AAFP President Takes Message to Senate, White House

In anticipation of congressional action on medical liability, the Academy has launched a targeted strategy to garner support for reform legislation among U.S. senators and other federal policy makers.

The effort began April 6 when AAFP President Larry Fields, M.D., of Ashland, Ky., met with U.S. senators, White House staff and legislative aides to discuss the impact of the current medical malpractice environment on patients' access to health care. The effort expanded to include a national Speak Out campaign that urges Academy members to contact their senators and ask them to support medical liability reform.

Fields' Capitol Hill meetings took place as Senate Republicans planned a May "Health Week," during which they expect to introduce legislation that includes provisions similar to those in California and Texas medical liability reform laws.

The expected federal proposal would limit medical liability noneconomic damages to $250,000 for any one health care provider, with an additional $250,000 cap on judgments against a single health care institution and $500,000 for all institutions. The total cap for noneconomic damages would be $750,000. The bill also is expected to include a provision to preserve states’ rights by keeping state medical liability statutes in place and allowing future state laws to supersede federal limits on damages. Sen. John Ensign, R-Nev., is expected to be the primary sponsor of the bill, Fields said after meeting with Ensign's health policy specialist.

"Our primary point is that the liability issue is not a doctor-versus-lawyer issue," said Fields of his meetings. "It's a problem of access to care for their constituents."

In general, Congress acknowledges problems of skyrocketing medical liability premiums, but several senators oppose the proposal currently being debated for a variety of reasons. Among their concerns: A federal law might undercut existing, more stringent state medical liability laws, and capping attorney fees would be an anticompetitive force in the marketplace, said Fields.

"If we really want to get the votes, we will have to make some compromise to answer the (senators') minor objections while maintaining hard caps" on noneconomic damages, he added.

Fields' visits to Capitol Hill and the White House are part of the Academy's concerted effort to put medical liability reform on the front burner and get action on the legislation. The Academy also has launched the nationwide Speak Out alert that provides a model letter members can send to their senators.

The letter urges senators to support medical liability legislation "that includes reforms that have been effectively utilized in California for the past 30 years as well as more recent reforms that have been so successful in Texas."

Among the provisions of California's Medical Injury Compensation Reform Act, passed in 1976, are a $250,000 limit on noneconomic damages, no limit on economic damages, limitations on plaintiffs' attorneys' contingency fees, and a statute of limitations of one year from time of discovery of an injury and its negligent cause or within three years of the injury.

"From 1976 to 2003, total premiums in the rest of the U.S. rose 920 percent; in the same period, the increase in California premiums was only 282 percent," the model letter says. "Claims are settled sooner, allowing patients to receive awards more quickly."

The Texas law, passed in 2003, limits noneconomic damage claims to $250,000 against a physician or health care provider. In cases with multiple defendants, the bill would place a $750,000 cap on noneconomic damages.

Since implementation, the Texas Medical Liability Trust, which is the largest liability insurer in the state, reduced premiums by 17 percent and physicians "are flooding into Texas from states without significant liability reforms, thus increasing access to care for Texans," the model letter says.

In addition, participants in the Academy's key contacts program have been asked to urge their senators to support the expected liability reform package.