Wha? Was there just a breeze in Hell?

From the “I’ll believe it when I see it, but I’d like to see it” files, via Overlawyered:

Confirming earlier reports: “In closed-door talks, Mr. Obama has been making the case that reducing malpractice lawsuits — a goal of many doctors and Republicans — can help drive down health care costs, and should be considered as part of any health care overhaul, according to lawmakers of both parties, as well as A.M.A. officials.

 

I’m not going to hold my breath, but…


Comments

  1. it’s just fluff and happy talk. And you know I’m an Obama guy, so if I think it’s BS, you know it’s really BS, right?

  2. Two things. First, Obama, like Bush before him, has little ability to do anything in the way of the “tort reform” you so crave, because it’s a state law issue, not a federal. Two, all he said was that if physicians develop guidelines for care in certain situations, and follow those, then they should prevail in lawsuits. Well, that’s called the standard of care, and if physicians would do that today the same thing would happen. You don’t need the President.

    Besides, Grunt, you Texans have already given free rein to negligence among your physicians and decided the value of a person’s lost quality of life is worth the average surgeon’s yearly salary and given your liability carriers plenty of protection. What more do you want? Infallibility by legislation? Even your liability carriers won’t back that because then you don’t need them!

    What you should be more concerned about, particularly you who seems to have a modicum of sense about the political aspects of healthcare, is the tradeoff for Obama pretending to throw you (or more accurately your insurers) a bone. What does he want from you in exchange? Given how little physicians benefit from “tort reform” and given Obama’s desire for a national health care system I’m betting the trade will ultimately be a piss poor one for physicians, even if they are too politically silly to realize it.

  3. Although, I may be giving you too much credit if you think Overlawyered is a viable news source, as opposed to a lobbying tool.

  4. Always charming and persuasive, as usual. Thanks for being so predictable.

  5. You’re right. If I’d just used more charm you’d care about patients injured by negligence more. Your opinion on the subject is not in the least predictable, and I should have recognized that and used more cream and sugar to win you over.

    However, you ought to care about being nationalized. If I’m real sweet do you think physicians will wake up and realize what’s happening? Which affects all us nonphysicians and taxpayers to be sure, but affects physicians in a very meaningful way on a daily basis? Would a little cream and sugar help wean them off the government teat before they swallow the udder?

  6. BladeDoc says:

    Prior to the election the Obama website’s section on health care had one line about malpractice — basically to lower malpractice costs physicians should just stop making mistakes. In short, the same bullshit matt is espousing. You will note that his comments to the AMA don’t contradict this in any way. Yes, I’m sure he is in favor of lowering malpractice costs — just not in any way unfavorable to the trial lawyers.

  7. Or the patient who is injured by malpractice. You remember them right?

  8. BladeDoc says:

    Yep, I also remember how it’s “impossible to put a value on pain and suffering” or “it’s not about the money” — and then they want the money.

    And then I actually look at the studies who find that only 30% of lawsuits have any negligence attached, most being just a bad outcome AND conversely that most incidents of negligence do not become the basis of a lawsuit and come to the conclusion that the only person the current system favors is the trial atty. Unsurprisingly that’s who developed the system and perpetuates it and donates a sackload of money every year (est. at $10K per ATLA member) to keep it just like it is.

    I’ll believe the trial attorneys care about the patients — well, pretty much never.

  9. As a legal nurse consultant and life care planner, I used to think most cases were frivolous. Not anymore.

    It is amazing what some (not all) have gone through and how they have been forever damaged and their lives forever changed. I am working on a case right now that will have damages in the millions of dollars. If there was a cap on damages this patient would not have a chance. The patient is very young and has a long life ahead…albeit forever changed. The medical care will be astronomical. Caps are not the answer or else folks like this will fall through the cracks. I do believe we need a stop to defensive medicine and I don’t claim to know the answer.

    It wasn’t until I began working in this business that I saw some of the carelessness, even repeat offenders that left a path of destruction and families torn apart. If you ever have a chance to really look into some of these cases you, too might be amazed.

    I do support a cap on non-monetary damages…but I think it should be a percentage of the economic damages rather than a set figure. I am anxiously awaiting to see what is going to become of healthcare reform, the AMA, and Mr. Obama. (as well as my career!)

  10. Sultan of swage says:

    The establishment of health care courts would address the matter of nuisance and frivolous suits very effectively, passing the meritorious claims on to civil litigation, without arbitrary limits on damages, ideally. As for the non-economic damages that Matt seemingly wants to equate with the merit of the suit, I have only to say that I personally am unfamiliar with any physician who practices with wanton negligence just because they know that their insurance companies’ liability will be capped. Most of us go to work everyday with one goal: help the sick and injured return to health and do so in a caring and competent fashion.

    Every time I come to this blog to visit I find that Matt seems to believe that no physician is capable of concomitantly wanting to 1) practice caring, empathetic medicine and 2) not get sued for it if they can avoid it. Can’t you understand that good doctors don’t practice negligently but a lot of good doctors still get sued, and more often than not there is no malpractice found, despite the very best attempts and wordsmithing of the attorneys? Cases where the original claim is for malpractice but, once depositions are obtained, the med mal claim is dropped, only to be replaced by a claim of improper supervision of a physician extender or emotional suffering from learning of a diagnosis in an abrasive and unprofessional manner or any number of other claims after the lawyers figure there was no malpractice but there may still be money to be had?

    Truly negligent or reckless or inappropriate care should be recognized and punished and, when damages are caused, compensated for. The purveyors of such care should be either given an opportunity for education and improvement or, if that should fail, be denied the privilege of practicing medicine.

    As for the caps Matt so despises, I must say that I did not agree with Prop 12, either. As an ER doc in TX I thought that it was a devil’s bargain that was not the professional or dignified means to achieve medical tort reform. Remember that Texas’ citizens voted on that measure, not just doctors. However, the strong push against Prop 12 by the trial attorneys in Dallas, Houston, and Austin predictably and publically focused on the supposed denial of patient rights while the fall off in the number of med mal cases in Texas has much more to do with the sudden drop in the profitability of these cases for the lawyers. If Matt’s logic is to be believed, then Texas should have a steady increase in reckless and nefarious doctors, thus creating ever more suits, each just as meritorious as the former, keeping the attorneys ever busier filing ever more suits. Has that happened?

    The liability climate has to change. Caps are not the way to do it. But the med mal lawyers haven’t exactly been burning the midnight oil trying to figure out how to keep patients safer so they can pay themselves less. Truth be told, keeping patients safer is our job, though. As a group, physicians need to take point on offering a solution that protects patients and doctors and signing on to a caps system that mostly just let’s the insurance companies off the hook is not the way. Let’s get a solution that does what it is supposed to do: identify negligent doctors, punish and/or reducate them, compensate the injured fairly and without arbitrary caps, eliminate the incentive to pursue claims of questionable merit in order to enrich the lawyers. Can’t we all agree on that?

  11. “Yep, I also remember how it’s “impossible to put a value on pain and suffering” or “it’s not about the money” — and then they want the money.”

    Well, it’s a civil lawsuit. If you sue for candy hearts and kisses it will be dismissed. Physicians sue for money, what’s wrong with that?

    “And then I actually look at the studies who find that only 30% of lawsuits have any negligence attached”

    Never seen that study. The most comprehensive study on medical malpractice, the Studdert study of 2006, concluded ““Overall, the malpractice system appears to be getting it right about three quarters of the time,” said Studdert. “That’s far from a perfect record, but it’s not bad, especially considering that questions of error and negligence can be complex.” Of the remaining 25%, over 1/2 were claims that should have been paid but weren’t. I’m sure you’re not advocating for MORE payments are you?

    “Unsurprisingly that’s who developed the system ”

    Actually, the British developed the system.

    “I’ll believe the trial attorneys care about the patients — well, pretty much never.”

    Well, if the person helping them get recovery isn’t of assistance, who is? The doctor who won’t speak to them, the insurer who is stonewalling? You? Do tell.

  12. “The establishment of health care courts would address the matter of nuisance and frivolous suits very effectively”

    Perhaps, but putting aside the Constitutional concerns, how? There would still have to be discovery to develop the case.

    ” As for the non-economic damages that Matt seemingly wants to equate with the merit of the suit,”

    That is incorrect. The degree of negligence has nothing to do with the pain and suffering. A person can be incredibly negligent, even intentional in causing the harm, and there may be limited noneconomic damages. For example, if a physician were to intentionally break a patient’s arm, they’re clearly at fault, but the long term damage is slight, and noneconomics are not much of a factor.

    “Cases where the original claim is for malpractice but, once depositions are obtained, the med mal claim is dropped. . .”

    While I empathize with being sued and having the case dropped and the stress involved, how else would you suggest either side get the other to give their position under oath? Even a healthcourt would need that testimony.

    ” while the fall off in the number of med mal cases in Texas has much more to do with the sudden drop in the profitability of these cases for the lawyers”

    Actually, it has more to do that there were a bunch of cases that would have been filed the following years but were filed before the cap went into affect.

    “then Texas should have a steady increase in reckless and nefarious doctors, thus creating ever more suits, each just as meritorious as the former, keeping the attorneys ever busier filing ever more suits. ”

    That’s not my logic at all. I actually don’t believe physicians move for liability protection, given that it constitutes such a small part of their overhead. That’s a claim often made by physicians however, who are always leaving for some mythical tort free place. Ironically, California has had horrible (for the patients) tort reform for decades but it is losing physicians.

    The problem with capping noneconomic damages from my perspective is two fold. One, as a conservative, I do not believe in allowing lobbyists to decide the value of a case they’ve never heard the evidence in. Two, it unfairly penalizes those with no economic damages and makes their cases economically unviable – ie stay at home moms, the elderly, and kids.

    “The liability climate has to change.”

    I see this claim and I wonder why. What proof is there that it’s “out of control” other than physician perception? There are roughly 1 billion patient interactions according to Whitecoat of Whitecoat Rants. How many incidents of negligence would one expect with that many interactions? How many lawsuits are there total? No one knows. All we have is half reported anecdotes mostly obtained from a newspaper article. Why are we making policy based on so little info, and why are the people that have the information, the insurers, not releasing it? It is those questions we must answer to start.

  13. sultan of swage says:

    “Actually, it has more to do that there were a bunch of cases that would have been filed the following years but were filed before the cap went into affect. ”

    Matt, you know that this is not true. Just ask your colleagues in Texas and they will tell you. Also, Prop 12 was passed long ago enough that the statute of limitations for suits that were being considered around that time would have passed by now, and should have been filed.

    “That’s not my logic at all. I actually don’t believe physicians move for liability protection, given that it constitutes such a small part of their overhead. That’s a claim often made by physicians however, who are always leaving for some mythical tort free place. Ironically, California has had horrible (for the patients) tort reform for decades but it is losing physicians.”

    Actually, if you look at the number of applications for Texas medical licenses over the last 5 years you will see that they have increased compared to other states. You cannot be oblivious to the fact that California has its own economic disincentives for doctors (and everyone else for that matter) in that the cost of living and taxes are significantly higher than, say Louisiana or Texas. Salaries for ER docs are significantly lower as corporate groups know they can pay less because, well, it’s California and people just want to live there and will take a substantial pay cut to do so.

    “Perhaps, but putting aside the Constitutional concerns, how? There would still have to be discovery to develop the case.”

    Obviously, this would have to be addressed in the form of an ammendment that would be a component of the overall health care reform package currently being developed by Congress, with the help of medical and legal professionals. As for discovery, this is not debated. I would argue that facts determined by discovery would be deliberated by the health care court, with civil courts determining damages after the health court recommended professional action against the doctor if so warranted. Incidentally, the ideal health court would be comprised of a panel that included both medical specialists and specialty lawyers.

    “The problem with capping noneconomic damages from my perspective is two fold. One, as a conservative, I do not believe in allowing lobbyists to decide the value of a case they’ve never heard the evidence in. Two, it unfairly penalizes those with no economic damages and makes their cases economically unviable – ie stay at home moms, the elderly, and kids.”

    I actually agree that there should not be an arbitrary cap on damages but I will also argue that the very notion of non-economic rewards effectively says that it is possible to put a value on an ineffible entity. Thus, if a value can be placed, then a limit can exist and could be sought, putting aside any notion of sensationalism attatched to tabloid-friendly multi-million dollar pain and suffering awards (which are pretty uncommon.)

    “While I empathize with being sued and having the case dropped and the stress involved, how else would you suggest either side get the other to give their position under oath? Even a healthcourt would need that testimony.”

    Empathize, Matt? Really? Regardless, I am not arguing against discovery or testimony. What I am referring to is the lawsuit that is originally filied claiming malpractice but then is changed to something entirely unrelated to malpractice (such as the two examples I gave). From the defendant’s perspective: Oh, so first you claim that I committed malpractice but now you are saying that I actually didn’t but the patient did not like how they were communicated with so I am to be professionally liable for their feelings, instead? Regardless of outcome, which is all that is supposed to matter, ultimately? Matt, you and I both know that there are lawyers out there who fish and fish and fish until something bites, and then take 40% plus expenses. Don’t act for a minute that you either are unaware of this or do not believe it exists.

  14. “Matt, you know that this is not true.”

    I’m sorry, I thought you were referring to the significant drop the first two years after the “reform” was passed. That was attributable to what I mentioned. However, you are right, in the long term fewer cases will be filed simply because for those without economic damages (old people, kids) they are not economically viable. So, rather than the at fault party or their insurer paying for the past and future care, us taxpayers do!

    “Actually, if you look at the number of applications for Texas medical licenses over the last 5 years you will see that they have increased compared to other states.”

    I have no doubt Texas has experienced an increase. Texas in the last 5 years opened a number of new facilities, and has experienced significant population growth. However, where’s the evidence it is due to tort “reform”? Is Texas gaining physicians at a faster rate per capita than states without it? If you don’t know, that statistic doesn’t mean much. As for California, physicians don’t go into that level of nuance when they’re pushing tort reform, they say docs are disappearing and going to favorable “liability climates” because of lawsuits. Period.

    “Incidentally, the ideal health court would be comprised of a panel that included both medical specialists and specialty lawyers.”

    So basically, on sketchy to no evidence that we need to do this, we will 1. amend the US Constitution; and 2. add one more layer of bureaucracy plus significant taxpayer cost, to this process? All so insurers save some money? Doesn’t sound very wise.

    “Empathize, Matt? Really? ”

    Absolutely. When I had a net worth of probably $25,000 I was sued for $2 million. Now, the case didn’t have merit in my opinion, and didn’t go past discovery, but not only did I not have $2M, I didn’t have insurance to pay legal expenses or a judgment because it wasn’t the kind of thing that was insurable. Now, do I have some professional detachment? Of course, same as physicians. But do you question physicians’ empathy simply because they can look analytically at a medical issue that may be quite painful to the person involved?

    “What I am referring to is the lawsuit that is originally filied claiming malpractice but then is changed to something entirely unrelated to malpractice”

    I honestly don’t understand your examples, as they seem to have different plaintiffs. And you seem to equate a civil suit for damages with a professional board action. I don’t think one has much to do with the other.

    ” Matt, you and I both know that there are lawyers out there who fish and fish and fish until something bites, and then take 40% plus expenses.”

    With car wrecks, I’d agree with you. No doubt, there are shitty people in every profession, including physicians. However, it doesn’t make economic sense in medical malpractice to take a bunch of bottom feeders hoping for the big score because the costs are too high when you lose. Plus, to be an effective medical malpractice lawyer (on either side) you’ve got to be a pretty good lawyer. Why would you take dogs when you could get paid well trying other kinds of cases that don’t require tens of thousands up front? Are there a few? Perhaps, but do the actions of a small percentage truly justify a Constitutional Amendment?

  15. sultan of swage says:

    “I honestly don’t understand your examples, as they seem to have different plaintiffs. And you seem to equate a civil suit for damages with a professional board action. I don’t think one has much to do with the other.”

    Perhaps you are unfamiliar with the strategies of some of your bretheren. I am personally familiar with two cases that were originally filed as claims of negligence but the claim was left open for other future claims related to the care of the patient. In each example I gave you the same plaintiff originally filed suit for negligence, deviation from the standard of care for medical treatment, only later to have the claim changed to the aforementioned issues of supervision and emotional mistreatment. The lawyers went after the big high-dollar fish first, then only after getting the depos did they realize that they had to go after something, anything, since the negligence wasn’t there, as they had hoped. Hence the other claims. This happens, Matt. You are sticking your head in the sand if you don’t believe it. Do you also doubt that med mal attorneys wouldn’t ever file a meritless claim in the hopes of a settlement, the so-called nuisance suit?

    “But do you question physicians’ empathy simply because they can look analytically at a medical issue that may be quite painful to the person involved?”

    You misunderstood me. Why question was whether you were using the term appropriately as empathy requires experience in the matter discussed, not whether you were were capable of understanding it’s meaning. The reasons why the best physicians practice with empathy is that the human condition requires suffering at some level, often including pain, and we can all understand to some degree what it is to feel as our patients feel.

    “So basically, on sketchy to no evidence that we need to do this, we will 1. amend the US Constitution; and 2. add one more layer of bureaucracy plus significant taxpayer cost, to this process? All so insurers save some money? Doesn’t sound very wise.”

    I agree that the evidence must be vetted objectively before making such a drastic chnage to our tort system. However, your argument is to either leave matters as they are, which enriches lawyers disproportionately more than their clients, regardless of side or outcome, or…what? You seem resistant to a Constitutional amendment but the climate of business and the practice of medicine-and law-have changed in the 220 years since its conception. The elegance of the Constitution is that its format and provisions allow for amendments as our society evolves. With much deliberation, to be sure, but doesn’t that go without saying? By the way, eliminating medical tort cases from the case loads of our courts while adding them to that of a health care court would not add as much bureaucracy as you imply, I think.

    “As for California, physicians don’t go into that level of nuance when they’re pushing tort reform, they say docs are disappearing and going to favorable “liability climates” because of lawsuits. Period.”

    Come now, Matt. Be reasonable, at least. We are not all of us a collective bunch of know-nothings that glaze over, oblivious, once confronted with sensational melodrama espoused by lay media and insurance PAC mailings cloaked in a facsimile of Hippocrates’ sacred duty. Any doctor paying attention knows that tort reform ain’t the whole ball of wax and should recognize that caps are only truly beneficial for the insurance companies, with the doctors secondarily benefiting from the lack of nuisance and frivilous suits that are eliminated, which are likely very few to begin with. The very unpleasant side effect being that truly harmed patients now stand to collect so little, in many cases, that no lawyer will take their case because the bucks just aren’t there for the legal team. Payoff shrinks, suits dry up. The truly harmed have less of a case today than they did before caps, is that what we are to believe?

    “I see this claim and I wonder why. What proof is there that it’s “out of control” other than physician perception? There are roughly 1 billion patient interactions according to Whitecoat of Whitecoat Rants. How many incidents of negligence would one expect with that many interactions? How many lawsuits are there total? No one knows. All we have is half reported anecdotes mostly obtained from a newspaper article. Why are we making policy based on so little info, and why are the people that have the information, the insurers, not releasing it? It is those questions we must answer to start.”

    I agree wholeheartedly with you here, Matt. Why in the world do people have to DIE for lack of a neurosurgeon in South Florida? Well, if neurosurgeons have to pay $120k a year for med mal, that might be a start. But why the hell do we let insurance companies charge this if your statements about the relative paucity of med mal suits and their subsequent rewards are to be believed? Market losses in insurance company portfolios? Huge CEO bonuses? Gambling problems amongst board members?

    The liability climate has to change if it is THE determinant of the availability of care and people need care. OB/GYN looks at $110k med mal insurance bill in state A; looks at $50k med mal insurance bill in state B. State A also much more expensive to live in, maybe she needs to keep office open an extra 2 hours a day. Gonna have to miss kid’s soccer practice or have someone else take him. Utilities cost more, too. Her office staff going to expect to be paid more since cost of living is so high, relative to state B. And, she has a better chance of getting sued in state A. She has never been sued before in her life but that doesn’t matter. Insurance company detemines rates and she needs it to practice her life’s work. She does the math, talks with her family, decides that it just won’t work out in state A. So state B it is. Problem is, there aren’t near enough OB/GYN docs in state A and the citizens are expecting to continue procreating, with or without sufficient OB/GYNs. This is, admittedly, anecedotal, but this is not an unfamiliar situation for doctors in several states.

    Access to care and fairness are the only two legitimate reasons I can think of to encourage liability reform. As long as our system requires the services and resources of med mal insurance companies and as long as they have the ears of our elected representatives on both sides of the aisle, and as long as they have the deepest pockets, then they will continue to determine what the terms of this issue are.

  16. “I am personally familiar with two cases that were originally filed as claims of negligence but the claim was left open for other future claims related to the care of the patient.”

    First, let me say I appreciate the tone of the discussion. As to this comment, really all suits are “open” to being amended as information develops in the case. When you file suit, you really only know one view of the case. It shouldn’t be surprising if it changes through discovery. Emotional mistreatment, and I think you mean “intentional infliction of emotional distress” requires a physical injury in my state. As for negligent supervision, there has to be some underlying negligence, so I’m not sure how that claim went forward.

    “Do you also doubt that med mal attorneys wouldn’t ever file a meritless claim in the hopes of a settlement, the so-called nuisance suit?”

    I never say never, just as I’m sure you’d never say that physicians don’t falsify medical records to cover up claims. I just think both are pretty rare, and I wouldn’t go changing policy based on either example.

    “but the climate of business and the practice of medicine-and law-have changed in the 220 years since its conception. ”

    Couldn’t you use this argument to nearly any of the Amendments encapsulated in the Bill of Rights? Could the founders have anticipated that free speech would permit all the content out there now? How about freedom of religion? To me, that argument doesn’t hold much water. The value of a jury trial still remains in the sense that it is the CITIZENS deciding the outcome, rather than it being dictated to them.

    “By the way, eliminating medical tort cases from the case loads of our courts while adding them to that of a health care court would not add as much bureaucracy as you imply, I think.”

    Considering that the number of these cases isn’t that high I don’t believe that it changes the case load much. It does add a whole other court, with highly paid specialists sitting as judges in every specialty, and the various support staff required to support such a system. With at least one if not more in every state.

    “We are not all of us a collective bunch of know-nothings that glaze over,. . . ”

    Not what I said. What I said was that while you’re willing to discuss nuances now, your lobbying efforts do not. Granted, that’s not their role, but you don’t get to have it both ways.

    “The truly harmed have less of a case today than they did before caps, is that what we are to believe?”

    If you can’t get to court, does it matter?

    “Well, if neurosurgeons have to pay $120k a year for med mal, that might be a start.”

    Well, do they? What is the actual average cost of insurance in the region? What is it as a percentage of overhead and income? How many claims does the person have? Without knowing these simply telling me that one person pays a lot, and not naming that person, doesn’t tell us much.

    “But why the hell do we let insurance companies charge this . . ”

    I don’t know. Correct me if I’m wrong, but I think it’s fair to say that most physicians have no idea what their insurer’s rate of return on investments are, what they pay their CEOs, what their loss reserves are and how they compare to historical numbers, and what their insurer’s profit is over the long term (they all know it in years when the insurer is down because the insurer publishes it as a prelude to raising rates and pushing tort reform). I think you should know this, at least before you reach a conclusion on the necessity of tort “reform”.

    “This is, admittedly, anecedotal, but this is not an unfamiliar situation for doctors in several states.”

    Perhaps it is, but two things. One, you didn’t tell me how much more or less she could earn in State A v. State B. And two, you don’t make policy on anecdotes. I can tell you horror stories of children injured by negligence for a lifetime, but would you think that a person should be AGAINST tort reform based on those? I’d venture to say you wouldn’t.

    “Access to care and fairness are the only two legitimate reasons I can think of to encourage liability reform.”

    Well, if those are the reasons, we have 30 years of history of tort reform of the kind physicians love in California. Has it improved either? If no one has bothered to look, why do you think that is? Even disregarding the insurance reform California enacted when rates didn’t fall.

    “As long as our system requires the services and resources of med mal insurance companies and as long as they have the ears of our elected representatives on both sides of the aisle, and as long as they have the deepest pockets, then they will continue to determine what the terms of this issue are.”

    True, the question is will physicians continue to carry the water for these insurers? The insurers know they are politically unpopular, but a bunch of guys in white coats? Well, most people like and trust their doctor.

  17. You want really effective reform? In either medicine or law, the majority of the problems are caused by a minority of practitioners. First, licensing should be national, not state-by-state, so that an incompetent health care practitioner who loses their license in one state can’t get a license to cause more damage in another state. The AMA needs to get serious about weeding out the bad apples quickly.

    Same with the ABA. I do believe that the cause of excessive litigation has a lot to do with bottom-feeding ambulance chasers who will take any case, no matter how spurious, in the hope that they get lucky with a sympathetic jury. Lawyers who continually file frivolous lawsuits should lose their right to practice. In their case, national level licensing isn’t possible since laws (unlike human bodies) really are different from one state to another. Instead, in order to step on the ambulance chasers, judges should be given the ability to impose fines on lawyers who waste the court’s time with spurious lawsuits. Don’t make the plaintiff pay the court costs (they probably can’t anyway) — make the law firm pay the court costs. Failure to pay fines should result in revocation of the firm’s ability to bring suit in that court. That would make the lawyers think twice about taking flimsy cases from patients who, say, want to sue an ER doc for problems that resulted from the patient’s failure to get the followup care the ER doc told them to.

    In short, to minimize the amount of malpractice litigation going on, efforts need to be made on both sides. Both law organizations and medical organizations need to weed out the corrupt or incompetent members of their professions more quickly.