Status of current medicolegal reform in the United States: a neurosurgical perspective

Abstract

OBJECTIVEThere are approximately 85,000 lawsuits filed against medical practitioners every year in the US. Among these lawsuits, neurosurgery has been identified as a “high-risk specialty” with exceptional chance of having medical malpractice suits filed. Major issues affecting the overall medicolegal environment include tort reform, the formation of medical review panels, the increasing practice of defensive medicine, and the rising costs of medical insurance. In this study, the authors provide a concise update of the current medicolegal environments of the 50 states and provide a general guide to favorable and unfavorable states in which to practice neurosurgery.METHODSData were acquired related to state-by-state medical review panel status, noneconomic damage caps, economic damage caps, and civil suit filing fees. States were placed into 5 categories based on the status of their current medicolegal environment.RESULTSOf the 50 states in the US, 18 have established a medical review panel process. Fifteen states have a mandatory medical review process, whereas 3 states rely on a voluntary process. Thirty-five states have tort reform and have placed a cap on noneconomic damages. These caps range from $250,000 to $2,350,000, with the median cap of $465,900. Only 8 states have placed a cap on total economic damages. These caps range from $500,000 to $2,350,000, with the median cap of $1,050,000. All states have a filing fee for a medical malpractice lawsuit. These costs range from $37 to $884, with the median cost for filing of $335.CONCLUSIONSMedicolegal healthcare reform will continue to play a vital role in physicians’ lives. It will dictate if physicians may practice proactively or be forced to act defensively. With medicolegal reform varying greatly among states, it will ultimately dictate if physicians move into or away from certain states and thus guide the availability of healthcare services. A desirable legal system for neurosurgeons, including caps on economic and noneconomic damages and availability of medical review panels, can lead to safer practice.

Out-of-scope Cosmetic Surgery: A Review of Malpractice Lawsuits against Nonplastic Surgeons

“…13,17 The unique medico-legal environment of Florida may serve as a potential explanation for this phenomenon; however, a recent study rated their legal environment as "fair" to physicians and highlighted that tort reform had been reinstated in recent years, which would only serve to cap noneconomic damages and not severely reduce the number of cosmetic surgery malpractice cases. 47 This study is not without its limitations. First, the malpractice cases resolved privately before a trial could not be included in our analysis due to the limited public availability of this information.…”

“…13,17 The unique medico-legal environment of Florida may serve as a potential explanation for this phenomenon; however, a recent study rated their legal environment as “fair” to physicians and highlighted that tort reform had been reinstated in recent years, which would only serve to cap noneconomic damages and not severely reduce the number of cosmetic surgery malpractice cases. 47…”

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“…(6) The study includes data from Europe. *USA,11 12 14 76–145 New Zealand,74 75 146 147 China,148–150 Japan,151 152 Iran,153 Israel,154–160 Sudan,161 Canada,162 163 Australia,164 165 South Africa,166 Singapore,167 India,168 Hong Kong,169 Brazil170 and one study from both USA, Canada and South Africa 73…”

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“…Tort reform explicitly addressing liability during crisis conditions and allowing surgeons and physicians a measure of protection under good Samaritan provisions for actions undertaken in support of public health initiatives. [23][24][25][26][27][28][29] 7. Surgeons caring for individual patients must not be directed to abandon them for the good of the collective.…”