Judges hit classroom to learn about medicine

Physicians know that scientific evidence in medical liability cases can be a tough subject for judges to grasp.

To help educate them and restore doctors' sometimes shaky confidence in the legal system, the National Judges' Medical School was established in March to give nearly 70 federal and state judges more understanding of the complexity of patient care.

Guided by doctors, scientists and judges, the school provided medical science knowledge judges could use to help them with their cases and allow them to become a resource for others. The effort to assist judges in resolving cases in the fairest, most expeditious way possible is believed to be the first of its kind. It grew out of the Einstein Institute for Science, Health and the Courts, a nongovernmental organization paid for by the National Institute of Environmental Health Sciences.

Physicians say the judges' medical school might help repair a legal system that has put them in the business of practicing defensive medicine.

"What we see a lot in courtrooms is that people have bad results but not necessarily bad medicine," said Benjamin Calvo, MD, a surgical oncologist and professor at University of North Carolina Chapel Hill Medical School, who taught at the judges' medical school.

Judges from eight states and the District of Columbia immersed themselves in a weekend curriculum at UNC focusing on an area that often leads to physicians being sued -- cancer. Classes included hands-on courses in cancer screening and technology, genetic causes of cancer, and interactions between doctors and patients.

"The objective in this was to give judges a feel for the span of judgment that physicians and other health care providers have to exercise when detecting, diagnosing, treating and to some extent predicting the outcome of cancer," said Franklin Zweig, PhD, president of the Advanced Science and Technology Adjudication Resource Center, which recruited the judges who attended the program. The ongoing ASTAR/EINSHAC project is free to invited judges.

The March school was the anchor for a program participating judges have committed to attending periodically in the next two years. Future classes will branch into areas such as genetics and clinical trials. In the fall, ASTAR will invite another 125 participants.

Dr. Calvo said the goal is to show judges that most of human biology and medicine is not black and white.

And judges at the first round of classes said they learned exactly that. In addition to acquiring a scientific knowledge base, judges said they learned that understanding physician-patient communication is key to interpreting complex medical cases.

Ohio trial Judge Lee Sinclair said he was particularly enlightened by a mock exercise in which a newly diagnosed cancer patient evaluated treatment options with several doctors, including a surgeon and an oncologist.

When the judges got together to discuss the conversation, "what you realized was everyone in the room heard things in a different way," Sinclair said. "Often what you hear in medical malpractice cases is the physician saying he explained it to the patient and the patient saying it never happened."

The insights are especially valuable in helping judges eliminate potentially frivolous lawsuits or find alternate ways to resolve legal disputes without going to trial, said Marvin J. Garvis, a Maryland federal judge.

"The easiest thing for a judge to do is to say, 'Go to trial and sort it out there,' " he said. With scientific and medical training, Garvis said, "there is a significant increase in their ability to make a definitive decision," whether it's before litigation or during the course of a trial.

Courts evolving

Judges say there is more pressure on the courts because of the 1993 U.S. Supreme Court Daubert v. Merrell Dow Pharmaceuticals Inc. ruling, which held that trial judges are responsible for determining the validity of the science presented in their courtrooms. But judges say they are not equipped to keep up with battling experts and medical advancements that play into the complex decisions physicians and patients make.

"What we want to do is be anticipatory, so that when these issues come up, we are in a position to make confident decisions regarding the credibility of the science itself," said Robert M. Bell, chief judge of the Maryland Court of Appeals, a co-sponsor of the judges' medical school with the Illinois, North Carolina and Ohio Supreme Courts.

Judges specializing in medical issues might be a novel approach to resolving health care disputes, but specialized courts are not a new concept in the legal system. For example, some courts specialize in areas such as bankruptcy and illegal drugs.

The judges' medical school's objectives resemble those of specialized health courts, said Philip K. Howard, chair and founder of Common Good, an advocacy group supporting legal reform. Both ideas are "founded on the belief that decisions in health care disputes need to be based on science and need to be consistent," he said.

But Howard said the question is: "Will it be enough to restore the trust by doctors and other health care providers in the system of justice?"

Doctors and judges hope so. "At the end of the day, [judges] are the ones who have to mediate, and it's in everybody's interest to make sure it reflects reality," Dr. Calvo said. "Otherwise we will end up with a system where physicians continue to overtreat."

Garvis agrees. "I really hope [the program] expands, and in its own way, I hope it is going to help the medical profession have greater confidence in the judicial system and help judges have greater confidence as well."