Wednesday, May 26, 2004

In the latest Bulletin of the American College of Surgeons (PDF) The Story of Tort Reform in West Virginia describes the near-meltdown of a state's medical infrastructure that has led to one of the most progressive tort reform packages in the nation. The story is one of the power physicians hold when they "hit them where it hurts":

In the already overburdened Level I trauma center in the state capital of Charleston, the orthopaedic surgeons finally rebelled, faced with an avalanche of patients being transferred to their institution around the clock from outlying communities that found themselves without orthopaedic coverage or the courage to assume the risk of liability. The surgeons announced the decision to stop taking trauma call. Immediately thereafter, the hospital was downgraded to a Level III trauma center. The public perception based on the media coverage was that the hospital was essentially closed for all critical patients. The state capital was in an uproar as the legislature was about to convene for the 2003 session.

While this did not get much coverage nationwide, what followed most certainly did:

a large group of northern panhandle surgical specialists stopped all their elective cases. Hospitals in the area, which were already struggling under inadequate reimbursement, began to suffer mounting losses in income. The hospital association’s involvement in the lobbying effort intensified dramatically.

Coverage of that may be found here. While the ethics of such a move may be debated, there is no doubt that it was effective. It was effective because it forced the politicians and citizens of West Virginia to see the consequences of an out-of control tort system firsthand. It was no longer a theoretical problem, it was here and now. And just what did the physicians get for their efforts:

Critical portions of the tort reform bill include a $250,000 cap on noneconomic damages and a $500,000 cap on all damages for treatment of emergency conditions for patients who receive care at a designated trauma center. Joint liability has been eliminated, and each individual defendant bears liability equal to his or her percentage of fault. Collateral payments, which had not been allowed in court before, may now be presented. The “ostensible agency theory” of liability was abolished. Additionally, a committee was established to develop a patient injury compensation fund to provide for economic damages that exceed financial limits set in the bill.

Sounds like just what the doctor ordered...
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