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Pure and Effective Lobbying for Tort Reform

Hossfeld, George MD

doi: 10.1097/01.EEM.0000390749.56351.41
You've Been Served


Good news for tort reform has been as hard to come by as one-legged pogo champions. As best I can decipher, what Obamacare calls “tort reform” are prohibitions against limits on punitive damages and bans against limiting lawyer's fees. It seems the White House feels the only problem with medical litigation is that it doesn't cost enough. In that environment, I'm pleased to report a few candles in the darkness of our efforts to become a rational and fair medical-legal nation.

First is the eye-opening report by the Massachusetts Medical Society to objectify the true cost of defensive medicine in that state. They asked some 900 society members of eight different specialties, including emergency medicine, what percentage of their lab tests, x-rays, CT scans, ultrasounds, MRIs, and consults were done primarily for defensive reasons. It will come as no surprise to clinicians that they found that 83 percent of the physicians said they practiced defensive medicine, and 18 percent to 28 percent of all tests were done for that reason. And 13 percent of all admissions were done primarily for defensive reasons.

The enormous number of dollars this represents should get the attention of all legislators trying to keep their states, not to mention this country, financially afloat. In Massachusetts alone, defensive medicine costs a conservatively estimated $1.4 billion. Hopefully, politicians will recognize they can't afford not to enact tort reform.

The Illinois State Medical Society recently reported a similar study of their membership with related results. Illinois, even more than Massachusetts, is consistently rated as one of the worst malpractice environments. The Land of Lincoln also has had three separate legislative tort reform bills overturned by its state supreme court. The consequent exodus of obstetricians, neurosurgeons, and other high risk specialists was inevitable. The Illinois report, besides confirming that 90 percent of the state's physicians are practicing defensive medicine, found that 82 percent of doctors see every patient as a potential lawsuit risk.



Other authors, some with agendas of their own, have debated the huge cost of defensive medicine. Health Affairs recently published a study by public health experts who reviewed decades of other clinicians' old guesses, made dubious assumptions, and reasoned themselves into a conclusion that a mere 2.4 percent of health care costs are due to defensive medicine. Although this study is being highly promoted by the trial lawyers, it should be noted that there are no new data whatsoever in the “study,” and it is a position paper, not an objective study.

So the tally sheet gets longer and longer. Meritless attacks on many fine physicians, billions of dollars in unnecessary defensive medicine testing, and even an assault upon that sacred patient-physician relationship, can all be attributed to an American medical-legal system spiraling out of control.

Incidentally, Illinois is gearing up for a campaign to unseat four of their seven state Supreme Court justices who are up for retention votes this month. These are the justices who did not support the Illinois State Medical Society position that a terrible malpractice climate was leading to decreased patient access to health care in the state. All over the country, similar pressure is being applied to decision-makers because the public is sick of a legal system gone awry and its stranglehold on America.

It is in response to this threat to medical decision-making that spawned a new partnership of patients and doctors known as Docs4PatientCare ( Physicians are healers by nature, and not given to politics as a rule, but this direct affront to the practice of medicine has convinced doctors that those days of ignorant bliss are over.

Docs4PatientCare was created in 2009 by a group of Atlanta physicians who saw the need for physicians (and patients) to organize so their voices could be heard. Politicians seem dead set on excluding actual practicing doctors from any health care reform. Go figure. These physicians felt that no other group, including the American Medical Association, has represented them satisfactorily. Docs4PatientCare claims more than 17,000 members in its first year of existence, and is growing rapidly. Allied Health Care and patients are also welcomed; after all, it is our health care we're talking about. I challenge anyone to read its mission statement and disagree:

We are an organization of concerned physicians committed to the establishment of a health care system that preserves the sanctity of the doctor-patient relationship, promotes quality of care, supports affordable access to all Americans, and protects patients' freedom of choice.

They are not the only organization out there lobbying for doctors and patients. Docs4PatientCare just might be the purest and most effective, and you may have seen or heard representatives on national TV and radio shows. It's free to join, and worth looking into.

They say the night is always darkest just before the dawn. I hope to be here and be a part of the sunrise to come.

Dr. Hossfeld is an assistant professor of emergency medicine at the University of Illinois-Chicago. He is a past president of the Illinois College of Emergency Physicians, and has been involved in the legal side of emergency medicine for more than 25 years. A collection of his columns is available on the EMN web site:

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