Health Care and the Legal Industry
It is hard to comprehend how much health care money is wasted each year due to the legal industry. From malpractice insurance payments and defensive medicine to the huge volume of medical records now generated simply to cover all possible angles of a potential lawsuit. Recently a patient of mine was in France and had the onset of a cardiac condition. She was treated for five days in a French hospital and discharged back to me. I received a full copy of the medical records by mail. The records were medically complete and detailed. Interestingly, there were fewer pages from her five day stay in the hospital than in one of our routine emergency visit charts. They seem more centered around medical information rather than on legal protection.
Malpractice decisions have in some cases increased the chance of a bad outcome. When the "clot busting drugs" first became available for use in stroke patients we had some leeway on a time frame in which to use them. There is a risk anytime these drugs are used though the balance is that often this is the only chance one has to avoid certain paralysis. The current "legal" time window is three hours. At this point in time, if a stroke workup is completed at 3 hours and 15 minutes, the option to use this treatment will not be extended. We know if there is a bad outcome we will be sued due to being 15 minutes past the accepted time window. If we explain this to the stroke patient and if they would rather risk death than to be severely disabled, we could still be sued by the patient or the surviving family simply because they were under duress at the time of the stroke and therefore could not really give informed consent. In other words, we have very little option to treat this patient as they might want.
In the same pattern, I saw a patient in an outlying Emergency Room when I was a resident who had suffered a bee sting respiratory failure and was brought in by ambulance. He was a lung cancer survivor by almost ten years, but still had a "Do Not Resuscitate" order on his medical record. He was unconscious and no family was available. I elected to put him on the ventilator anyway and within two hours he recovered enough to breath on his own. He was thankful. Never-the-less, for a solid year I worried about the possibility of a lawsuit for violating his written request. For if he had died in the process or within a year of the event, a gold-digging next of kin and a clever lawyer could have made a case against me. Interestingly, had I let him die by honoring his ten year old paperwork, I would have been fully protected legally, though not morally.
What we need is to establish a system of free standing 3 member arbitration panels that render binding judgments in the face of a bad outcome. Reasonable monetary damages could be awarded for ongoing care, treatments and support and would be based on similar judgments from across the entire medical system. Any practitioner mistakes could be tracked specifically and in aggregate to allow re-education or disciplinary action for the practitioner as needed and the data could be reviewed for system wide problems that also need correcting. This would eliminate the legal industry mantra that some lives are worth more than others, simply because they earn more money. The latter is the reason we have life insurance. In medical circles, the life of a janitor is just as important as the life of a corporate executive.
The malpractice/legal industry has no place in medical care, though rational compensation is reasonable.