Examining Malpractice

...And their hearts are in the right place...

...As health care consumes more and more of the GNP and of government budgets, there is an increasing divergence between expert and popular perceptions of current problems and their solutions...

...Such individuals will doubtless gobble up Jacobs' cases, each of which contains a victim with a fictitious name, little bits and pieces of medical lore, and clear summary judgments on the culpability of the medical villains...

...In fact, I think one of the fascinating aspects of the malpractice controversy is that it pits our two largest and most prosperous professions against one another in a conflict characterized, above all, by near-total mutual mistrust and incomprehension...

...They believe in the tort system, in the general principle of insuring potential tortfeasors, and in the desirability of judicial resolution of individual damage claims...

...an intensive glossary...

...This slant, unfortunately, keeps Pain & Profit from living up to its subtitle: It contains strikingly little politics—too little to provide enough analysis or liveliness in a discussion that often bogs down into three "on the one hands" and two "on the others...

...They agree that legal fees consume too much of the total insurance costs, yet offer nothing except a generalized distaste for the size of lawyers' incomes...

...17.95...

...reruns...

...To their credit, Sylvia Law and Steven Polan, authors of Pain & Profit, resist the temptation to focus on the more spectacular and egregious malpractice cases that culminated in the 1974-75 crisis...

...and a legal system of tort liability that threatens to collapse under its own weight...

...Still, as much as one would have liked Pain and Profit to be more pragmatic and less dull, its approach is vastly preferable to the intermittent hysterics of H. Barry Jacobs' The Spectre of Malpractice...

...Medical malpractice, lying at the intersection of law, medicine and insurance, would seem an appropriate target for a skilled and ambitious researcher eager to combine the specifics of an immediate political issue with a creative examination of major institutions in our society...

...everyone else is suspect, and the more corporate they are, the more suspect they are...

...Finally, they regard Federal regulation as the solution to the insurance firms' poor performance?without letting us know why regulations will work any better here than they have with airlines or railroads...

...In a way, Law and Polan have let their own political viewpoints lock them into a bind: Because they are so thoroughly opposed to the status quo, they feel only systematic reform—of income distribution, the role of professions, and the like—will suffice...

...491pp...

...The contrast between Pain & Profit and The Spectre of Malpractice does more than illuminate the character of the two books...

...The formidable clout of both the medical profession and the insurance industry is taken for granted, and the battle between them in the state legislatures —where the heavy hitting has largely taken place—is ignored...

...I do not mean to suggest, though, that Pain & Profit is a bad book...

...and a set of anatomical charts, presumably to allow the lay reader to enjoy the gory details of the case studies...

...They are also trenchant, albeit rather brief, in their analysis of the economics that precipitated the '74-'75 crisis, and how much of it was really the insurers' fault...

...In large part, the communication gap between experts and the wider public is a failure of the moderate Left, which elsewhere—in housing, for example, or tax policy—provides the best translations of policy debates into comprehensible language...

...The authors' discussion of legislative reforms in liability law over the last five years is particularly valuable...

...Assuming this goal, a book about malpractice could tell us a great deal not only about the technical details of an important subject, but about how society is organized to perform its vital tasks...

...the changing character of doctor-patient relations...

...A physician who has apparently made a career as an expert witness for the prosecution in malpractice cases, Jacobs has given us a compilation—book would be an inaccurate word—that consists mostly of capsule summaries of 101 cases of malpractice...

...The curious layman has available any number of popularly oriented—and too often wildly misleading—diatribes and exposes...

...Just as some people are addicted to soap operas or to playing the horses, others are hooked on medicine—they read all the popularized accounts and consume all the Marcus Welby, M.D...

...So it is hardly surprising that politicians generally feel the subject is too fraught with political minefields and that legislatures try to avoid taking it up unless circumstances force them to...

...Quite the contrary: It is the best volume so far written on the subject in this country...

...They correctly view the central problem as the incompetence and cupidity of a few doctors, but their remedy is the standard one: strengthened professional policing backed by government regulation...

...Also included are six cases of patient injury where malpractice was not involved...

...They also fiddled with the rules relating to malpractice litigation (shortening statues of limitation, changing standards of proof, etc...

...Thus when a "crisis" was precipitated in late 1974 by requests from malpractice insurers for 200-300 per cent premium increases, and by the subsequent withdrawal of some of them from the market altogether, state governments took the simplest course: They established joint underwriting associations and reinsurance programs that guaranteed continued availability of coverage to physicians at less than astronomical rates...

...several chapters of essentially sound—if rather overwrought—discussion of the basic medical, legal and insurance issues...

...Regrettably, doctors are too easy and tempting a target for the Left to say anything about health care as a whole...

...The solutions put forth, however, are strikingly complacent...

...On balance, then, they have produced a hard-headed exploration of the legal tangles...

...Perhaps because they feel they lack the sociological insight that would permit them to say anything interesting here, the authors merely note the collision...

...Yet the underlying problems remain, as intractable as ever...

...the specialist is confronted by foundation-sponsored studies and reports of official commissions that tend to be long on sobriety and short on workable ideas...

...Reviewed by Bruce C. Vladeck Associate Professor of Public Health (Health Administration) and Political Science, Columbia University The problem of medical malpractice —how injuries are committed, discovered, litigated, adjudicated, and (sometimes) compensated—is extraordinarily complex...

...It reflects as well the trouble with the general level of all aspects of the health-policy debate...

...They are careful to point out that many legislators have financial connections with insurance companies, but even more are lawyers...

...Similarly, Law and Polan are properly hostile to the organized bar, yet give short shrift to its influence in formulating malpractice legislation...

...Consumers, especially those who have been injured by the medical care system, are the goods guys...

...These stop-gap measures quieted things down, and malpractice is now low on the list of national priorities...

...Most such reforms, they convincingly argue, cut into the rights of seriously aggrieved citizens without doing much about malpractice itself or the costs of insurance for it...

...Full comprehension (never mind resolution) of the issue is impossible without at least touching on basic aspects of the organization and financing of American health care...

...Intermediate measures that might be more plausible politically and therefore more effective are largely absent from their discussion...

...Theirs is largely a careful, often bloodless, recounting and analysis of the major legal issues—with special attention to the "reforms" adopted or proposed in the last five years—written from the perspective of young lawyers with backgrounds in poverty law and consumer advocacy...

...the training, regulation and disciplining of physicians...