Still, the results add to a growing body of evidence suggesting that tort reforms aren't associated with better outcomes, said Michelle Mellow, a law professor at Stanford University in California who wasn't involved in the study.

"This study contributes further evidence that liability pressure doesn't spur doctors to get better results for patients, but neither does adopting reforms to limit liability," Mellow said by email.


It's not surprising that the study didn't find a consistent link between malpractice environment and surgical complications, because these associations can be specific to certain procedures or fields within medicine, said Dr. William Sage, a law and medicine professor at the University of Texas at Austin who wasn't involved in the study.

"The only things that are really clear are that too many patients are injured, too few of those receive compensation, and the whole process is slow and miserable for both physicians and patients," Sage said by email. "We also know that tort reforms capping damages at low amounts discourage most people from suing because lawyers won’t take the cases, which in turn reduces the malpractice insurance premiums that physicians pay – both of which are pretty obvious."

Some previous research suggests that one type of law, that compares doctors' results against national averages, can help improve outcomes in below-average states, said Dr. Anupam Jena, a researcher at Harvard University in Boston who wasn't involved in the study.

"Changing the standards against which physicians are judged, either by ensuring that all states adopt national standard laws, or using administrative courts that hold physicians to a pre-specified clinical standard, are ways that I think the malpractice system can be leveraged to improve quality," Jena said by email.

SOURCE: http://bit.ly/2iQDZlo Journal of the American College of Surgeons, online December 23, 2016.


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