Health courts?

Boston University Law Review

Volumn 88, Issue 1, 2008, Pages 227-289

  Peters Jr , Philip G ^a  

^a UNIVERSITY OF MISSOURI   (United States)

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EID: 41749114087     PISSN: 00068047     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (544)

1. See Fair and Reliable Medical Justice Act, S. 1337, 109th Cong. § 2 (2006);
2. Medical Liability Procedural Reform Act of 2005, H.R. 1546, 109th Cong. (2006).
3. See infra notes 40-54 and accompanying text.
4. See generally INST, OF MED., FOSTERING RAPID ADVANCES IN HEALTH CARE: LEARNING FROM SYSTEM DEMONSTRATIONS 10 (Janet M. Corrigan et al. eds., 2002).
5. See generally INST, OF MED., TO ERR IS HUMAN (2000).
6. Jeanne Lenzer, Medical Courts Could Ease US Malpractice Crisis, Group Says, 330 BRIT. MED. J. 382 (2005).
7. Progressive Policy Institute Endorses Special Health Courts, COMMON GOOD, Feb. 17, 2005, http://cgood.org/healthcare- newscommentary-inthenews-224.html; Senate Majority Leader Bill Frist Calls for the Creation of Special Health Courts, COMMON GOOD, July 19, 2004, http://cgood.org/healthcare-newscommentary-inthenews-140.html?. For more detailed information on endorsements for health courts see Common Good, Endorsements, http://cgood.org/learn-people-endorsements.html (last visited Jan. 31, 2008).
8. See, e.g., Innovative Solutions to Medical Liability: Hearing Before the Subcomm. on Health of the Comm. on Energy and Commerce, 109th Cong. 26-27 (2006) (statement of Michelle Mello);
9. Medical Liability: New Ideas for Making the System Work Better for Patients: Hearing of the Comm. on Health, Education, Labor, and Pensions, 109th Cong. 44, 45 (2006) (statement of Philip K. Howard, Founder and Chair, Common Good; Professor of Law, Columbia Law School).
10. See, e.g., PAUL C. WEILER ET AL., A MEASURE OF MALPRACTICE: MEDICAL INJURY, MALPRACTICE LITIGATION, AND PATIENT COMPENSATION 144-52 (1993) [hereinafter WEILER ET AL., A MEASURE OF MALPRACTICE].
11. For the most recent and complete account of this, see generally Michelle M. Mello et al., "Health Courts " and Accountability for Patient Safety, 84 MILBANK Q. 459 (2006).
12. Id. at 464. Under one possible claims process, the hospital would be required to report the event to the insurer and would be surcharged if the insurer learned of the incident from the patient. Id.
13. Id.
14. Id. at 466.
15. Id.
16. Id. at 464. Claimants without lawyers could also ask the health court to evaluate the settlement offer made by the insurer. Id.
17. Id. at 464-65.
18. Id. at 464.
19. Id. at 467, 476.
20. Id. at 467-68, 470.
21. Id. at 462-63.
22. Id. at 464; Common Good, Frequently Asked Questions About Health Courts, http://cgood.org/f-healthcourtsfaq.html (last visited Jan. 31, 2008).
23. Innovative Solutions to Medical Liability, supra note 7, at 26-27 (statement of Michelle Mello). This might magnify tort law's deterrent signal. Mello et al., supra note 9, at 471 (arguing that improvements in the system's accuracy should clarify the deterrent signals to providers). The effectiveness of the deterrent will depend on whether this effect is offset by the reduction in compensable damages.
24. Mello et al., supra note 9, at 470-71. In addition, doctors may be more willing to disclose and discuss errors under a standard of care that does not imply negligence. Id. at 471-74.
25. Id. at 471-74.
26. Id. at 476.
27. More than 80 Prominent Leaders Endorse Special Health Courts, COMMON GOOD, Feb. 7, 2005, http://cgood.org/ healthcare-newscommentary-inthenews-218.html.
28. Id.
29. Id.
30. Id.
31. Patient Safety & Health Care Quality Leaders Support Health Court Pilot Projects, COMMON GOOD, July 5, 2006, http://cgood.org/healthcare-newscommentary-inthenews-321.html.
32. Common Good, Who Supports Health Courts?, http://cgood.org/ forgendorsements.html (last visited Jan. 31, 2008).
33. Editorial, Malpractice Mythology, N.Y. TIMES, Jan. 9, 2005, § 4, at 12 (calling for pilot projects, including health courts, to promote tort reform).
34. Editorial, Scalpel, Scissors, Lawyer, ECONOMIST, Dec. 14,2005, at 70.
35. Editorial, 'Health Courts' Offer Cure, USA TODAY, July 4, 2005, available at http://www.usatoday.com/news/opinion/editorials/2005- 07-04-our-view_x.htm.
36. Common Good, Who Supports Health Courts?, supra note 30.
37. See generally AM. MED. ASS'N, HEALTH COURT PRINCIPLES (2007), available at http://www.ama-assn.org/amal/pub/upload/mm/378/healthcrt_principles.pdf.
38. Fair and Reliable Medical Justice Act, S. 1481, 110th Cong. § 1 (2007).
39. Id. § 3.
40. Fair and Reliable Medical Justice Act, H.R. 2497, 110th Cong. § 1 (2007).
41. Common Good, Legislative Activity on Health Courts, http://cgood.org/ fhealthcourtslegislation.html (last visited Jan. 31, 2008).
42. See S. 508, 422d Gen. Assem., Reg. Sess. (Md. 2007) (establishing a medical liability division in circuit courts);
43. H.B. 779, 422d Gen. Assem., Reg. Sess. (Md. 2007) (creating a Task Force to study the creation of a medical liability division within the Maryland circuit courts on the model of an existing, separate case management system for business and technology cases);
44. H.B. 338, 422d Gen. Assem., Reg. Sess. (Md. 2007) (establishing a task force to study administrative compensation programs for birth-related neurological injury);
45. H.B. 48, 422d Gen. Assem., Reg. Sess. (Md. 2007) (creating a medical malpractice review board of trained judges with the authority to hire neutral experts).
46. See S. 4149, 2007 Leg., 230th Sess. (N.Y. 2007) (authorizing health court pilot projects within the court system), available at http://cgood.org/assets/attachments/S4149.pdf.
47. See S. 655, 74th Leg., Reg. Sess. (Or. 2007), available at http://cgood.org/assets/attachments/OR_SB655.pdf.
48. See S. 678, 2007 Gen. Assem., Reg. Sess. (Pa. 2007) (authorizing a demonstration program to examine an administrative medical liability system), available at http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck. cfm?txtType=HTM&sessYr=2007&sessInd=0&billBody=S&billTyp= B&billnbr=0678&pn=0725.
49. See S. J. Res. 90, 2006 Sess. (Va. 2006), available at http://cgood.org/assets/attachments/Va_Joint_Resolution_90.pdf;
50. H.R.J. Res. 183, 2006 Sess. (Va. 2006) (providing for continuance of the Joint Subcommittee to Study Risk Management Plans for Physicians and Hospitals, which is investigating the feasibility of establishing a pilot health court and subsequently a system of health courts), available at http://cgood.org/assets/attachments/Va_Joint_Resolution_183.pdf.
51. Innovative Solutions to Medical Liability, supra note 7, at 49 (statement of Paul Barringer, General Counsel, Common Good).
52. See Mello et al., supra note 9, at 460.
53. See AMA/SPECIALTY SOC'Y MED. LIAB. PROJECT, A PROPOSED ALTERNATIVE TO THE CIVIL JUSTICE SYSTEM FOR RESOLVING MEDICAL LIABILITY DISPUTES: A FAULT- BASED, ADMINISTRATIVE SYSTEM 1 (1988);
54. Kirk B. Johnson et al., A Fault-Based Administrative Alternative for Resolving Medical Malpractice Claims, 42 VAND. L. REV. 1365, 1367 (1989).
55. AMA/SPECIALTY SOCIETY MEDICAL LIABILITY PROJECT, supra note 47, at 17.
56. Id. at 21-23.
57. Id. at 67-78, 145-46.
58. AM. LAW INST., REPORTERS' STUDY, ENTERPRISE RESPONSIBILITY FOR PERSONAL INJURY 112 & n.5 (1991);
59. WEILER ET AL., A MEASURE OF MALPRACTICE, supra note 8, at 144.
60. AM. LAW INST., REPORTERS' STUDY, supra note 51, at ch. 10 (discussing medical injury);
61. id. at chs. 4, 15 (discussing medical malpractice and elective no-fault medical liability;
62. Paul Weiler was the Chief Reporter of the study); see also PAUL WEILER, MEDICAL MALPRACTICE ON TRIAL (1991). Weiler's book was originally written as an ALI background paper and Chapter 6 was the basis for ALI chapter 15 on no-fault medical liability. 2 AM. LAW INST., REPORTERS' STUDY, supra note 51, at 487.
63. See, e.g., Clark C. Havighurst & Lawrence R. Tancredi, "Medical Adversity Insurance" - A No-Fault Approach to Medical Malpractice and Quality Assurance, 51 MILBANK Q. 125, 125-26 (1973);
64. Robert E. Keeton, Compensation for Medical Accidents, 121 U. PA. L. REV. 590, 616-17 (1973);
65. Jeffrey O'Connell, Expanding No-Fault Beyond Auto Insurance: Some Proposals, 59 VA. L. REV. 749, 827 (1973).
66. See infra notes 439-446 and accompanying text.
67. AMERICAN LAW INSTITUTE, REPORTERS' STUDY, supra note 51, at 111-13.
68. Id. at 119.
69. Id. at 123, 512.
70. Compare id. ch. 15, with AMA/SPECIALTY SOC'Y MED. LIAB. PROJECT, supra note 47, at 3-12.
71. HARVARD MEDICAL PRACTICE STUDY, PATIENTS, DOCTORS, AND LAWYERS: MEDICAL INJURY, MALPRACTICE LITIGATION, AND PATIENT COMPENSATION IN NEW YORK 11-9 (1990). That team included two Harvard scholars who had helped write the earlier ALI study. Paul Weiler, a Harvard law professor, was both the Chief Reporter of the ALI report and the senior legal investigator on the Harvard Study. Troyen Brennan, a faculty member at the Harvard Schools of Medicine and Public Health, also served on both projects.
72. See generally WEILER ET AL., A MEASURE OF MALPRACTICE, supra note 8.
73. Faculty members Troyen Brennan, Joseph Newhouse, Lucian Leape, and David Studdert have written extensively on the subject, including the following: WEILER ET AL., A MEASURE OF MALPRACTICE, supra note 8;
74. Joseph P. Newhouse & Paul C. Weiler, Reforming Medical Malpractice and Insurance, 14 REG. 78 (1991);
75. William G. Johnson, Troyen A. Brennan, Joseph P. Newhouse, Lucian L. Leape, Ann G. Lawthers, Howard H. Hiatt & Paul C. Weiler, The Economic Consequences of Medical Injuries: Implications for a No-Fault Insurance Plan, 267 JAMA 2487 (1992);
76. David Studdert & Troyen Brennan, No-Fault Compensation for Medical Injuries: The Prospect for Error Prevention, 286 JAMA 217 (2001);
77. David M. Studdert, Eric J. Thomas, Brett I.W. Zbar, Joseph P. Newhouse, Paul C. Weiler, Jonathan Bayuk & Troyen A. Brennan, Can the United States Afford a "No-Fault" System of Compensation for Medical Injury?, 60 LAW & CONTEMP. PROBS. 1 (1997);
78. David M. Studdert & Troyen A. Brennan, Toward a Workable Model of "No-Fault" Compensation for Medical Injury in the United States, 27 AM. J.L. & MED. 225 (2001);
79. Paul C. Weiler, Joseph P. Newhouse & Howard H. Hiatt, Proposal for Medical Liability Reform, 267 JAMA 2355 (1992).
80. Michelle M. Mello & Troyen A. Brennan, Deterrence of Medical Errors: Theory and Evidence for Malpractice Reform, 80 TEX. L. REV. 1595, 1625, 1628 (2002).
81. Id. at 1629.
82. Common Good, Frequently Asked Questions About Health Courts, supra note 20.
83. See supra notes 1-7, 37-46 and accompanying text.
84. The improvements include a heightened standard of care, a schedule of damages, and reliance on private plaintiff's attorneys.
85. See, e.g., Mello et al., supra note 9, at 465-67.
86. See, e.g., id. at 471;
87. More Than 80 Prominent Leaders Endorse Special Health Courts, supra note 25.
88. See, e.g., STEPHEN DANIELS & JOANNE MARTIN, CIVIL JURIES AND THE POLITICS OF REFORM 1-2 (1995).
89. See id.;
90. NEIL VIDMAR, MEDICAL MALPRACTICE AND THE AMERICAN JURY: CONFRONTING THE MYTHS ABOUT JURY INCOMPETENCE, DEEP POCKETS, AND OUTRAGEOUS DAMAGE AWARDS 122-23 (1995). Both the AMA and the Physician Payment Review Commission have concluded that lay juries reach different decisions than physicians would. VIDMAR, supra at 162;
91. see also PHYSICIAN PAYMENT REVIEW COMM'N, ANNUAL REPORT TO CONGRESS 186 (1992);
92. AMA/SPECIALTY SOC'Y MED. LIAB. PROJECT, supra note 47, at 7-11;
93. Johnson et al., supra note 47, at 1370-71.
94. Troyen A. Brennan et al., Relation Between Negligent Adverse Events and the Outcomes of Medical-Malpractice Litigation, 335 NEW ENG. J. MED. 1963,1967 (1996).
95. TOM BAKER, THE MEDICAL MALPRACTICE MYTH 13 (2005) (quoting President George W. Bush, Speech in Collinsville, Ill. (Jan. 2005)).
96. See, e.g., Troyen A. Brennan & Philip K. Howard, Heal the Law, then Health Care, WASH. POST, Jan. 25, 2004, at B7.
97. See id.
98. Philip G. Peters Jr., Doctors & Juries, 105 MICH. L. REV. 1453, 1454 (2007).
99. Id.
100. Id.
101. Id. at 1476 (citing Bryan A. Liang, Assessing Medical Malpractice Jury Verdicts: A Case Study of an Anesthesiology Department, 7 CORNELL J.L. & PUB. POL'Y 121 (1997)).
102. Id.
103. Id. at 1464.
104. Id. at 1478. In addition, some of these disagreements can probably be attributed to reviewer bias in favor of physicians and to jury access to more complete and stronger evidence of medical negligence. Id. at 1478-79.
105. Id. at 1464.
106. See, e.g., Henry S. Farber & Michelle J. White, Medical Malpractice: An Empirical Examination of the Litigation Process, 22 RAND J. ECON. 199, 204-05 (1991) (finding 30% disagreement or ambiguous findings);
107. A. Russell Localio et al., Identifying Adverse Events Caused by Medical Care: Degree of Physician Agreement in a Retrospective Chart Review, 125 ANNALS INTERNAL MED. 457, 457 (1996) (finding a similar disagreement rate on both negligence and causation);
108. Ralph Peeples et al., The Process of Managing Medical Malpractice Cases: The Role of Standard of Care, 37 WAKE FOREST L. REV. 877, 884 (finding that reviewers disagreed in 34.3% of the cases).
109. See Shari Seidman Diamond, Order in the Court: Consistency in Criminal-Court Decisions, in 2 THE MASTER LECTURE SERIES: PSYCHOLOGY AND THE LAW 119, 125 (C. James Scheirer & Barbara L. Hammonds eds., 1983) (finding a disagreement rate among scientists engaged in peer review of 25%, among employment interviewers of 30%, among psychiatrists diagnosing psychiatric illness of 30%, and among physicians diagnosing physical illness of between 23% and 33%).
110. Medical Liability: New Ideas for Making the System Work Better for Patients: Hearing of the Comm. on Health, Education, Labor, and Pensions, supra note 7, at 44-45 (statement of Philip K.Howard).
111. Peters, supra note 75, at 1492.
112. Id. at 1493.
113. Id. at 1484.
114. Id. at 1489.
115. Id. at 1491.
116. See Brennan et al., supra note 71, at 1963;
117. Philip G. Peters, Jr., What We Know About Malpractice Settlements, 92 IOWA L. REV. 1783, 1819 (2007) [hereinafter Peters, Settlements];
118. David M. Studdert et al., Claims, Errors, and Compensation Payments in Medical Malpractice Litigation, 354 NEW ENG. J. MED. 2024, 2025 (2006) [hereinafter Studdert et al., Claims].
119. See generally HARVARD MEDICAL PRACTICE STUDY, supra note 59.
120. See Peters, Settlements, supra note 91, at 1819.
121. Id. at 1787-95 (synthesizing several studies).
122. Id. at 1788-1801.
123. Id. at 1804 fig.2.
124. Id. at 1813.
125. Id. at 1797, 1801.
126. Id. at 1802;
127. infra note 101.
128. Studdert et al., Claims, supra note 91, at 2031.
129. Id. at 2029 fig.2. To do this, they used a one-to-six scale to measure the reviewer's level of confidence for a determination of fault, ranging from "little or no evidence" to "[v]rtually certain evidence." Id.
130. Id. These numbers exclude claims with dignitary injuries only (nine), no injuries (thirty-seven), and no-error judgments (two). Id. Roughly 6% of the cases in which payment was made followed a plaintiff's verdict (50 of the 798). Id. at 2030 tbl.2.
131. Id. at 2031.
132. Peters, Settlements, supra note 91, at 1796-1801.
133. Id. at 1813.
134. Id. at 1817-18.
135. See FRANK A. SLOAN ET AL., SUING FOR MEDICAL MALPRACTICE 220 (1993) (explaining that settlements, unlike trials, will discount the damages to reflect the probability of failure);
136. Stephen J. Spurr & Sandra Howze, The Effect of Care Quality on Medical Malpractice Litigation, 41 Q. REV. ECON. & FIN. 491, 502-04 (2001).
137. Peters, Settlements, supra note 91, at 1806 fig.4, 1814-16.
138. See Farber & White, supra note 83, at 207-08;
139. Walter Orlando Simmons, An Economic Analysis of Mandatory Mediation and the Disposition of Medical Malpractice Claims, 6 J. LEGAL ECON. 41, 51-52 (1996);
140. cf Stephen J. Spurr & Walter O. Simmons, Medical Malpractice in Michigan: An Economic Analysis, 21 J. HEALTH POL. POL'Y & L. 315, 337 (1996) (presenting consistent, but not statistically significant, findings).
141. See Peeples et al, supra note 83, at 884-85, 891-93.
142. Id. at 892.
143. See Peters, Settlements, supra note 91, at 1819-22.
144. Id. at 1824-25.
145. Id. at 1825-28.
146. Id. at 1828-31.
147. See, e.g., Thomas B. Metzloff, Resolving Malpractice Disputes: Imaging the Jury's Shadow, 54 LAW & CONTEMP. PROBS. 43, 74-75, 83 n. 126 (1991);
148. Paul L. Ogburn, Jr. et al, Perinatal Medical Negligence Closed Claims from the St. Paul Company, 1980-1982, 33 J. REPROD. MED. 608, 610 (1988).
149. With the significant exception of attorney experience (which strongly favors malpractice defendants), we don't yet know whether strategic factors tend to favor one side more often than the other. See Peters, Settlements, supra note 91, at 1829-31.
150. Mello et al., supra note 9, at 460.
151. Id. at 464.
152. Id. at 468.
153. See supra Part II.A.1.
154. See id.
155. HARRY KALVEN, JR. & HANS ZEISEL, THE AMERICAN JURY (1966).
156. Id. at 64 n. 12.
157. Id. at 63-65 (finding that the jury, but not the judge, favored the defendant in 10% of cases, while the jury alone favored the plaintiff in 12% of cases). Heuer and Penrod did a similar analysis with similar results. In the cases on which the judge and jury had disagreed (37% of the total set of cases), judges disagreed with jury defense verdicts (19%) as frequently as they disagreed with jury verdicts for plaintiffs (18%). Larry Heuer & Steven Penrod, Trial Complexity: A Field Investigation of Its Meaning and Its Effects, 18 LAW & HUM. BEHAV. 29, 48 tbl. 13 (1994).
158. In addition, researchers have found similar rates of judge-jury agreement in criminal trials. See, e.g., KALVEN & ZEISEL, supra note 122, at 58 tbl. 12 (finding 78% agreement);
159. Heuer & Penrod, supra note 124, at 48 tbl. 12 (finding 71% agreement). Other surveys of judicial opinion have found similar or higher estimates of the rate of judge-jury agreement.
160. See John B. Attanasio, Foreword: Juries Rule, 54 SMU L. REV. 1681, 1684 (2001);
161. R. Perry Sentell, Jr., The Georgia Jury and Negligence: The View from the Bench, 26 GA. L. REV. 85, 97-98 (1991);
162. R. Perry Sentell, Jr., The Georgia Jury and Negligence: The View from the (Federal) Bench, 27 GA. L. REV. 59, 70-71 (1992) [hereinafter Sentell, Federal Bench].
163. See Diamond, supra note 84, at 125 tbl. 1.
164. In the Kalven and Zeisel study, for example, the judges typically believed that juries that decided cases differently had reached reasonable decisions. See Neil Vidmar, The Performance of the American Civil Jury: An Empirical Perspective, 40 ARIZ. L. REV. 849, 853 (1998). A Georgia survey of state and federal judges found 94% of the judges felt that the jury understood the case, and 87% believed that juries are not pro-plaintiff. Sentell, Federal Bench, supra note 125, at 116 tbls.16 & 17. All of the federal judges and 98% of the state judges felt that jury performance was satisfactory or would be if some procedural reforms were adopted. Id. at 117 tbl. 18. At least 97% of both groups reported agreeing with jury verdicts more than eight times out of ten, the approximate figure from the Kalven and Zeisel study. Id. at 115 tbl. 14.
165. See, e.g., Shari Seidman Diamond & Mary R. Rose, Real Juries, 1 ANN. REV. L. & SOC. SCI. 255, 271 (2005) (collecting and reviewing the studies);
166. Neil Vidmar & Shari Seidman Diamond, Juries and Expert Evidence, 66 BROOK. L. REV. 1121, 1126, 1174, 1177 (2001).
167. KALVEN & ZEISEL, supra note 122, at 157. At the same time, other studies have documented the limitations of a lay jury in complex cases. See, e.g., Joe S. Cecil et al., Citizen Comprehension of Difficult Issues: Lessons from Civil Jury Trials, 40 AM. U. L. REV. 727, 755-60 (1991);
168. Joseph Sanders, Scientifically Complex Cases, Trial by Jury, and the Erosion of Adversarial Processes, 48 DEPAUL L. REV. 355, 365 (1998). The most clearly established juror weakness lies in the comprehension and application of probabilistic evidence. For example, people tend to overestimate the significance of some low probability risks.
169. See David L. Faigman & A.J. Baglioni, Jr., Bayes' Theorem in the Trial Process: Instructing Jurors on the Value of Statistical Evidence, 12 LAW & HUM. BEHAV. 1, 13-14 (1988);
170. Brian C. Smith et al., Jurors' Use of Probabilistic Evidence, 20 LAW & HUM. BEHAV. 49, 60-70 (1996).
171. See generally Cecil et al., supra, at 755-60. This could cause them to overestimate, in hindsight, the riskiness of a physician's treatment. However, the data on agreement rates suggest that this risk is offset by other factors that favor malpractice defendants.
172. Kevin M. Clermont & Theodore Eisenberg, Trial by Jury or Judge: Transcending Empiricism, 11 CORNELL L. REV. 1124, 1137 tbl.3 (1992).
173. THOMAS H. COHEN, BUREAU OF JUSTICE STATISTICS, U.S. DEP'T OF JUSTICE, TORT TRIALS AND VERDICTS IN LARGE COUNTIES, 2001, at 4 tbl.3 (2004), available at http://www.ojp.usdoj.gov/bjs/pub/pdf/ttvlc01.pdf.
174. See Clermont & Eisenberg, supra note 130, at 1137 & tbl.3 (1992). The Bureau findings also suggest that malpractice litigation is unusual. The judge-jury discrepancy rate was much larger in medical malpractice cases than it was in civil litigation generally (24% compared to 14%). COHEN, supra note 131, at 4 tbl.3 (finding, for civil litigation generally, a 65% win rate in bench trials versus a 51% win rate injury trials).
175. See supra text at notes 86-90 (exploring the reasons for jury bias in favor of defendants).
176. See, e.g., Chris Guthrie et al., Inside the Judicial Mind, 86 CORNELL L. REV. 777, 796-97, 801-03 (2001);
177. Jennifer K. Robbennolt, Evaluating Juries by Comparison to Judges: A Benchmark for Judging?, 32 FLA. ST. U. L. REV. 469,491-93,497-98 (2005).
178. See Harold H. Bruff, Specialized Courts in Administrative Law, 43 ADMIN. L. REV. 329, 331 (1991). However, the intellectual challenge presented in Tax Courts may help attract able judges. Id. at 337. The applicant pool would likely improve substantially if health courts were created at the federal level, because federal court judgeships are much more prestigious than state positions. Even in the federal system, however, administrative law judges are paid far less than federal district court judges. Id. at 352.
179. See, e.g., SLOAN ET AL., supra note 106, at 207-08, 216 (finding that specialists constitute a minority of plaintiffs' attorneys and recommending specialty certification);
180. Marc Galanter, Why the "Haves" Come Out Ahead: Speculations on the Limits of Legal Change, 9 LAW & SOC'Y REV. 95, 107 fig.l, 110 (1974) (explaining that personal injury insurers are typically repeat players, while personal injury plaintiffs are not);
181. Catherine T. Harris et al., Who Are Those Guys? An Empirical Examination of Medical Malpractice Plaintiffs' Attorneys, 58 SMU L. REV. 225, 237 (2005) (reporting that defense counsel in the study sample had handled, on average, more than twice as many malpractice cases as compared to their counterparts).
182. Bruff, supra note 135, at 331-32.
183. Kristin Eliasberg, Malpractice Fix, BOSTON GLOBE, Aug. 21, 2005, at El (quoting Tom Baker);
184. see also Carl W. Tobias, Essay, Health Courts: Panacea or Palliative?, 40 U. RICH. L. REV. 49, 51 (2005) (observing the risk of capture).
185. See KALVEN & ZEISEL, supra note 122, at 6-7;
186. Stephen Landsman, The History and Objectives of the Civil Jury System, in VERDICT: ASSESSING THE CIVIL JURY SYSTEM 22, 29-39 (Robert E. Litan ed., 1993).
187. WILLIAM BLACKSTONE, 3 COMMENTARIES *374.
188. Dimick v. Schiedt, 293 U.S. 474,486 (1935).
189. See, e.g., Atlas Roofing Co. v. Occupational Safety & Health Review Comm'n, 430 U.S. 442, 455 (1977);
190. Wright v. Cent. Du Page Hosp. Ass'n, 347 N.E.2d 736, 741 (Ill. 1976);
191. Simon v. St. Elizabeth Med. Ctr., 355 N.E.2d 903, 904 (Ohio 1976);
192. Lucas v. United States, 757 S.W.2d 687, 691-92 (Tex. 1988);
193. Howard Alan Learner, Restrictive Medical Malpractice Compensation Schemes: A Constitutional "Quid Pro Quo" Analysis to Safeguard Individual Liberties, 18 HARV. J. LEGIS. 143, 155-66 (1981);
194. Amy Widman, Why Health Courts Are Unconstitutional, 27 PACE L. REV. 55, 74-81 (2006). On the federal right to trial by jury.
195. see Crowell v. Benson, 285 U.S. 22, 51 (1932) (holding that private rights may not be removed from Article III courts) and Granfmanciera, S. Am. v. Nordberg, 492 U.S. 33, 42, 51 (1989). The Seventh Amendment provides: "In Suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise re-examined in any Court of the United States, than according to the rules of the common law." U.S. CONST, amend. VII. Nearly all states have similar constitutional provisions.
196. See Widman, supra, at 84.
197. See W. PAGE KEETON ET AL., PROSSER AND KEETON ON THE LAW OF TORTS 573 (5th ed. 1984). Workers are guaranteed immediate compensation for injuries arising from the workplace in return for the loss of a jury decision on causation and damages.
198. Mello et al, supra note 9, at 464-65.
199. Troyan A. Brennan, Helping Courts with Toxic Torts: Some Proposals Regarding Alterative Methods for Presenting and Assessing Scientific Evidence in Common Law Courts, 51 U. PITT. L. REV. 1, 13-18(1989).
200. See supra text at notes 75-90.
201. WEILER ET AL., supra note 8, at 125.
202. Mello et al., supra note 9, at 473.
203. See, e.g., Steve Ellman, Medical Associations Step Up Scrutiny of Doctors Who Testify for Medical Malpractice Plaintiffs, DAILY BUS. REV., June 25, 2003, http://www.dailybusinessreview.com/ AwardStories/CodeOfSilence.html.
204. See Mello et al, supra note 9, at 472.
205. Innovative Solutions to Medical Liability, supra note 7, at 46.
206. Id.
207. Id. at 47.
208. Id.
209. See 1 BARRY R. FURROW ET AL., HEALTH LAW 363-64 (1995) (commenting that the source of the guideline determines its weight).
210. See id. at 362-66.
211. OLIVER WENDELL HOLMES, JR., THE COMMON LAW 111-12 (Little, Brown & Co. 1945) (1881).
212. Balt. & Ohio R.R. v. Goodman, 275 U.S. 66, 70 (1927). The Court ruled that a person driving a car across a railroad track who cannot see whether a train is approaching must "stop and get out of his vehicle" to check for trains. Id. at 69-70.
213. Id. at 70.
214. Pokora v. Wabash Ry. Co., 292 U.S. 98, 103-05 (1934).
215. Id.
216. Id.
217. See, e.g., David M. Eddy, Variations in Physician Practice: The Role of Uncertainty, 3 HEALTH AFF. 74, 75 (1984);
218. John Wennberg, Dealing with Medical Malpractice Variations: A Proposal for Action, 3 HEALTH AFF. 6, 7 (1984).
219. See supra notes 75-90 and accompanying text.
220. See supra notes 93-116 and accompanying text.
221. See supra notes 144-150 and accompanying text.
222. See supra notes 75-90, 93-116 and accompanying text.
223. See supra notes 86 and 87 and accompanying text.
224. See supra notes 147-150 and accompanying text.
225. See supra notes 151-154 and accompanying text.
226. See supra notes 151-154 and accompanying text.
227. See supra notes 157-163 and accompanying text.
228. See supra Part II.A.5.
229. See Innovative Solutions to Medical Liability, supra note 7, at 21;
230. Weiler et al., supra note 61, at 2355.
231. A. Russell Localio et al., Relation Between Malpractice Claims and Adverse Events Due to Negligence, 325 NEW ENG. J. MED. 245,247 (1991).
232. See, e.g., Innovative Solutions to Medical Liability, supra note 7, at 26 (statement of Michelle Mello).
233. See, e.g., id.;
234. Johnson et al., supra note 47, at 1366.
235. Mello et al., supra note 9, at 471.
236. In addition, the "state-of-the-art" standard of care might prompt more claims by making it easier for patients to determine whether they have a justified claim.
237. See BAKER, supra note 72, at 91.
238. See id.
239. See Patricia M. Danzon, The Swedish Patient Compensation System: Myths and Realities, 14 INT'L REV. L. & ECON. 453, 454 (1994). In Sweden, physicians are not named as individual defendants. Id. at 455-56. In fact, neither the physicians nor their hospitals pay premiums for liability insurance. Id. at 455. Instead, that insurance is funded out of tax revenues. Id. Furthermore, claims made against the fund do not name individual defendants. Id. at 460. These factors produce a climate of cooperation that is justly envied by health safety advocates in the U.S. See generally id.
240. BLACK'S LAW DICTIONARY 238 (5th ed. 1979).
241. See Innovative Solutions to Medical Liability, supra note 7, at 27-28 (statement of Michelle Mello).
242. See Peters, Settlements, supra note 91, at 1828.
243. See infra Part II.C for a defense of this conclusion.
244. This is not meant to suggest that abrogation of the collateral source rule is never appropriate; that would be essential in a system of no-fault recovery and patients would receive a fair quid pro quo.
245. Studdert et al., Claims, supra note 91, at 2024.
246. Id.
247. Id. at 2030-31. Many claims are difficult to evaluate without hearing the recollections of the physicians and nurses who provided the patient's care.
248. See BAKER, supra note 72, at 91-92. Typically, they will not talk to a patient's attorneys unless the patient files suit and takes their depositions.
249. See id. at 90. Thus, filing a lawsuit is often a necessary part of investigating the merits of a claim.
250. See id. at 91-92. Until some form of "pre-lawsuit" discovery is crafted to provide the necessary information, these lawsuits will continue.
251. Peters, Settlements, supra note 91, at 1475.
252. Id. at 1459-60 (finding that of the cases where liability was not admitted and liability was a legitimate issue only 11% of the plaintiffs received a significant award of damages).
253. See Charles M. Yablon, The Good, the Bad, and the Frivolous Case: An Essay on Probability and Rule 11, 44 UCLAL. REV. 65, 102 (1996).
254. Sara C. Charles et al., Sued and Nonsued Physicians' Self-Reported Reactions to Malpractice Litigation, 141 AM. J. PSYCHIATRY 563, 565 (1984).
255. See O'Connell, supra note 53, at 756.
256. See BAKER, supra note 72, at 18.
257. Id.
258. WEILER ET AL., supra note 8, at 126.
259. Richard E. Anderson, Billions for Defense: The Pervasive Nature of Defensive Medicine, 159 ARCHIVES INTERNAL MED. 2399, 2400 (1999).
260. Id.
261. Id.
262. See Teresa M. Waters et al., Impact of the National Practitioner Data Bank on Resolution of Malpractice Claims, 40 INQUIRY 283, 283 (2003) (finding that physicians have been less likely to settle claims since introduction of the NPDB in 1990, especially for payments less than $50,000).
263. Elliott M. Perlman, Well-Managed Case Gets Caught in Malpractice Fervor, AM. MED. NEWS, Feb. 21,1994, at 14.
264. Id.
265. Lucian L. Leape, Error in Medicine, 272 JAMA 1851, 1851 (1994).
266. Id.
267. See id. at 1852.
268. See, e.g., Brennan & Howard, supra note 73, at B7;
269. Perlman, supra note 203, at 14.
270. See Samuel R. Gross & Kent D. Syverud, Getting to No: A Study of Settlement Negotiations and the Selection of Cases for Trial, 90 MICH. L. REV. 319, 365 (1991).
271. Sara C. Charles et al., Sued and Nonsued Physicians' Self-Reported Reactions to Malpractice Litigation, 142 AM. J. PSYCHIATRY 437, 437-38 (1985). They were also significantly more likely to say that litigation caused suffering to them and their families. Id. at 440.
272. Id. at 438. When they interviewed nonresponders, the researchers learned that many had not completed the questionnaire because doing so was too emotionally disruptive. Id. at 440.
273. Charles et al., supra note 194, at 564 tbl.1, 565 (1984).
274. Id. at 565.
275. Charles et al., supra note 210, at 438.
276. Charles et al., supra note 194, at 565.
277. See Charles et al., supra note 210, at 440.
278. E.g., FLA. STAT. § 766.104(1) (2006) (requiring that the attorney filing the action has a good faith belief that there has been negligence in the treatment of the claimant);
279. GA. CODE ANN. § 9-11-9.1(a) (1998) (requiring a plaintiff to file with the complaint an expert's affidavit setting forth at least one negligent act or omission).
280. See, e.g., FURROW ET AL., supra note 155, at 531-32.
281. Id. at 532.
282. Mello et al., supra note 9, at 467-68.
283. See Innovative Solutions to Medical Liability, supra note 7, at 26 (statement of Michelle Mello).
284. Id. at 19 (statement of Michelle Mello).
285. Id. at 24-27 (statement of Michelle Mello).
286. Id. at 26 (statement of Michelle Mello).
287. O'Connell, supra note 53, at 752.
288. See id. at 826-29.
289. Mello et al., supra note 9, at 462-65.
290. Id. at 464.
291. See Innovative Solutions to Medical Liability, supra note 7, at 26-27 (statement of Michelle Mello).
292. Troyen A. Brennan & Michelle M. Mello, Patient Safety and Medical Malpractice: A Case Study, 139 ANNALS INTERNAL MED. 267, 267 (2003) (acknowledging that the administrative cost savings produced by no-fault programs come "largely by minimizing the role of the lawyers").
293. ALFRED C. AMAN, JR. & WILLIAM T. MAYTON, ADMINISTRATIVE LAW 173-74 (2d ed. 2001).
294. See AMAN & MAYTON, supra note 231, at 252-62;
295. infra text accompanying notes 246-255.
296. 26 U.S.C. § 7441 (2000);
297. KENNETH CULP DAVIS & RICHARD J. PIERCE, JR., ADMINISTRATIVE LAW TREATISE 90-91 (3d ed. 1994);
298. CHARLES ALAN WRIGHT, ARTHUR R. MILLER & EDWARD H. COOPER, FEDERAL
299. DAVIS & PIERCE, supra note 233, at 90.
300. WRIGHT, MILLER & COOPER, supra note 233, at § 4101.
301. Id. § 4106.
302. Id.
303. BENJAMIN WEINTRAUB & ALAN N. RESNICK, BANKRUPTCY LAW MANUAL ¶ 6.04, at 6-8 to-10 (1980).
304. Id. at 6-9 to-10.
305. Id. at 6-8.
306. See, e.g., Innovative Solutions to Medical Liability, supra note 7, at 26-27 (statement of Michelle Mello);
307. Mello et al., supra note 9, at 462-65.
308. Bruff, supra note 135, at 345-47.
309. Id. at 346-47.
310. Id. at 359.
311. Id. at 329.
312. Congress determines whether the federal APA applies. RICHARD J. PIERCE, JR. ET AL., ADMINISTRATIVE LAW AND PROCESS 304 (4th ed. 2004). At a minimum, the process must include notice, an opportunity to present evidence, and an unbiased decision-maker. Cleveland Bd. of Educ. v. Loudermill, 470 U.S. 532, 546 (1985);
313. Memphis Light, Gas & Water Div. v. Craft, 436 U.S. 1, 13 (1978);
314. AMAN & MAYTON, supra note 231, at 173-74.
315. See AMAN & MAYTON, supra note 231, at 254-62.
316. Id. at 173, 219.
317. In tribunals governed by the APA, the decision-maker is an "administrative law judge." PIERCE ET AL., supra note 246, at 308. "Informal" adjudication not governed by the APA is presided over by an "administrative judge." Id. at 309. The latter have much less independence from the agency and lower pay. Id. at 309-10.
318. Bruff, supra note 135, at 349 (describing a controversial policy in the social security disability benefits program).
319. Id. at 331.
320. 5 U.S.C. § 554(c)(2) (2000);
321. AMAN & MAYTON, supra note 231, at 220.
322. See AMAN & MAYTON, supra note 231, at 220.
323. 5 U.S.C. § 556(d) (2000);
324. AMAN & MAYTON, supra note 231, at 220.
325. AMAN & MAYTON, supra note 231, at 221.
326. See, e.g., Ernest Gellhorn, Rules of Evidence and Official Notice in Formal Administrative Hearings, 1971 DUKE L.J. 1, 37;
327. PIERCE ET AL., supra note 246, at 311.
328. AMAN & MAYTON, supra note 231, at 219-20. Discovery is not constitutionally required in administrative proceedings. Silverman v. Commodity Futures Trading Comm'n, 549 F.2d 28, 33 (7th Cir. 1977);
329. NLRB v. Interboro Contractors, Inc., 432 F.2d 854, 857-58 (2d Cir. 1970), cert, denied, 402 U.S. 915 (1971).
330. AMAN & MAYTON, supra note 231, at 221-34;
331. PIERCE ET AL., supra note 246, at 310-11.
332. AMAN & MAYTON, supra note 231, at 229-30 (stating that the APA requires parties be given the opportunity "to show the contrary" under 5 U.S.C. § 556(e) (2000));
333. PIERCE ET AL., supra note 246, at 311.
334. AMAN & MAYTON, supra note 231, at 219-20.
335. See Stephen N. Subrin, How Equity Conquered Common Law: The Federal Rules of Civil Procedure in Historical Perspective, 135 U. PA. L. REV. 909, 922-25 (1987).
336. Id. at 944.
337. Id. at 919.
338. See 5A CHARLES ALAN WRIGHT & ARTHUR R. MILLER, FEDERAL PRACTICE AND PROCEDURE § 1331, at 467 (3d ed. 2004).
339. See Subrin, supra note 261, at 917-18.
340. See WRIGHT & MILLER, supra note 264, at 467.
341. See id. (commenting that these rules kept many meritorious suits out of court because the pre-litigation investigation required to ascertain the necessary facts was impossible under the limited rules of formal discovery then in effect).
342. See FRIEDENTHAL ET AL., CIVIL PROCEDURE 253 (4th ed. 2005) (observing that most states then followed suit).
343. Id. at 255.
344. FED. R. CIV. P. 8(a)(2).
345. See WRIGHT & MILLER, supra note 264, at 469.
346. See FRIEDENTHAL ET AL., supra note 268, at 254.
347. See id. at 254-55.
348. See id.
349. Hosp. Bldg. v. Trs. of Rex Hosp., 425 U.S. 738, 746 (1976) (quoting Conley v. Gibson, 355 U.S. 41, 45-46 (1957)).
350. See FLEMING JAMES, JR. ET AL., CIVIL PROCEDURE 287 (5th ed. 2001).
351. DAVIS & PIERCE, supra note 233, at 90-91.
352. See id. at 378-79 (opining that government "would collapse under its own weight" if full judicial process were required).
353. See id.
354. See AMAN & MAYTON, supra note 231, at 118 n.3. Undue proceduralism could deplete the resources intended for program beneficiaries.
355. See Richardson v. Perales, 402 U.S. 389,406(1971).
356. DAVIS & PIERCE, supra note 233, at 379.
357. See Lori B. Andrews et al., An Alternative Strategy for Studying Adverse Events in Medical Care, 349 LANCET 309, 312 (1997).
358. See id. (implying that not all medical errors are recorded in medical charts).
359. See Michael J. Saks, Medical Malpractice: Facing Real Problems and Finding Real Solutions, 35 WM. & MARY L. REV. 693, 709 (1994).
360. See Gerald B. Hickson et al., Factors that Prompted Families To File Medical Malpractice Claims Following Perinatal Injuries, 267 JAMA 1359, 1361 (1992).
361. See id.
362. PHYSICIAN PAYMENT REVIEW COMM'N, ANNUAL REPORT TO CONGRESS B-19 (1995) (on file with author).
363. See Lucian Arye Bebchuk, Litigation and Settlement Under Imperfect Information, 15 RAND J. OF ECON. 404,409 (1984).
364. Henry S. Farber & Michelle J. White, A Comparison of Formal and Informal Dispute Resolution in Medical Malpractice, 23 J. LEGAL STUD. 777, 789 (1994) (37 of 355 claims).
365. Id. at 778. These "empirical results are consistent with an information structure in which patients initially are poorly informed about the quality of medical care and the hospital initially is poorly informed about how litigious patients are." Id. at 806.
366. Roger A. Rosenblatt & Andy Hurst, An Analysis of Closed Obstetric Malpractice Claims, 74 OBSTETRICS & GYNECOLOGY 710,711 (1989).
367. Id. at 712.
368. See Farber & White, supra note 185, at 795. The goal is to avoid settling with the "peaceful" patients who will not file suit. Id.
369. See Mello et al., supra note 9, at 462-63.
370. See id. at 465.
371. COMMON GOOD INST., AN URGENT CALL FOR SPECIAL HEALTH COURTS 6 (2005), available at http://cgood.org/assets/attachments/130.pdf.
372. See generally Mello et al., supra note 9.
373. Patricia Munch Danzon & Lee A. Lillard, Settlement Out of Court: The Disposition of Medical Malpractice Claims, 12 J. LEGAL STUD. 345, 363 (1983).
374. See William Meadow, Operationalizing the Standard of Medical Care: Uses and Limitations of Epidemiology To Guide Expert Testimony in Medical Negligence Allegations, 37 WAKE FOREST L. REV. 675, 676 (2002) (calling this "so obvious as to almost go without saying");
375. Tim Cramm et al., Ascertaining Customary Care in Malpractice Cases: Asking Those Who Know, 37 WAKE FOREST L. REV. 699, 711 (2002) (stating that physicians do this "covertly").
376. Meadow, supra note 299, at 688.
377. However, an argument could certainly be made for a separate, more simplified process for the handling of small claims.
378. See supra note 52 and accompanying text.
379. See Keeton, supra note 53, at 594.
380. See id.
381. See Mello et al., supra note 9, at 468 (crediting a damages proposal by Bovbjerg, Sloan, and Blumstein in 1989).
382. E.g., David W. Leebron, Final Moments: Damages for Pain and Suffering Prior to Death, 64 N.Y.U. L. REV. 256, 259 (1989) (arguing that awards for pain and suffering vary significantly and inexplicably).
383. See, e.g., Mello et al., supra note 9, at 467-68.
384. Id. at 468, 470.
385. See Joanne Doroshow, The Health Courts Facade, 42 TRIAL 20, 22 (2006) (explaining that these plans fail to fully compensate even for lost pre-injury income and lamenting that statutory damage schedules are subject to reduction over time by legislation).
386. Mello et al., supra note 9, at 470.
387. See, e.g., id.
388. Id.;
389. Innovative Solutions to Medical Liability, supra note 7, at 45 (statement of Paul Barringer, General Counsel, Common Good).
390. Mello et al., supra note 9, at 468-71.
391. See Hickson et al, supra note 285, at 1361-62.
392. See Mello & Brennan, supra note 62, at 1597-98.
393. See id.
394. See id. at 1607-13.
395. Id. at 1616.
396. Id. at 1618. In addition, the combination of a very low claims rate among people with valid claims and a high number of baseless claims sends a distorted deterrence signal to providers. Id. at 1620. Moreover, insufficient claiming insufficiently internalizes for physicians the damages caused by poor medicine. Id.
397. See Mello et al., supra note 9, at 469.
398. See Mello & Brennan, supra note 62, at 1619 (discussing the "incredibly small overlap between the group of patients injured by negligence and the group who brought suit").
399. INST, OF MED., TO ERR IS HUMAN 43 (2000).
400. Mello et al, supra note 9, at 472 ("[H]onesty about potential problems will both promote overall discussion and reiterate to the professional that the patient's well-being is the first objective.").
401. Id. at 473.
402. See WEILER ET AL., supra note 8, at 129.
403. Mello et al., supra note 9, at 470-71.
404. John H. Eichhorn et al., Standards for Patient Monitoring During Anesthesia at Harvard Medical School, 256 JAMA 1017, 1020 (1986).
405. See id.
406. See infra text accompanying notes 406-411.
407. Innovative Solutions to Medical Liability, supra note 7, at 43-47 (statements of James M. Wootton & Paul Barringer).
408. Id. at 43, 46, 47 (statements of James M. Wootton & Paul Barringer). That label is used because it imposes liability whenever the injuries suffered by the patient could have been avoided using state-of-the-art practices. Mello et al, supra note 9, at 474.
409. Innovative Solutions to Medical Liability, supra note 7, at 47 (statements of James M. Wootton & Paul Barringer).
410. Id. at 46 (statements of James M. Wootton & Paul Barringer).
411. See Mello et al., supra note 9, at 472-73.
412. Innovative Solutions to Medical Liability, supra note 7, at 46 (statements of James M. Wootton & Paul Barringer).
413. See John E. Wennberg & Philip G. Peters, Jr., Unwarranted Variations in the Quality of Health Care: Can the Law Help Medicine Provide a Remedy/Remedies?, 37 WAKE FOREST L. REV. 925,938 (2002).
414. See, e.g., id. at 927-28 (citing as an example the systematic under use of beta-blockers).
415. See, e.g., Johnson et al., supra note 47, at 1387 & n. 116.
416. See Mello & Brennan, supra note 62, at 1617-18.
417. See Mello et al., supra note 9, at 461.
418. See Innovative Solutions to Medical Liability, supra note 7, at 46-47 (statement of Paul Barringer).
419. See Mello et al., supra note 9, at 468-69.
420. Id. at 465.
421. See Innovative Solutions to Medical Liability, supra note 7, at 46-47 (statement of Paul Barringer).
422. See id. at 47.
423. Mello et al., supra note 9, at 471. This rosy scenario also seems to assume that patients will be better able to sort legitimate claims from unwarranted ones. Otherwise, the extra claims would simply produce more static. It is not clear why this would be so, unless we assume that physicians and nurses will guide patients' decisions. I explain in the text why this is unlikely to occur as long as providers risk individual liability. The new standard of care will, of course, mean that an unknown fraction of currently marginal or weak claims will become legally compensable.
424. See supra text at notes 175-187.
425. See supra text at notes 175-187.
426. See Mello et al., supra note 9, at 476.
427. See Innovative Solutions to Medical Liability, supra note 7, at 44, 54, 55, 76 (statements of Paul Barringer, Margaret VanAmringe, and Joanne Doroshow);
428. WEILER ET AL., supra note 8, at 33-59.
429. See Innovative Solutions to Medical Liability, supra note 7, at 44, 54, 55.
430. See id. at 27.
431. See Mello et al., supra note 9, at 478-82 (contending that benefits have accrued in other countries which have adopted administrative claims processes).
432. Id. at 464.
433. Id. at 465.
434. Id. at 461, 471.
435. Id. at 465.
436. Id. at 467-68.
437. Id. at 472-74.
438. See id. at 474.
439. See id.
440. See id. It is also possible that an adverse verdict under the new standard will not lead to the same harmful professional consequences associated with a finding of negligence. Id.
441. Medical Liability: New Ideas for Making the System Work Better for Patients, supra note 7, at 41, 42 (statement of Philip K. Howard).
442. Mello et al., supra note 9, at 473.
443. Id. at 473-74.
444. Thomas H. Gallagher et al., Choosing Your Words Carefully: How Physicians Would Disclose Harmful Medical Errors to Patients, 166 ARCHIVES INTERNAL MED. 1585, 1591-92 (2006) [hereinafter Gallagher et al., Choosing Your Words Carefully].
445. Congress passed the Patient Safety Quality Improvement Act in 2005. Pub. L. No. 109-41, 119 Stat. 424 (codified at 42 U.S.C.A. §§ 299b-22 to 299c (2007)). A revamped Health Courts proposal came out the next year. See generally Mello et al., supra note 9.
446. Pub. L. No. 109-41.
447. INST, OF MED., TO ERR IS HUMAN (2000).
448. Id. at 87.
449. See 42 U.S.C.A. §§ 299b-22 to 299c (2005).
450. See Id. §299b-22.
451. See generally Mello et al., supra note 9.
452. See, e.g., Ralph Peeples, Catherine T. Harris & Thomas Metzloff, Settlement Has Many Faces: Physicians, Attorneys, and Medical Malpractice, 41 J. HEALTH & SOC. BEHAV. 333, 341 (2000).
453. Gallagher et al, Choosing Your Words Carefully, supra note 366, at 1585.
454. See Mello et al., supra note 9, at 473.
455. Thomas H. Gallagher et al., US and Canadian Physicians' Attitudes and Experiences Regarding Disclosing Errors to Patients, 166 ARCHIVES INTERNAL MED. 1605, 1606 (2006) [hereinafter Gallagher et al., US and Canadian Physicians].
456. Id. at 1609.
457. Id. at 1605, 1607.
458. Gallagher et al., Choosing Your Words Carefully, supra note 366, at 1592.
459. Gallagher et al., US and Canadian Physicians, supra note 377, at 1609.
460. Id.
461. Gallagher et al., Choosing Your Words Carefully, supra note 366, at 1592. 50% of physicians deny that systemic errors cause most medical errors.
462. See Gallagher et al., US and Canadian Physicians, supra note 377, at 1610. Others studies have confirmed the widespread perception that physicians resist the modern tools of quality improvement such as outcome reviews, data sharing, and collective design of safer systems. Anne-Marie J. Audet et al., Measure, Learn, and Improve: Physicians' Involvement in Quality Improvement, 24 HEALTH AFF. 843, 850 (2005);
463. see also Michael D. Cabana et al., Why Don't Physicians Follow Clinical Practice Guidelines? A Framework for Improvement, 282 JAMA 1458, 1458 (1999);
464. Arnold Milstein & Nancy E. Adler, Out of Sight, Out of Mind: Why Doesn't Widespread Clinical Quality Failure Command Our Attention?, 22 HEALTH AFF. 119, 124(2003).
465. Under a health courts regime, physicians would still buy their liability insurance and would still be individually liable for injuries they inflict. Their disclosures of error to hospital or national quality improvement programs would be no more confidential than they already are.
466. Newhouse & Weiler, supra note 61, at 81.
467. See FURROW ET AL., supra note 155, at 374-76. Some, but not all, states have begun to impose vicarious liability on hospitals for the conduct of physicians who are exclusively hospital-based and who are selected by the hospital, rather than the patient - such as many emergency medicine doctors and anesthesiology departments - using a theory of ostensible or apparent agency. Id. at 377-78. However, that legal theory won't support liability for the torts of physicians who are chosen by patients outside of the hospital. Id. at 376.
468. See, e.g., DAN B. DOBBS, THE LAW OF TORTS 910-17 (2000) (explaining that the negligence must occur within the scope of employment).
469. I base this statement on my experience as a tort defense attorney.
470. See FURROW ET AL., supra note 155, at 374, 376;
471. see also DOBBS, supra note 387, at 917.
472. AM. LAW INST., REPORTERS' STUDY, supra note 51, at 125-26.
473. See Mark A. Hall, Institutional Control of Physician Behavior: Legal Barriers to Health Care Cost Containment, 137 U. PA. L. REV. 431, 445-46 (1988).
474. Id.
475. See 2 AM. LAW INST., REPORTERS' STUDY, supra note 51, at 118 n.14.
476. See id. at 121.
477. See Mello & Brennan, supra note 62, at 1623.
478. See id.
479. Hospital enterprise liability is, therefore, consistent with models favored by legal economists, like Guido Calabresi, who suggested that the law should impose liability on the party best positioned to see safety issues, including the relevant trade-offs, and to take appropriate measures to prevent accidents or to induce others to prevent accidents. See GUIDO CALABRESI, THE COSTS OF ACCIDENTS: A LEGAL AND ECONOMIC ANALYSIS 135-73 (1970). He called parties in this position "the cheapest cost avoiders." Id. at 135 n.1. Hospitals undoubtedly play this role in the delivery of in-patient health care.
480. There is limited empirical evidence suggesting that hospitals are more responsive than physicians to the deterrence signals transmitted by tort law. See Troyen A. Brennan, The Role of Regulation in Quality Improvement, 76 MILBANK Q. 709, 721 (1998).
481. AM. LAW INST., REPORTERS' STUDY, supra note 51, at 123-24;
482. Mello & Brennan, supra note 62, at 1617-18, 1633.
483. AM. LAW INST., REPORTERS' STUDY, supra note 51, at 506-07 (citing MICHAEL J. MOORE & W. KIP VISCUSI, COMPENSATION MECHANISMS FOR JOB RISKS: WAGES, WORKERS' COMPENSATION, AND PRODUCT LIABILITY 133-35 (1990));
484. see also JOSEPH V. REES, REFORMING THE WORKPLACE: A STUDY OF SELF-REGULATION IN OCCUPATIONAL SAFETY 72-80, 114-18 (1988) (offering a case study in the influence of workers' compensation premiums and employer safety policy).
485. Mello & Brennan, supra note 62, at 1623.
486. Id.
487. Leape, supra note 205, at 1855 (discussing the aviation industry).
488. AMERICAN LAW INSTITUTE, REPORTERS' STUDY, supra note 51, at 118 n.14.
489. Id. at 115.
490. See generally John H. Eichhorn et al., supra note 327.
491. Id. at 1017.
492. Id. at 1018-20.
493. See David A. Hyman & Charles Silver, The Poor State of Health Care Quality in the U.S.: Is Malpractice Liability Part of the Problem or Part of the Solution?, 90 CORNELL L. REV. 893, 919-20 (2005) (describing the history of anesthesia quality improvement).
494. Lucian L. Leape, Error in Medicine, in MARGIN OF ERROR: THE ETHICS OF MISTAKES IN THE PRACTICE OF MEDICINE 95, 107 (Susan B. Rubin & Laurie Zoloth eds., 2000).
495. Hyman & Silver, supra note 409, at 918.
496. Id. at 918-20.
497. Eichhorn et al., supra note 406, at 1017.
498. Tom Baker calls this "enterprise insurance." BAKER, supra note 72, at 174-78. Others call it insurance "channeling. " See, e.g., WEILER, supra note 52 , at 126.
499. Laura Landro, The Informed Patient: Preventing the Tragedy of Misdiagnosis, WALL ST. J., NOV. 29, 2006, at D1.
500. Id.
501. For a discussion of reasons why legal reforms are destined to have limited effect, see supra text accompanying notes 374-384.
502. See Randall R. Bovbjerg, Reform of Medical Liability and Patient Safety: Are Health Courts and Medicare the Keys to Effective Change?, 9 J. HEALTH CARE L. & POL'Y 252, 254 (2006).
503. See Gallagher et al., US and Canadian Physicians, supra note 377, at 1610;
504. see also Gallagher et al., Choosing Your Words Carefully, supra note 380, at 1591.
505. Thomas H. Gallagher & Wendy Levinson, Commentary, Disclosing Harmful Medical Errors to Patients: A Time for Professional Action, 165 ARCHIVES OF INTERNAL MED. 1819, 1819(2005).
506. Id.
507. Id.
508. BAKER, supra note 72, at 178.
509. AM. LAW INST., REPORTERS' STUDY, supra note 51, at 119.
510. See BAKER, supra note 72, at 165.
511. See id. at 51-52.
512. See id. at 67.
513. See id. at 163-64.
514. AM. LAWINST., REPORTERS' STUDY, supra note 51, at 116.
515. Id. at 115-16.
516. See BAKER, supra note 72, at 175.
517. AM. LAW INST., REPORTERS' STUDY, supra note 51, at 116&n.l4.
518. Furthermore, about 90% of the claims and payments now being made arise out of care given inside a hospital. Id. at 114.
519. Id. at 113-14.
520. See BAKER, supra note 72, at 176.
521. Id. at 176-77.
522. See WEILER ET AL., supra note 8, at 147-48;
523. Mello & Brennan, supra note 62, at 1626.
524. See Mello & Brennan, supra note 62, at 1604-06.
525. Clark C. Havighurst, Vicarious Liability: Relocating Responsibility for the Quality of Medical Care, 26 AM. J. L. & MED. 7, 8 (2000) (advocating vicarious liability for managed care plans).
526. Kenneth S. Abraham & Paul C. Weiler, Enterprise Medical Liability and the Evolution of the American Health Care System, 108 HARV. L. REV. 381, 381 (1994);
527. see also WEILER ET AL., supra note 8, at 114.
528. Mello & Brennan, supra note 62, at 1598.
529. Id.
530. See generally supra note 61.
531. BAKER, supra note 72, at 164-65 (recommending that hospitals be obliged to purchase "enterprise insurance" covering all claims against medical providers using hospital facilities). He believes that doctors and hospitals might more readily accept enterprise insurance than enterprise liability because formal liability is resisted by physicians. Id. at 175-76.
532. William M. Sage et al., Enterprise Liability for Medical Malpractice and Health Care Quality Improvement, 20 AM. J. L. & MED. 1, 1 (1994) (advocating vicarious liability for managed care plans).
533. See Jennifer Arlen & W. Bentley MacLeod, Malpractice Liability for Physicians and Managed Care Organizations, 78 N.Y.U. L. REV. 1929, 1979 (2003) (using economic analysis to show that managed care organizations should be vicariously liable even if they do not exert direct control over physicians).
534. See Mello & Brennan, supra note 62, at 1629.
535. AM. LAW INST., REPORTERS' STUDY, supra note 51, at 125.
536. Id.
537. BAKER, supra note 72, at 177.
538. AM. LAW INST., REPORTERS' STUDY, supra note 51, at 126.
539. See supra notes 117-119 and accompanying text.
540. See supra notes 91-116 and accompanying text.
541. See supra notes 86-87 and accompanying text.
542. See supra notes 139-143 and accompanying text.
543. See supra note 235 and accompanying text.
544. These provisions include a tougher standard of care, the centralized collection of data on medical errors, and the clearer ex ante guidance provided by the combination of the new definition of the standard of care, the issuance of written opinions with precedential effect, the greater weight given to authoritative clinical guidelines, and the identification of ACEs in advance. Of course, the magnitude of the safety improvements is impossible to predict.