairs/newsDetails.asp?
dept_id=&news_id=18231&rso_abbrev=bwh
[4] MAG Mutual Insurance Company.
[5] T. Luu, “Reducing the Costs of Civil Litigation: What are the Costs of Litigation?” PLRI Public Law Research Institute, 1995.
[6] Kenneth E. Thorpe, The Medical Malpractice ‘Crisis’: Recent Trends And The Impact Of State Tort Reforms, Health Affairs, January 21, 2004.
[7] Testimony of the Alliance of Specialty Medicine Capitol Hill hearing October 2003.
[8] Kenneth E. Thorpe, The Medical Malpractice ‘Crisis’: Recent Trends And The Impact Of State Tort Reforms, Health Affairs, January 21, 2004.
[9] Alan Plummer, “Medical Liability In Georgia: The Crisis is Now,” Momentum Magazine, Winter 2003, http://www.emory.edu/WHSC/HSNEWS/PUB/Momentum/Winter03/onpoint.html.
[10] Health Law Journal, 1993, Volume 1, page 97.
[11] “America’s Liability Crisis: A National View,” American Medical Association (2003), available at http://www.ama-assn.org/ama1/pub/upload/mm/-1/med_liab_19stat.pdf
[12] Alan Plummer, Medical Liability In Georgia: The Crisis is Now, 5 MOMENTUM 3 (Winter 2003) available at http://www.emory.edu/WHSC/HSNEWS/PUB/Momentum/Winter03/onpoint.html
[13] June 2003 General Accounting Office report.
[14] Joseph P. Newhouse and Paul C. Weiler, “Reforming Medical Malpractice and Insurance,” Regulation magazine, p. 6, https://www.cato.org/pubs/regulation/regv14n4/reg14n4-newhouse.html.
[15] For more information, see “The Need for Mandatory Medical Review Panels: The Medical Malpractice Crisis in Georgia,”, Mac Gibson and Josh Belinfante, Georgia Public Policy Foundation, November 14, 2003,http://www.gppf.org/article.asp?RT=9&p=pub/HealthCare/
Malpractice/malpractice_full_study.htm.
[16] “Medical Malpractice Insurance: Multiple Factors Have Contributed to Increased Premium Rates,” U.S. General Accounting Office, June 2003, http:www.gao.gov/cgi-bin/getrpt?GAO-03-702.
[17] “Setting the Record Straight: It’s A Malpractice Insurance Cycle – Not a Tort Crisis,” p. 14, http://gtla.org/public/justice-preservation/legpacket/tab4.html
[18] Kenneth E. Thorpe, The Medical Malpractice ‘Crisis’: Recent Trends And The Impact Of State Tort Reforms, Health Affairs, January 21, 2004.
[19] Fred J. Hellinger, Ph.D and William E. Encinosa, Ph.D., “The Impact of State Laws Limiting Malpractice Awards on the Geographic Distribution of Physicians,” U.S. Department of Health and Human Services,http://www.ahrq.gov/research/tortcaps/tortcaps.htm.
[21] Capitol Hill testimony October 2003.
Dr. Brenda Fitzgerald is an OB-GYN and the chairman of the Board of Governors of the Georgia Public Policy Foundation. The Foundation is an independent think tank that proposes practical, market-oriented approaches to public policy to improve the lives of Georgians. Nothing written here is to be construed as necessarily reflecting the views of the Georgia Public Policy Foundation or as an attempt to aid or hinder the passage of any bill before the U.S. Congress or the Georgia Legislature.
© Georgia Public Policy Foundation (February 11, 2005). Permission to reprint in whole or in part is hereby granted, provided the author and her affiliations are cited.
By Brenda Fitzgerald
The risk of medical injury due to physician negligence is the same today as it was 30 years ago. Medical liability awards have greatly increased, medical insurance rates have greatly increased, but the risk of injury due to negligence has remained the same.
Even the best health care in the world cannot prevent all bad outcomes. Many medical procedures involve the risk of complications or injury, even when the highest standard of care is meticulously followed. There is a clear difference between bad outcome and bad care.
The purpose of our medical liability system is to provide compensation to the victims of medical errors and to create an incentive for health care providers to take steps to reduce medical errors. At the same time, these goals cannot be allowed to undermine access to good medical care because a liability system that becomes too expensive can cause health care providers to leave the market, particularly in rural areas and in high-risk professions.
Unfortunately, it is clear our current medical liability system is increasingly inefficient and ineffective at balancing these objectives. Not only have negligence rates not changed, but many charge that the system has become so expensive that access, especially in high-risk specialties such as obstetrics, has been reduced.
A permanent solution must address the legal system, the medical liability insurance system and the health care system.
The System is Broken
Compensation to victims is neither timely nor efficient.
In the current system, fault must be established to obtain compensation. This process is adversarial, difficult and long, with average cases lasting two to three years and some lasting five or more years. This process takes up the time of the court, the health care provider(s) and the attorneys representing both sides. It also takes up the time of the injured party – time that could be critical in speeding their recovery.
Studies have shown that the majority of patients who suffer malpractice do not sue.[1] The Harvard Medical Practice Study found that only one malpractice claim was filed for every eight negligent medical injuries.[2] In fact, another Harvard study found that “physicians were more likely to be sued for rendering non-negligent care.”[3] This certainly appears to hold true in Georgia, where health care providers win 82 percent of malpractice lawsuits.[4]
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Only 42 percent of the money awarded in medical tort cases ever reaches the patients or their families. |
For those who sue and win, only 42 percent of the money awarded in medical tort cases ever reaches the patients or their families: 33 percent goes to lawyers and 25 percent goes to administrative costs.[5] Emory University health care expert Kenneth Thorpe notes in a recent study that “program administration – defense and underwriting costs – accounts for approximately 60 percent of total malpractice costs … These costs are high even when compared with other tort-based systems, such as automobile litigation or airplane crashes, that determine fault and compensate victims.”[6]
Costs are rising.
Medical liability awards have been growing steadily. According to Jury Verdict Research data from 1994 to 2000, the median jury award rose by 176 percent. In 1996, 34 percent of all jury awards exceeded $1 million. Four years later, the number of these large awards increased to 52 percent.
Medical liability costs are increasing at a far more rapid rate than medical costs generally. According to the Insurance Information Institute, from 1990 to 2000, medical liability costs rose 140 percent, which is more than double the 60 percent rise in general medical costs during the same period. From 1975 to 2000, medical liability costs exploded by 1,642 percent, as compared to a 449 percent increase for general medical costs.[7] Median malpractice awards (including both jury awards and settlements) per paid claim doubled in real terms between 1990 and 2001.[8] In Georgia, the number of medical malpractice claims of $500,000 or more have doubled since 1995, and claims of $1 million and $2 million or more have tripled.[9]
A July 2002 report prepared for the U.S. Department of Health and Human Services identified the average cost to defend a malpractice as was over $24,000, even though the majority of cases were dropped or dismissed. Countersuits to regain these monies have been for the most part unsuccessful since the courts are reluctant to discourage plaintiffs from utilizing the judicial system for meritorious claims.
| Claims Disposition and Defense Costs Average Share of Share of Claim Disposition Claims DefenseDropped or Dismissed 61% $16,743 Settled 32% $39,891 Trial Verdict Defense verdict 6% $85,718 Plaintiff verdict 1% $91,423 Source: Physician Insurers Association of America |
There are enormous additional costs in the medical system because of the current system of handling adverse medical events. The estimated cost of defensive medicine (when doctors order expensive tests and procedures even when the odds of finding disease are very low) in the United States is $15 billion per year.[10] At the Loyola University Chicago Institute for Health Law annual health policy forum in November 2003, law professor Barry Furrow reported that other health care costs associated with medical errors are $17 billion per year. These costs include providing additional care for the patients, disability costs, lost income and productivity costs.
Despite increased costs, medical error rates have not improved.
The results of several studies indicate that statistically you are just as likely to be a victim of medical malpractice today as you were 30 years ago. In a 1974 study of adverse medical events in California, 1 percent was found to be due to negligence. In a New York study of adverse medical events in 1984, 1 percent was found to be due to negligence. In a 1992 study of adverse medical events in Utah and Colorado, 1 percent was found to be due to negligence. In spite of the increasing amounts of money spent, the incidence of negligence has been unchanged for almost 30 years. We are not getting rid of “bad” doctors. Some patients are being compensated, but the current system is not improving.
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The results of several studies indicate that statistically you are just as likely to be a victim of medical malpractice today as you were 30 years ago. |
The Institute of Medicine’s 2000 report focused attention on the principal factors that feed the problem of medical error and related injury. It estimated that there are 1 million errors in American medicine each year and that between 44,000 and 98,000 people die each year due to medical error. It cites the main problem as a failure by medical providers to observe and learn from errors and a continued focus on individual rather than systematic causes of error. It finds epidemiologic research in recent years shows that “modern medicine’s increasing capacity to alleviate disease, injury and disability comes with significant risks to independently cause harm.” It also notes, “Data on the supposed deterrent effect of medical malpractice suits alone has not been sufficient to address the problem.” It concludes that most of the preventable injuries in our hospitals are not due to bad medical professionals but rather to the imperfect systems in which these professionals work.
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There is a reluctance to openly discuss or reveal problems because of the fear of a malpractice claim. Mistakes or bad outcomes are not the learning opportunity they should be and therefore the current system is actually a hindrance to improved quality of care over time. |
Medicine can extend or improve life, but it can never guarantee that you will live always without disease or defect. Because doctors know this, most, or perhaps all, firmly believe that the tort system is capricious and malpractice claims rarely reflect quality of care. There is a reluctance to openly discuss or reveal problems because of the fear of a malpractice claim. Mistakes or bad outcomes are not the learning opportunity they should be and therefore the current system is actually a hindrance to improved quality of care over time.
Medical training programs have always emphasized non-punitive, vigorous review of outcomes. This results in open and honest evaluation of medical care. It also results in changes in medical decision-making. However, once doctors leave the training environment, the current legal system encourages defensive medicine, (i.e. more C-sections) without open review. This results in increased costs with no improvement of care.
For the family with a baby with cerebral palsy, there are enormous medical and emotional costs. These are present whether the doctor who delivered the baby was a “good” or a “bad” doctor. The bottom line is that errors occur. Only a small number, 1 percent, are due to negligence. Medical professionals who are negligent or inadequate should be retrained or lose their license to practice medicine, but costs could be reduced and quality of care improved if the system also encouraged learning from these errors.
Access to quality medical care is being endangered in many areas of the state.
The American Medical Association currently lists Georgia as one of the 19 states with a malpractice crisis.[11] In Georgia, the number of medical malpractice claims of $500,000 or more has doubled since 1995 and the claims over a million dollars have tripled.[12] The clearest example of the effect of this statistic is that 12 percent of Georgian obstetricians were expected to have stopped delivering babies between 2002 and 2005.
Obstetricians Who Will Stop or Have Already Stopped Delivering Babies
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| Albany 2 | Alpharetta 1 |
| Athens 9 | Atlanta (city) 17 |
| Augusta 4 | Bainbridge 2 |
| Brunswick 1 | Carrollton 2 |
| Columbus 4 | Dalton 1 |
| Dublin 4 | Eastman 2 |
| Elberton 1 | Gainesville 6 |
| Griffin 1 | Kingsland 1 |
| Lawrenceville 5 | Macon 9 |
| Marietta 4 | Newnan 1 |
| Norcross 2 | Riverdale 1 |
| Rome 2 | Roswell 3 |
| Royston 1 | Sandersville 1 |
| Savannah 3 | Statesboro 2 |
| Smyrna 1 | Tifton 1 |
| Toccoa 1 | Valdosta 1 |
| Vidalia 1 | Woodstock 1 |
| Total Stopping Delivery Services: 98 |
Ob/Gyns Who Have Already Left or Are Leaving Practice
| Alpharetta 1 | Americus 1 |
| Athens 2 | Atlanta (city) 4 |
| Augusta 2 | Canton 1 |
| Cartersville 2 | Columbus 3 |
| Covington 1 | Dalton 1 |
| Demorest 1 | Douglasville 1 |
| Eastman 1 | Elberton 1 |
| Gainesville 5 | Lawrenceville 2 |
| Macon 4 | Marietta 2 |
| Monroe 1 | Riverdale 1 |
| Rome 1 | Roswell 1 |
| Savannah 1 | Thomasville 1 |
| Toccoa 1 | Total Leaving Practice: 44 |
These positions may not be easily filled. The American College of Obstetricians and Gynecologists reports a significant decrease in the number of obstetricians being trained. Only 66 percent of new residency training positions were filled in the United States in 2003 and fewer students are choosing to go into Ob/Gyn. For example, Common Good, a legal reform coalition, reports that in 2003 in Maryland, which has been hard hit by lawsuits, no medical graduates of the University of Maryland chose residencies in obstetrics. In 2004, only one student out of 150 chose obstetrics. Johns Hopkins Medical School is also in Maryland. Of 115 medical graduates at Johns Hopkins Medical School in 2004, only three students chose obstetrics.
In the four Georgia medical schools, Emory, Medical College of Georgia, Mercer and Morehouse, there were 359 medical graduates in 2004, but only 20 planned to go into Ob/Gyn. The current statistic is that 50 percent of obstetricians trained in Georgia leave the state. Thirty percent of practicing Ob/Gyns are over age 55. With earlier retirement and fewer students entering the field, potential loss of services looms large.
| An Illustration of the Crisis: Athens, Georgia
The main reason cited by doctors for stopping needed services is medical malpractice costs. Although one large claim may not necessarily impact access to health care statewide, its impact in a community can be tremendous. For example, in Athens, Georgia, one group of obstetricians was forced to stop delivering babies in 2004 after serving Athens for 35 years. The total number of doctors in this practice has varied from a high of 11 doctors to the recent count of seven doctors – more than 173 years of combined experience. They have provided care for the most complicated obstetric patients in Athens. In the entire 35 years of the practice, there have been three malpractice suits. (The national average is three suits in the life of every obstetrician.) The fourth suit, this year, closed their obstetric practice – they could no longer purchase adequate malpractice insurance. The suit was brought after an Emory University-trained obstetrician in this group delivered a baby by C-section who had cerebral palsy. The best data suggest that cerebral palsy babies develop the problem during the pregnancy and method of delivery does not affect outcome. The doctor was nevertheless sued and the suit resulted in an out-of-court settlement for a large sum. The group’s malpractice insurance was not renewed even though the doctor had been in practice for 12 years and had never been previously sued. Another insurance company agreed to insure the involved doctor, but for a price that was greater than her entire annual salary. She left the group and is no longer delivering babies. As an additional result of this case, the rest of the group could no longer get obstetric insurance coverage at an adequate level. One younger partner left to join another group and the rest stopped obstetrics entirely. Athens now has lost a third of its obstetricians. Perhaps more importantly, it has lost the experienced doctors who had been treating the high-risk, more difficult pregnancies in Athens. |
A March 2003 study conducted by the American Medical Association reports that 65 percent of America’s high-risk specialists such as those in neurosurgery, trauma surgery, emergency medicine and obstetrics, have made changes to their practices including no longer providing certain services, referring complex cases and closing their practices. Of these, a fourth have completely stopped needed services such as emergency and trauma care and delivering babies. The majority, 92 percent, of these physicians say liability pressures were important in their decision to stop these services.
Trauma surgeons, obstetricians, neurosurgeons and emergency physicians have all been faced with career-ending increases in malpractice costs. This has resulted in closing of hospital emergency departments, trauma centers and critical care medicine. Soon, only elective, low-risk surgical cases and routine medical care may be readily available.
The market for medical malpractice insurance is very volatile, leading to cyclical changes in premiums.
The current malpractice insurance crisis is the third in 30 years. In the mid-1970s, and again in the mid-1980s, medical malpractice markets experienced rapid increases in the frequency of claims, rising premiums, and in some places, decreasing options for professional coverage.
In 2003, many states averaged premium increases of 25 percent. The Georgia Ob-Gyn Society reports that 70 percent of respondents to their survey have had over a 40 percent increase in their malpractice rates in the last two years, with 38 percent reporting a 70 to over 100 percent increase. Board-certified emergency medicine groups in Georgia with no malpractice suits against them have experienced a 50 percent increase in the last two years.
The largest malpractice insurer in the country and in Georgia, The St. Paul Company, declared in December 2001 its plan to discontinue its services to the medical community. Twenty out of 40 insurance carriers in Florida have withdrawn from the market in the last 10 years. In addition to St. Paul, MIXX, PHICO, Frontier Insurance Group and Doctors Insurance Reciprocal have all stopped medical malpractice coverage.[13]
The National Academy for State Health Policy describes the role of insurance in the health care system: “Insurance underwriting practices are cyclical, with periodic adjusting of rates after the fact to reflect actual losses during a given period. The premiums are invested and the return on investments is factored in as a part of a company’s profit and losses. During times of high interest rates or a strong stock market, companies keep their premiums low to remain competitive. During these times, new companies enter the market and the resulting price wars cause companies to sell malpractice insurance at rates too low to cover costs of subsequent claims. When the boom stock market went bust, exacerbated by the September 11th attacks, many companies suffered large losses and either drastically raised premiums or stopped offering malpractice insurance.”
The Solution Must Be Comprehensive
To finally solve this recurrent problem, a thorough discussion and comprehensive understanding of all the systems involved is needed. Medical care, liability insurance and tort law all play a role in costs and consequences. Any solution that only deals with one of the components is doomed to failure.
The Medical System
Separating bad outcomes and bad care with mandatory malpractice review panels.
Practicing medicine often involves risk and judgment, and bad outcomes can and do occur. Studies show that less than one-third of these bad outcomes are due to negligence on behalf of the medical provider.[14] Unfortunately, in many cases a physician is labeled a “bad” doctor even when the highest standard of care is followed. It is critical that we separate medical providers who are guilty of negligent care from those who have met the expected standard of care and should not be held legally liable for a bad outcome.
To accomplish this goal, the state should require medical professionals to serve on statewide medical malpractice review boards that would determine whether the care given in a case where there was a bad outcome met the expected standard of care. These professionals should be chosen, like jury duty, from another area of the state than the case in question. To insure fairness and accuracy, these boards should be composed of three board-certified doctors in the specialty involved in the case, and two members not from the medical community. These two could be from the legal community, patient advocates or community members appointed by a grand jury.
Once created, the panel should review only written evidence, such as the medical chart, affidavits and depositions. This process would work to focus the inquiry on objective evidence and prevent potentially excessive costs. Upon completion of its review, the panel would decide if the doctor provided the standard of care and if the doctor should have additional medical training required before his license is renewed. Importantly, if either party is dissatisfied with the panel’s conclusion, it may move for trial after a 30-day waiting period. As in many other states, the panel’s finding regarding liability should be admissible at trial, and fairness dictates that panel members should be available to testify.
Fairness would also dictate that at trial the dissatisfied party must obtain a reversal of the liability decision or be assessed the fees of the panel, court costs and reasonable attorney’s fees.
The mandatory medical malpractice panel system works. Of the 21 states that enacted such a system, only three (14 percent) are considered crisis states by the AMA. Conversely, 66 percent of the 12 states that repealed their system are listed as crisis states.
Although some review panels in other states have been ruled unconstitutional, this system is likely to pass constitutional muster in Georgia. Currently, the Fulton County Superior Court requires litigants in non-medical malpractice cases involving alleged damages of $25,000 or less to submit to non-binding arbitration. The Georgia Supreme Court has upheld that requirement over claims that it denies a party’s access to courts, violates separation or powers and infringes on litigants’ rights of equal protection.[15]
This proposal differs from other states because it will be directly linked with the physician licensing process. If care were inadequate, the physician must complete the additional training recommended by the medical review panel before the medical license can be renewed. The recommendation to require additional updates could be made even if the standard of care were met. Medicine is a field with new treatments and new procedures constantly being introduced. This system would continually improve and update doctors while taking swift action to address negligence.
The Insurance System: More disclosure and transparency
There has been great debate concerning the relationship between jury awards and medical malpractice premiums. Medical malpractice insurance premiums are influenced by multiple factors: the size and number of paid claims, investment returns, the level of competition in the market between insurance carriers and other unforeseen impacts such as the impact of 9-11 on the reinsurance market.
Unfortunately, these debates are rarely settled because much of the data necessary to analyze the situation are difficult to obtain or unavailable. Many significant paid claims are the result of settlements and this information remains confidential. Other data, such as jury verdicts and investment income, are either not required to be disclosed by insurance companies or are only available in a form that is very difficult or time consuming for researchers, much less the public, to access.
Better disclosure and transparency of this information would not only help policy-makers identify the true drivers of medical malpractice premiums, but would also provide insurance carriers with better information to gauge the Georgia market. This would lead to more accurate pricing, would limit the profit taking we have seen in the Georgia market due to a lack of information and would provide better data to track the impact of reforms.
The Tort System: Balancing compensation and access
There is no dispute that medical injuries occur, and that they can often be heartrending and tragic. As discussed above, medical injuries occur due to medical negligence as well as when medical providers have followed all accepted standards of care. It is equally tragic if Georgians are harmed by a lack of access to health care services caused by excessively expensive malpractice costs.
Limiting non-economic damages
Physicians do not wish to restrain the right of patients to obtain compensation for the economic costs of their injuries – both those that are caused by negligence and even those that are not. There is significant debate concerning whether limiting non-economic damages is an effective solution to limit the increase in malpractice premiums and ensure access to health care.
The General Accounting Office (now the Government Accountability Office) conducted a study on medical malpractice insurance rates in 2003. While citing many factors (investment losses, reinsurance rates, market concentration, etc.), the study found that “losses on medical malpractice claims – which make up the largest part of insurers’ costs – appear to be the primary driver of [medical malpractice] rate increases in the long run.”[16]
The Georgia Trial Lawyers Association argues that caps on non-economic damages do not reduce malpractice premiums.[17] However, Emory University health care expert Kenneth Thorpe studied data from 1985-2001 and found that “premiums in states with a cap on awards were 17.1 percent lower than in states without such caps.”[18]
According to a July 2003 study by the U.S. Department of Health and Human Services, states that have passed legislation that caps non-economic damages in medical liability cases have more doctors.[19] In 1970, before any cap legislation, all states had virtually identical levels of physicians per 100,000 citizens. In 2000, states with caps averaged 11 percent more physicians per 100,000 compared to those states without caps. A study in May 2003 conducted by the U.S. Congressional Joint Economic Committee also found that higher malpractice premiums reduce the number of practicing physicians in a state.[20]
In the early 1970s, California, with bipartisan support, passed the Medical Injury Compensation Reform Act (MICRA). The provisions were:
- Full compensation for all economic damages including medical bills, lost wages, future earnings, custodial care and rehabilitation
- A limit of $250,000 on non-economic damages, such as pain and suffering
- A fair and reasonable statute of limitations
- Periodic payment of damages and ensuring that the bulk of any award goes to the plaintiffs
From 1976 to 2000, medical liability premiums for physicians in California have risen only 167 percent as compared to a 505 percent increase for the entire United States. The awards in California have outpaced inflation, but because the increases have been only in economic damages, insurance companies have been better able to predict future costs and stability has been brought to the health care delivery system. The difference is even more dramatic in high-risk specialties. In a nationwide survey of neurosurgeons from 2000 to 2002, the average rate of increase of malpractice insurance in non-reform states was 143 percent. In Los Angeles, California, the rate of increase for neurosurgeons was just 8 percent.[21]
Studies of the California system have concluded that the most effective part of the legislation in controlling costs has been the $250,000 cap on non-economic damages. In 1993, the U.S. Office of Technology Assessment concluded that caps on damages consistently lowered medical liability insurance premiums.
No-fault compensation: Moving toward a better balance
Tort cases have not improved negligence rates and many believe they have hindered improvements in error rates. The costs of the system are enormous and increasing, while only 42 percent of the money awarded ever makes it to the damaged party. If our goal is to compensate patients when bad things happen, we need a more efficient system. If our goal is to improve medical care and get rid of bad doctors, we need a more efficient system. If our goal is to improve access to good medical care for all Georgians, we need a more efficient system. An improved system requires fundamental reform rather than changes around the edges.
Bad outcomes have significant consequences for patients even if the doctor rendered the best care. A perfect system would provide swift no-fault compensation for every patient who suffers a significant, permanent, adverse medical event coupled with a professional review of each questioned case – similar to the mandatory medical malpractice review panels discussed previously.
The review should be admissible in court and it should clearly state whether there was negligence or below-standard care. Doctors should be required to take training courses before their licenses are renewed if inadequate care were given. Doctors who did not complete the required training or have too many poor-care cases would lose their license. If a patient or family wanted to reject the compensation and take the case to the current tort system, they certainly should be able to, with the caveat that the loser pays costs. Lawyers working on a contingency fee basis could be required to purchase a bond to pay for court costs if they lost the case.
Patients and families who need help would get money in a timely manner, and doctors who are inadequate would be subject to mandatory retraining or lose their medical license. Trust would be restored to the healing profession. Access to the courts would be preserved. Insurance companies would have better data to determine costs. Juries would know that adequate money was available to a family to cover costs. Theoretically, only those doctors who were actually negligent would be taken to court.
Conclusion
A compensation system for all patients who have a bad outcome is ideal. This is an insurance system for patients, not doctors. We have an insurance system for automobile mishaps and we deserve an insurance system for “human mishaps.” This is a new idea for Georgia, but we should begin to think about how to achieve compensation for all who need it and not just compensation for those who happened to have a bad doctor.
Georgia, however, must act this year. In other states, reasonable caps on non-economic damages have most consistently insured medical access and controlled costs.
Whichever compensation method we choose, we should couple it with a mandatory medical review panel to increase patient safety and provide for the continuing improvement of Georgia’s entire medical system. Georgia deserves no less.
References
[1] Harvard Medical Practice Study, “Patients, Doctors and Lawyers: Studies of Medical Injury, Malpractice Litigation and Patient Compensation in New York,” 1990, 7-37; and David M. Studdert, Eric J. Thomas, Helen R. Burstin, Brett I.W. Zbar, E.J. Orav, and Troyen A. Brennan, “Negligent Care and Malpractice Claiming Behavior in Utah and Colorado,” Medical Care 38 (2000): 253.
[2] P.C. Weiler et al., “A Measure of Malpractice: Medical Injury, Malpractice Litigation, and Patient Compensation,” Harvard University Press, 1993.
[3] Harvard School of Public Health, Brigham and Women’s Hospital, http://www.brighamandwomens.org/publicaffairs/newsDetails.asp?
dept_id=&news_id=18231&rso_abbrev=bwh
[4] MAG Mutual Insurance Company.
[5] T. Luu, “Reducing the Costs of Civil Litigation: What are the Costs of Litigation?” PLRI Public Law Research Institute, 1995.
[6] Kenneth E. Thorpe, The Medical Malpractice ‘Crisis’: Recent Trends And The Impact Of State Tort Reforms, Health Affairs, January 21, 2004.
[7] Testimony of the Alliance of Specialty Medicine Capitol Hill hearing October 2003.
[8] Kenneth E. Thorpe, The Medical Malpractice ‘Crisis’: Recent Trends And The Impact Of State Tort Reforms, Health Affairs, January 21, 2004.
[9] Alan Plummer, “Medical Liability In Georgia: The Crisis is Now,” Momentum Magazine, Winter 2003, http://www.emory.edu/WHSC/HSNEWS/PUB/Momentum/Winter03/onpoint.html.
[10] Health Law Journal, 1993, Volume 1, page 97.
[11] “America’s Liability Crisis: A National View,” American Medical Association (2003), available at http://www.ama-assn.org/ama1/pub/upload/mm/-1/med_liab_19stat.pdf
[12] Alan Plummer, Medical Liability In Georgia: The Crisis is Now, 5 MOMENTUM 3 (Winter 2003) available at http://www.emory.edu/WHSC/HSNEWS/PUB/Momentum/Winter03/onpoint.html
[13] June 2003 General Accounting Office report.
[14] Joseph P. Newhouse and Paul C. Weiler, “Reforming Medical Malpractice and Insurance,” Regulation magazine, p. 6, https://www.cato.org/pubs/regulation/regv14n4/reg14n4-newhouse.html.
[15] For more information, see “The Need for Mandatory Medical Review Panels: The Medical Malpractice Crisis in Georgia,”, Mac Gibson and Josh Belinfante, Georgia Public Policy Foundation, November 14, 2003,http://www.gppf.org/article.asp?RT=9&p=pub/HealthCare/
Malpractice/malpractice_full_study.htm.
[16] “Medical Malpractice Insurance: Multiple Factors Have Contributed to Increased Premium Rates,” U.S. General Accounting Office, June 2003, http:www.gao.gov/cgi-bin/getrpt?GAO-03-702.
[17] “Setting the Record Straight: It’s A Malpractice Insurance Cycle – Not a Tort Crisis,” p. 14, http://gtla.org/public/justice-preservation/legpacket/tab4.html
[18] Kenneth E. Thorpe, The Medical Malpractice ‘Crisis’: Recent Trends And The Impact Of State Tort Reforms, Health Affairs, January 21, 2004.
[19] Fred J. Hellinger, Ph.D and William E. Encinosa, Ph.D., “The Impact of State Laws Limiting Malpractice Awards on the Geographic Distribution of Physicians,” U.S. Department of Health and Human Services,http://www.ahrq.gov/research/tortcaps/tortcaps.htm.
[21] Capitol Hill testimony October 2003.
Dr. Brenda Fitzgerald is an OB-GYN and the chairman of the Board of Governors of the Georgia Public Policy Foundation. The Foundation is an independent think tank that proposes practical, market-oriented approaches to public policy to improve the lives of Georgians. Nothing written here is to be construed as necessarily reflecting the views of the Georgia Public Policy Foundation or as an attempt to aid or hinder the passage of any bill before the U.S. Congress or the Georgia Legislature.
© Georgia Public Policy Foundation (February 11, 2005). Permission to reprint in whole or in part is hereby granted, provided the author and her affiliations are cited.
