I’ve been a critical care nurse for 12 years. I rarely find out about the costs my patients incur as they get care in my unit, though occasionally I hear figures. One gentleman, who had open heart surgery to fix one of his heart valves had to come back 3 months later for a re-do. His wife told me that they had just received the bills that added up to almost $200,000. That was about 8 years ago.

Not long ago I learned that the charge per day in intensive care units like mine was now $11,000. Not unrelated to that fact, just the other day, one of our patients who was a ’self pay’ (read ‘no insurance’) was quickly and quietly packed up and transferred to the county hospital for the remainder of her critical care stay which was going to be several days.

ludlow’s diary :: ::
Though I am not a health care economist I do believe that the true costs of care are incomprehensibly skewed as everyone in the system scrambles to make up for ’self pay’ patients who would most likely never in a million years have the astronomical amounts needed to cover care while the private insurers and Medicare and Medicaid negotiate greatly reduced prices from that ‘retail’ cost. And it is further skewed by plain old greed.

The whole system is such a many-headed hydra monster! And if you try to reform it bit by bit you end up with a 10,000-paged bill that still fails the American People. Just as with the many-headed hydra who immediately regrew one and sometimes more heads when one was lopped off, when you attempt to reform and regulate an aspect of the similarly poisonous insurance/pharmaceutical complex, one or more new problems spring up. The ‘hydra’ can’t be regulated or compromised with. It needs to be taken out in order to make the system safe for everyone. Once that is done, Problem. Solved.

Just today the Senate HELP Executive Committee discussed medical liability and ways to handle malpractice suits. Included in the discussion was an amendment from Senator Enzi (that he said he developed with Montana Max!) to have Medical Courts decide malpractice cases. These ‘courts’ would not be trial-by-jury but rather have some entity (who in my view would be in the insurance industry’s pocket, limiting the industry’s expenses) decide who was wronged and how much if anything they should be compensated. At least that crazy idea was rejected by the committee.

What would happen to medical malpractice costs under Single Payer? With no private insurance companies zealously trying to guard their bottom line? The Physicians for a National Health Program tell us this:
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On May 21, Oklahoma Gov. Brad Henry today signed into law historic tort reform legislation, saying House Bill 1603 by Rep. Dan Sullivan and Senate President Pro Tempore Glenn Coffee will help improve the legal process without impeding a citizen’s access to the courts. The measure would help curb frivolous lawsuits and reduce costs associated with the justice system, among other things.

“This legislation enacts reasonable and responsible reforms that improve the civil justice system without impairing a citizen’s constitutional right to have his or her legitimate grievances appropriately addressed in court,” Gov. Henry said.

“It is perhaps the most comprehensive tort reform measure in state history, and I want to thank all the parties who were involved in crafting this bipartisan legislation. Now it is time to put this issue behind us and give the new reforms an opportunity to work.”

The Legislature overwhelmingly approved the measure last week in a bipartisan vote. Today, legislative leaders applauded Gov. Henry’s action on the bill.

“This is a huge day for Oklahoma,” said Senate President Pro Tem Glenn Coffee. “Thanks to the good faith efforts on the part of health care and business interests, legislative leadership, the Trial Bar and Royalty
Owners, we can proudly proclaim that Oklahoma is open for business. We have made it possible for Oklahoma to keep our best and brightest physicians, and assure that those legitimately wronged will have their day in court.

“I thank the Governor for signing this legislation and helping move Oklahoma a giant step forward.”

“This law represents a truly bipartisan effort between legislative and executive leaders, doctors, trial attorneys, mineral owners, the business community and numerous other affected groups. As with most compromises, this isn’t a perfect bill by our standards, but we believe it is true reform that
will ensure access to quality, affordable health care while encouraging economic development and jobs creation in our state,” said House Speaker Chris Benge, R-Tulsa. “This is an historic day for our state and is one that should make the people of Oklahoma proud.”

HB 1603 will become effective on Nov. 1, 2009.

It looks like a few rule changes have dramatically lowered the number of malpractice suits filed in Pennsylvania. There were 1,602 filings last year, a 41% decline from the annual average between 2000 and 2002, before the changes were put in place.

One of the new rules requires a “certificate of merit” from a medical professional, establishing that “the medical procedures in a case fell below applicable standards of care,” according to a recent statement from the Administrative Office of Pennsylvania Courts. Another rule requires cases to be filed in the county where the alleged malpractice took place — an effort to discourage so-called venue shopping, where cases would be filed in counties thought to be sympathetic to plaintiffs.

The number of malpractice cases fell sharply in 2003, when the rules were in place, and have stayed down.

“The results have been extraordinarily impressive in abating the malpractice insurance crisis,” Pennsylvania’s governor said yesterday, the Philly Inquirer reports.

The president of the state’s medical society told the paper the decline in cases is encouraging, but said malpractice insurance rates in the state are among the costliest in the country. A spokesman for the society told the Health Blog that, for the most part, state doctors’ malpractice premiums have been stable or decreased slightly since 2002.

A representative of the state’s trial lawyers group told the Inquirer the group was satisfied with the rules, partly because there are no longer calls for caps on awards in the state.

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In 2004 Nevada passed a law that capped punitive damages to $350,000 in medical malpractice cases. The bill was part of the “Keep our Doctors in Nevada Act” in which supporters claimed limits on recovery were necessary in order to keep doctors in high specialties in the state.

Now, due to a hepatitis outbreak, as a result of unsanitary vaccination practices, Nevada has re-evaluated its stance on tort reform and is initiated the passing of AB495, which would eliminate the cap on non-economic damages.

The hepatitis outbreak resulted in 50,000 patients being notified that they were put at risk for contracting the disease. The AP reports that this is the largest patient notification in U.S. history.

Opponents of AB495 reiterate that the lifting the limit on non-economic damages will place doctors in the same precarious situation to either relocate their practices or face high insurance premiums.

Supporters of the bill contend that $350,000 does not adequately compensate victims of medical malpractice. For example, Cathy Bussewitz of the Associated Press noted:

Megan Gasper, 33, a mother of two children, told legislators she contracted hepatitis C after having two colonoscopies performed at the two clinics where the outbreak occurred, the Endoscopy Center of Southern Nevada and the Desert Shadow Endoscopy Center.

“This has pretty much stolen a year of my life,” Gasper said, fighting tears. “When you have to get up out of bed every day, and know that you have to take a medicine that will seriously affect your ability to play with your children, it’s hard to give yourself a self-injection.”

Former patients and family members told frightening stories of substandard care. Kevin Murray lost his daughter when doctors failed to notice the signs of meningitis. Michael Washington, who was the first patient to test positive for hepatitis C after the outbreak, said he would never be normal again.
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In a decision of broad impact tomedical malpractice lawsuits across Maryland, a circuit judge in Rockville
has refused to apply the state’s “cap” on non-economic damages in a malpractice case.

Judge John Debelius ruled that when the Maryland General Assembly revised the damage cap in 2005 to lower the amount that malpractice victims could recover from negligent doctors and hospitals, the legislature exempted casesin which the parties had not first gone through the state’s pre-suit arbitration system.

The decision was handed down late on April 20, 2009 in the case of Semsker v. Lockshin. The case concerned the death of 47-year-old Richard Semsker, a Bethesda employment attorney, from malignant melanoma, a curable skin cancer. A jury last November found a prominent dermatology practice, Norman
A. Lockshin, M.D., P.A., in Silver Spring, Md., was liable for Mr. Semsker’s death because one of the practice’s dermatologists, Michael Albert, M.D., failed to remove a suspicious mole from Mr. Semsker’s back, which later turned into melanoma. The jury awarded damages to Mr. Semsker’s widow and
two daughters in the amount of $5.8 million. The verdict included $3 million for the widow and children’s grief and loss of companionship, and Mr. Semsker’s own suffering as he battled the cancer over the last year of his life.
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