This Doctor's Love Affair Became Malpractice; Peer-Review Privacy; and More

Wayne J. Guglielmo, MA


December 13, 2012

In This Article

Some Georgia Doctors Jump on New Tort Reform Idea

Georgia's physicians are among the latest to consider replacing their state's tort-driven medical malpractice system with something resembling workers' compensation, says a posting on[3]

In 2005, state lawmakers approved a sweeping set of tort reforms, the centerpiece of which was a $350,000 cap on noneconomic damages. But in 2010, the Georgia Supreme Court struck down the cap as unconstitutional, declaring "it improperly nullified a jury's ability to award damages based on the facts in a case."

Now debate has begun within state healthcare circles about what to do next.

Some, like Richard Jackson, CEO of physician staffing firm Jackson Healthcare Solutions, would like to replace the current medical malpractice system with "the one utilized to resolve workers' compensation claims." Through the advocacy group Patients for Fair Compensation, Jackson and like-minded Georgians are pushing "for the creation of a no-fault system whereby claims would be funneled through an independent review panel." Those claims deemed to have merit would be forwarded "to a compensation department that would create a fee schedule for damages." Patients who were dissatisfied with a decision would be able to appeal it to an administrative law judge.

"If you are poor, unemployed, or a child, attorneys will not take the case," says Jackson. "What we want is a no-blame, streamlined system that pays patients and is way more efficient."

For his part, Bill Clark, political director of the Georgia Trial Lawyers Association, raises a number of objections to the workers' comp idea. First, he says, such a system would have disproportionate physician representation and would therefore be biased. Second, in so far as it denied patients' access to a jury, it would face the same constitutional hurdles as any noneconomic damages cap. And third, patients would still be required to demonstrate, as they do now in the current liability system, that the malpractice was caused by a doctor and that if he or she had provided the right care it wouldn't have occurred.

Even some doctor groups are skeptical of the no-fault system. "We know that the cap on noneconomic damages works," said Donald Palmisano, Jr., executive director of the Medical Association of Georgia, which has yet taken no formal stance on the workers' comp proposal. "In 2005, it reduced claims and more physicians entered Georgia." Palmisano thinks that one possible alternative to the status quo is for doctors at some point to push for a constitutional amendment that would reinstate the cap.

For Major Patient Safety Strides, Try Crawling Before Walking

Before a major leap in patient safety can occur, a number of critical baby steps need to be taken first. That's one of the key messages of a new collection of essays reviewed in the November issue of Health Affairs.[4]

The collection is First, Do Less Harm: Confronting the Inconvenient Problems of Patient Safety, edited by Ross Koppel, a researcher and sociologist at the University of Pennsylvania, and Suzanne Gordon, a journalist, author, and nursing professor. The reviewer is Janet Corrigan, former president and CEO of the National Quality Forum, a nonprofit organization, and one of the architects of the Institute of Medicine's groundbreaking 1999 report on building a safer health system.

According to Corrigan, the essays in the collection, many of which were written by the editors, lay out the "inconvenient" problems that must be addressed first before we can create "a safe healthcare environment for both patients and workers." Among these is fixing "the profound culture of disrespect and incivility toward colleagues -- often the next generation of professionals -- that seems to have its roots in the health professions' education and training." Both doctors and nurses learn early in their careers, Corrigan says, that reporting an error or lapse of one kind or another invites retaliation from more senior colleagues.

Another effect of what Gordon describes as this "toxic hierarchy," says Corrigan, "is that many institutions involved in the patient safety movement have failed to constructively engage front-line workers in patient safety initiatives -- and the resulting worker anger is palpable." A top-down, rather collaborative approach to patient safety, says Corrigan, viewing the collection's evidence, is -- with some notable exceptions -- the norm.

Some of the essays in the collection also point to a related problem: the gap between patient safety and worker safety. Often working under far less-than-ideal conditions -- long shifts, a heavy workload, unclean and hazardous environments -- doctors and nurses do all they can do to get through their routine responsibilities, much less focus consistently on safety. Says Corrigan, "It is hard to imagine a scenario in which a culture of safety will survive if the workforce feels undervalued and disrespected."

The collection ends with a message that Corrigan considers key: "Achieving safe care for patients demands specific actions and constant vigilance, both at a worm's-eye view and at a bird's-eye view." In other words, sometimes policy makers need to know and take seriously what's happening on the frontlines of medicine before they can come up with broader plans to improve it.