Bottom line? Worries over malpractice don't add up

THE BALTIMORE SUN

HOW DO YOU suppose the president of the United States arrived at the $250,000 price tag on pain and suffering? Do you think he would be satisfied with $250,000 for pain and suffering if, say, a member of his family sustained abdominal trauma from a fall from a tree swing and bled to death because emergency room physicians didn't make a timely and precise diagnosis? (True story, Baltimore County, 1992. You can look it up.)

Or maybe pain and suffering - or "noneconomic damages" - should max out at $650,000. That's what the governor of Maryland thinks. Everybody like that number?

Or perhaps families should be compensated for pain and suffering at a higher rate - say, $812,500, which is the number the Maryland General Assembly approved during a special session last week. How many of you would be content with Eight-Twelve-Five?

Or maybe the limit should have stayed at $1.6 million. Let me see hands on that figure.

This is a macabre exercise, isn't it?

The idea of a ceiling on pain and suffering has always seemed bizarre to me, all things being relative in life (and death). I don't know how you put any price - never mind a legislated one - on the impact of a wrongful death in a family. I always believed that was best left to juries to hash out, human beings quantifying the pain and suffering of other human beings.

But we like to bottom-line things in this country, so that's part of the reason there's been a movement - and it started long before George W. Bush was in office - to standardize something as subjective as pain and suffering. You can get a fixed price for a combo meal at McDonald's - why not for pain and suffering, too?

In the big, swirling debate over medical malpractice, I have more questions than answers because, frankly, there doesn't seem to be a whole lot of hard information available when it comes to this subject.

"Lawyers are filing baseless suits against hospitals and doctors, that's just a plain fact," President Bush said in Illinois yesterday, and I'm sure he's correct to some extent. But to what extent?

It's very hard, for instance, to get accurate information on wrongful death cases in Maryland, particularly their outcomes and settlement figures.

We've been told that doctors are going out of business left and right because of malpractice awards and the spiraling costs of malpractice insurance. Yet most of the evidence appears to be anecdotal, not indicative of a widespread trend.

In Maryland, the legislature approved a significant subsidy last week of doctors' premiums, trimming a proposed 33 percent increase in malpractice insurance costs to 5 percent.

We seem to have accepted the argument that the 33 percent premium increase was necessary.

And we seem to have accepted the argument that paying this increase would be ruinous to physicians' practices - basically, that doctors can't afford it.

But is that true?

Is it true for all doctors? Isn't this really a crisis for doctors in high-risk specialties, particularly those in obstetrics?

And even then, are doctors really going to suffer because of this, or are they just going to have to hang onto the '02 BMW for an extra year?

If doctors - non-OB-GYNs - are insulted by that BMW crack, I challenge them to back up their claims that increased malpractice premiums are going to make their lives unlivable, their careers unsustainable.

Pardon me for sounding jaded. (It's a chronic condition.) But I think a lot of people have made assumptions about this "crisis."

Yesterday, I spoke to an 82-year-old man who was gravely distressed about the retirement of one of his doctors, a longtime Baltimore urologist named Horst Schirmer. Dr. Schirmer has seen his last patient. He announced a year ago that he would close his practice at the end of 2004 because he could no longer afford to keep the practice going while paying escalating insurance premiums. Dr. Schirmer told me yesterday that he was paying $77,000 a year, and that an increase of 33 percent was "out of the question."

So he has retired, he says, before he wanted to.

Dr. Schirmer is 73. He has been practicing medicine for 49 years. This is a sad time for him because, he says, he is forced to leave on terms other than his own making.

The governor's call for a special session of the General Assembly - and the General Assembly's vote to limit the malpractice premiums to 5 percent - came too late for Dr. Schirmer. And the doctor thinks the legislature's malpractice reforms did not go far enough, that the limit on "pain and suffering" should have been brought down to the kind of level President Bush is advocating.

We keep coming back to that as the answer to this "crisis," as if the only way to fix it is to make people who have suffered at the hands of doctors settle for less in compensation. (Some heavy fines for lawyers who file unjustified medical malpractice lawsuits might be nice.)

Perhaps I need medication. I remain unconvinced that there is a "crisis." I remain skeptical about big premium increases by insurance companies, and I remain skeptical that doctors can't afford them. That makes me skeptical of insurance companies, lawyers and even doctors. I am a victim of my times.

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