Health care on trial: America's medical malpractice crisis.

Abstract

The specter of medical malpractice in the United States has assumed crisis proportions. The American Medical Association has declared that malpractice issues are at least “serious and deteriorating” in 44 states.1 Public awareness has been heightened by sporadic reports of physician work stoppages or closures (at least temporary) of hospital high-risk services (eg, emergency rooms, obstetrics).2 In addition, physician outmigration has occurred from the most egregiously affected regions. A crossroads in American medicine has been reached that both threatens public access to quality care and further endangers an already limited supply of subspecialty physician providers.3,4 Conversely, public disclosure of medical error and negligence5,6 has prompted reasonable demands for responsibility among healthcare providers and compensation to the injured parties. The multiple and diverse factors that have contributed to the current crisis, its medical and public ramifications, and potential remedies are detailed in the present issue of Circulation by Donald J. Palmisano, MD, JD, President of the American Medical Association, Robert Cline, MD, a cardiothoracic surgeon, and Carl J. Pepine, MD, Immediate Past President of the American College of Cardiology.7,8 At the heart of the malpractice crisis appears to be a tort system without adequate controls.9 This system has aptly demonstrated its ability to obtain large settlements in the class action case of silicone breast implants without strong scientific evidence for their harm.9 The expert opinions from noted thought leaders expressed in Circulation are remarkably passionate and consistent in their professional pride as well as commitment to compassionate, quality patient care. Our experts express hope that we are on the verge of a meaningful change in the current tort system, as well as fear of the consequences if change does not occur. On the other hand, we also must be mindful of the fact that …