Medical liability reform -- let's do it together now!

A message to all physicians from AMA President Donald J. Palmisano, MD

By Donald J. Palmisano, MDis a general and vascular surgeon in private practice in New Orleans. He was AMA president during 2003-04. Posted Jan. 19, 2004.

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For those who are concerned about the future of medical liability reform -- and what physician isn't -- I have good news.

Last month, in his news conference just after Saddam Hussein's capture was announced, President Bush once again expressed his support of such reform. "Unfinished business remains," he said. "The House passed a medical liability reform bill -- it is stuck in the Senate. ... When the House and Senate return in January, there will be more to do, and I look forward to working with them -- I've got a few ideas about what we can do together in the year 2004."

Just before the president held his news conference, I was honored to be invited to the president's meeting in the White House with six physicians from Iraq and Bud Alpert, MD, the American physician who encouraged their visit. Two of the Iraqi physicians just had joined us at the AMA Interim Meeting, Dr. Quraish Al-Kasir, president of the Society of Iraqi Surgeons, and his wife, Dr. Nahla Dawood.

Senate Majority Leader Bill Frist, MD (R, Tenn.); Surgeon General Richard Carmona, MD; National Security Adviser Condoleezza Rice, PhD; and Assistant Secretary of Defense for Health Affairs William Winkenwerder Jr., MD, also were present at the president's meeting.

President Bush was eloquent in his praise for the AMA on its potential for help in Iraq, and he thanked me personally for the work on Medicare reform. When I later met with Dr. Frist one-on-one, he, too, thanked the AMA for all our hard work with the Medicare legislation.

This meeting of the doctors from Iraq would not have been possible had it not been for the generosity of retired Gen. William Lyon, who gave a grant to the division of plastic and reconstructive surgery at the Keck School of Medicine of the University of Southern California, Los Angeles, funding the entire educational trip for the Iraqi physicians. Randy Sherman, MD, chair and professor of the plastic surgery program at Keck, shared this important information with me. He and Lyon attended the meeting. It again demonstrates that success is the effort of many working together, and we always should give thanks and credit to those who quietly help great things happen.

In my speech, "United We Triumph, Divided We Fail," to the House of Delegates at our AMA Interim Meeting in December 2003, on the importance of physician unity (link), I emphasized that the Medicare prescription drug bill was a victory for medicine, a victory earned because the family of medicine spoke with one voice. One message -- a unified voice ensuring that all Medicare patients will be eligible for a prescription drug benefit, and that the neediest will receive the most help. And yes, it stopped the physician payment cuts, gave us regulatory relief and makes possible for all Americans the option of medical health accounts, which is long-standing AMA policy.

We need to apply that same winning strategy to our fight for medical liability reform: working together and speaking with the same message.

During the last six months, the AMA, the specialty societies, and state and county medical societies have advanced the fight for medical liability reform, in some instances, in dramatic fashion.

For example, the Texas Medical Assn. once again spearheaded liability reform in the Legislature and won. But Texas doctors didn't stop there, as they remembered their state Supreme Court's previous rejections of earlier reforms. TMA advanced Proposition 12, a constitutional amendment that sanctions medical liability caps. It passed and had an immediate effect.

Texas' largest insurer of physicians has announced a 12% decrease in 2004 premiums.

When I met with President Bush in December, I showed him my TMA "Yes on 12" lapel pin and told him I wear it all the time, especially when I debate trial attorneys. He laughed, and repeated loudly, "Vote yes on 12!"

We need to look at the setback in the Senate in July 2003 not as a barrier, but as an opportunity.

What the Senate vote taught us is that there is no longer disagreement about whether there is a crisis -- the disagreement is only on what constitutes the solution.

We will work with the Senate leadership to press for more votes on this bill in 2004.

We are urging Dr. Frist to set the date for the Senate floor vote well in advance, so we have time to implement a more effective campaign to get those 11 votes that stand between us and success on a federal solution for medical liability reform.

If any group has an alternative plan for effective reform that can get the vote of 60 senators and break the filibuster by the obstructionists, bring it to the AMA and we'll chat.

My friend, the wise orator and former AMA president, Edward Annis, MD, recently sent me a poem he learned while a medical student. The poem, "Help One Another," tells how snowflakes joining together make great drifts, and dew drops, by joining together, avoid evaporation and make rivers that run to the sea. A simple poem by an unknown author, but the meaning is clear: We can achieve great things if we work together. Imagine the chaos and disaster on D-Day if the Canadians and British decided not to go to Normandy, or the U.S. Navy dropped the Army off somewhere else. Divided we fail!

So together, let's do it this year -- establish meaningful, national medical liability reform. Reform based on actuarial evidence and not political expediency. National reform that does not undermine the effective state reforms already in place. Reform consistent with AMA policy, voted on by all the states and specialty societies represented in the AMA House of Delegates. We can do it. We must do it. And 2004 is the year in which we will do it! Yes, united we triumph!

Donald J. Palmisano, MD is a general and vascular surgeon in private practice in New Orleans. He was AMA president during 2003-04.

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