Below is a proposal for dealing with adverse medical outcomes (injuries) that a doctor practicing in North Carolina emailed me. S/he wanted to remain anonymous.
Basically this proposal has two steps. The first is determining injury and what is needed to compensate for that. The second is determining whether the doctor was negligent. Obviously the details are important. One part that seemed interesting to me is the notion that providers would pay premiums for two things: (1) injury; and (2) malpractice. Thus, errors, mistakes and general quality problems would be everyone's problem as all such bad outcomes would influence everyone's premium (would it differentiate by speciality?; or would it also be funded by insurance premium tax?). The malpractice portion could presumably be aggressively underwritten.
Just one person's proposal that I thought was interesting. What do you think?
Adverse Medical Outcomes Reform
February 11, 2007
1. The First phase is used to determine if a compensation payment will be made to the patient or family.
2. Plaintiff lawyer reviews complaints and documentation and prepares summary statement
3. Defense lawyer reviews provider replies and documentation and prepares summary statement.
4. Establish Health Care Outcomes Review Boards
a. National standards and guidelines
b. Boards divided by states, regions … etc.
c. Boards headed by medical director(s) may be paid and full time or part time. All given national standards/guidelines education.
d. Board divided into Specialty Review Sections manned by appropriately trained health care providers. May also include appropriately trained lawyers and laypeople.
e. All actively licensed and practicing physicians may be required to participate and rotate through review sections. Well trained retired or semi-retired providers will also be considered for rotation. Will be paid.
f. Boards funded by premiums and fees/fines.
g. Funding pool(s) established nationally or by large regions to spread risk.
5. Medical directors or trained others will read/review summary statements and decide if case moves to review sections. May ask for and review additional information.
6. Review sections examine all pertinent/appropriate redacted medical records and other pertinent information. Patient and provider identity is never revealed. May request additional anonymous information from provider, patient, family, medical experts only through plaintiff or defense lawyers. All information/evidence provided under oath.
7. All outcomes considered accident or poor outcome for determination of compensation.
8. Results of Review Section analyzed and approved by medical director.
9. If Board determines that there was a true bad outcome for any reason and that the patient/family accumulated significant personal expenses related to the above and/or that the patient will have a significant ongoing disability which will require continuing care and/or the patient does not have the ability to earn a livelihood comparable to the pre-outcomes level, then the board may award a payment based on:
a. Actual expenses incurred because of the bad outcome. May not receive a reward for expenses paid by any other source such as health insurance, life/disability insurance, government payments… etc.
b. Continuing expenses incurred which are not covered by any other sources such as health insurance, life/disability insurance payments, workers compensation payments… etc.
c. Loss of reasonable lifestyle monies due to lack of the ability to work and produce an income because of the injury. This means the money required to live according to the pre-disability lifestyle or a lifestyle which provides for the necessities of life and a reasonable level of comfort, whichever if less. The system can’t afford to provide extravagant lifestyles even to those who lived or expected to live this lifestyle. Those who lived this lifestyle or who expected to live it probably/hopefully had significant disability insurance anyway.
d. Additional money may be awarded for pain and suffering, but this amount must be very reasonable and minimal for the system to work.
10. Lawyers will be paid by a national or regional formula only for work done.
11. Plaintiff lawyer still paid some amount even if the summary case does not move to the level of review. This lawyer may be paid more if the case does move on.
12. Defense lawyer paid for summary statement and for additional time if required.
13. The Second phase is for health care provider status determination. This can be done by the same review board (preferred), another board with or without input from medical director. Provider identity still remains anonymous.
14. This second separate phase will determine for the provider:
a. No consequence and no negligence by the provider
b. Negligence by the provider resulting in:
i. Retraining, mentoring, other skills improving
ii. Loss of license
iii. Limitations of license
iv. Penalties and fines
15. All monies paid go back into the national or regional income pool
16. Providers will pay two premiums
a. To national or regional review boards to cover patient compensation payments
b. To private malpractice insurers to cover legal costs, penalties and fines.
XXXXXXXX, MD 2/11/2007