STATE LEGISLATIVE UPDATE

As of the end of the month, the following state legislatures were not in adjournment: CA, DC, IL, MA, MI, NH, NJ, NY, OH, PA and WI. Through the middle of November, there have been 162,689 new bills introduced in the states and 39,926 have become law. Some of the bills the department of Socioeconomic & State Society Affairs is tracking are outlined below. If you have any questions, please contact Bruce Allain at allain@aaos.org (or at 847-384-4336).

TORT REFORM

The biggest news of the month came from Washington state, which placed two medical malpractice referendums before the voters in November. One initiative, backed by the trial lawyers, would have revoked doctor's licenses if they lose three malpractice claims in one decade. The other, backed by the medical community, would have limited lawyers' fees and pain and suffering awards for malpractice cases. Voters rejected both initiatives. The initiative supported by physicians had 46% of voters approving, while the trial lawyers’ proposal got only 41% approval, neither getting the support needed to pass.

A bills to reinstate Wisconsin’s cap on noneconomic damages has been sent to Governor Doyle. The governor plans to veto the legislation, as he feels that it is too similar to the law the state Supreme Court rejected recently. The previous cap had been at $445,755, and was struck down (in part) because the court felt the cap number was arbitrarily picked. In regards to the new legislation, an aide for the governor said, “It’s pretty hard to imaging how $450,000 is constitutional.”

Recent tort reforms in Pennsylvania have resulted in significant drop-offs in the number of cases filed, the percentage of cases won by the plaintiff, and in verdicts exceeding $1 million. And plaintiff-oriented law firms are beginning to feel the pinch. One of Philadelphia’s top plaintiff firms closed its doors last year citing economic pressures, and another top firm has reported that only 18-20% of its fees generated in 2005 have come from med-mal cases, down from 30% on 2000. It should be noted that the Pennsylvania reforms did not include a cap on non-economic damages, as they are forbidden by the state’s constitution.

Physicians rallied this month in Washington, D.C., in support of Mayor Tony Williams proposed legislation for medical liability reform, which includes caps on noneconomic damages. D.C. council members have not been enthusiastic about the Mayor’s plan, and instead have been focusing on changing insurance regulations. A panel of Iowa legislators charged with making recommendations for 2006 malpractice reform legislation have proposed a number of ideas, including screening panels, malpractice premium subsidies, and safe apology laws. The panel stated that it was unlikely that caps on noneconomic damages would be considered in the upcoming year.

MEDICAL LIABILITY INSURANCE

Ohio is currently considering a bill (OH S 231) that would create a one year moratorium on increases in medical liability insurance premiums. In Pennsylvania, lawmakers are considering new legislation that would require each malpractice insurer to record and report its loss and expense experience, along with other related data, in order to determine if rates being charged to physicians are fair and appropriate.

HOSPITALS

A health care committee in Wyoming has voted in favor of a bill to put a year long moratorium on licensing specialty hospitals. Committee members said the moratorium is needed to allow time to study the possible effects of specialty hospitals. Two-thirds of the state’s legislature would have to agree to consider the measure before it could be voted on in the upcoming legislative session.

Under a new law set to take effect in January of 2008, Illinois hospitals will be required to publicly report anytime they commit one of 24 types of events. The state hospital association said that the law will help hospitals learn from their mistakes and create a culture of safety.

REIMBURSEMENT ISSUES

A recent report from the California Medical Association has highlighted the significant number of physicians that are planning to limit or abandon workers’ compensation practices as a result of major problems with the system. The overwhelming majority of doctors surveyed said that they had problems reaching insurance company reviewers for treatment authorizations, and many doctors reported that at least half their requests for treatment were denied. Some doctors said that they were told by reviewers that the reviewers had denial quotas to meet.

MISCELLANEOUS

In Vermont, legislators have wrapped up public sessions to come up with ideas for a new health reform bill for next year. A wide variety of opinions were heard, recommending everything from a single payor system, to complete government withdrawal from the healthcare field. There is no apparent consensus yet as how to best fix the system.

Leaders from the Hawaii medical and legal communities are coming together to push for a state law that would encourage physicians and hospital staff to apologize for medical errors without being exposed to increased lawsuit risk. The Illinois legislature has sent bill HB 3801 to the Governor, which would require applicants to medical school undergo background checks for violent felonies. The bill would protect schools that reject candidates on this basis from being sued, but would not prevent someone with such a felony from becoming a doctor.