How can Howard Dean say he is for the little guy? (Tort Reform)

[nothingshocksmeanymore]

Hope it gets worse?

To the Editor:

Randall Bezanson and Gilbert Cranberg detailed a situation that I hope will get far worse. As a physician, I have been frustrated for years by the reluctance of state legislatures and the United States Congress to deal with liability problems of all kinds.

I have long maintained that until the legal profession and the news media are also afflicted with the increasingly severe consequences of a tort system that benefits few people outside the legal profession, there will be no return to a fair and reasonable system of justice.

The trends toward lawyers suing one another for malpractice and toward outrageous-size punitive damages in libel cases give me hope that the crisis in our tort system may finally come to the attention of those who can make this a public issue and improve the situation for all of us who require liability insurance to do business.

HOWARD DEAN, M.D.

http://pqasb.pqarchiver.com/nytimes/115379714.html?did=115379714&FMT=ABS&FMTS=AI&desc=Hope+It+Gets+Worse

[NewYorkerfromMass]

1. "a situation that I hope will get far worse"

reminds me of something Nader said in 2000.
That Dean would ever hope any situation get "far worse" before it gets better is telling.

[HuckleB]

2. Quite easily.

Knowing that Dean comes from a rural state, he likely has noted a history of both specialists and generalists having to pack up shop because an outlandish settlement on a nearby practitioner sent malpractice rates beyond their ability to make a living. I fully understand that insurance companies are a part of the problem, as well as the court system. However, the point is there are plenty of progressive physicians, nurse practitioners, physicians assistants, nurses, physical therapists and every specialty you can think of who look at tort reform as something that will be necessary to enable practitioners to work in rural areas and serve the little guy. Whether or not you believe them to be wrong, do not doubt their hearts.

I am one of them.

[nothingshocksmeanymore]

3. Insurance reform is the only thing that has ever resulted in permanent

rate decreases in premiums. Google California's prop 105. Dean uses rhetoric in this letter that any Republican would be proud to endorse.
Not only that, he would DEFUND the Democratic party permanently by demonizing lawyers as he does in this letter.

[HuckleB]

5. I understand that this is your belief.

Unfortunately, the situation is now far too dire to see much relief with such a one-pronged solution. Tort reform is necessary, and, unfortunately, there are lawyers worthy of demonization out there. Their counterparts would do well to separate themselves, both professionally and as a public service.

A couple of pieces on the dire situation:

Does Limitless Litigation Restrict Access to Health Care?
http://www.aafp.org/x10723.xml

High Insurance Premiums Jeopardize Rural OBs.
http://www.raconline.org/newsletter/web/ss02_vol9-1.html

[QC]

16. Doctors would also do well to police themselves more effectively,

considering that a large proportion of malpractice complaints involve repeat offenders. If medical boards would get these people out of the profession, instead of protecting them, then there might be fewer successful lawsuits.

[HuckleB]

17. Do you have any studies to show that this is a huge problem?

And that this is a big part of the increase in malpractice insurance that is driving doctors in rural areas out of business?

[QC]

18. Is Public Citizen good enough for you?

At a press conference held to unveil the report, Public Citizen President Joan Claybrook also released a letter from Public Citizen to the West Virginia Board of Medicine, asking the board to investigate 20 doctors who have lost or settled five or more medical malpractice cases but who have never been disciplined. One doctor settled 40 malpractice suits in four years; another settled 36 malpractice suits in two years....

Repeat offenders are responsible for most malpractice costs in West Virginia. Doctors who paid two or more malpractice claims are responsible for 62.2 percent of all payments between September 1990 and September 2002. Just 3.5 percent of the state’s doctors (all of whom made three or more malpractice payments) are responsible for 36.5 percent of all payments, according to Public Citizen research based on the federal government’s National Practitioner Data Bank....

West Virginia has received national attention because some surgeons recently walked off the job to protest malpractice insurance rates. Contrary to what the state’s medical lobby says, though, the median amount of malpractice awards in West Virginia has remained the same – $145,000 – between 1997 and 2002. It has not increased. Adjusting for inflation, it actually represents a significant decrease. Only a handful of sizable jury verdicts have been awarded in recent years – there is no evidence of "runaway jury awards" – and the number of licensed doctors in the state is increasing, not decreasing....

Only 25.5 percent of doctors who have made five or more medical malpractice payouts between 1990 and 2002 have been disciplined by the state. Only 14.3 percent of doctors who made 10 or more payments have been disciplined.

http://www.citizen.org/pressroom/release.cfm?ID=1309

[HuckleB]

23. That's not what I asked for, is it?

That's not research, that's finding some examples and showing them without context in order to keep the philosophy pure. Sorry, you know my point, and you avoided it.

[Name removed]

25. Deleted message

Message removed by moderator. Click here to review the message board rules.

[HuckleB]

26. Who's being snotty?

Give me a break.

It makes claims. It offers no actual research into the true causes. This is anecdotal and completely out of context. I want hard stuff, with context, with specialties, with research into the whys of the cases in question. I've been around health care far too long not to know that this is necessary, if you are truly going to discuss this issue. Public Citizen isn't even touching on the real bottom lines. It is making conclusions without getting the whole story. it's the old too little information story. Now, you made the claim, now offer real proof or forget it.

Nevermind that Public Citizen can't even do this type of scratch the surface stuff right: http://philadelphia.bizjournals.com/philadelphia/stories/2003/03/31/newscolumn1.html

[QC]

27. Just as I suspected, you didn't read it.

If you had, you would see that the study examines payouts, numbers of claims, numbers of large payouts, corporate losses, overall increases in the cost of other types of insurance compared to malpractice premium increases, the number of doctors in that state before and after the alleged crisis, and some other very relevant information.

That's a detailed 28-page report, so I'm fairly certain you were not able to read it in the two or three minutes it has taken you to tap out your last few hostile and factless posts. If so, then you need to open your own chain of speed-reading schools--you could put Evelyn Woods out of business in no time!

[Name removed]

28. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Name removed]

29. Deleted message

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[Name removed]

31. Deleted message

Message removed by moderator. Click here to review the message board rules.

[QC]

34. Sorry, but when more than 75% of a post consists of additions,

that's more than just editing. That's a rewrite. And it is generally viewed with suspicion, for good reason.

But enough of that. I freely admit that I'm not a medical professional, just someone who is extremely suspicious of tort reform given who consistently advocates it (George W. Bush, the various business lobbies, the GOP, etc.). I'm willing to admit that's not an argument in itself--it's entirely possible that all of those greedy interests who are so very hostile to regular people just happen to be right this time.

So I will grant you that there has been a vast increase in malpractice payouts which has caused premiums to skyrocket.

What, then, would you recommend doing to make sure that the other problems that have contributed to the rise in premiums are addressed? By that I refer to the business practices of the insurers. Are they at fault in any way, or is this all the doing of sleazy lawyers in shiny, double-breasted suits?

Also, is there a significant problem with incompetent doctors? If so, is there anything that the profession can do to remedy the problem?

Since you clearly know this issue well, I am genuinely interested in your answers.

[HuckleB]

35. Sorry, I don't play that way.

It's called not adding additional posts. Since you didn't even get to most of those posts until the addition were made, the point of suspicion seems to be under suspicion.

As for your questions, I stated above that a multi-prong solution is necessary, including insurance reform. Studies clearly indicate that insurance company practices are a big part of the problem. However, this is a multi-faceted matter, at this point in time. As for the theory that the major problem is "incompetent doctors," I have yet to see a study that actually looks into the matter, as one of the studies I posted does, that indicates this is the issue. The truth is that one of the problems with increasing health care costs is the constant concern of malpractice suits leading to repetitive documentation, unnecessary tests, and uneven levels of care. Do I suspect that one could find some bad doctors who have found a way around the system? Sure. Do I see evidence that this is a rampant problem and a big part of the increase in malpractice costs? No, I haven't seen the evidence that shows that. I have seen evidence pointing the other way, as noted in the 1996 study in the New England Journal of Medicine. Still, as noted in one of the studies, it's not actual negligence that leads to big jury awards, but other factors. And many rural clinics have shut down after one malpractice suit, often a very questionable one, because the award was in outer space, leading to a rise in insurance that disabled the entire outfit. Not only do studies show this, but my own experience has noted this over time. At any rate, the purpose, ultimately, of the system is to improve safety for the public. It's not doing this right now. In fact, it may be doing the opposite. Change is necessary.

As for some of the pieces I offered, here are the references:

JAMA, Volume 283(13).April 5,
2000.1731-1737

N Engl J Med, Volume
342(15).April 13, 2000.1123-1125


N Engl J Med, Volume
335(26).December 26, 1996.1963-1967

And check the January 15, 2004 JAMA for a comprehensive piece on the matter.

Good day.

[HuckleB]

37. As I noted originally, I did read it.

It doesn't get into the factors that would tell us what we need to know to make such claims. It's an accounting overview. The story is much bigger. The confounding variables numerous.

[nothingshocksmeanymore]

38. Here you go

Medical Errors Reported as a
Leading Cause of Death


WASHINGTON -- According to a recent report by the Institute of Medicine, medical errors are responsible for at least 44,000 deaths each year in the United States and possibly as many as 98,000 each year.This means that more people die from medical mistakes each year than from breast cancer, highway accidents, or AIDS, the report noted.


The report entitled "To Err is Human" was released by the Institute of Medicine which is part of the National Academy of Sciences, a private organization created by Congress to advise government on scientific matters.

"These stunningly high rates of medical errors resulting in deaths, permanent disability, and unnecessary suffering are simply unacceptable in a medical system that promises to 'do no harm,'" says William Richardson, Chair of the Committee that wrote the report and President and Chief Executive Officer of the W.K. Kellogg Foundation, Battle Creek, Michigan.

According to the report, medical mistakes occur not only in hospitals but in day surgery and outpatient clinics, retail pharmacies, nursing homes, and home care. The report states that medication errors alone contribute to more than 7,000 deaths annually, exceeding those resulting from workplace injuries.

Medical malpractice is responsible for up to 98,000 deaths per year in the U.S.

http://www.freecasereview.com/InjuryLawArticles/medicalerrors.htm

[HuckleB]

41. As has been noted, extensively.

There are serious problems with those "studies." Lack of context, for one. The definition of error, for another. They have been dissected, redissected and shown to be sketches of what is wrong with journalism in this nation. Further, those studies have nothing to do with the question at hand. They tie no correlation to malpractice claims or increases in malpractice insurance.

On edit:

If you would like to look into medical error, malpractice, and such, here are some places to start. If you have a local health science university, the library there should carry most of these journals, if not in hard copy then electronically.

"Medical errors, medical negligence, and professional medical liability reform" in the May-June 2003 journal "Public Health Reports."

Also, "Layperson and physician perceptions of the malpractice system: implications for patient safety" in the July 2003 journal "Social Science and Medicine."

Also, "Medical malpractice: treating the causes instead of the symptoms," "Negligent Care and Malpractice Claiming Behavior in Utah and Colorado," and "Incidence and types of adverse events and negligent care in Utah and Colorado" in the March 2000 Journal, "Medical Care."

Also, "The challenge and cost of patient safety" in the October 2003 Journal of Pediatric Hematology/Oncology.

Also, "Excess Length of Stay, Charges, and Mortality Attributable to Medical Injuries During Hospitalization" in the October 8, 2003 issue of JAMA.

Also, "Medical errors" in the March 3, 2001 British Medical Journal.

Also, "The criminalisation of fatal medical mistakes" in the November 15, 2003 British Medical Journal.

Also, "Are clinical negligence and legal action related?" in the September 13, 2003 British Medical Journal.

Also, "Medical liability and patient safety" in the July-August 2003 Journal "Health Affairs."

Also, "Error, Blame, and the Law in Health Care—An Antipodean Perspective" in the June 17, 2003 Annals of Internal Medicine.

Also, "Tort reform isn't enough" in the May 9, 2003 journal "Medical Economics."

[Mile Hi]

4. Something to consider

[Cheswick2.0]

6. John Kerry on tort reform

John Kerry's Views on Tort Reform

John Kerry has been in the Senate longer than any of the other leading candidates, and so, along with Joe Lieberman, he has had the most opportunities to actually respond to national tort reform efforts. However, Kerry seems to have stayed on the sidelines as much as possible with regard to questions of civil justice.

Kerry voted for the 1995 Private Securities Litigation Reform Act, a Clinton-era limitation on the right to sue for federal securities fraud. The Act was passed in part because in the mid-90's, the Democratic Party was sensitive to the concerns of a new group of wealthy funders--Internet entrepreneurs who thought the class action plaintiffs' bar was unfairly targeting Silicon Valley.

Later, Kerry voted against the Common Sense Product Liability Reform Act of 1996. But that was unexceptional: Almost all of the Democratic Party (Lieberman excepted) opposed the Act.

Finally, and curiously, Kerry was absent for the vote to end the Democrats' filibuster of the Class Action Fairness Act, a major recent tort reform effort.

http://writ.corporate.findlaw.com/sebok/20040126.html

How can Kerry be for the little guy when he doesn't bother to show up and vote?

[nothingshocksmeanymore]

8. Funny, you didn't print what he had to say about Dean and here is how

he finished up with Kerry: Consumers groups appear to have a problem with some of Dean's ideas.

Kerry's website says nothing specifically about tort reform. But he does, in an oblique way, suggest that he wants to see more federal civil litigation in one area--RICO, the Racketeering-Influenced Corrupt Organizations Act. (RICO was enacted to address organized crime, but by its language may reach a number of different kinds of patterns of conduct involving criminal activity.) Kerry, who was once a prosecutor, suggests that one step he would take as president is to propose that RICO be expanded so that "investors who have lost money due to late-trading schemes" can sue in federal court to recover their losses.

Obviously, Kerry's view on RICO, in particular, does not tell us much, if anything, about his true feelings about civil litigation in general. What this view does tells us, though, is that Kerry understands that Americans are quite angry about corporate fraud.

[Duncan Grant]

7. First, I need to know what situation Randall Bezanson and Gilbert Cranberg

detailed in their original article (did I miss that in the link you provided?). Then I might be able to comment on Howard Dean's letter to the editor about the article; June 29, 1988.

Just want to be thorough when dissecting the arguments.

[DFLforever]

9. Sounds spot on -

a doctor's point of view as a member of a group frequently sued.

It's great to have someone besides the usual lawyer/legislator in this race!

[HuckleB]

10. Dean's actual policy stand, now.

I know it's 16 years later, but I figured this was kind of important.

Medical Malpractice: Supporting Doctors and Their Patients
http://www.deanforamerica.com/site/cg/index.html?type=page&pagename=policy_policy_health_medicalmalpractice

Also, just curious, does any other candidate have a plan to help avert the nursing shortage? As a nurse and a sometime patient, I have to say that this is definitely fighting for the little guy -- for all of us, really.

Fast Action To Avert A Nursing Shortage
http://www.deanforamerica.com/site/cg/index.html?type=page&pagename=policy_statement_health_nurses

[Duncan Grant]

11. Thanks HuckleB for the "timely" information.

The nursing shortage and it's relationship to the health care debate might make for a very interesting post here in the GDP forum. :hi:

[stickdog]

12. A better question is how can the media keep pretending that Kerry

is more conservative and thus more electable than Dean?

[HuckleB]

13. What does that have to do with this issue?

[NashVegas]

14. You'll Wait Forever

for the answer to that one.

[nothingshocksmeanymore]

15. What is so admirable about being conservative?

[stickdog]

21. Nothing. But it seems to make you ELECTABLE.

Or haven't you heard?

[Maddy McCall]

19. Tort Reform is a Republican plank

and it is usually pushed by Republican physicians. It is undemocratic and anti-first-amendment.

[HuckleB]

24. Wrong.

I've spent time with hundreds of progressive physicians, nurse practitioners and other health care specialists. Very, very few would not recommend tort reform because they know that real people are getting less and less health care under the current system. Sorry, it's not undemocratic and it's not anti-first-amendment. It is creating a crisis and keeping real people from being able to access health care. If you don't think that's a progressive issue, well then so be it.

[Ramsey]

20. That's a totally reasonable position

He's saying that the legal professions and insurance professions and the other special interest parties should have to have the same reforms as people are demanding for the medical professionals. I can guarantee you that doctors malfeasance and caps on malpractice claims are a drop in the bucket. It is the insurance companies and their legal staffs in particular who are raping the system and who are seemingly exempt from blame.

I have refused to march for medical malpractice reform in my state (where it is so bad that it is driving practitioners out of state constantly) until it includes ALL the perpetrators of abuse of the public, meaning the legal professions and the insurance companies and the HMOs.

The news media gets to spew their biased crap with impunity. Maybe they should be libel for their deliberate lies. Isn't that what Dean is suggesting??

I strongly believe that this is the only equitable solution. I think Dean is right on. All he is saying is reform everybody, not just some. That sounds right to me.

Edit: LOL!! I am editing because I didn't even see that the article you quoted is from 1988!!! Dean was way ahead of his time wasn't he!!!

And by the way, are you going to give the next person who brings up a 15+ year-old statement or vote of Kerry's a complete pass?? Because you really should after this post!

[Cheswick2.0]

40. But Ramsey, Kerry alone should not be criticized

Of course there are different types of Tort reform. Not all of them are evil. In Pa we are talking about forcing suits to live up to a certain standard before making it to court. There has to be a way to limit nonsense suits which are clogging the courts. Garbage suits are keeping legitimate victims from being heard in a timely manner. That has nothing to do with putting caps on victims awards.

My own Family Doctor says the big ticket players (surgeons and other specialists) should stop whining and leave the state already since they are only paying about 10 percent of their income for insurance just the same as he is. He has a point. However he has been pulled into many suits that have nothing to do with him and even though he has never lost one of those suits, it costs him money to constantly defend himself and leave his practice unattended. Clearly this is a circumstance that calls for reform. The good guys should not be punished for the small percentage of doctors who actually deserve to be sued.

[Armstead]

22. He seems to be seeking balance

His position seems reasonable to me.

The Republicans are, as usual, taking a real problem and using it to squash the rights and position of ordinary people.

In the case of malpractice, and tort reform in general, they are not trying to fix the excesses of the system, but instead are trying to restrict the right for victims to gain redress through the courts.

However, the problem is real, and needs to be addressed. I know at least two doctors with long good records, who are respected and totally decent people, who retired from medicine because of the malpractice siutuation.

There are many patients who deserve to be compensated for true malpractice. But there are also a lot of scammers and ambulance chasers who abuse the legal system to make a quick buck.

And the insurance companies are real culprits too. The burden they place on doctors is out of proportion to the actual losses to suits filed.

Dean seems to be taking a balanced approach to deal with the legitimate need to balance protection of the insured as well as those of patients/consumers.

------

From Dean's website:


As a physician, I understand the concerns doctors have with medical malpractice system. Faced with rapidly increasing insurance premiums, doctors are avoiding certain specialties, and many are leaving the medical profession altogether. This isn’t good for patients or for the American health care system generally.

But access to the courts is a fundamental civil right for all Americans, and many patients receive compensation for their injuries through the justice system.

We need a medical malpractice system that works for both doctors and patients. Patients and their families should have recourse to legal remedies if they suffer injuries and are wronged. Doctors shouldn’t be run out of business by soaring premiums or spend countless hours defending frivolous lawsuits.

Fixing the problems with the system requires compromise and thoughtful reform. But perhaps most importantly, it requires a recognition by doctors and by their patients that we need to fix the system in a way that preserves both the medical profession and the rights of patients to seek compensation and justice.

I support state efforts to discourage frivolous lawsuits while still holding the health care system accountable for its mistakes. For example, I believe that many malpractice actions can be resolved through mediation or pre-trial expert panels. Maine has enacted a sensible reform under which malpractice litigants must submit to a non-binding pre-litigation review. The review weeds out frivolous lawsuits without depriving real malpractice victims of the right to be compensated. Other states should weigh such reforms.
During my tenure as Governor, Vermont moved in this direction. I pushed for a law requiring submission of malpractice claims to an arbitration panel before trial. In 2002, I also signed a bill that strengthens the state’s ability to monitor health care delivery. Vermont now has one of the lowest medical malpractice rates in the country. We protect the rights of patients, but our doctors do not face the crisis of rising insurance costs that confront doctors elsewhere.

The federal government has an important role to play. First, the Senate should enact a bill sponsored by Senator Jeffords and others to provide legal protections for patient safety reporting systems. The Institute of Medicine found that thousands of patients die each year due to medical errors, many of which reflect system-wide problems instead of individual negligence. To reduce errors, we need to move from a culture of blame to a culture of safety in which the health care system learns from its mistakes. Reporting systems have had great success in the aviation industry. They can improve health care outcomes as well. The House passed such a bill 418 to 6, and the Senate Health Committee recently approved the Jeffords bill. The full Senate should act promptly.

Second, I support federal demonstration programs to identify promising models for improving state medical malpractice systems. For example, the federal government might support experimentation with alternative compensation systems, enterprise liability systems or pre-trial expert panel review systems such as the one enacted in Maine.

Any reforms in this area should meet two tests. They should screen out frivolous lawsuits, and they should protect access to the courts for valid claims so that victims of medical negligence receive fair compensation.

I oppose the Republican medical malpractice bill now before the U.S. Senate. It represents unwarranted and probably unconstitutional federal interference with state tort laws. It is essentially being used for political purposes and it will never be enacted. I favor real solutions at the state level and federal support and guidance for states to implement those solutions.

[stickdog]

30. This is a letter to the editor of the NY Times from 6 years ago signed

"Howard Dean, MD".

Is this even the same guy who is running for President?

[HuckleB]

32. Actually, it's from 16 years ago, and you're right, we don't know

if the author is the Howard Dean running for president.

[nothingshocksmeanymore]

39. It is Howard Dean and you can purchase the whole thing as I did

Furthermore Dean has ony recentle back off his micra talk, he underfunded the public defender's office in VT and made the following statements according to this article:

For the defense:

snip

Just two years ago Dean tried to prevent Appel from accepting a $150,000 federal grant aimed at assisting defendants with mental disabilities. For Dean to block a government agency from receiving federal money was unusual in itself. But Dean’s openly expressed bias against criminal defendants provided a partial explanation.

Dean has made no secret of his belief that the justice system gives all the breaks to defendants. Consequently, during the 1990s, state’s attorneys, police, and corrections all received budget increases vastly exceeding increases enjoyed by the defender general’s office. That meant the state’s attorneys were able to round up ever increasing numbers of criminal defendants, but the public defenders were not given comparable resources to respond.

http://rutlandherald.com/Archive/Articles/Article/31792

THis is a guy that criticizes others for signing the Patriot act in the days following 9/11

[HuckleB]

42. How do you know that it's THE Howard Dean?

Please don't ask me to waste money. I'm a little guy.

As for the rest of your claims, I'd like a lot more context. There are many reasons why increases in one area are justified, while corresponding increases in other areas are not. This piece makes assumptions based on part of the story. That's not good journalism.

[Clark Can WIN]

33. I know many doctors have the red ass from worrying about lawsuits

sometimes over drugs they prescribe that are found to be bad later, like the doctor is supposed to have this in-house research lab for every drug that goes out of his office.

On the other hand, how can you begin to think about limiting jury awards for the 19 year old woman who went in for an appendectomy and had her uterus removed by mistake or the 41 year old father of 3 that died because they gave him the wrong pills when he went in for a vasectomy?

Waiting for it to get worse is probably not the answer I would choose.

[Freddie Stubbs]

36. The little guy has to pay more for a Dr. because of lawsuits

The doctors just pass on the higher premiums to their patients.

[Edwards4President]

43. The little guy is paying more because insurance companies

are jacking up their rates for reasons totally unrelated to the cost of malpractice claims.

Unfortunately, people are buying into the lies that these companies have been spreading and believe that "tort reform" in the form of caps will lower their costs. It won't. It will only protect insurance companies and help them shore up their profits while providing no incentive for them to pass on the savings to doctors and the little.

[HuckleB]

44. Sorry, the matter is not that simple.

Does insurance reform give us one part of a solution? You bet. But it's not the only problem, and it's not the only part of a real and complete solution. I posted some articles on the complexity of the matter above. Here are few more, if you would like to look into the matter. This is only a beginning, however.

If you would like to look into medical error, malpractice, and such, here are some places to start. If you have a local health science university, the library there should carry most of these journals, if not in hard copy then electronically.

"Medical errors, medical negligence, and professional medical liability reform" in the May-June 2003 journal "Public Health Reports."

Also, "Layperson and physician perceptions of the malpractice system: implications for patient safety" in the July 2003 journal "Social Science and Medicine."

Also, "Medical malpractice: treating the causes instead of the symptoms," "Negligent Care and Malpractice Claiming Behavior in Utah and Colorado," and "Incidence and types of adverse events and negligent care in Utah and Colorado" in the March 2000 Journal, "Medical Care."

Also, "The challenge and cost of patient safety" in the October 2003 Journal of Pediatric Hematology/Oncology.

Also, "Excess Length of Stay, Charges, and Mortality Attributable to Medical Injuries During Hospitalization" in the October 8, 2003 issue of JAMA.

Also, "Medical errors" in the March 3, 2001 British Medical Journal.

Also, "The criminalisation of fatal medical mistakes" in the November 15, 2003 British Medical Journal.

Also, "Are clinical negligence and legal action related?" in the September 13, 2003 British Medical Journal.

Also, "Medical liability and patient safety" in the July-August 2003 Journal "Health Affairs."

Also, "Error, Blame, and the Law in Health Care—An Antipodean Perspective" in the June 17, 2003 Annals of Internal Medicine.

Also, "Tort reform isn't enough" in the May 9, 2003 journal "Medical Economics."