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bhk
05-17-08, 11:24 AM
http://online.wsj.com/article/SB121097874071799863.html?mod=opinion_main_commentaries

By JOSEPH NIXON
May 17, 2008; Page A9

Houston

When Sam Houston was still hanging his hat in Tennessee in the 1830s, it wasn't uncommon for fellow Tennesseans who were packing up and moving south and west to hang a sign on their cabins that read "GTT" – Gone to Texas.

Today obstetricians, surgeons and other doctors might consider reviving the practice. Over the past three years, some 7,000 M.D.s have flooded into Texas, many from Tennessee.
Why?
Two words: Tort reform.

In 2003 and in 2005, Texas enacted a series of reforms to the state's civil justice system. They are stunning in their success. Texas Medical Liability Trust, one of the largest malpractice insurance companies in the state, has slashed its premiums by 35%, saving doctors some $217 million over four years. There is also a competitive malpractice insurance industry in Texas, with over 30 companies competing for business. This is driving rates down.

The result is an influx of doctors so great that recently the State Board of Medical Examiners couldn't process all the new medical-license applications quickly enough. The board faced a backlog of 3,000 applications. To handle the extra workload, the legislature rushed through an emergency appropriation last year.

Now many of the newly arriving doctors are heading to rural or underserved parts of the state. Four new anesthesiologists have headed to Beaumont, for example. Meanwhile, San Antonio has experienced a 52% growth in the number of new doctors.

But if tort reform has been a boon – and it is likely one of the reasons the state's economy has thrived in recent years – it was not easy to enact.

In one particularly grueling fight in the legislature in 2003, an important piece of a reform bill went down to a narrow defeat in the state Senate after a single Republican switched his support to vote against it. Republican Gov. Rick Perry was so incensed that he bolted out of his office in the Capitol, sprinted into the Senate chamber, and vaulted a railing to come face to face with the defecting senator.

That confrontation fizzled, however, and before long Texas succeeded at enacting two simple but effective reforms. One capped medical malpractice awards for noneconomic damages at $250,000, changed the burden of proof for claiming injury for emergency room care from simple negligence to "willful and wanton neglect," and required that an independent medical expert file a report in support of the claimant.

This has allowed doctors and hospitals to cut costs and even increase the resources devoted to charity care. Take Christus Health, a nonprofit Catholic health system across the state. Thanks to tort reform, over the past four years Christus saved $100 million that it otherwise would have spent fending off bogus lawsuits or paying higher insurance premiums. Every dollar saved was reinvested in helping poor patients.

The second 2003 reform cleaned up much of the mess surrounding asbestos litigation by creating something called multidistrict litigation (MDL). This took every case in the state involving a common injury or complaint, like silicosis or asbestosis, and consolidated it for pretrial discovery in one court.

One judge now makes all pretrial discovery and evidence rulings, including the validity of expert doctor reports, for all cases. This creates legal consistency and virtually eliminates "venue shopping" – a process by which trial lawyers file briefs in districts that they know will be friendly to frivolous suits. Trials still occur in plaintiffs' home counties.

More change sailed through the legislature in 2005; tort reform had become popular with voters and lobbying against it was ineffectual. The 2005 reform created minimum medical standards to prove an injury in asbestos and silica cases. Now plaintiffs must show diminished lung capacity in addition to an X-ray indicating disease.

In sum, these reforms have worked wonders. There are about 85,000 asbestos plaintiffs in Texas. Under the old system, each would be advancing in the courts. But in the four years since the creation of MDLs, only 300 plaintiffs' cases have been certified ready for trial. And in each case the plaintiff is almost certainly sick with mesothelioma or cancer.

No one else claiming "asbestosis" has yet filed a pulmonology report showing diminished lung capacity. This means that only one-third of 1% of all those people who have filed suit claiming they were sick with asbestosis have actually had a qualified and impartial doctor agree that they have an asbestos-caused illness.

In the silica MDL, there are somewhere between 4,000 and 6,000 plaintiff cases. In the four years since the cases were consolidated under the MDL, 47 plaintiffs have filed a motion to proceed to trial based on a medical report indicating diminished pulmonary capacity. Of those 47, the court has certified 29 people as having diminished lung capacity. This, too, is less than 1% of all the "silicosis" claims made in Texas. No one has proven the real cause of his illness to be silica, as no case yet has been certified for trial.

Before the asbestos and silica MDLs were created, nonmalignancy plaintiffs settled with defendants for anywhere between $30,000 to $150,000 per case. No one knows how many bogus cases were settled in the state with large cash payments. Lawyers who specialized in defending those cases say there were tens of thousands.

The full costs of large settlements and runaway malpractice suits may never be known. But it is clear that the costs were paid for by consumers through the increased price of goods, by pensioners through diminished stock prices, and by workers through lost jobs. Another group often overlooked is those who are priced out of health care, or who didn't receive charity care because doctors were squeezed by tort lawyers. Frivolous lawsuits hit the uninsured the hardest.

Texas recently became home to more Fortune 500 companies than New York and California. Things are trending well for the Lone Star State. Anecdotally, we can see that while doctors are moving in, trial lawyers are packing up and heading west. They're GTC -- Gone to California.

Mr. Nixon, a former member of the Texas House of Representatives, is a senior fellow at the Texas Public Policy Foundation.


For those states complaining about the drain of physicians and healthcare services, the solution is above.

Ranger
05-17-08, 11:48 AM
If there's absolutely no limit on economic damages then the reform doesn't bother me.

I don't know what the other part of the reform is supposed to do. Change burden of proof for injury in ER from "simple negligence" to "willful and wanton neglect" - why single out ERs?

kvrdave
05-17-08, 12:59 PM
I didn't read it all, but did it actually result in health care costs coming down for the consumer?

DVD Polizei
05-17-08, 04:35 PM
In my house, GTT means Gone To Toilet.

grundle
05-17-08, 04:44 PM
Texas recently became home to more Fortune 500 companies than New York and California.

That's because Texas doesn't harass businesses as much as most other states do. You can read more about that here:

http://online.wsj.com/public/article_print/SB120450306595906431.html

grundle
05-17-08, 04:50 PM
http://boortz.com/nuze/200501/01062005.html

by Neal Boortz

January 06, 2005

First ... let's address Bush's call for a $250,000 cap on non-economic damages. This means that a jury could award the plaintiff enough money to cover all of the anticipated costs of future medical care and other necessary expenses to compensate the plaintiff for the costs incurred as a result of the malpractice for the remainder of the patient's life. Fine. So far so good. Beyond that, Bush wants to limit any additional awards to just $250,000.

Consider this case. About 15 or so years ago two newborn males were horribly disfigured at an Atlanta hospital. A doctor made a horrible mistake during the circumcision process and literally burned the penises off of these two males. The parents of at least one of these babies took the doctor's advice and agreed to a sex-change operation. Since there was no longer a penis, the doctors just surgically changed this poor child to a female. (I lost tract of what happened to the other baby.) Now ... let's consider a medical practice action here. The question of negligence was not an issue. The doctor was clearly negligent .. open-and-shut case. The question was how much to award. Let's consider that award in light of Bush's reform proposals. This child would be entitled to have the cost of the sex-change surgery and the cost of any future hormone replacement therapies covered. The parents would presumably be compensated for the cost of all those male-oriented baby clothes they had bought.

What else would the child get? $250,000, that's what. Here we have a child, born male, who will never be able to father a child. A child who will have a confused sexual identity for the rest of its life. What is it worth to you to be able to have a child? What is your sexual identity worth? Hell ... let's cut to the chase. What is your penis worth?

At the time these babies were born their life expectancy was about 75 years. If you take that $250,000 and stretch it out over that time you would come up with a grand total of about $275 a month. That's it. That's what you get for having your penis burned off by a doctor and for never being able to have satisfactory sex let alone father a child. Do you think $275 a month is enough?

Superboy
05-18-08, 07:54 AM
Thank you, Grundle.

orangecrush
05-19-08, 09:51 AM
In general I am in favor of caping non-economic damages, but grundle's article points out one of the numurous hospital errors that really causes a priceless loss.

al_bundy
05-19-08, 11:42 AM
how do you burn a penis off? My son's procedure took all of 15 minutes by a Rabbi and most of that was prayer and other customs. I saw the Rabbi's kit and it was just some surgical instruments and nothing that can burn anything

Numanoid
05-19-08, 12:47 PM
Sorry, but when I'm looking for a doctor, I don't want one that thinks even "simple negligence" is acceptable. There is no excuse for any negligence. Do your job and do it well. If you've got something on your mind, or aren't feeling 100%, take a fucking day off. These tort reforms are nothing more than "I want to be able to fuck up once in a while and get away with it" laws.

orangecrush
05-19-08, 02:31 PM
Sorry, but when I'm looking for a doctor, I don't want one that thinks even "simple negligence" is acceptable. There is no excuse for any negligence. Do your job and do it well. If you've got something on your mind, or aren't feeling 100%, take a fucking day off. These tort reforms are nothing more than "I want to be able to fuck up once in a while and get away with it" laws.
Doctors, like all people, are not perfect. 100% of all doctors will make a mistake at some point in their lives. In fact, most doctors will probably kill at least 1 person because of their mistakes. Not every doctor should be sued into oblivion because of "normal" mistakes.

al_bundy
05-19-08, 02:43 PM
what exactly is a mistake? 2 years ago someone on my wife's side died in a hospital because they didn't catch a clot in time. was that a mistake, falling through the cracks, normal medicine or negligence?

orangecrush
05-19-08, 03:46 PM
what exactly is a mistake? 2 years ago someone on my wife's side died in a hospital because they didn't catch a clot in time. was that a mistake, falling through the cracks, normal medicine or negligence?
Tough to say. I just think that the sue-happy people who expect doctors to be flawless are being unrealistic.

Numanoid
05-19-08, 04:26 PM
Doctors, like all people, are not perfect. 100% of all doctors will make a mistake at some point in their lives. In fact, most doctors will probably kill at least 1 person because of their mistakes. Not every doctor should be sued into oblivion because of "normal" mistakes.I agree. A normal "human error" mistake is understandable. Negligence is not.

neg·li·gence (nĕg'lĭ-jəns)
n.
The state or quality of being negligent.
A negligent act or a failure to act.
Law. Failure to exercise the degree of care considered reasonable under the circumstances, resulting in an unintended injury to another party.If you're harmed by someone using an unreasonably low level of care, why shouldn't there be repercussions?

bhk
05-19-08, 07:48 PM
Nice definition. Define "reasonable under the circumstances" and according to whose standard. Realize that even experts in many medical fields disagree on sometimes fundamental things. People need to realize that bad result is not equal to negligence.

foggy
05-19-08, 08:15 PM
how do you burn a penis off? My son's procedure took all of 15 minutes by a Rabbi and most of that was prayer and other customs. I saw the Rabbi's kit and it was just some surgical instruments and nothing that can burn anything

IIRC this was some kind of an experimental procedure where they were performing circumcisions with a surgical laser.

orangecrush
05-20-08, 08:31 AM
IIRC this was some kind of an experimental procedure where they were performing circumcisions with a surgical laser.
You know the most ridiculous thing about this situation is that they don't even recommend circumcisions for newborns any more.

aktick
05-20-08, 09:11 AM
Of course if people (juries, lawyers, judges, etc.) just had a little common sense, there would be no need for tort reforms. But alas, that ship sailed long ago...

aktick
05-20-08, 09:12 AM
You know the most ridiculous thing about this situation is that they don't even recommend circumcisions for newborns any more.
When do they recommend them? And not knowing shit about the process, when have they generally been performed in the past?

al_bundy
05-20-08, 11:32 AM
You know the most ridiculous thing about this situation is that they don't even recommend circumcisions for newborns any more.

some people still do them for traditional/religious reasons

Pistol Pete
05-21-08, 03:15 PM
Doctors, like all people, are not perfect. 100% of all doctors will make a mistake at some point in their lives. In fact, most doctors will probably kill at least 1 person because of their mistakes. Not every doctor should be sued into oblivion because of "normal" mistakes.
I know a doctor who is in the top 5 in his field. He's the guy that the other doctors refer their difficult cases to. He's heavily involved in research and is constantly searching to better his field. If you need to see someone in his specialty, he's the guy you want to see.

And he gets sued at least once a year by unhappy patients.

orangecrush
05-21-08, 04:12 PM
When do they recommend them? And not knowing shit about the process, when have they generally been performed in the past?
It was only recently that the AAP (or some other group) stoped recomeneding circumcisions for all newborn boys. http://www.cnn.com/HEALTH/9903/01/circumcision.recomendation/


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