Act now as medical liability reform gains momentum

AMA Leader Commentary. By Yank D. Coble Jr., MD. Feb. 17, 2003.

AMA LEADER COMMENTARY

A few words about current events in medical practice

SEE ARCHIVES

A message to all physicians from AMA President Yank D. Coble Jr., MD.

As physicians, our patients' access to quality medical care and the relationship of trust between us is paramount.

Now, that access -- and that trust -- are in jeopardy.

Excessive jury awards -- delivered by a broken tort system -- have sent liability insurance premiums skyrocketing. The AMA has identified 12 states where the crisis is at its worst. Another 30 are on the brink. In these states, a rapidly growing number of physicians can no longer find -- or afford -- liability insurance.

It's forcing physicians to restrict their practices -- to avoid high-risk, but necessary, medical procedures such as delivering babies or covering emergency departments. Physicians are retiring early or relocating to states with affordable premiums.

The liability crisis is leading others to limit their practices or close up shop because of the stress, or because of the risk to their reputations or their family's future. A physician can be made to feel and look like a criminal during a court proceeding. And it can take years for a suit to snake its way through the system -- some actions have occurred even after the physician plaintiff has died, leaving family to deal with the strain and expense.

It takes a terrible toll in terms of cost and in the loss of the expertise of skilled, experienced physicians who are irreplaceable.

As a profession, we are at war against a form of toxic tort terrorism. In order to turn the tide of battle, physicians have to be informed and involved as never before. And so do our patients.

Poll after poll shows that physicians are among America's most trusted individuals. But the trust of our patients doesn't guarantee their support for our goals. Organized medicine has to earn that trust -- through our actions, our positions, our command of the facts, and the truth behind our message.

Many of us are more comfortable in the realm of science than of politics. But to be effective advocates for our profession and our patients, we have to participate in both worlds.

And we need to participate now.

On the issue of liability reform, we're running out of chances -- and we're running out of time. Momentum for reform has perhaps never been greater. The medical liability meltdown has been featured on network and cable news shows and the front pages of newspapers -- big and small -- across the country.

The liability crisis is getting widespread coverage because it affects not only physicians but also the business community, our patients and anyone who participates in civic life in our country. And that's just about everybody. That's why the AMA's phones are ringing off the hook with calls from reporters. And it's why three-fourths of the American public agrees with us that reforms are needed.

We're countering the myths, half-truths and untruths from some of our opponents. We're getting our message out -- and we have powerful allies.

Including President Bush, who again spoke out on the issue in his State of the Union Address:

"Because of excessive litigation, everybody pays more for health care, and many parts of America are losing fine doctors. No one has ever been healed by a frivolous lawsuit. I urge the Congress to pass medical liability reform."

Because of these high costs -- in both human and financial terms -- the AMA hails the president's call to fix this broken system. His support for capping noneconomic damages would ease erosion of access and save our country as much as $100 billion each year in health care costs, according to a recent Dept. of Health and Human Services' study.

The AMA's reform proposal is based on California's Medical Injury Compensation Reform Act, which set a reasonable limit -- $250,000 -- on noneconomic damages, or "pain and suffering."

Without a cap, such damages are unpredictable and subjective, and breed the "lottery" mentality that has turned our courtrooms into casinos. That mentality forces physicians to practice defensively, to take into account not only the patients' needs, but to anticipate what a lawyer might ask in tricky, humiliating, courtroom interrogations.

As President Bush recently put it, "If you think you're going to get sued, you do everything you can to prevent the trial lawyer from coming after you."

But under MICRA reforms, patients still have full access to the courts and can recover 100% of their economic damages. When a patient is harmed by a doctor's negligence, he or she should be fully compensated. But we need a law that is fair for all. MICRA reforms provide that balance -- and they are part of reform legislation that is again before Congress.

Currently, 70% to 80% of all cases filed against doctors are dismissed. Such cases should never have been brought in the first place.

As a physician, if I pursued an intervention that failed that often, I'd find a new approach. The trial bar should do the same.

Contrary to the claim of opponents to reform, the current liability system does nothing to identify negligence.

In fact, a Harvard study shows no correlation between medical liability award payments and physician negligence. We are making medicine safer, but the current liability system does nothing to advance that cause. In fact, it impedes quality and safety efforts.

The states in crisis are those with no cap on noneconomic damages, or a cap too high to be effective. Society must decide: Do we want trial lawyers having access to every dollar they can squeeze from an out-of-control tort system, or do we want patients having access to their physicians when they need them?

The AMA encourages every physician and every patient to contact their state and federal representatives and tell them, "Enough is enough -- pass medical liability reforms that protect patient access to health care. Pass them now."

Visit the AMA Web site Web site (http://www.ama-assn.org/go/liability) to learn more about the issue and how you can help. Call our AMA grassroots hot line [(800) 833-6354] to urge your legislators to fix our broken system.

We may not get a better -- or another -- chance. Shame on us -- all of us -- if we miss this opportunity.

Dr. Coble, an endocrinologist in private practice in Jacksonville, Fla., was president of the AMA during 2002-03.