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The Flip Side of the Medical Malpractice Coin

American physicians are appropriately frustrated about the high cost of medical malpractice insurance, and the frequency with which false and/or exaggerated claims are filed against them. In the Philadelphia region, a spine surgeon must pay upwards of $300,000.00 a year in malpractice insurance. The law allows Obstetricians to be sued for mishandling the birthing process until the “child” is 20 years old. In many states, there is no cap on the amount of money awarded in a true case of negligence, and juries set the pay out – which can exceed 20 million dollars per verdict.

Interestingly, Texas instituted a new policy in which firm caps were placed on malpractice claims. The cost of medical malpractice insurance dropped precipitously, and over 7000 physicians flooded into the state.

I recently interviewed Canadian Senator Michael Kirby about the medical malpractice process in Canada, and he laughed at how litigious the American system is. He said that keeping the malpractice system from being abused is quite simple: fine plaintiffs who bring forth frivolous suits, set caps on pay outs, and allow awards to be set by judges, not juries. You can listen to our discussion here.

However, there is a flip side to this coin – when providers are permitted to practice without any real legal recourse. I was astonished to learn (from my blogging colleague across the pond, Dr. John Crippen), that in New Zealand midwives are permitted to practice without any form of malpractice insurance. In fact, a recent case demonstrated obvious negligence resulting in the death of a newborn baby. What recourse did the mother have? Apparently, her legal actions resulted in a payout of $2,000.00 and a promise of closer oversight of the practices of midwives.


On the spectrum of “reasonableness” for medical malpractice policy, I believe the Canadians win, followed perhaps by Texans. What do you think?This post originally appeared on Dr. Val’s blog at

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4 Responses to “The Flip Side of the Medical Malpractice Coin”

  1. says:

    Malpractice insurance for a family physician in the province of Quebec, Canada is $2200 (no obstetrics).  If you can learn French then American doctors would be very welcome here. Forget Texas. This is our recruitment movie – ‘La Grande Seduction.‘ See my Canadian medicine blog at

  2. Anonymous says:

    Indeed, the question is what recourse does a patient have against a reckless physician in an environment where malpractice suits are restricted?

  3. Alison Cummins says:

    Reasonableness is all about context. Malpractice will favour the plaintiffs more often in a society without an adequate safety net, because the extra costs associated with caring for someone who has sustained an injury have to come from somewhere. If they come either from one’s own pocket or from an insured business (medical practice), there is an understandable temptation to engage the insured business in covering costs. If there are third or fourth options, then the pressure on the doctor can be significantly reduced and found acceptable to all.

    The New Zealand case is interesting. If it’s assumed that all pregnant women have full access to fully-paid, fully-insured medical care for pregnancy and birth, then one could make a case that as long as families are fully informed they can opt to pay for a private midwife and forgo the possibility of suing her for malpractice.

    These are lots of ifs. Context!

  4. Ian Furst says:

    Hey Val,  I’ll at to comments and say that my malpractice is under 1% of that spinal surgeon and lawsuits are not common.  I don’t know the ins and outs but I think the system makes it hard for contingency fees  and plantiff’s can be assessed court costs.  I changes the way you practice (for the better I think).  Ian 

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