Medical Malpractice: A Comprehensive Analysis

By Hall, Charles P. | Journal of Risk and Insurance, June 2003 | Go to article overview

Medical Malpractice: A Comprehensive Analysis


Hall, Charles P., Journal of Risk and Insurance


Medical Malpractice: A Comprehensive Analysis, by Vasanthakumar N. Bhat, 2001, Westport, Conn. & London: Auburn House

Reviewer: Charles P. Hall, Temple University

The author states in his preface that "the purpose of this book is to present a comprehensive overview of the medical malpractice system." He also states that his goal "is to present an overview of the latest literature along with my observations about medical malpractice from a statistical analysis." He achieves his first objective via an almost encyclopedic inclusion of hundreds of footnotes selected from the more than 70,000 research papers discovered in his search of MEDLINEplus, as well as numerous additional references found in social science and statistical journals. Indeed, the extent of the statistical content is such that the book is liable to be extremely intimidating to anyone who lacks a degree of statistical sophistication. Clearly, this is not a book for the average man or woman, despite the helpful Appendix I on statistical methods.

That said, a serious researcher on the topic of medical malpractice would find a lot of valuable information that has been summarized, analyzed, and presented in considerable statistical detail. Students in law, medicine, and health administration will also find it useful. For this reviewer, however, a number of the author's "observations about medical malpractice" drawn from his statistical analyses of the data seems both biased and, in some cases, simply wrong. Furthermore, starting with the very first sentence in his preface, he occasionally drops "observations" that are unsupported by references. In stating, "There has been an ongoing medical malpractice crisis in the United States starting from around the 1840s," he provides not a single jot of evidence to support such a sweeping allegation. Indeed, for it to be true would necessitate an extremely loose definition of the word "crisis." (To be fair, he does cite a source for this exaggerated allegation in Chapter 1-the source, however, considers 217 U.S. Appellate Court cases over a span of 110 years to constitute a "crisis." This is not a definition that most observers would accept.)

He follows that opening statement by saying, "Malpractice lawsuits are filed to recover costs of injuries resulting from a treatment that deviates from the standard of care." While this may be a theoretically accurate characterization of what should be required for success in a malpractice case, it seems a bit naive in light of actual practice. It is well-known that many malpractice suits are filed and, yes, sometimes even won, because the patient is unhappy with the outcome, even if treatment followed the normal standard of care.

The above examples are cited as reasons for any reader or reviewer of this work to be on the alert for other potentially questionable conclusions. At the same time, the author is quite correct in some of his other opening observations. Certainly, there "is no consensus about the cause of the (sic) medical malpractice liability." That continues to be best described as a "where you stand depends on where you sit" situation, with physicians, lawyers, insurance companies, and more recently, managed care organizations all attempting to point the finger of blame anywhere except at themselves. Here, the author quite correctly concludes, "Politics will decide how the tort game will be played."

In the opening chapter, the author provides a brief summary of U.S. versus world health statistics, noting that we spend more both in absolute dollars and on a per capita basis than anyone else, yet our results are not very good. He outlines various ways in which responsibility could be allocated for adverse outcomes of medical treatment and gives a summary of the pro and con arguments of the usual protagonists. He also summarizes the impact of the current system on various stakeholders and provides a litany of the array of reforms that have been proposed and/or implemented around the country, along with the expected impact of each reform on costs and behavior of the interested parties. …

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