Sunday, June 10, 2007

Pennsylvania Doctor Trap Number Two Proposed

Pennsylvania has chosen an interesting strategy to keep doctors from leaving the state. Rather than fix the current jackpot medical malpractice system they've decided to try to trap doctors that are already here.

The first example of this was something called the MCARE abatement program. The Medical Care Availability and Reduction of Error (MCARE) Act replaced an existing catastrophic coverage fund with a new fund to cover awards which exceeded the primary coverage provided by professional liability policies. Each physician must pay into the fund a percentage of their primary premium to sustain the fund.

The MCARE abatement program (or Health Care Provider Retention Program) provides some financial relief from paying premiums to the fund. How much relief a physician gets depends on the practitioners specialty. And here we come to trap number one. If you accept the abatement, you agree to practice in the state for the year in which you receive the abatement AND the next year. If you leave early, you have to pay back the full amount of the abatement.

The legislature is now working on trap number two--a physician loan forgiveness program. For a period of ten years, for every year a physician practices in Pennsylvania after completing training the state will pay off ten percent of their student loan debt. If they leave early (say, after five years), they have to pay the state back ALL of the money the state paid toward their loans.



Friday, June 8, 2007

Pennsylvania's Lawmakers Could Learn From Texas

Texas enacted tort reform in 2003, capping damage awards at $250,000. In an article titled "Insurance companies, doctors flock to Texas" David Hendricks passes along some facts I hope Pennsylvania legislators take to heart:

  • Malpractice insurance rates have fallen an average of 21%
  • The number of companies offering malpractice insurance in the state has risen from four to thirty
  • Malpractice lawsuits have fallen 50%
  • Doctors are coming to Texas, as evidenced by 2,250 pending applications for medical licensure

[Kevin, MD]



Monday, May 7, 2007

Another Obstetrics Ward in Philadelphia Plans To Close

The Philadelphia Inquirer published an article over the weekend titled Demise of maternity wards is inducing . . . The Baby Scramble
"Blaming financial losses and a deluge of patients who previously might have gone to other, now-defunct maternity wards, Jeanes Hospital is closing its obstetrics unit May 31. Chestnut Hill Hospital is reviewing its obstetrics program as well and has not ruled out closure."

Lots of other good data in that article, too, such as the time-line for closure of other OB units in the greater Philadelphia area:

  • Medical College of Pennsylvania (1997)
  • Nazareth (1998)
  • Germantown (1999)
  • City Avenue (1999)
  • Roxborough (1999)
  • Warminster (2000)
  • Elkins Park (2001)
  • Episcopal (2001)
  • Mercy Philadelphia (2002)
  • Methodist (2002)
  • Mercy Fitzgerald (2003)
  • Parkview (2003)
  • Frankford-Torresdale (2006)
  • Jeanes (2007)

Pennsylvania Physician Supply Back In The News

A recent Health Affairs article titled Changes In Physician Supply And Scope of Practice During A Malpractice Crisis: Evidence From Pennsylvania has gotten a great deal of national media attention. It's conclusion was as follows:

"...This study found that the proportions of physicians restricting their scope of practice and exiting practice in Pennsylvania were similar during and before the malpractice crisis for most high-risk specialties. The overall supply of high-risk specialists did not decrease during the crisis except in obstetrics-gynecology."

I've been thinking about this article for a while now. I've written to the lead author asking about the inclusion of medical residents-in-training in their statistics but have yet to hear back. Including residents may hide important trends. For example, new residency programs may have opened during the study period. Trading doctors who are fresh out of internship for experienced specialists is not a good deal, but the numbers as used wouldn't show this.

Another question I have is 'compared to what?' What has happened in other states during this time? According to the Dauphin County Medical Society, among the twenty most populous states, only Pennsylvania and California saw their physician supply drop during the study period. All others saw an increase of 10-20% in physician supply.



Friday, April 27, 2007

Pennsylvania Malpractice Numbers Ignored?

I composed a polite letter to the editor of our local paper, the Patriot-News. It went something like this (exactly like this, actually):
"Title: Is Pennsylvania's Malpractice Crisis Solved? Maybe for trial lawyers.

Dear Editor,

Data just published by the non-profit, non-partisan Kaiser Family Foundation at http://www.statehealthfacts.org/ provides facts to consider in our discussion of health care reform in Pennsylvania.

Based on data from the National Practitioner Databank, Pennsylvania ranks third in the nation in the number of paid malpractice claims per thousand physicians (http://tinyurl.com/22mppw). Pennsylvania ranks second only to New York in total payments for claims made during 2006--over $300,000,000 (http://tinyurl.com/26hh9p).

Please consider passing these facts on to your readers so that they may form their own conclusions about the state of Pennsylvania's malpractice system. I submit that being ranked second and third in the nation in two objective measures of malpractice payouts does not support those who contend that our malpractice crisis is 'over.'"

Was it published? Nope. Oh, well.


It WAS published on Sunday, April 29th, 2007,


Wednesday, April 18, 2007

PA Ranks Second in Total Dollars Paid in Malpractice Claims

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...

PA Ranks Third in Paid Malpractice Claims

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.



Tuesday, March 27, 2007

New Study on Malpractice Costs

Pacific Research Institute:

JACKPOT JUSTICE: The True Cost of America's Tort System

Processing....



Thursday, March 8, 2007

Why Are C-Section Rates Still Going Up?

csectionrate.gif

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

"At least one study found that physicians' malpractice premiums, the number of claims against physicians and hospitals, and the physician's preception of the risk fo being sued were all positively correlated with the likelihood of cesarean delivery. Many in the field defend the rising cesarean rates by citing concern about legal jeopardy, and indeed lawsuits often allege a failure to perform a timely cesarean delivery."

Look at John Edwards' list of law cases (thank you, Google). Notice the medical malpractice cases:

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.
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
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
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
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
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

Despite the increase in c-section rates nationwide, we have seen no reduction in the cerebral palsy rate...



Tuesday, February 27, 2007

Even Malpractice Lawyers Need Doctors, Sometimes

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....

"Yeah, I'm a personal injury lawyer. I have no problems telling doctors that. I get better care that way, actually. Makes you guys more careful around me."

"Yes, I know you very well, Mr. Cochran. You were the plaintiff attorney accusing me of being a baby killer, remember?!"



Wednesday, May 24, 2006

Pennsylvania's Health Care Crisis has NOT 'turned the corner'

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:

"Frankford Health Care System, which is already getting ready to discontinue maternity services at its Torresdale division, is losing another group of specialists at its Frankford campus in another departure tied in part to Pennsylvania's high medical malpractice insurance costs. --Philadelphia Business Journal"

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?



Sunday, May 14, 2006

RangelMD on Tort Reform in Texas

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.

"Obviously the need is to reduce legal costs, increase ease and access to the system, increase efficiency and speed of proceedings so that justified compensation finds its way to the plaintiff with all deliberate speed, and establish much more consistency in finding fault and awarding compensation. One solution is the establishment of special health courts where neutral expert witnesses would be hired by the court, judges or panels would hand down judgments, and guidelines would be in place for the determining of fault and compensation.

It's easy to see why trial lawyers oppose special health courts because their roles would be significantly reduced. A system like this would be far less susceptible to such intangibles as the fickle mood of a jury or the charisma of the lawyer. We've been talking for years about reducing costs and improving access to health care. Maybe it's about time we started doing the same with our tort system. Proposition 12 may have been the first small step in that direction."

[RangelMD]

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