Strib’s doctor discipline story fails to connect the dots

The Star Tribune has run good pieces yesterday and today on the issue of doctor discipline in the state.  Specifically, it raised the issue of whether or not the state’s Board of Medical Practice is going too easy on doctors.  From Sunday’s story:

Since 2000, at least 46 Minnesota doctors escaped board discipline after authorities in other states took action against their licenses for such missteps as committing crimes, patient care errors or having sexual or inappropriate relationships with patients, records show.

In addition, more than half of the 74 doctors who lost their privileges to work in Minnesota hospitals and clinics over the past decade were never disciplined by the Minnesota board, according to a federal database used by the health care industry to track actions against physicians. At least 13 of the 47 doctors who avoided discipline were flagged for incompetence, substandard care or inadequate skills.

Minnesota’s board also has consistently declined to keep the public informed about problem practitioners by not publicizing malpractice awards and other adverse actions that are routinely disclosed in states from California to North Carolina.

What the stories have failed to do, though, is to connect the dots.  The inevitable result of the failure of the Board of Medical Practice to adequately discipline doctors is more injured patients and more medical malpractice expense.

Which brings us to Minnesota’s Republican legislative delegation — one of their hot topics is “tort reform”.  As part of that, medical malpractice reform is frequently discussed — specifically capping the damages victims can collect.  The rationale for this is to protect doctors from excessively high malpractice insurance rates.  Of course, this hasn’t actually proven to work, as numerous studies have determined.)

The reality here, though, is that we don’t need “tort reform” or liability caps.  We need to get tough on doctors who make avoidable errors.  The numbers demonstrate the reality — much of our medical malpractice problem comes from a small group of repeat offender doctors.  Nationwide statistics show that 4.8% of doctors have two or more medical malpractice claims against them, and they represent 51% of medical malpractice incidents and 53% of medical malpractice dollars paid.

The answer here is simple:  Get rid of repeat offenders, and you’ve got safer patients and less malpractice expense in the system.


6 Responses to “Strib’s doctor discipline story fails to connect the dots”

  1. The reason we need tort reform is the cascading effect that malpractice suits have on our health care system. I witnessed this first hand a few years ago. I was having a pain in my chest, not from the heart, but a skeletal muscle pull. There was no sign of a heart attack what so ever. But because I had reported chest pain, the hospital performed defensive medicine. Since the insurance covers looking into every aspect of what could be causing the pain, the hospital performed many tests, keeping me overnight, and then sending me via ambulance the next day to have those same tests and more performed at one of the Mpls hospitals. They wanted to keep me another night, because while they hadn’t determined the exact cause of the pain, they had make darn certain that I wouldn’t have a heart attack in the near future, because they could be sued. A strained skeletal muscle, which likely needed nothing more than some rest, and and some Advil cost my and my insurance company many thousands of dollars, so the hospitals could have their rear ends covered from a law suit. And that’s why we need tort reform.

    • The problem with that logic, John, is that malpractice lawsuits aren’t nearly a big of a problem as they are made out to be. Increase in total malpractice expense (lawsuits & insurance) is less than the rate of overall medical inflation, and it’s less than the total societal cost of medical malpractice in terms of economic costs, lost wages, and productivity. Not to mention the fact that over 40,000 lose their lives each year to preventable medical errors. Capping malpractice awards only serves the interests of bad doctors and insurance companies.

      • So you have statistics on defensive medicine that refute this? RIght now, the only folks working on our behalf to prevent these unnecessary expenses are the insurance companies. Patients will normally submit to whatever the hospital recommends, which can and do run up costs, simply to cover the hospital from damages.

        And doctor’s are human. they make mistakes, just like you and I do. the difference is that people don’t expect millions of dollars for my mistakes.

        • Sure.

          Here’s a news story that cites three studies regarding defensive medicine. Key takeaways are that total malpractice costs (including defensive medicine) are just 2.4% of total health care spending and that capping malpractice awards would have no meaningful impact on the situation.

          The CBO has a similar study that shows that tort reform of the sort Republicans prefer would result in a minimal — 0.3% — reduction in procedures ordered.

          Here’s a telling anecdote from a story about McAllen, Texas, which has rapidly escalating Medicare costs:

          One night, I went to dinner with six McAllen doctors. All were what you would call bread-and-butter physicians: busy, full-time, private-practice doctors who work from seven in the morning to seven at night and sometimes later, their waiting rooms teeming and their desks stacked with medical charts to review.
          Some were dubious when I told them that McAllen was the country’s most expensive place for health care. I gave them the spending data from Medicare. In 1992, in the McAllen market, the average cost per Medicare enrollee was $4,891, almost exactly the national average. But since then, year after year, McAllen’s health costs have grown faster than any other market in the country, ultimately soaring by more than ten thousand dollars per person.
          “Maybe the service is better here,” the cardiologist suggested. People can be seen faster and get their tests more readily, he said.
          Others were skeptical. “I don’t think that explains the costs he’s talking about,” the general surgeon said.
          “It’s malpractice,” a family physician who had practiced here for thirty-three years said.
          “McAllen is legal hell,” the cardiologist agreed. Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.
          That explanation puzzled me. Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down?
          “Practically to zero,” the cardiologist admitted.
          “Come on,” the general surgeon finally said. “We all know these arguments are bullshit. There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.

          Read more


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