The Las Vegas issue
A Washington Post article discloses: "Las Vegas Trauma Center Closes as Doctors Quit; Surgeons Cite Rising Costs of Malpractice Insurance, Lawsuits -- a Growing National Problem". It says that 11 of 13 trauma surgeons and 57 of 58 orthopedists have "resigned from practice" at the University Medical Center, the town's only Level 1 trauma center. Although the WaPo reporters perhaps don't know it, these doctors have not all abandoned their practices and taken jobs selling shoes at Payless. Presumably what they have done is stop taking call at the UMC, but continue to practice there.
What is not often appreciated is that hospitals are at the mercy of their staff doctors, particularly in large cities, where it is a simple matter to decide to stop doing surgery at St. Alpha in favor of Beta Memorial. In many cases, the surgeon does not even have to change the location of his office. And the staff surgeons are responsible for a goodly proportion of the revenue of any hospital, so the hospital will usually do what it can to accommodate them. So look for the UMC to do something to change the situation for the benefit of their staff surgeons. Very often it involves assuming some part of the malpractice insurance premium.
The story says that this action is aimed at pressuring the Nevada legislature to pass a tort reform measure similar to that in effect in California, involving limits on awards for pain and suffering and limits on attorneys' fees.
Here in Michigan, we had limits on attorneys' fees for several years, involving a "sliding scale" for fees based on larger awards, but this no appreciable effect on the rate of filings and was dropped after a time. (A limit of one third of the net recovery remains.)
We have also had, famously, caps on damages since 1986, which were refined in 1993. The totality of the several reforms in both years have significantly reduced the number of medical malpractice cases that are filed, but it is the limits on expert witnesses and the requirement that a case be supported by an Affidavit of Merit signed by a qualified physician that have had the greatest impact. The caps on non-economic damages are currently over $620,000 in the more serious cases, and this has probably not prevented any filings, although it has surely limited the awards in many of the cases that have been tried and the settlements in thousands of others.
The most prominent effect of the limits on non-economic damages (pain and suffering) is that the plaintiff's bar has become very adept at building the case for economic damages. A cottage industry of "Life Care Planners" has grown up, and their expertise largely consists of thinking up interventions that will be needed to assist the injured person and putting a price tag on them -- one wheelchair every three years @$8,000 per unit, three psychotherapy sessions per week @$150 per session, etc. One case tried in the Detroit area, on behalf of a catastrophically injured child, saw an award of $18 million without any award for pain and suffering at all.
Some day I would like to see a study done. My prediction: of the tort victims who have received money based on a jury's verdict based on testimony from a Life Care Planner, very little of the money will actually be spent on the things that the LCP said the victim so desperately needs.
9:58:19 AM 
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