The Elephant in the Room
“Primum non nocere” – First, do no harm. This is one of the first things we are taught as physicians going through training. If Hippocrates were alive today, I think he would make it even simpler – “Do the right thing. Every time.” It seems simple. It seems so straight forward. But as we all learn, practicing medicine is neither of those things. To many physicians, medicine seems to have become a maze of complex clinical algorithms laced with a myriad of regulatory and legal hurdles and barriers to overcome. And at the center of it all is the dirty little issue no one seems to want to discuss – defensive medicine and tort reform.
On Jan 25th, to very little fanfare, the HEALTH act was reintroduced into the House and passed by the Judiciary Committee several days later. The bill has been introduced to congress annually for the last 6 years with little or no traction at all. The bill, which focuses on medical malpractice reform, is a mere 28 pages in length - 1900 pages less than PPACA. The bill’s basic tenets are pretty straight forward: cap punitive damages; replace joint and several liability (in other words, not every physician can be held liable for the actions of other physicians); set statute of limitations on filing claims; and limit the amount attorneys can make on malpractice claims.
The arguments on both sides of tort reform are certainly passionate, both for and against, but one thing is certain – sweeping the discussion under the proverbial rug and doing nothing (again) is no longer an option. Whether defensive medicine costs $7 billion, as the CBO claims, or $70 billion, as the AMA claims, it is a very real practice leading to the waste of very real dollars.
We are all trying to make progress on changing the healthcare system to one that is focused on decreasing costs, improving outcomes, and holding one another accountable. If we do not address this barrier to providing high quality, appropriate clinical care, our ability to focus on the real issues will continue to be clouded and our chances of developing a truly improved care delivery system are greatly diminished.
Good post, but you're missing what's been the most amazing and important result of state-level liability reform: a return of access to care that had begun to vanish during the epidemic of liability suits.
In 2003, the Texas Legislature passed sweeping liability reforms to combat health care lawsuit abuse, reverse skyrocketing professional liability insurance premiums, and ensure Texans' access to high-quality medical care. Texas voters then approved Proposition 12, a constitutional amendment that ratified the legislature's authority to impose these important reforms.
By all measures, the reforms have worked exactly as promised. Patients have better access to needed and timely care. More physicians provide specialty and high-risk obstetrical and emergency care in both urban and rural areas. Physicians enjoy lower premiums and a more competitive liability insurance market.
Sick and injured Texans now have more physicians who are more willing and able to give them the medical care they need. The state now has more than 21,000 new physicians to take care of Texas patients. Many of these physicians practice high-risk specialties such as emergency medicine, neurosurgery, pediatric intensive care, and pediatric infectious disease medicine. Patients now can get more timely and convenient care when they are sick or injured.
Twenty-two rural Texas counties have added at least one obstetrician since the passage of Proposition 12, including 10 counties that previously had none.
The emergency care provisions have saved lives by helping ensure Texas patients have access to critical and timely care. Twenty-three rural counties now have at least one emergency medicine physician, and 18 counties added their first ER doctor.
The 2003 liability reforms have worked. They've lived up to their promise. Sick and injured Texans now have more physicians who are more willing and able to give them the medical care they need.