BOOK REVIEW |
Medical Malpractice—A Physician's Sourcebook. R. E. Anderson (editor). Published by Humana Press, Totowa. Pp. 301; indexed. Price $59.90. ISBN 1-58829-389-0
E-mail: heneghanc{at}aol.comThis is a fascinating book, to me at least, with a legal and medical viewpoint. It is about medical malpractice law in the USA. Malpractice is of course what we call negligence, and the book is so interesting because it gives so much detail about American practice, of which we hear so much about, but mostly through the television.
The first of the three sections is several chapters advising doctors on litigation: likely events, what to do, how to give evidence. While much of it is very similar to English law, there are of course crucial differences: Firstly, almost all malpractice suits are heard before a jury, so advocacy and evidence giving are enormously more theatrical and emotionally biased than here, where a judge will usually take a (fairly) rigorous view of evidence. Another difference, apart of course from counsel having to object during the hearing to anything that might warrant appeal later, is that any witness can be required to attend the opposing lawyer's office to give a statement, which, incautiously handled, could sink you before you begin. Like here, most cases are discontinued before they come to trial, many because they are flawed. Unlike here, awards and fees are very different, to which I will return.
The second major section is devoted to specific areas of practice, including Anesthesiology. This is generally unhelpful to the trained anaesthetist, telling you what you already know, although there are some surprising sections, e.g. operating room fires, one on sleep apnoea and narcotic analgesia, and one on office anesthesia (does MMC know about this?).
The final, and largest section, is about problems and reform of litigation. We know that litigation in the US is a much worse problem than here, but how many knew that liability insurance makes up 30% of the cost of a step ladder, 95% of the cost of a childhood vaccine, 25% of a bus fare in the US, or of the Ohio urologist whose malpractice insurance is 7/12 of his annual income! Litigation, we know is an appalling problem in the US, and many believe we are going that way, and we probably are when it comes to product liability.
However, we may be ahead of the game in medical litigation, as in some US states, including California, they have managed to reduce dramatically the impact of litigation by (i) limiting the maximum financial award to $250 000, and (ii) limiting lawyers contingency fees. Doctors can once again be found for specialities and areas that for some time had no takers, and insurance costs in those states that have these limitations have been static. In the UK, financial awards are of course much lower than in the US, limited by judicial standards, and solicitors fees are very much better controlled than in the US. We will probably not get quite as bad as the US, whatever happens!
Over all, a fascinating book, though perhaps of rather limited appeal. A definite for the shelves of those like me who are interested in litigation. The more general appeal is limited by the fact that the section advising dealing with litigation is very US specific. Perhaps we need a UK version?
Abergavenny, UK
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