Premature baby dies, then goes missing for 6 days. The infant’s body was mistakenly put in a pathology department refrigerator, being mistaken for an ice pack. Rrrrright.
In other news, the hospital pathology department is congratulating Ms. Deborah Peel on delivering twins — a baloney sandwich and bottle of Evian.
In still other news, JCAHO has now banned all refrigerators from hospitals as a patient safety measure so that things like this don’t happen again.
What’s a few more rads of radiation between friends? New studies are showing that chest CT scans are effective at ruling out heart attacks. Between 80 and 90 percent of patients getting either CT scans or radionucleotide scanning were found to have clean coronary arteries and were able to be sent home. CT scans were just faster and less expensive.
Memorable ED survey quote: “After seeing the bill for your services, I needed your services again.” This anesthesiologist expresses sticker shock at how much he was charged for a trip to the ED for a face laceration. Hey pal, during the birth of our last child, the fee an anesthesiologist charged for my wife’s epidural wasn’t exactly a bargain, either.
Can you guess the amount of the bill? Hint: one of the charges was $360 for a tetanus shot with a wholesale cost of $27 (and why is an anesthesiologist buying tetanus boosters, anyway?). Of course, the hospital bill was “barely understandable” — a pet peeve of mine which I think is a crime in itself.
Coming to a neighborhood near you? Feds and states slash budgets for mental health care. As a result, more patients with mental illness are put back out on the streets. Police then respond to remove patients from camping out in condemned housing or to investigate complaints about paranoid schizophrenic patients that walk the streets yelling at children to the point that parents won’t let their children play alone outside. Police arrest some patients on “disorderly conduct” charges just so that the patients can get plugged back into the mental health system.
On the horizon? You guessed it. More budget cuts ranging from 10-30%
Wonder if the same budget cuts would occur if mental health patients were released in the lawmakers’ neighborhoods … maybe walked up to their kids while waiting for the school bus … said “Hi” to them … wearing a placard that said “I’m on early release from a mental health facility due to state budget cuts.”
Where are Mulder and Scully when you need them? British scientists trying to learn more about the new deadly infection that is killing victims in the Ukraine and turning their lungs black “like they have been burned.”
AMA is “uneasy” in support of ObamaCare, but goes along with the charade anyway.
In other news, AMA members becoming “uneasy” in support of AMA.
Really … it’s all about protecting patients from bad doctors. A Las Vegas patient gets a $5.75 million arbitration panel award when she developed reflex sympathetic dystrophy in her arm after a surgery. A law passed in Nevada limited the contingency fees that lawyers can receive and was applied retroactively, so the patient’s attorney got “only” $800,000 from the settlement. Now former med mal plaintiff attorney Robert Vannah is suing, stating that he should receive $2.3 million instead of that measly $800,000. According to the article, he now refuses to let his firm take any more medical malpractice cases.
In other news, Mr. Vannah was reportedly later seen pouting, kicking his rattle across the sidewalk, and stomping his feet up and down on the courthouse steps.
This medical malpractice plaintiff is being sued by the City of Grand Rapids, Michigan. The patient dove into shallow water and suffered a spinal cord injury. Later he settled a medical malpractice claim for about $2 million. After attorney’s fees, the patient was left with … oh … about $16.27. Ooops. No. Sorry. This case was in Michigan, not Las Vegas.
Anyway, Grand Rapids had a taxpayer-funded plan that covers medical expenses for employees and their dependents which paid for most of the patient’s care. Now Grand Rapids is suing, stating that it is entitled to recover the money that it spent in caring for the patient. Former Las Vegas med mal plaintiff attorney Robert Vannah had no comment on the matter.
“Dead or in jail.” Sobering statistics from upstate New York. Young victims of violence brought to the emergency departments will, on average, return three times. Within five years, 20% of those teenagers will be dead. Hopefully the new interventions undertaken in NY will change these statistics.
A Colorado company is marketing an iPhone app called iTriage that “allows people who are experiencing sudden health problems to look up likely diagnoses and then find the closest appropriate medical center to get treatment.” Apparently, the program works quite well. Type “sore throat” and “nausea” into the application and it instructs you to go directly to the nearest cath lab.
The American Association for Justice is now working on a partner application called “iNeedAPlaintiffAttorney” for when the iTriage program gives you wrong advice.
Congress is now going to regulate emergency medical helicopter transports. The number of deaths during helicopter transport increased from 7 in 2007 to 29 in 2008. The number of transports has substantially increased, so the “accident rate per hour flown” has been relatively steady despite the increased number of deaths. Studies show that “pilot error, bad weather, darkness and difficult terrain” contribute to 75% of all helicopter accidents. The NTSB recommends night vision gear, terrain avoidance equipment, and cockpit data recorders in all helicopters to improve safety.
In other news, JCAHO has demanded that hospitals remove all storm clouds, trees, and mountains within a 10 mile radius of patient transport areas as those things constitute patient safety threats.
Why so snarky about Mr. Vannah? He did exactly what you wanted – quit taking medical malpractice cases after a law was passed limiting what one side could pay their lawyers. It obviously didn’t limit malpractice, as the heirs of his client can attest, though. But “reform” isn’t really about improving medicine, is it? I’m not sure you read closely – this case isn’t why he stopped taking these cases, the 2004 law was.
No doubt Mr. Vannah, if he can win awards this size, can make plenty of money working for corporate America. So I guess the goal of keeping those who can’t afford to pay an attorney hourly from getting in the courtroom was achieved!! Yay Physicians!! Screwed some more poor people!!! GO you!!
As to the Grand Rapids thing, that’s not really “news”. It’s called subrogation, and exists in nearly every insurance policy that an individual consumer buys. These claims between insurers and insured happen all the time.
Physicians forget, or perhaps never knew, that often a malpractice award goes to pay the health insurer or past providers of services, as well as the future needs if the person is now uninsurable as a result of the negligence of a physician. In short, much of the money goes to pay the doctors’ bill.
If only as much time and money was spent on legislation to improve the delivery of medical services as was spent keeping poor people from having financially viable cases. Ironically, Nevada remains around 48th in physicians per capita, a spot it has held down for about 20 years now. So not only did physician insurers make more money, but the patients don’t have any more doctors!! A win-win, of course!
Matt,
I would think that justice would have prevailed – they won and the client was awarded money. The reason this is unfair is the attorney (who’s website boasts of more than 30 verdicts and 150 settlements in excess of 1 million dollars)was limited in the amount he was able to make. 180 cases X $800,000 would give us… lessee… $144,000,000.00.. The BASTARDS. How can he afford to live? Yes, his clients are ripping him off.
The courts are limiting what attorney’s are to be paid and it’s driving them out of business? Why can’t he represent those wrongfully injured and get this kind of reimbursment and be happy with that? Why would they have to work for Corporate America to get those kinds of awards. I would think that so long as he clears dollar one in profit, so long as he’s doing the correct thing by helping rid the system of incompetant, impaired and ner do well physicians – this would be reward enough. And the article clearly say’s the attorney reports he spent $172,000. Which would give him a profit of $628,000.00 – well over half of a million. Not a bad return on his investment… nearly 4.65%. So it is about the money after all, and not just doing the right thing?
I’m sorry, I mis wrote what I wanted to say. It should have been nearly 465% was the return on his investment, not 4.65%. As you can see, not used to writing that much of a return.
Painless,
It’s always interesting to me when people start deciding what other people should make, despite the fact the complainer literally has never done the work before. You say $800,000 is plenty for 6 years of work (he got the client in 1999), even though you have no idea how much work was involved, how to value the risk of fronting that $172,000, and even though the client agreed to pay him his full rate. Fair enough.
What if I think that even though your employer has agreed to pay you X dollars, I think that it should be cut by 15%, because it’s just too much. Now, I have no idea what goes into the work you do. I have no idea how hard you work or how good a job you do. But I think it should be cut. Fair enough?
“The courts are limiting what attorney’s are to be paid and it’s driving them out of business?”
You misread. It won’t drive him out of business. A lawyer that good at trial will always have work. There are plenty of companies that will pay and can pay him hourly and he can make a damn fine living. What I said was that you and I, who probably can’t afford to pay him hourly or pay that $172,000 up front, won’t be able to hire him. What I also said was how is it fair that only one side is limited in what it can pay its attorneys? Is there a cap on defense fees? No. You seem like a fair person – tell me how that’s just?
“So it is about the money after all, and not just doing the right thing?”
How do you think one affords to front $172,000 in costs if they don’t make any money? You say he ought to be happy if he only clears $1? OK, but how does that pay the expenses for the next poor person who can’t afford to pay hourly? If you get hit by a car today and can’t afford an hourly rate plus the cost of your life care planner, the economist, the physician to testify to your injuries, etc., who is going to pay for that?
Do you work for $1? Why not? Is it all about the money for you?
You’re a nurse right? Do the physicians you work with only make $1? Is it all about the money for them if they make more?
If you support tort reform because insurance rates are “too high”, aren’t you just trying to keep a few more dollars in your pocket? Is it all about the money?
I would think, as much as the medical industry whines about the government being involved in their pay and begs for a free market, they would actively discourage the government arbitrarily setting the value of one’s services.
First of all, if this lawyer really fronted $172,000 in actual costs, he’s a dolt. Let’s talk some inflated numbers. Say he hires 3 experts at $500/hour and each spends 20 hours picking through case files. That adds up to $30,000. Copying fees go for what – another $5,000? Depositions and transcription fees go for another $10,000? I’ve seen breakdowns of the “costs” fronted by plaintiff attorneys. Most of it is the time they bill. So go on … give me an idea where the other $130 grand went.
Next, even incompetent attorneys carry more than one case at a time. An average attorney has what — about 20-30 open cases at any time? I’ve heard attorneys admit they’re carrying 150 open cases at a time. For you to imply that the $800,000 is the attorney’s only income for the six years is dishonest. Let’s do some rough estimates. Say that Mr. V carries 15 open cases at a time which is a lowball number. On average, he’ll win 33% of them at trial. Over five years, he wins 5 cases – or about a case per year. If he settles for $800,000 each case, divide that by 2000 work hours per year and he makes $400/hour. If he makes the $2 million settlement each year, he’s getting paid $1000/hour. Poor guy.
Guess what will happen if “no one can afford to hire him”? Either he’ll lower the hourly wages he charges or he’ll go broke. Funny thing about the free market. Just because someone thinks he’s worth $1000/hour doesn’t mean that everyone else will think he’s worth $1000/hour.
Is there a cap on defense attorney fees? Of course there is and you know it. Defense attorneys and their relationship with malpractice insurance companies are the legal version of doctors and health insurers for the medical profession. Malpractice insurers tell attorneys what fees they will pay and if the attorneys won’t take it, they don’t get on the insurer’s list of defense counsel. Take it or leave it. Since almost all physicians have malpractice insurance, the insurers have a monopoly on the market. Again, you’re being misleading and/or dishonest by suggesting that defense fees aren’t capped in some way.
Your example about injured parties being unable to pay for counsel is off point. Medical providers care for indigent patients all the time. Ever heard of EMTALA? In some hospital emergency departments NONE of the patients can afford to pay and yet they all receive medical care. Got a similar example for the civil side of the legal profession? That’s what I thought.
Want a quick way to make sure that all of a plaintiff’s costs are paid? Shift to “loser pays.” If there’s liability, then the defendant pays for all the plaintiff’s costs – including the attorney as well as the “life care planner, the economist, and the physician”. If there’s questionable liability, then maybe the plaintiff shouldn’t be filing a case to begin with.
Finally, most people don’t support tort reform to “keep a few more dollars in our pockets.” Most people support tort reform so that they don’t lose their life’s work because the plaintiff’s attorney shopped around long enough to find an expert to advocate for his position – regardless of the “standard of care.”
What a load of nonsense. Do you know a single insured physician who has ever paid a judgment out of pocket? Losing your life savings? Be serious. You don’t like being held accountable and you don’t like paying insurance premiums. At least be honest about it with yourself if no one else.
And stop lying about EMTALA. That is the tradeoff for govt money. It’s a financial decision by the provider or their employer. You get govt money so the govt asks you to abide by it, you’re not doing it out of the goodness of your heart. You don’t want to provide free care, don’t take govt money.
You wrote: “Medical providers care for indigent patients all the time. Ever heard of EMTALA? In some hospital emergency departments NONE of the patients can afford to pay and yet they all receive medical care. Got a similar example for the civil side of the legal profession? That’s what I thought.”
Riddle me this: then how do EDs survive? Answer: by making a large profit off of the insured ones. Just like how medmal attorneys work. Given the high risk of most cases losing or breaking even or making a small profit, you really need a home run every now and then to keep the cases going. Problem is, absolutely none of the cases are obvious home runs when they come in; some cases that look great end up collecting nothing. You have to see what has merit and run with it.
I like this comment: “I’ve seen breakdowns of the “costs” fronted by plaintiff attorneys. Most of it is the time they bill.”
Incorrect. In a contingent fee relationship there’s no “time” to bill. If some plaintiff saw a bunch of “time” billed on their contingent fee representation, they need to talk to another lawyer and fire up another lawsuit. Some “blended” fee arrangements do that, but those are exceedingly rare in medmal. 99% is straightforward contingent fee: the lawyer never bills a cent for their “time,” their whole fee is the contingent fee.
As for costs, your numbers are indeed correct for a straightforward case where everything goes according to plan and the case settles before trial. You can often do that for $25k to $60k.
But let me give you some appoximate numbers from a real case that went to trial:
Service & Subpoenas: $4,200
Research fees: $12,000
Medical record copying: $1,500
Cert of merit expert fees: $3,000
Pretrial expert fees: $79,000
Trial expert fees: $48,000
Illustrative exhibits (video, medical diagrams, etc): $18,000
Court reporting pre-trial: $18,000
Court reporting trial: $20,000
Copy, phone, postage & fax: $35,000
Keep in mind: not one penny of that went to us. It’s not like we juiced up the file with junk fees or “handling” fees or the like – those were the actual fees third parties charged us. Do those copy, phone, postage & fax fees sound crazy? Yes, they do. Believe me, we try desperately to keep them low, but there really is that much paperwork and that many calls. We’ve got records behind all of that.
The NV case at issue went on for several years, involved a complicated subject with few experts (surgery-induced RSD), likely involved retaining outside counsel on an hourly fee to assist with estate issues (since the defendant died), may have involved retaining outside counsel on an hourly fee to deal with insurance coverage issues (since the defendant’s conduct was reckless and thus may have triggered an insurance exception), and went through a full arbitration.
Can those circumstances result in $172,000 costs? Absolutely. I’d be amazed if anyone could do that for under $100,000 even in the best of circumstances.
My favorite is this line: “If there’s questionable liability, then maybe the plaintiff shouldn’t be filing a case to begin with.”
You’re right, scrap the whole civil justice system. No one should file a case where the outcome is anything but certain.
Now let’s apply that to doctors. A common practice among health insurance companies is to audit the past few years of a doctor’s billing, find some trivial coding error, then send the doctor a charming letter informing the doctor that the insurance company will no longer pay the doctor anything, and instead will apply the money the doctor earns in the future to pay down the hundreds of thousands of dollars in claimed debt.
Don’t think for a moment I made up a word of this hypothetical. It happens every day. A friend of mine has devoted his practice to representing doctors in these cases.
In your version of the civil justice system, the doctor will just have to sit there and take it, since it’s “questionable” if they’ll be able to prove the insurance company is wrong (the insurance company always has SOME explanation for it), and the doctor obviously can’t afford also paying the insurance company’s legal fees on top of the claimed billed.
In my version of the civil justice system, there is a genuine dispute between the parties, and the doctor is entitled to have a court and jury evaluate who is right and who is wrong.
Which way do you really want it to be? Do you really want the powerful to be able to shove around the weaker because only the most certain of cases should be allowed to be filed?
But let’s get back to the bigger point. How much does the NV guy make from medmal? I don’t know – obviously it’s not that much anymore if he’s stopped taking cases. So all these hypotheticals about taking home millions of dollars are bunk – if that was the case, he’d still be out there earning millions.
http://www.ama-assn.org/amednews/site/free/prca0116.htm
New invention, Matt. It’s called Google.
Amazing what you can find when you actually take 30 seconds to *try* to find something rather than making misleading innuendos.
Matt:
Even if you dont “take government money” you still have to comply with EMTALA. This is the side effect of having to work out of hospitals. It is the hospital that takes the money. As a result of being on staff of the hospital, you end up having to comply with both EMTALA and COBRO regardless if you take Medicare or Medicaid.
Max Kennerly:
I have to ask. Are you sure that the costs for copy, fax, postage and phone are $35,000? For our 10 physician group where we have to document everything, fax reports on every patient and duplicate charts, we come it at far less? I am even considering man hours and FTE requirements.
WC, did you read your link? The plaintiff offered to settle for policy limits and the insurer dropped the ball. In fact, while it’s not explicitly stated, it sounds like the physician is pursuing a bad faith claim against the insurer. Of course it’s obvious why it’s not explicitly stated.
By the way, I really enjoyed your treatise on law firm economics. I found it as well informed as you would find my theories on the economics of your practice.
Throck, I hear what you are saying with regard to EMTALA. But again, you take that as a tradeoff for working out of the hospital. That’s an economic decision you are wholly on control of-for now at least.
“Malpractice insurers tell attorneys what fees they will pay and if the attorneys won’t take it, they don’t get on the insurer’s list of defense counsel. Take it or leave it. Since almost all physicians have malpractice insurance, the insurers have a monopoly on the market. Again, you’re being misleading and/or dishonest by suggesting that defense fees aren’t capped in some way.”
WC, do you EVER get tired of opining on things you know nothing about? Med mal defense lawyers are a highly prized commodity and have substantially more bargaining power than those that, for example, have a firm based around handling premises liability or car wrecks. The stakes are too large in these cases, and the issues too complex to just jump them around to the next guy with the cheaper rate.
Plus, if you alienate too many of your defense lawyers with cutting costs, they’ll jump to the plaintiff’s side. If your profession paid based on your skill, you might appreciate this more. As it is, it appears (and please correct me if I’m wrong) that the most talented ER physician won’t make much more, if any, than the least.
“Guess what will happen if “no one can afford to hire him”? Either he’ll lower the hourly wages he charges or he’ll go broke. Funny thing about the free market. Just because someone thinks he’s worth $1000/hour doesn’t mean that everyone else will think he’s worth $1000/hour.”
You misunderstand. There will be entities who can afford to pay him $1000 an hour. And if he’s good enough, they certainly will. But you know what – you and I likely won’t, and the poor definitely won’t. So once again you’ve limited the access of the poor to justice. Just like you do with your loser pays desires.
I understand that you’ve never practiced law and have no concept of the economics of the business of law, but please, stop yammering on about it. You really have no clue.
throckmorton,
Remember the part in “The Firm” where they installed keypads on all the copiers? We have those. The phone, too, doesn’t work unless you put in a case code. We can trace all of those copy, postage & phone fees to the date, number of pages, etc.
Those costs in the case I cited were abnormally high; the case involved eight defendants and went on for a long time. That said, it’s dumbfounding how quickly a firm can go through paper. Everything gets printed several times to be proofed before being served/filed, everything filed has to be mailed to every single party, everything gets forwarded to the client, lots of things have to be hand-delivered, lots of things have to be sent via UPS (e.g., hundreds of pages of medical records), etc.
Believe me, every lawyer gets shell-shock from the sheer cost of copying, and every lawyer tries to figure out how to cut them back (e.g., we’re as “paperless” as we can be, and I scan everything then keep only a single printed copy), but it really is that bad. I think with my “paperless” practices (that case wasn’t mine, I just helped out) I could have shaved $10k off of that, but probably not more.
Medmal is expensive. That’s why, among plaintiffs, it’s concentrated among a small number of firms. It’s also why 9 out of 10 cases are rejected by firms prior to even going out to an expert for pre-suit review.
Matt –
I’m glad malpractice defense lawyers are a “highly prized commodity” in your area. Around here, they are paid $110 to $140 per hour, even attorneys who have tried dozens and dozens of cases to verdict with a success rate of greater than 90%. Anyone who expresses dissatisfaction with that level of compensation stops receiving new files.WhiteCoat’s take on this is much closer to reality than yours.
Must depend on the jurisdiction.
“It should have been nearly 465% was the return on his investment, not 4.65%.”
Incidentally, your number only counts his out of pocket costs. It does not count his time, which would likely be larger. Nor does it factor in the risk of investing that $172,000. There’s no guarantee one gets it back. Which is why med mal is not the type of cases where truly frivolous actions are typically pursued to trial. The costs are too high. You’d be better off doing bogus car wreck cases if you were inclined to file truly frivolous cases for a living.
Incidentally, I see a lot of condemnation for the attorney – is the doctor still working and getting paid for his work?
“Incidentally, I see a lot of condemnation for the attorney – is the doctor still working and getting paid for his work? “ Actually Matt, according to the article, the physician not only is NOT working nor is he getting paid for his work (and from the looks of it he probably wasn’t paid for her work either), as he’s deceased – he died the afternoon that she had the surgery. We are discussing the attorney here and that’s why it seems like we are condemning him. Because we aren’t talking about anyone else. Should we talk about the fact that the named client likely would never have seen 5.75 million in her life if she had never been injured? She got paid, and paid extremely well for what happened to her. Maybe too well. That’s not the issue here.
I don’t maintain that attorney’s shouldn’t get paid for their services. I wouldn’t deny anyone the opportunity to earn a reasonable living. In answer to your question/statement, yes, I am very good at what I do, I’m very experienced, and I enjoy what I do. And it wouldn’t be right for anyone to just take 15% away from me. I honestly don’t think I get paid enough for what I do, however I do get paid and in today’s economy that’s a good thing. Again, I don’t have a problem with anyone being paid for the work they do, nor do I have a problem with them being paid adequately.
What I do have a problem with, is a group acting predatory on another group in the name of stopping medical error. He did his job, and made significantly more than I make, and even most physicians I know make. Granted it did take 6 years, but I’m reasonably sure that was not his only client. Let’s see – he made $428,000.00 after he paid his expenses, which is about $71,333 a year average. Now if this was the only thing he did day in and day out for 6 years, working 40 hours a week on just this case, I would say No, he did not get paid enough. That’s assuming he worked an average of 2,000 hours a year for 6 years. You and I don’t see eye to eye, and I think we can agree on this. I don’t think he was grossly underpaid. Period. I think he should be happy with what he received. Period. Whether or not you or I agree, or whether or not the courts agree means nothing much other than the attorney perceived a wrong and is suing to get that wrong fixed. It reminds me of a car salesman. All that matters is the commission. Now before I get all kinds of angry hate mail from car salesmen – no I’m not putting you in the same category as attorney’s.
What I am saying, (i.e. my opinion, right wrong or indifferent) is that the attorney lobbied for his client who obviously had been harmed. She walked away a millionaire – money she can spend on her future health care, rehabilitation, whatever. He didn’t get nearly the half of it he felt he was entitled to, so he’s mad. He more than covered his expenses. He was reimbursed adequately. If this was the only thing he did, working 2000 hours a year, not taking any other cases on, he would have made just about $71,333 a year. I know that doesn’t go far towards paying the Mercedes or Porsche payment, or the gated community dues – but somehow I just can’t see that being an unfair wage for a year’s work. I know lots of people who would love to make that much in a year.
Ultimately, if he had a contract for X money he should have made X money. Whether it was a dollar or a million dollars. It’s unfortunate that the agreement he came to was changed by the law as the law deemed it was too much. However, he still made a lot more than most folks will ever see in their life on that one case, even if he didn’t get what he wanted. He received annually what is really not a bad wage. He made what the law let him make. Now he wants us to feel bad for him because of that? The law is ok until it affects him, then the law is wrong?
“Should we talk about the fact that the named client likely would never have seen 5.75 million in her life if she had never been injured? She got paid, and paid extremely well for what happened to her. Maybe too well. That’s not the issue here.”
Another misconception on your part. One, you assume that all that money goes in her pocket. More likely, much of it goes to medical providers and health insurers, for past and future care. And, if she’s unable to work, it represents lost wages as well, although how much we don’t know. So, while it may be more than she’d ever expected to see at once, it certainly is not all going in her pocket.
Now, there may be a punitive factor to this award, but we don’t know because evidently this lawyer worked his emotional plea on these sympathetic arbitrators. The breakdown of the award isn’t known. So you’re at best guessing as to what she would get but for this trial. And like most people with a med mal verdict in the millions, I bet she’d trade it back for her health. Would you trade places with her for that money?
” I wouldn’t deny anyone the opportunity to earn a reasonable living. ”
Oddly though, you seem to believe you should decide what is “reasonable”. Quite the socialist, aren’t you? Contracts shouldn’t matter, society should decide reasonableness. Unless it’s YOU who is being cut, right?
“What I do have a problem with, is a group acting predatory on another group in the name of stopping medical error.”
Ah, you misunderstand what a lawsuit is. It’s not done to stop medical error. The error, as this case makes clear, is done. A lawsuit is merely two parties determining fault and assessing damages. That’s it. In this case, both parties put on their best case to these arbitrators and they found for the plaintiff. There is no larger societal movement here.
“He did his job, and made significantly more than I make, and even most physicians I know make.”
So it’s jealousy that’s the real problem. You have no idea what it takes to do his job, but you believe yours is harder and should be paid more.
When have you ever invested $172,000 cash out of your pocket in a patient? Do you not believe in a risk premium?
As for physicians not making more, the average physician makes $150,000 a year, the average surgeon $250,000. The average lawyer? Just shy of $100,000. Obviously, people very good at what they do in any field make more. You knew that you would not make as much as a lot of people when you went in your field, I expect. Are you now angry because they make more?
“Let’s see – he made $428,000.00 after he paid his expenses, which is about $71,333 a year average.”
But in your calculation you forget some other numbers. You haven’t paid his staff. You haven’t paid his paralegals. You haven’t paid his building costs. You haven’t paid any of those other things.
Now, does this guy make a lot? Probably. And if he’s good, he should. That’s the way a free market is supposed to work. Don’t be mad at others because your industry sold itself to the feds 40 years ago and now is dealing with the consequences of it.
“It reminds me of a car salesman. All that matters is the commission.”
Do you hire an attorney to lose for you? If they take your case on contingency, a contract you voluntarily sign, do you expect them to then waive the contract later?
Like I said – if society decides later that YOU are overpaid, is it ok to tear up your agreement? No, of course not, because it’s YOUR ox that’s being gored now, isn’t it?
“Now he wants us to feel bad for him because of that? The law is ok until it affects him, then the law is wrong?”
You didn’t read very closely. This guy never agreed with the law itself. Again, for the rather obvious reason that it hamstrings one side of a lawsuit. Surely someone who believes in societal justice like yourself can see the wrong in that.
And I don’t think he is asking you to feel bad for him. I think he’s filed suit to test the retroactive nature of the law. By that I mean he signed a contract in 1999, and the law wasn’t passed until 2004, and he argues it should not be retroactive.
Just as if you signed a contract in 2010 to make X dollars, and on January 1, 2011 a law passes that says you have to give 15% back because society thinks that’s fair. You should be happy with what you have because you probably made more than 99% of the people in the world that year even WITH the pay cut.
OH MY GOD! This is SO unfair! What’s next, the government will tell a group of professionals that they must provide services to everyone who ass, regardless of ability to pay?
Please Matt. A lawyer being limited to a 465% ROI and the injured party seeing more of their award… What is the problem?
Hooray for regulating the fees professionals can charge their customers! Let’s apply it to medicine, the most expensive profession of all!
While we’re at it… what’s the ROI for a single CT Scan? Over 5,000%? The cost of electricity and a couple minutes of technician and radiologist time isn’t that much, right?
“465%!” only sounds right if you’re so foolish as to ignore the rest of the business, much like how “over 1,000% ROI for a single CT” requires ignoring the rest of the business.
Max,
They do. I have one of 6 charges I can make to cover the care of every single patient who comes to the ED. (Levels 1-5 or CC). Each is based not only on the complaint, but also on fairly inane rules that mandate the actual counting of various compnents of my history and physical. I would have no problem at all having lawyers be on a set scale where there are six distinct levels of pay thta they are limited to for any given client…
You’re talking Medicare/Medicaid.
The bulk of the money you get is from freely-negotiated private insurance.
All private insurance “negotiated” (more like dictated) are based on E&M codes and RVUs with a negotiated modifier. I can only bill six levels, regardless of who gets the bill.
And CT scans etc. is based on the hospital. That is like us complaining about expert witness fees. Let’s compare apples and apples and keep the discussion on professional fees.
And Matt,
Physicians are hardly the highest paid profession. We are regularly out earned by the CEOs that run our facilities, investment bankers, trial lawyers, business consultants, etc. No one in their right mind goes into medicine for the money. Between the cost of lost opportunity over the time spent in training and the student loan indebtedness, it takes an ignorant man to believe physicians are so well paid. My younger brother is a retail store general manager. After my student loans are paid, he takes home 20% more than I do each month…
A Max:
“Freely negotiated insurance” (an oxymoron if you know anything about the subject) keys off of medicare rates. Depending on your practice the majority of your income may come from medicare/medicaid. As it stands now roughly 50% of all dollars come from government entities. Please become educated about the subject if you want to rationally discuss it.
“Keys off,” eh? Please, do tell what that means. You seem to think that Medicare sets the rate for private reimbursement; it’s typically exactly the opposite, with Medicare demanding a discount based on the rate set by the free market.
But if you’ve got some novel theory on how Medicare dictates the private rates, analogous to the government limiting contingent fee agreements, I’d like to hear it.
While you’re at it, tell me your source of the “50%” number, and say who you’re applying it to. I spoke to the chair of a hospital department two weeks ago about how 90% of his department’s reimbursement was from private insurance; I’m sure you know better than him, though.
Max Kennerly:
This is bit about how the government affects private insurance contracts. First, by law I as a physician can not discuss rates with physicians outside of my group in regards to negotiating contracts with private insurance providers. It would be great if we could see what our competition is bidding and be able to use this in our negotiations. If we make our group bigger so that we are the majority of a medical specialty in a given area, the Feds step in with anti-trust lawsuits. So, the Feds restrict how we negotiate and restrict our ability to freely set contracts. Now, as to Medicare. Every insurance contract we have is tied to Medicare rates. Every billing system is tied to Medicare codes. They are inseperable.
So why are you guys spending all your time and legislative dollars on malpractice “reforms”, which have such a minimal effect on your lives?
Matt:
Reforms are more about the practice of medicine than the dollars. Right now medical students and residents are being trained in the era of “lawsuit avoidance” instead of evidence based medicine. The perception that you can be sued for anything has become the reality and has wormed itself into the fabric of medicine. In biologic terms the host has been taken over by the parasites. Medicine needs a deworming.
The problem with your theory is that the perception is very much not the reality. The majority of malpractice never even results in a claim, much less a lawsuit. Your beliefs have not become facts, no matter how much you wish them to be.
However, this is a minimal issue in comparison to the oncoming “reforms” in congress. It’s a shame you don’t see it.
Max:
For someone trying to be so argumentative you really don’t know much about what you are talking about. A little life experience may be in order max.
“Keys off” is simple and well known to anyone around medicine (including lawyers). Different health plans will reimburse a certain percentage of medicare rates. (110% or more if you are lucky). Throck is correct in that we cannot talk with our brethren outside our own groups with respect to setting rates and we certainly cannot try to price-fix with other groups against insurance companies. As a lawyer I am SURE you know about the antitrust exemption that was established in the 1945 McCarran-Ferguson Act which health insurance companies hide behind and do the same to docs right?
Lastly, your hospital chair conversation is one of two things:
A: a lie
B: A very middle-upper class situated hospital that I and most docs would love to work at.
Those numbers are from the CDC in 2007
http://www.cdc.gov/nchs/data/hus/hus07.pdf
“Overall, private health insurance paid for 36% of total personal health expenditures in 2005, the federal government 34%, state and local government 11%, and out-of-pocket payments accounted for 15%.
Not quite 50% of public funds (not just medicare and medicaid but the vast majority being those two entities), but also that was for 2005, four years ago. I (and anyone here in the business) highly doubt those percentages have gone down.
Again, if you want to be part of the conversation max, quit being lazy, those numbers are hardly hidden. Do I need to wipe your butt after you take a crap too?
Joe,
It seems you’ve lost the point of your own argument. A law in Nevada expressly caps the amount plaintiff’s lawyers can make.
You have analogized this law to situations where by some health care plans will freely negotiate rates with providers that bear a relation to the government’s own reimbursement rate.
Do you really and truly not see the difference between an express restriction on fees and a freely-negotiated rate that bears a freely-negotiated relation to a separate government rate?
re: “seems you’ve lost the point of your own argument. A law in Nevada expressly caps the amount plaintiff’s lawyers can make.”
Max I am not talking anything about plantiff lawyers. I don’t even know what point you are trying to make.
It is clear to me you know nothing about the percent of medicine that is funded by public dollars. You know nothing about how about the laws that exempt health insurers from antitrust laws. Heck, Sen Patrick Leahy held hearings last month to look at repealing this exmption due to allegations of price-fixing. I mean really, quit embarassing yourself and LOOK IT UP. You do know how to use google don’t you?
“No doubt Mr. Vannah, if he can win awards this size, can make plenty of money working for corporate America. So I guess the goal of keeping those who can’t afford to pay an attorney hourly from getting in the courtroom was achieved!! Yay Physicians!! Screwed some more poor people!!! GO you!!”
Really, because if Mr. Vannah’s concern is the poor, down trodden “victims” of medmal, why is $800,000 per winning case such a bad living? Lots of doctors donate their time on tragic cases where an individual can afford treatment. Heck, St. Jude’s Childrens Hospital is founded that way. Where is the Med Mal legal equivalent. Why wouldn’t Mr. Vannah say, hey, you know what, $600,000+ dollars is a heck of a lot of money to have made in this trial. My poor client, who, lets face it, can’t be made whole with any amount of money, deserves to have the extra funds to help with her pain and suffering. This was clearly the voters intent in passing the law they did. How again does that “screw” the lawyer? Maybe lawyers should put some of that “we are the defenders of the poor, downtrodden victims” rhetoric into practice…
Oh yeah, when it is just hyperbolic rhetoric, and the reality is they are in it for the money, it is difficult to be altruistic…
“Throck, I hear what you are saying with regard to EMTALA. But again, you take that as a tradeoff for working out of the hospital. That’s an economic decision you are wholly on control of-for now at least.”
There is no trade-off. Given the rules on certificates of need regulating the capital purchases that are required for the equipment necessary to practice emergency medicine, there is no way to do so and not accept MC/MA. As such, EMTALA applies. There is no trade-off, a hospital base is required to practice medicine. Your argument is equivalent to saying that a trial lawyer who wishes to avoid being assigned occasional pro bono work should avoid judges. I would assume that avoids all judges is impossible for a trial lawyer (yes, other forms of law probably could avoid them).
In the US, the practice of emergency medicine = subject to EMTALA.
Do any of you physicians get the intellectual inconsistency of complaining about the government interference in your profession and then championing government interference in other professions?
Do you really think this won’t come back to bite you? As the cost of healthcare inevitably increases, do you think someone is not going to notice that you are the highest paid profession in the world by far and start thinking along the same lines as some of you are pushing here? “Hmmm, I work really hard, and I do not make anywhere near what a physician makes, they can surely live on (pick your percentage) less.”
In a time when you should be really working hard to gather all the backers you can for more freedom in your profession, you are alienating the one group whose practice model is most similar to yours. And a group you believe (whether it’s correct or not who knows) is immensely powerful in Congress.
Your actions with respect to business and political issues continues to defy logic.
Good point. Let’s all us dumb doctors cozy up to plaintiffs lawyers and make it easier for them to sue us. Then they’ll tell their buddies in Congress to make laws favorable to us.
Why didn’t I think of that?
“Hmmm, I work really hard, and I do not make anywhere near what a physician makes, they can surely live on (pick your percentage) less.”
Duh. Read the news once in a while. Why do you think a lot of patients are having difficulty finding physicians?
Maybe they can call Gerry Spence instead.
Don’t be a fool. The reason that patients can’t find doctors is because they’re poor. Doctors flock to places which already have plenty of doctors and avoid places that are underserved. Why? Because they go where the money is.
“Good point. Let’s all us dumb doctors cozy up to plaintiffs lawyers and make it easier for them to sue us. Then they’ll tell their buddies in Congress to make laws favorable to us.”
I shouldn’t be surprised you don’t have a clue, given how little of your posts are about the real battle going on, and how much time you spend fussing about malpractice issues, which are a tiny aspect of your worries (or should be). Single payer makes this all moot. Do you get that? Malpractice suits as we know them almost certainly goes away. Likewise, so do the last vestiges of your autonomy.
By begging the government to regulate what other professionals can be paid, by begging them to usurp juries, you have lost the free market principle you claim to seek. You only want them when you think they benefit you. People see through that. And why are you alienating any group when you need all the friends you can get to avoid single payer?
ESPECIALLY a group physicians routinely turn to when they file suit. Who do you think represents you in those billion dollar class actions you physicians file against health insurers? Just more hypocrisy from a group that claims to loath lawyers – except, of course, when you want to sue. Again, people see your hypocrisy.
Do you not get that you’re in a battle for your profession in Congress right now? Do you not see that what’s going on will result in an even more fundamental change than Medicare/Medicaid’s introduction?
“Awful big words from someone who doesn’t actually handle medical malpractice cases.
Your conclusions only demonstrate once again that *you* are the one that has no clue.”
I didn’t say I never had – I said I don’t now, except in the rare clear liability cases (2 in 6 years). I’ve certainly worked for firms that do that work in my career, and I still refer cases and keep track of those cases I refer.
Which conclusions do you think are incorrect? You’re big on the bold pronouncements, but always pretty light on the details. What’s next from you “Nanynanybooboo”?
“http://www.ama-assn.org/amednews/site/free/prca0116.htm
New invention, Matt. It’s called Google.
Amazing what you can find when you actually take 30 seconds to *try* to find something rather than making misleading innuendos.”
By the way WC, I did find a link where Mr. Rutkowski DID sue his insurer for failing to settle for policy limits, which the plaintiff would have accepted. It was mentioned on overlawyered, that physicians legal bible, no less.
So, still looking for that case where the physician lost his life savings due to a lawsuit. As opposed to due to his insurer’s bad faith. Facts, man, facts!
Please, find me some drunk or high physician and tell me how he’s been wronged!
“The problem with your theory is that the perception is very much not the reality. The majority of malpractice never even results in a claim, much less a lawsuit. Your beliefs have not become facts, no matter how much you wish them to be.”
Buses crash far, far more commonly than airplanes, but John Madden still won’t fly. And what you don’t get, or don’t want to get is that if all doctors are doing extensive testing in the false belief it will help them in a suit, it doesn’t matter if it is not actually helping. That doesn’t make the test any cheaper…
Awful big words from someone who doesn’t actually handle medical malpractice cases.
Your conclusions only demonstrate once again that *you* are the one that has no clue.
But I think that most of the people who read medical blogs already know that.
I have itemized lists of expenses from a plaintiff’s firm that was recently submitted to a court as proof of costs and it significantly less than the costs you cited.
So I need to know without you violating your client’s confidentiality …
What was the issue in the medical malpractice case?
How many defendants were there?
How many experts did you retain?
What was researched that cost $12,000?
What are you copying that costs $35,000?
Claim ended up being about surgery & anesthesia, but other issues were pursued with experts. Costs grew in particular when the main defendant filed a third-party claim against someone we hadn’t sued, and when they raised wacky causation issues (later abandoned) that required we get new experts from another field;
eight, most of whom were dismissed or released prior to trial, which involved three;
14 total (3 testified at trial);
legal research (e.g., cases, treatises, articles on LexisNexis) was about half of the research costs, while medical journals, books, etc, was the other half;
See above reply to throckmorton. Shipping off med records, depositions, pleadings, and discovery to our experts easily cost $5k by itself. Several hundred filings were made in the case, each of which were sent to the court, all eight defendants, and the client. Case was boiled down to 10,000 documents for trial, which had to be put into five separate copies for us, the court, and the remaining defendants. Everything had to be scanned and bates-stamped, too, for reference at trial and use on a projector. That ain’t cheap.
It was an unusually expensive case. That said, even on a “simple” case you can easily get your copying/postage/etc up to $5k before trial, then well above $10k getting ready for trial.
Here’s a really rough approximation of the costs of medmal:
Simple case, pre-trial: $20k-$40k
Simple case, post-trial: $30k-$80k
Complex case, pre-trial: $40k-$100k
Complex case, post-trial: $60k-$150k
Very complex case, pre-trial: $100k-$200k
Very complex case, post-trial: $150k-$300k
These are really rough approximations, and can be thrown off by a host of factors, most of which are outside the control of the plaintiff and plaintiff’s lawyers.
Put another way, it’s rare to see a medmal case get to trial for below $25k, and rare to have a medmal case cost $300k prior to trial. For trial, those numbers are $35k and $400k.
Everything inbetween is fair game. The NV case involved multiple defendants, a complicated issue (surgery-induced RSD), was apparently vigorously contested (hence taking several years), and was pursued all the way through ‘trial’ (there ‘arbitration,’ which requires just as much preparation).
A plaintiff’s lawyer would have to be exceedingly frugal AND lucky to get that done for under $120k. I have no doubt he spent $170k on it.