September 2002


By Michael J. Katin, MD

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