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How Would Tort Reform Affect the Quality of Emergency Healthcare?

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In 1975, the California State Legislature passed the California Medical Injury Compensation Reform Act (MICRA) which placed a cap on damages for medical malpractice claims. According to this Act, an injured plaintiff cannot recover non-economic losses in excess of $250,000. This tort reform statute has been in effect in California for thirty-two years. Because this California law has been in effect for so long, perhaps we can look to this state to determine whether tort reform has been effective in improving the quality and price of medical care. In general, I believe private market conditions rather than government interference and regulation leads to higher quality and efficiency. This means that I do not believe that artificial caps on damages are effective in improving the quality and cost of medical care.

Today, I came across a shocking news story about the quality of emergency room care in at least one hospital in California. A patient who was bleeding from her mouth and crying out in pain while she was forced to wait more than forty-five minutes in the lobby of the emergency room at Martin Luther King Jr.-Harbor Hospital died because she did not receive timely emergency care. According to news accounts, family members tried to call 911 to receive timely medical care and transport the patient to another facility. Unfortunately, dispatchers refused to call paramedics after learning about her location. According to news accounts of the breakdown in patient care:

In the recordings of two 911 calls that day, first obtained by the Los Angeles Times under a California Public Records Act request, callers pleaded for help for Rodriguez but were referred to hospital staff instead.

“I’m in the emergency room. My wife is dying and the nurses don’t want to help her out,” Rodriguez’s boyfriend, Jose Prado, is heard saying in Spanish through an interpreter on the tapes.

“What’s wrong with her?” a female dispatcher asked.

“She’s vomiting blood,” Prado said.

“OK, and why aren’t they helping her?” the dispatcher asked

‘They’re just watching her’
“They’re watching her there and they’re not doing anything. They’re just watching her,” Prado said.

The dispatcher told Prado to contact a doctor and then said paramedics wouldn’t pick her up because she was already in a hospital. She later told him to contact county police officers at a security desk.

The patient died after suffering from a perforated bowel which according to the coroner, could have been surgically repaired if it had been caught in time. Clearly, the emergency medical care provided to this patient fell well below the standard of care required for emergency medical providers. In fact, according to press reports, the hospital had a history of patient safety problems. The federal government previously even warned this hospital about safety problems placing emergency room patients at immediate risk of harm. The hospital risked losing federal funding had it not improved patient safety.

What do caps on damages in medical malpractice litigation have to do with this California hospital? Perhaps nothing. However, I believe that possible litigation damage awards usually play a role in how people manage risks. Because risk management departments evaluate safety based upon exposure to damage awards, damage caps can play a role in the priorities placed on patient safety programs. Perhaps if this hospital placed more emphasis on patient safety, it would have had a more effective patient triage program in place rather than forcing a patient with a perforated bowel to wait in an emergency room lobby until she died.

I must admit that other than what has been reported in news stories, I know nothing about this hospital. However, I firmly believe that risk management departments place an increased emphasis on patient safety when facing an unlimited exposure to litigation risk . As a result, litigation can be an effective tool to promote safety. This hospital never faced a civil judgment beyond exposure to civil damages caps. Because such risks never existed in California, perhaps patients suffer from poor quality of care. Do you believe the hospital has adequate incentive to provide safe patient care? Do you believe that damage caps play a role in the safety decisions corporations and medical providers make? Would damage caps in California work in Arizona? Let me know your thoughts.