Dear Colleague,

On May 8, 2006, a filibuster on an impressive medical liability reform bill, the Medical Care Access Protection Act of 2006, was voted down. Supporters failed to gain a vote margin necessary to move the bill to the Senate floor. Based on successful medical liability laws passed in Texas in 2003, this proposed bill allowed for unlimited economic damages, caps on noneconomic damages (ie, “pain and suffering”), court-imposed sanctions against frivolous lawsuits, a sliding attorney contingency fee percentage inversely proportional to award amount, and a statute of limitations on injuries, among other provisions.¹

When I learned the following day that cloture on the motion to proceed had not passed, I sensed a lump in my throat—concern for my future, disquiet over the entrenchment of American health care in partisan polemic, compassion for the millions of innocent patients whose quality and quantity of life will suffer from political crossfire and the avarice of some.

According to the US Department of Health and Human Services, “limiting unreasonable awards for non-economic damages could reduce health care costs by 5%-9% without adversely affecting quality of care. This would save $60-$108 billion in health care costs each year. These savings would lower the cost of health insurance and permit an additional 2.4-4.3 million Americans to obtain insurance.”²

In the past 4 years of collected data, plaintiff awards in excess of $1 million have doubled, and legal expenses have consumed half of the monies available to pay victims.³As a consequence, annual liability insurance premiums have risen in some specialties to several hundred thousands of dollars, forcing doctors to limit their services, move out of state, or even close their doors.

With such clear and convincing evidence, it is egregious that the 109th Congress has failed to invoke meaningful medical liability reform. Those disavowed to tort reform claim that such restrictions infringe upon the civil liberties of potential victims to receive due compensation for injuries. What such statements of conjecture do not address, however, is the certain social injustice imposed by a boundless litigation system. As access to quality health care becomes ever narrower, the American public is sacrificed at the Bar-millions live without the health care they need or deserve to sustain the gluttony of a tort system without limits.

Perhaps I should not be so incredulous of the apparent rent in our Congress’ moral fabric. Speaking for medical liability reform this past March, I stepped into a Mississippi Congressman’s office, where I presented compelling statistics and personal anecdotes in favor of such legislation. Tunica County, Mississippi, in this Representative’s district, is in a state of health care access crisis. According to a 2003 report from the Mississippi State Department of Health, Tunica County has only 5 primary care physicians and one of the worst infant mortality rates in the country.⁴ Instead of a sympathetic ear, the legislative assistant with whom I spoke said-without acknowledgement to constituents, ethics, or duty-“I’m sorry ma’am; I work for my boss to get votes.” It was no surprise to later discover that one of this Congressman’s top 10 campaign supporters has been the American Trial Lawyers Association’s Political Action Committee.⁵

Temporarily buffered from the direct impact of skyrocketing malpractice premiums through institutes of graduate medical education, residents and fellows can unwittingly become laissez-faire to the political context of their careers until their training nears completion. In a poll of members of the American Medical Association (AMA) Resident and Fellow Section released in June, 69% considered medical liability environment as a factor in their choice of state to practice in and 50% in their choice of specialty.⁶

Daunted by the seemingly desperate sociopolitical climate surrounding American health care, it is easy to adopt the psychology of Martin Seligman’s whimpering dogs in his experiments of learned helplessness, but it is our professional mores and humanitarian duty that should inspire us to rise to the challenge before us. The AMA has placed tort reform as a top legislative priority, but our voice and power to influence Congress is only as strong as our members. Join the AMA in fixing the medical liability crisis, and in a spirit of compassion and responsibility, may we be champions for our patients and profession.  

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

References
1. 109th Congress, 2nd session. S. 22, Medical Care Access Protection Act of 2006. May 8, 2006. Available at http://thomas.loc.gov/ cgi-bin/bdquery/z?d109:s.00022:.

2. Office of the Assistant Secretary for Planning and Evaluation. Confronting the New Health Care Crisis: Improving Health Care Quality and Lowering Costs by Fixing Our Medical Liability System. Washington, DC: US Department of Health and Human Services; July 24, 2002. Available at http:// aspe.hhs.gov/daltcp/reports/litrefm.pdf.

3. PIAA, NPDB data show medical malpractice costs still rising; NPDB puts total payout increase at 8% [press release]. Rockville, MD: Physician Insurers Association of America; May 4, 2004. Available at www.thepiaa.org pdf_files/20040504_NPDB_Data_Release.pdf.

4. Office of Science. Tunica County Health Profile. Jackson, Miss: Mississippi State Department of Health; 2003. Available at www. health.ms.gov/county/tunica.pdf.

5. The 109th Congress. Available at www. opensecrets.org/politicians/index.asp.

6. American Medical Association Division of Market Research and Analysis. MemberConnect® issues of importance to resident physicians and fellows: highlights. May 2006. Available at www.ama-assn.org/ama1/pub upload/mm/16/2006_rfs_issues_surv.pdf.