4 ms·

You mean a lynch mob that patiently waits for weeks or months while the defense lays out its side of the story? A lynch mob that abides by whatever decision a j

You mean a lynch mob that patiently waits for weeks or months while the defense lays out its side of the story? A lynch mob that abides by whatever decision a judge or jury eventually reaches, after weeks or months of testimony? That kind of lynch mob?

sliverstorm 13y ago
I mean the kind of lynch mob that extracts comically absurd recompense for errors. I'm a little busy to go digging for examples right now, but suffice to say that when a doctor has made a small mistake he does not deserve to be subsequently ruined.
- mtdewcmu 13y ago
  Patients don't deserve to be ruined, either. Risk from unfair lawsuits and misfires of civil law are something we all have to accept.
  - sliverstorm 13y ago
    Patients don't deserve to be ruined, either. Agreed Risk from unfair lawsuits and misfires of civil law are something we all have to accept. Not agreed. First of all, you give no reason why "it just has to be this way". Is there no compromise, no middle-ground? Second of all, it's awfully easy for the patient to decide the doctor should bear all the risk, eh?
    - dragonwriter 13y ago
      > Is there no compromise, no middle-ground? A civil lawsuit system with proof requirements for damages but full exposure to at least all actual damages is the middle ground (or at least one of them.) Patient bears all or disproportionate risk (as is the case with damage caps or not having a liability system at all) is an extreme, as would be doctor bears disproportionate risk (which would be the case with something less than the usual civil standard of proof, or a presumption of guilt that had to be rebutted). You can't really get "doctor bears all risk", because no matter how easy it is to punish the doctor, or how extreme the punishments are, the patient is still going to bear the risk of non-compensable injury or death from medical malpractice. > Second of all, it's awfully easy for the patient to decide the doctor should bear all the risk, eh? That's not even a possible option (much less a fair description of anything on the table), so while it might be easy for someone to decide it in the abstract, its not really relevant to the issue at hand.
      - chc 13y ago
        > A civil lawsuit system with proof requirements for damages but full exposure to at least all actual damages is the middle ground It's trickier than that. Will the prosecution pay the defense's attorney fees if the doctor wins? Because otherwise you incentivize frivolous suits meant to force the defense to settle because winning is more expensive than settling.
        dragonwriter 13y ago
        > Will the prosecution pay the defense's attorney fees if the doctor wins? Sometimes, but winning isn't enough. > Because otherwise you incentivize frivolous suits meant to force the defense to settle because winning is more expensive than settling. This assumes that "unsuccessful" is equivalent to "frivolous". The fact that this is not true (whether it comes to either initiating a suit or defending it) is why those who lose, on either side, don't automatically pay the other sides attorney's fees, while it is possible for them to be awarded such fees. Note that a strict loser-pays system disincentivizes meritorious suits that are difficult to prove, or any cases near the boundaries of whatever the formal rules are, since there it drives up the expected cost of such suits. And, if its not an obviously-biased-to-favor-the-defense system that only has strict loser-pays for the plaintiff, it also disincentives certain meritorious defenses in favor of settling, for the same reason that it disincentives certain meritorious are tough-to-categorize suits. Again, the system we have is already the middle ground (or, at least, one of the available middle grounds) between undesirable extremes.
        chc 13y ago
        > This assumes that "unsuccessful" is equivalent to "frivolous". You're going to have to explain this more, because I do not believe I was assuming that.
        dragonwriter 13y ago
        "Implies" might be better than "assumes"; what is actually incentivized (or, perhaps more accurately, not disincentivized) by the absence of a strict loser-pays system isn't "frivolous" lawsuits, per se, but lawsuits which it is less than certain will succeed, of which actually "frivolous" lawsuits are a small subset.
    - mtdewcmu 13y ago
      First of all, you give no reason why "it just has to be this way" dragonwriter said it better than me. I know just enough about law to know that it's a carefully studied problem and there are several established doctrines used in tort law. A lot of people seem to think law is made by idiots.
- anigbrowl 13y ago
  A doctor that makes a small mistake doesn't deserve to be ruined, but should have to deal with increased malpractice insurance premiums. A doctor that makes an egregious mistake may well deserve to be ruined, as does one that deliberately engages in malpractice (in this case, collusion about the diagnosis, which undercuts the entire scientific foundation of medicine). The problem is that so-called tort-referom laws protect the bad and truly incompetent actors just as much as they protect the good-but-unlucky ones. In the case we're discussing here, all the economic risk has been transferred to the patient. $250,000 is peanuts in medical expense terms, about the starting annual salary of a specialist and certainly much less than the annual salary of most surgeons or oncologists. So the doctor has perhaps 6 months salary at stake (leaving aside malpractice insurance for simplicity), whereas the patient may be facing an economic burden running into the tens of millions. A burden which you and I as taxpayers will eventually be sharing, when by rights it should have fallen on the malpractitioners, their employers, and their insurers. For those who say that the insurance costs will just get passed on to the public in the form of higher medical costs, this is not actually the case due to price elasticity. In meantime, I can only advise avoiding malpractice states in general and Texas in particular. Txas likes to boast that licensing of new doctors has gone up by 25% since the law was enacted in 2003, but Texas is still ranked 46th nationally in terms of doctor:patient ratio, with only 176 doctors per 100k people instead of the national mean of 219. [1] so it's harder to see a doctor, they can charge more, and you have no comeback if they fuck up. 1. http://abclocal.go.com/ktrk/story?section=news/state&id=9226588 http://abclocal.go.com/ktrk/story?section=news/state&id=9226...
  - sliverstorm 13y ago
    I'm not specifically supporting Texas's implementation of tort reform.
- clavalle 13y ago
  The /doctor/ is ruined? The insurance company would have to pay. Would a doctor become uninsurable because of insurance company lawyer ineptitude (if indeed they are forced into an expensive settlement for a small mistake)? Have there been huge settlements? Sure. But those settlements are usually punitive and serve as a deterrent to bad behavior for hospitals that can make hundreds of millions in profit a year. A $500K slap on the wrist would carry the same weight as a $150 traffic ticket to a member of the middle class...annoying but forgettable. Now $10m? $20m? Suddenly everyone from the Chairman on down takes an interest in preventing whatever went wrong.
  - talmand 13y ago
    Do you think the insurance company would blame the lawyer or the doctor in that case? I may not think straight but I'm willing to bet they would blame the doctor and increase the premiums. If a doctor's premiums become large enough then he is in effect uninsurable. If that doctor still has educational debt to pay? Ruined. Except those costs that hospitals incur are often passed down to other people to pay. Hospitals are not always the money-printing machine you seem to think they are. Well, some are I suppose. Of course, those increased fees by the hospital is often covered by medical insurance, which now has to increase premiums across the board to cover the increases.
    - clavalle 13y ago
      >Of course, those increased fees by the hospital is often covered by medical insurance, Insurance carriers have a lot of pull to decide how much they are willing to pay. They don't just blindly accept whatever numbers a hospital gives them. Those settlements come straight from the bottom line and are not simple to recoup.

sliverstorm 13y ago

I mean the kind of lynch mob that extracts comically absurd recompense for errors. I'm a little busy to go digging for examples right now, but suffice to say that when a doctor has made a small mistake he does not deserve to be subsequently ruined.

mtdewcmu 13y ago
Patients don't deserve to be ruined, either. Risk from unfair lawsuits and misfires of civil law are something we all have to accept.
- sliverstorm 13y ago
  Patients don't deserve to be ruined, either. Agreed Risk from unfair lawsuits and misfires of civil law are something we all have to accept. Not agreed. First of all, you give no reason why "it just has to be this way". Is there no compromise, no middle-ground? Second of all, it's awfully easy for the patient to decide the doctor should bear all the risk, eh?
  - dragonwriter 13y ago
    > Is there no compromise, no middle-ground? A civil lawsuit system with proof requirements for damages but full exposure to at least all actual damages is the middle ground (or at least one of them.) Patient bears all or disproportionate risk (as is the case with damage caps or not having a liability system at all) is an extreme, as would be doctor bears disproportionate risk (which would be the case with something less than the usual civil standard of proof, or a presumption of guilt that had to be rebutted). You can't really get "doctor bears all risk", because no matter how easy it is to punish the doctor, or how extreme the punishments are, the patient is still going to bear the risk of non-compensable injury or death from medical malpractice. > Second of all, it's awfully easy for the patient to decide the doctor should bear all the risk, eh? That's not even a possible option (much less a fair description of anything on the table), so while it might be easy for someone to decide it in the abstract, its not really relevant to the issue at hand.
    - chc 13y ago
      > A civil lawsuit system with proof requirements for damages but full exposure to at least all actual damages is the middle ground It's trickier than that. Will the prosecution pay the defense's attorney fees if the doctor wins? Because otherwise you incentivize frivolous suits meant to force the defense to settle because winning is more expensive than settling.
      - dragonwriter 13y ago
        > Will the prosecution pay the defense's attorney fees if the doctor wins? Sometimes, but winning isn't enough. > Because otherwise you incentivize frivolous suits meant to force the defense to settle because winning is more expensive than settling. This assumes that "unsuccessful" is equivalent to "frivolous". The fact that this is not true (whether it comes to either initiating a suit or defending it) is why those who lose, on either side, don't automatically pay the other sides attorney's fees, while it is possible for them to be awarded such fees. Note that a strict loser-pays system disincentivizes meritorious suits that are difficult to prove, or any cases near the boundaries of whatever the formal rules are, since there it drives up the expected cost of such suits. And, if its not an obviously-biased-to-favor-the-defense system that only has strict loser-pays for the plaintiff, it also disincentives certain meritorious defenses in favor of settling, for the same reason that it disincentives certain meritorious are tough-to-categorize suits. Again, the system we have is already the middle ground (or, at least, one of the available middle grounds) between undesirable extremes.
        chc 13y ago
        > This assumes that "unsuccessful" is equivalent to "frivolous". You're going to have to explain this more, because I do not believe I was assuming that.
        dragonwriter 13y ago
        "Implies" might be better than "assumes"; what is actually incentivized (or, perhaps more accurately, not disincentivized) by the absence of a strict loser-pays system isn't "frivolous" lawsuits, per se, but lawsuits which it is less than certain will succeed, of which actually "frivolous" lawsuits are a small subset.
  - mtdewcmu 13y ago
    First of all, you give no reason why "it just has to be this way" dragonwriter said it better than me. I know just enough about law to know that it's a carefully studied problem and there are several established doctrines used in tort law. A lot of people seem to think law is made by idiots.
anigbrowl 13y ago
A doctor that makes a small mistake doesn't deserve to be ruined, but should have to deal with increased malpractice insurance premiums. A doctor that makes an egregious mistake may well deserve to be ruined, as does one that deliberately engages in malpractice (in this case, collusion about the diagnosis, which undercuts the entire scientific foundation of medicine). The problem is that so-called tort-referom laws protect the bad and truly incompetent actors just as much as they protect the good-but-unlucky ones. In the case we're discussing here, all the economic risk has been transferred to the patient. $250,000 is peanuts in medical expense terms, about the starting annual salary of a specialist and certainly much less than the annual salary of most surgeons or oncologists. So the doctor has perhaps 6 months salary at stake (leaving aside malpractice insurance for simplicity), whereas the patient may be facing an economic burden running into the tens of millions. A burden which you and I as taxpayers will eventually be sharing, when by rights it should have fallen on the malpractitioners, their employers, and their insurers. For those who say that the insurance costs will just get passed on to the public in the form of higher medical costs, this is not actually the case due to price elasticity. In meantime, I can only advise avoiding malpractice states in general and Texas in particular. Txas likes to boast that licensing of new doctors has gone up by 25% since the law was enacted in 2003, but Texas is still ranked 46th nationally in terms of doctor:patient ratio, with only 176 doctors per 100k people instead of the national mean of 219. [1] so it's harder to see a doctor, they can charge more, and you have no comeback if they fuck up. 1. http://abclocal.go.com/ktrk/story?section=news/state&id=9226588 http://abclocal.go.com/ktrk/story?section=news/state&id=9226...
- sliverstorm 13y ago
  I'm not specifically supporting Texas's implementation of tort reform.
clavalle 13y ago
The /doctor/ is ruined? The insurance company would have to pay. Would a doctor become uninsurable because of insurance company lawyer ineptitude (if indeed they are forced into an expensive settlement for a small mistake)? Have there been huge settlements? Sure. But those settlements are usually punitive and serve as a deterrent to bad behavior for hospitals that can make hundreds of millions in profit a year. A $500K slap on the wrist would carry the same weight as a $150 traffic ticket to a member of the middle class...annoying but forgettable. Now $10m? $20m? Suddenly everyone from the Chairman on down takes an interest in preventing whatever went wrong.
- talmand 13y ago
  Do you think the insurance company would blame the lawyer or the doctor in that case? I may not think straight but I'm willing to bet they would blame the doctor and increase the premiums. If a doctor's premiums become large enough then he is in effect uninsurable. If that doctor still has educational debt to pay? Ruined. Except those costs that hospitals incur are often passed down to other people to pay. Hospitals are not always the money-printing machine you seem to think they are. Well, some are I suppose. Of course, those increased fees by the hospital is often covered by medical insurance, which now has to increase premiums across the board to cover the increases.
  - clavalle 13y ago
    >Of course, those increased fees by the hospital is often covered by medical insurance, Insurance carriers have a lot of pull to decide how much they are willing to pay. They don't just blindly accept whatever numbers a hospital gives them. Those settlements come straight from the bottom line and are not simple to recoup.