March 30th, 2011

Scalia Ticketed After Rear-Ending Car

Supreme Court Justice Antonin Scalia, it seems from this news report, started a four-car collision while heading southbound George Washington Parkway across the Potomac River from Washington in Virginia. He was going to work, about to hear arguments in a labor case involving Wal Mart.

Three interesting little tidbits from this story:

Supreme Court Justice Antonin Scalia was ticketed by U.S. Park Police after being found responsible for a four-car traffic accident on his way to the high court Tuesday morning.

Why would Justice Scalia be responsible? Because he hit another in the rear. Assuming local laws down there are the same as up here, that makes him liable for following too close to the car in front of him and failing to see what was there to be seen. No, that “failing to see” is not a political joke, but part of the law. It’s possible, of course, that he has a non-negligent excuse for the accident (for example, the other driver cut him off and slammed on his brakes in traffic). But that doesn’t seem likely from this report from the Washington Post:

Brooke Salkoff saw it all go down. The former NBC reporter told us she was just behind Scalia’s vehicle, a shiny black BMW in the left lane. “It slammed into the car in front of his, which pushed the other two forward,” and caused them all to skew into the right lane, she said.

The second tidbit is this:

“It was a busy traffic area,” [U.S. Park Police spokesman David] Schlosser said. “It just happens.”

Well, no, it doesn’t “just happen.” That makes it sound like an unavoidable accident, like a deer that darts into the road. But an accident like this happens because one (or more) people weren’t driving carefully. Thus, the ticket.

The third tidbit:

No one was injured.

This is possible, but as any doctor that has seen trauma patients will tell you, many to connective tissue and soft tissue structures won’t appear for a day or more, often the result of inflammation that develops after the trauma.

Final note: According to his bio, he spent his first six years as a lawyer at a Cleveland law firm. Did he ever argue a case? If Scalia were to actually show up in court to challenge the ticket, would it be the first matter he ever argued from the courtroom well?

(More at Above the Law)

 

March 28th, 2011

New York Courts To Suffer More Budget Slashing

Yesterday the New York Legislature and Gov. Andrew Cuomo reached a budget deal that includes $170M in cuts to the judiciary, representing 6.3% of the its budget. This is bad, bad news for anyone who values a competent justice system.

It was just three weeks ago that I wrote how we were going to lose 300 former judges now acting as Judicial Hearing Officers as part of $100 million in cutbacks. The budget deal, however, now advances those cuts to $170 million.

According to this New York Law Journal article today, the pain will be far worse than previously expected, and  Chief Administrative Judge Ann Pfau said she doesn’t yet know where the cuts will come from.

My prediction: The civil justice system will slow to a crawl, and judges will become overwhelmed even more so than now. Retiring judges won’t be replaced. Staff will be cut. The judiciary will try to force litigants into less of the time-consuming motion practice that sucks up much of the limited resources. Many of the motions are merely “money motions” that were done to drive billable hours. Others are for a variety of recalcitrant discovery issues. Judges may be urged to deal more harshly, in terms of sanctions, in order to discourage that type of conduct.

 

March 20th, 2011

My Op-Ed in The Journal News

I have an op-ed in today’s Journal News. This is a Gannett paper that serves the suburban counties just north of New York City:

Cuomo’s medical malpractice ‘reform’ will hurt victims and taxpayers

Gov. Andrew Cuomo is now proposing to grant immunities and protections to hospitals that injure or kill patients by acting negligently. Voters and consumers should be alarmed, because the effect of the proposal will shift the burdens of those most seriously hurt onto both the victims and the taxpayers. The beneficiaries are the insurance companies and those that acted negligently.

These new proposals are tucked inside a document, far from public view, called the Medicaid Redesign Report. The proposed new law would create an artificial one-size-fits-all cap of $250,000 on medical malpractice pain and suffering claims — even for those who’ve been paralyzed or brain damaged from negligence. It would also strip rights away from neurologically impaired infants by creating a new government-created fund, so that taxpayers end up subsidizing malpractice. The authors of the report are insurance companies and medical institutions. There were no patient representatives on the committee.

This is an anti-consumer bill that is flawed on both public policy and monetary grounds. The New York State Bar Association — the largest bar association in the state, with lawyers who represent both doctors and patients — has condemned these two proposals. Essentially, the taxpayers will be picking up the tab for the negligence of others.

Currently, New York caps personal injury cases for those runaway verdicts you see in the papers from time to time. These caps are geared to individual cases, a process the state has undertaken for almost 200 years. Fundamentally, if a verdict “deviates materially from what would be reasonable compensation” (either by being way too high or way too low) the trial court, or the appellate court after that, will order a new trial. So the system in place has both a belt and suspenders to protect litigants from the occasional outlier verdict.

What is the advantage of changing a system that isn’t broken? Well, by limiting the rights of the citizenry to a trial by jury, it gives a healthy dose of immunities and protections to those that committed the wrongful acts. Is that an advantage? It is if you are the one that caused the injury.

If the arbitrary cap is in place, of course, the injuries won’t be diminished. The only thing that will change is that the economic burden of those injuries will be borne by the victim instead of the party that caused them. To the extent that people are bankrupted by the toll of their injuries, the taxpayers will then foot the bill for Medicaid and a host of other social safety net programs.

Is it sound public policy to victimize the injured person a second time and discard the concept of personal responsibility? Should taxpayers bear the burden of loss instead of the insurance companies that collect premiums for just this reason?

Natural cap

Factors already keep malpractice cases in check. First, the suits are very expensive to bring. It could cost more in experts, records and depositions to get a verdict. Second, New York’s low legal fees, the result of “reforms” that were enacted in the mid-1980s, are a disincentive to lawyers to overreach. Legal fees start at 30 percent of the first $250,000 and rapidly slide down to 10 percent of anything over $1,250,000. In other words, complex and expensive malpractice cases have lower legal fees than the norm, causing a predictable drop in the number of attorneys willing to undertake these difficult cases.

The result of that “sliding-scale” fee structure is that doctors and hospitals in New York now enjoy significant immunity from medical malpractice cases. It is simply too expensive to bring many of the actions, even if they have merit.

The insurance companies and medical professionals that drafted the “reform” proposal now ask for a second giant helping of immunity by eviscerating the pain-and-suffering damages. The ones who will be hurt, of course, are those who have been most seriously hurt. It will have no effect on frivolous cases, as they do not have a value over $250,000.

If the government wants to cut Medicaid costs, and cut lawsuits, the efforts must be devoted to patient safety, not killing patient rights. Telling people they can act with impunity doesn’t increase safety. According to the February issue of American Journal of Obstetrics & Gynecology, New York Presbyterian Hospital/Weill Cornell reduced errors and slashed their medical malpractice payouts by 99 percent due to enhanced patient safety initiatives. The message is clear; tort “reform” does not equal patient safety.

With respect to the plan for a new fund to pay the costs associated with those lives that been devastated the most — neurologically impaired infants — testimony in Albany on this issue uncovered a startling fact: They haven’t figured out how to pay for it, though a “baby tax” is contemplated on people and companies that buy insurance. This gets the insurance companies off the hook for paying for the errors of the people they insure, and places more burdens on the taxpayers.

If Big Hospital Inc. commits malpractice and injures someone, why should the taxpayers subsidize that malpractice? Ultimately, of course, someone will pay, and it makes sense that the one that did the damage should pay the bill.

This scheme makes no sense on either public policy or economic grounds. There will, however, be a windfall profit for the insurance companies and those doctors who hurt the most people and make the biggest mistakes.

 

 

 

March 15th, 2011

Does Tort “Reform” Kill Patients?

Medical malpractice payments plunge after comprehensive patient safety improvements are made

Two questions today as New York ponders putting a $250K cap on medical malpractice awards among its “reform” measures:

Question 1: Has medical malpractice tort “reform” ever saved a life?

Answer: No. OK, that one was easy. So-called reforms merely strip rights from the injured, they do zippo to improve medical care.

Question 2: Does medical malpractice tort “reform” kill patients?

Answer: Yes. Now this question was in dispute up until recently, but no longer given a study that showed plunging medical malpractice payments and “sentinel events” after patient safety improvements were made (graph at right). But since everyone knows that histrionics aren’t my style,  an explanation as to how I come to that conclusion that tort “reform” kills is in order.

Prior medical studies had tried to address the issue of whether “reform” had an effect on increasing injury/death due to less medical care. This was a tough subject because, on one side you had “reformers” claim there was defensive medicine for fear of malpractice suits and wasted money, and on the other you had patients pointing out that doctors actually billed for, and profited from, those tests. Also, those “unnecessary” tests often found things.

So I turned to the Congressional Budget Office, which does non-partisan cost analysis of government expenditures of various budgetary changes, and found a letter to Congressman Bruce Brayley that directly addressed the issue. (On page 3, entitled The Effects of Tort Reform on Patients’ Health). The CBO opinion was inconclusive, citing  conflicting medical studies.

So why would I, faced with conflicting evidence on the issue of whether tort “reform” kills, now claim that it does?

Because the American Journal of Obstetrics and Gynecology published a study in February from Columbia Presbyterian Hosptial / Cornell Weill Medical Center that devastates the arguments of the so-called “reformers.” The study found that “instituting a comprehensive obstetric patient safety program decreased compensation payments and sentinel events resulting in immediate and significant savings.” What does that mean in dollars and cents? It means that their payments due to malpractice plunged, as the graph in the upper right hand corner shows. Quoting the report itself: “The 2009 compensation payment total constituted a 99.1% drop from the average 2003-2006 payments (from $27,591,610 to $ 250,000).”

It is abundantly clear then, from a pure dollars and cents point of view, that the medical profession has a spectacular opportunity to save money by slashing its malpractice payments. But to do that, they have to improve patient safety. You can see the raw savings in the chart on the left.

Of course, if that incentive is taken away by simply giving immunities and protections to the those that committed preventable errors, which is what tort “reform” is all about, the safety improvements would not take place. That means patients will continue to be injured and die from malpractice.

Conservatives should take note, as they have long held beliefs that market forces will win the day when a better mousetrap has been built. And Columbia Presbyterian / Cornell had now devised that better mousetrap by figuring out how to keep patients safer, resulting in lower costs. Focusing on “reform” that offers protection from lawsuits instead of protection from injury/death merely perpetuates the current problems in hospitals today. Such “reforms” take away the critical incentive to improve.

So this is the two-part conclusion:

Safety improvements = fewer malpractice payments and healthier patients.

Tort reform = more patient deaths.

Some money quotes from the report:

Our results show that implementing a comprehensive obstetric patient safety program not only decreases severe adverse outcomes but can also have an immediate impact on compensation payments.

Our experience supports the recommen-dation that: “. . . Malpractice loss is best avoided by reduction in adverse out-comes and the development of unambiguous practice guidelines.”

Good teamwork promotes professional integrity and is essential in delivering optimal patient care, and failure in communication and teamwork is often cited as a common cause of adverse events.

Making significant changes on a labor and delivery unit including such features as the implementation of a standardized oxytocin protocol, electronic charting, team training, and improving situational awareness through a central communi- cation system, should be considered by all obstetric services. As we have shown, these changes can increase pa-tient safety, decrease sentinel events, and, as a consequence, reduce compensation payments.

The myth that medical malpractice tort “reform” was needed  has not just been deflated, but its been disproven and debunked, and it was done by one of the nation’s leading hospitals.

And why have I put the word “reform” in quotes all these years? Because the concept of reform is built about improving a system, not making it worse.

Addendum: My op-ed in The Journal News on Sunday, March 20th.

 

March 15th, 2011

North Carolina to Allow Non-Lawyers to Buy Interest in Firms? (Lousy Idea)

There is a bill pending in North Carolina that would allow non-lawyers to buy interests in law firms, up to 49% of the total. This violates the age old prohibition on sharing legal fees with non-lawyers, and is one hell of a lousy idea. First, read the short piece by Dan Fisher @ Forbes on the bill, then come back.

Welcome back. Now here is the problem from my perch in the personal injury field. If non-lawyers profit from the legal business then there is an incentive for them to “help” their investment by finding cases to refer to the firm. In other words, it is an invitation for private “investigators” to troll for clients. We have legalized ambulance chasing, bringing more disrespect to the profession and our justice system since the non-lawyers aren’t bound by the ethics rules. And the lawyers who get the cases may simply choose to turn a blind eye as to how the cases are coming to the firm, or worse, give equity in the firm to the investigators without asking the critical questions of how the clients were obtained.

When the disciplinary committee comes a callin’, they will profess to be shocked, just shocked, at how their firms’ names were given to potential clients.

Let me show you how this works in the real world. This past weekend there was a horrific bus crash in the Bronx that killed 15 people. And attorneys are prohibited under New York’s 30-day anti-solicitation rules from approaching any of the injured victims or next of kin.

So how can lawyers work around this? By using marketing firms to launder their ethics.

Other firms, such as this one and this one, run “blog” posts about the accident that merely regurgitate the facts from a news article and then follow up with a call to action (If you or someone you know…). I discussed this problem back in 2007 after the new anti-solicitiaton rules went into effect (see: Attorney Solicitation 2.0: Is it ethical?)

So what will happen if non-lawyers have a financial interest in the firm? You can bet your last dollar the situation will worsen.

Larry Ribstein asks why non-lawyers shouldn’t be allowed to own shares of firms, under the theory that the restrictions limit the market for legal skills in the business world. But I don’t think he has given enough thought on how that plays out among other fields of the law.

Elsewhere:

Legal Services Act comes to US (Legal Transformation: The Changing Legal Profession)

Are ABSs coming to America? They may be in North Carolina (Legal Futures)

Lay Ownership Share In Law Firms Proposed in North Carolina (Law Forward)