“Whatever is measured is managed” is the fundamental principle in management science. Nowhere is this better exemplified than in a small, obscure reciprocal insurance company in Washington, D.C., once the provider of choice for two-thirds of all doctors in Washington, D.C.
For it, the writing is on the wall in 2001. It is rated “AMB3” by AM Best. This corresponds to an “adequate ability to pay short-term financial obligations.” In 2004, …
In 2004, the AMA declared a “medical malpractice crisis.” At that time, 34 percent of all physicians in the United States had been sued. The practice of medicine was at risk. Hospitals were closing. Coverage for certain high-risk specialties was unaffordable. Medical services were unavailable. Some malpractice carriers were on the verge of insolvency.
This has been the case since the mid-1970s. Coincidentally, so has a political initiative for national health …
A nurse practitioner (NP) in urgent care saw a patient with a severe headache following a fall. Initial testing and symptoms suggested a concussion, leading to discharge. However, when the patient’s worsening condition later revealed an elevated white blood cell count, they were rushed for further evaluation—but it was too late. The patient succumbed to bacterial meningitis. …
Random mal-occurrences have always accompanied medical interventions, even under the best of circumstances. These are errors of nature. In the 1960s, some attorneys in California were the first to exploit these unfortunate random outcomes to their advantage. Lawyers made money from lawsuits.
There is a huge return on investment when an error of nature can be portrayed as a medical error. There is always a settlement value.
Creating a demand is easy: …
“Crappy doc” terminations. First, let me apologize for the use of legalese. Of late, I have been hearing concerning stories about physicians who were terminated from employment on the grounds of supposedly poor-quality care. These are not what you would call slam dunks—I’m not talking about leaving a scalpel in the patient or showing up drunk for rounds.
The stories I hear (admittedly, I’m only hearing the physician’s side) have been …
Medical malpractice is a subject about which I am passionate. I am an obstetrician-gynecologist; I have been sued five times (one case ends in a mistrial, two in settlements of convenience, and two are dismissed with prejudice); I paid over $1 million in medical malpractice premiums over a career, and I abandoned my specialty because of threats of medical malpractice. These are reasons enough to be passionate.
There are 85,000 medical …
I write these words after a full week of jury deliberation in the Daniel Penny trial. I now realize that what I have been describing about medical malpractice litigation is a signal of a much more serious problem infecting the social order of the entire country. It goes far beyond 85,000 medical malpractice lawsuits filed per year and even the inability, or the unwillingness, of finders-of-fact to discriminate between a …
Of note, today, of all days, when the Supreme Court of the United States is to consider state bans on treatments for gender-affirming care of transsexual youths, virtually every internet site on the subject is blocked.
Nevertheless, I am a medical student in 1967. I do not need the internet; I lived through the beginning of gender-affirming care. My memory is clear.
I am reminded of the story of Dr. John Money, …
We recently resolved a complex peer review case involving a surgeon in a Midwestern state. The case arose as the hospital began transitioning to an employed-physician model, seeking to phase out its non-employed, voluntary medical staff. Our client, a non-employed surgeon with privileges to treat patients at the hospital, was among those targeted in what appeared to be a strategic effort to remove voluntary non-employed physicians from the …
There are one million physicians practicing medicine in the United States. No medical intervention they recommend is immune from a complication. The exact number of complications is unknown. Some are medical errors inherent to the intervention, while others are random errors of nature caused by external factors.
When you add to this the fact that there are more lawyers in the United States today than ever before, something has to give. …
It all begins with a political movement for national health in the 1970s. There are no “health systems,” just doctors and hospitals. Fee-for-service is determined by conventional principles of cost accounting, in which payment for services compensates for overhead and leaves enough profit to remain in practice and enjoy the American dream.
There are health insurance companies. The purpose of health insurance is to protect patients against medical expenses, not to …
A medical liability litigation industrial complex manipulates medical liability litigation with three talking points. As a result, 85,000 lawsuits are filed per year. Of these, 56,000 are summarily dropped; 28,000 are settled; 300 are plaintiff verdicts, and 700 are defense verdicts. The cost of health care is $60 billion per year, and the medical liability litigation industrial complex takes a chunk of the action. There is considerable uncertainty. Facilities close …
Data indicates that there are 85,000 malpractice lawsuits filed per year. This is the status quo.
What if the status quo is worse? There are other data showing that 85,000 is only the number of lawsuits represented by lawyers. There are 3.065 million additional claims that lawyers do not represent. The total could be 3.15 million. Plaintiff lawyers agree that, for every 37 cases that cross their desks, 36 are summarily …
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There are 85,000 medical malpractice lawsuits filed per year. There are 1 million physicians. Therefore, your odds as a doctor for being sued for malpractice are 8.5 percent per year, which corresponds to one lawsuit every 12 years. To make matters worse, two-thirds of lawsuits have questionable merit.
A malpractice lawsuit is inevitable because a complication is inevitable. It just takes one complication. The problem arises when a complication is a …
Fundamental in a medical malpractice lawsuit is determining whether an unfortunate outcome is an error of nature or a medical error. An error of nature results from a medical intervention that aligns with the standard of care. A medical error, on the other hand, results from a medical intervention that departs from the standard of care.
The problem in medical malpractice is that errors of nature can be random occurrences even …
Primum non nocere, “first, do no harm,” is the prime directive of medical ethics for all physicians. It is also the first thing that comes into question when maleficence by a doctor is suspected.
The standard of care is how any prudent and competent practitioner should exercise their duty to, “first, do no harm,” when managing a specific medical condition. The standard of care is empirical and adjusts to circumstances that …
As shown in my earlier post, when prosecuting Byrom vs. Johns Hopkins Bayview Hospital with inductive reasoning, as is traditional, the medical intervention is compared to the standard of care in a very general and subjective way. The medical intervention “more likely than not” departs from the standard of care. “More likely than not” corresponds to a level of confidence of around 51 percent and a type-1 error of …
In medical malpractice, inductive reasoning regards the standard of care as the duty to do no harm. If there is a complication from a medical intervention and the medical intervention differs from the standard of care in any conceivable way, the difference alone is sufficient to conclude that the medical intervention departs from that duty.
However, unanticipated threats require nimbleness. This is a calculated risk. It causes a difference, but it …
A quote by Sir Winston Churchill: “However beautiful the strategy, you should occasionally look at the results.”
Actually, Churchill never said this. It may have been Ian Gilmour, a member of Margaret Thatcher’s Cabinet, years after Churchill’s death. Nevertheless, this quote is often cited in the context of risk management. It is as relevant in a medical malpractice lawsuit as it is a warning to malpractice attorneys. No matter how elegant …
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