Madam President, our Nation's medical litigation system is broken and we need to start working to fix it. I urge my colleagues to vote for cloture on the Gregg-Ensign bill. It is time to stop filibustering and to start working. I just got…
Madam President, our Nation's medical litigation system is broken and we need to start working to fix it. I urge my colleagues to vote for cloture on the Gregg-Ensign bill. It is time to stop filibustering and to start working.
I just got back from Wyoming. They are having this same debate there. They don't trust us to finish it here. They are trying to finish it on a local basis. They are having a debate on a constitutional amendment to be able to do medical tort reform.
I tell you, that is a very difficult thing. Litigation reform requires a constitutional amendment in Wyoming. That means there may be a vote of the people, but that can't happen until at least November and we are in a crisis in Wyoming right now. We are not the only State in a crisis.
Last year, we brought a medical litigation reform bill to the Senate. The legislation would have placed reasonable limits on the amount of money attorneys can take from a verdict or a settlement in an injured patient's favor. The bill also would have limited awards for punitive damages and noneconomic damages. In other words, the pain and suffering awards.
The bill would not have limited awards to compensate patients for economic losses. This is an important point for everyone to keep in mind. If a judge and jury were to decide a person suffered an injury due to a doctor's mistake or a hospital's negligence, that person would be entitled to receive full compensation for their economic loss, including everything from rehabilitation to lost wages resulting from their injury. I cannot stress this point enough. The bill would not have limited awards for any part of economic losses.
What the bill would have done is place a ceiling on noneconomic damages. The bill would have limited the maximum award for noneconomic damages to $250,000 in States that do not have their own limits on such awards.
In Wyoming, we do not currently have limits on noneconomic damage awards. We do not have limits despite evidence which shows limits on noneconomic damage awards have helped control the cost of medical liability insurance premiums in other States.
As a result, people in Wyoming are losing access to affordable health care in their communities. The rising cost of medical liability insurance in my State of Wyoming is forcing doctors to curtail their practices or close them entirely. We have a shortage of doctors in Wyoming as it is and the cost of medical liability insurance is making a bad problem even worse.
To address this problem, I cosponsored the medical litigation reform bill we offered for debate last year. We needed 60 Members in this body to vote in favor of working on the bill to get past a filibuster, but only 49 voted in favor. So it was back to the drawing board.
Here we are again, 9 months later, with a new bill. It is ironic we are here 9 months later because this bill focuses on mothers and babies.
Medical liability crisis affects many patients and doctors. Those it affects most are the expectant mothers and their obstetricians.
Doctors who deliver babies have a dubious honor when it comes to medical liability insurance. The typical obstetrician pays more in annual premiums for professional liability insurance than almost any other type of doctor. Part of the reason is that in some states the child has the right to sue when they get to adulthood. That is a pretty long tail on the liability. If the parent fails to sue, the child can sue.
Some of my colleagues have pointed out the statistics and numbers on this crisis, so instead I will tell a short story about an obstetrician in Wyoming. I told this story in July so I apologize if you have heard it before, but it is worth retelling.
There was an article in the Washington Post about a year ago about the medical liability crisis. The reporter for the Post had gone to Wyoming to
see how the crisis affected a State already struggling to keep enough doctors as it is.
According to the article in the Washington Post, the doctor in Wheatland, WY, went to a high school basketball game between the Wheatland Bulldogs and the nearby Douglas Bearcats.
Here is Wheatland on a map; here is Douglas. Wyoming is a pretty big State. This map shows about a quarter of the State. Each of the counties on this map is bigger than Delaware, and the distance between Wheatland and Cheyenne is pretty close to the length of Delaware. We are talking about a lot of distance, but not many people. One of these counties the size of Delaware has 2,500 people living in it total, so we have a lot of land, few people, and consequently not many doctors. Wheatland and Douglas are 60 miles apart. That qualifies as nearby in my State.
Now the doctor had just announced he would not be delivering any more babies in Wheatland or Douglas because of the cost of liability insurance. The irony is he delivered just about every player on both teams at that basketball game.
I would like to read a section of this story. The name of the doctor is Willard Woods:
The national malpractice insurance crisis . . . hit home
for Wheatland this winter when Woods' insurance company
joined a number of national malpractice carriers in declaring
bankruptcy.
I emphasize that last part. Malpractice carriers are declaring bankruptcy. Some people say these companies are making out like bandits on medical liability insurance. If they are, they would not be declaring bankruptcy. These insurance companies are in crisis. They are raising their rates to cover the costs from legal cases and settlements.
Back to the quote.
That left only two firms selling malpractice insurance in
Wyoming, and neither one was willing to take on a new
obstetrical coverage. Woods did get insurance for his
gynecological practice--a branch of medicine that spawns far
fewer lawsuits than delivering babies--but the annual premium
cost him $116,000, three times what he paid the year before.
In this wheat-growing region of eastern Wyoming, where
medical services are sparse and scattered, the impact is
acute. Platte County, with a population of less than 9,000,
has five doctors, equal to the number of veterinarians.
Women with normal pregnancies can still have their babies
delivered in the hospital; Woods's two partners, both general
practitioners, share the delivery duties.
``But if you have any kind of problem like I did,'' said
Wheatland mother Kori Wilhelm, who has a genetic blood
mutation that makes pregnancy dangerous, ``you have to go to
Cheyenne now''--and that's a 140-mile round trip--``to get
the specialized treatment we used to get right down the
street at Dr. Woods's clinic.''
Put yourself in that woman's shoes. Until the cost of medical liability insurance drove Dr. Woods out of obstetrics, a woman experiencing a difficult pregnancy in Wheatland could get specialized care in her own community. Now that woman has to drive 140 miles round trip for proper prenatal care and to have a specialist deliver her baby.
Madam President, 140 miles is a long way for anyone to travel to see a doctor. It is even a longer 140 miles for a pregnant woman. And it is truly a long 140 miles for a pregnant woman in the middle of winter when high winds and blowing snow often force the highway department to close the interstate between Wheatland and Cheyenne.
I wish this were the only story I could tell about the crisis in Wyoming, but it is not.
I could talk about Dr. Jack Richard, an OB/GYN who reluctantly retired last year due to his high cost of medical liability insurance. Dr. Richard served the people of Casper, WY, for more than 30 years, but he was not ready to retire at the age of 61. Dr. Richard had already stopped providing routine obstetrical care in 2000, but even as a part-time physician, his premiums had doubled since then.
I could talk about Lisa Minge, an OB/GYN who left my hometown of Gillette in November and moved her practice to Boise, Idaho. She cited the high cost of liability insurance as one of the factors in her move to Idaho, which has a $250,000 limit on noneconomic damage awards.
I could talk about Dr. Bert Wagner, an OB/GYN in Cheyenne who stopped delivering babies this year to avoid the high cost of insurance for the obstetrical side of his practice.
Or I could talk about a group of family practice doctors in Cheyenne who are trying to decide whether they can keep delivering babies. The four doctors in this group saw their premiums go from $65,000 in 2003 to $110,000 in 2004. This is despite the fact they had already limited the number of babies they would deliver to 30 per doctor per year to avoid having to pay the full obstetrical rate. I don't know what you do if you are the mom who needs the 31st baby delivered.
I have more stories I could tell, but I am not sure what good it would do. I am an optimist by nature, but I am afraid I am pessimistic about the outcome of this vote.
Nevertheless, I commend Senators Gregg and Ensign and our majority leader, Dr. Frist, for trying again. They have developed a bill that is focused on one of the most critical parts of this nationwide crisis-- the plight of expectant mothers who depend on obstetricians to provide a safe and healthy delivery for their babies.
What Senators Gregg and Ensign have proposed is a modest approach that will provide some measure of relief to doctors who are squeezed by the high cost of medical liability insurance. The bill puts reasonable limits in place on the amount of money attorneys can take from settlements and verdicts awarded to injured mothers and babies.
The bill does not limit the amount of money juries and judges can award to cover lost wages, rehabilitation, special services, and other economic losses an injured mother or child might face. It simply puts a reasonable limit on what judges and juries can award for punitive and noneconomic damages, which are the types of unpredictable awards that are contributing to this health care access crisis.
I have noticed something interesting during our debates on this issue. While we have been debating the pros and cons of reform, no one is standing up to defend our current system of medical litigation. No one is standing up to defend our current system. We are talking about limits on noneconomic damages, or the role of the insurance industry, and Senators are saying: Yes, there is a problem, but the bill before us doesn't solve it.
One thing I have not heard is a rousing defense of our medical litigation system. Even some of the lawyers in this body have agreed frivolous lawsuits are a problem and our medical litigation system needs reform.
Why aren't we hearing anyone defend the merits of our current medical litigation system? It is because it is indefensible. Our system does not work. It simply does not work for the patients or for the health care providers.
The bill we are debating today is a good bill for mothers and babies and the doctors who serve them. But even the sponsors would probably admit it is a short-term measure that does not address the fundamental problems with our medical litigation system. This is an important bill, but it is just a tourniquet to stop the bleeding. It is not going to heal our broken system.
I would like to share with my colleagues a brief analysis of our medical litigation system. It comes from this book, ``Fostering Rapid Advances in Health Care, Learning From System Demonstrations,'' published by the Institute of Medicine of the National Academy of Sciences.
Let me quote a section of this book:
There is widespread agreement that the current system of
tort liability is a poor way to prevent and redress injury
resulting from medical error.
Most instances of negligence do not give rise to lawsuits,
and most legal claims do not relate to negligent care. Many
injured patients do not know they have suffered an injury
resulting from error, and those who go through the legal
process often do not even recover the cost of their continued
health care.
A few plaintiffs and their attorneys, however, win large
sums that may be disproportionate to their injuries or
unrelated to the defendant's conduct. Prolonged, adversarial
haggling over claims by plaintiffs' attorneys and liability
insurers alienates both providers and patients, and generates
legal fees and administrative expenses that consume more than
half the cost of liability insurance premiums.
The apparent randomness and delay associated with this
pattern of accountability not only prevent severely injured
patients from receiving prompt, fair compensation, but
destabilize liability insurance markets and attenuate the
signal that liability is supposed
to send health care providers regarding the need for quality
improvement. Fear and distrust breed inefficient ``defensive
medicine,'' and lead to missed opportunities for information
exchange and apology that might avoid lawsuits in the first
place.
The shortcomings of the current malpractice system
therefore come from three directions, all of which have
contributed to the present crisis: inefficient and
inequitable legal processes for resolving disputes,
problematic responses by clinicians to the threat and cost of
liability, and volatile markets for liability insurance.
Although some states face greater insurance instability than
others as the result of different legal standards, public
expectations, and professional cultures, no state is immune
to the threat of service interruptions affecting physicians,
hospitals, and other health care providers.
These are not my words. They are not the words of personal injury lawyers. They are not the words of tort reform advocates either. As I pointed out earlier, these words are from the National Academy of Sciences, specifically the Institute of Medicine. This organization was created by the Federal Government and chartered by Congress to provide unbiased and evidence-based advice on health policy.
This congressionally chartered body issued a report in 2002 that called upon the Federal Government to support demonstration projects in the States to evaluate alternatives to current medical tort litigation. In response, I have introduced a bill in the spirit of this report.
This bill, the Reliable Medical Justice Act, would authorize funding for States to create alternatives to current tort litigation. The funding would cover the costs of planning and initiating proposals based on models outlined in the bill or other innovative ideas.
My bill would require participating States and the Federal Government to work together in evaluating the results of the alternatives as compared to traditional tort litigation. This way, all States and the Federal Government could learn from new approaches.
As I speak, some States are already looking into alternatives to medical litigation as we know it. My home State of Wyoming is one of them. Another is Massachusetts, where Governor Romney is working with Harvard University on an innovative project. Another is Florida, where the Governor's task force recommended the implementation of projects along the lines of those suggested in my bill. We should encourage and support these States and others that are considering similar ideas.
Believe it or not, both Newt Gingrich and the editors of the New York Times have endorsed the idea of creating and evaluating alternatives to medical litigation. If Newt Gingrich and the New York Times are in the same tent on an issue, maybe there is room in that tent for most of my fellow Senators to support it as well.
I support the Gregg-Ensign bill. It provides some short-term relief for mothers and babies and their doctors. A lot of my colleagues will be voting with me, and a lot will probably vote against me. Regardless of how we vote on this legislation before us, we must acknowledge there is a medical liability crisis, and we must work together to find a solution.
Our medical litigation system is failing us. Medical lawsuits are supposed to compensate people fairly and deter future errors. But most patients do not get fair and timely compensation, and there is nothing to show the lawsuits are deterring medical errors or making patients safer.
I hope my colleagues will vote in favor of providing mothers, babies, and their doctors with some immediate relief through the Gregg-Ensign bill. I also hope they will look seriously at my legislation, S. 1518, which would put us on the road to replacing medical lawsuits with better and fairer systems for compensating and protecting patients. We need to pass both of these bills before we can say we have begun to solve this medical liability crisis.
I thank the Chair and yield the floor.