Healing Health Care: Malpractice not the hurdle people think

Fourth in a series

The medical malpractice crisis has been thrown out as a major cause of health care problems for as long as I’ve been in the field. However, examination of the facts strongly disputes this claim.

The first issue in malpractice is the direct cost of payments and insurance. By most analysis, this accounts for about 1.5 percent of our total health care expenses. Malpractice premiums have been dropping in the United States for several years. The number of lawsuits filed has not increased. Meritless suits being filed have dropped dramatically, largely due to insurers not giving quick settlements, as well as the sea-change in jury attitudes about personal-injury suits. Few attorneys take on a case that does not have significant merit because of the high, unrecoverable costs of pressing these lawsuits. I will explain some of the other things that have caused a drop in suits in the follow-up column.

The real problem with malpractice is that so much of it exists. Hospital deaths attributable to error are staggering. Dr. Carolyn Clancy, the head of the Agency for Health Care Quality and Research, said, after reviewing the tragic cases of children dying at a renowned medical center from the same error in a seven-month period (mismatching a transplant organ), “Starbucks has more procedures in place for catching errors than many hospitals do.” Yet we continue to hear from medical groups that the problem is the legal system.

The Government Accountability Office found, after an extensive investigation, that doctors’ groups have misled, fabricated evidence or, at the very least, overstated how malpractice insurance problems have limited access to health care. The only health care access problems that GAO could confirm were isolated and the result of other factors. Also, it is estimated that patients learn of errors less than one-third of the time, and that only 8 percent of patients injured file suit.

What about the so-called defensive medicine problem that costs our system so much? In the 35 years I’ve been in health care, I still don’t know understand this argument. The idea that doing an unnecessary test or procedure can somehow prevent malpractice is ludicrous.

When I was placed in charge of a major health care facility, I would frequently walk the facility to review with doctors their reasons for ordering some simple tests. Routinely, patients presenting with a week or two of a cough who were otherwise healthy and had no physical findings suggestive of a serious underlying disorder were ordered chest X-rays and blood tests. I would ask them the reason, and they would often explain, “I don’t want to miss anything.”

What serious problem could they have missed by not getting the chest X-ray that wouldn’t have been picked up on examination? I never got an answer to that question.

The same with the blood tests. By making doctors think more, and document better, our costs of “defensive medicine” dropped dramatically.

Changing the legal system is not a cure for bad medicine. A 2003 Congressional Budget Office analysis determined that aggressive malpractice law changes would not result in lower health care expenditures.

What about the unnecessary MRIs and CT scans done in the ER? All doctors working in an ER should know the indications for these tests. The colleges of emergency physicians, radiology, pediatrics, orthopedics, neurology, etc. all have well-accepted guidelines. Head injuries result in numerous CT scans in ERs, but almost all are justified. A condition called bilateral subdural hematoma may result in no findings in the ER but can result in death hours later. Ronald Reagan had this condition from a fall during his presidency. MRIs for back pain are mostly unnecessary, and represent an ignoring of accepted guidelines, not because of malpractice fears.

Does this mean defensive medicine doesn’t exist? No. It exists. But it is mostly in very specific areas, such as obstetrics and neurosurgery. Many obstetricians won’t see high-risk pregnancies or will do C-sections or labor induction earlier than completely indicated out of fear. But specific situations don’t mean the entire system is in crisis.

In the follow-up column I will show how many states have significantly improved the malpractice situation by simply listening to Brenda Lee’s 1960 hit song “I’m Sorry,” as well as other logical and workable methods.

Charles Barta retired to Green Valley this summer after 10 years as a medical director for several health care insurers in Denver, including Colorado Access, the non-profit Medicaid HMO, Community HealthPlan of the Rockies, United Healthcare and Anthem Blue Cross. Before that, he was physician-in-charge of Kaiser Permanente of Colorado. He also was a private internist in Las Cruces, N.M. He had previously held a management position in the Medical Systems Division of Pfizer. He can be reached at Cbar52@aol.com.