VA Proves Fear of Malpractice Suits Isn’t Responsible for Overtesting

Malpractice lawsuits are routinely blamed for unnecessary medical practices, but a new study published in JAMA Internal Medicine supports the truth: Fear of lawsuits is just a noisy campaign to restrict patients’ rights and redress when they have been harmed.

Among the interpreters of the JAMA article was Aboutlawsuits.com, which concluded that “The underlying culture of health-care providers in the United States, not greed or a fear of facing a medical malpractice lawsuit, appears to be the driving force behind … expensive and unnecessary medical testing, …”

The overuse of medical resources to protect against claims of negligent treatment often is referred to as practicing “defensive medicine.” We’ve discussed how this is a bogus idea that interests keen to limit malpractice awards continue to voice.

In the JAMA study, researchers analyzed the diagnosing and treating habits of doctors at a Veterans Health Administration hospital. Because such facilities are run by the government, their doctors generally are shielded from the effects of most malpractice lawsuits. Complaints against VA treatment are processed through a long, bureaucratic system that emphasizes resolution via mediation, not litigation.

Yet, the JAMA researchers learned, VA doctors request just as many unnecessary medical tests as private sector practitioners, who are far more vulnerable to lawsuits.

Specifically, researchers examined how often VA doctors used myocardial perfusion imaging (MPI) to test patients for coronary ischemia, or insufficient blood in the coronary arteries. MPI, also called myocardial perfusion stress testing, relies on injections of radioactive dye to highlight heart function. Risks to the patient include allergic reactions to the dye, increased risk of cancer from radiation and false positives that can mean patients undergo other unnecessary and often invasive medical procedures, such as heart stents.

Although MPI is a common test, many experts believe that it is overprescribed, as AboutLawsuits explains, either because doctors fear potential lawsuits or because they have a financial interest in the screening technology and will profit from self-referral.

The researchers had expected to find a much lower use of MPI at the VA hospital compared with private and public hospitals. But the rates were about the same-“VA doctors,” according to AboutLawsuits, “were just as likely to prescribe unnecessary MPI tests as other doctors.”

Based on guidelines devised by the American College of Cardiology Foundation and the American Heart Association, about 13 in 100 MPI tests are unnecessary.

The lead JAMA researcher concluded that neither potential profit from self-referrals nor fear of medical malpractice lawsuits was driving the unnecessary tests. And an editor of the publication commented that such overtesting reflects a certain culture within the medical community. We’ve written about this, about how much medicine loves technology, even when its use might not be best for the patient. That love affair, not malpractice claims, fuels overtreatesting.

A recent study at Johns Hopkins pegged the cost of malpractice payouts at less than 1% of U.S. health-care costs, as we wrote in May.

How long will it be before promoters of tort reform-measures to cap medical malpractice awards-finally are accepted as the purveyors of misleading information that they are?