New Orleans, LA -- Advocating solely for tort reform in the legislative arena does not get to the root of the medical liability crisis, according to Richard Boothman, JD, chief risk officer for the University of Michigan Health Systems, who presented the 6th Scientific Session—The Donald F. Richardson International Symposium, "Medical Malpractice Reform: Beyond Caps"—today at The American College of Obstetricians and Gynecologists' (ACOG) 56th Annual Clinical Meeting. Moreover, Mr. Boothman contends, the health care system needs to address the reason that patients sue doctors in the first place and focus on key patient safety and communication issues.

"Study after study suggests that patients sue primarily because they feel they haven't gotten answers. They feel that no one is accountable when an error has caused injury. They also feel a huge sense of responsibility to protect others, to make sure what happened to them won't happen to other patients," Mr. Boothman said. "Blaming lawyers and imposing caps and other hurdles to litigation simply doesn't get to what is actually driving patients to lawyers."

In 2001, Mr. Boothman helped the University of Michigan adopt new policies encouraging full disclosure of errors and apologies to patients when warranted. The university aimed to reduce its medical liability claims with a new effort based on three principles: quick and fair compensation when inappropriate medical care causes injury; vigorous defense of medically appropriate care; and reduction of patient injuries (and therefore, claims) by learning from mistakes.

In August 2001, the university had 262 medical liability claims. By August 2007, there were only 83 cases pending. Processing time dropped from 20.3 months to 9.5 months; total hospital reserves earmarked for claims decreased by more than two-thirds; and average litigation costs were cut in half.

"Michigan instituted a rigorous process to answer the core question 'Was the care reasonable or not?'" Mr. Boothman said. "If a mistake was made, the patient gets an apology quickly and an offer of compensation. If we haven't made a mistake, we give a full explanation to the patient." The university placed more emphasis on patient communication and patient safety, which included improving the informed consent process, instituting a strong peer review system, improving clinical care, responding to complaints quickly, helping patients deal with unanticipated outcomes, and setting realistic patient expectations.

"ACOG believes a comprehensive, multi-pronged approach is needed to address the liability problem, and it likely will require innovative and effective solutions," noted ACOG President Kenneth L. Noller, MD, MS. "It's important that our specialty be willing to explore alternatives for better ways to address cases of poor medical outcomes. The University of Michigan is a good example."

According to Robert C. Lyneham, MD, chair of the Medicolegal Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, who also spoke at the 6th Scientific Session, the medical liability crisis is not just a problem in the US. In fact, in 2002, Australia's health care system faced a near catastrophe because physicians threatened to walk off the job. "The response from government, business, and the medical profession was swift and effective," said Dr. Lyneham.

Dr. Lyneham said that among the solutions was legislation that limited damages for noneconomic losses payable to plaintiffs injured by negligent defendants and modified the test to determine the standard of care in cases in which the practitioner was accused of negligence. Additionally, most jurisdictions introduced an expert witness code of conduct. The federal government also helped physicians with rising premiums by underwriting "incurred but not reported liabilities," covering part of very high claims, and subsidizing premiums.

For its part, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists addressed expert witness testimony. "There were anecdotal complaints against experts made by Fellows involved with cases, judicial criticism in certain judgments, and well-defined criticisms in a detailed survey of all 478 Australian judges," Dr. Lyneham commented. "Our College's first step was to introduce an 'Expert Witness Register,' with certain criteria requiring fullfilment for Fellows to be on the register. The next step was to develop an expert witness training program. Eventually, completion of this program will be a requirement for being on the register."

"America's medical liability crisis is severely threatening the future of women's health. Ob-gyns will not give up our fight for immediate, meaningful tort reform," noted Dr. Noller. "ACOG is committed to amplifying our efforts to bring the strongest possible initiatives before both state and federal legislators to end this health care crisis. It's a battle we cannot afford to lose."

# # #