Perry: Tort reform must be part of health care reform

[DarrinS]

http://www.washingtonexaminer.com/op...m-8096175.html

If already posted, my bad.

To hear federal officials tell it, they've got all the answers on health care and it's up to the rest of us to sit, wait and embrace whatever solution -- if any -- they may eventually provide.

I find this troubling, since states have shown they know a thing or two about solving problems that affect their citizens.

Texas, in fact, stands as a good example of how smart, responsible policy can help us take major steps toward fixing a damaged medical system, starting with legal reforms.

Just six years ago, Texas was mired in a health care crisis. Our doctors were leaving the state, or abandoning the profession entirely, because of frivolous lawsuits and the steadily increasing medical malpractice insurance premiums that resulted.

Two thirds of our state's counties had no practicing obstetricians, and for pregnant women that meant long trips in cramped cars and higher fuel bills. Sixty percent of our counties had no pediatricians, which often meant delayed, or denied, health care for sick children.

And 24 counties in the Rio Grande Valley had no primary care doctors at all.

Each of those factors made it more likely that patients in underserved areas would postpone seeking care, which meant minor issues became major issues, and illnesses that could have been treated simply, easily and economically in the doctor's office turned into severe health crises that had to be treated in the emergency room.

And the situation was worsening with every passing day. By 2002, 13 of the state's 17 liability insurance carriers had left Texas, leaving less compe ion and leaving doctors with insurance bills that were seeing double-digit increases, if they could get insurance at all. That same year, applications for medical licenses plummeted to the lowest level in a decade.

This being Texas, instead of throwing money at the problem or debating endlessly, we identified the root causes and decided to do something about it.

In 2003, I declared the medical liability crisis an emergency item, and the legislature responded, passing sweeping reforms that protected the patient, but also shielded doctors and hospitals from unscrupulous trial lawyers eager to make a quick buck at the system's expense.

We capped non-economic damages at $250,000 per defendant, or up to $750,000 per incident, while placing no cap on more easily determined economic damages, such as lost wages or cost of medical care due to injury.

We ended the practice of allowing baseless, but expensive, lawsuits to drag on indefinitely, requiring plaintiffs to provide expert witness reports to support their claims within four months of filing suit or drop the case.

These measures were supported by the people of Texas, who in September of 2003 approved a ballot measure, Proposition 12, authorizing all of these changes.

Changes were seen immediately, and continue to be felt. All major liability insurers cut their rates upon passage of our reforms, with most of those cuts ranging in the double-digits. More than 10 new insurance carriers entered the Texas market, increasing compe ion and further lowering costs.

As a result, Texas doctors have seen their insurance rates decline by, on average, 27 percent.

The number of doctors applying to practice medicine in Texas has skyrocketed by 57 percent. In 2008, the Texas Medical Board received 4,023 licensure applications and issued a record 3,621 new licenses.

In all, in just the first five years after reforms passed, 14,498 doctors either returned to practice in Texas or began practicing here for the first time.

And our reforms finally brought critical specialties to underserved areas. The number of obstetricians practicing in rural Texas is up by 27 percent, and 12 counties that previously had no obstetricians now have at least one. The statistics show major gains in fields like orthopedic surgery, pediatrics, neurosurgery and emergency medicine.

The Rio Grande Valley has seen an 18 percent growth in applications to practice medicine, adding about 200 doctors to this critically underserved area.

And what about the money that used to go to defending all those frivolous lawsuits? You can find it in budgets for upgraded equipment, expanded emergency rooms, patient safety programs and improved primary and charity care.

Success stories like ours need to be told, and need to be remembered as we continue this national debate.

Instead of handing down "one size fits all" mandates on how it's going to be, Washington should be enabling states to set their own agendas, and solve their own problems, when it comes to health care.

[rjv]

juxtapose this next to the stat that almost 100,000 people die from medical malpractice each year and you get some perspective on this issue.

http://www.chron.com/disp/story.mpl/...e/6555095.html

[TeyshaBlue]

I'd sure like to see the data backing Cpt. Haircut's ascertations.

I can't believe anything that slips through that syncophant's lips.

[SouthernFried]

Of course...if the govt takes it over, you wont have to worry about tort reform. Not many people have the funds it takes to sue the govt...not many lawyers have the time.

[DarrinS]

I'd sure like to see the data backing Cpt. Haircut's ascertations.

I can't believe anything that slips through that syncophant's lips.

You want to see the data (which is in the OP)? Or, do you want the source of the data?

[DarrinS]

Of course...if the govt takes it over, you wont have to worry about tort reform. Not many people have the funds it takes to sue the govt...not many lawyers have the time.

You can't sue the fed. I don't think.

[TeyshaBlue]

You want to see the data (which is in the OP)? Or, do you want the source of the data?

I'd like to see the source. I certainly don't have a good feel for his conclusions as they fly in the face of what I think is goin on.

[DarrinS]

juxtapose this next to the stat that almost 100,000 people die from medical malpractice each year and you get some perspective on this issue.

http://www.chron.com/disp/story.mpl/...e/6555095.html

So, it's twice as dangerous to go to the hospital than it is to drive a car? I find this a little hard to believe.

[rjv]

You can't sue the fed. I don't think.

that is more or less true outside the scope of sueing a person acting for the federal government.

Under the FTCA, the government can only be sued 'under cir stances where the United States, if a private person, would be liable to the claimant in accordance with the law of the place where the act or omission occurred.' 28 U.S.C. S 1346(b). Thus, the FTCA does not apply to conduct that is uniquely governmental, that is, incapable of performance by a private individual.

[rjv]

So, it's twice as dangerous to go to the hospital than it is to drive a car? I find this a little hard to believe.

i work as a medical physicist who contracts out of various hospitals and have seen some teaching hospitals that i would never allow myself to be admitted to. not hard for me to believe at all.

[DarrinS]

i work as a medical physicist who contracts out of various hospitals and have seen some teaching hospitals that i would never allow myself to be admitted to. not hard for me to believe at all.

100,000 per year doesn't seem high to you?

That's about how many American casualties we'd have in Iraq if we stayed there for 120 years.

I'd say that there's a lot of subjectivity in that 100,000 figure.

[LnGrrrR]

A question: What are the negatives of tort reform? I've only heard the side that's for it.

[FuzzyLumpkins]

You can't sue the fed. I don't think.

Yes you can. You cannot sue the military but there are cases involving government agencies all the time.

[coyotes_geek]

A question: What are the negatives of tort reform? I've only heard the side that's for it.

I've got the same question. It seems to me that the only ones against tort reform are trial lawyers and those who are going to automatically be against whatever it is that republicans are for. So long as the direct economic damages aren't capped, what's the harm in limiting non-economic damages?

[rjv]

100,000 per year doesn't seem high to you?

That's about how many American casualties we'd have in Iraq if we stayed there for 120 years.

I'd say that there's a lot of subjectivity in that 100,000 figure.

from the CDC:

HAIs account for an estimated 107 million infections and 99,000 deaths per year and affect 5-10 % patients anually. this adds up to 20,000,000,000 dollars per year to healthcare costs.

i've personally witnessed health care works hold no regard whatsoever for standard hygiene procedures when dealing with patients.

http://www.cdc.gov/ncidod/dhqp/pdf/h...CPAC_11_08.pdf

[SnakeBoy]

A question: What are the negatives of tort reform? I've only heard the side that's for it.

I don't know the details of how Texas tort reform affects cases of gross negligence but the potential downside is that if it is not done correctly it will not provide enough financial incentive for hospitals to change their practices or get rid of incompetent physicians. There is quite a bit of dishonesty going on here as far as what cons utes negligence. I don't support any caps in the cases blatant negligence/incompetence. Amputating the right leg of someone who was supposed to have their left leg amputated for example.

The number being used in this thread (~100k) is referencing hospital borne infection though. It is dishonest to imply that all of those or even the majority are do to negligence. Opportunistic bacteria are called opportunistic for a reason and as we enter into the post antbiotic era you can only expect to see those numbers go up. It is also dishonest to use that as a condemnation of our healthcare system. We have a 100 thousand deaths from hospital borne infections as compared to 12-14 thousand in the Canadian healthcare system. So we are in fact doing a better job controlling these infections than they are in the Canadian system.

As far as the OP, I can tell you that my wife's malpractice insurance went from $18k/yr to 11k/yr after tort reform. So it has had a positive impact. However Texas tort reform has not done enough to end the practice of defensive medicine. I don't know and have heard any good proposals on how to better acheive that. Much of it has to with Texas physicians still being in the habit of practicing defensive medicine so any further reform would have to include guidelines and legal education for physicians on how to reduce the cost of healthcare without placing themselves at risk legally.

[DarrinS]

from the CDC:

HAIs account for an estimated 107 million infections and 99,000 deaths per year and affect 5-10 % patients anually. this adds up to 20,000,000,000 dollars per year to healthcare costs.

i've personally witnessed health care works hold no regard whatsoever for standard hygiene procedures when dealing with patients.

http://www.cdc.gov/ncidod/dhqp/pdf/h...CPAC_11_08.pdf

So THIS is what you are counting as medical malpractice?

[rjv]

So THIS is what you are counting as medical malpractice?

Medical Malpractice occurs when a negligent act or omission by a doctor or other medical professional results in damage or harm to a patient.


Negligence by a medical professional can include an error in diagnosis, treatment, or illness management. If such negligence results in injury to a patient, a legal case for medical malpractice can arise against:

• The doctor, if his or her actions deviated from generally accepted standards of practice; The hospital for improper care or inadequate training, such as problems with medications or sanitation;
• Local, state or federal agencies that operate hospital facilities.

http://www.statelawyers.com/Practice...cticeTypeID:63

hospitals also fall under the au es of corporate negligence.

as a medical physicist who contracts, i myself need malpractice insurance coverage.

[FuzzyLumpkins]

Medical Malpractice occurs when a negligent act or omission by a doctor or other medical professional results in damage or harm to a patient.


Negligence by a medical professional can include an error in diagnosis, treatment, or illness management. If such negligence results in injury to a patient, a legal case for medical malpractice can arise against:

• The doctor, if his or her actions deviated from generally accepted standards of practice; The hospital for improper care or inadequate training, such as problems with medications or sanitation;
• Local, state or federal agencies that operate hospital facilities.

http://www.statelawyers.com/Practice...cticeTypeID:63

hospitals also fall under the au es of corporate negligence.

as a medical physicist who contracts, i myself need malpractice insurance coverage.

What is a medical physicist? The reason I ask is because I am highly considering going back to school for biomechanical engineering.

[SnakeBoy]

Medical Malpractice occurs when a negligent act or omission by a doctor or other medical professional results in damage or harm to a patient.


Negligence by a medical professional can include an error in diagnosis, treatment, or illness management. If such negligence results in injury to a patient, a legal case for medical malpractice can arise against:

• The doctor, if his or her actions deviated from generally accepted standards of practice; The hospital for improper care or inadequate training, such as problems with medications or sanitation;
• Local, state or federal agencies that operate hospital facilities.

http://www.statelawyers.com/Practice...cticeTypeID:63

hospitals also fall under the au es of corporate negligence.

as a medical physicist who contracts, i myself need malpractice insurance coverage.

Thanks for providing an excellent example of why tort reform is needed. Under this legal definition lawyers can sue for negligence in this case...
http://www.theatlantic.com/doc/200909/health-care

When you cut through the emotional aspect of this guys story it boils down to this. 83 year old man with multiple health issues develops pneumonia and ultimately dies from secondary infections due to his failing immune system. You may call this negligence, I call it life. We don't get to live forever.

[ChumpDumper]

Interesting. I didn't see anything about lower health costs brought about by tort reform.

Now Texas doctors are ing about the increase in the number of complaints to the medical board. That number more than doubled the year after tort reform was enacted.

[rjv]

What is a medical physicist? The reason I ask is because I am highly considering going back to school for biomechanical engineering.

plainly put, it is physics applied to medicine, especially in the areas of medical imaging and radiotherapy. you will see mp's working is dosimetry or in programming algorithms for PET (positron emission topography) scans, MRIs and CTs. they can also train radiology techs, they monitor radiation exposure for health care providers as well as patients and may work with radiologists, oncologists and radiation therapists. i myself work with radiology picture, archiving and collection (PAC) systems. i did my graduate work at UT health science center and got certified in imaging informatics at the veterbi school of engineering at USC (it is an oline program by the way and is under the school of biomedical engineering). you probably have taken at least up to quantum physics and diff eq as well as some c++ classes so you can easily qualify for admission into a program.

[SnakeBoy]

plainly put, it is physics applied to medicine, especially in the areas of medical imaging and radiotherapy. you will see mp's working is dosimetry or in programming algorithms for PET (positron emission topography) scans, MRIs and CTs.

Maybe you can answer this question. Why is it that I can get an MRI on my dog for $400 but for a person it costs thousands? Same equipment/results or no?

[SnakeBoy]

Now Texas doctors are ing about the increase in the number of complaints to the medical board. That number more than doubled the year after tort reform was enacted.

Always two sides to the story...

DOCTORS SUE TEXAS MEDICAL BOARD FOR MISCONDUCT – Cites ins utional culture of retaliation & intimidation
December 21st, 2007 The entire Texas Medical Board (TMB) and its officials have been named in a lawsuit filed by the Association of American Physicians and Surgeons (AAPS). The complaint, filed this week in District Court in Texarkana, accuses the board of misconduct while performing its official duties, specifically:

1.Manipulation of anonymous complaints;
2.Conflicts of interest;
3.Violation of due process;
4.Breach of privacy; and
5.Retaliation against those who speak out.
“The situation has reached the crisis point for patients and doctors,” said Jane M. Orient, M.D, Executive Director of AAPS. “Our members are too afraid of retaliation to sue the Board as individuals.”

The lawsuit specifically points out misconduct by Roberta Kalafut, the Board president. The law suit claims that Kalafut “arranged for her husband to file anonymous complaints again other physicians, including her compe ors in Abilene…”

She then “…worked inside the TMB, with other defendants, to discipline doctors based on anonymous complaints filed by her physician husband.”

The lawsuit also charges that Kalafut and Donald Patrick, Executive Director, knew about the conflict of interest of Keith Miller while he was Chair of the Disciplinary Process Review Committee. Miller served as plaintiffs’ witness in at least 50 cases brought before the Board without disclosing that to the disciplined doctors or the public.

During a marathon 11-and-a-half hour legislative hearing about the Texas Medical Board on October 23, 2007, Kalafut and Patrick admitted under oath that they were aware of the conflicts of interest.

“It seems clear from the sworn testimony before the legislative committee that they knew about the problems and had done what they could to hide them,” said Dr. Orient.


The lawsuit demands that the Court put an immediate stop to abuses by the Board, and that previous disciplinary actions tainted by the Board’s violations be re-opened.

“Doctors in Texas should not be forced to practice in this atmosphere of fear and intimidation,” said Dr. Orient. “Complaints from our members have identified the TMB as probably the worst in the country. It’s bad for patients when their doctors are afraid that doing the right thing could result in licensure action.”

[rjv]

Thanks for providing an excellent example of why tort reform is needed. Under this legal definition lawyers can sue for negligence in this case...
http://www.theatlantic.com/doc/200909/health-care

When you cut through the emotional aspect of this guys story it boils down to this. 83 year old man with multiple health issues develops pneumonia and ultimately dies from secondary infections due to his failing immune system. You may call this negligence, I call it life. We don't get to live forever.

As of 1999, in the United States alone, an estimated 27 million surgical procedures are performed each year. The CDC’s National Nosocomial Infections Surveillance (NNIS) system, established in 1970, monitors reported trends in nosocomial infections in U.S. acute-care hospitals.
Based on 1993 NNIS system reports, SSIs are the third most frequently reported nosocomial infection, accounting for 14% to 16% of all nosocomial infections among hospitalized patients. NIs are infections acquired in hospitals (yes, even pneumonia can be considered such an infection and that is why we distinguish between viral and bacterial forms of pneumonia). in larger hospitals the quick movement from patient to patient is an ideal way to spread pathogens. and everyone, not just the elderly, fall into the risk demographic. from the period between 1992-2002, there were 33,269 deaths in high risk nurseries, 19,059 in well baby nurseries and 417.946 deaths amongst adult and children outside of ICUs .

www.cdc.gov/ncidod/dhqp/pdf/hicpac/infections_deaths.pdf

as for the emotive aspect of this, hard for me to look at the picture that way. this isn't like triage and i am not machiavellan so i am not easily persuaded to be so nihilistic about medicine.