Pigs Rule! 
It's Somebody Else's Fault, 
and They Should Pay
by E. Noel Preston, MD 

   Last week I was surprised to see a doctor friend being televised in court on the late night TV newscast. An obstetrician, he had cared for a woman who had miscarried in early pregnancy and was now suing him. She claimed he had failed to remove all the "products of conception" from her uterus after she delivered a dead one-and-a half pound fetus. Two days later she passed part of a fetal head, no larger than the cap to an aspirin bottle, in her toilet-- and this, she claimed, caused her such severe emotional distress she suffered Post Traumatic Stress Syndrome. I know this doctor, and he is a good one. Third year medical students are taught the most common reason for post partum bleeding is retained products of conception, and this obstetrician, with more than 20 years experience, would not have overlooked something as basic as checking to be sure the woman's uterus was clear. A fine, caring, and careful doctor, he has invented special shoes for women to wear during pregnancy to minimize the discomforts of swollen feet and puffy ankles. While he was taking care of the woman who was suing him, he was not drunk on duty or high on drugs -- he was on call for another obstetrician who was the woman's usual doctor. He did try to check for retained fetal and placental tissues, but was unable to do so because of the tremendously distorted condition of her uterus.

   The doctor did the best he could under the circumstances, but he couldn't examine her uterus completely without making the bleeding from her miscarriage worse. He warned her to be aware of what might happen, but she is suing him anyway for an unspecified amount of damages. 

   This weekend I was in Tuesday Morning and the woman in front of me in the check-out line was loading her shopping cart after the clerk had rung up her purchases. She had bought an enormous amount of pots, pans, candlesticks, wastebaskets, and other things, and her shopping cart was overflowing. Her final purchase was a large picture frame, and after she paid for everything and was lifting the frame off the check-out counter, the clerk said "You'd better get another cart -- that won't all fit in just one," but she ignored him and literally dumped the frame, glass side down, on top of her other purchases. The glass broke, tumbling shards of broken glass into the basket and onto the floor. The clerk said "That's all right, you can get another one," and she did.

   Yesterday a mother in my practice wanted a Medicaid referral to a plastic surgeon for her 13-year-old daughter. The girl had tripped at school and cut her face, and the mother is suing the school for negligence. She needs a medical statement from a plastic surgeon that the scar will be permanent to bolster her case, and she wants the State of Georgia to pay for the surgeon's statement so she can sue the county because her clumsy daughter tripped and fell.

   What in the world is going on here? Harry Truman said you know a civilization has gone to hell when it loses its manners, and if we haven't lost our manners we've at least lost a sense of decency and fair play. I can see Tuesday Morning giving its customer another picture frame, even though she was the one who ignored the clerk and broke the frame. "The customer is always right," especially if she spends more than $200, is a repeat customer, and might shop at the competition next time. But suing the school because your daughter tripped and fell? Or suing your doctor because your sexual behavior has distorted your uterus' internal anatomy and precluded his being able to do the work he was trained to perform? The idea seems to be "I have had an unexpected and unhappy outcome. Somebody should pay for this. That somebody (or an insurance company) has the money. I should get some."

   I am no advocate for the insurance companies. They raise their premiums, increase their deductibles, raise their co-payments, and then lower their payments to doctors -- but increase the multi-million dollar salaries and bonuses for their CEO's. In the meantime, their share prices go up at the stock exchange because they make record earnings and profits, and then the public blames doctors for the escalating costs of medical care. I believe tort reform will help the insurance companies a lot more than it will help doctors, and I haven't seen an insurance company yet that did me any favors. But there's something colossally wrong here. I've been in practice 34 years and have never been sued, but my professional liability premium is 26% higher this year than it was last year. If I go from full time to part time practice I can lower my premium to only a 20% increase, but even that is outrageous.

   Jury awards for liability suits are higher in states that have lotteries, and that's no coincidence. As long as people refuse to take responsibility for their own actions and have an entitlement attitude, as long as they can find attorneys happy to work for 35% or higher contingency fees, as long as juries believe people who have had bad things happen to them deserve to have somebody else pay for their misfortune, even if they brought it on themselves, this revolting state of affairs will continue.

   When all the good doctors are fed up and quit, and all you have left are contract doctors working on an hourly basis, who's going to treat a child with asthma at 3 AM, or a woman with a heart attack on a Sunday afternoon, or a grandmother who falls and breaks her hip on Christmas Day? You might get a nurse practitioner, or a physician's assistant, or even a moonlighting medical resident trying to help pay off his medical student loan -- but I can tell you this: no one's going to care, except maybe an attorney. And that will be when the pigs rule.

E. Noel Preston, M.D. is a pediatrician in solo practice in Peachtree Corners. 6063 Peachtree Parkway, Suite 202-A, Norcross. (770) 448-1553. More information can be found at  http://www.peachtreecornerspediatrics.com

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