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Published: Sunday, 1/9/2005

Disciplining the docs

As President Bush focuses attention on the medical malpractice insurance crisis, a White House advisory panel has come up with some sound advice: More effective policing of incompetent physicians by state medical boards would reduce the kind of negligence that leads to malpractice lawsuits.

Removing the "worst performers" from medical practice would cut malpractice suits, says Randall R. Bovbjerg, a researcher for the Urban Institute, which studied the problem for the presidential commission.

"Most doctors have few or no claims filed against them," Mr. Bovbjerg told the New York Times. "But within any specialty, a few doctors have a high proportion of the claims."

That is precisely the case in Massachusetts, where, over the past 10 years, 98 doctors - just one-fourth of 1 percent of 37,369 physicians in practice - accounted for more than 13 percent of payments in malpractice cases.

Instead of simply reacting to complaints, the Massachusetts Board of Registration in Medicine has taken an active approach. It launches a clinical review of any doctor who has made three or more payments to settle malpractice claims.

"Three is the magic number," said Nancy Audesse, the board's executive director. "Doctors who have to make three or more payments are also more likely to be named in consumer complaints and to be subject to discipline by hospitals and the medical board."

Tossing out the bad apples in the medical profession would be harder than it sounds, however. State medical boards as a rule don't have the staff or budget to adequately pursue every serious case, which sometimes take years to prosecute.

One reason is that physicians, like other professionals, traditionally have been reluctant to speak out against one of their own. It's a tradition that will have to change but, even so, experts point out that disciplining doctors based on a claim of incompetence has proven exceedingly difficult.

Another problem that bears on the malpractice crisis and deserves more attention is the prevalence of medical errors which, according to a study by the federal Institute of Medicine cause the deaths each year of at least 44,000 Americans and maybe as many as 98,000. Even assuming the lower estimate, that would be more deaths than the toll in recent years from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516).

While we agree with Mr. Bush that frivolous lawsuits are a major contributor to the malpractice insurance crisis, it is also evident that fewer mistakes by medical practitioners would mean less costly litigation.



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