Articles Posted in Medical Malpractice News

Maryland enacted a self referral law in 1993 to help decrease the costs of health insurance and medical care after concerns that Maryland doctors would order unnecessary testing if they had a financial stake in ordering the testing. I think this was a problem with few doctors, but as we saw with the St. Joe’s stent debacle; it does not take many doctors to create a real problem for patients. Accordingly, Maryland-Self Referral Law prohibits any self-referral or any arrangement which has the practical effect of a self referral.

Where there is radar, there is usually a radar detector. I don’t mean that necessarily in a sinister way, but doctors are looking to make a profit like anyone else. It does not necessarily mean they plan to order unnecessary tests, but if they see a chance to make byproduct business, many doctors want to take that opportunity.

In Potomac Valley Orthopaedic Associates, et al. v. Maryland State Board, doctors appealed a ruling by the Maryland State Board of Physicians forbidding orthopedic doctors from referring patients for an MRI to a facility that is owned or leased by the orthopedic group in which the doctor holds a financial interest.

A lot of very smart people are looking at ways to decrease the incidence of medical malpractice in this country. The early returns are not good, according to a new study published in the New England Journal of Medicine. The study found that efforts to decrease medical malpractice in our hospitals has, at least as of 2007, failed and that the Institute of Medicine’s goal of a 50% reduction during a 5-year period has not been met, to say the least.

Interestingly, the 10 North Carolina hospitals chosen in the study were picked in part because they were considered progressive in their handling of and addressing the root causes of medical malpractice. The authors, and we have no way of gauging this beyond taking their word for it, believe these results are indicative of malpractice rates in this country generally.

Does this mean that efforts to reduce malpractice don’t work? The authors suggest the opposite, saying that focused efforts to reduce discrete harms, such as nosocomial infections and surgical complications, can significantly improve safety. I think it means that we have to do more of what we have been doing and do it better.

Let’s take a sampling of people who answer yes to this question: “Are medical malpractice insurance rates for doctors in Maryland too high?” The follow-up question that 95% (source: my best guess) of them cannot answer is: “Exactly how much does malpractice insurance cost?” To say the least, it varies wildly by specialty.

In Maryland malpractice lawsuits, the most common insurance company at risk is Medical Mutual of Maryland, a doctor-owned insurance company. This chart provides the rates according to one source, which includes data on how the rates changed from 2008 to 2009:

My comments:

There has been a settlement in the St. Joseph’s stent case. No, not those cases. This settlement was for the not so unrelated lawsuit by the federal government for the kickbacks given for referrals from Mid-Atlantic Cardiovascular Associates. St. Joseph was accused of making payments to Mid-Atlantic for referrals for cardiac procedures, most notably, stents.

How many people were privy to this scheme? We are talking about a nonprofit hospital here. Why is a nonprofit – basically a publicly owned business – willing to risk its reputation by engaging in an illegal scheme to get more patients? On its face, it seems crazy.

Nonprofit or not, most hospital executives have a vested interest is a big and “profitable” hospital. It means more prestige and, not so parenthetically, more money for everyone involved in the hospital. The added perks and future job opportunities don’t hurt the motivation to get bigger and better. Notwithstanding the nonprofit veil that most Maryland hospitals have, there is an economic motivation that guides, to varying degrees by hospital and administrator, their decision-making process.

The $11.5 million medical malpractice verdict won against a Miami orthopedist this spring, by former Dolphins receiver O.J. McDuffie, has been overturned.

At trial, McDuffie testified that the doctor never told him that he had completely ruptured the ligaments in his toe, as evidenced by MRIs performed in subsequent weeks. In fact, McDuffie told the jury that the doctor encouraged him to continue to practice and play.

So, the crux of this malpractice lawsuit is that McDuffie continued to practice and play with ruptured ligaments, which caused irreversible joint surface damage even after his doctor knew or should have known that he was causing further injury by continuing to play with the injury. It is not a surprise to see a malpractice verdict disturbed. What is surprising is when the trial judge grants a new trial for his own error on an evidentiary issue that would likely be an abuse of discretion question on appeal: whether the use of a medical manual as evidence at trial was appropriate. The judge apparently agreed that it was relevant and then reversed himself and ordered a new trial.

A new study published in the Archives of Internal Medicine underscores what patients have known for a long time: good research to find the right doctor does not necessarily yield the right doctor.

The study found only a thin correlation between how the doctor performed according to the patient and the objective facts – education, board certification, malpractice claims, disciplinary actions, etc. – that are commonly used to evaluate doctors on-line.

The study did find one thing that I have a hard time believing is true: there is no meaningful correlation between doctors who paid on malpractice claims and those who have not. There is no doubt that good doctors (and good lawyers, by the way) commit malpractice. But studies have also shown that a small number of doctors make up a large percentage of the malpractice payouts and that many of those doctors are “frequent flyers” who have been sued in the past. Moreover, there are other studies suggesting some doctors get sued more than others because they communicate so poorly. Patients usually don’t report that the doctor who communicates poorly did a great job treating them. So it’s hard to imagine how this data could be accurate. But it sounds like a quality study in a good medical journal so it will be interesting to see if there are follow-up studies that look at this issue more closely.

The Baltimore Sun published a well-written rant about the deterioration of the doctor-patient relationship. The editorial stems from the well-publicized shooting at Johns Hopkins by a man distraught about his mother’s medical treatment. The writer paints an awful picture of a war between doctors and patients that is beginning to boil over.

I can tell you that none of this is going on in my doctor’s office. But I don’t know what is going on elsewhere. The author appears to be someone in the “know” but there is no explanation of the author’s frame of reference. I would have expected the author to be identified as a doctor or other health care provider. (A quick Google search indicated the author was a writer which would make sense. The piece is well-written, florid, and dramatic.)

The author sees the problems as a symptom of the “erosion of civility, humility and reason across America.” I could not disagree more. Certainly, minorities, women, gays, and lesbians, and many others have experienced an increase in civility and reason. The good ole days never really were. I’ll take 2010 over any other year in human history.

A Salisbury cardiologist has been indicted in federal court on charges stemming from the doctor’s giving patients unnecessary stents. Many patients have already filed civil lawsuits in Salisbury claiming medical malpractice for the unnecessary stents.

The debacle at St. Joe’s has caused a fresh look into every doctor who has been putting in stents by the bushel load. What we are seeing in many cases is not a pretty picture.