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Meddik
06-16-04, 10:57 AM
Doctors shun lawyers (http://www.sunherald.com/mld/sunherald/8932714.htm)

Malpractice debate grows uglier

By DON BABWIN

THE ASSOCIATED PRESS


Fighting back

CHICAGO - Two area doctors say they understand why a South Carolina physician suggested a ban on treating attorneys involved in medical malpractice cases.

"We don't have many ways to fight back, and as distasteful as it sounds, that's one of the only recourses to fight back," said Dr. Michael Moses, a general surgeon.

Moses said he knows of a couple of doctors who are already declining to treat trial lawyers involved in malpractice suits. But he said he would not decline treating anyone.

"I've treated plaintiff attorneys before," he said.

"I've operated on plaintiffs attorneys more than once," said Dr. Paul Mace, a general surgeon. "I'm not going to turn my back on any patient who is in need for medical attention. It's part of our canon of ethics that we subscribe to."

But he knows others might feel differently.

"I can understand how other physicians might be willing to use that as a tool," Mace said. "We've been preyed upon unjustly by attorneys for their own financial gain."

DAVID TORTORANO A South Carolina surgeon dropped a patient when he found out her husband was a trial lawyer.

In New Hampshire, a neurosurgeon told the head of the state's trial lawyers that he wouldn't treat him for non-emergencies.

A plastic surgeon in Mississippi refused to treat the daughter of a state lawmaker because of his stand on malpractice suits.

The long-running battle over the high cost of malpractice insurance has taken an ugly turn. Many doctors blame trial lawyers and their malpractice suits for causing huge jumps in insurance premiums. Lawyers blame it on the insurance industry.

At this week's meeting of the American Medical Association, many doctors stayed out of the fray. They angrily shouted down a proposal by Dr. J. Chris Hawk of Charleston, S.C., to refuse treatment for attorneys involved in medical malpractice cases.

But the actions of other doctors and hospitals suggest that plenty of them agree that taking out their anger on lawyers - and sometimes their families - is an acceptable response to what they see as a threat to their livelihood.

"If somebody takes a position that is very deleterious to your welfare, you have a right not to do business with him," said Dr. Clinton "Rick" Miller, a neurosurgeon in Portsmouth, N.H. Miller did just that, telling Tim Coughlin, president of the state's trial lawyers association, that he would not treat him for elective surgery because he lobbied against limits on malpractice lawsuits.

"He's one of the reasons I have $84,000 medical practice premiums even though I've never had a malpractice judgment against me in my life," said Miller, who also emphasized that he would treat Coughlin in an emergency.

Coughlin said Miller's anger is misplaced.

"His insurance company is charging him too much," Coughlin said.

While Miller said he would have no problem treating Coughlin's family, Hawk would. He dropped a patient when he found out her husband was a prominent trial attorney.

"I don't think it violates the Hippocratic oath," he said.

Nor, apparently, did Dr. Michael Kanosky, a plastic surgeon in Mississippi. Just last week it was reported that Kanosky refused to treat the daughter of a state lawmaker who opposed limits in damage lawsuits against physicians in the state.

"He asked me who I worked for and then asked me who my father was," Kimberly Banks told The Associated Press. "I told him (state Rep.) Earle Banks. He told me, 'I can't see you because your father is against tort reform.' "

Kanosky was in Chicago for the AMA meeting and did not immediately return calls for comment. He earlier told a Mississippi television station that he believed treating the woman would be a conflict of interest because his wife is a lobbyist for doctors.

Doctors say such cases are rare. Dr. Ken Printen, the president of the Illinois State Medical Society, said he has never heard of any doctor in the state refusing care to an attorney, nor should it ever happen.

"To deny somebody treatment just because he's a lawyer, you just can't do that," he said.

At the AMA's annual meeting a committee recommended that the policy-making delegates reject Hawk's proposal, saying it would "jeopardize and sidetrack" the group's efforts to combat high insurance rates and malpractice lawsuits. The delegates endorsed the rejection by voice vote Tuesday without debate.

A number of doctors at the meeting agreed with the committee's concern. Several said that they would never deny medical care to a lawyer.

Joseph Selby, a doctor from Morgantown, W. Va., said his 12-year-old son has a friend whose attorney father recently won a $6 million judgment against the hospital where Selby works.

"Do I hate him? Would I not treat him? Would I not treat his son? Of course not," Selby said. "I don't criticize attorneys for doing what the law allows. We need to change our legal system."

But there are indications that the fight over medical malpractice is getting more contentious.

Earlier this year, a furor erupted over a database that was billed as the first to profile plaintiffs, their lawyers and expert witnesses in malpractice cases in Texas and other states. The Web site, www.DoctorsKnow.Us, shut down after critics accused it of blacklisting patients who had sued doctors for malpractice.

In New Jersey, Dr. George Ciechanowski has sued the state's medical society, claiming other doctors have boycotted his practice because of his support for a medical malpractice reform plan they opposed.

And in Texas, a nursing student claims she was dismissed from her job at a hospital because her husband works for a firm that handles medical malpractice cases.

It all adds to "an alarming trend in a kind of vigilante-style behavior for what appears to be an extremist group of doctors... looking to punish innocent patients and their attorneys who help them exercise their constitutional rights," said Dan Lambe of Texas Watch, a consumer research and advocacy group that helped publicize the Web site.

This anger is showing up in more subtle ways, too. Lawyer Ken Suggs said some doctors are becoming less willing to help attorneys when called to provide their expert opinions.

"It's a little bit harder to get their cooperation in those things," said Suggs, who like Hawk practices in South Carolina.

But Suggs agrees with fellow lawyers who think doctors' anger with them is misplaced.

"We've always considered this an insurance issue," he said. "Their malpractice insurance is rising, as is ours."

This is great. The only thing that concerned me at first was the thing about the one lawmaker's daughter being rejected by one doctor, until I re-red it and saw it was a plastic surgeon, meaning odds are it was optional cosmetic surgery, not something for a medical need. I wouldn't want some doctor turnign away an injured or sick child, but if its someone getting a nose job for their 17 year old daughter, thats an entirely different story.

Mythas
06-16-04, 11:44 AM
Going into the medical field, this has great pertinence to me. Personally i think its a-ok that they do that. The lawyers cry "its teh ur insurance i swaer!" yet, how much $$$ in dmg do they ask for??? HUNDREDS OF ****ING MILLIONS OF DOLLARS. They are the reason the insurance is the way it is. Where my mother works *OBGYN* every doctor there has to pay $250,000 a year just to be able to work. I think lawyers should have to pay a $500,000 ******* tax yearly just to be able to sue every one left and right.

Ugh so much on this issue that really irks me off....better just end it here

Nenjin
06-16-04, 12:00 PM
Is this like a complete and total violation of the hippocratic oath to help people? "I'm sorry sir, but you've just taken my yearly income from 175,000 dollars, to only 110,000. I refuse to help you!"

ciba
06-16-04, 12:11 PM
I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.


The argument could be made that treating attorneys, who are more likely to sue is a violation of the oath. Seeing as how a lawsuit will impact a doctor's ability to treat ALL of their patients, does the doctor have a greater duty to the attorney or to the other 99% of their patients?

Nenjin
06-16-04, 12:36 PM
Correct me if I'm wrong, but doesn't malpractice actually have to occur before a suit can be brought? I mean, a lawyer could waste a doctor's time in court proving it, but if the doctor is preforming like they should, they shouldn't be as concerned about a suit. I understand lawyers can rake people over coals for nothing, but if you swore to help people in need, you swore to help them, not your checkbook, not your reputation. If anything ever made medicine seem more about the money than the relief, this would be it.

Meecham
06-16-04, 12:47 PM
So on the one hand you're defending lawyers, and at the same time denigrating doctors for a lack of altruism?

Darkefang
06-16-04, 01:01 PM
Correct me if I'm wrong, but doesn't malpractice actually have to occur before a suit can be brought? I mean, a lawyer could waste a doctor's time in court proving it, but if the doctor is preforming like they should, they shouldn't be as concerned about a suit. I understand lawyers can rake people over coals for nothing, but if you swore to help people in need, you swore to help them, not your checkbook, not your reputation. If anything ever made medicine seem more about the money than the relief, this would be it.

Medicine isn't an exact science. Physicians have to figure out how to proceed in diagnosis and treatment. They have to make sure and eliminate conflicts with other treatments, medications, or allergies. They have to weight the risks of side-effects and other problems that can result from their treatment. They also have to deal with the regulations of HMOs, Medicare and health insurance companies when dealing with their patients.

When they are sued for malpractice, there usually isn't a dispute about if the treatment worked or not. Usually, it has failed. The dispute is usually regarding the procedure. Did the physician run all the tests necessary to find the ailment? Did the physician use procedures that are generally accepted at legitimate by other physicians? Was the patient aware of all the risks associated with the treatment? There is a lot of room in medicine for second-guessing. And if they can show that the doctor used a potentially dangerous method, attorneys can win a lawsuit in successful treatments.

Attorneys can bring suit against physicians at any time for malpractice. For each of these lawsuits, someone has to pay for a defense attorney, either the insurance company or the physician. Because medical malpractice is such a specialized field, these attorneys are expensive. The costs can quickly get out of hand, even for physicians who have never been found to commit malpractice.

None of these doctors advocated refusing to treat malpractice attorneys in harmful situations, only for things like elective surgery and general medical appointments. They have every right to deny service. Some physicians do not accept Medicare patients. Some do not accept people with some forms of medical insurance. Most will not accept people with no medical insurance without payment up front. This is just another way doctors can choose to run their practice.

Nenjin
06-16-04, 01:03 PM
How am I defending lawyers by saying they deserve treatment just like everyone else?

As for doctors having a lack of altruism compared to lawyers, there is a higher expectation for you to BE altruistic as a doctor than a lawyer.

Worrying about a malpractice suit before you've even met a patient, because they are a lawyer, is 1 step away from saying "I don't treat poor people, because they will try and sue me and interfere with my practice(steal my money)".

edit
*sig*

Nenjin
06-16-04, 01:10 PM
Most of what you mentioned Hord, I find repugnant about medical practice. Knowing that in other countries, people make room in their taxation to provide medical care for all, makes me angry about our system over here. Help comes at a premium here. Hospitals are run on business models, and doctors are 1/2 salesmen, or corporate CEO. Maybe I just have loftier ideals about medicine.

Dragynphyre
06-16-04, 01:40 PM
Don't blame the doctors so much - blame the insurance companies - both doctors' malpractice insurance and patients' health insurance.

For example - My health insurance company has already told my oncologist that there are several blood tests that they find 'unnecessary" because they are somewhat more expensive and are relatively new - but that he feels are necessary - I wound up having to pay for these out of pocket...

Health insurance companies should not be telling a doctor what he can and cannot do - this can spark a malpractice suit if the doctor isn't allowed to do what he feels needs to be done because insurance doesn't cover it, and the patient is hurt or dies from not being able to have what needed to be done.

Malpractice insurance (pharmacists have to have this too) is the only recourse a physician has to even the most fraudulent suit against them - but the premiums are killer. Even if there was no wrongdoing, a suit can cost a doctor thousands of dollars more than their insurance premiums, however. And even if there wasn't any wrongdoing, but the prosecuting lawyer can convince a jury that there was... well, the insurance is going to save you from having millions of dollars coming out of your own pocket.

As was said, medicine is an inexact science. Veterinary medicine even moreso, as there is less research done on animal illnesses. There is a reason that doctors go to school for longer than your average car mechanic.

And don't think that doctors are necessarily raking it in. Depending on specialty and location of where they are working, they might not be making much more than a worker bee like me. Plus, consider that a doctor has a much longer time in school than most of us and, depending on which medical school they went to, will be paying off their student loans for something like the first 10 years that they are in practice, I think I read somewhere, so they might not have as much money as you think.

Marbh
06-16-04, 02:08 PM
I for one think we have our priorities messed up. Take all the money that is spent every 4 yrs in a presidential election. Imagine how many doctors and nurses that could send to school, or medicine it could buy.

nekoken
06-16-04, 02:08 PM
Don't blame the doctors so much - blame the insurance companies - both doctors' malpractice insurance and patients' health insurance.

I don't believe there's a bit of fault in the malpractice insurers. Blame instead their insane premiums on your fellow patients who are routinely suing for insane amounts of money. An insurance company is in the business to make money. One jackass getting a $50M malpractice award has just screwed over thousands of other patients and doctors because somebody has to make up that immense amount in premiums.

Health insurance companies are a whole other ball of wax. Sure coverage is expensive, and they don't want to pay for expensive procedures. You know why? It is because they are also in the business of making money. Think about it. I would be willing to bet that one serious ailment more than wipes out the amount paid for your plan in a multi-year span.

As long as insurance is privatized and in the business of making money you will have serious problems with cost and the services they are going to pay for. However, I'd rather have it that way than have it be a government institution. Medicare and Medicaid cost me enough as it is. With corporate healthcare I have the right to choose to have coverage and pay for it. I sincerely doubt that option would be available to me with government healthcare.

Meddik
06-16-04, 02:53 PM
Correct me if I'm wrong, but doesn't malpractice actually have to occur before a suit can be brought?

Ok, lets say there are 100 doctors in your state.

Trial lawyers file suit on 10 of them for multi-multi million dollar claims.

What do you think would happen to the malpractice insurance in that state?

Well, thats exactly whats happening. Doctors are having to pay insane percentages of their pay to keep malpractice insurance, even if they don't do anything wrong, all because of predatorial trial lawyers.

I for one think we have our priorities messed up. Take all the money that is spent every 4 yrs in a presidential election. Imagine how many doctors and nurses that could send to school, or medicine it could buy.

Trivial amount of money. They said that during the last campaign season (2000) more money was spent on bubble gum advertising than on presidential campaign ads. Not Buying bubble gum, but just the amount spent advertising it.

ciba
06-16-04, 04:01 PM
Hospitals are run on business models, and doctors are 1/2 salesmen, or corporate CEO

God forbid doctors be compensated for their work!

Another thing to consider: Doctors are more likely to order unecessary tests in our litigious society. Say there is a disease with symptoms exactly like the common cold. 1/1000 patients coming to a doctor has this. Testing for this desease costs $253. Should the doctor test every patient? Is not testing the one patient that gets it negligence on the doctor's part.

Carry this on. A doctor could not order the test, saving insurance/patients $253,000 per thousand. Now, say 1/10 patients sues a doctor for $5million when they get the disease. Total cost to test 10,000 patients? $2.53 million. Cost to the doctor for not testing them? $5 million. What does the doctor do?

Nenjin
06-16-04, 08:06 PM
God forbid doctors be compensated for their work!

Way to take the easy road out on that one Ciba.

Mythas
06-16-04, 10:22 PM
It may be the easy road, but its also the right road. In the end, doctors are HUMAN.

How would you like to be sued for a slight error in your work, better yet how would you like to pay some one oftentimes a large amount of money just so you could goto work that year.

That error you put in the billing database at your job. Causing Joe Brown to recieve Billy Bobs grandmaws thank you card...Just cost you A) your job or B) your sallary for the next 10 years of your life...The reason Joe had an identity crisis and needs to be awarded $100m in emotional damages.

Nenjin
06-16-04, 10:45 PM
There is a LARGE difference between getting compensated for your work, not the issue here(doctors will always make a lot of money), and simply refusing people service(although I like the 'in an emergency' that gets thrown in), because you are afraid they might sue, not based on their personal characteristics, not because of a past history of suing for malpractice, but because they are lawyers none the less. If you go into the medical profession, having people be critical of your work is an occupational hazard. There are better ways to protect yourself from litigation than just refusing people service. It's bloody absurd.

The problem lies in the juries who award damages and the open ended nature of damages, as well as fear of the insurers who jack up rates. Deal with it on that front. Health care doesn't need to get anymore selective in this country than it already is.

Yalum
06-16-04, 11:55 PM
These doctors aren't turning away malpractice attorneys because they're afraid of being sued (after all, they're insured), they're doing it because they feel malpractice attorneys are repugnant bloodsuckers who prey on people's grief and have no wish to be in the same room with one, much less hold his privates and tell him to cough.

Loxmyf
06-17-04, 02:33 AM
So some doctors refuse to help lawyers who practice the art of malpractise suits?

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

There's an 'out' for the doctor just there. Lawyers aren't human.

Fix it all by returning to ancient Sumarian law. An eye for an eye, a spleen for a spleen. :beatup

ciba
06-17-04, 06:37 AM
The problem lies in the juries who award damages and the open ended nature of damages, as well as fear of the insurers who jack up rates. Deal with it on that front. Health care doesn't need to get anymore selective in this country than it already is.

Nenjin, there is a major problem you're missing here. Most lawyers oppose tort reform of any sort. Would it be better that doctors go on strike? That would be interesting.

I think you are trying to hold doctors to a higher standard. You're right, the systems suck. Most doctors are forced to be businessmen so they can continue doing what they enjoy - providing medical care. As a group, lawyers are the single biggest obstacle to this.

Meddik
06-17-04, 08:14 AM
Not only do they oppose tort reform, they give HUGE contributions to politicians who oppose it. Top donor category to one of the parties (http://www.opensecrets.org/parties/indus.asp?Cmte=DPC), I'll let you guess who.

And its not really All lawyers so much as it is Trial Lawyers. (i.e., those who specialize in filing these sorts of lawsuits.)

Auslander
06-17-04, 11:46 AM
I remember reading about a similar situation here in Ontario a few years ago. Doctors were refusing to deliver babies because the malpractice insurance costs were higher than the fees that OHIP would pay the doctor for the deliveries. Performing a birth actually cost a Doctor money. I think that the government stepped in and fixed the problem, since I haven't heard about it recently.

(For those unfamiliar with the Canadian system, the government pays for most medical fees, and they do so froma set fee for each procedure, so raising their fees was not an option for the doctors).

Caowyth
06-17-04, 03:36 PM
But a doctor raising his fees is part of the downward spiral we are in right now.

When a person sues a doctor, regardless of reason, malpractice insurance costs go up.

When malpractice insurance costs go up, doctors/hospitals charge more for services and order more unnecessary tests.

When doctors/hospitals charge more for services, and order more unnecessary tests, health insurance rates climb.

The problem starts with the lawsuits.

Lawsuit problem #1-

Defending a lawsuit is so expensive that it is cheaper for hospitals to settle out of court than it is to go to trial.


Lawsuit problem #2-

Juries award huge punitive damages in trial that are completely out of line with actual damages. The risk of these types of damages also contribute to the reasons behind #1.


Lawsuit problem #3-

Regardless of whether or not you have been sued, any doctor being sued will cause the malpractice insurance rates in your area to increase.


There needs to be greater protection for doctors and hospitals from punitive damages. There needs to be some way to lower the costs of defending a lawsuit so that doctors and hospitals don't settle out of court to avoid costs. And there needs to be some form of punishment for bringing a frivolent of false lawsuit.

Just my thoughts on the subject.

Cao

DoonBackfighter
06-18-04, 12:01 AM
One thing I wish could be done is to stop giving punitive damages to the Plaintiff. It's money taken from the defendant in order to punish them, there is no reason it should result in some gigantic jackpot for the person/people filing suit. Give it to charity, use it fund schools, or even just put all the money in a big pile and burn it while roasting weenies over the money-fire. The plaintiffs would still receive their payment for damages, but it would keep people from wanting to file suit just to win the lottery.

Of course, there's no way in hell the trial lawyers will ever let a law like that pass, but I can dream. ;)

Nenjin
06-18-04, 12:46 AM
I'm not sure there is much you can do about reducing the cost of defending yourself against Malpractice suits without getting the gov't directly involved either through funding or jurisdiction. I can't imagine that idea flying straight with anyone.