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medpundit |
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Thursday, October 02, 2003This is stupid for several reasons, and I'm not a shark plaintiffs' attorney, I'm sure they'd be glad to explain more reasons. First, from a purely practical aspect, most hospitals won't let you be on staff unless you're insured for at least a minimum amount. They aren't interested in being the deepest pocket, and as we're (mostly) not their employees they don't want the multi-mil$ liability. Second, as was explained to me when I was but a pup, "yeah, you have nothing now, but you will someday, so I'd get a judgement and then renew it every 7 years". Because your net worth is negative today doesn't mean it'll stay that way. Just remember that bankruptcy doesn't wipe out many jury verdicts. Third, the nail that sticks up is the one that gets hammered down. This doc is deliberately making himself a target, and might get sued just to scare others into not going bare. Lastly, say he gets sued. All his legal expenses are out of pocket (mine are covered in my policy), billed at huge numbers per hour (more than an FP collects by far), and there's no settling for more than you have in savings, because you don't have it. The doctor who goes without malpractice insurance is taking a substantial risk. It’s one that I wouldn’t be comfortable taking, either, unless I had no other choice. But, it isn’t complete folly. What we have today is a system that’s being gamed far too much by trial lawyers. Think about people you know who have been in auto accidents. How many times have you seen them shrug their shoulders and say they have to pay their own repair expenses because the other driver didn’t have insurance? Why can’t they just sue him for the repairs? Because they can’t find a lawyer willing to take the case. BUT, add in insurance, and not only will a lawyer gladly take the case, he’ll find ways to ask for more money. The same thing happens in malpractice. A few years ago there was a case that got prominent play in the front pages of the New York Times. There was an abortion clinic in the city that was run by a doctor who had no malpractice insurance. One of his patients died from a hemorrhage after an abortion. The main angle of their stories was not that abortions have risks, but how horrible it was that this guy had no malpractice insurance because no one could sue him. Of course they could sue him, they just wouldn’t. (He ended up losing his license, by the way, so justice was done.) The doctor from Chicago who’s going bare explains everything on his website (Thanks to fellow physician blogger Veshland for the link). This is how he explains it to his patients: They have to know that bad things happen. Being alive carries a risk of dying, being healthy carries a risk of being sick, and the best medical care in the world can't always prevent it. They have to know that I am human, and although I am very, very good at what I do, I can err. Just last week I locked my keys in my car (although that was the first time I have ever done that). They have to know that I am not my own insurance policy. I own a Tercel, a large mortgage, $150,000 in student loans, as well as 7 years of post-graduate education, and 6 years of clinical experience. And if you think that the trial lawyers are only in it to keep medicine safe for the patients think again: Over the course of three years, my malpractice insurance went from to $2500, to $4000, to $10,000, and this year I was told it would be $40,000. If I had decided to continue delivering babies, it would cost me $150,000. If I quit my practice, and move to a different county, my insurance would only cost me $5000. There is no reason that moving to the next county would improve a doctor’s performance enough to cut his malpractice premium by $35,000. The only reason the next county is that much cheaper is that it’s too hard for big city law firms to gather up clients from there. And as for patients, their motive isn’t too far from the lawyers’: My experience with my patients has been that their concern is that a disaster will befall them, not that I will commit malpractice. If disaster struck, they could find themselves in the position of needing to sue me, just to cover their medical costs, or lost earnings. What these patients really need is disaster or disability coverage. Imagine spreading the risk of two-thousand patients over two-thousand policies as an alternative to traditional malpractice. Imagine people filing claims instead of suits...no court costs, no attorney fees. (emphasis mine) If we’ve come to regard our tort system as the equivalent of an insurance policy, then there’s no doubt the system is broken. (His website has a link to the attorney who is helping him make this possible. Not all lawyers are blind to the faults of the system.) UPDATE: A lawyer/doctor reader point out: The tort systems only real justification is as insurance. It was originally set up as a way to shift costs to the one responsible. Torts predate actual insurance. A whole area of research called law and economics explores the justification of tort law. Essentially torts can only be justified as either a cost shifting mechanism, ie placing the costs on the party responsible, or as private vengence, ie I want to hurt the person who I think hurt me. A subset of private vengence is the deterrance function. This might be viewed as "Its not really venegance I'm after, its just to prevent this from happening to others." No one has shown to a level of proof that would be accepted in medicine that the deterrance function works in tort. The insurance justification is known to be so inefficient that it is a theortic basis but not an best practice basis. It is more efficient to allow patients to insure themselves against malpractice through policies or price differentials. (Price differential would be an OV costs x if you agree you can not sue for anything or x plus y if you want to be able to sue). Private vengence is an interesting justifiaction but do we really want to allow private vengence in our society. Lawyers/judges/patient advocates assume torts are good for society but have never actually proven why. Since law rejects the scientific hypothesis/enlightenment and hews to a Platonic theory of proof discussion of tort reform tends to break down. I would suggest that until society decides what exactly is the function of tort law and how that is best accomplished all tort reform does is rearrange the deck chairs on the Titanic. posted by Sydney on 10/02/2003 09:29:00 AM 0 comments 0 Comments: |
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