Yet another reason to despise the ambulance chaser

[Bill Glasheen]

When you behave badly, expect to be the target of others' wrath

Which is why we have an impartial court system to those behaving badly - illicit actions by corporations, medical malpractice and rogue police and prosecutors to name a few - can be the target of of severe financial penalties for their wrongdoing.

Gene

I learn not to take you seriously. Why? In spite of evidence sitting in front of you that the sun rises in the east, you'll argue otherwise if it fits your political point of view.

You have evidence of bad behavior by trial attorneys, and yet you ignore it. Instead you want to have us believe that (all) attorneys are proper virgins. Or maybe virgin for a day??? Any "sniff test" for an argument would detect something of a fecal nature when a party leads the other to believe that any sector of society is completely as it should be.

Folks wonder why government is so polarized. No wonder to me.

Come back when you can address the facts. Meanwhile, I'd suggest you put something on. Your bias is showing again.

- Bill

P.S. Please don't bore us all with the adolescent "No, you are!" I probably should be flattered that you use my arguments against me, but it's getting old. Skewer me if you like; I enjoy a good verbal dual. But you'll score more artistic points with me if you try something original.

[IJ]

Hey, are lawyers making too much money just spinning legalistic wheels at 600$ an hour and not producing anything, and eventually relying on sob stories to push through huge settlements despite a lack of clear evidence? The solution, clearly, is our impartial court system, wherein lawyers can make $600 an hour spinning more wheels and BS'ing nearly indefinitely about the problem, some more!

No, seriously, when matters of science are decided by the emotional insights of a few random people, sorta backed up by the common practice standard in which a community of misguided physicians can more or less do something wrong and still create a standard of care, we're hosed.

UNLESS, we look to England, where doctors are immune (IMMUNE) to malpractice provided they have been following the standards laid down by national agency that decides which health care measures are cost effective to pursue (I think it's "NICE").

Imagine that! If a doctor were sued for a post op wound infection and was found to have clipped and not shaved, used the right skin sterilzant, kept the patient warm during the procedure, given perioperative antibiotics at the right time and dose, etc, then there would be no case, and the lawyers would scurry like cockroaches in daylight from pursuing it further.

That said, there is soooo much ERROR in our system that we could still find lots to sue for. Let's make an analogy. Some drugs are extremely expensive, and fraught with issues. Epogen, which fixes anemia for many, seemed like a great idea. Turns out that only a little is appropriate--pushing the dose until normal blood counts occur causes stroke, hypertension, and death. In cancer patients, who need them the most, tumor recurrence and death are increased and now they're banished. And it's very costly. Still, there is a role for many patients.

Malpractice law is not dissimilar. If it were a medical procedure, the NICE people in England would laugh it out of consideration. It takes YEARS to make anyone whole. The side effects are huge. The cost is tremendous. The effect on the rest of medicine is unacceptable. The punitive effect is totally ineffective. It is the very worst "medicine" out there, and only appropriate in a very few situations.

And have you EVER heard of a lawyer getting sued or carrying malpractice insurance? I saw a show on a mentally retarded woman who was executed for murder, whose lawyer fell asleep during her case repeatedly, who didn't raise concerns that her shrink had made multiple times about how her violent tendencies needed to be headed off that were ignored by authorities, and so on. Not only did she not get her retrial, her lawyer's prosecution never came up. Suing had that been a doctor would have jumped to anyone's mind. That's just the way our culture is. But this is a guy who seriously underperformed, not just an honest mistake but egregious conduct, and his "patient" was dead. Where's his malpractice premium? Where are all the lawyers offering the woman a chance to sue her lawyer? Hmm?

[Gene DeMambro]

Give it a rest, Bill. Your single minded solution to this issue is mind boggling. I continue to remain unconvince you really want actual tort reform - just business protection reform. Kow how I know this, Bill? Because you haven't mentioned a single solution that helps to protect those onthe wrong end of it. Also, you stated it yourself. To wit:

What this really has been about is squelching freedom of speech of corporate America so that they can be bullied by the media and those with lesser means. Never mind that said entities pay the bulk of the taxes which empower the rulers who govern them. - emphasis mine

So the more taxes one pays, the better government one gets?

If you'd relly want tort reform, then you would address joint and several liability. You would address the amazing disparity in health care reimbursements between medical providers. You'd convince health care insurers to expect quality but be prepared to pay for it. You'd set a high bar for doctors, nurses, pharmacists et al to meet but tell them they'd be fairly compensated for their efforts and skills (how's that for capitalism).

I work in health care, Bill. Do you? I know what regulations exist and how to follow them. Wan't to know something, Bill. There isn't a single regulation, law or practice that I must follow that isn't absolutely necessary for proper patient care. Period. I dare you or anyone to find one that isn't. Go ahead - I dare you.

As someone who feels compelled to comment on and on about the Consitutitonal law aptitude about the current holder of the keys to the Oval Office, you can anwser me this: What part of the Constitution prohibits Dow Chemical from tryingto recover their payouts for silicone breasts? WHat part prohibits these Ob/Gyns from recovering for their payouts in births gone awry. Let know if you find it.

So when in doubt, it seems that falling back on The Constitution is a safe bet. - Bill Glasheen

If you can't see that we have a tort system because of the Consitution, maybe a civics class is in order.

But go ahead, continue to go on and on about trials lawyers and wealth redistribution and all that. I'lll just get a good laugh while I show how you got it wrong.

[Gene DeMambro]

Yes, Ian, I have heard of lawyers getting sued and loosing for malpractice. They are in the papers all the time. Legal malpractice insurance isn't cheap, either.

I agree with you on following policies for better care. What do we do with doctors who won't? Also something Bill hasn't addressed.

Gene

[IJ]

"As someone who feels compelled to comment on and on about the Consitutitonal law aptitude about the current holder of the keys to the Oval Office, you can anwser me this: What part of the Constitution prohibits Dow Chemical from tryingto recover their payouts for silicone breasts? WHat part prohibits these Ob/Gyns from recovering for their payouts in births gone awry. Let know if you find it."

See, the solution is more lawyering Personally, I think the fact that the windows were shuttered by this explosively expensive litigation means that the damage is done. Business were permanently changed. And we know these companies believe in self interest, which means if the system were conducive to efficient recuperation of losses, they'd have pursued it, because they were wronged. They haven't; the system isn't. Does that logic hold for you?

As for lawyers getting sued, well, that's reassuring. I must not be reading those papers though--seems the pressures aren't really comparable.

And as for policies for better care? Things must be individualized. The literature is full of doctors complaining that performance measures don't address things like the noncompliance of their impoverished patients, cultural barriers to things like paps, or the inflexibility to treat individuals, eg, the right to say no aspirin for this heart disease patient because he bleeds all the time, and no ACE inhibitor for that one because he has hyperkalemia and the ACEI will worsen it. There is some truth: doctors and hospitals now get dinged for not preventing blood clots in major ortho surgery and urinary infection from foleys. But the preventive measures for clots are only about 50% effective and some foleys are unavoidable, so we will get penalized for doing the right thing. In the case of the blood clots, we should be penalized ONLY if prophylaxis wasn't given right, or the doctor didn't indicate ahead of time that it was contraindicated for good reason. There is no reason why performance measures shouldn't have this flexbility.

Once that's taken care of, doctors who won't use proven therapies because of their God complex and whims should be sent to North Korea style reeducation camps. Seriously. Or they SHOULD be sued or payers should refuse to handle any of their mess. If they won't play ball they're not professionals in my book.

[Bill Glasheen]

Gene

The subject is TORT REFORM. Meanwhile, I get this from you.

I work in health care, Bill. Do you?

You're a pharmacist, Gene. Noted.

I have over 30 publications in systems physiology, health-care technology, cardiology, epidemiology, and health-care delivery. I'm consider a world expert on health-care risk. I'm married to a primary care practitioner. My former employee is now the Virginia State Health Commissioner.

There's more where that came from. But I'd just insult you more - as you tried to insult me.



Next!

you haven't mentioned a single solution that helps to protect those onthe wrong end of it.

You are wrong. But then I repeat myself.

1) Prevent the problem in the first place through standardization of EHR and application of six sigma methods. Instead of trolling for malpractice episodes, why not put malpractice attorneys out of work? (Hint: THEY DON'T WANT THAT!!!!)

2) Binding arbitration.

And while we're at it,

3) Abolish financial punitive damages. There are better ways to handle this that don't make trial attorneys rich.

4) Adopt a practice of the British tort system. You sue and you lose? You pay legal costs of both parties.

Better yet, make the trial attorneys absorb said costs. That would only be fair to any potential victims.

So what do we have at the end of the day?

1) Higher quality health-care

2) Lower cost health-care

3) The best and the brightest going into professions where they actually produce something for a living.



- Bill

[Valkenar]

4) Adopt a practice of the British tort system. You sue and you lose? You pay legal costs of both parties.

I'd be absolutely for this, except that it would mean that only the rich can afford to sue. Unless you make the ridiculous assumption that you only lose a case if you're in the wrong. It'd be nice if that were true, but it isn't. Which means that say, a consumer could never, ever sue a company for damages, but a group like the RIAA would have even more power to browbeat people with just the threat of a lawsuit.

Better yet, make the trial attorneys absorb said costs. That would only be fair to any potential victims.

While I'm sure you wouldn't shed any tears, this is basically like abolishing tort law entirely. No sane lawyer is going to take on a case if there's a chance they'll be on the hook for essentially unlimited costs.

[Bill Glasheen]

Got you thinking didn't I, Justin?

That's the most I can ask from those who feel differently.

- Bill

[Valkenar]

Got you thinking didn't I, Justin?

That's the most I can ask from those who feel differently.

- Bill

Well don't hurt your shoulder patting yourself on the back. This isn't t he first time the idea of loser-pays tort law has come to my attention.

[Glenn]

3) The best and the brightest going into professions where they actually produce something for a living.

Someone once said 'everybody hates attorneys until they need one', although an attorney once modified that to 'everybody hates attorneys until they need one, then they REALLY hate attorneys'. Given how much I have had to pay one in Kentucky recently, I certainly am still not a fan of attorneys (except Matlock, Perry Mason, and Rumpole) just because I needed one.

But in reality attorneys produce no more nor no less than any other service provider. They produce legal advice/representation and legal documents. What lawyers produce may be less tangible than agriculture and industry production, but is no less tangible than what is produced by scientists/researchers (much of what attorneys do is research, and they often enlist scientists as expert witnesses), teachers, politicians, insurers, financial institutions, IT support/programmers, doctors, etc. Doctors and attorneys are pretty close conceptually in what they produce, the former either an improvement of a patient's health condition or not and the latter either an improvement in a client's legal situation or not. With the recent auto accident, I received a number of calls/mailings from both attorneys and doctors who had been trolling accident reports for business, so they seem to also be adopting similar practices for getting new patients/clients.

Given that in the U.S. ag makes up about 2% of the job force and 7% of the GDP while industry makes up around 20% of the job force and 12% of the GDP, service production, much of which is intangible, is the bulk of our economy with about 78% of the job force and 81% of the GDP. Love it or hate it, intangible production is about all America has left for an economy.

As for setting up a situation where the "best and brightest" are forced to choose some career other than law, do you really want someone less than ideal to represent you when you need an attorney?

[IJ]

I think the concern isn't that they don't really have value. We know they do. The problem is that often the value is in negotiating a system of nonsense rules and protecting yourself from a complicated system which is too often designed to serve the interests of those who navigate it. It's like the lawyers are toolbooth operators and Bill would like to drive without interference.

There is no way I would want to face serious charges without an attorney, on the other hand, I know from personal experience and examples like our birth control impaired former presidential candidate that much of malpractice is robbery and much of the little steps along the way are nonsensical.

The norm, I'm told, in Boston is for the cases to get to depositions in 3 years and maybe payouts after trial in 5 years. 5 years! Getting paid for faxes, hearings, objections, requests and other legal maneuvering for five years while the ostensible victim gets nothing but hassle and the MD has a coronary from stress all to settle an issue about clinical care that any reasonable clinician could determine MORE fairly in a matter of hours.

Let's say the case is about failure to use standard pneumonia antibiotics with a death. I can tell you in a matter of minutes to hours what the death rate with and without standard antibiotics would be, extenuating circumstances specific to the patient's case, and the likelihood the care was responsible for the outcome. I could even get you a more accurate penalty, for example, if the absolute difference in death rates between options the doctor used and those that were guideline advised were 4%, then the death is only due to the error in 1 in 25 similar cases. Our legal system, of course, is going to find that liability is a yes or no issue. Figuring out what lost wages ought to be should take a few hours if there's an honest discussion and an offer could be produced same day. The plaintiff's guide to that process could hardly claim they deserved 40%, however

[Gene DeMambro]

From Bill, we get

1) Prevent the problem in the first place through standardization of EHR and application of six sigma methods.

From Ian, we get:

And as for policies for better care? Things must be individualized.

Let me know when the experts agree. Then we can talk. Otherwise, Bill gets the gridlock he so often votes for.

Cheers,
Gene

[IJ]

Oh come on. Are you SERIOUS?

I said "things must be individualized" and went on to explain that we shouldn't fault hospitals or doctors for events that occur despite optimal care or for making reasonable exceptions, then go on to clearly explain that while we shouldn't get dinged for doing the right thing, doctors DON'T provide good care are responsible: "In the case of the blood clots, we should be penalized ONLY if prophylaxis wasn't given right, or the doctor didn't indicate ahead of time that it was contraindicated for good reason."

But you just failed to notice that detail about us deviating from standardized care only while documenting our concerns and having a good reason, and me insisting we not just make some kind of efforts but do the prophylaxis optimally? How about those myriad other posts I've made roasting doctors who have a financial stake in the care they recommend, who imagine themselves smarter than the experts, who won't follow evidence based care, you know, the ones I suggested sending to prison reeducation camps? Not enough?

You really can't make some people happy.

[Bill Glasheen]

From John Ruskin we get...

Quality is never an accident; it is always the result of intelligent effort.

It's the "intelligent effort" part you're having difficulty with, Gene.

- Bill

[Bill Glasheen]

1) Prevent the problem in the first place through standardization of EHR and application of six sigma methods.

Let me translate.

The key here is getting the right information in the right form where it is needed and in a timely fashion. That facilitates the PROCESS of care. That care however is always delivered by the health care provider based upon his/her observations of individual patients.

- Bill