February 7, 2011 Malpractice reform rests on thin evidence The Register's editorial

Washington lawmakers who advocate for medical malpractice reform assume they know what goes on in doctors' offices. They say physicians order unnecessary tests because they fear being sued. So-called "defensive medicine" drives up health spending, the argument goes. They don't acknowledge many doctors order tests because they're trying to do a thorough job with patients. They rarely mention too much testing is a result of this country's "fee for service" system of paying doctors. The more care they provide, the more they bill. Yet proponents of tort reform continue to call for changes in the law - usually caps on the amount of money in non-economic damages patients can collect in a malpractice lawsuits. Even if that did drive down the price of insurance for doctors, that doesn't mean the savings would be passed on to consumers. It wouldn't automatically lead to reduced health costs. Proponents of malpractice reform make a huge assumption: Doctors would order fewer medical tests if patients could receive only a limited amount of money in a potential lawsuit. That assumption isn't necessarily true, according to a study from the University of Iowa. Published in the journal Health Affairs, researchers found that reducing malpractice costs doesn't make doctors less concerned about being sued. It also doesn't necessarily result in them ordering fewer tests. "Overall, the study suggests that current tort reform efforts aimed at reducing malpractice risk would be relatively ineffective in alleviating physicians' concern about lawsuits and therefore may not alter defensive medicine practices," according to information from the University of Iowa. This rings true with discussions the Register's editorial page staff has had with Iowa doctors over the years. The most memorable was a 2009 conversation with Dr. Thomas Carlstrom, a Des Moines neurosurgeon. An advocate of both tort reform and a single-payer health care system, he said in one day he ordered about $10,000 worth of what he calls "CYA" tests - an acronym for "Cover You're A-" medicine. These included MRIs, CAT scans and lab work he said were not medically necessary, but needed to prove he did his job in case he was ever sued. Yet, he also told us he didn't think he'd change how he works if someone could collect a limited amount of money in a lawsuit. "I doubt it. You're talking to a 63-year-old," he said at the time. "I don't think I'd ever change." And when we checked with him again recently, he hadn't changed his mind, but offered a reminder that "malpractice and civil litigation remain a big problem." Yet critics of the new health reform law continue to point to malpractice reform as a way to lower health care costs in this country. It is part of the Republican "repeal and replace" mantra directed at striking down the new health reform law. But there's little evidence it would have any impact on reducing costs - or, just as important, getting millions of Americans health insurance.