Credit: CDC
Making it more difficult for patients to sue physicians for medical malpractice may not reduce the amount of “defensive medicine” physicians
practice, new research suggests.
Investigators studied patient records in 3 states that raised the standard for malpractice in the emergency room to gross negligence.
And they found that strong new legal protections did not significantly reduce the use of common defensive medicine practices or the cost of care.
The team detailed these findings in NEJM.
“Our findings suggest that malpractice reform may have less effect on costs than has been projected by conventional wisdom,” said lead study author Daniel A. Waxman, MD, PhD, of RAND Health in Santa Monica, California.
“Physicians say they order unnecessary tests strictly out of fear of being sued, but our results suggest the story is more complicated.”
The investigators evaluated the results of malpractice reform in 3 states—Georgia, Texas, and South Carolina.
About a decade ago, these states changed the legal malpractice standard for emergency care to gross negligence. The higher standard means plaintiffs must prove that doctors consciously disregarded the need to use reasonable care, knowing full well that their actions were likely to cause serious injury.
“These malpractice reforms have been said to provide virtual immunity against lawsuits,” Dr Waxman noted.
He and his colleagues examined 3.8 million Medicare patient records from 1166 hospital emergency departments spanning the period from 1997 to 2011. They compared care in the 3 reform states, before and after the statutes took effect, to care in neighboring states that did not pass malpractice reform.
The team assessed whether physicians ordered an advanced imaging study (CT or MRI scan), whether the patient was hospitalized after the emergency visit, and total charges for the visit.
Advanced imaging and hospitalization are among the most costly consequences of an emergency room visit, and physicians have identified them as common defensive medicine practices.
The malpractice reform laws had no effect on the use of imaging or the rate of hospitalization following emergency visits.
For 2 of the states, Texas and South Carolina, the law did not appear to cause any reduction in charges. Relative to neighboring states, Georgia saw a drop of 3.6% in average emergency room charges following its 2005 reform.
“This study suggests that, even when the risk of being sued for malpractice decreases, the path of least resistance still may favor resource-intensive care, at least in hospital emergency departments,” Dr Waxman said.
