The medical liability system in the United States is broken and fixing it will take an innovative multifaceted approach, the American College of Physicians (ACP) said in a new position paper on medical liability reform.

"While medical liability premiums have leveled off in the past few years, physicians still fear litigation, expect lawsuits, and feel the psychological burden of navigating the complex medico-legal system," ACP president Molly Cooke, MD, said in a statement. "Patients harmed by medical negligence also suffer under the existing medical liability system."

The current system "just doesn't work, it's unfair to patients...and it spends an enormous amount of money to compensate a small minority of injured patients," Dr. Cooke said during a media briefing.

The position paper, "Medical Liability Reform: Innovative Solutions for a New Health Care System," was released yesterday at Internal Medicine 2014, the ACP's annual scientific meeting, in Orlando, Florida. It provides an update of the medical liability landscape and state-based activity on medical liability reform, and summarizes traditional and newer reform proposals and their ability to affect system efficiency and encourage patient safety.

The paper recommends 9 approaches that should be incorporated into a multifaceted medical liability reform initiative:

  • Continued focus on patient safety and prevention of medical errors;

  • Passage of a comprehensive tort reform package, including caps on noneconomic damages;

  • Minimum standards and qualifications for expert witnesses;

  • Oversight of medical liability insurers;

  • Testing, and if warranted, expansion of communication and disclosure programs;

  • Pilot-testing of a variety of alternative dispute resolution models;

  • Development of effective safe harbor protections that improve quality of care, increase efficiency, and reduce costs;

  • Expanded testing of health courts and administrative compensation systems;

  • Research into the effect of team-based care on medical liability, as well as testing of enterprise liability and other products that protect and encourage team-based care.

Breaking Through Political Impasse
The ACP says that a multifaceted approach "should allow for innovation, pilot-testing, and further research on the most effective reforms."
The group notes that traditional medical liability reforms may currently have "little chance" of passing at the federal level. However, states have taken action to pass laws that not only establish caps on noneconomic damages, but also delve into alternative dispute resolution, injury funds, and a statute of limitations on the time frame during which injury claims can be filed.
"Perhaps more promising," Dr. Cooke said, "is the testing of innovative liability protection models, such as health courts, enterprise liability, safe harbor protections, and disclosure laws, which seek to break through the political impasse and create a system that encourages the prevention of errors, improved patient safety, and timely resolution of legitimate claims."
The "fear of liability" continues to undermine the physician-patient relationship, Thomas Tape, MD, chair of ACP's Health and Public Policy Committee, said during the briefing.
By releasing this new position paper, "ACP hopes to introduce into the contentious medical liability reform debate a set of evidenced-based ideas that could lead to real progress on developing solutions — solutions that both political parties could support," Dr. Tape said.
"These ideas have great potential to reduce harm to patients from medical errors while ensuring fair, timely and appropriate compensation when patients are harmed," he added.
Internal Medicine 2014. ACP position paper: Medical Liability Reform: Innovative Solutions for a New Health Care System. Presented April 10, 2014.