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Study: Pennsylvania Doctors Practice Defensive Medicine

Posted on: Wednesday, 1 June 2005, 15:00 CDT

Jun. 1--Fear of lawsuits caused doctors in Pennsylvania to order extra tests, refer more patients to specialists, and avoid complicated cases, according to a study published in today's issue of the Journal of the American Medical Association.

Nearly 93 percent of the 824 Pennsylvania doctors in six high-risk specialties who were surveyed said they practiced defensive medicine, including using diagnostic imaging, such as CT Scans or MRIs, in "clinically unnecessary circumstances." The study concluded that these and other defensive practices had potentially serious implications for the cost of, and access to, care.

The study, and several others to be published today in prominent medical journals, are likely to add fuel to the debate in Washington and Harrisburg over medical malpractice.

Pennsylvania has been at the center of that debate since 2000, when liability premiums for doctors, hospitals and other providers here began to soar.

"The medical malpractice system is a dismal failure, but it is not simply a reflection of problems in the legal system," William M. Sage, a coauthor of two of the studies, said in a conference call. Those studies, on defensive medicine in Pennsylvania, and an additional one on whether caps on damages affect the supply of physicians, were funded by the Pew Charitable Trusts as part of the Project on Medical Liability in Pennsylvania.

Sage, a doctor, lawyer and professor at Columbia Law School, said removing medical malpractice from the legal system through mediation and other dispute-resolution processes would allow policymakers to address issues such as providing greater access to care and preventing medical errors.

The medical industry, joined by insurers and business groups, has argued that the General Assembly and governor should limit awards for noneconomic damages, such as pain and suffering. Without such caps, they argue, doctors will cease practicing in the state.

Plaintiff lawyers and some consumer advocates respond that such limits would hurt the most severely injured patients and the most vulnerable, such as the poor and the elderly, without easing the rise in malpractice premiums.

Plaintiff lawyers will point to a Health Affairs article by Dartmouth economist Amitabh Chandra that found payments for malpractice claims rising at the same rate as overall health-care costs.

"Payments as a fraction of national health-care spending ... have not risen significantly," Chandra wrote. "This suggests that rising medical costs, which contribute to the size of compensatory awards, may explain a sizable portion of payment growth."

Chandra's findings appear to bolster the arguments made by opponents of caps on noneconomic damages that factors other than the number and size of suits are driving up malpractice costs.

At the same time, articles in the Journal of the American Medical Association and in Health Affairs show that states with caps on damages have a faster growth rate in the number of doctors, particularly in high-risk specialties.

Those findings and the survey of Pennsylvania doctors that found many are practicing defensive medicine are likely to support arguments made by the medical community that limits on damages are needed to ensure access to care.

On July 1, Pennsylvania Insurance Commissioner M. Dianne Koken must decide whether to decrease the amount of malpractice coverage a state fund provides doctors and hospitals. If she does so, malpractice premiums are likely to increase significantly and reignite anger among doctors.

In Washington, Congress is considering legislation on medical malpractice, including bills supported by President Bush that would establish nationwide limits on damages for pain and suffering.

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Source: The Philadelphia Inquirer

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