At the same website mentioned in the preceding post one can find information on total dollars paid in malpractice cases in 2006. Pennsylvania ranked second with $308,781,000 paid (second only to New York). See for yourself.
Vermont looks pretty good to me right now...
The Kaiser Family Foundation maintains StateHealthFacts.org, a site "designed to provide free, up-to-date, and easy-to-use health data on all 50 states". The site just published Number of Paid Medical Malpractice Claims, 2006. Pennsylvania ranks third among all states in number of malpractice claims paid per thousand physicians. See for yourself.
Pacific Research Institute:
JACKPOT JUSTICE: The True Cost of America's Tort System
Processing....
As an anesthesiologist I provide anesthesia for cesarean sections quite often. In fact, when I'm on overnight call it's what I spend most of my time doing. Usually, anesthesia for c-section consists of a spinal anesthetic, or using a pre-existing epidural catheter, or (more rarely and usually only in emergencies) a general anesthetic. I am therefore quite interested in the subject of cesarean section rates and what effects how often they are done. I learned some things from this article [free full text]:
Cesarean Delivery and The Risk-Benefit Calculus
1. Parturients are different--they are heavier and older.
2. The number of premature and low birth-weight babies has grown.
3. Vaginal breech deliveries are no longer recommended.
4. Operative deliveries (forceps or vacuum) are less common due to better data describing their risks.
5. More labors are induced (20% in 2003 vs 9.5% in 1990) and induced labors are more likely to result in C-section.
6. Changes in provider behavior
Look at John Edwards' list of law cases (thank you, Google). Notice the medical malpractice cases:
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MEDICAL MALPRACTICE CASES Another specialty Edwards developed was in medical malpractice cases involving problems during births of babies. According to the New York Times, after Edwards won a $6.5M verdict for a baby born with cerbral-palsy, he filed at least 20 similar lawsuits against doctors and hospitals in deliveries gone wrong, winning verdicts and settlements of more than $60M. |
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| Case | Summary of Facts | Case Type | Result | |
| Griffin v. Teague, et al. (Mecklenburg Co. Superior Ct., NC, 1997) |
Application of abdominal pressure and delay in performing c-section caused brain damage to infant and resulted in child having cerebral palsy and spastic quadriplegia. Verdict set record for malpractice award. | Medical Malpractice | $23.25M verdict |
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Campbell v. Pitt County Memorial Hosp. (Pitt County, NC, 1985) |
Infant born with cerebral palsy after breech birth via vaginal delivery, rather than cesarean. Established North Carolina precedent of physician and hospital liability for failing to determine if patient understood risks of particular procedure. | Medical Malpractice |
$5.75M settlement |
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| Wiggs v. Glover, et al. | Plaintiff alleged infant's severe cerebral palsy was caused by negligent administration of pitocin, failure to use fetal monitor, or timely intervening in baby's fetal distress. | Medical Malpractice |
2.5M settlement |
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| Cooper v. Craven Regional Med. Ctr., et al. | Infant suffered severe brain damage after obstetrician failed to moderate use of Picotin after baby displayed clear fetal distress. | Medical Malpractice |
$2.5M settlement |
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| Dixon v. Pitt County Memorial Hospital (Pitt County, NC) |
Birth-related injuries including cerebral palsy and mental retardation allegedly caused by obstetrician's failure to diagnose fetal distress, including umbilical cord wrapped around baby's neck prior to delivery. | Medical Malpractice |
2.4M settlement |
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Despite the increase in c-section rates nationwide, we have seen no reduction in the cerebral palsy rate...
In An Eye For An Eye, Charity Doc describes a close encounter with a malpractice attorney who once sued him. I'm not sure I would have been as, um, gracious....
Our Governor is quoted as saying that Pennsylvania's health care crisis has turned a corner. It has not and as evidence I point you to the following article about a Cardiology group in Philadelphia that will no longer provide coverage at one health center there:
Imagine you're, say, a plastic surgeon. There used to be fifteen of you on staff at a hospital so you took ER call only two days per months (as a precondition for maintaining staff privileges). Well, because of a malpractice crisis that has NOT turned the corner there are only three of you now. That's ten days of ER call each month. Kinda forces you to ponder whether maintaining staff privileges is worth is, doesn't it? And if you decide it's not, then patients loose access to yet another specialist at the hospital. See where this goes?
Texas enacted caps on medical malpractice awards in 2003. The debate there on whether these caps are good or have been responsible for the drop in new malpractice cases by 60%-80% continues.
[RangelMD]
Wisconsin Senate Approves Limits On Noneconomic Damages In Malpractice Suits:
[Via UK Medical News Today]
An organization called Doctor's Advocate is announcing it's first successful effort to stop a 'frivolous' lawsuit in Pennsylvania: Doctor's Advocate Terminates First Frivolous Medical Malpractice Lawsuit; Case Against OB-GYN Dropped in Seven Weeks:
Here's the background on the organization: "Doctor's Advocate works to reverse the medical malpractice crisis and keep doctors in Pennsylvania by raising public awareness, lobbying for legislation to produce tort reform, and combating frivolous lawsuits with an inexpensive legal service."
Looks like being a member costs $1200 per year.
The Impact of Caps on Damages: How are Markets for Medical Liability Insurance and Medical Services Affected?
and concludes
The American Medical Association has released a new article which takes to task the so-called 'Angoff Report' which claimed that the medical liability insurance crisis is caused by insurance companies booming profits, overcharging physicians for coverage, and ballooning surpluses. It refers to two subsequent analyses which point up the flaws in the approach used by Angoff. Revised analysis shows the growth rate of insurance company surpluses was only 3.9% per year, and they were profitable in only one year (2004) when they made 5%
Walter Olson responded to my earlier post and I feel I need to clarify what I meant. I thank him for pointing out (gently) the error of my words.
First off, I trained in the early 1990's after the advent of improved monitoring such as pulse oximetry and end tidal gas monitoring. My statement that 'overdose risk is not and was never a cause of patient morbidity and mortality in my field' was overly broad and, as Olson points out, incorrect.
The point I tried to make (though not well) was that overdose is not something we presently worry about and does not explain the apparent increase in awareness under anesthesia. What can explain it (in part) is the use of muscle paralyzing drugs (even when they are not absolutely necessary) often together with medical errors such as empty vaporizers (inhaled anesthetic delivery source), incorrectly installed vaporizers, or other human error.
Though Google turns up many hits on anesthesia and overdose, these tend to be written by non-anesthesiologists for the lay public and should not be taken as evidence that anesthetic overdoses is a cause of malpractice claims (though, admittedly, it is a term that most juries readily understand)
Walter, if you're reading this, I'd love to be able to read more about how the legal system portrays us during trials. Any pointers?
Walter Olson has taught me much about the legal system as it pertains to medicine via the PointOfLaw forum. I have to take exception with a post made today however. In pointing to an article that considers whether the lessons of patient safety in anesthesiology are generalizable to other fields of medicine, he writes:
Overdose risk is not and was never a cause of patient morbidity and mortality in my field. Second, it is not at all clear whether the 'rising incidence of the phenomenon of anesthesia awareness' is anything but a) better reporting (i.e. you don't find what you don't look for) b) realization among patients that there's something else they can sue for or c) an effort by one medical device company which makes depth of anesthesia monitors to panic hospitals and anesthesia groups into buying their product (a product which, by the way, has not been shown to decrease the incidence of awareness).
The specialty is actively engaged in evaluating this 'problem' with the same approach it has used to improve patient safety in other areas such as airway management and positioning injuries.
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