Malpractice lawsuits may undergo changes


WASHINGTON -- President Clinton's advisers outlined a proposal yesterday for sweeping change in the handling of medical malpractice lawsuits under which individual doctors would be relieved of legal responsibility for negligence.

Instead of suing their doctors, injured patients would sue insurance companies and health maintenance organizations that employ the doctors.

Dr. Robert Berenson, a senior member of the staff of Mr. Clinton's Task Force on National Health Care Reform, said the proposal was based on the idea of "enterprise liability." Corporate enterprises -- networks of doctors, hospitals and insurance companies -- would be legally responsible for injuries caused by a doctor's negligence, he said.

Under this approach, Dr. Berenson said: "Settlements would occur many years earlier in many cases. Patients would get the compensation they need, would get their rehabilitation and their lost wages, instead of having the sort of lottery that now takes five or 10 years."

Administration officials would make health plans responsible for monitoring the quality of care delivered by doctors, on the theory that managers of a health plan would then crack down on doctors delivering substandard care. Health plans would set guidelines, and doctors following the guidelines would be presumed to practice good medicine.

Federal officials say the guidelines may also discourage doctors from performing unneeded tests and procedures. Moreover, they say, the proposal could encourage health plans to settle meritorious claims, through informal hearings and other alternatives to litigation.

Doctors have long sought changes in the handling of malpractice cases, and the White House apparently hoped to win their support. But doctors' groups complained yesterday that the plan would lead to intrusive supervision of their care by insurance companies and other corporate enterprises.

The administration contends that its proposal can reduce litigation costs, but it does not envision huge savings. It does say the proposal can benefit consumers by giving health plans incentives to monitor and improve the quality of care.

Mr. Clinton will also ask Congress to establish certain legal standards and uniform procedures for the handling of malpractice cases, administration officials said.

The handling of such claims is now governed mainly by state law and, as a result, varies widely from state to state.

Dr. Berenson, the head of a committee working on malpractice, and Kathleen Hastings, a member of the committee, gave details of the administration's thinking at separate conferences yesterday. Describing the proposal, Dr. Berenson said: "A health plan would be liable for the negligent acts of its contracted or employed practitioners and providers. The individual physician would not be personally liable for negligence, but rather the health plan would be."

Mr. Clinton originally intended to send his health plan to Congress by May 3 but has fallen behind schedule, and the White House now says he will not unveil it before mid-June. Congress is sure to alter it, but lawmakers express confidence that they will pass legislation by the end of next year to remake the nation's health care system.

Mr. Clinton has not made final decisions about the details of his health plan. But Dr. Berenson's decision to speak publicly about the idea of enterprise liability suggests that it has already cleared many hurdles and is likely to be included, in some form, in the president's package.

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