Judge Directed Negotiation-Another Solution for Medical Liability Reform

A new program known as "judge-directed negotiation" is being tested in New York as a way to solve some of the malpractice liability issues discussed earlier this month in this blog.  Under this program, Judges are involved in the cases from the start and actively suggest settlements.  This helps resolve malpractice cases years earlier, prevents lengthy appeals and allows those patients that truly have been harmed to receive compensation much earlier than usual.  This may be another notch in the tort reform belt that aids in reducing the malpractice crisis.  See this recent article in the New York Times for more information: http://www.nytimes.com/2011/06/13/nyregion/to-curb-malpractice-costs-judges-jump-in-early.html?_r=1&ref=todayspaper

We have a medical situation,Is there a Doctor or Nurse on the plane?

Ever been flying and hear the flight attendant announce overhead "Is there a Doctor or Nurse on the plane?"  Have you ever wondered what liability you have when you provide emergency medical assistance in this situation? Under the Aviation Medical Assistance Act, anyone (including physicians) that provides medical assistance on an airplane is protected from liability, as long as they did not act with willful or wanton misconduct (gross negligence).   Aviation Medical Assistance Act 1998 (H R 2843).

Limiting ER Medicaid Patient ER Visits: A Way to Curb ER Overcrowding, or a Dangerous Limitation of Access to Medical Care

Washington State has approximately 1.1 million of their residents covered by Medicaid and two thirds of these are children.  In 2003, President Bush passed a law allowing states to limit access to ER's for Medicaid patients.  Since then, a few states have enacted such laws.    In an effort to lower the cost of health care, Washington State is proposing limiting the amount of ER visits Medicaid patients can make in a year.  They plan to only allow for three “non-emergency” visits per year.  If the patient makes more than three visits, the state will not pay the hospital for any services provided for after the third visit.  They estimate that the can save up to seventy-six million dollars over two years. 

They have a fifteen page list of nonemergency conditions.  However, some of the conditions they include as non-emergent include hypoglycemic coma, asthma attacks, abdominal pain, some types of bleeding and other potentially dangerous medical conditions.     Crises from chronic conditions like Sickle Cell anemia are included in the list as well. The person that developed this list is not a physician, and said the list was not intended to be used to make health care decisions or payments.  In fact, he has stated that the list was actually created to help officials find out where patients have trouble accessing primary care and help figure out if particular programs work well. 

It is extremely dangerous to place these limits on patients.  It may deter a patient bringing their child in with an asthma attack, because it is going to be labeled as non-emergent.  This can cause many deaths.  Even things that are truly non-emergent, can become emergent.  For patient that needs a medication refill or has lost their prescription, and cannot get an appointment with a doctor to get a, sometimes going to the ER is their only solution to get access to potentially life-saving medication.  Although ER overcrowding is a problem, deterring patients from seeking medical care is not a proper solution to this problem. 

Anyone else have a problem wtih this?  What do you think?

Tort Reform

In my previous post I discussed medical malpractice.  The majority of malpractice claims (sixty-four percent) are either withdrawn, dropped or dismissed without any payment to the plaintiff.  In an effort to fix some of these problems, some states (California and Texas) enacted tort reform (some like to call it medical liability reform).    There is also current legislation to make tort reform national law (the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2011).  So far in areas where there is tort reform, states  have seen decreased the numbers of malpractice cases and a decrease in the cost of liability insurance, leading to increased numbers of practicing physicians in those states which helps relieve physician shortages.    However, there haven't been any clear indications that tort reform actually decreases the cost of health care, but it is still too early to tell the long term effects of tort reform.  I believe in the long run it will decrease defensive medicine leading to decrease health care costs.

For more information check out this article:  Medical Liability Reform: The Good, The Bad and The Ugly,

http://www.emra.org/emra_articles.aspx?id=43611&_cldee=cmI0QGJjbS5lZHU%3d

Medical Malpractice in the ER

Probably every doctor's worse fear (other than harming a patient) is getting sued, but overall, only 1% of total claims studied found a verdict for the plaintiff (29% of cases were settled with some payment to the plaintiff). 

Did you know that in the Emergency Department, only 19% of claims were actually attributable to Emergency Medicine physicians. 

The most common ED lawsuits involved acute myocardial infarction and appendicitis (missed diagnoses).  

To read more about this issue, check out a breif article I wrote in What's Up in Emergency Medicine:  http://www.emra.org/emra_articles.aspx?id=43544

The Litigators Lions Pit: The Top 10 Medical Malpractice Issues Every Resident Should Know

Why a Health Law Blog?

I am both a doctor and a lawyer so health and law both interest me.  I am presently an Emergency Medicine resident at the Baylor College of Medicine, but have a bit of a non-traditional background that got me to where I am today.  Before medical school I was a patent attorney (represented generic drug companies that were trying to get their lower cost drugs on the market).  Over the past few years I have become intrigued by various health law topics, went back to school (while in residency) and got a LL.M (Masters in Health Law).  Since then I have started writing on a few health law topics.  I am also interested in developing a Health Law curriculum for physicians, residents and medical students. One of my mentor's suggested that I start writing a Health Law Blog; it sounds like a great idea so I thought I would give it a shot.  I will post various Health Law topics, give my opinion and would like to hear others opinions on the topics as well.  Most of the topics may focus on Emergency Medicine related issues since that is what I deal with every day, but we will see what happens.  Any critique, comments or suggestions is welcome.