Dear Colleague,

In March 2005, the case of Gregory G. Phelps v Physicians Insurance Company of Wisconsin came before the Wisconsin Supreme Court.¹ The case involved a Milwaukee intern who provided primary obstetrical care without consulting a senior resident or an attending physician. The patient, who was expecting twins, experienced placental abruption, and one of her twins, in breech, later died from cord entrapment with resultant asphyxia. In June 2005, the Wisconsin Supreme Court upheld the trial court’s apportionment of 80% negligence to the treating intern, with the remaining 20% of negligence attributable to the hospital. Also upheld was the trial court’s conclusion that Wisconsin’s then $423,000 noneconomic damage (ie, “pain and suffering”) cap limit did not apply to unlicensed, first-year residents. Within the interpretation of Wisconsin law, “health care providers” were deemed not to include unlicensed trainees, and thus the intern in question was liable for the sum awarded by the jury.

The Wisconsin Supreme Court ruled in July 2005 in another case, Ferdon v Wisconsin Patients Compensation Fund, that Wisconsin’s noneconomic damage capitation violated the Equal Protection Clause of the Wisconsin Constitution, repealing tort reform legislation that provided a ceiling for “pain and suffering” awards.²

This case demonstrates a dangerous precedent, whereby loopholes in the law may leave unlicensed residents or medical students vulnerable to unlimited jury awards in malpractice decisions against them, even in states that have enacted caps on noneconomic damages.

The American Medical Association (AMA) is recognized for placing tort reform as one of its top priorities.³ However, in a resident’s life consumed with concerns of providing excellent patient care in the face of fatigue, studying, and reducing medical education debt, “political issues” such as medical liability can seem distant and not germane to the daily grind.

The AMA Resident and Fellow Section at its November 2005 interim meeting recommended that the AMA officially support and advocate for the inclusion of all physicians (including unlicensed residents) in legislation concerning medical liability caps. The case of Gregory G. Phelps v Physicians Insurance Company of Wisconsin should cause pause for every training physician with its provocative emotional valence, and place legislative awareness on their radar of import. It is incumbent upon state medical societies to examine state law for similar loopholes, but this Wisconsin Supreme Court decision also underscores the necessity of comprehensive federal medical liability legislation.

The AMA’s Congressional Affairs staff lobbies everyday for issues like this paramount to the House of Medicine, but on March 13, 2006, the doctors take over. This annual event, Lobby Day, held in conjunction with the National Advocacy Conference (NAC), brings hundreds of residents and medical students to Capitol Hill to advocate for those issues most important to young physicians and their patients.

The mechanism of the AMA’s Lobby Day affords residents and fellows the opportunity to sit down, often on a one-to-one basis, with their Congressional representatives. Do not underestimate the power that these meetings can proffer. Washington, DC, is a town overrun with lawyers; relating patient and personal stories as a physician puts a face to the legislation that comes across the desk of our elected officials. These emotive appeals can be more effective and influential than a room full of professional lobbyists. I encourage you to sublimate the visceral reaction evoked from learning of the Phelps case to impact votes in the houses of Congress. Be a part of the physician effort that lobbies for a more favorable medical liability climate, public health measures, coverage of the uninsured, and Medicare’s physician payment updates.

Join your colleagues in Washington, DC, this March, and do not let inexperience with political advocacy or finances deter you from attending. As part of the day’s events, educational sessions on effective lobbying and briefings on timely legislative issues will groom you for success before your meetings on the Hill. The AMA Political Action Committee (AMPAC) will provide lodging at the Hotel Washington on Sunday night, March 12, for 2006 AMPAC members, and NAC events on March 12-13 are open to all free of charge. Sign up for 2006 AMPAC membership at www.ampaconline.org, and keep abreast of pending federal legislation pertinent to organized medicine by signing on to AMA’s Grassroots Network at www.ama-assn.org/ama/ pub/category/12776.html. Save the date, March 13, 2006. Protect the future of health care for physicians and patients across America.

Michelle Nichols, MD
Member-at-Large American Medical Association Resident and Fellow Section

References
1. Gregory G. Phelps v Physicians Insurance Company of Wisconsin. 273 Wis2d 667, 681 NW2d 571.

2. Ferdon v Wisconsin Patients Compensation Fund. 2003AP0988, 2005 WI 125.

3. American Medical Association. Policy No D-435.984. Tort Reform. Available at www.ama-assn.org/apps/pf_new/pf_online

American Medical Association
Resident and Fellow Section
2005-2006 Governing Council

Joe Craft III, MD, Chair
Sunny Ramchandani, MD, MPH, Chair-Elect
Kelly Caverzagie, MD, Vice Chair
Douglas Che Miller, MD, Secretary
David Rosman, MD, Delegate
Adam Levine, MD, Alternate Delegate
Alexander Llanos, MD, Member- at-Large
Michelle Nichols, MD, Member-at- Large

Samantha Cramoy, MD, Resident Trustee
Julie Snelling, Director
Department of Resident and Fellow Services

"Code Blue" is prepared by the Resident and Fellow Section of the AMA. Unless specifically indicated, its articles and opinions do not necessarily reflect the policy of the AMA or the opinions of the editors or the publisher of Resident & Staff Physician. This newsletter is contained in Resident & Staff Physician solely as a service to reidents.

The journal is not in any way involved in deciding the content of "Code Blue." All questions, suggestions, or requests for additional information should be sent to the AMA Department of Resident and Fellow Services, 515 North State Street, Chicago, IL 60610, or phone 312/464-4751. The American Medical Association–Resident and Fellow Section (AMA-RFS) is this nation’s strongest voice for residents and their patients. Visit our Web page at www.ama-assn.org/go/rfs. To join or renew your membership, call the AMA-RFS at 800/AMA-3211.