Doctors' Lobby Attack on Reform Aimed at Forcing Malpractice Caps on Obama

The American Medical Association has proven again that the greed of the medical insurance complex is the chief obstacle to health care reform in America.

The most established mouthpiece for American doctors weighed in against the pivotal plank of Obamacare -- a public alternative to the private health insurance market. The stated reason for the doctors' opposition was fear that the public health care system would displace private insurers, and doctors would have to take a pay cut. But the AMA has been pretty hard on private insurers over the years, filing reams of class action lawsuits. The real reason for the AMA's opposition appears even more cynical and myopic.

With President Obama scheduled to speak to the group Monday, the AMA seems to be holding its support for health reform hostage until Obama embraces the interest group's sacred cow -- draconian limits on patients injured by medical malpractice. For decades the doctors' lobby has fought to impose stiff limits on how much juries could give to injured patients in medical negligence cases.

State damage caps, such as California's cruel and draconian 30 year old limits, have locked injured patients out of court, degraded the quality of health care and denied justice to too many families. President Bush could never foist the AMA's wish list on even the Republican Congress so now the AMA is taking aim at Obama, who is anxious to enact health reform.

The evidence of how limits on victims of medical negligence have harmed patients has been well established. The JusticeForPatients.org site has a video monument to the stories of injured patients denied justice under California's draconian medical malpractice laws. Consumer Watchdog has shown that malpractice damage caps do not even limit doctors' malpractice premiums, only insurance regulation does that. The Los Angeles Times also published a large investigation demonstrating how injured patients have been locked out of the justice system in California due to malpractice caps in the state.

President Obama should let the AMA know Monday that he won't allow the trade association to hold a gun to the head of health care reform just so dangerous doctors can avoid legal accountability. Better yet, he should cancel his speech and let it be known on Capitol Hill that he believes regulating how much doctors and insurers can charge is exactly the cost control needed in health care reform.

Greed, waste, fraud are the big cost drivers in health care. A small minority of bad doctors drive waste and fraud just like only a small percentage of dangerous doctors commit most of the malpractice. If the AMA really wants to protect these bad apples, it needs to know the government intends to watch and regulate the profession even more closely. More accountability needs to be the response to the AMA's selfish attack, not capitulation.

Comments

[pinball]

No one likes to be sued, but if the fine doctor can't come up with some type of "reform" that doesn't punish those with legitimate claims, perhaps the courts are still the best remedy.

[doc3osh]

(The other 5 comments from me should be read in reverse order... I had to split them up to post them, but I wasn't smart enough to split them up "backwards" so they read consecutiv­ely...)

[doc3osh]

I know this will fall on deaf ears for the most part. People will still think doctors are just being greedy and just want lower malpractice premiums (or, they will think I was sued three times in 2008 because I'm a bad doctor. All I can say is, I will not lose (or settle) any of the lawsuits..­. and no one thinks I should lose my license). But I hope some of you will listen and understand that it is the patient that is being harmed by this. The patient waiting ten hours in the ER for a CAT scan because now EVERYONE is being scanned-- and meanwhile her appendix ruptures while she waits and she gets a scar and a long hospital stay instead of being home the next day. The patient getting tests they don't need. The taxpayer paying for the tests. Everyone but the lawyers suffers for it-- and the lawyers suffer too, as soon as they or their family members are patients.
There are 5 "players" at the table in healthcare in this country: patients, doctors, hospitals, insurance companies, and lawyers. If we are to truly reform healthcare, all five of those groups should be sacrificing something. If lawyers maintain the status quo, all of us will pay more, in dollars and in health, for it.

[doc3osh]

Now put yourself in the shoes of a New York radiologist: any time you are asked to read a scan that has even the SLIGHTEST hint of abnormality, you have two choices: you can say "I think it's normal" and accept that in the (however unlikely) event that you are wrong, YOU will be sued and have months of aggravation, OR you can say "inadequate study, may represent xyz abnormality-- recommend MRI (or some other study) to further evaluate"-- in which case a couple hours later you get paid again to read the MRI! What would YOU do-- worry about being sued, or collect another paycheck for reading another study? This doesn't make radiologists bad people-- it makes them humans trying to adapt to a terrible system. You can't expect them to do what YOU (the patient) thinks is the "right thing" when they are wearing a bullseye on their back.
The number of unnecessary scans, especially in trauma patients, is astounding. And no, they are not harmless-- we are, in essence, intentionally giving people cancer from the cumulative radiation. But the cancer won't show up for 20 years, and we can't be sued for that. What a sad bastardization of "do no harm".

[doc3osh]

Here is an example: an 80 year old man fell down 3 steps and broke his hip. I called orthopedic surgery to admit him. They tell me they can't admit him unless the Trauma Surgeon "clears" the patient-- i.e. signs on the chart that he is sure the patient has no other hidden injuries besides his hip fracture. I say "But you can come examine the patient, he just fell a couple steps". They refuse-- the issue is, who will be liable in the unlikely event that there is another injury. So I call the Trauma surgeon. The trauma surgeon won't "clear" the patient unless we "pan-scan" him: get a CAT scan of head, c-spine, chest/abdo­men/pelvis (the latter 3 with intravenous contrast). So now with neither of them having examined the patient, we have run up $7500 in unnecessary bills. Hopefully the I.V. contrast will not cause kidney failure. Then the CT shows a "possible" malalignment in the spine, so the neurosurgeon is consulted and insists on an MRI. All of this is essentially to "pass the liability buck" which ultimately lands on the radiologist.

[doc3osh]

I moved to NY from Texas, where there is tort reform. I practiced in Texas for 6 years and was never sued. When I got to NY I was incredulous at all the CT scans ordered. Then I learned why: here in NY, I was sued 3 times in 2008. Now I understand. If a patient wants a CT (as hundreds of patients did in the week after Natasha Richardson died), I no longer explain to them why it isn't warranted in their case-- I simply get the CT and irradiate their brain as requested. Because in NY, if they are the 1-in-a-thousand that actually has a bleed, it is nearly GUARANTEED that they will sue me. Of course if I practice good medicine I will probably WIN the lawsuit-- but once you have gone through the aggravation and heartache of a lawsuit you realize that "winning" it is not the goal-- NOT BEING SUED is the goal. And the most reliable way to not be sued in NY is to CT scan everyone you see.

[doc3osh]

I wish we doctors had some way to adequately convey to our patients how they are harmed by NOT having malpractice reforms. I know the average person thinks that we only want malpractice reform so that our premiums will go down... it just isn't so. I can't express how quickly I would leap at malpractice reform even if I had to agree that my premiums would NEVER go down. Nor is it a "patient safety" issue, as lawyers want people to believe. (This is easy enough to prove: Do you know any doctors that have been sued? Most likely the answer is "yes". Now, do you know any doctors that have lost their license because they are "unsafe"? Doubtful. If lawyers were out to safeguard patients from dangerous doctors, they would sue to have the doctor's license revoked. But they have no interest in that; they are interested in money, which is why they sue for money.) The "curse" of the current malpractice system, for both doctors and patients, is that it forces us to practice not using common sense or good medicine, but rather for the one-in-a-thousand possibility of a bad outcome. Once a doctor has been sued once... or twice... (or three times, as I was in 2008), we spend all our time worrying about how to make the case "bulletproof" against lawyers.

[sunnybunny]

Isn't that the main reason they do uneccesary procedures then, and use invasive or toxic methods of treatment rather than things that make more sense, cost less, and cause the patient way less pain? If this is known (even I have heard it) , why would that not be a big part of the impending reform?