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Lack of doctor accountability is at root of medical malpractice woes


In Virginia, there is a special word for being victimized by medical malpractice – being “Plotnicked.” Virginia doctor Stephen Plotnick became so notorious for injuring patients that his name is now the word for what happens when doctors make mistakes. It is shocking that any doctor could earn such a shameful tribute without being stopped first. But the Virginia Board of Medicine failed to suspend Plotnick’s medical license until after five patients died on his watch and he was sued six times.

The medical profession suffers from a lack of accountability on more mundane matters as well.

In last month’s New England Journal of Medicine, Drs. Robert Wachter and Peter Pronovost write that physicians frequently neglect simple practices such as hand washing. They attribute this failure to “lax enforcement of safety rules.”

The need for enforcement could hardly be greater. In the 17 years since the federal government’s National Practitioner Data Bank was created to track reports of doctor discipline, nearly 50 percent of U.S. hospitals have failed to submit a single report, according to a Public Citizen study. The deficient reporting stems mostly from hospitals failing to discipline doctors and hospitals evading reporting requirements. Wachter and Pronovost note that hospitals are disinclined to punish doctors for fear of “alienating them and losing the business they bring in.”

State medical boards also under-discipline doctors, according to a Public Citizen analysis of data from the Federation of State Medical Boards. For example, state medical boards issued only “non-severe” discipline in a significant number of cases involving criminal convictions for insurance fraud and controlled substances.

When doctors don’t police their own, the courts offer the only remaining hope for deterring medical negligence, holding negligent doctors and hospitals accountable, and compensating victims of malpractice. It is not surprising that the medical industry is constantly attacking the courts.

The current fad among opponents of the courts is to create an administrative compensation scheme that, in the typical model, would bar most victims of medical errors from receiving compensation altogether and provide the remaining victims with much less than they would receive in public court. The severe limitation on compensation is a cost-control measure. Medical negligence is so rampant that compensating all victims would cost several times more than the current malpractice litigation system, in which only 3 percent of malpractice victims sue. Unfortunately, it also goes without saying that these schemes usually insulate negligent providers from taking full responsibility for their actions.

These proposals are problematic not just because of the injustice to injured patients, but also in the bad incentives they create. If Congress shields negligent parties from accountability, then medical providers will have even less incentive to police their own and provide competent care, meaning that we can expect the nation’s epidemic of medical errors to worsen.

Wachter and Pronovost note that positive encouragement alone is insufficient to improve patient safety. They recommend internal accountability systems, such as suspending privileges for doctors who repeatedly fail to follow safety procedures – the types of measures that most people would assume are already in place. Hospitals should implement these systems immediately. Congress can help as well, by requiring them to do so.

We currently face an epidemic of preventable medical errors, and the courts offer one of the few mechanisms for confronting it. Everyone knows that doctors detest lawsuits. Less well known is that doctors can do more than any other group to prevent them. They can start by policing their own.

Christine Hines is the Consumer and Civil Justice Counsel at Public Citizen’s Congress Watch division.