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Ralph Nader > In the Public Interest > Medical Malpractice

A curious paradox is playing in the area of medical incompetence. More reports are documenting the growing scope of medical malpractice and its patient casualties, while more medical associations are lobbying state legislatures to make it more difficult for patients to take doctors who harmed them to court and win an adequate award.

Hovering like birds of prey above the battlefields are the insurance companies whose gouging premiums are driving physicians to demand restrictions on victims’ rights.

The growing complexity of medical diagnosis, equipment and treatment has meant that more mistakes can be made by physicians. The Wall Street Journal headlined a page one story last month with the words: “How Medical Advances Often Worsen Illnesses and Even Cause Death.” The article declared: “The problems are manifold: Bad diagnoses. Unnecessary surgery. Overprescribing or misprescribing drugs. High rates of hospital infection. Lab-test errors. Faulty medical devices. Alcoholic or drug-addicted doctors.”

Listen to Reagan’s Secretary of Health and Human Services, Dr. Otis R. Bowen: “Experts have estimated that anywhere from 5 to 15 percent of practicing physicians would be candidates for some kind of disciplinary action, many because of drug and alcohol problems.” He urged physicians to “no longer abide a brotherhood of silence.”

Five to fifteen percent of about 500,000 practicing physicians means millions of patients being treated by these addicts. In addition to studies showing the tens of thousands of annual unnecessary hysterectomies, coronary bypasses, cardiac pacemaker implants and carotid endarterectomies, there is a rising rate of hospital infections (one in twenty admitted patients) and the widespread prescription of dangerous or useless drugs. Dr. Sidney Wolfe has just authored Worst Pills, Best Pills ($12 from Health Research Group, 2000 P Street, NW, Washington, DC 20036) describing 104 Pills Older Adults Should not Use and 183 safer alternatives.

No one knows the full extent of negligent doctoring in America. The most conservative figures cited estimate at least 350,000 serious malpractice cases a year resulting in death or serious injury or disease. Economist Patricia Danzon, a specialist on malpractice at the University of Pennsylvania, believes that only 10 percent of genuine medical negligence leads to a claim.

If you wish to delve into a trove of information about hospital and physician malpractice, a new book entitled Medicine on Trial (Prentice-Hall) co-authored by Professor Lowell Levin of the Yale School of Medicine, assembles the available data and recommends a spate of reforms and precautions. Among these changes are stronger doctor discipline by licensing review boards, recertification of doctors, experience-rating of the good and bad physicians by insurance companies and reducing the number of subspecialties for insurance purposes.

Experience-rating will surcharge the small number of physicians who are responsible for a large number of paid malpractice claims (typically, one percent of doctors in a state account for 20 to 25 percent of the paid claims) and lighten up on the premiums for competent doctors. At the same time, compressing the number of categories will avoid the singling out of neurosurgeons or obstetricians for huge premiums instead of spreading the risk more broadly.

Most malpractice insurance companies have been making handsome profits, Holding on to large reservers and high profits (their average is almost double that of manufacturing industry), they cry poor and threaten to pull out of states in order to bring legislators and regulators to their knees.

The latest such curtailment of business comes from Kansas — a state where medical malpractice insurers have averaged 27.3% profits over the past ten years, even using their calculated, non-discounted reserves.

So here you have a situation where barely one in ten victims of malpractice collect any compensation, where the total malpractice premiums paid by physicians amount to less than 3% of gross physician revenue (or a little over $3 billion in 1987), and where organized medicine wants to diminish the legal rights of injured patients and the resultant deterrence against future medical carelessness.

William Bennett, the editor of the Harvard Medical School Health Letter, wrote in the New York Times last week that “erroneous awards appear to be small,” and that “the malpractice system can be dispassionately analyzed as though it were a form of medical testing, a way to find out whether something unhealthy is happening, and to correct


Three years ago, Dr. Barry Shifrin told the American College of Obstetrics and Gynecology: “you must understand that some of the malpractice out there is so grievous, offensive and implausible as to beggar the imagination. Without real malpractice, we would not have this problem.” Say it again and again.