Physicians don't have to get sued to get smart about malpractice liability. Riverside and San Bernardino County doctors are learning by doing case reviews. And many physicians are gaining insight about the role their staffs play in lawsuits.
The more things change, the more they stay the same.
No matter how much medical technology advances...
No matter how many generations of physicians enter practice, have rewarding careers and retire...
No matter what crazy shape health insurance takes...
Patients still sue.
And too often, doctors lose when perhaps they should not have.
Since 1975, California's cherished Medical Injury Compensation Reform Act has helped keep malpractice liability premiums in check for Golden State doctors. But trial lawyers and well-meaning patient advocates are still trying, 30 years later, to chip at its famed protections. There's probably little anyone can do about this unpleasant aspect of healthcare.
But what is changing is the way physicians prepare themselves for the possibility of medical malpractice lawsuits. Some are studying active malpractice lawsuits to see what they can learn and others are becoming more aware of the role that office staffs play in preventing frustration from turning into litigation. Indeed, physicians are changing the way they think and act to minimize the chance of a malpractice suit wreaking havoc on their incomes, their practices and their patients' access to care.
Supported by the major local, state and national associations and virtually every insurer that writes malpractice coverage, today's physicians are grabbing the litigation bull by the proverbial horns and getting educated like never before.
Hands-On Learning for Doctors
The Riverside County Medical Association and the San Bernardino County Medical Society have partnered with Norcal Mutual Insurance Co., San Francisco, to form Medical Review Advisory Committees (MRACs). The committees are made up of physicians from all specialties who review active malpractice lawsuits to help the carrier and the defendant doctor measure their likelihood of prevailing at trial. The committees study three or four cases at a time. The San Bernardino group meets every
other month and the Riverside group meets every quarter.
While the stated mission of the committees is to assist Norcal in evaluating the community standard of practice in a particular case and developing defense strategies, everybody involved gets a lot more out of it than just a recommendation on whether to settle or go to trial.
"It's a superb type of review, having the physicians and the lawyers in a room together," says MRAC committee member Lawrence Clark, MD, a neurosurgeon and associate at Riverside Neurosurgical Associates. "It's an excellent way of getting information out to other doctors on the committee that this is how things work."
MRAC committee member John Sullivan, MD, a family practitioner in Upland, explains the process. "The lawyers from Norcal bring the details of a case to the committee," he says. "And one of the members is assigned to study it in depth-usually somebody in the same specialty as the physician named in the lawsuit. He or she then presents the case to the group, with the occasional assistance of an outside consultant physician. We discuss the case and make a recommendation to the insurance company about any errors the doctor may have committed, so the carrier can either prepare an adequate defense or make a decision to negotiate a settlement."
"[The exercise is] very enlightening. It's probably the best two hours of professional education you can get," Dr. Sullivan says.
Doctors who participate take great care to ensure nothing confidential leaves the room, says Victor Ching, MD, a urologist in Upland and vice chair of the San Bernardino County MRAC. "The cases are discussed and evaluated based on the facts and issues of the case without revealing the identities of the physicians or the patients treated," he says.
Dr. Ching says the meetings are appropriately interactive. "The Norcal claims staff and the defense attorneys handling each case are present at the MRAC to answer any questions the participating physicians may have," he says. "The defense attorneys also have the opportunity to ask questions. The goal is to have each case discussion take place in a thorough, balanced manner, allowing the MRAC discussions to be comprehensive in their scope. This is also an educational process for the members."
Stephen M. Farber, vice president of risk management at Norcal, couldn't agree more. "Physicians who participate in the review exercises learn a lot," he says. "Actual cases are great teachers, because they represent real life rather than textbook situations. The value of having physicians review cases is their critique in physician-oriented terms and concepts. Often they are better at educating the errant physician in their critiques than a defense lawyer or insurance company can be. The program represents ongoing education for both the potential defendant and the reviewing physician."
