DoctorsKnowUs.com: Helping Doctors Blacklist Patients

[lucwarm]

@artemis

Thanks for sharing your thoughts on this lucwarm. I have just one minor quibble: “reasonably strong case” is not always synonymous with “probable malpractice”, even though in a rational system it ought to be. And that is the problem with the system.

Actually, there are many problems with the system. I will concede that it does happen that folks who don’t deserve to get paid do. But it also happens that folks who deserve to get paid don’t. Because the claim is too small; or because there’s insufficient proof; or because the defendants lie and falsify evidence; or because the judge and/or jury is biased in favor of the defendant.

Here’s a real-life example.

. . .

there is in fact NO evidence of malpractice in this case at all!

Frankly I’m skeptical that a case with no evidence of malpractice would succeed.

And ultimately, that’s why women in small towns in Nevada can’t find a local doctor to deliver their babies, and have to drive two hours to Las Vegas to obtain care that used to be available in their own community.

You’re gonna have to explain that one a little better for me. Why would the risk of lawsuits cause doctors to choose practicing in big cities over rural areas?

I want to see patients who’ve suffered potentially preventable medical injuries be compensated for their pain and suffering. I want to see incompetent physicians removed from practice. But our current system doesn’t do either task well, and it’s really hurting the quality of patient care in this country.

For what it’s worth, I’m skeptical that making doctors LESS accountable will improve the quality of patient care.

[lucwarm]

Well it seems to be going well for the endless stream of lawyers advertising on TV, buses, subways, etc.

I still have no idea what your point is. Are you claiming that lawyers who advertise extensively are filing lots of frivolous cases and getting rich in the process?

[artemis]

@lucwarm

Actually, there are many problems with the system. I will concede that it does happen that folks who don’t deserve to get paid do. But it also happens that folks who deserve to get paid don’t. Because the claim is too small; or because there’s insufficient proof; or because the defendants lie and falsify evidence; or because the judge and/or jury is biased in favor of the defendant.

Exactly - the system is broken. How does the current malpractice system protect patients from incompetent physicians (one of the claims its current supporters keep touting) if perfectly legitimate claims never make it into the system because they’re “too small”? How many patients might an incompetent doctor injure with such “small” claims before he finally screws up badly enough to do sufficient financial damage to someone to end up in court?

The current system is not efficient at fairly compensating injured patients, and it’s not efficient at punishing incompetent doctors.
[/QUOTE]

@lucwarm

Frankly I’m skeptical that a case with no evidence of malpractice would succeed…

Be as skeptical as you like - it happens. Juries are swayed by all sorts of things, many having little to do with the relevant facts at hand. If the case I described does engender a lawsuit, and if the suit makes it to trial, there is an excellent chance the jury will find for the plaintiff for precisely the reasons I indicated.

For that matter, look at the different rates at which various physician specialties are sued. Do you really believe that neurosurgeons and OB-GYNs screw up more frequently and are less competent on average than internists and pediatricians? They’re certainly sued far more often!

@lucwarm

You’re gonna have to explain that one a little better for me. Why would the risk of lawsuits cause doctors to choose practicing in big cities over rural areas?

The example I gave is easy to understand. In sparsely populated rural areas, the patient density won’t suppport a full-time OB-GYN; the routine obstetrics care is performed by a family practice physician. It’s only a minor part of what he does, but it exposes him to a disproportionate risk of litigation and accounts for a huge percentage of his malpractice premium. When the litigation risk and the cost of the premiums rises high enough, it makes sense for the clinician to simply close the obstetrics part of his practice and refer his pregnant patients to an out-of-town OB. Result = no local obsetrical care, even for extremely low-risk pregnancies, is available in that area anymore. It’s a good thing for the doc, but lousy for the patient who now has to drive 2 or 3 hours one-way for each obstetrics appointment.

The same thing can happen in subspecialties in more densly populated areas, too - the more the malpractice premiums cost, the larger the physician’s patient base has to be for the physician to cover his costs. The larger the city, the larger the potential patient base. It’s simple math.

@lucwarm

For what it’s worth, I’m skeptical that making doctors LESS accountable will improve the quality of patient care.

How does exposing them to the legal equivalent of Russian roulette IMPROVE the quality of patient care? It doesn’t lead good physicans to be more careful, because they’re already being careful - it leads instead to a climate where no one’s willing to discuss possible mistakes or even admit they can happen, lest they become a target of legal action. That makes it impossible to design processes that effectively minimize the likelihood of the big mistakes happening in the first place. You can’t study errors no one will admit to making!

[Jackmannii]

@lucwarm

You’re gonna have to explain that one (the loss of rural obstetricians in Nevada, obliging patients to travel long distances to Las Vegas) a little better for me. Why would the risk of lawsuits cause doctors to choose practicing in big cities over rural areas?

As this story explains, malpractice rates recently quadrupled in Nevada. This would have a disproportionate impact on smaller rural practices. It would also be safer for an obstetrician to practice in an urban center with all the latest high-tech monitoring and immediate access to ancillary services. Even if this were unnecessary in the vast majority of pregnancies.

According to a website on rural medicine in Oregon: “Obstetrics is currently undergoing a major crisis-as malpractice insurance rates double or even quadruple in one year’s time, more and more rural providers are electing to drop their obstetrics support. A recent Oregon Health & Science University study found that 22 percent of obstetrics doctors have left the practice since 1999; of them, 74 percent were outside of Portland. This leaves women driving further, in all kinds of weather, to the nearest delivering hospital…'Last year, [an obstetrics] doctor in Roseburg had two huge malpractice awards against him,” she (a midwife) says. His insurance provider dropped him, and subsequently two other doctors stopped taking obstetrics patients, leaving one physician and one midwife in the hospital. "It’s incredibly busy.’

For what it’s worth, I’m skeptical that making doctors LESS accountable will improve the quality of patient care.

Agreed. But I don’t see anyone here claiming that.

[lucwarm]

@artemis

Exactly - the system is broken. **

It seems to me it’s an overstatement to say that the system is “broken.” There has always been injustice in the courts, as far as I know.

How does the current malpractice system protect patients from incompetent physicians (one of the claims its current supporters keep touting) if perfectly legitimate claims never make it into the system because they’re “too small”?

I have no idea, but perhaps they should pass a law giving prevailing plaintiffs the right to recover attorneys fees in medical malpractice cases.

**

The current system is not efficient at fairly compensating injured patients, and it’s not efficient at punishing incompetent doctors.

It certainly is imperfect. My basic point – that frivolous lawsuits are rare – still stands.

Be as skeptical as you like - it happens. Juries are swayed by all sorts of things, many having little to do with the relevant facts at hand. If the case I described does engender a lawsuit, and if the suit makes it to trial, there is an excellent chance the jury will find for the plaintiff for precisely the reasons I indicated.

The second “if” is pretty big. It’s hard to get a case to a jury with no evidence. In any event, my basic point still stands.

Do you really believe that neurosurgeons and OB-GYNs screw up more frequently and are less competent on average than internists and pediatricians? They’re certainly sued far more often!

Isn’t it possible that (1) in certain areas of medicine, it’s easier for doctors to make mistakes; or (2) in some areas of medicine, the consequences of a mistake are more severe; or (3) in some areas of medicine, mistakes are easier to detect and/or prove; or (4) in some areas of medicine, patients are more likely to just walk away from a mistake?

The example I gave is easy to understand. In sparsely populated rural areas, the patient density won’t suppport a full-time OB-GYN; the routine obstetrics care is performed by a family practice physician. It’s only a minor part of what he does, but it exposes him to a disproportionate risk of litigation and accounts for a huge percentage of his malpractice premium. When the litigation risk and the cost of the premiums rises high enough, it makes sense for the clinician to simply close the obstetrics part of his practice and refer his pregnant patients to an out-of-town OB. Result = no local obsetrical care, even for extremely low-risk pregnancies, is available in that area anymore. It’s a good thing for the doc, but lousy for the patient who now has to drive 2 or 3 hours one-way for each obstetrics appointment.

Ok I understand now. The patients get a specialist and more advanced equipment but have to put up with a serious inconvenience. This doesn’t seem like the end of the world to me, but I see your point. In any event, my basic point still stands.

How does exposing them to the legal equivalent of Russian roulette IMPROVE the quality of patient care?

It seems to me that the Russian roulette anaglogy is flawed. Although justice is not perfect, it’s not totally random either.

It doesn’t lead good physicans to be more careful, because they’re already being careful - it leads instead to a climate where no one’s willing to discuss possible mistakes or even admit they can happen, lest they become a target of legal action. That makes it impossible to design processes that effectively minimize the likelihood of the big mistakes happening in the first place. You can’t study errors no one will admit to making!

I’m not sure what your point is here . . . are you suggesting that doctors be completely shielded from liability for their mistakes? That we should go to some sort of no-fault system? Because those are the only ways I can see to get rid of the incentive you describe.

[lucwarm]

@Jackmannii

Agreed. But I don’t see anyone here claiming that.

Well, let’s see:

What changes would you or anyone else make to the legal system that you think would improve the quality of patient care?

[Lizard]

I read this same article before I saw the thread. I’m with everyone who pointed out the outcome of civi trials are public. In addition, I think doctors have a right to treat whom they wish, within limits, and to protect themselves from legal risk.
HOWEVER. . . .
I think the company that puts up this website should not list anyone on it who has only filed one malpractice suit in their lifetime. This would naturally cut the list down to people who are displaying a habit of litigousness.

[Odesio]

@Metacom

I think it should be a one way situation. The patient is putting his or her life in the doctor’s hands, not vica versa. Yes, it’s a great burden on the doctor, but they are ultimately well compensated.

And the doctor is putting his license and perhaps millions of dollars on the line. I don’t think it’s unreasonable for them to protect themselves the same way patients can protect themselves. Shouldn’t a private practice be able to refuse treatment to non-emergency cases for whatever reason?

Making people suffer (which is what withholding treatment does) is contrary to the ideals of their profession. If there’s a problem with the legal system, then change the legal system.

They aren’t making people suffer. Not treating someone isn’t the same as doing harm.
Marc

[Shodan]

What changes would you or anyone else make to the legal system that you think would improve the quality of patient care?

Since you ask:
[ul][li]A cap of $250,000 on all pain and suffering claims.[/li][li]Neither the plaintiff nor her attorneys may receive any portion of any punitive damages. All such damages go into a publicly administered fund that covers the cost of medical care for the uninsured.Elimination of the “deep pockets” concept. If you are 10% at fault, you are liable for no more than 10% of actual damages and/or $25,000, whichever is less.[/ul]By making patient care more affordable, it would raise the quality of patient care. [/li]
Regards,
Shodan

[lucwarm]

[QUOTE=Shodan]
Since you ask:
[LIST][li]A cap of $250,000 on all pain and suffering claims.[/li][li]Neither the plaintiff nor her attorneys may receive any portion of any punitive damages. All such damages go into a publicly administered fund that covers the cost of medical care for the uninsured.Elimination of the “deep pockets” concept. If you are 10% at fault, you are liable for no more than 10% of actual damages and/or $25,000, whichever is less.[/li][/quote]

Ok, thanks.

Jackmanjii, you have your answer. Shodan is proposing to make doctors less accountable by limiting the extent of their civil liability for their wrongs.

[ralph124c]

One big reason for the stupendous increase in the number of lawsuits is the fact that filing such malpractice lawsuits is essentially free! Of course, the expense of running the courts, judges salaries, etc., are paid for by the taxpayers, but you (as a litigant) don’t directly bear any of these costs!
That is why a small number of people file a huge number of lawsuits, simply because uts costs them nothing, and there is a HUGE potential payout to them if their suits are successful. Take the auto-insurance situation: states (like Massachusetts) have declared that automobileinsurance MUST be available to EVERYONE (regardless of their driving records). Under this system, bad drivers are subsidized by good drivers, and the state allows you to sue for personal injuries ONCE YOUR INJURIES exceed $2000.00!
So, what do you do to make money? You h get involved in a fender bender, and go to a crooked lawyer…he will steer youto a crooked chiropractor, who will bill your insurance $2000.00 (!) foryour “soft-tissue” injuries. Then, your lawyer will file a lawsuit for you, and the fun begins! Upto this point, YOU have NO out-of-pocket expense, and you have a HUGE potential payout!
Everybody is happy…your lawyer, your chiropractor,…eveybody but the poor guy who got hit. As automobile insurance rates rise to the moon, the lawyers say “what crisis?”
It is the same with medical malpractice-there opught to be huge costs associated with filing a lawsuit…rather than the current system which encourages them!

[DSeid]

In regards to the op, can we keep it real here?

I’ve been named in suits twice. Neither time was the accuser someone who had previously sued anyone else. Just someone who had a bad outcome and who someone convinced that a court might get them money to help take care of the results of that bad outcome. What I did and how I did it was irrevelant to that thought process; “I might get a million dollars or more and it won’t cost me a thing unless I win!” was.

The docs who might consider this list are the docs in the extreme high risk specialties. Bad outcomes are an unavoidable regularity in those specialties and unfortunately, with jackpot awards dangling and no cost associated to buying the lottery ticket, bad outcomes will result in suits. Yes, more often if the doc is a schmuck who doesn’t communicate well, but unavoidable even if you are a caring doc who does your God’s honest best. Having done things right is no guarentee of not losing a case and being judged in amounts well over your policy limits; let alone of not being sued and losing all the time associated with the case for the next several years for a situation of no merit.

If a few of those docs want to take a page from the acturials’ playbook and not take care of higher-law suit risk patients then I can’t blame them. If some are motivated by wanting to associate a cost to buying the lottery ticket, then I can understand that as well. I just think the tactic will be unlikely to do much in either regard. That said, the prospect of someone who had a meritorious suit being unable to get care because of this list is much less likely than the prospect that whole communities will be unable to get care because certain specialties have been driven out of doing business in that state by absurd malpractice costs.

What about my two cases? Both had venue in a county famous for juries awarding jackpot awards.

In the first I knew that I did nothing wrong. The lawyers knew I did nothing wrong. But they told me that there was perhaps a one out of ten possibility thqat a jury of laypeople would be convinced otherwise anyway, and if they did that a judgement of well over policy limits was possible in that county. I wasn’t going to risk my kid’s college funds and the rest of my savings on principle; I agreed to a settlement up to policy limits feeling dirty in the process. I still feel sick years later.

The second is in process. My involvement in the case? None until after the alleged “mistake” occured; I provided the child’s regular care afterwards. But my living in this particular county means that if I am named they can get that county for venue, and their lawyer knows what that means. It sucks. My lawyer says I should move to a different county to avoid this in the future.

Punitive jackpot awards in no way make for better care; they make for worse care. They make for unneeded testing just TCYA and those tests have small but real risks, let alone discomfort. Jackpot awards and out of control malpractice insurance rates are driving some specialties out of business in many communities.

Most avoidable mistakes are not “bad doc” mistakes but system issues; our current litigenous environment prevents us from anlyzing the systems with honest self-appraisal. I am on a large group practice Quality Assurance Committee - we have now been informed that our minutes are discoverable. What doc in their right mind will now honestly look for ways to improve their systems in a place where what he/she says might be later taken out of context against them?

Shodan’s proposals are a good start.

[lucwarm]

@ralph124c

One big reason for the stupendous increase in the number of lawsuits is the fact that filing such malpractice lawsuits is essentially free!**

This is essentially false. To prosecute a malpractice lawsuit, you need to spend thousands of dollars hiring experts, taking depositions, etc. It also takes a lot of attorney time.

(Technically, to file a lawsuit, all it costs is the filing fee. And it does happen that defendants sometimes pay right after you file. But only if you have a really strong case.)

Anyway, I have a couple questions for ya:

(1) What percentage of lawsuits filed are frivolous, in your opinion?

(2) Do you believe that it’s generally possible to file a meritless lawsuit and extract a nuisance settlement from defendants?

[Paul_in_Qatar]

If a doctor screws up and you are injured to the amount of (say) a gazillion dollars, why do you deserve three gazillion dollars? To punish the doctor?

Punishment is what the criminal courts and other disciplinary measures are for.

The money does not come out of the doctors pocket. You are just tapping into the insurance company’s pocket. The doctor is feeling no especial pain.

If you have the wrong leg cut off (which happens way too often), why do you deserve to get a yacht?

[DSeid]

Luc, your ignorance is showing. You may want to zip up.

It doesn’t cost a plaintiff one red cent unless they win. A plaintiff’s attorny bears those costs and, in return gets a sizable percentage of any jackpot or quick settlement. One jackpot win pays for a ton of losses. A few quick nuisance settlements will keep the lawyer in business for a few more losses.

To answer your question though, most malpractice cases that get to trial are found to be without merit. It has still cost the doc lots. Many that are without merit, like mine, settle because other docs had as little balls as I had. (Not proud of it, but it was the case.)

[lucwarm]

@DSeid

Luc, your ignorance is showing. You may want to zip up.**

Umm, I’m a contingency fee lawyer. No, I don’t do medical malpractice. But half my income comes from suing people and taking a percentage (usually 1/3) of the recovery. I also represent the establishment on a regular basis.

Feel free to point out exactly where my ignorance lies, though.

It doesn’t cost a plaintiff one red cent unless they win. A plaintiff’s attorny bears those costs and, in return gets a sizable percentage of any jackpot or quick settlement.

This is generally correct. Have I said anything differently?

One jackpot win pays for a ton of losses. A few quick nuisance settlements will keep the lawyer in business for a few more losses.

Are you an attorney who is familiar with contingency fee practice? Because if you aren’t you should consider the possibility that you are the one who is ignorant.

As I said on the previous page, I don’t file suit on well over 90% of the calls I get. If it were possible to extract even $3000 on a typical nuisance claim, I’d be a multi-millionaire. I’m not.

To answer your question though, most malpractice cases that get to trial are found to be without merit.

I don’t think that’s an answer to my question, but let me ask you something:

If a defense verdict means the case has no merit, do you believe that a plaintiff’s verdict for X dollars means that the case does have merit and is worth X dollars?

[Jackmannii]

lucwarm, I have the feeling you would not have spoken so casually of the “inconvenience” of not having a local obstetrician, if you were the one in labor, forced to travel hours in bad winter driving conditions to the nearest big city.

Jackmanjii, you have your answer.

And you have been given food for thought on the question of “accountability”.

If you persist in equating accountability with monster jury awards, I will be obliged to send a herd of water buffaloes stampeding through your bathroom.
Yours,

“Jackmanjii”

[lucwarm]

@Jackmannii

lucwarm, I have the feeling you would not have spoken so casually of the “inconvenience” of not having a local obstetrician, if you were the one in labor, forced to travel hours in bad winter driving conditions to the nearest big city.**

Look, I’m sure it freaking sucks to schlepp into the city like that. My basic point still stands.

If you persist in equating accountability with monster jury awards, I will be obliged to send a herd of water buffaloes stampeding through your bathroom.

Hopefully they won’t slip on all the straw from your strawman.

[MsRobyn]

@lucwarm

Look, I’m sure it freaking sucks to schlepp into the city like that. My basic point still stands.

Freakin’ sucks? Uh, no. Try “it can be deadly”. For some women and their babies, not having a local obstetrician can mean the difference between living and dying. Literally. Labor and delivery in an uncontrolled setting can result in a myriad of problems happening. Having an obstetrician in attendance who can identify and take care of any of these problems shouldn’t be a luxury; it should be a necessity. Doctors shouldn’t be forced to abandon their patients and communities because of economics.

That said, I don’t think this database is a good idea. It forces doctors into the unenviable position of choosing who gets care and who doesn’t. A patient who may have filed one lawsuit over something legitimate may not be able to find care on the basis that he filed that one lawsuit. Even if the doctor interviews the patient on the lawsuit, the doctor may be pressured by his insurance carrier or partners not to take the patient.

Robin

[lucwarm]

@MsRobyn

Freakin’ sucks? Uh, no. Try “it can be deadly”. For some women and their babies, not having a local obstetrician can mean the difference between living and dying. Literally. Labor and delivery in an uncontrolled setting can result in a myriad of problems happening. Having an obstetrician in attendance who can identify and take care of any of these problems shouldn’t be a luxury; it should be a necessity.

I’m getting a little confused here – Based on the earlier comments, I thought that these women were previously seeing local general practictioners, not obstetricians.