Editorial: Patients’ needs are paramount

Friday, July 26, 2002 | 3:45 a.m.

WEEKEND EDITION: July 28, 2002

The Legislature begins meeting in special session Monday for one purpose -- to relieve the health-care crisis imperiling patients, particularly in Southern Nevada. University Medical Center's trauma center, which closed for 10 days earlier this month, could abruptly close again if the Legislature fails to restore a working balance among patients, doctors, lawyers and insurers.

Legislators cannot rush a bill through that will trigger court challenges that could extend the crisis for years. While their work will require policymaking skills of the highest order, legislators are not facing an impossible task. Here's how we see the major issues:

Caps: Nevada doctors want a cap of $250,000 on jury awards for pain and suffering. This would mimic California, which has the most restrictive medical malpractice laws in the country. The other extreme, advocated by lawyers, is no cap. Realistically, some type of cap must come out of this session.

Care must be taken, however. In seven states, caps have been legislated only to be overturned by their courts on constitutional grounds. The states with no caps are in the majority. And of the states with caps, eight have set the bar at $500,000 or more. For Nevada, we see a cap that certainly exceeds $250,000, which is too low for patients and families who have endured debilitating malpractice. A cap this low would also make it difficult for patients to find an attorney, whose percentage of any jury award might not adequately cover expenses. Ultimately, this would mean that doctors would be less accountable for malpractice, a scenario that must be avoided. No limit, however, means that doctors would be at permanent risk of financial ruin and that insurers would have no number they could use to calculate lower malpractice premiums.

Medical errors: After a complaint against a doctor has been investigated and found valid, the complaint and investigative findings should be public information. Patients could then avoid doctors who have accumulated several valid complaints, thus reducing chances of becoming a malpractice victim.

Attorneys fees: A provision should establish a minimum percentage that a patient must receive from any jury award.

Juror knowledge: In Nevada, only the judge is allowed to know how much an insurance company has already compensated a plaintiff for economic damages. Before awarding pain and suffering damages, juries should also be informed.

Culpability: Many malpractice cases involve multiple doctors and each are assessed a percentage of blame. No doctor should have to pay more than the percentage of his blame, even if the other doctors do not pay for some reason.

Medical panel: The panel of doctors and lawyers that screens potential malpractice suits should render decisions more quickly. Regarding complaints against specialists, the panel should include at least one doctor who specializes in the same field. All information bearing on a case should be revealed at the hearing, leaving no surprises if the case goes to court.

Premiums: Insurance companies should be required to base their malpractice premiums exclusively on the amount they pay out in medical settlements. Their returns in the stock market, good or bad, should have no bearing on premiums in Nevada.

Earlier in this crisis, a panel of lawyers, doctors and insurers found the problem insolvable because each looked at the issue from their own perspective and refused to budge. In contrast, legislators should pass a bill based on what's best for the public. After all is said and done, however, there is no guarantee that the insurance companies will do the right thing and lower malpractice insurance premiums, no matter how restrictive the cap is on jury awards. Ultimately the fate of this health-care crisis rests with insurance companies -- and that's not a reassuring thought.