Former White House Budget Director Peter Orszag weighed in on his former boss’ healthcare reform initiative this morning in the NY Times. Orszag wrote that the reform legislation didn’t go far enough because it didn’t provide for “evidence-based” guidelines that would shield doctors from medical malpractice liability. According to Orszag, doctors should be immune from malpractice lawsuits if they followed certain guidelines established by their peers.
The ink wasn’t dry on his Times piece when Huffington Post reporter Joanne Doroshow wrote a compelling piece about how Orszag’s idea was bad policy. Noting it was a “horrendous idea”, she wrote, “Clinical practice guidelines should never be the legal basis for determining whether or not patient harm was the result of negligence. And allowing use of guidelines only by a physician or facility to defend itself against a medical malpractice claim and not by an injured patient to show negligence is without any justification and is fundamentally unfair.”
Doroshow has a good point since such evidence-based guidelines is skewed to protect doctors from lawsuits and look after the best interests of the patient. She cites such failed experiments in Maine and Florida as evidence that Orszag’s idea is not such a good policy move.
“For example, in the 1990s, Maine established a program that allowed doctors in four specialties–anesthesiology, emergency medicine, obstetrics and gynecology, and radiology–to participate in a program allowing use of guidelines as exculpatory evidence in lawsuits. Other specialties were encouraged to take advantage of this program but did not. The program expired, and the Maine Bureau of Insurance concluded, “the medical demonstration project had no measurable effect on medical professional liability claims, claims settlement costs, or malpractice premiums.”
In 1996, Florida also began a demonstration project for cesarean deliveries, but reportedly “garnered relatively little support among physicians–only 20% of physicians eligible to participate chose to do so and the project ended in 1998….Three other states (Kentucky, Maryland, and Minnesota) adopted test projects in the 1990s, though none of the projects is fully operational today (the Maryland and Minnesota projects have fully expired).” In other words, the medical profession itself has not accepted clinical practice guidelines as appropriate legal standards, even for exculpatory purposes.”
Read both pieces and decide for yourself. I think you may find that the goal of any healthcare reform should be patient safety not the protection of doctors from lawsuits.