At the end of May, Physician’s Weekly featured an article describing a bill that was introduced into the House of Representatives called HR 1406 The Saving Lives, Saving Costs Act. It would create a “safe harbor” for physicians who could show that they followed best practice guidelines when faced with a malpractice suit. At the end of the piece, a question was asked, “Do you think this bill will help safeguard physicians against the influx of federal rules and regulations?”
Knowing little about the bill at the time, I tweeted that such a bill would never pass.
I couldn’t list the reasons in a tweet, but here are a few.
Although guidelines are useful, they can be controversial too. Take the guidelines on screening mammography and PSA testing. When they came out, there was so much criticism that it would be difficult for any defense lawyer to use them as safe harbors. Plaintiffs’ experts would simply say they disagreed with any guideline. A seed of doubt would be planted in the minds of jurors, and the safe harbor defense would fail.
The Dr. Whitecoat blog published a conversation between an emergency physician and a plaintiff’s lawyer. It should be read in its entirety, including the comments, to be appreciated.
The conversation was mostly about the Choosing Wisely campaign, in which specialty societies publish guidelines listing certain tests and treatments that they feel can be avoided.
He said, “There will be a lot of bad discharges, refused admits, procedure delays, diagnoses delays, all in the name of ‘costs.’ Your societies and hospitals are masking this as evidence based practice, etc. But I can get a jury to see that very differently. A lot of physicians will be paying out before long, as will hospitals…Testing is what makes diagnoses, saves people.
“I have a pretty set script here. To the effect of ‘so Doctor, you just didn’t care enough about my client to order this test?’ Or ‘so my client was just a statistic, just a percentage to you?’… [Juries] love that stuff!”
A post I wrote last year about a supposed set of common goals shared by lawyers and surgeons had these comments from another plaintiff’s lawyer.
Regarding the use of guidelines as a malpractice defense, which some have labeled a “safe harbor,” the lawyer said, “The safe harbor concept becomes unacceptable if it allows guidelines to be used as a ‘get out of jail free’ card. Guidelines must be useful in exonerating and implicating clinician wrongdoing.” My interpretation of what he said was that it’s OK to use a guideline to prove a clinician did wrong, but following guidelines should not be a fail-safe defense strategy.
Just for fun, I looked up HR 1406’s history. It was introduced on February 27, 2014 and immediately referred to three committees—the Energy and Commerce Committee, The Judiciary Committee, And the Subcommittee on Health. On March 20, 2014 it was referred to the Subcommittee on the Constitution and Civil Justice.
A website that tracks bills gave it an 8% chance of getting past committee and a 2% chance of being enacted. The odds have not been revised to account for the four committees the bill now languishes in or the 5 months that have elapsed since any activity took place.
According to the Congressional Research Service, 197 (45%) Members of the House and 60 (60%) Senators have law degrees. Lawyers are not going to hinder their colleagues from pursuing malpractice suits with any law like this one.
Now that I know a lot more about the bill, I am more certain it will never pass, and maybe that’s not a bad thing.
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 9900 followers on Twitter.