Malpractice and Patient Safety
Thursday, September 10 2009
Dr. Wes is on a tear about President Obama’s speech; apparently, he didn’t spend enough time on malpractice reform. I suspect President Obama could have spent hours and hours on malpractice reform, and it would not have been enough. In any case, Dr. Wes thinks the reference to the 2006 article Obama co-authored with then-Senator Clinton in the NEJM is trivial:
In this article, Clinton and Obama stated:
Instead of focusing on the few areas of intense disagreement, such as the possibility of mandating caps on the financial damages awarded to patients, we believe that the discussion should center on a more fundamental issue: the need to improve patient safety.
So there you have it. It will be medical liability reform through more safety supervisors, hand soap dispensers, operative “time outs” and hall monitors. No unseemly caps on financial damages. Boy, the Bar Association members must be giving each other “high fives” for how well the President handled that part of his speech, don’t you think?
But that article was about more than just soap dispensers. Clinton and Obama had sponsored a bill, called MEDiC, to bring real changes to the way hospitals, doctors, and patients deal with malpractice. This is also from the NEJM article:
The MEDiC program is based on model programs around the country that have demonstrated successful approaches to protecting both patients and doctors while improving the quality of care. A number of hospital systems and liability insurance providers have already adopted a policy of robust disclosure of medical errors. These programs have been successful in reducing administrative and legal costs for providers, insurers, and hospitals.
These programs work. They reduce costs, and they do so without denying patients their rights to compensation for wrongful injury. This would have been a real change in the malpractice environment in this country – but the bill died in the Republican-controlled Judiciary committee. Granted, I don’t expect Dr. Wes to have read the language of the MEDiC bill. I do expect him to have read the entire article he’s quoting (it’s not long).
Just as an added little bit of irony, remember that Dr. Wes was on the specialists’ panel at Putting Patients First earlier this summer. This was my first question for the specialists’ panel, as posted on this blog immediately prior to the event:
1) Since I know the answer to all my questions is “malpractice reform”, let’s start there. Four years ago, then-Senators Clinton and Obama co-sponsored a bill to revamp medical malpractice, giving physicians and patients a way to avoid the tort system. Under the bill, physicians were encouraged to be more open about disclosing and preventing errors, and in return they would face less risk of a high jury verdict against them. Of course, that bill died in the (Republican-run) committee. For all the talk about the importance of malpractice reform, why weren’t more physicians (and physicians’ advocacy groups) supportive of that effort? Would you support a similar effort as part of the current health care reform?
Dr. Wes didn’t answer that question. (By contrast, Dr. Rob and Kevin, MD both weighed in on my questions for the primary care panel.)
President Obama also said this last night:
But know this: I will not waste time with those who have made the calculation that it’s better politics to kill this plan than to improve it. (Applause.) I won’t stand by while the special interests use the same old tactics to keep things exactly the way they are. If you misrepresent what’s in this plan, we will call you out.
I don’t think Dr. Wes is engaged in this debate as someone who sincerely wants to improve health care. I think he prefers the status quo, and I think he’s willing to deliberately misrepresent President Obama’s agenda in order to keep things exactly the way they are. Dr. Wes, I am calling you out.
Duncan,
As Clinton and Obama’s piece states: “We realize that the implementation of the MEDiC model will not come without effort. A safe and appropriately confidential environment must be created that allows open communication between physicians and patients about adverse outcomes. Initially, medical-error transparency may be difficult to foster.”
Any reform that does not address the issue of caps on liability judgements is a disingenuous attempt at real liability reform and will do nothing to deter the practice of defensive medicine. In his speech last night, then, the President has only reaffirmed his prior discussions on this subject and offered nothing new, including the requirement for doctors to walk lock-step in concert with Comparative Effectiveness Research to avoid liability judgements against them while still being subject to potentially monstrous settlements.
The President, despite his rhetoric, really does NOT seem ready to negotiate on this critical and very sensive aspect of liability reform.
Dr. Wes – caps on liability judgments are a shortcut, at the expense of patients, for real malpractice reform. The only fair way to reform malpractice is to establish an alternative, non-adversarial forum where doctors and patients can discuss errors and arrive at reasonable compensation. That’s what MEDiC proposed, in essence.
Meanwhile, you’ve managed to respond to my accusation that you’re misrepresenting Obama’s plan by… misrepresenting Obama’s plan. Where in MEDiC does is say doctors will have “walk lock-step in concert with Comparative Effectiveness Research”? (And what’s so bad about insisting doctor’s follow the science, anyway?)
There are good reasons why tort reform is not in the bills in Congress – see, for example, Tim Foley’s post at Change.org. President Obama can’t insist that Congress include tort reform in those bills – but the fact that he’s willing to use his regulatory authority through HHS to work on the problem shows at least some interest in addressing the problem.