Bush Administration Grandstanding on Medical Malpractice,Failing Patients in Need of Better Medical Care

The Bush Administration’s political appointees at the Department of Health and Human Services (HHS) have produced a clip-job “report” on medical malpractice that, not surprisingly, concludes that the problem with medical malpractice is not patients’ death or injuries but too many lawsuits. But the health care professionals at HHS, the Centers for Disease Control and the Institute of Medicine at the National Academy of Sciences have different stories to tell:

Adverse effects of medical care doubled from 1993 to 2000.

According to the HHS’s Agency for Healthcare Research and Quality (AHRQ) data collected from hospital discharges across the United States, the number of adverse effects of medical treatment in the U.S. has skyrocketed from 302,118 in 1993 to 710,000 in 2000. (1) Over the past two decades, the issue of patient safety and medical errors has been made more visible by research funded by AHRQ. Medical errors are responsible for injury in as many as 1 out of every 25 hospital patients. Errors in health care have been estimated to cost more than $5 million per year in a large teaching hospital, and preventable health care-related errors cost the economy from $17 to $29 billion each year. (2)

Errors in health care: a leading cause of death and injury.

A report released in late 1999 by the Institute of Medicine for the National Academy of Science, shocked the nation by citing a large body of evidence that indicates that preventable medical errors are a leading cause of death in the United States. “At least 44,000 and perhaps as many as 98,000 Americans die in hospitals each year as a result of medical errors. Deaths due to preventable adverse events exceed the deaths attributable to motor vehicle accidents (43,458), breast cancer (42,297) or AIDS (16,516).” (3)

Infection epidemic carves a deadly path in the nation’s hospitals.

The Centers for Disease Control has found that 90,000 deaths per year are linked to hospital infections.(4) This represents the fourth leading cause of mortality among Americans, behind heart disease, cancer and strokes. These infections also kill more people each year than car accidents, fires and drowning combined. A recent investigation by the Chicago Tribune, using data collected by the Centers for Disease Control, found that in 2000 nearly three-quarters of deadly hospital infections-or about 75,000 deaths – were preventable, the result of unsanitary facilities, germ-laden instruments, unwashed hands and other lapses.(5)

The Bush Administration Has It Wrong!
Medical Reform Is Needed, not Sacrificing Victims’ Rights

Are the numbers of medical malpractice claims “spiraling out of control”?

The number of claims per 100 doctors has remained surprisingly constant over the years. Nationwide, the total number of claims closed per 100 doctors is about 17.4.(6) Here are the numbers:

 Year     Total claims  # US Doctors  Closed/Doctor
 1991  106,189   631,400  16.8%
 1992  113,816  652,100  17.5%
 1993  120,549  670,300  18.0%
 1994  123,935  684,400  18.1%
 1995  125,417  720,300  17.4%
 1996  123,410  737,800  16.7%

As the above statistics demonstrate, as the number of doctors has increased gradually over the years, that growth in claims has been in proportion to the corresponding increase in the number of doctors. Data for years 1997 to now are not included because not all of the claims filed in those years have been closed.

Are medical malpractice payments “skyrocketing”?

Analysis of medical malpractice payments demonstrates that the amount paid remained surprisingly stable during the 1990s. The average payment for all claims closed was about $30,000 and the average payment considering only those claims closed with a payment was about $112,183. (7)

 Year        Average Payment for
All Claims Closed
Average Payment for
Claims Closed with payment
 1991  $29,093  $100,172
 1992  $28,731  $105,219
 1993  $28,519  $104,751
 1994  $29,826  $118,682
 1995  $31,127  $124,978
 1996  $29,504  $119,296

It is worth noting that this 19% increase in the claims closed with payment category is modest when compared to the corresponding 34.9% increase in health care inflation from 1991 to 1996.(8) A claim settled for $100,172 in 1991 was worth $128,207 in 1996.

Are medical malpractice insurance premiums gobbling-up an ever increasing share of the national health care dollar?

Historically, the cost of medical malpractice insurance premiums has represented less than one-penny of every dollar spent on health care in this country. That continues to be the case.(9)

 Year       Total Malpractice
Premiums
$ in Millions
 National Health
 Costs
 $ in Millions
 Premium as
% of Costs
 1996  $6,190  $1,042,500  0.59%
 1997  $6,402  $1,092,400  0.59%
 1998  $6,559  $1,146,000  0.57%
 1999  $6,703  $1,211,000  0.55%
 2000  $7,360  $1,311,000  0.56%

Increasing insurance premiums are not unique to malpractice insurance.

Doctors insist that the tort system is fueling increases in malpractice insurance, yet the same upward trends are present in other lines of insurance as well. According to the Insurance Information Institute (IIS),(10) average expenditures on auto insurance will rise from an estimated $693 in 2000 to $855 in 2003, a 23% increase. The IIS also reports that average expenditures for homeowner’s insurance will rise from $500 in 2000 to $603 in 2003, a 21% increase.

Similarly, rates for property and casualty insurance have been skyrocketing. Insurance Journal notes that between October of 2001 and May of 2002 property and casualty insurance premiums increased by between 10% and 300%.(11)

The reasons for these increases are the same as for malpractice premium increases – rates had previously been kept artificially low, and the industry had experienced poor investment returns in recent years.


Endnotes
 

1 The above information is from weighted national estimates from Health Care Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), Agency for Healthcare Research and Quality (AHRQ), based on data collected by individual states and provided to AHRQ by the states. Total number weighted discharges in the U.S. based on HCUP NIS = 36,417,565.

2 Id.

3 IOM Report, To err is human: building a safer health system, (National Academy of Science) November 1999, p. 26.

4 www.cdc.gov/drugresistance/healthcare

5 Chicago Tribune, Infection epidemic carves deadly path, July 21, 2002.

6 Best’s Aggregates and Averages, Schedule P, as reported by the Consumer Federation of America. Data for years 1997 to now are not included because not all of the claims filed in those years have been closed.

7 Id.

8 Bureau of Labor Statistics, calculation provided to Public Citizen via telephone, July 30, 2002.

9 Supra footnote 6

10 Insurance Information Institute, 2002/2003 Outlook for Auto and Homeowners Insurance Rates available at: http://www.iii.org/media/hottopics/hot/20022003outlook/

11 Insurance Journal, “Standard and Poor’s: U.S. P/C Insurance Rates to Continue Increase on Renewals May 17, 2002