News What are the factors driving the rising costs of healthcare?

[member 5645]

The point I was making is that all the animus is directed at lawyers, but juries are quite capable of making up their own minds.

I hoep you aren't really using this as your main defense here.
Do I need to show you a list of many times with 12 people were OBVIOUSLY wrong?

 

[adrenaline]

Nothing happens in a vacuum. Maybe something else happened in Texas.

States with caps raised the premiums at a higher rate than states without caps.

http://www.weissratings.com/malpractice.asp

It still affects rates. Here is an independant study :

Physicians in states with caps on medical malpractice awards enjoy premiums that are 17.1% lower than those in states without caps, according to a new study from the chair of the health policy and management department at Emory University Rollins School of Public Health in Atlanta.

Author Kenneth E. Thorpe said caps at the federal level ultimately would mean lower insurance premiums, but he questioned whether that would accomplish the liability system goals. "The results suggest that capping awards may improve the profitability of malpractice carriers and reduce premiums," Thorpe said in the study. "Whether this is socially desirable or improves the goals of deterrence and compensation remains an open question."

The report, "The Medical Malpractice 'Crisis': Recent Trends And The Impact Of State Tort Reforms," is available online (content.healthaffairs.org/cgi/content/full/hlthaff.w4.20v1/DC1).

I trust advocates of public health, many who are not physicians but scientists and are not susceptible to lawsuits.



Quote:
...we are quick to use other people'smoney

Since the only "we" are doctors paying insurance premiums than we bear the ultimate cost. Taxpayers don't unless we seguaey into a more socialized model which i would not mind, (you also can't sue in that model yet these medical systems still outdo us in providing quality medical care (WHO ranking put Canada, cuba, many european countries such as france and germany etc. above the US) So I am not using other people's money, I see it in my yearly increases despite an impeccable track record.

From 1988 to 1998 malpractice insurance rates increased by a total of only 5.7% while medical costs increased by 74%. This was an enormous windfall for doctors. You can not expect to benefit from the effects of one side of a business cycle and be immune to the negative effects of the other.

Doctor's salaries account for less than 2 percent of the health costs you are talking about. The 74 % increase is the overall cost of medicine in the system. My salary has gone down yearly in the past five years of practice despite being so full I have closed my practice to new patients for three years. I'm still doing well, but I sure did not increase my salary by 74%! (I have 12,000 active patients.)You make it sound like we all had a 74% increase in salaries! By the way, 90% of what I take in every month goes to overhead according to my accountant. (Workman's comp insurance, unemployment insurance, malpractice, 401k for my employees, medical and dental, yearly raises, uniform stipends, CMEs for all the nurses and insurance personell, (which now total above 25 for us measly 4 doctor practice, a $150,000 dollar electronic medical record system purchase Omni-Doc, Intergy, $7,000 a month telephone system to help handle insurance and patient calls ) a $30,000 dollar a month rental.etc etc.

http://medrants.com/archives/2003/0...lpractice-laws/

Here is a more reliable independant source about the premiums.

:
The Employment Policy Foundation (EPF) is a nonprofit, nonpartisan public policy research and educational foundation based in Washington, D.C. focused on workplace trends and policies. Its mission: to shape the direction and development of U.S. employment policies by providing policymakers, the media and the public with timely, high quality economic analysis and commentary. Federal and state executive branch officials and legislators, corporations, think tanks, universities, media and the public use EPF as a primary source of unbiased, reliable data, research and knowledge on employment and labor issues.


Rising Verdicts and Increasing Cost of Discovery Forces Rate Increases

Doctors, nurses and hospitals have been faced with skyrocketing malpractice insurance premiums in response to increasing claims. The rising litigation costs are reflected in malpractice insurance underwriting losses, which doubled from $4.1 billion in 1991 to $8.6 billion in 2001. This total includes amounts paid to plaintiffs and their attorneys, expenditures for processing and investigating claims, including the majority that are subsequently dropped or dismissed and expenditures to defend litigated claims. The study found that as the number of claims increased, so too have jury awards. Between 1995 and 2001, median jury awards in medical malpractice cases doubled from $500,000 to $1,000,000 for the typical case with the maximum annual claim award reported nationwide increasing from $5.3 to $20.7 million over the same period.

Malpractice insurers paid out $1.53 in claims settlements and claims adjustment and defense expenses for every dollar that they collected in premiums. In 2001, the gap between premiums collected and underwriting losses amounted to $4,033 per physician, assuming that all 744,000 full-time physicians in the U.S. were covered.

Most Litigation Costs Do Not Benefit Injured Patients

EPF’s analysis found that the malpractice litigation system is a highly inefficient method for identifying and correcting medical errors. Plaintiffs eventually receive only 38 percent of the total dollars that flow through the malpractice litigation system. The majority - 62 percent - compensates the plaintiff?s lawyers and expert witnesses and the insurer?s claims adjustment, cost of investigating claims and defending claims made against insured physicians and hospitals.


Caps on Non-Economic Damage Awards Are Effective

The study found that significant cost differences do exist between states with non-economic damage award caps and those states without limits. Between 1976 and 2000, malpractice insurance premiums nationwide increased 505 percent - equivalent to 7.8 percent annual premium growth compounded over 24 years. In California - which caps non-economic damage awards - malpractice premiums increased 167 percent?equivalent to a 4.2 percent annual growth rate. The resulting impact on premiums is very real. In 2001, the premium range for obstetricians was $143,000 to $203,000 per physician in Florida compared to $23,000 to $72,000 in California. The pattern was similar for surgeons - $63,000 to $159,000 in Florida compared to $14,000 to $42,000 in California.

Indirect Costs Result from ?Defensive? Medicine

Faced with the prospect of litigation, the study found many doctors and hospitals practiced “defensive” medicine. This practice artificially inflates EPF’s analysis found that controlling excesses in the malpractice litigation system could reduce current health care costs by 5 to 9 percent without sacraficing quality of care. The dollar impact on annual medical expenditures is large - up to $68.8 billion.

your source says a single digit malpractive premium percentage raise, the above source says 505% increase within almost the same time period except it starts in the late seventies. The obstetrician's premium in Florida which went up from $143,000 to over $200,000 three years ago would not call that an 7.4% increase.

:
That is a good example of the type of statistics the AMA loves. It is completely meaningless. How long does a case "pend"? A year? Two years? Ten years?

Because the lawyers drag it out that way. Victims are told to wait until the very last day of the statute of limitations ( which is two years) in hopes the memory of the incident will be a fog and this will cloud memory of critical events and puts doctors at great disadvantage. And the draggingit out, its the lawyers, not doctors. we are generally want things to get done and over with.

I would be very surprised if the number of lawsuits had no relationship to competence. I'm sure the relationship is not absolute, there are undoubtedly other factors. But when those factors are normallized, though there will be randomness, there will also be a positive correlation.

It's because this is what the lawyers want you to believe. Thus, more and more doctors are giving up treating risky patients so their "numbers" can look good both in outcomes and lawsuits.


Instead of listing to media rhetoric, this is what I have seen on the front lines. When we serve our 2 year tenures as chief of medicine, we are privey to every lawsuit out there since the Chief of Medicine and Surgery get dragged in indirectly as representatives of the hospital and doctor. (This is due to laws of statistical averaging , the most popular and sought after doctor have more patients due to their popularity and higher expectations of perfection which translates to more lawsuits.) Every, and I mean every professor of medicine, both associate and tenured, at both Emory and MCG, the two main teaching hospitals in Georgia, has been sued at least once. Most if not all, multiple times. Especially the ones I consider outstanding. I have a hard time believing the number of increased lawsuits suggest our medical training has diminished in quality over the last 20 years.

The best way to reduce "frivolous" (not every failed suit is frivolous) claims is to reduce grounds for non-frivolous claim.

Exactly why some believe capping emotional pain and suffering will do it. Cases are bought to court when no physical disability or injury has happened, the non economic damages is the lotto ticket. Case in point, a woman sues a dermatologist in Tampa because a shave biopsey that removed a stage II melanomaleft a small scar on her scapula. She sued him for 1.2 million becaue of emotional pain and suffering despite being forwarned about the possibility of scarring.

.

 

[adrenaline]

Without punitive damages there is no incentive to change dangerous but economical systems.

As previous chief of medicine I went to meetings after meeting about improving patient safety. Safety measures such as those implemented to reduce complications of infections and reduce hospital stay etc. meant more reimbursement to the hospital administrators due to DRGs or diagnostic related groups which provide fixed fee reimbursement for certain conditions. Study after study shows faster quick discharges if antibiotics are implemented within three hours of the patient arriving in the ER for pneumonia. Of course, as doctors, we care about how it affects mortatlity . Not lawsuits. In fact, that was rarely a topic of the underlying motivation for those on the hospital executive committees. Of course, doctors don't look at things from that end of the telescope and just hope administrative and doctor patient interests stay aligned as much as possible.

Consider by-pass surgery. The patients are generally old, with little future earnings, and often no dependents. Mistakes usually lead to death. Without significant punitive damages, there are no repurcussions for incompetence.

People who have oopen heart are in general old and sick and have multiple comorbidities such as diabetes, previous strokes, peripheral arterial disease,smoke etc. which increases their chance of developing complications and death. That's why open heart surgeons (the bestof the best)IN ACADEMIA have the WORSE LOOKING outcomes statistics because they operate on older, sicker, more medically complicated folks that some private surgeons will refuse to treat so as not to skew their statistiscs. They have greater numbers of bad outcomes and even death because it is the nature of human biology.


You have just hit on the most expensive part of our medical practice, doctors practicing defensive medicine. I even admit to ordering xrays, 1000 dollar MRI's etc. because my lawyer told me to , not because i felt it was clinically necessary. I spend just as much time charting into my electronic medical records (Which pro safety people love) as I do seeing my patients. It's not about practicing better medicine, you practice better defensive medicine and get saavy leaving a better paper trail.




.

Setting more rigorous standards for whether a suit can proceed would be good. A step where the plaintiff must convince a judge that he has a legitimate suit would be reasonable. However, without an opposing counsel, any lawyer will usually win. You can't ask the state to provide a judge who will rigorously oppose the plaintiff's lawyer. That is essentially asking the state to fund the first round of the defendent's case.

It would not be a judge. A panel of doctors, nurses, non doctor scientists, ethicists, pharmacist, epidimiologists, business men and lawyers who can view things from many differnt angles. A malpractice board surcharge fee so to speak could be implemented and most doctors are willing to pay. (Oregon had something similar during the days of Marcus Welby)

I found 61 Gastroenterology entries in the Philly yellow pages and 80 in the Pittsburgh yellow pages. I'm sure there are many that are multiple doctor practices, though some might also be multiple practice doctors. Those two cities were cited as having disproportionately high malpractice awards, even compared to the rest of the state.

There used to be twice that. Call and see how long it takes to make an appt.

. Since 2000:

870 physicians relocated to other states.
163 physicians retired earlier than planned.
213 physicians were laid off, forced to close their practices, gave up practicing medicine, or died and were not replaced.
379 physicians significantly altered their practices or curtailed high-risk services.
Source: Pennsylvania's Disappearing Doctors list, maintained by the Pennsylvania Medical Society Alliance

you'll probably find how many were in the specialties hit hard.

I checked the Charleston WV yellow pages for cardiologists, and got 60 entries. I can't say for sure they were cardiologists though, the format was poor.

Call any of them up and see if they are interventional cardiolgist.(The ones who actually do angioplasty, stent placement etc.) The majority remaining are general cardiologists who are glorified internists. (They only have one more year of training than I do, read echos, stress tests and administer clot blosters...all the things internists can do.)

As for the obgyns in a telephone listing in Athens. They are still board certified as obgyns so they are listed as obgyns,even many are now fully gyns only. They have not fled the Athen's area but no longer practice obstetrics, only gynecology. There are a few obstetritrians manning their high risk unit but now take call almost every night to provide for coverage. MCG's subsidiary hospital in Savannah has only one obstetrician taking medicaid and is now the sole medicaid ob provider and works 45 days on call night and day straight. She is independantly wealthy and pays her own premiums and garnishes her salary from savvy investments, not because of her revenue from medicaid (which don't even pay for overhead costs.) Guess what, she is going to be making mistakes.

Most of all, the tort reform is blind siding everyone but the doctors by distracting the public from the real issue of changing the whole system, of which, tort reform is a small part . The tort lawyers are not interested in changing a systme that benefits them, they have shown no support for any legislature , bills or studies seeking to improve overall safety valves in the system. These aren't antidotes, just look at the Assoc for Trial lawyers website and see how they support what I mentioned already the Patient Safety and Quality Improvement Act or HR 663 that would help create a voluntary, confidential error reporting system that allows review by experts, who report back to those involved on how to fix the system. The fix is then shared with all and Patient Safety and Quality Improvement Act (S 720), a proposed federal law that would allow the voluntary, confidential reporting of errors to patient safety experts. We want this to be an open system to all.

 

[adrenaline]

Without punitive damages there is no incentive to change dangerous but economical systems.

As previous chief of medicine I went to meetings after meeting about improving patient safety. Safety measures such as those implemented to reduce complications of infections and reduce hospital stay etc. meant more reimbursement to the hospital administrators due to DRGs or diagnostic related groups which provide fixed fee reimbursement for certain conditions. Study after study shows faster quick discharges if antibiotics are implemented within three hours of the patient arriving in the ER for pneumonia. Of course, as doctors, we care about how it affects mortatlity . Not lawsuits. In fact, that was rarely a topic of the underlying motivation for those on the hospital executive committees. Of course, doctors don't look at things from that end of the telescope and just hope administrative and doctor patient interests stay aligned as much as possible.

Consider by-pass surgery. The patients are generally old, with little future earnings, and often no dependents. Mistakes usually lead to death. Without significant punitive damages, there are no repurcussions for incompetence.

People who have oopen heart are in general old and sick and have multiple comorbidities such as diabetes, previous strokes, peripheral arterial disease,smoke etc. which increases their chance of developing complications and death. That's why open heart surgeons (the bestof the best)IN ACADEMIA have the WORSE LOOKING outcomes statistics because they operate on older, sicker, more medically complicated folks that some private surgeons will refuse to treat so as not to skew their statistiscs. They have greater numbers of bad outcomes and even death because it is the nature of human biology.


You have just hit on the most expensive part of our medical practice, doctors practicing defensive medicine. I even admit to ordering xrays, 1000 dollar MRI's etc. because my lawyer told me to , not because i felt it was clinically necessary. I spend just as much time charting into my electronic medical records (Which pro safety people love) as I do seeing my patients. It's not about practicing better medicine, you practice better defensive medicine and get saavy leaving a better paper trail.




.

Setting more rigorous standards for whether a suit can proceed would be good. A step where the plaintiff must convince a judge that he has a legitimate suit would be reasonable. However, without an opposing counsel, any lawyer will usually win. You can't ask the state to provide a judge who will rigorously oppose the plaintiff's lawyer. That is essentially asking the state to fund the first round of the defendent's case.

It would not be a judge. A panel of doctors, nurses, non doctor scientists, ethicists, pharmacist, epidimiologists, business men and lawyers who can view things from many differnt angles. A malpractice board surcharge fee so to speak could be implemented and most doctors are willing to pay. (Oregon had something similar during the days of Marcus Welby, the real one Thomas Stern Md)

I found 61 Gastroenterology entries in the Philly yellow pages and 80 in the Pittsburgh yellow pages. I'm sure there are many that are multiple doctor practices, though some might also be multiple practice doctors. Those two cities were cited as having disproportionately high malpractice awards, even compared to the rest of the state.

This represents a decrease. Such large cities need three times the amount. Call and see how long it takes to make an appt.

. Since 2000:

870 physicians relocated to other states.
163 physicians retired earlier than planned.
213 physicians were laid off, forced to close their practices, gave up practicing medicine, or died and were not replaced.
379 physicians significantly altered their practices or curtailed high-risk services.
Source: Pennsylvania's Disappearing Doctors list, maintained by the Pennsylvania Medical Society Alliance

you'll probably find how many were in the specialties hit hard.

I checked the Charleston WV yellow pages for cardiologists, and got 60 entries. I can't say for sure they were cardiologists though, the format was poor.

Call any of them up and see if they are interventional cardiolgist.(The ones who actually do angioplasty, stent placement etc.) The majority remaining are general cardiologists who are glorified internists. (They only have one more year of training than I do, read echos, stress tests and administer clot blosters...all the things internists can do.)

As for the obgyns in a telephone listing in Athens. . They have not fled the Athen's area but no longer practice obstetrics, only gynecology. There are a few obstetritrians manning their high risk unit but now take call night and day for ungodly amounts of time. MCG's subsidiary hospital in Savannah has only one obstetrician taking medicaid and is now the sole medicaid ob provider and works 45 days at a time. She pays her own premiums and garnishes her salary from savvy investments, not because of her revenue from medicaid (which don't even pay for overhead costs.) Guess what, she is going to be making mistakes.

Most of all, the tort reform is blind siding everyone but the doctors by distracting the public from the real issue of changing the whole system, of which, tort reform is a small part . The tort lawyers are not interested in changing a systme that benefits them, they have shown no support for any legislature , bills or studies seeking to improve overall safety valves in the system. These aren't antidotes, just look at the Assoc for Trial lawyers website and see how they support what I mentioned already the Patient Safety and Quality Improvement Act or HR 663 that would help create a voluntary, confidential error reporting system that allows review by experts, who report back to those involved on how to fix the system. The fix is then shared with all and Patient Safety and Quality Improvement Act (S 720), a proposed federal law that would allow the voluntary, confidential reporting of errors to patient safety experts. We want this to be an open system to all.

 

[adrenaline]

I see no reason to believe the AMA wants accountability for doctors. They do not perform actions that support that contention. Their actions indicate the opposite is true. The AMA seeks to protect doctors from accountability.

you need to back that up.

This is nothing new. Solutions to many problems are known. Doctors feel no need to adopt them. Every medical school in the country should teach, and every hospital should adopt exactly the same pre-operative system of checks to ensure that the operation performed is the operation the patient is supposed to receive. They don't. It is preferable to amputate the wrong limb or remove the wrong eye than to do this. Incompetance is acceptable

patently false. Every hospital has a QI committee staffed without pay by highly dedicated doctors, nurses, pharmacists, lawyers (usually one of the legally trained administrators) who rigorously try to establish better and safer standards. Such standards may not be the perview of the doctor to adopt. The problem is due to different state laws, civil laws, etc. (the state medicare guidelines, osha guidelines, differ from the federal ones and so on.). If we want to prevent falls in the elderly, demented by placing posies, in some states ,this is a violation of individual, civil rights. Yet, not every elderly has a family member willing to stay in the room to enusre they don't climb out of bed, while our understaffed nurses are starting ivs and treating other patients. )By the way, the warning systems don't work half the time, they have fallen out and broken a hip within seconds of setting off their alarms.) That is just one such example.

You are attacking the very constitutional and fundamental aspect of individual state's perogative in establishing their own guidelines, and not just in the medical sector. Don't point to doctors as the barrier to inertia. We can easily remedy this by making all the hospitals federal, (rather than county or public or funded by academic funds) and supported by our government tax dollars. It already exists, it's called the Veterans Administration hospitals.

 

[JohnDubYa]

RE: "I agree. However, "court-room shenanigans" are no excuse for depriving Americans of the right to sue for redress of grievances."

Actually, it is the perfect excuse. Rights are taken away because someone takes advantage of them for their own gain and, as a result, hurts society. In this situation, depriving the People of their rights is a necessary shield to protect American business from the likes of people like Edwards.

We limit freedom when it comes to business practices. Why? For the same reason.

So if Americans are denied their right, wouldn't Edwards be considered partly to blame? Couldn't someone say that Americans would have that right if it hadn't been for people like Edwards that prostituted the system for his own gain?

If you really want people to have the right to sue for as much as they wish, then you should be mad as Hell at people like Edwards who took advantage of the situation.

 

[Njorl]

It still affects rates. Here is an independant study :


I trust advocates of public health, many who are not physicians but scientists and are not susceptible to lawsuits.

.

That "17.1%" statistic is irrelevant. To demonstrate the effect of caps, it is necessary to compare the rate of change in premiums between capped and uncapped states, or the rate of change in a state before and after caps are placed. A simple comparison of a snapshot of rates in capped and uncapped states is worthless, and profoundly unscientific. The author writes like a policy analyst, not a scientist.

Quote:
...we are quick to use other people'smoney

Since the only "we" are doctors paying insurance premiums than we bear the ultimate cost.
.

I was refuting your point that the benevolance of the AMA somehow was meaningful in this discussion. Insurance companies control whether a check is cut.

Doctor's salaries account for less than 2 percent of the health costs you are talking about. The 74 % increase is the overall cost of medicine in the system. My salary has gone down yearly in the past five years of practice despite being so full I have closed my practice to new patients for three years. I'm still doing well, but I sure did not increase my salary by 74%! (I have 12,000 active patients.)You make it sound like we all had a 74% increase in salaries!
.

1988-1998 is not the last 5 years.

My point was not even about doctor's salaries, it was about the artificially low rates they paid. Insurance payouts are significantly impacted by the cost of future medical care. How could the puny premium increases possibly cover the increased medical care costs injured parties would receive? The ridiculously low rate of premium increase in this period was unrealistic. Doctors paid too little. Insurance companies felt the impact in 2000. Doctors have felt it since. Due to the nature of the insurance business, I'm sure insurers are overcompensating now.

By the way, 90% of what I take in every month goes to overhead according to my accountant. (Workman's comp insurance, unemployment insurance, malpractice, 401k for my employees, medical and dental, yearly raises, uniform stipends, CMEs for all the nurses and insurance personell, (which now total above 25 for us measly 4 doctor practice, a $150,000 dollar electronic medical record system purchase Omni-Doc, Intergy, $7,000 a month telephone system to help handle insurance and patient calls ) a $30,000 dollar a month rental.etc etc.
.

And none of this is slightly relevant to tort reform.

http://medrants.com/archives/2003/0...lpractice-laws/

Here is a more reliable independant source about the premiums.



your source says a single digit malpractive premium percentage raise, the above source says 505% increase within almost the same time period except it starts in the late seventies.

The link was not working.

Going back to the late seventies more than doubles the time period I was discussing. It is not remotely "almost the same". It also conveniently includes the last correction to premiums from boom bust cycles.

The obstetrician's premium in Florida which went up from $143,000 to over $200,000 three years ago would not call that an 7.4% increase.

Please. I quoted a 5.7% increase, not 7.4%. I talked about 1988-1998, not 3 years ago. And you resort to using selective anecdotes as data.

What were this doctors premiums doing in the 90's?

Consider an OB's likely damage payments. An injured child will have mostly medical expenses as the payout. It is entirely reasonable that an OB's insurance rates would parallel medical care inflation when compounded over an entire boom-bust cycle.

Compounding the 74% inflation from 1988-98, and the 52% inflation from 1999-2003 an OB's rates should be at least 2.65 times what they were in 1988.

Because the lawyers drag it out that way.

You missed the point entirely. The point was that the statistic is just hype. It has no educational value. It just sounds good. Everything I hear from the AMA and insurers is of this nature. If they have a good statistical case, they are not bothering to make it.

It's because this is what the lawyers want you to believe. Thus, more and more doctors are giving up treating risky patients so their "numbers" can look good both in outcomes and lawsuits.


Instead of listing to media rhetoric, this is what I have seen on the front lines. When we serve our 2 year tenures as chief of medicine, we are privey to every lawsuit out there since the Chief of Medicine and Surgery get dragged in indirectly as representatives of the hospital and doctor. (This is due to laws of statistical averaging , the most popular and sought after doctor have more patients due to their popularity and higher expectations of perfection which translates to more lawsuits.) Every, and I mean every professor of medicine, both associate and tenured, at both Emory and MCG, the two main teaching hospitals in Georgia, has been sued at least once. Most if not all, multiple times. Especially the ones I consider outstanding. I have a hard time believing the number of increased lawsuits suggest our medical training has diminished in quality over the last 20 years.

I will repeat. Those sorts of things can be statisticly accounted for. I never implied the notion of comparing general practitioners with research neurosurgeons.

Yes, there are factors that can explain a large number of lawsuits for a specific doctor. But sometimes those factors will not be there. Even then, the correlation will not be absolute, but there will be a correlation. To believe otherwise is naive. It is to believe that there is no relationship between lawsuits and malpractice. That is the fantasy the AMA would like people to accept.

Exactly why some believe capping emotional pain and suffering will do it. Cases are bought to court when no physical disability or injury has happened, the non economic damages is the lotto ticket. Case in point, a woman sues a dermatologist in Tampa because a shave biopsey that removed a stage II melanomaleft a small scar on her scapula. She sued him for 1.2 million becaue of emotional pain and suffering despite being forwarned about the possibility of scarring.

Just win the lawsuit or find another solution that doesn't deny people their rights.
Denying people their rights solves all sorts of problems.

Pain and suffering are real. Real people are genuinely injured by medical incompetence. They don't consider it winning the lottery. If I were blinded by a medical error no amount of money would make it right, but some money would make it more bearable. $250,000 would be an insult. I would use it to hire a hit man.

Njorl

 

[Njorl]

RE: "I agree. However, "court-room shenanigans" are no excuse for depriving Americans of the right to sue for redress of grievances."

Actually, it is the perfect excuse. Rights are taken away because someone takes advantage of them for their own gain and, as a result, hurts society.

That is for individuals. We call it criminal justice. When practiced against groups we call it civil rights violations.

In this situation, depriving the People of their rights is a necessary shield to protect American business from the likes of people like Edwards.
.

No, it is an expedient way to make money to overcome poor business practices of last decade.

We limit freedom when it comes to business practices. Why? For the same reason.
.

Business practices are not constitutionally protected rights. Damage caps infringe upon the first and seventh amendment.

So if Americans are denied their right, wouldn't Edwards be considered partly to blame? Couldn't someone say that Americans would have that right if it hadn't been for people like Edwards that prostituted the system for his own gain?

If you really want people to have the right to sue for as much as they wish, then you should be mad as Hell at people like Edwards who took advantage of the situation.

Sometimes people elect bad presidents. The right to vote should be taken away.

Sometimes people say things I don't like. All people should lose the right to free speech.

Njorl

 

[member 5645]

This is a great thread :D!

 

[JohnDubYa]

RE: "Business practices are not constitutionally protected rights. Damage caps infringe upon the first and seventh amendment."

Here is the First Amendment: Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances.

Here is the Seventh Amendment: In suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise reexamined in any court of the United States, than according to the rules of the common law.

Now kindly explain how damage caps, which are only applied to future litigation, violate either of these two amendments.

RE: "Sometimes people elect bad presidents. The right to vote should be taken away. Sometimes people say things I don't like. All people should lose the right to free speech."

These are not analagous to the situations I am describing. A better analogy would be to say:

Because some people in the past have abused the right to free speech by yelling "fire" in crowded theaters, my right to free speech has become limited.

All I am saying is, if you want the right to sue for mega-millions preserved, then you should condemn Edwards' legal activity, because it is the type of activity that ultimately produces lawsuit caps.

 

[Njorl]

This is a great thread :D!

I agree, but far too time consuming. I want ATLA to pay me!

Njorl

 

[loseyourname]

Since this thread was initially about John Edwards, and not tort reform, I'm reposting a link that phatmonky posted that everyone seemed to ignore:

http://www.cnsnews.com/ViewPolitics.asp?Page=%5CPolitics%5Carchive%5C200401%5CPOL20040120a.html

Edwards became one of America's wealthiest trial lawyers by winning record jury verdicts and settlements in cases alleging that the botched treatment of women in labor and their deliveries caused infants to develop cerebral palsy, a brain disorder that causes motor function impairment and lifelong disability.

The cause of cerebral palsy has been debated since the 19th century. Some medical studies dating back to at least the 1980s asserted that doctors could do very little to cause cerebral palsy during the birthing process. Two new studies in 2003 further undermined the scientific premise of the high profile court cases that helped Edwards become a multi-millionaire and finance his own successful campaign for the U.S. Senate.

Dr. Murray Goldstein, a neurologist and the medical director of the United Cerebral Palsy Research and Educational Foundation, said it is conceivable for a doctor's incompetence to cause cerebral palsy in an infant. "There are some cases where the brain damage did occur at the time of delivery. But it's really unusual. It's really quite unusual," Goldstein said.

"The overwhelming majority of children that are born with developmental brain damage, the ob/gyn could not have done anything about it, could not have, not at this stage of what we know," Goldstein added.

But some of Edwards' critics say that as a trial lawyer, he relied more on his verbal skills than the latest scientific evidence to persuade juries that the doctors' mistakes had been instrumental in causing the cerebral palsy in the infants.

Edwards' trial summaries "routinely went beyond a recitation of his case to a heart-wrenching plea to jurors to listen to the unspoken voices of injured children," according to a comprehensive analysis of Edwards' legal career by The Boston Globe in 2003.

The Globe cited an example of Edwards' oratorical skills from a medical malpractice trial in 1985. Edwards had alleged that a doctor and a hospital had been responsible for the cerebral palsy afflicting then-five-year-old Jennifer Campbell.

'I have to tell you right now -- I didn't plan to talk about this -- right now I feel her (Jennifer), I feel her presence,' Edwards told the jury according to court records. "[Jennifer's] inside me and she's talking to you ... And this is what she says to you. She says, 'I don't ask for your pity. What I ask for is your strength. And I don't ask for your sympathy, but I do ask for your courage.'"

Sounds like a real sleezeball to me. Njorl's attempts to justify this by saying that Edwards was simply doing his job and doing it well are sickening. Personally, I do not want a man that does an immoral and exploitative job very well running my country. Then again, Bush made his money by driving oil companies into the ground yet somehow always getting bailed out by Saudi billionaires, seemingly in return for favor by either the CIA or US foreign policy, depending on which the Bush family was in charge of at the time.

What a great election in which to be an American.

 

[JohnDubYa]

RE: "Then again, Bush made his money by driving oil companies into the ground yet somehow always getting bailed out by Saudi billionaires, seemingly in return for favor by either the CIA or US foreign policy, depending on which the Bush family was in charge of at the time."

Let me guess: You watched Fahrenheit 911?

 

[loseyourname]

If you want to go off on that tangent, start another thread. I did not see that movie, but the investments are all a matter of public record. I'm just trying to be fair here. It is clear, to me at least, that Edwards made his money in an unethical manner. If I'm going to publicize that, then I'm also going to bring up the source of the Bush fortune so as not to be overly partisan like every other poster on this forum.

 

[JohnDubYa]

Okay, so let me ask: Which Saudi billionaire gave the Bushes money, and how do you know it? Was this a legitimate loan?

And which oil companies did the Bushes drive into the ground? And was this just a matter of competition, or did the Bushes do something illegal?

 

[Njorl]

Since this thread was initially about John Edwards, and not tort reform, I'm reposting a link that phatmonky posted that everyone seemed to ignore:

http://www.cnsnews.com/ViewPolitics.asp?Page=%5CPolitics%5Carchive%5C200401%5CPOL20040120a.html



Sounds like a real sleezeball to me. Njorl's attempts to justify this by saying that Edwards was simply doing his job and doing it well are sickening. Personally, I do not want a man that does an immoral and exploitative job very well running my country. Then again, Bush made his money by driving oil companies into the ground yet somehow always getting bailed out by Saudi billionaires, seemingly in return for favor by either the CIA or US foreign policy, depending on which the Bush family was in charge of at the time.

What a great election in which to be an American.

You're taking it on faith that Edwards' critics are correct. Evidently, you believe a court of law finding for a plaintiff to be irrefutable evidence that the plaintiff was not justified in their suit. Do you have evidence that Edwards was doing "an immoral and exploitative job", or do you just hate lawyers so much you enjoy believing bad things about them.

Njorl

 

[member 5645]

You're taking it on faith that Edwards' critics are correct. Evidently, you believe a court of law finding for a plaintiff to be irrefutable evidence that the plaintiff was not justified in their suit. Do you have evidence that Edwards was doing "an immoral and exploitative job", or do you just hate lawyers so much you enjoy believing bad things about them.

Njorl

Did you read any of my links??

 

[loseyourname]

Okay, so let me ask: Which Saudi billionaire gave the Bushes money, and how do you know it? Was this a legitimate loan?

And which oil companies did the Bushes drive into the ground? And was this just a matter of competition, or did the Bushes do something illegal?

Look, this thread is not about George Bush. If you want to discuss this, start another thread. The only reason I brought it up was to be fair to both parties. Anybody that has a lot of money likely stepped on some toes to get it. I'm not condemning the man for it. There are a lot of reasons that I don't like Bush; his business dealings are not one of them.

 

[member 5645]

You're taking it on faith that Edwards' critics are correct.

And just for the record the statements of CP not being caused at delivery, thus not the OB's fault, were first really stated in the 1999 British Medicine e (article referencing it in plain English: http://news.bbc.co.uk/1/hi/health/475160.stm )
and the findings were echoed this year and last by an American government study (supported by several international ogranizations) and an American College of Obstetricians and Gynecologists .

I can pull links for all, but I'm sure you are capable of delving in as far as you'd like.

 

[loseyourname]

You're taking it on faith that Edwards' critics are correct. Evidently, you believe a court of law finding for a plaintiff to be irrefutable evidence that the plaintiff was not justified in their suit. Do you have evidence that Edwards was doing "an immoral and exploitative job", or do you just hate lawyers so much you enjoy believing bad things about them.

Njorl

Edwards' critics are correct. The science he cited in his cases was untrue and he used appeals to emotion largely in favor of a more reasoned argument. I will admit that I have no proof that Edwards knew the science he used was untrue, but it is clear that he did not look into as much as he should. Like any good lawyer - and you are certainly right to say that he was a great lawyer -he was more concerned with winning his cases than he was with uncovering the truth. It is my belief that placing any concern higher than the concern for truth is immoral. In particular, placing any concern higher than the concern for justice, as a member of the judiciary system, is immoral.

It is also my belief that if Edwards was a republican, you would be jumping on this bandwagon faster than Rosie O'Donnell on a hot dog.

 

[Njorl]

And just for the record the statements of CP not being caused at delivery, thus not the OB's fault, were first really stated in the 1999 British Medicine e (article referencing it in plain English: http://news.bbc.co.uk/1/hi/health/475160.stm )
and the findings were echoed this year and last by an American government study (supported by several international ogranizations) and an American College of Obstetricians and Gynecologists .

I can pull links for all, but I'm sure you are capable of delving in as far as you'd like.

Edwards gave up practicing law before this. So, evidently, he was using accepted science at the time. You seem to be demanding that he should have been prophetic.

Njorl

 

[Njorl]

Edwards' critics are correct. The science he cited in his cases was untrue and he used appeals to emotion largely in favor of a more reasoned argument. I will admit that I have no proof that Edwards knew the science he used was untrue, but it is clear that he did not look into as much as he should. Like any good lawyer - and you are certainly right to say that he was a great lawyer -he was more concerned with winning his cases than he was with uncovering the truth. It is my belief that placing any concern higher than the concern for truth is immoral. In particular, placing any concern higher than the concern for justice, as a member of the judiciary system, is immoral.

It is also my belief that if Edwards was a republican, you would be jumping on this bandwagon faster than Rosie O'Donnell on a hot dog.

As I stated before. Edwards was using the accepted science of the time. Should he have known the science better than the scientific community? That is absolutely outrageous.

Opposing counsel both have access to expert witnesses. They can cross examine each other's experts. They can request evidentiary hearings to exclude experts who are not genuine, so that the jury never hears them.

I can see why you expect Edwards should have been prophetic, you yourself claim to be a mindreader.


Njorl

 

[Njorl]

Let me just ask.

Has any child ever been afflicted with cerebral palsy due to a health care provider's avoidable error? Is it conceivable that John Edwards could have represented such children? The rest of you seem to be saying that, "In theory such an injury could occur, but we know John Edwards didn't represent such people."

Njorl

 

[JohnDubYa]

Has any child ever been afflicted with cerebral palsy due to a health care provider's avoidable error? Is it conceivable that John Edwards could have represented such children? The rest of you seem to be saying that, "In theory such an injury could occur, but we know John Edwards didn't represent such people.

He may well have represented such children. And I am sure John Gotti engaged in legitimate business practices at times. So what? (No, I am not equating the two men.)

As I stated before. Edwards was using the accepted science of the time. Should he have known the science better than the scientific community? That is absolutely outrageous.

If Edwards was using the accepted science at the time, it would have been the defendants who were interviewing one expert after another looking for someone to back their view.

 

[member 5645]

I will admit that I have no proof that Edwards knew the science he used was untrue, but it is clear that he did not look into as much as he should. Like any good lawyer - and you are certainly right to say that he was a great lawyer -he was more concerned with winning his cases than he was with uncovering the truth.

http://www.cnsnews.com/Culture/archive/200402/CUL20040202a.html
Well according to him he didn't just not go far enough:

I took very seriously our responsibility to determine if our cases were merited," Edwards told the New York Times in an interview on Friday, just days after refusing to answer CNSNews.com's questions on the same topic.

"Before I ever accepted a brain-injured child case, we would spend months investigating it," Edwards added.

Which means he spent the time to investigate the case, and then ignored the facts.

 

[member 5645]

Let me just ask.

Has any child ever been afflicted with cerebral palsy due to a health care provider's avoidable error? Is it conceivable that John Edwards could have represented such children? The rest of you seem to be saying that, "In theory such an injury could occur, but we know John Edwards didn't represent such people."

Njorl

Edwards claims were that the doctor did not do the C section soon enough, and therefore it was his fault that the baby had CP. There is NO evidence to back this up, and as we know the burden of proof lies on the PLAINTIFF.
In this case, both edwards, and his 42nd (if I'm remembering that number right) expert witness are both scum who look to abuse the system.

The point is a moral one. Edwards is NOT the kind of person I want leading my country and/or healthcare system and/or future profession.

 

[loseyourname]

Let me just ask.

Has any child ever been afflicted with cerebral palsy due to a health care provider's avoidable error? Is it conceivable that John Edwards could have represented such children? The rest of you seem to be saying that, "In theory such an injury could occur, but we know John Edwards didn't represent such people."

Njorl

No, what we're saying is that whether or not Edwards won a couple of legitimate cases (heck, even if most of them were legitimate), there is no doubt that he put doctors out of business that did nothing wrong, and that he made countless millions of dollars doing it.

 

[Njorl]

http://www.cnsnews.com/Culture/archive/200402/CUL20040202a.html
Well according to him he didn't just not go far enough:



Which means he spent the time to investigate the case, and then ignored the facts.

That is nonsense. When Edwards was practicing it was still accepted that 10-15% of palsy cases were caused by perinatal asphyxia. It was also assumed that many of those cases were avoidable.

Even using the most conservative estimates of the most modern data, you should expect 1 or 2 justified suits for cerebral palsy in N. Carolina per year. You would also expect to see more than this in which reasonable people disagree as to the justice of the situation. Given the accepted science of Edwards' day, you would expect at least 5 times this number of cases - 5 to 10 justified cases, per year, and more cases that experts would reasonably disagree upon. Edwards won fewer than 2 palsy cases per year early in his career, and about 3 per year later. He was aknowledged as the best attorney in the state for this kind of case. If you did have a legitimate case, why on Earth would you go to anyone else. Statistically, all of this is perfectly reasonble. If you want to discredit him, the statistics are just not there. You will have to do it with specifics.

Do you really find it unreasonable that the best tort lawyer in North Carolina, one of the 8 best in the country, who specialized in cerebral palsy malpractice cases, should win 2 or 3 of those cases per year?


Njorl

 

[JohnDubYa]

One fact that gets lost in this thread is that WE pay for this litigation. The doctors continue to work and make their money. No, WE pay for the damages. So every time you write a check for your health insurance (or wonder why your salary isn't as high as it could be), you can thank John Edwards.

 

[Njorl]

No, what we're saying is that whether or not Edwards won a couple of legitimate cases (heck, even if most of them were legitimate), there is no doubt that he put doctors out of business that did nothing wrong, and that he made countless millions of dollars doing it.

He made about 6-7 million a year in his best years, winning about 8 cases a year. That is not uncounted millions. Only about 1/4 of those were palsy cases. Not all of the others were medical malpractice.

Please list the name of a Dr. that Edwards put out of business.

For Edwards to do that, he would have to hit a doctor at least 3 times with an unjustified suit. With just 2 palsy cases per year I find it unlikely. I haven't seen any reason to believe any of his cases were not justified. Just a lot of hand-wringing.

Njorl

 

[Njorl]

Edwards claims were that the doctor did not do the C section soon enough, and therefore it was his fault that the baby had CP. There is NO evidence to back this up, and as we know the burden of proof lies on the PLAINTIFF.
In this case, both edwards, and his 42nd (if I'm remembering that number right) expert witness are both scum who look to abuse the system.

The point is a moral one. Edwards is NOT the kind of person I want leading my country and/or healthcare system and/or future profession.

What case? Please provide some reference. I did not notice one in the two links I followed up.

Njorl

 

[Njorl]

One fact that gets lost in this thread is that WE pay for this litigation. The doctors continue to work and make their money. No, WE pay for the damages. So every time you write a check for your health insurance (or wonder why your salary isn't as high as it could be), you can thank John Edwards.

None of this affects health insurance, it affects malpractice insurance. Of every $100.00 dollars you spend for health care, you spend fifty-six cents (cents, not dollars) on malpractice insurance. I can afford it.

Njorl

 

[member 5645]

What case? Please provide some reference. I did not notice one in the two links I followed up.

Njorl

First, there is no doubt of what the 'baby brain damage' cases were arguing, right?? I'll put that link I guess, but this far it seems you are aware of Edwards original accusation, RIGHT??

Secondly, when I said case, I didn't mean legal case - but that is an interesting double meaning, and one I will address later. I just need to pull the link, but am leaving work now. Let me know if you needed that link explaining what the cases were about too - I assume you already know though

 

[loseyourname]

He made about 6-7 million a year in his best years, winning about 8 cases a year. That is not uncounted millions. Only about 1/4 of those were palsy cases. Not all of the others were medical malpractice.

Please list the name of a Dr. that Edwards put out of business.

For Edwards to do that, he would have to hit a doctor at least 3 times with an unjustified suit. With just 2 palsy cases per year I find it unlikely. I haven't seen any reason to believe any of his cases were not justified. Just a lot of hand-wringing.

Njorl

I didn't mean to imply that Edwards directly took the license of any doctor. What he did is greatly raise malpractice insurance premiums, which makes it very difficult for a doctor-owned practice to get off the ground. Raise the expenses to the point where they can no longer afford to own a practice, and you have put them out of business. I'm not trying to say that Edwards alone is responsible for this, but the fact remains that he (along with a lot of other lawyers) forced insurance companies to pay huge awards when it was not warranted. It is highly doubtful that even half of the doctors filed against were in fact responsible for the injuries suffered (in particular with the cerebral palsy cases). Obviously, hindsight plays a factor here, and perhaps you are right. Perhaps Edwards honestly believed that he was doing the right thing, despite the fact that it is now clear he was not. But just by looking at some of the transcipts of his cases (selected, admittedly, by conservative websites), he comes across as a man appealing to emotion, far more concerned with winning the case than with finding the truth, and thereby serving the cause of justice, which I'm pretty sure is what a lawyer is supposed to do.

 

[JohnDubYa]

RE: "None of this affects health insurance, it affects malpractice insurance."

You see no connection between the two?

 

[Njorl]

RE: "None of this affects health insurance, it affects malpractice insurance."

You see no connection between the two?

There is the concept of the second order effect of defensive medicine; Doctors order more tests to prevent lawsuits.

First, defensive medicine is not necessarily a bad thing. I'm sure some of it is waste, but not all, not even most.

Second, it is not logical, economically speaking, that defensive medicine could have such great costs when malpractice premiums are at 0.56% of medical costs. Money is only spent on defensive medicine to the extent that it is marginally more profitable than spending it on malpractice premiums.

Njorl

 

[JohnDubYa]

There is the concept of the second order effect of defensive medicine; Doctors order more tests to prevent lawsuits.

And they also charge more to pay for their higher malpractice rates, right?

 

[adrenaline]

And they also charge more to pay for their higher malpractice rates, right?

No, not allowed to. Remember, third party payers, whether it is medicare, Hmos, medicaid etc. fix the prices for a doctor's services : physical exam= x amount, , ekg= x amount, , urinalysis, skin biopsey etc. The prices cannot be inflated to cover overhead costs such as malpractice ins.premiums, etc. The most a doc can do is try to see more patients which isn't the best option for either the doctor or the patient. There are quite a few docs pushing for liability surcharges in place of tort reform but some in the AMA argue that it would look as if docs are taking advantage of the medical malpractice insurance crisis and using it to raise their fees.

 

[JohnDubYa]

No, not allowed to. Remember, third party payers, whether it is medicare, Hmos, medicaid etc. fix the prices for a doctor's services :

And what is that price, and is subject to change?

I am not talking about a case where a single doctor increases his rates to overcome a loss in court. I am talking about the overall cost of health care. All of a sudden, the following year its physical exam = X + dX.