ksagnostic

Back to the OP. Denying services to someone because she refuses to sign a political petetion in his office is inappropriate on so many levels. I don't give a rat's ass about the "rightness" of tort reform. BTW, I guarantee you an expereinced special education teacher is going to see some kids where OBGYN's did seriously screw up, so she might have her own professional viewpoint. Besides which, how valid are the signatures of Mulholland's patients if they are signed under the threat of of being cut loose by their doctor?

A professional does not coerce a patient into signing a political petetion in order to continue to receive services. Dr. Mulholland's behavior is extremely unprofessional. Or, to put it another way, he is acting like a bullying asshole. Period.

Nothing in this post should be taken as suggesting a position on tort reform. I am talking about the doctor's behavior.

Loren Pechtel

If it's a lawyer site it will say tort reform doesn't help. It will likely use the level of honesty in doing so that lawyers are known for.

It can be hard to identify lawyer sites. What I've found generally works is to look at the about and link pages.

Beware of any pro-consumer site that looks professionally designed.

My experience with looking at the info is the lawyers say one thing and pretty much everyone else says the opposite.

Loren Pechtel

1) Tort reform is generally a reaction to runaway rates.

2) Often the lawyers manage to sabotage tort reform measures so they look good but don't work. The lawyers then point to these states as evidence it doesn't work.

Interesting assertion, as the doctors here are simply trying to replicate California's tort reform. They obviously have a different opinion of it than you do.

Note, also, that this files in the face of reality. St. Paul's quit because they were paying out $1.99 for every $1 they took in.

It wouldn't help one bit.

Yes, they're the ones I'm referring to.

Your allegations don't pass the reality test. Losses would not have made them quit if they were making a profit on the insurance.

As for that supposed St. Paul study, got a non-lawyer link?

It's moot anyway, the lawyers sabotaged the measure.

The lawyers are obviously running scared of it--they tried to slip (the amendmants purported to be very different than what they really were) two constitutional amendmants through in the last election whose real purpose was to block tort reform. If it does no good why are they spending millions to try to block it?

????

Agreed. They aren't an issue in malpractice.

Pain and suffering, though, is noneconomic and can get insane.

Loren Pechtel

The lawyers would love to have you believe that cerebral palsy is the doctor's fault. It rarely is, though.

ksagnostic

I'm not talking about "the lawyers", nor I didn't specifically mention cerebral palsy (which can be due to any one of many etiologies). I am talking about case histories where the cause is clearly identified as an error, and sometimes even negligence, by a doctor. They're rare cases, to be sure, but they happen. But when you work in special education for more than just a couple of years (I have 20 plus years of experience in a special education/dd related field) you will run into such cases. There is a selective bias for someone in the special education field to encounter the results of medical malpractice by an OBGYN (or for that matter a Pediatrician). It doesn't take a rocket scientist to figure out why.

I was simply suggesting that this mother's professional experience, as a special education teacher, may have influenced her perception of the issue just as the doctor's experience influenced his perception of the issue. The fact remains, his conduct is unprofessional and, in my extremely strong opinion, inexcusable. His petetion, and his response to her refusal to sign it, amounts to blackmail. Imagine some asshole fundy OBGYN demanding that a mother he has been working with for five months sign a petetion opposing abortion, or for that matter a petetion supporting him for the State School Board, or he will cut her loose. He may have the legal right to do so, but I strongly suspect his actions are a breach of professional ethics. I know if someone in my field (speech-language pathology) pulled a stunt like that even in private practice she would face the potential loss of her certification (and rightly so). I certainly doubt the special education teacher would refuse to work with his child because of his stand on tort reform.

pug846

Loren wrote:

They did not mail out the survey to all of their members, as noted in the previous link—they only had 2,185 responses.

But I am glad that you’ve put the entire field of statistics to shame by declaring, without sufficient information, that it is a “reasonably accurate picture.�? Some people, myself for example, are hesitant to draw conclusions from insufficient data—not you though! I know you are beyond hope, but I do hope lurkers see through your inability to support your opinions with facts.

It must be easy to be right when you’ve declared that anything that contradicts your opinion is “lying.�? If you would provide FACTS to back up your opinion, that would be helpful.

Loren Pechtel

So? They presumably sent it to a random sampling of their members. That number of responses is quite sufficient to get the error margin below 3%.

You do *NOT* need enormous sample sizes to get good data. From a practical standpoint, all that matters is the number of people you survey--what percentage of the total population this is has only a trivial effect on the final answer and in fact is generally ignored--for large populations (and most surveys involve large populations) you simply use the simpler form of the equation that uses infinity for the population size.

I've seen similar results from other surveys and I see nothing about this one that sounds bad. Why shouldn't it be a reasonable picture of reality?

Just because it blows the lawyer's story about a few bad doctors out of the water is no reason to call it wrong.

Note that even if there is an extreme selection bias in who answered the survey it would still leave 1 in 3 having been sued. Thus the only counter is to say that there's something about their membership that makes them far more likely to be sued.

What's really weird is I just went looking for the total obstetricians in the US and the Bureau of Labor gives only 18,000--far below what that acog site has in it's list.


I consider any laywer site that isn't clearly a lawyer site to be presumed to be lying. I'm not tossing out other stuff.

Sauron

Correct.

Stephen Maturin

1) True as far as it goes, but it doesn't go nearly far enough. The "runaway rates" you mention are the result of insurers jacking up premiums to recover losses on speculative investments such as stocks. There have been three major waves of tort "reform" in the U.S. All occurred at times when investment income tanked. That's no coincidence.

2) That claim is more than a little specious. Insurers know how the legislative game works because they play it so often. Their initial proposals to state legislators are submitted with full knowledge that they won't get everything they want. They ask for the sun, the moon and the stars knowing that their proposals will be pared down. The end result is almost always everything the insurers could have reasonably expected.

Moreover, the sole purpose of tort "reform" is reducing insurers' payouts in cases involving serious injury. In that respect, it "works" quite well. What doesn't work is the notion that such "reforms" reduce insurance premiums. The data simply don't support that notion.

Ain't no opinion involved, mah man.

More on this later. For the moment, suffice it to say that payouts-to-premiums comparisons yield a grossly incomplete and misleading picture of what's actually going on. Needless to say, the insurance industry trots out such comparisons regularly. Giving grossly incomplete and misleading pictures of what's actually going on is what they do best.

Interesting. Care to elaborate?

They pass the reality test pretty well, actually. "[M]aking a profit on the insurance" isn't how insurance companies make their money. The big bucks come from investing the premiums they collect. You'd be amazed at how many insurers pay out more on claims than they collect in premiums on certain lines of insurance.

St. Paul's problem, a problem shared by a number of other companies, stemmed from an excess of enthusiasm over the big returns to be had on investments during the 1990s. At any given time there's a fixed number of customers for medical malpractice insurance. St. Paul and others underpriced their med mal coverage in an effort to get a bigger share of the customer pool, thus bringing in more money to invest. The companies figured that the return on investments would be more than enough to handle all the claims plus register a healthy profit. St. Paul did very well in attracting new customers, but when investment income turned into massive losses it simply didn't have the money to cover claims.

I knew you were gonna ask for that. I used to have copies of St. Paul internal memoranda, but they're stuffed in a desk drawer at my former employer's office 1,300 miles away. I'll rummage around the intarweb and see what I can find. Rest assured, though, it's entirely legit.

Apologies for putting words in your mouth, but in a roundabout way you seem to agree that the insurance industry is bullshitting when it says that premiums will drop if/when the Nevada Supreme Court upholds the law.

The meaning of "tort reform works" is addressed above. It's all about reducing insurers' payouts. The notion that reform-related payout reduction translates to lower premiums simply doesn't fly.

Why do trial lawyers spend so much money trying to block these "reforms"? Some do it out of naked economic self interest. Some do it out of genuine outrage that legislators are shoring up insurance companies' bottom lines at the expense of innocent victims. Some do it for both reasons. Clearly, though, none do it out of hatred for reasonable malpractice insurance premiums.

Tort damages fall into two broad categories: compensatory and punitive. Compensatory damages, as the name implies, compensate the injured person for actual injury-related loss. Punitive damages have nothing to do with compensation; they're meant to punish especially egregious misconduct and to deter similar misconduct in the future.

Compensatory damages break down further into economic and noneconomic damages. Economic damages compensate the injured person for items such as injury-related medical expenses, lost income, diminished earning capacity, etc. Noneconomic damages compensate for losses not normally measured in money. When a tortious act causes someone to lose an arm, for example, the fact that the victim no longer has an arm is an element of noneconomic damages.

So, then, noneconomic damages are compensatory and punitive damages are not. Never the twain shall meet.

Actual instances of verdicts that include outrageous noneconomic damages awards are few and far between. In cases where such verdicts occur, trial judges and appellate courts are very good at seeing to it that the award doesn't stand.

Another favorite tactic of the insurance industry is reporting anecdotal evidence of seemingly outrageous jury verdicts while saying nothing about the underlying facts of the case or how much, if anything, the plaintiff actually collected.

Loren Pechtel

You're believing the liars (lawyers) again.

1) Investment losses wouldn't only affect malpractice rates.

2) One of the reactions here was some physicians creating a new insurance company. Since it's a new company it can't have any losses from the market collapse. By your reasoning they should be charging rates like the old rates. They're not.

The Stock market does have something to do with the rates, but it's the other way around--gains in the market allowed them to keep rates low.

Agreed. That's how the game is played. I don't see the relevance, though.

You think the doctors here are really so naive that they didn't look at the results before making their proposal??



Ain't no opinion involved, mah man.

For a time they were able to run with payouts exceeding premiums but that didn't last. It's not the insurance company's fault it didn't last.

What's so incomplete and misleading about the $ of payouts vs $ of premium? It seems to me that's a pretty clear measure of how bad the situation was.

You can't drive rates below costs. *ANYTHING* which tries to do this (even the extortion states like to practice: Sell x below cost or you can't sell anything) is inherently doomed in the long run. This is merely one such proposal.

Yeah, many companies do pay out more on some times of insurance. This is an example of the extortion I mentioned above. You can get a small excess of payouts to premiums due to market gains but in general the gain doesn't add up to more than a few percent.

Agreed. There was basically a price war. However, that doesn't mean that state would be permanent, nor should the insurance companies be blamed for the end of the war.

They said that before the measure was passed. It's not their fault the lawyers got a gaping loophole in it that renders the cap basically meaningless. Since the measure doesn't meet the standards of what they talked about it doesn't matter what the Supreme Court does with it.

No, your logic doesn't fly. If there is excess profit, competition will drive prices down.

Exactly. Our problems started when California passed tort reform. They now had an excess of lawyers and some came here. Our notorious ambulance-chasers came from California.

Both sides are guilty of that.

In an earlier debate on this someone linked to a page that among other things griped about a $6 million obstetric case that's still not been collected. Never mind (facts you won't find on the page in question, but which I have picked up from our local paper--the case is local):

1) The doctor they are trying to collect the $6 million from was assigned no blame in the first trial and only 5% of blame in the second. He's the only one with money, though.

2) The doctor examined the woman once while she was in labor. He wasn't involved in the delivery.

3) Both trials assigned the vast majority of the blame to the woman herself. By the second trial, she's 18 times as guilty as the doc--why should the doc have to pay anything, let alone the whole judgement?