Healthcare Trade-Off

[DC Tom]

aka evidence based medicine. more is often not better despite that almost universal belief (another reason to avoid jury trials). countries who spend less and do less have better outcomes than the us. tests can do harm. yet "failure to diagnose" is one of the most common malpractice complaints. there is a balance between risk (cost) and reward and the us system is a long ways from it.

 

Figures you'd miss the point. You have a lot to learn about medicine.

[birdog1960]

The same system. There are a variety of legal remedies you may be able to seek depending on the state you live in and the facts of the either particular case. And if the case was thrown out the other side lost money it was not in their best interest to simply throw spaghetti at the wall. If the facts don't give rise to any COA that can provide any relief and the news paper coverage hurt you, then that's life. It's not a perfect world I'm not saying it is. But the threat of litigation is a necessary evil in our society...and the press is the press.

from 10 - 20 % of cases brought to trial are won by the plaintiff. that implies a lot of spaghetti throwing to get a meatball. it cost/benefit again and the the benefits go towards attempting to litigate some very iffy cases.

 

Figures you'd miss the point. You have a lot to learn about medicine.

and you're gonna school me? everyone has a lot to learn about medicine. it's a vast field that changes constantly. what was true yesterday, is often considered totally incorrect the next.

[dayman]

from 10 - 20 % of cases brought to trial are won by the plaintiff. that implies a lot of spaghetti throwing to get a meatball. it cost/benefit again and the the benefits go towards attempting to litigate some very iffy cases.

 

 

 

 

Trust me it's no business model. Big firms aren't going to tolerate losing trials all over the place and if you are anything but a large firm losing a few trials in a row is a one way ticket to being broke as a lawyer and teaching writing at your local law school. Hell...a lot of plaintiffs lawyers can't stand to lose more than 2 trials in a row.

Edited June 14, 2012 by TheNewBills

[birdog1960]

Trust me it's no business model. Big firms aren't going to tolerate losing trials all over the place and if you are anything but a large firm losing a few trials in a row is a one way ticket to being broke as a lawyer and teaching writing at your local law school. Hell...a lot of plaintiffs lawyers can't stand to lose more than 2 cases in a row.

so how do you explain those figures? and that's not including the cases thrown out before court. maybe that's why so many big law firms are hurting right now. can't say i have much sympathy.

[dayman]

so how do you explain those figures? and that's not including the cases thrown out before court. maybe that's why so many big law firms are hurting right now. can't say i have much sympathy.

 

Well first off I'm not asking for you to have sympathy for the attorneys. While I'm not sure about the 10% number (it's probably closer to 25%ish) it's certainly much lower in medmal than in all other tort cases. But what you need to see is this refutes the idea that they take everything that comes their way. These are difficult cases to win, expensive cases to finance, and they don't just take them right and left to throw spaghetti at the wall b/c as the numbers show you will go broke doing that.

Edited June 14, 2012 by TheNewBills

[birdog1960]

Well first off I'm not asking for you to have sympathy for the attorneys. While I'm not sure about the 10% number (it's probably closer to 25%ish) it's certainly much lower in medmal than in all other tort cases. But what you need to see is this refutes the idea that they take everything that comes their way. These are difficult cases to win, expensive cases to finance, and they don't just take them right and left to throw spaghetti at the wall b/c as the numbers show you will go broke doing that.

new england journal published a study about 5 years ago estimating that 40% of malpractice cases were unfounded. this was based on the fact that in about 2% of cases there was no actual harm and in about 38% there was no causal medical mistake. sounds like spaghetti throwing to me but maybe we're arguing semantics.

[DC Tom]

and you're gonna school me?

 

No. Let someone do it who doesn't realize you're hopelessly closed-minded.

[B-Man]

Thanks Obamacare: 83% of Doctors Surveyed Say They May Quit.

 

The Doctor Patient Medical Association has released a new survey of about 700 doctors, and the results are bleak. Scary bleak. Among other dismal figures, Doctors' Attitudes on the Future of Medicine: What’s Wrong, Who’s to Blame, and What Will Fix It found that 83% of respondents are contemplating leaving the industry if Obamacare is fully implemented, owing to its disastrous projected consequences. Indeed, they openly blame the healthcare law for their industry's woes.

 

DPMA Foundation

 

.

[Bigfatbillsfan]

http://www.msnbc.msn.com/id/47745646/ns/politics-the_new_york_times/

 

 

"After weeks of talks, drug industry lobbyists were growing nervous. To cut a deal with the White House on overhauling health care, they needed to be sure that President Obama would stop a proposal intended to bring down medicine prices."

 

"The e-mail exchange three years ago was among a cache of messages obtained from the industry and released in recent weeks by House Republicans — including a new batch put out Friday detailing the industry’s advertising campaign supporting Mr. Obama’s health care overhaul. The broad contours of his dealings with the industry were known in 2009, but the newly public e-mails open a window into the compromises underlying a health care law now awaiting the judgment of the Supreme Court.

 

Mr. Obama’s deal-making in 2009 represented a pivotal moment in his young presidency, a juncture where the heady idealism of the campaign trail collided with the messy reality of Washington policy making. A president who had promised to negotiate on C-Span cut a closed-door deal with a powerful lobby, signifying to disillusioned liberal supporters a loss of innocence, or perhaps even the triumph of cynicism.

 

Tax cut ahead if high court voids health care law

But the bargain was one that the president deemed necessary to forestall industry opposition that had thwarted efforts to cover the uninsured for generations. Without the deal, in which the industry agreed to provide $80 billion to expand coverage in exchange for protection from policies that would cost more, Mr. Obama calculated he might get nowhere."

 

And this is news... Why?

 

He stated in the past that it would be a couple of decades to get to universal government controlled healthcare. He's trying to implement it by starting the snowball rolling down the hill. If the SCOTUS or new legislature can't or won't get rid of this schit, we'll be saddled with a European or Canadian healthcare system.

 

You say that as though it's a bad thing.

[ExiledInIllinois]

Thanks Obamacare: 83% of Doctors Surveyed Say They May Quit.

 

The Doctor Patient Medical Association has released a new survey of about 700 doctors, and the results are bleak. Scary bleak. Among other dismal figures, Doctors' Attitudes on the Future of Medicine: What’s Wrong, Who’s to Blame, and What Will Fix It found that 83% of respondents are contemplating leaving the industry if Obamacare is fully implemented, owing to its disastrous projected consequences. Indeed, they openly blame the healthcare law for their industry's woes.

 

DPMA Foundation

 

.

Is this like when all the libs ran to Canada when Bush was placed into office?

 

What has been happening under RomneyCare?... Are the docs in MA stomping their feet, kicking and screaming while taking the ball home? Good let them, shake the system up. Don't let the door hit you in the ass...

 

What do you think they will do? Go into IT, maybe toll collecting?

[BiggieScooby]

Is this like when all the libs ran to Canada when Bush was placed into office?

 

What has been happening under RomneyCare?... Are the docs in MA stomping their feet, kicking and screaming while taking the ball home? Good let them, shake the system up. Don't let the door hit you in the ass...

 

What do you think they will do? Go into IT, maybe toll collecting?

 

Like Bill O'Reilly so eloquently said if you implement this "some folks" are gonna shut 'er down.

 

My answer to that is fine Mr. O. Us Generation Xers are ready for the Baby Boomers to hang 'er up.

[3rdnlng]

And this is news... Why?

 

 

 

You say that as though it's a bad thing.

 

 

 

Hey, being fat is curable, but being stupid is just being stupid. If you can't see the problems, I can't help you.

[Juror#8]

so how do you explain those figures? and that's not including the cases thrown out before court. maybe that's why so many big law firms are hurting right now. can't say i have much sympathy.

 

I think that your figures may be somewhat misleading and not representative of the point that you're trying to make. What do you mean "thrown out before court"? Do you mean cases tossed during the pleading stage? You're saying that only 10-20% of cases that are decided on the merits win? If so, that seems a bit low. But I'll try to "explain those figures."

 

Do your numbers account for cases that are settled prior to opening arguments? Methinks that there is where the disconnect is, and why your numbers don't accurately reflect the breadth of cases with legal merit. "Settled" cases are traditionally settled after discovery and before the contentiousness begins. Those cases are generally decidedly legally sound and articulate colorable legal arguments. Once those cases are removed from consideration, you're typically left with the cantankerous or the frivolous.

 

It is suspect to indict tort jurisprudence based on that.

 

Now if you would have said (and could prove) that only 10-20% of all medical malpractice cases survive summary judgment or a motion for a directed verdict, then that would be persuasive. And that would be a pathetic percentage of cases that couldn't satisfy the basic threshold of articulating a legally cognizable claim.

 

But that is not what you're saying.

 

To say, though, that only 10-20% of plaintiff cases are successful, and that percentage may or may not be comprised of cases that are tossed in the pleading stage (incidentally, the judicial system's self-regulating mechanism and a tool to avoid protracted legal expense for either party), and those that lose on the merits, but doesn't contemplate the large volume of cases that are settled in the plaintiff's favor, is truncating the numbers - and with it, the argument. You've basically disqualified a robust number of legally cogent cases - the majority of which likely had the proponderance of the evidence on their side - in order to make a point.

 

As an aside, and as an ancillary follow up point: I've represented 3 plaintiffs in tort litigation matters. I've won once (libel claim against a mid-size city newspaper) and have been told to "try again" twice (GM kicked my ass on SJ and a movie theater company was victorious because they had a better audiologist, who was well endowed, and who happened to be on the take). The point is that taking on corporations and large entities is difficult enough. They can bring to bear resources that the working stiff just doesn't have. That is their strength. Why make it any more difficult for someone without resources to take on the hegemony? The balance is already in the hegemony's favor because they have the resources to suppress even the most fruitful of claims. Do a study on how many legally significant cases have never seen the inside of the courtroom because people don't have the resources to go against the apes. Find out how many aggrieved plantiffs lose because the only attorney that they can afford, a guy two years out of law school, is working on contingency and doesn't have the resources to hire a good enough audiologist and Carmike has a cadre of 3 attorneys wearing Brioni suits and Allen Edmonds Park Avenues.

 

But even if you're not compelled by the lawyerly "what about the little guy" argument, at least don't indict tort jurisprudence based on sketchy percentages - which is what I feel you did above.

Edited June 15, 2012 by Juror#8

[birdog1960]

I think that your figures may be somewhat misleading and not representative of the point that you're trying to make. What do you mean "thrown out before court"? Do you mean cases tossed during the pleading stage? You're saying that only 10-20% of cases that are decided on the merits win? If so, that seems a bit low. But I'll try to "explain those figures."

 

Do your numbers account for cases that are settled prior to opening arguments? Methinks that there is where the disconnect is, and why your numbers don't accurately reflect the breadth of cases with legal merit. "Settled" cases are traditionally settled after discovery and before the contentiousness begins. Those cases are generally decidedly legally sound and articulate colorable legal arguments. Once those cases are removed from consideration, you're typically left with the cantankerous or the frivolous.

 

It is suspect to indict tort jurisprudence based on that.

 

Now if you would have said (and could prove) that only 10-20% of all medical malpractice cases survive summary judgment or a motion for a directed verdict, then that would be persuasive. And that would be a pathetic percentage of cases that couldn't satisfy the basic threshold of articulating a legally cognizable claim.

 

But that is not what you're saying.

 

To say, though, that only 10-20% of plaintiff cases are successful, and that percentage may or may not be comprised of cases that are tossed in the pleading stage (incidentally, the judicial system's self-regulating mechanism and a tool to avoid protracted legal expense for either party), and those that lose on the merits, but doesn't contemplate the large volume of cases that are settled in the plaintiff's favor, is truncating the numbers - and with it, the argument. You've basically disqualified a robust number of legally cogent cases - the majority of which likely had the proponderance of the evidence on their side - in order to make a point.

 

As an aside, and as an ancillary follow up point: I've represented 3 plaintiffs in tort litigation matters. I've won once (libel claim against a mid-size city newspaper) and have been told to "try again" twice (GM kicked my ass on SJ and a movie theater company was victorious because they had a better audiologist, who was well endowed, and who happened to be on the take). The point is that taking on corporations and large entities is difficult enough. They can bring to bear resources that the working stiff just doesn't have. That is their strength. Why make it any more difficult for someone without resources to take on the hegemony? The balance is already in the hegemony's favor because they have the resources to suppress even the most fruitful of claims. Do a study on how many legally significant cases have never seen the inside of the courtroom because people don't have the resources to go against the apes. Find out how many aggrieved plantiffs lose because the only attorney that they can afford, a guy two years out of law school, is working on contingency and doesn't have the resources to hire a good enough audiologist and Carmike has a cadre of 3 attorneys wearing Brioni suits and Allen Edmonds Park Avenues.

 

But even if you're not compelled by the lawyerly "what about the little guy" argument, at least don't indict tort jurisprudence based on sketchy percentages - which is what I feel you did above.

perhaps next time you can be compelled to do some research before declaring reported statistics incorrect. check out nejm may 11, 2006 (it can be accessed online without subscription. it is a harvard based a study done by lawyers and clinicians. for a short summary of med malpractice statistics see medicalmalpractice.comm. this is a site supported by malparactice plantiff lawyers and could therefore be expected to use high end numbers for wins. it givews 21% as the number and seperates settlements out of that figure. i'm certain a google search will turn up many more references.

 

i use thrown out to mean dropped from the suit after depositions (extremely common- often every doctor that was near a patient is sued initially in a fishing expedition) csae dropped entirely after obtaining expert opinions and depositions, case dropped for any other reason (except settlement) before trial.

 

btw, i have been retained by defense attorneys in multiple medmal cases as an expert to review records and give opinions. so despite, d/c's contentions, sveral regional law firms think i know a bit about medicine.

Edited June 15, 2012 by birdog1960

[dayman]

perhaps next time you can be compelled to do some research before declaring reported statistics incorrect. check out nejm may 11, 2006 (it can be accessed online without subscription. it is a harvard based a study done by lawyers and clinicians. for a short summary of med malpractice statistics see medicalmalpractice.comm. this is a site supported by malparactice plantiff lawyers and could therefore be expected to use high end numbers for wins. it givews 21% as the number and seperates settlements out of that figure. i'm certain a google search will turn up many more references.

 

i use thrown out to mean dropped from the suit after depositions (extremely common- often every doctor that was near a patient is sued initially in a fishing expedition) csae dropped entirely after obtaining expert opinions and depositions, case dropped for any other reason (except settlement) before trial.

 

btw, i have been retained by defense attorneys in multiple medmal cases as an expert to review records and give opinions. so despite, d/c's contentions, sveral regional law firms think i know a bit about medicine.

 

 

But what exactly are you trying to say here? They're tough to win, often complicated, and really expensive...they get dropped and thrown out often...if you actually to go trial and lose you just blew thousands (often 10s of thousands) of dollars...the win rate is (at best) 25% lower than other tort cases (in reality much lower)...everything we're both saying doesn't exactly sound like it's a good thing going to just sue all over for medmal eh?

Edited June 15, 2012 by TheNewBills

[birdog1960]

But what exactly are you trying to say here? They're tough to win, often complicated, and really expensive...they get dropped and thrown out often...if you actually to go trial and lose you just blew thousands (often 10s of thousands) of dollars...the win rate is (at best) 25% lower than other tort cases (in reality much lower)...everything we're both saying doesn't exactly sound like it's a good thing going to just sue all over for medmal eh?

i'm concluding that too many meritless cases are being pursued. too many fishing expeditions. too much harm done to too many blameless docs. and i think the prospect of a mutimillion dollar jackpot at the end of the fishing trip is at least part of the incentive.

[Juror#8]

perhaps next time you can be compelled to do some research before declaring reported statistics incorrect. check out nejm may 11, 2006 (it can be accessed online without subscription. it is a harvard based a study done by lawyers and clinicians. for a short summary of med malpractice statistics see medicalmalpractice.comm. this is a site supported by malparactice plantiff lawyers and could therefore be expected to use high end numbers for wins. it givews 21% as the number and seperates settlements out of that figure. i'm certain a google search will turn up many more references.

 

i use thrown out to mean dropped from the suit after depositions (extremely common- often every doctor that was near a patient is sued initially in a fishing expedition) csae dropped entirely after obtaining expert opinions and depositions, case dropped for any other reason (except settlement) before trial.

 

btw, i have been retained by defense attorneys in multiple medmal cases as an expert to review records and give opinions. so despite, d/c's contentions, sveral regional law firms think i know a bit about medicine.

 

Ooooooh, snarky. Hehe. Anyway, I read your studies....twice.

 

http://www.nejm.org/doi/full/10.1056/NEJMsa054479#t=articleMethods

 

I read your link and study and can't find anything that directly contradicts the points I made in my post. If there is something in your studies that contradicts what I mentioned in my previous post, please point it out. I can simplify my thesis if it makes it easier for you to address (I understand that it was a long post).

 

Apropos....whose position do you feel that this supports, mine or yours?

 

"However, plaintiffs rarely won damages at trial, prevailing in only 21 percent of verdicts as compared with 61 percent of claims resolved out of court. Administrative (or overhead) costs associated with defending the claims averaged $52,521 per claim, with the mean administrative costs for claims that were resolved by trial ($112,968) nearly three times those for claims resolved out of court ($42,015)."

 

 

"Our findings point toward two general conclusions. One is that portraits of a malpractice system that is stricken with frivolous litigation are overblown. Although one third of the claims we examined did not involve errors, most of these went unpaid. The costs of defending against them were not trivial. Nevertheless, eliminating the claims that did not involve errors would have decreased the direct system costs by no more than 13 percent (excluding close calls) to 16 percent (including close calls). In other words, disputing and paying for errors account for the lion's share of malpractice costs. A second conclusion is that the malpractice system performs reasonably well in its function of separating claims without merit from those with merit and compensating the latter. In a sense, our findings lend support to this view: three quarters of the litigation outcomes were concordant with the merits of the claim.

 

However, both of these general conclusions obscure several troubling aspects of the system's performance. Although the number of claims without merit that resulted in compensation was fairly small, the converse form of inaccuracy claims associated with error and injury that did not result in compensation was substantially more common. One in six claims involved errors and received no payment. The plaintiffs behind such unrequited claims must shoulder the substantial economic and noneconomic burdens that flow from preventable injury.33,34 Moreover, failure to pay claims involving error adds to a larger phenomenon of underpayment generated by the vast number of negligent injuries that never surface as claims."

 

 

You're up counselor.

Edited June 15, 2012 by Juror#8

[birdog1960]

Ooooooh, snarky. Hehe. Anyway, I read your studies....twice.

 

http://www.nejm.org/doi/full/10.1056/NEJMsa054479#t=articleMethods

 

I read your link and study and can't find anything that directly contradicts the points I made in my post. If there is something in your studies that contradicts what I mentioned in my previous post, please point it out. I can simplify my thesis if it makes it easier for you to address (I understand that it was a long post).

 

Apropos....whose position do you feel that this supports, mine or yours?

 

"However, plaintiffs rarely won damages at trial, prevailing in only 21 percent of verdicts as compared with 61 percent of claims resolved out of court. Administrative (or overhead) costs associated with defending the claims averaged $52,521 per claim, with the mean administrative costs for claims that were resolved by trial ($112,968) nearly three times those for claims resolved out of court ($42,015)."

 

 

"Our findings point toward two general conclusions. One is that portraits of a malpractice system that is stricken with frivolous litigation are overblown. Although one third of the claims we examined did not involve errors, most of these went unpaid. The costs of defending against them were not trivial. Nevertheless, eliminating the claims that did not involve errors would have decreased the direct system costs by no more than 13 percent (excluding close calls) to 16 percent (including close calls). In other words, disputing and paying for errors account for the lion's share of malpractice costs. A second conclusion is that the malpractice system performs reasonably well in its function of separating claims without merit from those with merit and compensating the latter. In a sense, our findings lend support to this view: three quarters of the litigation outcomes were concordant with the merits of the claim.

 

However, both of these general conclusions obscure several troubling aspects of the system's performance. Although the number of claims without merit that resulted in compensation was fairly small, the converse form of inaccuracy — claims associated with error and injury that did not result in compensation — was substantially more common. One in six claims involved errors and received no payment. The plaintiffs behind such unrequited claims must shoulder the substantial economic and noneconomic burdens that flow from preventable injury.33,34 Moreover, failure to pay claims involving error adds to a larger phenomenon of underpayment generated by the vast number of negligent injuries that never surface as claims."

 

 

You're up counselor.

while the authors find 1/3 of claims (it was actually 37% as only 63%of claims were judged to be the result of error) without merit to be acceptable, presumably because most went unpaid, i doubt many practicing physicians would agree. the fact that this many cases were ever brought is harmful in and of itself, especially to the physicians. not only to the doc who's been unfairly targeted but to the courts with wasted resources. one can accept a papers results and not the conclusions...happens all the time in medicine and i suspect other fields.

and what of the 3% of claims where no adverse medical outcome was present? how can this be justified.

and did you not state that if my numbers were correct on succesful litigation being so low that you would concewde a problem? the numbers from this study are are widely cited. you seem to accept them. yet you still don't see a problem.

 

if i were wrong 40% of the time as were the plaintiffs attorneys in this study, i'd be in court more than i'd be working. why should attorneys be held to a lowewr standard?

[Juror#8]

while the authors find 1/3 of claims (it was actually 37% as only 63%of claims were judged to be the result of error) without merit to be acceptable, presumably because most went unpaid, i doubt many practicing physicians would agree. the fact that this many cases were ever brought is harmful in and of itself, especially to the physicians. not only to the doc who's been unfairly targeted but to the courts with wasted resources. one can accept a papers results and not the conclusions...happens all the time in medicine and i suspect other fields.

and what of the 3% of claims where no adverse medical outcome was present? how can this be justified.

and did you not state that if my numbers were correct on succesful litigation being so low that you would concewde a problem? the numbers from this study are are widely cited. you seem to accept them. yet you still don't see a problem.

 

if i were wrong 40% of the time as were the plaintiffs attorneys in this study, i'd be in court more than i'd be working. why should attorneys be held to a lowewr standard?

 

Concessions....when, where, why, how?

 

I addressed your initial thread about 10-20% success rate by plaintiffs in medical malpractice instances by mentioning the affect of settlements on that number - essentially advancing the point that of course the cogent legal claims are going to be diluted, because many of them settle and a good amount of those who remain after that are either the bull-headed or the bullschit.

 

You responded with some blurb about how the settlement figure was already contemplated by the statistics that you were parroting.

 

Really? In a way that challenges my claims?

 

I read the same info that you did and arrived at a completely different conclusion. In fact, it supports my position that the good stuff settles out and the chaffe that remains is what comprises the 10-20% figure. So if "successful litigation" means what is not settled before opening arguments (and afterwards, in fact), then you're arguing against imagined straw men - if you're using those percentages to support the thesis that most complaints shouldn't be allowed to come forward to lady justice in the first place.

 

It's also interesting to note that the journal that you're using to support your position, is actually betraying you in many respects.

 

And lastly, and just as a technical point, if a complaint makes it through SJ, then it should be there and it is not, by definition, frivolous in the eyes of the law. It has satisfied a certain threshhold of legal criteria to be entertained by judge and jury. That may not mean anything to you - but it does to me, and I imagine that it would to most attorneys/legal professionals.

[birdog1960]

Concessions....when, where, why, how?

 

I addressed your initial thread about 10-20% success rate by plaintiffs in medical malpractice instances by mentioning the affect of settlements on that number - essentially advancing the point that of course the cogent legal claims are going to be diluted, because many of them settle and a good amount of those who remain after that are either the bull-headed or the bullschit.

 

You responded with some blurb about how the settlement figure was already contemplated by the statistics that you were parroting.

 

Really? In a way that challenges my claims?

 

I read the same info that you did and arrived at a completely different conclusion. In fact, it supports my position that the good stuff settles out and the chaffe that remains is what comprises the 10-20% figure. So if "successful litigation" means what is not settled before opening arguments (and afterwards, in fact), then you're arguing against imagined straw men - if you're using those percentages to support the thesis that most complaints shouldn't be allowed to come forward to lady justice in the first place.

 

It's also interesting to note that the journal that you're using to support your position, is actually betraying you in many respects.

 

And lastly, and just as a technical point, if a complaint makes it through SJ, then it should be there and it is not, by definition, frivolous in the eyes of the law. It has satisfied a certain threshhold of legal criteria to be entertained by judge and jury. That may not mean anything to you - but it does to me, and I imagine that it would to most attorneys/legal professionals.

read the qoute you cited "prevailing in only 21% of the verdicts"...i'm no lawyer (thank god- most i've known are miserable) but a verdict implies a trial, non?