Saturday, May 13, 2006

Study: Four out of 10 Medical Malpractice Cases Are Groundless

About 40 percent of the medical malpractice cases filed in the United States are groundless, according to a Harvard analysis of the hotly debated issue that pits trial lawyers against doctors, with lawmakers in the middle. Many of the lawsuits analyzed contained no evidence that a medical error was committed or that the patient suffered any injury, the researchers reported. The vast majority of those dubious cases were dismissed with no payout to the patient. However, groundless lawsuits still accounted for 15 percent of the money paid out in settlements or verdicts.

The study's lead researcher, David Studdert of the Harvard School of Public Health, said the findings challenge the view among tort reform supporters that the legal system is riddled with frivolous claims that lead to exorbitant payouts. "We found the system did reasonably well in sorting the good claims from the bad ones, but there were problems," he said.

However, the American Medical Association, which favors caps on malpractice awards, called the study proof that a substantial number of meritless claims continue to slip through the cracks, "clogging the courts" and forcing doctors to waste time defending them, association board member Dr. Cecil Wilson said in a statement.

The findings were published in Thursday's New England Journal of Medicine. The study found 3 percent of claims analyzed were filed by patients who had no injury. Of the claims that involved injuries, two-thirds were caused by medical error. But the remaining injury claims, or 37 percent, lacked evidence of a medical mistake, and most of those -- 72 percent -- were thrown out or otherwise resolved without a payout to the patient. Altogether, the Harvard researchers reviewed 1,452 malpractice claims randomly selected from five insurance companies. The cases were resolved -- meaning they ended in a verdict, a settlement or a dismissal -- between 1984 and 2004. The claims resulted in a combined $449 million in verdicts and settlements. The researchers examined medical records, depositions and court transcripts to determine if the patients were injured and whether the injury was due to a medical error.

In one instance, a young woman with no family history of breast cancer underwent routine breast exams for four years and came back with a clean bill of health. But doctors later found she had breast cancer that had spread to other parts of the body. The researchers determined the case did not involve medical error because proper procedures were followed. The woman filed a malpractice claim and received an undisclosed settlement.

The study also confirmed that defending a claim is expensive and long, taking an average of five years to resolve. It also found that for every dollar awarded to patients, about half went to cover lawyer fees and other expenses. Chris Mather, a spokeswoman for the Association of Trial Lawyers for America, said the study was biased because data was taken from insurers, which sometimes are the defendants in malpractice suits.

The debate over malpractice litigation simmered in Congress this week when Senate Democrats defeated a pair of Republican-backed bills aimed at limiting how much pain-and-suffering damages juries can award in malpractice cases. Similar legislation already passed the House.

George Annas, a Boston University bioethicist who had no role in the study, said he was not surprised by the findings. Many personal injury attorneys receive a contingency fee -- meaning they get paid only if they win -- and will not go to court with a baseless lawsuit, Annas said. "There's really no motivation to bring a frivolous lawsuit," he said. "It's not worth their time and effort." Among the findings:

* An overwhelming number of malpractice claims (97 percent) involved a severe disability or death. Seventy-three percent of all of the injury claims that were due to medical error were settled with a payment.

* In about a quarter of cases where a groundless claim was settled, the average payout was lower than that given to a legitimate claim ($313,000 versus $521,000).



Three stories from one day below:

Queensland Health: Nurse-hiring as incompetent as its doctor-hiring

Queensland Health appointed a senior nurse with false qualifications and called her boyfriend as her principal referee, State Parliament was told yesterday. The three-year-old blunder is now under investigation by the Crime and Misconduct Commission after it was revealed that a senior doctor who raised concerns about the appointment was disciplined and ignored by the department.

The Opposition yesterday issued a list of allegations against Prince Charles Hospital nursing manager Virginia Hancl, suggesting she was removed from clinical duties in her previous job because of concerns about her nursing skills. It was also alleged she falsified her master's degree in public administration from the University of Tasmania and the doctor discovered her past employer had not been contacted about a reference. The Opposition said the fiasco bore striking similarities to the Jayant Patel scandal, where nurse Toni Hoffman was ignored after complaining about the surgeon's ability, and accused the Government of attempting to cover up the matter.

After uncovering the concerns last year, doctor Chris Davis sought a review of Ms Hancl's appointment and applied for whistleblower protection, but instead was disciplined for breaching her privacy. Yesterday, Health Minister Stephen Robertson admitted the reference check had not been thorough and involved someone close to the nurse. "In terms of the referee that was contacted, that referee did not disclose the personal relationship he had with Hancl at that point in time," he said.

Defending yet another Queensland Health bungle, Premier Peter Beattie said the matter was a product of "the old" Queensland Health. "What you've got . . . is the legacy of the bad old days of Health - the new days are on the way," he said. Mr Beattie said any staff found to have erred would have "the book thrown at them". The department where the woman worked at Prince Charles will be reviewed to decide whether her appointment and the ensuing staff concerns resulted in reduced services.

The admissions are in stark contrast to comments last November when Mr Robertson said two internal reviews had found no problem with her appointment, her reference checks were "appropriate" and she was fully qualified. Yesterday, Mr Robertson said he had acted "decisively and transparently" when the real facts of the matter came to light in May, when the department prepared documents before an industrial relations hearing into Dr Davis's appeal for whistleblower protection. Since then, Mr Robertson has apologised to the doctor, offered to pay his legal fees, strike the disciplinary action from his record and give him whistleblower protection.

Ms Hancl is still employed by Queensland Health but has been on unpaid leave for several months. Mr Robertson said there was no evidence that any patients had experienced adverse outcomes as a result of her appointment.


Resigning surgeons 'had no choice': "One of four urological surgeons, who have resigned from Sir Charles Gardiner Hospital, says they had no choice but to quit in protest over delays in treating patients and ever-increasing waiting lists. Robert Davies and three other specialists will leave the hospital within six weeks. He says surgeons, nurses and other medical workers at the coal face feel disenfranchised with the health system. "We don't feel as though we have control or any real input into the way the system is organised and run," Dr Davies said. "What we see at the end of the line is a diminishing resources in the face of increased demands."

Superbug link to 103 deaths in Victoria's public hospitals: "A deadly superbug has been linked to 103 Victorian deaths in public hospitals. The MRSA superbug, a multi-antibiotic-resistant golden staph, has infected 1447 Victorians who were admitted to Melbourne hospitals last year. Department of Human Services figures show Bayside Health, which oversees the Alfred hospital, had the highest number of MRSA cases of all Melbourne health networks. More than 530 patients admitted to Bayside hospitals had MRSA -- 29 of them died. At Southern Health, which includes the Monash Medical Centre and Casey and Dandenong hospitals, 17 patients with MRSA died. And 11 patients died at Northern Health, which runs the Northern Hospital in Epping. MRSA, or methicillin-resistant staphylococcus aureus, is spread by doctors and nurses who have not washed their hands properly, and by dirty hospital equipment. The bug can be found in harmless levels on the skin, but once it enters the bloodstream it can become lethal... Department of Human Services acting director of quality and safety Alison McMillan said 75 per cent of Victoria's MRSA cases caught the superbug in hospitals. Ms McMillan said MRSA rates had improved since the introduction of a hand hygiene program in all Victorian hospitals last year, but there was still a lot of work to be done. "It's not an easy area to tackle, it's an enormous challenge," she said. "We've got this rolling program of educating hospitals, setting up systems to encourage people to use the hand gel, but that's going to take some time because there are a lot of hospitals in Victoria."


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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