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Viewpoint: Protecting Good Physicians

Bailey, Regina MD, JD, LLM

doi: 10.1097/01.EEM.0000471532.98580.ca
Viewpoint

Dr. Bailey holds a bachelor's degree in molecular biology from Hampton University, a law degree from Georgetown University, a medical degree from George Washington University, and a master's in health law from the University of Houston Law Center. She is currently an emergency physician at North Cypress Medical Center and an assistant clinical professor of medicine at UTMB Galveston.

A study published in the New England Journal of Medicine examined whether protecting physicians from unwarranted lawsuits could curb unnecessary health care costs, particularly in the emergency department where patients are high-risk and information about them is often incomplete. (2014; 371:1518; http://bit.ly/1viLBPK.) This environment, the researchers contended, lends itself to defensive practice and increased costs.

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Texas, Georgia, and South Carolina enacted laws in the past decade that changed the legal malpractice standard to gross negligence for emergency care. This means that a physician could not be found liable for a bad outcome unless they displayed carelessness toward the patient and total disregard for potential harm. This level of protection allows physicians to order tests and imaging studies they think are necessary and avoid spending health care dollars on interventions that yield little diagnostic or treatment benefit.

The study compared these three states with neighboring control states that did not have rigorous malpractice standards. They analyzed patient outcomes, changes in CT and MRI use, per-visit charges, and hospital admission rates.

Did gross negligence standards reduce costs? The researchers found no reduction in the intensity of care in the states that were studied, concluding that malpractice reform had little effect on the intensity of practice (imaging, hospital admission, and hospital charges).

Nevertheless, I wouldn't throw out malpractice reforms just yet. The authors fail to note that the purpose of medical liability reform was not only to reduce defensive medicine, but also to reduce the cost of medical liability insurance, which does seem to have occurred. Liability premiums in Texas have risen more slowly than the rest of the country, and the rate of lawsuits has declined (60% fewer malpractice claims filed). I believe these are crucial effects of malpractice reform that not only affect the field of emergency medicine, but are beneficial for all medical practice.

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