Steven Farmer, M.D., Ph.D., recently conducted a study analyzing how physicians treating coronary artery disease (CAD) change their treatment actions when legislators implement caps (limitations) on awards for damages in medical malpractice cases. The findings published in JAMA Cardiology evaluated clinical decision making in both diagnosis and treatment. They found that when caps were in place physicians were less likely to choose an invasive initial diagnostic test.
Non-invasive stress test usage rose by nearly 8% and angiography referrals fell by 21%. Researchers suggest that physicians who feel less susceptible to major claims of medical malpractice are less aggressive in their choices regarding CAD diagnosis and treatment.
The study evaluated data from 36,647 physicians in states with caps on damages for medical malpractice actions and 39,154 in states that did not have these limitations. They noted that states with recently implemented caps tended to have demographic characteristics such as a younger resident populations, increased numbers of minority residents, more low-income residents, and a lower concentration of practicing physicians.
The majority of caps are applicable to noneconomic damages, which are those for losses such as pain and suffering. The researchers had a hypothesis that physicians treating CAD were more likely to “tolerate greater clinical uncertainty involving CAD”. This reduced likelihood is demonstrated as follows:
- Doctors are less likely to proactively order CAD testing
- Doctors are less likely to order angiography for diagnostic testing
- They order more non-invasive tests for diagnosis
- They refer fewer patients for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)
Influence of Caps on Damages
This was believed to be the first study done to evaluate how caps on damages impact medical treatment choices regarding CAD. When CAD is not detected, patients are susceptible to potentially disastrous outcomes and medical providers face potential liability for a missed diagnosis. Those physicians who are subject to the new limitations on damages are ordering PCI less frequently; however, overall ischemic evaluations remained about the same.
Coronary Artery Disease
CAD involves damage or disease to the primary blood vessels necessary for transporting the blood, which supplies critical nutrients and oxygen. Plaque, formed by cholesterol, may obstruct and inflame the arteries of those with CAD. This leads to partial blockages that disrupt critical blood flow. There are three primary signs that CAD exhibits as follows:
- Angina: Pain in the chest area that may include feelings of pressure or tightening that may increase during periods of stress
- Shortness of breath: Develops when blood flow is insufficient causing feelings of fatigue
- Heart attack: Occurs when there is a significantly blocked coronary artery. Typically the individual experiences pressure in the chest, shoulder, or arm, along with exertion and sweating
Damages in Washington D.C. Medical Malpractice Cases
D.C. law does not place limitations (caps) on damages, which are classified as follows:
- Economic: Monetary losses such as funeral expenses, medical treatment costs, and losses of wages from missing work.
- Noneconomic: These are subjective in nature and more difficult to quantify, such as pain and suffering, loss of consortium etc.
- Punitive: Are only applicable in cases where the defendant demonstrates actions that are fraudulent, malicious, or committed with willful intent. They are intended to deter such behavior and punish those defendants. In D.C., punitive damages are generally not recoverable in claims against the government.