The American Medical Assn., in a far-reaching proposal certain to spark debate over the thorny malpractice dilemma, called Wednesday for the creation of state panels of experts that would handle all claims of medical wrongdoing and would essentially do away with judicial system review of such cases.
The proposal drew immediate and expected fire from the legal profession. Consumer interest groups also questioned its potential chilling effect on patient claims. One critic even denounced the plan as "reckless and dangerous."
But AMA officials called the proposal, 18 months in the making, a "radical" and "revolutionary" response to a malpractice crisis that has seen settlements and expenses from claims climb fivefold in the last decade.
Supporters and critics alike agree that success of the proposal would depend on how effective it is in turning the tide of soaring malpractice damages--an impact that even AMA officials concede remains unknown.
Under the 160-page plan, developed by the AMA with 32 other medical groups nationwide, the responsibility for settling malpractice claims, disciplining negligent members of the profession and establishing threshold standards for liability would fall under the auspices of either vastly expanded state medical boards or, more likely, a new administrative agency.
Members of the proposed administrative body would be appointed by governors and would include two to three doctors, along with experts from related fields such as law and insurance. Initial reviewers on the panel would have the power to dismiss "frivolous" claims found lacking in substance or to forward cases to the full agency, which could award damages.
The medical, legal and insurance professions have found themselves at loggerheads in recent years over the malpractice question. Claims and awards have risen dramatically, insurance premiums have increased and many doctors have said that they were forced to cut back on services for fear of suits.
While each industry has offered its own, often-conflicting ideas on reforming the personal injury laws that now exist, the AMA plan put forth Wednesday marks perhaps the first--and certainly the most dramatic--call for replacing the current system altogether.
Called 'Quicker, Fairer'
The jury system is cumbersome, unpredictable and "ill-suited to finding out what the facts are" in malpractice claims, said Dr. James S. Todd, an AMA vice president. In its place, Todd said at a press conference, an administrative panel of experts would make handling of cases quicker, fairer and more consistent.
On the financial effect, he initially contended that removing malpractice claims from the realm of the courts, where huge legal fees can sometimes reach 50% of the damages awarded, will bring down the size of "inflated" amounts but still leave "tremendous savings to compensate patients."
Later, however, Todd seemed to hedge on that estimate, saying that after considering the costs of setting up a vast new administrative agency to handle claims, it may not be any cheaper than the current judicial system.
Todd said that the savings, if any, of the proposed reform cannot be gauged until a few states agree to implement the administrative plan on a trial basis. He added that several states, which he would not name, have expressed an interest in putting the plan into practice.
AMA attorney Kirk B. Johnson said later that California is "the last state that would want to do it. . . . They're pretty stable on malpractice, and they wouldn't want to risk it."
Slowed in California
California, which now has a $250,000 "pain and suffering" cap and has instituted other tort reforms, was found in a federal General Accounting Office report last year to have successfully slowed the malpractice problem.
Ronald S. Gass, senior counsel of the American Insurance Assn. in Washington, applauded the AMA for "breaking new ground" on the malpractice issue. Similarly, Dr. Bryant Galusha of the Federation of State Medical Boards in Texas, said that "this radical departure from what we do now" appears to be a "wise" beginning.
Both cautioned, however, that reform of this magnitude would need significant study before being implemented.
American Bar Assn. President Robert MacCrate suggested, however, that a claimant's "established right to fair and just compensation" may not be preserved under an administrative system. Furthermore, there is no evidence "to support a wholesale shift away from the courts" on such claims.
And Dr. Sidney M. Wolfe of the Public Citizen Health Research Group, calling the plan "absurd . . . reckless and dangerous," said in a statement: "Abolishing the system of jury by peers for malpractice suits is tantamount to closing the door for most patients" in recovering for a doctor's negligence.