So, if this is true, why is the president (and, for that matter, many Republicans and Democrats right here in Illinois) only talking about going after the trial lawyers? (link via here and here)

Experts retained by the Bush administration said Tuesday that more effective disciplining of incompetent doctors could significantly alleviate the problem of medical malpractice litigation.

The experts, from the University of Iowa and the Urban Institute, came up with this idea:

Randall Bovbjerg, a researcher at the Urban Institute, said, “If you take the worst performers out of practice, that will have an impact” on malpractice litigation. “Most doctors have few or no claims filed against them. But within any specialty, a few doctors have a high proportion of the claims.”

You gotta wonder how many of those white-coated docs surrounding the president in Collinsville this week were part of the problem, not the solution.

Massachusetts has adopted an approach that experts say may provide a model for other states. Without waiting for a complaint to be filed, the Massachusetts Board of Registration in Medicine conducts a clinical review of any doctor who has made three or more malpractice payments to patients, as a result of jury verdicts or settlements. Nancy Achin Audesse, executive director of the board, said: “Three is a magic number. Doctors who have to make three or more payments are also more likely to be named in consumer complaints and to be subject to discipline by hospitals and the medical board.”

And here’s the kicker:

In Massachusetts during the last 10 years, Audesse said, “one-fourth of 1 percent of all the doctors — 98 of the 37,369 doctors — accounted for more than 13 percent of all the malpractice payments, $134 million of the $1 billion in total payments.”

Amazing. Thirteen percent of the malpractice payments were generated by just a quarter of a percent of all the doctors in the state, yet the solution is to cap non-economic damages. So, if a dirt poor single mother of three is blinded because of a medical error, she gets the capped amount and almost nothing else (if she can find an attorney, and if she then wins her case). If a corporate CEO is similarly blinded, she gets millions in lost income on top of the relatively paltry cap amount.

It would be interesting to see how the numbers work in Illinois, but the state’s website is of little help.

Here’s a good summary of what the Urban Institute’s Mr. Bovbjerg recommended in a recent article:

The current medical liability system works poorly for patients and physicians, the authors say. Because of steep increases in malpractice premiums, physicians tend to practice “defensive medicine,” ordering unnecessary medical tests, procedures, and referrals for their patients. Not only are patients exposed to unnecessary physical risk, but health care costs rise even further. Meanwhile, large numbers of Americans continue to suffer preventable medical injuries.

Bovbjerg points out that in the mid 1980s, anesthesiologists adopted “practice guidelines” that “drastically” reduced patient deaths and insurance premiums.

He also recommended several legislative solutions (highlighting mine):

* States could implement physician licensure requirements, such as the risk management training required by the Massachusetts Board of Registration.

* Insurance regulators could provide premium discounts on malpractice insurance based on doctors’ performance — an up-front investment in quality improvement that would reap savings in the long term.

* Tort reform could be contingent on reporting of errors, or implementing specific activities that increase patient safety.

* Health plans, Medicare, and Medicaid could provide partial subsidies of physicians’ premiums in return for specific safety enhancements.

* Doctors could invest in tools such as electronic prescribing aids and automated systems for tracking of tests.

* Better information on patient safety could be collected and reported to facilitate safety improvement and physician involvement.

But just when you think you’ve got it figured out, you read articles like this and you see the other side. (Registration and fee required, but well worth it.)

A new leader is emerging among Chicago’s powerful medical malpractice plaintiffs lawyers, 50-year-old Kevin G. Burke, who operates with a distinct advantage over his better-known competitors: his eight years spent on the other side, defending doctors and hospitals.

That experience, all but unique among the city’s top medical malpractice plaintiffs’ lawyers, helped Mr. Burke secure verdicts and settlements last year totaling $89.8 million, tops in Chicago.

Man, that’s a lot of dough. Here are his top three verdicts:

Evelyn Arkebauer, et al. v. Northwestern Medical Faculty Foundation, Northwestern Memorial Hospital, et al.
Settlement: $35.0 million
Allegation: Plaintiff’s son was rendered permanently disabled after a delay in treatment.

Misty Campbell, et al. v. St. Francis Hospital and Health Center, et al.
Verdict: $32.0 million
Allegation: Plaintiff’s son suffered brain damage and blindness after the medical staff failed to recognize signs of fetal distress.

Heather Duvall, et al. v. Evanston Northwestern Healthcare, et al.
Settlement: $15.0 million
Allegation: Plaintiff’s son suffered brain damage after physician applied excessive force during delivery.