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Medical Malpractice Reform: The Role of Alternative Dispute Resolution

  • Symposium: Evolving Medicolegal Concepts
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Alternative dispute resolution (ADR) refers to techniques used to resolve conflicts without going to the courtroom. As healthcare and malpractice costs continue to rise, there is growing interest in tactics such as early apology, mediation, and arbitration in the medical arena.

Questions/purposes

(1) Why is ADR needed? (2) Is ADR useful in health care? (3) What are the current legal and political developments favoring ADR? (4) What obstacles remain?

Methods

We performed MEDLINE, PubMed, and Google Scholar searches with key words “medical malpractice”, “ADR”, and “alternative dispute resolution” to obtain public policy studies, law review articles, case analyses, ADR surveys, and healthcare review articles.

Results

Early apology and disclosure programs report 50% to 67% success in avoiding litigation as well as substantial reductions in the amount paid per claim. Mediation boasts 75% to 90% success in avoiding litigation, cost savings of $50,000 per claim, and 90% satisfaction rates among both plaintiffs and defendants. Arbitration is viewed as less satisfying and less efficient than mediation but still more time- and cost-effective than litigation. The current legal environment is favorable to ADR with recent court decisions upholding pretreatment arbitration clauses. The main obstacle to ADR is the mandatory reporting requirement of the National Practitioner Data Bank (NPDB).

Conclusions

ADR has the potential to help reform the current tort system, reducing cost and increasing both parties’ satisfaction. Easing the reporting requirements for the NPDB would lead to more widespread acceptance of ADR among physicians.

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References

  1. Arber A, Gallagher A. Breaking bad news revisited: the push for negotiated disclosure and changing practice implications. Int J Palliat Nurs. 2003;9:166–172.

    PubMed  Google Scholar 

  2. Ballasy N. Howard Dean: Democrats left tort reform out of health care bill because they feared ‘taking on’ trial lawyers. 2009. Available at: www.CNSNews.com. Accessed August 21, 2011.

  3. Boothman RC, Blackwell AC, Campbell DA Jr, Commiskey E, Anderson S. A better approach to medical malpractice claims? The University of Michigan experience. J Health Life Sci Law. 2009;2:125–159.

    PubMed  Google Scholar 

  4. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH; Harvard Medical Practice Study I. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. 1991. Qual Saf Health Care. 2004;13:145–151; discussion 151–152.

  5. Commissioners Report. Profitability by Line by State in 1976 and 2002. Kansas City, MO, USA: National Association of Insurance Commissioners; 2003.

  6. “Confronting the New Health Care Crisis: Improving Health Care Quality and Lowering Costs by Fixing Our Medical Liability System.” US Department of Health and Human Services (2002). Available at: http://aspe.hhs.gov/daltcp/reports/litrefm.htm. Accessed November 12, 2011.

  7. Consultation Paper: Alternative Dispute Resolution. Dublin, UK: Law Reform Commission; 2008.

  8. Creo RA, Shogan JO, Turner CT. Malpractice Case Alternative Dispute Resolution. Narberth, PA, USA: Physician’s News Digest; 2005.

    Google Scholar 

  9. Dauer EA. Alternatives to litigation for health care conflicts and claims: alternative dispute resolution in medicine. Hematol Oncol Clin North Am. 2002;16:1415–1431.

    Article  PubMed  Google Scholar 

  10. DeMaria AN. Medical malpractice insurance: a multifaceted problem. J Am Coll Cardiol. 2003;42:1683–1684.

    Article  PubMed  Google Scholar 

  11. Elmendorf D. Letter to Senator Orrin Hatch, October 10, 2009. Available at: http://www.cbo.gov/ftpdocs/106xx/doc10641/10-09-Tort_Reform.pdf. Accessed August 21, 2011.

  12. Elmendorf D. The Effects of Health Reform on the Federal Budget. CBO Director’s Blog. 2010.

  13. Fraser JJ Jr. American Academy of Pediatrics: technical report: alternative dispute resolution in medical malpractice. Pediatrics. 2001;107:602–607.

    Article  PubMed  Google Scholar 

  14. Furlong GT. The Conflict Resolution Toolbox. Ontario, Canada: John Wiley & Sons; 2005:38.

    Google Scholar 

  15. Gallagher TH, Waterman AD, Ebers AG, Fraser VJ, Levinson W. Patients’ and physicians’ attitudes regarding the disclosure of medical errors. JAMA. 2003;289:1001–1007.

    Article  PubMed  Google Scholar 

  16. Greer TE. Alternative dispute resolution in medical liability cases. AAOS Now. 2009. Available at: http://www.aaos.org/news/aaosnow/jul09/managing7.asp. Accessed November 11, 2011.

  17. Hartwig R. Medical Malpractice Insurance Jury Verdict Research. New York, NY, USA: Insurance Information Institute; 2008:1.

    Google Scholar 

  18. Hyman CS, Liebman CB, Schechter CB, Sage WM. Interest-based mediation of medical malpractice lawsuits: a route to improved patient safety? J Health Polit Policy Law. 2010;35:797–828.

    Article  PubMed  Google Scholar 

  19. Hyman CS, Schechter CB. Mediating medical malpractice lawsuits against hospitals: New York City’s pilot project. Health Affairs. 2006;25:1394–1399.

    Article  PubMed  Google Scholar 

  20. Kachalia A, Mello MM. New directions in medical liability reform. N Engl J Med. 2011;364:1564–1572.

    Article  PubMed  CAS  Google Scholar 

  21. Kelly C. Healthcare reimbursement: HMO arbitration clause enforced. J Law Med Ethics. 2003;31:731–734.

    Article  PubMed  Google Scholar 

  22. Kessler D, McClellan M. Do doctors practice defensive medicine? Q J Econ. 1996;111:353–390.

    Article  Google Scholar 

  23. Kraman SS, Hamm G. Risk management: extreme honesty may be the best policy. Ann Intern Med. 1999;131:963–967.

    PubMed  CAS  Google Scholar 

  24. Localio AR, Lawthers AG, Brennan TA, Laird NM, Hebert LE, Peterson LM, Newhouse JP, Weiler PC, Hiatt HH. Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. N Engl J Med. 1991;325:245–251.

    Article  PubMed  CAS  Google Scholar 

  25. Maine Rev Stats Title 24, 2851 and 2853.

  26. Medicare Physician Payment Reform Act of 2009. HR 3961 (2010).

  27. Metzloff TB. Alternative dispute resolution strategies in medical malpractice. Alaska Law Review. 1992;9:429–457.

    Google Scholar 

  28. National Practitioner Data Bank 2006 Annual Report, US Dept of Health and Human Services (2006). Available at: www.npdb-hipdb.hrsa.gov/resources/reports/2006NPDBAnnualReport.pdf. Accessed August 21, 2011.

  29. National Practitioner Data Bank Guidebook. US Dept of Health and Human Services (1999). Available at: www.npdb-hipdb.hrsa.gov/resources/NPDBGuidebook.pdf. Accessed August 21, 2011.

  30. Pace NM, Golinelli D, Zakaras L. Capping Non-Economic Awards in Medical Malpractice Trials: California Jury Verdicts Under MICRA. Santa Monica, CA, USA: RAND Corporation, Institute for Civil Justice; 2004. Available at: http://www.rand.org/pubs/monographs/2004/RAND_MG234.pdf. Accessed August 21, 2011.

  31. Pate R, Hunter D. Code Blue: The Case for Serious State Medical Liability Reform. THFBN 1908; 2008.

  32. Patient Protection and Affordable Care Act. HR 3590 (2010).

  33. Peeples R, Harris C, Metzloff T. Following the script: an empirical analysis of court-ordered mediation of medical malpractice cases. J Disp Resolution. 2007;1:101–118.

    Google Scholar 

  34. PIAA Claim Trend Analysis (2004).

  35. Politics, CfR (2011). Available at: http://www.opensecrets.org/industries/background.php?cycle=2012&ind=K01. Accessed August 21, 2011.

  36. Rosengard LA, Parker M. Medical malpractice mediation: a ‘healthy’ resolution for patients, doctors and insurance companies. The ADR Advisor. 2010;Winter:1–3.

    Google Scholar 

  37. Sack K. Doctors say, ‘I’m sorry’ before see you in court. The New York Times. 2008.

  38. Simpson A, Bowles E. Co-Chairs Proposal. NCoFR a Reform; 2010.

  39. Stimpanowich TJ. ADR and the ‘vanishing trial’: the growth and impact of ‘alternative dispute resolution.’ J Empir Legal Stud. 2004:843–912.

  40. Studdert DM, Mello MM, Gawande AA, Gandhi TK, Kachalia A, Yoon C, Puopolo AL, Brennan TA. Claims, errors, and compensation payments in medical malpractice litigation. N Engl J Med. 2006;354:2024–2033.

    Article  PubMed  CAS  Google Scholar 

  41. Szmania SJ, Johnson AM, Mulligan M. Alternative dispute resolution in medical malpractice: a survey of emerging trends and practices. Conflict Resolution Q. 2008;26:71–96.

    Article  Google Scholar 

  42. Tabler NG. Should physicians apologize for medical errors? The Health Lawyer. 2007;19.

  43. Webb RJ. New Jersey Court Green Lights Provider-Patient Arbitration Agreements. Healthcare Neutral ADR Blog. Califon, NJ, USA: Healthcare Neutral, LLC; 2010.

    Google Scholar 

  44. Weiler PC. A Measure of Malpractice: Medical Injury, Malpractice Litigation, and Patient Compensation. Cambridge, MA, USA: Harvard University Press; 1993.

    Google Scholar 

  45. Weinstein SL. Medical liability reform crisis 2008. Clin Orthop Relat Res. 2009;467:392–401.

    Article  PubMed  Google Scholar 

  46. Wisconsin Statute 655.42(1).

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Acknowledgment

We thank Steven C. Friedman for his invaluable help with the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Toledo Medical Center, 3000 Arlington Avenue, Toledo, OH, 43551, USA

    David H. Sohn JD, MD

  2. Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA

    B. Sonny Bal MD, JD, MBA

Authors
  1. David H. Sohn JD, MD
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  2. B. Sonny Bal MD, JD, MBA
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Corresponding author

Correspondence to David H. Sohn JD, MD.

Additional information

One of the authors (DHS) is a course instructor in hip arthroscopy for Smith & Nephew (Memphis, TN, USA) but has declined any compensation or reimbursement for this.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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Sohn, D.H., Sonny Bal, B. Medical Malpractice Reform: The Role of Alternative Dispute Resolution. Clin Orthop Relat Res 470, 1370–1378 (2012). https://doi.org/10.1007/s11999-011-2206-2

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