If you have just 30 minutes to bone up on the medical malpractice crisis in America, there's no better place to turn than the pithy, nine-page article appearing today in the New England Journal of Medicine, succinctly titled "Medical Malpractice."
But if you're seeking a signpost pointing a quick way out of our med mal swamp, look elsewhere.
The three authors from the Harvard School of Public Health predict there's a long slog ahead for all physicians, hospitals, insurers and lawyers bedeviled by the current med mal mess.
Any likely reforms will be piecemeal, probably will have negligible impact on med mal premiums and will do nothing to end the inefficiencies of the current system, the writers conclude.
"The bleakness is really a reflection of our read on the political situation," says co-author David Studdert. "There is certainly ongoing what we call conventional tort reform in many of the states. But the possibility for what we refer to as systemic reform is fairly slim."
Studdert and colleagues Michelle Mello and Troyen Brennan, M.D., all faculty members at the school's Department of Health Policy and Management, write, "Sweeping reforms of the system . . . have attracted some high-profile support in the current debate." But they suspect that damage caps, the latest salve pushed by physicians' organizations and hospitals, will afford these providers little financial relief.
"It's too soon to judge the effects of the most recent wave of reforms," they write, "but studies from earlier eras are informative." The authors remind the reader that med mal "crises" existed in the 1970s and the 1980s.
"Most regression analyses that control for the presence of multiple tort reforms . . . have shown that caps on damages significantly reduce payouts, but their effect on premiums is less clear," they add.
Physicians and hospital leaders will be cheered to read that a study cited by the authors found only one in 10 incidents that could have given rise to a finding of negligence in court ever produced a lawsuit. The same leaders will take discomfort, however, from the perverse finding of another study that revealed just 17% of malpractice claims that were taken to court appear to have involved a negligent injury.
So it would seem that nine of 10 people don't sue when they could, while nearly five out of six who do sue don't have a case.
"Weiler et al have suggested the analogy of a traffic cop who regularly gives out more tickets to drivers who go through green lights than to those who run red lights," the authors write.
Aside from tort caps, Studdert and his colleagues reviewed three other commonly cited approaches to remedy the med mal problem: alternative dispute resolution mechanisms rather than the courts, locating responsibility for accidents at the institutional level and dispensing with negligence as the basis for compensation.
They didn't pick their favorite, because the goal of this article was simply to review the terrain, Studdert says. Plus, the authors have previously written on what they think is the best path to long-term reform, he says.
"It's more complex than workers' comp, but the system would be similar," he says. "You would not be trying to prove negligence; you would look at some other tests, such as was this a preventable event."
Under such a system, often referred to as "no-fault" (an imprecise description, according to Studdert), the number of malpractice filings would probably rise, since access to administrative remedy would be easier than filing a lawsuit. But the median payout and the overall costs to society would be lower, Studdert says.
So, too, would be the type size in news headlines about future med mal verdicts, he predicts.
"You would not see $15 million awards. They would be more uniform in size," he says.