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This page contains a single entry from the blog posted on June 23, 2006 10:36 AM. The previous post in this blog was Get ready for the World Cup pool. The next post in this blog is Here's your World Cup "football" pool. Many more can be found on the main index page or by looking through the archives.



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Friday, June 23, 2006

How much damage does OHSU get away with?

A reader writes:

You may not have seen this gem on page 2 of Thursday's Business section in the O -- a quote from OHSU's always credible Steve Stadum: "We're not trying to game these numbers."

So what was he talking about? If you guessed the costs for the aerial tram, you'd be wrong. He was referring to OHSU's "study" on what it would cost them if they lose tort claims immunity. The estimated range was $8.7 - 43 million per year, plus $14 - 50 million in one-time costs. One would think that at a level of precision that low, they could have done the study for less than the $35K they spent.

But what is curious to me is that they seem to think that a high number is more compelling for their argument that they shouldn't lose their immunity. Without getting into the well-worn substantive arguments on OHSU's very low percentage of public funding and charitable service, it seems illogical to argue that if OHSU causes *that* much harm to people, it is *more* deserving of immunity from civil liability. If any institution causes the public persistent serious harm, doesn't it seem like it should be held up to higher scrutiny, not lower responsibility?

That's the same thought I had when I read that story. Instead of reading, "If its tort liability cap is lifted, OHSU wll have to pay millions in damages and insurance," it could have read, "If OHSU's tort liability cap is lifted, victims of malpractice on Pill Hill will no longer be subjected to millions of dollars' worth of harm, without any right to recover for it." (Could have, but never would.)

Yes, funny thing, Mr. Stadum, justice isn't free.

Comments (10)

Of all your many great posts, this is the subject that I think is most important. I feel as Portlanders we should make this right. How can we feel good about our city if a little kid can get screwed over this badly by the system? Free market values could take care of this eventually. I mean if enough people pass on getting care at OHSU because the patient could face financial ruin if something goes wrong, then OHSU will have to change. It's part of what they are selling, like a warranty on a new car, and right now the OHSU product can't compete with other hospitals in this area. So why haven't these free market values kicked in? Because the patients aren't advised when they seek help, of what could happen should something go wrong, according to the report I saw on local television. Instead of going out of their way to inform their patients of the catastrophic financial risk they are taking by seekiing surgery there, OHSU spends a ton of money on ads touting their Smart Healthcare. We'd be doing OHSU a favor to force them to change because they could then offer the public a better product. It's ridiculous.

This is the difference between doing what is right and the attorney driven mentality at City Hall and other government entitites.

I remember the Goldschmidt Quote when he said he did "it" because he could, a power thing.

Everything you read for the folks whose house was flooded by a sewer back-up caused by the City, to this poor kid, to all the money fighting those ladies Renee Mitchel wrote about in her column.

Why can't they just work out a reciprocity deal with another hospital to take care of this kid, as I am sure they probably don't want to go back to OHSU.

Why do our taxpayer dollars go to penalizing and punishing taxpayers and city employees.

"Why do our taxpayer dollars go to penalizing and punishing taxpayers and city employees."

To preserve precious resources for urban development and for our local government employees' retirement and disability.

It is sort of the same rationale for the Price-Anderson Act, which caps liability for nuclear accicents at commercial nuclear facilities. The potential damages are so horrendous that the corporations designing, building, owning, or operating nuclear plants must be shielded from liability. If the potential damages were not so big, no liability cap would be needed.

In addition, I wonder how the study accounted for the incentive effects of the liability cap. With a low limit on liability, medical negligence has little financial consequence for the hospital. Economics would predict that this would reduce the incentive to avoid negligence. So, imposing ordinary tort liability on the hospital would be expected to reduce the incidence of negligence and thus reduce both the harm to patients and the financial losses to the hospital from paying tort judgmentgs and settlements.

Just a thought.

But what is curious to me is that they seem to think that a high number is more compelling for their argument that they shouldn't lose their immunity. Without getting into the well-worn substantive arguments on OHSU's very low percentage of public funding and charitable service, it seems illogical to argue that if OHSU causes *that* much harm to people, it is *more* deserving of immunity from civil liability.
You must admit that such terms is a bit of an unfair trickbag, damned if they do, damned if they don't. The quintessential double bind. If they didn't show that they stood to lose beaucoup bucks without immunity, then why have immunity at all? I mean, after all, that's one big reason immunity is there: because it would be financially perilous without it. But then on the other hand, if they showed that immunity could be done away with with minimal exposure, then what's the argument for keeping it?

Which essentially devolves to the propriety of a tort claims act at all. Why blanket immunity carte blanche for all public entities?

Or, another question, is OHSU public or private? Part both? Which part is public and which part is private?

A statutory scheme that divines these things may be due.

Did you see where Media Insiders claims some hospital muzzled Lars in one of today's posts.

Claims it was confirmed by a second source.

They are going to need to save every dollar they can to cover their 85% share of Tram operating costs.

Think of Pill Hill as Jackson Hole, and all the Doctors are ski bums. They need to economize if they are going to keep skiing the fresh powder.

Which would you rather the hospital purchase: malpractice insurance or lift tickets?

In this continuing saga of how OHSU still claims at their convenience that they are a "private institution" in some circumstances and in others they are "public", we must not forget that OHSU has recently benefited from over $200M of public money from the state cigarette settlement. This taxpayer money is being misused per settlement directives.

And in the North Macadam URA Amendment Agreement, soon to be before city council again, OHSU is being given over $26M of the Amendment $38 M total in "gimmies"-under the table benefits from the City of Portland general budget. The amount doesn't even include the interest on the $38M borrowed at market rate.

There are many more cases of public/taxpayer money given to OHSU, but they claim they are "private" when it is convenient. But when it comes to "liability" they claim they are "public".

It is fun to watch the games they play.

I cannot defend OHSU in many of their antics, in particular the new "attraction" between the hill and SOWA, but I will defend them on the tort issue. I am not an OHSU attorney, not anyone in charge of running the hospital, but a humble health care practitioner. And no, I'm not a doc.

If you walked the halls of the floors and units, you would see that OHSU is different from any other hospital in Oregon. As a teaching hospital, OHSU gets the most serious of cases, the sickest of the sick, the population that comes in often as complete train wrecks with multiple issues and comorbities, and they do a pretty good darn job of taking care of these folks all the while training nursing, residents and medical students. Even more important, OHSU treats many uninsured and Medicaid patients, which doesn't cover costs. Watch the dollars circle the drain...

While patients who suffer damage need some sort of medical compensation, I do not think the answer is to eliminate the tort caps. There must be some sort of compromise that will allow OHSU to continue providing often risky complex care to the masses, while somehow fairly compensating the patient should they be damaged at OHSU.

I wish people could see for themselves the good work that goes on there. The bad press about the tram has made us forget what REALLY happens up on the hill.

There must be some sort of protection when they provide care to those that don't have other options. There should be some sort of protection for doing cutting edge procedures and treatments. Science isn't perfect. People are people, and that includes physicians.

There must be a balance to allow OHSU to continue to do what they do. And that's a lot of great stuff! And sometimes some silly stuff, too.

Free tram rides for all!

Cutting-edge, experimental procedures are one thing -- Dr. Death taking out your appendix is something else. But our "leaders" in the Legislature don't see a difference -- and the Dr. Deaths in their McMansions and Porsches like it that way.


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