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Targeted reforms could help defuse malpractice crisis

It is pleasant to believe that the conflict between physicians and trial lawyers can be resolved by combining a small dollop of tort reform with larger doses of "rate stabilization" and medical discipline ("Political malpractice," editorial, July 5). But as chairman of a commission on this subject that offered its report in 1984 and vice chairman of a 1985 task force that gave rise to changes which kept a lid on this problem for 20 years, I cannot endorse this approach.

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The mid-1980s proposals imposed a cap on pain-and-suffering awards, halved the number of lawsuits by introducing a "certificate of merit" procedure- and eliminated a duplicative arbitration system. Obstetricians were protected by shortening the statute of limitations for actions by minors. Finally, the commissions sought to drastically limit the double recoveries made possible by failure to subtract other insurance recoveries from malpractice awards.

The last of these proposals was not fully enacted. And the Maryland Court of Appeals, in a recent feat of judicial activism, found the change in the statute of limitations "unreasonable" without discussing the findings that led two state commissions to consider it reasonable.

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The trial lawyers in 1994 secured an increase in the pain-and-suffering cap, which was automatically adjusted for inflation. Predictably, we have a new crisis.

Efforts to pretend that this situation is the result of uncorrected malpractice by a small minority of doctors involve lying with statistics.

Most specialties attract few lawsuits, but they are a problem for high-risk specialties, notably neurosurgery, cardiology and obstetrics. And they fall on the competent as well as the incompetent.

Nearly all births are attended by obstetricians, and few happen perfectly. Most deaths take place in hospitals, and some of the aggrieved lash out at any supposed human cause, particularly one that is well-insured.

Studies indicate that few awards are caused by "rogue elephants" in the profession, and justified awards are frequently inflated by estimates of future medical expenses based on worst-case scenarios.

It still seems wise to profit from the effort at conservative reforms, respectful of the jury system, the state made in the 1980s.

Maryland should provide, as have other states, for an offset for damage awards for recoveries from other insurers. It should require, in lawsuits for birth injuries brought more than five years after the event, that negligence be proved by clear and convincing evidence.

It should allow awards for future medical costs to be deferred by providing a health insurance policy so that actual costs, not extravagantly estimated ones, are reimbursed.

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Proposals for the use of public funds to enrich the trial bar should be rejected.

George W. Liebmann

Baltimore

New rules to ensure drugs are fairly sold

I am a practicing psychiatrist who is active in clinical trials testing new psychiatric medications. The editorial "Asking for trouble" (July 5), which criticized the pharmaceutical industry's marketing practices, struck a chord in me, and I would like to propose some suggestions to address the problems it raised.

First, direct-to-consumer advertisements must be modified. Industry sponsors should be limited to describing disease states, which would educate consumers. Consumers could then bring their concerns to their physicians.

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The advertisements should not be allowed to name the product; if treatment is indicated, the physician and patient can co-operate in choosing the best treatment.

Second, the marketing representatives who inundate physicians' practices must be limited in how they promote products.

Advocating use of a product for an illness for which it is not approved is still a common practice, despite Food and Drug Administration rules prohibiting it. Physicians should document and report any such violations to the FDA and the pharmaceutical industry. In addition, marketing representatives must be prohibited from giving false or misleading information regarding competing products.

Third, no marketing representative should be permitted to intimidate a physician by threatening to withhold product samples because a physician disagrees with product information promoted by the representative or because his or her prescribing practices make insufficient use of the product.

Fourth, marketing representatives should be prohibited from providing free lunches, free dinners, free pens, free coffee mugs, free laser pointers, etc., to physicians. These gifts constitute subtle bribes.

Finally, clinical investigators who conduct clinical trials for various pharmaceutical sponsors should be prohibited from accepting payment from pharmaceutical sponsors for giving promotional talks to other physicians. Payments vary from $750 for lunch presentations to more than $2,000 for out-of-town presentations.

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No clinical investigator who accepts such stipends can claim to be an unbiased clinical scientist.

Dr. Lawrence Adler

Glen Burnie

Taxing nonprofits shreds safety net

I was greatly disappointed that the mayor and City Council decided to take the short-sighted approach to solving the city's budget shortfall by imposing taxes on nonprofit organizations.

At a time when many city residents need more of the services that the nonprofits provide, the mayor and City Council have effectively reduced the nonprofit groups' budget for services. I would think that our city officials would take actions to enhance and support our nonprofits' ability to care for the poor and downtrodden in Baltimore.

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Aren't these nonprofits actually assisting the government of Baltimore in providing a social safety net?

The leaders of nonprofit groups will be forced to make hard choices by these taxes.

With so many worthy causes competing for each philanthropic dollar, it is unrealistic to expect the nonprofits to instantly start collecting more donations. To maintain the level of services provided, the nonprofit groups could either freeze or reduce salaries or reduce their workforces.

Neither of these options will help Baltimore in the long run, as the workers affected will see their standard of living reduced.

So, what is left but reducing the help and services these groups offer to those in our city who need it the most?

I understand that the city needs fiscal help and cannot count on additional assistance from the state government; however, the city should not balance its budget on the backs of the nonprofits.

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Stanley K. Mical

Baltimore

Let motorcycles park for free?

Baltimore has a new parking meter system (EZ Park) that can take coins or credit cards and spews out a ticket to be placed inside the windshield to indicate how long a car can be legally parked ("Fells Point to lose free parking, July 4). I have read that it is important to place the ticket inside the car to prevent someone from taking your ticket, as it can be used at other locations as long as it has not expired.

The program sounds good, unless one drives a motorcycle. There is no way to secure a ticket on a bike without it either being liable to be taken or simply blowing away.

I like to park at Fells Point and take the water taxi to the harbor, but now I'll have to take my chances parking at the Inner Harbor.

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The only motorcycle parking I have found is at the harbor near the new visitor center. The parking is small, awkward to maneuver in and on an incline, but it's better than nothing.

Motorcycles are cheap on gas, take up less space than cars or trucks and yet have no sure way to park legally with this new system.

Perhaps motorcycles can be allowed to park for free as a reward for being less intrusive on the environment.

Stephen G. Kariotis

Owings Mills

Freedom is the key to creating wealth

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Walter Williams' column "Two Americas" (Opinion

Commentary, July 6) argues that the disparity between rich and poor is the result of liberty and equality being misaligned, when in fact it is increased liberty that gives individuals the opportunity to increase their well-being.

Freedom helps create wealth and gives people incentives to work to earn the fruits of their labor.

On the other hand, a paternalistic government discourages personal responsibility -- redistribution of income is not only unjust, but contributes to a stagnant lower class.

I commend Mr. Williams for his concern for America's less fortunate, but his remedy for change is destructive.

And I strongly disagree with his assumption that our constitutional framers would support our inheritance tax -- it is inefficient and unfair. The tax not only destroys an individual's choice to do as he sees fit with his or her wealth, but has ill effects on the poor as well.

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Many of the assets it taxes are tied up in business capital. Taxation may require the liquidation of such assets, which means less machinery and closing shops and businesses -- and hence less employment.

More freedom leads to more opportunity for America's poor.

Wealth is acquired through a mixture of entrepreneurship, vision, hard work, good fortune, desire to succeed and the ability to go about life freely.

Without government interference, individuals have the opportunity to create this wealth -- and this is essential for themselves and America.

Jonathan Gray

Baltimore

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Goree Island still a symbol of slavery

Philip D. Curtin's scholarship on the slave trade has long been dismissed by most academics as outdated, misleading and flawed. I was surprised that The Sun did not interview scholars who have done far better and more recent research on the trans-Atlantic slave trade than Mr. Curtin's time-bound, 1960s-era research on this crime against humanity ("Powerful symbol, weak in facts," June 30).

For example, Professor Madge Dresser of the University of the West of England has provided data that show that 300,000 Africans were processed through Goree Island in the 17th century alone.

What Mr. Curtin has consistently failed to do during the past 20 years is understand that the vast majority of the trans-Atlantic slave trade was illegal and that much of his data are based on legal documents from various sources.

There were several "doors of no return" on the west coast of Africa, just as there were several crematoria scattered throughout Europe during the Holocaust.

Yet Goree Island has become symbolic of this crime against humanity just as Auschwitz has become a symbol of the Holocaust.

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Raymond A. Winbush

Baltimore

The writer is director of the Institute for Urban Research at Morgan State University.

Crownsville's closure will improve care

The Sun's recent article on the closure of the Crownsville Hospital Center misses the big picture entirely ("Crownsville Hospital Center is set to shut down this week," June 27).

This facility's closure, which was sought by mental health advocates for decades, is about two things: ensuring individuals with mental illnesses have the same opportunity to participate in community life as other citizens -- a right upheld by the U.S. Supreme Court not long ago -- and ensuring that the inadequate funding we provide for public mental health care is used as efficiently as possible so the largest number of Maryland citizens in need can be helped.

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Systemic change cannot occur without some pain, whether the facility being closed is a hospital, library or military base. People lose jobs or must travel further to obtain services, and hardships are involved.

The important thing is that necessary changes occur with due respect for these concerns and that every attempt is made to minimize the painful results of change.

On the other side of the equation are equally painful stories of hardship for those whose needs go tragically unmet day in and out when state mental health resources are used inefficiently to maintain aging facilities.

Look at the large numbers of children who experience school failure and end up in the Charles H. Hickey Jr. School and similar facilities because community mental health programs are unavailable to them.

How about the guy with untreated major depression who ends up getting treatment through the revolving door of a hospital emergency room because his low-paying job disqualifies him from getting the care he really needs at a community clinic?

These are the sort of tragedies that the redistribution of the resources that have been devoted to the Crownsville hospital seek to address.

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Linda Raines

Baltimore

The writer is executive director of the Mental Health Association of Maryland.

New trade barriers hurt Cuban people

The Bush administration has made yet another foreign policy blunder in its recent attempt to hasten the end of Fidel Castro's 45-year rule ("U.S. imposes trade and travel restrictions on Cuba," June 30).

Curtailing Cuban-Americans' access to their ancestral homeland will spark widespread resentment in Florida's Cuban constituencies.

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Essentially, President Bush has chosen to favor older, whiter, more conservative and wealthier Cuban-Americans who came to the United States right after the 1959 revolution as political refugees, rather than those who came after 1980, at the time of the Mariel exodus.

Those latter refugees have closer family ties and feel greater despair over not being able to adequately help their families back in Cuba because of the new policy.

Although cloaked in the guise of promoting democracy in Cuba and curbing funds to a supposedly terrorist regime, the restrictions, in reality, are just another example of the residual Cold War thinking on the part of this administration.

To expect Mr. Castro to yield to U.S. pressure misreads his enduring stubbornness in the face of hostile and puerile provocations from Washington.

The Cuban people, as usual, will be the victims, but Republican candidates could very well be punished at the polls as well if, as is likely, Miami's Cuban-American community splits over the issue.

Seth McClaskey

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Washington

The writer is a research associate at the Council on Hemispheric Affairs.

Is O'Malley right to back baseball in D.C.?

It is unfortunate and surprising to hear an elected city leader suggest the Baltimore-Washington region could sustain a second professional baseball franchise ("O'Malley gets boos on D.C. baseball," July 2). This would severely compromise the Orioles, negatively affect the city's economy and drain millions from city and state coffers.

After a thorough review of the region's market, the respected consulting firm of Deloitte & Touche concluded that this region could not sustain two successful Major League Baseball franchises ("Washington baseball creates pitchmen duel," June 14) .

Unlike professional football, which derives much of its revenues from its national television rights agreements, baseball is heavily dependent on local revenues, including local ticket sales, advertising, sponsorships and, most important, television and cable rights agreements.

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While two professional football teams can co-exist in the same market because of the heavy stream of national revenues, the same cannot be said about two professional baseball teams competing for the same essential local revenues.

The Orioles would have substantially fewer resources to pursue high-quality players, renew existing contracts and compete with the larger-market teams in their division. Both teams in the region would be relegated to "small market" status, if they even could survive financially.

The Orioles and the state are financial partners. Currently, the Orioles pay $8 million annually to the state in rent, plus a city-state admissions tax of 10 percent on every ticket sold. Since 1992, the Orioles have paid more than $65 million in rent and more than $50 million in admissions tax.

In addition, the Orioles pay $1.5 million annually in sales tax on concessions-related items and millions more in withholding and parking taxes.

Any diminution of revenues in a shared marketplace would reduce city and state revenues.

The Orioles are part of the economic and cultural fabric of this region. The region's economic benefit from the Orioles exceeds $225 million annually. Harborplace, Little Italy and city businesses benefit directly from the Orioles.

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In short, supporting the Orioles is good for local businesses and good for the Maryland economy.

It is therefore surprising to hear any local official suggest that one of this region's most valuable resources should be compromised.

Alan M. Rifkin

Annapolis

The writer is an attorney who has represented the Orioles on this and other matters.

Peter G. Angelos is mistaken when he says a Washington baseball team would harm Baltimore. It might hurt his bulging pocketbook, but it would be great for Orioles fans.

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Here's what a team in Washington would mean for baseball fans in Baltimore: a chance to watch National League stars we'd otherwise never see (or see only once every leap year); fewer annoying, half-interested Washington fans in our midst at Camden Yards; and possibly even cheaper prices for tickets and concessions.

As for how a team 40 miles away might affect the play on the field, the sad fact is the Orioles couldn't get any worse. They've finished in fourth place four years in a row, and are now stuck in last place with one of the worst records in baseball.

If Washington got the Expos, in recent years the punching bag of the National League, it would at least give the Orioles someone to beat up on and something for self-conscious Baltimore to feel good about. If nothing else, this could be our chance to stop playing second fiddle to Washington.

Christopher Heun

Baltimore

It is courageous of Mayor Martin O'Malley and other Maryland politicians to say they would not oppose relocating the Montreal Expos to Washington.

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Peter G. Angelos and the civic boosters who are fighting a Washington team have a paranoid fear that the ballpark and surrounding restaurants would suddenly be empty. That notion is ridiculous.

Despite their proximity, the two cities are separate markets. And if Washington owners blocked a professional team's entry into Baltimore, there's no doubt Baltimore residents would be incensed.

Mr. Angelos simply wants monopolistic media coverage of his team in two markets.

He should focus his energies on fielding a competitive team, something he has failed to do for the past seven years.

Michael Laff

Washington

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I totally agree with Mayor Martin O'Malley about the Orioles and a baseball team in Washington.

Maybe some competition right down the road would force Orioles owner Peter G. Angelos to field a decent team instead of that bush-league stuff he's been feeding us the past several years.

Rich Barnett

Baltimore

Mayor Martin O'Malley is correct that Washington should be able to have a baseball team.

I remember when a family could afford to attend major-league baseball games in Baltimore and Washington. Perhaps a team in Washington would force the owners of the Baltimore Orioles to figure out how to make the games affordable for the average fan.

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At the very least, it would enable Orioles fans to see a few away games just down the road.

D. B. Wagner

Catonsville

When the Cleveland Browns franchise moved to Baltimore, no one in Baltimore felt that there was a problem with the city supporting an NFL team with the Washington Redskins so close.

Also, when the Orioles have a quality team, the attendance is good, and when the team plays poorly, the attendance drops.

Baltimore is capable of supporting the Orioles without help from the Washington area, and I think Mayor Martin O'Malley deserves kudos for stating his convictions.

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Baltimore will be fine with or without a major league team in Washington.

Arnold J. Honkofsky

Owings Mills

I see the mayor is taking a lot of heat for thinking a baseball team in Washington might be the right thing.

As a native of Baltimore, I recall with pride that April day in 1954 when the St. Louis Browns took the field as the Baltimore Orioles. I recall that Clark Griffith, owner of the Washington Senators, gave his OK to the relocation of the St. Louis ballclub to Baltimore.

Then, as now, the two cities are separate and distinct and have their own fan bases.

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Come on now, Baltimore, let's play fair.

Hyman Shapiro

Rockville


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