"Hi, Donna:

Thanks for sending this.  Yes, I was finally quoted correctly!

 

I think this is a very good news story (and research study) for your readers to think about.  Everyone who was quoted by the journalist was thoughtful, not knee-jerk, and made a meaningful contribution to the debate.  The findings are quite clear that malpractice litigation doesn't work well for anyone, except those paid to administer it.  And most of the administrative people would do just fine in a system that worked better for patients and physicians.

Best

Bill
 

William M. Sage, MD, JD"))
 

One front group has amusing ideas about another

Paul Carpenter

May 14, 2006

http://www.mcall.com/news/columnists/all-b1-5frontmay14,0,3904771.column?coll=all-randomcolumnistsnews-misc

 

Who says that ambulance-chasing lawyers don't have a great sense of humor?

In a press release on Thursday, they attacked a study released earlier that same day, because it came from what they called a ''corporate front group.'' The 91-page study had a ''tort liability index'' on how well the various states keep bogus lawsuits under control.

This front group, said the release, is the Pacific Research Institute. PRI is bogus, it said, because the experts consulted in its tort study did not include any ambulance chasers, or (gasp) any groups affiliated or allied with Ralph Nader.

For some odd reason, their press release did not mention that PRI is admired by some respected people. For example: ''PRI is one of the most innovative and effective think tanks in the world,'' said Nobel Laureate Milton Friedman.

Anyway, the ambulance chasers said that, as a result of such ''front group'' chicanery, PRI's report on tort reform makes the lawyers in many states look just awful. To the surprise of absolutely no one, Pennsylvania is rated dead last in the nation in one key category and is 47th overall.

That unhappy disclosure comes just two months after another report — on lawyer discipline — said Pennsylvania had initiated enough disciplinary reforms to elevate the state from dead last to fifth place. You may recall that, in March, I praised those technical improvements, although I noted that Pennsylvania has a dismal record on tort reform, which lets many lawyers get rich by filing bogus suits, at the expense of everyone else.

I'll get back to that, but first the punch line from these amusing ambulance chasers:

Their press release, attacking the PRI as a front group (tee-hee), did not identify its source as ambulance-chasing lawyers and their allies in Ralph Nader's special interest groups. It said only that it was from the ''Center for Justice & Democracy.'' What could sound more noble than that?  ((Um....the Committee for Justice for All, perhaps?  That's another personal injury lawyer front group....as is the PA Citizens for Fairness....pay attention to the names of the groups.  If they contain the words "consumer," "justice," or "fairness" in them, follow the money....they may CLAIM to be "consumer" groups, but they're likely shilling for the trial bar....))

So what is CJ&D? Why, it's a front group for ambulance-chasing lawyers and demagogues like Nader and Michael Moore. ((Thank you SO MUCH, Mr. Carpenter, for doing your journalistic duty - i.e., a little bit of research - and arriving at the "front group" conclusion on your own....))  So, on Friday, I called Laurie Beacham, author of the release, to ask why it did not identify CJ&D as a front for ambulance chasers.

''Clearly, we would disagree with that characterization,'' she replied, so I used another term: personal injury lawyers.

''No, we're not a front group for personal injury lawyers. We represent consumers,'' Beacham said.

I said CJ&D's board is dominated by lawyers — and consumers harmed by the tobacco industry did not get a dime from that massive settlement, while lawyers got billions .

She did not respond directly to that, so I asked if she did not think her press release represented a bit of hypocrisy.

''No, I don't,'' Beacham said.

Later, I got a call from Joanne Doroshow, president of CJ&D, who insisted that CJ&D works for consumers who have been harmed and cannot get access to the courts for recompense. I asked if she could give me any examples.

She referred to a case in Texas, where there was a cap on ''noneconomic damages'' — meaning the consumer (and her lawyer) could not rake in millions over and above the actual damages she suffered.

I asked her about my favorite tort reform — a modified ''English rule,'' to make those who file lawsuits pay the other side's expenses if it can be proved the lawsuit was bogus.

''The better solution is to sanction the attorney,'' said Doroshow, who is both a lawyer and a Nader associate.

I said that would be great, but cannot happen in Pennsylvania, where, as the PRI study found, procedural and structural rules and tort reforms are in the toilet. (We rank 50th out of 50 states in that category.)

At that point, Doroshow said she had to catch a plane.

She did not seem amused.

paul.carpenter@mcall.com 610-820-6176

 

 

 

8.....Philadelphia Business Journal

Medical malpractice filings decline

Doctors say progress has been made but stats are deceiving

The Pennsylvania Supreme Court released state court medical malpractice statistics for 2005 that show a sustained decline in filings and a drop in large jury verdicts in Philadelphia and statewide. While the legal community says it is a sign that lawsuits and trial lawyers can no longer be blamed for so-called med mal insurance rates, doctors' groups contend the state continues to be inhospitable to doctors.

Amid the long-running debate is Pennsylvania's reputation as a place to practice medicine. Doctors' advocates have long contended that physicians who practice in high-risk specialties such as obstetrics and neurosurgery are in short supply and that, while many doctors are educated in the state, they generally choose not to stay. ((Only 7.8% of they stayed in 2004....down from over 50% a decade earlier...am I the only one who is scared half to DEATH by that number.....?))

The new data show the number of med mal cases filed in Pennsylvania has dropped from 2,903 in 2002 to 1,698 last year. Filings are down almost 38 percent compared to the average between 2000 and 2002 and have decreased by 55 percent in Philadelphia when compared to the same time period.

Filings and verdict numbers start to dip in 2002 and 2003 when the legislature passed the Medical Care Availability and Reduction of Error (Mcare) Act and the state Supreme Court introduced rules for change of venue, which moved a number of cases out of Philadelphia and to the suburbs, and made lawyers secure a certificate of merit for their cases. Philadelphia juries have a reputation for awarding large judgments against health-care providers.

The number of cases filed in the city reached a peak of 1,365 in 2002 but plummeted in 2003 to 577 and have hovered around that number in 2004 and 2005, when there were 559 and 540 cases filed. Conversely, Montgomery County, which had a combined 79 cases filed between 2000 and 2003, saw a dramatic increase in the past two years. There were 102 cases filed there in 2004 and 104 last year.

The 2005 numbers in Montgomery County represented a 380 percent increase from the average number filed between 2000 and 2003. Bucks County experienced a 19 percent rise and Chester County saw a 6 percent increase while Delaware County had a 13.5 percent decline.

Jury verdicts also decreased in number and monetary value. ((If they have that data, why didn't they release the TOTAL payouts?  I suspect it's because that number is HIGHER than in the previous year.  Total payouts rose 13.5% from 2003 to an all-time high of $448 million in 2004....)) In the 223 medical malpractice jury verdicts reached in 2005 statewide, 80.3 percent were defense verdicts, only 5.8 percent were greater than $1 million. None exceeded $10 million. ((And yet, in each of those 80.3% of cases, it cost the doctor, whom the jury found to have done NOTHING WRONG, roughly $85,000....))

From 2000 to 2003, there was an annual average of 326 cases filed, with 73 percent resulting in defense verdicts, 10.4 percent greater than $1 million and 1.2 percent higher than $10 million.

In Philadelphia, there were 56 jury verdicts during 2005, with 62.5 percent being verdicts for the defense, ((still giving away other peoples' money in Philadelphia....)) and 14.3 percent exceeding $1 million in judgments. All 15 of Montgomery County's decisions resulted in defense verdicts and all 10 in Delaware County were defense verdicts. Six of seven in Bucks County were defense verdicts and five of seven in Chester County were.

Between 2000 and 2003, more than 20 percent of all jury verdicts in Philadelphia resulted in awards exceeding $1 million while 59.2 percent were defense verdicts. There were nine cases with verdicts higher than $10 million during that span.

Shanin Specter of Kline & Specter, one of the city's leading plaintiff personal injury firms, said the decline in filings and verdicts has caused many firms to decrease the percentage of med mal cases they handle and diversify their practices into areas such as mass tort, class action and employment.

"I've been waiting for doctors to declare victory but they haven't," Specter said. ((Don't hold your breath, counselor....tell us about a reduction in premiums of about 50 or 60%, to bring rates down to circa-2000 levels, and maybe doctors will declare "victory.")) "There are some doctors out there who are still angry and won't be happy unless no one can get sued for anything." ((I'm sorry - would YOU be "happy" if your annual house payment had gone up 247% in the past five years, and you got NOTHING more to show for the extra expenditure?))

Doctors' groups were not swayed by the numbers. Ken Kilpatrick, spokesman for the Politically Active Physicians Association, said his organization is pleased that venue shopping has been addressed but believes caps on pain and suffering damages are needed. He said the decline in Philadelphia cases has resulted in a "suburban sprawl" of filings in outside the city. He said Chester County once had six neurosurgeons. It now has one, who practices part-time because specialists in high-risk areas can't afford the insurance.

"This has gone from a crisis to a catastrophe because people are dying due to diminished access to health care," Kilpatrick said. "Doctors are still leaving the state and others are curtailing services because the insurance rates are too high. And there's nothing to hold back cases from exploding at any time because there are no caps on pain and suffering damages."

Charles Moran, spokesman for the Pennsylvania Medical Society, said the numbers do show positive signs in that the number of filings are down. He said they also prove the point doctors had been trying to make about venue shopping in Philadelphia and frivolous lawsuits, which have been curtailed somewhat by the certificate of merit rule. But he said the numbers don't take into account that total payouts from insurers and underwriters have not declined in recent years. According to the U.S. Health Resources Services Administration, Pennsylvania total payouts were listed at $398.9 million for 2002, $394.5 million in 2003 and $448 million in 2004. No numbers are yet available for 2005.

Robert Surrick, executive director of Doctor's Advocate, said the high court's statistics are misleading.

"The number of case filings is irrelevant; it is the number of doctors being sued that is important and impacts the health-care delivery system," Surrick said. "Trial lawyers always name more than one physician on one lawsuit, so more than one doctor is named in one case. The more doctors that get sued, the higher malpractice premiums will rise along with the number of doctors who will leave the state, close their practice and curtail services."

But Nancy Kippenhan, chief of the prosecution division for the Pennsylvania Medical Board, said there are no clear statistics to determine whether the number of doctors sued has increased. She said the Medical Board opens a file every time a doctor reports being sued or fails to report being sued, but doctors have 60 days to report cases and many don't report them at all. There are currently 429 doctors being investigated for not reporting. ((So there are actually MORE physicians being sued than even the state medical board is tracking...))

There were 3,016 physicians' files opened during fiscal year 2004-05, up from 2,100 in fiscal year 2003-04.

Specter said there are lots of cases where only one doctor is listed as a defendant.

"And even if there are cases where more than one is being sued, if there is a 38 percent decrease in filings, obviously the number of doctors being sued has gone down," he said. "And when a case is filed, you need a certificate of merit from a medical specialist to proceed, which has reduced the number of doctors [named as defendants in each case]." ((Um.....then why is the number of doctors self-reporting being named in suits increasing?  And, just for the record, the certificate of merit doesn't require that personal injury lawyers like Atty. Specter actually obtain and file a statement from a doctor stating that there is reasonable cause for a suit - it just requires that the lawyer SAY he or she has such a thing.  The doctor doesn't even need to be identified....))

 

9....Doctor's Advocate Response

Misleading print media reporting

TO: All Pennsylvania doctors

FROM: Robert B. Surrick, Esquire

              Executive Director, Doctor’s Advocate 484-688-8218

DATE: May 14, 2006

 

     A fraud is being perpetrated on every citizen of Pennsylvania by Chief Justice Cappy and Governor Rendell. The print media, without analyzing the available data, goes along. In April, Justice Cappy put out cherry-picked statistics purporting to show that medical malpractice filings are in a “sustained decline.” Using the Supreme Court numbers, which compare 2001 and 2002 against 2005 numbers, Governor Rendell declares that the “crisis has abated significantly.” The print media goes along with this misleading information by printing articles such as “Signs of crisis fading” (Philadelphia Inquirer, January 2, 2006) and “Medical malpractice filings decline” (Philadelphia Business Journal , May 5, 2006). In point of fact, the case filings have been steady for the last three years: 1,712 in 2003, 1,816 in 2004 and 1,698 in 2005. There is no “sustained decline”.

 

    THE NUMBER OF LAWSUITS FILED IS IRRELEVANT—MEANINGLESS. IT IS THE NUMBER OF DOCTORS SUED THAT IMPACTS THE HEALTH CARE DELIVERY SYSTEM AS DOCTORS RETIRE EARLY, LEAVE THE STATE, CURTAIL CERTAIN PROCEDURES LIKE DELIVERING BABIES, AND MEDICAL RESIDENTS FLEE (92% IN 2005) TO AVOID OUTRAGEOUS INSURANCE PREMIUMS AND THE ONSLAUGHT OF LAWSUITS.

 

Below are statistics I obtained from the Pennsylvania Medical Board      which show an alarming increase in the number of doctors sued. If you haven’t been sued, you will be. It is only a matter of time.

 

Number of Pennsylvania Doctors Named in Lawsuits

 

START        END           MONTHS     # DOCS SUED    TOTAL    PER MONTH   PER DAY

 

5/22/02      3/1/05             31                6,185              6,185          200                6.1                     

 

3/1/05       10/31/05           8                 1,784              7,969          223                7.3         

 

10/31/05   4/1/06               5                 1,332              9,301          266                8.8    

 

The total number of doctors named in lawsuits in fiscal year 2003-04 was 2,100. The following year, in fiscal year 2004-05, the number rose to 3,016, an increase of 43%

 

The source for all statistics is the Pennsylvania Medical Board.

 

The Board began keeping track of lawsuits filed against doctors on May 22, 2002, when Act 13 was passed requiring doctors to report when they were sued.

 

10....Issues PA Release

Medical Malpractice in Pennsylvania: The Impact of Recent Reforms - Is It Too Soon to Tell?

(April 2006) For decades, medical malpractice has been a major concern in Pennsylvania. Why? It impacts the cost of health care because malpractice insurance costs and, more importantly, the costs of defensive medicine are paid, in part, through higher insurance rates. It impacts access because medical malpractice may drive physicians away from high-risk specialties. It impacts quality to the extent the medical malpractice climate affects how health care practitioners do their job.

The most recent malpractice insurance crisis – one of availability and affordability – arrived in 2000. Mirroring national trends, insurance companies which had been enjoying high investment earnings during the 1990s and were able to offer attractive premium pricing to build market share encountered serious financial difficulty as equity markets weakened. The number of paid physician claims per 100,000 Pennsylvanians grew 23% between 1990 and 2001, compared to nationwide growth of about 11%. Three of the 5 major private medical liability insurers ceased writing policies in Pennsylvania after 2001. And insurance premiums rapidly increased in certain high risk specialties such as neurosurgery and orthopedic surgery, if coverage was available at all except through the state’s insurer-of-last-resort.

How has state government responded?

In 2002, a coalition of stakeholders and state government leaders developed legislation that became the “MCARE Act.” The goals were to make the medical malpractice insurance system more stable and less prone to destructive cycles, to make coverage more available and affordable, and to improve patient safety. The Council of State Governments commented, “Pennsylvania is unique in that the MCARE Act reform package addresses all three aspects of the problem, patient safety, legal reforms to reduce the number of frivolous lawsuits and excessive rewards, and financial reforms initiating insurance restructuring.”

After the MCARE Act, other significant legislative pieces followed. And, in 2004, the Pennsylvania Supreme Court implemented changes to the rules of civil procedure to both reinforce the MCARE legislation and to effect reforms of its own.

Some of the significant reforms of the early 21st century:

• Pennsylvania became the first state in the nation to require reporting of adverse events and near misses. 

• To help reduce the number of medical errors and improve patient safety, the state created a Patient Safety Authority to review medical error data and make recommendations on how to avoid errors. 

• The courts implemented changes to reduce the number of frivolous lawsuits and excessive rewards and to make the system more predictable and stable. 

• There’s now a restriction on “venue shopping” in Pennsylvania: a lawsuit must be filed where treatment actually occurred. 

• New rules of civil procedure address pretrial procedures and litigation and require lawyers for the plaintiff obtain a “certificate of merit” establishing the medical work in a case falls outside acceptable standards. 

• Another new law provided abatements for MCARE assessments owed by physicians and nurse-midwives. Originally targeted to cover calendar years 2003 and 2004 – approximately $220 million per year – the abatement has been renewed annually at the same subsidy level.

Although they’ve been discussed and debated, “caps” on non-economic damages have never been legislated.

What are the results?

It’s too early to know for sure. Determining progress requires three measures: payouts from the MCARE fund, premiums for physicians, and the availability of liability insurance. So far the results are mixed. To learn more, read this IssuesPA Article.

MCARE payouts: According to the Pennsylvania Department of Insurance, which administers the MCARE fund, MCARE payouts were lower in 2004 than in 2002 and 2003 – $318.9 million in 2004 compared to $348.1 million in 2002 and $376.8 million in 2003. Payouts for 2005 were lower again. The assessment fees charged to doctors to support the fund dropped significantly for 2006. ((It is vitally important to note that the proportion of MCARE payouts as compared to commercial payouts has altered significantly as a result of legislation passed in 1996, or, according to the PA Medical Society, "Reductions in Mcare coverage enacted in Act 135 of 1996 have worked their way through the courts.  Pursuant to Act 135, Mcare coverage (and exposure) dropped from $1 million in 1996 to $900,000 in 1997 and 1998, to $800,000 in 1999 and 2000 and to $700,000 in 2001.  Private carrier exposure INCREASED correspondingly during that period, as the total insurance requirement remained constant at $1.2 million."  The Mcare Act, passed in 2002, decreased that total mandated level of insurance to $1 million from $1.2 million.  So what we need to be looking at here are TOTAL payouts, not just Mcare numbers....and total payouts were up 13.5% to an all time high of $448 million in 2004....))

Premium costs for physicians: Despite the recent good news from the MCARE Fund regarding lower claims payouts and assessment levels, the real question is whether total costs – both primary insurance premiums and MCARE assessments – are under control. In 2005, total costs for most physicians did not decrease significantly. Major insurers didn’t request a rate increase for 2006, but the medical community says premiums still are much too high. ((For example, PMSLIC raised rates a cumulative total of 247% since 2000 - and MANY physicians did see increases in 2006...)) And the Governor and legislature still must decide in future years whether to continue to MCARE abatements – a $200 million relief package for physicians.

Availability of liability insurance: Non-traditional insurers continue to enter the market – many of them risk-retention groups that are exempt from state rate-setting and other important market controls. Traditional insurers, however, have not returned, suggesting that Pennsylvanian’s liability insurance market does not have the predictability and stability that insurers prefer. In some cases, the traditional insurers that remain have reduced their business in Pennsylvania over the last few years through non-renewals and limitations on new business they’ll cover.

While the formation of risk-retention groups is good news that there are more insurance options for some physicians, the good news may be offset by the risk. The exemptions the non-traditional insurers enjoy may expose those insured to personal risk for the insurer’s liabilities in the event of insolvency.

Because of the unstable market, over 1,900 physicians (out of approximately 34,000) now are forced to obtain coverage – expensive coverage – from the Joint Underwriting Association (JUA), the state-operated insurer-of-last-resort. While 1,900 may seem to be a relatively small number, it reflects a 450% increase since 2001.

Bottom line?

Moving forward, lawmakers and advocates must strike a careful balance: 

• First, determine the impact of current reforms and allow time for them to work. 

• Second, monitor them carefully to make sure they’re being implemented appropriately. 

• Third, continue to seek more ways to help assure long-term access to a high-quality health care system for all Pennsylvanians.

In 2006, policymakers and candidates would be wise to monitor this volatile issue.

 

 

11...Pennsylvania Physicians for the Protection of Specialty Care (3PSC) Release

Pennsylvania Patients Lose Another Specialty Surgeon to Medical Liability Crisis 

While Senators in Washington, D.C. debate whether or not to enact common sense medical liability reforms such as those in S. 22, the Medical Care Access Protection Act of 2006, patients in Pennsylvania have lost another specialty surgeon to a state with a more balanced medical liability system.

PA Physicians for the Protection of Specialty Care – 3PSC President Scot Paris, M.D. said Adam M. Freedhand, M.D. an orthopaedic surgeon with Chester County Orthopaedic Associates is leaving for California where his medical liability insurance premium will be significantly less and he will be able to practice medicine without the constant threat of frivolous lawsuits.

"Pennsylvania is losing one of its finest young surgeons with Dr. Freedhand's move," Paris said. "Pennsylvania's rapidly aging population has a growing demand for specialized medical care at a time when the state's out-of-balance legal system is sending our top docs out of state or out of practice."

Freedhand, 40, leaves a busy practice in sports medicine and joint replacement surgery in the Chester County area where he and his four colleagues serve 13,000 patients annually.

"Losing another specialty surgeon, puts pressure on an already fragile healthcare system in our state," Paris explained. "Surgical practices here continue to face great difficulty recruiting doctors to Pennsylvania – even when the doctor has been trained at one of our great institutions here. We need common sense medical liability reforms to strengthen our healthcare system."

3PSC represents high-risk specialty surgeons such as orthopaedic, general and thoracic surgeons, neurosurgeons and obstetricians and their patients to preserve world-class medical care through common sense medical liability reforms and best practices in patient safety. To find out more about 3PSC visit our website at www.3psc.org.

Check out 3PSC's advertisement in Pittsburgh Magazine's Top Docs issue and Philadelphia Magazine's Top Doctors issue this month.

3PSC has launched a cooperative effort with the Pennsylvania Patient Safety Authority to promote the independent agency's patient safety advisories. Physicians can sign up for quarterly Patient Safety Advisories, which fulfill physician's requirements for Continuing Medical Education credits in patient safety and risk management. Click here for more information

 

12....Patriot News

Letter to the Editor - Doctor Shortage

04/12/06

 

There is and will continue to be, barring reform in tort law, a shortage of doctors in Pennsylvania in high-risk specialties -- obstetrics, neurosurgery, cardiac surgery and general surgery.

 

However, we train plenty of doctors in Pennsylvania at excellent state-subsidized medical schools who elect to practice elsewhere because of the problems caused by the Pennsylvania Constitution. The constitution prohibits the Legislature from enacting laws that would reduce jury awards in personal injury tort cases. Hence we have no pain and suffering caps. Doctors swarm to states such as Texas and California, which have caps and hence lower premiums for medical malpractice insurance.

 

The fix proposed by The Patriot-News, taxpayer-paid medical school tuition, is like putting a Band-Aid on a massive chest wound. It does not