Questions and Answers about Medical Liability

Why does Pennsylvania’s medical liability system need to change?
Because it is beginning to limit your access to care, and if changes aren't made soon your access to care could continue to erode. Costs for medical liability insurance have exploded. Increases of 50 percent or more are common. The Jefferson Health System hospitals alone will spend more than $18 million for liability insurance this year and more than $23 million next year. At the same time, the number of claims against doctors and hospitals is growing. In 1998, more money was awarded in medical liability damages in Philadelphia alone than in the entire state of California. The number of claims of $1 million or more increased almost 75 percent from 1998 to 1999 alone—at a time when the Philadelphia region is recognized as having some of the finest hospitals and physicians in the United States.

How does this limit my access to care?

The explosion in costs has forced some physicians to:

• Limit the type of care they provide or the types of patients they see;
• Leave Pennsylvania to practice in other states with lower liability insurance rates;
• Retire from medicine early.

In addition, many new doctors, when choosing where to start their practices, are avoiding Pennsylvania and choosing other states, like New Jersey and Delaware, where insurance costs less. It is getting harder to recruit new physicians to Pennsylvania.

More obstetricians have stopped delivering babies. More orthopedists have stopped performing surgery. It can take you months to get an appointment with a physician. Add it all up and it’s clear that Pennsylvania has a problem. Your access to care is already being limited.

How is my hospital affected?
Your hospital has one goal: to provide you with comprehensive, convenient, quality medical care. The out-of-control medical liability system, however, is threatening that goal. Liability insurance costs for the hospitals of the Jefferson Health System will grow by more than $5 million next year—to more than $23 million. To cover this increase we must use money that would otherwise go toward hiring and retaining staff, buying new technology, and developing and retaining health services and programs—the activities that are central to providing you the best possible care.

Shouldn’t hospitals and doctors pay when things go wrong?
We strongly support the rights of patients to be compensated when they are injured through error or negligence. The Institutes of Medicine (IOM) report, To Err is Human, notes that a medical error is rarely caused by a single person. Errors happen when processes do not work as intended. The goal should be to identify breakdowns that potentially cause harm and to correct them. According to the IOM: “The focus must shift from blaming individuals for past errors to a focus on preventing future errors…blaming an individual does little to make the (healthcare) system safer….”

The men and women who work at the Jefferson Health System hospitals are personally devoted to healing, and strive constantly to improve the care we provide patients. We believe the medical liability system can and should support this important social mission.

What can be done?
Pennsylvania needs a system that achieves three equally important goals: protecting patient access to comprehensive care, protecting the rights of injured patients to compensation, and working to reduce and eliminate medical errors. For example, one possible reform would be to reduce a plaintiff attorney’s fees from 30 percent of the award to 15 percent. The other 15 percent could go to an independent organization to help hospitals and physicians implement quality improvement programs. Pennsylvania could also create a fund that would provide care for newborns no matter what caused their injury or handicap. This would help parents and children in need, regardless of their access to a skillful lawyer.

As the frequency and size of liability awards has increased, it has created an incentive for more suits for more money against more doctors and hospitals. We need to enact some common-sense changes in our legal system. These include: improving the use of expert witnesses; allowing juries to consider other sources of payment for medical expenses; making award payments over time; and regulating the size of punitive damages. These are just a few possible improvements that could be made.

I’m concerned about my access to care. What can I do?
Medical liability is a complicated issue on which many people have differing points of view. Everyone involved—doctors, hospitals, lawyers, insurers, the Governor and General Assembly, and the public—all have a role to play in improving our liability system. One thing is clear: without reform, your access to care could become increasingly limited. Reforms to protect your access to care need to be enacted by the General Assembly and Governor. We encourage you to express your concern about this issue to your state Senator and Representative, as well as Governor Rendell.