Malpractice Picture Brightens

Physicians’ greatest fear, dread, and anger focuses on frivolous malpractice suits and high malpractice premiums that ensue.

Things may getting better. According to The American Medical News, there’s room for optimism as 84% of liability companies reported in 2007 rates held steady or dropped,

But rates remain sky-high in certain markets. Furthermore, national tort reform is unlikely. So are reduced rates in high risk cities.

The 2007 Medical Liability Monitor Rate Survey indicates wide regional variations among states.

• Highest rates for internists ($68,867), general surgeons ($275, 466), and Ob-Gyns ($275,466), are all in Dade Country, Florida.

• Lowest rates for internists ($3,375), general surgeons ($11,306), and Ob-Gyns ($20.626), are all in Minnesota.


• Besides Florida, states ranking in the top tier rates are Michigan (Wayne) , Illinois (Cook, Madison, St. Clair) and Ohio (Cuyahoga, Loraine)

• Besides Minnesota, states ranking in low tier are South Dakota, Wisconsin, and Iowa.

What’s going on here?

I suspect factors at work are, :

• Cultural. High rate states are crowded metropolitan regions with a mixed citizenry, while low rate states are more thinly populated, have more homogeneous populations, have higher society trust levels, and have citizens who are less inclined to litigate

• Reform based. This is noteworthy in Texas, where voters in 2003 passed a $250,000 non-economic damage cap as a constitutional amendment. Ob-Gyns in Texas now have rates $26,516, a drop of 5.7% from 2006.

• Competition among medical liability companies increasingly offering credits and rebates to physician policy holders.

• A series of favorable court rulings in Ohio and Louisiana holding lawyers accountable for filing liability suits without merit. .


There may other factors as well. These vary from state to state and include:

• Risk-resource organizations in hospitals where doctors and the hospital partner in systematic programs to reduce risk.

• Formation of alternative risk reduction groups among doctor-led state medical society liability organizations.

• On-line services that make informed consent documentation routine and engage patients in the process.

• A general awareness among physicians of what it takes to reduce liability risks:

1) carefully documenting each patient encounter and doing it electronically;

2) providing patients with details of their visit before they leave the office:

3) communicating thoroughly through conversation and paper documentation;

4) having patients repeat what they have been told;

5) having patient sign informed consent waivers saying they won’t sue for frivolous reasons;

6) informing patients of risk through patient education materials;

7) systematically spotting potentially litiginous patients and handling them cautiously.

I spoke to Dr. Mark Odland, a surgeon at Hennepin County Medical Society and Group Chairman of the Minnesota Medical Insurance Company (MMIC), to ask why Minnesota has the lowest malpractice rates in the nation. He said it’s a combination of things – a culture of collegiality among doctors and society as a whole, more doctors practicing in large groups or in large organizations, and MMIC-sponsored aggressive programs focusing on reducing malpractice risks, patient safety, communication, and quality. In my next post, I will sum up my conversation with Dr. Odland.