A medical liability reform bill that would have capped noneconomic damages at $250,000 failed in the U.S. Senate last month.

Efforts to end a Democratic filibuster in the Senate on the Pregnancy and Trauma Care Access Protection Act (S 2207) and bring the bill to the floor was defeated by a vote of 49-48. The failure of the "cloture" vote effectively kills the bill for this year.

The AMA, which has repeatedly blamed the failure to pass liability reform on the influence of the trial lawyers association, has vowed to continue to pursue reform.

"Medical liability reform is the AMA’s number-one legislative priority, and we will be relentless in our pursuit of medical liability reform for all America’s patients and physicians," said AMA Trustee J. Edward Hill, M.D. "We are confident that senators will soon realize that the crisis is too dire to ignore."

APA and the AMA have supported a House-approved bill known as the Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2003 (HR 5). That bill would also limit noneconomic damages to $250,000, but for all physicians; the Senate bill sought to provide relief first to obstetrician-gynecologists and trauma physicians, who have among the highest premiums (Psychiatric News, April 4, 2003).

"In 2003, the U.S. House of Representatives recognized the severity of the crisis and passed HR 5, which includes a quarter-million-dollar cap on noneconomic damages for all physicians, similar to reforms working in California for more than 25 years," Hill said. "As more and more states face the limited access to medical care that the medical liability crisis causes, the Senate will have no choice but to act to help patients."

At the AMA House of Delegates meeting in Honolulu in December 2003, the American College of Obstetrician-Gynecologists, which has backed the Senate bill, argued that it was designed to get the proverbial "nose under the tent"—providing relief to physicians who need it most first, thereby paving the way for reform for all physicians (Psychiatric News, January 2).

In the days leading up to the vote, the AMA repeated its claims that liability insurance premiums were driving physicians out of practice.

In a statement released the day before the Senate vote, the AMA said, "An astounding 67 percent of Mississippi ob-gyns have been forced to retire, relocate, or restrict the services they provide—including no longer delivering babies—due to the medical liability crisis."

Some 324 Mississippi physicians stopped delivering babies in the last decade, and only 10 percent of family physicians in Mississippi deliver babies, according to the AMA.

But some of the AMA’s claims have been disputed by the Washington, D.C.,—based advocacy group, Public Citizen.

The group claimed that its own survey found "a plenitude of trauma care facilities in states the AMA says are experiencing a malpractice crisis."

"The AMA’s campaign against malpractice victims has been built on a big lie—that lawsuits are threatening access to care," said Joan Claybrook, president of Public Citizen. "But when you look at the hard statistics or scratch the surface of the phony anecdotes, you find no relationship between malpractice suits in a state and the number of doctors there."

In a letter to U.S. Sens. Bill Frist (R-Tenn.) and John Ensign (R-Nev.), sponsors of the liability reform bill, Claybrook urged that the Senate’s time be spent on other initiatives to increase access to care.

"The chronic problems of our health care system—too many uninsured, declining reimbursements, lack of doctors in rural and inner-city areas, and the defection of surgeons to doctor-owned specialty hospitals—must be addressed," Claybrook said. "We suggest that the Senate’s valuable floor time would be better spent confronting these systemic problems rather than trying to score political points with anti-lawyer rhetoric."

An AMA spokesperson responded that the AMA’s reports on physicians dropping out or restricting practice were culled from newspaper reports from around the country, all of which were compiled in a document provided to the Senate.

Moreover, the spokesperson said, many of Public Citizen’s claims were themselves suspect: one Pennsylvania obstetrician whom Public Citizen claimed was still practicing turned out to be still seeing some prenatal patients, but had indeed ceased delivering babies, as the AMA had originally claimed.

In a statement released in response to the Public Citizen claims, the AMA detailed a number of such cases that had been challenged by the group.

"It is unclear how Public Citizen did its research, but it is spotty and misleading at best and flat-out incorrect on other occasions," the AMA said. "The AMA staff not only confirmed the original news reports but talked directly to several of the physicians involved or organizations knowledgeable about the news events." ▪