Public Citizen completed a study on Arkansas medical misdiagnosis
Public Citizen completed a study on Arkansas medical misdiagnosis and released an executive summary on January 27, 2003. The highlights of the Public Citizen Arkansas medical malpractice report, as taken from Public Citizen's web site, include:
The cost of medical negligence to Arkansas' patients and consumers is considerable, especially when measured against the cost of malpractice insurance to Arkansas' doctors. Extrapolating from Institute of Medicine findings, we estimate that medical errors cause 418 to 931 preventable deaths in Arkansas each year. The cost resulting from preventable medical errors to Arkansas' residents, families, and communities is estimated at $161 million to $275 million each year. But the cost of medical malpractice insurance to Arkansas' doctors is less than $40 million a year.
Arkansas doctor's liability premiums are among the lowest in the nation. Malpractice insurance premiums in Arkansas are some of the lowest in all 50 states and the District of Columbia, according to data collected by Medical Liability Monitor. The median premium for a general surgeon practicing in Arkansas in 2002 was $16,400 - about the same amount paid by general surgeons in North Dakota or South Dakota, and higher than those in only four other states.
Government data shows that large malpractice award payments have been the rare exception in Arkansas. According to the federal government's National Practitioner Data Bank (NPDB), Arkansas physicians made only two multi-million dollar award payments between 1998 and 2001. The largest was only $2,550,000. The number of large (more than $100,000) malpractice payments in Arkansas remained constant over the past four years, and so has the total amount of malpractice payments - declining from $15.8 million in 1998 to $15.1 million in 2001. Adjusting for inflation, this steady level of awards represents a significant decline in dollar value.
Government data show that malpractice payments in Arkansas have increased at a slower pace than national medical costs. According to the National Practitioner Data Bank, the median medical malpractice payment by an Arkansas physician to a patient rose 48.6 percent between 1992 and 2002, or less than 5 percent a year. However, during those same years, medical costs increased by 53.7 percent nationally, or 5.4 percent a year. (Medical costs typically represent the lion's share of most malpractice awards.) Moreover, between 1999 and 2002, the median malpractice payment by an Arkansas physician actually dropped by more than 10 percent.
Arkansas' cumulative median malpractice payment has remained less than the national average. Among the 50 states and the District of Columbia, Arkansas historically has ranked below the national average for the median malpractice payment by a physician to a patient. According to the NPDB, the cumulative median malpractice payment from 1991 to 2001 was $90,000 in Arkansas - compared with $100,000 nationally for the same period.
The number of Arkansas malpractice lawsuits filed in 2002 was less than in the preceding years. In each of the past two years, which was the height of the insurance "crisis," the number of malpractice lawsuits filed in the state decreased. In 2002, 371 malpractice cases were filed in Arkansas, compared with 383 in 2001, and 413 in 2000. Overall, this represented a 10 percent decrease in lawsuits filed.
Doctors diagnose a crisis where the Chamber of Commerce sees none. The American Medical Association added to a false sense of crisis when it included Arkansas on a list of states showing "problem signs" with their medical liability systems. On the same list, however, the AMA included Delaware and Virginia - states that the U.S. Chamber of Commerce ranks first and second among states with the best liability systems.
The number of doctors in Arkansas has been increasing. Despite gloomy forecasts issued by those declaring a malpractice "crisis" in the state, the Arkansas State Medical Board reports that from 1998 to 2002 the state experienced an increase of 209 doctors, an average of 52 additional doctors each year. In 1995, Arkansas had 192 doctors for each 100,000 citizens. By 2001, the ratio was 212 per 100,000, an improvement of 10.4 percent.
"Repeat offender" physicians are responsible for the bulk of malpractice costs. According to the federal government's National Practitioner Data Bank, which covers malpractice judgments and settlements since September 1990, 2.6 percent of Arkansas' doctors have made two or more malpractice payments to patients. These repeat offender doctors are responsible for 43.7 percent of all payments. Overall, they have paid out $48.9 million in damages. Even more surprising, less than 1 percent of Arkansas' doctors, each of whom has paid three or more malpractice claims, are responsible for 20.3 percent of all payments.
Repeat offender doctors suffer few consequences in Arkansas. The Arkansas state government and the state's health-care providers have done little to rein in those doctors who repeatedly commit negligence. According to the National Practitioner Data Bank and Public Citizen's analysis of NPDB data, disciplinary actions have been few and far between for Arkansas physicians. Of the 153 physicians in Arkansas who have made two or more payments to patients for malpractice since 1990, only 15 have been disciplined by the Arkansas State Board of Medicine - that is fewer than one out of 10. Moreover, only 14 percent of those doctors who made three or more malpractice payments were disciplined by the Board. A brief description of eight repeat offender doctors is contained in the body of this report.
Where's the doctor watchdog? The Arkansas State Board of Medicine is dangerously lenient with doctors, repeatedly letting serious and sometimes repeat offenders off the hook. In 2001, only 24 doctors in Arkansas had serious sanctions levied against them. Arkansas took 4.18 serious actions per 1,000 doctors - slightly better than the national average, but only half as good as the best performing states and not nearly high enough to prevent bad doctors from practicing. Further, Arkansas is one of 10 states that provides no public information about doctors disciplined by their licensing boards.
The spike in medical liability premiums was caused by the insurance cycle, not by "skyrocketing" malpractice awards. J. Robert Hunter, one of the country's most knowledgeable insurance actuaries and director of insurance for the Consumer Federation of America, recently analyzed the growth in medical liability premiums. He found that amounts charged for premiums do not track losses paid, but instead rise and fall in concert with the state of the economy. When the economy booms and investment returns are high, companies maintain premiums at modest levels; however, when the economy falters and interest rates fall, companies increase premiums.
Insurer mismanagement compounded the problems. Underpriced premiums, reckless cash-flow policies, and ill-fated involvement with Enron and asbestos subsidiaries forced one major carrier, the St. Paul Companies, to stop offering malpractice insurance. The company had covered more than 40 percent of Arkansas' doctors. According to a Wall Street Journal analysis, St. Paul generated large cash reserves by raising rates during the 1980s, and then released $1.1 billion from reserves between 1992 and 1997 -dramatically boosting its bottom line. This artificial profitability attracted numerous, smaller competitors into the malpractice insurance market and led to widespread price-cutting. By the end of the 1990s, revenue from premiums no longer could cover malpractice claims, causing some companies to collapse and others, like St. Paul, to drop coverage.
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