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Thursday, March 20, 2003 Page: 9A
Only recently I’ve learned via the print media that personal injury lawyers
are the true advocates for patients.
Unerring themselves, their selfless pursuit of patient safety and
unflinching criticism of daily fatal physician error is heroic. Their scripted
indictment of medical error could seem a foil to deny their culpability in the
exodus of Pennsylvania doctors unable to find or afford state-mandated
insurance, but that can’t be so: Look no further for evidence of their
sincerity than the heated objections to caps on non-economic and non-medical
damages. To the uninitiated this might appear to be self-serving, threatened
with the loss of their 40 percent skim of pain and suffering moneys, but I’m
certain our citizens understand these lawyers are simply protecting the
public’s rights against the army of incompetent slackers known as physicians.
If I didn’t know better, though, I would suspect these attorneys of
mistakes: It is difficult to equate the holier-than-thou attitude on medical
error when their success rate in court against doctors is about 20 percent.
Since they claim no frivolous case ever gets to a courtroom, legal error must
play a part, or can juries see through the frequently farcical charges?
Thankfully, medical success rates are far higher.
On the serious question of medical error, the public continues to see the
same worrisome death rates sprayed about by personal injury lawyers. Virtually
each incomplete statistic originates from a 1991 review of a 1984 study in New
York hospitals where there was a seven-fold inter-hospital difference in the
rate of “adverse” events, which were anything from a patient fall to
incisional infection. A second group of reviewers couldn’t even confirm the
same adverse events. Accepting study results, for a moment, 3.7 percent of
admitted patients had an adverse event and 2 percent of patients had such an
event attributed to error, 1 percent ascribed to negligence. The chance of
dying of an adverse event was .5 percent.
No distinction was made of patients who may have refused advanced care or
those who may have had a terminal illness: Reviewing physicians were not
trained in the specialty of the service caring for these patients.
Interestingly, most of the patients supposedly exposed to error did not sue,
and in the group that did, reviewers found no evidence of medical injury in
greater than 50 percent. The same study superficially quoted by trial lawyers
demonstrates the inadequacies of the legal system in proving error or
obtaining just compensation. While any error or accidental death is
devastating to~ victims, families and caregivers, this oft-quoted study is
neither as grim or scientific as lawyers purport; extrapolating it to predict
a national mortality rate in 2003 is erroneous.
Most errors are known to be system errors. Such was the case in two recent
well-publicized cases: I can’t imagine a poorly matched organ being offered or
shipped from the donor hospital to Duke’s transplant team, but the anxiety to
transplant a grievously ill youngster and lack of a redundant identification
system spelled disaster. These were not bad surgeons botching surgery or
walking away from a patient in need. When a Midwestern woman underwent an
unnecessary mastectomy, her slides were not misread or a surgeon careless;
rather the system for slide identification was flawed.
System improvement is needed in hospitals; some feel many errors would
vanish with computerized systems for order entry. Very expensive. Hospitals
could better afford them with improved reimbursement and far lower liability
insurance premiums. Perhaps some of the estimated $28-47 billion of federal
funds lost to defensive medicine and liability expenses could be diverted to
systems for increased safety.
This cannot happen without reform of the means by which negligence is
evaluated and compensated. Those same so-called legal advocates of patient
safety, also the largest contributors to political campaigns nationally, will
continue to fight all reforms which threaten their enormous purses. Neither
the best safety measures, best doctors nor all of our hospitals will survive
the current system which encourages finger-pointing and casting the widest net
possible in attempts to glean the big lottery payout at the first sign of an
adverse event. Sadly, if this continues, and the plight of our doctors is
ignored, our exodus will continue. There will be many victims, indeed, if
sophisticated care becomes scarce in our communities.
Mark F. Schiowitz, M.D.
Wilkes-Barre