¹ See Patricia M. Danzon, Medical Malpractice 2-4 (1985); Paul C. Weiler, Medical Malpractice on Trial 2-5 (1991); James R. Posner, Trends in Medical Malpractice Insurance, 1970-1985, 49 Law & Contemp. Probs., Spring 1986, at 37, 38.

² See Weiler, supra note 1, at 26-32; Danzon, supra note 1, at 95-114. See also Bovbjerg, Randall R., Legislation on Medical Malpractice: Further Developments and a Preliminary Report Card, 22 U.C. Davis L. Rev. 499, 500-04 (1989)Google Scholar (discussing legislative responses to the problems associated with medical malpractice litigation).

³ See John H. Snyder et al., The Industry at a Turning Point, Best'S Review: Property/Casualty Ins. Edition, Jan. 1996, at 36,43. See also Physician Insurers Association of America, Claims Frequency and Severity, 1990-97 (data on file with authors).

⁴ See, e.g., Hope Maxwell, Just What The Doctor Ordered: Measures Medical Malpractice Insurers Are Taking To Remain Competitive, Best'S Review: Property/Casualty Ins. Ed., May 1998, at 71; Patrick M. Sweeney, Not What the Doctor Ordered: Medical Malpractice Liability Insurance, Best'S Review: Property/Casualty Ins. Ed., Nov. 1997, at 81; Christine Woolsey, Malpractice Coverage In Stable Condition, Bus. Ins., March 28, 1994, at 1.

⁵ See Maxwell, supra note 4, at 73.

⁶ See Walter J. Wadlington, A Medical Malpractice Crisis in 1995?: Some Conceivable Scenarios, 36 St. Louis U. L.J. 897, 898 (1992).

⁷ See Zablotsky, Peter, From a Whimper to a Bang: The Trend Toward Finding Occurrence Based Statutes of Limitations Governing Negligent Misdiagnosis of Diseases With Long Latency Periods Unconstitutional, 103 Dick. L. Rev. 455, 457 (1999)Google Scholar (noting that nearly one-third of states have found unconstitutional statutes of limitations on malpractice claims). See generally Keith, Elizabeth A., Pulliam v. Coastal Emergency Services of Richmond, Inc.: Reconsidering the Standard of Review and Constitutionality of Virginia's Medical Malpractice Cap, 8 Geo. Mason L. Rev. 587 (2000)Google Scholar (discussing the constitutionality of Virginia's medical malpractice cap); Kinney, Eleanor D., Malpractice Reform in the 1990s: Past Disappointments, Future Success, 20 J. Health Pol. Pol'Y & L. 99 (1995)CrossRefGoogle Scholar (discussing proposals made in the early 1990's that intended to make malpractice suits more efficient and rational).

⁸ See, e.g., Bovbjerg, Randall R. & Sloan, Frank A., No-Fault for Medical Injury: Theory and Evidence, 67 U. ClN. L. Rev. 53 (1998)Google Scholar; Liang, Bryan A, Medical Malpractice: Do Physicians Have Knowledge of Legal Standards and Assess Cases as Juries Do?, 3 U. Chi. L. Sch. Roundtable 59, 90 (1996)Google Scholar; Sloan, Frank A. et al., Tort Liability and Obstetricians' Care Levels, 17 Int'L Rev. L. & Econ. 245 (1997)CrossRefGoogle Scholar; Studdert, David M. et al., Negligent Care and Malpractice Claiming Behavior in Utah and Colorado, 38 Med. Care 250, 254 (2000)CrossRefGoogle Scholar.

⁹ See Weiler, Paul C., Fixing the Tail: The Place of Malpractice in Health Care Reform, 47 Rutgers L. Rev. 1157, 1162 (1995)Google Scholar.

¹⁰ See Committee On Quality Of Health Care In America, Insititue of Medicine, T O Err is Human: Building A Safer Health System (Linda T. Kohn et al., eds., 2000) [hereinafter To Err is Human].

¹¹ See, e.g., Julie Marquis & Alissa J. Rubin, Hospitals, Doctors Fear Fallout of Call for Error Reporting, L. A. Times, Feb. 23, 2000, at A2; Must Mistakes Happen"?, Wash. Post, Dec. 2, 1999, at A38; Robert Pear, U.S. Health Officials Reject Plan to Report Medical Mistakes, N.Y. Times, Jan. 24, 2000, at A14; Michael Pretzer, Will Congress Do Anything to Stop Medical Errors?, Med. Econ., Feb. 21, 2000, at 37; Sarah A. Webster, Hospitals Hide Errors That Kill, Injure Patients: Report Blames Fear of Lawsuits for Health Industry's Silence, Detroit News, Feb. 6, 2000, at Al.

¹² See, e.g., Medical Errors: Improving Quality of Care and Consumer Information: Joint Hearing Before the Subcomms. on Health and Environment, and Oversight and Investigations of the House Comtn. on Commerce, and the Subcomm. on Health of the House Comm. on Veteran's Affairs, 106th Cong. 14-18 (2000) (statement of Donald Berwick, President and CEO, Inst, for Healthcare Improvement), 126-31 (2000) (statement of William E. Golden, President, American Health Quality Ass'n); Reducing Medical Errors: A Look at the IOM Report, Hearing Before the Senate Health, Education, Labor and Pensions Comm., 106th Cong. 101-02 (2000) (prepared statement of Sen. James Jeffords, Chairman, Senate Comm. on Health, Educ, Labor, and Pensions); Andrea Gerlin, Employers, Insurers Committing Funds to Reduce Medical Errors, Philadelphia Inquirer, Jan. 26, 2000, at D1.

¹³ See David M. Studdert & Troyen A. Brennan, No-fault Compensation for Medical Injuries: The Prospect for Error Prevention (unpublished manuscript on file with authors).

¹⁴ See, e.g., Weiler, supra note 1, at 114-58; Danzon, supra note 1, at 154-56; Fruchter, Joshua, Doctors on Trial: A Comparison of American and Jewish Legal Approaches to Medical Malpractice, 19 Am. J.L. & Med. 453 (1993)Google Scholar; Havighurst, Clark C. & Tancredi, Laurence R., “Medical Insurance"— A No-Fault Approach to Medical Malpractice and Quality Assurance, 51 MlLbank Q. 125 (1973)Google Scholar; O'Connell, Jeffrey, No-Fault Insurance for Injuries Arising From Medical Treatment: A Proposal for Elective Coverage, 24 Emory L.J. 21 (1975)Google Scholar; Saks, Michael J., Do We Really Know Anything About the Behavior of the Tort Litigation System—and Why Not?, 140 U. Pa. L. Rev. 1147 (1992)CrossRefGoogle Scholar; Sugarman, Stephen D., Doing Away with Tort Law, 73 Cal. L. Rev. 558 (1985)CrossRefGoogle Scholar.

¹⁵ See David M. Studdert et al., Can the United States Afford a “No-Fault” System of Compensation for Medical Injury?, 60 Law & Contemp. Probs., Spring 1997, at 1, 29-32.

¹⁶ See, e.g., Paul C. Weiler Et Al., A Measure of Malpractice (1993); Bates, David W. et al., Incidence and Preventability of Adverse Drug Events in Hospitalized Adults, 8 J. Gen. Internal Med. 289 (1993)CrossRefGoogle Scholar; Rothschild, Jeffrey M., et al., Preventable Medical Injuries in Older Patients, 160 Archives Internal. Med. 2717 (2000)CrossRefGoogle Scholar; Thomas, Eric J. et al., Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado, 38 Med. Care 261 (2000)CrossRefGoogle Scholar.

¹⁷ See Studdert & Brennan, supra note 13.

¹⁸ The IOM itself recommended specific versions of voluntary and mandatory reporting schemes. See To Err is Human, supra note 10, at 74-77. It also spurred a series of state and federal proposals. Among the leading federal proposals were: S. 2038, Medical Error Reduction Act of 2000, 106th Cong. (2000); S. 2378, Stop All Frequent Errors (Safe) in Medicare and Medicaid Act of 2000, 106th Cong. (2000); S. 2738, Patient Safety and Errors Reduction Act, 106th Cong. (2000); S. 2743, Voluntary Error Reduction and Improvement in Patient Safety Act, 106th Cong. (2000); H.R. 5404, Medicare Comprehensive Quality of Care and Safety Act of 2000, 106th Cong. (2000).

¹⁹ See, e.g., Human Error in Med., (Marilyn S. Bogner ed., 1994); Charles Perrow, Normal Accidents: Living With High-Risk Technologies (1984); James Reason, Human Error (1990); James Reason, Managing the Risks of Organizational Accidents (1997); Donald M. Berwick & Lucian L. Leape, Reducing Errors In Medicine: It's Time to Take This More Seriously. 319 Brit. Med. J. 136(1999).

²⁰ See e.g., Charles L. Bosk, Forgive and Remember: Managing Medical Failure (1979); Scott et al., Physician Reporting of Adverse Drug Reactions: Results of the Rhode Island Adverse Drug Reaction Reporting Project. 263 Jama 1785 (1990); Audrey Smith Rogers, et al., Physician Knowledge, Attitudes, and Behavior Related to Adverse Drug Events, 148 Archives Internal Med. 1596 (1998); L. M. Ross, et al., Medication Errors in a Paediatric Teaching Hospital in the UK: Five Years Operational Experience, 83 Archives Disease in Childhood 492 (2000).

²¹ See Studdert & Brennan, supra note 13. See also James Reason, Human Error: Models and Management, 320 Brit. Med. J. 768, 770 (2000) (discussing the need to avoid what Reason calls “the blame trap,” the tendency to focus remedial action on the last and arguably least remediable link in the accident chain, those individuals in direct contact with defective parts of the system).

²² See Bovbjerg & Sloan, supra note 8, at 58.

²³ See, e.g., Barry R. Furrow, Medical Mapractice and Cost Containment: Tightening the Screws, 36 Case W. L. Rev. 985 (1986); Frank A. Sloan et al., The Road from Medical Injury to Claims Resolution: How No-Fault and Tort Differ, 60 Law & Contemp. Probs., Spring 1997, at 35.

²⁴ See Donald M. Berwick, Continuous Improvement as an Ideal in Health Care, 320 New Eng. J. Med. 53, 53 (1989).

²⁵ See Bovbjerg & Sloan, supra note 8, at 55-56. See also Brennan, Toyen A. & Rosenthal, Marilyn, Medical Malpractice Reform: The Current Proposals, 10 J. Gen. Internal Med. 211, 216 (1995)CrossRefGoogle Scholar (offering elective, enterprise liability-based no-fault compensation as an alternative to the current tort system).

²⁶ See generally Spieler, Emily, Perpetuating Risk? Workers Compensation and the Persistence of Occupational Injuries, 31 Houston L. Rev. 119 (1994)Google Scholar (examining why worker's compensation expenditures have failed to motivate employers to implement aggressive safety practices).

²⁷ For descriptions of the New Zealand scheme, see for example Ian B. Campbell, Compensation for Personal Injury in New Zealand (1996); Walter Gellhorn, Medical Malpractice Litigation (U.S.)—Medical Mishap Compensation New Zealand, 73 Cornell L. Rev. 170 (1988); Miller, Richard S., An Analysis and Critique of the 1992 Changes to New Zealand's Accident Compensation Scheme, 52 Md. L. Rev. 1070 (1993)Google Scholar; Palmer, Geoffrey, New Zealand's Accidental Compensation Scheme: Twenty Years On, 44 U. Toronto L.J. 223 (1994)CrossRefGoogle Scholar; Todd, Stephen, Privatization of Accident Compensation: Policy and Politics in New Zealand, 39 Washburn L.J. 404 (2000)Google Scholar. For descriptions of the Swedish scheme, see for example Marilynn M. Rosenthal, Dealing with Medical Malpractice: the British and Swedish Experience (1988); Danzon, Patricia M., The Swedish Patient Compensation System: Lessons for the United States, 15 J. Leg. Med. 199 (1994)CrossRefGoogle Scholar; Studdert et al., supra note 15; Carl Espersson, The Swedish Patient Insurance: A Descriptive Report, paper presented at Balliol College, Oxford, England, (April, 1992) (on file with authors).

²⁸ See Bovbjerg, & Sloan, , supra note 8, at 55-56; Diana Brahams, No Fault Compensation Finnish Style, 332 Lancet 733, 733-34 (1988)Google Scholar.

²⁹ See generally Randall R. Bovbjerg et al., Administrative Performance of No-Fault Compensation for Medical Injury, 60 Law & Contemp. Probs., Spring 1997, at 71 (arguing that while no-fault is not a perfect system, it will more efficiently address certain feasible medical issues than the traditional tort system); David M. Studdert et al., The Jury is Still In: Florida's Birth-Related Neurological Injury Compensation Association After a Decade, 25 J. Health Pol. Pol'Y & L. 499 (2000) (arguing that no-fault did not extinguish high-cost tort cases because the two systems are competing). See also Ridgway, Derry, No-fault Vaccine Insurance: Lessons from the National Vaccine Injury Compensation Program, 24 J. Health Pol. Pol'Y & L. 59, 85-86 (1999)CrossRefGoogle Scholar (finding the Program's successes to provide a model for other areas of liability).

³⁰ See Bovbjerg & Sloan, supra note 8, at 55-56; Weiler, Paul C., The Case for No-Fault Medical Liability, 52 Md. L. Rev. 908, 925 (1993)Google Scholar (comparing medical malpractice with no-fault, and finding no-fault a reasonable alternative).

³¹ See Bovbjerg et al., supra note 29, at 86-96, Sloan et al., supra note 23, at 63-66; Studdert et al., supra note 29, at 523-24.

³² See Studdert & Brennan, supra note 13.

³³ See Gellhorn, supra note 27, at 195, Studdert et al., supra note 15, at 5-7.

³⁴ See Gellhorn, supra note 27, at 195, Studdert et al., supra note 15, at 5-7.

³⁵ See Gellhorn, supra note 27, at 195; Studdert et al., supra note 15, at 5-7.

³⁶ See Studdert et al., supra note 15, at 6.

³⁷ See Elgie, Robert G., et al., Medical Injuries and Malpractice: Is It Time for “No-Fault"?, 1 Health L.J. 97, 113-15 (1993)Google ScholarPubMed (arguing that Canada should explore the design and introduction of a no-fault compensation system for victims of both negligent and non-negligent iatrogenic injuries).

³⁸ See Studdert, David M. & Brennan, Troyen A., Beyond Dead Reckoning: Measures of Medical Injury Burden, Malpractice Litigation, and Alternative Compensation Models from Utah and Colorado, 33 Ind. L. Rev. 1643, 1673-77(2000)Google Scholar.

³⁹ See Abraham, Kenneth S. & Weiler, Paul C., Enterprise Medical Liability and the Evolution of the American Health Care System, 108 Harv. L. Rev. 381, 407-15 (1994)CrossRefGoogle Scholar; Sage, William M. et al., Enterprise Liability for Medical Malpractice and Health Care Quality Improvement, 20 Am. J.L. & Med. 1, 19-21 (1994)Google Scholar.

⁴⁰ See To Err is Human, supra note 10, at 134-59.

⁴¹ See Studdert & Brennan, supra note 13, at 13-15.

⁴² See Abraham & Weiler, supra note 39, at 434-36.

⁴³ See Christopherson, James A., The Captive Medical Malpractice Insurance Company Alternative, 5 Annals Health Law 121, 141 (1996)Google Scholar (discussing how steadily rising medical malpractice premiums have led health care providers to seek alternatives to the traditional policies and services provided by large, independent, commercial insurance companies).

⁴⁴ In the inpatient setting, the conventional definition for an “adverse event” is an injury caused by treatment or omission, as opposed to the underlying disease process, which results in prolonged hospitalization or disability at discharge. See Brennan, Troyen A. et al., Incidence of Adverse Events and Negligence in Hospitalized Patients: Results of the Harvard Medical Practices Study I, 324 New Eng. J. Med. 370, 371 (1991)CrossRefGoogle Scholar.

⁴⁵ See Thomas, Eric J. et al., Costs of Medical Injuries in Colorado and Utah in 1992, 36 Inquiry 255 (1999)Google Scholar; Studdert et al., supra note 15, at 30.

⁴⁶ The additional resources for such claims essentially come from the savings in administrative costs reaped from the elimination of the costly process of adjudicating negligence claims. See Studdert et al., supra note 15, at 30.

⁴⁷ See Julie Fitzjohn & David Studdert, A Compensation Perspective on Error Prevention: Is the Acc Medical Misadventure Scheme Compensating the Right Sort of Injury (forthcoming 2001).

⁴⁸ See id.

⁴⁹ This pre-designation of eligible injuries resembles the idea of “designated compensable events,” or their later manifestation, “accelerated compensation events.” See Bovbjerg, Randall R. et al., Obstetrics and Malpractice: Evidence on the Performance of a Selective No-Fault System, 265 Jama 2836 (1991)CrossRefGoogle Scholar; Tancredi, Laurence R. & Bovbjerg, Randall R., Rethinking Responsibility for Patient Injury: Accelerated Compensation Events, A Malpractice and Quality Reform Ripe for a Test, 54 Law & Contemp. Probs. at 147 (1991)CrossRefGoogle Scholar.

⁵⁰ See Todd, supra note 27, at 415.

⁵¹ The disability threshold is analogous to a “deductible” in other forms of insurance. See Harvey S. Rosen, Public Finance 576 (4th Ed 1995).

⁵² See Studdert et al., supra note 15 at 8, 15.

⁵³ See Bovbjerg et al., supra note 29, at 80.

⁵⁴ See Herbert M. Kritzer, The Justice Broker: Lawyers and Ordinary Litigation (1990).

⁵⁵ See Bovbjerg, Randall R. et al., Valuing Life and Limb in Tort: Scheduling Pain and Suffering, 83 Nw. U. L. Rev. 908, 937 (1989)Google Scholar.

⁵⁶ See Studdert et al., supra note 15, at 18-22.

⁵⁷ For an analysis of schedules based on average jury awards, see Bovbjerg et al., supra note 55, at 923.

⁵⁸ See Studdert et al., supra note 15, at 22.

⁵⁹ See Henderson, Roger C., Designing A Responsible Periodic-Payment System for Tort Awards: Arizona Enacts a Prototype, 32 Ariz. L. Rev. 21, 29 (1990)Google Scholar; Plant, Marcus L., Periodic Payment of Damages for Personal Injury, 44 LA. L. Rev. 1327, 1327-28 (1984)Google Scholar; Kolbach, Barbara Balzer, Variable Periodic Payments of Damages: An Alternative to Lump Sum Awards, 64 Iowa L. Rev. 138 (1978)Google Scholar.

⁶⁰ See Jones & Laughlin Steel Corp. v. Pfeifer, 462 U.S. 523, 533; see also Henderson, supra note 59, at 28.

⁶¹ See Blumenberg, Amy B., Note, Medical Monitoring Funds: The Periodic Payment of Future Medical Surveillance Expenses in Toxic Exposure Litigation, 43 Hastings L.J. 661, 691 (1992)Google Scholar.

⁶² See Kenneth Abraham, Individual and Collective Repsonsibility: The Dilemma of Mass Tort Reform, 73 VA. L. Rev. 845, 905; see also Bovbjerg & Sloan, supra note 8, at 68.

⁶³ See Studdert et al., supra note 15, at 25.

⁶⁴ See Peter Davis et al., The Social and Clinical Context of Claiming for Medical Injury Under “No-Fault": A New Zealand Study (unpublished manuscript on file with authors).

⁶⁵ See Russell Localio, A. et al., Relation Between Malpractice Claims and Adverse Events Due to Negligence: Results of the Harvard Medical Practice Study III, 325 New Eng. J. Med. 245, 248 (1991)CrossRefGoogle Scholar; Studdert et al., supra note 15, at 24.

⁶⁶ See Sloan et al., supra note 23, at 46-48, Studdert et al., supra note 29, at 508-14.

⁶⁷ The leading case is Galen v. Braniff, 696 So. 2d 308, 309 (Fla. 1997). See also Behan v. Florida Birth-Related Neurological Injury Compensation Ass'n, 664 So. 2d 1173 (Fla. Dist. Ct. App. 1995); Bradford v. Florida Birth-Related Neurological Injury Compensation Ass'n, 667 So. 2d 401 (Fla. Dist. Ct. App. 1995); Board of Regents v. Athey, 21 Fla. L. Weekly D 2046 (Fla. Dist. Ct. App. 1996); Mills v. North Broward Hosp. Dist., 664 So. 2d 65, 65 (Fla. Dist. Ct. App. 1995); Siravo v. Florida Birth-Related Neurological Injury Compensation Ass'n, 667 So. 2d 971, 972 (Fla. Dist. Ct. App. 1996); Turner v. Hubrich, 656 So. 2d 970, 971 (Fla. Dist. Ct. App. 1995).

⁶⁸ See Studdert et al., supra note 29, at 520-21.

⁶⁹ See Bovbjerg & Sloan, supra note 8, at 115-16.

⁷⁰ See Jay Katz, The Silent World of doctor and Patient (1984).

⁷¹ See Studdert et al., supra note 15, at 16.

⁷² See 29 U.S.C. § 1001 et seq. (1994).

⁷³ See, e.g., Elizabeth Rolph et al., Arbitration Agreements In Health Care: Myths and Reality, 60 Law & Contemp. Probs., Spring 1997, at 153; Metzloff, Tom, The Unrealized Potential of Malpractice Arbitration, 31 Wake Forest L. Rev. 203, 208 (1996)Google Scholar; Zukher, David, The Role of Arbitration In Resolving Medical Malpractice Abuse: Will a Well-Drafted Arbitration Agreement Help the Medicine Go Down?, 49 Syracuse L. Rev. 135, 138 (1998)Google Scholar. For an opinion criticizing arbitration agreements as they are currently enforced, see Michael, F. Green, Z., Preempting Justice Through Binding Arbitration of Future Disputes: Mere Adhesion Contracts or a Trap for the Unwary Consumer?, 5 Loy. Consumer L. Rep. 112, 113 (1993)Google Scholar (arguing that agreements to arbitrate future consumer disputes should not be enforceable when they consist of adhesion contracts lacking voluntary consent or any effective choice by the consumer).

⁷⁴ See 9 U.S.C. §2(1976).

⁷⁵ See Perry v. Thomas, 482 U.S. 483, 491 (1983) (holding that state law is applicable only if the law concerns the validity, revocability, and enforceability of contracts generally).

⁷⁶ See Doctor's Assocs. v. Casarotto, 517 U.S. 681, 686-687 (1996) (holding that contracts can be voided in state courts on substantive grounds such as fraud or duress, unless an arbitration clause is at issue).

⁷⁷ See Graham v. Scissor-Tail, Inc., 623 P.2d 165, 171-73 (Cal. 1981) (describing adhesion contracts).

⁷⁸ 1975 Cal. Stat. 2d. Ex. Sess. 3949, amended by 1975 Cal. Stat 2d. Ex. Sess. 4007.

⁷⁹ See Cal. Civ. Proc. § 1295 (West 1999).

⁸⁰ 552P.2d. 1178 (Cal. 1976).

⁸¹ See id. at 1188.

⁸² See id. at 1181.

⁸³ See id. at 1185-86.

⁸⁴ See id. at 1185.

⁸⁵ See id.

⁸⁶ See id. at 1186.

⁸⁷ 383P.2d. 441 (Cal. 1963).

⁸⁸ See id. at 441.

⁸⁹ See id. at 447.

⁹⁰ See id.

⁹¹ See Armand Leone, Jr., Is Adr the Rxfor Malpractice?, 49 DlSp. Resol. J. 7, 10 (1994).

⁹² See Pietrelli v. Peacock, 13 Cal. App. 4th 943, 947 (Cal. Ct. App. 1993) (holding that an unborn person can be bound from the moment of conception); Wilson v. Kaiser Found. Hosps., 141 Cal. App. 3d 891, 896-98 (Cal. Ct. App. 1983) (holding that claims of prenatal malpractice can be addressed through arbitration).

⁹³ See Hawkins v. Superior Court, 89 Cal. App. 3d 413, 419 (Cal. Ct. App. 1979) (holding that decedent husband had implied authority to agree for himself and heirs to arbitrate claims arising out of medical malpractice).

⁹⁴ See Weldon E. Havins & James Dalessio, Limiting the Scope of Arbitration Clauses in Medical Malpractice Disputes Arising in California, 28 Cap. U. L. Rev. 331, 334-36 (2000).

⁹⁵ See Moncharsh v. Heily & Blase, 832 P.2d. 899, 914 (Cal. 1992) (holding that the Legislature's silence reflects an intent to reject judicial review of arbitration awards).

⁹⁶ 938 P.2d. 903 (Cal. 1997).

⁹⁷ See id. at 965.

⁹⁸ See id. at 967.

⁹⁹ See id.

¹⁰⁰ See id.

¹⁰¹ See id. at 985-86.

¹⁰² Id. at 925.

¹⁰³ See The Blue Ribbon Advisory Panel of Kaiser Permanente Arbitration, The Kaiser Permanente Arbitrations System: A Review and Recommendations for Improvement (Jan. 5, 1998) (on file with authors); Agreement Creating the Office of Independent Administrator for the Kaiser Foundation Health Plan, Inc.: Mandatory Arbitration System for Disputes with Health Plan Members (Nov. 4, 1998) (on file with authors).

¹⁰⁴ See State Senate Panel Approves Bill Letting Plan Enrollees Opt Out of Arbitration, 7 Health L. Rep., Aug. 13, 1998, at 1283.

¹⁰⁵ See Gary T. Schwartz, Medical Malpractice, Tort, Contract and Managed Care, 1998 U. Ill. L. Rev. 885, 906(1998).

¹⁰⁶ See Mark A. Hall, A Theory of Economic Informed Consent, 31 GA. L. Rev. 511, 512 (1997).

¹⁰⁷ See Studdert and Brennan, supra note 13; Weiler supra note 30, at 922-25.

¹⁰⁸ See Bovbjerg et al., supra note 29, at 93.

¹⁰⁹ See, e.g., Thomas et al., supra note 16; David C. Classen et al., Adverse Drug Events in Hospitalized Patients: Excess Length of Stay, Extra Costs, and Attributable Mortality, 277 Jama 301 (1997); William G. Johnson, The Economic Consequences of Medical Injuries, 267 Jama 2487 (1992).

¹¹⁰ See Milt Freudenheim, Big Companies Lead Effort to Reduce Medical Errors, N. Y. Times, Nov. 16,2000, at C19.

¹¹¹ See, e.g., Joseph H. King, Jr., The Exclusiveness of an Employer's Workers' Compensation Remedy Against His Employer, 55 Tenn. L. Rev. 405 (1988) (arguing that for the exclusive remedy rule to fulfill its intended purpose, the scope of the rule as well as its exceptions should be clear and predictable); Paul C. Weiler, Workers' Compensation and Product Liability: The Interaction of a Tort and a Non-Tort Regime, 50 Ohio St. L.J. 825 (1989) (examining the pressures that have been placed on the exclusivity doctrine by the growing appeal of the tort system); Note, Exceptions to the Exclusive Remedy Requirements of Workers' Compensation Statutes, 96 Harv. L. Rev. 1641 (1983) (examines the workers' compensation system as a response to the problem of work-related accidents and evaluates the significance and merit of the emerging exceptions to the exclusive remedy rule).

¹¹² See Florida Birth Related Neurological Injury Compensation Act of 1988, Fla. Stat. Ann. §§ 766.301-.316 (West 1997); Virginia Birth-Related Neurological Injury Compensation Act,, VA. Code Ann. §§ 38.2-5000-5021 (Michie 2000) (creating a cause of action for birth-related neurological injuries). See generally Bovbjerg & Sloan, supra note 8, at 98-109; Tedcastle, Thomas R. & Dewar, Marvin A., Medical Malpractice: A New Treatment for an Old Illness, 16 Fla. St. U.L. Rev. 535, 595 (1988)Google Scholar; White, Peter H., Note, Innovative No-Fault Tort Reform for an Endangered Specialty, 74 Va. L. Rev. 1487, 1523-26(1998)Google Scholar.

¹¹³ See, e.g., Bovbjerg et al., supra note 29, Jill Horwitz & Troyen A. Brennan, No-Fault Compensation for Medical Injury: A Case Study, 14 Health Affairs, Winter 1995, at 164.

¹¹⁴ See Studdert et al, supra note 29, at 502.

¹¹⁵ See Bovbjerg et al., supra note 29, at 87 n.159.

¹¹⁶ Fla. Stat. Ann, § 766.303(2) (West 1997).

¹¹⁷ A “birth-related neurological injury” is defined as “injury to the brain or spinal cord of a live infant weighing at least 2,500 grams at birth caused by oxygen deprivation or mechanical injury occurring in the course of labor, delivery, or resuscitation in the immediate post delivery period in a hospital which renders the infant permanently and substantially mentally impaired.” Fla. Stat. Ann. § 766.302(2) (West 1997).

¹¹⁸ See Sloan et al., supra note 8, at 46-48, Studdert et al., supra note 29, at 521.

¹¹⁹ See Florida Birth-Related Neurological Injury Compensation Ass'n v. McKaughan, 668 So. 2d. 974,977(1996).

¹²⁰ See 1998 Fla. Laws ch. 113 (establishing the exclusive jurisdiction of administrative law judges of certain claims filed under Nica).

¹²¹ Weiler, supra note 111, at 825.

¹²² See, e.g., E. Blair & Fiona J. Stanley, Intrapartum Asphyxia: A Rare Cause of Cerebral Palsy, 112 J. Pediatrics 515 (1988); Karen B. Nelson & J.H. Ellenberg, Antecedents of Cerebral Palsy: Multivariate Analysis of Risk, 315 New Eng. J. Med. 315 (1986).

¹²³ See Richard A. Epstein, The Historical Origins and Economic Structure of Workers' Compensation Law, 16 Ga. L. Rev. 775, 797 (1982).

¹²⁴ See Jeffrey O'Connell & David Partlett, An America's Cup for Tort Reform? Australia and America Compared, 21 U. Mich. J.L. Reform 443, 448-450.

¹²⁵ Id. at 448.

¹²⁶ Id. at 449.

¹²⁷ Id. at 450.

¹²⁸ For accounts of general reforms, and the constitutional challenges they have faced, see for example, Manzer, Nancy L., 1986 Tort Reform Legislation: A Systematic Evaluation of Caps on Damages and Limitations on Joint and Several Liability, 73 Cornell L. Rev. 628, 647 (1988)Google Scholar; Redish, Martin H., Legislative Response to the Medical Malpractice Insurance Crisis: Constitutional Implications, 55 Tex. L. Rev. 759, 759-60 (1977)Google Scholar; Marco de Sa e Silva, Comment, Constitutional Challenges to Washington's Limit on Noneconomic Damages in Cases of Personal Injury and Death, 63 Wash. L. Rev. 653, 675 (1988;,- Richard C. Turrington, Constitutional Limitations on Tort Reform: Have the State Courts Placed Insurmountable Obstacles in the Path of Legislative Responses to the Perceived Liability Insurance Crisis?, 32 VlLl. L. Rev. 1299 (1987); Paul B. Weiss, Reforming Tort Reform: Is There Substance to the Seventh Amendment?, 38 Cath. U L. Rev. 737, 740-46 (1989); Note, Fein v. Permanente Medical Group: Future Trends in Damage Limitation Adjudication, 80 Nw. U.L. Rev. 1643, 1649 n.49 (1986).

¹²⁹ See, e.g., Victor E. Schwartz et al., Tort Reform Past, Present and Future: Solving Old Problems and Dealing with “New Style” Litigation, 27 Wm. Mitchell L. Rev. 237 (2000).

¹³⁰ 827P.2d. 531 (Colo. 1992).

¹³¹ See id. at 534, 537, 539, 541.

¹³² See id. at 534-35. The Court noted that Colorado was one of thirty-seven states that had established its own right of access guarantees in its state constitution.

¹³³ See id. at 538.

¹³⁴ See id. at 536-37.

¹³⁵ See id. at 537.

¹³⁶ See id. at 538.

¹³⁷ See id. at 540.

¹³⁸ See id.

¹³⁹ See Weiler supra note 1, at 114-58.

¹⁴⁰ See Gary T. Schwartz, The Beginning and the Possible End of the Rise of Modern American Tort Law, 26 Ga. L. Rev. 601 n.435 (1992).

¹⁴¹ See Bovbjerg, supra note 2, at 500-04.

¹⁴² 507 So. 2d. 1080 (1987).

¹⁴³ See University of Miami v. Echarte, 618 So. 2d 189, 197-98 (Fla. 1993).

¹⁴⁴ See id. at 195, citing Kluger v. White, 281 So. 2d 1,4 (Fla. 1993).

¹⁴⁵ See id. at 194.

¹⁴⁶ Id. at 198.

¹⁴⁷ Id.

¹⁴⁸ See, e.g., Arneson v. Olson, 270 N.W.2d 125, (N.D. 1978) (finding a $300,000 medical negligence cap violates the equal protection clauses of both the North Dakota and United States Constitutions); Lucas v. U.S., 757 S.W. 2d. 687 (Tex. 1988) (holding that a $500,000 cap on medical malpractice damages violates right to remedy end jury trial); Morris v. Savoy, 576 N.E. 2d. 765, (Ohio 1991) (finding a $200,000 cap on non-economic damages violates due process); Sofie v. Fibreboard Corp., 771 P.2d. 711 (Wash. 1991) (holding Washington's limits on non-economic damages violates the right to jury trial).

¹⁴⁹ No. 90-196 (S.D. 1” Cir. July 23, 1992).

¹⁵⁰ See id. at 8. See also Gail Eiseland, Miller v. Gilmore: The Constitutionality of South Dakota's Medical Malpractice Statute of Limitations, 38 S.D. L. Rev. 672, 674 (1993) (arguing that deference should not be granted a legislative enactment that locks the courthouse door to a medical malpractice claim before that claim has even arisen).

¹⁵¹ 151878 S.W. 2d. 105 (Tenn. 1994), cert, denied, 513 U.S. 869 (1994).

¹⁵² See id. at 107.

¹⁵³ See id.

¹⁵⁴ See id.

¹⁵⁵ See id. at 109.

¹⁵⁶ See DiFilippo v. Beck, 520 F. Supp. 1009, 1014-16 (Del. 1981); Johnson v. St. Vincent Hospital, Inc., 404 N.E.2d. 585, 602-603 (Ind. 1980); Roa v. Lodi Med. Group, Inc. 695 P.2d. 164, 170-71 (Cal. 1985) cert, dismissed, 474 U.S. 990 (1985).

¹⁵⁷ See Carson v. Maurer, 424 A.2d. 825, 834 (N.H. 1980).

¹⁵⁸ Consider, for example, McGibony v. Florida Birth-Related Neurological Injury Compensation Plan, 564 So. 2d. 177, 179 (1990), cert, denied, 506 U.S. 867 (1992), in which the Florida Supreme Court reviewed the constitutional validity of the physician charges levied by Florida's Nica scheme. The plaintiffs, physicians who did not deliver obstetrical services, argued that the charges violated equal protection and due process guarantees because they singled out physicians, who derived no greater benefit from the program than other members of the public. The court refused to find that they were a suspect class and noted a rational basis for the program, including its financing structure. See id. Florida Birth Related Neurological Injury Compensation Ass 'n v. Karrais, 633 So. 2d. 1103, 1107 (Fla. Dist. Ct. App. 1994), considered attorney compensation under the Nica scheme, which is based on an objective amount reasonably expended by local lawyers, and is reviewable. The Court held the fee should be determined using an hourly billing rate, not a prevailing contingent fee. Again, no specific constitutional impediment was found. See id.

¹⁵⁹ The estimates also included full compensation for a predicted proportion of claimants lacking health insurance. See Studdert et al., supra note 15, at 21.

¹⁶⁰ See id. at 26.

¹⁶¹ See, e.g., Epstein, Richard A., The Federalist Society: Conference: Civil Justice and the Litigation Process: Do the Merits and the Search for Truth Matter Anymore?: Conference Dialogue: Day One: Panel Three: Insurance and the Litigation Process: Subrogation and Insurance, with Special Reference to the Tobacco Litigation, 41 N.Y.L. Sch. L. Rev. 493, 497 (1997)Google Scholar.

¹⁶² Michael S. Quinn, Subrogation, Restitution, and Indemnity, 74 Tex. L. Rev. 1361, 1361 (1996) (reviewing Charles Mitchell, the Law of Subrogation (1994)).

¹⁶³ Black'S Law Dictionary 1427 (6th ed. 1990).

¹⁶⁴ See Roger M. Baron, Subrogation: A Pandora's Box Awaiting Closure, 41 S.D. L. Rev. 237, 238 (1996). See also National Union Fire Ins. Co. v. Cna Ins. Co., 28 F.3d 29, 31, n.2 (5th Cir. 1994).

¹⁶⁵ See Keith E. Edeus, Jr., Subrogation of Personal Injury Claims: Toward Ending an Inequitable Practice, 17 N. 111. U. L. Rev. 509, 512 n.15 (1997). See generally Robert E. Keeton & Alan I. Widiss, Insurance Law § 3.10 (student ed. 1983) (describing types of subrogation).

¹⁶⁶ See Jeffrey A. Greenblatt, Insurance and Subrogation: When the Pie Isn 't Big Enough, Who Eats Last?, 64 U. Chi. L. Rev. 1337, 1339-40 (1997); Baron supra note 164, at 238.

¹⁶⁷ See Baron, supra note 164, at 239.

¹⁶⁸ See id. at 237-40.

¹⁶⁹ See, e.g., DeCespedes v Prudence Mutual Casualty Co., 193 So. 2d 224, 227 (Fla. Dist. Ct. App. 1996); Western Casualty and Surety Co. v. Bowling, 565 P.2d 970, 971 (Colo. Ct. App. 1977). See also Greenblatt, supra note 166, at 1341; Richard L. Jasperson, Medical Benefits Subrogation: Coming of Age in the 1990's, The Bench & Bar of Minn., Feb. 1990, at 25, 25-30 (outlining the law and practical considerations faced by individuals with medical benefits subrogation claims).

¹⁷⁰ See Baron, supra note 164, at 239.

¹⁷¹ See Jasperson, supra note 169, at 28.

¹⁷² See Keeton & Wmiss, supra note 165, at § 3.10(a)(7). See also Peller v. Liberty Mutual Fire Ins. Co., 34 Cal. Rptr. 41, 42-43 (Cal. Ct. App. 1963); State Farm Fire & Casualty Co. v. Knapp, 484 P.2d 180, 181 (Ariz. 1971); Travelers Indemnity Co. v. Chumbley, 394 S.W.2d 418, 425 (Mo. Ct. App. 1965).

¹⁷³ For examples of cases that have enforced subrogation clauses in insurance policies to permit recovery of medical expenses, see Sentry Ins. Co. v. Stuart, 439 S.W.2d 797, 801 (Ark. 1969); Smith v. Travelers Ins. Co., 362 N.E.2d 264, 266 (Ohio 1977); Travelers Indemnity Co. v. Vaccari, 245 N.W.2d 844, 846 (Minn. 1976).

¹⁷⁴ According to the “made whole” doctrine, subrogation is permitted only after the insured has been fully compensated. This limitation on action by the subrogee acknowledges that a foundational rationale for subrogation is to prevent double recovery by the insured, not impede full recovery. See Greenblatt, supra note 166, at 1342.

¹⁷⁵ See 29 U.S.C. § 1002(1) (1994). For overviews of Erisa's operation in the health care arena see for example, Mary Ann Chirba-Martin & Troyen A. Brennan, The Critical Role of Erisa in State Health Reform, 13 Health Affairs, Spring 1994, at 142; Wendy K. Mariner, State Regulation of Managed Care and the Employee Retirement Income Security Act, 335 Neweng. J. Med. 1986 (1996).

¹⁷⁶ See D. Brian Boggess, Erisa's Silent Pre-emption of State Employee Welfare Benefit Laws: The Perils of Relying Upon the Road Less Traveled, Det. Col. L. Rev. 745, 747, 753 (1992); David Gregory, 77ie Scope of Erisa Preemption of State Law: A Study in Effective Federalism, 48 U. Pitt. L. Rev. 427,428-32, 457, 70 (1987).

¹⁷⁷ See Pilot Life Ins. Co. v. Dedeaux, 481 U.S. 41, 56 (1987) (finding that courts are to develop a “federal common law of rights and obligations under Erisa-regulated plans”).

¹⁷⁸ See Robert L. Bennefield, Current Population Reports: Health Insurance Coverage: 1997, (Sept. 1998), available at http://www.census.gOv/prod/3/98pubs/p60-202.pdf.

¹⁷⁹ Note, however, that approximately 60 percent of these individuals are “insured” plans, which are primarily subject to state insurance regulation. See U.S. General Accounting Office, Employer-Based Health Plans: Issues, Trends, and Challenges Posed by Erisa 2 (1995).

¹⁸⁰ 498 U.S. 52(1990).

¹⁸¹ See id. at 54.

¹⁸² Section 1720 of Pennsylvania's Motor Vehicle Responsibility Law provides, “In actions arising out of the maintenance or use of a motor vehicle, there shall be no right of subrogation or reimbursement from a claimant's tort recovery with respect to … benefits paid or payable … under section 1719.” 75 Pa. Cons. Stat. § 1720 (2000). Section 1719(a) provides, “Except for workers' compensation, a policy of insurance issued or delivered pursuant to this subchapter shall be primary. Any program, group contract or other arrangement for payment of benefits … shall be construed to contain a provision that all benefits provided therein shall be in excess of and not in duplication of any valid and collectible first party benefits. 75 Pa. Cons. Stat. § 1719(a) (2000).

¹⁸³ See Fmc Corporation, 498 U.S. at 58.

¹⁸⁴ See id.

¹⁸⁵ Id. at 61 (emphasis added). Consequently, the Court concluded that the statute “does not merely have an impact on the insurance industry; it is aimed at it.” Id.

¹⁸⁶ On the other hand, the Court did observe that the anti-subrogation statute would apply to a regulated commercial insurer servicing an employee benefit plan. See id. at 65.

¹⁸⁷ Id. at 60; see also Alessi v. Raybestos-Manhattan, Inc., 451 U.S. 504, 523 (1981) (discussing Congress' intention to establish pension plan regulation as exclusively a federal concern).

¹⁸⁸ 514 U.S. 645(1995).

¹⁸⁹ See M. at 658.

¹⁹⁰ See Zelinksy, Edward A., Travelers, Reasoned Textualism and the New Jurisprudence of Erisa Preemption, 21 Cardozo L. Rev. 807, 834-39 (1999)Google Scholar (finding Travelers to provide an unsatisfactory formulation of Erisa preemption); William M. Acker, Jr., Can the Courts Rescue Erisa?, 29 Cumb. L. Rev. 285, 292 (1998-1999) (noting that Travelers has been interpreted differently by the Eighth and Ninth Circuits).

¹⁹¹ See John R. Ceila, Jr., The Pursuit of Proceeds by Plans, Participants and Plaintiffs Lawyers: Dissonant Solutions to an Alliterative Problem, 22 Campbell L. Rev. 317 (2000) (examining the process through which injured persons, tortfeasors, and employee welfare benefit plans battle over subrogation and reimbursement).

¹⁹² No. 99-1558, 2000 U.S. App. Lexis 6883 (4th Cir. Apr. 17, 2000).

¹⁹³ See id. at *6.

¹⁹⁴ Id. at *11.

¹⁹⁵ No. 97-4390, 1999 U.S. App. Lexis 1195 (6th Cir. Jan. 22, 1999).

¹⁹⁶ See id. at *8. See also Marshall v. Employees Health Ins. Co., Nos. 96-6063, 96-6112, 1997 U.S. App. Lexis 36769, *2-17 (6th Cir. Dec. 30, 1997). For a discussion of similar issues in the context of attorney fees, see generally Amber A. Anstine, Erisa Qualified Subrogation Liens: Should They Be Reduced to Reflect a Pro Rata Share of Attorney Fees?, 104 Dick. L. Rev. 359 (2000) (arguing that the federal courts should create and adopt a uniform federal common law requiring a reduction in subrogation liens covering attorney's fees).

¹⁹⁷ See. e.g., Tyson Foods, Inc. v. Williams, 858 F. Supp. 907, 912 (D. Ark. 1994); Hamilton V. Pilgrim's Pride Employee Group Health Plan, 37 F. Supp.2d 817, 824-25 (Tex. 1998). But see Trustees of Hotel Employees and Rest. Employees Int'I Union Welfare Fund v Kirby, 890 F Supp 939, 943-45 (Nev. 1995).

¹⁹⁸ No. 99-3988, 2001 U.S. App. Lexis 4895 (6th Cir. Mar. 27, 2001).

¹⁹⁹ See id. at *4.

²⁰⁰ See id.

²⁰¹ See id. at *5.

²⁰² See id.

²⁰³ See id. at *3.

²⁰⁴ See id. at*23.

²⁰⁵ The applicable law was section 3333.1(b) of the California Civil Code, an anti-subrogation provision. This provision, part of the Micra legislation, was intended to limit recoveries against physicians and hospitals by permitting evidence of collateral sources, as well as limiting the subrogation rights of these collateral sources. See id at * 18-19.

²⁰⁶ The court stated, “First, section 3333.1 has the effect of transferring or spreading risk….Second, it is an integral part of the policy relationship between the insurer and the insured…. Finally, section 3333.1 is limited to the insurance industry.… Accordingly, section 3333.1 is not preempted by Erisa and governs the disposition of this case.” See id. at *32-34.

²⁰⁷ For an exposition of the three relevant criteria under the McCarran-Ferguson Act used to make this determination, see Metropolitan Life Ins. Co. v. Massachusetts, 471 U.S. 724, 743 (1985).

²⁰⁸ See Unum Life Ins. of America v. Ward, 526 U.S. 358, 373 (1999) (stating that all three factors in the test need not be present).

²⁰⁹ See Devon P. Groves, Erisa Waivers and State Health Care Reform, 28 Colum. J.L. & Soc. Probs. 609, 630-35 (1995).

²¹⁰ See id. at 630-36.

²¹¹ 42 U.S.C. § 1395(y)(b)(5) (2000). For regulations made pursuant to this law, see 42 Cfr § 411 (2000).

²¹² See, e.g., St. Agnes Hosp. v. Jaeckel, 616 F. Supp. 426,428 (D. Wis. 1985).

²¹³ See Colonial Penn Ins. Comp. v. Heckler, 721 F.2d 431, 433-34 (3rd Cir. 1983); Rybicki v. Hartley, 792 F.2d. 260, 262-63 (1st Cir. 1986).

²¹⁴ See Abrams v. Heckler, 582 F. Supp. 1155, 1165 (S.D.N.Y. 1984).

²¹⁵ See Health Care Financing Authority, Medicare Secondary Payer, at http://www.hcfa.gov/medicare/cob/employers/emp_msp.htm (last modified Sept. 11, 2000). See also, Scott J. David, Better Msp Process May Boost Payments, Healthcare Fin. Mgmt., Aug. 1991, at 48-60 (discussing problems with recovering payments under the secondary payer program).

²¹⁶ See David, supra note 215, at 55.

²¹⁷ See. e.g., Roberts v. Total Health Care, Inc., 709 A.2d 142, 147-49 (Md. App. 1998); Arkansas Dept. of Human Servs. v. Estate of Ferrell, 984 S.W.2d 807, 811 (Ark. 1999).

²¹⁸ private communication with Lynn Dickinson, Executive Director of Nica, (Feb. 2, 1998). In Virginia, an attorney general's opinion supported payment by Medicaid ahead of the no-fault scheme. See also Bovbjerg & Sloan, supra note 8, at 93.