John Edwards and his malpractice fortune

[juddson]

Originally posted by Sessamoid
Not all state bars require pro bono work. Pretty much all doctors do a certain amount of free work. I have more than a few family members who aren't required by their respective state bars to work for free. Any doctor who is on a on call board of their hospital (pretty much all of them) is going to end up doing a certain amount of indigent care. As an emergency physician, about 20-25% of the patients I see are "cash pay" (i.e. "no pay"). So that's about about 300-400 hours per year I work without getting paid. But it gets worse than that. Because of slimy sh*ts like Edwards, it actually costs me money to treat these patients since I still have to pay malpractice insurance for these non-paying patients. So don't give me a line about how poor, underappreciated (and underpaid) lawyers have it tough. Let me know when you have to pay someone else for the privilege of working for non-paying clients.

I'm not counting Medicaid patients among those non-payers. Medicaid typically pays only 20% (or less) of your bill. The government prohibits us from going after the other 80%. How would you feel as a lawyer if he government decreed that you were only allowed to charge 20% of your regular fees to a large segment of the population?

No no. I'm not suggesting that there are any laws that require free work. We outlawed slavery last century. The pro bono requirements are just guidelines and suggestions.

I'm not sure how call works at a hospital, but I was under the impression that the hospital pays you for your work regardless of the patient's ability to pay. Same thing goes for your "service" that covers the hospital, no? I don't know anything about this though. I do know, however, that every state has indigent care laws which require certain hospitals (and therefore the services that cover them) to provide care to people who cannot pay.

To suggest that this, in the aggregate, somehow makes you more altruistic than anybody else is ridiculous.

And in any event, my intention is not to get into a pissing match with you regarding who the bigger victim is. Doctors and lawyers, on average, are compensated for thier work more richly than 99.9% of the people on the planet. I'll make you a deal. I won't complain about how little I'm paid if you don't. You should find another shoulder to cry on.

Judd

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[juddson]

Originally posted by avendesora
Anyone ever hear the adage that 90% of malpractice lawsuits are not the result of malpractice and 90% of malpractice does not result in legal action? (I hope somebody didn't already say this). Obviously there's no data for this, but from my personal experience it could easily be true. Despite what you may think, some patients need the barest of suggestion to sue. Usually the medicaid patient who paid nothing for the service to begin with.

No reasonable physician would argue that docs are perfect or that mistakes don't happen. In fact, they probably happen at a rate similar to those of the general population. The problem is that whereas a businessman (or lawyer) might mistype a slide in a PP presentation, when the slide comes up at a meeting, laughs all around, the end. For a physician, a mistake of the same magnitude (2mm off for a central line, miswriting a script) can result in the end of a career.

The reasonable thing would be a system that could absorb mistakes within the range of normal human nature without catastrophic result. Take the airline industry -- pilots no doubt make mistakes about as often as physicians, yet very few planes crash. The current system, though, where any admission of guilt or self reporting can end a career and cost millions, precludes improvement.

I think there was a study on that first part. I seem to remember reading it, and I think it is probably true. I'll have a look for it.

I agree with you 100% about the system which can absorb some level of error committed by doctors within the boundries of human nature. Read some of my posts above (not sure how far up it is) where I lay out just such a plan.

We are largly in agree on all these issues.

Judd

 

[dry dre]

Originally posted by juddson

I agree with you 100% about the system which can absorb some level of error committed by doctors within the boundries of human nature. Read some of my posts above (not sure how far up it is) where I lay out just such a plan.

Judd

Dude,

You must have posted in excess of 20 pages of text in the last 2 days.

Look up "lithium."

 

[dry dre]

Originally posted by juddson

And in any event, my intention is not to get into a pissing match with you regarding who the bigger victim is. Doctors and lawyers, on average, are compensated for thier work more richly than 99.9% of the people on the planet. I'll make you a deal. I won't complain about how little I'm paid if you don't. You should find another shoulder to cry on.

Judd

You don't even know how physicians are reimbursed, yet you can talk lots about it. You are indeed a lawyer.

An attorney bills in terms of billable hours. You can charge for 15 minutes of service for a 2 minute phone call. In one hour, you could bill for 7.5 hours of "work."

Other than the fact that both lawyers and physicians make above-average salaries, you can't compare the two in terms of methods of reimbursement, or intellectual capacity required to practice.

If an attorney was genuinely interested in "helping patients," they would act to change legislation to that extent. Most all lawyers (such as yourself) don't seek to change legislation to limit bad outcomes, rather, you seek to profit from them. Go ahead and keep telling yourself otherwise...

 

[Sessamoid]

Originally posted by juddson
No no. I'm not suggesting that there are any laws that require free work. We outlawed slavery last century. The pro bono requirements are just guidelines and suggestions.

Geez, lawyers really do have it easy then.

I'm not sure how call works at a hospital, but I was under the impression that the hospital pays you for your work regardless of the patient's ability to pay. Same thing goes for your "service" that covers the hospital, no? I don't know anything about this though.

You sure don't know anything about this, so stop making presumptions based on lack of knowledge. The hospital pays me exactly nothing for indigent pateints, because the hospital does not employ me. Every minute I spend with indigent patients is time I'm not getting paid for. In fact, I could spend two hours on a critically ill indigent patient, and the ONLY THING I'd have to show for it is the increased liability from taking care of a very sick patient (and whatever moral satisfaction I get out of it, which don't count for much). So I end up working for two hours insanely hard, and I have to pay the malpractice insurance company for the privilege of doing so. This goes for pretty much all physicians. On call work on indigent patients is work done for free. Absolutely free.

To suggest that this, in the aggregte, somehow makes you more altruistic than anybody else is ridiculous.

That I went into medicine to help those who couldn't help themselves makes me more altruistic than lawyers whose main intention is to enrich themselves on frivolous cases.

 

[chillin]

This lawyer is standing at the gates of heaven and St. Peter is listening to his sins:
1. defending a large corporation in a pollution suit where he knew they were guilty.
2. defending an obviously guilty murderer because he knew the fee was high, aka Cochran
3. overcharging fees to many clients....
The lawyer immediately objects and argues he admits these are true, but he has done some good in his life.
Saint Peter looks at him and says: Yes you once gave a nickel to a beggar, and a dime to a shoeshine boy.
The lawyer replies: yes, you see I have done some good.
Saint Peter turns to his Angel and says. O.K. Give this lawyer 15 cents and send him to hell.
In Summary, all those lying, cheating politicians/lawyers will get theirs in the end...The only good lawyer is a dead lawyer.

 

[DireWolf]

What do you call a bus full of lawyers falling off a cliff with one empty seat?

a damn shame.

 

[juddson]

Originally posted by dry dre
Dude,

You must have posted in excess of 20 pages of text in the last 2 days.

Look up "lithium."

Oh come on. Most of that is cut and paste.

Judd

 

[juddson]

Originally posted by Sessamoid
In fact, I could spend two hours on a critically ill indigent patient, and the ONLY THING I'd have to show for it is the increased liability from taking care of a very sick patient (and whatever moral satisfaction I get out of it, which don't count for much).

[/B]

It's almost hysterical to read this line (written by you) in the same post that claims you went to medical school to be altruistic.

I love it!!!!

Please, by what species of twisted logic do you hope to convince us that you are super altruistic by complaining on and on about all the free work you have to do provide to the less fortunate? You've spent two posts now complaining about all the free care you have to give - and this is designed to convince me that you are an altruist. That you went into medicine to help people? This ISN'T the way to make that case.

Anyway, I think i was pretty clear in my last post to you that I had no idea how physicians like yourself were compensated. Let's see, I said "I don't know anything about this though." I told you how I thought it worked, but admitted I had no clue. The intellectually honest thing to do would have been to say, "yea, that's not how it works. This is how it works on my hospital." Instead, you PRETENDED that I claimed to know exactly how it worked (when you know damned well I said i didn't) and called me an idiot for claiming that i did. This is an intellectually dishonest tack on your part, desiged to win rhetircial advantage rather than engage me on the issues.

I'd still like to know how one claims to be an altruist while going on about all the stinking free care they have to give.

I think the answer's pretty clear, really. State laws have required you to treat indigent patients - and its pretty damned clear from your posts that THIS is the true reason YOU provide free medical care. But I'd be unfair to all the other doctors who choose to spend thier careers (or significant parts of it) treating indigent, low income and disadvantaged patients for little or no money. It would be unfair of me to suggest that your apparent disgust with having to provide free medical care represents the sentiments of the medical community as a whole.

Likewise (and I'll never understand why you seem to think all all lawyers are medical malpractice attorneys) Lawyers come in all stripes too. Go up and read my posts wherein I describe (just like doctors) those lawyers who choose to practice in civil rights, or homelessness, or juvenile or poverty law.

You're getting nowhere with this line of argument. doctors are people, and lawyers are people. Some are altruists and some are not. Some are nice, and some are dinguses. Some care about thier patients/clients and some don't. Some are in it just for the money. Some aren't.

And why are you behaving this way, anway? I never accused doctors of not being altruists. Nor did I say that lawyers were god's gift to humanity. I simply rebutted a RIDICULOUS statement by Goober (and pressed subsequently by you) that doctors are more altruistic than lawyers (or than any other segment of the population). Get over yourself.

judd

 

[RADRULES]

Why don't you get over yourself?? You come to this board and spout your nonsense like it is gospel. I see no facts to back up any of your assertions. In fact, everything you are saying is totally without any evidence presented.

You must be a sh*tty lawyer.

Lawyers, to me, are nothing more than a pain in the @ss. The less I have to interact with lawyers the rest of my life the better.

It doesn't make any difference who is more altruistic, more worthy of respect, etc. Bottom line is that medicine would be MUCH better without the current medicolegal bullsh*t.... my ideal would be one where I would never have to deal with our "for sale" legal system (notice I didn't say justice).

 

[juddson]

Originally posted by dry dre
You don't even know how physicians are reimbursed, yet you can talk lots about it. You are indeed a lawyer.

An attorney bills in terms of billable hours. You can charge for 15 minutes of service for a 2 minute phone call. In one hour, you could bill for 7.5 hours of "work."

Other than the fact that both lawyers and physicians make above-average salaries, you can't compare the two in terms of methods of reimbursement, or intellectual capacity required to practice.

If an attorney was genuinely interested in "helping patients," they would act to change legislation to that extent. Most all lawyers (such as yourself) don't seek to change legislation to limit bad outcomes, rather, you seek to profit from them. Go ahead and keep telling yourself otherwise...

I have made reference to how doctors are compensated in exactly one post so far. And in that post i said, very clearly "I don't know anything about this though." You are setting me up as straw man.

Your understand of legal billing is contemptable. A two minute phone call is normally simply eaten. An hours worth of work is billed as an hour. Deviations from this are simply varying degrees of fraud, of which, undoubtedly, some attorneys are guilty. Much like medicare fraud.

I've NOT ONCE mentioned the relative intellectual capacities required to practice in law or medicine, and you know it. Your statement on this issue is here for one purpose, and one purpose only - you've decided to degenerate this discussion into claiming that doctors are smarter than lawyers. Come on, you smooth cat. Admit it. this is what you've got on me. First you agree that on average we both make a ton. Then you claim that I don't know the intricacies of reimbursement schemes (never claimed to - and so what, the point is, we both make a ton). And then, inexplicably we have you comparing our brains. Does that make you feel better? You are sad.

As i said before, lawyers come in all stripes. Some of us push legislation all the time designed to protect the interests of our clients. Some of us push legislation designed to provide a steady stream of clients in the first place. We have good people and bad people. So do you.

BTW, why aren't M&M's made public? Surely a genuine interest in righting wrongs, in protecting the interests of patients and thier families would dictate a robust and transparent airing of the sorts of things that go in an M&M, right? Right?

You're never going to get it. You have selfish interests just like everybody else on the planet does. You are no better and you are no worse. By and large, doctors have a genuine interest in helping people and are good people. Lawyers are the same way. You've done nothing but be insulting so far.


Judd

 

[juddson]

It seems that there's a fence between Heaven and Hell, which had fallen into disrepair. God sought out Satan.

"Hey, Satan, it's your turn to fix the fence. it looks awful."

"I like the way it looks," Satan answered. "I'm not doing anything."

"You have to," said God. "It's your duty. You signed a contract when we built the fence, and you are obligated to repair it."

"You think I care about that contract?" asked Satan. "You should know better than that. I said I am not doing anything, and if you don't leave me alone, I may just tell you what you can do with that contract."

"If you don't make the repairs," God said angrily, "I'll sue you."

"Sue me?" Satan couldn't help laughing. "Where are YOU gonna get a lawyer?"

I got em all. My favorate kinds of jokes.
Judd

 

[chillin]

Dude, don't you have anything else better to do than write some book that noboby reads. That's the problem with lawyers. They have way to much time on their hands so they concoct some ludicrous lawsuit with the first ambulance they chase down.

 

[juddson]

Originally posted by RADRULES
Why don't you get over yourself?? You come to this board and spout your nonsense like it is gospel. I see no facts to back up any of your assertions. In fact, everything you are saying is totally without any evidence presented.

You must be a sh*tty lawyer.

Lawyers, to me, are nothing more than a pain in the @ss. The less I have to interact with lawyers the rest of my life the better.

It doesn't make any difference who is more altruistic, more worthy of respect, etc. Bottom line is that medicine would be MUCH better without the current medicolegal bullsh*t.... my ideal would be one where I would never have to deal with our "for sale" legal system (notice I didn't say justice).

You are smooth. I'm thinking you didn't read the studies I posted above.

Anyway, most of your post is just personal insult based on your blinding hatred of lawyers. It was, after all, the doctors on this forum who claimed the holier than thou attitude, not me. I'm just saying it's not true. I'm quite certain it's not true with you.

Judd

 

[juddson]

Originally posted by chillin
Dude, don't you have anything else better to do than write some book that noboby reads. That's the problem with lawyers. They have way to much time on their hands so they concoct some ludicrous lawsuit with the first ambulance they chase down.

My son's asleep and I'm just chillin on the internet. Same as you. Go away if you have nothing constructiev to say. You are just being insulting.

Judd

 

[group_theory]

Originally posted by avendesora
Anyone ever hear the adage that 90% of malpractice lawsuits are not the result of malpractice and 90% of malpractice does not result in legal action? (I hope somebody didn't already say this). Obviously there's no data for this,

"Only 1% of patients suffering a medical injury due to negligence receive any compensation for that injury. 99% receive no compensation. Of 100 malpractice claim filed, only 17 involved cases of medical negligence. 83% of malpractice claims do not involve medical negligence."

Brennan TA et al. Incidence of adverse events and negligence in hospitalized patients. N Engl J Med 1991;324:370

Localio AR et al. Relation between malpractice claims and adverse events due to negligence. N Engl J Med 1991;325:245

Weiler PC, Newhouse JP, Hiatt HH. Proposal for medical liability reform. JAMA 1992;267:2355




juddson - what is your opinion on the shotgun approach that med mal lawyers use? I mean, if a physician did nothing wrong, that physician will eventually be dropped from the suit (hopefully during discovery). BUT it will cause a lot of emotional stress on the physician, $$$ because that physician will need to get a lawyer, potential med mal insurance increase for being named in a suit, ordering more tests than usual, etc.

 

[Apollyon]

Originally posted by juddson
Your understand of legal billing is contemptable. A two minute phone call is normally simply eaten. An hours worth of work is billed as an hour.

My lawyer bills in tenths of an hour - phone call, reading/responding to emails, etc. I feel "nickel and dimed" to death. I never thought that "NO CHARGE" would ever mean so much to me.

 

[Sessamoid]

Originally posted by juddson
It's almost hysterical to read this line (written by you) in the same post that claims you went to medical school to be altruistic.

I never claimed to go to medical school to be altruistic. Part of the reason I went to medical school was altruism, but that has it's limits. You're getting cause and effect mixed up. I never claimed to be Mother Theresa. I like helping those who can't be helped elsewhere, but it gets old sometimes, especially when getting lectured to by lawyers who think that I AM getting paid to do it.

well I said i didn't) and called me an idiot for claiming that i did.

If I called you an idiot or implied that you were, then I apologize, but I don't think I did.

Likewise (and I'll never understand why you seem to think all all lawyers are medical malpractice attorneys) Lawyers come in all stripes too.

Show me a quote where I stated that all lawyers are malpractice attorneys, or even that all lawyers are bad. You're getting my posts confused with someone else's. My family has lots of lawyers, and I like them just fine.

You're arguing points that you don't have disagreement with me on. I started this thread to talk about John Edwards and his ugly stunts in the courtroom to get rich. You hijacked it into a general malpractice discussion.

 

[Sessamoid]

Originally posted by Apollyon
My lawyer bills in tenths of an hour - phone call, reading/responding to emails, etc. I feel "nickel and dimed" to death. I never thought that "NO CHARGE" would ever mean so much to me.

And most large law practices round up in billing. I had plenty of friends who ended up billing for like 12 hours a day when they didn't spend nearly that much time in the office.

 

[Sessamoid]

Originally posted by juddson
BTW, why aren't M&M's made public? Surely a genuine interest in righting wrongs, in protecting the interests of patients and thier families would dictate a robust and transparent airing of the sorts of things that go in an M&M, right? Right?

M&Ms are not public because if they were forced to be public, they'd stop happening altogether. And that would be a bad thing. Others doctors wouldn't get the benefit of learning from others' mistakes, and the doc who made the mistake (if there was one) won't get the input from other physicians.

M&Ms do however come in lots of different colors and peanuts inside (my favorite kind).

 

[juddson]

Originally posted by group_theory


juddson - what is your opinion on the shotgun approach that med mal lawyers use? I mean, if a physician did nothing wrong, that physician will eventually be dropped from the suit (hopefully during discovery). BUT it will cause a lot of emotional stress on the physician, $$$ because that physician will need to get a lawyer, potential med mal insurance increase for being named in a suit, ordering more tests than usual, etc. [/B]

Well, I don't know exactly how I feel about it. The inclination is to sue everybody in the room with the patient, regardless of whether you have any evidence that a particular provider in the room is responsible for the injury. Why? Because unlike most torts, the plantiff (1) was probably asleep when the alleged malpractice took place, and/or (2) wouldn't recognize the malpractice if he saw it in the first place. Hence, it is not until discovery (when most of the evidence is obtained) before its evident that certain care providers in the room were probably not the cause of the injury and therefor should be dropped.

Remember, there are stututes of limitations for medical malpractice cases (two to three years in many states) which require the patient to name the relevant parties and file the suit before the time expires. If you fail to name the anesthesiologist, and the statute tolls, you can't get her back even if its becomes evident during discovery that her negligence played a role in the injury.

The current med mal system is not perfect (far from it). There are many pitfalls for both plaintiffs and defendants. One of the most unfortunate aspects of it is that dismissed defendants who have done nothing wrong still incur enormous costs (via thier insurance company) to defend against the suit.

Judd

 

[juddson]

Originally posted by Apollyon
My lawyer bills in tenths of an hour - phone call, reading/responding to emails, etc. I feel "nickel and dimed" to death. I never thought that "NO CHARGE" would ever mean so much to me.

Believe me, this is an improvement with the client's interests in mind. Lawyers used to bill in half hours, leading to the sorts of overbilling alluded to above. The billing in 10 minute increments is a recent change, demanded by clients, NOT attorneys. Lawyers would love nothing more than to go back to the old system.

Judd

 

[juddson]

Sessamoid, We are generally in agreement.

And, yes, I did hijack your thread, and I applogize for that. I hate it when people do that to me.

Judd

 

[Sessamoid]

Originally posted by juddson
I do know, however, that every state has indigent care laws which require certain hospitals (and therefore the services that cover them) to provide care to people who cannot pay.

The system you speak of is the "county hospital" system, where one (or several) hospitals are designated as county hospitals and are given county monies to compensate them for the cost of indigent care. Not all states have such a system. In particular, Florida does not have such a system. Hospitals are pretty much left to fend for themselves when it comes to the costs of indigent care. Thankfully, there's a pretty large population of retired (i.e. Medicare) patients, so that even the hospitals in the bad part of town can usually break even.

None of which helps the docs at those hospitals who still have to care for those patients for free. Some hard to find subspecialties have started demanding a subsidy for taking call at these hospitals, and they can just because they're hard to find.

 

[secretwave101]

Gotta weigh in...sorry, it's kinda looong (not even close to some of those totally unreadable copy and pastes, however). Also, I'm MS3 so factor that in:

Oh, and as to John Edwards -- the punk sued the American Red Cross 3 freaking times! What more needs to be said? The ARC has a few problems, but jeez...who's next, Goodwill?

I've recently been attracted to the idea - no matter what is decided about the larger issue - of disconnecting lawyer profits from the litigation itself. While it is fair to say that no patient should have to pay for care that is required due to a medical mistake, it is also fair to say that no one, least of all lawyers, should get rich from that mistake.

I'm friends with a doctor in California who is on the board for admitting priviledges at his hospital. As such, he sees the pending or past litigation on every doctor who applies for priviledges. By his estimation, virtually EVERY doctor has a pending or resolved lawsuit on their record. Most average 2 or 3. This is unequivocally absurd. Doctors are the most tested and culled professionals in the American workforce. The great majority of them are "Type A" perfectionists who abhor mistakes. That they are so often sued for these mistakes is an illogic based in cash, not reason and certainly not justice.

I'll refer you to an excellent essay written by Dr. David Hilfiker called "Mistakes". The essay is published in the book "On Doctoring" an anthology of medically-oriented literature. In his essay, Dr. Hilfiker describes a number of appalling mistakes he made while working as a rural primary care practitioner in Minnesota.

One compelling story he recounts is a time when he aborted a couple's living child because he mistakenly thought the fetus had died. The mother had taken 4 separate pregnancy tests and the results were negative each time. However, he did not order an ultrasound because at the time it would have been very expensive for the couple. Just before he performed the D&C, he said his physical exam of the woman's abdomen suggested that there had been fetal growth since his last examination. But he ignored his new suspicions and went ahead with the procedure. Only during the D&C - when body parts were drastically larger than would be expected for the "fetal death" that had supposedly occurred - did Dr. Hilfiker know for certain that he had killed the child.

His response to his mistake was to tell the parents everything he did. The husband directly asked him if an ultrasound would have revealed the living baby and the doctor's answer was that, yes, the ultrasound would have identified the living baby and would have prevented the tragedy. There were complications from the D&C and the mother was unable to get pregnant for another 2 years. And she was required to pass the remaining body parts over the week following the procedure - watching her child come out of her in pieces. Think of the settlement this case would have won by today's litigious standards, largely due to the doctor's honesty!

In the essay, he admits "I had relied too heavily on one test; I had not been skillful in determining the size of the uterus by pelvic examination; I should have ordered the ultrasound before proceeding to the D&C. There was no way I could justify what I had done."

But Dr. Hilfiker is no idiot. "My initial response to mistakes is to question my competence. Perhaps I just didn't have the necessary intelligence, judgment, and discipline to be a physician. But was I really incompetent? My University of Minnesota Medical School class had voted me one of the two most promising clinicians. My diploma from the National Board of Medical Examiners showed scores well above average." Dr. Hilfiker did his undergrad at Yale, and was respected as a good physician by his colleagues, other specialists and his patients.

He wrote this essay before these days of rampant litigation, but he saw enormous problems with the tendency to hide mistakes already embedded in medical culture. "The drastic consequences of our mistakes, the repeated opportunities to make them, the uncertainty about our culpability, and the professional denial that mistakes happen all work together to create an intolerable dilema for the physician."

"Obviously, we physicians must do everything we can to keep mistakes to a minimum. But if we are unable to deal openly with those that do occur, we will find neurotic ways to protect ourselves...Little wonder that we are defensive about our judgements, that we blame the patient or the previous physician when things go wrong, that we yell at nurses for their mistakes, that we have such high rates of alcoholism, drug addiction, and suicide."

"Physicians need permission to admit errors. They need permission to share them with their patients. The practice of medicine is difficult enough without having to bear the yoke of perfection."

In my estimation, litigation has done nothing but harm to American medicine and American society as a whole. Previous to rampant litigation, doctors were already ill-equipped to deal with their mistakes and were largely incapable of admitting those mistakes to their patients. Now, it's legal suicide to do so. Patients get less of the truth, and doctors have no incentive to rectify untruth if it could be used against them in court.

And who bears the lion-share of responsibility for this pathetic contraction in whatever openness and trust that once existed betwee doctor and patient? That would be John Edwards - the man who made millions on the backs of people who work in a profession that is fundamentally riddled with errors. Medicine is a field in which decisions are made that are indefensible to second-guessing and thoughtful hindsight. For a personal-injury lawyer, it's like shooting fish in a barrel.

Incidentally, Dr. Hilfiker was not sued by the couple in his story. They accepted his explanation, and all 3 bore the burden of his mistake together through frequent meetings and copious tears. I fear we have lost this priceless common humanity in our culture today, and we suffer for it.

Geoff

 

[RADRULES]

Yes, for the most part I think lawyers are leeches who contribute very little to society.

Despite my feelings, I would have little problem with lawyers if they stayed out of medicine.... what lawyers such as John Edwards have done to the practice of medicine these days is absolutely disgusting.

It makes me sick on a daily basis when I read avoidable study after study which are ordered as part of CYA medicolegal ****.

Lawyers have done tremendous damage to the physician-patient relationship and the practice of medicine in general.

 

[docjr]

Well, this thread has been both amusing and exhausting to read. Sorry for entering the fray so late. I only did so when I saw my tagline being abused, but more on that later. I would hope after all of this that we could at least come to an agreement on two points.

First, doctors make errors that result in death or serious injury to their patients on the order of tens of thousands of times per year (or more). These people deserve to be compensated fairly for their injuries. We are loathe to admit this, but the evidence plainly bears this out.

Second, the current medical tort system is badly broken and needs to be drastically overhauled if not scrapped entirely. As has previously been mentioned, it does an exceptionally poor job of compensating those who have been harmed (i.e. the ?90% of malpractice [that] does not result in legal action?) and is fraught with systematic abuse by those trying to ?game the system?. Plaintiff?s attorneys are loathe to admit these facts, though they too seem relatively clear.

We need a new system, preferably a non-adversarial one. I would suggest a system in which doctors pay a fee based on their specialty and past claim history. These fees would go into a ?Malpractice Victim?s Compensation Fund? for want of a better term, and awards would be disbursed after the victim?s claim had been evaluated by an ?expert panel? composed of doctors, lawyers, actuaries, patient representatives, etc. This system is similar in many respects to the system used today for vaccine related adverse effects. These awards wouldn?t likely be as large as the multi-million dollar jackpots that make headlines today, but I think it would do a far better job of actually compensating those who are injured.

In my opinion, lay civil juries have no more business deciding complicated medical malpractice cases than they do deciding equally complex corporate bankruptcy proceedings. In both contexts, juries simply aren?t equipped to handle the case?s intricacies, of which they know little and understand less. Yet it is precisely this understanding that is fundamental to rendering a just decision. Of course, this won?t ever happen because most politicians are lawyers, and it would put a large number of their brethren out of work.

Getting back to the original point of the thread, the reasons that I dislike John Edwards can be summed up pretty nicely in this paragraph from the Times article:

"An examination of Mr. Edwards's legal career also opens a window onto the world of personal injury litigation. In building his career, Mr. Edwards underbid other lawyers to win promising clients, sifted through several dozen expert witnesses to find one who would attest to his claims, and opposed state legislation that would have helped all families with brain-damaged children and not just those few who win big malpractice awards."

It?s this kind of self-serving nonsense disguised as compassion that makes me sick. I?m not saying all lawyers are like this, but Edwards certainly isn?t the only one. That being said, if ever I need to give an example of an ad hominem argument, I?m in the right place. Some of these posts are just ridiculous!

As far as Shakespeare goes though, juddson, only a lawyer?s sophistry could take what is clearly intended and understood as an insult, and turn it into a compliment. While you?re quite correct that the character quoted below, Dick the Butcher, is plotting to overthrow the government, that is really quite tangential to the meaning and intent of the quote. He?s actually describing his idea of the perfect kingdom for the common man. The Butcher, as he?s known, is playing a classic ?low-plot? role in which Shakespeare uses a plain-spoken and ignoble character to insult and deride the wealthy and powerful, in this case, lawyers. Cf. the Fool in Lear, ??Tis like the breath of an unfee?d lawyer, he gave me nothing for it.? Not that Shakespeare didn?t take shots at doctors too, most famously in the Scottish play, ?Throw physic to the dogs; I?ll none of it.?

Anyway, that's my two cents.

 

[juddson]

Originally posted by docjr


As far as Shakespeare goes though, juddson, only a lawyer?s sophistry could take what is clearly intended and understood as an insult, and turn it into a compliment. While you?re quite correct that the character quoted below, Dick the Butcher, is plotting to overthrow the government, that is really quite tangential to the meaning and intent of the quote. He?s actually describing his idea of the perfect kingdom for the common man. The Butcher, as he?s known, is playing a classic ?low-plot? role in which Shakespeare uses a plain-spoken and ignoble character to insult and deride the wealthy and powerful, in this case, lawyers. Cf. the Fool in Lear, ??Tis like the breath of an unfee?d lawyer, he gave me nothing for it.? Not that Shakespeare didn?t take shots at doctors too, most famously in the Scottish play, ?Throw physic to the dogs; I?ll none of it.?

Anyway, that's my two cents. [/B]

There is much derision of lawyers throughout the whole of Shakespeare's works, as well as what appears to be, at times, a striking understanding of the law as it existed. Commentary relating to his obvious fascination and competence in the minutia of Elizabethan law is abundant and varied. I'll not claim that he was an attorney. That debate is for another day.

In any event, I'll not engage you in a debate as to the true meaning of Dick the Butcher's infamous imparative (else the pages we fill and the tangents we explore make the preceding group of posts seem concise) except to note that one should hardly attribute meaning to "the first thing we do, let's kill all the lawyers" without mentioning in whose cause Dick the Butcher operates. Jack Cade is an anarchist and a soundrel, who aspires to overthrow the sitting power. Later he has them killing the clerk of courts because he could read and write.

Judd

 

[secretwave101]

Wellllll, I think this thread has just about worn itself out --

 

[JohnnyJ]

I dont know why so many people are engaging in this ridiculous back and forth with this parasite. Trial lawyers are nothing but a bunch of thieves that use the law to extort as much money as they can out of society. They dont create anything useful or expand the economic pie. They just funnel back their stolen dough back to their law school buddies that run for political office. We're never going to see any meaningful tort reform for medical mal under a democratic adminsitration. Our lot is basically cast with the Republicans even though most of their positions are against what I believe in.

Read what Radrules wrote a few posts ago about asset protection. Its the only useful info in all this crap. Read it, understand it, and practice it or youre basicallly flirting with financial ruin.

Be as poor as you can on paper so youre not a viable lawsuit target. Consider going "bare" on malpractice, sock as much RE equity away using the homstead provision in Texas or Florida and use ERISA protected retirement accounts and state laws that protect other IRA assets.

 

[juddson]

Judd

 

[neglect]

Judd takes on the medical world through tireless posts! Wow. I've never seen this much devotion to anything other than crack or heroin or smoking.

Well, I think there are some problems on both sides, I'll start with the doctor side:

Doctors, we like to think that we can't make errors, and someone even mentioned that errors are rare, but I think that's nonsense. I'm constantly amazed that MORE errors aren't committed every day. Our system of medicine, with its primary reliance on a single doctor's clinical judgement and actions as he completes scut work is far from perfect.

So many possibilities for error.

An admit for something simple, cellulitis, could be made safe and simple if you could copy all medications into the chart and orders in a modern manner: ie., cut and paste. But how many hospitals have this other than the VA? How many times does a patient leave your service without strict medication instructions? How many times does your patient not get that outpatient study you requested (and, although difficult to track, you are still liable for)?

Why aren't there prompts present when you try to give a Seizure patient Wellbutrin? Or when you don't get CSF on the febrile confused patient who's tachy and nothing else will explains confusion? Or automatic lyte repletions? Why aren't you asked when discharging your post MI, 'why no ASA/ACE/B-blocker/Statin/rehab' should you forget any of them?

The reason is because medicine sucks.

It sucks because there's not enough money to invest in the IT to do any of this. Budgets are razor thin throughout the country.

It sucks because there are still doctors out there who think they are above and beyond such safety measures that are tried and true in other fields (think airlines - if getting onto a plane was anything like going to the hospital, how many people would fly?).

It sucks because if people knew how easy it is to follow a medical algorhythm, then we feel our business would become even more eroded by the PAs, NPs, herbalists who are ALREADY making inroads and cutting into profits.

It sucks because we are all stuck in this field, doing our best not to make a major error, but knowing, in our heart, that one may be right around the corner. That only will and hard work and knowledge is preventing a slip up, so we're fighting against the unavoidable with little or no support.

That's our inheritance from the profession when they couldn't do anything other than give morphine and sometimes cut things out.

Now Judd, crack boy, please don't flame me for calling you a crack head. Its just that you have so much typing energy that no human and few hummingbirds can match you. You're wasted on medicine, stick with the law.

I mentioned razor thin budgets above. One part of the problem in the big scheme of things ARE LAWSUITS, and the malpractice insurance industry (making it a huge one that in and of itself consumes health care dollars - its a 10 billion dollar industry), and the defensive medicine that we all practice when confronted with axis II patients. The lawyers take full advantage of the tight spot that people in medicine are in, bankrupting the system, and that's why we hate you.

Health insurance:
We have 1/7 of the country without insurance.

Those who pay: The average health insurance premium is 220 a month, 2600 a year, which is a TITHE of the national average salary.

Where does it all go?

The answer is that a lot of it goes into malpractice insurance. At big hospitals, their malpractice insurance could pay for tens of thousands of health care premiums.

Malpractice:
Look at the inflation for suffering. What medical error cost the system half a million in 1995 now costs more than a million (averages). What happened?

In the meantime, insurance companies, which have lost money with the market, can't keep it up. They take in 100%, and spend 150%. Its like Milo in Catch 22. And the system is breaking.

Defensive medicine:
And that's not even considering the defensive medicine we start practicing. Every headache gets an MRI. Why not? In 3 years, this patient may have a tumor. Get one now, cover your bases. I do. Where does the money spent on useless tests come from? If you're working, you know. Where could this money and the malpractice premiems be better spent?

Right Judd, I know that med-mal lawyers are making the world a better place - it should feed their starving children.

More on how good our malpractice system is:
Malpractice awards are random and oversized. They go to those who are best at manipulating the system.

Their kiddo was born with CP. They were in labor for 3 hours. (I can hear Judd's drool from here). What was it? OMG? Did you get the 3 month US results right? Should they have pulled when they told her to push? Should they have cut? Or would ANY of it make ANY difference? Most likely not. Estimates are that only 10% of CP kids are hurt in birth or by malpractice. Can you tell the difference?

If you look at the award money, it ranges from $0 for most, hundred thousand for some, and millions for rare cases. All for kids with the exact same claim and needs. Talk about lack of standards. Now that's social justice, right?

Anyway, I've rambled on. In short, I think medicine is in a bad spot, some of which is its own fault, and some of which is due to the horrible legal system around it, due, in turn, to the greed of the few, which comes back to hurt us all. At least it will when you're out looking for an OB doctor and the nearest one is in Kansas.

Finally, people in medicine should probably get out; people not in medicine should certainly stay away.

Why do doctors even get malpractice. Seems easier to go bare and stay as poor as possible. Put the money, house, cars, kids, alpine ski into someone else's name and stay a not-deep pocket? There must be something wrong with that, right?

 

[papilloma]

I think every lawyer that sues another person (or doctor) and loses should have a right to get sued for law malpractice. i mean, if patients could be maltreated, so can defendants and plaintiffs by the lawyers. Everytime a lawyer loses, the party that wins should have the right to sue that lawyer for wrongfully suing in the first place. If that is the case, lawyers would be much more careful with handling their clients and defendents cases, wont they? If doctors can be sued for doing a poor job, so should lawyers.

 

[edinOH]

Originally posted by papilloma
I think every lawyer that sues another person (or doctor) and loses should have a right to get sued for law malpractice. i mean, if patients could be maltreated, so can defendants and plaintiffs by the lawyers. Everytime a lawyer loses, the party that wins should have the right to sue that lawyer for wrongfully suing in the first place. If that is the case, lawyers would be much more careful with handling their clients and defendents cases, wont they? If doctors can be sued for doing a poor job, so should lawyers.

But what if it wasn't the lawyer's fault that the case was lost? What if the lawyer informed his client that there was a real risk that the case could be lost? What if the client either was unable or chose not to provide the lawyer with all the necessary and relevant information that would make representing his case more simple? What if the client refused to follow the lawyer's advice and contributed to the loss of the case? What if the case was shakey at best and the lawyer just did the best he could with the facts as they were?

How then could you justify suing or settling with the lawyer?

 

[ny skindoc]

Folks..Dont worry too much ..the current malpractice sysytem is going belly up soon...There is virtually no room left for premiums to rise..How much more can you charge a pediatrician who works 50 hrs a week for 150K or so? Many if not most OB-GYNs are on a fixed income from their insurers...they would have to get a substantial increase in reimbursment to pay higher premiums and as fees are usually fixed to medicare schedules this isnt likely. ..
There will be significant reform soon or access to care will become restricted.A good alternative would be a workmans comp type system for med-mal.

 

[papilloma]

These are some things doctors get sued for everyday. A simile could be made with your argument (compare this with your previous post):

1) what if it wasnt the doctor's fault that the surgery went wrong? what if the doctor informed his patient that there was a real risk that the life could be lost?

2) what if the patient either was unable to provide or chose not to provide the doctor with all the ncessary and relevant history (privacy or other reasons?) that could make the surgery more simple?

3) what if the patient refused to follow the doctor's advice (noncompliance, own decisiong making) and contributed to the injury or death? What if the surgery was shakey at best and the doctor just did the best he could with the facts as they were?

yet, doctors are sued for the exact reasons i stated above all the time. if doctors get sued for that, so should lawyers. and then lawyers would be more careful about their practice wont they?

Originally posted by edinOH
But what if it wasn't the lawyer's fault that the case was lost? What if the lawyer informed his client that there was a real risk that the case could be lost? What if the client either was unable or chose not to provide the lawyer with all the necessary and relevant information that would make representing his case more simple? What if the client refused to follow the lawyer's advice and contributed to the loss of the case? What if the case was shakey at best and the lawyer just did the best he could with the facts as they were?

How then could you justify suing or settling with the lawyer?

 

[juddson]

Originally posted by papilloma
These are some things doctors get sued for everyday. A simile could be made with your argument (compare this with your previous post):

1) what if it wasnt the doctor's fault that the surgery went wrong? what if the doctor informed his patient that there was a real risk that the life could be lost?

2) what if the patient either was unable to provide or chose not to provide the doctor with all the ncessary and relevant history (privacy or other reasons?) that could make the surgery more simple?

3) what if the patient refused to follow the doctor's advice (noncompliance, own decisiong making) and contributed to the injury or death? What if the surgery was shakey at best and the doctor just did the best he could with the facts as they were?

yet, doctors are sued for the exact reasons i stated above all the time. if doctors get sued for that, so should lawyers. and then lawyers would be more careful about their practice wont they?

1. If the doctor is not at fault that the surgery went wrong, there is no legal liability. Bad outcomes are not sufficient to demonstrate medical malpractice. In each and every case, in order for a patient to win in a med mal case, he has to demonstrate that the doctor deviated from the prevailing standard of care. Where the doctor did not deviate from the standard of care (ie, it wasn't his fault), he's not liable for the bad outcome. This principle is already the very foundation of tort law.

The OVERWHELMING majority of cases against doctors are dismissed in favor of the physician. Why? Because of the very principle set forth above. There has been no showing that the doctor did anything wrong. There's a tendency to think that (a) doctors lose these suits all the time, and (b) that it wasn't thier fault anyway. But the reality is that doctors win the vast majority of these suits (through dismissal or jury verdict) and of that small number that they do not win, there's no evidence that the Jury gets it wrong. Do juries get it wrong sometimes? No doubt - they do. But that's a far stretch from claiming they get it wrong all the time, or even most of the time. Some lawsuits that result in large jury verdicts against doctors are, no doubt, bona fide and determined correctly.

2. Again, under the current system the doctor is judged by the prevailing standard of care. Whether the patient failed to give the doctor important information (and the standard of care does not require him to take precautions against it anyway) there is no legal liability. But sometimes the standard of care DOES require that he take precautions against things like this. For example, it would not be uncommon for a patient brought into the ER to deny she had taken illicit drugs (say, cocaine), even though she has. Even so, the prevailing standard of care does NOT permit the doctor to take her word for it if her symptoms suggest otherwise. Hence, despite her insistence that she's clean, the prevailing standard of care would require the doctor to do a tox screen if she is exhibiting certain conditions (This is just an example - I have no idea whether the actual standard of care requires he do a tox screen in these situations). The same can be said of any number of procedures - though in varying degrees of complication. It all depends.

3. The notion of "contributory negligence" is available to a doctor who feels that the patient contributed to his own injury. In some states if the patient's liability is 50% or more, the doctor is not liable at all. In other, no matter what the contribution of the patient is, the doctor's liability is reduced by that amount. In addition, if the patient's own actions are wholey responsible for the injury (ie, the Hernia surgery went fine, but the patient went jogging the next day, and ****ed it up) the doctor isn't liable. Why? Because the doctor didn't deviate from the prevailing standard of care (ie, he did everything he was supposed to do during the surgery). On the other hand, if the doctor failed to tell the patient he should NOT run for 6 weeks after the surgery, no matter how well he feels, AND the standard of care requires the doctor to inform the patient of this, then the doctor would be liable. Again, under the notion that he deviated from the standard of care.

The elements of a lawsuit are not difficult to understand. You need (1) negligence (ie, a deviation from the standard of care), (2) an injury and (3) a showing that the negligence was the proximate (legal) cause if the injury. Without showing these three elements, doctors are not liable for bad outcomes.

Doctors gets sued all the time even though one or more of these three elements are not present. But they win (or are dismissed from) the vast majority of these suits. And, sometimes they lose.

The reality, however, is that patients are not in a position to know whether these elements are present until a suit is filed, an expert witness id secured, and discovery is progressed. This is because medicine is complicated. And a patient can't know what the cause of his injury is until he's sued and been through discovery.

Your solution would be to close the courthouse (effectively, because lawyers would not bring suits) to all those patients EXCEPT those who (1) know enough medicine to determine megligence without the help of an expert witness, and (2) those who happened to be awake when the injury occurred (many injuries occur during surgery when the patient is asleep.

It's not a perfect system. And many solutions may be proposed. Your's is not a very good one.

Judd

 

[edinOH]

Originally posted by papilloma
These are some things doctors get sued for everyday. A simile could be made with your argument (compare this with your previous post):

1) what if it wasnt the doctor's fault that the surgery went wrong? what if the doctor informed his patient that there was a real risk that the life could be lost?

2) what if the patient either was unable to provide or chose not to provide the doctor with all the ncessary and relevant history (privacy or other reasons?) that could make the surgery more simple?

3) what if the patient refused to follow the doctor's advice (noncompliance, own decisiong making) and contributed to the injury or death? What if the surgery was shakey at best and the doctor just did the best he could with the facts as they were?

yet, doctors are sued for the exact reasons i stated above all the time. if doctors get sued for that, so should lawyers. and then lawyers would be more careful about their practice wont they?

I see you understood the point of my post.

 

[papilloma]

I understand your point. However, whether the doctor wins or loses doesnt take away the fact that the doctor will have to pay a sum of money to the defense attorney. That is why the malpractice insurance is so high nowadays because doctors have to pay lawyers even when they are good docs and not negligent. If lawyers are more careful with their malpractice suits, then good doctors wont have to get sued, win, and pay the defense lawyers, will they?

Your point is exactly correct. I do believe only lawyers who are experts of medicine or MD/JDs should be able to sue doctors. That's the only way patients are going to be able to afford healthcare these days. Now patients are paying high costs to the docs for the docs to pay lawyers. The high costs for healthcare exist because we need to pay off lawyers and that's ridiculous. I respect lawyers but they shouldnt exist to put strains on our society and the healthcare system. MD/JDs or med expert lawyers should exist in our society to protect us from negligent docs, but what are all these ignorant lawyers who promise patients "no win no fee" to "encourage patients to sue any doc" trying to pull??

Originally posted by juddson
1. If the doctor is not at fault that the surgery went wrong, there is no legal liability. Bad outcomes are not sufficient to demonstrate medical malpractice. In each and every case, in order for a patient to win in a med mal case, he has to demonstrate that the doctor deviated from the prevailing standard of care. Where the doctor did not deviate from the standard of care (ie, it wasn't his fault), he's not liable for the bad outcome. This principle is already the very foundation of tort law.

The OVERWHELMING majority of cases against doctors are dismissed in favor of the physician. Why? Because of the very principle set forth above. There has been no showing that the doctor did anything wrong. There's a tendency to think that (a) doctors lose these suits all the time, and (b) that it wasn't thier fault anyway. But the reality is that doctors win the vast majority of these suits (through dismissal or jury verdict) and of that small number that they do not win, there's no evidence that the Jury gets it wrong. Do juries get it wrong sometimes? No doubt - they do. But that's a far stretch from claiming they get it wrong all the time, or even most of the time. Some lawsuits that result in large jury verdicts against doctors are, no doubt, bona fide and determined correctly.

2. Again, under the current system the doctor is judged by the prevailing standard of care. Whether the patient failed to give the doctor important information (and the standard of care does not require him to take precautions against it anyway) there is no legal liability. But sometimes the standard of care DOES require that he take precautions against things like this. For example, it would not be uncommon for a patient brought into the ER to deny she had taken illicit drugs (say, cocaine), even though she has. Even so, the prevailing standard of care does NOT permit the doctor to take her word for it if her symptoms suggest otherwise. Hence, despite her insistence that she's clean, the prevailing standard of care would require the doctor to do a tox screen if she is exhibiting certain conditions (This is just an example - I have no idea whether the actual standard of care requires he do a tox screen in these situations). The same can be said of any number of procedures - though in varying degrees of complication. It all depends.

3. The notion of "contributory negligence" is available to a doctor who feels that the patient contributed to his own injury. In some states if the patient's liability is 50% or more, the doctor is not liable at all. In other, no matter what the contribution of the patient is, the doctor's liability is reduced by that amount. In addition, if the patient's own actions are wholey responsible for the injury (ie, the Hernia surgery went fine, but the patient went jogging the next day, and ****ed it up) the doctor isn't liable. Why? Because the doctor didn't deviate from the prevailing standard of care (ie, he did everything he was supposed to do during the surgery). On the other hand, if the doctor failed to tell the patient he should NOT run for 6 weeks after the surgery, no matter how well he feels, AND the standard of care requires the doctor to inform the patient of this, then the doctor would be liable. Again, under the notion that he deviated from the standard of care.

The elements of a lawsuit are not difficult to understand. You need (1) negligence (ie, a deviation from the standard of care), (2) an injury and (3) a showing that the negligence was the proximate (legal) cause if the injury. Without showing these three elements, doctors are not liable for bad outcomes.

Doctors gets sued all the time even though one or more of these three elements are not present. But they win (or are dismissed from) the vast majority of these suits. And, sometimes they lose.

The reality, however, is that patients are not in a position to know whether these elements are present until a suit is filed, an expert witness id secured, and discovery is progressed. This is because medicine is complicated. And a patient can't know what the cause of his injury is until he's sued and been through discovery.

Your solution would be to close the courthouse (effectively, because lawyers would not bring suits) to all those patients EXCEPT those who (1) know enough medicine to determine megligence without the help of an expert witness, and (2) those who happened to be awake when the injury occurred (many injuries occur during surgery when the patient is asleep.

It's not a perfect system. And many solutions may be proposed. Your's is not a very good one.

Judd

 

[aphistis]

Originally posted by papilloma
I understand your point. However, whether the doctor wins or loses doesnt take away the fact that the doctor will have to pay a sum of money to the defense attorney. That is why the malpractice insurance is so high nowadays because doctors have to pay lawyers even when they are good docs and not negligent. If lawyers are more careful with their malpractice suits, then good doctors wont have to get sued, win, and pay the defense lawyers, will they?

Your point is exactly correct. I do believe only lawyers who are experts of medicine or MD/JDs should be able to sue doctors. That's the only way patients are going to be able to afford healthcare these days. Now patients are paying high costs to the docs for the docs to pay lawyers. The high costs for healthcare exist because we need to pay off lawyers and that's ridiculous. I respect lawyers but they shouldnt exist to put strains on our society and the healthcare system. MD/JDs or med expert lawyers should exist in our society to protect us from negligent docs, but what are all these ignorant lawyers who promise patients "no win no fee" to "encourage patients to sue any doc" trying to pull??

I like this idea. We'd be much better off as professionals, of course. But can you imagine the fees these JD/MD, JD/DDS, etc. would command? I might have to change careers if that became commonplace.

 

[papilloma]

Costs for these guys will probably be higher, but the number of cases will reduce because of my previous proposal: they run a risk of your suing them back for malpractice suit malpractice, so they wont sue you in the first place without a very reasonable case. The number of suits will reduce, and if you are not negligent, you will probably never get sued. In the long run, you will pay less for defense, and you wont waste so much time going to court or conjuring a defense for yourself.

Originally posted by aphistis
I like this idea. We'd be much better off as professionals, of course. But can you imagine the fees these JD/MD, JD/DDS, etc. would command? I might have to change careers if that became commonplace.

 

[papilloma]

I just think how much more affordable healthcare would be if lawyers sued only when there is a very reasonable case against the doc. The fact that doctors should be liable to their practice if they are negligent, so should lawyers. I have nothing against lawyers, but I am thinking of ways to improve our society. also, i'm creating jobs for lawyers: a new branch called attorney malpractice.

 

[juddson]

Wait a minute here.

To the extent that high insurance premiums are due to the high costs of medical malpractice cases (and there is HUGE disagreement on this point - certainly the poor investment portfolios of the insurance companies have as much to do with this as actual malpractice lawsuits) these costs are due to HUGE jury awards and HUGE settlements, NOT the mere cost of defending a suit - even when the suit goes the distance.

Read some of the recent threads above. The most vocal complaints have been the steady increase in the award levels, not necessarily the frequency with which suits are brought.

Hence, if you believe that the malpractice lawsuit climate is largely responsible for the high cost of insurance (I don't happen to believe this - but let's assume it is true) you should blame the size of the awards, not the costs of defense. And this being the case, your proposal would do little (if anything) to bring the costs down - presumably because these JD/MD's (****ing bastards!!) would still continue to secure huge awards (and maybe even larger than before) even if the number of suits is diminished.

But your point is well taken anyway. Presumably (I gather) these JD/MD's would understand enough medicine to act as reliable gatekeepers to the courthouse. Assuming this is true, it doesn't address the other issues I mentioned. For instance, this JD/MD could be the best doctor in the world. He's still not going to have ANY insight into what went on in the operating room (or ER or wherever) until discovery. As it stands now, good plaintiff firms already have MD's who they keep on retainer who are supposed to make these sorts of "gatekeeper" decisions by way of consulting. But without discovery, they are worthless (how could they know anything - they weren't there) and therefore I don't see how this JD/MD would be any better at it. And you can't get to discovery unless you file a lawsuit. And this costs the doctor's insurance company money (though not a lot of money if it's pretty clear there was no malpractice - he'll be dismissed pretty early on when it's clear).

But maybe you are on to something. Perhaps one way to deal with this issue is to make the M&M's public record. This would permit a sort of discovery without having to file suit (as soon as this happened, though, M&M's would stop). Or, require doctors to submit to discovery without having to first file suit against them. Maybe that would serve to release good doctors from the system before they have to be sued for no reason (doctors would never do this either).

Judd

 

[group_theory]

If I understand juddson correctly (and feel free to tell me if I am mistaken), the reason lawyers sue in the first place is so they can see if they have a case (during the discovery period). Before then, they only have the words of their patient/client

Why don't we set up a commission or a permenant panel consisting of doctors, lawyers, hospital administration, and patient advocacy groups. Their role is to review all potential malpractice cases. They should function something like a preliminary hearing, or a grand jury - and determine whether or not the plantiff have sufficient cause to proceed.

They can take testimony from the patient, the doctors involved, review the medical records, etc.

Doctors benefit from this because if there is no case, it won't proceed to trial. And the doctors involved won't have to hire defense attorneys.

Malpractice Lawyers will benefit from this because this can screen cases that would otherwise have been a loser for them (and costing them money)

The court system will benefit from this due to fewer cases being filed

Med Mal Insurance benefits because they won't have to spend $$$ on lawyers to defend doctors on frivilous suits

Patients overall will benefit from a fairer tort system. In fact, more people might use this system since it won't cost as much as a trial - hence those who did suffer from malpractice will see their day in court faster (rather than waiting years). However, people with baseless claims (from a legal standpoint) will obviously hate this, since they want their day in court (or a cash settlement)

Not sure about the constitutionality of this or whether or not the panel's ruling is binding. There also must be an appeal process. But this could be a good start, no?

 

[juddson]

That's a fantastic idea. One that has been floating around the tort reform arena for many years. To various extents, even some jurisdictions have tried it to varying degrees of success.

As one way to address the problem, I am in favor of a sort of "grand jury" system for medical malpractice cases. This would serve all the functions you mention.

The only problem is the pesky "right to a jury" clause in the consitition. As the current understand of the constitution stands, these commissions could not be binding on either party.

Perhaps arbitration instead (enforced by contract). These would be OK constitutionally.

Judd

 

[Apollyon]

I thought Florida has some committee about that, if you're privately employed, and a high-risk (Ob/Gyn, EM, surgery) provider. If you are a state employee, you have sovereign immunity, and there's some tougher committee that prospective suitors must face, and, if that committee finds the suit has merit, THEN the person can sue the state (not the doc).

That's how I understand it. Hopefully, someone can clarify it if I'm wrong.