AID MDs AND PATIENTS TOO
AID MDs AND PATIENTS TOO
Los Angeles Times: From patients with the wrong limb amputated to mothers stripped of their childbearing ability because of a botch in the delivery room, courts have delivered fair compensation to victims of bad medicine. In recent years, however, soaring pain-and-suffering jury awards have begun turning lawsuits into a lottery-style bonanza.
Trial lawyers focus on claims with the highest reward potential, a relative few, while ignoring other claims with merit, and they admit they concentrate on states that have no caps on pain-and-suffering damages. There is scant evidence that such lawsuits compel hospitals and doctors to adopt better standards. Meanwhile, it can take years to get a penny to any patient.
The nation's medical malpractice system is "punitive, expensive and inequitable for all, jeopardizing the availability of care," as Dr. Lisa Hollier, president of the Texas Association of Obstetricians and Gynecologists, neatly framed the problem in recent testimony to Congress.
Hollier's testimony helped prompt the House last month to pass HR 4600, a bill capping pain-and-suffering damage awards for medical negligence at $250,000, the same limit now imposed by California. The legislation, by Rep. Jim Greenwood, R-Pa., would help lower doctors' medical malpractice premiums, which are soaring in states without caps. The size of median jury awards for medical malpractice has risen nationally -- from $474,536 in 1996 to $1 million in 2000.
Too little compensation?
Trial lawyers say the $250,000 cap, imposed in California in 1975 and never raised to account for inflation, provides far too little compensation in 2002, however. They're right. It's also very hard to find a lawyer to take a $250,000 case. To provide the same level of compensation in today's dollars, the cap would have to be about $800,000.
But regardless of the figure that Congress finally sets, some cap on these so-called punitive damages (compensation not for direct economic loss but for impaired quality of life) makes sense. The current lottery-style system hurts everyone, forcing physicians in some states to close their practices. One measure of the chaos: In California, insurance companies offer general surgeons malpractice coverage for $21,000 to $43,000 a year, whereas in parts of Florida annual premiums are as high as $159,000.
Chances are slim that the Senate will agree to the medical malpractice bill as it's now worded, for Democrats rightly argue that if Congress is going to weaken patients' ability to penalize doctors and health plans, then it must give them an alternate means of appeal and improve detection of medical errors.
Californians have enjoyed such recourse since 1999, with a law guaranteeing patients the right to an independent medical review when they believe they have been harmed by their health plan's treatment -- or denial of treatment.
Federal legislators, rather than giving up on reform, should at least begin drafting compromise legislation. Rather than focusing narrowly on lowering the pain-and-suffering damages cap, Congress should look at ways to seamlessly combine such caps with reviews of treatment and care decisions by an independent board of medical experts and better quality controls. The right policy would give relief to patients as well as doctors.
HISTORY'S THINGS AND IDEAS
Providence Journal: Historians are generally skeptical about the sort of naval archaeology that raised the turret of the U.S.S. Monitor, the first ironclad ship, off Cape Hatteras last summer. What is important in history is events and ideas, they argue, not things. And the money lavished on the salvage of the Monitor might be better-spent preserving papers or commissioning research projects.
Well, we agree that more state and federal money should be spent on archival projects, and that to understand America's past, events and ideas are more significant than objects. But the raising of the Monitor's turret -- its resurrection from legend, as it were -- is an exciting event.
And a formidable challenge as well. The Monitor, which fought only one inconclusive battle against the Confederate ironclad C.S.S. Virginia, off Hampton Roads, Va., was being towed to participate in a blockade when it ran afoul of a gale on the night of Dec. 31, 1862. When it sank in some 240 feet, along with some 16 crewmen, not only was the world's first ironclad lost, but evidence of a revolution in naval warfare vanished as well. The Monitor, designed by the Swedish-American engineer John Ericsson, had a flat deck with a revolving turret, which weighed 160 tons, letting its two 11-inch cannons be aimed in any direction without moving the vessel. As one report puts it, "Nearly every fighting ship since uses a variation on that theme."
Complex salvage operation
The Monitor's remains were first discovered in 1973, but the complex salvage operation began only five years ago. Since then, divers have recovered the propeller, the anchor, the engine and thousands of miscellaneous items, including working thermometers, condiment bottles, a leather book cover, wood paneling from the captain's quarters, and a piece of porcelain with the word "Push" painted on it. It will take several years of careful restoraton and reconstruction to return the turret to its 1862 condition, complete with cannonball dents from the Virginia. But the process will be open to the public, and, when finished, the ship will be on permanent display at the Mariners' Museum in Cape Hatteras.
A slice of history or historical show biz? Well, as President Bush wrote to the Navy salvage team, "Anything we can do to preserve our history and share it with the public, especially students and other young people, is an important service in these challenging times."