Tort reform laws have little if any impact on the intensity of medical treatments in emergency rooms, according to a study recently published in the New England Journal of Medicine.
The level of diagnostic testing, rate of admissions, and average charges for medical treatments did not decline as a result of tort reform legislation. It was designed to make it more difficult for injured patients to prove medical malpractice.
Proponents of tort reform argue that medical professionals practice “defensive” medicine in the absence of restrictions on medical malpractice lawsuits. Defensive medicine involves ordering diagnostic tests or treatments to protect against potential professional liability claims, even when the tests may not be necessary or the best options for the patient. Physicians practicing defensive medicine also avoid treating high-risk cases. Tort reform advocates claim emergency room departments are a prime setting for defensive medical practices.
Placing caps on damages and making it harder to prove medical malpractice will purportedly reduce the practice of defensive medicine and lead to huge sums of medical care savings, claim tort reform advocates.
Study of Effects of Malpractice Reform on Emergency Room Care
However, results of the study in the New England Journal of Medicine do not support tort reform as a means of reducing defensive medicine.
The study examined three states (Texas, Georgia and South Carolina) that enacted legislation changing the medical malpractice standard to “gross negligence” (a higher burden of proof for claimants). Neighboring states were also investigated for control purposes. The purpose of the study was to assess what affect the tort reform laws had on medical practice in emergency rooms.
Data from the Study
The study monitored emergency department visits from 1997 through 2011 in the three reform states and neighboring control states. Among other factors, the study assessed CT scans, MRIs, charges per visit, and hospital admissions, both before and after legislation was enacted.
In eight of the nine states studied, the intensity of medical care and treatments did not decline following passage of the laws designed to make it harder to prove medical malpractice by ER medical professionals.
The use of CT scans or MRIs did not decrease in any of the three reform states, and emergency room charges in South Carolina or Texas did not decline. Georgia showed only a 3.6 percent reduction in per-visit charges.
The study concluded that substantial changes in the legal standard of practice brought about through legislation had little effect on the intensity of practice by emergency room physicians in Texas, Georgia, and South Carolina.
State-by-State Comparison of Medical Malpractice Laws
A recent article in Emergency Physicians Monthly compares medical liability laws and culture in all 50 states. As discussed in this article, written by an ER physician in Texas, questions remain about malpractice reform in Texas. Yet to be determined is whether the system works for patients, whether the new laws have reduced defensive medicine and healthcare costs, and whether genuine medical malpractice victims receive the compensation they deserve.
Indiana made a favorable showing in the state-by-state comparison. In the author’s experience, risk tolerance was high among emergency room physicians (low incidence of defensive medicine), and medical malpractice claims without merit “died” in the Medical Review Panel, which is the hallmark of Indiana’s tort reform package.
Medical Liability Laws in Indiana
Indiana law imposes a $250,000 cap on the damages a patient can recover from a healthcare provider for medical malpractice. However, a patient whose damages exceed the cap may recover an additional amount of up to $1 million from the Indiana Patient’s Compensation Fund.
The state has operated the fund since 1975 as part of the Indiana Medical Malpractice Act. The purpose of the fund is to keep medical malpractice insurance premiums down for physicians and to guarantee that victims of medical malpractice can recover the money they need for their injuries.
- New England Journal of Medicine. “The Effect of Malpractice Reform on Emergency Department Care.”
- Emergency Physicians Monthly. “The Medical Malpractice Rundown: A State-by-State Report Card.”