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February 24, 2006

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Public Health Press

A few thoughts on the weird bill:

Requiring a certificate of merit is a real change, but the devil is in the details (I don't have the bill in front of me, but that won't stop me from posting my thoughts!). Illinois requires such certificates, and recently made changes to their process. Generally, certificates are filed by the plaintiff's attorney with an attached Affidavit of Merit by a licensed medical practitioner, who must review the record and state there is a meritorious claim. That, in and of itself, is an additional administrative hurdle and cost incurred by the attorney and the patient/victim up front, and the burden goes up depending on the qualifications required of the expert (for example, do they have to be in the same or a similar specialty, or can it be just any physician with some working knowledge of the area in question?). But here's the way they can make a big difference in the number of suits filed: if the affidavit of merit requires details about the reviewing physician be disclosed (e.g., physician's names, addresses, etc.), it can create a tremendous amount of peer pressure to prevent physicians from signing on to these cases, and therefore make it significantly more difficult to get over the hurdles needed to file the claim.

The insurance review will eventually make it into the hands of researchers, I suspsect, and that will be a boon for the debate over malpractice rates the next time there's a malpractice crisis/bond market downturn.

The public members are generally political players, and, if it's anything like the process that the Massachusetts board had when I was out there, they are not loose cannons out to prosecute every doc with a complaint filed against them. It's a largely symbolic gesture that the public has some say in overseeing physician licensure, and not just the so-called foxes guarding the henhouse. The board will take some time to train up the public members, but they're not just grabbing folks off the street.

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