Physician leaders are voicing support for a proposed federal law that aims to reduce litigation against doctors, lower health care costs, and establish more fairness in the analyzing of malpractice claims. The Saving Lives, Saving Costs Act, introduced in March by Rep. Dr. Ami Bera, (D-CA), would provide safe harbor protection to doctors who are sued if they followed evidence-based clinical guidelines.
"The Bera/Barr bill would accomplish two very important things," said Dr. John C. Jennings, president of the American Congress of Obstetricians and Gynecologists and professor of obstetrics and gynecology at Texas Tech University Health Sciences Center at the Permian Basin. "First, it would provide an incentive for every physician to follow the best clinical guidelines developed by his or her specialty, reducing care variations and potentially increasing patient safety and quality of care. Second, it would provide an affirmative defense for physicians who have followed their specialties’ guidelines and find themselves in the middle of a malpractice suit."
Rep. Ami Bera (D-Ca.)
Under the bill, clinical guidelines developed by professional medical organizations would be used to determine whether a plaintiff’s lawsuit could continue against a physician defendant. If a doctor adhered to the approved guidelines during the time of the alleged malpractice event, the case would be removed from court proceedings, while a medical review panel investigated the claim. The bill would also allow for relevant cases to be moved from state to federal court if they involved federal dollars such as Medicare.The bill was referred to the Subcommittee on the Constitution and Civil Justice on March 20 for review.
Dr. Bera declined to comment for this article. In a statement, he said the measure is a practical way to decrease the skyrocketing cost of health care and to ensure the malpractice system works better for patients and physicians.
"As a doctor, I know that physicians want to do what’s best for their patients, and promoting evidence-based medicine will help us do that," he said.
Dr. John C. Jennings
The proposed safe harbor measure is a beneficial initiative that would potentially have a positive impact on multiple aspects of the health care system, adds Dr. David A. Fleming, president-elect of the American College of Physicians and chair of the department of medicine for the University of Missouri–Columbia.
"I think anything that standardized a patient-centered and evidence-based approach to care will serve only to improve clinical outcomes and decrease health care costs, as well as decrease liability costs at every level," Dr. Fleming said in an interview. "Encouraging the use of generally accepted and evidence-based clinical guidelines, as promoted by the Saving Lives, Saving Costs federal bill, is a good way to reach that."
Dr. Fleming noted an ACP position paper published in April that discusses the medical liability crisis physicians continue to face and outlines innovative solutions for a better malpractice environment. "Medical Liability Reform – Innovative Solutions for New Health Care System," also provides an update on state-based medical liability activities and summarizes traditional and newer tort reform proposals.
The paper highlights the positive effect of such state reforms as caps on noneconomic damages, injury funds, stronger expert witness rules, and alternative dispute resolution initiatives such as apology, disclosure, and compensation programs. The report provides nine approaches that should be incorporated into a multifaceted medical malpractice reform initiative, including passage of a comprehensive tort reform package, oversight of medical liability insurers, and development of effective safe harbor protections that improve quality of care, increase efficiency, and reduce costs.
As for federal reform, Dr. Fleming said legislation at the congressional level often faces successful challenges by trial attorneys and advocacy groups that argue plaintiffs’ rights would be violated. The politicization of the issue is also a problem, he said. However, federal tort reform is still possible and physicians should keep advocating significant changes by Congress, he said.
"The litigious environment in which we live continues to contribute to a sense of fear and consternation by practicing physicians that affects how they relate to patients and undoubtedly adds to health care costs," Dr. Fleming said.
Along with the Saving Lives, Saving Costs bills, doctors are closely watching several other federal malpractice reform measures under review. For instance, the Health Care Safety Net Enhancement Act would help ensure that physicians furnishing medical services, pursuant to the Emergency Medical Treatment & Active Labor Act (EMTALA), receive the same liability coverage currently extended to health professionals who provide Medicaid services at free clinics. The bill has been referred to the Subcommittee on Health.