Kevin, M.D. - Medical Weblog

The market speaks.
 

This can't be. Dr, Elliot and CJD tell us that doctor shortages don't develop because of the malpractice crisis seen in some areas. This story is bunk. These patients are only imagining that there is a doctor shortage.
 

No one has ever said malpractice rates haven't gone up. The only dispute is why, anonymice.
 

Some anonymous posters are just loathsome jerks.

A more balanced article without the hype about malpractice. The real problem appears to be rural hospitals closing their maternity wards because of low volumes. Rural hospitals all over the country face budget issues and closing money losing departments is one way that they are addressing the issue.

http://www.virginiabusiness.com/magazine/yr2004/nov04/hospitals.shtml
 

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The real problem appears to be rural hospitals closing their maternity wards because of low volumes.

See. I knew Dr. Elliot would set you guys straight. Those doctors in the article clearly are liars. They didn't leave because they were being sued right and left and because insurance premiums are very high. They left because of "low volumes". Thanks for setting 'em straight again, Dr. Elliot!
 

The article Elliott quotes also says:

Practitioners have trouble getting or paying for malpractice insurance.
 

Does anyone know if midwives face the same type of malpractice insurance issues? Do they get sued as much as OB docs? I've wondered if people are less likely to sue a midwife if something goes wrong? No agenda here, just curious...
 

The absurd gang-like attacks on Eliot really bespeaks to the arrogant, hateful, greedy tendency of doctors. Sorry, guys, but it has not been shown that malpractice premia have caused a nation-wide exit from the medical profession. The "proofs" are anecdotal and they are isolated--mostly rural ares like coastal Virginia or southern Illinois (that on pure economic grounds are not likely to have too many doctors anyway).

Doctors, refusing to recognize their own biases, take these examples as faith and ridicule those who do not accept their credo.

The tragedy is that the number of states with caps are the great majority--doctors will continue to kill, maime, and injure with virtual impunity.
 

No doubt about it Rich, the lack of malpractice insurance for the ob/gyns made it impossible for them to continue their practice. The article seemed to indicate that the unwillingness of the insurance companies to offer coverage was because the there was no hospital for delivery to occur at. The solution the doctors are/were working on was a birthing center.
 

"The tragedy is that the number of states with caps are the great majority--doctors will continue to kill, maime, and injure with virtual impunity."

I killed maimed and injured a few at work today just for you Elliot, and they don't have malpractice caps in my state, got a woody yet, Elliot? The only reasons Lawyers are against caps is it makes it financially less attractive to file suit....The more volatile the system the more lawyers can score. Why don't you go down to the Gulf on a life raft and hand out your card to some of the newly homeless? Call yourself "lawyers without borders"
 

Oh, now this is good:

"The absurd gang-like attacks on Eliot really bespeaks to the arrogant, hateful, greedy tendency of doctors."

Then this little bit of hateful invective from the same deep-thinking genius:

"doctors will continue to kill, maime, and injure with virtual impunity."

Methinks the pot calls the kettle black...
 

Yep, Malpractice problems aren't driving OB-GYNS out of business (though every doc knows at least 1 OB who quit cause of malpractice problems), the Holocaust is a made-up Jewish conspiracy (though every Jew has a family member who died in the holocaust), There is parity in Major league baseball (though the KC Royals will never win another world series) and Most of all, I am Jesus Christ.
 

Hmmm . . . my dear hysterical doctors. A little reality here. You all say you know so many OB/GYNs who have left practice because of malpractice. Fine.

Yet, you say the claim "doctors will continue to kill, maime, and injure with virtual impunity." is "hateful invective from the same deep-thinking genius"

Do you not all know instance in which a doctor killed, maimed or injured without punishment? Why does anecdote prove your first claim, but not yr second?
 

"Do you not all know instance in which a doctor killed, maimed or injured without punishment? "

In 20 years of practice I can't remember any that was the result of clear negligence (not just a misdiagnosis, normal comlication, etc.) that wasn't punished somehow. I know it has happens occaisionally but to say it happens with "virtual impunity" is so ignorant that it is obvious that the poster has no direct knowledge of patient care in this country.
 

A collegue of mine - no I am not a doctor - once had an interesting idea about tort reform (not just malpractice). The big portion of damages are not the compensation to the plaintiff, but so-called 'punitive damages' which are supposed to punish the defendant for some actions. But why should punitive damages go to the plaintiff and his/her lawyer? Sure the plaintiff - provided he can prove his case - is entitled to compensation for his/her suffering/medical bills, but if someone needs to be punished for some misdeeds, this money can go to the state. This would remove a large part of the incentive and may reduce the number of lawsuits.
 

I always say give the "punitive damages" to a hospital safety committee, since the Ass Clown who won the lottery usually says he's suing so this "never happens to anyone again". Yeah right.
 

Punitive damages are rare in medical malpractice cases against individual physicians. Unless the physician is drunk or high or something like that.

Few of those cases are taken on the bet that punitives will be really high.
 

CJD, none of those cases, or for that matter any case, should be taken with the idea that the punitive damages would be anything at all.

It is an outrageous perversion of civil law that "punitive damages" even exist. If a corporate malfeasor does huge harm, the damages should be manifest. If it is done on a mass scale, the numbers of plaintiffs with real damages should be easy to find. But the idea that a civil lawyer should be able to extract private fines under the rules of civil procedure is nothing less than a usurping of criminal due process rights to the benefit of, you guessed it, the civil tort bar.

And please don't hand me the ATLA line about public good derived from these punitive awards and how they are the only thing that makes heartless and indifferent corporations sit up and take notice where they would otherwise heedlessly trample the little people. Harm is harm. Just being mad is not harm. And neither is being mad with a greedy lawyer. Imposing private fines as punitive damages makes every man (and his lawyer) a law unto himself, and every punishment arbitrary, not exactly
the spirit of equality before the law.

Punishment is the right of the state. If a corporation commits crimes, then the state should prosecute the officers, managers, and the corporation. If the officers are found guilty, they can be jailed. If the corporation is guilty, it can be fined or dissolved.
 

CJD isn't around to answer your charges. He just rowed down to Lousiana in a canoe, he's in a wetsuit handing out his business card in Ochsner Hospitals waiting room, telling people they can sue the hospital for EMTALA violations if they're not seen in less than 6 hours.
 

Maybe he's off getting a subpoena to find out if these stupid, vicious, troll anonymous comments are from a physician and then off to present the evidence to the state medical board.

too lazy to register, too stupid to think up a pseudonym, too cowardly to own their words.
 

Re. "too lazy to register, too stupid to think up a pseudonym, too cowardly to own their words."

with regares to our own Dr. Elliot: too lazy to to look at both sides of an argument, too stupid to post honestly, too cowardly to admit his massive anti-doctor, pro-lawyer bias. :)
 

"too lazy to register, too stupid to think up a pseudonym, too cowardly to own their words."

Elliott, you seem to be the only one bothered by the fact that others choose not to enroll in Blogger. Another user name and password combination for an activity that most of us here, except perhaps you,
see as a leisure activity is something most, including me, don't want to bother with. I can be civil and rational without having to have all my posts tagged.
You, on the other hand, are insulting and abrasive. That my anonymous post is a bee in your bonnet is just one more reason to keep posting that way.
 

Why would I post my name here? Posting here anonymously is the only outlet I have to vent my frustrations with the venomous cancer that Lawyers have put upon our healthcare system that we have no control over. Put down my name and have it quoted in court the next time one of you morons sue me? Yeah right! Don't we have a right to be upset that lawyers like CJD will exploit the situation in the Gulf for their own financial benefit once it's PC to do so?
 

When you click on Dr. Elliot's name at the top of his posts you get this:

"The Blogger Profile you requested cannot be displayed. Many Blogger users have not yet elected to publicly share their Profile.

If you're a Blogger user, we encourage you to enable access to your Profile."

LOL, this is the same dim-witted hypocrite who chastizes evryone else for posting with an anonymous pseudonym.
 

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Maybe I should add too stupid to read given that I've waxed eloquent on the advantage of a psuedonym over simply anonymous (and been lambasted for my trouble).

too lazy to register, too stupid to think up a pseudonym, to cowardly to own their words.
 

"Maybe I should add too stupid to read given that I've waxed eloquent on the advantage of a psuedonym over simply anonymous"

Yeah, now we'll take advice from one of the parasites that makes a living trying to destroy us. I'd rather be sitting in hell, obtaining a hot coal enema.
 

Dr. Elliot: too lazy to to look at both sides of an argument, too stupid to post honestly, too cowardly to admit his massive anti-doctor, pro-lawyer bias, and too much of a hypocrite to let us see his profile. :)
 

" If a corporation commits crimes, then the state should prosecute the officers, managers, and the corporation. If the officers are found guilty, they can be jailed. If the corporation is guilty, it can be fined or dissolved."

You should probably stick to your tenuous grasp on medicine, because this paragraph illustrates how little you know about law.

"Imposing private fines as punitive damages makes every man (and his lawyer) a law unto himself, and every punishment arbitrary, not exactly the spirit of equality before the law."

This paragraph isn't far behind.
 

As for the topic of this post, Kevin and Common Good, as lobbyists will, tell half the story.

The truth is the number of physicians in Virginia has increased, but what has decreased are Medicare payments. Those have gone down between 2003-2005 an average of nearly $18,000 per physician. A number which is undoubtedly higher for rural physicians who will likely have more Medicare claimants as a percentage of their practice. Do you think that might have anything to do with fewer physicians in rural areas?
 

I do feel sorry for you, though, Anonymous 12:24. I can't imagine what it's like to go through life so filled with hate and fear over something you have no understanding of.
 

So CJD, do you deny 12:24's allegations? Where were you then if you weren't trying to drum up a little business in NOLA like any good plaintiffs lawyer would? ;^)
 

"" If a corporation commits crimes, then the state should prosecute the officers, managers, and the corporation. If the officers are found guilty, they can be jailed. If the corporation is guilty, it can be fined or dissolved."

You should probably stick to your tenuous grasp on medicine, because this paragraph illustrates how little you know about law.

"Imposing private fines as punitive damages makes every man (and his lawyer) a law unto himself, and every punishment arbitrary, not exactly the spirit of equality before the law."

This paragraph isn't far behind."


CJD, you hardly seem very informed about the law or history, if that is what you think. Disappointing, for a lawyer.

As for prosecuting corporations, there is plenty of history for that. I.G. Farben in postwar Germany. for one. As for prosecuting corporate malfeasors for misconduct in their business activities, Bernie Ebbers of recent conviction, and Kenneth Lay, now indicted don't require much of a reach back into history to recall.

You ought to worry more about your own "tenuous" grasp of the law.
 

What we should all understand is that our next president will be a physician, and even though George W. couldn't defeat the Law Lobby's money on Tort reform, Bill Frist is going to make alot of you guys unemployed. What does a Lawyer do when there's no more easy to poach money out there?
 

" to go through life so filled with hate and fear"

I'm not full of hate and fear. The only thing I hate and fear on this planet is you parasites ruining the healthcare system. All docs hate and fear you guys. It's as natural as a morning bowel movement.
 

"Where were you then if you weren't trying to drum up a little business in NOLA like any good plaintiffs lawyer would? ;^)"

Believe it or not, I do other things than educate physicians on the law. If I'd known how much you guys missed me, I would have checked in more often.

Warning - I'll be gone for 6 days starting the 14th of September. If you want, I'll post extra so you'll have plenty of homework.
 

"As for prosecuting corporations, there is plenty of history for that. I.G. Farben in postwar Germany. for one."

That's one. But let me ask you, are you advocating that the federal government be the sole prosecutor of all corporate fraud, and that individual claimants have no redress except through the criminal justice system? I suppose you're willing to have your taxes increased to fund this undertaking, correct? Will physicians be firing the private attorneys they use to sue insurance companies and turning that over to the feds?

You're quite the old-school liberal!

"As for prosecuting corporate malfeasors for misconduct in their business activities, Bernie Ebbers of recent conviction, and Kenneth Lay, now indicted don't require much of a reach back into history to recall."

Who ever said individual officers couldn't be prosecuted? It is however, pretty difficult to reach the criminal standard of "beyond a reasonable doubt" given the multiple layers of management in a corporation. But maybe you are advocating a lessening of that standard for corporate fraud and corruption?
 

"What we should all understand is that our next president will be a physician"

And not only can he, like most physicians, diagnose malpractice without the benefit of medical records, he can tell if you are in a PVS from CNN!! Everyone wins!

"Bill Frist is going to make alot of you guys unemployed. What does a Lawyer do when there's no more easy to poach money out there?"

Here's how ignorant you are. You know where they'll go to work? For the defense. For the insurers that you guys are currently suing for jerking you around on reimbursements. It's even easier money because you get paid by the hour, win or lose, and you don't have to front the expenses!

You, as the individual will have just taken away your best chance in a case. Nice job of cutting the old nose off to spite the face.
 

"I'm not full of hate and fear. The only thing I hate and fear on this planet is you parasites ruining the healthcare system."

I'm not full of hate and fear - wait, I am. This reminds me of your tort reform arguments - you can't keep them straight.

I agree with you - those class actions filed by physicians against health insurers are driving up my rates. Greedy physicians get paid enough already!!

"All docs hate and fear you guys."

That doesn't speak well of your industry. Men of science in cold sweats based on faulty information.
 

"But maybe you are advocating a lessening of that standard for corporate fraud and corruption?"


Any lower than the standards for criminal law? No.
So, by extension, not to the looser standards of civil law, at least for "punitives".

"are you advocating that the federal government be the sole prosecutor of all corporate fraud. . ." No. State and local law enforcement are capable entities too. Ask Elliott Spitzer.

" . . . and that individual claimants have no redress except through the criminal justice system?" Yes. If actual harm is done, civil law has remedies. If a private citizen wants to punish above obtaining any
recovery for harm done, that belongs to the criminal
justice system. Punitive damages under civil tort law are an abdication of government obligation to maintain criminal due process rights.

And no, I am not an "Old School Liberal," unless being a Democrat of the Scoop Jackson type makes me one.

CH
 

"Any lower than the standards for criminal law? No. So, by extension, not to the looser standards of civil law, at least for "punitives"."

So you want all corporate fraud to be determined and compensated for on the "beyond a reasonable doubt" basis? As opposed to the "preponderance of the evidence"? If that were to occur, you would never have another conviction of a high level official.

"No. State and local law enforcement are capable entities too. Ask Elliott Spitzer."

Elliott Spitzer's office is unique in its resources. You really are advocating at least a tripling of the number of US attorneys and a quadrupling of federal law enforcement officers, not to mention accounting staffs and such.

". Punitive damages under civil tort law are an abdication of government obligation to maintain criminal due process rights."

That's just patently false. It is now, and always has been, a civil and not a criminal matter. For the simple reason that a corporation is an entity. It exists to make money or facilitate the making of money. You can't jail something that only exists on paper. It's sole impetus is making money, so that's how we punish it.

I guess I don't see how you are getting due process rights in there, though. Although for someone who is not an old school liberal, you sure are advocating for one big bureacracy!
 

Once Frist gets rid of all the Lawyer waste, I think CJD would make a good "Squeegee guy". He could talk you into a dollar for dirtying your window with his squeegee. Plus he'd be polite, ala Mark Lanier. (another great future "squeegee guy") Elliot is such an asshole though, I think he'd be murdered off by the other squeegee guys.
 

"Warning - I'll be gone for 6 days starting the 14th of September."

Where are you going? I want to warn any relatives there to make sure there's no wet spots on the floor of their supermarket, that the coffee is not "too hot", that the dog is on a leash.
 

"That's just patently false. It is now, and always has been, a civil and not a criminal matter"

Not really. Punitive damages have the same effect as criminal fines, and are levied for the same reasons, as a deterrent. The significant exceptions are that they can be imposed by tribunals operating under the looser standards of civil procedure and that the plaintiff and plaintiff's counsel are the beneficiaries, not the state. Even the tax laws implicitly recognize them for what they are and are not: punitive "damages", when collected, are treated as taxable income, whereas other damages are not.

Punitives should be recognized for what they are--privately-won and privately-collected pirates' booty, and not damages at all. And yes, the state is selling out its right to punish under the color of civil law, and those who are required to forfeit monies under
punitive awards are being fined--with the authority of the government-- but without the benefit of criminal standards of due process. And that is abdication of the government's fundamental responsibility, regardless of how many prosecutors you think it replaces.
 

"Where are you going? I want to warn any relatives there to make sure there's no wet spots on the floor of their supermarket, that the coffee is not "too hot", that the dog is on a leash."

Orange County, CA. Please do alert your relatives. I always like to be in a safe environment.
 

CJD: "Warning - I'll be gone for 6 days starting the 14th of September."

Maybe if you search hard enough you can find yourself a life before you come back. If not, then maybe you can at least educate yourself so you won't embarrass yourself by being wrong so often here.
 

"Not really. Punitive damages have the same effect as criminal fines, and are levied for the same reasons, as a deterrent."

Then we should raise the amount of the fines available to make sure they are sufficient to deter. Or tie them to net worth of the wrongdoer. (incidentally, this is a broader policy discussion that has little to no impact on medical malpractice against the individual physician).

How about this though - why not just make punitives payable into a victim's compensation fund for those who have been harmed by bankrupt individuals or entities? The incentive is still there to go after them, but since they aren't compensating for harm to the individual, let all of us benefit from the deterrence?

"The significant exceptions are that they can be imposed by tribunals operating under the looser standards of civil procedure."

Other than the standard of proof - preponderance of the evidence as opposed to reasonable doubt, I guess I don't know what looser standards you are referring to. The rules of evidence remain the same. And already the standard is higher for punitives than compensatory, since typically you have to show "willful and wanton" conduct, or "reckless indifference to the consequences" to get punitives, which are midway between the two.

"And yes, the state is selling out its right to punish under the color of civil law, and those who are required to forfeit monies under punitive awards are being fined--with the authority of the government-- but without the benefit of criminal standards of due process."

The state isn't "selling out" its right. Do you really want the state to have to chase down every punitive damages case? Every time a trucking company hires someone they know is a drunk and they run you down have the state prosecute them? Or when an insurer wrongfully and repeatedly denies claims it knows it should pay. I guess that's OK, just be prepared for a significant tax increase to pay for all the additional state employees. Not to mention federal for crimes across multiple state lines.

It would be "pirate's booty" if it were "stolen" from the defendant. You aren't arguing they don't owe it, you're just arguing that it's the state's job to collect it. And they aren't being fined with the "authority" of government, because you can't jail a corporation if it doesn't pay, and there is no criminal record associated with it.

I still don't know what you're talking about with regard to due process. That has a pretty specific legal meaning with a number of specific applications, so you may be using it more broadly than you intend or than I understand.
 

"Maybe if you search hard enough you can find yourself a life before you come back. If not, then maybe you can at least educate yourself so you won't embarrass yourself by being wrong so often here."

See, you already miss me. It's making me feel all warm and fuzzy!
 

"Once Frist gets rid of all the Lawyer waste, I think CJD would make a good "Squeegee guy". He could talk you into a dollar for dirtying your window with his squeegee. Plus he'd be polite, ala Mark Lanier. (another great future "squeegee guy")"

You know what's great about you? You don't have the foresight or the common sense to realize that if you or your spouse had a devastating injury that would require lifelong care Mark Lanier is exactly the type of lawyer you'd try and hire. Putting him out of business doesn't help you in the least.

Now, off with that nose!
 

"The state isn't "selling out" its right."

Actually, it is. Perhaps a better analogy is bounty hunting, with the government taking a taxed share of the punitive award and without it having to expend any of its prosecutorial resources. Sort of another version of a qui tam prosecution, using private counsel.

"How about this though - why not just make punitives payable into a victim's compensation fund for those who have been harmed by bankrupt individuals or entities? "

Very convenient, blurring the line again between redress for demonstrable harms and awards made
to deter conduct. This is not the proper purpose of tort action. And yes, it is an issue of broader political concern, with one very interested party being the tort bar. Private lawyer buccaneering is not an acceptable substiute for inadequate state resources for law enforcement and prosecution, or for inadequate legislation for fining convicted lawbreakers. The tort bar would have us believe otherwise, though.

"The incentive is still there to go after them, but since they aren't compensating for harm to the individual, let all of us benefit from the deterrence? "

Sure, pass me some of that walkin' around money.
You are advocating a form of corruption, whatever else you want to call it.

"And they aren't being fined with the "authority" of government, because you can't jail a corporation if it doesn't pay, and there is no criminal record associated with it."

They sure are. And if the company didn't pay (assuming the court's officers couldn't seize assets) you don't think someone wouldn't be held in contempt?
 

"You don't have the foresight or the common sense to realize that if you or your spouse had a devastating injury that would require lifelong care Mark Lanier is exactly the type of lawyer you'd try and hire. Putting him out of business doesn't help you in the least."

Sure, for a case with REAL merit you need a good trial lawyer but not for the the other 80-90% of personal injury cases without merit. Therein lies the problem. ;)
 

"Actually, it is. Perhaps a better analogy is bounty hunting, with the government taking a taxed share of the punitive award and without it having to expend any of its prosecutorial resources. Sort of another version of a qui tam prosecution, using private counsel."

So anytime a private actor performs a service that the government could, the government is allowing bounty hunting? Simply because the income earned is taxed? Are you going to apply that theory across the board? Just how big of a government are you after?

"Very convenient, blurring the line again between redress for demonstrable harms and awards made
to deter conduct. This is not the proper purpose of tort action."

Since when? Punitive damages are not a new concept, and predate the foundation of this country. I'm not blurring the line at all - I'm talking public policy, same as you.

"And yes, it is an issue of broader political concern, with one very interested party being the tort bar. Private lawyer buccaneering is not an acceptable substiute for inadequate state resources for law enforcement and prosecution, or for inadequate legislation for fining convicted lawbreakers. The tort bar would have us believe otherwise, though."

Buccaneering - nice use of the term. You forget the other interested party - corporate america. A group that would have much more power because of the ability to assert political influence on prosecutors and those who appoint them if you go to government only prosecution. Not to mention the ability to overwhelm underpaid and overworked civil servants with teams of high priced lawyers and mountains of paperwork.

"Sure, pass me some of that walkin' around money.
You are advocating a form of corruption, whatever else you want to call it."

Why is that corruption? You're advocating the same thing, just with a different party (the government) doing the work. Or are you advocating the end of all punitive damages?

"They sure are. And if the company didn't pay (assuming the court's officers couldn't seize assets) you don't think someone wouldn't be held in contempt?"

Who? Show me an example of where that has happened.
 

"Sure, for a case with REAL merit you need a good trial lawyer but not for the the other 80-90% of personal injury cases without merit. Therein lies the problem. ;)"

Obviously, this claim, like all of yours, is based on your usual sophisticated analysis. Excellent work, Friday.
 

"Or are you advocating the end of all punitive damages?"

That is about it. If the government has an interest in
deterring specific conduct in the interest of the larger society, then legislatures are the proper venue for proscribing unwanted action with appropriate fines or other penalties for those who violate those laws. And prosecutors should be the appropriate persons to bring legal action, under the rules of criminal procedure. If an action is punishable, the state should be doing the punishing. If it isn't punishable, then it should not be delegated under looser procedural rules to the hands and into the pockets of private lawyers and their clients, who
already have the opportunity to seek redress under other theories of tort.

Whether punitive damages preexist the founding of the U.S. is irrelevant. So did torture. What of it?

CH
 

The only purpose of pointing out the age of punitive damages is to remind you that it IS a proper purpose for a tort action.

Are you advocating the elimination of punitives in contract actions as well? Or just tort?

Again, I'm unfamiliar with the looser procedural rules you are referring to. Do you mean the standard of proof? That's not a procedural rule.

You truly are advocating government for corporate interests, by corporate interests, and on behalf of corporate interests when you do this. I guess we'll just have to agree to disagree.