It is not just ironic but potentially dangerous that Peter Orszag argues that following clinical guidelines should immunize doctors from malpractice liability.

Two days earlier, The Times reported on a new study finding that similar standards were inadequate to prevent catastrophic medical errors ("Surgical Errors Continue Despite Protocols," Vital Signs, Science Times, Oct. 19).

It may be appropriate to set clinical guidelines as a floor for medical care, but allowing guidelines to provide immunity for severe medical mistakes may instead make them a ceiling.

If that happens, patients - 100,000 or more of whom now die each year because of medical errors - would suffer.

Tragically, more incentives remain necessary to focus the health care professions on improving quality and minimizing mistakes.

But those incentives should come from payment reform, access to better information technology and meaningful disciplinary procedures - not from allowing doctors to escape responsibility for avoidable mistakes by simply meeting the lowest common denominator of care.

Nicholas I. Timko
President, New York State
Trial Lawyers Association
New York, Oct. 21, 2010