Reply

By Ignagni, Karen | Frontiers of Health Services Management, Fall 2003 | Go to article overview

Reply


Ignagni, Karen, Frontiers of Health Services Management


MY ARTICLE OFFERS a rationale for systematic malpractice legal reforms linked to quality improvement and patient protection. The comments by Mary Alexander; Eleanor D. Kinney, J.D.; A. Gordon McAleer, FACHE; and Lawrence E. Smarr are both intriguing and instructive. They illustrate the range of strongly held views that stakeholders bring to bear on this vexing issue, and in two instances they suggest how hard it will be to move beyond the blame game.

The first and most crucial step in elevating the debate is to call a halt to reflexive finger-pointing. As with most healthcare issues, this one is complex and nuanced. Everyone with a stake in the outcome-including physicians, hospitals, health plans, and attorneys-ought to be willing by now to agree that a multidimensional medical liability crisis requires multidimensional solutions.

Alexander, president of the Association of Trial Lawyers of America (ATLA), reiterates ATLA'S now-familiar charge that the insurance industry alone is responsible for the crisis. But the oft-repeated accusation that investment losses rather than claims losses have driven premium increases does not withstand scrutiny. The General Accounting Office (2003) recently concluded, for example, that although multiple factors have contributed to premium increases, "losses on medical malpractice claims-which make up the largest part of insurers' costs-appear to be the primary driver of rate increases in the long run."

Scapegoating insurers distracts us from examining the full range of reasons for the surge in claims losses. The nation is burdened by an out-of-control "litigation lottery" that functions poorly for most plaintiffs and defendants alike. Trial lawyers interested in improving the fairness and effectiveness of the nation's tort law system should be willing to unclutter it-for example by steering more disputes to independent reviews and weeding out unwarranted lawsuits-rather than simply digging in and counting on their legendary lobbying power to forever protect them from reform. That strategy, aside from inviting a public backlash, does a disservice to everyone whose access to healthcare is jeopardized by rising costs that have no relation to the actual cost of healthcare services.

Professor Kinney, while acknowledging that the medical liability crisis is both real and complex, chooses to focus on some issues that, unfortunately, tend to obfuscate rather than clarify the dimensions of the crisis and the need for reform. She raises questions, for example, about whether the costs of defensive medicine can be quantified. No one disagrees that precisely quantifying such costs is nearly impossible (researchers would have to determine the circumstances influencing every test and treatment, requiring constant communication with the physicians ordering them). We can argue about whether defensive medicine wastes $40 billion or $400 billion a year; whatever the figure, it is too big. But to infer from the difficulty in precisely pinning down such costs that defensive medicine is a non-problem requires ignoring much evidence from surveys, testimony, empirical research, and media investigations.

Similarly, Kinney seems to be making the argument that trial lawyers are not solely responsible for the liability crisis because, after all, medical errors do occur, patients do suffer, and therefore there must be recourse. Who would argue otherwise? The issue is not whether aggrieved patients should have access to the courts but whether reforms can make recourse to the courts unnecessary in the great majority of cases. In essence, the issue is whether we can ensure that a long, drawn-out, hugely expensive (and in most instances unsatisfactory) jury trial is the last resort rather than the first-and whether we can improve the chances that jury trials, when they do occur, will lead to objectively reasonable outcomes.

It is ironic that Kinney provides a good example of why arguments before a jury so often distort reality. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Reply
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.