Friday, June 24, 2011

6/24/11 - Fair Share Act Passes PA Senate - Now Back to the House

6/24/11 - Liability and Health Reform Update
Fair Share Act Passes PA Senate
Now back to the House

((Editor's comments in blue italics. Please scroll to the end for more information, disclaimer, etc.))


Editor's Comments:

MANY THANKS to everyone who called, wrote and emailed members of the PA Senate to support the Fair Share Act! Your advocacy made all the difference in the world!

Please watch for more comments further down in this newsletter....

And thanks again for all your help!



Bill to limit lawsuit liability passes state Senate
GOP leaders expect it to move quickly through House to Corbett.,0,7756316.story
by Mark Llevy

HARRISBURG — A top priority of Gov.
Tom Corbett moved an important step closer to becoming law Tuesday as the state Senate passed a bill limiting the liability of defendants in some civil court cases for negligence after passionate debate that pitted the interests of business owners, hospitals and insurers against lawyers who represent victims.
Senators in the Republican-controlled chamber voted 32-18 to send the bill to the House, which handily passed a nearly identical bill in April and where leaders of the
GOP majority expect to move it quickly to Corbett's desk. All but one Republican voted for it, and all but three Democrats opposed it.
The vote came after 90 minutes of floor debate Monday and Tuesday over what impact the bill would have on the state's economy and what would happen to people who are wronged and seek justice through the courts.
Current law holds all guilty defendants potentially liable for 100 percent of damages if their co-defendants cannot pay for the negligence resulting in death or injury to a person or property.
But supporters of the bill say the law hurts
Pennsylvania's business climate because it allows a victim's lawyers to drag a deep-pocketed company with little connection to the negligent act into the case because of its ability to pay. Opponents of the bill, however, say changing the law will hurt victims of negligent acts and their families who seek justice in the courts after they are maimed and unable to work, or killed.
"This is a bill that's been identified by every business organization that I'm aware of in the state as a No. 1 priority to help them create jobs in this commonwealth," said Senate Appropriations Committee Chairman
Jake Corman, R-Centre. "This is a bill that the health care organizations have been strongly supportive of to help them keep their viability in their communities."
Democrats accused Republicans of driving a larger agenda to take away rights.
"It hurts people," said Sen. Larry Farnese, D-
Philadelphia. "It doesn't create an economic boom. It doesn't create jobs. It puts people in a position where they can be hurt, where their quality of life can be destroyed and where government does nothing to make their lives better."
On Monday, senators voted 28-22 to approve a Corman-sponsored amendment to an underlying bill written by Senate Judiciary Committee Chairman Stewart Greenleaf, R-Montgomery, who, like trial lawyers and labor unions, opposed the bill that came over from the House.
Under the bill, defendants found to be less than 60 percent at fault wouldn't have to pay more than their share of the damages, except for awards in circumstances including intentional misrepresentation, an intentional act, an environmental crime or a liquor law violation.
Corman's amendment eliminated two additional exceptions for cases where children are involved and where the victim lost wages because of injury or death.
Hospitals, insurers and business groups lobbied against Greenleaf's bill and said it carried too many exceptions to fix the inherent unfairness in the law.
"If you think the civil justice system is a welfare program where everybody gets everything they're asking for, then vote against this bill," said Sen.
Jeffrey Piccola, R-Dauphin. "But that's not what civil justice is all about. Civil justice is about fairness, this bill is about fairness."
Senate Minority Leader
Jay Costa, D-Allegheny, then called out Piccola for apparently flipping his arm during Costa's response — "we're not going to flip our arm to the people of Pennsylvania who are going to be harmed by this legislation," Costa said — and Greenleaf warned that Medicaid claims will rise, but insurers won't lower premiums if the bill becomes law.
"This will be a welfare state if you pass this legislation," Greenleaf said.
A similar bill has passed a GOP-controlled Legislature twice before in Pennsylvania. After it became law in 2002, House Democratic leaders sued and state appellate courts overturned it on grounds that the bill it was written into violated the Pennsylvania Constitution's requirement that bills confine themselves to a single subject.
The Legislature later passed a replacement bill, but it was vetoed in 2006 by then-Gov.
Ed Rendell, a Democrat.


Details for RCS# 182
Monday Jun. 20, 2011
Senate Bill 1131 PN 1322



Details for RCS# 190
Tuesday Jun. 21, 2011
Senate Bill 1131 PN 1389




From the PA Medical Society Website:

Bill to Modify Pennsylvania’s Joint and Several Liability Law Now in the House

A much needed liability reform bill is another step closer to becoming law. After passing the Senate by a vote of 32-18, Senate Bill 1131, which would modify Pennsylvania’s joint and several liability law, was approved by the House Judiciary Committee and now goes to the House floor for its consideration. As amended by Sen. Jake Corman (Centre, Juniata, Mifflin, Perry, and Union) and passed by the Senate, SB 1131 is now identical to House Bill 1 and Senate Bill 2, which will no longer be considered. Pennsylvania is one of only a handful of states that has complete joint and several liability. Under the current law, if one defendant is without assets or has insufficient funds to pay their share, the other defendant(s) can be held responsible for 100 percent of the jury’s award. If this legislation is passed, each responsible defendant would only have to pay their share as long as the jury finds them less than 60 percent at fault. If a defendant is found more than 60 percent at fault, they can be made to pay 100 percent of the damages, if the other defendant(s) are without sufficient funds. Some exceptions for full joint and several liability would still exist, including intentional misrepresentation, hazardous tort(s), hazardous substances released or threatened to be released, and liquor code violations. This is not the first time around for this legislation. In 2002, a very similar bill was signed into law, but was thrown out by the state Supreme Court on a procedural technicality. In 2006, Gov. Ed Rendell vetoed yet another bill after previously indicating he would sign it if it passed.PAMED has been a long-time advocate for medical liability reforms, and has been successful in getting a number of reforms passed in Pennsylvania, including Act 13 of 2002. Currently, PAMED also supports a bill to allow physician apologies (HB 495) and a bill to strengthen the certificate of merit requirements.


The Legal Intelligencer
With Senate Votes, Joint and Several Liability on Track to Be Transformed
Amaris Elliott-Engel
June 22, 2011

As state Sen. Jake Corman fought back a proposal to temper changes to Pennsylvania's joint and several liability doctrine, he said the original proposal to limit the circumstances under which a defendant has to pay for another defendant's part of a judgment was the result of a compromise struck back in 2002.
The state Senate voted Monday 28-22 and Tuesday 32-18 to amend Senate Bill 1131 to strip it of exceptions that would have maintained the application of joint and several liability to economic damages and cases involving the interests of minors.
With the amendment, Senate Bill 1131's language mirrors the language of a bill passed by the House of Representatives, backed by Gov. Tom Corbett, but bottled up in the Senate Judiciary Committee. The proposal would require defendants that are apportioned responsibility for causing a plaintiff's injuries at 60 percent or less to only pay the portion for which they were found liable.
The 60 percent proposal is the same as one that became law in 2002 before being struck down by the state Supreme Court on procedural grounds and was passed by the General Assembly in 2006, only to be vetoed by then-Gov. Edward G. Rendell, a Democrat.
Corman, a Centre County Republican, said that the exemptions backed by state Sen. Stewart Greenleaf, R-Montgomery, the majority chair of the Senate Judiciary Committee, were well meaning but would dramatically reduce the impact of what Republicans in Harrisburg are trying to accomplish with changing the state's tort law.
"We don't compensate one by taking from another who was not found by a jury to have that level of responsibility," Corman said. He also pointed out that about 40 states have changed the doctrine of joint and several liability in some form.
Pennsylvania's doctrine of joint and several liability is likely to be revised because the House of Representatives already has passed parallel legislation to modify the doctrine and Corbett said in his budget address that he would sign legislation abrogating the doctrine of joint and several liability, arguing legal liability scares jobs away and leaves minor players stuck paying the full price of lawsuits.
While the language is the same in the amended SB 1131 and House Bill 1, the same bill has to pass both chambers of the General Assembly. In April, the state House of Representatives approved HB 1, known as the "Fair Share Act," on a 112-88 vote.
Erik Arneson, communications and policy director for Sen. Majority Leader Dominic Pileggi, R-Delaware, said in an e-mail the most likely option would be for the House to take up SB 1131 after it reached final passage in the Senate.
Defense attorney Craig Murphey, president of the Pennsylvania Defense Institute and a partner with MacDonald Illig in Erie, said unlike other states, this proposal would not completely eliminate the concept of joint and several liability.
"We believe that this will create a more even playing field for plaintiffs and defendants," Murphey said. "We think the 60 percent threshold is a reasonable compromise and it eliminates the real harm" to defendants compelled to pay more than their proportion of a judgment because a co-defendant could not afford to pay the award.
Fewer defendants could be brought into lawsuits under the proposed regime because there will be less likelihood of having to pay the entire judgment, so there may be less motivation "to bring in a co-defendant who may only have a tangential involvement in an incident," Murphey said.
Plaintiffs attorney Mark W. Tanner, co-managing partner of Feldman Shepherd Wohlgelernter Tanner Weinstock & Dodig in Philadelphia, said in an e-mail that legislators "elected to shift the burden of providing fair compensation to victims away from wrongdoers, and have placed it squarely on the shoulders of the taxpayers. At the end of the day, that is who will bear ultimate responsibility for the socioeconomic survival of victims and their families who may now be unable, by virtue of this legislation, to collect the fair compensation from the parties responsible for causing them harm."
Tanner predicted that the bill may cause defendants to bring in more co-defendants because primary tortfeasors will face less exposure if there are more co-defendants.
Greenleaf said on the floor of the Senate Monday that he agreed it was important to revise joint and several liability, but he said the 60 percent threshold was abandoning a state policy that favors injured victims.
Now all of a sudden, "instead of protecting victims we're protecting defendants," Greenleaf said.
Greenleaf bottled up HB 1's companion, SB 2, in committee and crafted alternatives to the proposal because he argued joint and several liability still provides important protection in the tort system to injured victims.
The proposal already preserves joint and several liability in cases of intentional misrepresentation, an intentional tort, release of a hazardous substance or a dram shop action.
State Sen. Daylin Leach, D-Montgomery, asked why an innocent victim should bear the risk in an imperfect world when a defendant who has done wrong can't pay damages.
State Sen. Jay Costa, D-Allegheny, and Greenleaf argued that states that have limited the doctrine of joint and several liability have worse unemployment rates than Pennsylvania, while Sen. Donald White, R-Indiana, said that Pennsylvania ranks at the bottom in the country's job growth. Reforming joint and several liability could increase the number of jobs in the state because businesses may feel more likely to engage in a job-creating enterprise, White said.
Corman said that representatives of Pennsylvania businesses and the health care industry said changing joint and several liability was their top legislative priority. •


((Excellent piece, only four pages, good analysis of what works and what doesn't work....))

The State of Medical Liability Reform
July 2011 Bulletin of the American College of Surgeons


Mississippi Clarion Ledger
Torts: Remember bad, ol' days?
3:53 PM, Jun. 16, 2011

Mississippi's tort reform efforts were being widely criticized over the past week, as the state Supreme Court addresses the issue.
The court is trying to determine if the state's $1 million cap on non-economic damages is constitutional. The 5th U.S. Circuit Court of Appeals made the request in the case of a Mississippi woman who sued Sears, Roebuck and Co. after she was involved in a collision with one of its vans in Neshoba County.
As per the state's cap, a federal judge reduced a federal jury's award from $4 million, of which $2.2 million was for non-economic damages. The appeals court asked the state court to review the case.
That has prompted renewed debate about the "fairness" of Mississippi tort reforms. Some folks must have short memories.
Some may not remember that less than a decade ago, the state faced a crisis in the availability and affordability of insurance. Doctors were retiring early, leaving the state and limiting high-risk services. Hospitals couldn't retain doctors or recruit new ones with rising insurance rates.
The Clarion-Ledger's 2002 series "Fighting Lawyers, Fleeing Doctors: Seeking A Cure" and "Hitting the Jackpot in Mississippi Courtrooms" elucidated the issues.
Under former Democratic Gov. Ronnie Musgrove, the 2002 Legislature capped non-economic "or pain and suffering" damages in medical malpractice lawsuits and other reforms. It was a historic moment for the state. But insurers and businesses complained that tort reform was only half done, both in civil justice (business) and medical malpractice reforms.
Some groups labeled Mississippi a "judicial hellhole" for frivolous lawsuits and multi-million dollar verdicts.
Republican Gov. Haley Barbour campaigned on the issue, saying he would finish the reform job.
So, in 2004, under Barbour, the Legislature passed a comprehensive package of business tort reforms and expanded on medical issues from 2002.
Since Mississippi adopted tort reforms, the state has lost its reputation as a place where "jackpot justice" ruled.
Other states have caps, too, so the state Supreme Court action is being closely watched.
The essential element should be remembered that it is not the amount of the cap that's key, but that a cap is set. Insurance companies must have a standard to determine risk, some basis for potential losses.
Caps on non-economic damages do just that.


From the Institute for Legal Reform
The Lone Star Model:

Lawsuit Reform Has Helped Fuel Texas' Job Creation Machine

While the most of the nation continues to struggle to recover from the economic downturn, one state has led the way in creating jobs: Texas.In fact, according to Dallas Federal Reserve President Richard Fisher:

Since the recovery began, 38 percent of all the jobs created in America have been created in the State of Texas.And, according to Fisher, lawsuit reform has been an integral part of Texas' amazing jobs recovery.During the past decade, Texas Governor Rick Perry has signed into law three major pieces of lawsuit reform legislation -- the most recent coming this spring.These reforms are helping making the Lone Star State a less-threatening place to do business, and they are helping to fuel the state's job creation machine.Click below to watch the clip of Richard Fisher explaining the impact of lawsuit reform on CNBC's Squawk Box:

The Institute for Legal Reform is an advocacy group working to end lawsuit abuse. ILR is a national campaign of the U.S. Chamber of Commerce, with the critical mission of making America's legal system simpler, faster, and fairer for everyone.


June 20, 2011

Rep. Fleming Tells the Truth on Medicare
To view this youtube video please click the video below:

For the latest videos from Washington, D.C.
Please Click Here
Sincerely, JOHN FLEMING, M.D.Member of Congress

Dr. John Fleming is Chairman of the Natural Resources Subcommittee on Fisheries, Wildlife, Oceans and Insular Affairs and is a member of the House Armed Services Committee. He is a physician and small business owner and represents the 4th Congressional District of Louisiana.


((This is a marvelous montage of the members of the Doctors' Caucus talking about Medicare reform!))

The Medicare Truth - GOP Doctors Caucus
larep04 Jun 17, 2011


From the Editor:

Important qualifier here - while I disagree with the AMA's position on the PPACA and will work in any way possible to see the new health care law repealed, defunded, declared unconstitutional or any combination of the three, I find the vast majority of the work which has been done in the past - and continues to be done today - by the AMA and the AMA Alliance, to which I PROUDLY belong, to be of GREAT VALUE to America's health and welfare.

Another important qualifier - unless otherwise stated, NOTHING I SAY IN THIS NEWSLETTER IS THE OFFICIAL OR UNOFFICIAL POSITION OF THE AMA ALLIANCE, WHICH IS A NON-POLITICAL CHARITABLE ORGANIZATION which engages in legislative, but NEVER political advocacy. My opinions are MY opinions, and shouldn't reflect on the AMA Alliance or the PA Medical Society Alliance in any way.

As in the AMA, there are Alliance members on BOTH sides of the political divide over the PPACA. But that doesn't stop us from working together to help improve the health of America's communities through health awareness projects, medical and nursing school scholarships, support of medical families and health projects, and much, much more, and that important work needs to continue, regardless of whether we agree on a single policy point or not. There WAS no dissent at the AMA Alliance meeting in Chicago, at which I proudly represented the Pennsylvania Medical Society Alliance, for which I will become president in October. In fact, the amazing group of volunteers representing their state and county Alliances may be the most productive and forward-thinking group of people I've ever known, and we don't intend to let policy disagreements interrupt the important work we do to improve America's health.

I don't want anyone to assume that I want to see the AMA diminished by what I consider to be a poor policy choice about the PPACA. In fact, my advice to the physicians with whom I correspond regularly and in this newsletter has always been that if doctors don't LIKE AMA policy, they should get involved and CHANGE AMA policy. I still firmly believe that - the AMA is just like Congress in that respect - its members shape the policies it adopts.

I respect the efforts being made by those within the AMA to change policy, even if they weren't successful this time, as I respect and admire the efforts being made by those who've chosen another path and support OTHER organizations which represent physicians.

The bottom line for me has always been this - doctors need to be involved in policy, legislation, and politics, no matter HOW MUCH they might hate the necessity. If they're not, someone ELSE will decide how doctors should practice medicine, what kind of health care Americans will be able to access, and who will be responsible for making decisions about that care. Right NOW, a whole lot of people who didn't go to medical school are making decisions that ONLY DOCTORS should be making, and America's doctors are at least partially responsible for the position they find themselves in right now.

For far too long, America's doctors have been SO focused on providing quality health care to their patients that they've forgotten to take care of their own profession. They've been content to pay dues to some organization - or worse, pay dues to NO organizations - to represent their interests. But the only person who can be relied upon to look out for one's interests all the time is oneself - and the majority of doctors in America have defaulted the protection of their right to practice medicine in the way they were trained to other people for FAR TOO LONG.

It may already be too late to preserve medicine as an independent profession dedicated to quality care and the doctor-patient relationship. Already, there are bureaucrats writing thousands of pages of regulation that will put themselves in between doctors and patients. And if doctors don't speak up and get involved RIGHT NOW, it will be too late.

So here's your challenge - if you're mad at the AMA, JOIN IT and take it back. If you're not sure where your state medical society stands, FIND OUT. MANY of them openly oppose the PPACA and others don't support it even if they haven't taken a public position. Join your COUNTY medical society - there's nowhere you can impact policy more than at the local level.

Find out where your specialty society stands and JOIN IT at the state and national level. Explore the many other groups which are advocating for repeal of the PPACA, like the American Association of Physicians and Surgeons or AAPS, Docs4PatientCare, the Coalition to Protect Patients' Rights, the Benjamin Rush Society, Take Back the Profession, the Coalition of State Medical and National Specialty Societies, the Citizens Council for Health Freedom, the Lucidicus Project - you can google and find any of these, and there are more, probably lots more.

Join more than one. HELL, JOIN THEM ALL - and then DO SOMETHING instead of waiting for a lobbyist or a staff member to do it for you. Yeah, I know you don't have the time. You need to MAKE THE TIME. Unless you've GIVEN UP on being able to provide the best quality care for your patients - then, just sit back and let it all happen.

Legislators at all levels of government need to hear from America's doctors and medical families more now than ever before. Doctors and the people who support them must stand together to protect not only the profession, but America's quality of health care. Dissonance among health care professionals WEAKENS their ability to stand up to the challenges facing the profession.

Physicians and physicians' groups which oppose the PPACA and support repeal of the PPACA need to find ways to network and work together to achieve that goal. More doctors need to run for Congress in 2012 - or for their state legislatures. More doctors need to get onto legislators' advisory boards, or get involved in campaigns for people who support their goals.

I'll do whatever I can to make what YOU have to do easier - and so will all the groups I listed and others I probably don't even know about. But YOU must take the initiative to reach out and partner with other physicians who feel the way you do. Bitching in the doctors' lounge or on a blog or on Facebook may make you feel better for a little while, but it doesn't make a real difference. Only GETTING INVOLVED can make the difference that needs to be made.

And ONLY YOU can do that for yourself and your profession.

Need direction? Just ask - I'm here to help. And, as always, it is my honor to fight alongside of America's dedicated doctors....


From Modern Physician

Is the AMA right on the individual mandate?

Do you agree with the AMA's decision to continue its support for the so-called individual mandate?

TAKE OUR POLL » — Modern Physician

((The NO votes were winning when I last checked....but not by much.))


Chicago Examiner
Former AMA chief predicts demise of ObamaCare 23, 2011 10:35 am CT
Keith Liscio

In an exclusive interview, former
American Medical Association President Donald Palmisano predicted that whether by court action or the legislative process, President Obama’s signature healthcare reform law would be overturned. Dr. Palmisano spoke to your Chicago Conservative Examiner while he was in Chicago for the AMA’s annual conference this week and is the spokesman for the Coalition to Protect Patients’ Rights.
First and foremost, Palmisano (who is an attorney as well as a doctor) believes that the law will not survive scrutiny in the Supreme Court. He bases this opinion on an analysis of the expected swing vote on the Court,
Justice Anthony Kennedy.
According to Palmisano, Kennedy has generally been reluctant to extend the Commerce Clause of the Constitution unnecessarily. In this case, the Obama administration is hoping that the court will essentially give it permission to regulate a person’s right not to buy health insurance by imposing a fine. Palmisano believes that this will be viewed by the court as regulating “inactivity” and will not stand, saying, “If the government can regulate that, they can force you to do anything.”
Regardless of the eventual legal outcome of the measure, however, he believes that public dissatisfaction with the law may cause the election of enough Republicans in the Senate in 2012 to overturn it legislatively. The Republican-controlled House of Representatives has already voted to defund implementation of the law.
As to the AMA Convention, Palmisano was disappointed that the organization voted to reaffirm its position that individuals be responsible for purchasing health insurance. This position has been widely seen as tacit support for the individual mandate in the President’s healthcare law.
Perhaps more importantly, however, the organization voted to oppose the law’s Independent Payment Advisory Board and the AMA will now actively work to overturn it. IPAB is a new unelected and unaccountable 15- member group appointed by the President and empowered to make recommendations without Congressional approval to cut spending in Medicare if spending growth exceeds certain levels. Palmisano, CPPR and now the AMA believe that sweeping changes to the nation’s healthcare policy should have Congressional approval.
Although he is strenuously opposed to the law, Palmisano refuses to call it “ObamaCare,” considering that term “a pejorative.” At the same time, he feels like the official name of the act, the
Patient Protection and Affordable Care Act is something of a misnomer, claiming, “It doesn’t protect patients and isn’t making care more affordable.”
Asked if his position was influenced by partisan considerations, Palmisano said, “I’m a scientist. I believe in applying the scientific method and making decisions based on experimentation and proof. By that standard, [ObamaCare] is a disaster.”
The Coalition to Protect Patients’ Rights is made up of thousands of health care professionals who are dedicated to improving the quality and availability of healthcare for all Americans. The organization believes that President Obama’s healthcare reform has reduced the quality and accessibility of American health care.

Donald Palmisano, MD, JD, FACS, is a clinical professor of surgery and clinical professor of medical jurisprudence at
Tulane University School of Medicine and an adjunct professor at The Tulane University School of Public Health and Tropical Medicine in the department of Health Systems Management. He is the author of the book On Leadership – Essential Principles for Success.


The Washington Times
PALMISANO: Nailing Obamacare’s rationing board
Republicans and Democrats join forces to stop a Medicare killer
By Dr. Donald J. Palmisano
6:50 p.m., Monday, June 20, 2011

Medicare’s trustees predicting the Medicare program will go bankrupt in 2024 - five years earlier than was projected before the passage of the Patient Protection and Affordable Care Act - even Americans who strongly supported Obamacare have little choice but to acknowledge that Medicare must be reformed - and soon. While lawmakers continue to argue about the best way to protect this vital program for the seniors it serves and those who it has yet to serve, there is a growing bipartisan consensus that the Independent Payment Advisory Board (IPAB) is one provision of the new health law that will do more to undermine the program than save it.
Rep. Allyson Schwartz, Pennsylvania Democrat, became the seventh Democrat to sign on as a co-sponsor to a Republican bill that calls for the repeal of the board. In announcing her decision, she referred to the IPAB as a “flawed policy that will risk beneficiary access to care.”
This new effort to repeal
IPAB is gaining momentum and could eventually bring together most House Republicans and many of the 72 House Democrats who fought to prevent the the board from being included in the new law in the first place. In addition, many of the groups that supported Obamacare like the American Medical Association, American Heart Association and AARP are now expressing opposition to IPAB and joining those that opposed it, including the organization for which I am a spokesperson, the Coalition to Protect Patients’ Rights.
Unfortunately, most people in the country, including seniors relying on
Medicare, have no idea what IPAB is or how it will affect their lives if it ever becomes operational. More concerning, President Obama decided to make the board the centerpiece of his efforts to reduce the deficit by calling for it to be strengthened - not eliminated. Starting in 2015, the IPAB will give 15 unelected bureaucrats unprecedented power to slash billions of dollars from Medicare when spending exceeds targeted growth rates. The cuts made by the board will come on top of the $500 billion that was transferred from Medicare to a new entitlement program as a result of the new health care law. Democrats and Republicans have found little common ground in recent years, but there has been widespread agreement that the IPAB could exacerbate the shortage of doctors who see Medicare patients and ultimately, contribute to a reduced quality of care for our most vulnerable.
At a time when all Americans are tiring of partisan politics from both political parties, we must take advantage of the few issues on which both sides can agree. Our lawmakers must now show they are still able to put their short-term political squabbles aside for the common good of America’s patients by repealing
IPAB and uniting for a constructive debate on ways to save our nation’s valued Medicare program.

Dr. Donald J. Palmisano is the former president of
American Medical Association and spokesperson for the Coalition to Protect Patients’ Rights.


Dr. Donald Palmisano - Past President of the American Medical Association (AMA) 2003-2004 - joins Don and Roma - 6/21/2011
Download this show

Don and Roma talk with Dr. Donald Palmisano, Past President of the American Medical Association 2003-2004.
Find out more about what Dr. Palmisano is writing and talking about
Find out about Dr. Palmisano's book, "On Leadership: Essential Principles for Business, Political and Personal Success"www.OnLeadership.US


((Dr. Palmisano is a clarion voice for the kind of health care reform America REALLY needs - not to mention one of my personal heroes. Anyone who aspires to be a success at anything should read his book, On Leadership, Essential Principles for Business, Political and Personal Success. It was a pleasure to see Dr. P and his wife Robin at the AMA meeting in Chicago earlier this week. As always, Dr. Palmisano was standing up for what he believes is right and fighting for America's health. It is an honor to know this outstanding leader. A more detailed review of On Leadership will follow in a subsequent edition of this newsletter.))

Find out about Dr. Palmisano's book, "On Leadership: Essential Principles for Business, Political and Personal Success"

Or buy it on Amazon:


This LIABILITY & HEALTH REFORM UPDATE is a free service which I provide, as a volunteer, to help supply medical liability reform and health care reform news and information, legislative updates, and political insight to physicians, patients, liability reform and quality health care advocates. NO ONE pays me to do this. I am not employed by any physician or health care reform advocacy or liability reform organization, political party or candidate, although I volunteer for several. I am an advocate for quality health care, physicians, and patients , a breast cancer survivor, physician's spouse, journalist, political noisemaker, mom, and freelance writer. I am not, nor will I ever claim to be, unbiased (I am....biased, I mean), unlike many in the mainstream media. Most information in this newsletter is copied and pasted from other sources, and will always be identified with links. Opinions and clarifications are my own, and do not reflect the official position of any physician or patient advocacy organization, tort reform, or health care reform group unless stated as such. My opinions are placed in double parentheses (("my opinion")), italicized and appear in blue.
This Update is emailed to health professionals, physician and patient advocates, and others interested in ensuring access to quality medical care.
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Donna Baver Rovito, Editor, Liability and Health Reform Update

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Saturday, June 18, 2011

6/18/11 - ACTION ALERT - Fair Share AMENDMENT Vote Wednesday

6/18/11 - Liability and Health Reform Update
ACTION ALERT - Fair Share AMENDMENT Vote Wednesday

((Editor's comments in blue italics. Please scroll to the end for more information, disclaimer, etc.))


Pennsylvania's doctors, hospitals and businesses support the Fair Share Act - the ORIGINAL Fair Share Act, passed by the PA House and then bottled up in the Senate.

On Wednesday, the only measure that could make it our of Sen. Stuart Greenleaf's Judiciary Committee will reach the Senate floor - but before it passes, it needs MAJOR work. So we're asking you to contact your state senator and ask him or her to vote YES on the Corman Amendment to Sen. Greenleaf's SB1131.

Without the Corman Amendment, SB1131 isn't worth passing - so you need to ask your senators to vote Yes on the Corman amendment BEFORE they vote on SB1311. After the CORMAN AMENDMENT passes and is attached to SB1311, THEN we'd like them to vote Yes on it.

Following is important information to help you get engaged in the fight - WE NEED YOUR CALLS AND EMAILS BEFORE WEDNESDAY'S VOTE.

How to contact your Pennsylvania State Senators (alphabetically):

If you don't know who represents you, use this easy tool to find out:

Do it right now, before you forget.

Thank you!



From our friends at Cold Spark Media and Citizens to Protect PA Jobs:

Hello everyone,We need your help to score a major victory for tort reform in Pennsylvania.

The PA Senate is going to vote on SB 1131 on joint and several - but this is not the bill which will help Pennsylvania businesses like HB1, which passed the house with a huge margin, would have. This is a significantly watered-down version and needs to be amended on the Senate Floor in order to make it effective.

Senator Corman is offering an amendment to SB1131 that reforms the failed Joint and Several liability system in Pennsylvania. This is the Fair Share Act that we've been fighting for over the last many months. Your help so far has been crucial but this is not the time to let up. Please call your Senator and ask him or her to vote for CORMAN AMENDMENT to SB1131. Tell them to stand on the side of small business, hospitals, doctors, and manufacturers, and not on the side of the trial lawyers.Find your senator here:

We believe that Senators Erickson, Mary Jo White, and Gene Yaw are on the fence. Please encourage them to stand up for job creation in Pennsylvania by supporting the CORMAN AMENDMENT

Sincerely,Citizens to Protect PA Jobs


A proposal to abolish the common-law doctrine of joint and several liability has become law once in the last decade before being struck down by the state Supreme Court on procedural grounds. The same proposal was passed by the General Assembly in 2006, only to be vetoed by a Democratic governor.

But in 2011, the measure isn't getting past a state Senate committee chairman in its original form, despite the fact that Republicans control the governor's mansion and both houses of the state legislature.

Instead, state Sen. Stewart Greenleaf, R-Montgomery, the majority chairman of the Senate Judiciary Committee, crafted alternatives to a proposal that has been popular with lawmakers in the past and would require defendants that are apportioned responsibility for causing a plaintiff's injuries at 60 percent or less to only pay the portion for which they were found liable.

Greenleaf's latest alternative to House Bill 1/Senate Bill 2 was introduced Monday and was approved by the Judiciary Committee 13-1 Tuesday. The bill also was sponsored by State Sen. Jake Corman, R-Centre, who was one of the sponsors of SB2.

Senate Bill 1131, the latest Senate alternative to HB1/SB2, would still apply joint and several liability to economic damages and in cases "where a minor has a beneficial interest."

State Sen. Dominic Pileggi, R-Delaware, the Senate Republican Majority Leader, plans for the Senate to vote on the issue of joint and several liability this month, perhaps as early as next week, spokesman Erik Arneson said in an e-mail, but amendments are almost certain to be offered.
Greenleaf said that he amended SB2 because joint and several lability needs to be reformed, but still provides an important function in Pennsylvania law: ensuring that injured victims are substantially compensated for their injuries.

"Joint and several liability has always had the philosophy that we should protect the victims of wrongdoing and make sure, best as we can, that they're fully compensated and not throw them onto the taxpayer."

Greenleaf argued that SB2 would cause victims, subject to physical injuries and who cannot get fully compensated, to rely on the governmental programs of Medicaid or Medicare for their care.
Employers who cannot get compensated for workers' compensation claims from judgments also will be adversely affected, and doctor defendants in medical malpractice cases will no longer be able to turn to hospital co-defendants to supplement their share of defense verdicts, Greenleaf said.

Even though the stars might have seemed aligned for changes to Pennsylvania's tort law because Republicans control the General Assembly and the executive branch, the Pennsylvania Republican Party is not a monolith on issues that have support among Republican voters, including tort reform, school choice and whether to tax natural gas drillers, said Christopher Borick, director of the Muhlenberg College Institute of Public Opinion.

"What happens sometimes in the small body of the Senate, it only takes a few key members who have differences on the matter to really hold it up and in this case craft a version that is less intense relative to the House version," Borick said.

James Redmond, senior vice president for legislative services for The Hospital and Healthsystem Association of Pennsylvania, said that proponents of changing Pennsylvania's tort law hope that SB1131 can be amended so it ends up looking more like SB2.

The association opposes SB1131, not only because of the proposed exception of ending joint and several liability for noneconomic damages, but because making an exception for minors who have a beneficial interest in tort cases "could be interpreted as including most cases," Redmond said.
Greenleaf deserves credit for trying to bring the proponents and opponents of changing the doctrine of joint and several liability together, but the health care provider community, business community and insurance community view SB2/HB1 as non-negotiable, Redmond said.

Redmond said he believes that the majority of the Senate is supportive of SB2, but that version of tort reform is opposed by Greenleaf and will not get out of the Judiciary Committee.

Mark E. Phenicie, legislative counsel for the trial lawyer group Pennsylvania Association of Justice, said that one reason that SB2/HB1 may be less popular in the Senate than in the past is that there are 20 new senators and a totally new Senate leadership since the 60 percent standard was last passed by legislators.

Phenicie said that SB1 is a compromise between SB2 and Senate Bill 500, a prior bill introduced by Greenleaf which would abolish joint liability for any defendant whose percentage share of liability is less than the percentage share attributed to the plaintiff. The bill would bar a plaintiff from recovering damages from the defendant in excess of the defendant's percentage share.

"We think that [compromise] eminently fair," Phenicie said. "Most of the angst on tort reform has mostly come to non-economic damages. While they're very real they're hard to quantify."

Redmond said SB1131 is only being called a compromise by the state's trial lawyers.

Proponents of the Greenleaf's proposal fear that Gov. Tom Corbett will find it unacceptable, Phenicie said.

Corbett's press office did not respond to a request for comment Wednesday.

A spokesman for Republican House Majority Leader Mike Turzai, R-Allegheny, said there is nothing to comment on regarding alternatives to HB1 until the full Senate acts.

In April, the state House of Representatives approved HB1, the "Fair Share Act," on a 112-88 vote
During his budget address in March, Corbett said that he would sign legislation abrogating the doctrine of joint and several liability, arguing legal liability scares jobs away and leaves minor players stuck paying the full price of lawsuits. •

Torts' tough track

Sunday, June 12, 2011

How much clout does a committee chairman have? Quite a lot, is the answer. But in the end, not more than a majority of his or her caucus or the will of the House or Senate.

It's an issue now because Senate Judiciary Chairman Stewart Greenleaf will not allow the "Fair Share Act" to emerge from his committee for a Senate vote. It has been passed by the House and it's a top priority of Gov. Tom Corbett.

It's issue No. 1 for the business community but Greenleaf thinks it shortchanges victims.

The bill would prevent minor parties in lawsuits from having to pay full damages when those most responsible can't pay. Supporters say it prevents targeting "deep pocket" defendants who bear a small share of the responsibility for causing damages. It's based on the concept of "comparative responsibility."

Ultimately, Greenleaf knows he can't block it if a majority of Senate Republican Caucus members demand action. But he is trying to hold out for some modifications.

It's likely there's a majority. And a member of leadership, Senate Appropriations Chairman Jake Corman, R-Centre County, has his own bill, which is like the House bill. It's also parked in the Judiciary Committee.

The bill has been passed twice before by the General Assembly but never became law. So supporters see no need to compromise on a weaker version. The legislation was overturned by the courts and later vetoed by then-Gov. Ed Rendell, a Democrat.

It pits trial lawyers against the business and insurance communities.

Greenleaf wants to make sure victims have a fair shot and ultimately taxpayers and ratepayers aren't left holding the bag.

But supporters say taking this step is critical for reducing Pennsylvania's reputation as a haven for plaintiffs' lawyers and to improve the overall climate for business. It's the first step in "tort reform" and Corbett and House Majority Leader Mike Turzai, R-Bradford Woods, will have more to follow.
What Greenleaf is doing is no different from what numerous committee chairmen have done in the past. When Rep. Bill DeWeese, D-Greene, was House Judiciary chairman in the 1980s, he used to bottle up bills restricting abortion.

Last session, former House Appropriations Chairman Dwight Evans, D-Philadelphia, refused for the longest time to release the so-called Castle Doctrine bill. That bill expands the concept of self-defense by allowing people to shoot an assailant outside their home without retreat when their lives are in danger. Currently they can do that in their homes. But the majority of the House wanted action on the bill. Many Democrats supported it.

A "discharge resolution" was filed and then-Democrat House leaders saw the handwriting on the wall. Evans released it. It was approved by both chambers, then vetoed by Rendell.

It should soon end up on Corbett's desk. Like several other bills, it's stuck in a no-man's land with a House-passed and Senate-passed version. It's all about who gets the credit -- which legislator becomes the final sponsor.

Greenleaf says it's the business community that won't compromise. He said he offered "compromise after compromise." Businesses leaders say: Why should we if we have the votes?

Erik Arneson, a spokesman for Senate Majority Leader Dominic Pileggi, R-Delaware County, said there will be a vote this month. On what version, it remains to be seen.

As for the clout of committee chairmen, it's like most other arenas, including the private sector -- there are limits on a boss's power.


Members of the PA Senate JUDICIARY Committee


Greenleaf, Stewart J. , Chair
19 East Wing
(717) 787-6599
Senate District 12 Bucks (part) and Montgomery (part) Counties

White, Mary Jo, Vice Chair
169 Capitol Building
(717) 787-9684
Senate District 21 Butler (part), Clarion, Erie (part), Forest, Venango and Warren (part) Counties

Leach, Daylin , Minority Chair
184 Main Capitol
(717) 787-5544
Senate District 17 Delaware (part) and Montgomery (part) Counties

Scarnati, Joseph B., III, ex-officio
292 Capitol Building
(717) 787-7084
Senate District 25 Cameron, Clearfield (part), Elk, Jefferson, Mckean, Potter, Tioga and Warren (part) Counties


Alloway, Richard L., II
187 Main Capitol
(717) 787-4651
Senate District 33 Adams, Franklin and York (part) Counties

Earll, Jane M.
177 Capitol Building
(717) 787-8927
Senate District 49 Erie (part) County

Gordner, John R.
351 Main Capitol
(717) 787-8928
Senate District 27 Columbia, Dauphin (part), Luzerne (part), Montour, Northumberland and Snyder Counties

Orie, Jane Clare
362 Main Capitol
(717) 787-6538
Senate District 40 Allegheny (part) and Butler (part) Counties

Piccola, Jeffrey E.
173 Capitol Building (717) 787-6801
Senate District 15 Dauphin (part) and York (part) Counties

Rafferty, John C., Jr.
20 East Wing (717) 787-1398
Senate District 44 Berks (part), Chester (part) and Montgomery (part) Counties


Boscola, Lisa M.
458 Capitol Building
(717) 787-4236
Senate District 18 Lehigh (part), Monroe (part) and Northampton (part) Counties

Farnese, Jr., Lawrence M.
543 Main Capitol (717) 787-5662
Senate District 1 Philadelphia (part) County

Hughes, Vincent J.
545 Capitol Building
(717) 787-7112
Senate District 7 Montgomery (part) and Philadelphia (part) Counties

Stack, Michael J.
543 Main Capitol (717) 787-9608
Senate District 5 Philadelphia (part) County


Corbett pushes limits on who would pay damage awards from lawsuits

Tuesday, June 7, 2011

HARRISBURG — Republican Gov. Tom Corbett wants the General Assembly to place limits on who would have to pay damage awards in civil suits before lawmakers recess for the summer, a spokesman said on Monday.

Specifically, Corbett is asking the House and Senate to approve legislation that would apportion liability based on one's degree of actual responsibility — for those parties deemed less than 60 percent responsible, said Kevin Harley, the governor's press secretary.

Currently, an award can be collected from any liable defendant. Supporters of the legislation say a company 10 percent responsible for an accident now can be required to pay 100 percent of damages if others can't pay.

The governor sees it as a major step to making Pennsylvania more business-friendly, Harley said.
A House-passed bill, and an identical Senate bill, are pending in the Senate Judiciary Committee. Chairman Stewart Greenleaf, R-Montgomery County, met with supporters and opponents yesterday from the legal, insurance and business communities in an effort to find middle ground.
Greenleaf said he proposed several compromises rejected by business leaders.

"They said they want the Legislature to decide," he said.

Greenleaf said he will continue to seek compromise on modified versions of the legislation Corbett is seeking.

Asked if he would release the House bill or a similar Senate bill from his committee, Greenleaf said, "No. Those bills are terribly unfair." ((Says Sen. Greenleaf.....))

While House leaders call the legislation the Fair Share Act. Mark Phenicie, legislative counsel for the Pennsylvania Trial Lawyers Association, which opposes the legislation, calls it the Corporate Irresponsibility Act.

"There's nothing fair about that bill," Phenicie said. ((Oh, and the guy the trial lawyers pay to make sure they keep making lots of money in PA....he says it's unfair, too.))

Gene Barr, vice president for government and public affairs for the Pennsylvania Chamber of Business and Industry, argued that "broad-based legal reform is very important in making Pennsylvania a more competitive state in terms of attracting business.

"We are one of a handful of states that has not reformed civil liability for businesses, and that's a big reason why we are viewed by CEOs as among the costliest states to do business."

Legal reform and property tax reform are on Corbett's list of "wants" from the Legislature along with a no-tax-hike budget, Harley said..

Under a law enacted five years ago, school boards are required to submit proposed property tax increases to voters if the increases exceed a so-called "education index," slightly higher than the inflation rate. But there are 10 exceptions to seeking voter approval, and they have prevented most tax increases from going to a referendum.

In five years, only 14 such referendums have appeared on the ballot. Pennsylvania has 500 school districts.

Corbett in his March budget address called for eliminating all exceptions.


From Defense of Medicine Blog
High Quality Care Does Not Reduce Litigation Exposure
by Jonathan B. Stepanian, Esq.

Providing high quality care is not strongly associated with a reduction in litigation exposure according to a recent study published in the New England Journal of Medicine. The results of this study, while frustrating to some, reaffirm our belief that litigation has more to do with the process of care rather than the quality of care; I have written about this point in the past.

The New England Journal authors sought to assess “whether high-quality health care institutions are less likely to be sued for negligence than their low-performing counterparts.” Although this premise may seem logical, its validity has been questioned by many studies.

In this recent study, the authors compared 1465 nursing homes in terms of quality indicators and demands for compensation for injury. The authors chose nursing homes because quality data on those facilities is widely available and standardized. Hospital data is less available and standard. Additionally, the incidence of malpractice claims against institutions is not widely available. For this study, the authors were able to look to five of the largest nursing home chains in the United States to obtain information related to the incidence of claims against their facilities.

To define which nursing homes provided “high quality care,” the study authors selected 10 specific quality indicators to compare across facilities, such as the incidence of falls or fractures, the development of pressure ulcers, and staffing. They questioned whether those facilities with better quality indicators faced a lower incidence of malpractice claims.

Some will find their results frustrating. Although the authors found an inverse relationship between nursing home performance and litigation risk for several of the measured quality indicators, the associations were weak. The authors observed

[T]he levels of litigation were only fractionally lower for the best-performing nursing homes than for their worst-performing counterparts.

Intuitively, we like to think that increases in quality of care will lead to lower risk of litigation.

However, this recent New England Journal study does not demonstrate that this is necessarily true. Although quality care is certainly important, health care providers need to remember that the process of providing care is equally important. Refining that process of care may help to lower the risk of negligence litigation.

About the author - Jon is a partner at the McQuaide Blasko law firm whose practice is specialized in litigation, complex medical professional liability defense, health care, and providing legal counsel on numerous issues associated with day-to-day hospital operations. He has successfully tried several cases to verdict as first-chair trial counsel before juries in both state and federal court. Jon has also represented clients in appellate litigation, mediation, and in connection with administrative agency investigations. Contact Jon by email.


((And at the federal level, kudos to Reps. Dent and Paulson for this latest entry in the medical liability reform saga...))
Press Releases -
June 16, 2011
Dent and Paulsen Introduce Medical Liability Reform Bill

WASHINGTON, D.C. -- U.S. Reps. Charlie Dent (PA-15) and Erik Paulsen (MN-3) today introduced legislation (H.R. 2205) to decrease the cost of health care and improve protections for patients through comprehensive medical liability reform.

“The 2010 health care law missed a critical opportunity to enact meaningful medical liability reforms,” said Rep. Dent. “Our medical justice system is a major cost driver for health care spending and it impacts the ability of patients to receive high quality care. We expect doctors to make decisions based solely on what is best for their patients, not on what is best to defend against frivolous lawsuits. Across the United States, the lack of comprehensive reform has affected where qualified doctors practice, what fields of medicine they pursue, and the services they provide. As Congress continues to discuss ways to reform and strengthen our health care system, advancing the common-sense policies included in H.R. 2205 will help reduce health care spending and ensure access to quality care.”

“The reality is medical liability does contribute to increased healthcare costs. Healthcare professionals practice defensive medicine for fear of frivolous lawsuits and end up ordering billions of dollars in extra tests and treatments,” said Rep. Paulsen. “The current environment not only increases the cost of care for patients, but also discourages highly skilled and dedicated physicians from providing important services. Three out of four emergency rooms have reported shortages of specialists, and many orthopedic surgeons have chosen to retire early or scale back their surgical duties, because of liability concerns. These reforms are needed to protect patients, reduce healthcare costs, and ensure that this nation continues to produce the world’s greatest healthcare professionals.”

The practice of defensive medicine – when doctors order tests and treatments in order to protect themselves against frivolous lawsuits – is estimated to cost as much as $200 billion annually.

Congressional Budget Office (CBO) analyses indicate comprehensive medical liability reform would save the government $54 billion over the next decade and cut national health care spending by 0.5 percent per year.

H.R. 2205 will help end the costly practice of defensive medicine by encouraging states to adopt effective alternative medical liability laws that reduce the number of health care lawsuits initiated, reduce the average amount of time taken to resolve lawsuits and reduce the cost of malpractice insurance. The legislation will also enact nationwide reforms to stabilize compensation for injured patients, hold parties responsible for their degree of fault, ensure that meritorious claims are swiftly resolved, encourage compliance with accepted clinical practice guidelines, and guarantee that medical care is available to those who need it the most by providing protections to safety-net providers.

Charles W. Dent (R-PA-15) Erik Paulsen (R-3-MN)
1009 Longworth House Office Building 127 Cannon HOB
Washington, DC 20515 Washington, D.C., 20515
Telephone: 202-226-0778 Telephone: 202-225-2871
FAX: 202-226-0778 FAX: 202-225-6351


From MedInnovation
Monday, June 6, 2011
Health Reform and the Great Unmentionable : Lack of Patient Compliance as One Cause of Poor Outcomes

The typical attempt to solve a social ill focuses on giving people information, or it tries to motivate people through fear. But these strategies tend to fail…The more important and deeply rooted the behavior, the less impact information has the more people close their minds to messages that scare them.

Tina Rosenberg, Join the Club: How Peer Pressure Can Transform the World, W.W. Norton and Company, 2011June 6, 2011 - U.S. health system critics and health reform zealots often close their minds to a major cause of poor outcomes – lack of patient compliance. Instead , they attribute poor outcomes to lack of universal coverage, socioeconomic distress, or the profit-seeking medical industrial complex. To say bad outcomes stems from bad behavior to cultural and peer conformity is unmentionable and therefore unspeakable because patients are sacred. Criticism of patients as a source of bad results is off-limits. It is viewed as bad politics. These are potential voters you are criticizing. Health professionals and the capitalistic system in which they practice, not patients or population factors, are said to be responsible for the bad health of the nation, even though abundant evidence exists that other things – life style, poverty, income differences, inferior education, lack of family cohesion, violence in the streets and homes, clean water, adequate energy sources, culture, and simply following the crowd – are more responsible (1, 2).The “Social Cure”In her new book, Join the Club, How Peer Pressure Can Transform the Word (3), Tina Rosenberg, a Pulitzer-prize winning author , does us a favor by reminding us that patient behavior, dictated by the culture in which they live and their desire for social acceptance by peers, plays just as great a role as most other factors combined . Rosenberg reminds us, again and again, that the “social cure” – people responding positively to peer pressure and new social norms – may be more important than health reform itself. No amount of information she asserts, or warnings from government expert or from doctors “can budge us when we refuse to be budged…We often lie to others about our bad behavior, but the more interesting and powerful excuses come when we lie to ourselves.” People do not like to be lectured to about their health. They prefer to listen to their own inner demons, no matter what the consequences, To them, it is short-term gratification, not long-term consequences, that count.Patient Non-ComplianceIn the paragraph that follows, she gives these examples of what she is talking about.“Take, for example, patient adherence – failure to carry out a doctor’s orders. Poor patient adherence is a serious problem; dozens of studies have shown this. Only a fourth of the people on blood-pressure drugs in one study took their pills correctly. Only 13 percent of diabetes patients taking certain drugs complied with their regimens for a year. Three-quarter of patients in a study did not keep follow-up appointments and 50 percent of patients with chronic illnesses dropped out of a treatment within a year.”Failure of Alternative ApproachesAlternative approaches have been tried to help patients comply – counseling, group therapy of patients with common diseases, patient information brochures, electronic beeping pillboxes, automated –reminder phone calls, DOTS (Directly Observed Treatment, Short-Course) by loved ones, a nurse, or a community worker) – may work temporarily but in the long-term none of these approaches can get people to take their pills more than half the time.Innovative "social Cure" ProgramsThe point of Rosenberg’s book is this. People do not respond to what authorities or doctors tell them to do, but to what their peers approve of or what they do. Creating innovative peer groups to respond to health problems, whether these groups be similar to alcoholics anonymous, to maverick organizations persuading teenagers it is manipulative tobacco companies not adult do-gooders that are trying to get them to stop smoking, peers telling gays and HIV-positive individuals that condom use is a good thing – creates positive social change and the “social cures.” These programs , she says, are what we ought to be concentrating upon.Summing UpIn summary, the health of society may depend more on social and peer conformity than its national health system. People will do what they want to do and what they think pleases their peers rather than following the advice or warnings of harm from health experts or doctors.References1. L. Sagan, The Health of Nations: The Cause of Sickness and Well-Being, Basic Books, 1987.2. D. Satcher, and R. Pamies, Multicultural Medicine and Health Differences, MacGraw Hill, 2006.3. T. Rosenberg, Join the Club: How Peer Pressure Can Transform the World, W, W. Norton and Company, 2011.
Posted by Richard L. Reece, MD at 6:30 AM


Some Programs OK’d By Health Law Lacking Funding
Phil Galewitz
KHN Staff Writer
Jun 09, 2011

((The administration promised medical liability reform as a carrot to get the AMA to endorse the PPACA and threw $25 million at states for "demonstration projects." Then, this year, they promised more....but, not surprisingly, the money just isn't there....))

While the health care law has survived Republican efforts to repeal it, some of its individual initiatives are in limbo or limping along because of funding problems. The law authorized the new efforts but didn’t provide appropriations for them. That has to occur separately – and given current deficit woes, as well as wrangling between Democrats and Republicans, the programs might never get off the ground, some experts say. “Since the law was passed, the budgetary picture in Congress has changed dramatically," said Bruce Vladeck, former Medicare administrator in the Clinton administration and now a New York health care consultant. "So stuff (Obama administration officials) were interested in doing when health reform passed, they now have a realistic sense that …they are never going to get an appropriation to do it.”

One of the higher-profile initiatives that has not received any funding is a $50 million program to help states test alternatives to resolve medical malpractice disputes.

The American Medical Association, which backed the health law, is upset. “Congress should fully fund medical liability demonstration and pilot programs in the health reform law,” said Dr. Cecil Wilson, president of the AMA. “Everyone pays for the increasingly irrational medical liability system in this country.” ((That's what happens when you accept promises from politicians....))

A separate program that is providing $25 million in grants to test malpractice reforms to improve patient safety hasn’t been affected. The White House approved those grants six months before the health care law was enacted.

Other initiatives in the health law slated for this year that haven't started or been fully funded include:
--A $24 million program to help test regional systems for delivering emergency care. The effort would help hospitals work together to assure adequate physician staffing in the ERs. No money has been proposed.

--A program to have health clinics run by nurse practitioners. The program has received $15 million instead of the $50 million called for in the law.

--A project to monitor for-profit nursing home chains and a program to increase use of information technology such as electronic health records in nursing homes. No money has been proposed.

Although these programs were authorized under the health law, funding was not mandated.
Administration officials say, given the budget squeeze, they’ve had to set priorities on funding.

“While recognizing the importance of restraining federal spending, the administration has proposed funding for some activities authorized by the Affordable Care Act, such as nurse-managed health centers and many workforce programs,” said Jessica Santillo, a spokeswoman for the Health and Human Services Department.

Some lobbying groups aren’t satisfied. For example, emergency room physicians worry they may lost an opportunity to improve care. “We’ve been very disappointed at the lack of federal funding to implement the regionalized systems of emergency care pilot projects that were created under the Affordable Care Act,” said Dr. Sandra Schneider, president of the American College of Emergency Physicians. She said numerous studies have proven that “regionalized, coordinated and accountable emergency care systems would not only improve patient outcomes, but do so at less cost.”

Another program from the law that has not been funded is a $60 million program to test alternative dental providers such as hygienists or dental aides who would extract teeth and fill cavities in rural areas where dentists are scarce. The program, which is supposed to start by March 2012 was strongly supported by the Battle Creek, Mich.-based W.K. Kellogg Foundation which has been funding a similar program in Alaska. The federal money would be awarded to colleges, community health centers and Indian health clinics.

“We were excited to see the inclusion of the oral health provision in the bill,” said Alice Warner, program officer at the Kellogg Foundation. “We thought it was forward thinking.”

The American Dental Association, which opposes the idea of letting anyone but trained dentists extract teeth and fill cavities, applauded the lack of funding in Obama’s 2012 budget request. “We didn’t want this concept to get a foot in the door,” said an ADA spokesman.


From the Washington Examiner
Texas makes losers pay for bringing frivolous lawsuits
Examiner Editorial 06/04/11 8:05 PM


It's no wonder that Texas Gov. Rick Perry has recently been the focus of speculation about whether he might run for president in 2012. Texas has been on an economic roll since 2001, creating far more new jobs than any other state in the nation even as its population swelled to 25 million. Love him or hate him, Perry is in his fourth term in Austin and thus deserves a big chunk of the credit for many of the good things happening in the Lone Star State. Texas also has implemented some of the most significant state-level reforms in the country aimed at reducing or eliminating lawsuit abuse.

The latest of these is a "loser-pays" provision requiring plaintiffs to pay the winners' legal costs in civil suits seeking punitive damages. The provision is included in the 2011 Omnibus Tort Reform Act Perry signed May 30. In addition to the loser-pays provision, the new law:

• Allows a trial judge to send a question of law directly to the appellate court without requiring all parties to agree if a ruling by a court of appeals could decide the case.
• Allows plaintiffs seeking less than $100,000 in damages to request an expedited civil action.
• Allows a trial court to dismiss a frivolous lawsuit immediately if there is no basis in law or fact for the lawsuit.

((Along with the caps on non-economic damages passed in 2003, it's no wonder there's a backlog of thousands of doctors seeking licenses to practice medicine in Texas.))

Because such litigation is controlled at the state level, the United States is unique among the industrialized nations in not having a national loser-pays law. That fact is likely among the key reasons why the American media so frequently report new examples of people suing for the most outrageous of reasons. Take, for example, Mark S. Gold, a Miami traffic court lawyer who got drunk at a local strip club last November, then woke up the next morning with a tab of nearly $19,000. He promptly sued the strip club's corporate owner, claiming he should not be held responsible for the huge bill because the bar "continuously served plaintiff alcoholic beverages to the extent that he was rendered intoxicated, partially or temporarily unconscious, and further to the extent that he had a complete loss of judgment, rational thought, or ability to enter into lawful contracts or agreements."

Odds are Gold will walk away with most, if not all, of his bar tab forgiven since the defendants know they could lose big-time if he convinces a jury to award him punitive damages. As things now stand, plaintiffs like Gold have nothing to lose and everything to gain by clogging the courts with frivolous litigation. How many such suits would be filed if losing plaintiffs everywhere knew that they would have to pay the defendants' legal fees? The absence of loser-pays provisions in the vast majority of states helps explain why class-action plaintiff litigation cost more than $248 billion last year, according to the Towers Watson (formerly Towers Perrin) 2010 Update on U.S. Tort Cost Trends. That's $808 for every man, woman and child in the country. It also makes the U.S. legal system twice as expensive, measured as a percentage of gross domestic product, as those of other industrialized nations, according to the Institute for Legal Reform


This LIABILITY & HEALTH REFORM UPDATE is a free service which I provide, as a volunteer, to help supply medical liability reform and health care reform news and information, legislative updates, and political insight to physicians, patients, liability reform and quality health care advocates. NO ONE pays me to do this.

I am not employed by any physician or health care reform advocacy or liability reform organization, political party or candidate, although I volunteer for several. I am an advocate for quality health care, physicians, and patients , a breast cancer survivor, physician's spouse, journalist, political noisemaker, mom, and freelance writer. I am not, nor will I ever claim to be, unbiased (I am....biased, I mean), unlike many in the mainstream media.

Most information in this newsletter is copied and pasted from other sources, and will always be identified with links. Opinions and clarifications are my own, and do not reflect the official position of any physician or patient advocacy organization, tort reform, or health care reform group unless stated as such. My opinions are placed in double parentheses (("my opinion")), italicized and appear in blue.

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