Letters to the Editor - December 2003 -- FP Report

Solve liability insurance crisis

To the editor:

Let's get down to the difficult business of solving the malpractice insurance crisis. I propose reform in five equally important areas:

Eliminate spurious claims. A medically informed panel, similar to a grand jury, should review claims before they can proceed.
Establish a national panel to monitor and sanction physicians with a pattern of adverse malpractice outcomes. Those of us who work hard to maintain our skills cannot afford to bear the cost of those who don't.
Get rid of lawyers' contingency fees. There's no justification for increasing fees above standard hourly rates. Assign legal representation to indigent patients whose claims pass the initial review panel.
Hold insurers accountable for their fiscal policies. As jury awards have skyrocketed, many insurers have pocketed any profits, then abandoned the business. If we can't make malpractice insurance profitable enough for them, perhaps it needs to be publicly or governmentally administered.
Establish national standards on jury awards. It's distasteful to have to broadly decide what a life or a leg or an eye is worth, but not doing so is inherently unjust.

I am fairly certain my proposal will alienate most of the groups involved. This possibility alone suggests it may be a reasonable start!

Mary Jo Groves, M.D.
Springfield, Ohio

Cutting costs can cut quality

To the editor:

Is this where our medical system is going?

I recently wrote a managed care system regarding the poor care my late grandfather received. He was primarily treated for heart failure by a cardiology nurse practitioner, whose evaluation and treatment were limited. No cardiologist saw him despite his failing health. The primary care physician who referred him to the NP did only problem-focused visits. He had scheduled no regular follow-ups and didn't do preventive care (i.e., complete physicals).

Consequently, my grandfather's hypothyroidism was undiagnosed and neglected until it was too late. He was hospitalized three times in his last month of life, each time by different hospitalists, causing disjointed care and medical errors. Social workers pressured staff to discharge him quickly despite his failing condition. He died in a nursing home the morning after the final discharge.

I am concerned that more medical care problems will occur as health systems try to cut costs. Already, physicians are underpaid for their level of education, skill and responsibility. They are pressured to see more patients for less reimbursement. It would not be surprising if their quality of care were declining. However, replacing physician care with that of less-trained providers isn't necessarily helpful for quality of care.

Hopefully society will recognize this trend and re-evaluate its priorities.

Cheryl Regalia, M.D.
South San Francisco, Calif.

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