Malpractice Makes Perfect

[Guest guest]

http://www.washingtonmonthly.com/features/2003/0310.mencimer.html

 

Malpractice Makes PerfectHow the GOP milks a bogus doctors' insurance crisis.

By Stephanie Mencimer

 

 

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t() " );}//-->When he went out on strike last January, Dr. Robert Zaleski had his

15 minutes of fame. The Wheeling, W. Va., orthopedic surgeon was one of two

dozen surgeons to walk off the job in January to protest his state's high costs

of malpractice insurance. Arguing

that " frivolous lawsuits " were driving up insurance premiums and forcing

physicians to leave the state, Zaleski and his colleagues threatened to stay out

for 30 days unless the legislature passed a bill that would cap non-economic

damages in such suits at $250,000. As the walkout turned into a national story,

Zaleski became one of its most visible faces, making the rounds of TV news shows

and telling CNN, " I would certainly jump in front of a bus if I could to

continue to serve my patients as I have for 23 years. " Just a few weeks later,

Zaleski's mug shot appeared with those of five other doctors in The New York

Times Magazine, where he claimed to be " on the brink " of moving out of state

because of high insurance rates and lawsuits.

Zaleski and his colleagues are the leading edge of a much broader movement. All

across the country, doctors like him are telling reporters, legislators, and

even their patients that frivolous lawsuits are driving up insurance costs and

driving doctors out of practice and out of state, threatening access to care.

They've mobilized around state legislation to limit malpractice lawsuits and

linked arms with President Bush and Republicans in Congress who have been

pushing similar bills in Washington. Indeed, Zaleski himself was even personally

invited to attend a speech President Bush delivered in Scranton, Pa., where he

railed against the threat to patient care posed by out-of-control lawsuits.

 

Upon closer inspection, however, it appears that Zaleski may be more a source of

the problem than a victim of it. Between 1987 and 2002, according to the West

Virginia Board of Medicine, patients filed 14 lawsuits against Zaleski, eight of

which resulted in payouts that together came to $1.7 million. By contrast,

according to a Public Citizen study, only 1 percent of the state's doctors made

five or more malpractice payouts over the past decade. And while Zaleski says

the settlement figures are misleading because they also include defense costs,

his record is hardly squeaky clean. In a 1985 lawsuit (one not among the 14

reported to the Board of Medicine), he admitted in a deposition to being

addicted to prescription painkillers for a substantial part of the time that he

was operating on people in the early 1980s. Not only was he a drug addict, but

to maintain his Percodan habit, Zaleski allegedly wrote prescriptions for other

local addicts, who filled them and kicked back some pills

to the doctor, according to court documents that include copies of the

prescriptions and depositions from some of the addicts.

Yet even though a suspicious police officer reported him to the state medical

board, Zaleski was never disciplined by his fellow physicians. (He says he does

not remember the specifics of the case, and while he acknowledges a past

substance-abuse problem, insists that he has been clean and sober for 21 years.)

Given this history, the real scandal may not be how high Zaleski's insurance

premiums are, but the fact that he can get insurance at all. Zaleski's

malpractice record may have been extreme, but it was not unusual among the

doctors who walked out of West Virginia hospitals in January. According to a

Charleston Gazette report, nine of the 18 doctors striking at Wheeling Hospital,

including Zaleski, had cost their insurers more than $6 million in malpractice

settlements and judgments. At least some of the suits don't seem to merit the

adjective " frivolous. " In one case, a doctor had left a clip on an artery,

eventually forcing the patient to have a liver transplant. In another, a

surgeon cut into his patient's stomach wall during surgery, causing a massive,

fatal infection. Indeed, a number of those doctors leading the protest movement

include former drug addicts, felons, doctors whose licenses have been revoked,

and many, many others who get sued a lot--and far more than most of their

colleagues.

Not all the physicians angry about malpractice lawsuits and high insurance rates

have such checkered histories as Dr. Zaleski. Many ethical and responsible

doctors say the system invites frivolous litigation, subjecting them to

considerable hassle and anxiety. One result, they argue, is an increase in

" defensive medicine " --when doctors schedule too many tests, just to be

safe--which contributes to higher health care costs for everybody. But even the

respected General Accounting Office (GAO) has recently concluded that there's

little evidence to back the striking doctors' main claim, which is that lawsuits

are forcing many of them to abandon the practice of medicine or to avoid

high-risk procedures. And while there's no doubt that malpractice insurance is

getting more expensive across the board--about 30 to 40 percent, on average,

during the last three years--this increase is largely due to the ailing stock

market and poor business practices in a virtually unregulated industry. As a

result, there's no reason to think that capping jury awards would bring

premiums down, a fact the insurance industry itself acknowledges. Robert E.

White Jr., president of First Professional Insurance Company, the leading

medical malpractice insurer in Florida, told the Palm Beach Post in January, " No

responsible insurer can cut its rates after a [medical malpractice] bill

passes. " The one surefire way to bring down the number of big-payout lawsuits is

to reduce the number of those doctors who inspire most of them. But state

medical boards--which are run by doctors--have been notoriously reluctant to

aggressively police their own.

The doctors' protests aren't about good policy. They're about good politics.

Although the malpractice strikes look like a natural outgrowth of physician

frustration, they are, in fact, the product of a sophisticated lobbying campaign

coordinated by Republican operatives and underwritten by business groups with

little interest in the practice of medicine. GOP leaders view malpractice

lawsuits as a pivotal issue for the 2004 campaign. With health-care costs

skyrocketing on its watch, the GOP is eager to shift blame onto the Democrats,

who have long enjoyed greater public trust on the issue. And doctors, who enjoy

great credibility among voters, are the key. By linking rising health-care costs

to frivolous medical lawsuits, Republicans can use doctors as a cudgel against

trial lawyers, the Democratic Party's second-largest funding base and one which

could be paralyzed by lawsuit caps. Once bills to restrict malpractice lawsuits

are on the table--in Congress and in the state

legislatures--Republicans can slip in much broader legal relief for

corporations under the guise of bringing down health-care costs, especially for

senior citizens. Frank Galitski, a former Bush campaign staffer who works with

the doctors as head of the Texas Alliance for Patient Access (TAPA), a coalition

of insurance companies and health-care corporations, puts it bluntly: " This is a

great issue for the president, particularly in the key battleground states of

Pennsylvania, Michigan, Ohio, where they have an aging population. " Indeed, if

the experience in West Virginia is any indication, the GOP has found itself a

winning formula.

The perfect storm

The doctors who walked off the job last January were primarily from the Wheeling

and Weirton areas of West Virginia, right in the heart of steel country and on

the borders of Ohio and Pennsylvania--the only solidly Republican section of

historically Democratic West Virginia. Nestled in the Ohio Valley, Wheeling is a

relic of the Industrial Revolution. Once home to a bustling steel, glass and

even tobacco industry, the area today offers a rusting landscape of smokestacks

and the dying steel mills which are an endangered species in America. Downtown

Wheeling is nearly deserted, its once grand Victorian architecture blackened

from years of neglect. A " Coffee Shop " on the main drag is actually a video

poker hall with a single coffee pot to provide an occasional pick-up to the

pasty, overweight gamblers glued to video poker machines and smoking cigarettes

in dark rooms.

Like much of West Virginia, Wheeling and the surrounding Ohio County rank among

the poorest places in the country. Thanks to the closing of the steel mills,

Ohio County has lost 30 percent of its population since 1968, leaving it with

one of the oldest populations of any county in the country. Today's residents

are thus heavily dependent on the local hospitals, which also happen to be the

area's largest employers. Wheeling Hospital, where most of the doctors went on

strike, employs some 3,000 local residents.

Thanks to the health-care-based economy, doctors make up the area's upper crust,

and their patients are mostly poor folks reliant upon government health-care

programs like Medicaid and Medicare. As trial lawyers are quick to point out,

with its high rates of poverty and uninsured residents--as many as one in

five--Wheeling is not exactly a magnet for medical talent, especially because it

must compete with the highly-acclaimed University of Pittsburgh Medical Center

only 60 miles away.

As a result, many of West Virginia's striking doctors were foreign-born and

-trained, and even some of the native doctors were trained in places like

Guadalajara, Mexico. At the same time, Ohio County has an unusually active and

talented trial bar, lawyers who honed their skills through decades spent suing

coal companies for workers' cases of black lung. The tension between the two

groups has been brewing for years, and by 2001, when malpractice insurance

companies imposed stiff premium increases on doctors, conditions were ripe for

the perfect storm.

While the jury verdicts aren't nearly as outrageous as the doctors make them out

to be, there have been a few whoppers in Ohio County--albeit usually in cases

involving egregious malpractice--and these seem to be what really riled the

doctors. The case that really sticks in their craw is that of Dr. Fred Payne.

Like his colleague Robert Zaleski, Payne had been sued a dozen times over the

past decade, and had paid out settlements of at least $7.3 million, according to

the Charleston Gazette. In 1998, Payne operated to repair a minor spine injury

on a spry 76-year-old World War II veteran who had fallen out of a tree. On his

way to the operating room, he ran into a medical-equipment salesman who

encouraged him to try out a new type of clamp. The patient hadn't consented to

the procedure, nor had Payne ever even seen the tool used or studied its use;

but he tried it out anyway. After Payne left the hospital, a nurse paged him to

let him know that the patient wasn't doing well in

recovery. An examination found that the clamp had slipped into the spinal canal

and paralyzed the man from the neck down--a hideously worse injury than he had

initially sustained. He died a year later. A lawsuit over the case, which

charged that the man didn't even need surgery in the first place, was settled

for $4.6 million.

The Ohio Valley Medical Center agreed to pay $3.5 million of the settlement, but

insisted that Payne was responsible for the rest. But Payne's minimal insurance

didn't cover the balance, so the judge on the case, Fred Risovich II, insisted

that he use his personal assets to pay his share of the settlement, a rare move

in a malpractice case. " The negligence was so gross, and the injury so bad that

justice required that he pay something, " says Risovich. Payne has not practiced

medicine since.

Doctors in Wheeling had not been particularly politically active before this,

but they were outraged by the case--not by Payne's behavior, but by Risovich's.

The doctors organized to oust him in a nasty campaign that would foreshadow the

tenor of the battle over malpractice suit caps two years later. According to

Risovich and people in the local medical community, during the 2000 judicial

race, anonymous flyers appeared on the windshields of cars at the local

supermarket, accusing Risovich of beating his wife and being a racist. Risovich

says one night someone set fire to his campaign materials in his front yard and

urinated on his stoop. " Someone sent investigators to call my children at

college, asked my stepchildren if they'd ever been molested. It was horrible, "

says Risovich. Dozens of Republican physicians changed their party affiliation

so they could vote against Risovich in the Democratic primary, and many today

take credit for his crushing defeat.

Claim adjustment

Just as the doctors were becoming politically energized, the malpractice

insurance industry went into a financial tailspin. St. Paul Companies, once the

nation's largest malpractice insurance firm, pulled out of West Virginia and

other states in 2001, leaving 1,000 West Virginia doctors without insurance.

Doctors in Charleston--apparently not averse to lawsuits when these suit their

own purposes--filed a class action against the company, alleging that St. Paul

stiffed the doctors after pursuing a business strategy designed to enrich top

executives with more than $45 million in bonuses, salaries, and stock options.

The suit alleged that St. Paul raided $1.1 billion in reserved doctors' premiums

to artificially inflate its earnings in 1999 and 2000, a move that helped

executives to $5.2 million in bonuses and increased the value of their stock

options to $28 million.

Despite evidence of insurance company shenanigans, though, doctors put the blame

for their insurance woes on trial lawyers, malpractice suits, and juries. They

had some help in staying focused: Between 1995 and 2001, Medical Assurance, a

large company which provided medical malpractice insurance to doctors to cover

their legal costs and damages in lawsuits, paid the state medical association at

least $115,000 to lobby on the company's behalf, according to a story in the

Charleston Gazette by Lawrence Messina. Medical Assurance offered members breaks

on their insurance premiums for attending " White Coat Day " at the legislature

and provided the glossy brochures and information on " meritless lawsuits " and

" outrageous " damage awards that doctors used in their talking points with

reporters and elected officials.

Similarly, the PR materials on " lawsuit abuse " and patient petitions that began

to fill doctors' offices last year came from the West Virginia Care Coalition;

the coalition was actually a project of Maple Creative, a Charleston-based PR

firm with close ties to the Bush administration. Those groups footing the bill

for Maple's services included, not surprisingly, several with a direct stake in

medical issues. The state HMO association and the local hospital association,

according to Wheeling Hospital CEO Donald Hofreuder, gave the Care Coalition

more than $200,000. But other business groups with a broader agenda of lawsuit

restrictions also pitched in, including the West Virginia Oil and Gas Coalition,

the state chambers of commerce, the West Virginia Building and Industry

Coalition and the Business Roundtable.

Once corralled behind malpractice caps, doctors came up with their own

innovations. At one point, physicians in Wheeling began adding a " tax " to their

bills, $5 or $10 above and beyond what insurance would pay for, telling patients

it was intended to cover their outrageous malpractice insurance premiums.

Predictably, older people on fixed incomes were outraged and flooded their

elected officials with calls for lawsuit restrictions.

All in all, claims about a " lawsuit abuse crisis " proved remarkably effective in

West Virginia--and resistant to contradictory evidence. In February 2001,

responding to the doctors' allegations, the Charleston Gazette undertook a

computer-assisted analysis of more than 2,000 medical malpractice claims

reported to the West Virginia Board of Medicine. The paper determined that far

from being in a state of crisis, West Virginia ranked 35th in the country for

median malpractice payouts. The paper also found that both the number of

malpractice claims and the dollar amounts of the settlements and verdicts had

actually declined between 1993 and 2001. Nor was West Virginia suffering under

an epidemic of " disappearing doctors. " Last August, the Gazette's Messina

attended a rally at which the West Virginia medical society set out 37 empty

chairs labeled with the names of local doctors who supposedly had been forced

out of practice because of insurance costs. He discovered that at least two of

the doctors named were indeed not practicing--because they were dead. Another

two were still actually treating Wheeling patients. A Public Citizen study of

the state medical board records later found that the number of doctors in West

Virginia increased by more than 350 between 1997 and 2002.

This fall, the GAO reached a similar conclusion: of five states identified by

the American Medical Association (AMA) as malpractice " crisis " states, including

West Virginia, it found that " many of the reported provider actions taken in

response to malpractice pressures were not substantiated or did not widely

affect access to health care … some reports of physicians relocating to other

states, retiring, or closing practices were not accurate or involved relatively

few physicians. " Nor, in those same states, could the GAO " identify any major

reductions in the utilization of certain services some physicians reported

reducing because they consider the services to be high risk. "

Lawyers' trial

As doctors and insurance companies in West Virginia mobilized to impose caps,

Republicans in Washington began to ramp up their own campaign for lawsuit

restrictions. In July of last year, the Bush administration kicked off the

effort with the release of a report called, " Confronting the New Health Care

Crisis: Improving Health Care Quality and Lowering Costs by Fixing Our Medical

Liability System, " which claimed that the " critical element " for expanding

health insurance to uninsured Americans was " curbing excessive litigation. " Soon

after, in mid-July, congressional Republicans launched a hearing titled " Harming

Patient Access to Care: The Impact of Excessive Litigation. " The supposed

travails of West Virginia doctors made a perfect case study. Rep. Shelley Moore

Capito (R-W.Va.), a close confidant of White House adviser Karl Rove, personally

escorted a West Virginia doctor named Dr. Samuel Roberts to the House floor to

testify. Roberts, one of only three doctors who testified, told

the committee that he could not afford the insurance to continue delivering

babies, and claimed that this year, " I will have to stop, leaving seven counties

around me with no family physician delivering prenatal or maternity care. "

As with so much of the malpractice campaign, Roberts's testimony omitted some

critical facts that might have explained some of his insurance woes: In 1987, he

pleaded guilty to five counts of cocaine possession and was sentenced to five

years probation, according to the Charleston Gazette. In response, the state

suspended his medical license for a year, though it later reduced the penalty to

five years of supervised probation. (Incidentally, a year after his dire

warnings to Congress, Roberts is today still delivering babies, according to his

office.)

Nonetheless, the campaign gained steam, and in July 2002, Bush gave a major

speech on medical malpractice in North Carolina, home state of trial lawyer and

Democratic presidential hopeful John Edwards. " Healthcare costs are up because

docs are worried about getting sued, " the president declared. Before the speech,

Bush met privately with AMA president-elect Donald Palmisano, who told The Wall

Street Journal that Bush had counseled him to " get out the grassroots " if he

wanted caps on malpractice damages. The West Virginia doctors took his advice.

When they staged their strike in January, it coincided perfectly with Bush's

State of the Union address, in which he raised the malpractice issue before a

national TV audience.

The West Virginia strike did inconvenience a few patients, but its real sting

was felt--as intended--at the statehouse. Joe DeLong, a delegate from

Weirton--where some of the surgeons walked out--views the doctors' strike as a

form of extortion. " When I grew up, a strike was a sacrifice, " he says. " The

doctors' livelihoods were never at stake. This was a movement to inflict pain on

the sick and the elderly. " He recalls being flooded with calls, including one

from a 96-year-old woman in tears because she was dependent on a state

transportation program to get to her doctors. The shuttle wouldn't cross state

lines to take her to Pennsylvania or Ohio if doctors in West Virginia quit

practicing; she only calmed down when DeLong offered to drive her should it

prove necessary.

Such calls sent the legislature into a frenzy. " It's an emotional issue for

them, " DeLong says, noting that the doctors have done a good job of turning

their insurance problems into an anti-lawyer issue. Aside from the trial

lawyers, there has been very little organized opposition on the other side. In

March, state legislators, most of them Democratic, voted overwhelmingly in favor

of a sweeping malpractice bill. (DeLong was among them.) Gov. Bob Wise

practically begged to sign it.

Thanks in part to the ripple effect of the West Virginia strike, the national

campaign by protesting doctors has been a smashing success. In state after

state, doctors have had only to threaten walkouts to win promises of damage caps

from local legislators. Shortly after the West Virginia doctors went on strike,

for instance, doctors in Scranton, Pa., sat down to talk strategy with Frank

Galitski, the former Bush campaign worker--who admits that " there is some

coordination " between the doctors' protests and the White House. Which makes

sense: At the national level, Republican-led efforts to impose restrictions on

medical malpractice lawsuits have helped unite otherwise disparate elements of

the health-care industry behind a broader effort for lawsuit restrictions. A

malpractice bill passed by the House in March with backing from the AMA, for

instance, would completely exempt not just doctors but also drug companies,

medical-device manufacturers, nursing-home operators, and HMOs from

punitive damage awards for reckless conduct. The Senate just rejected a similar

measure, but the GOP plans to use the issue during next year's election--and for

good reason. Limits on malpractice suits have proved to be a powerful inducement

to the medical community at a time when frustration with managed care has been

alienating this once-reliably Republican constituency. (Lawsuit-prone doctors

like Zaleski have proven especially eager to lead the crusade against trial

lawyers.) After the West Virginia success, the AMA pledged to spend a whopping

$22 million this year on the malpractice issue alone, establishing a nationwide,

state-level grassroots operation that will come in handy during the 2004

election--a figure nearly eight times larger than the entire budget of the

Association of the Trial Lawyers of America. And so far this year, Bush's

reelection campaign has netted more than $750,000 from doctors.

Error reports

It's worth noting that the walkouts would never have proved so effective had the

media taken a closer look at the doctors involved--and the interests backing

them. Aside from a few skeptical reporters in West Virginia, most of the press

has taken the doctors' claims at face value, rarely challenging their evidence

and anecdotes. In June, for instance, Time magazine devoted an entire cover

story to " disappearing doctors, " complete with data supplied by the AMA--the

same data that previously had been challenged by consumer groups around the

country and later was authoritatively debunked by the GAO. Reporters have also

abetted the campaign by portraying wealthy doctors as the impoverished victims

of " lawsuit abuse " and the often poor and injured plaintiffs as the greedy pawns

of billionaire trial lawyers. Yet as with the AMA's data, that image doesn't

hold up under inspection.

Take Dr. Rajai Khoury, a striking Wheeling cardiovascular surgeon who told a

local TV news interviewer in January, " We're hurting, our patients are hurting,

the community is suffering. " It's no secret in Wheeling that Khoury recently

built a 12,000-foot mansion with a five-car garage, a pool, and a lovely view of

the countryside from " Pill Hill, " the ritzy neighborhood that's home to many

doctors. (According to county building records, the house is valued at close to

$3 million, in a town where houses go for as little as $19,000.) Even Zaleski

seems to be doing pretty well, despite his claims on television. He says his

malpractice insurance of $150,000 a year is about 30 percent of his income,

which would net him $300,000 annually. " I'm not starving, " he admits.

Dr. Greg Saracco, the telegenic surgeon who became the unofficial spokesman for

the Wheeling walkout, defends his profession, saying, " I don't think it's really

an issue how much a doctor makes. Who says we have to do this for free? " In an

interview, Saracco rails against the " outrageous jury awards " given in Wheeling,

offering the story of a local man who violated company rules and safety

guidelines on the job and used a broomstick to unstick some kind of machine,

which then cut his arm off. Saracco says the man then sued the company for

safety violations, and a jury awarded him $4 million for his stupidity.

" Is somebody's arm worth $4 million? " he says with amazement. Alas, the story

may be apocryphal, as many " frivolous lawsuit " stories often are. Verdicts over

$1 million are rare in West Virginia (there were none last year), and none of

the trial lawyers I spoke with in Wheeling could recall such a case. They

suggest Saracco may be confusing it with a similar case--lost leg, not arm--but

the suit was against an insurance company, a very different issue.

When asked whether he's ever been sued, Saracco says he just settled a

" crappola " suit for $25,000. In that " crappola " suit, James Westfall, a man in

his mid-50s, came into the hospital for a hernia repair surgery, performed by

Saracco and his partner, Dr. Robert Cross. According to the lawsuit, during

surgery, Saracco pierced Westfall's bowel while stitching him up and sewed it

into his abdomen. The wound closure later tore and created a hole in Westfall's

bowel, causing it to leak. Cross failed to respond to nurses' reports of

complications until Westfall was in critical condition--too late, as it turned

out. Westfall died a miserable death two days later. The lawsuit was ultimately

settled with Cross and the hospital for well over a million dollars.

Bad medicine

Saracco suggests that most of the people who suffer from " malpractice " usually

have themselves to blame, like obese people and the smokers he says are getting

money from asbestos lawsuits. The solution, he insists, is a cap on jury awards

like the one passed in California during the '70s--the law all the doctors'

talking points refer to as proof of the efficacy of such caps. But Saracco and

his fellow physicians have a short memory. California passed its law in 1976,

after malpractice insurers, blaming out-of-control lawsuits, suddenly hiked

doctors' premiums by more than 300 percent in a single year. Some years after

the law took effect, insurance premiums had shown no sign of going down.

California doctors ended up suing Travelers' Insurance Co., alleging that it

grossly overcharged in the name of a non-existent malpractice crisis. (Here,

too, the plantiff's bar came in handy: A trial lawyer won the doctors a $50

million refund.) The state ultimately passed strict insurance reform

that kept a lid on future premium increases.

There are, however, other solutions that might help reduce insurance rates that

Saracco and his colleagues never mention. Studies have repeatedly shown that

only 5 percent of the nation's doctors are responsible for more than half of all

malpractice payouts. Yet those lawsuit-magnet practitioners generally pay the

same insurance rates as doctors who've never been sued, the equivalent of giving

drunks the same car insurance rates as soccer moms with perfect driving records.

This practice exists among malpractice insurers partly because many of them are

owned by doctors themselves, but mostly because they make their money on

investments, not on claims management. As a result, the insurers have an

incentive to sign up as many doctors as possible so they can invest their

premiums in the stock market--a strategy which ensured that, when the economy

went south they would have to begin hiking premiums sharply. The use of

experience rating, like that employed by auto insurers to weed out the

dangerous drivers, would reward better doctors and price those who attract the

most lawsuits out of business rather than subsidizing them.

Better regulation of health care would likely reduce the number of malpractice

lawsuits simply by reducing the number of medical injuries. In 1999, the

Institute of Medicine (IOM) reported that preventable medical errors kill as

many as 100,000 people a year--and cause a tremendous number of lawsuits. The

IOM recommended a national mandatory public error-reporting system, along with

stronger requirements that doctors regularly upgrade their skills as a condition

of maintaining their licenses. Error reporting would allow better data-mining

that, in turn, would help the health-care industry combat mistakes more

systematically by detecting problem areas and suggesting remedies. Research has

already shown that surgeons who do a large volume of high-risk procedures such

as bypass or delicate spine surgery make the fewest mistakes, since practice

makes perfect. That's why the IOM also has recommended that such procedures be

restricted only to experienced doctors at high-volume specialty

facilities rather than letting any neurosurgeon in Wheeling, W. Va., try his

hand at it now and then.

Yet striking doctors aren't advocating any of these proposals: Their

organizational lobbyists have indeed vigorously fought such measures, even

simple protocols such as marking surgical sites with a pen to avoid, say,

amputating the wrong foot, as did a doctor in Florida in 1995. These days, the

only solution that doctors seem to offer for any of the nation's myriad health

care problems is limiting the patients' right to sue. And the Bush

administration is just fine with that.

 

 

Stephanie Mencimer is a contributing editor of The Washington Monthly.

 

 

 

 

 

 

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