Fight medical errors, not lawyers
President Bush may be right to push medical malpractice reform to keep doctors from walking off their jobs, but he should also address a companion crisis: health care quality.
Bush repeatedly attacks “junk lawsuits” — and the trial lawyers who file them — but he has taken few steps to prevent the errors and deaths that cause victims to sue.
One particular medical horror story — the unnecessary double mastectomy undergone last year in Minnesota by 46-year-old Navy veteran Linda McDougal, who had been mistakenly told, following a mix-up of test results, that she had invasive breast cancer — is being seized upon by trial lawyers to counter Bush’s proposed limits on malpractice awards.
But hundreds of thousands of other medical errors occur annually. In 2000, the Institute of Medicine, an arm of the National Academy of Sciences, estimated that errors may kill between 40,000 and 100,000 Americans per year.
And a survey last year by the Harvard School of Public Health and the Kaiser Family Foundation found that 35 percent of doctors reported that they or their families had experienced medical errors in the course of being treated, with most saying that “serious health consequences” resulted.
The Institute of Medicine called for a $1 billion federal investment in information technology and other steps to establish “best practices” among providers to reduce errors.
Former Treasury Secretary Paul O’Neill, who is now working to improve health quality in Pennsylvania, told me he pushed hard in the administration to establish a nationally standardized database for medical records — controlled by patients — and for a reimbursement system based on patient outcomes, not time in the hospital or procedures performed.
He got nowhere, he said in a phone interview. “I was Treasury secretary. I had no standing on health matters,” even though he argued that “up to 50 percent of the national resources we devote to health care is wasted.”
The Bush administration argues that huge sums of money can be saved through caps on malpractice lawsuit awards — $60 billion to $108 billion a year in insurance costs for tests and procedures ordered only because doctors are practicing “defensive medicine.”
White House officials say that a proposal on information technology is under study, but it didn’t have enough priority to make it into Bush’s State of the Union address.
Meantime, the administration and tort reform advocates in Congress say that recent well-publicized liability crises in West Virginia, Pennsylvania, Nevada and Florida will help their cause this year.
With malpractice insurance premiums doubling and tripling in some states, doctors have quit working or have moved away, trauma centers and maternity wards have closed, and hospitals have quit performing neurosurgery and other high-risk procedures.
Senate Majority Whip Mitch McConnell (R-Ky.), who sponsored a medical malpractice reform bill last year that received only 42 votes, said, “without naming names, I’ve talked to a number of senators who are rethinking.”
The American Medical Association, which sided with ATLA to fight for patients’ rights legislation against insurers, has switched and has made malpractice reform its top issue. ATLA contends malpractice insurance rates are rising because insurance companies are trying to recoup losses in the stock market.
But this claim is refuted by the Physician Insurers Association of America (whose members insure most doctors), which says that only 10 percent of companies’ revenues can be invested in stocks.
There’s a good case to be made for Bush’s malpractice reforms. But there’s also a compelling need for measures to ensure that mistakes like the one damaging Linda McDougal’s life won’t happen.
(Morton Kondracke is executive editor of Roll Call, the newspaper of Capitol Hill.)