Tort Reform: Reigning In the Costs Of Medical Care

A tort is an action that results in harm to a person or property. Torts can be litigated, and the person who initiates the litigation can be awarded damages if the person accused of wrongdoing had a duty to act in a particular manner but breached that duty, and if damages or injuries occurred as a result.

Torts of negligence are careless acts that cause injuries or damage. Medical malpractice suits accuse healthcare providers of torts of negligence by causing harm to a patient through deviation from acceptable medical practices. Malpractice suits generally allege a medical error by the physician.

In order to win a malpractice tort claim, a plaintiff must first demonstrate that the defendant owed a legal duty to provide care, then that the defendant breached that duty by failing to conform to the relevant standard of care, then that the breach of duty was the cause of harm or damages, and finally that harm or damages actually occurred.

Because relevant standard of care is a subjective term, tort liability is a contentious issue for the medical community. Healthcare providers must maintain expensive medical malpractice insurance to protect themselves from lawsuits, and they must often request diagnostic tests which are unnecessary but must be performed to absolutely rule out unlikely diagnoses. These additional tests cost patients and insurance companies money, but without them a physician may be held responsible for failing to perform to a certain standard of care.

Many physicians argue that they spend more of their time ruling out unlikely medical diagnoses than they do treating actual illnesses. They are forced to do this, however, because failure to rule out an unlikely condition could result in a high financial liability in the extremely small percentage of cases where that particular illness actually occurs.

Medical malpractice suits are viewed as harsh because they can award a plaintiff many times the amount of damage actually incurred, and because the defendant can be punished multiple times for a single act. To cover the costs of potential lawsuits, insurance companies charge higher premiums. To cover the cost of the higher premiums, healthcare providers charge more for office visits and care.

The associated costs of the tort system have risen sharply in the past 30 years. Healthcare providers have become increasingly risk averse, sacrificing efficiency for the sake of the comprehensive elimination of all possible claims of negligence. Although malpractice insurance premiums are still low for ophthalmologists when compared to neurosurgeons and obstetricians, rates have still increased dramatically. In some parts of the country, malpractice insurance premiums increased by more than 50 percent in the 3-year period between 2001 and 2004, and costs have continued to rise. Many ophthalmologists feel threatened by these increases and are concerned about their future.

In a survey published by Ophthalmology Management, many physicians reported that they have adopted more defensive risk management strategies in response to rising malpractice insurance costs. Most ophthalmologists reported that premium increases have forced them reduce time per patient and to see more patients in order to maintain practice profitability.

Malpractice insurance premiums vary by state, and rate increases have been as low as 15 percent in some areas. In others, however, they have been much more. An eye surgeon in Miami reported a 400 percent increase in premium costs, and stated that he currently pays an annual premium of $60,000. A high-volume practice in Kentucky that has been sued several times reported annual premiums of $172,000 for an office with four doctors.

A surgeon in California, however, reported paying only $6,300 for malpractice insurance during the past year. California differs from Florida and Kentucky in that California places a $250,000 cap on non-economic damages and limits attorneys’ contingency fees.

Advocates of tort reform call for these types of changes throughout the country. They argue that the current system inflates the cost of medical care to heights beyond affordability, and believe that a balanced system would enhance public safety, continue to punish wrongdoers for acts of true negligence, and foster personal responsibility on the part of patients.

Les writes for Personal Eyes about cataracts, macular degeneration, LASIK eye surgery & more.

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