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DJP 5-17-2005 AMA Update - World Medical Association and Med Liability - Rhode Island Crisis state
Just a brief note to bring you up to date on two items in the medical liability arena:
The World Medical Association Council passed a policy on medical liability and patient safety and Rhode Island has been classified as a crisis state in medical liability. The WMA action is another important step forward in the quest to bring common sense to a medical liability system that threatens access to care to patients in their hour of need.
ITEM ONE: World Medical Association
I just returned late last night from the World Medical Association in Divonne, France. It was my last meeting representing American physicians at WMA and as Chair of AMA Delegation to AMA. Dr. Hill and Dr. Nelson also are members of the delegation (the 3 AMA presidents, president-elect, president, and immediate past-president make up the AMA delegation) and Dr. Coble is President of WMA. Will only alert you to one of many activities that are moving ahead at WMA, namely, the passage of a medical liability and patient safety policy.
AMA took the lead on this report and we are pleased with the result. Keep in mind that the document had to take into account the laws and customs and language differences of the 84 countries that could have input to this report. Israel, Great Britian, Canada, and Spain were the countries that supplied the most comments to our draft resolution and everyone was pleased with the final product.
The statement of WMA is placed into this email.
SMAC/Liability/May2005
PROPOSED WORLD MEDICAL ASSOCIATION STATEMENT ON MEDICAL LIABILITY REFORM
1. A culture of litigation is growing around the world that is adversely affecting the practice of medicine and eroding the availability and quality of health care services. Some National Medical Associations report a medical liability crisis whereby the lawsuit culture is increasing health care costs, restraining access to health care services, and hindering efforts to improve patient safety and quality. In other countries, medical liability claims are less rampant, but National Medical Associations in those countries should be alert to the issues and circumstances that could result in an increase in the frequency and severity of medical liability claims brought against physicians.
2. Medical liability claims have greatly increased health care costs, diverting scarce health care resources to the legal system and away from direct patient care, research, and physician training. The lawsuit culture has also blurred the distinction between negligence and unavoidable adverse outcomes, often resulting in a random determination of the standard of care. This has led to the broad perception that anyone can sue for almost anything, betting on a chance to win a big award. Such a culture breeds cynicism and distrust in both the medical and legal systems with damaging consequences to the patient–physician relationship.
3. In adopting this Statement, the World Medical Association makes an urgent call to all National Medical Associations to demand the establishment of a reliable system of medical justice in their respective countries. Legal systems should ensure that patients are protected against harmful practices, physicians are protected against unmeritorious lawsuits, and standard of care determinations are consistent and reliable so that all parties know where they stand.
4. Associations of some of the facts and issues related to medical liability claims. The laws and legal systems in each country, as well as the social traditions and the economic conditions of the country, will affect the relevance of some portions of this Statement to each National Medical Association but do not detract from the fundamental importance of such a Statement. 5. An increase in the frequency and severity of medical liability claims may result, in part, from one or more of the following circumstances: (a) Increases in medical knowledge and medical technology that have enabled physicians to accomplish medical feats that were not possible in the past, but that involve considerable risks in many instances. (b) Pressures on physicians by private managed care organizations or government-managed health care systems to limit the costs of medical care. (c) Confusing the right to access to health care, which is attainable, with the right to achieve and maintain health, which cannot be guaranteed. (d) The role of the media in fostering mistrust of physicians by questioning their ability, knowledge, behavior, and management of patients, and by prompting patients to submit complaints against physicians. 6. A distinction must be made between harm caused by medical negligence and an untoward result occurring in the course of medical care and treatment that is not the fault of the physician.
(b) An untoward result is an injury occurring in the course of medical treatment that was not the result of any lack of skill or knowledge on the part of the treating physician, and for which the physician should not bear any liability. 7. Compensation for patients suffering a medical injury should be determined differently for medical liability claims than for the untoward results that occur during medical care and treatment, unless there is an alternative system in place such as a no-fault system or alternate resolution system. (a) Where an untoward result occurs without fault on the part of the physician, each country must determine if the patient should be compensated for the injuries suffered, and if so, the source from which the funds will be paid. The economic conditions of the country will determine if such solidarity funds are available to compensate the patient without being at the expense of the physician. (b) The laws of each jurisdiction should provide the procedures for deciding liability for medical liability claims and for determining the amount of compensation owed to the patient in those cases where negligence is proven. 8. National Medical Associations should consider some or all of the following activities in an effort to provide fair and equitable treatment for both physicians and patients: (a) Establish public education programs on the risks inherent in some of the new advances in treatment modalities and surgery, and professional education programs on the need for obtaining the patient's informed consent to such treatment and surgery. (b) Implement public advocacy programs to demonstrate the problems in medicine and the delivery of health care resulting from strict cost containment limitations. (c) Enhance the level and quality of medical education for all physicians, including improved clinical training experiences. (d) Develop and participate in programs for physicians to improve the quality of medical care and treatment. (e) Develop appropriate policy positions on remedial training for physicians found to be deficient in knowledge or skills, including policy positions on limiting the physician's medical practice until the deficiencies are corrected. (f) Inform the public and government of the danger that various manifestations of defensive medicine may pose (the multiplication of medical acts or, on the contrary, the abstention of the doctors, the disaffection of young physicians for certain higher risk specialties or the reluctance by physicians or hospitals to treat higher-risk patients). (g) Educate the public on the possible occurrence of injuries during medical treatment that are not the result of physician negligence and establish simple procedures to allow patients to receive explanations in the case of adverse events and to be informed of the steps that must be taken to obtain compensation, if available. (h) Advocate for legal protection for physicians when patients are injured by untoward results not caused by any negligence and participate in decisions relating to the advisability of providing compensation for patients injured during medical treatment without any negligence. (i) Participate in the development of the laws and procedures applicable to medical liability claims. (j) Develop active opposition to meritless or frivolous claims and to contingency billing by lawyers. (k) Explore innovative alternative dispute resolution procedures for handling medical liability claims, such as arbitration, rather than court proceedings. (l) Encourage self-insurance by physicians against medical liability claims, paid by the practitioners themselves or by the employer if the doctor is employed. (m) Encourage the development of voluntary, confidential, and legally protected systems for reporting untoward outcomes or medical errors for the purpose of analysis and making recommendations on reducing untoward outcomes and improving patient safety and health care quality. (n) Advocate against the increasing criminalization or penal liability of medical acts by the courts.
§ § § 14.5.2005
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ITEM TWO: Rhode Island Joins States In Medical Liability Crisis
FOR IMMEDIATE RELEASE May 16, 2005
RHODE ISLAND JOINS STATES IN MEDICAL LIABILITY CRISISTexas liability reforms halting crisis there
CHICAGO – The American Medical Association (AMA) today announced that Rhode Island is the latest state to be trapped by the medical liability crisis that is sweeping the nation. Rhode Island joins 19 other states designated by the AMA as “in crisis” due to a deteriorating medical liability climate and a growing threat of patients’ losing access to care.
“An unrestrained legal assault has eroded Rhode Island’s health care system to the point where physicians are restricting services, and patients are losing access to care,” said AMA Trustee William G. Plested, M.D. “Until lawmakers enact proven reforms, our nation’s crisis will only get worse.”
Soaring jury verdicts, which produce lucrative returns for personal injury lawyers, are driving medical liability insurance premiums beyond the reach of many doctors. As insurance premiums skyrocket, physicians in Rhode Island and across the nation are forced to limit patient services, retire early, or consider moving to other states.
“Patients bear the brunt of the nation’s broken medical liability system,” said Dr. Plested. “The cost of unrestrained litigation not only jeopardizes patients’ access to physicians, hospitals and clinics, but also inflates the cost of medical services.”
A recent survey by the Rhode Island Medical Society provides a snapshot of how patients’ access to care is placed in jeopardy by the excesses of an out-of-control legal system. The survey found:
· 49 percent of Rhode Island physicians say that increasing medical liability costs has caused them to discontinue or consider discontinuing certain services. · 48 percent of Rhode Island physicians say that increasing medical liability costs has forced them to consider leaving the state or giving up clinical practice.
“We need to fix a jackpot justice system that is bad for our patients, bad for health care, and bad for local economies,” Dr. Plested said. “It’s time for Rhode Island’s state and federal representatives to stand up and do what is necessary to ensure that when patients need care, physicians are there to provide it.”
Rhode Island today joins: Arkansas, Connecticut, Florida, Georgia, Illinois, Kentucky, Massachusetts, Mississippi, Missouri, New Jersey, Nevada, New York, North Carolina, Ohio, Oregon, Pennsylvania, Washington, West Virginia and Wyoming as states in crisis.
Recognizing that a unique turnaround is underway in Texas, the AMA also announced today it was removing Texas from the list of crisis states. The medical liability crisis in Texas was halted thanks to sweeping reforms that took effect Sept. 2003 after voters passed a constitutional amendment to eliminate potential court challenges.
Since reforms were passed, signs of improvement are widespread in Texas. Access to care is increasing and claims are down. Physician recruitment and retention is up, especially in high-risk specialties. New insurers are entering the Texas medical liability market creating more choices for physicians. Subsequently, competition is increasing, and all five of the largest insurers in the Texas medical liability market have announced rate cuts. The rate cuts will produce about $50 million in savings for Texans.
“Lawmakers and voters acted to bring Texas back from a meltdown of their health system,” said Dr. Plested. “We urge Rhode Island’s state and federal lawmakers to consider the example of other states and look to proven remedies when considering medical liability reform.”
Further details on the situations in Rhode Island and Texas can found on the AMA Web site. Please visit http://www.ama-assn.org/go/crisismap and click on “Rhode Island” and “Texas.”
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For more information, please call: Robert J. Mills AMA Media Relations Office: (312) 464-5970 Mobile: (312) 543-7268
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