AMA vows united voice in battle for tort reform

Medical courts and state legislative action were also on the medical liability agenda at the AMA Interim Meeting.

By Tanya Albert amednews correspondent — Posted Jan. 5, 2004

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Honolulu -- After lengthy debate on the best strategy for getting federal tort reform enacted, state medical and specialty societies say they are united and will speak with one voice rather than pursue legislation that would "divide or diminish the voice of the House of Medicine."

Physicians at the American Medical Association House of Delegates 2003 Interim Meeting last month stopped short of saying they would not pursue specialty-specific legislation that could give protection to obstetricians or other high-risk specialties that have been particularly hard-hit by medical liability insurance costs and unavailability, leaving the door open to look at and evaluate that type of bill.

During 90 minutes of debate, some state and specialty societies supported the idea of pursuing specialty-specific tort reform that could potentially garner the 60 votes needed in the Senate to avoid a filibuster, pass the bill and send it to conference committee. A Senate bill could then be hashed out with a 2003 House-passed bill that included all specialties and a $250,000 cap on noneconomic damages, proponents argued.

But many physicians testified that pursing a specialty-specific bill could ultimately result in costs and insurance problems being passed on to other specialists who would not be protected in a final bill. And they worried that politicians who felt like they had already addressed the problem would not take up the issue again if other specialties then sought federal tort reform as well.

The AMA sees the final policy as a good compromise that allowed physicians from states and specialty societies to walk out of the meeting with "locked arms" and in "harmony." That, they said, will ultimately breed tort reform success.

"Everyone pledged today to enhance communication and to cooperate with all involved with medical liability reform," AMA President Donald J. Palmisano, MD, said. "Success will come when we speak with the same message."

With a 305-174 vote in favor of the final language, most physicians said vowing to pursue legislation that doesn't divide the House of Medicine will benefit physicians and patients.

"It accomplishes what everyone wants and gives the AMA the muscle it needs to move forward," said Rhode Island ophthalmologist and AMA delegate Michael E. Migliori, MD.

Some specialty societies say the language the AMA adopted leaves room for exploring the idea of specialty-specific federal legislation, something they say they've been told may have a better chance of moving through the U.S. Senate -- a stumbling block in the drive for federal tort reform.

"State and specialty societies need flexibility and strength in traveling the rocky road to tort reform," said Providence, R.I., gynecologist Kathleen Fitzgerald, MD, a delegate from the American College of Obstetricians and Gynecologists. "This allows flexibility. When you are a crusader and only do things one way, you may not be successful."

Road to reform

Enacting proven tort reforms such as the $250,000 cap on noneconomic damages at the federal level has been the AMA's highest legislative priority since June 2002, but success has been elusive.

Although the House passed a bill last spring that included a $250,000 cap on noneconomic damages, doctors were unable to get similar legislation passed in the Senate.

There were not 60 votes in the Senate to avoid a filibuster. Although it is not clear whether specialty-specific legislation would garner those 60 votes, some say that it is important to leave that option open.

"It will help keep the issue alive in the Senate," said Lexington, Ky., neurosurgeon James R. Bean, MD, an alternate delegate from the Congress of Neurological Surgeons. "It also keeps the issue alive before the American public and reinforces there is a crisis. We believe the strategy in the end can lead to the solution we all want -- MICRA-type reforms."

But some fear language adopted by the AMA could lead to division among physicians as tort reform options unfold in Washington, D.C., this year.

"Although it gives the appearance of unity, any specialty-specific legislation is divisive," said Eugene, Ore., anesthesiologist Richard R. Johnston, MD, a delegate from the American Society of Anesthesiologists.

Dr. Palmisano said the Association will evaluate any proposed bill by asking a series of questions, including: Does it include proven reforms? Will it destroy established state reforms? Does it benefit medicine? And does it divide or diminish the voice of the House of Medicine?

"When we have all the information, we will make a decision," Dr. Palmisano said.

Other medical liability goals

In addition to going forward with one voice, physicians at the AMA's Interim Meeting:

  • Reaffirmed their drive to make medical liability reform that contains proven methods the "highest legislative priority."
  • Directed the Association to work with state and national specialty societies to develop and implement a strategic plan to address the problems associated with the medical liability crisis while doctors continue to lobby for reform at the national level.
  • Directed the AMA to draft an alternative judicial model that promotes medical malpractice claims being heard in special courts where judges are trained in medical standards.

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Limiting their options

According to a new AMA study of nearly 4,000 medical students in 45 states and the District of Columbia, the medical liability environment was a factor for 50% of students in choosing a specialty and for 39% in deciding where to do their residency. The study also reported on:

Familiarity with the medical liability problem

59% were somewhat familiar.
21% were not very familiar.
15% were very familiar.
4% were not at all familiar.
1% missing, no answer.

Perception of the magnitude of the problem

59% say it is a "major problem."
37% say it is a "crisis."
4% say it is a "minor problem."

Discussion with professors about specific topics as they relate to medical liability insurance

81% have heard about premium increases.
77% have discussed health care cost increases.
69% have heard about unnecessary or excessive care (defense medicine).
62% have discussed specific areas of the country with high-risk liability climates.
37% have talked about limits on choice of insurance.

Source: American Medical Association

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