American health care is in crisis because of exploding medical malpractice litigation. Insurance premiums for doctors and malpractice lawsuits are skyrocketing, rendering doctors both afraid and unable to afford to continue to practice medicine. Undeserving victims sue at the drop of a hat, egged on by greedy lawyers, and receive eye-popping awards that insurance companies, hospitals, and doctors themselves struggle to pay. The plaintiffs and lawyers always win; doctors, and the nonlitigious, always lose; and affordable health care is the real victim. This, according to Tom Baker, is the myth of medical malpractice, and as a reality check he offers The Medical Malpractice Myth , a stunning dismantling of this familiar, but inaccurate, picture of the health care industry. Are there too many medical malpractice suits? No, according to Baker; there is actually a great deal more medical malpractice, with only a fraction of the cases ever seeing the inside of a courtroom. Is too much litigation to blame for the malpractice insurance crisis? No, for that we can look to financial trends and competitive behavior in the insurance industry. Are these lawsuits frivolous? Very rarely. Point by point, Baker—a leading authority on insurance and law—pulls together the research that demolishes the myths that have taken hold about medical malpractice and suggests a series of legal reforms that would help doctors manage malpractice insurance while also improving patient safety and medical accountability. President Bush has made medical malpractice reform a priority in his last term in office, but if history is any indication, legislative reform would only worsen the situation and perpetuate the gross misunderstanding of it. The debate surely will be transformed by The Medical Malpractice Myth , a book aimed squarely at general readers but with radical conclusions that speak to the highest level of domestic policymaking. Tom Baker is Professor of Law at the University of Pennsylvania Law School and coeditor of Embracing Risk: The Changing Culture of Insurance and Responsibility , published by the University of Chicago Press. Baker has also worked as a consultant to insurance companies and law firms. The Medical Malpractice Myth By Tom Baker University of Chicago Press Copyright © 2005 University of Chicago All right reserved. ISBN: 978-0-226-03649-6 Chapter One Medical malpractice premiums are skyrocketing. "Closed" signs are sprouting on health clinic doors. Doctors are leaving the field of medicine, and those who remain are practicing in fear and silence. Pregnant women cannot find obstetricians. Billions of dollars are wasted on defensive medicine. And angry doctors are marching on state capitols across the country. All this is because medical malpractice litigation is exploding. Egged on by greedy lawyers, plaintiffs sue at the drop of a hat. Juries award eye-popping sums to undeserving claimants, leaving doctors, hospitals, and their insurance companies no choice but to pay huge ransoms for release from the clutches of the so-called "civil justice" system. Medical malpractice litigation is a sick joke, a roulette game rigged so that plaintiffs and their lawyers' numbers come up all too often, and doctors and the honest people who pay in the end always lose. This is the medical malpractice myth. Built on a foundation of urban legend mixed with the occasional true story, supported by selective references to academic studies, and repeated so often that even the mythmakers forget the exaggeration, half truth, and outright misinformation employed in the service of their greater good, the medical malpractice myth has filled doctors, patients, legislators, and voters with the kind of fear that short circuits critical thinking. This fear has inspired legislative action on a nationwide scale three times in my lifetime. The first time was back in the mid-1970s. I remember sitting at the dinner table listening to my father report what he'd heard at his medical society meeting: "Medical malpractice insurance premiums are going through the roof. Frivolous litigation and runaway juries will drive doctors out of the profession." The answer, the medical societies and their insurance companies said, was medical malpractice tort reform-to make it harder for misguided patients and their lawyers to sue. What the medical societies did not tell my father, or almost anyone else, was that their own research showed that the real problem was too much medical malpractice, not too much litigation. In the mid-1970s the California Hospital and Medical Associations sponsored a study on medical malpractice that they expected would support their tort reform efforts. But, to their surprise and dismay, the study showed that medical malpractice injured tens of thousands of people every year-more than automobile and workplace accidents. The study also showed that, despite the rhetoric, most of the victims did not su