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September 2002
Tort-uosity
By Michael J. Katin, MD
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Once again a topic has emerged to supersede the planned topic for this
month, which is just as well since it contributes further to the stockpiling
of articles which can be used later in case of creativity block, not to
mention that with columns dating back to 1997 some of the older ones can
probably be dragged out again without anyone noticing. This is not one of
them, however.
There are only a few days now before primary elections in many states,
and just over 2 months before Congressional elections on November 5. Now
that life has returned at least somewhat to normality, with most people
having become moderately immune to 200-point drops in the stock market and
with heightened vigilance but less anxiety about potential terrorist threats,
and with the last of the automobile flags vanishing from sight, the issues
which will affect most Americans in deciding their voting preferences will
be less dramatic. The tops items of concern, of course, include domestic
security and military preparedness, but the topics of government prescription
drug plans, tax cuts, reparations for slavery, same-sex marriages, and forestry
management are more frequently raised. Farther down the list, holding up
at position #743, is tort reform.
. . . . or is it further? Either way, the topic of tort reform is considered
by physicians to be far more important, ranking ahead of food, warmth, shelter,
and affection and only slightly behind air and water. Most of us have been
solicited to contribute to campaigns of politicians who promise to support
tort reform, which in most cases turns out to be to change the system to
have payments made faster. True tort reform would help to dramatically cut
costs and simplify patterns of medical practice, with the ultimate goal
of eliminating concern about losing one's life savings for failing to follow
up on an equivocal finding on an FDG-PET scan ordered for completeness'
sake on a patient with basal cell carcinoma of the nose. It should be recognized
that this is not a concern simply of the medical profession, since the aggressiveness
of the tort industry makes everything we do more expensive and more stressful.
An example of the morass in which we find ourselves is as follows: A 78-year-old
gentleman with metastatic lung cancer goes shopping at the local Won't Be
Food Again Supermarket. Ten minutes earlier, a bottle of ketchup has fallen
from the fourth shelf and smashed in the aisle. This event was ignored by
one of the workers, an illegal alien of Carpathian extraction, who is still
working regularly despite a record of hypocompetence since the store manager
verbally abused him and in return was threatened with a civil action. Another,
more dependable, worker, had stocked the ketchup bottles but had not done
an optimal job since he had read the warning label on the stepladder and
was afraid to climb up it to reach the fourth shelf more easily. The 78-year-old
gentleman slips and falls on the ketchup and fractures his right arm. He
ultimately collects $2,000,000 from the store and $5,000,000 from the oncologist,
who failed to properly warn him of the risk of pathologic fracture ($1,000,000
for the injury itself and
$4,000,000 for loss of consortium).
This may be considered an exaggeration, but not totally out of the realm
of possiblity. Regardless, no injury is to be taken lightly, and maybe it
would be better to recognize that the law
is for protection of the people. Whether or not there is any change
in the system, we should do everything we can to protect our patients, and
not get into bad habits that may catch up with us.
email: mkatin@radiotherapy.com