Wednesday, March 26, 2008

The Irony of Medical Malpractice Limits

When the issue of placing limits on medical malpractice comes up, I always cringe. Bush proposed it for the nation in 2005 and some doctors proposed it for Nevada in 2002 under the biased title: Keep Our Doctors in Nevada. I cringe because I have patients interests in mind and not negligent businesses, who Republicans seem to be so eager to support.

Here are the main points of the law that passed in Nevada:
(a) "non-economic damages," aka pain and suffering or punitive damages, are capped at $350,000.
(b) the defendant can make payments over time for the amount awarded.
(c) the patient has to sue within 1 year instead of two.
(d) new limits on lawyer's contingency fees.

Supporters of medical malpractice caps would want you to believe that the costs of medical malpractice insurance are increasing because frivolous lawsuits are skyrocketing and awarding sinister patients millions of dollars.

First of all, if a lawsuit is really that frivolous, don't you think that a judge with 7 years of education and 10 years of legal experience would see right through it? I mean come on, give a judge some credit, any "frivolous" lawsuit would be tossed right out of court. Second, as stated in a New York times article, "The recent jump in premiums shows little correlation to the rise in claims." In fact, the rise in premiums is tied to their declining investments. Insurance companies lost billions of dollars in the Enron company alone. Legal costs account for less than 1% of health care costs. The study conducted by the prestigious RAND corporation also found that baseless lawsuits were "efficiently thrown out."

Their main argument is to reduce malpractice insurance premiums by placing caps on awards, but this doesn't actually work, so there goes that argument.

And what really is the value of medical malpractice? If a doctor chops off the wrong arm or infects you with HIV, is $350,000 really going to compensate you for your troubles? I doubt it. It's something that will still permanently screw your life up, so can you really even place a number on it? There are probably a few numbers with at least 6 zeros that would at least make you feel better about living with your new found misfortune.

Plus the whole point of not having a limit is that it is a deterrent effect for a negligent corporation. If a company can run a cost-benefit analysis of the risk of getting sued and of giving you crappy care, they will put profits over patient health. This is what a huge clinic in Nevada decided to do recently.

Syringes, needles and/or vials were re-used at the Endoscopy center of Nevada. The center is comprised of about 6 or so clinics, each of which has been shut down as of late. The city is estimating that 40,000 people are at risk for Hepatitis C or HIV. This is a lot of people to be at risk! A brand new needle costs about $1, so a place that uses a thousand needles a day can save a few hundred thousand dollars a year. This adds up as years pass by. Of course the cost of needles was already factored into the price that patients and insurance companies were paying for, so "invisible costs" were passed on. It took 4 years for the medical board to catch onto the Endoscopy center murderers/doctors.

Under the old law, one patient's successful lawsuit would have wiped out their entire net profit from doing this kind of practice. Punitive damages would probably be in the millions to prevent this from ever happening again. But "Keeping our doctors in Nevada" allowed cost-benefit analysis for a company to choose between patient care and profits to become a reality. Dr. Dipak Desai, the leader of the Endoscopy center, was one of the main supporters for this law. Gee, why did he support this law change so much?

So then we come to other wonderful aspects of the new law that all end up screwing the patient. If a patient successfully sues, the guilty malpractice doctor and insurance company is allowed to make payments over time. What is this, the freakin' lotto? Another change is that patients now have to sue within 1 year instead of two. The problem with this is that Hepatitis or HIV takes a long time to show symptoms. It could even take up to 6 months for antibodies to register on a HIV test. The proponents of the law want to close the window for people eligible to file a claim against them. And one of the final changes is limiting contingency fees for lawyers. This sounds nice up front, but all it does is prevent patients from having lawyers take their cases. This just limits the pool of patients that will be able to sue. I'm no fan of lawyers, but I understand that if they take on a contingency case, they risk a lot of time and effort that could take years. If a case doesn't even have the opportunity to net a decent return for their time and risk, then they won't even bother with the case.

So what can we do?

Instead of insurance payments, I propose that every doctor should post a $1 million interest paying bond and have his or her license tied to that bond. This way, instead of passing the burden onto insurance companies, the doctor will be responsible for his or her actions. Plus, it will weed out the bad doctors and allow good doctors to keep their money. When a doctor retires from medicine, they get to redeem their bond. For doctors starting out, there could be a payment plan, with a percentage of the payment going to an insurance company in case a claim is made before the full bond value is reached.

The unfortunate fact is that voters are sheep. I've mentioned this point several times on my blog, if you haven't noticed. They will believe the propaganda and lies that gets spewed, that in the end, put their health at risk. It's easy to buy into the bull the way politicians spin law changes and if you don't stop and think for a minute what their real reason for promoting a change is, it could end up affecting you.

Well Nevada, you got what you asked for! Now 40,000 or more of you are at risk for deadly diseases that were spread by ruthless doctors who only cared about saving a few dollars. As of March, 71 or so have turned up positive. Maybe it is time to rethink this law?

In closing, who in their right mind in today's age would re-use a syringe?? Fifth graders even know that this is deadly. Everybody involved, including nurses, doctors or the people who pick up bio-hazard waste that never noticed needles in the sharpy box should be imprisoned for LIFE and have all their assets donated to the families that are affected by this tragedy. If this were China, they would be publicly EXECUTED. I hope one of these poor patients gets their revenge and murders these bastards - I know I would if they infected me.

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