PART II OF II. The Key to Reducing Medical Malpractice in the U.S.

Stopping Repeat Offenders: Five Percent Of The Doctors In The United States Are Responsible For Half The Malpractice Claims.

In reality, states a report in Public Citizen only a small percentage of doctors are responsible for the bulk of malpractice in the United States. Public Citizen’s analysis of the National Practitioner Data Bank, which covers malpractice judgments and settlements since September 1990, found that about five percent of the doctors in the United States are responsible for half the malpractice.

Specifically, 4.8 percent of doctors (40,118) have paid two or more malpractice awards to patients. These doctors are responsible for 51 percent of all the reports made to the Data Bank, and have paid out nearly $21 billion in damages, more than 53 percent of the total damages paid. In addition, 14,293 doctors, representing 1.7 percent of the doctors in the U.S., have made three or more payments, totaling $11 billion. These doctors are thus responsible for 27.5 percent of all malpractice awards.

This distribution very much resembles the pattern of drunk driving recidivism says Public Citizen. There are over 6,000 doctors in the U.S. who have paid four or more malpractice claims, amounting to more than $6 billion.

Number of Medical Malpractice Payments and Amounts Paid by Doctors

Number of Payment Reports Number of Doctors Percent/Total Doctors in US Total Number of Payments Total Amount of Payments Percent of Total Number of

Payments

All 147,378 17.6% 219,272 $38,993,664,850 100%
1 107,260 12.8% 107,260 $18,131,973,750 48.9%
2 or more 40,118 4.8% 112,012 $20,861,691,100 51.1%
3 or more 14,293 1.7% 60,362 $11,084,300,850 27.5%
4 or more 6,193 0.7% 36,063 $6,481,629,350 16.5%
5 or more 3,071 0.4% 23,576 $4,073,749,100 10.8%

Redacted records from the National Practitioner Data Bank demonstrate the following examples.

• Physician Number 94358, licensed in New Jersey, settled or lost 33 medical malpractice suits involving improper diagnosis or treatment between 1988 and 1993, inflicting over $400,000 in disability costs to his patients.

• Physician Number 64625, licensed in Pennsylvania, paid 24 medical malpractice claims involving improper performance of surgery between 1989 and 2001. Damages to this doctor’s patients exceeded $370,000.

• Physician Number 125457, while licensed in Nevada, paid 5 malpractice claims involving improper performance of surgery between 1995 and 1997, with damages totalling $2.3 million. Recent news accounts have reported that doctors are fleeing from Las Vegas to other states to avoid high malpractice insurance premiums. Physician 125457 was ahead of the curve in moving his practice to California. There he paid another 8 malpractice claims with damages exceeding $7.5 million.

• Physician Number 37949, licensed in Texas, settled or lost 13 medical malpractice suits involving improper treatment or improper performance of surgery between 1990 and 1997. Two of the suits involved the same allegation—a foreign body left in the patient during surgery. Damages to this doctor’s patients exceeded $2 million.
How about these stories?

• Surgeon Hits Double Digits in Medical Malpractice Complaints is a headline in an Illinois paper-A surgeon had a 15th medical malpractice complaint filed against him after international exposure for allegedly leaving a Russian teen brain dead. This last complaint was filed in civil court and the attorney was mum to details. Among the complaints, the surgeon is a defendant in a litigation involving “wrongful death.”

• A negligent surgeon barred in another state linked to deaths in a VA hospital. A patient hemorrhaged after routine surgery at a VA Hospital The surgeon, was barred from practicing in another state because he had previously been accused of causing life-threatening complications and deaths by providing "grossly substandard care" and making repeated errors in a series of inpatient surgeries shortly associated with post-surgical deaths. The hospital was responsible for a mortality rate over four times the normal amount. The barred surgeon was involved in all of them. The same surgeon had been linked to deaths all over the country.

• A Pennsylvania doctor with 27 malpractice suits no longer has operating privileges in any hospital which fortunately has prevented him from performing further surgeries. He said in December 2008 that he would be on “medical administrative leave" for "several months" but would return to his practice.” Yet despite his record of 27 malpractice lawsuits and settlements, the Pennsylvania Board of Medicine renewed this doctor’s license to practice in December 2008 which is valid through the end of 2010.

RECOMMENDATIONS

Good Ideas:
1. Institute experience rating.
Doctors should be rated on performance for malpractice premiums. Doctors with numerous malpractice claims must be reviewed and higher premiums imposed so that they are discouraged from practicing and competent doctors do not subsidize them.
2. Empower Patients with More Information
Public Citizen has long sought greater consumer access to information about doctors, and there have been recent improvements in making that information available. Most state medical boards now provide some physician information on the Internet, but the information about disciplinary actions varies greatly, is often inadequate and can be difficult for people to access. To read Public Citizen’s survey of state medical board Web sites, go to: http://www.citizen.org/publications/release.cfm?ID=7168
3. Legislate More Information Out to the Public

One state bill that would allow residents to have full access to a physician’s history was approved. The bill was named after a patient who died at age 25 due to when he underwent unnecessary brain surgery after a misdiagnosis of a brain cyst. His neurosurgeon had many previous medical malpractice lawsuits in multiple states. The bill requires the state Board of Medical Examiners to collect information on physicians’ history of disciplinary action, malpractice and license probation, their criminal records, limits on their hospital privileges and their ownership and employment affiliation. This information would then be made public.

Bad Idea
4. Open the National Practitioner Data Bank. Information about doctor discipline, including state sanctions, hospital disciplinary actions and medical malpractice awards is now contained in the National Practitioner Data Bank. HMOs, hospitals and medical boards can look at the National Practitioner Data Bank. The names of physicians in the database are kept secret from the public. Public citizen wants Congress should allow people to get the information they need from this source on the Internet.

This is a bad idea because it will lead to vital information going underground and out of reach of any agencies. It will also weaken those agencies now delegated to deal with these problems in an orderly manner and with due process instead of with a populist witch hunt.

It will make matters worse, because it will force underground what should be reported to the National Data bank-although some critics say it can’t get much worse than this.

A May 27, 2009 Report suggests hospitals not reporting discipline against physicians.

More than a third of Michigan hospitals have never reported a single doctor disciplinary action against a physician in 17 years of a national database, according to the report by a Washington, D.C., health watchdog organization and "nearly half of all hospitals" in the US "failed to report actions against doctors to the National Practitioner Data Bank between Sept. 1, 1990, when the database began, through December 2007." Although "federal law requires hospitals to report physicians who have had their admitting privileges revoked or restricted for more than 30 days," the group "charged that hospitals use loopholes in the law, avoiding filing requirements by putting doctors on leave, or disciplining them for less than 30 days." Public Citizen "sent a letter and recommendations on the issue to HHS secretary including a proposal to "tie a hospital's Medicare reimbursement with its participation in the data bank."

Even doctors with more than two disciplinary actions weren’t reported to the database.

In all, U.S. hospitals filed 11,221 reports to the data bank in its first 17 years, significantly less than the 10,000 a year expected by industry leaders and 5,000 a year the government estimated before beginning the system.It is run by the Health Resources and Services Administration, part of the U.S. Department of Health and Human Services
The report and recommendations are at www.citizen.org.

REFERENCES:
Sloan et al, "Medical Malpractice Experience of Physicians: Predictable or Haphazard?" 262 JAMA 3291 (1989)
www.questionabledoctors.org
http://www.injuryboard.com/national-news/bad-doctors-going undisciplined.aspx?googleid=261504
Book I - “Medical Malpractice Expert Witnessing: Introductory Guide for Physicians and Medical Professionals” (Hardcover) by Perry Hookman, MD (Author) : 592 pages.27 chapters. Publisher: CRC; Potomac Press; Language: English ISBN-10: 1420058959 ISBN-13: 978-1420058956; Dimensions: 10.1 x 7.1 x 1.4 inches; Shipping Weight: 2.6 pounds; price $239.95.
For author information visit www.Hookman.com; for book purchase visit www.MedMalBook.com

Book II –“Medical Expert Testimony: Advanced Syllabus for Physicians and Medical Professionals”
(Hardcover) by Perry Hookman MD (Author) 32 chapters; 936 pages. Proj.Pub date Spring 2009. Publisher: Potomac Press-CRC; ; Language: English ISBN: 978-0-9817570-0-1; ISBN:10:0-9817570-0-6 - Barcode (9780981757001.eps) Dimensions: 10.1 x 7.1 x 2.1 inches; Shipping Weight: 3.0 pounds; Price $289.95; includes CD-ROM. For author information visit www.Hookman.com; for book purchase visit www.MedMalBook.com