Tom Coburn for president. You and My state senator R. Burr are right on target. Patients do need a mechanism of relief and I do not see a perfect solution what you have proposed is likely the best possible solution that will be fair to all parties involved

Oh by the way we would love to have you join us in the million med march

In order to expert panels to be effective in deciding malpractice cases, the experts must be vetted or certified by some process that they are bonafide experts. It is unfortunate that some physicians sell themselves out to lawyers for a certain price and therefore contribute to the escalating lawsuit awards and malpractice costs.

I agree that the sound bites from Congress and White House currently show very little respect or regard for physicians and that most politicians truly do not understand how medicine works. Malpractice cases and costs will not be impacted by electronic records or imposing practice patterns on physicians. Texas has clearly demonstrated that tort reform has real place in health reform.

The bulk of health reform needs to be focused on insurance companies who deny care, demand pre-authorization, deny reimbursement after the fact, deny refills, and impede care of patients.

And for small business there needs to be a mechanism by which we can obtain affordable health care. The big business like universities and hospitals are able to get substantially lower rates for the exact same care. I used to on my wife's university policy. Now, in private practice, I pay twice as much for the exact same health insurance plan. That is simply wrong.

Thank you very much for weighing in on this issue, Dr. Coburn! I agree with what you have said above and will add more to these comments when time allows. It is very nice to have you here.

Richard A. Armstrong MD FACS

Senator Dr. Coburn:
There is a solution to defensive medicine as it is practiced in the US.
1) You can cap the malpractice award or institute "I am sorry" policies. These measures will NOT reduce defensive medicine one bit. PLEASE UNDERSTAND ...It is not the dollar amount of malpractice that drives up the cost of care. It is the extreme, unreasonable effort to avoid mistakes, the need to avoid chart reviews by paralegals of powerful attorneys and bean counters appointed by government that escalates the cost and even leads to iatrogenic problems. Some degree of medical errors and bad outcomes are both inevitable. You need to institute a "NO FAULT MEDICAL INDEMNITY" for physicians, very similar to auto insurance based on community rating. It is the bad outcome that has to be insured NOT the physician action. Except in rare criminal cases, most practicing doctors aim to do good and help people in pain or distress. We do not need to find criminality in every poor outcome. Part of the funding for such "Medical outcomes indemnity insurance" has to come from local taxes. If there is no pain for their rash actions, people will abuse all kinds of facilities including claims for pain and suffering. If there is a cost to community for frivolous lawsuits, the community will learn to discipline and police itself.
2) We urgently need changes in HIPAA to allow unfettered access to patient records from any facility, as long s the need for chart review is documented. Physicians are not the problem, it is the vast number of bums feeding off our work that leads to abuse of information for profits.
3) We need a national Health ID number, biometric ID for every person so that social security numbers are not collected and abused. This has to be done before any kind of universal healthcare is even contemplated. At the point of service, a patient should be able to use his biometric card and allow complete access to all records from any facility where he has been treated. this will reduce errors, increase patient satisfaction and put trial lawyers out of business. Stimulus money should be used for this before wasting it on EMRs. EMRs will NOT reduce errors or cost of treatment. If EMRs were so helpful, doctors would be lining to buy them. We don't need handouts for buying medical software! What a waste of public funds!

There needs to be some mechanism for plantiffs' attorneys, particularly those working on contingency, to have some "skin in the game." Currently, if they take on a case hoping to get 50% of the plaintiff's damage-dollars, the worst that happens to them is they walk away empty-handed. If they risked having to pay for the defendant's legal costs and/or time lost from work, they might think twice before filing.

BTW: No tax breaks for trial/ contingency lawyers as proposed by Arlen Spector and Lindsey Graham.. If you are not familiar with this proposed bill we can send you a link from SERMO.

Agree with Sermo Doc 4 about no fault indemnity, perhaps coupled with a medical court system or expert panels (either one would work) to determine if there was, indeed, a compensable injury. The panel or court could determine the injury and extent of compensation.

I think I agree in principal to the tort attorney argument that legitimate "pain and suffering" be compensated, if there has been a true injury as a result of negligent medical care. A compromise of some sort is probably needed, whereby future medical costs related to the injury are covered, as would be lost wages to preserve actual or projected life style (lets face it, if a physician in residency is injured, compensation should take into account lost potential earnings, not just current status), but some of the intangibles are still legitimate to consider (what value would you place on lost sexual function if it happened to you?).

Funding--equivalent to what we do now with malpractive, but in a no fault system.

And what if there is "fault"? That is a matter for the medical boards and professional society to determine, not the courts. In egregious cases, I would suspect the medical profession would police its own. As a profession we support these practicioners by our increased insurance premiums, and therefore would be self-motivated to deal with them.

Dear Senator Coburn:

At least 50% of current health cost is defensive medicine as a consequence of tort law--not 0.1 % like the Bacus people have said---50%--remember that number. No significant health reform will happen until this changes. If an attempt is made to introduce ultilization control without protecting doctors legally when they say "no" to requests for tests, procedures etc... expect the system to collapse

-pete council, MD rural family medicine in Montana

The current proposal in DC is to establish a new federal agency to write detailed national standards for treatment of anything and everything. This will not create the "safe harbor" they claim. The lawyers will simply claim we chose the wrong guideline. The only solution is separate health care courts. As I understand it there is already a precedent in patent courts.

Agree with Sermo Doc 5, the plaintiff and his/her attorney(s) jointly and severally should be automatically responsible for the total cost endured by the defense in every case that they do not win, no exceptions ! Just like it is else where, like in England. No further tort reform would be needed.

I practice in Indiana and have participated on a number of physician panels that are required by state law prior to the case proceeding to formal litigation. Having spoken with attorneys who both sue and defend physicians I can say from first hand experience that this system works very, very well. Three physicians who practice in fields related to the case but who have no affiliation with the physicians involved make a joint recommendation as to the validity for any given case to move forward in the legal process. The plaintiff can pursue litigation even in the event that the panel finds no malpractice merit however per the attorneys I have spoken with these cases then become very, very hard to justify. Physicians are noble and fair as a group and when true malpractice occurs I believe we have no issue with appropriate action against the offending physician being taken. However, a system such as we have in Indiana cuts down dramatically on the frivolous suits that are pursued with the hope of a pay day, not justice for the patient.

I agree with Sermo Doc 5, in that the plaintiff's attorneys can walk away scott free from frivolous lawsuits. There needs to be some accountability into the system from this group, in that if a frivolous lawsuit is brought against a physician, the plaintiff attorney must then be responsible for some punititive damages to reimburse the system, as well as the defendants loss of income and prestige for this lawsuit.

Another issue at hand is the concept of the jury trial in medical malpractice issues. Juries will have sympathy for the plaintiff, and not the physician, because they have more in common with the plaintiff than the doctor. There is also the issue with paritial awards which tag "fault" to the physician, even if the jury doesn't feel that the physician is totally at fault in the judgement. There needs to be some kind of medical review board which evaluates these cases to provide fair and reasonable opinion regarding malpractice issues.

Finally, instead of large award sums to individual parties, why not set up some kind of patient compensation fund that will pay the expenses of patients who have suffered at the neglect of their physicians. There already exists some element of this for children harmed by vaccines, so why can't there be a more broad ranging scope for other types of injuries?

I agree with above doctors comment. There has to be a mechanism to filter out the "malpractice" attorneys. Just like in medical community there are some "bad apples"
In legal system, these are present. We need to hold them responsible and accountable for their actions. VA healthcare systems have a great mechanism that maybe partially integrated: For any nonprofit and charity medical practice, the physicians shall be immune from any legal action against them. Someone has to sue uncle Sam, not physicians to encourage physicians to do more charity work. For medically undeserved area, this is going to be a great incentive for physicians who are willing to work there. Thinking about the old days, the malpractice lawsuit was very rare, and medical insurances had almost always paid physicians fully, and patients have nearly paid zero from their pockets, the medical insurance premium were very affordable for the income levels at that time. What has happened? Why can we move back by cutting out the difference. Medical technology has advanced , so does everyones income. The ratio of premium and income has drastically increased. The ratio of healthcare cost per capita and income per capita has drastically increased.

It is difficult to reply to any issue supported by Coburn. He is the source of outrageously unscientific nonesense related to global warming, the Schiavo case, intelligent design and on and on. Medical tort reform is needed but remember that this is lumped in Coburn's mind with any measure to lower the chance that big business might be a target of lawsuits. He has already registered his opposition to any improvements in medical care coverage and deliver.

Tort Reform is no different than health care reform. It costs are going to be contained the plaintiff/patient needs to have some financial responsibility for attorney fees or health care expenses. Contingency arrangements only encourage frivolous lawsuits as health insurance with limited or no personal financial responsibility encourage over utilization.

I completely agree with the previous commentaries but I doubt change will come. Why? The problem in healthcare stems from the abuses and lack of ethics in the majority of trial lawyers that feed from the "lottery mentality" they have promoted amongst a significant number of our patients. Solving this would require strong efforts by our politicians to go against the interests of the legal profession. But most politicians are lawyers and antagonizing their own would prevent their advance in their political careers. The only solution is tho establish a united front as physicians and probably even to unionize to have enough competitive force against Insurance companies, lawyers, pharmaceutical companies and all the "sharks" that profit from our work.

I work in Texas and the tort reform here has made medicine better. We still watch what we are doing, but don't feel as if we have targets on our backs anymore.
The trial lawyers are so entrenched in Washington I doubt any real reform will happen.
Dr. Coburn glad to have you on Sermo. Keep up the good work.

Frivolous lawsuits must stop and plaintiff attorneys must have something to risk in the game. The pain that a physician experiences when sued is unknown to anyone who has not personally experienced it. Let the plaintiff attorney experience even 1% of that and something might change. Defensive medicine exists on a daily basis. Health care reform cannont occur wihtout tort reform.

The idea of health courts and expert panels is a good first step. We need to get the contingency system of payments for attorneys changed.

However, I do not think tort reform will likely have a significant impact on healthcare costs. Malpractice premiums will go down certainly but the way that we practice medicine will not likely change. Much of the so-called defensive medicine is simply a style of practice which we have become accustomed. It is both the physician and the patient's desire to remove all uncertainty from the practice of medicine. We continue to do testing even though the results may not change the outcome, make any difference in treatment.

We need to train physicians to feel somewhat more comfortable with some degree of uncertainty in their diagnostic approach to patients.

In the State of Utah, we have binding arbitration. At least 95% of my patients sign it and I think that is typical for most offices. Malpractice premiums stabilized once arbitration became widespread. The other very noticeable difference was that all the attorney ads on television changed from focusing on medical malpractice to big rig truck accidents. Malpractice premiums and CONCERNS about malpractice has closed hospitals and eliminated the availability of entire specialties in locations accross the country. Doctors cannot practice in an environment where they fear that they are one error, or one perceived error away from complete ruin. This causes over-testing and over-treating to err on the side of caution. I estimate that as much as 50% of cost in medicine could be eliminated if torts were capped nationally and arbitration was the norm for 100% of patients.

One clear benefit of an expert panel is removing the bias to deal only with massive potential payouts. By removing this bias, cases can be seen based on merit, regardless of payout. Thus the "small fries" have more ability to get what they deserve, while at the same time reducing the crapshoot for frivolous lottery payouts based solely on jury ignorance. This reduces total costs, increases reasonable payouts to real victims, and still identifies repeat offenders.

and if we are wise, it could also protect good docs from losing insurance for being named frivolously.

Sermo Doc 21-neurology

I am in total agreement with Senator Colburn's assessment of the tort problem and also his pointing out the continued hiring of government bureaucrats

I would like to remind the Sermo community that in June/July 2008, Senator Coburn voted against SB 3101 3 times - voting to cut Medicare payments to physicians by 10.1 %. He even voted against the veto override after it had passed the Senate by a veto-proof margin of 68 votes. Why would a physician do such a thing? Because the money to pay for the physician reimbursements was to come out of the Medicare Advantage boondoggle.

If Senator Coburn is interested in healthcare reform in any fashion, it is only to please the insurance industry. He does not stand with physicians.

Senator Coburn, thank you for your efforts. I agree that Tort reform is a necessary part of reducing healthcare costs. A large part of medical care is "defensive". Along with Tort reform should be strengthening of protections for Peer Review, as wellas hospital disciplinary boards. If physicians are freed from fear of being sued if they report dangerous practices, we can do a better job of "policing ourselves". On the broader societal scale, how much money slated for education, for example, is wasted on legal fees to either create cover our ass protocols for school districts or to defend or settle frivolous law suits. How about money for city and county governments? Police forces? Fire departments? The effects of rampant lawsuits in our society touches much more than healthcare.

I would favor the health court model, presided over by a judge with binding decisions. I would recommend that the judge solicit medical input from vetted clinicians with years of working experience in the field that is related to the case. I would do away with all contingency fees for the plaintiff's attorney and agree that there must be some disincentive for bringing frivolous cases before this court. Attorneys should be paid hourly by their client or charge a "lump sum" that could be paid after the decision. The medical lottery currently in existence needs to end.

As you are very much aware, tort reform represents only one of the critical legal obstacles that we face as physicians. Anti-trust reform, reform of EMTALA, major reform of how health insurance is marketed and sold and returning health insurance to the status of true insurance should be a part of any comprehensive, constructive overhaul of the American health care "system".

I know of no physician who does not believe that a patient who is truly harmed by a medical error or negligence should receive FAIR compensation. But, plaintiff's attorneys should not be able to get rich on the back of some one's medical career or the misfortune of an individual patient.

This will require a radical change in our current culture. But, we must begin these changes with rational discussion and debate of the true critical issues facing the medical profession and our patients. This discussion has been glaringly absent from the current so-called "reform" debate.

The fact that the AMA signed on to this so early in the process is a travesty and a sad commentary on the state of organized medicine in America.

My best wishes in your endeavours!

If you accuse me of malpractice you should have to prove it to a higher standard than preponderance of the evidence which allows attorneys from both sides to try and sway a jury with court room theatrical productions and win cases based on emotion rather than facts. If the rules of evidence were changed to clear and convincing then most cases would never see the light of day and frivolous cases for sure would go away. The patient retains his right to sue but the doctor is given true due process because the patient is tasked with proving the doctor did something wrong.

All the current debate on health care reform is totally misleading. No one understands what is at stake or what others are proposing. Obama is the only one who knows what he is aiming, - complete socialist government controlled everything.
Ok to keep talking about Tort reform, etc. But realistically most politicians are lawyers and they will not reform themselvs. The only hope we have is that the fat greedy insurance companies can be controlled like hospitals and doctors. If they can set the limit on doctors' fees, why can they not set the limit on Insurance company CEO's???
William Oh, M.D. Orthopaedic Surgery

Real simple: Give the people a choice, if you want to try your luck in the lottery, be prepared to pay up if you lose your bet. Make the plaintiffs and their lawyers pay for court costs and damages if they lose. If someone feels they have suffered as a result of a malpractice and they do not want to risk the consequences of losing, they can bring their case before a panel as described by Senator Coburn.

Coburn - you are a fraud and a disgrace to physicians in this country.
Where were you when your party had the White House and majorities in the Senate and House of Reps? Where was the concern for tort reform then?
Why didn't you respond to Obama's efforts to include malpractice reform in the current healthcare bill?
Why do you play your fellow doctors like fiddles when you know you're not interested in passing any real reform?

Senator Coburn,

1) Caps on non-economic damages
2) Penalties for lawyers who bring frivolous lawsuits to the courts.
3) Limit the cost of malpractice insurance charged by insurance companies.
4) Offer a "bond" system like Florida which allows physicians to place $200.000 into an escrow account and forgo malpractice insurance altogether (or some other similar alternative).
5) Help curb "defensive medical practices" which are directly related to malpractice suits and are a significant contributor to the cost of healthcare in this nation.

Thank you.

I agree with Mr. Coburn's ideas - without a fix in the tort system, there can be no meaningful reform of health care prices. Each suit, each lawyer, each law office, on both sides, drives the cost of health care up. The billable hours spent by lawyers on cases well exceeds the actual time physically spent. They don't have to rely on byzantine coding systems for their payments, nor do they have to go through some middle party telling them that their payment will be denied and that they will need to appeal if they want to get paid.

If the ease of filing suit and the potential promise of riches for the "injured" was taken away (by that I mean the money that the lawyers, not the actual injured person, make), then we might have some meaninful reform.

To suggest that medicine is a faulty product, and that doctors are somehow part of some big conspiracy to promote a faulty product, is simply ridiculous. Get tort reform done, and then allow physicians to develop and drive protocols to improve the quality of health care without the fear that if something falls out of protocol, a physician will not be crucified and lose their career and their savings. There is simply no way, given the vagaries of the human body, that every protocol will catch every problem and there will always be a "complication" of some sort or other.

What matters is whether the complication is intentional or not. Standard of care is currently at best defined in an unclear way. And that simply serves to make the attorneys rich.

Thanks to tort reform in Texas, Neurosurgical care is now available to Texas citizens living south of Houston. Care is more available in many rural communities because of the influx of physicians since tort reform passed. The only change that was made here was to LIMIT THE AWARDS FOR PAIN AND SUFFERING. Awards for medical/surgical costs and loss of earning power, etc. were not affected.

There is, however, a better solution. We are guaranteed a trial by a jury of our peers. Malpractice cases should be tried before a jury of physicians, not lay persons. They have the knowledge to understand the nuances of medical conditions, known complications versus true mistakes, and the unpredictabliity of biological phenomenon. There is no other constitutional solution.

Dear Senator Coburn,

The Expert Panel idea is intriguing, but I would be much more comfortable with the notion if there were also non-professional, non-voting observers on the panel. The risk of "insider deals" on a panel such as you have described is always very high.

The same risk of "insider deals" makes the health court notion equally risky. I believe that if this mechanism were to be used, it would be of paramount importance to ensure that the presiding judges were not known to the participants prior to convening the court, and that the judges always be from a distinctly separate geographic location (out of state and out of region) from the plaintiffs and defendants. The logistics would be difficult, but the cost savings of such courts would offset the logistical costs.

A different but concrete proposal for tort reform involves asking the AHRQ and the NIH to shift the emphasis on their guideline development program to establishing explicitly "liability proof" guidelines for diagnostic testing and treatment procedures; i.e. creating guidelines which, if adhered to, protect the physician from the threat of a lawsuit based on the diagnostic or treatment steps followed. This is almost, but not quite, what has been proposed in Congress.

For example, a guideline for appendectomy diagnosis could involve WBC count, certain physical signs or symptoms (fever, nause/vomiting, pain relief on leg adduction, etc - 3 out of 5), an ultrasound, and/or an abdo CT (with or without contrast) - ultimately, whatever steps are supported by evidence based medicine. If those criteria were met, the Sermo Doc 186 would be held free of liability in the case of a negative appy, or a more serious intraop finding. Likewise, the anesthesiologist could be held free of liability if following guidelines for rapid sequence induction and endotracheal intubation, even if a malignant hyperthermic event occurred on the administration of succinylcholine (assuming the MH were properly handled, but regardless of outcome.)

The agencies want to form guidelines, and everyone recognizes that good solid guidelines can increase the quality of care, but many practitioners are reluctant to follow them for a variety of reasons. Liability-free guidelines would certainly increase compliance, would presumably result in a higher level of care quality, and would protect physicians from the lottery aspect that arises with any unexpected event. Likewise, liability free guidelines would do much to prevent the practice of excessive defensive medicine in the cases to which they are applicable.

Thank You for your interest and attention.

We need universal healthcare where litigation would be rare. Trial lawyers will fight this. Insurance companies will fight this. I haven't seen any plans for giving physicians a windfall profit.

Tort reform is important but universal coverage is more important. You and your fellow Republicans should stop being reactionaries and reflexively opposing any proposal that actually helps people. Lead, follow, or get out of the way.

Senator Coburn:

Every single problem with the current tort system could be solved by 1) adopting a "loser pays" rule, and 2) placing a majority of NON-lawyers on state bar disciplinary boards. The second would be almost impossible to accomplish, the first is the rule in almost every other civilized country.

A "loser pays" rule, STRICTLY ENFORCED, would almost immediately reduce filings by 80%, which would, in turn, reduce insurance costs, and reduce 'defensive medicine'. The loser pays rule should include that provision that, whatever economic BENEFIT the attorney stands to gain by winning a case (eg., a 35% contingency fee system), that percentage of the costs of defense will be assessed TO THE ATTORNEY if the plaintiff loses. The remainder would be assessed to the plaintiff, unless the plaintiff cannot pay, in which case the ENTIRE amount would be assessed TO THE ATTORNEY.

I can assure you this would stop the filing of meritless lawsuits.

Picture yourself, walking down the street. Another fellow walks up and says "I am going to start a fight with you. However, if I lose, you can't beat the crap out of me. You just have to stop, and let me walk away. That's the law. On the other hand, if I win, I DO get to beat the crap out of you."

This is not justice. This is robbery, pure and simple, and the system as it is ENCOURAGES such behavior.

Loser pays. Simple, direct, and to the point.

Do not be swayed by the "universal coverage" argument (and, as an astute physician, I am sure you are not). Unfortunately, many physicians' economic education and understanding is childlike and primitive, and they are unable to understand the unintended consequences of "universal coverage", even with numerous examples all over the world for the to learn from. Let us all be free. Free to choose what we wish to pay for, with our own money, or not. Statism/socialism/communism has been tried, it does not work.

My concern with a health care court is the ability of physicians to prostitute themselves and make an income off of such a court, much as they do now for being "expert witnesses". My suggestions:

1) limit attorney fees to some small percentage of the total winnings (?10%)

2) have a "loser pays all" award system, where the losing party in any suit would have to pay for all legal fees of both parties

3) limit the moneys collected on charity cases to some nominal amount, so that I'm not inheriting 100% risk and 0% payment.

1. Loser Pays.
2. "Trip Insurance" - patient-purchased for specific procedures that may have inherent risks of bad results.
3. Dual degree ( Medical-Legal) certification to practice law in Medical-Law Court
4. Ability for physicians to purchase Legal Defense Insurance only without the judgment award.
Gerald N. Yorioka, M.D.

I like the panel mechanism, it works well in Indiana. In addition, there should not be variability from state to state in malpractice premiums, a compensation fund like in indiana should be set up nationally to award monies to those hurt by malpractice. There is also no reason that cases that are pursued can not go before a judge of the type you suggested. I.e. there is no reason why one of your second suggestion senator should outweigh the other. They both can work.

Also, costs associated with a case that are rendered in favor of the defense should be paid for by the plaintiffs

I've worked in a "loser pays" state and on a civil matter was unable to find an atty to take the case because my potential opponent was politically well connected. All atty's I spoke with said my case had strong merits; all, once aware of the opponent, also said the risk of loss was too high and became unwilling to take on any of the cost risk. "Loser pays" impedes the function of the system in favor of the powerful.

Dr./Senator Coburn -
Please use your influence to change the final bill with regard to acceptance of people with pre-existing conditions. There will need to be age adjusted community ratings for everyone. Otherwise it might be possible for an insurer to accept anyone ,including very,very ill people but charge them some exorbitant rate.
There needs to be community or population age adjustment of health insurance premiums - it is not fair to ask a 25 year old person to pay the same as a 64 year old person.
BJW 13474 Rad Onc

Dr./Senator Coburn,

One man's courage makes a majority. Thank you for being America's physician eyes and ears in the Senate and Congress.

I hope you will share our collective thoughts with President Obama, since I believe your unique background as a physician and legislator will carry the appropriate influence to give physicians the voice we need in health reform.

Robert A. Beltran, M.D, M.B.A.
President, Latino Med Policy Institute

I recommend advanced payment for the right to pursue litigation; for example, if you choose the "no tort" option, your health insurance premiums are decreased by, let's say, 50%, as opposed to those who chose the "tort option". Also, when undergoing specific procedures, such as elective surgery, you can purchase the tort option (or various tort options) for that specific procedure, by paying an extra premium (e.g. $1,000), just like we purchase extended warranties...those who have state-funded insurance, like medicare, should have state-regulated caps on rewards.

It is unfair for the entire US population to pay for ultra-expensive healthcare, so that 1% of the population can collect multimillion dollar rewards.

What's been lost in the debate is the contribution of the litigious climate in the medical field to overall health care costs. If you look at many other countries, even those we tout as models for a nationalized health care system, they all have sigifincant caps on lawsuit damages and mechanisms on deterring frivolous lawsuits that our country does not. It stands to reason that medicolegal reform is essential to cap health care costs.

Implementing a "loser pays" format is the simplest way to achieve tort reform that would signficantly reduce health care costs for all. Over two-thirds of physicians will get sued at some point in their careers. Weed out the frivolous lawsuits so we can do our jobs without worrying about trival ligitation. Also putting caps on damages awarded to plantiffs is key to this effort.

From the trenches:

Dr. Coburn,
Mine is just one clear example- God willing, my status would remain this way...but it may just be a matter of time...
I have been judgment-free ever since I started...and yet, my malpractice premium had increased 150%. I called our State society's Insurance representative and explained my frustration. She explained that in our area, an FP like me gets sued on the average, every 7 years, and since I'm beyond 7 years, my premium should go up (in not so many words- that's essentially the gist of it). In short, the longer you stay in practice, the higher your premiums. Do a procedure, premiums go up even more significantly.
This is THE ONLY profession that's so OVERREGULATED, and repeatedly RAPED by professionals whose only expertise is to work around loopholes for their benefit.

This is a concept I've mentioned before, but I realize also the likelihood of something like this being adopted.
Sometimes there are bad outcomes regardless of the quality of medical care. The present system focuses on what is probably a minority of cases, namely those that are litigated.
I would like to see a charge made for every hospital admission. This money would fund a program to provide for every bad outcome regardless of cause.
Most hospitals have a review system to review such cases as it is. This system would focuse more intensely on the source of the problem - to see if is correctable.
If the physicain were responsible, then the panel has multiple options. They could require further training, limiting procedures to demonstrated competence, suspension, supervison, etc..
Unexpected bad outcomes are problematic for almost all involved, but only a minority find reasonable compensation. This would provide some compensation for all.
I'm aware that the likelihood of changing a system that removes litigious lawyers from the playing field is probably a magnitude lower that the chances of a snowball in hell surviving intact, but it is doable.
For example: there are several suggestions above that would help if implemented.
I appreciate your willing to get involved with the hope of finding some improvement in our current system.
Thank you.

We have to be a little bit careful, here. I personally have sued for wrongful termination poor products and services, etc What does this have to do with the topic?? Nothing and everything. Once the Neocons take away the right to sue MDs, they will take away the right to sue asbestos manufacturerers, toxic waste dumpers, wrongful death on the job... until it's like the union busting which put hard working people on minimum wage jobs at Mickey Ds. Some inner city juries like in Detroit and Chicago pay out big b/c they resent the "rich doctors." Attorneys even change venue from the suburbs there. But the solution to that is to not have ghettoes in the first place. If their is a "cap" it should not be 250k or other ridiculosly low level. The lawsuit should be based on the seriousness of the error and the outcome. Obs Sermo Doc 186s and ER have the most to fear under the current system. Dade County Fl Obs have VERY high rates! They can practice "naked" if they put house in wife's name have family limited partnership etc.

Come to think of it, how did MDs get involved anyway?? surgeries take place and babies are delivered at the hospital. Sue the hospital only (deepest pocket) and let THEM expel the doctor (if warranted.) Another issue is that the "life's unfair no lawsuit" neocons also are against "entitlements." A Forrest Gump baby may cost 2 million dollars over a lifetime and they say "let the extended family pay or collect money at the local Chuch." That's not right.

I am agreeing with a Republican. What has the world come to?!

*ducks behind counter to avoid approaching flock of flying pigs*

1- No fault medical indemnity for physicians
2- If case is lost, the lawyers and their Plaintiffs should be responsible for the cost, expenses, time lost, etc.
3- Medical courts or "legitimate" and properly selected expert panels would be the place to settle medical lawsuits.
4- Standard of care guidelines to be formulated by respectable medical bodies NOT bureacratic/political/legislative committees!!!

All this will assure the system will rein itself rather than the current mess of frivolous lawsuits and expensive defensive medicine - the main reasons why our healthcare costs so much!

Thank you, Senator!

Senator Coburn,
Thank you for your voice of reason in the US Congress. Unfortunately, even with your reasonable suggestions on tort reform I still read a lot of physicians here on Sermo disagreeing with you or asking for more. Many of the suggestions on this thread would never see the light of day in today's US Congress.
I fully support your leadership on this issue and look forward to hearing more.

There are several countries around the world (Australia or New Zealand for example) in which all physicians pay an annual fee to a compensation fund. When physician errors damage a patient an appropriate sum is paid from this fund. How much is decided by the administrators of the fund. Accordingly, litigation is very uncommon. One very positive part of this practice is that the erring physician admits his mistake and apologizes and encourages the injured party to get just compensation from the fund. This goes a long way towards satisfying the injured party and restoring a positive doctor patient relationship. If litigation is pursued, however, there should be no artificial cap. How much is paid should be determined by the extent of the injury and the ongoing needs of the injured party resulting from the injury.
In this system, because of the rarity of litigation, doctors don't continuously live and practice medicine under the cloud of malpractice litigation.

I'm afraid that any federal tort reform will undo California's cap on non-economic damages (MICRA). Any attempt at reform should not pre-empt state laws, like California's which are more protective.
We also have to watch out for special medical courts -- they could go the way of special courts for injured workers. Anyone who's had to deal with workers compensation knows how the goals and outcomes of a system can diverge.

1. If we had universal health care, there would be no need to pay for a lifetime of care for a disabled baby or other injured patient.
2. Eliminate joint and several liability and the collateral source rule.
3. Panels sound like a great idea, and MD-JDs would be well suited for this job. There are several thousand of us nationwide.

As an Internist, I don't practice all that much "CYA" medicine (maybe I SHOULD) I just lecture pts on smoking controlling Diabetes weight loss etc. I do NOT order MRII for a headache unless there are new seizures or it is severe. I probably don't fire enough non compliant patietns.

Jaded- you need to be a bit more specific- You agree with the Republican Senator on this one single issue.. I think tort reform it is one of the very few things that actually would have a very broad consensus among most, if not all, physicians....

( But if you know anything more about Coburn I doubt there is much more you would agree with... His opinions about a whole variety of issues - including abortion, the death penalty, evolution, gun control, AIDS research, 'rampant' lesbianism , even the Holocaust, cast him as a very unfortunate representative for anyone, let alone physicians....)

You need to address the data to which opponents of tort reform refer--Macallan, Tx Medicare per capita spending vs. El Paso, Tx--both in the same state that has had some degree of malpractice reform. 250K cap on noneconomic damages is simply not enough to reform the system, and you cannot extrapolate this Medicare discrepancy to conclude that tort reform will make no difference.
On an unrelated note, it's important to dispel a few myths--among your colleagues and constituents:
i) 'Healthcare expenses would be greatly diminished if we cut physician reimbursements' - wrong, since only 20 cents on the healthcare dollar are physician compensation, and typically 60% of this goes for overhead. Throw in that 50% goes back in taxes and only 4 cents per dollar actually ends up in the physician's pocket;
ii) 'We spend more on healthcare and don't live as long as those in other countries' - true but not related! We are a nation of obese, sedentary people, and you cannot blame the healthcare system for our lifestyle choices. We also value the individual over the greater good, and are willing to pay for cutting-edge procedures and drugs that don't always reap benefits. But we as a nation produce the lions' share of new drugs, devices and procedures that benefit the world--with the cost of R&D borne here.
iii) 'fee-for-service is a perverse system of paying doctors' - just because a system of reimbursement can be abused doesn't mean that it is not the most fair and accurate system. Capitation promotes undertreatment, and penalizes those who treat more complex patients; salary discourages hard work and entrance into more demanding, longer-training fields; fee-for-service can encourage over-utilization, but with appropriate monitoring and co-pays to re-engage the medical consumer fee-for-service remains the fairest, most accurate form of reimbursement.
I think meaningful tort reform is unlikely, given that 80% of the world's attorneys practice in the U.S. You would do the physicians and patients of our country better service by helping to ensure that medicine remains an attractive field for our best and brightest--if we superimpose a restrictive, underfunded Canadian-style system on top of the current malpractice setting and expensive education found in the U.S., no smart kids will want to go into medicine any more.

Meaninggful Federal Tort reform is a must. I like the idea of the No fault medical indemnity. Massive public education is also necessary because families don't understand medical futility, and keep demanding unreasonable tests and procedures on terminally ill patients. Also, radical reform of the insurance industry is essential. Presently, both physicians and patients are constantly and routinely being "denied", and yet, CEOs keep raking in billions of dollars in profits. There is something wrong with this formula, and it has got to stop. Thank you,

The TORT reform is the healthy start for health care industry. The senator has self interest, party interest, insurance industry, trial attorneys, patients, country economy, and lastly physicians.These polyogonal forces of interests find the equilibrium based upon their relative strengths, if the sytems were to be viable. Politics is an ambiguous and nebulous system full of tricks. I hope we physicians survive through this health care crisis with senator Tom Coburn's cutting edge treatment.

Tort reform is a critical component of any meaningful attempt to reduce healthcare costs and improve patient access to treatment. We all know that patient access is adversely affected by the current malpractice climate and is continuing to deteriorate in the face of decreasing reimbursement to physicians. There are too many disincentives for docs to care for patients in the current environment. Additionally, respected sources on the direct and indirect costs of defensive medicine place it above 100 billions dollars annually in the USA.

Here's my suggestion, which will never be adopted.

1. Patients using the healthcare system would have to contribute to a medical disability insurance pool for payments related to adverse outcomes from medical or surgical treatment. A schedule of payments would be established much like that for disability related to industrial accidents. Patients would be compensated according to this schedule without consideration for intangibles like "emotional distress". Compensation decsions would be made by a board comprised of the appropriate individuals including physicians and laypersons. Since all persons pay into the pool, it would reduce the premiums for physicians. Also, since this system would disincentivize plaintiff's attorneys from seeking lottery verdicts, it would reduce legal costs dramatically. Simultaneously a greater percentage of patients who have bonaf fide complications from treatment would recieve compensation commensurate with their disability level as opposed to taking their chances in court.

Under the proposed system, physician negligence would be addressed separately from the compensation question by an impartial review panel or court to determine if appropriate standard of care was met. Standards of care would be established by experts not by lay juries under this system in the interests of fairness and reproducibility.

This system would achieve the goals of fair compensation for any patient with a legitimate disability related to medical care, distribute costs amongst all persons using the system, thus reducing premiums, and separate the issue of negligence from that of financial compensation. My guess is that most patients having complications if they were covered by an insurance policy for disability would not sue their doctors, since their costs would be covered and no lottery pot of gold was on the table.

One thing you can learn from UK and Australia or France is how medical mishaps are compensated. Docs DO NOT engage in criminal misconduct..If they do they can be prosecuted to the full extent of law under the existing laws. To take common medical mishaps to civil courts and claim all kinds of damages is an invention of the American legal industry. The impact of their propaganda is so severe that 9/10 highly educated people posting on this thread are still asking for "tort reform". We urgently need a "no-fault" compensation system without criminalizing every medical mishap and making it an event worthy of "torts" !

Senator

Thank you for taking the leed on the most important component of healthcare reform.

As you are aware defensive medicine is estimated to cost in the neighborhood of $125 to $150 Billion dollars per year and tacks on an estimated 2-3K on each individuals insurance premium.

I agree with all your proposals and would add, as others have, the ability to sue malpractice attorneys who go fishing with frivolous suits. I would take things a step further and allow the physician to collect damages and not just recover court costs.

I also agree with Sermo Doc 31. We need to have better standards of care which has its roots in evidenced based medicine. The courts could then use this to approve or deny cases. We also need to have an acceptable error rate built in as medicine is not an exact science.

Thank you again

Liike other primary care practitioners in small solo practices (have been an internist for over 25 years), I have witnessed my income decreasing each year, to the point where I am about ready to just close my office. I have even thought about training 2 years to become a physician's assistant, whereby my malpractice would be lower and I would receive about the same salary. The death knell for my and other small practices is the mandate that we personally finance EMR's, which provides negligible benefits to me and my practice. I have been a fervent user of e-prescribing, which was offered gratis through Allscripts. If we are to have interoperable, universal electronic records, why should struggling solo offices be forced to finance up to $50,000 initially (which is 50% of my income, by the way!)? And, by the way, the government stimulus, which is dependent on the number of visits reimbursed by Medicare or Medicaid, will defray a very minimal part of the cost for low volume practices like mine. The private insurance companies ( to which most of the benefits of EMR's accrue), still operating in the black, might be called upon to set up the system as an on-line universal system, to which all health care facilities have access. Or why not make the much-touted VA hospital system available to all at no cost?? Personally, I don't really expect any improvement in health care when experienced primary care practitioners like me become extinct and we all have to rely on N.P's and P.A.'s for our care.

Dr Coburn, an expert panel that includes a "tied" number of lawyers and doctors, is not appealing, particularly a 3 to 3 ratio. Just doctor/s as experts is also not appealing, as I have personally seen a doctor that was hired by a lawyer just to support the lawyer's argument, no matter how obviously wrong it was in the merits.

I am not opposed to some sort of arbitration panels but I like better the concept of "caps" . The recent history of the lawyer and ex presidential candidate that made a living by doing this should remind us all, that the system of compensation is completely broken and needs to be drastically changed. Lawyers should not be compensated at their individual hourly fees but at some sort of community adjusted rate and a limit on maximal compensation per case that should not exceed or even come close to what the patient or family get.

I hope you are successful in making tort reform as part of the health bill. No bill should pass unless there is tort reform. But some sort of tort reforma should be introduced, regardless of what happens to the health bill.

Sen. Coburn: Despite a minority that echo Pres. Obama's ideas (entirely suicidal, I believe), the vast majority of Sermoans believe that a serious change in medical liability laws is a critical piece of any meaningful reform of health care. Now that the President likes to call it "health insurance reform", perhaps the Republicans can address "health care reform" in a methodical manner and actually involve patients and physicians.

I control the cost of my patients' health care by ordering or not ordering tests and admissions.When I see a patient with a headache and his symptoms and exam do now warrant testing, I do none and follow him.If that same patient presents to any ER in America, he will get a CT scan regardless of the H&P.One ER doc has said "I'll xray them till they glow if it keeps me out of the court"Without tort reform there is no way any of us are going to change our ways...therefore there will not be any savings to be had.

Organized medicine should demand tort reform as a part of health care reform. I applaud Dr Coburn for making this an issue. Welcome to Sermo Dr. Coburn!! No fault malpractice ins. is a great idea with a health court to make final decisions re: fault. No brainer....things would be much better. The court would be able to distinguish between bad out comes (which are enevitable) and malpractice. I would also support strict disciplne on the "bad apples" minority. 3 strikes and you are out!

The USA is the only country in the world that allows lawyers to charge contingency fees.
Get rid of contingency fees and the problem of frivolous law suits is solved.

Marvin Abrams MD

There is nothing here about insurance reform.

Just wondering...
Anyone think the "good" Senator is (or will be) sitting by a computer to read or respond to these posts?
Similar to Senator Specter, I suspect his involvement is in name only- with a junior staffer accessing and reading this....
Maybe a better use of his time, and still some partial access is better than none, but hardly worth getting too enthusiastic about welcoming his presence.....

At least so far, until we see where it leads...

Dr. Coburn, we definitely need to put forth our thoughts if we want change. Being from Canada and having worked in both systems, I have to agree with the general ideas proposed by Sermo Doc 4 (Gastroenterology). We need a system that goes back to "thinking" rather than just "doing", especially if the "doing" is out of fear, rather than what is best for patient. Tort reform is a step that may make us healthier not only when it comes to medical practices, but when we consider its overall impact on our philosophy as a society.

Great post, Senator Coburn. I do appreciate that your initiatives are broken up into individual posts, which gives us a chance to hash out each issue. Thanks for making sure that physicians are at the table (for a change) in this process.

I do agree with the formation of expert panels to deem merit of cases. It may help to do away with lawsuits for cases of simply bad outcomes.

I think caps are a great idea and would like that incorporated to national legislation.

I agree with a limit on the amount that lawyers are compensated, that either maxes out at a certain percentage and/or allows them to bill for time actually spent on case (with a max on the hourly rate) and prohibits them from agreeing to a payment that is a percentage of the award. That would limit their incentive and can be spun as "Making sure the patients rightly get as much of the compensation as they were due"

I also think that tort reform should address physician consultants and set up a code of conduct- making sure they have credentials that make them representative of their medical peers, in terms of board certification membership with professional organizations, documentation of adherence to current practice, and documentation or current practice in the field in which they are testifying. Any code of conduct make these physcians accountable for medically erroneous testimony and should give state medical boards authority to investigate and sanction anyone who is found to testify 'basically what the lawyer wants to hear"

There should be strict guidelines on the sources used for the definition of standard of care, in terms of defining from where this information can be derived. It should not be something simply made up by an expert testiying in court that day.

As was pointed out, a system that incorporates a 'loser pays all' penalty may decrease incentive for frivolous lawsuits, but may also promote a culture where those who are polictically connected may seem beyond reproach.

ID, I wonder the same thing. But, I don't think that should deter any of us from enthusiastically answering. This is just another way of getting the message through. I'm in favor of getting the message through as a citizen without having to pony up $1000 to become part of some legislator's physician advisory group that is a front for the NRCC or any other group. I'm tired of our Senators and Representatives having to be whores for money just to get their jobs done. An honest request for information that occurs outside of the PAC system or other lobbyists is particularly refreshing.

First, I am happy to talk to anyone who will listen, regardless of their previous actions.

Second, I have worked as an expert witness for both plaintiffs and defendants so I have some experience with "real" medmal; this leads me to conclude that there are patients who are truly harmed by substandard medical care (often a system failure) who deserve compensation for injuries sustained as a result of this care.

So, here are my thoughts:

1] medical malpractice law is primarily a law of working-age adults, because damages for lost wages and the costs of additional medical care are modest in the elderly

2] defensive medicine is practiced most aggressively upon fairly healthy people who just might have a very rare condition, or who are fearful and don't trust their doctors; the physician practices defensively (CYA tests) or adaptively (giving in to patient demands is faster than resisting them)

3] the fear of just being sued is sufficient to drive defensive practice, because the lawsuit process itself is emotionally, physicially and sometimes financially debilitating

So the best "tort" reform is a reform to the method of health care delivery and payment that changes incentives. Taking it point by point:

1] set a fairly high bar for filing a suit (EW report, attorney puts up earnest money); establish CONTRIBUTORY NEGLIGENCE as the medmal standard; ELIMINATE non-economic damages (often translated into physician-punishment damages)

2] convert to a high-deductible model whereby the patient is responsible for payment of the first X thousand dollars of medical care - there is no more powerful incentive to listen to the MD say "I doubt your back pain is spine cancer, let's try a new office chair before an MRI"

3] establish a system of health courts than accelerates the process of investigation, mediation and settlement to decrease physician fear

That's a rough outline. Thanks for listening.

look at states with long standing and court tested reforms like Sermo Doc 10 reports from Indiana. Already tested in the courts. Why reinvent the wheel?

Snakes in the grass.............

Even though you are a MD because you are a politician your motives are automatically suspect...........that's the degree of respect we have for members of congress...

To quote from " Red October" I'm a politician which means I'm either kissing a baby or stealing her lollipop!

I would rather let the doctors police their own profession....I've seen too many MD's sell out becuse it's more lucrative so I would have each MD vetted no outside affiliations with lobbyist and less than friendly entities like AARP or the AMA.

How about seeing a little balance....let's review the practice of every lawyer and see how many are guilty of malpractice and see how many still would have a license after being given the scrutiny we are under......

I will never trust TORT reform until lawyers are taken out of the equation!!!!

GOT IT ! ?

Thank you DR. Coburn for initiating this dialogue. It is sad to watch a town hall meeting with Dr. Howard Dean, as he was questioned about medical malpractice, he just stated in public that the Democratic party was not willing to take on the plaintiff lawyers.
We all agree that there is a huge hidden cost of medical care known as "defensive medicine." We could cut some of this by changing the incentives for the lawyers. However, I agree with some of the participants above, that there are still some bad actors.
In Texas, the tort reform has reduced the number of medical malpractice suits, simply because of the limitations for pain and suffering. So true economic damages are paid. However, the trade off has been a very threatening Board of Medical Examiners.
The idea of an expert panel, which would essentially objective peer review, sounds the fairest. I do not know how to insulate such a panel of experts from political maneuvering, however, that would be ideal. A judge versed in health care law as a mediator with such a panel may be a good linkage to the legal system.

There is no better deterrent to frivolous law suits than the English Common Law System where loosers pay all the costs incurred by the defendant ( including loses to his business as a result of the time spent defending himself). For those who admire the British National Health Care System, this should also be very attractive.

Thank you Senator Coburn for coming to physicians for solutions. As a resident physician I am scared about how health care reform is shaping up and unless some sort of Tort reform is implemented with it, it will certainly not be as effective as it could be. We are taught from day one of medical school to practice defensive medicine, not because it's in the patients best interest but because one error is so devestating in so many ways and could cost us our livelihood. So in making decisions about reform you either have to decrease the incentive to sue (capping the amount of money lawyers get) or decrease the punishment for making an error (instead of revoking a license require additional teaching or courses for improved training). The sad reality is medical errors are likely to increase as the patient to physician ratio is going to increase with the baby booomer generation getting older, meaning less time with patients and more room for errors. If we don't fix it now we will be a lot worse of in the next 20 years.

I would be cautious about a "health panel". Would we get said panel from which head hunting, politically appointed Board of Medical examiners are derived?

Thank you for taking the time to get our opinions.

Trial by jury is a bed rock of the US Constitution. Every specialty court that relies on professional experts becomes corrupt. It is always better to be able to get my own experts.

The fundamental problem rests with lax rules of evidence and scientific illiteracy among judges and lawyers. No conclussory opinion should ever be admitted into evidence, but conclussory expert opinions are overwhelmingly the rule, not the exception

Although I applaud your initiative, Senator, I do think more controversial issues should be discussed than tort reform. You are, as you said, preaching to the choir.

Let's address this fundamental question: is health care a right or a business? As a 34 year old hospitalist who entered medicine because of it's ability to improve society, & who will be practicing another 3 decades (God willing) I'm committed to health care as a human right.

Republican physicians with a strong moral consciousness (social conservatives) will, I hope, champion the view that God put us here to heal people, not make a profit. The example of Jesus Christ is clear, beyond argument. Remember the rich young man who reneged on his desire to enter the Kingdom by serving the poor.

What does this mean now? Don't focus on ourselves (of COURSE, we should have tort reform!) but on the opportunity to heal bring better care to millions of the poor and disadvantaged. I don't care if this is not politically convenient for Republicans desiring to regain influence. As physicians, health reform for the poor and disadvantaged is a moral imperative for which we'll be held responsible before a stern God.

"I imagine many of you are frustrated when politicians or lobbying organizations claim to speak on behalf of "the doctors," as if we are part of a monolithic group. "

I agree we are not monolithic and the docs hereat Sermo are welcome to keep belly aching, but THANK GOD organized medicine has finally come to terms with its professional responsibilities and is backing reform.

The AMA, AOA, ACP, AAFP, ACS, ACOG, the American Cancer Society and many more recognize that enough is enough. These problems cannot be solved with more tinkering around the edges, more tax breaks, more HSA's, or caps on damages. They must be solved by the entire country working together and recognizing that 18,000 American dying each year due to lack of access to health care is a national disgrace.

Your answer to the woman at your town hall pleading for help was so disappointing. It reminded me of Ronald Reagan and his magical thinking that if he helped fix one problem, all the millions of others would not be a problem any longer. The problem of lack of access to healthcare is not going to go away by charity care. If the free market could solve this problem, it already would have. This is a problem of our national community, and we have to be good neighbors and take care of the least among us, or we will have a lot of explaining to do to God when our times come.

I would like to see "loser pays". Also, in WI we do have some non-economic caps.

Additionally. if we have Obamacare with all of the attendant restrictions and rationing, the liability issue will become acute. If physicians cannot get patients into key studies such as MRI scanners, we will see more failure to diagnose suits, poorer outcomes from cancer etc. As a physician, I will have to have the patient sign a waiver stating that we are not responsible for a delay in getting a needed study in a timely fashion because of bureaucratic delays. If a patient needs a study and there is a delay, they can go pay for it themselves. Doctors will not accept this trap. And if the patient is a jerk, good luck on finding anyone to help them.

Two of the top states for offering a livable malpractice climate, Indiana and Wisconsin (http://www.physicianspractice.com/index.cfm?fuseaction=articles.details&articleID=430), both have desirable characteristics which could be applied nationwide. Indiana's has been detailed by Sermo Doc 10, and in WI, caps and a statewide compensation fund has been in place for decades. In fact, there is an ongoing legal battle over the money in the compensation fund, as state government has tried to give it away to other state entities.

Bottom line: I agree with most contributors that tort reform is a necessary aspect of health care reform.

Other states appear to use "contributory liability" or something similar to help control tort extravagance. If the patient had any role in their condition or complication, it is much more difficult to file or win a malpractice claim.

We need to get past the blame game!
I don't think anyone is against individuals being compensated for an unintended treatment consequence but we need to stop looking for scapegoats. Physicians are trying to help, not intending to harm. They should not be penalized for bad outcomes as they are now. This compensation should come from a source other than physician purchased insurance (which is mandatory to practice in my state). This is just legal thievery. How about a system like workman's comp where medical costs and salary loss are covered but pain and suffering are not? Doctors do not cause the problems that initially require people to seek care, they should not be responsible for any and all outcomes. Lawyers compenation should be capped. Lawyers should only be allowed up to bill to a certain amount on a hourly basis without windfall payments based on wins or losses. If I remove a cancerous organ from a patient curing their cancer, do i get a windfall payment based on the number of years of life I have given them? The legal reimbursement formula is ridiculous. It just encourages lawwsuits and defensive medicine (a major cause of rising expenses). God forbid the government put the brakes on the lawyers who fund their campaigns.

How about we also mandate that all insurance companies involved in healthcare must be non-profits with specific caps on executive compensation?

Medical experts raises a red flag, how will they be chosen, how can they be insulated from pressures of undue interferrance, how will they be compensated?

All physician's ask from this is to have trial by peers who can understand the issues being discussed about the case. To be tried by a jury of medically ignorant laypeople who see only the "rich" vs. the "poor" on trial, causes great inequity in the legal justice system as it applies to medical liability. This works in Louisiana, trial lawyers hate it.

We also want the plaintive (plaintiffs' lawyers) to have some risk to discourage frivolous suits. This would be accomplished by a "loser pays costs" system like the UK.

We also want society to define the monetary value of life in realistic terms applied to judgments. This also goes for pain and suffering, loss of companionship, loss of consortium, etc.

Senator, with respect. It is well documented that the immensity of the crisis in the medical liability system is the reciprocal of interest rates. That is because insurance carriers get the funds they need to maintain reserves to pay appropriate claims from two sources: premiums and investment income. When investment income -- essentially interest on high quality bonds -- is high, premiums may be low; but when we are in a period of low interest rates, as we are now, premiums must rise to keep reserves at the correct level. You suggest another way to keep reserves high: prevent people who were injured from being made whole. That is disgusting and unnecessary, and violates our sense of justice. The correct solution to the problem is to follow the advice Richard M. Nixon proposed when automobile claims got out of hand (you can find his article in an old Duke Law Journal), a system of no-fault adverse effects insurance.

Colleagues, the concept of expert panels is seductive. Consider, though, that once we go this route, there may be expert panels for lots of other things, to include allegations of crime. That can lead inexorably to 'death panels' which are fare more efficient in getting rid of undesired elements of our society than the current jury system. Is this possibility worth a few dollars reduction in your insurance premiums?

I am so glad to see an earnest debate among many doctors, I have been disappointed in the mean-spirited vulgarity-prone discussions lately on Sermo.

It is good to have a doctor in the senate. He is outnumbered by all the lawyers in both houses of congress. I hope Dr. Coburn is on our side.

Yes, of course there should be tort reform. 2 things to consider:

Dr. Samuel R. Bierstock wrote a pertinent blog recently about electronic medical records. With all our thought processes written down in a digital file, how easy would it be for any malpractice lawyer to comb through our medical records to pick us off with frivolous lawsuits? Any health care reform needs to address this problem.

And, as a primary care physician, I have a few concerns about the focus by reformers on using mid-level providers for medical care. How many mis-diagnoses and bad practice issues will be brought up in such a situation and who will pay for their malpractice?

I concur with Sermo Doc 66 per the patient who is paying and other incentive based proposals. My best patients (in the past since now we are universally covered in MA & no one expects to pay anyway) were those who were paying ie self pay or high ded. They will ask why and how much and not want tests you feel are marginal. That is in contrast to the father with the minor head injured child who wants the head CT (to recoup his prior premiums & to "just be sure") who will argue and threaten to report you to the administration if you do not order it.
Having been sued, I felt the jury was fair though I know it may not be that way everywhere. Lawsuits do make us consider missing the Zebras but that is not all bad. We all know stories from patients of missed dx which can be devastating. However, we all want to do the right thing even if just for our ego! The problem is being sued even when doing the right things but still a bad outcome. Or being made responsible for inappropriate patient behavior.

I would suggest that to follow the lead of the state of Indiana for tort reform would be prudent. We have had relief since Otis Bowen, MD was governor.

Congressman Thornberry from my district in Texas has worked on a plan that uses health courts to settle disputes. We of course need a no fault system that compensates injured people when adverse events occur. As an OB yourself you know that bad things can happen when everything is done right. A no fault system with compensation would really solve the problem. But as Gov. Dean has said, the tort lawyers have bought the show and they are not going to give up their front row seats in the Obama theater.

Dear Senator Coburn, M.D.,

Thank you for your interest and support.

I am in complete agreement with Dr. Sermo Doc 4, especially with regard to "No fault" (Bad outcome) indemnity.

My main concern about your proposals is obviously who will sit on the panels. There can be MD's who can be bought. Also I would be concerned about an expert Judge overseeing lawsuits. Ultimately he/she is a lawyer. I think capping is the best way but lawyers will not agree.
There are many great ideas as written by the good physicians on Sermo. Please keep fighting our fight. Remember, we will be the ones overseeing your loved ones at some point. The way health care debate is going, I predict a decay in the quality of our healthcare in the future if something is not done correctly to protect who is actually delivering the care to the patient. The population needs to know that. I know many fine physicians developing their "exit strategy" to get out of medicine- including me.

Retired Sermo Doc 186

Drug costs are significant. If Congress can dictate fees for physicians (Medicare/Medicaid and other payors who base payments on Medicare), then why not dictate to the pharmaceutical companies? And as far as I know, manufacturers of expensive equipment, CT and PET scanners for example, charge whatever they wish.

Personally, I pay far more for my medications under Medicare D (including monthly premiums) than I would without Medicare D. The extra 1% premium that one must pay for each month that one delays in subscribing to Medicare D was the "incentive" that led me to subscribe.

Electronic health records will be a huge cost to the health care dollar, both to implement and to maintain forevermore. If a physician overlooks some obscure but significant entry, the liability lawyers will rejoice. Voluminous health records may requires hours to peruse, less one overlook that obscure fact.

Why AMA is not pushing tort reform?

A little off-topic, but since you mentioned it: Where does "lack of emphasis on prevention" come from? Everyone I know works on that, but exactly how much can we prevent and prevention isn't free. You can only counsel so much, and you can't force a diabetic to take his insulin.

We can't prevent the POTUS from smoking. His Sermo Doc 186 General is obese. What do we do with Joe Sixpack?

What can we really prevent? Broken ankles? Gallstones? Aortic aneurysms? Herniated disks? Shingles? The COMMON COLD?

Preventing heart attacks requires spending money on statins and ASA. Preventing polio, pertussis, diphtheria and tetanus depends on spending money on vaccines.

As for tort reform, we recently saw that Zeke Emmanuel thinks medical care costs so much because we are TOO THOROUGH since we take the Hippocratic Oath too seriously. Well, if he wants me to be less thorough, he needs to help me on the back end and protect me from the lawsuits that result from not being thorough enough.

Texas tort reform has been a raging success. My malpractice costs have dropped thousands of dollars. Doctors have been flooding into the state so fast the Board is overwhelmed.

Transparency: It is very transparent if you are a health insurer. Doctors can't exchange fee information but insurance companies can purchase databases that include all of our contracted fees.

We should set their payout rates at 95% and have strict accounting rules so they don't game the system. They might have to use paper plates on their private jets but hey, we're all making sacrifices.

Better still, if you have a public option make the policy holders the shareholders like Texas Medical Liability Trust does with malpractice insurance. When TMLT runs an excess they pay us distributions.

And why are we paying a premium over Medicare cost to medicare Advantage programs?

Dr. Coburn,

It's encouraging to see at least one practicing physician among 100 current Senators advocating rational "private market solution" responses to six of the major structural flaws responsible for U.S. healthcare's cost, quality and access problems, rather than just another variation of the expanded "government control solution" being proposed by Congress and the White House.

The experience-based opinions of a radiologist who escaped from the Canadian government control solution for healthcare are instructive, but only for those seeking rational, practical and sustainable U.S. market reforms.

See: tinyurl.com
(from Dave Racer, MLitt at FreeMarketHealthCare.com in St Paul, MN )

There is compelling evidence at the National Practioners Data Bank that all three of the major components of the medical liability industry now support the least competent 20 percent minority of physicians with three or more malpractice claim settlements, (many of whom have also received one or more federal or state licensure actions), at the considerable expense of the 80 percent majority who have had two or less claim settlements.

While state expert panels and state health courts could improve this toxic and costly status quo, the optimum long-term federal solution for the intractable medical liability problem is the same triad of reforms enacted in Texas in September 2003 that simultaneously reformed:

(1) the lottery-like, jury trial-based tort system,

(2) the anti-excellent physicians medical malpractice insurance market, and

(3) the anti-consumer safety medical licensure and discipline system.

See: www.med-malliabilityreform.blogspot.com

The members of Sermo now constitute about 10 percent of the total non-federal U.S. physicians in 2008 (www.statehealthfacts.org).

Other than providing our input, is there anything else we can do to help educate the policy makers and the public about the real dangers and futility of a government control solution and the substantial value of an appropriately regulated private market solution?

In case anyone's counting votes, I too agree with Sermo Doc 4.

And...I'd like to see some indication that he's listening/reading these opinions.

I have not seen anyone stand up for the problem of Teen Pregancy. Of course one would have to discuss alternative forms of birth control besides abstainance for the conversation to be meaningful, and that is not politically favorable. But here lies the rub, Dr. Coburn, you are against abortions but what can be done to prevent pregancies which are unwanted in the first place?
Kevin M. Passer, M.D.

Dear Senator Coburn:

Thanks for your excellent efforts.

I don't believe that costs are the reason for "health care reform", although that's the spin on the matter. More, this is about people who want control and power and furthering of a particular agenda--political or otherwise.

Your Health Savings Account expansion ideas and taking third parties out of health care decisions and costs will automatically adjust costs 'to-market' just as free markets do everywhere.

I've long-favored your professional courts/juries proposal. They should probably be mandated to function on a state-by-state basis, rather than federalizing them, as the various states have differing needs, postures and views on a wide variety of issues that may come before said courts.

As I was saying . . .

This just arrived in my email:

August 25, 2009

Contact:
Dana Leidig
Vice President Communications & Advertising
512-425-5934, dana-leidig@tmlt.org

TMLT announces 24% dividend and 1% rate reduction effective January 2010

AUSTIN, TEXAS . . . The Governing Board of Texas Medical Liability Trust (TMLT) has announced a 24% policyholder dividend for renewing TMLT policyholders and a 1% rate reduction for TMLT policyholders effective January 1, 2010.

This is the fifth time TMLT has declared a policyholder dividend. The 24% dividend is the largest to date and will amount to approximately $36 million dollars in 2010 premium savings for TMLT physicians.

TMLT has reduced rates for Texas physicians for seven consecutive years since the passage of House Bill 4 by the Texas legislature and Governor Rick Perry in 2003. For the first five years, rates were reduced across the board for all policyholders: 12% in 2004, 5% in 2005, 5% in 2006, 7.5% in 2007, and 6.5% in 2008. For 2009, all physicians received a rate decrease but the reduction varied by specialty and territory with an average statewide decrease of 4.7%. In 2010, all TMLT-insured physicians will receive a 1% rate reduction.

According to Bob R. Fields, TMLT's president and CEO, medical liability reform has fostered an environment in Texas where physicians can spend their time taking care of their patients rather than fighting lawsuits. Since the passage of medical liability reform, TMLT insured physicians will have saved $519.6 million, once this latest round of rate cuts and dividends is implemented.

Physicians interested in applying for TMLT coverage or who would like more information about how this rate decrease and dividend will benefit them can call the sales department at 800-580-8658. Current policyholders will receive detailed information before their policy renews or they may direct questions to their underwriter.

TMLT is the state's largest medical liability insurance provider, serving nearly 15,000 Texas Medical Association (TMA) member physicians. TMLT is a health care liability claim trust created and endorsed by TMA and owned by its physician policyholders. The Trust is headquartered in Austin, Texas.

Thank you for your efforts at meaningful change. I believe that you are right in that those outside the system have no idea about reality. The old proverb about "walking in our shoes . . ."

I read recently that MEDCO's patient records and prescription computer was hacked and this information was breached. This is of major concern with the EMR mandate.

I also have concern about computer crashes and what will happen in ICUs, etc. when paper records are no longer available.

It is most unfortunate that this whole issue has been termed "health care reform". This implies the necessity to change the system and takes the moral high ground for those proposing it. How can reform mean putting an even higher amount of our GNP into health care when our GNP expenditures are already the highest in the world?

From what I can see, everyone wants reform: except pharmaceuticals who want to keep charging higher prices in the US than in other first world countries; except , unions who want their tax privileged benefits of their members touched even though they are incredibly regressive; except trial lawyers who want to continue to be able to second guess and scare physicians into exceptional overuse of resources; except patients who wish to have every first dollar expense covered even though this encourages excess use of medical care and makes administrative costs much higher: except hospitals who can continue to charge above normal market rates because insurance has established an often false floor underneath their prices that may not be justified by true economics; except insurance companies who skim off large amounts of the health care dollars in overhead and administrative expense; and even except physicians, particularly specialists who perform procedures, whose incomes have soared under Medicare and the economic floors provided by other health insurance programs.

True reform will not occur until ALL of these parties ( plus others who have profited from these weaknesses in our system) are EQUITABLY forced into putting some of their money on the table to pay for change.

Sermo Doc 94, your EMR concern is very real. The reality is poorly understood by the administration and most legislators. We are not even close to a usable, functional EMR that does anything to reduce error and control costs. It is a political ploy that is being used because the public doesn't understand the issues.

The development of a user friendly, reliable electronic medical record will require a herculean national effort and a complete revolution in the way we currently use the very cumbersome systems that the government wants to force upon us.

This is off topic and I'm sorry, but, this is another area of "reform" reality that has not been rationally addressed and is being driven by corporate interests(including the AMA) to the overall detriment of the national conversation/debate.

Your comments and responses have been terrific. Thank you. Let me respond to a couple of points.

First, several of you have raised the issue of caps on punitive, non-medical damages. Though the bill's cosponsors chose not include a cap in the Patients' Choice Act, I am in favor of a cap and have supported it in the past. Capping punitive damages is a proven, common sense approach, and as many of you pointed out, was part of a successful reform in Texas ( www.washingtonexaminer.com ).

Second, many of you had raised issues other than tort reform as part of health care reform. In future posts, I look forward to gathering your thoughts on topics like health insurance, Medicaid, the creation of a new government-run plan, and other topics.

Third, some of you asked what I am for in health care reform. I certainly believe we need real reform. Please take a moment and peruse my health care reform bill, The Patients' Choice Act ( coburn.senate.gov ) , which I am cosponsoring with fifteen other Senators and Congressmen.

You can also watch me and Senator Barrasso, also a physician, discuss health care reform on the Senate Doctors' Show ( republican.senate.gov ) . We've traveled across the country in recent weeks talking with thousands of Americans and many physicians. You too can email us questions or follow us on Facebook ( www.facebook.com ) and Twitter ( twitter.com ) .

Thanks again for your participation. I look forward to sharing your responses and thoughts with my colleagues.

Tom Coburn, M.D.
U.S. Senator

Sermo Doc 95, you are quite correct! What would be incredible is if the President would have the knowledge and the courage to address exactly what you just stated. We are all in this together. A true leader would understand this as fact and work to move the debate forward in a positive, not partisan, direction.

We need an expert medical panel to review issues, but the decesion thereafter is triaged to either a pure malpractice action or an "adverse medical event" action. The latter can be covered by an insurance that all patients purchase for compensation which will leave 80% of the actions of out the malpractice arena and save significant money.

Healthcare reform without tort reform is a non-starter, certainly insofar as the current versions of healthcare reform are concerned. To ask us, as physicians, to simply roll over and accept that we will endure further cuts in compensation while malpractice rates continue to rise all over the country is ludicrous. To think that we will simply sit back and allow it to happen is laughable.

We are a community in which each of us has endured at least 11-13 years of higher education -- at our own cost, thank-you very much -- and many, if not most of us are still paying for that education even decades out of medical school. In many of the other countries that have a national healthcare system, the costs of that education are borne mainly by the government. Here, we would be forced to take further cuts and yet nobody sees fit to suggest that medical school education be paid for by the government. Perhaps Sallie Mae might forgive all loans if the current healthcare reform bill passes? I seriously doubt it.

The fact is that if the present version of healthcare reform is passed, then the care of our nation's sick is going to fall on the lowest common denominator among us, since the rest of us will have to likely -- and reluctantly -- leave the practice of medicine. This is a situation that is completely unacceptable.

So how do we fix it? As mentioned before, the biggest single step towards making a universal coverage plan that will allow real, good, and competent doctors to continue to practice is tort reform. First, institute caps on non-monetary losses, i.e. "pain and suffering". There are so many folks out there who see a bad outcome as their winning Powerball ticket. Second, a "loser pays" system is absolutely necessary. Getting such a system past a Congress in which most members in both houses are JDs is going to require a major miracle, but nothing less will be needed if all of us who do not support the AMA's stance are to ever agree to the system. Finally, malpractice insurers will need to be regulated: There is no reason why merely being mentioned in a lawsuit should cause a doctor's rates to rise, and there should be some oversight of these and other shoddy insurance practices.

Next, let us bring some reality back into healthcare. There is no reason a charity-care patient should receive a titanium and ceramic joint replacement when a stainless steel one will function adequately at less than a fifth the cost. Like it or not, even in countries with a national health plan there exists a two-tiered system of healthcare. Those that can afford to pay for their care get access to treatments and equipment that may not be available to the masses. That may not sit well with all the egalitarians out there, but it is nonetheless how things are.

As things are, I don't see a bright future for me, my colleagues, or my family. I'm already planning for a life outside of medicine, and I have only had my MD for a little more than a decade. Shame on the government for trying to place the blame for decades of inaction on their part onto the shoulders of those of us who live with the consequences of that lack of activity every day.

Sen Coburn:
Don't mandate electronic records but make a rule that the patient should be the sole custodian of the medical records. In all other developing countries, doctors give a copy of medical note or lab test to the patient. Patient dutifully files this stuff in a round- or flat file and carries with him. I have never seen lousy medical care stemming from information patient carries with him/her. These patients also pay for services with their own money and value the information provided. They guard it in the same way people guard their air tickets while traveling...You see the logic... People value what they pay for. Third party system is the problem. Entitlement society is the problem. Stimulus packages are the problem. Free markets are not the problem..
It may be a good idea to facilitate centralized data collection of all labs, X-rays and tests and the patient should be provided with a smart card to enable appropriate people to view this information.It is all about patient centricity. Taiwan does this and they have a superb system of healthcare. Today in the US we have a convoluted system to serve everyone except the patient. Pharma, insurance industry, EMR industry, lawyers, hospitals and their lobbyists, politicians are all skimming off over 70% of money. ..Senator, There is a lot of work ahead of you!

Thank you, again, Dr. Coburn, for taking the time and making the effort to communicate. We are a varied group here on Sermo. But, there are a huge number of physicians who participate and monitor this site.

I appreciate your efforts and I'm pleased you are here to participate.

Tort is a bad way to compensate patients who are harmed. It is also a bad way to prevent harm. Any tort reform solution must provide a comprehensive approach that fairly compensates patients, protects physicians from frivolous lawsuits, incents physicians to avoid unnecessary procedures and tests, and provides a mechanism to identify and retrain sub-par physicians. Without such an approach the reform will only shift funds from one area to another while doing nothing to prevent harm, the most important issue of all. Here is a link to an article I wrote some time ago on this issue:

www.docsnetwork.com

1. Eliminate malpractice law and substitute a panel that evaluates the complaint and both compensates the complainer and punishes the offender (by taking away his license if necessary, or for a lesser offense by requiring him to be supervised closely). All the money that would go to the lawyers, to the malpractice insurors, and to the defensive medical practices would then be saved.

2. Strictly limit the profit that could be made on providing health insurance, and let insurance companies earn no more than they do now as 3rd party intermediaries for Medicare. All of the money that now goes to insurance companies for profit would be saved, AND the insurance companies would no longer have incentives to manage care.

3. Require that all physicians and other providers be able to read and write to a credit card sized EMR that patients could elect to use at their option. This would eliminate a lot of waste in the form of duplicate testing, repeat visits and/or wasted time because the labs would always be available, etc. It would also mean that the patient was in charge of his own data, and had the option of sharing it or not.

4. For years it has been possible to join the armed forces of our country and go to medical school and PG training paid for by the service, with the resulting physician being required to spend a number of years in obligated service to his country. Expand that. Produce a health care delivery system staffed by such people, so that care is provided by salaried physicians just like we have at the VA Hospitals, the Mayo Clinic, the Army Navy and Air Force, etc. etc. I know this is socialized medicine, but we already have it at the above institutions, and noone is complaining about it!!! Produce a two tier system of access to care so that those who wish to go to private can, and those who can't afford it at least get care that otherwise would be denied.

Well, there's my input. I call this the Snowball in August suggestion.

Effective tort reform would lower the barriers that slow-down legitimate claims and raise the barriers for unsubstantiated claims to move forward. That's a win-win for both sides- plaintiff don't have to wait for years for their cases to percolate through the courts and physicians can practice without the fear of frivolous lawsuits.

Just who the experts will be is a critical question that needs to be answered before creating systems that depend on experts. Right now the problem we have is that there is no shortage of doctors who are willing to whore themselves out for the fees they collect as 'expert witnesses.' There needs to be a process that vets prospective experts and monitors their performance with the ability to de-certify those experts whose decisions show bias.

As an example of how an alternative-resolution strategy can go wrong, you don't have to look any further than binding arbitration. Businesses love to include arbitration clauses in contracts because they know that they've got the upper hand in those proceedings. If an arbitrator is assigned who doesn't have a favorable track record, it's not uncommon for the case to be withdrawn only to be resubmitted a short time later with the hope of drawing a more favorable arbitrator. I've read articles that describe arbitrators whose decisions have been in favor of the corporation 99% of the time. That doesn't sound like a fair and balanced process. We do not want the expert review process to fall into a similar trap.

We value life and until that changes, there's nothing we can do to remove the emotion that surrounds tragedies where outcomes do not fall in-line with expectations. What we need is a system that separates the emotions from the reality that sometimes things don't go well and that's just the nature of medicine. The current system needs to go because it doesn't acknowledge that.

We clearly need direction from a leader that represents our best collective interests. Hopefully we have that with the Republican Senator from Oklahoma.

A tort system similar to the "vaccine court" would be best. If we truly end up with a mostly socialized medical system, then medical bills associated with poor outcomes (not necessarily by any means malpractice) would be covered anyway, likewise disability would cover the very basic economic needs.

I would like a system where I don't feel pressured to keep checking CT scans for patients with chronic abdominal pain, where I don't feel like I can't tell a patient "no" when they want more (futile) work-up, where I don't have to hope and pray that I never have a procedure complication for fear that it may result in a suit (even if one wins, one is often never the same--I've seen it in colleagues), and where the lawsuit "lottery" is no longer an incentive to money-seeking lawyers.

And where you don't see those AWFUL ads on cable news stations asking: "Did you have renal failure after receiving 'so and so'?" Or "Did you use Reglan and get diagnosed with tardive dyskinesia?" "Do you have mesothelioma? You may be entitiled to FINANCIAL COMPENSATION!" Man, those ads make my blood boil!

Loser pays

If you look at my blog on this topic, you will see details of my plan to have the specialty boards do the evaluations of malpractice. Essentially peer review that is admissible in court, so the opinions are protected. drbrenner.blogspot.com

The problem I have with the expert panel you are proposing is a)what do lawyers know about medical standards? The don't need to be involved until the doctors decide. b) what kinds of docs on the board? They should be docs only from the specialty that the physician is trained in. And I think it should be 5 docs, majority decision.

Health courts could worsen things. Again, what do judges know about medicine? I'd rather try my luck with a jury.

Also, recognize that even w/tort reform stemming the bleeding that is happening, defensive medicine won't change for 5-10 years (at least) after meaningful reform. Here is my take on that: drbrenner.blogspot.com

Tort reform is critical to the cost savings component of the healthcare reform equation, as you simply cannot overlook the billions of dollars wasted on defensive medicine. For President Obama to say that tort reform is off the table only validates his indebtedness to the trial bar, and completely dismisses a key factor in reducing the skyrocketing costs of care. Lawyers drain billions of dollars away from healthcare only to enrich themselves—they must be removed from the system. You will never realize cost effectiveness without meaningful tort reform.

I support a medical court system consisting of physician and citizen membership with judicial oversight, and a no fault indemnity solution.

Please do not overlook an equally important component of improving the healthcare for all Americans: INSURANCE INDUSTRY REFORM. Perhaps the next post will address this.

Methinks Sen. Dr. Coburn has found an excellent and cheap means to garner contributions from the angry Sermo crowd. Too bad his input in this debate is limited to rants on the fringes-- if his colleagues on the right respected his opinion as a doctor, wouldn't they have included him in that Gang of Six that's supposed to salvage this fiasco? If he really wanted OUR voice heard, wouldn't he have bullied his way into that room? Instead the GOP sent in a farmer, a shoe salesman, and a professional legislator, who apparently have better records on health care.

I suspect Sen. Dr. Coburn figured he'd get the same response as his pal, Dr. Broun from Georgia, who invited me by fax last week to join one of his "influential doctors" panels to help him formulate a plan. This exercise smells a nothing more than an appeal for money.

There must be a spring training equivalent for new legislators where these Doctors get brainwashed into forgetting that they are MDs until they need our money.

The disconnect between the $150,000 annual premium that I pay as a NYS Orthopaedic Sermo Doc 186 and the $500 average reimbursement for a surgical case that Medicare pays has made it impossible to earn a living. Rather than do 5 unindicated Arthroscopies a week, just to cover my overhead, I quit doing surgery a year ago at only age 60. I know of 5 other Orthopods in my neck of the woods, who also were forced to prematurely stop doing surgery by unsustainable malpractice premiums.

The situation is so bad in NYS that 6 counties have no Orthopaedic Sermo Doc 186; 7 counties only 1 & 13 counties just two; making it impossible for the county hospitals to cover trauma. Tort reform will never happen in NYS as the government is controlled by the Speaker of the Assembly, a crook who is a partner in Wietz & Luxenberg: the largest personal injury law firm in the world.

How about a mechanism for Doctors to recoup losses incurred by having a medical malpractice lawsuit brought against that is eventually dismissed or found in favor of the physician. Perhaps even something as simple as holding the plantiff's attorney and plantiff liable for all legal fees, cost of the courts, physician's time and a reasonable "Pain and Suffering" award for the physician. Now it's a lottery for patient's and attorney's who pay little to nothing to play and without penalty if they lose.

Senator Coburn,
Thank you for your interest in providing meaningful tort reform.

I feel I can offer a different perspective on this issue, as I practiced medicine in New Zealand in their National Health Care Program. When a complaint is brought against a physician, they blind the records and location, and send all the medical records along with the patient complaint to three physicians in that particular field--generally two academicians and one in private practice (in this instance somewhere in New Zealand and/or Australia). If any one of the three finds that a STANDARD OF CARE was violated that resulted in patient injury, then the claim was forwarded to five physicians. If two or more found a STANDARD OF CARE was violated, then the attorneys would become involved and the physician would inevitably have a lawsuit filed. (They do have caps on damages.)
This system had a number of benefits. The few that I would highlight are:
1. We were constantly discussing as a department and medical society what our standards of care were for any and almost all clinical situations that would arise. This kept everyone focused on the best standards that they could provide their patients.
2. The hospital and department and regional medical board were notified when a physician was found to be violating a standard of care. This led to an extensive institutional review with required steps, evaluation, and options for action against the physician. This review board could also find that there were extenuating circumstances that prompted a deviation from STANDARD OF CARE, which would also become part of the case record.
3, This type of review will force our medical system to more clearly define and insist upon standards of care. This will help both standardize the medical care we deliver by establishing clear guidelines that protect us from ordering unnecessary tests (ex. everyone in the ER with abdominal pain does not require a CT, and the algorithms exist which would allow you to not scan the majority of patients that present to the ER with abdominal pain, but currently the legal environment almost mandates these expensive tests.)
4. Under the current tort system, bad physicians are hidden by consistently settling out of court. This protects their practice, the medical institutions have no recourse, and it perpetuates incompetency. Also, ask any member of a medical executive committee how difficult it is to have incompetent physicians removed from ones medical staff. Also, in speaking with a member of our state malpractice insurance board, she stated that if we could get rid of a dozen physicians in our state it would drop the number of significant malpractice claims by 50%!!

I will be interested to see if anything will be done. This is such a dysfunctional system as it currently stands, it places physicians against their patients, and is a major drag on the daily life of those of us who practice medicine. It literally takes the joy out of what could be a marvelous profession. Fortunately, I was able to recapture that feeling when practicing in New Zealand. I hope I can find that again here.

Let the loser and the lawyer pay both sides and maybe they will stop nusance suits. Any "health Court" or " Expert panel" will be biased toward the plaintiff. Doctors have never received a fair break. So why now should we expect one? I already left a malpractice crisis state. When doctors decide to say "enough" and walk out, then maybe something will happen and not one day before.

Thanks for your help, Dr Coburn- or whatever staffer reads all this!

It appears there is a wobbly consensus here - 1. Tort reform mandatory for success of any program 2. Caps on non-economic damages work in TX 3. Pre-trial panels help reduce # of actions. 4. No fault payments from a fund (whose income is from both Pts and Physicians) would promptly and justly assist those inadvertently injured and reduce subsequent suits. 5. In spite of the asinine statement by the W VA attorney / rep that 'defensive medicine problems would go away if doctors followed The Guidelines For Treatment, we physicians recognize the true burden on the system and on us of the CYA process. 6. EMR is not the answer for inefficiency, contrary to statements from the POTUS and his advisors.

Dr. Coburn:

Tort reform should include No Fault Insurance with low premiums for doctors to pay for costs of defending against any Plaintiff's action.

This should be accompanied by Binding Arbitration, as in Utah, with the Court appointed Arbitrator assisted by Three Board Certified Medical Experts. If there is no valid injury and the Claim is found to be without merit, then all costs
and Plaintiff's damages should be paid by the Plaintiffs's Attorney.

The physician should be publicly exonerated. His time and other costs (office, legal, etc.) should be paid by the Plaintiff's Attorney and his Insurance Co. reimbursed.

If there is a valid injury (not reasonable complication or unexpected adverse effect of appropriate drugs or a procedure), then a State Medical Fund should determine and pay any amount for medical care, loss of income, and pain/suffering.

In the event of a valid injury, the offending physician should be referred to his/her State Board of Medical Examiners for disciplinary action which could include many actions (required education, fine, pro-bono work, probation, loss of License, or even referral to a State Prosecutor if there is any suggestion of criminal action.

Thank you for your attention.

I practice in the state of Louisiana where we have a panel system. The panel system has become an easy and cheap way for trial lawyers to get an expert opinion, and in the process, our claim frequency is double the national average. We have seen a significant drop in panel request with only a $100 filing fee by the plaintiff. A loser pays system would be an even greater deterrent to non-meritorious claims. Because of my experience in Louisiana I would favor a medical courts system, however I understand there are problems with workers comp courts that may need evaluation prior to proceeding with such a system. We also have a cap in Louisiana, but like I said earlier we have exchanged high awards for greater frequency which leads to more fear and a poor quality of life.

I like the judge and experts idea - get the sympathetic and easily swayed jury of non-peers out of the picture. Verify the expert status - hard to do, but essential.
For health care reform:
1) Universal access
2) Outlaw insurance company profit (apparently we are the only industrialized country that allows insurance companies to profit on health care - the priorities are all wrong)
3) Eliminate any restrictions on coverage ("pre-existing disease" excuse must be removed)/ require universal participation
4) Public option/ subsidised option; remove insurance from employment (apparently, again, we are the only industrialized nation to link health care to employment - BAD IDEA)

Once again, thank you for taking this time.

The problem is that the insurance industry is a major problem, and in this case the malpractice insurance industry is as much a problem as the health insurance industry.

The malpractice premiums are way too high based on the actual loss data, and because the industry games the system by a legal loop hole that allows it to declare a loss for tax purposes even when no money is ever paid out.

Doctors have been scammed by this industry into being convinced that the problem is bigger than it really is and the defense bar is happy to perpetuate this because it is paid by the industrym, not the doctors.

We need to stop the victimization of the doctors.

Real tort reform starts by cracing down on dishonest "experts" who drive the problem by lying under oath. Tightening the rules of evidence is the starting place, plus educating judges in scientific literacy (where studied, 7/8 of judges are scientifically illiterate and cannot tell bunk from real, so cannot exclude fake expert testimony)

A malpractice suit rest fundamentally on the expert testimony, and if conclussory testimony were excluded routinely under rule 104(a) as it should be, 2/3 to 3/4 of all cases filed would be dismissed at the outset of the case.
This seems indirect and unsatisfying to most non-lawyers, but the essence of reforming the system while preserving constitutional rights involves getting the judges to enforce their role.

The US Supreme Court has, in fact, already ruled on this in Kuhmo v Carmichael in a ruling where the actual holding has been largely ignored,namely that a failure of the judge to do what I have stated above, is, by definition,abuse of discretion, and grounds for reversal or dismissal of the case.

Please, please, have a competent lawyer tackle this. The industry is not in favor of the reform I propose because premiums would have to fall precipitously if the Kuhmo "intellectual rigor: standard for opinion evidence where applied to the states.

An additional issue lost repeatedly is that the IOM report "To err is human" clearly establishes that 80% of the bad outcomes for which doctors are sued are not even the doctor's fault, but rather system errors.

A truly knowledgeable approach will cut premiums to doctors but also address these system errors.

All good points above; here is my concern, medicine is a practice, and there is a basis of subjectivity to the practice of medicine; however, our profession (MD's) has taken us to the point of doing more in less time, and at the least expensive way possible (and hope you don't make a mistake), and that means seeing more people faster, and spending less time in adequate education and management of patients. The doctor who is less likely to be sued is one who is COMPASSIONATE; until we get young doctors to be more compassionate for their patients and less profit driven, law suits will decline by natural process. Just like the family doctor of old, who would go and see grandpa or gandma when they were ill at home, and didn't charge for every visit, or simply seek others opinion, when they were not certain of diagnostic work up or disease management (and didn't care how their fellow colleagues felt about whether or not they we competent/smart/knowledgeable etc). That's what we need, as well as OPENED MEDICAL PRACTICE WITHOUT WALLS FOR SECOND OPINION< AND monitoring incompetent money driven doctors. Tort reform should not change patient's ability to go after those types of doctors, ever.

I'm glad to see that Sen Coburn responds to Sermo comments. As one of his constituents, I received absolutely no response when I wrote him personally.

Attorneys tell their clients: it's not a big deal, if they lose the insurance pays the judgment. It is not personal, the insurance will take care of it, and you really need the money, so let's do this. They expect a certain loss on this or they would not have such insurance. Take advantage of this. It is not personal, you are not taking the physicians money, it is just "insurance".
It is personal! There is a lot of time, sleepless nights, fear, second guessing, loss of self-esteem, perhaps overtesting on other patients, fear of losing license, fear of losing ability to make a living, and wondering why in the hell I volunteered for this. It will be a data bank reporting if you lose. You will probably have to appear before every state board in every state you are licensed. You will always have to report the judgment every single time you re-license, apply for privileges to practice anywhere, and anytime you change locations for what ever reason.
Attorneys don't have to report the cases they lose or bad decisions they have made in their personal or professional life. I agree fully with the English common law of loser pays. If the attorney gets to pay my legal expense and my lost wages (and those of my employees), they may be a bit more select as to the cases they take and the harassment they wish to deal. True medmal cases will stand up to the test of this. If someone has a case so weak no one wants it, then, maybe, it should not be filed.
People will die for various reasons. Not all of these are medmal related. But, as long as we are viewed as lottery tickets to be scratched at will, and there is no risk to do so, it will continue. Everyone needs skin in the game. If the plaintiff's lawyer thinks he has a good case, he should take some risk as well. If I go through this as a defendant and prevail, I will spend everything to sue the crap out of the attorney that brought suit on me as a matter of principle. Anything I get beyond breaking even, I will donate to a worthy cause. Just as it should be.

A large percentage of my medical spending is defensive "CYA" medicine. An expert panel to review potential malpractice suits is a good idea as well as caps on noneconomic awards. Health-Care reform CANNOT occur without comprehensive TORT reform - it's as simple as that.

Hi Senator: first off, I hope you get a chance to read this personally. Second, I admire what I have observed to be your unbashed pro-life position, no compromises, nothing politically more important. Third, I would suggest insurance reform as such: end the commoditization of medical care by ending the 3rd party "reimbursement" method of payment for services rendered, to be replaced by direct Physician/Patient payment. The patient is responsible, up front, for the cost of medical services, and is responsible for collecting reimbursement from the insurance company. Lastly, with respect to tort reform, start with the Great Bard: "first, kill all lawyers"

I agree with both of these proposals. The Canadian system is made a workable model for the physicians who practice there in no small part due to the lack of contingency fees and damage caps for malpractice suits. Unfortunately, not only are you preaching to the choir, you are also whistling in the political dark. For physicians to acquiesce to reimbursement and practice standards changes without a quid pro quo on the legal side is absurd. It demonstrates the utter lack of utility (to the member physicians) of organized medicine groups like the AMA.

i feel that everyone in this country should have access to healthcare. our reps including coburn should work to get that done. tort reform needs to be part of that and as been stated, there is no reason to reinvent the wheel..within these suggestions there are enough good ideas to build a very good national system of patient protection and physician education if things go wrong.... i think that tort reform may not change the way people practice and maybe i am wrong...the overuse of imaging and testing is now part of the way many physicians evaluate their patients...the fear of lawsuits may have started the behavior but now i am not sure if we can go back to more clinical approaches. have the costs of patient care diminished in states in which acceptable tort reform has occurred?

If a hospital / physician can discount a fee(s) by 20 to 40% for cash payment, what does that say about the cost of 3rd party payor (government & nongovernmental) overhead to the medical field.
If the nonpatient-care related paper work can be decreased by half of the above, it would solve many financial woes. How about a debit card & let the patient shop instead of 3rd party micromanagement.

As for tort reform, I despair. By the time a physician has been professionally, personally, & psychologically assasinated by a plaintiff's attorney, is it any wonder they are defensive & limit practices, retire early, urge their children to find another profession / occupation? I've personnaly seen 4 retirees & 3 medical school drop outs in the last 3 months for this reason. Expert panels & assumption of attorney fees by plantiff, loss to the physician, etc may help decrease the burden. I'd favor a trial.

Sermo Doc 123 anesthesia i have been in practice over 40 years , I f there is no tort reform the cost of medicine stays the same because all docotors will have to cover and pull all knid of unescessary tests and procedures allso malpractice rates dont go down neurosurgeons now pay over 100,000.00 per year

Senator Coburn,
I agree with your proposal.

Tort reform need to be part of this health care reform, with out that there is no savings any where and thye defensive medicine goes on.this talk about health insurence reform with proper tort reform is not compleate.

Lots of good ideas. Most malpractice suits are not about malpractice at all - simply high risk cases or bad outcomes despite good care. The bad apples have to be fired from medical practice. Period. The rest have to be protected against frivolous suits and outrageous awards, regarldess of the mechanism. There should be no health care reform discussion without tort reform *first*. I, too, am rapidly approaching age 60 and will be looking to retire rather than continue to participate in this nonsensical scheme where physicians are looked to fund the extravagance of the judicial system and trial lawyers -- in addition to themselves and their employees.

Tort reform is an essential part of any healthcare reform. The fact that the president has ignored this is an OUTRAGE. The trial lawyers run amok over physicians and every other aspect of society and get away with it. If you or I practiced such forms of extortion we would be convicted of extortion and placed in prison. It is time to end this senseless drain on society and our economy.

Senator Coburn,
I think the emphasis on tort reform is a bit misplaced. If we can achieve universal coverage we will have eliminated the main reason for lawsuits, the need for compensation for medical care due to an error, whether real or perceived. Pass universal healthcare and you will have drastically altered the litigation playing field.

A health court, along the lines of family court or other specialized courts, is vastly superior to an expert panel. A system in which a particular community is charged with policing itself is rife for abuse and lack of perspective. Litigants may bring frivolous lawsuits or they may bring perfectly valid lawsuits. It should be up to a neutral party trained in law to adjudicate these matters: a judge.

But let's be real. As physicians we are in the 90th percentile of income. We'll survive. Our patients who don't have health care are in a far worse situation and that's where we should be focusing our energy. Senator Coburn, we need you to support a robust public option.

Does anyone other than me find it awesome that at least some politicians are actually finally talking with us on line? I can guarantee that few truly realize that they have a great opportunity to engage some of the brightest minds in america in a safe and well-thought out forum. Instead of holding congressional hearing, in just one thread this Senator can get a whole host of ideas and suggestion from people who live every minute with these issues. This is the real power of sermo and I bet Senator Coburn gets it. I hope he passes it on.

Tort reform has nothing to do with providing health care to all. Don't confuse the issue with this straw man. If you want tort reform go for it. Doctors don't have to practice defensive medicine, just good medicine in conformity with community standards. Might you get sued? Yes. But tort reform is a big issue in lots of industries not just ours. We need universal health care coverage and Dr. Coburn is obstructing it like he has almost every idea that doesn't benefit the wealthy ahead of the poor and the mighty against the weak. And Sermo is only making the situation worse by claiming to represent doctors when in fact there is a very very Republican slant that doesn't conform to most doctors I know.

lou, you are absolutely right! What Sermo has provided is unprecedented in the history of our profession. Not only that, it's great fun:-)

uhhhhh then Sermo Doc 129...you don't know many doctors

oye veh

Sen. Coburn, MD is a republican senator from Oklahoma. (I voted for him this last election cycle) Sermo Doc 129, you might be at a loss for what is going on here because some of my patients have MI's and suffer from dementia. Peds issues are usually much more simple than much of the stuff some of us deal with daily. This is not a race war or a "have vs a have not issue". It is about what is constitutional. I am no longer republican. They lost their way over the last 6 years. They also lost congress because they turned their backs on their voter base and did not support their president. (yeah, George Bush, the only person people hate worse than Hitler) GWB was a very reasonable president. Look back 50 years and you will see that history repeats itself. I have become so disenfranchised, I have become libertarian/conservative. I believe in the constitution of the United States. I believe everyone has the right to compete. Not everyone will be successful, but they do have the same rights as anyone else. There are no guarantees in politics or in life itself. The best you can hope for is a level playing field. Presently this is the best country to play . It might not be so in the next few years if we destroy the basis of our republic.

Thank you, Senator Coburn! It is refreshing to finally hear someone from our congress speaking on our behalf! Unlike AMA, who has sold out to the White House, you actually have listed several very important issues that will help lower the health care cost. I agree whole-heartedly that tort reform has to be part of any attempt at health care reform.

I gave money to the republican party and both of president bush's terms in the hope that tort reform would happen. This issue was my biggest disappointment when the republicans had majorities in the house and senate. i hope this time the american people realize how serious this isuue is. Arthur Lubitz M.D.FAAAAI

The panel approach is the better, in my opinion. There can be no meaningful health care reform without tort reform. Robert Waddell

Dear Senator Coburn,
I've been reading and reading through the variety of recommendations listed above by Sermo members. Be that as it may, it will be an uphill battle to enact any meanful tort reform due to Democratic majority's power to ignore any such change.
The American people are most concerned about cost of health care, and access to physicians foremost. Your strategy MUST be to convince your peers of how cost
and access has been improved in states like Texas, California, Wisconsin and Indiana where tort reform is working. Then quite frankly, I implore you to nibble something--piecemeal it-- with the premise that if it works, additional reforms can be forth coming. But, don't mess with Texas!

Numerous studies show the high cost of malpractice and the ultra high cost of defensive medicine(I have seen as high as $250 billion/year). I say shift the malpractice burden from the docs and hospitals to the federal government and eliminate pain and suffering from the equation. This would save doctors alot of $$ and worry. In return reduce Medicare payments (private insurance companies will be able to do the same). The result would be that Medicare's final bankurpcy would be delayed and private insurance costs would go down incrementally.
The only losers would be few that would lose multimillion dollar payouts and the attorneys.
By the way, I would make all other torts "loser pays". This would decrease one of the costs that are making businesses see red and would give some extra $$ for hiring new employees and paying didvidends to shareholders(taxpayers).
Thank you listening.

Please ask the Physicians who were victimized by Senator John Edwards who "channeled" dead babies before ignorant juries whether they received justice? Consider that the supposedly educated and fair Judges allowed this travesty to go on for years, while Edwards received tens of millions of Doctor's malpractice premium dollars which he keeps as his own today.

I challenge you to do a survey of Physicians who have been sued to ask if they found the American system of Justice to be fair.

Dr. Coburn,

I agree with the first reform proposal: independent health courts. This would be the equivalent of independent arbitration. Here in Florida, many physicians have patients waive their right to sue in favor of independent arbitration. This would certainly cut down the costs of healthcare, because we essentially eliminated the middle man: trial lawyers. We should also limit punitive damages to $250K. Thus, if a patient wins a malpractice case, he gets the entire 100% sum award, and 0% goes to a lawyer.

If a patient does not want independent arbitration, then give them a choice. Let them pay higher insurance premiums with the current tort system, or let them pay less for their insurance premiums by agreeing to independent health courts/arbitration. If the patient is recieving tax-payer subsidized health insurance program, the patient loses that choice and mandated to health court system. Remember, it is already harder for patients to sue government healthcare systems such as the VA or military health care, so a double standard already exists!

If you get into a vehicular accident you can sustain more serious injuries than a doctor related mistake and yet there are caps to automobile insurance payments.

1) Tie the medical liab. insurance premiums (that we pay) to Medicare reimbursement.
We can't be paying almost $100k a year for premiums and get paid $300 to fix a hernia or $120 for an endoscopy.

2) We as a country need to decide is Medicine is going to be the million dollar game or the $20 dollar game, but don't make us pay liability premiums in the expensive world and make us work and earn pennies in the $20 world !!

Step back... a little farther, perhaps.

Tort reform is crutial, no doubt, but still a micromanagment issue and a singular facet to "the system".


I support a painful return to free market health care... and let it run Fed-free on a State to State level. With 50 test tubes running in paralelle, all learning from each other, AN OPTIMAL SYSTEM WILL ARISE FROM CONCENCUS, NOT MANDATE.

For this, the Fed should and must absolve itself from tort reform, and all other health care issues.... deligate it to the States to come up with their own plan that their constituants can live with.

From a politicians point of view... this is the way to go. All "Hot Button" issues from Tort Reform to Abortion should be removed from the Federal platform and the States should address it locally. From that, more responsable politicians will be elected; it is easier to judge a candidates views on foriegn policy without muddling it with a Hot Button.

Further... any Tort Reform made in Washington would be made ultimatly by Lawyers. THERE IS A REMARKABLE CONFLICT OF INTEREST HERE, no?

The fight for Tort Reform should be a fight to make it Fed-free. Let the States see if thay can attract us physicians.

The Federal Gov't can provide benchmarks, standards for EMR, transperancy of outcomes State by State, CDC guidlines... and the like. BUT NO ADMINITRATION BEYOND WHAT THE STATES WANT TO DO.

Again... THE OPTIMAL SYSTEM WILL ARISE ONLY FROM CONCENCUS OF THE STATES, NOT MANDATES.

I'll gladly trade this set of problems for that set of problems.

Addenedum of thought:
True Tort Reform can never happen until the fundemental culture of entitilment has drifted. The foundation of Liberalism is based on the creation of victims, victim group mentality, and "learned helplessness". This is how Liberal power is aquired and mantained. Objectivly, this is the Age of Entitilment and must return to the American mindset of Individual Liberty before any meaningful Tort Reform can get footing.

Tort Welfare is a symptom of much deeper pathology.

Senator Coburn, 
I have read all these posts, and I hope you are able to as well. I did not read all of the >1000 submitted responses to the poll question. I fully agree with Sermo Doc 37 that it is fantastic you are using this to get direct physician imput. You have over a thousand opinions of some of the most educated Americans, and people with skin in the game daily.  We feel that, as a crucial element in the Healthcare Equation, we have largely been ignored in creating the solution. 
The public does not understand our daily frustrations. They do not have a clue how dissatisfied many doctors are and how many are closing their practices for an early retirement, or changing careers and leaving medicine altogether because of the quagmire if our current system, particularly with regards to reimbursement. And, either the President doesn't understand our predicament either, or he doesn't care, and  made a political move to paint us in bad light by suggesting we do unnecessary procedures on our patients for financial motives. The clear majority of us agree we order unnecessary defensive tests to avoid a lawsuit.  Medical malpractice liability reform MUST be part of the solution, along with health insurance reform, adjusting patient/family expectations on end-of-life care, and preventative measures. Leaving med-mal reform "off the table," because the lawyers fund the party in power is inexcusable. 
I hope you can help make these realities more public. Too much focus has been on death panels and rationing, and not enough on what is missing from the house bill.  
There are a range of opinions here, but it certainly appears that the majority believe that having the loser pay, such as the UK system has, is the solution. 
The Democratic politicians are largely funded by lawyers, and of course they will want to fight the reduction in suits, because, when all is said and done, they are the only ones that profit every time a case is filed. If the public clamors around the idea that the patients will be left out (or more likely the 'american association of justice' will clamor on behalf of the patients), cap the return to the lawyer, and keep the award as intended: for the patient. But, in my opinion, the only way to acheive real reduction in costs is reduce tests/procedures/referrals that are unnecessary, and only serve to limit our lawsuit concerns.  I can see huge differences in the amount of workup ordered by my colleagues that have been sued vs the ones that have not.
I sincerely hope you can make this known. Deliberately excluding malpractice reform of any sort, especially since it has been proven to work in TX, is grounds for the house bill to fail. It is sad that the AMA wants to speak for all of us, but is quiet on this and supporting the bill. It undoubtedly seems apparent to you that the practicing physicians here on Sermo disagree with their support. 
As far as your suggestions for the expert panels and health court go, I think they are good solutions. Perhaps to assuage concerns voiced on here, you could describe further how these panels would be composed? Maybe by the board certifying specialty of the involved physician? Maybe the board needs to be MD/JD? Somehow, the potential for a 'hired-gun' on the panel needs to be eliminated.
Good luck! It looks like you have the support of most of us!

Sincerely,

Richard G Lassiter, MD

I am in favor of a no-fault indemnity system. I share the concerns expressed by some about corruption tainting expert panels used for arbitration.

Agree with Sermo Doc 4's sentiments expressed early on in the course of this post.

Also agree with Dr Passer (although I'm not sure how its relevant to tort reform) that teen pregnancy is a huge problem, and is draining our state and federal coffers.

Thanks, Dr Coburn...

There should be a Senate bill like a Doctor Screening Committee before a malpractice suit is initiated in all states!

Perhapsyou can start with a SERMO Physician Screening Committee!!!

Agree, armstrong, Sermo Doc 4... thanks.. my support at anytime!

Why are we trying to reinvent the wheel? The military has been able to handle malpractice cases for years. The military system IS part of the government. That would take care of tort reform.

While I do not support HB3200, and at first blush, like what is contained in S1099, I looked into the history of the bill. In 2008, it was known as S. 3118 that came out to counter S.3101. S. 3101 was designed to block mandated cuts in payments to physicians. You voted against S.3101 in all cases--effectively voting for cuts in medical reimbursements. Please explain yourself.

Sermo Doc 57,
It IS sad, but you just confirmed what I already know.

I just heard commentators on NPR downplaying the possible benefits of Tort reform, mentioning a possible savings of 1% or maybe 4-5% at most. I think we need to apply data / statistics from states that have already implemented some form of tort reform to show how much it has helped; because people out there are fighting it already.

Responding to above:

I believe we have a basic human right to keep what we have earned with our sweat and the days of our lives without having other people help themselves to it without permission.

It is ludicrous to me to hear people advocating healthcare as a "right." Are free groceries a basic human right? Dental care? Bottled water? Gasoline? Cable? Does anyone who happens to have a need somehow gain the right to come take my stuff away from me? How can that not result in anarchy?

And if healthcare is a basic human right don't the people in Africa deserve it as much as our citizens? If we provide it to some isn't it wrong not to provide it to all?

We could decide as a nation to make it an entitlement or not, but to decide that something about our being born on this earth makes a free service our right seems just preposterous.

Lastly, Hello Dr. Coburn from your classmate at OU 1983 - and you are doing a great job. It gives me hope to know we have you in Washington.

This may have been mentioned already, but think we can make a better argument for tort reform if we can come up with a way to better police ourselves. There are patients who are legitimately harmed by real medical malpractice and we need to show the public that we care more about the patients than we care about protecting bad doctors.

Medicine is about taking care of patients and the patients need to believe that is the main concern of their doctors.

Senator,
You and I both recognize the fact the BO's rush to "reform" health care is just pure politics and nothing else. "Reform" is not what he and his minions seek; a totally new federalized system is what is in that dang bill.
And that, Sir, is what angers me. The federal government does not have a great track record of running social programs. In fact, you could say that the federal government pretty much could not make a go at running a legal brothel and selling booze............which it did and could not compete and thus closed down. Now, it takes some pretty stupid people to not be able to make a brothel financially sound. And now, they want to take that same stupidity and apply to the lives of my family and my patients.......hogwash I say.
This bill is not salvageable....................the good in it is simply overshadowed by the piss-poor bad found on each page. Most Americans do not want what BO wants them to want.........and hopefully, he will learn this in no small measure with the mid terms.
Socialized medicine..............and this is what this is and anyone who states differently is an idiot or a bald faced liar..............is not what this nation needs nor wants. We need to get doctors back in the driver's seat of running medicine. We need to start reigning in the massive insurance companies and their negative impact upon our practices and our patients........one way would be to remove their anti trust protection across the board. We need fewer wannabes like PA's and NPs clouding up the waters of medicine unless they are clearly under the control of physicians and not out on their own. We need the legal profession to grow up and see all the negative things that they are doing to our nation, not just to medicine, but every frigging aspect of our country...................and they need to change...........not the collective citizenry, but their own profession.
We have problems.........but these fade in the light of the problems that Obamacare will bring to this nation.

will be interesting to see what becomes with all of this

Senator,
You have included many of the important issues that are important to doctors, and therefore important for patients. I feel that the idea of the expert panels is really one the most important for liability reform.

It is now important for you to become the LEADER in Washington for health care reform. Get your ideas out to the American people and they will follow. We support you. Glad to see that you are staying true to your roots as a physician. (Unlike Howard Dean, who is a typical politician.)

Thank You.
Dean Heller

Senator Coburn,
Thank you for your interest, and for attempting to delineate some specific issues to be tackled. Regarding tort reform specifically, I think we all feel this personally, but we should look at it also as part of health care costs. As in many areas of medicine, it is a small part of the overall costs, but a much larger element in the unhappiness of physicians. To the extent that I see myself as a scientist, I would like to believe that plans for reform will be based on what objectively works, not on what feels good to those with the most money and loudest voices, whether that is a doctor's group, the insurance companies, or anyone else. I think part of making a plan work, of course, is making it tolerable to the people who will be asked to work in a new system, and I would be agreeable to some form of mediation/expert panel, noting the caveats stated above.

Senator:
The issues include:

1. Tort Reform: Indict corrupt Lobbyists. Pass a Tort (Malpractice) Reform Bill with No Fault Insurance for doctors.

2. Insurance Reform: Break up 5 largest Health Insurersinto 25 smaller competitors using Justice Dept. and ant-trust investigation. Remove Ant-Trust Exemption from these large insurance companies and allow free market competition.

3. HSA's: Help implement more Employer HSA's adding tax credits/deduction for Employers/Employees. Allow docs to negotiate with HSA's. Checkout Wholesale Foods Plan.

4. Remove present bills. Prevent any new bill from superimposiing Medicare Reimbursement onto private Health Insurance CO's (new "Public Option").

5. Tax defer Medicare/Social Security taxes paid by employees and self-employed.

6. EMRs: Paid by Gov. stimulus plan, not doctors. who are already overburdened financially.

Help us inform our patients who vote by whatever means possible, the media could care less as they love the W.H.

Go on the Million Med. March to D.C on 10/01/09.

Thank you.

as someone who thinks the gov't is the problem, you seem to embrace gov't solutions. sure those are all good ideas. you know what would be a good idea too? not being obstructionist and hammering out a bi-partison health care bill.

Agree with Sermo Doc 4 as well. The cronies want it both ways: price fixing with 100% liability. I did an epidural on a patient for free b/c his doctor asked me to, saying he thought the guy would go back to work if his back felt better. Yet that patient can still sue me for millions in the event of a bad outcome. This house of cards is a'fallin'.

Btw, didn't even get a "thank you" card from this guy. It's the last one I did for free.

Sermo Doc 152: Just as you explain with example...I have problem with free anything. It has NO value. Medicaid is a great example of how not to run our society. The bulk of Americans are unique people in that they recognize all their rights but none of their duties. The least we can do is to impose the pain of bad decisions on them and not on the society. This rule should extend to law suits. If they are awarded huge malpractice awards, the local community should bear 75% o f the costs. It will change jury behavior very fast.

Senator Coburn,
First,thank you for being here and for your interest in the current misguided plans of Congress and President Obama.
I have been in practice in Florida for over 33 years and can tell you that tort reform works.Anyone who has treated Worker's Comp patients can relate how difficult it was to find an attorney after Florida passed a cap and removed "the sky's the limit" mentality.

I read your proposal and have always hoped that the media would bring it to light. Unfortunately they perpetuated the myth that the opposition to Obama Care did not have any solutions except the word "NO". I believe that your proposal would bring us closer to restoring the doctor-patient relationship as employees would own their own insurance, not employers. If the doctor-patient relationship were to be restored that would go a long way to reducing malpractice suits. But your tort reform package is a reasonable way to get the greed incentive out of the trial lawyers hands.

I would be in support of having a "death panel". Seriously, I would. And I would be happy to serve on one.

I practiced for the better part of three decades in louisiana where every case filed has to be reviewed by a panel of three physicians, similar to the german system. The panel's findings were unlike the german system not binding. Such a system would be helpful in reducing litigation overall and not rob the truly injured from some measure of justice and help for their incapcitation, that is if the panel's findings are binding. In louisiana in the wrong parish the panel has no effect on a jury's decision. However, this doesn't address product liability costs which drive up the costs of drugs and medical devices. Once a drug has passed the rigorous demands of the FDA to be released and no integrity issues can be found should expensive class action lawsuits be permitted which then drive up the costs hundreds of percentages or so we are told by the procucers of the drugs and devices? The real costs of medical malpractice are many times more than we see in awards, litigation costs and premiums paid. From my observation the present crisis would be resolved by adressing the costs that have nothing to do with patient care.

One thing in Zeke Emanuel MD's proposal is clearly true. You can not "fix" one aspect of the medical care delivery system without affecting another. It is built up from the 19th Century system, really the medieval guild system with merely add-on after add-on. (Those wonderful National Board of Medical Examiner or FLEX exams were the hold-over from the conversion from licensure based upon the say-so of your mentor to scientific basis of medicine, for example.) Our system is like a mobile - it began with merely two elements: the physician and the patient. (I'd love to describe it and/or actually build a mock-up model. That would be much better than all those silly charts.)

What really is the purpose of medical malpractice? Is it really for compensating the patient for the break in the assumed contract? If so, is that supposed to be justice? Or is it to provide sufficient funds to assure for medical care of the aggrieved party (as has been used as an excuse of megamillion awards, but really do not cover all costs under the current delivery system.) Or is it to "out" a "bad" physician and/or institution?

Currently, it seems mostly there to act as a feeding trough for personal injury lawyers (who, I am told, are generally considered to be the dregs of the law school class.) It takes too long to actually provide compensation to the patient. The awards, as mentioned, dont really cover future medical costs. (The best for that is to reform the uniform access or nondiscrimination from insurance companies.) It doesn't "punish" physicians other than lead them to greater self-doubt leading to ordering any and all tests and consultations imaginable to CYA for the next time - thus driving up all medical costs. (How many order, say, rapid strep test or cultures because the result will truly alter your therapy rather than to keep the patient/parent happy?) And, I daresay that the current medical malpractice system stifles any real quality improvement. It encourages everyone to be as silent as possible about alternative ways to address a particular situation/case. It stifles open discussion.

The proposal is basically for an arbitration panel. But without clarification about who the "expert" professionals are and their background and what is presented over what time frame you are basically reproducing the current system, only with more players. Until the issues outlined above, which contribute to current filings and awards, you are merely moving the deck chairs about the Titanic.

Each is tied inexorably to other aspect of medical care delivery. You can not change one without changing another. The key is to predict (accurately) which way and how much it will perturb each of the other aspects of care. As a physician, you know that that is what we try to do for our patients. But, I remind you, MD is not an abbreviation for Minor (or major) Diety.

There must be a national LITIGICARE program that attorneys participate in, just the same as Medicare. Here they will be forced to accept fees that will not even cover their expenses. The mechanism of the program will be set up and run by physicians, just as the Medicare program is set up and run by attroneys and admin people who understand nothing of what it takes to run a medical office. It's only fair. (Tongue in cheek?? Not really!!)

Health insurance companies NEED to be made non profit!!!!!!! When the CEO of UnitedHealthCare has an income of $539 MILLION dollars in any year, then we can really see where the money goes. This figure is from data provided by Families USA, a non profit group that tries to help everyday people negotiate the health care maze that has been created by the insurance companies. Yes that number includes salary, autos, country club memberships, private jets, "incentives"--a nice word for cutting down payments for needed care, stock options etc. As these companies are publicly held, the data is available. Do you have any idea how much over $1/2 billion can buy in terms of immunizations, mammograms, colonoscopies, stop smoking and increase exercise campaigns, etc? It is purely criminal that anyone have that sort of income when people are being denied care and the $$ goes to the chief swindler.

I have 10 more suggestions to consider:

1. Loser Pays
2. Loser Pays
3. Loser Pays
4. Loser Pays
5. Loser Pays
6. Loser Pays
7. Loser Pays
8. Loser Pays
9. Loser Pays
10. Caps on payouts to plaintiffs

Get the point?

Sermo Doc 31:

Please tell us what state in the US has a true "loser pays" rule. An "offer of settlement" provision is not loser pays. A loser pays rule which provides for a "portIon" of the costs of defense to be paid is not loser pays. A loser pays rule for only certain CLASSES of litigation is not loser pays.

In fact, there is NO STATE in the US which has instituted a true "loser pays" system.

Sermo Doc 158, here's some more info on Health Insurance CEO's pay in 2008.
Wonder how our docs compare?

Ins. Co. & CEO With 2008 Total CEO Compensation:

■Aetna, Ronald A. Williams: $24,300,112
■Cigna, H. Edward Hanway: $12,236,740
■Coventry, Dale Wolf: $9,047,469
■Health Net, Jay Gellert: $4,425,355
■Humana, Michael McCallister: $4,764,309
■U. Health Group, Stephen J. Hemsley: $3,241,042
■Wellpoint, Angela Braly: $9,844,212

Not sure if this includes bonuses and stock options.

Dr. Coburn,
I read all the comments in the poll. There is a great deal of enthusiasm for the Indiana system. I have experience with that system and would like to throw in a small dose of reality.

The system in Indiana USED to work well, emphasis on past tense! It was instituted by a Republican Governor who was a physician and it worked well initially. However, when the Democrats took over the Governor's mansion (Bayh and O'Bannon), the medical review panels were chastised for ruling too often in favor of the doctor, and there was a concerted political effort (which succeeded...sadly) to push the Review Panel to rule against physicians more often.

For the Medical Review Panel to be truly effective, it needs to be more insulated from politics, AND the burden of proof for the plaintiff needs to be considerably higher. At this time, before the MRP and the Medical Board, doctors are still considered guilty until proven innocent. One physician from Indiana noted correctly that there is still no penalty for the patients suing when they were "non-compliant". As he/she mentioned, non-compliance should be grounds for automatic dismissal of any lawsuit!

I personally lost two lawsuits before the Indiana Medical Review Panel. In both cases, the patients were completely "non-compliant" and alcoholic, AND I saved their lives.

This shows that even a system with good intentions and ostensibly decent controls, can be corrupted by political influence.

Seriously Dr. Coburn, Keep fighting the good fight and thank you for your time on Sermo. I have seen you on Cspan and am impressed.
Please do not let them get a bill passed without some time of reform for the litigation system. Look at Texas as an experiment that is working. There will be alot of gnashing of teeth by the trial lawyers. The maggots have fed on us and our patient's long enough.

I will admit that I did not read all these postings so if I am repeating a previous post I am sorry about this post.

Yes Indiana has physician panels to review a case before it goes to court. This legislation goes back to when our Governor was Otitis Bowen, MD, was our governor from 1973 until 1981. It is a primary reason why I am practicing in Indiana.

A bio on Bowen as a governor is found with this link:

www.in.gov

Did you peple read these postings about Dr. Coburn and his voting record? Do you still want to praise Dr. Coburn's efforts and the implicit motives behind them?
I was pleased with my ability to treat patients without charge or limits on visits while in the U.S. Army. I also like the care I get at the VA with electronic medical records. Hawaii seems to have a good system of care also with Kaiser or public system as choices, and working for many years.
It seems wrong to me that Medicare pays more than Medicaid for the same procedure. Why not combine them into one program?

Sermo Doc 51 Infectious Diseases Posted Aug 31, 2009 at 1:06 PM
Jaded- you need to be a bit more specific- You agree with the Republican Senator on this one single issue.. I think tort reform it is one of the very few things that actually would have a very broad consensus among most, if not all, physicians....

( But if you know anything more about Coburn I doubt there is much more you would agree with... His opinions about a whole variety of issues - including abortion, the death penalty, evolution, gun control, AIDS research, 'rampant' lesbianism , even the Holocaust, cast him as a very unfortunate representative for anyone, let alone physicians....)


lenben Ophthalmology Posted Aug 31, 2009 at 11:37 AM
It is difficult to reply to any issue supported by Coburn. He is the source of outrageously unscientific nonesense related to global warming, the Schiavo case, intelligent design and on and on. Medical tort reform is needed but remember that this is lumped in Coburn's mind with any measure to lower the chance that big business might be a target of lawsuits. He has already registered his opposition to any improvements in medical care coverage and deliver.



kevinh76 Internal Medicine Posted Aug 31, 2009 at 11:45 AM
I would like to remind the Sermo community that in June/July 2008, Senator Coburn voted against SB 3101 3 times - voting to cut Medicare payments to physicians by 10.1 %. He even voted against the veto override after it had passed the Senate by a veto-proof margin of 68 votes. Why would a physician do such a thing? Because the money to pay for the physician reimbursements was to come out of the Medicare Advantage boondoggle.

If Senator Coburn is interested in healthcare reform in any fashion, it is only to please the insurance industry. He does not stand with physicians.

Dr. Coburn:
If you can provide all of us doctors with a lump sum payment at the same annual pay each year as any of the Health CEO's listed below, we could work for free the rest of the Year!

■Aetna, Ronald A. Williams: $24,300,112
■Cigna, H. Edward Hanway: $12,236,740
■Coventry, Dale Wolf: $9,047,469
■Health Net, Jay Gellert: $4,425,355
■Humana, Michael McCallister: $4,764,309
■U. Health Group, Stephen J. Hemsley: $3,241,042
■Wellpoint, Angela Braly: $9,844,212

That's not much to ask considering your annual earnings, Social Security, Health Plan, Lobbyist Payments, Retirement Plan, Gulfstream Jet Usage, D.C. Parties, and Boondogle trips.

The entire system needs to be thrown away, carefully analyse all medical delivery/pay systems world wide and kraft a program for the USA.
And pigs will fly!!!!!!!!!!!!!!!!!

Workman's Comp
do the same for patients
PATIENTS COMP
PATIENTS COMP
PATIENTS COMP
no fault, no shame, better for reporting and for systems improvement.
a no lawyer - no greed and system abuse,
objective repair of damages incurred during medical treatment according to predefined tables,
If it work for workmen. it works for patients
PATIENTS COMP!

The Plaintiff pays if they lose the lawsuit.

Thank you for providing some sanity and a cogent approach to healthcare. Thank you also for efforts in protection and defense of physician/healthcare provider's rights of conscience.

Thank you for including every day practicing docs in the discussion! Tort reform is obviously vital to any real health care reform initiative although most of your colleagues in both parties do not agree or will not agree because of the lobbyists from the Tort attorneys!

Anyway, there are a lot of good ideas out there. I think what is often missed is protecting medical organizations from getting sued if they remove certain "docs for higher" from there colleges. For example, there is a Cardiologist who goes from state to state and will work for any lawyer for any reason and say anything for money. He has no ethics whatsever. He makes over $500,000 a year as an expert witness. The ACC cannot remove him from the ACC and strip his FACC designation, nor can the states that he works in remove his medical license (which would put him out of work) because they are not immune to prosecution. A simple change in the law would take care of these "docs for higher" who are an embarrassment to our field.

I do believe that there should also be some kind of a review board to evaluate all lawsuits that are filed, and the ridiculous and up surd cases should be closed before they get started!

I agree with the idea of a panel of docs and lawyers to decide on cases that are of merit, and to end the jury trial system for malpractice. I have dabbled in expert testimony and only in support of doctors being sued. I would say it is 50-50 as far as when the jury gets the decision correct. More has to do with who has the better lawyer. This has to stop!

I could go on for days on this topic. Feel free to get back to me through this website if you would like to discuss my ideas further.

Thanks.

From another OB.
Why can't we start with 2 of the largest problems ( tort reform and control of the ridiculous profits the insurance companies are taking.) ... and then tackle the others one or 2 at a time. Reinvention of the entire system overnight while maintaining the status quo with these 2 cancers of the system makes the entire thing seem a farce.

Does anyone in Congress have the courage to ask our POTUS why Tort reform is not on his radar screen? Is it really as simple as being owned by the trial attorneys? If it is, refer to paragraph 1....... a farce.

Thanks for your help.

If someone sues a doc and it is deemed to be a frivilous lawsuit than the plaintiff should be responsible for not only their own court costs, but the defendants-including the lawyer fee.
If reasonable true non-economic caps are not on the table, which i doubt they will be because of all the money the democrats get from the trial attorneys, than at the VERY least the limits of the malpractice coverage ie 1 million/3 million should be the max allowable by the law.
Granted that is not my first choice, but at least that is a little piece of mind that if i were to make a mistake and get sued they can't take everything-house, car, savings for my childrens college education.

Thanks for your active role in this healthcare issue, Senator Dr. Coburn.

The ominous and constant threat of "fraud and abuse" investigations and prosecution by the federal government is one of the fundamental escalators of healthcare costs (not to mention at-or- below-cost reimbursement). Combined with HIPAA mandates, the time and cost demands for compliance (often over-compliance) drives down productivity and escalates costs for non-entitled patients. Physicians could reduce fees significantly if Medicare and Medicaid paid competitive market rates. Many politicians are startlingly ignorant about this and continue to believe there is fat to be found in more "fraud and abuse" witch hunts. Tort reform and reform of federal fraud investigations and actions should go hand in hand.

I am not in favor of single-judge medical courts. These sound like misery in the making. There are always some bad apples in any barrel and one bad judge would do great harm. If necessary, I much prefer the professional panel court.

Prelitigation panels have been very helpful in Idaho but I think the binding arbitration in Utah, as described previously in this string, sounds like an even better idea.

Prevention is a nice idea but is useless and counter-productive for cost savings. There are too many variables, for example, in etiology of heart disease to see much benefit from prevention programs as an essential government-driven reform. Certainly, as physicians we need to continue to emphasize prevention, e.g. smoking cessation, weight loss, exercise, etc. Spending a lot of taxpayer money on federal programs will be another enormous waste.

Without legislators like you, and organizations like SERMO and AAPS, and a few others, who are bringing some sanity and reality to the healthcare debate, I would be planning a new career for the near future.

One last thing: There should be ONE indispensable litmus test for any legislation on healthcare, which is the Constitution. The current bills under consideration are pure socialism, pure and simple.

Regards and good luck!

I think Texas is a good example of how good Tort reform works. Since reform in 2003 medical malpractice fees have decreased every year saving doctors millions and millions of dollars. That essentially gave doctors in Texas a raise and allows for better practice of medicine. The only people who lose in Tort reform is lawyers.

Are we going to get an answer about Senator Coburn's voting recored?
IN JUNE 2008 SENATOR COBURN VOTED AGAINST S3101 THREE TIMES.
HIS VOTE WAS TO ALLOW 10.1% MEDICARE CUTS.
HE THEN VOTED AGAINST THE VETO TO OVERRIDE IT.
There seem to be just a few on here who are as outraged as I.......

Catastrophic Insurance not Malpractice Insurance

Having been in surgical practice for 30 years I have seen my share of malpractice cases. Most cases are as a result of a less than desired outcome. Many times disasters occur in very ill patients that were not the fault of the Sermo Doc 186. Often these disasters produce severe financial loss for the patient. Why can't these patients receive some form of compensation (or at least coverage of their bills) due to the disaster without having to assess blame.

Lawyers argue that it is the blame that keeps the system clean by weeding out bad doctors., What if the state licensing agency reviewed all disasters that occurred. Those would be categorized (as is done at M&M conferences at our hospitals and universities) preventable or nature of the disease. Preventable can be further subdivided into errors in judgement and errors in technique. Should a physician make too many preventable errors, their license might be revoked or remedial action recommended. Problem solved.

A final plus is there are some doctors that have catastrophe after catastrophe but for some reason don't get sued so they stay below the radar. They would be uncovered with catastrophic insurance.

The best part is it would be part of regular health insurance so no premiums for the doctor. The insurance would be funded by the enormous savings by eliminating depositions, expert witnesses, and jury trials - we are talking multi-millions.

So - I'm told the lawyers will never go for it. Like what else is new. How do we get our legislators to buy into this?

Health Court with one judge deciding—no way. I have been squashed by incompetent and/or corrupt one-judge, non-jury court appearances for non-medical situations.

How about a true jury of peers?

Even better, how about a revolving, binding (without appeal) 5 member probable cause panel, drawing constituents by lottery from a pool of
1) Physicians,
2) Nurses,
3) Plaintiff's attorneys,
4) Defendants attorneys and
5) Certified health care administrators.
The probable cause panel should be empowered to sever non-negligent parties named in any action.
And, finally, cases with merit permitted by the probable cause panel must go to trial (no settling, unless the lawyer agrees to donate all expenses and fees to the plaintiff), on a specific date, no later than six months from the decision by the probable cause panel, with no "manufactured" delays (either show up on appointed court date, or loose by default) and looser pays all.

Caps on liability? No way, I have seen some horrific outcomes caused by physician/facility staff incompetence or neglect and am opposed to caps on liability. Tied into this concept, all parties should be subject to automatic jail sentence if they attempt to fraudulently transfer assists.

P Richard Wirt, III, DO

We all agree that we need Health Reform. If the GOP won't sit down with the Dems to hammer out a reform, the Dems, who has the majority both in the house and the senate will pass a health reform anyway. Why does the GOP won't work with the Dems for the good of the nation? A bipartisan health reform, I believed, would be better bill than unipartisan.

Dear Coburn,
Read excellent review from my fellow colleagues..Agree wholeheartedly
1. use British system.." loser pays"..
2. Use experts from the respective fields...e.g. Three Orthopedists will review the case and see if it is justifiable to go forward or settle without tremendous court costs.
3. Let pts buy Risk Ins from dispensers we had @ the airports before u took a flight!
4. Or surcharge $30 per pt added to the bill just like a trip ins.
5. HSA and increase copays and deductibles for ALL pts. including the medicare pts..
6. If a pt signs tthe consebt form, not to sue..then pt cannot sue..

Look at the British system. They have a Tribunal composed of experts in the medical field. Lawyers being on the panel will not help because they have no idea about medicine. More than 90 % of the lawsuits are frivolous to begin with. Cost of health care could come down 30-40%. I came here from London in 1995 to start my Residency training in Internal Mediicine. I was completely aghast at the amounts of tests which were ordered to cover a medical condition. I could not fathom as to how this system could survive with the kind of wastage built into it. Sure enough after 14 years my worst fears have come true. This system is not sustainable. Defensive medicine has severely undermined the healthcare system. Without tort reform, the cost of health care will not come down anytime soon. The president is right that Doctor are very expensive, but the realisation is lacking, that we are practicing medicine more to protect ourselves from lawsuits rather than treating the patients problems. Losers to pay would also be a deterrant

Of course we need tort reform...enough said.

We also need to quit paying for doctor visits for these low life drug seekers who see over 50 different doctors a year seeking controlled substances. The insuance companies including medicare have ways to track this and yet they continue to pay for these office visits for young healthy people with no medical problems. One to two of these patients come in my urgent care every day, and they have seen at least one different doctor a week trying to get drugs...yet the insurance companies turn their heads becasue it is easier to raise the premuim on the other patients than fight with these people. The drug enforcement units do not want to deal with them either because there are so many of them and of course, they get an attorney and then no one wants a legal battle. Once again the attorneys have us by the you know whats. If you add up what is paid in physician visits alone for these peple, it is a significant amount. Trust me, the doctors would not miss having these people out of their offices. Then we could see people who are really sick.

Another target would be those on federally/state funded health plans who run into the office at the first sign of a sniffle or use UC's and ED's as a primary care...It is no skin off their nose becasue it is all free for them.

If we just trimmed up the current system, it would go a long way towards fixing it!

Yes. Tort reform is critical for healthcare reform or even maintaining the healthcare system we have. Sadly, short of voting out the demofelons and severing the pervasive and extremely influencial linkages between the trial lawyers and the democratic politicians who refuse to give us tort reform, nothing is going to happen.

Support folks like Colburn and anyone else who is not a demofelon in the pocket of the trial attorneys!

RioLado, agreed! We do not need caps on lawsuits. Real doctors are not afraid of truly justifiable lawsuits. They are rare. What we want is a forum where facts and truth prevail. That does not happen at the present time. The court of law is a circus. Plaintiff's attorneys are the biggest liars and crooks I have ever seen!

It is the frivolous lawsuits caused by a lottery mentality, patient non-compliance, and occasional bad luck that must be purged. These lawsuits are just legalized extortion and a money grab for the lawyers. There is ZERO concern for what they do to the doctor's time, business, emotional well-being, and reputation.

It is just insane to constantly blame others for unsatisfactory results. Satisfaction is a relative phenomenon, and curiously the only folks who ever get blamed are those with money. How strange!

FOX News announced today: ("Phishing Suit")

A Doctors group, the Assoc. American Physicians and Sermo Doc 186s, is suing the White House and the Company who sent out phishing emails to people who never signed up for WH emails, never had contact with WH by email, and never requested anything from the WH by email.

There's a big data base out there under control of the WH which can be used later.

Can we create a Class Action Lawsuit against The American Trial Lawyers Association ? We must have a lot of serious, well documented grounds for action going back decades???? This should be feasible, esp. if doctors groups got together! What do our lawyer docs say?

Good luck to the AAPS!

Sermo Doc 162,

Thanks for setting the record straight about Senator Coburn. We have to be careful about who we call our allies based on a single tasty morsel of propaganda (tort reform) they lay before us. I certainly will think twice about Coburn's "keen interest in health care reform" before I lend him my support.

Senator Coburn-Do you see patients 1/2 day per week? or do you simply push a pencil, devoid of clinical skills? I have watched you and listened to you, and you lack credibility. However, you have presented some good ideas with regards tort reform, a vital part of the question not on the table and a possible contender to end the practice of cya medicine. This proposal of yours is a good start. Nonetheless, I prefer the feds on the sideline to the corporation between physicians and patients dictating with impunity and without legal liability while rationing and raking in massive profits. I want them gone, anywhere else, any other business, gone from anything to do with the practice, art, and science of medicine and surgery.

couldn't have said it better. and although i knew about many of the things Sermo Doc 162 said he also articulated it better than I. has anyone seen the youtube video of Coburn telling a woman whose husband had a stroke and is unable to get nursing and rehab care to suck it up and to ask her neighbors for help (sort of like a barn raising but instead you show your neighbor how to chew and swallow).

Tort reform should include No Fault Insurance with low premiums for doctors to pay for costs of defending against any Plaintiff's action.

This should be accompanied by Binding Arbitration with the Court appointed Arbitrator assisted by Three Board Certified Medical Experts,one NP, and one Actuary. If there is no valid injury and the Claim is found to be without merit, then all Physician/Arbitration costs and Plaintiff's costs/damages (if any) should be paid by the Plaintiffs's Attorney.

The physician should be publicly exonerated. His time and other costs (office, legal, etc.) should be paid by the Plaintiff's Attorney and his Insurance Co. reimbursed. His record should be expunged from any Public Records.

If there is an innocent injury (reasonable complication or unexpected adverse effect of appropriate drugs or a procedure), then a State Medical Fund should determine and pay any amount for medical care, loss of income, and pain/suffering.

In the event of a valid medical induced injury, the Arbitrator shall determine the Plaintiff's award and the offending physician should be referred to his/her State Board of Medical Examiners for disciplinary action which could include many actions (required education, fine, pro-bono work, probation, loss of License, or even referral to a State Prosecutor if there is any suggestion of criminal action.

Medical doctor groups should cooperate together and create a Class Action Lawsuit against the Assoc. of Trial Lawyers for the damages to innocent doctors who have been savaged financially and emotionally over many decades. There must be a mass of legal grounds for such a Class Action Suit and data bases that could be used.

Join the good fight!

Tort Reform must be addressed, the only downside to Tort Reform is a decrease in the salary of trial lawyers and a decrease in donations to politicians from trial lawyers. I solved my issues by quiting private practice a year ago and only working in government agencies. I will never work in the private sector again.

Your continued feedback is great. I know how busy you can be as a physician. Thank you again for taking time to share your thoughts and contribute to the debate.

A few of you raised the issue of insurance market reforms, pre-existing conditions, and profit margins. I strongly support health care reform that will ensure all Americans can afford health insurance ( coburn.senate.gov ) and are not excluded for pre-existing conditions ( coburn.senate.gov ). I believe achieving this goal is not best accomplished with more government interference and monopolization of health care. My plan would incentivize states to create State Health Exchanges where any American could select an affordable, high-quality private health insurance plan like Members of Congress enjoy, regardless of health status or age. States would be able to hold insurers accountable and disincentivize cherry picking through a risk adjustment mechanism. This would help unleash the forces of choice, competition, and transparency to drive value for patients.

Health coverage is important, but as a physician, you know it does not represent the totality of health care. We must also ensure we tackle fundamentally important issues like lowering costs ( www.rasmussenreports.com ), improving quality, and increasing access. Unfortunately, the American people overwhelmingly don't believe that the current bills advanced by the Congressional majority meet these simple goals ( abcnews.go.com ). The American people are right.

I am focusing on these goals. I am also talking with everyone I can about the importance of protecting patient choice, preserving physicians' ability to freely practice the art of medicine, reducing fraud and waste, and improving prevention/wellness efforts. I get the feeling that August has merely been the prequel to an historically important debate this fall.

Your voice is so important in this discussion. You have a unique contribution as someone who has actually provided health care. I encourage you to continue to engage in this venue and others. People elected to represent you should value your thoughts on health care reform.

I look forward to continuing a dialogue with you and sharing your perspectives with my colleagues.

Tom Coburn, M.D.
U.S. Senator

The Patients' Choice Act ( coburn.senate.gov ) compared to HR3200 ( coburn.senate.gov )

Senate Doctors' Show ( republican.senate.gov )

Sen Coburn, why is it that even you are so silent about the malpractice menace which we all know is a major cost driver? I don't see anything about this in your post above..
2) What in your opinion is affordable insurance for a family of four. As a physician I find $540/month for a superbly healthy family of four with a $10000 deductible is becoming unaffordable for me.
3) Insurance companies will raise rates for everyone by a few hundred a month if you insist on covering all comers regardless of risk..
What exactly is your plan. Please spell it out. Please use numbers as talk makes no sense to us.

Again, thank you for your continued interest, Dr. Coburn. I agree with Sermo Doc 4 that the absolute absence of a meaningful debate about tort reform is a glaring defect in this discussion(in Washington). There are many complex issues that deserve attention. Please, as you have asked in this discussion, make tort reform a central issue in the Senate.

This is not just critically important to physicians, it is critically important to all Americans.

Dr. Coburn....Please tell your fellow senators, most of whom are lawyers to do the right thing; Fight for tort reform and not only be a hero, but re-elected.

State Health Exchanges---is that where people go to pick who will be their neighbors so they can come by and give them the health care services they need?

i just came from a meeting with congressman Diaz-Balart--he is republican, and he is very much a free-market guy but he runs rings around you in knowing the issues and what is needed. i find your proposals a travesty.

Are you guys crazy? "Thank you Senator Coburn..." Yes, he is an MD, but he also is (one of the most conservative) a Republican Senator. This means, in my opinion, he checked his compassion at the Capitol door, as a member of the "I've got mine, the hell with the rest of you" party. He'll take all of your comments about tort reform, a worthy issue no doubt, and he will use it for distraction, fodder, propaganda in the GOP attempt to mess up real health care reform. We need a national health plan like every other civilized nation in the world. How are we so different from those countries? Oh yeah, I forgot... lobbyists. Like the ones who throw money at Coburn, Grassley, Baucus, and Conrad.

Hopefully, we all became physicians to help people. Here is our chance to help millions. And we could fix some of those Medicare annoyances at the same time. Some debt relief for young docs with big debts would be a good idea as well.

After reading Coburn's post above. I am convinced of two things: 1) He didn't write it. Some staff person just regurgitated talking points in a PR effort. And 2) He didn't read any of the posts on this thread! The posts were about solutions to the tort reform problem. There is ZERO acknowledgement of any of the proposals put forth by well-intentioned physicians.

I want to know when politicians will ACTUALLY start listening and stop treating us like children?!

For there to be "dialogue", there has to BE dialogue!

As we know, sometimes the money lost by hospitals is by people without health insurance using the ER as an urgent clinic. Wasn't there a report a year ago about a hospital in Texas where something like 15-20% of the hospital budget was used by 13 people coming to the ER repeatedly for things like toe pain and toothache. How can we resolve this? Educate the public more on what is appropriate use of resources too. Attack the issue from all angles. Thank you for being in the Senate, doctor.

nsmurali good idea, Sermo Doc 66 also with thoughtful comments.

Indiana/Wisconsin examples good.

I know that Alaska, Maine, Idaho and a few others also have injury panels, where the cases are presented to an "impartial" panel... prior to suits being filed.

If the AMA really wanted to contribute ANYTHING to this debate (questionable), they would do a state by state analysis of how these questions are addressed, publish the results and propose a rational hybrid for the country that includes the best ideas, and also rewards patients with bad outcomes (by fault or not) and sets up an education system/disciplinary system for MD remediation, if needed.

Colleagues .. WE DO NOT NEED TO REINVENT THE WHEEL!!

Dr. Coburn has been in congress for years... where was his interest in this when we have been rotting under the status quo? When Republicans controlled house/senate and presidency... He was more interested in keeping a brain dead Schiavo alive than representing our interests and patients problems. I doubt he is reading any of this, but has some low level flack who will only cherry pick what they like and feed it to him... I hope I am wrong, but I doubt it.

Raw and unvarnished opinions can be scalding, as illustrated by this thread. Sen Coburn is hearing from people who hold the keys to success of healthcare affordability. A good leader will seek out honest critics and use the opinions wisely. . I hope Sen. Coburn is cut out from this block...

Howard Dean said recently that the reason there is no tort reform in the >1,000 page HR 3200 is that the trial lawyers would shut it down. The initiative wouldn't get past the judicial review committee. Just limiting pain and suffering to $250,000 would keep malpractice premiums under control as they have in California for the last 33 years but would prevent trial lawyers from lining their pockets with gold.

I got to attend the town hall meeting with congressman Nick Rahall last night who is a clear and unequivocal supporter of a single payer system with the elimination of private health insurance. I was a little surprised at the number of people who supported him in this despite the fact that even a public plan option is now acknowledged as DOA on the Hill and no longer being discussed by the President. One retired Doc got up and said that the majority of physicians in the U.S. support a single payer system, citing the American College of Physicians as representative of practicing doctors opinions, which apparently are in line with the AFL-CIO and the American Nurses Association. I really see this as a call to arms for practicing community docs and hope everyone will attend the Million Med March on Washington D.C. Thursday October 1st on the Mall, or at a minimum close their officed and clear their schedules in support. MMM, hopefully you can meet us there Senator Coburn!

aside from the fact that Canadian FP's earn 3 times the amount of their US counterpart, and that all Canadian citizens have access to care, the repubs continue to protect the privates and their profits and their inability to understand that its a conflict of interest for them to provide health care (or rather pay for it). during our discussion with Cong. Diaz (and he's as right wing as they come)--he acknowledged that the private insurers need to reigned in. the pre-existing conditions, changing the coverage when people get sick, limiting formulary--all has to change. the problem is that the repubs are more concerned seeing this pres and admin fail rather than help fix this problem.

Dr. Sermo Doc 186:
I've read your well written posts and am really surprised at the one above. One retired doc and even the ACP (or AMA either) do not represent the majority of Physicians. During many years of practice, I've talked to a lot of docs, Primary Care, ER, and Specialists. I've never heard one say he supported a one payor system or even Medicare. Most agree that good medical care is based on a free market system operating in competition that keeps costs down, and that Tort Reform would help lower costs even more.

No one I know wants to have the Government or an Insurance company control their Practice as is happening now.
I agree the Million Med.March on Oct. 1st is a great move but, also, at the end of the March, will a few of our spokespeople, who oppose the Government/Single Payor System, be able to address Congress about our specific concerns?

We need meaningful reform so that docs can practice good medical care with a decent reimbursement, but without the Government, Insurance Co's, and Trial Lawyers taking up half their valuable time.

Let's Go Green and Recycle Congress in 2010 if we are not heard now!
Aloha.

Although tort reform will certainly put more money in our pockets, so far it has not been shown to benefit patients in terms of lowered premiums and less expensive healthcare.

US healthcare has been touted as being the best given the care we can provide to our wealthiest, but should be judged on the care we provide to our poorest, especially the working poor who do not qualify for Medicaid. Until 100% of Americans have access to essential care, we will remain low on the list of quality care.

Any legislation must be approached from the moral standpoint that we have a constitution mandate to provide for the general welfare, as well as spiritual mandate to care for all of those who need it.

Anything less is just a variation of business as usual.

Finally, I have to take anything proposed by Sen Coburn with great scepticism, based on radical statements he has made, such as favoring the death penalty for physicians who provide abortions. He is a religious extremist whose seems to have stopped reading the bible after the Old Testament.

First off, can anyone believe that with lawyers running the show in Congress (sorry Dr. Coburn) that tort-reform of any meaningful magnitude will occur?

Second, if you take a giant step back and look at the whole 'health care reform' bill, it really is about government control of another sector of the economy. Do you really believe it is about compassion for the "uninsured"? Follow the money...Why are the AMA and AARP in the position they are? So that they can benefit by being surrogates for the government.

Third. What a hoot some of these comments are! "Religious extremist" "rotting under the status quo" Oh, too bad I cannot go back much further.

Canadians pay some 15% for sales tax and the average tax liability is 48%. Is that what you really want?

Sermo Doc 188, our sector of the economy is 6%, not peanuts!

Why wouldn't Congress want control over us?

Even if Sen. Coburn was able to line my pockets with wads of $100 bills, I would not support him. Just because a politician may agree with you on one issue (tort reform?)but is wrong on 99 others is not enough to gain my vote or support.

THE single most important fact of the matter is, there is a huge corporate interest here, billions of dollars of profits are at stake if a real heath insurance reform bill were passed, and the insurance industry will pour as much money as it takes into the coffers of Congress to keep the status quo, which does not serve us or our patients well, but otherwise works quite well for the corporate shareholders and CEOs, and, at the bottom of the s#@tpile, the elected officials who represent them.

So here they are, with their hired guns and their smoke & mirrors, telling us "The American people are right" and we should abandon healthcare reform. Meanwhile people are being denied for basic coverage by their commercial insurer, and facing rising premiums everyday.

This is not a health insurance reform bill! I would be ecstatic if that were to be the case. Lots of things HR3200 is, insurance reform it is not! A single payer solution is the death knell of private insurance and the beginning of a UK or Irish - style NHS. That is not reform, that is revolution.

My Grand Coalition Theory of Progress, based on reading all of the above, is that health care reform should occur at the STATE level. Consider tort reform. Already we have heard convincing, first-hand reports that certain states are dealing with the problem effectively...and using different mechanisms. 50 experimental incubators, with the potential to combine best practices from each. A disastrous choice by one state (think MA) wouldn't bring the entire country to its collective knees.

All we really need from the feds is that they 1) reform the tax code to remove whacked out incentives, 2) fix whatever rules necessary so that insurance companies can compete nation-wide, 3) expand the MSA concept so that significant accrual can occur over time, which encourages long-term planning on the part of patients. The states can deal with cherry-picking and the rest of the noise.

In your heart of hearts do you want the feds to pay you more through Medicare? Ain't gonna happen. Physicians need to take our lips off the federal Medicare teat. Opt out, go cash, rethink your life. Can you make a living with 1 1/2 rooms, 1 phone and 2 plastic chairs?

I've tried to review all the above comments, despite many of them straying from the topic. I too passionately believe that healthcare reform cannot meaningfully occur without malpractice (tort) reform. So here are my thoughts, many having already been mentioned:

EXECUTIVE SUMMARY FOR DR.TOM:
1. Expert (all MD- with majority of physicians from involved specialty) preview panel to assess cases for worthiness, eliminating frivolous and nonmeritorious claims;
2. Expert panel of professionals with healthcare experience; majority physicians (again with most from involved specialty), possibly attorneys, HC administrator, to render judgment in case; the physician component will also render judgment on the medical care in the case, and make a referral to the state Medical Board in case of substandard care or malpractice, with the Board assuring appropriate penalties if needed (this last is critical);
3. A judge expert in healthcare to concur with or rarely to override the above expert panel so some semblance or perception of fairness is retained;
4. Final decisions rendered by above panel and judge are final and binding;
5. All judgments are rendered as 'no fault', with monies for payments coming from a pool paid into by all participants (physicians, attorneys who try cases, patients, hospitals, etc.); all joint and several assessments and collateral source arrangements would be eliminated;
6. All verdicts would have structured caps to control costs: no runaway awards, but significant harm would be appropriately compensated; low caps, as currently successfully exist in many states, for pain and suffering;
7. Structured limits on attorney payments (especially since we physicians have to accept
structured fees from the government); again, no runaway John Edwards payouts.

Thanks Dr. Tom, for spearheading this attempt at reform. Good luck trying to get anything like this done against the powerful Trial Attorney army and their minions in your ranks. I look forward to contributing to your other queries.
Sermoans-kindly keep comments on target. There is too much whining about side issues. Let's take Tom Coburn's attempt to give us some voice on these issues at face value; it's at least as much if not more than the AMA's!

I say, get the government OUT of medicine. They have ruined it and paid no one's tuition to boot. Get out.

As many others have commented, there's a fundamental need to change the way medical injury, and perceived medical injury are handled in this country. Only the most idealistic, or cynical, would attempt to argue that there is a fundamental right to sue in the Constitution. Still, occasionally patients are injured by error, or incompetence on the part of physicians. While the actual incidence is greatly exaggerated by the media, and organizations like the Institute for Medical Errors, those injuries do occasionally occur.
Over my 25 year career I have seen very few instances of patient injury caused by physician negligence. I have seen many instances in which injuries occurred, and physician negligence was assumed to be the cause, without any evidence to that effect.
The first decision that needs to be made is whether we are going to compensate injured patients for both perceived, and physician, incompetence. If we are going to continue to compensate both, then we really can't change anything. If we choose to compensate only those who are actually injured through physician negligence, then we must limit the individuals who make that decision, to persons who understand the medical process. Juries made up of laypeople, or arbitration panels which include attorneys, simply cannot make that decision. For that matter, neither can judges.
So, we've decided that only physicians should decide physician negligence. Otherwise, nothing will really change.
Second, we must decide how to compensate those very few individuals who are injured by physician negligence. In my view, there should be standardized tables which take into account lost income, continual medical care, and long-term maintenance. There should not be massive regional variations. Only those factors which can be quantified should be compensated.
While I have no problem with injured patients being represented by attorneys, I believe those attorneys should be paid based on a standardized schedule of fees, with periodic audits of their activities. The facts presented in injury claims should be limited to the actual facts of the incident. Attorneys, and their clients, should be responsible for the costs of cases which do not result in judgment.
Expert witnesses should be represented by actual practicing physicians, rather than by academics who are rarely forced to make the real world decisions that practicing physicians make a daily basis. Expert witnesses who have not treated patients, or who decide standard care based on journal articles, should not be allowed to pass judgment or offer opinions, on the care of physicians who are on the firing line daily.
Frankly, I think it's unlikely that any tort reform will occur as long as there is an attorney occupying the White House. Additionally, while Democrats are usually blamed for the tort system, and high tort costs, it should be remembered that there are Republican attorneys in the Congress and the Senate. All attorneys, have a vested interest in maintaining the current tort system.
Good luck Sen. Coburn

Howard Dean has said that Tort reform will not take place because of the power and influence of trial attorneys. Physicians need a powerful lobbying group and we will need to do more than just complain. We must each be wiling to pledge large sums of money because one way or another its going to hurt and I'd rather pay up now rather than wait for the consequences of out-of control medical malpractice suits.

Tort reform is important but universal coverage is also very important.

Medicare Payments Commission

The Congressional Budget Office weighed in 2 days ago on a proposal that the Blue Dogs have pushed to control costs, a new independent commission to oversee payments made by Medicare, the government program for the elderly. The CBO estimated the panel would save $2 billion over 10 years.

If there is to be a new Commission to oversee Medicare payments, it should be PRIVATE and INDEPENDENT of Congress and the W.H. It should have a majority of physicians on it (Primary Care inc. Fam. Med, Surgery, and I.M.) as well as elderly patients, not just Obamacrats.

Any ideas out there?

Dear Doctor Coburn,
Malpractice is not a significant driver of global medical spending, but rather unrestrained demand for low value, yet expensive treatments. If we are to seriously reform health care, we first must have a national consensus as to "what is" health and how can we reliably measure it, Only then can use cost effectiveness to fairly and affordably allocate resources. "If you can't measure it, you can't improve it" is the basic doctrine of any successful venture, be it a corporation or government services.
My own definition of health is functional longevity (the European model), and simply measured by how long you live while still functioning independently in your own residence (Census data can provide this). Anything that does not reliably promote individual or collective gains in measurable health (as defined above) is just "medical services" and not true "health care".
Government only has a vested interest and social duty to provide "health care", and certainly not the much more broad array of "medical services". My guess is that true "health care" is perhaps only one-tenth of the current American $2.5 trillion medical spending.
Obama is a great cheer leader, but an inexperienced change agent. The Dem's should have avoided any threat of changing Medicare, and started first with reforming Medicaid, an entirely wasteful system that promotes very little actual health gains for its beneficiaries.
There is no doubt that the nation needs a very bare bones safety net "health care" plan that is affordable (probably sold on a means test-perhaps income tax marginal rate, etc.) and one that does not exclude any prior illness, etc. If crafted properly, this plan could self fund (after an initial federal pump priming), and not raise taxes. Once Congress gets successful experience in the health insurance business, it can simply convert Medicaid over to the same plan, and eventually Medicare (politically, the toughest nut to crack).
Lastly, Congress needs desperately to repeal the WWII holdover income tax deduction for medical insurance. Congress should raise the income tax standard deduction sufficient to make this swap revenue neutral. Immediately, this repeal would encourage market driven reforms and innovation that will take the burden off small business. Medical insurance should never have been linked to employment anymore than would be home or auto insurance.

Congress conceived of this current mess in American medical care, and it is totally naive to think they can craft anything better this session. Instead, the reforms should be a never ending evolution of small improvements based upon data and not politics.

I also agree with the need for a "no fault" compensation system for those that have suffered an injury. This should be determined by a panel of experts in the pertinent fields of medicine. I would rather pay into a system that helps those that really need the help, not to line some attorney's pocket. If there is negligence found, then it should be referred to an appropriate disciplinary board to determine the next course of action.

I do not think that financial penalties (lawsuit awards) should be applied to physicians at all. Medicine is fundamentally different from any other relationship. Doctors invest heavily in their careers in order to render the care they provide in good will to their patients. Somehow, the idea that a doctor can go so deeply into debt in order to help his fellow man, and then get sued for more than he can possibly ever earn, seems downright unfair.
There are better ways to police physicians. If a physician consistently provides care that is sub-par, send him to further education, or revoke his license. Reprimand him, or penalize him in some constructive way, but placing a bullseye on each of our backs is not productive, and takes away from the overall process in medicine.
Now, if you want to establish a no-fault pool like the NICA fund we have in Florida for birth defects, so be it. I even encourage it. I'd much, much rather donate to that fund than pay 10% of my income to malpractice premiums every year.
Doctors do not promise perfection. I never have. We just promise to do the best job we are able to do. That is all that can be expected of us. An honest mistake, even if it takes a life, or causes irreversible damage, is still just an honest mistake and ought not to be the grounds for ruining the life of an otherwise good physician. This already exists, by the way in various institutions around the nation. It is called "soverign immunity" and if I am not mistaken, it is awarded to docs in the federal, or VA system, as well as faculty in teaching institutions. If it is appropriate for them, then why is it not appropriate for those of us in private practice?

Senator Orin Hatch on meet the press last week said that Medicare pays its docs 20%, and its hospitals 30% less than private insurance and it is still trillions of dollars in debt. The fact is medicaid is much worse. Both are failing miserably, why on earth should we have any faith that the public option will work. That question has been asked and asked, but nobody ever answers it. They are also taking about taking billions of dollars out of medicare to pay for this public option.
Why don't they try to fix medicare and medicaid before they try to insure millions of people, when it is clear they don't have a clue when it comes to health care.

The system can be fixed with 2 things
tort reform would save 200 billion a year
simply regulate the health care industry-get rid of pre-existing conditions, caps, and limit increases in premiums and copays.

Health care should be consumer based and NOT government owned and operated. The government should regulate bug Pharma and health insurance carriers so that they are not price gauging. So when are we reforming the judicial system....oh, I forgot the governement is run by lawyers. Can doctors be allowed to run medicine????

Here is a suggestion. It may not be perfect..but it can create a basis for drastic behavioural correction to ensure sustainability of healthcare insurance system--the kind we are used to, in this country:
Drop premiums by 50% , add across the board 15-20% copayment for all visits,procedures etc( 10-15% for the poorer people and 15-20% for theose who have salaries over 200,000. For the very poor, let the local communities raise money and help. there are zillions of churches, non-profits who don't pay taxes anyway. This will bring unbridled consumption to a quick halt. Of course, there will be a few who favor a "blackberry bold" over a "colectomy for cancer" and choose to miss having "vital tests and procedures" ..that is the cost the society has to pay for making care affordable. You will then not need DNPs, Quasi medical practitioners running the "Code IV E and M Mills"... This should be accompanied by "no fault compensation system for medical mishaps. 25% of the premiums for such a coverage should be from the federal government, 25% by local government, 25% by patient and 25% by physician. That will even out charges to compensate for economic inequities. It will also tune decision makers to think of "helathcare Spending" in the same sense they view their personal finances.
Stop handouts to big pharma and insurance companies. Ban lobbying..try it!

Reform RX:

Most Docs agree that good medical care is based on a free market system operating in competition that keeps costs down, and that Tort Reform would help lower costs even more.

No one I know wants to have the Government or an Insurance company control their Practice as is happening now.

We need meaningful reform so that docs can practice good medical care with a decent reimbursement, but without the Government, Insurance Co's, and Trial Lawyers taking up half our valuable time.

So, we need the Government out of Health Care now, Insurance Co's competing freely without ant-trust Exemption, a push for HSA's and tax deductions, and no-fault Insurance/Med. Practice with Arbitration Panels chaired by Docs!

Recycle Congress next year!

Dr. Coburn,
Thank you for recognizing the flaws in the current health care reform debate. Your ideas sound excellent and would certainly be an improvement to the current system. But we do not need to try something new to reform the tort system. We have had successful tort reform in Texas for almost a decade with caps on noneconomic damages. This reform has drastically reduced frivolous lawsuits, lowered costs and generally made Texas a good place to practice medicine for patients and doctors. Since the Texas tort reform has shown proven success why isn't it being considered in the US Congress?

Suggest reading this:

www.changewave.com

EXECUTIVE SUMMARY FOR DR.TOM:
1. Expert (all MD- with majority of physicians from involved specialty) preview panel to assess cases for worthiness, eliminating frivolous and nonmeritorious claims;
2. Expert panel of professionals with healthcare experience; majority physicians (again with most from involved specialty), possibly attorneys, HC administrator, to render judgment in case; the physician component will also render judgment on the medical care in the case, and make a referral to the state Medical Board in case of substandard care or malpractice, with the Board assuring appropriate penalties if needed (this last is critical);
3. A judge expert in healthcare to concur with or rarely to override the above expert panel so some semblance or perception of fairness is retained;
4. Final decisions rendered by above panel and judge are final and binding;
5. All judgments are rendered as 'no fault', with monies for payments coming from a pool paid into by all participants (physicians, attorneys who try cases, patients, hospitals, etc.); all joint and several assessments and collateral source arrangements would be eliminated;
6. All verdicts would have structured caps to control costs: no runaway awards, but significant harm would be appropriately compensated; low caps, as currently successfully exist in many states, for pain and suffering;
7. Structured limits on attorney payments (especially since we physicians have to accept
structured fees from the government); again, no runaway John Edwards payouts.

refinancing the infrastructure costs of health (treating capital costs for healthcare as if we were dealing with a public utility), eliminating individual risk rating from insurance policies, mandating minimal insurance coverage for catastrophic illness (not routine monitoring), and ensuring adequate compensation for physicians services, reforming the malpractice system -- these are the essential ingredients that need reform. If these few items are addressed, through reform of our tax code, and our legal code, along with passing a few regulatory rules, then much of the discussion about health care reform will become muted.

Sermo Doc 148 .............. AMEN (comment posted middle of page two).

I participated in the comments from Arlan Specter also. Mr Specter gave these nebulous comments in response to Sermo's suggestions. Well, I think that, we should make health care better. I get the same sort of feeling from Senator Coburn.

1. The need for fundamental tort reform:
No kidding.......................

2. Establishing transparency in healthcare pricing and quality
What does that mean........ Establishing a rating system on physicians so that we only take the easy cases to keep our quality ratings up? Requiring patients to complete a graduate course on the CPT and ICD9 code books so they can try to understand that convoluted mess also?

3. Lack of emphasis on prevention
If 1/3 to ½ of the costs of health care is spent in a patient's last 6 months to a year of their life, does not mean that we just need to prevent death? OR Contain the costs i.e. Tort Reform.......

Example a patient with acute back pain.
With Tort Reform: Ice/heat, stretching, time

Without Tort Reform:
Plain films, CT with and without contrast, MRI and now we need to do a PET scan to just be sure we have not missed anything. But just in case refer to pain management and neurosurgery to spread the blame.

4. The need to create state based exchanges for purchasing insurance
Or do nothing and just let insurance carriers compete across state lines.

5. Providing tax incentives for individuals to purchase health care and expand the use of health savings accounts
i.e let the tax payers subsidize more health care

6. Improving and modernizing Medicare and Medicaid
Really, does someone else think that the Medicare and Medicaid systems are so broken and mismanaged that they need to be fixed. I want to know what they are going to do to fix this so that it does not cost physicians and tax payers even more money.

COMMENTS

Physicians have spent hours providing specific examples of how and what need to be fixed.

Why can we not get a straight answer from our politicans on exactly what we are going to do?

This is almost like a patient seeking treatment and the physician responding, "I guess you need to take a medication to fix that."

These people are PAID to figure out what medication this country needs and I think we should all sue them for everything they are worth if they pick the wrong one......

One other item:

Keep Obama out of our schools and the Education System.
Kids get their Health Care from Doctors, not from our massive, growing Healthspeak Bureaucracy!

Our children are our FUTURE!

Dr. Coburn,

I agree with the majority of my collegues who state that defensive medicine is one of the leading causes of rising medical costs. In the Hospital where I currently practice, physicians order an inordinate number of MRI's and CT scans. When I have asked my collegues about this they inform me that they do not want to "miss anything" just in case because of the possibility of a lawsuit. While I feel comfortable with my Physical examination and diagnostic skills, I have found myself becoming more concerned about the "What if's?" and I must admit that at times I, too, have fallen prey to the fear that pervades our current healthcare system. How can physician's be objective in their assessments when the spectre of a lawsuit sits on their shoulder threatening their very livelihood?

Over the years, my fears have lessened as experience had made me more comfortable with my skills and documentation. I am also VERY fortunate to practice in Wisconsin which has been a leader in tort reform by placing a cap on the "pain and suffering settlement" awarded to injured patients. The Patient's Compensation Fund (which was illegally raided by our current governor in 2007) also provides an extra barrier of protection for physicians and helps maintain reasonable malpractice insurance rates. The cap dissuades greedy, unethical lawyers from bringing forth frivolous lawsuits but it does not prvent them altogether as evidenced by our hospitals rate of unnecessary imaging studies.

Unfortunately, President Obama has consistantly refused to listen to physicians on this matter and I have little hope that meaningful tort reform will pass during his administration. Unfortunately, without Tort reform, the current healthcare system will become more expensive; and given increased governement funding will create a significant burden on our nations ability to sustain meaningful economic growth.

Dr. Coburn, I applaud you for your efforts and ask that you continue to speak on behalf of practicing physicians and our beseiged healthcare system regarding the importance of meaningful tort reform.

Although it seems most of the tort reform proposals are coming from the Republican side of things, I don't believe it will matter. I don't see the Republicans actually helping to pass any healthcare reform, because if a healthcare bill passed and Obama signed it, that would help Obama. The Republicans in Congress and the RNC are thinking about 2010 and 2012 and how they can win back seats and even the presidency. They see failure of any healthcare reform as helping them.

Plus, if you haven't actually looked at Sen. Coburn's Bill, I urge you to look at this section of the bill, Forum for Quality and Effectiveness in Health Care:
thomas.loc.gov

This looks similar to the Federal Coordinating Council for Comparative Effectiveness Research which was established in the Stimulus bill, but it cannot recommend clinical guidelines for payment, coverage or treatment (this was also in the Stimulus bill) Sen. Coburn's Bill,on the other hand, would set guidelines, performance measures and standards, and if not followed, physicians could be fined or kicked out of any Federal Health Care program.

It's start over time which seems to be Obama's Plan.

We have little time to assist whoever in Congress will listen to our suggestions to effect meaningful reform. We've said it all above in this and other postings. How do we get Congress to listen to a Plan that will improve patient care, remove interference by Government, Insurance Co's., and Trial Lawyers, and keep good doctors in our Profession?

We all need to act now for said reform or there will be fewer of us left in the near future.
Aloha.

The expert panel seems less fickle and more democratic. Another thought it to adopt the old English common law where if you sue and lose then you must automatically pay all the defendant's legal fees. That would cut down on frivilous lawsuits in a big hurry!

Without good tort reform any major healthcare reform is almost garaunteed to fail.

Is this to much to ask?

Improve patient care, remove interference by Government, Insurance Co's., and Trial Lawyers, and keep good doctors in our Profession with fair treatment including Reimbursement?

We can't give up now...this is a major turning point for Medical Care.

EXECUTIVE SUMMARY FOR DR.TOM:
1. All MD (majority in same specialty as case at hand) expert preview panel to assess cases for worthiness, eliminating frivolous and nonmeritorious claims;
2. Expert panel of professionals with healthcare experience; majority physicians (again with most from involved specialty), possibly attorneys, HC administrator, to render judgment in case; the physician component will also render judgment on the medical care in the case, with referral to the state Medical Board in case of substandard care or malpractice, with the Board assuring appropriate penalties if needed;
3. Judge expert in healthcare to concur with or rarely to override the above expert panel so perception of fairness is retained;
4. Decisions rendered by above panel and judge are final and binding;
5. All judgments 'no fault', payments coming from a pool paid into by all participants (physicians, attorneys who try cases, patients, hospitals, etc.); all joint and several assessments and collateral source arrangements eliminated;
6. All verdicts would have structured caps to control costs: significant harm would be appropriately compensated; low caps, as currently successfully exist in many states, for pain and suffering;
7. Structured limits on attorney payments.

Sermo Doc 189, if you can afford it, why not make 50 copies of your post above and send it to all our Senators with my (our) Blessings! If the cost is a problem, I think there are enough of us who will send you funds to cover it.

God Bless!

Senator, it is well documented that 85-90% of malpractice suits are frivolous and yet are paid out because a) it is cheaper to just settle and pay out b) sympathetic juries award for the plaintiff despite no justified medical negligence. The attorneys understand this, and play the numbers game. The more suits they bring, the more likely they will get small settlements that add up and support their lifestyle. Of course, the majority of congress have a law degree, so they are biased against "hurting their own". This flawed system creates huge costs which are ultimately transferred onto the end consumer. IF Congress is serious about tort reform as 1 way to decrease medical costs, then they need to create a medical negligence law that ensures payout only if negligence can be proven. Payouts for bad outcomes without negligence should be outlawed. This might be accomplished by professional juries or a health professional judge - both which seem like good ideas. My malpractice insurer has set up a program to help patients defray medical costs in bad outcomes which has decreased lawsuits. Such a no fault assistance program might cut tort costs as well.

Isledoc- I will consider your suggestion; in the meantime I am hoping Dr. Coburn will save me the effort and consider these as 7 core principles for malpractice reform and present them to his associates...

Sermo Doc 189....one problem.

There has to be skin in the game. There has to be a cost for filing that is substantial but returned if the case is won to prevent people from just filing case after case. Say 5,000 dollars to file. This will eliminate the vast majority of frivolous cases prior to filing.

there is some skin in the game. how many law firms want to take 2 yrs and about 100K out of pocket to maybe get a plaintiff verdict or settlement. its getting less and less. these suits are expensive and time consuming. only the most "slam dunk" cases are getting taken--at least where i am. and the most recent one locally just ended and the hosp settled and the 3 docs that went to trial all won.

Skin in the game:

About 5 to 10K sounds good to me. A good Defense Attorney will ask that much as a Retainer.

If the Plaintiff loses, who will take the front money, the Court or will it go to the Doctor to assist with his costs?

what doctor costs are you referring to?

The Doctor being sued may hire an a Defense Attorney for himself aside from the Malpractice Ins. Co. who has other interests at heart. There are also research and office costs not to mention time lost from work or time in Depositions, Conferences, and Court. Those are real costs for a Doctor to defend himself.

These kinds of details can be ironed out as it goes. First off, we need Tom Coburn to bring the tort reform issue to the forefront, make it a 'make or break' issue, like the AMA DID NOT DO!
I hope TC can move on to the next item he wants our insight on- transparency was it?
Time's a wastin'

of the over 90% of defense verdicts, how many of these physicians hire an additional defense attorney?

Zetis:
It is suicidal NOt to have a powerful defense attorney. The average cost of defending an unmeritorious suit can easily top 30K. Most of these suits are dropped after 3 months.
You might want to contact Sen. Lindsey Grahama nd Arlen spector for specifics about these charges..they represent the SIG! ( I'm not beign funny!)

I still want to see a post from Dr. Coburn himself confirming that he has personally read the comments that are responses to his post. Not the BS-type propaganda that was posted earlier!

I want to see REAL physicians with REAL practices and practice issues testifying before Congressional committees, not political hacks from the AMA. Have Dr. Coburn solicit volunteers from this board to testify in person and tell their stories and opinions directly to legislators with the Press present.

Then we can be sure that these people have definitely heard the truth, and they can be held responsible at the next election!

Sermo Doc 4--if you don't have confidence in the MP attorney brought in by the liability co perhaps one should hire their own. but the MP attorneys that these co's hire are usually very good, have been doing it for a while and your interest should be their interest. unless you made a major screw-up like changed, deleted or added notes to a chart they should defend you to the teeth and it shouldn't cost you anything (you've already paid for the service). as for depos, some cost to the practice but these can be done at your convenience and it may mean giving up a sat. as for research--Google doesn't cost me anything.
if you want to worry about legal costs then think about defending accusations about harrassment or disruptive behavior or other things that are not covered by your MP insurance.

I agree with you that the MP attorneys hired by insurance companies are good. I thought you were referring to hiring separate attorneys..The job of educating them is still that of that of the doctor. I am referring to the cost incurred by the Insurance company for defending these unmeritorious suits. the money has to come from somewhere.. it is obviously passed on down the food chain...

CZARS!
Also, we can educate the Public that 31 paid Obama Czars ($ 117,000 to $ 174,000 per year) are developing Policy, including Health Policy, without Advice or Consent of Congress! These CZARS are not vetted as Cabinet Secretaries are and are only responsible to Obama.
Jones, the Green Czar, who resigned was a joke!

Senator,
As an Emergency physician practicing in Va, you can bet that defensive medicine wastes healthcare dollars and will continue to do so without significant tort reform. A recent local case in point... a patient visited 2 local ED's 3 times over several months for a complaint without following up as referred. Ultimately developed significant organ dysfunction and sued all three ED physicians for 'missed' diagnosis. Dropped the first two MD's and went for the jugular with the last treating MD. Awarded $4M by the jury. In Va, the cap (hooray, it allows us to 'afford' malpractice here) reduced the award to $1.8M. Unfortunately for the patient, her attorney will get nearly half.
Without that cap, as my $2M/$6M policy is what is affordable, I and my partners cannot continue to practice with the risk of losing everything with these ridiculous cases. The Physicians will continue to order additional testing despite clinical judgement, to protect themselves as the patient seems to bear no responsibility for participating in their care and outcomes. I hope reform efforts will include training attorneys to staff emergency departments as an exodus of providers will leave gaping holes in our already strained system.

www.foxnews.com

Well, its pretty disappointing that only the rabidly right Fox news appears to be giving any coverage to the presentation of the open letter. I think this again is clear evidence that we need to put bodies on the Mall to garnish the kind of press coverage it will take for tort reform and reduced beaurocracy to become a foundation of health care reform. MMM Thursday October 1st in D.C.!

Malpractice premiums are estimated to be over $29 billion annually, of that the actual cost of litigation is about $10.5 billion, with certain specialties in certain states much more affected than others. However, the largest costs arise because all physicians believe they must practice defensive medicine, working up every possible obscure cause of any condition, for fear of missing something and the patient not following up in a timely manner. It is estimated that those costs account for 5% to 9% of the cost of healthcare or $115 to $207 billion per year.

"No one wants to see patients harmed by bad medical practice or negligence, least of all doctors. The problem with the current civil system is that doctors are not judged by a jury of their peers; they are judged by non-medical people. (Anyone who has ever been in a meeting of physicians can verify that doctors tend to be the harshest critics of one another.) Both the plaintiff's and defendant's lawyers proceed to parade their experts in front of the medically naive jury. Between the few unscrupulous physicians who make an excellent living saying whatever will benefit the party paying them and good lawyers who divert attention from the actual medical issue, it is small wonder that the process is seen as less than fair to all.

The standard we use in the insurance industry is outside peer-review. Qualified peer-reviewers are board-certified physicians with a number of years in clinical practice, as well as an academic appointment and/or research background. They are authorities in their field.

Why not apply that to malpractice cases? A panel of say, five qualified, same-specialty physicians could peer-review the medical records of the case. To avoid the appearance of a conflict of interest these individuals should not be from areas in close geographic proximity to the defendant. The plaintiff, defendant and their counsels and experts could make presentations before the panel and the panel could question both sides. Much like the Supreme Court, the panel would deliberate, vote and write an opinion, including dissenting views.

If the panel decides that there is a case, it would proceed to the courts. A jury of the general public would hear the case and then be given a copy of the panel's report. In the presence of the attorneys and judge, the jury could question a member representing the panel regarding the report. The member may not give an opinion. The opinion is the report. His job is merely clarification. The jury would then be sequestered to deliberate the case and judgment award.

There are two components to the award. Economic damages refer to the cost to the inured person, such as past and future medical expenses, lost wages, etc. Noneconomic damages refer to pain and suffering. Both are intended to provide compensation to the injured party. Punitive or exemplary damages are awarded to punish conduct that is reckless disregard for the safety of others beyond negligence. Some states have statutes imposing caps on punitive noneconomic damages treating them separately from compensatory noneconomic damages. Many advocate limiting noneconomic damages and punitive awards to $250,000. In most cases, that is reasonable; however, I have also seen some horrific mistakes that $250,000 would not cover. Limits have been shown to decrease medical malpractice rates for physicians. However, I believe the solution just presented is fair to everyone, eliminating frivolous suits and moving only credible suits forward. Medical judgment is determined by same-specialty medical professionals who understand how to apply the standards of care to the case. The damages are determined by a jury representing the public, with the standard oversight by a trial judge.

Medical malpractice truly is eliminating "access to care" in many parts of the country. In West Virginia, I was told by a gentleman on the medical board at the time that virtually every suit brought, resulted in a judgment against the doctor. In fact, it had gotten so bad that certain specialties were in danger of becoming extinct in the state, such a trauma Sermo Doc 186s and neuroSermo Doc 186s. Imagine if you or a loved one were in an accident with a head injury, and there was nowhere in the state you could be flown for treatment. A considerable number of states face this issue with "high risk" specialties, such as those listed above, as well as obstetricians, cardiothoracic Sermo Doc 186s and anesthesiology. Other physicians in high liability states have chosen to limit their scope of practice to reduce their liability. Others move to another state. We can no longer ignore this growing problem," if we are going to preserve access to care and lower healthcare costs.

Debra A. Smith DO, MIHM, MBA, FACPM, FACOPM, FAIHQ
Physician, Economist and Health Administrator
Healthcare Solved - Real Answers, No Politics

Actually, the statistic I found most interesting was the settlement review that indicated that when payment was made, in over 30% of those cases reviewed by dispassionate third parties the determination was made that -NO- malpractice occured. Nobody really picked up on that, or seemed to think it was a problem.

Dr. Coburn:

You have the best Health Care Plan of all called "CongessCare".

What if your "Golden" Health Care System provided both to Congress and the White House were taken away from you all today, and all were placed in our present system of Big Insurance, Drug Plans, Big Hospitals, Medical Liability, ER Care, Inner City Clinics, Medicare and Medicaid??

Would you buy in to the Malpractice Lottery game and sue your Doctor if you had an unexpected, adverse, no-fault result from a Drug or Procedure?

Do you think that you and Congress just might have a different view of our present Health Care System and our Doctors such that our voices would be heard and changes made forthwith to our Malpractice Tort System?

Walk in our shoes!

Still no response from Coburn, I see. We are being ignored again as usual. Will somebody please tell the Senator that NO health reform can be accomplished without our consent and willing participation!?

Surprisingly, Isledoc, Congressman Nick Rahal was less than thrilled with his own health coverage, which offers no vision, no dental, and apparently required him to leave our fair state to undergo his Prostate surgery at Walter Reed. Not sure how universal this feeling is among our representatives, its always been portrayed that they have the ultimate caddilac system.

Sermo Doc 186, if Congress and the W.H. don't have the Golden System, why is that none have yet volunteered to change, even B.O. who's pushing reform?

It's a "puzzlement"!!?

The main incentive for the trial attorneys is the deep pockets of the professionals and the general jelousy of the public reg the physicians status. Every one forgets how hard it is to get there and what the amount of stress the physicians go through. Of course there are physicians that are very greedy and unscrupulous.
The important thing to lower the cost of medicine is to address the problem of Defensive Medicine and eliminate the frivulous law suits.
Capping the payment to the attorney should be the first thing. It should not be percentage of the award. There is no reason for the attorney to make hundreds of thousands for the services he or she provides. It should be commensurate with the work load the number of hours one puts in etc. The amount can be calculated on the basis of the available fee scale in the community.
Capping the payment to the patient on realistic grounds is the next thing. If a beggar gets hurt and needs to be paid, he should be paid according to what he would be worth at the time of the incident. The rest of the award should go to a Public fund that can be used for public needs.There should be a STOP to the PAY DAY kind of system.
There should be a system to curtail the unethical billing practices - billing ten times but agreeing to be paid a quarter of it through some big insurances and demanding full payment from an uninsured middle class self employed honest person.

Sermo Doc 205,
It wasn't clear from your post how additional testing would have kept you or your colleague from being held liable for $4 million. Are you saying that the first two EM docs were dropped from the suit because they performed excessive or unnecessary testing? and the third doctor did not, therefore he lost the suit? It's clear that the rising cost of malpractice payouts and premiums is driving docs out of business and limiting access to care for many of our patients. I'm not entirely convinced, however, that defensive medicine is the primary reason healthcare costs, as a whole, are skyrocketing. I think that has more to do with insurance company profiteering, by raising premiums and denying care, and their useless 30% overhead bureaucracy. Add to this the rising cost of unproven but expensive medical technologies.

Mesothelioma Suits:

Had to testify re mesothioma cases where I'd done autopsies and family was suing Government?Asbestos Co. money pool. Plaintiffs usually won, but Plaintiff 's attorney was paid out-of-pocket expenses first, then 30 % of the award. The family got the crumbs!

My colleagues and I used to joke about "if lawyers get 30%, why don't the doctors get the same?"

Seriously, I can understand collecting office expenses but another 30 % on top of that?
What's wrong with fee for service as with most doctors and other Professionals? Who originated this 30 % system for medical lawsuits?

If nothing else, can we change the Tort laws to fee-for-service lawsuits and no more % of the award to Trial Lawyers???

Remove all lawyers from Congress up for reelection in 2010 and get the People back to represent us!

Medical/Dental screening panels with loser pays for suits deemed frivolous by the panel.

Create a Medical/Dental screening panel comprised of physicians/dentists, attorneys, and hospital administrators. Every plaintiff must prepare a brief for the panel. Panel can rule, MERIT, NO MERIT, or UNDECIDED.

If panel rules NO MERIT to case, and plaintiff insists on proceeding, then process becomes "loser pays," putting plaintiff at risk, and finding of NO MERIT is admissible in court.

This would help screen out frivolous cases, while continuing to provide access for potentially meritorious cases to proceed at no risk to plaintiff.

Sermo Doc 208, who is " loser pays for suits deemed frivolous"?

The Plaintiff's Attorney, the Plaintiff, or both?

Will any record of the suit be expunged so Doctor is not listed in Government data of Physicians records?

Just wondering.

Dr. Smith- let's leave the general public out of the jury for physicians; they are too vulnerable to John Edwards' emotional nonsense to render sensible decisions.

What happened to Dr. Coburn?

No response for a long while.

I suggest that since it appears Dr. Coburn has abandoned us, we discontinue our comments on this topic and await the next... (if he decides to return to this forum).

B.O.'s speeches are smoke and Teleprompters with words signifying nothing! Let's keep it simple (KISS) for the Bomorons.

We need 1 separateTort Reform Bill.

We need 1 separate Health Reform Bill with no Public Option (no Big Government), no Government Co-ops, Insurance Reform with removal of Anti-Trust Exemption, more HSA's with Tax Deductions, and an Independent MD Compensation Review Commission headed by Doctors.

Return Stimulus dollars to Treasury and give some to MD's for implementation of EMR Sysytems.

Where is Dr. Coburn when you need him?

Defensive Medicine costs $200-500 Billion dollars per year.
No fault medicine - Savings $200 to $500 Billion health care dollars
Eliminate caps, let the attorney's run wild - increase $500 Billion or more in costs

This is very simple - how much do you want to save or how much do you want to spend?

I work in Indiana and although I will never get rich working here, since 1975 we have had caps now limiting recovery to $1,250,000 . I paid my tail to get out of Chicago 10 years ago when a senior partner's case went "over the limits" and they were coming after him and our group for recovery. All of America needsd to follow Indiana's model.

Save $$$:

Let's push for 1 separateTort Reform Bill written by a Subcommittee with a group of 5 Docs (Ob/FM/IM). Any sop from Borama in the present HC Reform Bill will accomplish nothing.

I can't believe that 225 Lawyers in Congress are all blood suckers! Some of them must have Doctors who will tell them our story! They must also believe that $ 300 Billion for malpractice costs is real money!

Guess I'm naive but I'll carry on!

Borama Care:

Here's the latest from the College of American Pathologists re the HCR Bill for your comments:

The Baucus framework includes insurance reforms, coverage mandates and a proposal to establish nonprofit healthcare cooperatives instead of a government-sponsored "public option." It also outlines several significant new proposals to improve quality, reduce costs and finance expanded coverage.

In addition, in a speech before Congress on Wednesday night, President Obama laid out his proposal for health care reform, seeking to galvanize support for action in Congress. He acknowledged the need to address medical malpractice issues but made no specific mention of caps on damage awards.

Although details are still sketchy, Senator Baucus's framework includes specific reforms currently under discussion by the Finance Committee's group of top Democratic and Republican negotiators, called the "Group of Six."

In addition to insurance reform and mandatory coverage beginning in 2013, it includes several reforms which, if enacted, could have a direct impact on pathologists:

Primary Care Bonuses: Primary care practitioners and general Sermo Doc 186s practicing in underserved areas would receive a 10% Medicare payment bonus for five years. Half of the cost of the bonuses would be offset through an across-the-board reduction in all other services, including pathologists, of approximately 0.5 percent.

SGR Remains Intact: The scheduled 21% reduction in Medicare physician payment rates in 2010 would be replaced with a 0.5% increase. The framework does not include any proposal to permanently fix or replace the current Medicare physician payment formula.

Part B Updates Reduced: Payment updates for Part B providers would be reduced by an estimate of increased productivity.

New Annual Fees for Clinical Laboratories: An annual fee of $750 million would be imposed on clinical laboratories beginning in 2010. The fee would be allocated by market share, except for small businesses. Medical device manufacturers would face an annual fee of $4 billion, allocated by market share, starting in 2010.

Improvements to the Quality Infrastructure and the Physician Quality Reporting.
Initiative (PQRI): HHS would be directed to develop a national quality strategy to strengthen the quality measure development and endorsement processes; and establish a process for HHS to work with external stakeholders, such as the National Quality Foundation, to select quality measures to be included in Medicare value-based purchasing and pay-for-reporting programs. All eligible health professionals would be required to participate in the PQRI program by 2011. The Medicare physician feedback program would be expanded, and physicians who utilize significantly more resources than their peers would be penalized.

Incentives for Accountable Care Organizations: Groups of providers who work together to improve the quality of care they deliver to Medicare beneficiaries would be able to keep half of the savings they achieve over a three-year period.

New CMS Innovation Center and Pilot Project on Payment Bundling: Two separate provisions are included. The first would fund the establishment of a $10 billion Innovation Center at the Centers for Medicare and Medicaid Services (CMS), which would have authority to test new provider payment models and expand successful programs into the Medicare program. The second directs the HHS Secretary to develop a voluntary pilot program encouraging hospitals, doctors and post acute care providers to achieve savings for the Medicare program through increased collaboration and improved coordination of patient care by allowing participating providers to share in the savings.

New Panel to Identify Overvalued Physician Services: This panel would be comprised of healthcare providers, experts, and stakeholders to identify physicians' services that are overvalued in the Medicare physician fee schedule. In consultation with the panel, the HHS Secretary would be required to adjust payments for those services that have increased at unusually high rates without clinical evidence to support the increase.
New Independent Commission to Extend Medicare Solvency: This Commission would submit proposals to Congress to extend Medicare solvency which could include cuts to specific providers. Congress could amend a proposal from the Commission or pass an alternate with an equivalent amount of budgetary savings. If Congress fails to pass an alternative measure, the Secretary would be required to implement the provisions included in the Commission's original proposal.
Comparative Effectiveness Research Receives $600 Million Yearly: A non-profit institute would be created to set a research agenda and provide for the conduct of comparative effectiveness research, per the Patient Centered Outcomes Research Act of 2009.

What do we continue this discourse?

What happened to Dr. Coburn?

He seems to have deserted us... like the rest of our politicians!

Find Coburn:
It's been said that Politicians come and go, but the consequences of the legislation they enact will continue indefinitely.
If true, we must continue to communicate with Dr. Coburn and any others in Congress who will listen.
The Gang of Six in the Senate seem to be moving in the right direction and the Public Option is dead so let's find Coburn and also determine what the "Six Pack" are writing!

Does anyone know the specifics of the Bill the "Six" have written so far?

Senator Coburn,

Republicans need a plan to propose against Dems or else they will go in history with the blame for doing nothing. All the media is ridiculing them for this.

I am giving you a plan. It will be only one page long. Easy to read, easy to understand. Dems will not be able to say it no.

Propose a public option, funded fully by premiums. No burden on treasury. This will pay medicare rates.

AND, this will allow balance billing.

Same rate for individuals and employers. No tax benefit or same tax benefits to everyone.
If it is not bailed out by me (tax payer), it will introduce competition for ins co at a level playing field.

Allowing balance billing will ensure enough participation and introduction of responsibility by the pt. Good docs can expect to make more, encouraging quality. Underserved area will have potential promise of higher income for docs, encouraging docs to move there.