Mr. President, I ask unanimous consent that the time I use be charged against the resolution. Mr. President, today I rise to speak about the medical liability and litigation crisis in our country. This is a crisis that is preventing…
Mr. President, I ask unanimous consent that the time I use be charged against the resolution.
Mr. President, today I rise to speak about the medical liability and litigation crisis in our country.
This is a crisis that is preventing patients from accessing high- quality health care--or, in some cases, any care at all--because doctors are being driven out of practice. It is a crisis that is needlessly increasing the cost of health care for every American.
This is not the first time we have addressed this issue. As many of you will recall, we debated, and passed, medical litigation relief in the Commonsense Product Liability and Legal Reform Act back in 1995. Unfortunately, the language we passed was stripped from that bill in conference.
I am sorely disappointed that--in the ensuing eight years--we have not addressed this problem. As a result, the situation has become worse, not better; the problem has expanded, not shrunk. We must act now if we are to fix the crisis in health care delivery this has caused in many parts of our country.
I was pleased last summer when President Bush announced his desire to address this issue. I am even more pleased that the President has continued to emphasize the importance of the problem and the need for reform in speeches around the country, and in his State of the Union Address. We in the Senate welcome the President's support in this effort.
Make no mistake. We have a health care crisis in this country, one that is due in large part to litigation that is out of control. But not all Americans may be aware of just how serious are the ramifications of this crisis.
This map, with data supplied by the American Medical Association, shows the states that currently are experiencing a medical liability crisis and those that are showing signs of developing a crisis. The 18 red states are in crisis. The 27 yellow states are showing problem signs. Only five states are currently ``ok''. On a map with last year's data, only 12 states were in crisis. The problem is growing and it reaches from coast to coast.
I ask unanimous consent to have printed in the Record a July 18, 2002, Associated Press article, ``Soaring Malpractice Insurance Squeezes out Doctors, Clinics,'' that highlights some of the problems faced by patients and doctors.
The article points to the ``national problem that doctors say is obliging many of them to flee certain states or give up certain specialties--or the entire profession--because of skyrocketing insurance premiums linked to soaring jury awards.''
The article notes, as I am sure my colleagues from Nevada are acutely aware, that the University Medical Center trauma clinic in Las Vegas-- the only Level one trauma center in Nevada--closed on July 3 last year.
The 58 doctors who were associated with the trauma center had requested, but had not received, much-needed relief from soaring medical liability insurance costs.
Let me give you just one example of the havoc this wreaked. On the 4th of July, the day after the center closed, Jim Lawson could not access the Level one trauma care that he needed. Mr. Lawson was the victim of a serious traffic accident, and on that day, the closest Level one trauma center was more than an hour away by air!
Unfortunately, Mr. Lawson did not survive. The trauma center was hurriedly reopened on July 13, but with only 10-15 doctors working on a temporary basis, with limited liability. Commenting on the trauma center's closure, its director, Dr. John Fildes, stated, ``The standard of care in our community was set back 25 years.''
Mr. Lawson's family spoke at a press conference here in the Senate last week. His death was a tragedy to his family and to his community. No one knows whether Mr. Lawson could have been saved had he been treated at the nearby trauma center. But would any of us want that to happen to one of our loved ones? To be forced to bypass the nearest trauma center, and travel an hour to receive emergency care?
I certainly would not. And, the Senate should take the necessary steps to ensure that it does not happen to anyone else. But this crisis is not limited to emergency services. Ensuring the availability of adequate obstetric care is also an increasing problem.
According to the same Associated Press article, one Arizona hospital, a clinic in Oregon, and two Pennsylvania hospitals closed their obstetrics units recently. Several counties in upstate New York have no obstetricians covering night shifts.
What does that say to the expectant mother whose child comes into the world at night . . . ``There's no room at the inn''?
The crisis is particularly acute in the farming and ranching communities of rural America. Mr. President, I ask unanimous consent to print in the Record a Washington Post article from February 3, 2003, titled ``Insurance Crisis Hits Hard on Prairie; Denied Coverage, Obstetrician for 3 Wyoming Counties Ends Practice.''
Mr. President, the article describes the plight of the people of Platte County, WY, population 9000, where the only obstetrician has been forced to give up delivering babies because obstetrics liability insurance is unavailable.
The article states:
As the only ``baby doctor'' serving a three-county swath of
the . . . Wyoming prairie for the past quarter-century, (Dr.)
Woods has delivered about 2,500 infants, including almost all
the high school athletes in Wheatland, Douglas, Chugwater and
other rural communities. But this winter, Woods ended his
obstetrical practice. ``I love delivering babies,'' the
intense (56-year-old) physician said. ``I really love
delivering the babies of women I delivered a couple of
decades ago. And I know this community needs an obstetrician.
But you can't practice without (malpractice) insurance. And I
can't get coverage for deliveries any more.''
This is not news to the rural West. There is an increasing shortage in my home state of Utah as well. Studies by both the Utah Medical Association and the Utah Chapter of the American College of Obstetricians and Gynecologists underscore the problem in my state. According to the Utah Medical Association:
50.5 percent of Family Practitioners in Utah have already
given up obstetrical services or never practiced obstetrics.
Of the remaining 49.5 percent who still deliver babies, 32.7
percent say they plan to stop providing OB services within
the next decade. Most plan to stop within the next five
years.
The Utah Medical Association study also relates:
Professional liability concerns [were] given as the chief
contributing factor in the decision to discontinue
obstetrical services. Such concerns include the cost of
liability insurance premiums, the hassles and costs involved
in defending against obstetrical lawsuits and a general fear
of being sued in today's litigious environment.
Mr. President, ensuring the availability of high-quality prenatal and delivery care for pregnant women and their babies, the most vulnerable members of our society, is imperative. But these are not the only members of society who have difficulty in accessing healthcare.
According to the July 2002 Department of Health and Human Services report, ``Confronting the New Health Care Crisis: Improving Health Care Quality and Lowering Cost by Fixing our Medical Liability System,'' the indigent are finding it increasingly difficult to access care also.
The HHS report states that ``[m]any doctors cannot volunteer their services for a patient who cannot pay, and the proportion of the physicians who provide charity care at all has declined, because doctors cannot afford the required liability coverage.''
The July, 2002 report and the Department's report released this month, ``Addressing the New Health Care Crisis: Reforming the Medical Litigation System to Improve the Quality of Health Care,'' describe the economic consequences of rising insurance costs also.
While many Americans have experienced problems accessing healthcare due to excessive litigation, all Americans are paying for it. This is a national problem and one that requires a national solution.
In my letter of March 12 to Budget Committee Chairman Nickles and ranking Democrat Conrad, I emphasized the important implications of medical liability litigation on the Federal budget.
In that letter, I wrote:
The Federal Government pays directly for health care for
members of the armed forces, veterans, and patients served in
the Indian Health Service. The Federal Government provides
reimbursements for the Medicare and Medicaid programs.
According to the Department of Health and Human Services
March 3, 2003, report . . . the Federal Government spends
$33.7 billion-$56.2 billion per year for malpractice coverage
and the costs of defensive medicine. That report states,
``reasonable limits on non-economic damages would reduce the
amount of taxpayers' money the Federal Government spends by
$28.1 billion-$50.6 billion per year.''
I continued to write:
In my view, federal legislation that would decrease costly
frivolous medical liability lawsuits and limit awards for
non-economic damages is necessary, not only to ensure patient
access to health care, but to curb increasing Federal health
care costs. Because of the substantial and important
budgetary implications, particularly to the Medicare and
Medicaid programs, we request that the budget resolution
include language calling for medical liability legislation
reform.
I am pleased to report that the budget resolution we are considering today recognizes the tremendous impact of medical liability costs. In fact, the budget resolution as reported includes $11.3 billion in savings over 10 years as a result of medical liability reform, based on CBO calculations. The Medicare program alone will save $7.9 billion, while Medicaid will save $2.9 billion. The remaining savings will occur in the Federal Employee Health Benefits Program and the Department of Defense.
Medical liability litigation directly and dramatically increases health care costs for all Americans. But, skyrocketing medical litigation costs also increase health care costs indirectly by changing the way doctors practice medicine. In an effort to avoid frivolous suits, doctors often feel compelled to perform diagnostic tests that are costly and unnecessary.
This defensive medicine is wasteful, but for doctors it has unfortunately become necessary. According to a recent Harris poll, fear of being sued has led 79 percent of doctors to order more tests than are medically needed, 74 percent to refer patients to specialists more often than necessary, 51 percent to recommend invasive procedures that they thought were unnecessary, and 41 percent to prescribe more medications, including antibiotics, that they did not think were necessary.
Defensive medicine increases health care costs, but the real risk of the current medical liability system and the resulting practice of defensive medicine is that it also puts Americans at risk. Every test and every treatment poses a risk to the patient. Every unnecessary test, procedure, and treatment potentially puts a patient in harm's way. According to the Harris poll, 76 percent of the physicians are concerned that malpractice litigation has hurt their ability to provide quality care to patients.
And so, that brings us to the big question: What can we do to address this crisis? The answer is plenty. There are excellent examples of what works. The March, 2003 Department of Health and Human Services report describes how reasonable reforms in some states have reduced health care costs and improved access to quality health care. According to the report, over the last two years, in states with limits of $250,000 to $350,000 on non-economic damages, premiums have increased at an average of 18 percent compared to 45 percent in States without such limits.
California enacted the Medical Injury Compensation Reform Act, also known as MICRA, over 25 years ago in 1975. MICRA slowed the rate of increase in medical liability premiums dramatically without affecting negatively the quality of health care received by the State's residents. As a result, doctors are not leaving California. Furthermore, between 1976 and 2000, premiums increased by 167 percent in California. But, believe it or not, they increased three times as much, an incredible 505 percent, in the rest of the country. Consequently, Californians were saved billions of dollars in health care costs
and Federal taxpayers were saved billions of dollars in the Medicare and Medicaid programs.
The March, 2003 report goes on to state:
A leading study estimates that reasonable limits on non-
economic damages such as California has had in effect for 25
years, can reduce health care costs by 5-9 percent without
``substantial effects on mortality or medical
complications.'' With national health care expenditures
currently estimated to be $1.4 trillion, if this reform were
adopted nationally, it would save $70-126 billion in health
care costs per year.
I would guess that no one in this body--with perhaps the exception of our colleague from Tennessee, Dr. Bill Frist, our majority leader--is more keenly aware of the defects in this system than I. Before coming to Congress, I litigated several medical liability cases as a defense lawyer. I have seen heart-wrenching cases in which mistakes were made. But, more often, I have seen heart-wrenching cases in which mistakes were not made and doctors were forced to expend valuable time and resources defending themselves against frivolous lawsuits.
It has been estimated that 66 percent of all medical liability lawsuits brought are frivolous. They are brought by plaintiff's attorneys who seek to obtain the costs of defense, costs that approach $100,000 per case.
Let me take a moment to address the unfortunate incident that occurred recently in North Carolina. As the country is so painfully aware, Jesica Santillan, a young girl who needed a heart and lung transplant, received organs of the wrong blood type. Her death was a tragedy and our hearts go out to everyone involved.
Some are seizing on Jesica's most unfortunate death to argue that we should not proceed with medical liability reform legislation. I would argue just the opposite: Jesica's death shows the need for reform of the current system. Let me make clear that we do not know all of the facts surrounding Jesica's case. We are not the doctors, the family, the Duke personnel or their lawyers. But we do know that the current medical liability system did not prevent Jesica's death. In fact, many experts believe that the current system, by discouraging communication between doctors, nurses, and hospitals, increases the likelihood that medical errors will occur.
The recent Institute of Medicine report, ``To Err is Human'' described the impact of preventable medical errors in America's health care system. One of the report's main conclusions was that:
The majority of medical errors do not result from
individual recklessness or the actions of a particular group
this is not a ``bad apple'' problem. More commonly, errors
are caused by faulty systems, processes, and conditions that
lead people to make mistakes or fail to prevent them.
We do not know all of the facts of Jesica's case. But, we do know that more lawsuits cannot prevent medical errors from occurring. Her death should not be used by those who oppose medical litigation reform to prevent other patients from receiving access to the care they deserve. No, Jesica's death does not indicate that medical liability reform is unnecessary. If anything, cases such as this support the need for reform.
We need reform to identify better and more efficiently when malpractice has occurred and which patients should be compensated. We need reform to identify better when malpractice has not occurred. The reform that I envision would address litigation abuses in order to provide swift and appropriate compensation for malpractice victims, redress for serious problems, and ensure that medical liability costs do not prevent patients from accessing the care they need.
Jesica's death was a tragedy. But it would be a greater tragedy if we let her death prevent other little boys and girls from receiving access to the life-saving care they need. That is what is happening in many parts of America today. And that is what will continue to happen if we do not address this crisis in this Congress.
And so, we need to move ahead with legislation to improve patient safety and reduce medical errors. I agree that we need to find an appropriate way to address egregious cases. No one believes more than I that victims of malpractice should be compensated swiftly and appropriately for their losses. But that is not what is happening in our current medical legal system. Patients are forced to meander through a complicated legal system and often are awarded damages only after years of legal bickering. Juries are awarding astounding and unreasonable sums for pain and suffering. A sizable portion of those awards goes to the attorney rather than the patient. The result: Doctors cannot get insurance and patients cannot get the care they need.
As Chairmen of the HELP and Judiciary Committees, Senator Gregg and I held a joint hearing earlier this month in an attempt to identify the root causes of the crisis. We heard from a patient who experienced an adverse outcome due to a medical error. But, we also heard from a patient and a patient's wife who were victims of the current crisis, unable to find the medical care they or their loved ones desperately needed because medical liability insurance costs had driven doctors out of practice.
We heard from a lawyer who believes that insurance reform is the answer. But, in addition, we heard from the Texas State Insurance Commissioner and also from the president of Physician Insurance Association of America, representing provider-owned or operated insurance companies that provide insurance for the majority of American doctors. These gentlemen face this crisis and its consequences every day. Their data and their studies as well as those from the Department of Health and Human Services show that increasingly frequent frivolous lawsuits and skyrocketing awards are responsible for rapidly rising premiums.
Has the recent downturn in the economy and the stock market affected medical liability premiums? Possibly, but this does not appear to be a major cause of the current crisis. Insurance companies invest conservatively, primarily in bonds and State insurance commissioners monitor and regulate insurance business practices closely. Moreover, insurance companies are precluded from increasing premiums to make up for past losses.
As a matter of fact, they have to cover these losses. The country's largest medical liability insurance company, St. Paul, no longer provides this insurance. Now doctors are forming their own nonprofit corporations to handle these matters and one can imagine that they are doing their best to reduce costs.
It seems to me that the insurance reform discussed at the hearing not only misses the mark badly; it would do nothing to address the cause of the crisis and it would prevent State Insurance Commissioners from performing the job they were appointed to do. I have to say that I came away from our hearing convinced that out-of-control medical litigation is the major cause of the crisis and that we must do something to stop it.
The current medical litigation system resembles a lottery more than it does a justice system. This system harms patients in many ways and raids every American's wallet. All Americans deserve the access to care, the cost savings and the legal protections that States like California provide their residents. This problem has reached crisis proportions and it is high time that we act. The task before us is to design a system that protects both the patient and the provider. It is important that we take steps to benefit both patients and health care providers, not the trial lawyers. Or else, we are in danger of losing access to necessary healthcare.
Let's put some sense into the system by passing medical litigation improvement legislation this year that gives patients access to their doctors and enables doctors to provide high quality cost-effective medical care. I yield the floor.