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Physician Responses to the Malpractice Crisis: From Defense to Offense

Published online by Cambridge University Press:  01 January 2021

Extract

Medical science brings innovations in patient care at an astounding pace today - new chemotherapeutic agents, coated stents, and minimally invasive surgery are just few recent examples. For physicians, though, the specter of malpractice liability can overshadow the marvel of practicing in this era. Many physicians are working in a volatile liability environment; they face spiraling costs for malpractice insurance, have difficulties purchasing liability coverage at any price, and see record payouts in a growing number of claims against their colleagues. The American Medical Association (AMA) has declared that at least 20 states are currently in a malpractice “crisis,” with another 24 states showing early signs of an impending crisis.

There have been two comparable periods of instability in the last thirty years, but these predecessor crises differ from the current one in important ways. First, while physicians mainly experienced dwindling options for obtaining coverage in the mid-1970s (i.e., availability) and exorbitant prices in the mid-1980s (i.e., affordability), the current crisis appears to have elements of both availability and affordability.

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Article
Copyright
Copyright © American Society of Law, Medicine and Ethics 2005

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References

Studdert, D. M. Mello, M. M. Brennan, T. A., “Medical Malpractice,” N. Engl. J. Med. 350, no. 3 (2004): 283292.CrossRefGoogle Scholar
AMA: Medical Liability Reform, at <http://www.ama-assn.org/ama/pub/category/9255.html> (last visited May 27, 2005).+(last+visited+May+27,+2005).>Google Scholar
Mohr, J. C., “American Medical Malpractice Litigation in Historical Perspective,” JAMA 283, no. 13 (2000): 17311737.CrossRefGoogle Scholar
See Studdert, , supra note 1; Thorpe, K. E., The Medical Malpractice “Crisis”: Recent Trends and the Impact of State Tort Reforms, January 21, 2004, at <http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.20vl> (last visited May 26, 2005).CrossRef+(last+visited+May+26,+2005).>Google Scholar
See Studdert, , supra note 1.Google Scholar
Zuger, A., “Dissatisfaction with Medical Practice,” N. Engl. J. Med. 350, no. 1 (2004): 6975; Mello, M. M. Studdert, D. M. DesRoches, C. M. et al., “Caring for Patients in a Malpractice Crisis: Physician Satisfaction and Quality of Care,” Health Affairs 23, no. 4 (2004): 42–53.CrossRefGoogle Scholar
Page Keeton, W. et al., Prosser and Keeton on The Law of Torts (St. Paul, MN: West Publishing Company, 1984); Kessler, D. P. McClellan, M. B., “Medical Malpractice: External Influences and Controls: The Effects of Malpractice Pressure and Liability Reforms on Physicians’ Perceptions of Medical Care,” Journal of Law and Contemporary Problems 60 (1997): 81–106.Google Scholar
Brennan, T. A. Leape, L. L. Laird, N. M. et al., “Incidence of Adverse Events and Negligence in Hospitalized Patients: Results of the Harvard Medical Practice Study I,” N. Engl. J. Med. 324, no. 6 (1991): 370376; Thomas, E. J. Studdert, D. M. Burstin, H. R. et al., “Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado,” Medical Care 38, no. 3 (2000): 261–271; Localio, A. R. Lawthers, A. G. Brennan, T. A. et al., “Relation Between Malpractice Claims and Adverse Events Due to Negligence: Results of the Harvard Medical Practice Study III,” N. Engl. J. Med. 325, no. 4 (1991): 245–251.CrossRefGoogle Scholar
Lawthers, A. G. Localio, A. R. Laird, N. M. Lipsitz, S. Hebert, L. Brennan, T. A., “Physicians' Perceptions of the Risk of Being Sued,” Journal of Health, Politics, and Policy Law 17, no. 3 (1992): 463482.CrossRefGoogle Scholar
See Localio, , supra note 8; Brennan, T. A. Sox, C. M. Burstin, H. R., “Relation Between Negligent Adverse Events and the Outcomes of Medical-Malpractice Litigation,” N. Engl. J. Med. 335, no. 26 (1996): 19631967.Google Scholar
Mello, M. M. Brennan, T. A., “What We Know and Do Not Know About the Impact of Civil Justice on the American Economy and Policy: Deterrence of Medical Errors: Theory and Evidence for Malpractice Reform,” Texas Law Review 80 (2002): 15951637.Google Scholar
Danzon, P. M. Pauly, M. V. Kington, R. S., “The Effects of Malpractice Litigation on Physicians' Fees and Incomes,” American Economic Review 80 (1990): 122127; Gunnar, W. P., “Is There an Acceptable Answer to Rising Malpractice Premiums?” Annals of Health Law 13 (2004): 465–500.Google Scholar
Kletke, P. R. Emmons, D. W. Gillis, K. D., “Current Trends in Physicians’ Practice Arrangements: From Owners to Employees,” JAMA 276, no. 7 (1996): 555560.CrossRefGoogle Scholar
See Mello, , supra note 6; Charles, S. C., “Malpractice Suits: Their Effect on Physicians, Patients, and Families,” Journal of the Medical Association of Georgia 76 (1987): 171172; Charles, S. C. Wilbert, J. R. Franke, K. J., “Sued and Nonsued Physicians’ Self-Reported Reactions to Malpractice Litigation? American Journal of Psychiatry 142, no. 4 (1985): 437–440.Google Scholar
See Mohr, , supra note 3.Google Scholar
DeVille, K. A., Medical Malpractice in Nineteenth-Century America: Origins and Legacy (New York: New York University Press, 1990).Google Scholar
See AMA, supra note 2.Google Scholar
See Studdert, supra note 1.Google Scholar
See Studdert, supra note 1; See Thorpe, , supra note 4; Lauter, D., “Controlling Malpractice Recovery; 9 States Set Limits; 21 Others Have Strict Procedures,” National Law Journal, August 15, 1983, at 10; Glassman, A. D., “The Imposition of Federal Caps in Medical Malpractice Liability Actions: Will They Cure the Current Crisis in Health Care?” Akron Law Review 37 (2004): 417468.Google Scholar
Studdert, D. M. Yang, Y. T. Mello, M. M., “Are Damages Caps Regressive? A Study of Malpractice Jury Verdicts in California,” Health Affairs 23, no. 4 (2004): 5467.CrossRefGoogle Scholar
See Studdert, supra note 20.Google Scholar
See Gunnar, supra note 12; See Glassman, supra note 19.Google Scholar
Studdert, D. M. Mello, M. M. Sage, W. M. et al., “Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Crisis,” JAMA 293, no. 21 (2005): 26092617CrossRefGoogle Scholar
See Studdert, , supra note 23.Google Scholar
Bush, G. W., “Ensuring Access to Health Care: The Bush Plan,” JAMA 292, no. 16 (2004): 20102011.CrossRefGoogle Scholar
Liability Survey: OB/Gyns Quitting Obstetrics, at <http://www.ama-assn.org/ama/pub/article/9255–8713.html> (last visited May 26, 2005); Austin, M., “Malpractice Insurance Rates Send Doctors Fleeing to Colorado.” Denver Post, March 4, 2004, at A1; Maguire, P., “As the Malpractice Crisis Enters Year Two, Doctors and Insurers Flee Some Markets,” ACP-ASIM Observer, April, 2002; Worland, G., “Doctors Flee Insurance Costs, State; Saying Malpractice Insurance Premiums Have Soared, They Relocate to Wisconsin or Indiana,” Chicago Tribune, March 12, 2004, at C1.+(last+visited+May+26,+2005);+Austin,+M.,+“Malpractice+Insurance+Rates+Send+Doctors+Fleeing+to+Colorado.”+Denver+Post,+March+4,+2004,+at+A1;+Maguire,+P.,+“As+the+Malpractice+Crisis+Enters+Year+Two,+Doctors+and+Insurers+Flee+Some+Markets,”+ACP-ASIM+Observer,+April,+2002;+Worland,+G.,+“Doctors+Flee+Insurance+Costs,+State;+Saying+Malpractice+Insurance+Premiums+Have+Soared,+They+Relocate+to+Wisconsin+or+Indiana,”+Chicago+Tribune,+March+12,+2004,+at+C1.>Google Scholar
National Physician Survey on Professional Medical Liability, at <http://www.ama-assn.org/ama/pub/category/7800.html> (last visited May 26, 2005).+(last+visited+May+26,+2005).>Google Scholar
Stein, R., “Increase in Physician's Insurance Hurts Care; Services are Being Pared, and Clinics are Closing,” Washington Post, January 5, 2003, at A1; Cole, B., “When Doctors Start Leaving Town; A City Decides to Take Extraordinary Steps to Regulate Medical Malpractice Suits by Enacting Caps on Non-Economic Damages,” Chicago Tribune, July 13, 2004, at C19.Google Scholar
General Accounting Office, Medical Malpractice: Implications of Rising Premiums on Access to Health Care, Washington, D.C. 2003. GAO-03-836.Google Scholar
See General Accounting Office, supra note 29.Google Scholar
Brooks, R. G. Menachemi, N. Hughes, C. Clawson, A., “Impact of the Medical Professional Liability Insurance Crisis on Access to Care in Florida,” Archives of Internal Medicine 164, no. 20 (2004): 22172222.CrossRefGoogle Scholar
Pennachio, D., “The Target of a ‘Shotgun’ Suit Fires Back,” Medical Economics 80, no. 7 (2003): 43; Silverman, R. E., “Doctors Take the Offensive,” Wall Street Journal, March 23, 2004, at D3; Sokol, D. J., “The Current Status of Medical Malpractice Countersuits,” American Journal of Law & Medicine 10 (1985): 439–457; Silverman, J., “Physicians Fight Against ‘Frivolous’ Lawsuits: Will It Hurt Doctor-Patient Relationship,” Family Practice News, May 15, 2004, at 72.Google Scholar
See Silverman, R. E. supra note 32; See Silverman, J. supra note 32.Google Scholar
See Keeton, , supra note 7; Raine v. Drasin, 621 S.W.2d 895 (KY, 1981); See Sokol, , supra note 32.Google Scholar
See Sokol, , supra note 32.Google Scholar
See Keeton, , supra note 7; See Sokol, , supra note 32.Google Scholar
See Keeton, , supra note 7; See Sokol, , supra note 32.Google Scholar
“One Doctor's Tort Reform: Stop Caring for Lawyers,” Modern Healthcare (2004): 36.Google Scholar
Rovner, J., “Election Day Approaches and Both Candidates Focus on Health Care,” National Public Radio (NPR), October 22, 2004.Google Scholar
Doctors for Medical Liability Reform, at <http://www.protect-patientsnow.org> (last visited May 26, 2005).+(last+visited+May+26,+2005).>Google Scholar
Fryer, A., “Doctors Group Targets State in Fight Over Malpractice Insurance Rates,” Seattle Times, February 23, 2004, at B1.Google Scholar
See Mohr, , supra note 3; Dixon, M. G., “‘Going Bare’ May Be Hazardous to Your Fiscal Health,” Journal of Legal Medicine 4, no. 10 (1976): 2324.Google Scholar
Ramos, M. R., “Legal Malpractice: The Profession's Dirty Little Secret,” Vanderbilt Law Review 47 (1994): 16571734.Google Scholar
Lewin, T., “The Liability Insurance Spiral,” New York Times, March 8, 1986, at 35.Google Scholar
See Dixon, , supra note 44; Constantine, R. P. Jr. Tinnon, S. E., “The Bare Facts About Going Naked,” Journal of the Medical Association of Georgia 75, no. 11 (1986): 680682.Google Scholar
Borfitz, D., “Malpractice: Is Going Bare the Only Option?” Medical Economics 80, no. 6 (2003): 9798, 104106; Page, L., “Indecent Exposure; Physicians Throw Caution to the Wind as Malpractice Premiums Skyrocket,” Modern Physician April 1, 2002, at 3.Google Scholar
MSNBC News: Doctors Going Without Malpractice Insurance. Physicians Fed Up With Skyrocketing Premiums, at <http://www.msnbc.msn.com/id/5234637/> (last visited May 26, 2005).+(last+visited+May+26,+2005).>Google Scholar
Johnson, L. J., “Go Bankrupt? Go Bare? Malpractice Consult,” Medical Economics 80, no. 11 (2003): 106.Google Scholar
Chin, A. Peterson, M. A., Deep Pockets, Empty Pockets: Who Wins in Cook County Jury Trials (RAND, 1985): R-3249; Rustad, M., “The Incidence, Scope, and Purpose of Punitive Damages: Unraveling Punitive Damages, Current Data and Further Inquiry” Wisconsin Law Review 1 (1998): 15–68.Google Scholar
Lowes, R., “Protect Your Assets Before You’re Sued,” Medical Economics 80, no. 4 (2003): 8286.Google Scholar
See Borfitz, , supra note 48.Google Scholar
Goldenberg v. Sawczak, 791 So. 2d 1078 (FL, 2001); Fla. Stat. § 458.320 (2004).Google Scholar
Silverman, R. E., “So Sue Me: Doctors Without Insurance,” Wall Street Journal, January 28, 2004, at D1; Cline, R. E. Pepine, C. J., “Medical Malpractice Crisis: Florida's Recent Experience,” Circulation 109, no. 24 (2004): 29362938.Google Scholar
Dorschner, J., “Doctor: Bills Could Be a ‘Death Blow,’” Miami Herald, April 1, 2005, at <http://www.miami.com/mld/miamiherald/business/11282273.htm>..>Google Scholar
Mehlman, M. J., “Fiduciary Contracting: Limitations on Bargaining Between Patients and Health Care Providers,” University of Pittsburgh Law Review 51 (1990): 365417.Google Scholar
See Keeton, , supra note 7.Google Scholar
See Mohr, , supra note 3.Google Scholar
See Goldenberg, , supra note 56.Google Scholar
Spencer, J., “Signing Away Your Right to Sue,” Wall Street Journal, October 1, 2003, at DI; Carlson, B., “First Business, Now Health Care: Signing Away One's Right to Sue,” Managed Care 11, no. 6 (2002): 2831, 35.Google Scholar
Sternlight, J. R., “The Rise and Spread of Mandatory Arbitration as a Substitution for the Jury Trial,” University of San Francisco Law Review 38 (2003): 1738.Google Scholar
Galle, K. K., “The Appearance of Impropriety: Making Agreements to Arbitrate in Health Care Contacts More Palatable,” William Mitchell Law Review 30 (2004): 969999.Google Scholar
See Carlson, , supra note 65.Google Scholar
General Accounting Office, Medical Malpractice: Alternatives of Litigation (Washington, D.C. 1992). GAO/HRD-92-28. Cal. Civ. Proc. Code § 1295 (2004); NY. Pub. Health Law § 4406-a (Consol 2004).Google Scholar
Engalla v. Permanente Medical Group, 938 P.2d 903 (CA, 1997); Buraczynski v. Eyring, 919 S.W.2d 314 (TN. 1996).Google Scholar
See Buraczynski, , supra note 70.Google Scholar
See Broemmer v. Abortion Services of Phoenix Ltd., 840 P.2d 1013 (AZ, 1992); William F. Robinson, M.D. Ltd. v. Pepper, 693 P.2d 1259 (NV, 1985); Beynon v. Garden Grove Medical Group, 161 Cal.Rptr. 146 (Cal. App. 1980); Leong v. Kaiser Foundation Hospital, 788 P.2d 164 (HI, 1990).Google Scholar
See Engalla, supra note 70.Google Scholar
See Silverman, supra note 32.Google Scholar
Schutkowski v. Carey, 725 P.2d 1057 (WY, 1986).Google Scholar
Havighurst, C. C., Health Care Choices: Private Contracts as Instruments of Health Reform (Washington, DC: AEI Press, 1995); Ash v. New York University Dental Center, 164 A.D.2d 366 (NY, 1990); Olson v. Molzen, 558 S.W.2d 429 (TN, 1977); Cudnik v. William Beaumont Hospital, 207 N.W.2d 378 (MI. Ct. App. 1994).Google Scholar
See Mehlman, , supra note 61.Google Scholar
“New Jersey Doctors Hold Back Services In Insurance Protest,” New York Times, February 4, 2003, at A2.Google Scholar
Frangos, A., “The Doctor is Out… On Strike,” Wall Street Journal, May 8, 2003, at D1.Google Scholar
Miller, A. C., “Surgeons in W.Va. Strike Over Costs of Malpractice,” Los Angeles Times, January 2, 2003, at 1.Google Scholar
Baer, N., “Despite Some PR Fallout, Proponents Say MD walkouts Increase Awareness and May Improve Health Care,” Canadian Medical Association Journal 157, no. 9 (1997): 12681271; Turone, F., “Italian Doctors Strike Over Threat to Break Up State Health Service,” British Medical Journal 328, no. 7446 (2004): 976; Dorozynski, A., “French Healthcare System Beset by Strikes,” British Medical Journal 324, no. 7332 (2002): 258c.Google Scholar
Anawis, M., “The Ethics of Physician Unionization: What Will Happen if Your Doctor Becomes a Teamster,” DePaul Journal of Health Care Law 6 (2002): 83110; American College of Physicians-American Society of Internal Medicine, “Physicians and Joint Negotiations,” Annals of Internal Medicine 134 (2001): 787–792.Google Scholar
See Baer, , supra note 81; Fiester, A., “Physicians and Strikes: Can a Walkout over the Malpractice Crisis be Ethically Justified?” American Journal of Bioethics 4, no. 1 (2004): 1216.Google Scholar
Goldman, J. J., “N. J. Doctors Stage Walkout; Supporters Rally as Thousands of Physicians Stop Treating All But Emergency Cases to Protest Soaring Rates for Malpractice,” Los Angeles Times, February 4, 2003, at 10; Newman, M., “New Jersey Doctors Find Unity in Fight to Limit Malpractice Awards,” New York Times, February 1, 2003, at B1.Google Scholar
Jaspen, B., “Healthy Staffing Seen During Protest; Hospitals Say They’re Ready for Malpractice Strike,” Chicago Tribune, February 25, 2003, at N2.Google Scholar
Miller, A. C., “Surgeons in W.Va. Strike Over Costs of Malpractice,” Los Angeles Times, January 2, 2003, at 1.Google Scholar
New Jersey Division of Consumer Affairs: Medical Malpractice Liability Insurance Premium Assistance Fund (MMLIPA), at <http://www.njconsumeraffairs.gov/mmlipa.htm> (last visited May 26, 2005); Salganik, W., “Doctors Seek Showdown on Malpractice,” Baltimore Sun, December 26, 2004, at 1A.+(last+visited+May+26,+2005);+Salganik,+W.,+“Doctors+Seek+Showdown+on+Malpractice,”+Baltimore+Sun,+December+26,+2004,+at+1A.>Google Scholar
Andrews, M., “Making Malpractice Harder to Prove,” New York Times, December 21, 2003, at 8.Google Scholar
Grow, B., “Expert Witnesses Under Examinations,” Chicago Tribune, July 20, 2003, at C1; Liptak, A., “Doctor's Testimony Lead to a Complex Legal Fight,” New York Times, June 20, 2004, at 18.Google Scholar
Austin v. Am.Ass’n of Neurological Surgs, 253 F.3d 967, 972 (7th Cir. 2001).Google Scholar
Rice, B., “Malpractice: Who Should Judge the Experts?” Medical Economics 81, issue 20 (2004): 2128.Google Scholar
Medical Justice: Benefits of Membership, at <http://www.medicaljustice.com/carrier-insurance-malpractice.asp> (last visited May 26, 2005).+(last+visited+May+26,+2005).>Google Scholar
See Pennsylvania Medical Society: Society's Projects to Deter Frivolous Lawsuits, Disreputable Expert Witnesses, supra note 34.Google Scholar
See Grow, , supra note 90.Google Scholar
Romano, M., “Paying the Price; Practices Consider Surcharges to Combat High Cost of Malpractice Insurance,” Modern Healthcare, June 28, 2004, at 18; Salzman, A., “Pushing Insurance Reform with a $500 Surcharge,” New York Times, May 22, 2004, at B5; Boodman, S., “Insuring Controversy; When Malpractice Premiums Jump, Some Docs Ask Patients to ‘Donate’ to the Cause,” Washington Post, September 21, 2004, at F1.Google Scholar
See Romano, , supra note 96; See Salzman, , supra note 96.Google Scholar
Costello, D., “Asking Patients to Help Shoulder Malpractice Costs; Some Doctors are Adding Fees to Help Defray the High Price of Insurance. Others Call the Practice and Undue Burden on the Poor,” Los Angeles Times, October 25, 2004, at 1; Brook, R. Ware, J. Rogers, W. et al., “Does Free Care Improve Adults’ Health? Results From a Randomized Controlled Trial,” N. Engl. J. Med 309, no. 23 (1983): 14261434; J. P. Newhouse and the Insurance Experiment Group, Free for All? Lessons from the RAND Health Insurance Experiment (Cambridge, MA: Harvard University Press, 1993); Newhouse, J. P., “Consumer-Directed Health Plans and the RAND Health Insurance Experiment,” Health Affairs 23, no. 6 (2004: 107–113.Google Scholar
See Costello, , supra note 98.Google Scholar
See Romano, , supra note 96.Google Scholar
Blumenthal, R., “In Texas, Hire a Lawyer, Forget About a Doctor?” New York Times, March 5, 2004, at A12; Silverman, R. E., “Database for Doctors Tracks Litigious Patients,” Wall Street Journal, March 5, 2004, at A10.Google Scholar
Blumenthal, R., “Texas Company Removes Web List of Malpractice Plaintiffs,” New York Times, March 11, 2004, at A14.Google Scholar