Stricter state and federal rules for disciplining incompetent doctors and state-mandated caps on damages awarded patients for "pain and suffering" are among possible solutions to the soaring cost of medical malpractice insurance offered in a General Accounting Office report.
The report, released yesterday, was the final installment in a five-part study produced over two years. It suggests that a combination of tighter regulation of the medical profession, changes in liability laws and better consumer education could curb the rise of malpractice insurance costs, which grew from $2.5 billion in 1983 to $4.7 billion in 1985.
Increases in the number of suits filed and in the size of damages awarded have led to sharp rises in insurance premiums, particularly for obstetricians, neurosurgeons and orthopedic surgeons. The report said rates are highest in Florida, Illinois, Michigan, New York and the District of Columbia.
About 43 percent of malpractice claims closed in 1984 ended with some payment to the plaintiff, the GAO found. The median payment was $18,000. Only 5 percent of paid claims included "pain and suffering" awards of more than $100,000, but those cases accounted for 42 percent of damages paid, according to the report.
Past efforts to address the malpractice insurance crisis have been hampered by the inability of doctors, lawyers, consumers and insurance companies to agree on solutions.
"The debate up to this point . . . has been based on emotion and rhetoric, without this kind of data," said Richard Fogel, assistant comptroller general of the GAO, in presenting the report. "Logic seems to imply that some of these things should work."
Among the measures suggested by the GAO were:Enactment of a federal law to prohibit doctors who have their state licenses suspended from participating in Medicare or Medicaid. The House passed such a bill Tuesday. A similar one is pending in the Senate. Changing state laws to shorten the statute of limitations for filing malpractice suits, prevent plaintiffs from collecting twice for the same injury and reduce the share of malpractice awards paid to attorneys (contingency fees). Placing "reasonable" ceilings on the amount that could be collected for noneconomic damages, such as "pain and suffering." Several states have imposed such caps. The report said a 1986 study showed that their effect was to reduce the amount of the average paid claim by 23 percent. Allowing insurance companies to pay awards over the lifetime of the injured person, rather than in a lump sum. The report said this would ensure that money would be available to meet future medical costs and would save the companies money. Requiring doctors, as a condition of being licensed, to participate in risk-management programs, hospital-based programs designed to find deficiencies in medical care and correct them. Increasing efforts to educate consumers about the risks of medical treatment and to eliminate unrealistic expectations. Evaluation of methods of settling malpractice claims outside the court system, such as pretrial screening panels, arbitration and no-fault compensation schemes.
Rep. John Edward Porter (R-Ill.), who with Sen. John Heinz (R-Pa.), commissioned the GAO study, said he will introduce legislation to implement the agency's recommendations.