Dr. Cat v. Dog, Esq.

June 17, 2004 8:36 AM

Doctors refuse laywers. So your last client managed to get restitution from that quack who left the clamp in her abdomen, just in time to pay for your daughter's delivery. Good luck finding an OB. Or perhaps your husband works for a law firm. Good luck with that nursing job. Maybe you're a neurosurgeon making less take-home than your insurance premiums. What are you going to say to the next ambulance chaser with migrane trouble? The war between the two solitudes could start racking up a real body-count.
posted by bonehead (60 comments total)

Three things leap to my mind:

1) Is it ethical for a doctor to refuse to treat a patient?

2) Is it ethical to force doctors to treat patients that put them at risk?

3) Will more lawyers be dying, and is this an altogether bad thing?
posted by five fresh fish at 8:46 AM on June 17, 2004

Selina Leewright never thought that being married to [a lawyer] would cost her her job.

But that's why Leewright, a nurse, was fired last summer by Good Shepherd Medical Center in the East Texas city of Longview. In dismissing her, hospital officials praised her nursing skills as "fantastic." But they told her that because her husband, Marty, worked at a law firm that does medical-malpractice litigation, the hospital could not continue to employ her.

It's Texas. She's screwed.
posted by dash_slot- at 8:48 AM on June 17, 2004

Adding Florida to the list it's starting to smell.
posted by thomcatspike at 8:52 AM on June 17, 2004

It's fair enough: she's in a dire conflict of interest there.
posted by five fresh fish at 8:53 AM on June 17, 2004

How else is the medical profession suppose to make a stand? It sucks, but it makes sense.
posted by Witty at 8:57 AM on June 17, 2004

It's Texas. She's screwed.

That was my first thought. Isn't Texas is one of those, what-do-they-callums, right to work states? In Texas, your employer can fire you at will, no reason necessary, right? This foreigner doesn't see that she had a leg to stand on.
posted by bonehead at 9:01 AM on June 17, 2004

Disclaimer: I work as a legislative aide for a member of the New Jersey Assembly, which last week signed a Medical Malpractice reform bill. Wanted to point out that significant aspect of bias, while at the same time reflecting on the banker-boxes full of data I have on this. Opinions reflected in this and future comments do not reflect boss, party, etc. etc. etc.

That said: this is absolutely ridiculous. Doctors, who are supposed to be well-educated, become doddering idiots when they throw out the "limit damages" argument. There was a proposal to limit lawsuit awards to $250,000 in the recent New Jersey bill. Why was it ignored? Because the average payout among all malpractice settlements was around $280,000. The reality of lawyers extracting millions on a weekly basis from doctors as if they were gumball machines or something is simply non-existent.

There were issues that did affect malpractice rates- for example, that OB-GYNS had statutes of limitation extending to 20 years from birth of child- in other words, a doctor retiring at 70 could be sued at 90 for a baby delivered on the day of retirement. Parts of the refomr law fixed this by lowering and re-advising statues. A 3-year experimental fund, in which all lawyers are assessed a $75/year fee to go towards a general malpractice insurance fund to lower rates for doctors is also established. Give a little, take a little.

Amidst all these arguments, the one issue that stands as a non-argument among the rest is the damage caps. They will solve nothing. In fact, the likly scenario when/if caps are ever placed is the inevitable incident of sheer horror done to a patient, raising outrage after the law indicates a person can only recieve so-and-so for something ungodly done to them by a clearly negligent practitioner. And then the entire process will start reversing itself.

There are valid issues addressed by both sides, but I have difficulty reading past the lame argument that these doctors are always making. I'm not defending lawyers: clearly a huge portion of them are casual ambulance-chasers. But the whole "this can all be solved by capping damages" claim is ridiculous, and mostly fueled by conservatives who hate "the Trial Lawyer's union" and want to set precedents to remove legal liabilty at the behest of any entity- not just doctors.
posted by XQUZYPHYR at 9:02 AM on June 17, 2004

Lets just make it illegal for a lawyer's compensation to be a percentage of the settlement. The problem will go away.
posted by H. Roark at 9:05 AM on June 17, 2004

I'm sorry, you're a lawyer. I'm not treating you.
I'm sorry, you support abortion rights. I'm not treating you.
I'm sorry, you're from the south, and my great-grandfather was killed in the Civil War fighting for the Union. I'm not treating you.
I'm sorry, you're black. I'm not treating you.
I'm sorry, you have a condition that often results in death, and I can't risk the lawsuit. I'm not treating you.
I'm sorry, you smell bad. I'm not treating you.

I'm sorry. You claim to
posted by eriko at 9:08 AM on June 17, 2004

I'd say it's perfectly ethical, as long as the the illness isn't life-threatening.

And, XQUZYPHYR, you understand why so many people reflexively hate lawyers, right?
posted by trharlan at 9:09 AM on June 17, 2004

Shouldn't the doctor be refusing to treat the entire insurance industry too?
$84,151 a year for malpractice insurance and he claims to have never been sued?
posted by fatbaq at 9:12 AM on June 17, 2004

Dammit, who let Shub Internet back out?

I'm sorry. You claim to have taken an oath. I can't support you when you decide to let people die.
posted by eriko at 9:12 AM on June 17, 2004

It's fair enough: she's in a dire conflict of interest there.

It's not that her husband is suing the hospital. It's that the hospital believed (erroneously) that he engaged in some kind of malpractice litigation.

Never have I read a more compelling case for being a member of a union.

Overall, the article is weak, however. There are just two anecdotes -- one about the nurse and the other about a neurosurgeon in NH refusing to take the head of the NH trial lawyers association as a client.

Does this happen often? I have no idea.
posted by deanc at 9:12 AM on June 17, 2004

Lets just make it illegal for a lawyer's compensation to be a percentage of the settlement. The problem will go away.

And it will be promptly replaced with a new problem: poor people who can't pay for a lawyer. As much as we like to deride the contingency basis for compensation, it's often the only way a substantial portion of the population can afford a lawyer. Hell, I'm a first year lawyer and I bill out at close to $200 an hour. There's no way most people who need representation on something like a medical malpractice case can afford me. Lawyers who are willing to incur the risk of shouldering the costs from the outset of the lawsuit should earn a premium for the risk on the backend, i.e., a contingent fee.

It's fair enough: she's in a dire conflict of interest there.

And it was stupid of the hospital to fire her. Her husband's firm is the one with a conflict of interest, not the hospital. In fact, doctors should start hiring relatives of prominent plaintiffs' lawyers in their area, and try to conflict the lawyers out of representation in a suit against the hospital.
posted by monju_bosatsu at 9:19 AM on June 17, 2004

The distinction between elective vs. emergency treatment is of some relevance, but is not, I think, the main issue. From the article:

Some doctors are refusing medical treatment to lawyers, their families and their employees except in emergencies, and the doctors are urging the American Medical Association to endorse that view. Professional medical societies are trying to silence their peers by discouraging doctors from testifying as expert witnesses on behalf of plaintiffs.

This behavior is shameful. The right of a doctor to refuse treatment of a patient makes sense so long as the patient is able to receive treatment elsewhere. But here we have doctors collaborating with one another to deny medical treatment to an entire class of professionals, and trying to codify this position into the guidelines of professional organizations that have a tremendous amount of influence.

By analogy, I would say that if you own a single gas station, it is perfectly ethical for you to raise your prices. Maybe even if you own a small chain of gas stations. But there comes a point at which a) the ease with which someone can buy gas at a station other than yours and b) your pattern of price raising in combination constitute unethical behavior. Is that happening here? Maybe not in practice, although it seems the intent is certainly there.
posted by alphanerd at 9:28 AM on June 17, 2004

eriko, you do realize that there is a huge difference between "I'm sorry, you're a lawyer. I'm not treating you." and the rest on your list. Treating a lawyer creates a bigger legal risk. It's almost as if there were a large class of people who carried around automatic weapns all the time. Do they have an itchy trigger finger? How do you know until you upset them?

Not to mention the whole ethical problem you begin to run into by forcing a doctor to treat any particular individual. It may not be ethical for a doctor to refuse to treat a patient with a life-threateing problem -- but starting to dictate treatment has equally murky ethics.
posted by weston at 9:29 AM on June 17, 2004

I agree with the doctors.

This is a stand, the doctoring equivalant of going on strike, and I'm all for it. When you can be sued after doing your job competently (which is what we're talking about here), and not only is this is something that is happening more & more, but it's also an issue which society / government is refusing to do anything about, then it's time to go on strike.

As far as I can tell, the American legal system allows the most ridiculous settlements for the most minor (& sometimes none existant injuries). If I were a doctor, I'd be refusing to treat lawyers too.
posted by seanyboy at 9:31 AM on June 17, 2004

And it will be promptly replaced with a new problem: poor people who can't pay for a lawyer

Here is the root of the problem; filing lawsuits should not be free. When a service is free, it will be oversubscribed to. By allowing lawyers to get huge percentages of settlements, you are basically making lawsuits free and hence creating the environment we see today.


Oversimplification? perhaps.
posted by H. Roark at 9:34 AM on June 17, 2004

If doctors want some sort of special litigation protection, then they're going to need to submit to increased government regulation. The public needs protection from clearly negligent practitioners and there's only two real ways of doing it: let the government manage them or let private individuals redress in the judicial system.
posted by bshort at 9:42 AM on June 17, 2004

So the unhappy plight of these doctors would be much better if people just couldn't afford to sue them? As a descriptive matter, I guess you're right; certainly if people couldn't afford to bring lawsuits, there wouldn't be as many of them. Are you sure, though, that's the best method for winnowing out the bad suits?
posted by monju_bosatsu at 9:43 AM on June 17, 2004

Here is the root of the problem; filing lawsuits should not be free. When a service is free, it will be oversubscribed to. By allowing lawyers to get huge percentages of settlements, you are basically making lawsuits free and hence creating the environment we see today.

Then corporations get the freedom to do what they want since nobody will be able to afford an attorney that stands a chance. There are probably ways to reduce the frivolous lawsuits but capping a lawyers salary or making it impossible for the average person to file a lawsuit isn't it. One solution I've heard (and don't know if it has any negative repercussions) is to make the loser in a case pay for the winners court costs.

Making it so that an actual victim can't bring suit against somebody or something who's at fault to solve frivolous lawsuits is throwing the baby out with the bathwater. On the other hand I agree that too many people think they're a victim when in reality is that sometimes sheer dumb luck was out to get you.
posted by substrate at 9:47 AM on June 17, 2004

Lets just make it illegal for a lawyer's compensation to be a percentage of the settlement. The problem will go away.

And it will be promptly replaced with a new problem: poor people who can't pay for a lawyer.

Just for the sake of argument, maybe there's some room for middle ground here? What about imposing a cap on contingency fees based on some computation of rate for hourly fees (set by the ABA or some other professional org). I know that some folks go apoplectic when it's implied that the government might have a role beyond collecting taxes and providing for the common defense, but it seems like this might impose some reasonableness on the current state of affairs with regard to malpractice suits and contingency fees.

It's fair enough: she's in a dire conflict of interest there.

I disagree. I think putting a non-solicitation clause in her employment agreement (e.g.: her husband or other family member may not represent any current or former patient of the hospital) for the hospital administrators to be put at ease.
posted by psmealey at 9:52 AM on June 17, 2004

I seems to me that the main problem is insurance costs. So why don't doctors begin to stop working with insurance companies that charge exorbitant rates. Maybe find a solution in a state-backed, medical-profession-run med-insurance org.

Lawyers are a very easy target to place blame. In the end there are people (justified or not) behind these lawsuits.
For every one frivolous lawsuit I guarantee there are many more that are warranted.
posted by Dr_Octavius at 9:56 AM on June 17, 2004

An excellent beginning. Now if only all other professions would similarly elect not to deal with lawyers we might start to get somewhere (grocers, real estate agents...).
posted by rushmc at 10:10 AM on June 17, 2004

Doctors need to do a better job of policing their own.
I know one fellow whose surgeon put his artificial knee joints in upside down. A friend has a child my son's age who because of negligence during his birth was deprived of oxygen and suffers from cerebral palsy. Etc. (I had a friend at the time who was a nurse-she was legally prohibited from saying anything about that doctor, but when she found out I went to him when first pregnant, her facial expression said it all.)

Meanwhile the good docs have to pay and pay a lot because of the bad apples.
posted by konolia at 10:12 AM on June 17, 2004

A non-solicitation clause is all well and good... except that her husband is a lawyer. How much can you trust him? Next thing you know, she overhears something, tells him, he tells a lawyer friend, and the lawsuits are a-flyin'.

This is the overwhelming problem: you simply can not trust lawyers.
posted by five fresh fish at 10:13 AM on June 17, 2004

This whole idea is immoral and stupid. It's not the lawyers' fault.

I repeat, it is not the lawyers' fault.

If the case is without merit, the system should have a way of quickly dismissing it. If so without merit as to be seen as willful extortion, the accuser should pay the doctor's legal costs. If the system doesn't work like that, it ain't the trial lawyers' fault.
posted by callmejay at 10:21 AM on June 17, 2004

Question the First: Is there any response in kind from members of the legal profession (i.e. refusal to represent doctors who refuses to treat lawyers)?

Question the Second: How likely is a malpractice suit to result from elective rather than emergency surgery?
posted by alphanerd at 10:23 AM on June 17, 2004

s/surgery/medical treatment/
posted by alphanerd at 10:25 AM on June 17, 2004

It appears that they are refusing treatment that is not life-threatening. No doctor will violate the Oath by not treating a person in need.

Someone coming in for a regular checkup, has a cold, broke an arm, etc... this is the gray area where doctors are taking a stand.

I'm not sure who I would side with on this issue. I certainly believe the insurance industry is an impressive scam in all its forms, and I despise frivolous lawsuits of any sort. It would be nice if doctors can be protected but still held liable for the treatment they provide, but the solution is not simple, and I have no suggestions.
posted by linux at 10:29 AM on June 17, 2004

An excellent beginning. Now if only all other professions would similarly elect not to deal with lawyers we might start to get somewhere (grocers, real estate agents...).

How much can you trust him? Next thing you know, she overhears something, tells him, he tells a lawyer friend, and the lawsuits are a-flyin'. This is the overwhelming problem: you simply can not trust lawyers.

Commies! Commies everywhere! We gotta round 'em up, see? Nyah! They could be in your town! In your home! Are they in your grocery stores? Loose lips sink ships, see? Nyah!
posted by XQUZYPHYR at 10:32 AM on June 17, 2004

It is not malpractice suits, but malpractice insurance that is the problem.

For those docs that are negligent and perform (clearly) negligent care, I do not mind if their insurance premiums are stratospheric.

However, it doesn't work this way. It works just like car insurance: lots of claims, your insurance goes up even if you are a safe driver with no accidents.

The healthcare company I work for pays, literally, HUNDREDS OF THOUSANDS OF DOLLARS per year in malpractice insurance.

How many malpractice claims have we had in the last 4 years (since incorporation)?

ZERO.

And believe me, we have shopped around for insurance.

Why do we pay it? Because it would only take one multi million dollar judgement (without insurance) to put us out of business.

It is one small step above extortion, but I can't figure out who the extorter is.

It is almost like the lawyers and insurance companies work in tandem. You know, have a few absurd awards that are large enough to scare everyone into paying their "protection" money each year.
posted by Ynoxas at 10:44 AM on June 17, 2004

The right of a doctor to refuse treatment of a patient makes sense so long as the patient is able to receive treatment elsewhere.

I dunno. Why does it make any more sense than those idiot pharmacists who won't give out birth control pills?

At some point when you're in medical school or residency, it should become obvious to you that part of the job of being a physician involves taking care of sick people. If you don't want to take care of the sick people that present themselves (and can pay directly or indirectly), don't be a physician.
posted by ROU_Xenophobe at 11:11 AM on June 17, 2004

The South Carolina doctor that wrote the AMA resolution withdrew it from consideration on June 12--the day before the linked story was published. "Many doctors stood up to denounce the resolution in passionate speeches - even after its sponsor, Dr. J. Chris Hawk, asked that it be withdrawn."

For some interesting viewpoints, I highly recommend taking the time to read this post (by a trial lawyer) responding to this post (by a doctor).

Also Ynoxas, it is commonly suggested that insurance rates are so high (and continue to climb) because the insurance industry writes policies for riskier clients (e.g. doctors) when the economic market is good (because it makes a large portion of its money through stock market investments and it can cover the higher risks). This is troublesome because when the stock market declines (like it began to do in 2000), the insurance companies lose a lot of money and then have to start paying claims resulting from all of the high risk doctors they insured in the previous years. It's a vicious cycle that requires them to raise rates because they are losing money from both ends of the pipe. Fortunately, for them, they can scapegoat the lawyers and avoid any real scrutiny. The only states where medical malpractice insurance premiums have been successfully regulated are those where insurance industry investments and practices have been subjected to more legal regulation. It has been proven time and time again that damage caps do not lower or contain medical malpractice costs. NPR did a series on this a year or two ago, but I couldn't find a link.
posted by ajr at 11:11 AM on June 17, 2004

Insurance companies painting lawyers as the problem.. and doctors are falling for it. Aren't doctors supposed to be smart?
posted by Space Coyote at 11:14 AM on June 17, 2004

In Mississippi there is a plastic surgeon refusing to treat a lawmaker's daughter. The lawmaker had recently voted against civil justice reforms.

Who else can we not treat? Jurors, lobbyists, judges...
posted by whatever at 11:34 AM on June 17, 2004

"As far as I can tell, the American legal system allows the most ridiculous settlements for the most minor (& sometimes none existant injuries)"

And I'm sure you have the statistics to back that up? Oh, wait, there are none. Oops.
posted by Outlawyr at 11:57 AM on June 17, 2004

Why does it make any more sense than those idiot pharmacists who won't give out birth control pills?

This may be a bit of a moot point as the resolution as the AMA resolution was killed, but it might be worth noting that the American Pharmacists Association requires a pharmacist who refuses to dispense medication on moral grounds to find an alternate means of getting the patient the medication. From this link:

"Pharmacists choosing to excuse themselves from ... a situation [they find morally objectionable] continue to have a responsibility to the patient—ensuring that the patient will be referred to another pharmacist or be channeled into another available health system. Exercising the authority to excuse themselves from the dispensing process, and thus avoiding having personal, moral decisions of others placed upon them, requires the same consideration of the patient—the patient should not be required to abide by the pharmacist’s personal, moral decision. Providing alternative mechanisms for patients in this situation ensures patient access to drug products, without requiring the pharmacist or the patient to abide by personal decisions other than their own."

It would be interesting to see if an analogous policy is adopted by the AMA (or already exists).
posted by alphanerd at 12:14 PM on June 17, 2004

For every one frivolous lawsuit I guarantee there are many more that are warranted.

Actually from what I saw working at my mom's company, going through the claim files, there are quite a lot of frivolous / unfounded claims for every one that has merit. (My mother is a medical malpractice insurance adjuster). You see lots of these cases close with nothing happening, or being settled for a pittance just to make them go away (the settlement fee is usually much less than a couple months of legal fees would be).

Then there are the two million dollar cases, the "bad baby" cases (the worst, really - when something, anything goes wrong with the birth of a baby, the doctor is always blamed), plus things like one doctor who was addicted to painkillers and would prescribe extra-huge doses for his patients, with the deal being they'd split the drugs with him. That one guy had at least ten claims / lawsuits resulting from that.

When something goes wrong, people are always looking for someone to blame, rightly or wrongly. Doctors make handy targets. Plus, if you have something like a "bad baby" case, that plays really well in front of a jury, you're going to get a lot of sympathy votes in the verdict whether or not the doctor actually did anything negligent. And after all, someone's got to pay for eighteen years / a lifetime's worth of home nurses, therapy, and on and on.

I think it's all right for the docs to choose their clients.
posted by beth at 12:34 PM on June 17, 2004

Ynoxas++

This is terrible behavior, and targetting the wrong industry. My father is a surgeon, who was essentially forced out of practice in PA (where there is currently no malpractice reform, though it's in the works) because his malpractice insurance went through the roof last year.

And the whole good doc/bad doc issue is blurred by the fact that if you work in a high-pressure area like surgery, you're GOING to get sued at some point. It's a statistical inevitability. Families of patients who die on the operating table will sue over minor issues even if the patient was clearly going to die anyway. And everyone in the room gets sued to maximize settlement money, because the pressure is to settle to avoid trial. So, the insurance companies jack up rates. It'd be funny if it weren't so tragic.
posted by mkultra at 12:35 PM on June 17, 2004

My refused-treatment story:

When we found out that my wife was pregnant, we began shopping around for a pediatrician. We were in a small town (Carrollton, GA), so there weren’t many options. The first practice we tried had terrible customer service, so we chose someone else. Our mistake was to then send a letter to the first place telling them why we chose someone else. It wasn’t a nasty letter, and included all the reasons we chose them first (their reputation for excellent care, for instance).

Fast forward 8 months. Our daughter is born with a heart defect. There were two pediatricians on call, one of whom belonged to the practice we’d written the letter to. We found out from a nurse that the practice had told the hospital staff not to call them if we came in. So we had to use the clearly second-string pediatrician (everything turned out fine, and my daughter’s healthy and happy now).

We were afraid to even complain about it. What if we pissed off another doctor? Like I said, it was a small town, and we were afraid we’d be without medical care. We eventually moved far, far away, and then went on a letter-writing campaign that eventually got a response from the hospital CEO. Nothing was actually done, though, as far as I know.
posted by MrMoonPie at 1:07 PM on June 17, 2004

The American Pharmacists Association is a professional organization that can make recommendations to pharmacists, but it can't require pharmacists to do anything. I know a lot of pharmacists that aren't even members of this particular organization.
posted by mokujin at 1:19 PM on June 17, 2004

The reason I posted this is that I find it fascinating how free-market systems can fail everyone with no obvious weasels in the system. Everybody's trying their best, but still losing to some degree, patients, doctors, and insurers alike. The lawyers do do ok, but they're more a symptom of the system breaking down than a cause, I think. My native Canada has a similar problem, but it's not as severe yet.

I can't help but think that some sort of managed arbitration is the way this will end up. Up here, BC has a government system for car insurance: X happens, you get $Y, right off of a rate sheet. An arbitrator with semi-judicial powers sets the award, adjusting for the circumstances. Their decisions are extremely hard to appeal and most people don't bother. I can see us going that way, but I don't see how something like that would fly in Texas.
posted by bonehead at 1:44 PM on June 17, 2004

mokujin: I understand that. My assumption was that it is the organization of record for pharmacists, much in the same way that the AMA is for doctors. But my point was that, when a pharmacist refuses to issue emergency contraception and does nothing to help a woman obtain it, their conduct is unacceptable according to a large number of people in their profession. The AMA, however, had before it a resolution stating that it is not unethical to deny elective treatment to a trial lawyer or their spouse, which thankfully was withdrawn. The AMA campaign singled out trial lawyers and their spouses and was basically saying, "Hey, you don't have to treat these people." My point was that the APhA says, "You can respect your conscience, just make sure the patient is taken care of" whereas certain doctors want not only not to treat lawyers (which I find ethically permissible), but for it to be very difficult for lawyers to receive medical attention from anyone (which I find very objectionable).
posted by alphanerd at 1:45 PM on June 17, 2004

The reason I posted this is that I find it fascinating how free-market systems can fail everyone with no obvious weasels in the system.

Nope. The US tort/insurance/healthcare complex is anything but a free-market system.

To wit:
1. Each industry is regulated.
2. The government has practically given a monopoly to accredited Medical Schools.
3. The tax code has severely distorted how Americans pay for health care.
4. A health care provider cannot require an arbitration agreement as a prerequisite for care.

I could go on. I realize that a true free market in health care would be unpalatable to many, (and I have no idea what such a system would look like) but please do not assert that one exists.
posted by trharlan at 2:16 PM on June 17, 2004

tough call.

on one hand, those poor doctors pay through the fucking nose for insurance which gets passed on to insurance-less consumers (I paid $120 to have a doctor tell me to take some OTC drugs!) - but on the other hand, people should be allowed to address legitimate malpractice without getting their name on a list and subsequently refused care.

i say we make malpractice insurance voluntary. Doctors will have the option of just being *extra careful* and insurance companies would be forced to offer rates that would entice doctors. As it is, they could [and probably do] collude as an industry to fuck everyone.

medical care consumers would have to be extra vigilent about who they put their trust in, but then id say that was a good thing.
posted by Tryptophan-5ht at 2:53 PM on June 17, 2004

Yet another brilliant consequence of a for-profit medical system. Doctors are refusing to treat lawyers, not because the lawyers themselves may sue, but out of revenge for past law-suits, which is unquestionably unethical. This is yet another symptom of the broken health care system in the US.
posted by elwoodwiles at 3:16 PM on June 17, 2004

What you guys need is a compulsory insurance, no fault regime. Eg New Zealand's Accident Compensation legislation. We give up the right to sue for compensatory or punitive damages (exemplary damages are still available), in return for guaranteed compensation for accidents, including medical misadventure. Insurance to pay for such compensation is paid for from a levy, effectively a tiny income tax, and the compensation is provided as an annuity based on your income in the year of the accident.

It's not perfect, and brings problems of its own, but it seems much fairer to me.

(The lawyers still win, because there's a whole new body of law on gaming the accident compensation legislation, but they don't win as big ;-) )
posted by i_am_joe's_spleen at 3:30 PM on June 17, 2004

Everybody hates lawyers. Until they need one.
posted by onlyconnect at 3:45 PM on June 17, 2004

The reason I posted this is that I find it fascinating how free-market systems can fail everyone with no obvious weasels in the system. Everybody's trying their best, but still losing to some degree, patients, doctors, and insurers alike.

Clearly what is needed is another level of bureaucracy!

Everybody hates lawyers. Until they need one.

Not true. Most people I know developed their deep and abiding hatred of lawyers AFTER they needed one.
posted by rushmc at 4:51 PM on June 17, 2004

The problem with lawyers is that they form part of a self-feeding system. The entire thing is destined to spin out of control simply by its very nature.

It's like trying to stop the bleeding by cutting more flesh out.
posted by five fresh fish at 5:22 PM on June 17, 2004

Not true. Most people I know developed their deep and abiding hatred of lawyers AFTER they needed one.

I can't tell you how many friends and family members* have entertained a group with lawyer jokes that insult the profession and then drawn me aside to ask for some guidance when no one else is looking.

They are happy to hate my profession in public, but in private they are eager to use the hell out of me.

Which is fine -- I enjoy my job and free favors are a given with friends and family. But this behavior is actually more hypocritical than anything I can recall doing in my professional capacity, and still I'm the bad guy. Whatever.

*also, inexplicably, cab drivers.
posted by onlyconnect at 5:46 PM on June 17, 2004

My dad was a doctor. He used to treat the indigent for free on occassion as a matter of acting on religious principle. It was these people who sued him for malpractice. And, they did so for bullshit reasons.

This was one of the many formative experiences that caused me to become a Republican. Poor people suck. And, they are almost always poor for a reason. Liability lawyers are their enablers.
posted by paleocon at 5:56 PM on June 17, 2004

Yeah, it's a real shame that all those doctors have to live in poverty because of all those outlandish lawsuits.

It's also a real shame that all those insurance companies are losing money because of it.

I hear that those of the law profession seem to be doing pretty good themselves also. [no link, though]

Cry me a river, folks. The only people getting raped here are the public.
posted by moonbiter at 6:42 PM on June 17, 2004

Which on further consideration is a sidetrack. Back to your regularly-scheduled program on medical ethics.
posted by moonbiter at 6:54 PM on June 17, 2004

It's strange that these doctors seem to be discriminating against all lawyers, not just medical malpractice lawyers. So would they refuse to treat lawyers who work for legal aid or other non-profits? A lot of lawyers do a lot of good and it seems they're painting with a very wide brush.
posted by gyc at 6:58 PM on June 17, 2004

Poor people suck. And, they are almost always poor for a reason.

I'm really hoping you are just a really bad satirist instead of what I think you are.

Doctor's son eh? I'm sure you know lots about being poor. Certainly enough to speak with such conviction.

I mean, rich people would never use the legal system for their own gain.
posted by Ynoxas at 8:51 PM on June 17, 2004

As I understand it, this is a partisan issue in the US.
Trial lawyers are traditionally contributors to the Democrats.
Politics makes for strange bedfellows.
posted by asok at 6:10 AM on June 18, 2004

They are happy to hate my profession in public, but in private they are eager to use the hell out of me.

I never disputed that lawyers have made themselves an often unavoidable part of our society. Don't confuse people's need for legal advice with affection. I don't see the hypocrisy.
posted by rushmc at 9:13 AM on June 18, 2004

Here in Texas they added a bit to the state constitution which limits pain and suffering awards to 250k. Since the law was passed, there has been no reduction in malpractice rates, no drops in patient fees...the only people who won with that law were the insurance companies.

I would considering unethical if a doctor told me who wouldn't treat me because I was somehow related to an attorney.

The entire healthcare system in this country is beyond fubar. It needs to be totally scrapped and rebuilt. I'm not against doctors making money. Good lord, after what they go through to become doctors, and the insane debt load they incur during the process, it seems only reasonable that doctors would be high income earners.

But, I find it tragic that medical care is priced out of the reach of even middle income people that don't have insurance. We had a period of time where we didn't have insurance after Corba ran out and we couldn't find a good private policy. Doctor's fees are insane, because insurance negotiates them down by 50%+. Private payees don't generally have that option.

By the same token, we now have insurance through my husband's job...it's at a cost that's almost 25% of his take-home pay. We never, ever, spent that much on doctor visits...but if you don't have insurance and have an emergency...there isn't a hospital within 70 minutes or so that is obligated to treat you. They're all private hospitals. If you can't show a bank statement of over 6 figures and you don't have insurance, the hospitals will stabilize you and then ship you to the county hospital more than an hour away in downtown Dallas.

My opinion is that the entire healthcare industry (not necessarily individual practitioners...but the collectives thereof) have colluded to create the biggest and most effective ponzi scheme in the history of the known universe.

And unfortunately, we as the consumers of the necessary resources will be bled dry until the system can no longer be sustained.
posted by dejah420 at 9:14 AM on June 18, 2004