Re: Outrageous!! We *must* have tort reform!

From: sinister (sinister_at_nospam.invalid)
Date: 11/16/04 

Date: Tue, 16 Nov 2004 13:17:12 GMT

<royls@telus.net> wrote in message news:41992cd3.19283101@news.telus.net...
> On Mon, 15 Nov 2004 13:40:45 GMT, "sinister" <sinister@nospam.invalid>
> wrote:
>
>><royls@telus.net> wrote in message news:4196551c.6827542@news.telus.net...
>>> On Sat, 13 Nov 2004 09:35:14 -0500, " jls" <jls1016@bellsouth.net>
>>> wrote:
>>>
>>>>Is tort law based on failure to use due care so hard for you
>>>>to understand?
>>>
>>> Tort law based on sympathy rather than justice is something that is
>>> obviously too hard for you to understand.
>>
>>Right. But why should MDs be exempted from the tort system, which is what
>>they want in the US?
>
> There are actually some good reasons to do that, just as there was to
> substitute workers' compensation for lawsuits against employers for
> injuries suffered on the job by their employees. There is an inherent

What were, historically, the reasons for that?

> hazard to patients in getting many treatments, and the extent of
> damages suffered often has little to do with the seriousness of the
> negligence (if any) involved. But it is important to understand that
> there is typically a _greater_ hazard in _not_ getting treatment.
>
> Obviously, we can't have MDs getting drunk before performing surgery,
> but how do you distinguish culpable negligence from honest error?

By having competent authorities monitor their work. Other things that could
be done would be to suspend the license of e.g. MDs addicted to drugs that
might impair their work, which is not now the case (cf the story about
Cheney's doctor).

I would even excuse occasional errors that they *shouldn't* make, according
to the principle that mistakes are always made. The right thing to do is to
attempt to locate those individuals whose competence is below some standard.

>>To make matters worse, it's difficult or even
>>impossible to get at information which would allow you to make an informed
>>choice about which doctors to see. And if someone created a website to
>>collate such information, they'd be sued by doctors for libel...via the
>>tort
>>system.
>
> Right. There is a huge problem with patient confidentiality and
> physician privilege being used as excuses to block access to
> information.
>
>>Currently, as far as I can tell, the rate at which doctors are stripped of
>>their right to practice medicine is far too low.
>
> Agreed. As a first step, doctors should have to pass a regular
> examination on the state of their knowledge and skills, say every five
> years. And anyone who can pass the exam and other qualifications
> (criminal record check, etc.) should get a license to practise.
> Requiring so many years of med school is ridiculous, especially for
> immigrant doctors who may be perfectly capable, but can't get their
> qualifications recognized without going back to school for several
> years.

My impression is that the obstacle isn't that they're required to go back to
medical school, but rather forced to repeat their residency.

>>IMHO the right thing to do
>>is regulate MDs based on case-adjusted statistical monitoring of their
>>performance. Incompetent MDs would have their license to practice
>>medicine
>>taken away.
>
> The devil is in the details.

Of course. But I don't see why MDs should be exempted from the tort system
without giving something up in return---in this case, the right to practice
medicine with almost no review of the quality of their work by competent
authorities. (A miscellaneous example---MDs in the US are allowed to
prescribe medications for non-FDA approved use. Why?)

Overall, people fixate on the insurance system when the issue of how to
"fix" medicine comes up. I don't deny the importance of that (I'm in favor
of national heath insurance since it seems more equitable and in the
aggregate more efficient), but I think there's at least as large a problem
in the delivery of care itself. Doctors seem to be a medieval style guild,
designed (IMHO) to maximize rent-collection opportunities. For example, why
are most doctors in the US small businessmen (either working alone or in
small partnerships) rather than employees of large organizations? I predict
there are large economies of scale that aren't being utilized.

> -- Roy L

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