Keep patients safe to reduce health costs (Times Union)
By Nicholas I. Timko
Published: 01:00 a.m., Monday, October 4, 2010
Lt. Gov. Richard Ravitch may have experience bean counting — evidenced by his recent proposals to manage Medicaid spending — but some of his proposals show how out of touch he is with the struggles of ordinary New Yorkers.
Virtually no one disputes that Medicaid spending must be controlled to ensure New York’s fiscal stability. And increased prevention efforts to curb substance abuse and obesity, which are among his suggestions, make sense. But Ravitch’s proposals to reduce incentives for improving patient safety and leave the families of innocent victims partially uncompensated for their doctors’ harmful errors are counterproductive.
Ravitch, who elsewhere has championed accountability, exaggerates the savings from limiting medical malpractice damages, displacing the civil justice system with a new unfunded entitlement for brain-damaged infants and vague and unproven specialized courts. At the same time, he ignores the implications of not holding providers responsible for their mistakes.
Most significantly, Ravitch has not proposed specific solutions for reducing occurrences of malpractice itself — 200,000 deaths annually are caused by avoidable medical mistakes, according to the Institute for Healthcare Improvement.
Studies have repeatedly concluded that Ravitch-style limitations have little effect on health care costs, while significantly impacting the families of those who have been hurt. Beyond being ineffective and unjust, some courts have found these proposals unconstitutional. Moreover, these proposals fail to reduce the risk that patients going into the hospital may get hurt there.
Pilot projects have shown substantial savings when health professionals take common-sense steps to prevent medical mistakes. Some doctors are delivering this message — instead of blaming the legal system for the profession’s woes.
Dr. Atul Gawande’s best-selling book, “The Checklist Manifesto,” details how common sense tools have reduced infection rates from intravenous lines to nearly zero in some hospitals. Hundreds of lives have been saved because nurses used checklists and reminded doctors to wash their hands and take other simple precautions.
Two Capital Region physicians, Dr. Arnold Ritterband of Albany Medical College and Dr. Roger Barrowman of Ellis Medicine in Schenectady, are urging colleagues to attend mini refresher courses to reduce mistakes in the emergency room. Physicians taking this course in Massachusetts reported almost 50 percent lower malpractice payouts than those who did not. Such courses should be made available to doctors statewide.
Ritterbrand told the Times Union this summer, “We are not going to the Legislature and saying cap malpractice verdicts. What we are saying is this is what physicians can and ought to be do(ing) to help.”
For decades, anesthesiologists have taken responsibility for reducing errors in their practice. By generating data that led to new standards of practice, error rates were reduced nearly seven-fold.
Insurers, too, benefit from these initiatives. ProMutual Group in Massachusetts offers a 20 percent discount to doctors who take the type of short training program that Ritterband and Barrowman are creating in the Capital Region. Insurers should be encouraged to take responsibility for incentivizing patient safety.
Sadly, other efforts to make health care safer, like better policing of bad doctors, are faltering. According to NYPIRG, a small minority of doctors are responsible for the lion’s share of malpractice payments — and the number of doctors sanctioned by the state has declined to a 15-year low, despite substantial increases in physicians practicing and in complaints.
Finally, Ravitch’s medical malpractice proposals, while ostensibly intended to save money for Medicaid, will just shift costs around, leaving the public to pay some of these costs of medical malpractice through public benefit programs when the courthouse doors are shut on the injured. Ravitch fails to acknowledge that malpractice victims recoup millions of dollars annually for Medicaid, reimbursing the state for costs due solely to negligent medical care.
A comprehensive program of patient safety must be the cornerstone of any real program to control health care costs.
Nicholas I. Timko of Brooklyn is president of the New York State Trial Lawyers Association.