The Medical Liability Insurance Crisis

Last week, Kim and I took Fiona to our pediatrician. While we were there we noted signs put up by Connecticut Doctor’s for Good Medicine. The sign was urging patients to support nine different candidates. We have spent a bit of time researching the PAC as well as the issues and would like to share the following observations.

About the PAC

Actually, Connecticut Doctor’s for Good Medicine is registered with the state as two separate two person PACs. Connecticut Doctor’s for Good Medicine (Norwalk Chapter), Claudia Gruss, MD, Treas.,P.O. Box 270, Georgetown, CT 06829 and Connecticut Doctor’s for Good Medicine (Stamford Chapter) Charles Littlejohn, MD, Treas., 70 Mill River Street, Stamford, CT 06902.

It is worth noting that Dr. Littlejohn is also listed as president of the Fairfield County Medical Association and has appeared with Rep. Shays stumping for tort reform.

On the latest PAC filing, the Norwalk chapter had 53 donors, all of whom are doctors with one exception. The Stamford chapter had 100 donors, again, all of whom are doctors with one exception.

The one exception is Mark Thompson, who is a lobbyist and executive director of the Fairfield County Medical Association.

The Stamford chapter has signs up at our pediatrician’s office. Kim also visited her gynecologist and found that there is a sign up there. On the sign, as well as on a pamphlet that they distribute, they have endorsed nine candidates. With the exception of Christel Truglia who is running unopposed in Stamford, all of the candidates are Republicans.

The other state reps that they have endorsed include John Hetherington and Dolly Powers who are also running unopposed. In the contested state rep races where they have made endorsements, there candidates are James Rubino, Gregory Vayneris, and Joseph Tarzio.

For State Senate, they have endorsed the incumbent Judith Freedman who is being challenged by Arlo Ellison, the incumbent William Nickerson who is being challenged by Green candidate John Amarilios, and Richard Cunningham who is challenging Andrew McDonald

About Medical Malpractice Reform

Kim and I have done some digging into the issue of Medical Malpractice Reform. Health care is an issue that many people feel very strongly about. As a general rule, patients usually trust their doctors, but not the medical system. There seems to be a strong feeling that the medical system is broken. We often speak about the rise in the number of people who lack health coverage and the rising costs of health coverage.

Republicans are trying to portray the problem as being a result of excessive litigation and suggest tort reform, particularly in terms of caps on malpractice settlements as being the panacea. In this, they paint trial lawyers as the culprits.

Caps have been tried in various states with differing levels of success. The AMA claims that states where caps have been used have seen a decrease in costs. However, this decrease is much less than the overall increases in health care costs. One doctor in California, who is an active Democrat, and yet campaigns for tort reform claims that the reason tort reform in various states has been less effective is that it gets watered down as it gets written into law. He also places the blame on trial lawyers. In one article I read, it observed that during the 12 years after MICRA was passed California continued to experience drastic premium increases, and it wasn’t until Proposition 103 was passed that the premiums were brought under control.

It may well be that some sort of caps on malpractice awards can be defended, however, there are several problems with caps. First and foremost, it hurts patients who have been hurt by failures of the medical system. It limits the rights of patients to get proper redress. While it does a little to protect good doctors, it also protects failing doctors that are part of the problem.

Several doctors have spoken to me expressing concern that caps on malpractice settlements will produce windfalls for the insurance companies and the savings will not be passed on to doctors or patients. I do not believe that this concern stands up well in Connecticut where the largest malpractice insurance company, CMIC, with 26.7% market share is a mutual insurer owned by its physician-policyholders, so the benefit to doctors is more direct.

As noted in the discussion about caps, their effectiveness is questionable and they don’t solve all of the problem.

In a Medical Malpractice statement from Gov. Dean during the presidential primaries, he noted other approaches that need to be considered. As an example, Maine enacted a reform under which malpractice litigants must submit to a non-binding pre-litigation review. The doctor in California that I spoke with about this objected that such reviews are non-binding. He claims they are ineffective and only raise the cost of defending oneself against frivolous attacks. Dr. Dean claims that the reviews weed out the frivolous lawsuits without depriving real malpractice victims of the right to be compensated.

The issue of medical review boards has been brought up and the effectiveness of the Connecticut medical review board has been questioned. The California doctor I spoke with suggests that this is because such review boards end up getting packed with people that the trial lawyers consider experts as opposed to people in the medical profession that doctors consider experts.

My cousin is a retiring hospital administrator in Massachusetts. In my discussions with him on this issue, he has talked about the ineffectiveness of caps and of the importance of medical review boards populated by practicing medical professionals.

It may well be that from these ideas, better solutions for malpractice reform can be found, including having doctors on the review boards, having these review boards involved in the non-binding pre-litigation review, and perhaps even recommending on case by case bases appropriate caps.

My cousin also spoke about the issue of how the indigent are cared for. Often, these costs get eaten up by the hospitals and the doctors. As the number of uninsured rises, this problem is likely to become more burdensome on hospitals and doctors. Restoring the Husky program will help out with this problem.

Gov. Dean spoke about another aspect of the problem, which I think is particularly important. Thousands of patients die each year due to medical errors, many of which reflect system-wide problems instead of individual negligence. Senator Jeffords and others sponsored a bill to provide legal protections for patient safety reporting systems. By improving reporting systems, the number of cases can be reduced, as illustrated by the great success of reporting systems in the aviation industry.

As we have researched this, we continue to get more and more information on the issue. We describe a little of this in a blog entry at Blog for America.

One of the best summaries about medical malpractice can be found in the American Medical Student Association's Principles Regarding Professionalism and Professional Liability

Abuse of doctor patient relationship

Back to the particulars of the PAC: A September 20th article in Connecticut Business News Journal, writes,

“When a group of Fairfield County doctors traveled to Hartford last spring to lobby for legislative reforms affecting the health-care industry, one lawmaker told them that if they were serious about change, they ought to recruit one of their own to run for state office.

The MDs listened to that advice, and while they haven't yet enlisted one of their own to throw a hat into the ring, they have formed a political action committee: Connecticut Doctors for Good Medicine.

The group says it intends to back, with words and dollars, candidates who support their agenda, particularly limits on awards in medical malpractice lawsuits.

That issue is a hugely controversial one. While skyrocket liability insurance premiums have indeed driven some physicians from practice, arbitrary limits on malpractice judgments are a pretty tough sell to families of those injured, or worse, by a doctors mistake.

Still, we support the physicians' right to bring their case to the public through direct political participation. A vigorous public dialogue on difficult issues is critical to the functioning of a healthy democracy.”

Personally, I believe it is good for Doctor’s talk openly about their concerns about medical malpractice insurance. However, the approach they have taken appears to abuse the doctor patient relationship and may be backfiring on them.

Numerous people have complained privately, and the following public blog comment, illustrates the complaint quite well:

“I vociferously complained to my mother's primary care physician when I saw that his practice hung posters and distributed flyers for a group called "Connecticut Doctors for Good Medicine" (or something like that), an organization advocating tort reform whose endorsed candidates are all Republicans with one exception. My mom was leaning toward changing doctors anyway since he's given her terrible care in the last four weeks, but seeing that kind of pro-Republican politicking in her doctors' office was the last straw for me.”

Not clear that they have thought out good policy

It appears as if Connecticut Doctors for Good Medicine have not thought out the issues very clearly, either in terms of what policies would really bring about better medicine in the state, nor what is best for patients in the short term.

As an illustration, their endorsement of Richard Cunningham is particularly striking. First and foremost, Cunningham has spoken out strongly against PACs and lobbyists, but he doesn’t seem to object to a PAC doing substantial advertising for him. Beyond that, while he is for tort reform, his strong anti-abortion positions get in the way of the doctor patient relationship and prevent him from supporting important medical research.

Our response

Kim and I believe that an informed discussion about the issues facing the medical system in Connecticut is extremely important. To the extent that the Connecticut Doctors for Good Medicine is interested in such a dialog, we applaud this. However, at this point, it does not appear that this is their interest.

Currently, we are contacting our doctors directly and expressing our concern about their placement of advertisements in their offices. We are encouraging others to do the same.

Beyond that, today Kim addressed a White Coat Rally organized by the Fairfield County Medical Association. Months ago, she had filled out a questionnaire by them and appeared close enough to be supporting caps that she was invited to address their rally. You can read the text of her speech here.

The doctors were hushed while Kim spoke. The politely applauded after she spoke, but one of the organizers refuted some of her claims for the podium and there were some tense discussions afterwards. A reporter from the local newspaper, the Stamford Advocate was there and spent a bit of time speaking with Kim.

Kim showed incredible courage in speaking to this gathering, and did much more to promote a well thought out discussion about the issues than the poorly thought out advertisements that the PAC has put up in various doctors’ offices.

The medical liability insurance crisis is a real and serious problem. It requires bravery to face this issue seriously, the ability think critically, to look at all the options and try to engage in an honest discussion. Needless to say, I’m very proud of all that Kim is doing to address the medical liability insurance crisis

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The Medical Liability Insurance Crisis