In case you thought Nationalized Health would take the lawyers out of it…

Times OnlineLAWYERS are earning £800 an hour from the National Health Service and taking “indefensible” fees of tens of millions of pounds in legal disputes. The money is coming from a government scheme intended to compensate patients for medical blunders and inadequate care, an investigation has found.

The compensation lawyers are claiming costs and “success fees” worth about £100m a year out of the scheme. In some cases the payouts claimed are 10 times more than the damages won by the patient.

Health professionals warn that it could get much more expensive. There is an estimated backlog of cases against the NHS amounting to £12 billion in claims, of which lawyers could get up to £6 billion.

Looks like the docs aren’t sued directly; I’m for compensating victims of actual malpractice, but it’s interesting the lawyers still manage to get al least half.


Hat Tip: Overlawyered.


  1. While it’s impossible to compare health and legal systems, particularly based on info from a site like Overlawyered, does this surprise you that lawyers will still be involved?

    How exactly are injured people, especially the grievously injured or those who have already died due to malpractice, supposed to present their cases? Mail in the records and hope for the best?

    Anyone who supports the current US tort reform efforts is not for compensating victims of malpractice, by the way. If you were, you wouldn’t support arbitrary caps on their damages.

    • Matt,
      in thirty words or less defend the legal fees outlined in the article. Seems rapaciousness doesn’t stop even when the Govt. pays for everything.

      Also, you keep tilting at the cap meme, and you’re wrong. You can still sue for, and collect for, actual damages and you know it. There’s just no lottery incentive any more.

  2. Pain and suffering are actual damages. Can you point me to someone with a large pain and suffering award that you think won the “lottery”? I see real lottery winners and I’d love to trade places with them. I see malpractice victims with big verdicts, and I don’t want their life – do you? That sound like a lottery to you? But I guess it’s OK that we let insurance lobbyists arbitrarily decide the value of their cases without seeing the evidence, huh? Tell me, what am I wrong about there?

    As for your “thirty words or less” challenge, without knowing the terms of the payment scheme the govt. cooked up, or even anything about the cases themselves, it’s impossible. It’s like a headline saying “Physician X makes 100x what their average patient does!”. Without knowing more, how can you say if it’s justified?

  3. By the way, isn’t having government arbitrarily decide what your time and work is worth one of physicians’ main gripes? Seems odd that you think it’s perfectly fair for others.

  4. Can I point to a patient with a big verdict and say ‘they won the lottery”? Of course not. That would be obscene.

    What I can call obscene is a plaintiff attorney taking 40+% of that verdict, and putting it in their pocket. Your inability to denounce obviously excessive attorneys fees (int the linked article) makes your position as clear as mine.

    Interesting that medmal filings plummeted after tort caps were imposed: seems when the lawyers cannot make big bucks, suddenly representing patients in medmal cases isn’t nearly as interesting/lucrative.

  5. “Can I point to a patient with a big verdict and say ‘they won the lottery”? Of course not. That would be obscene.”

    Then how exactly do you define a lottery?

    “What I can call obscene is a plaintiff attorney taking 40+% of that verdict, and putting it in their pocket.”

    What would you charge to do that work? Do you know anyone with a devastating malpractice injury who can afford to pay hourly like the physicians/hospitals lawyers get paid?

    ” Your inability to denounce obviously excessive attorneys fees (int the linked article) makes your position as clear as mine.”

    I don’t know if they are excessive because I don’t know the work involved. Half of it might have been expenses, who knows? Don’t tell me you’re one of those people who thinks anyone who makes a lot of money is “overpaid”, and is required to give so much back to everyone else as a result. I wouldn’t have guessed it.

    “Interesting that medmal filings plummeted after tort caps were imposed: ”

    Not really. The year before they took effect (there was a lag time after the legislation was passed) a record number were filed to beat the cap. Cases that normally would have still been in the insurance claim phase were filed to beat the cap. To do otherwise would have been legal malpractice. That’s really not surprising. If you had a malpractice claim wouldn’t you want your lawyer to do the same?

    As for fewer cases being taken, of course. That was the point of the legislation, to discourage cases regardless of merit. It’s an economic disincentive to both victims and lawyers now. If you’re a person without a job (kid, elderly, stay at home mom), and your case is now worth a total of $250K plus medical expenses no matter how badly hurt you are, why would you file suit? The law didn’t make your case get heard faster, so you’re looking at a two-three year battle with a doctor’s lawyers telling you you’re not hurt that bad. And if you win, you get the cost of medical bills which you pay back to your health insurer and the medical industry. Plus you have to pay your lawyer the expenses he’s spent (which the insurance industry claims is around $100K to go to trial), plus his fee, and then you are looking at what? $150K? On your very best day in court?

    If I’m a victim who is one of the weakest members of society, like the elderly or a kid, people without earnings, why would I pursue a case? If you were the victim, would you?

    And if I’m the lawyer, why would I spend the countless unpaid hours plus up front expenses involved in litigating a med mal to trial? It’s an almost certain money loser. If I’m talented enough to handle complex med mal cases, I’m probably a pretty good lawyer and can take other types of cases.

    Again, you don’t like having the govt. arbitrarily decide the value of your time and your work. Do you think it’s fair that the govt arbitrarily decide the value of your pain if you’re one of these victims? I know you can’t imagine it happening to you, but you have to admit it’s not totally inconceivable.

  6. The government already decides the value of my work, and neither I nor the hospital bill by the hour. Your crocodile tears for The Man setting our prices really warms my heart.

    Do I think caps are/were the right answer? No, but in our situation / current lottery society it was the only tool the Legislature had at hand to keep medicine from being run off a cliff bu plaintiff attorneys.

    I’ve been sued. My real, actual experience told me then and tells me now it was all about the money. You don’t deny that, and I appreciate your pointing out that you’re not concerned with justice when you cannot make a killing from it.

  7. No tears. You made that bed. Just noting the irony.

    That was the only tool the legislature had? I trust even you don’t believe that nonsense. I know you have to stick to a line but don’t lie to yourself.

    Of course it is about the money. It takes money to pay your medical bills resulting from the malpractice. To pay your mortgage, buy food, pay for child care because you can’t work. You can’t sue for an apology.

    Hell you support caps and screwing the legitimately injured because you think they’ll put more money in your pocket in lower premiums. Don’t act like you’re interning at the red cross while everyone else chases filthy lucre.

  8. I didn’t make this bed, it was there (and no chocolates on the pillows) well before I got there.

    Nobody believes every jury verdict for MedMal plaintiffs was / is justified; some are, some aren’t. I’m sorry your colleagues got greedy and decided suing docs for everything killed your golden goose. When even the legislature decides caps are the best answer, you have to admit there was a problem.

    BTW, I GIVE AWAY 40% of my efforts, each and every day. You keep 40%. Now it’s starting to add up…

  9. You make that bed every time you sign up to do it again. I honestly believe that bed is going to render this whole debate moot, since along with universal healthcare we’ll get a workers comp style no-fault system.

    As for your second paragraph, you’ve got no evidence for any of your claims, they’re nothing more than sheer speculation. Are you really citing a legislature’s actions as proof of wisdom or the necessity for something? Particularly the Texas legislature’s? Honestly? I’m assuming that was written in jest.

    You give away 40% of your efforts? How do you figure that? Are you on salary, paid by procedure, what?

    You never did tell me why you thought 40% was too much. Just general principles that people shouldn’t get more than X amount of money? How much would you charge for the work involved, based on your intricate knowledge of trying plaintiff’s medical malpractice cases?

  10. The Texas legislature thinks it needs a board to regulate interior designers. Must be the overwhelming need to protect the public from bad combinations of wallpaper and carpet in River Oaks and Highland Park.

    You really have a lot of trust in the collective wisdom of today’s politicians.

  11. TheNewGuy says:

    How much pro-bono work do you do, Matt?

  12. I don’t know. I don’t really keep track. I won an award from the Legal Aid society for my county two years ago for most hours, so they keep track of the cases I do for them, but on the others I don’t know. Since I’m not getting paid I don’t keep the time.


  13. TheNewGuy says:

    Oh, about 45%… a little more than Grunt.

    Just trying to keep things in perspective.

  14. 45% of what exactly? And how did you determine that figure?

  15. Are you guys on a salary, or do you bill hourly or get some percentage of your gross collections?

  16. TheNewGuy says:

    almost 50% of the patients I see are self-pay (eg. no pay) or some form of medicaid.

    My group is independent and does its own billing, which isn’t by the hour, it’s by level/type of service. The hospital services are billed by the hospital (cat scans, labs, etc), and we see no cut or percentage of that money (that would be illegal). I have to buy my own health/disability insurance; no benefits.

    Some docs are hospital employees, and get paid a flat hourly rate plus/minus some benefits.

    Some docs are “independent contractors” and receive a flat hourly rate and no benefits.

    Note: the hourly rate you get paid in the latter two scenarios bears no relation to the amount you bill, with the exception of groups that have a productivity-based incentive plan.

    The only salaried ER docs I know are in the .gov or .mil system, and having done that gig, I’ll say this: they can keep it.

  17. Well, if you agree to take Medicaid patients and thus accept the Medicaid billing rates, that’s not really charity. If you bill people who simply don’t pay, it’s not really charity until you write it off, and if you end up selling your debt to a collection company, that’s not charity either. Having to buy your own health/disability benefits is not unusual, all of us who run our own show do.

    I have no doubt you do a lot of charity work, though, and I commend you for it. Not really sure the relevance of your good works to this conversation, though. You may be a fine person, other than your willingness to act as point man so insurers can make a few more dollars (and hopefully you too if they pass the savings on) off the backs of elderly and children. We all have our blind spot. But it doesn’t really change the merits of the actual legislation. Nor does it tell us any more about what work was involved in these alleged “outrageous” fees.

    I think Grunt just doesn’t like it when people make a certain amount of money, regardless of the fact that he has no idea what the work involved in earning it was. He’d probably like a nice 90% tax on anyone who makes more than him. Problem with that theory is that there’s always someone who makes less than you who thinks their salary ought to be the top!

    • I have said no such thing Matt. What I haven’t said clearly enough for you is that I find it obscene that you want to wrap yourself in the good and noble deed of defending kids and the elderly as a pretext for taking 40+ percent of any award, then when there”s not a bonanza in it any more suddenly there’s no need to take those cases.

      I don’t think there should be caps on anyones’ income. I think the current plaintiff attorney payment scheme is fully abhorrent.

  18. Sure you said that. You keep saying that the way their lawyers get paid is abhorrent and such, but you’ve yet to say how much you think they should get paid for that work. So, how much do you want to cap that pay at?

    I’m sorry you find the truth obscene, but that’s who caps fall hardest on. You may not like the facts and the results of what you support, but it doesn’t change them. Caps, which you support, screw the weakest members of our society. You make a lifetime of pain and suffering, regardless of the injury or the cause, equal to about what the average surgeon makes in one year. Talk about obscene!

    Since you find it so abhorrent, how would you suggest people with injuries who can’t work and mountains of medical bills pay their attorneys? Hell, how would you suggest they even pay the case expenses?

    I guess it’s easier to throw out words like obscene and abhorrent than to actually do anything to help those people. At least when you’re trying to save a few bucks on your malpractice insurance.

  19. Heh. I help people every single day. I don’t ask what they can pay, I just take care of them, and let the rest sort itself out. So, I help people, and I’m comfortable with that.

    It’s not my job to say what anyone should make. I do think it’s your job (and that of your colleagues) to justify taking half any award, and to then justify walking away from cases where you can’t get a big payoff. You can’t have it both ways, Champion of the Aggrieved (but only if I make a big payday).

  20. Good for you. Although you don’t have to worry about collections, that’s why you can “let the rest sort itself out.” You get paid regardless, and you certainly don’t front any expenses. Easy to be magnanimous when it doesn’t affect your bottom line, so don’t break your arm patting yourself on the back.

    As for plaintiff’s counsel, they need only justify it to their clients. You know any of them complaining about the fee? Probably not, since your colleagues and their insurer were giving them the stiff arm before they hired a lawyer, who put his time and money on the line.

    No one is claiming to be “Champion of the Aggrieved” but you. Of course, when one of your colleagues leaves someone a paraplegic through the negligence, you’re nowhere to be found. The rest of us recognize that you will quickly go broke fronting tens of thousands of dollars to fight a doctor and his wealthy insurer for free. Like too many physicians, the basics of running a business appear to elude you.

    If it’s not your job to say what anyone should make, why do you keep calling what everyone else makes “obscene”? Still waiting on you to let us know how the victims of your colleagues negligence should pay for legal representation if not via contingency fee. I guess it’s easier to hold your opinions if you don’t think about the practical result of them. Ignorance is bliss.

  21. TheNewGuy says:

    We don’t worry about collections? Where do you get this stuff? You think groups like mine get paid if we don’t collect from patients and insurers? Every patient I see without insurance (or with medicaid, which doesn’t even begin to cover the actual cost of anything) costs my time, and increases the liability I shoulder (and pay for).

    You once thought we were billing for CT scans too.

    Maybe plaintiff’s attorneys should be justifying their fee to more than just their client, particularly considering the cost impact they have on the entire system.

    As for being “Champion of the aggrieved,” you paint yourself (and other plaintiff’s attorneys and the dysfunctional tort system) as the champions of the downtrodden in every one of these discussions… along with plenty of class warfare thrown in. “How are the injured supposed to be compensated without us plaintiff’s attorneys fighting against those rich doctors and their rich/evil insurers?”

    My bromides aside, I have a bigger, and serious question: would you support a med-mal system that compensated more victims, yet resulted in plaintiffs’ attorneys making less money?

  22. “We don’t worry about collections? ”

    Did I say “all of you”? No, I said him.

    “You once thought we were billing for CT scans too.”

    Depends on the practice. There is no set way of doing it.

    “Maybe plaintiff’s attorneys should be justifying their fee to more than just their client, particularly considering the cost impact they have on the entire system.”

    The complete total of malpractice payments (and remember, much of those payments goes back to the system in the form of payment of past and future medical bills) was 2% of the total cost of health care. Even assuming we could define every procedure that was “defensive medicine”, and even assuming there was a “reform” that eliminated it altogether, at its most optimistic assessments it is less than 10% of the total healthcare bill. So we are not a particularly large driver of healthcare costs.

    “you paint yourself (and other plaintiff’s attorneys and the dysfunctional tort system) as the champions of the downtrodden in every one of these discussions…”

    Who else is helping these people get compensation? I’m not glorifying it, as at the end of the day it’s a job, but the only people who are representing these people, and after an injury caused by malpractice often the only people who will speak to them, are their lawyers. Physicians don’t want to talk to them, hospitals don’t, and neither do insurers. And those groups certainly aren’t offering to help them pay their medical bills or lost wages, are they?

  23. ” would you support a med-mal system that compensated more victims, yet resulted in plaintiffs’ attorneys making less money?”

    Wanted to answer this separately. The answer is yes I am for a system that compensates more victims more quickly. And as long as you don’t handicap the plaintiff’s lawyers as opposed to the defense’s lawyers, or try to arbitrarily set pay, then I have no problem if the result is fewer payments.

    But that’s not on the table in any way, shape or form. All that’s on the table legislative is arbitrary caps chosen by insurance lobbyists on the value of cases, regardless of their merit or the injury involved.


  1. […] and a taxpayer compensation scheme for medical negligence. [Times Online]. More: GruntDoc headlines his post, “In case you thought Nationalized Health would take the lawyers out of […]