LETTERS TO THE EDITOR: The False Issue of Malpractice Costs

In an April 13 Rule of Law column--"How Come No One's Talking About This Health Reform?"--former vice president Dan Quayle says that skyrocketing medical malpractice litigation and the threat of such litigation on doctors' rising malpractice-insurance expenses have significantly increased the country's health care costs. Yet all of Mr. Quayle's figures cannot provide an explanation for hospital expenses in Indiana, a state that has enacted several of his suggested reform measures, that are greater than in states that have not enacted these so-called reforms.

For instance, in Indianapolis, average hospital expenses per inpatient day are $1,078, while in Chicago, in a state without the drastic measures Mr. Quayle advocates, that same hospital stay is $1,000, according to statistics from the American Hospital Association. That's $78 more per day in Indiana.

Mr. Quayle touts Indiana's damage caps that have been in place for 20 years. Yet they have had no effect on health care spending in that state, which is consistently ranked 32nd in the nation. Objective studies have demonstrated that malpractice litigation and health care costs have little to do with each other.

Mr. Quayle decries "defensive medicine" and cites doctors who say they conducted unnecessary testing out of a fear of being slapped with a lawsuit. One would have to question those doctors' ability as well as judgment. A surgeon driven by fear, and not knowledge, can be a dangerous thing. Interviews, in fact, have shown most tests would have been conducted anyway in the name of quality care.

Mr. Quayle neglects to mention a feasible explanation for this abundance of testing: the self-referral scheme that adds an estimated $10 billion to $20 billion each year to the medical care tab. A report by the Consumer Federation of America found that physicians who have profit incentives stemming from ownership or investment in such facilities order 34% to 96% more diagnostic studies than those doctors who do not.

Mr. Quayle instead focuses on the false issue of rising malpractice premiums. Perhaps insurance companies' profits should be examined instead. For instance, the Illinois Inter-Insurance Exchange, the largest insurer of doctors in the state, has boasted 10 years of a growing asset base and increased dividends.

The focus should not be on lowering premiums for the very people who cause the harm -- the negligent doctors. A five-year study of malpractice in New York state conducted by Harvard Medical School found that negligent medical treatment had injured some 27,000 patients. About 7,000 people died of their injuries inflicted in hospitals each year. In other words, their deaths could have been avoided. Even more disturbing was the finding that up to 90% of those errors were preventable. Rules governing doctors' behavior and punishment should be stricter. Perhaps increasing the insurance premiums of chronically negligent doctors may be a deterrent.

Robert A. Clifford
Chicago

(Mr. Clifford is a partner in a law firm concentrating in aviation, medical negligence, product liability and personal injury law.)