Nader Group Urges Improving Patient Safety, Removing Dangerous Doctors

January 17, 2007

Despite claims by business and medical lobbying interests, there is no medical malpractice lawsuit crisis in America, according to analysis released by Ralph Nader’s national group, Public Citizen.

But there is a problem with a small group of doctors who make mistakes.

The new report, “The Great Medical Malpractice Hoax,” claims to dispel myths of dwindling doctors and spiraling insurance premiums that proponents of tort reform use to support limits on the ability of injured patients to seek redress in the courts.

The Public Citizen report maintains that the real problems are a lack of attention to patient safety, the high incidence of preventable medical error and the lack of accountability for a small set of doctors who account for a majority of medical malpractice payments.

The report urges that steps be taken to identify and weed out the minority of doctors responsible for the bulk of malpractice payments. It maintains that the vast majority of doctors – 82 percent – have never had a medical malpractice payment.

The report maintains that improving physician oversight is vital to addressing the small percentage of repeat offenders who continue to practice medicine despite being responsible for a majority of malpractice claims in America. The report documents that just 5.9 percent of doctors have been responsible for 57.8 percent of the number of malpractice payments from 1991 to 2005, with each of these doctors making at least two payments. The vast majority of doctors – 82 percent – have never had a medical malpractice payment since the NPDB was created in 1990, according to the report.

Public Citizen reviewed publicly available information from 1990 to 2005 from the federal government’s National Practitioner Data Bank (NPDB), which tracks malpractice payments made on behalf of doctors as well as disciplinary actions taken against them by state medical boards or hospitals. According to the analysis, the total number of malpractice payments paid on behalf of doctors, with judgments and settlements, declined 15.4 percent between 1991 and 2005, and the number of payments per 100,000 people in the country declined more than 10 percent. In addition, the average payment for a medical malpractice verdict, adjusted for inflation, dropped eight percent in the same period.

According to the report, the numbers show that patients do not win large jury awards for less serious claims but that payments usually correspond to the severity of injury. In 2005, less than three percent of all payments were for million-dollar verdicts and more than 64 percent of payments involved death or significant injury – while less than one-third of one percent were for “insignificant injury,” the study says.

Doctors dispute the Public Citizen report, claiming among other things that it is based on a faulty database.

“Once again, Public Citizen has based its conclusions on an inherently flawed database, the National Practitioner Data Bank,” responded Cecil Wilson, MD, chairman of the board of the American Medical Association. Wilson said the federal government’s own accounting office has said raised concerns about the integrity of that data bank.

The Public Citizens report questions the claims that doctors are leaving states and practices where lawsuits are common.

“Despite assertions by the medical and business lobbies that physicians are leaving practice because of burdensome malpractice lawsuits, the number of doctors is increasing faster than the population,” said Laura MacCleery, director of Public Citizen’s Congress Watch group. “In recent years, medical malpractice insurers have been reaping huge profits, not paying out excessive jury awards. The false claims of a malpractice lawsuit crisis are really about putting profits ahead of patients. They distract from real health care reform designed to improve patient safety, enhance efficiency and cut costs.”

The AMA defended the efforts at tort reform.

“It is unfortunate that instead of trying to help patients by learning from state medical liability reform success stories, Public Citizen continues to put out variations of their same-old discredited studies,” Wilson said in a statement. “The entire nation has seen the positive results of medical liability reforms enacted in Texas. In 2003, Texas enacted medical liability reforms with limits on non-economic damages — and the new law works. Premiums are down, and physicians have flocked to the state, improving access to care for Texas patients.”

But Public Citizen said reforms should focus on reducing medical errors and tightening lax doctor discipline and oversight rather than o curbing lawsuits.

To improve patient safety and prevent errors, the Public Citizen report urges Congress to establish a national mandatory adverse event reporting system so that hospitals share information that can help them correct faulty systems and practices.

To combat medication errors, it recommends that hospitals invest in computer physician order entry systems, which it says would avoid mistakes associated with illegible handwriting and automatically check for errors or bad drug interactions. Despite a 2006 study by the Institute of Medicine concluding that medication error is one of the most common preventable mistakes and costs as much as $3.5 billion annually, fewer than five percent of hospitals have implemented such a system.

Hospitals and medical practices should also limit physicians’ workweeks to reduce fatigue-induced error, the report continues.

State medical boards, which are largely responsible for doctor discipline, should be given greater funding and staffing, and be required to provide stricter oversight to prevent dangerous doctors from practicing in their own or other states, the authors contend.

“Over the past few years, the Republican-led Congress has repeatedly attempted to curtail the legal rights of medical malpractice victims by capping damage awards and imposing other limits on access to the courts by consumers,” said Public Citizen President Joan Claybrook. “This report shows that lawmakers were misguided; in fact, Congress should work to reduce medical errors.”

The group also urges Congress to “lift the veil of secrecy” by allowing the public access to the names of sued doctors – which are now kept secret – and urges state legislatures to require state medical boards to improve their Web sites to provide better information about doctor discipline.

Sources: Public Citizen
American Medical Association

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