Doctors, lawyers say malpractice laws work in Minnesota

NHS Healthcare Organisation Looks To The Future
Minnesota has the second lowest medical liability insurance premiums in the country, making some doctors and lawyers reluctant to accept malpractice reform inserted into the health reform debate in Congress.
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President Obama last week tried to extend an olive branch to the GOP, by signaling support for some type of limited medical malpractice reform. But in Minnesota, doctors and lawyers say the state's malpractice laws are already working.

Dr. Susan Hasti has had only one run-in with the malpractice system in her 17 years of family medicine. In the early '90s Hasti was practicing in Connecticut, and a patient came to her office with a lump in her breast.

"When I saw it, it looked more like a cyst and an infection," Hasti said. "That was treated, and several months later, breast cancer was found."

The woman threatened to sue. Hasti remembers it was devastating.

"Automatically, your first gut instinct is to rethink: What did I do? Could I have missed something? Did I do anything wrong?" she said.

Hasti is confident she acted appropriately and said a lawsuit was never filed, because the woman couldn't find a lawyer willing to take the case.

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"Having it be dropped was a huge relief," she said. "But I still feel very bad that however the interaction worked between the patient and I, that I didn't capture in that one visit the level of trust that I needed, so she felt comfortable that I did the appropriate thing at that time."

Dr. Susan Hasti
Dr. Susan Hasti has had only one run-in with the medical malpractice system during her 17 years in family medicine. These days she doesn't think much about malpractice, and the insurance is less of a burden than it used to be.
MPR Photo/Curtis Gilbert

Despite the trauma of that experience, Hasti said she rarely thinks about the possibility of lawsuits when she sees patients today and malpractice insurance isn't nearly the burden it used to be for her.

That's because she lives in Minnesota now, and Minnesota has the second lowest medical liability insurance premiums in the country.

"An [obstetrician/gynecologist] in Minnesota will be paying somewhere around $20,000 in annual premium," said Mike Matray, who collects data on malpractice insurance as editor of the Medical Liability Monitor. "The worst county in the country would be Dade County, Florida, where Miami is, and they're paying $215,000 to $260,000 a year in premiums."

Minnesota's rates are lower because malpractice claims are relatively few here and jury awards relatively low. Health policy experts point to a variety of possible reasons for this, including the state's existing laws, high-quality health care system and a less litigious culture.

That's one reason why Minnesota Medical Association president Noel Peterson doesn't put it at the top of his priority list, even though he supports malpractice reform. Peterson also isn't convinced liability reform would have a big impact on health care costs here in Minnesota or nationally.

"You cannot file a frivolous case in Minnesota ... the judge is required to dismiss the case."

"I think there are certain reasons for doing liability reform from a different standpoint, which is: Why have cases going forward that really have no merit?" Peterson said.

President Obama does not support caps on how much juries can award for damages such as pain and suffering and has not asked Congress to include malpractice reform in its health insurance reform efforts. What he has done is invite states to apply for federal grants to experiment with other ways to reduce malpractice costs.

Those could include what's called a "certificate of merit." Under that system, if you want to sue your doctor, you first need to find another doctor to agree you have a case.

Minneapolis attorney Chris Messerly, who specializes in malpractice law, said Minnesota has had a law like that on the books since 1986, and it works well.

"You cannot file a frivolous case in Minnesota," Messerly said. "Anyone who tries do that, the judge is required to dismiss the case. That's maybe another reason we have the lowest rates in the nation."

Messerly has no problem with the certificate of merit, but he differs with the president on another potential reform. This one's based on research showing what some patients want more than money is a simple "I'm sorry" from the doctor.

When Obama was a U.S. senator, he sponsored a bill designed to encourage doctors at fault to apologize by making the apologies inadmissible in court. At least 20 states have laws like that, but Messerly wouldn't want Minnesota to join them.

"I think honesty and truthfulness should guide this, and we shouldn't be honest and truthful up front and then hide the truth and honesty later in court," he said.

But Messerly said he's not worried about Obama's statement about medical malpractice reform. Obama's proposal leaves decision about reform up to the states, and Messerly said Minnesota's existing malpractice laws are working just fine.