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Ralph Nader > In the Public Interest > The AMA and Medical Malpractice

The American Medical Association (AMA) came to Washington, D.C. the other day with 1000 physicians to lobby the Clintons and the Congress on health care policy. They gathered in the Mayflower Hotel on Connecticut Avenue and then fanned out to Capitol Hill to see what response they would receive from all those politicians greased by millions of dollars of campaign contributions from AMA Political Action Committee and affiliates. The medical lobby, led by the AMA, blocked President Harry Truman in the early Fifties from enacting national health insurance. That was a devastating blow to millions of Americans in subsequent years who could not afford health care and had no one to help them counter the powerful AMA.

In the mid-Sixties, the AMA only relented after they got the kinds of changes made in the medicare law that assured payment of doctors’ bills. For years there was no organized force against the AMA, except the part-time efforts of some labor unions pressing for universal coverage.

Now the AMA finds its membership slipping as a percentage of practicing physicians. Other physician associations such as the American College of Physicians are rising in influence and are more progressive. But the AMA has not changed its colors.

It is still opposing genuine restraint on physician fees and prices. It is fighting Congressional and state efforts to end self-referrals to laboratories and other physician owned centers whose conflict of interests increase the number and costs of procedures. And it wants to make victims of serious doctor malpractice have an even harder time obtaining compensation for often horrible injuries.

What is so notable about the AMA is its absence of any compassion for the hundreds of thousands of Americans yearly who are killed, injured or rendered sick by bad doctors and bad hospitals. The word “malpractice” does not convey the agony of the kind of negligence or worse that one California physician once called “mind-boggling”.

The most careful study of medical malpractice was published in 1990 by the Harvard School of Public Health for the NY Department of Public Health on rural, suburban and urban hospitals in New York state. Their very conservative estimate of the number of people in the Empire state who died in hospitals due to malpractice, projected nationwide to 80,000 Americans a year, illustrates some of the scope of this institutional violence. Add to that casualty toll the number of injuries and illnesses and one can sense its seriousness. By comparison, about 40,000 people will die on the highways this year.

So instead of the AMA launching a major drive to toughen the peer review system, to strengthen the medical licensing review boards in the fifty states and to focus on prevention of this toll of trauma and infection, this stubborn guild spends its muscle on legislatures to weaken rights of victims to obtain justice, to have their day in court, if necessary.

So wagon-circling is the AMA that when they refer to the malpractice crisis, they mean the litigation, not the malpractice epidemic of death and injury itself.

Actually, the volume of payouts for verdicts and settlements for malpracticed patients has been falling in the past five years relative to the overall amount spent on health care. In 1991, the latest available figures, the total was under $3 billion or what this country spends on dog food. As for the premiums collected by the very profitable malpractice insurance companies, the doctors and hospitals paid nearly $4.9 billion or only six-tenths of one percent of what was spent on health care that year.

Last week, the AMA office in Chicago was asked whether the Association had information on how many deaths and injuries were attributed to malpractice? No information said the spokesperson. Well, then, how many malpractice suits against doctors were there? No information, said the spokesperson. The AMA knows the best estimates, but doesn’t want the public to know.

Confronted by these deflating figures, the AMA cries out, “but there are the costs of defensive medicine.” Where is the hard data to show that all such procedures and operations are due to fear of malpractice claims and not simply fee generating business or just careful medical practice?

The Congressional Office of Technology Assessment is in the middle of a two year study of so-called “defensive medicine.” The researchers have found no “good data” on “defensive medicine.” What they are finding, observers suspect, is that more than a little “defensive medicine” is itself a form of medical malpractice.