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

royls_at_telus.net
Date: 11/18/04 

Date: Thu, 18 Nov 2004 21:56:50 GMT

On Tue, 16 Nov 2004 13:17:12 GMT, "sinister" <sinister@nospam.invalid>
wrote:

><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?

The high cost and uncertain outcomes of litigation, and the resulting
discouragement of both productive activity and rightful lawsuits by
impoverished workers.
 
>> 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.

That might work, but would be expensive, and leaves the matter of what
to do about honest errors unresolved.

>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).

One problem is that the MD's license to practise is his license to
print money. Will he imperil it by seeking treatment for an
addiction, or will he just try to hide it?

>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.

Agreed.

>>>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.

Which in many cases is also a torturous process involving excessive
hours of work, sleep deprivation, submission to capricious authority,
etc.

>>>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.

Agreed. Authority and responsibility must always go together. But
negligence is a funny kind of tort, and most especially in the case of
medical treatment which is often inherently hazardous and constitutes
a kind of assault (the body piercing fad was considered criminal
assault in many jurisdictions, and consent was not a defense!).

>(A miscellaneous example---MDs in the US are allowed to
>prescribe medications for non-FDA approved use. Why?)

In part because that's how better treatments are often discovered.

>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.

Agreed.

>Doctors seem to be a medieval style guild,
>designed (IMHO) to maximize rent-collection opportunities.

Too true.

>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.

It's a strange business, in part because the incentives are so screwed
up. As long as you stay healthy, your doctor doesn't make any money
off you. Doctors have a joke that the ideal specialty is dermatology,
because your patients never die in your care, but they never really
get better, either.

-- Roy L

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