- The Washington Times - Tuesday, May 31, 2005

States that capped jury awards for medical malpractice lawsuits saw a 9.6 percent increase in overall doctor services compared with states that have no caps, according to a medical report released today.

The report, part of a group of medical-malpractice studies released in two health journals, said physician services rose in every state from 1985 to 2001.

But the number of doctors in states with caps grew 2.4 percent more in those states than in states without tort reform.

More of that growth came from doctors with 20 or more years of experience, said the report in the June 1 edition of the Journal of American Medical Association (JAMA).

The medical reports come as federal and state lawmakers grapple with how best to curb rising medical liability insurance rates.

Currently, 27 states have capped payouts for noneconomic “pain and suffering” in medical malpractice cases.

Doctors and medical groups have asserted that caps are necessary to rein in excessive jury awards that have pushed up insurance rates and increased the use of defensive medicine.

Most doctors are practicing defensive medicine — conducting extra tests and procedures that are not medically necessary but protect a physician from lawsuits, according to another JAMA study released today.

About 93 percent of 824 specialists surveyed in May 2003 — including gynecologists, radiologists and general surgeons — said they practiced defensive medicine.

Nearly half of them cut back on procedures or referred patients with complex medical conditions to other doctors in the previous three years to reduce their litigation risk, according to the study.

Trial lawyers and other opponents of tort reform contend that capped malpractice awards are unfair to injured patients who need adequate compensation.

“Policy-makers should be cautious” when they interpret the results from the medical malpractice study, said William Sage, co-author of the study and Columbia Law School professor.

Mr. Sage said the goals were “narrowly defined, and our approach has significant limitations.”

Another report, released today in the online version of health policy journal Health Affairs, reiterated that the presence of caps on jury awards has an impact on where doctors choose to practice, especially in rural counties.

Counties with caps on noneconomic damages had a 2.2 percent rise in physicians — or an increase of five doctors per 100,000 people. Rural counties with a cap had 3.2 percent more doctors.

Surgeons and obstetricians — two groups that are more vulnerable to lawsuits — were the most influenced by the presence or absence of caps, said William Encinosa, co-author and senior economist at the Agency for Healthcare Research and Quality, a federal health agency.

However, a separate Health Affairs study published today said caps and other changes in the medical liability law have less of an effect on malpractice awards than tort-reform backers have suggested.

Malpractice award payments have paralleled the increases in health care spending, with the average payment climbing 4 percent annually from 1991 to 2003, the study said.

Ninety-six percent of malpractice cases in that period were settled out of court.

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