The need for Tort reform is clearly evident to all physicians and healthcare providers. There are more claims are filed every year, and the average amount of awards has been steadily increasing by as much as 500 percent over the last decade in some areas. This translates into higher medical liability insurance.
I still believe “Health Courts” are a viable option. These would be specialty courts that rely on educated judges, neutral experts, evidence-based proceedings, and a schedule of damages that not only keeps liability costs manageable, but also is better for patients.
The American Bar Association is adamantly opposed to the concept and claim that health courts deny patients access to a jury trial and full compensation. But this argument really doesn’t hold much water since we already use specialty courts in areas such as bankruptcy, workmen’ s comp cases, patent cases, family law, and tax courts.
The big problem with jury trials for medical malpractice cases is that juries can be swayed by emotion and they don’t always understand those facts or their importance. This should not be the basis of an award.
Health courts would use experienced adjudicators who would be used to seeing the same kinds of cases over and over and judges would become accustomed to what injuries are preventable and when a physician is truly liable. An adjudicator with experience in the medical liability area is far less likely than a jury to be misled by inaccurate testimony and sympathy appeals. Since judges aren’t doctors, they need neutral medical experts who can give an honest, unbiased opinion on the medical facts of a case. This is completely different than the paid experts that are now used on both sides and basically are paid to testify to the attorney’s desires.
Current thinking is to have independent experts drawn from outside the court’s geographic area to provide the expert analysis.
Current health court models propose a “schedule” of claim awards where a patient is compensated for his or her specific economic losses (e.g., medical bills, lost wages, etc.) and also according to the extent of damage suffered for noneconomic claims (what is sometimes called “pain and suffering”). This scenario would actually give awards to more claimants and based on the 1991 Harvard Medical Practice Study, they found that less than 2 percent of patients injured due to negligence ever file a claim and of the meritorious claims that are filed, about 25 percent never get paid.
Those few patients who do get compensated, almost 60 percent of the current system’s total costs go to attorney fees, paid expert testimony, and various administrative costs. These cases can drag on for years as attorneys on both sides file motion after motion, appeal after appeal. Health courts could actually remedy the problem of undercompensation that we see in the system right now. What this would eliminate are the very large awards that so many personal injury lawyers like to see. By keeping administrative costs low and adhering to a schedule of awards correlated to injury, health courts not only can provide restitution to patients who deserve it, but they also can expedite the process so that needy patients aren’t kept waiting for years and years. Workers’ compensation courts, which work similarly, often grant awards within six to nine months of filing. Malpractice is there for gross negligence and not necessarily minor mistakes. Doctors are human and will make mistakes and some patients are really ill and will have complications. These are not necessarily malpractice.
The current malpractice system has given rise to a culture of defensive medicine and according to a 2005 study in the Journal of the American Medical Association, more than 90 percent of physicians admitted to ordering unneeded tests and performing unnecessary procedures to protect against the possibility of future malpractice claims. The Department of Health and Human Services puts the cost of these practices at around $60 billion a year.
Investigators at the Harvard School of Public Health envision a system that can collect data on medical injuries and errors that can be used to improve healthcare systems and safety procedures rather than punish or utilize emotional rewards.
New Zealand already has health courts and basically, all injuries due to medical management are compensated, regardless of physician error or whether the injury was avoidable. About three out of every five claims results in compensation, but overall claim rates are fairly low with only around 3,000 claims each year out of a population of four million people. Administrative costs are also very low and account for only 10 percent of the total system cost (as opposed to 60 percent under the current U.S. system). The Scandinavian countries (Sweden, Denmark, Finland, Norway, and Iceland) all use the concept of avoidability in their health courts. In fact, Sweden pioneered the idea in 1975. The system uses expert reviewers and in-house claims adjusters who determine the total amount of awards. Like in New Zealand, the compensation rates under Scandinavian systems are fairly high, with Sweden compensating 40 percent to 45 percent of all claims filed. Actual awards tend to be fairly modest. Most of the claims are resolved with six to nine months of filing. Because of the “no-blame” nature of the system, physicians in Sweden help patients file for compensation in as much as 80 percent of cases.
Arbitration is another model for reform and it uses an experienced adjudicator and, usually, neutral expert testimony. It also keeps administrative costs lower than the typical malpractice court system. Health insurers are really taking the lead on using arbitration to lower costs, and many health plans already offer or require arbitration. The Kaiser Permanente managed care health plan in California, for example, requires all members of the plan to settle injury disputes through its own independent arbitration board. And the Utah Medical Insurance Association, which provides medical liability insurance for physicians, offers a discount for physicians who merely offer arbitration as an alternative to their patients.
Documentation is part of the physician’s battle when it comes to malpractice claims. But better documentation won’t eliminate medical mistakes in their entirety although it may minimize the number of cases that are brought not because a mistake was made but because a doctor didn’t write something down.
As medical liability insurance costs skyrocket and malpractice awards get even more out of hand, the idea of health courts could become increasingly popular. Based on the idea of workers’ compensation courts, a health court system proposes the following advantages:
· Experienced judges. Malpractice cases are too often decided by juries who are easily swayed by emotion. An experienced judge can make a determination based on facts.
· Neutral experts. Everyone knows that current “expert” opinions are often bought, but neutral experts can provide honest and unbiased reviews of cases to help judges make final determinations.
· Scheduled awards. Under the current system, a very small percentage of claims receive large damage awards. Health courts would ensure that reasonable awards were made to a larger number of deserving patients.
· Foregoing negligence. The current standard of negligence encourages a culture of secrecy and defensive medicine. Changing the standard not only saves money, it could even lead to an improvement of best practices.