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Don't crash in Las Vegas : UMC Trauma Center shuts.

By MightyTribble in News
Fri Jul 05, 2002 at 08:23:30 AM EST
Tags: News (all tags)

The only level 1 trauma center within 250 miles of Las Vegas has shut down, according to this AP report. The doctors who run the center withdrew their services, citing the rising cost of malpractice insurance. This is bad. Read on to find out why.

First : a disclaimer. My wife is a board-certified Emergency Physician who works in a Level 1 Trauma Center. I hear things that make me not want to ever go into hospital. Especially in July, when all the new residents start. However, I'm still a bit of an ultracrepidarian on the matter, so the following is only partially-informed opinion.

Now, if you have an accident near Las Vegas, you'll be taken to a community hospital Emergency Room. If you have an accident outside of normal coverage and need surgery (say, you have appendicitis) there'll be a wait as the surgeon on call drives in to the hospital (Community Hospitals typically don't have surgeons in the hospital 24/7, unlike Level 1 centers). If you're lucky, there'll be a doctor in the ER. If you're really lucky, that doctor will be a board-certified Emergency Physician who can do an appendectomy in a pinch, or perform an intubation if you need an airway clearing. But most likely they'll be a pediatrician or opthamologist - any specialist but Emergency - moonlighting in the ER for some extra money. If you actually need the services of Level 1 Trauma (a good trauma surgeon, for example, and a good surgical intensive care unit), then it's a one-hour transfer by helicopter to next nearest center. Which is probably already running at 105% capacity. This, of course, assumes that you're stable enough to transport, which if you need the services of a Trauma Center is a big assumption to make. Most likely you'll just die in the community ER, and your next-of-kin will be told that there was nothing that could be done. This happens more often than you might think.

What caused this closure? Malpractice insurance. It's getting ridiculously high. Attending physicians run practices at hospitals, and bill the hospital for services they provide to the patients. The hospital, in turn, bills the patient. At least that's how it's supposed to go. However with Medicare not paying the full cost of service, and ERs not able to turn anyone away, irregardless of ability to pay, there's often a problem of bills not getting paid. Add to that insurance premiums in excess of $150,000 dollars (when your salary might be $200,000, out of which you have to pay practice administration costs as well), and you can understand why these doctors decided to call it quits -it's entirely possible that the orthopedic surgeons were losing money by working in the ER. Every doctor I know is an altruist - but none of them are willing to pay for the pleasure of working.

In short, the US Healthcare system is collapsing, but regular folks don't quite realise how bad it is (those in the business, however, are painfully aware but can't do anything - there simply isn't the money to pay for what needs to be done). The closure of UMC Las Vegas (the third busiest Trauma Center in the nation) is a symptom of this collapse. Expect more of the same in the coming months and years, until enough rich people die preventable deaths and their next of kin lobby for change rather than sending in the lawyers.

I hope the state works something out, otherwise an awful lot of people are going to die over malpractice insurance in the next few months...so if you live in southern NV, drive safely and try not to get shot, mmkay?


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Don't crash in Las Vegas : UMC Trauma Center shuts. | 90 comments (86 topical, 4 editorial, 0 hidden)
You'd Collapse To If You Were Sued To Hell... (3.50 / 10) (#1)
by thelizman on Fri Jul 05, 2002 at 01:04:38 AM EST

In short, the US Healthcare system is collapsing,
This is not a problem of the health care system, it's a problem of the legal system. There are so many frivolous lawsuits (I would venture to say that they are the legal equivalent of trolls) and ludicrous payouts that several sectors are collapsing under the weight of sue-happy lawyers. Even the legal system can hardly catch up.

"Our language is sufficiently clumsy enough to allow us to believe foolish things." - George Orwell
Screw your dogma (3.83 / 6) (#2)
by Rahaan on Fri Jul 05, 2002 at 01:14:43 AM EST

Don't be so prejudiced.  Can't it be a little from Column A and a little from Column B?

you know, jake.. i've noticed that, since the tacos started coming, the mail doesn't so much come as often, or even at all
[ Parent ]
tort reform.. (4.25 / 4) (#5)
by infinitera on Fri Jul 05, 2002 at 01:54:31 AM EST

it's what corporations' wet dreams look like. And such an innocuous sounding phrase - Barnays [founder of PR industry in US] himself could not have done better.

[ Parent ]
I don't think tort reform is the answer (4.33 / 3) (#6)
by llamasex on Fri Jul 05, 2002 at 02:03:51 AM EST

But how about giving some of these doctors some sort of good faith protection.

Howard Dean punched me in the face
[ Parent ]
pop tort reform (4.00 / 1) (#46)
by thelizman on Fri Jul 05, 2002 at 12:26:16 PM EST

The problem with tort reform is that it is hard to structure such legislation so that the truly wronged won't be denied justice. If the doctor is supposed to remove my tonsils and takes my legg instead, I want that biatch to pay. But when dumb ass old ladies order hot coffee, then spill it on their own snatch, they don't have the right to sue McDonalds for their personal incompetance.

There are far grander problems with the legal system, however. "Guilty" by Judge Harold Rothwax is a good book to read on this issue.

"Our language is sufficiently clumsy enough to allow us to believe foolish things." - George Orwell
[ Parent ]
Don't pop torts... (none / 0) (#73)
by gte910h on Fri Jul 05, 2002 at 10:19:59 PM EST

...catch on fire if you cook them for three minutes? :)

[ Parent ]
dunno, I get toaster strudles [n/t] (none / 0) (#87)
by thelizman on Sat Jul 06, 2002 at 11:50:59 PM EST


"Our language is sufficiently clumsy enough to allow us to believe foolish things." - George Orwell
[ Parent ]
Screw My Dogma, I'll Screw Your Catma (none / 0) (#45)
by thelizman on Fri Jul 05, 2002 at 12:23:08 PM EST

I never said there wasn't. The vast majority of lawsuits that go through are legal system are legitimate. But it takes far fewer sharkbites, SLAPPs, and outrageous awards to cripple a system.

"Our language is sufficiently clumsy enough to allow us to believe foolish things." - George Orwell
[ Parent ]
Oh, I see (none / 0) (#89)
by Rahaan on Sun Jul 07, 2002 at 07:43:03 PM EST

So when you say "It's not a problem with the health care system" you actually mean that it is, partly, a problem with the health care system.

you know, jake.. i've noticed that, since the tacos started coming, the mail doesn't so much come as often, or even at all
[ Parent ]
frivolous lawsuits (3.66 / 6) (#8)
by streetlawyer on Fri Jul 05, 2002 at 04:58:37 AM EST

There are so many frivolous lawsuits (I would venture to say that they are the legal equivalent of trolls) and ludicrous payouts

To refer to a lawsuit as frivolous is to suggest it has no legal merit whatever. To refer to a lawsuit which was successful as "frivolous" is either a complete misuse of the word or an accusation of complete incompetence against the judge presiding.

Just because things have been nonergodic so far, doesn't mean that they'll be nonergodic forever
[ Parent ]

re: Frivolous lawsuits (3.75 / 4) (#29)
by locke baron on Fri Jul 05, 2002 at 10:04:41 AM EST

Maybe 'unnecessary' would be a better word?

Micro$oft uses Quake clannies to wage war on Iraq! - explodingheadboy
[ Parent ]
I Have No Problem With Either [n/t] (4.00 / 2) (#44)
by thelizman on Fri Jul 05, 2002 at 12:21:38 PM EST


"Our language is sufficiently clumsy enough to allow us to believe foolish things." - George Orwell
[ Parent ]
NPR did a bit about this (4.42 / 7) (#3)
by llamasex on Fri Jul 05, 2002 at 01:49:53 AM EST

Link to Real Audio
In Las Vegas, the University Medical Center's trauma center shut down today after 57 surgeons quit, citing exposure to costly medical malpractice lawsuits. Robert Siegel talks with Les Luke, chief operating officer of Mountain View Hospital in Las Vegas, about the adjustments being made at his hospital following the closing of the city's only trauma center. (4:15)
NPR does a great job covering this stuff.

Howard Dean punched me in the face
"Where there's blame, there's a claim..." (4.14 / 7) (#7)
by gordonjcp on Fri Jul 05, 2002 at 04:31:06 AM EST

There's an advert running in the UK with this as the tagline just now. I wish people would realise that sueing someone doesn't give you free money - it pushes up insurance. It even pushes up *your* insurance.

I'd love to find a suitably frivolous case, and take the company sueing for damages to court - for fraud.

Give a man a fish, and he'll eat for a day. Teach a man to fish, and he'll bore you rigid with fishing stories for the rest of your life.

Cycling publications (4.00 / 4) (#16)
by thebrix on Fri Jul 05, 2002 at 08:34:17 AM EST

They're a great favourite of such, which are almost becoming snuff magazines for lawyers; there are usually several of the 'have you had an accident in the past three years? then we can get together and milk the other party's insurance company and take about 40 per cent of the award for ourself' type of advert. Presumably they're a result of 'no win, no fee' legislation being passed, before which such a lawsuit was too risky to the plaintiff.

I've even had such adverts pushed through the door on pieces of paper together with the usual leaflets for rubbishy pizzas, cleaning companies 'in your area for the next few weeks' as though they travelled to work on flying saucers, and so on.

[ Parent ]

I had a near one with a cyclist... (4.00 / 1) (#55)
by gordonjcp on Fri Jul 05, 2002 at 02:03:51 PM EST

... a few months ago.

Said cyclist decided to cross a junction *against* a red light. Now, first off - decide, you mad cyclists! Are you "pedestrians", of a sort? Then cross with the green man. Are you vehicles? Then obey the traffic lights! Anyway, this cyclist swerved to avoid me, and fell off. He decided that I'd knocked him off (stupidly, I stopped to help him - had I known he was going to be such a wanker I'd have run him over properly). He had, in fact, noticed me at the last minute, and swerved and hit the control box for the traffic lights.

Now, if you're cycling along a busy road, and decide you're going to jump a red light, and you then *completely* *fail* *to* *see* a bloody great Volvo approaching from your 3-o'clock with lights all over it, who's fault is it?

Give a man a fish, and he'll eat for a day. Teach a man to fish, and he'll bore you rigid with fishing stories for the rest of your life.

[ Parent ]
Suing for frivalous cases (3.66 / 3) (#37)
by hollo on Fri Jul 05, 2002 at 11:06:46 AM EST

I'd love to find a suitably frivolous case, and take the company sueing for damages to court - for fraud.

I have heard of a UK doctor that was recently sued in a completely frivalous case.He later took the person who had sued him to court for defamation of character and won, so it is possible.

As for the adverts, you can see no win no fee adds in NHS hospital A&E departments now. They do at least seem to be for suing the person who you blame for the accident not the doctor who doesn't fix you up as well as you want.

[ Parent ]
Happening in Australia too (4.00 / 6) (#9)
by ovie on Fri Jul 05, 2002 at 05:14:26 AM EST

This is starting to happen in Australia too, altho things aren't quite as bad as they sound here. The insurance companies are blaming frivilous claims, with dubious evidence, as the reason for increasing premiums by rediculous amounts. This in turn is feeding politicians and the media who have declared it a 'crisis' and are doing their best to legislate away everyones right to sue, regardless of circumstance or gross negligance.

There has been very little focus on the financial status of the insurance companies doing this. From my position, with relatives in the legal profession, and an eye on the business pages (ie, im no expert) , it seems very much like a manufactured crisis to reduce the potential liability of insurance companies. It's very convenient to blame 'frivolous lawsuits' because the public does not understand the justice system (most cases of this nature are decided by juries in australia, ie, payouts by the public). It's a dangerous game these companies are playing as can be seen above.

rediculous (2.00 / 5) (#11)
by craigtubby on Fri Jul 05, 2002 at 05:39:41 AM EST

I seem to see this word quite often on Kuo5hin, is it because people use it on purpose, or a sort of community thing like USian, or can they not spell ridiculous?

try to make ends meet, you're a slave to money, then you die.

* Webpage *
[ Parent ]

i stand corrected (none / 0) (#68)
by ovie on Fri Jul 05, 2002 at 08:03:42 PM EST

i stand corrected :) i was actually half way out the door when i wrote that comment and didnt get to spell check it.. i do remember thinking it looked odd at the time.. mind was on other things

[ Parent ]
primary medical defense org is all but gone. (4.60 / 5) (#23)
by supine on Fri Jul 05, 2002 at 09:17:07 AM EST

have a read up on the woes of united medical protection (UMP).this is australia's primary medical defense organisation (MDO) (roughly 60% of australian doctors are/were covered by this company, upwards of 90% of doctors in nsw and queensland are/were covered by them) and they are broke from the escalation in payouts.

the statute of limitations is 3-6 years depending on the state (lets use 3 years as it holds in nsw) but juveniles are given to age 18 before the statute clock starts ticking. this means that someone who wants to litigate for something that happens at their birth can bring a case up to 21 years later.

this is what the insurance industry refers to as long tail. they have to allow for incidents that might come to light up to 21 years from when they happen. this is referred to as 'incurred but not reported' (INR) incidents and is one of the reasons that most insurance companies won't touch obstetricians with a ten foot pole.

medical defense organisations tried to cover all doctors by spreading some of the fees across all specialities. there was still a difference depending on the risk represented by ones work (from around AU$3000 a year for GPs up to AU$100,000+ for neurosurgeons and obstetricians) but all were asked to pay higher and higher premiums over the last decade.

unfortunately two things have been evident in recent times. doctors can't afford to pay the ever increasing premiums and, given the failure of UMP and concerns being expressed about other MDOs, that the fees aren't covering the situation anyway.

what is the solution? i'll leave that as an exercise to the reader.


"No GUI for you! Use lynx!!!, Come back, One year!" -- /avant
[ Parent ]

This might sound funny to you... (4.00 / 6) (#12)
by l3nz on Fri Jul 05, 2002 at 07:26:15 AM EST

...but in Europe this is not an issue. Maybe you should read the WHO report 2001. Living in Europe, I feel quite lucky I don't have to worry about medical insurance, and that hospitals are nearly free and still offer a high level of service.

Popk ToDo lists - yet another web-based ToDo list manager. 100% AJAX free :-)

Oh dear (4.50 / 6) (#17)
by Rogerborg on Fri Jul 05, 2002 at 08:37:13 AM EST

    Living in Europe, I feel quite lucky I don't have to worry about medical insurance

Please take the time to actually read the article. It's not about a lack of medical insurance by patients, it's about the costs of malpractice insurance for doctors.

If you want to see an example of enterprising cynicism, look at this advert for insurance for doctors. It's not even medical malpractice insurance, it's insurance against being sued by employees in the doctor's practice! One of the points it uses to crank up the fear factor is this: "There are more law students in colleges and universities than there are practicing lawyers, signaling an even greater explosion of this lucrative practice. "

I think that synopsises the problem quite neatly.

"Exterminate all rational thought." - W.S. Burroughs
[ Parent ]

Indeed (4.71 / 7) (#19)
by linca on Fri Jul 05, 2002 at 08:48:52 AM EST

In France recently, after a couple of suits over non-discovered foetus malformations that would have ended in abortion if actually noticed, but instead resulted in the birth of congenitally malformed babies, the rate of malpractice insurance soared for echography-practicing doctors. At one point so many of those said they'd simply stop practicing echographies, which might have been trouble-leading for the nation's pregnant women...

[ Parent ]
Enormous numbers (4.20 / 5) (#20)
by thebrix on Fri Jul 05, 2002 at 09:05:22 AM EST

A National Audit Office report gives the story in the United Kingdom. The observation that competent legal staff defending the claims save money is interesting, suggesting that weak complaints driven by motivated lawyers for the plaintiffs are much of the problem.

(Indeed, there are a few handfuls of fingers in the litigation pie).

[ Parent ]

chiropractors are not Doctors (3.60 / 5) (#22)
by Subtillus on Fri Jul 05, 2002 at 09:09:37 AM EST

they are dangerous people with often no medical knowledge. My mom works as a physiotherapist and can attest to the fact that they do a great deal of damage sometimes. espescailly strokes from pressure on the wrong "stuff".
While you may be thinking, who does this jerk think he is saying stuff on k5, but, you have to remember, I didn't claim to be a doctor.

[ Parent ]
Re: chiropractors are not Doctors (3.33 / 3) (#24)
by Rogerborg on Fri Jul 05, 2002 at 09:29:44 AM EST

OK, mea culpa. That was just the first link that I happened to find that illustrated my point, that all sorts of legal insurance are being sold on the back of the assertion that there are more lawyers coming up through the system. You can find more if you go looking.

That seems like a self fulfilling prophecy to me. More lawyers means more insurance means more money available means more incentive to become a lawyer means...

"Exterminate all rational thought." - W.S. Burroughs
[ Parent ]

Bias? (3.00 / 2) (#33)
by codemonkey_uk on Fri Jul 05, 2002 at 10:25:34 AM EST

Okay, so your mum, working as a physiotherapist, is in competition with chiropractors. Don't you think there is a small conflict of interests when she says that "chiropractors are dangerous people"?
"The most savage controversies are those about matters as to which there is no good evidence either way." - Bertrand Russell
[ Parent ]
Yes, they are (4.00 / 2) (#36)
by anon868 on Fri Jul 05, 2002 at 10:59:21 AM EST

Actually, Chiropractors are doctors. They go to school for 5-7 years to earn a D.C (Doctor of Chiropractic). They have to learn all the bones/muscles in the body, they take many of the same courses medical doctors do, they have to disect cadavers and take some of the hardest tests there are to get certified. No offense intended but they know a hell of alot more about the body than any physiotherapist does.
Open a window. No, not that one! One made from actual glass, set in an acual wall, you dork.
[ Parent ]
No, they're not (4.25 / 4) (#38)
by MightyTribble on Fri Jul 05, 2002 at 11:19:01 AM EST

The DC qualification was invented after the AMA refused to let them use MD, because  there's insufficient scientific basis for their treatment regimes. They're the modern-day equivilent of leaching and cupping. But if you want mumbo-jumbo and a massage that might give you an anuerysm, go right ahead.

If you want decent physical therapy, go to an osteopath. They're proper doctors - they're licensed to perform surgery, can prescribe drugs and actually know what they're doing. Anyone with an MD can't even hold a conversation with a chiropractor about the spine, because chiropractice doesn't even use standard medical terminology - they hide behind made-up words with no scientific backing.

Check this out if you want to know more. I'd rather go to an acupuncturist than a chiropractor. And yes, I don't like chiropractors. ;-)

[ Parent ]

Europeans don't pay doctors what they are worth (3.50 / 2) (#40)
by Weezul on Fri Jul 05, 2002 at 11:31:42 AM EST

I do like many of the European health care systems.  Especially the French system where doctors are free to charge more then what the government.  Still, I feal that people really should be spending 10% of their income on health care (including things like implanted cell phones, but not including malpractice inshurance).  Health care is just not easy, it has a high return on investment, and the Europeans (and the Americans) just don't take it seriously enough.  These people should be well compensated for their work.  Basically, the ideal system would be the French system where the doctors (a) went on strike all the time to get the government payments increased and/or (b) had a union to just raise their prices simultaniously.  Also, the French don't pay their collage professors enough either.

Anyway, this article was about the particular American problem of too many lawyers and has realitivly little to dow tih the cost of care or government funding of care.

"Fascism should more appropriately be called Corporatism because it is a merger of state and corporate power." - Benito Mussolini
[ Parent ]

Here's my guess at where the problem is: (4.66 / 21) (#14)
by Rogerborg on Fri Jul 05, 2002 at 08:26:24 AM EST

  • The United States has only five percent of the world's population, but seventy percent of the world's lawyers.
  • That's one lawyer for every 275 people and rising all the time.
  • That's more laywers than doctors. Imagine if all of the $132 billion that's spend on tort liability every year went to medical research.
  • There are very nearly one million lawyers in practice in the US. But shockingly, there are more law students in colleges right now than there are in practice. This is actually leveraged as a reason to buy better malpractice insurance, on the bald assumption that many of those new layers will try to get involved in lucrative litigation.
  • Half of both Congress and the Senate are members of the American Bar Association, as were the previous President and her husband.

Why are there so many lawyers? Because practicing law, particularly litigation, is lucrative. Why is it litigation lucrative for lawyers? Because lawyers charge high fees. Why can they charge high fees? Because their clients (or cats-paws depending on how you see it) are awarded high amounts? How is this sustainable? Because insurance companies can raise their fees to sustain it. Heck, they even justify that based on the simply observation that there are more lawyers out there looking to make a fast buck every day!

So does this effectively amount to a lawyer tax? I believe that it does. Do we want a layer tax? I certainly don't. So how can we address it?

What I can't see working is bringing in more legislation to try and fiddle with insurance. Trying to limit the amount that insurers can pay out, or stopping insurance covering legal fees would only punish those without the resources to scam the system. The main area of change is the courtroom.

  • Simplify proceedings and produce plain language crib sheets so that parties in civil litigation have a realistic chance of defending themselves. If you can't translate from legalese to English (and Spanish and...) then you have a law that's written for the benefit of lawyers, not for we, the people. Saying that you can't simplify laws is equivelant to saying that only lawyers can interpret law, and that gives lawyers absolute power over justice, which I find abhorent.
  • Allow the defence to disclose details on the plaintiff's previous legal actions. Let juries know when they're dealing with a serial litigator. Yes, this will prejudice them with respect to the current case, but damn it, we know people are scamming the system. We can either continue doing nothing about it, or we can let juries choose whether they want to address it.
  • Produce a national scale of reasonable settlement amounts and make it available to juries with advice that they view these as maximums.
  • Make it more common for courts to award both side's legal costs to the winning party, especially if it's the defendant. At the moment, it's common to have to counter-sue just to recover costs (and then you tack on emotional distress to scam a profit). Only the lawyers win when that happens.
  • Give courts carte blanche to award punitive damages against both sides. Suits over trivial matters should never come to court. Award Bob $10 token damages from Sally, and then fine them both the equivelant of a week's worth of income or gross revenue for wasting the court's time. Gasp! But that makes just defending litigation risky! Sure, but remember that many winning defendants then launch counter suits in the hope of winning money. Make litigation a no-win prospect for both parties. For an action to reach court, it's likely that at least one party is acting unreasonably, but let's not blind ourselves to the possiblity that both parties might be acting unreasonably.
  • In the case of civil litigation, recognise that council is acting as a paid agent of the client, not as an independent advisor. Council does most of the talking, and council has a vested financial interest in winning. So why does do we allow council in a civil case to be exempt from penalties if the case is thrown out as frivilous, or if the court decides that the plaintiff and/or defendant has acted unreasonably to allow it to come to court at all?

Gasps of outrage about that last one, I suspect. We have a notion that council must be treated as completely independent. Well, in civil litigation, it isn't. I'll just assert that flatly, because it seems so blindingly obvious. I'm not talking about public defendants or prosecutors working in criminal cases, I'm talking about parasites that make their living cleaving the spirit of the law apart from the letter for a personal share of the profit. If council really was just providing advice, this wouldn't be the case, but legal proceedings are run almost entirely by council. The actual parties in a case have almost no say in how it proceeds. And I believe that we've now accepted the insidious attitude that because we've allowed justice to be run by lawyers, it might as well be run for lawyers.

You want one of many, many examples? How about the lawyer in Illinois that billed a divorce client for time spent having sex with her. But that's just petty greed. You want to know the part that actually makes me wheeze in despair? That same lawyer was later appointed to the Illinois Supreme Court's Committee on Character and Fitness.

Enough. We're well beyond the point where it's commonly acknowledged that the system isn't working, and it's effecting us in our daily lives. I, for example, used to perform historic weapon reenactments and displays at public shows, usually at cash-poor historic sites, usually absolutely free or for token (~$10 - $20) compensation. I no longer do this, because clients absolutely insist that I carry personal liability insurance (in addition to their insurance), and the cost has simply become prohibitive for what is in effect a hobby and a volunteer educational service ($60 a year eight years ago, now $350 a year and rising, along with insistences that we put up signs and announce to the audience that it's dangerous to stick your head in front of a swinging sword, and no, I am not joking). And the worst part? There are almost no accidents at these events, ever, nor has the record got worse over the years. But insurers are pumping up premiums to cover their cost in other areas, and even specialist insurers are raising theirs to match (just because they can). That's the Lawyer Tax in action, right there.

So if we all know that this is wrong, why aren't we doing anything about it? It beats me. Unless, of course, it's something to do with half of the Legislative branch being lawyers. Do you think that might just possibly be a factor?

"Exterminate all rational thought." - W.S. Burroughs

American Trial Lawyers Association ... (3.50 / 4) (#26)
by MightyTribble on Fri Jul 05, 2002 at 09:34:21 AM EST

... opposes liability caps.

Why? Because they get a cut of any claim settlement. Cap liability claims, and you cap their income. Instead of getting a 50% cut of $5 mil, they may only get 50% of $250,000. That's hardly enough for a lawyer to live on. ;-)

[ Parent ]

Frivolous civil suits (4.00 / 6) (#30)
by bsee on Fri Jul 05, 2002 at 10:13:25 AM EST

So why does do we allow council in a civil case to be exempt from penalties if the case is thrown out as frivilous, or if the court decides that the plaintiff and/or defendant has acted unreasonably to allow it to come to court at all?

This is inaccurate.  If a lawyer files a frivolous civil suit, he is liable to be sanctioned by the Court, and could be liable for, among other things, the cost of the other side's fees.  Take a look at Fed.R.Civ.P. 11 (and the analogous state rules).

Perhaps the problem, though, is that the standard for determining what is "frivolous" is so high.  So the end result is that very little is "frivolous", because a good-faith argument for the extension of the law (or a change in the law) could be made.  

[ Parent ]

Challange: (3.00 / 1) (#48)
by MMcP on Fri Jul 05, 2002 at 12:44:42 PM EST

I challange you to actually back up this statistic:

The United States has only five percent of the world's population, but seventy percent of the world's lawyers.

Not by linking to some dubious article, but maybe to a .gov or a .edu site, or a site with a bunch of numbers in it and a picture of guys in lab coats.  I really suspect this is a Phoney Internet Statistic - not the first.

[ Parent ]

I am up to that challange... (5.00 / 1) (#50)
by MMcP on Fri Jul 05, 2002 at 12:58:38 PM EST

Check it, yo: Facts

As of 1987, this country actually had only 9.4 percent of the worlds 7.3 million lawyers...

There are enough numbers and references on that page to make me happy.

[ Parent ]
Law providers. (none / 0) (#64)
by Mitheral on Fri Jul 05, 2002 at 04:53:13 PM EST

The link is a really good article that at defines the problem of comparing per capita lawyers. I don't agree with the final conclusions based on his number but it does point out why any wide rangeing comparison is difficult if not impossible.

[ Parent ]
It's not the lawyers, it's the judges (3.50 / 2) (#54)
by werner on Fri Jul 05, 2002 at 01:55:38 PM EST

Ultimately, I don't think the lawyers are to blame. If American judges are prepared to award ridiculous sums of money for equally ridiculous reasons, then obviously there are going to be hordes of hopeful lawyers lining up and rubbing their hands.

Let me illustrate my point:

  • A woman sues McDonalds because their coffee is too hot. Hot coffee? Who would have thought it?
  • Another woman sues Burger King because she slipped and fell on a puddle of cola on the floor of the restaurant. It had got there when she had thrown her drink at her boyfriend immediately prior to falling.
  • A third woman sues a shop when she falls and injures herself as a result of an out-of-control child running around the store. It was her son.

All these people won large amounts of money. There appears to be a great lack of common sense amongst American judges.

Furthermore the payouts are phenomenal. Say for argument's sake 3 doctors, one in the US, one in the UK and one in Germany, all accidentally amputate the wrong leg.

The American victim can reasonably expect the kind of sum that would buy a football club six to ten of the finest legs in world football, perhaps the entire Brazil team.

Our unlucky Brit can expect enough to buy a fairly large house, as long as he doesn't live near London. If proposed government reforms go through, he would instead receive benefits for the rest of his life matched to the costs incurred by the mistake ( care, medication etc.).

Last of all, the unfortunate German is, in a word, fucked - you can't sue a doctor in Germany. They'll lock you up if you run someone over, but doctors in Germany do not pay for their mistakes. The victim will receive state benefits.

While anyone can see that the German system is utterly inadequate, it does highlight the extreme differences between the American legal system and European ones.

To my mind, these are the two essential problems of the US legal system: ridiculous payouts and a failure to hold people responsible for their own stupidity.

[ Parent ]

Gah (4.00 / 2) (#58)
by fluffy grue on Fri Jul 05, 2002 at 02:44:48 PM EST

The McDonald's coffee case wasn't about the coffee merely being "too hot," but being dangerously hot so as to cause third-degree burns and necessitate major surgery. That's not just "too hot."
I am a calm and tranquil flower.

Try the new Aborted Fœtus McFlurry! Cool and refreshing!
[ Hug Your Trikuare[ Parent ]

Repeated pattern of problems (details) (4.66 / 3) (#61)
by fencepost on Fri Jul 05, 2002 at 04:11:40 PM EST

Some items about the McDonald's hot coffee case:
  • The initial request was $20,000 to cover the cost of 7 days of hospitalization and skin debridement. McDonald's countered this with an offer of $800, and refused later offers (and a recommendation from a mediator) to settle for $200-300,000.
  • The burns were full-thickness, a.k.a. third degree.
  • McDonald's produced records of more than 700 claims against it for coffee burns (including other third-degree burns), some of which had been settled for more than $500,000.
  • McDonald's coffee was 45-50 degrees (F) hotter than typical home coffee, and was 20+ degrees hotter that at any other restaurants surveyed by McDonald's law firm.
  • Liquids at the temperature of McDonald's cofee cause third-degree burns with 2 to 7 seconds of contact.
  • McDonald's QA people testified that they were aware of the dangers but did not regard them as sufficient reason to lower the temperature.
  • The original award was $200,000 in compensatory damages, minus $40,000 because it found her 20% at fault.
  • The jury awarded $2.7 million in punitive damages, or ~2 days worth of coffee sales; this was later reduced by the court to $480,000 (three times the damages amount).
  • After the verdict, the parties reached a confidential settlement, presumably "We'll give you $X to end this now, or we'll appeal the decision."
  • "A Matter of Degree: How a Jury Decided That a Coffee Spill Is Worth $2.9 Million" by Andrea Gerlin, The Wall Street Journal, September 1, 1994
  • The 'Lectric Law Library

"nothing really says "don't hire me, I'm an idiot" quite as well as misspelling "pom-pom" on your resume." -- former Grinnellian
[ Parent ]
So what if the coffee was "too hot"? (none / 0) (#69)
by kcbrown on Fri Jul 05, 2002 at 08:39:46 PM EST

Others have pointed out that this wasn't an isolated incident, that there were a number of incidents in which people were burned by McDonald's coffee, and that this problem was widespread.

Well, this leads me to ask the obvious question: was this the first time this woman had purchased too-hot coffee from McDonald's in the recent past? Because McDonald's is so prevalent and because they apparently had a policy of making the coffee hotter than perhaps it ought to be, I think it's pretty reasonable to assume that she had purchased coffee from McDonald's before and that the coffee was too hot in those previous instances.

If, as is likely the case, it wasn't the first time, then isn't it reasonable to expect her to be suspicious of the temperature of the coffee the second (or third, or whatever) time around? More importantly, if she found that the coffee has historically been too hot then why would she (or anyone else) continue buying her coffee there?

This is why I think the judgement is ultimately ridiculous. We will all continue to pay as long as we insist on protecting people from their own stupidity.

[ Parent ]

Of course it wasn't (none / 0) (#80)
by sigwinch on Sat Jul 06, 2002 at 04:00:56 AM EST

...was this the first time this woman had purchased too-hot coffee from McDonald's in the recent past?
Indeed. Courts do not exist to serve the prevailing parties in lawsuits, they exist to serve *the public*. As such, when a tort is alleged the court should examine the actions of *all* of the respondents. All respondents who knew, or should reasonably have known, that they were creating a hazard should go to jail. If a plaintiff knew, or should reasonably have known, that they were contributing to the alleged hazard, they should be declared mentally incompetent and imprisoned forever.

I don't want the world, I just want your half.
[ Parent ]

Myths... (5.00 / 1) (#65)
by tdismukes on Fri Jul 05, 2002 at 05:06:26 PM EST

Fencepost has already noted the relevant facts on the hot coffee case - that the coffee was 50 degrees hotter than other establishments or homemade coffee, that this produced 3rd degree burns (and had done the same in previous cases), that the lady in question originally wanted to settle for just enough money to cover her medical expenses - but McDonalds turned her down, etc, etc.

I just wanted to note that your other 2 examples are apparently urban legends, at least according to Snopes. It's probably best to fashion public policy on the facts, rather than propaganda put out by the insurance companies.

[ Parent ]

okay, bad examples... (none / 0) (#88)
by werner on Sun Jul 07, 2002 at 04:06:34 PM EST

And the rest? Can you refute my claims regarding medical damages? They are, after all, the salient ones...

[ Parent ]
oh come on (none / 0) (#85)
by blisspix on Sat Jul 06, 2002 at 07:58:34 PM EST

it's so easy to lawyer bash, isn't it?

I want to go to law school when I've finished my PhD. I don't want to practice, I just want to have an understanding of it so I can help people in my current profession, librarianship.

I think you'd find that a lot of those students in law school don't want to practice either. Some will become researchers, some academics, some will go back to their old careers, and some will join legal aid.

I blame people. In Australia, every day there is another case in the paper of "$4 million payout for falling from a tree" and suchlike. People are getting ridiculous amounts of money for doing completely stupid things. Others then get the idea that maybe they could get money for slipping on a pea in supermarket. And on it goes.

Yes, there should be torts reform, but people also need to be made aware that they are responsible too.

[ Parent ]

question (4.25 / 4) (#15)
by streetlawyer on Fri Jul 05, 2002 at 08:27:21 AM EST

What caused this closure? Malpractice insurance. It's getting ridiculously high. Attending physicians run practices at hospitals, and bill the hospital for services they provide to the patients. The hospital, in turn, bills the patient. At least that's how it's supposed to go. However with Medicare not paying the full cost of service, and ERs not able to turn anyone away, irregardless of ability to pay, there's often a problem of bills not getting paid. Add to that insurance premiums in excess of $150,000 dollars (when your salary might be $200,000, out of which you have to pay practice administration costs as well),

Are the doctors salaried employees, or are they independent practitioners whose income comes from billng the hospitals? This would seem quite an important point and this para. isn't very clear.

Just because things have been nonergodic so far, doesn't mean that they'll be nonergodic forever

Most consultant doctors are in private practice. (4.40 / 5) (#25)
by MightyTribble on Fri Jul 05, 2002 at 09:32:16 AM EST

That means that groups of doctors form partnerships, much like law firms do, and then provide billable services to the hospital under a contract agreement. So they're employees/partners of "Doctor and Co.", which contracts to the hospital at a given rate.

Some doctors are employed directly by the hospital  - the residents and medical directors, for example. But most of the 'hot talent' (the trauma surgeons and other specialists) are private practice who agree to provide service to the hospital.

[ Parent ]

Must it be... (3.50 / 4) (#18)
by ariux on Fri Jul 05, 2002 at 08:38:14 AM EST

...the size and frequency of actual awards?

Couldn't it just be price fixing? It's not like anybody is watching.

As an aside, it sounds like we need some good muckraking. "Unconscious victim starves to death on ER floor!!" sort of thing.

Not really (none / 0) (#76)
by BeBoxer on Fri Jul 05, 2002 at 11:25:46 PM EST

The potential for price-fixing going forward certainly exists, largely because companies are fleeing the malpractice insurance business altogether. While the remaining few companies might (will?) start price fixing, the numerous companies leaving altogether certainly aren't price fixing.

[ Parent ]
"Irregardless"?? (2.00 / 7) (#21)
by What She Said on Fri Jul 05, 2002 at 09:09:06 AM EST


A little nitpick <OT> (2.71 / 7) (#28)
by phatkat on Fri Jul 05, 2002 at 09:35:21 AM EST

I wanted to make one incredibly small clarification about a word you used in your interesting and well stated article. The word "irregardless"--depending on who you ask--is a word that does not exist.

Irregardless is nonsensical: dictionary.com calls it "the logical absurdity of combining the negative ir- prefix and -less suffix in a single term." The word in practice is identical to "regardless," except with a needlessly confusing twist.

If you'll pardon my own patois, It's a form of vocabulation. Sort of like "inflammable." Except "inflammable" is a word, and those who don't learn it never advance from the shallow end of the gene pool.

It exists (3.50 / 2) (#31)
by pmc on Fri Jul 05, 2002 at 10:14:10 AM EST

"Irregardless" definitely does exist, but is frowned upon. It may seem nonsense, but other words - deboned and unravel* - also employ the double negative whilst meaning a single negative without attracting such scorn.

I'll reserve my ire for "raze to the ground"

* I do like a definition for ravel at dictionary.com - "1. To separate the fibers or threads of (cloth, for example); unravel".

[ Parent ]

OED says... (5.00 / 1) (#47)
by MMcP on Fri Jul 05, 2002 at 12:32:26 PM EST

Will I get sued for Cut'n'paste OED-style?

Anyways, it has a pretty tenuous hold on the whole being a word thing, but judge for yourself:

In non-standard or humorous use: regardless.

  1912 in WENTWORTH Amer. Dial. Dict. 1923 Lit. Digest 17 Feb. 76 Is there such a word as irregardless in the English language? 1934 in WEBSTER (labelled Erron. or Humorous, U.S.). 1938 I. KUHN Assigned to Adventure xxx. 310, I made a grand entrance and suffered immediate and complete obliteration, except on the pay-roll, which functioned automatically to present me with a three-figure cheque every week, `irregardless', as Hollywood says. 1939 C. MORLEY Kitty Foyle xxvii. 267 But she can take things in her stride, irregardless what's happened. 1955 Publ. Amer. Dial. Soc. XXIV. 19, I don't think like other people do and irregardless of how much or how little dope would cost me [etc.]. 1970 Current Trends in Linguistics X. 590 She tells the pastor that he should please quit using the word `irregardless' in his sermons as there is no such word. 1971 M. MCSHANE Man who left Well Enough iv. 96 The sun poured down on Purity irregardless of the fact that it received no welcome.

[ Parent ]

Or it could be... (3.00 / 1) (#32)
by R343L on Fri Jul 05, 2002 at 10:16:46 AM EST

It should mean something like "not without regard". In other words, a negative way of saying with regard. :) "ir-" is the assimilated form of a negation prefix (from latin) and "regardless" means "without regard or care". Of course, "ir-" could be the assimilated form of the latin prefix for "in, into or within" and then my definition wouldn't work. I rather like the idea of a double negative that actually means "with care". Unfortunately, its meaning is exactly opposite its colloquial meaning.

"Like cheese spread over too much cantelope, the people I spoke with liked their shoes." Ctrl-Alt-Del
[ Parent ]

Eh, that's what you get with Websters. :-) (4.66 / 3) (#39)
by MightyTribble on Fri Jul 05, 2002 at 11:26:29 AM EST

I'm sure irregardless is in the OED. While an editor at Websters may not like it, I use it. So they're wrong. Just look at how they spell colour, for crying out loud! They're cranks! CRANKS, I tell you! ;-)

Besides, where's my props for correct useage of ultracrepidation? Huh? Huh? That's not even in Websters, which shows what they know. Cranks.

[ Parent ]

I think, whatever points you got,... (4.00 / 1) (#42)
by special ed on Fri Jul 05, 2002 at 11:37:37 AM EST

you lost 'em for misspelling 'usage'.


Meanwhile, the world turns foolishly on and ants tickle his butt.
[ Parent ]

well, since we're nitpicking . . . (none / 0) (#59)
by Gumpzilla on Fri Jul 05, 2002 at 02:52:35 PM EST

The word you used in the article was "ultracrepidarian," not "ultracrepidation." And since the link you gave mentions that this word is an adjective, and you used it as a noun (I'm a bit of an ultracrepidarian), you'll be getting no such props from me.

Aside from that, nice article.

[ Parent ]
Damn you, Gumpzilla... (none / 0) (#77)
by MightyTribble on Fri Jul 05, 2002 at 11:46:07 PM EST

Er. It was a test. Yeah, that's right. I was just checking to see if you were paying attention. Well done, good eye. Carry on.

[ Parent ]
Market forces (3.44 / 9) (#34)
by Herring on Fri Jul 05, 2002 at 10:25:53 AM EST

Assuming a completely capitalist system, then if it costs more to provide emergency healthcare than people are willing to pay for it then nobody will provide it. These costs have to include the costs of malpractice suits as passed on to policy holders by insurance companies. Eventually, it will become uneconomical to provide healthcare to any but the richest. (I realise that this is a precis of the article.)

What is the answer though? Does the law in the US allow for cheaper healthcare to be provided to those that sign a disclaimer (saying they will not sue) first? What is that disclaimer worth? What about someone who cannot sign because they are unconcious?

I fully expect to see people suing firemen next because they sustained a bruise to the head whilst being carried out of a burning building. Let them burn, let them die - it's safer.

Say lol what again motherfucker, say lol what again, I dare you, no I double dare you
Lawyers (3.75 / 8) (#35)
by aberryman on Fri Jul 05, 2002 at 10:41:56 AM EST

I'd like to post something in defense of lawyers, since they seem to be targeted by quite a few members of the k5 community as the root of the problem.

First of all, not all lawyers are involved in suing other people for profit.  There are many other useful things lawyers do:

- wills
- tax law (so you can pay the least amount to Uncle Sam)
- business mergers

And so on.  Not to mention that I'm sure you would like a lawyer defending you if you were wrongly accused of a crime.

The point I'd like to make is that yes, there are unscrupulous persons that practice law, but there are unscrupulous people in any business.  Is there any difference between the ruthless unethical behaviour of Microsoft, pre-breakup-AT&T, Ford for creating the pinto, etc., and a lawyer suing for quick cash?

Also, remember that lawyers don't sue - people sue, using lawyers.

lawyers do so (4.00 / 2) (#43)
by squinky on Fri Jul 05, 2002 at 11:58:09 AM EST

My understanding of class action is that a law fimr thinks-- "here's some money to be made", then gets people to join the class, sues, gives everyone in the class $2, and walks away with $3 million.

That could be totally wrong of course.

[ Parent ]

To a large extent... (5.00 / 2) (#75)
by BeBoxer on Fri Jul 05, 2002 at 11:23:02 PM EST

Lawyers are needed in order to deal with lawyers. It's a self-serving cycle. Wills only get complex if you are trying to protect yourself against future lawsuits from smarter lawyers. You need tax lawyers because tax lawyers write the overly complex tax laws. Now I know that there are exceptions, but to a large extent normal folks need lawyers in order to deal with all of the lawyer-created complexity in our legal system.

[ Parent ]
Nurse problem as well (4.00 / 6) (#41)
by Nukelear on Fri Jul 05, 2002 at 11:32:38 AM EST

In addition to this problem there currently seems to be a nation wide shortage of nurses. Speaking stricly from the local sense, we have three hospitals, 2 for-profit and 1 non. Nurses realizing they are in short supply quit the stability of having a steady job and go into freelance mode jumping from hospital to hospital as the pay increases. Most nurses down here seem to be making around 75-100$ an hour.

I'm not saying it's bad that nurses get paid a lot of money; they do work I wouldn't want to do. But they are draining all the money out of our hospital. Every section, save one (imaging), operates at a loss and the nurse problem only exacerbates the problem here.

Just my rant on the problems of hospitals. I personally would like socialized medicine.
-- Dustin Lewis Freelance Hacker Greatest sword fighter in the world --
$75-100 AN HOUR?! (none / 0) (#79)
by Jaboski on Sat Jul 06, 2002 at 02:20:24 AM EST

Could you post the name and location of these hospitals? Nurses can get pretty good pay nowadays(especially agency/travelling ones), but that sounds slightly inflated to me.

[ Parent ]
A misplaced sense of entitlement (3.50 / 2) (#49)
by twh270 on Fri Jul 05, 2002 at 12:46:12 PM EST

It seems a lot of people have a sense that they have a right to get whatever they expect, and that when they don't get it, someone must be at fault and therefore must pay.  (Anyone will do, but preferably whoever has the most money.)  And there are lots of these expectations surrounding "safety" and "perfection" when it comes to professionals and companies.  They must always do the right thing, must never harm someone (unintentionally or not), must never make a mistake.

In addition, there's a general climate of distrust today.  An attitude that you just can't trust anyone anymore permeates our culture.  Anyone we don't know is suspicious; our kids are taught "never talk to strangers", and must conform to a narrow range of "normal" behavior or be subjected to discipline and counseling at school.  So that makes for a viewpoint that gives people very little reason to believe in others.

The burgeoning legal system is just a symptom of these problems, IMO.  

why this is happening here (4.66 / 3) (#51)
by Jeffrey on Fri Jul 05, 2002 at 01:22:36 PM EST

I am a resident of the Las Vegas area and this situation troubles me greatly. From what I understand a lot of this problem stems from the fact that the state of Nevada doesn't have good limits on the amount of money someone can sue for in a malpractice case. Say someone is pregnant and does not get any prenatal health care (i.e. never goes to see the doc while pregnant). Then she shows up to the er to have her kid and there are complications and the child dies of something that could have been prevented. She could now sue the doctor for a ridiculous amount of money. This makes the insurance the doctors need very expensive almost to the point where they can't afford it. Now correct me if I am wrong but I believe that other states have laws which limit the amount you can sue for, which in turn keeps the cost of malpractice insurance down. Hopefully the state government will quickly pass laws to rectify this situation.

Nevada pre natal care (5.00 / 1) (#62)
by Mitheral on Fri Jul 05, 2002 at 04:23:25 PM EST

Isn't it Nevada that has obstetricians closing their doors because they can't afford the malpractice insurance? Talk about your double edged swords, can not see a OB before birth because none of them are accepting new patients and the number of ER beds is being reduced. Here's a link Doctors Leaving Las Vegas

[ Parent ]
Obstetrical malpractice (5.00 / 1) (#72)
by Donna on Fri Jul 05, 2002 at 09:59:05 PM EST

> Say someone is pregnant and does not get any prenatal health care (i.e. never
> goes to see the doc while pregnant). Then she shows up to the er to have her
> kid and there are complications and the child dies of something that could
> have been prevented. She could now sue the doctor for a ridiculous amount of
> money.

Actually, if the child dies, the US court system says the parents are NOT due much money. It's when the child is permanently disabled that parents get million dollar awards.

A severely disabled child will need uninterrupted health insurance even though one parent will probably have to stay home for as long as the child lives. He might also need a lot of equipment that isn't covered by insurance, the house might need to be remodeled to accommodate a wheelchair, etc. There is no "social security disability" to replace the income of a mother who was planning to put the child in nursery school at 18 months and go back to work. No wonder they listen to lawyers who tell them it must have been the doctor's fault.

Ironically, years of lawyers suing because the doctor didn't do a cesarean section have caused an epidemic of unnecessary cesarean sections. It was once hypothesized that "fetal distress" could be detected by electronic fetal monitoring, and cerebral palsy prevented by rescuing babies with cesareans. However, this turned out not to be the case, and the cause of cerebral palsy remains unknown. Most pregnant women are still tied to the machines now, though, because it became "standard of care" before the data was examined and now to deviate from that standard could invite a lawsuit.

I personally believe that American pregnancy and birth care is the worst among all developed countries, and our infant mortality, cost, and cesarean rate support that belief. However, as insurance companies raise their rates due to their stock market losses last year, many doctors and midwives are just giving up on catching babies...and that's not going to fix anything. We've got to find some way other than a private lawsuit to help parents cope with sick kids.

[ Parent ]
List of articles (4.00 / 2) (#52)
by doormat on Fri Jul 05, 2002 at 01:32:55 PM EST

Articles from the local newspaper

Preface: I live in Vegas..
Its a shame that the lawyers are being greedy. The sad part is that I look at the amount of people at the local university (UNLV) in the Criminal Justice and other pre-law programs, and that I talk to who want to be a lawyer. UNLV has its own law school now, and I wonder as the proliferation of law students and thus graduates isnt just going to make the situation worse.

I think of the commercials I see on TV all the time now, most memorably the commercials for Edward M. Bernstein and Associates, whos tagline is something along the lines of if you've been hurt, we can get you compensation. Its only going to get worse in the city before it gets better. And the current govenor doesnt care enough to call a special session for the legislature to past tort reform.

Ambulance Chasers keep 500 ft back


Don't sue the medics! (4.00 / 2) (#53)
by avleenvig on Fri Jul 05, 2002 at 01:48:19 PM EST

It's not hard, really.
Doctors should be above being 'sued' for their mistakes in the hospital when the perform the wrong actions or the right actions badly, or do't do anything when something should be done.

Their jobs are hard enough as it is. LEAVE THEM ALONE. So your <insert relationship to person> died because the doctor gave them too much of one medicine or not enough of another. So it happened because they were walking into the room, tripped over their feet and this resulting in <insert horrible fatal accident here>.

How many lives do these people SAVE? If they accidentally lose one, they're human. Do you people out there suing doctors know what that means? It means they're allowed to make mistakes. It's unfortunate, but if you're only looking to maky money from your loss, maybe you should look again at your priorities.

Doctors should still be in reach of losing licenses and criminal law which results in jail sentances or community service, but people should not be able to sue them for money.

Apart from the one case, where the 'bread winner' of a household dies leaving financial responsibilities on those who ACTUALLY cannot cope, I can't think of a single reason to sue a doctor. Someone care to enlighten me?

It's checks and balances (4.00 / 3) (#56)
by squinky on Fri Jul 05, 2002 at 02:09:17 PM EST

I'd be fine with not suing if the docs were salaried, but they're not.

They're paid by procedure and by the hours to perform those procedures. Each procedure is a risk to the patient. Though there are a great many that are necessary, there are some that are of little or questionable value, but they are nontheless lucrative.

Financially, it is in the doc's best interest to poke you full of as many holes as possible, because there is a bill associated with every hole. Regardless of whether you needed it. (I'm not saying they *do* that, but they do have the motive).

You don't ask the barber if you need a hair cut.

This is a sticky mess-- because if they were salaried, then they'd do as little as possible, which may be worse (though my guess is it would be better-- especially with regards to prescriptions).

Medicine will always be a business of weighing health versus dollars.

[ Parent ]

Suing doctors (3.50 / 2) (#57)
by catseye on Fri Jul 05, 2002 at 02:44:18 PM EST

I can give three reasons to sue doctors:
  • Operated on the wrong patient
  • Removed/operated on the right patient, wrong body part
  • Malpractice caused by doctor substance abuse (doctor was drunk/high)
Basically, the only recourse a patient with a legitimate complaint has to punish a doctor is to sue. There is no system in place in the US to keep track of the actual number of mistakes that are made by doctors or other hospital personnel. As such, there is no punishment except in cases where the hospital administrators fire a doctor for gross negligence, or the particulars come out through malpractice or wrongful death suits.

Here's an example of malpractice that could not be prosecuted via lawsuit or any other means. My mother had cosmetic surgery done in the early 1980's. She had the fatty deposits above her upper eyelids removed. The person responsible for giving her the sedative one hour prior to the operation fucked up. She was given the sedative right outside the operating room. She was fully conscious during the procedure, strapped down (which is apparently standard procedure for twilight sleep anesthetics in many cases, as the patient may flail his/her arms around) and could feel the entire thing. When she said she could feel it, the OR staff responded that she was just being hysterical and she should just calm down. No effort was made to calm her down, nor was any effort made to check her medication level. The doctor also hit one of her eyes with the cauterizing iron, and she has problems with twitching in that eye to this day. Because the doctor was a highly respected plastic surgeon at a world-renown medical center, she could not get any other doctors to testify that what happened was malpractice, so she had no case. Reporting it to the hospital and the AMA went nowhere.

While it's hard to fault a doctor in an emergency trauma sitation, given the high level of stress and the snap decisions that need to be made, I have no trouble faulting, and suing, doctors and other medical personnel when they fuck up in non-emergency situations.

Perhaps if there were a system in place that ACCURATELY kept track of mistakes and after X number, the person would have his/her license suspended, we wouldn't need malpractice lawsuits. But, as it stands, we do.

We do need, however, to put some kind of restriction on things to get rid of the huge judgements and the frivolous lawsuits.

How can we fight Islamic Fundamentalism abroad if we do not fight Christian Fundamentalism at home?
[ Parent ]
This might sound callous (5.00 / 1) (#74)
by BeBoxer on Fri Jul 05, 2002 at 11:17:33 PM EST

But all surgery is a high risk procedure compared to just about anything else you do in day to day life. If your mother had had her eye burned and gotten a twitch during surgery which was needed to save her life or her eyesight, it would have seemed like a small price to pay. Likewise, even extreme pain during surgery which is needed to save her life or eyesight would have been tolerable.

It's only because your mother was having uneccessary surgery for her own vanity that she was at risk. I'm sorry your mother suffered some discomfort, but let's be clear. It was her own bad judgement that got her into the situation in the first place. Medicine is far from a perfect science. Much is still unknown, and almost all procedures carry some risk. Unfortunately, some people feel the need to sue if anything at all goes wrong at the doctor.

I think avleenvig is on the right track. The lawsuits will have to be curbed. Either legislation will limit when and for how much patients can sue for, or doctors will no longer be required to carry malpractice insurance. Because I don't think the blood-sucking lawyers are likely to stop ambulance chasing on their own.

In the end, it's the lawsuits by patients against doctors which is literally going to cripple our medical system. And this change is quite recent. In the past year or two, companies which have been providing malpractice insurance for decades are simply getting out altogether. It's not like you can accuse these insurance compaines of gauging. Most of them are leaving the business altogether. Malpractice lawsuits are destroying the entire health care system.

Personally, I prefer a health care system that is there when I need it due to disease or accident to one which has been sucked dry by people who experience discomfort during uneeded surgery.

[ Parent ]

tricky subject (none / 0) (#84)
by blisspix on Sat Jul 06, 2002 at 07:50:41 PM EST

yes there are some cases where people have frivolous claims and I can't believe they win multi-million dollar payouts.

yet doctors need to be accountable. there are too many doctors who do not keep up their training, pass their patients off onto junior registrars, make the wrong diagnoses, and overprescribe.

and there a lot of good doctors too who do the right thing, who should not live in fear of a malpractice suit.

i spent a hell of a lot of time in hospital as a child. i could have sued over half a dozen things when others have sued for less. but i didn't.

[ Parent ]

Maybe it's just... (3.50 / 4) (#60)
by Sesquipundalian on Fri Jul 05, 2002 at 03:37:45 PM EST

One of those natural adjustments that you get in an unregulated economy. Why not just leave it alone, I mean you don't want to make it worse do you?

You could wind up with a communist medical system like we have here in Canada!

Did you know that gullible is not actually an english word?
I know, I know, I shouldn't feed the troll... (3.66 / 3) (#71)
by liberalmafia on Fri Jul 05, 2002 at 09:07:13 PM EST

But if this post is serious, it's a perfect example of libertarians' lack of contact with reality.

Number one: stop using this libertarian Newspeak that confuses and conflates communism, socialism and liberalism into one brew of "badpolitics". It may make you politically correct in the eyes of your fellow libertarians, but it makes you look like an ignorant cultist and a jackass to everybody else.

Number two: get it through your head -- there are things for which the free market doesn't work, period. *No one* is prepared to die, or to watch their children or relatives or friends die, because it isn't profitable for someone to provide them with emergency medical care. We're not going to sacrifice our lives on the altar of your ill-conceived utopian notions.

Number three: last I saw, there wasn't a big fence keeping Canadians from fleeing to the U.S.

[ Parent ]

I'll feed the troll (5.00 / 2) (#82)
by lonemarauder on Sat Jul 06, 2002 at 01:25:16 PM EST

"Number one: stop using this libertarian Newspeak that confuses and conflates communism, socialism and liberalism into one brew of "badpolitics"."

Libertarian newspeak? I read and reread the original post, and I could find no newspeak. Newspeak is manufacturing terms in order to promote a particular political view, such as using the term "gunman" to describe a criminal who happens to be using a firearm. Indeed, it seems that you actually did the inventing with the clever term "badpolitics".

The only thing I could find which you could be referencing is the phrase "communist healthcare system lilke we have in Canada", to which you objected because you thought the word "communism" was misused. Okay...

dictatorship by the state.
putting the economy in the hands of the government.
The idea that an ever expanding government should be in charge of every aspect of our lives.
At best, these seem to be definitions of the same process in varying levels of completeness. Since the Canadians (within their borders) are forced to use government provided healthcare, it seems that the dictatorship level has been achieved (as evidenced by the great number of Canadians who actually do flee to the south when they get sick). Therefore, describing the Canadian healthcare system as communist is an accurate use of that word and in no way constitutes "newspeak".

there are things for which the free market doesn't work, period.

I agree. The highway system is a good example. Indeed, government provided healthcare makes sense as long as there is another country out there somewhere who has a free (as in speech) healthcare system where rewards exist for improving medical technologies and practices, and where communication is sufficient to steal their ideas. I should point out, however, that our troll friend who started this thread probably thinks a lot more like you than me, using this opportunity to make a sarcastic jab at the US healthcare system. I won't argue that there are problems with the American healthcare system, but since I've read things like HIPAA, I probably have a different viewpoint about what is bringing about those problems.

[ Parent ]
Oh bloody hell (2.00 / 1) (#63)
by ehintz on Fri Jul 05, 2002 at 04:42:47 PM EST

This isn't exactly what I wanted to see just a few weeks before Blackhat/Defcon... Now I not only have to worry about overzealous feds, but also simple accidents. Gawd bless amerika.

Ed Hintz
Economics of trauma (5.00 / 2) (#66)
by jseverin on Fri Jul 05, 2002 at 05:13:48 PM EST

I'd suspect that hospitals, being for-profit businesses, simply find that operating a trauma center does not help their bottom line. It's probably too expensive to keep enough specialists and equipment sitting around, just waiting for people to get badly injured. Thus, no more trauma center.

Trauma centers appear to be a good example of where the free market should not be. If I were a Nevadan I would think about encouraging my local and state governments to support that trauma center somehow, rather than letting the market dictate its fate. Is anyone thinking of doing that?

Hmm? (none / 0) (#67)
by ariux on Fri Jul 05, 2002 at 08:00:15 PM EST

I would think about encouraging my local and state governments to support that trauma center somehow, rather than letting the market dictate its fate. Is anyone thinking of doing that?

Well, apparently you are - why not try it and see what happens? The same thing is probably happening to hospitals in your state (I know it is in California).

[ Parent ]

I'd love to (none / 0) (#81)
by jseverin on Sat Jul 06, 2002 at 10:04:46 AM EST

but I'm not a Nevadan. I live in Manhattan, which is an unusual place. Hospitals are really thick on the ground here. I know of at least two level 1 trauma centers within a mile (!) of my apartment. So I'm fortunate in that regard.

But if I ever move to Nevada I'll be writing my representatives.

[ Parent ]

Here's my guess at where a solution must arise (5.00 / 1) (#70)
by taittiriya on Fri Jul 05, 2002 at 08:41:06 PM EST

Okay, so physicians are giving up their practices because insurance premiums are too high (among other things). Who is left to complain about the situation? Patients and insurance companies who are loosing clients. Let's assume that the insurance companies and associated lawyers have plenty of money. That means that the patients are the folks left out in the cold. Therefore, formal complaint should come from throngs of patients who are being denied quality healthcare because either their physicians are leaving or the available healthcare is too expensive to afford.

Only 7 medical malpractice awards last year! (5.00 / 3) (#78)
by GGardner on Sat Jul 06, 2002 at 12:00:58 AM EST

There's a lot of people complaining about frivolous lawsuits, and all, but let's step back and pretend like we are engineers and economists, and look at the actual numbers.

According to one of the newspaper reports, there were seven medical malpractice jury awards in all of Clark County in 2001, the top 3 of which were $6.5, $5.4 and $4.5 million dollars, and one of which was less than $1M. I wish the local papers would do just a bit of investigative journalism -- instead of interviewing both the trial lawyers and doctors, and getting their obvious opinions and sound bites, printing the details of these seven cases would show the public how frivolous they actually are. There certainly are few enough to investigate all of them.

Again, looking back at the numbers, there's around $25M of jury awards in 2001 in those seven cases, and about 1800 doctors in Clark County. Divide that out, and you get about $14k per doctor, which sounds a lot less than $150k for malpractice insuranc.

One wonders about private, out of court, settlements, which aren't available to the public, and why they are kept public.

The real problem, imho, is that both the AMA and the ABA are completely weak at self-policing -- neither work very hard at removing bad doctors or bad lawyers, and that's the real reason so many problems happen.

How many out of court settlements? (5.00 / 1) (#83)
by potsi on Sat Jul 06, 2002 at 04:46:22 PM EST

And how many out of court settlements where there? It doesn't take very many $6 million judgments to get insurance companies to realize it is cheaper to settle the claims than to risk a jury trial.

The numbers you stated are meaningless without the numbers of out of court settlements.

[ Parent ]

How about some numbers? (none / 0) (#86)
by GGardner on Sat Jul 06, 2002 at 08:24:46 PM EST

The numbers you stated are meaningless without the numbers of out of court settlements.

I wouldn't say they are meaningless -- they show that it isn't jury awards directly that are causing a huge problem. I would agree with you that more numbers would put a much finer point on what is really going on. Again, just a bit of investigative journalism would be a lot more useful than idly complaining about lawyers, frivolous lawsuits, or doctors.

That having been said, there's a lot of things hospitals could do to increase patient safety and needless injuries and deaths. Even the orginal poster said that he wouldn't want to be treated at a hospital when the new residents come aboard -- doesn't that speak to the need to make improvements in the system?

[ Parent ]

UMC LAS VEGAS SAVED MY LIFE & LEGS IN 1990 (none / 0) (#90)
by miracleman1 on Fri Jan 03, 2003 at 09:25:44 AM EST

I love you UMC and Doctor Terry Lewis head of trauma, you saved my life and Legs. I will never forget all the good you gave to me for listening to me from the first day in the emergency operating room, then for allowing me to work volunteer as a Clinical Pastor from August 1990 to June of 1994 I am truly blessed for having been sent to UMC back then and I wish it were still open for others to have the same wonderful treatments I was subject to. may God bless all those who served there and the patients as well, may they find someway to continue serving the citizens of the west coast trauma victims amen signed MIKE WARD LAS VEGAS TREE TRIMMER SHOCKED BY LIVE POWER LINE. I love all of you !

Don't crash in Las Vegas : UMC Trauma Center shuts. | 90 comments (86 topical, 4 editorial, 0 hidden)
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