Medical courts could ease US malpractice crisis, group says
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《英国医生杂志》
Researchers at the Harvard School of Public Health and the charity Common Good, which is based in Washington, DC, and campaigns for legal reform, have been awarded grants totalling almost $1.5m (?.8m; �1.2m) by the Robert Wood Johnson Foundation to design a medical court system that would replace jurors with expert panellists.
The move stems from the malpractice litigation crisis in the United States, which has led to controversy as some doctors have closed their practices, leaving areas of the country without obstetricians, orthopaedists, or neurosurgeons. It has also led a coalition of medical and health policy experts and the US Senate majority leader, Dr Bill Frist, to propose the creation of medical courts.
"The current system is not only very, very costly—it抯 capricious," said Dr William Roper, dean of the School of Medicine at the University of North Carolina at Chapel Hill, who endorses Common Good. "Some people who are harmed get a lot , while others get nothing."
The coalition cites studies by the Harvard School of Public Health showing a malpractice "mismatch," meaning that most patients injured through doctors?negligence never sue, while often when patients do sue no negligence is ever found. The coalition states that specialised medical courts could provide fairer decisions in roughly half the time taken by jury trials.
Quicker decisions would protect "good doctors, unfairly charged," who live "for years under threat of personal ruin," and would "clarify standards of proper care" and "provide incentives for doctors to keep up with the latest developments in medicine," according to statements issued by Common Good.
Other advantages cited by the coalition include reduction of legal fees and the creation of a body of evidence that can "set precedent" for appropriate medical care. Patients would receive automatic payment according to a predetermined reimbursement schedule of injuries once a preventable injury was verified. They would also be reimbursed for all medical costs and lost income.
But some critics say that medical courts pose problems of their own. Catherine Struve, assistant professor at the University of Pennsylvania Law School, said that specialised courts could be particularly vulnerable to politicisation. "In highly contested state court elections, have increasingly been asked to reveal their beliefs," said Ms Struve, adding that powerful groups with an interest in malpractice decisions would be far more able to focus their efforts on judges who hear malpractice cases.
Some of the changes recommended by the coalition, such as the use of neutral experts and standardised awards, could be incorporated into the current court system, said Ms Struve. She added that another drawback is that patients may have to travel long distances to reach a special medical court.
The coalition抯 recommendation to replace jurors with medical experts has caused concern among other critics, who say it could tilt the balance to decisions that favour doctors rather than patients.
However, David Studdert, associate professor at the Harvard School of Public Health and one of the project researchers, said, "The bias charge just depends on the details. The current system is already driven by experts on both sides of the cases and they tend to be very partisan voices. The goal for a court is to ensure a truly expert and independent group is involved in answering the medical and scientific questions. For other questions, you抎 want other perspectives."(New York Jeanne Lenzer)
The move stems from the malpractice litigation crisis in the United States, which has led to controversy as some doctors have closed their practices, leaving areas of the country without obstetricians, orthopaedists, or neurosurgeons. It has also led a coalition of medical and health policy experts and the US Senate majority leader, Dr Bill Frist, to propose the creation of medical courts.
"The current system is not only very, very costly—it抯 capricious," said Dr William Roper, dean of the School of Medicine at the University of North Carolina at Chapel Hill, who endorses Common Good. "Some people who are harmed get a lot , while others get nothing."
The coalition cites studies by the Harvard School of Public Health showing a malpractice "mismatch," meaning that most patients injured through doctors?negligence never sue, while often when patients do sue no negligence is ever found. The coalition states that specialised medical courts could provide fairer decisions in roughly half the time taken by jury trials.
Quicker decisions would protect "good doctors, unfairly charged," who live "for years under threat of personal ruin," and would "clarify standards of proper care" and "provide incentives for doctors to keep up with the latest developments in medicine," according to statements issued by Common Good.
Other advantages cited by the coalition include reduction of legal fees and the creation of a body of evidence that can "set precedent" for appropriate medical care. Patients would receive automatic payment according to a predetermined reimbursement schedule of injuries once a preventable injury was verified. They would also be reimbursed for all medical costs and lost income.
But some critics say that medical courts pose problems of their own. Catherine Struve, assistant professor at the University of Pennsylvania Law School, said that specialised courts could be particularly vulnerable to politicisation. "In highly contested state court elections, have increasingly been asked to reveal their beliefs," said Ms Struve, adding that powerful groups with an interest in malpractice decisions would be far more able to focus their efforts on judges who hear malpractice cases.
Some of the changes recommended by the coalition, such as the use of neutral experts and standardised awards, could be incorporated into the current court system, said Ms Struve. She added that another drawback is that patients may have to travel long distances to reach a special medical court.
The coalition抯 recommendation to replace jurors with medical experts has caused concern among other critics, who say it could tilt the balance to decisions that favour doctors rather than patients.
However, David Studdert, associate professor at the Harvard School of Public Health and one of the project researchers, said, "The bias charge just depends on the details. The current system is already driven by experts on both sides of the cases and they tend to be very partisan voices. The goal for a court is to ensure a truly expert and independent group is involved in answering the medical and scientific questions. For other questions, you抎 want other perspectives."(New York Jeanne Lenzer)