Hair sample may provide breast cancer diagnosis
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Trade with personal dealer service.NEW YORK (Reuters Health) - Hair from women with breast cancer can be distinguished from hair obtained from women without the disease, researchers in Australia report.
When hair is exposed to X-rays, the radiation is diffracted in a distinctive pattern by the alpha-keratin that forms hair, the researchers explain in the International Journal of Cancer. Dr. Gary L. Corino and Dr. Peter W. French, based at Fermiscan Ltd in Sydney, used the technique to look at samples of hair from 13 patients diagnosed with breast cancer and 20 healthy subjects.
Hair was cut as close to the skin as possible to obtain samples of the most recent hair growth. The investigators "successfully and consistently generated the basic alpha-keratin X-ray diffraction pattern in every hair sample."
Hair from the breast cancer patients produced the same features "with the only difference being the superimposition of a new feature." This was a distinctive low-intensity ring.
This ring sign was fairly accurate in identifying breast cancer. It missed one of the breast cancer patients, and showed up as a false-positive in three of the healthy subject.
The researchers went on to study a length of hair representing 6 months' growth from a breast cancer patient whose hair fell out following chemotherapy. X-ray diffraction at three points along the hair showed clear evidence of the ring at the position furthest from the hair root, a fainter ring at the middle point, and complete absence of the ring close to the root.
"This progressive reduction in the intensity of the ring appears to correlate with the patient's course of treatment and possibly indicates the eradication of the cancer as a result of that treatment," Corino and French suggest.
As for the reason for the ring pattern, they suggest it may represent "incorporation of extraneous lipid material into the fiber as a result of the presence of a tumor." It may also be that the disease affects hair follicles in some way.
Further testing is needed to establish the accuracy of this methodology as a diagnostic test for breast cancer, they conclude.
SOURCE: International Journal of Cancer, February 15, 2008.
http://www.reuters.com/article/healthNews/idUSKUA56971920080215?feedType=nl&feedName=ushealth1100
Thursday, February 28, 2008
Saturday, February 23, 2008
Health Net ordered to pay $9 million for canceling coverage during cancer treatment
The punitive damage award is the first of its kind and has prompted the giant medical insurer to scrap practices that have recently come under fire.
By Lisa Girion
Los Angeles Times
February 23, 2008
One of California's largest for-profit insurers stopped a controversial practice of canceling sick policyholders Friday after a judge ordered Health Net Inc. to pay more than $9 million to a breast cancer patient it dropped in the middle of chemotherapy.
The ruling by a private arbitration judge was the first of its kind and the most powerful rebuke to the state's major insurers whose cancellation practices are under fire from the courts, state regulators and elected officials.
Calling Woodland Hills-based Health Net's actions "egregious," Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, ruled that the company broke state laws and acted in bad faith.
"Health Net was primarily concerned with and considered its own financial interests and gave little, if any, consideration and concern for the interests of the insured," Cianchetti wrote in a 21-page ruling.
Patsy Bates, a 52-year-old grandmother, was at work at the Gardena hair salon she owns when her lawyer William Shernoff called with the news. Bates said she screamed and thanked the lawyer.
Then, "I thanked God," she said. "I praised the Lord."
Bates called the arbitration judge "an angel . . . a real stand-up kind of judge."
When Health Net dropped her in January 2004, Bates was stuck with more than $129,000 in medical bills and was forced to stop chemotherapy for several months until she found a charity to pay for it.
Health Net Chief Executive Jay Gellert ordered an immediate halt to cancellations and told The Times that the company would be changing its coverage applications and retraining its sales force.
"I felt bad about what happened to her," he said. "I feel bad about the whole situation."
Gellert said he would move quickly to "give people the confidence that they can count on their policy." Specifically, he pledged to stop all cancellations until an external review process could be established to approve all cancellations.
Other insurers were considering changing their own practices. A spokeswoman for WellPoint Inc., which operates Blue Cross of California, the state's largest for-profit insurer, said the company was in favor of such an idea. Blue Shield of California declined to comment.
Until Friday, the companies had uniformly defended cancellations, saying they were necessary to hold down costs by weeding out people who may have failed to disclose pre-existing conditions on applications for coverage. They say cancellations happen infrequently.
The judge's strong denunciation of the way Health Net carried out Bates' cancellation and big money award stunned and pleased regulators and patient advocates.
State Insurance Commissioner Steve Poizner applauded the judge, saying "health insurers simply cannot hold out the promise of insurance for their consumers and then snatch it away just when people need it most. That is illegal, immoral and will not be tolerated."
Earlier, Health Net had defended its actions, saying it never would have issued Bates a policy in the first place if she had disclosed her true weight and a preexisting heart condition on her application.
Bates said a broker filled out the application while she was styling a client's hair on a busy day in her shop. She said she answered his questions as best she could.
Bates said she already had insurance and wasn't in the market until the broker came by and told her that he thought he could get her a lower monthly premium if she switched to Health Net.
At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved.
"It's difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive," the judge wrote.
http://www.latimes.com/features/health/la-fi-insure23feb23,1,2680255.story
By Lisa Girion
Los Angeles Times
February 23, 2008
One of California's largest for-profit insurers stopped a controversial practice of canceling sick policyholders Friday after a judge ordered Health Net Inc. to pay more than $9 million to a breast cancer patient it dropped in the middle of chemotherapy.
The ruling by a private arbitration judge was the first of its kind and the most powerful rebuke to the state's major insurers whose cancellation practices are under fire from the courts, state regulators and elected officials.
Calling Woodland Hills-based Health Net's actions "egregious," Judge Sam Cianchetti, a retired Los Angeles County Superior Court judge, ruled that the company broke state laws and acted in bad faith.
"Health Net was primarily concerned with and considered its own financial interests and gave little, if any, consideration and concern for the interests of the insured," Cianchetti wrote in a 21-page ruling.
Patsy Bates, a 52-year-old grandmother, was at work at the Gardena hair salon she owns when her lawyer William Shernoff called with the news. Bates said she screamed and thanked the lawyer.
Then, "I thanked God," she said. "I praised the Lord."
Bates called the arbitration judge "an angel . . . a real stand-up kind of judge."
When Health Net dropped her in January 2004, Bates was stuck with more than $129,000 in medical bills and was forced to stop chemotherapy for several months until she found a charity to pay for it.
Health Net Chief Executive Jay Gellert ordered an immediate halt to cancellations and told The Times that the company would be changing its coverage applications and retraining its sales force.
"I felt bad about what happened to her," he said. "I feel bad about the whole situation."
Gellert said he would move quickly to "give people the confidence that they can count on their policy." Specifically, he pledged to stop all cancellations until an external review process could be established to approve all cancellations.
Other insurers were considering changing their own practices. A spokeswoman for WellPoint Inc., which operates Blue Cross of California, the state's largest for-profit insurer, said the company was in favor of such an idea. Blue Shield of California declined to comment.
Until Friday, the companies had uniformly defended cancellations, saying they were necessary to hold down costs by weeding out people who may have failed to disclose pre-existing conditions on applications for coverage. They say cancellations happen infrequently.
The judge's strong denunciation of the way Health Net carried out Bates' cancellation and big money award stunned and pleased regulators and patient advocates.
State Insurance Commissioner Steve Poizner applauded the judge, saying "health insurers simply cannot hold out the promise of insurance for their consumers and then snatch it away just when people need it most. That is illegal, immoral and will not be tolerated."
Earlier, Health Net had defended its actions, saying it never would have issued Bates a policy in the first place if she had disclosed her true weight and a preexisting heart condition on her application.
Bates said a broker filled out the application while she was styling a client's hair on a busy day in her shop. She said she answered his questions as best she could.
Bates said she already had insurance and wasn't in the market until the broker came by and told her that he thought he could get her a lower monthly premium if she switched to Health Net.
At the arbitration hearing, internal company documents were disclosed showing that Health Net had paid employee bonuses for meeting a cancellation quota and for the amount of money saved.
"It's difficult to imagine a policy more reprehensible than tying bonuses to encourage the rescission of health insurance that keeps the public well and alive," the judge wrote.
http://www.latimes.com/features/health/la-fi-insure23feb23,1,2680255.story
Universal Health Care cost 1.1% in Taiwan
Experts call for health cover in U.S., cite study
Wed Feb 20, 2008 8
HONG KONG (Reuters) -
Experts called for universal health insurance in the United States, citing a study in Taiwan that showed it increased life expectancy and closed the gap between those who were most healthy and least healthy.
In a commentary published in the Annals of Internal Medicine, the experts said Taiwan's experience lent "credence to the argument that the United States should join other industrialized nations in ensuring universal health insurance coverage".
"Our failure to introduce national health insurance undermines access to care for millions and is a major factor in health outcome disparities and highly preventable deaths in the United States," wrote Karen Davis, of The Commonwealth Fund, and Andrew Huang, of Duke University Medical Centre.
Their call accompanied an article in the same journal on a 10-year study in Taiwan that showed that universal health insurance raised life expectancy.
However, the Taiwan researchers considered the improvements to be modest and called for more aggressive disease prevention programs to reduce lifestyle-related illnesses, such as cancer.
"Two risk behaviors among men in Taiwan, smoking and betel quid chewing, remained high after the introduction of national health insurance," the Taiwan researchers wrote.
"Every second middle-aged man is a smoker and every fourth is a chewer ... which could account for the large increases in lung and oral cancer in the lower socioeconomic groups and the relatively small reduction in health disparities."
Taiwan introduced universal health insurance in 1995, which extended insurance coverage from 57 percent of the population to everyone. Co-payments are required, however: 10 percent for inpatient and 20 percent for outpatient care, although these are waived for the very poor, veterans and indigenous groups.
National health expenditure rose modestly, from 5.1 percent of gross national product before 1995 to 6.2 percent in 2005.
Visits to the doctor and use of medication increased substantially after 1995, especially among the elderly and poor.
The most obvious positive correlation was life expectancy for men, which increased to 74.22 years from 71.83 years after universal health insurance.
There was a reduction in deaths from cardiovascular and infectious diseases, and from accidents, but deaths from cancer and diabetes rose.
(Reporting by Tan Ee Lyn; Editing by Alex Richardson)
http://www.reuters.com/article/healthNews/idUSSHA36232320080220?feedType=nl&feedName=ushealth1100
Wed Feb 20, 2008 8
HONG KONG (Reuters) -
Experts called for universal health insurance in the United States, citing a study in Taiwan that showed it increased life expectancy and closed the gap between those who were most healthy and least healthy.
In a commentary published in the Annals of Internal Medicine, the experts said Taiwan's experience lent "credence to the argument that the United States should join other industrialized nations in ensuring universal health insurance coverage".
"Our failure to introduce national health insurance undermines access to care for millions and is a major factor in health outcome disparities and highly preventable deaths in the United States," wrote Karen Davis, of The Commonwealth Fund, and Andrew Huang, of Duke University Medical Centre.
Their call accompanied an article in the same journal on a 10-year study in Taiwan that showed that universal health insurance raised life expectancy.
However, the Taiwan researchers considered the improvements to be modest and called for more aggressive disease prevention programs to reduce lifestyle-related illnesses, such as cancer.
"Two risk behaviors among men in Taiwan, smoking and betel quid chewing, remained high after the introduction of national health insurance," the Taiwan researchers wrote.
"Every second middle-aged man is a smoker and every fourth is a chewer ... which could account for the large increases in lung and oral cancer in the lower socioeconomic groups and the relatively small reduction in health disparities."
Taiwan introduced universal health insurance in 1995, which extended insurance coverage from 57 percent of the population to everyone. Co-payments are required, however: 10 percent for inpatient and 20 percent for outpatient care, although these are waived for the very poor, veterans and indigenous groups.
National health expenditure rose modestly, from 5.1 percent of gross national product before 1995 to 6.2 percent in 2005.
Visits to the doctor and use of medication increased substantially after 1995, especially among the elderly and poor.
The most obvious positive correlation was life expectancy for men, which increased to 74.22 years from 71.83 years after universal health insurance.
There was a reduction in deaths from cardiovascular and infectious diseases, and from accidents, but deaths from cancer and diabetes rose.
(Reporting by Tan Ee Lyn; Editing by Alex Richardson)
http://www.reuters.com/article/healthNews/idUSSHA36232320080220?feedType=nl&feedName=ushealth1100
Music improves stroke recovery
Music hits right note for stroke patients
Tue Feb 19, 2008
21 Feb 2008
LONDON (Reuters) - A little Beethoven is good for the brain, according to a Finnish study published on Wednesday showing that music helps people recover more quickly from strokes.
And patients who listened to a few hours of music each day soon after a stroke also improved their verbal memory and were in a better mood compared to patients who did not listen to music or used audio books, the researchers said.
Music therapy has long been used in a range of treatments but the study published in the journal Brain is the first to show the effect in people, they added.
"These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood," the researchers wrote...
http://www.reuters.com/article/healthNews/idUSL1911114120080220?feedType=nl&feedName=ushealth1100
Tue Feb 19, 2008
21 Feb 2008
LONDON (Reuters) - A little Beethoven is good for the brain, according to a Finnish study published on Wednesday showing that music helps people recover more quickly from strokes.
And patients who listened to a few hours of music each day soon after a stroke also improved their verbal memory and were in a better mood compared to patients who did not listen to music or used audio books, the researchers said.
Music therapy has long been used in a range of treatments but the study published in the journal Brain is the first to show the effect in people, they added.
"These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood," the researchers wrote...
http://www.reuters.com/article/healthNews/idUSL1911114120080220?feedType=nl&feedName=ushealth1100
Hospitals slow on cardiac arrest treatment at night
Cardiac arrest: avoid nights, weekend, study says
Wed Feb 20, 2008
Daytime dozing may be warning sign of stroke
Reuters
CHICAGO (Reuters) - People who have a cardiac arrest in the hospital at night or on the weekend are far less likely to survive than those who suffer one during the day, U.S. researchers said on Tuesday.
Studies suggest this may be at least partly because of inadequate staffing at off-peak hours.
The researchers found only 14.7 percent of people whose hearts stop pumping during the night survive, compared with nearly 20 percent of people during the day.
Those who had a cardiac arrest at around 3 p.m. had the survival rate, Dr. Mary Ann Peberdy of Virginia Commonwealth University in Richmond and colleagues reported in the Journal of the American Medical Association.
The only part of the hospital with difference in survival day or night was the emergency department. "That survival difference by time of day was there regardless of where we looked, except in the emergency department," Peberdy said...
http://www.reuters.com/article/healthNews/idUSN1929246120080220?feedType=nl&feedName=ushealth1100
Wed Feb 20, 2008
Daytime dozing may be warning sign of stroke
Reuters
CHICAGO (Reuters) - People who have a cardiac arrest in the hospital at night or on the weekend are far less likely to survive than those who suffer one during the day, U.S. researchers said on Tuesday.
Studies suggest this may be at least partly because of inadequate staffing at off-peak hours.
The researchers found only 14.7 percent of people whose hearts stop pumping during the night survive, compared with nearly 20 percent of people during the day.
Those who had a cardiac arrest at around 3 p.m. had the survival rate, Dr. Mary Ann Peberdy of Virginia Commonwealth University in Richmond and colleagues reported in the Journal of the American Medical Association.
The only part of the hospital with difference in survival day or night was the emergency department. "That survival difference by time of day was there regardless of where we looked, except in the emergency department," Peberdy said...
http://www.reuters.com/article/healthNews/idUSN1929246120080220?feedType=nl&feedName=ushealth1100
Tuesday, January 22, 2008
How much do you have to lose before it's not frivolous?
Patients asked to sign contracts: company offers plans to curb frivolous lawsuits
May 1, 2004
by Jennifer Silverman
International Medical News Group
Gale Group
Click HERE for original article.
Patients asked to sign contracts: company offers plans to curb frivolous lawsuits
OB/GYN News, May 1, 2004 by Jennifer Silverman
Physicians across the country are taking a new aggressive stance to protect themselves against malpractice lawsuits: They're asking their patients to sign on the dotted line, specifying that they won't sue for any "frivolous" reason.
If it is a meritorious case, the patient "has to use a board-certified expert witness who follows the code of ethics for that particular professional society," said Dr. Jeff Segal, a nonpracticing neurosurgeon and founder of Medical Justice Corp., a company based in Greensboro, S.C., that provides these types of contracts as well as services designed to keep physicians from getting sued for so-called frivolous reasons.
In Dr. Segal's view, the term "frivolous" means the expert testimony against the physician was not compatible with what would be delivered by a majority of specialists, or at least a respectable minority.
In one example of a frivolous case, a urologist performed a vasectomy, performed postoperative semen counts at 1 week and at 1 month, and 1 year later got sued because the patient's wife became pregnant. "As it turns out, it wasn't his baby. I think that's a frivolous case," said Dr. Segal, who himself was sued while he practiced medicine.
Medical malpractice insurance pays for defending against a lawsuit and for the payment of a settlement or judgment. In contrast, Medical Justice plans are designed to help deter frivolous lawsuits and provide purchasers with assistance if they are sued. Also, Medical Justice will assist plan owners should they choose to countersue.
About 500 physicians from various specialties in 30 states have purchased plans from Medical Justice. It has grown most dramatically in the last several months, said Dr. Segal, whose clients pay from $625 to $1,800 a year, depending on the specialty's level of risk, for a plan. A neurosurgeon, for example, is going to pay a higher fee than a family doctor, he said.
These physicians' patients are asked to sign a contract that contains the clauses on lawsuits along with other standard provisions.
The language in the agreement is reciprocal, meaning that the physician agrees to the same stipulations as the patient. "Each side must use a board-certified expert witness in the same or similar specialty, who follows code of ethics for that specialty society," Dr. Segal said.
If a malpractice complaint is raised, "we send a letter to plaintiff's counsel telling them who we are, in the hopes that [the letter] will be enough to make a frivolous case go away," Dr. Segal said. If it doesn't, the next step is to examine the expert testimony on the plaintiff's side.
"Expert witnesses can make or break a case. We have our own panel of experts to determine whether there's a lie or hyperbole in expert testimony." If the expert's testimony is deemed fraudulent, the expert is reported to his or her professional society.
The society can make its own judgment of that expert witness, Dr. Segal said. In some cases, the expert can be expelled if the case is made that their testimony was tainted or untrue.
Dr. Compton Girdharry, an ob.gyn. in Alliance, Ohio, who retired in 2003, bought a plan from Medical Justice after his malpractice insurer went out of business and he couldn't afford the $250,000 tail coverage that would have covered him for an additional year. Medical Justice will offer assistance to him in any lawsuits that may come up from the time he was a practicing physician.
"The majority of suits in my profession are frivolous in my opinion," said Dr. Girdharry in an interview. He was involved in 10 lawsuits during his career. While most were either settled or dropped, two went to jury trial, including one he called "totally frivolous."
The patient had sued Dr. Girdharry, the anesthesiologist, and the hospital for experiencing pain during a repeat C-section and tubal ligation. "We stopped the procedure when she said she was in pain, and the anesthesiologist gave her some nitrous oxide so we could finish the procedure." According to Dr. Girdharry, the patient was fine for the rest of operation, and records showed no signs of complications.
To him, it made sense to call Medical Justice, even though he won both of the two jury trials in which he had been involved. Even as the winner, "I'd still seek compensation from the other party, because it costs money to defend myself."
Dr. Girdharry may go back into practice part-time for a federal clinic that's offering him malpractice insurance. In the meantime, he's keeping his insurance with Medical Justice, which in his opinion has already paid for itself. "We're living in a time when people have a higher expectation from physicians--that until proven otherwise, it's the doctor's fault."
Medical Justice is only 2 years old, yet, it's already had an impact, Dr. Segal said. A study conducted by SG Risk, an actuarial firm based in New Jersey, estimated that Medical Justice clients have a 2% chance of being sued per year.
Not everyone agrees with this concept. Joanne Doroshow, executive director of the nonprofit Center for Justice & Democracy in New York, argues that malpractice cases by their own merit are rarely frivolous, mainly because it's so expensive to line up the experts and develop the case. One of the obvious problems is that no doctor ever believes a lawsuit against him is anything less than frivolous, Ms. Doroshow said.
Kathy Olsen, of San Diego County, Calif., whose teenage son suffered permanent blindness as a result of an untreated cranial abscess, said she was "appalled" that insurance such as that offered by Medical Justice even exists. "How much do you have to lose before it's not frivolous?" Mrs. Olsen said. "As parents, we are assuming that physicians are going to take care of us."
Mrs. Olsen said the physicians treating her then-2-year-old son had written down "cranial abscess" as a possible reason for his symptoms, but never informed her of this possibility. "Instead, they told us he had some form of meningitis, and didn't scan him." As a result, the abscess herniated his brain and he had to spend 5 months in the hospital. "The physicians involved in his care should have done something about it and reported back to our pediatrician. A brain abscess, if detected in time, can be removed," said Mrs. Olsen, who won her case in court.
To Barry Furrow, director of the Health Law Institute at Widener University School of Law in Wilmington. Del., Medical Justice's approaches "are just scare tactics." In an interview, Mr. Furrow said he doubted that the courts would be very sympathetic to such vague agreements. "It is also not clear that a pure waiver of liability, as Florida doctors are now demanding, would hold up in state courts. But this is a highly politicized issue, and judges have sometimes been fooled by the arguments."
The board-certified expert witness requirement is an odd idea, he continued. "I've been an expert in several cases, and I certainly have no board certification. I think, however, that some medical societies are beginning to use this idea of certifying experts, as a way of scaring away doctors from testifying."
Dr. Segal says 99% of patients have signed the contracts provided by Medical Justice clients. "Most people believe that they wouldn't sue for a frivolous reason anyway."
Arrangements of this type do exist elsewhere, Arthur Levin, director of the Center for Medical Consumers in New York, said in an interview. Kaiser Permanente, for example, "requires enrollees to sign a 'willingness to arbitrate' agreement. That's one example where a health plan is saying it would rather resolve through arbitration than go through the courts."
In addition, some states have procedures that require some sort of affidavit from a medical expert that a case has merit, he said.
What Mr. Levin finds disturbing about Medical Justice is that a very ill person could walk into a physician's office, refuse to sign the consent form, and not get treated. "There's something very off-putting about telling patients that you won't treat them unless they sign an agreement."
No one is happy that physicians are paying for such high malpractice premiums, Mr. Levin said. "Does it unfairly punish physicians? Yes. However, the answer to the medical liability crisis isn't to create an atmosphere where the physician will only take care of sick people if they agree to his or her terms. It doesn't speak well to the profession."
Ms. Doroshow said it's unfair to force a patient who has no legal or medical training to sign this type of form. "It's intimidating, because they don't understand what kind of sanctions can be brought against them. It also hurts the doctor-patient relationship. Only the legal system and courts can decide if something is frivolous. That's what it's there for."
BY JENNIFER SILVERMAN
Associate Editor, Practice Trends
May 1, 2004
by Jennifer Silverman
International Medical News Group
Gale Group
Click HERE for original article.
Patients asked to sign contracts: company offers plans to curb frivolous lawsuits
OB/GYN News, May 1, 2004 by Jennifer Silverman
Physicians across the country are taking a new aggressive stance to protect themselves against malpractice lawsuits: They're asking their patients to sign on the dotted line, specifying that they won't sue for any "frivolous" reason.
If it is a meritorious case, the patient "has to use a board-certified expert witness who follows the code of ethics for that particular professional society," said Dr. Jeff Segal, a nonpracticing neurosurgeon and founder of Medical Justice Corp., a company based in Greensboro, S.C., that provides these types of contracts as well as services designed to keep physicians from getting sued for so-called frivolous reasons.
In Dr. Segal's view, the term "frivolous" means the expert testimony against the physician was not compatible with what would be delivered by a majority of specialists, or at least a respectable minority.
In one example of a frivolous case, a urologist performed a vasectomy, performed postoperative semen counts at 1 week and at 1 month, and 1 year later got sued because the patient's wife became pregnant. "As it turns out, it wasn't his baby. I think that's a frivolous case," said Dr. Segal, who himself was sued while he practiced medicine.
Medical malpractice insurance pays for defending against a lawsuit and for the payment of a settlement or judgment. In contrast, Medical Justice plans are designed to help deter frivolous lawsuits and provide purchasers with assistance if they are sued. Also, Medical Justice will assist plan owners should they choose to countersue.
About 500 physicians from various specialties in 30 states have purchased plans from Medical Justice. It has grown most dramatically in the last several months, said Dr. Segal, whose clients pay from $625 to $1,800 a year, depending on the specialty's level of risk, for a plan. A neurosurgeon, for example, is going to pay a higher fee than a family doctor, he said.
These physicians' patients are asked to sign a contract that contains the clauses on lawsuits along with other standard provisions.
The language in the agreement is reciprocal, meaning that the physician agrees to the same stipulations as the patient. "Each side must use a board-certified expert witness in the same or similar specialty, who follows code of ethics for that specialty society," Dr. Segal said.
If a malpractice complaint is raised, "we send a letter to plaintiff's counsel telling them who we are, in the hopes that [the letter] will be enough to make a frivolous case go away," Dr. Segal said. If it doesn't, the next step is to examine the expert testimony on the plaintiff's side.
"Expert witnesses can make or break a case. We have our own panel of experts to determine whether there's a lie or hyperbole in expert testimony." If the expert's testimony is deemed fraudulent, the expert is reported to his or her professional society.
The society can make its own judgment of that expert witness, Dr. Segal said. In some cases, the expert can be expelled if the case is made that their testimony was tainted or untrue.
Dr. Compton Girdharry, an ob.gyn. in Alliance, Ohio, who retired in 2003, bought a plan from Medical Justice after his malpractice insurer went out of business and he couldn't afford the $250,000 tail coverage that would have covered him for an additional year. Medical Justice will offer assistance to him in any lawsuits that may come up from the time he was a practicing physician.
"The majority of suits in my profession are frivolous in my opinion," said Dr. Girdharry in an interview. He was involved in 10 lawsuits during his career. While most were either settled or dropped, two went to jury trial, including one he called "totally frivolous."
The patient had sued Dr. Girdharry, the anesthesiologist, and the hospital for experiencing pain during a repeat C-section and tubal ligation. "We stopped the procedure when she said she was in pain, and the anesthesiologist gave her some nitrous oxide so we could finish the procedure." According to Dr. Girdharry, the patient was fine for the rest of operation, and records showed no signs of complications.
To him, it made sense to call Medical Justice, even though he won both of the two jury trials in which he had been involved. Even as the winner, "I'd still seek compensation from the other party, because it costs money to defend myself."
Dr. Girdharry may go back into practice part-time for a federal clinic that's offering him malpractice insurance. In the meantime, he's keeping his insurance with Medical Justice, which in his opinion has already paid for itself. "We're living in a time when people have a higher expectation from physicians--that until proven otherwise, it's the doctor's fault."
Medical Justice is only 2 years old, yet, it's already had an impact, Dr. Segal said. A study conducted by SG Risk, an actuarial firm based in New Jersey, estimated that Medical Justice clients have a 2% chance of being sued per year.
Not everyone agrees with this concept. Joanne Doroshow, executive director of the nonprofit Center for Justice & Democracy in New York, argues that malpractice cases by their own merit are rarely frivolous, mainly because it's so expensive to line up the experts and develop the case. One of the obvious problems is that no doctor ever believes a lawsuit against him is anything less than frivolous, Ms. Doroshow said.
Kathy Olsen, of San Diego County, Calif., whose teenage son suffered permanent blindness as a result of an untreated cranial abscess, said she was "appalled" that insurance such as that offered by Medical Justice even exists. "How much do you have to lose before it's not frivolous?" Mrs. Olsen said. "As parents, we are assuming that physicians are going to take care of us."
Mrs. Olsen said the physicians treating her then-2-year-old son had written down "cranial abscess" as a possible reason for his symptoms, but never informed her of this possibility. "Instead, they told us he had some form of meningitis, and didn't scan him." As a result, the abscess herniated his brain and he had to spend 5 months in the hospital. "The physicians involved in his care should have done something about it and reported back to our pediatrician. A brain abscess, if detected in time, can be removed," said Mrs. Olsen, who won her case in court.
To Barry Furrow, director of the Health Law Institute at Widener University School of Law in Wilmington. Del., Medical Justice's approaches "are just scare tactics." In an interview, Mr. Furrow said he doubted that the courts would be very sympathetic to such vague agreements. "It is also not clear that a pure waiver of liability, as Florida doctors are now demanding, would hold up in state courts. But this is a highly politicized issue, and judges have sometimes been fooled by the arguments."
The board-certified expert witness requirement is an odd idea, he continued. "I've been an expert in several cases, and I certainly have no board certification. I think, however, that some medical societies are beginning to use this idea of certifying experts, as a way of scaring away doctors from testifying."
Dr. Segal says 99% of patients have signed the contracts provided by Medical Justice clients. "Most people believe that they wouldn't sue for a frivolous reason anyway."
Arrangements of this type do exist elsewhere, Arthur Levin, director of the Center for Medical Consumers in New York, said in an interview. Kaiser Permanente, for example, "requires enrollees to sign a 'willingness to arbitrate' agreement. That's one example where a health plan is saying it would rather resolve through arbitration than go through the courts."
In addition, some states have procedures that require some sort of affidavit from a medical expert that a case has merit, he said.
What Mr. Levin finds disturbing about Medical Justice is that a very ill person could walk into a physician's office, refuse to sign the consent form, and not get treated. "There's something very off-putting about telling patients that you won't treat them unless they sign an agreement."
No one is happy that physicians are paying for such high malpractice premiums, Mr. Levin said. "Does it unfairly punish physicians? Yes. However, the answer to the medical liability crisis isn't to create an atmosphere where the physician will only take care of sick people if they agree to his or her terms. It doesn't speak well to the profession."
Ms. Doroshow said it's unfair to force a patient who has no legal or medical training to sign this type of form. "It's intimidating, because they don't understand what kind of sanctions can be brought against them. It also hurts the doctor-patient relationship. Only the legal system and courts can decide if something is frivolous. That's what it's there for."
BY JENNIFER SILVERMAN
Associate Editor, Practice Trends
Wednesday, January 9, 2008
The Myth Of Tort Reform: Taking away David's sling
CASD strongly opposes arbitrary attempts to limit tort remedies or consumers' access to the courts -- misleadingly labeled "tort reform". A person or industry which does something wrong should be held accountable for those actions.
The term "tort reform" is used for the proposition that there are too many lawsuits filed by consumers for the wrongs (torts) done by others which caused them injury. Using inflammatory and misleading terms like "jackpot justice" and "shakedown lawsuits," insurance companies and other big businesses spend millions of dollars on propaganda to convince the public there are too many lawsuits and that they are driving up the cost of medical care, increasing the price of products and insurance, clogging up the courts and creating a drag on the economy. These "tort reformers" want to protect the wrongdoers from responsibility for the harm they cause.
The greatest myth of all is that consumer lawsuits are tying up our courts and huge verdicts are hurting the economy. Most civil court filings involve family law disputes. The non-partisan Center for State Courts reports that tort claims account for only between 5 and 7% of all lawsuits in state courts. Tort law is good for consumers and leads to better business practices -- it provides consumers with the right to be financially reimbursed for injury or death caused by dangerous products or below-standard services. We must be able to hold wrongdoers, individual or corporate, accountable for the injuries they cause. The civil justice system is the only way to achieve this goal.
The term "tort reform" is used for the proposition that there are too many lawsuits filed by consumers for the wrongs (torts) done by others which caused them injury. Using inflammatory and misleading terms like "jackpot justice" and "shakedown lawsuits," insurance companies and other big businesses spend millions of dollars on propaganda to convince the public there are too many lawsuits and that they are driving up the cost of medical care, increasing the price of products and insurance, clogging up the courts and creating a drag on the economy. These "tort reformers" want to protect the wrongdoers from responsibility for the harm they cause.
The greatest myth of all is that consumer lawsuits are tying up our courts and huge verdicts are hurting the economy. Most civil court filings involve family law disputes. The non-partisan Center for State Courts reports that tort claims account for only between 5 and 7% of all lawsuits in state courts. Tort law is good for consumers and leads to better business practices -- it provides consumers with the right to be financially reimbursed for injury or death caused by dangerous products or below-standard services. We must be able to hold wrongdoers, individual or corporate, accountable for the injuries they cause. The civil justice system is the only way to achieve this goal.
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