Doctors' fear of lawsuits tied to added costs of $1.4b

A vast majority of physicians in Massachusetts say the fear of being sued is driving them to order unnecessary tests, procedures, referrals, and even hospitalizations, a phenomenon that is adding at least $1.4 billion to annual healthcare costs in the Bay State, according to a study released yesterday. The Massachusetts Medical Society reported that 83 percent of physicians surveyed said they have practiced so-called defensive medicine and that an average of 18 to 28 percent of tests, procedures, referrals, and consultations, and 13 percent of hospitalizations, were ordered to avoid lawsuits. The society said its findings, the first it has compiled on the issue, probably underestimate the cost of the problem because the 900 physicians surveyed, including family doctors, obstetricians, gynecologists, and general surgeons, accounted for only about 46 percent of the doctors in the state.

The findings, which roughly mirror the experience reported by doctors in other states, come amid skyrocketing malpractice insurance premiums for doctors nationwide and a heated debate in Massachusetts and across the country about overhauling the malpractice system. Among the proposals is capping monetary awards to patients. While defensive medicine has been highlighted as a major driver of healthcare costs by other organizations, some studies, including a 2004 Congressional Budget Office review, question that finding. But Dr. Alan Woodward, past president of the medical society, said the Massachusetts study dramatically illustrates the need to transform the system to one that is more conducive to doctors admitting mistakes to patients, offering apologies, and engaging in arbitration that offers fair and timely compensation. "The current liability system is toxic to patient safety," he said. Patients who undergo unneeded imaging tests, for example, may be exposed to extra risk from radiation and allergic reaction to contrast dyes, Woodward said.

By some accounts, patients expect - and sometimes even demand - treatment that doctors deem marginally necessary. "With our increasing technology, patients want more of a work up. They want the labs, the MRI, the CT scan," said Dr. Manish K. Sethi, the study's lead researcher and an orthopedic senior resident at Massachusetts General Hospital. "You don't think it's indicated but you do it because you are afraid that if on the 1 percent chance there is something and you missed that you are going to get sued."

Concern about malpractice lawsuits has prompted some physicians to become hypercautious. Thirty-eight percent of physicians surveyed by the society said they reduced the number of high-risk services they performed, with orthopedic surgeons, obstetricians, and gynecologists topping the list.

Efforts to overhaul the malpractice system in Massachusetts and nationwide have been stymied. A number of proposals filed by state lawmakers have gone down to defeat, among them one that would mirror a closely watched program piloted at the University of Michigan Health System that encourages doctors and hospitals to acknowledge medical mistakes promptly and to engage in early offers of compensation. The aim is to significantly lessen the time and money spent on medical malpractice lawsuits, which often drag on for years and cost tens of thousands of dollars

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