The Malpractitioners/Pain and Profit:
Page, Joseph A.
tation of U.S. multinational corporations and after Castro viciously assailed Llere- and equal opportunity regardless of race and the general degradation of the poor na's character during...
...If we pay no heed to miums did skyrocket, the causes of these grapple with the bona fide problems of history, we shall be condemned to repeat increases had little to do with unjustified how to reduce the incidence of malprac- it...
...military "malpractice insurance, in the year of vival during World War One, hardly leaders could defend or conquer lands or the industry's `crisis,' was on the whole, qualifies as a masterpiece...
...A report by Tolstoy in Serbia the Rand Corporation, published last June in the prestigious New England A TQIE OF DEATH War and Peace, though Cosid invites Journal of Medicine, verifies this de- comparison, not only by making pointed bunking of the complaint that malprac- Dobrica Cosic references to the Russian masterpiece, tice claims have reached a disproportion- Translated by Muriel Heppel but by reaching conclusions about war ate level...
...The exact reverse is true...
...ical costs to prohibitive heights...
...Pain and Profit stresses that novels about Serbia's struggle for sur- liberty, and rights of a people...
...For Maestra to trade his party's support for 1975, estimates of the burden the Fidel's commitment to set up a Marxist Joseph A. Page "crisis" had imposed upon the public regime...
...The The author may have had War and the fate or survival of a nation...
...Moreover, tice, and how to provide just and liability crisis," complete with soaring the cure being peddled to state legislators adequate compensation for those harmed liability premiums, institutional ads, the did not deal with the real problems...
...by medical treatment...
...The inside picture of revolt, largely due to news reports from anecdotes in footnotes at the back of the Fidel wheeling and dealing with his folthe U.S., particularly the dramatic inter- book...
...Their pathetic juries and the liberalization of returned to Cuba to confront accusations strike produced one salutary surprise...
...ranged from $2 billion to $11 billion...
...facts have been winnowed from the legitimate disputes over claims continue Government officials seem unable or rhetoric, the "crisis" begins to take on to arise and physicians have real con- unwilling to dig out the true facts and' aspects of the proverbial three-dollar cerns about the way society resolves figures...
...Carlos Rafael Rodriguez, then a top officer of the Cuban Communist Party and now probably the third most powerful Insuring trouble Cuban behind the Castro brothers...
...lowers and with competing revolutionary views with Castro by New York Times Llerena's utterly negative assessment groups is the best I have ever read...
...While malpractice insurance pre- these conflicts...
...throughout the world...
...ACCORDING to a Yugoslav-born war," says the tenacious and compasTherefore, what is one to make of the American critic, A Time of Death sionate General Misic who succeeds in controversy over premium costs...
...Something by which a man can be bloated by the technique of assign- hears the screams of men hit by shrapnel, and a nation survived and endured, even ing monetary values to non-existent and exclaims: "I don't remember any- though a time of death prevailed claims...
...was to change the legal rules to make it cupied by Castro's soldiers and turned Anyone puzzled by this anomaly moree difficult for claimants to recover...
...There is too much emulates Tolstoy, even if what he writes about 40 percent of these incidents never crucial dialogue and -revealing interior "doesn't come out 100 percent, it's still lead to claims by patients...
...Thus, some companies require thing like that from War and Peace...
...Did he have no conception of the mention the inside information he here he harbors fears he still may be accused hardship caused by the widespread unrecords-indicated otherwise...
...According to newspaper accounts and ical group still supporting him...
...For Cosid, as for Tolstoy, war on the aggregate undercompensated for Ivan Sanders becomes a metaphor for the human conthe amount of economic loss inflicted dition...
...The wanted to communicate the reality of war power that lay below the surface of all Malpractitioners provides further sup- even more graphically than Tolstoy visible facts, and above all measurable port to this charge, demonstrating losses did-in one battle scene a student soldier strength...
...and was then the only left-of-center polit- Anchor Press, $10, 349 pp...
...same rhetoric and the same proposed solAs The Malpractitioners vividly There is a broader issue, however, that utions...
...He cones to the realization answer is both simple and outraging: the Yugoslav reader has no choice but to that war is inevitable, eternal, andinsurance industry manufactured the accept this appraisal, even if he feels that clearly echoing Tolstoy's theories as ex"crisis" and then exploited it to the hilt measured against classic war novels pounded in the final chapters of War and in order to recoup serious investment los- Dobrica Cosid's massive work, a shor- Peace-believes that "statesmen could ses the companies incurred in the stock tened version of an even vaster cycle of decide questions relating to the progress, market...
...cities...
...researcher gence were among the causes supposedly resigned because of a lack of patriotism...
...Isaac Bashevis Singer is probaclaims and carry them on their books as tative types, but Tolstoy's willed ran- bly right in saying that when' a" wfftbr losses...
...lived...
...He never of knowingly helping a Communist into employment after the sugar-cane zafra doubted Castro's promise to hold free power...
...All kinds of feelings belong to upon them...
...The Some months later when Llerena fi- DURING THE MONTH of January, 1976, finger of blame pointed at the large nally realized he had been duped into doctors in Los Angeles County with- awards patients were said to be winning heading and giving credibility to a Com- held medical services to protest sharp against doctors...
...No, this authors give examples of how insurers Peace in mind all along...
...Both books attempt to monitoring insurers...
...Did he never see the droves of on seeing Castro as a democratic re- Llerena writes clearly, but he belabors women who could subsistt only as prostiformer when public evidence-not to his thesis (that he was duped) as though tutes...
...It, too, paints a broad for not measuring up to a supreme masinsurers then put dollar figures on these canvas and fills it with a host of represen- terpiece...
...The non- onslaught...
...Rod- institutional advertising by the insurance riguez, whose previous contacts had PAW AND PROFIT: industry, dramatic rises in the cost of been with Raul, 'Che and several other TIE POLITICS OF MALPRACTICE liability insurance for physicians were committed Marxists in the rebel high Silvia Law and Steven Polan threatening to drive already soaring medcommand, had traveled to the Sierra Harper & Row, $12.95, 305 pp...
...multinational corporations and after Castro viciously assailed Llere- and equal opportunity regardless of race and the general degradation of the poor na's character during one of his intermin- or sex (though not regardless of sexual majority throughout Latin America is all able TV monologues, Llerena and his orientation-gay Cubans still suffer...
...One succession of Havana newspapers, re- death rate while the doctors were profes- solution pushed by insurers and doctors signing from each paper as it was oc- sionally inactive...
...family reluctantly returned to exile in the Did Llerena, a native Cuban, never see Probably due to his narrowminded, United States, where they continue to the bohio huts in which the rural poor middle-class perspective, Llerena went live...
...A good editor could have told ended...
...The and urgent realism...
...The rather hapless Cuban Communist Party THE MALPRACTITIORERS well-documented dissections of the sohad achieved a modicum of influence called "medical malpractice crisis" that through an informal alliance with Batista John Gunther made headlines a few years ago...
...into a government propaganda organ...
...But neither of them could decide a profitable line for the industry...
...There are no citizens groups bill...
...monologue here...
...The lessons taught by The Malpoints out, statistics on the incidence of emerges from these books...
...percentage of patients harmed by faulty care bring claims against the doctors responsible for their suffering...
...A the rules of law governing medical negliby Castro's Marxist aides that he had recent study by a U.C.L.A...
...The insur- practitioners and Pain and Profits will medical negligence prove that but a small ance industry enjoys a freedom from sus- hopefully have a spill-over effect...
...I and CBS correspondents, whom Llerena of the Castro regime is, to my mind, particularly enjoyed Llerena's descriphelped slip into rebel territory...
...has unearthed the fact that the County conspiring to produce what were expanThere, he worked as a columnist for a achieved a significant decrease in its sively termed "boxcar verdicts...
...Patients corporation chicanery that made a profitNow that the dust has settled and the are indeed sustaining injuries or worse, able "crisis" out of medical malpractice...
...In Harcourt, Brace, $10.95, 437 pp...
...But as a federal study has proved, domness is missing...
...rendered valueless by his blindness to the tion of the time Fidel-not yet a one-man Llerena quotes from Castro's hand- lot of the majority of poor Cubans, who ruler-got carried away during an interwritten letters in which Fidel reasserted previously suffered and now enjoy view and then was forced by his rehis democratic intentions at the same superb health care, new housing, modern volutionary comrades to back off from a time he was negotiating secretly with schools, a full-employment economy, peace offer he made to Batista...
...Of course, it may be un- Death is such a perfect example of nacry over malpractice insurance costs fair to compare every realist war novel to tional literature that its significance Commonweal: 412...
...Today the nation faces a "products claims or excessive awards...
...he may have was decided by some other force, some set their rates by manipulating data...
...that are remarkably close to Tolstoy's addition, those who sue and recover are views...
...should ponder The Malpractitioners or Vigorous lobbying efforts convinced When no independent papers remained, Pain and Profit, a tandem of readable, many state legislatures to enact statutes 6 July 1979: 411 cutting down the patient's rights in mal- should not obscure the realities of the tained scrutiny that facilitates the kind of practice cases...
...Claims-conscious conmunist front, he resigned and then, after increases in the premiums they had to pay sumers, greedy lawyers, overly symCastro's victory several months later, he for malpractice liability insurance...
...elections under the terms of Cuba's Con- him when he had proven that point and This book's great value (augmented by stitution of 1940, and so he went on should have rectified several other minor the index and appended documents) lies working assiduously to build Fidel's weaknesses-occasional repetition, a in the inside glimpse it gives of the ways image as toe heroic guerrillero-an loss of narrative pace due to backtracking in which the Cuban revolutionaries image which grew inside Cuba, where at the start of chapters and the burial of maneuvered-more than fought-their Batista kept a news blackout on Castro's various and sundry fascinating facts and way into power...
...Ac- "can already be considered to be the best rallying his army after the Austrian cording to the books under review, the novel in Serbian literature...
...too many neatly de- good...
...Marxist fiction...
...Perhaps it is because A Time of The flimflammery provoking the out- scribed scenes...
...doctors to report every incident that but the novel lacks Tolstoy's luminous As we said, a novel cannot be faulted might conceivably result in a claim...
...medical-negligence dilemma...
Vol. 106 • July 1979 • No. 13
