Endocrinology Advisor: Can you elaborate on how changes would benefit both practitioner and patient?

Dr Mello: If we can refine our processes of resolving incidents at an early stage, everybody benefits. In fact, some institutions have adopted approaches in which they acknowledge error and provide compensation without requiring the patient to sue. This offers a number of benefits for the institution in terms of cost control, and the patient and the doctor involved in terms of enabling them to reconcile and move on with their lives.

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The other thing that is we rely on an adversarial system instead of an administrative compensation system. We require people who have already been through a traumatic event to go through another traumatic event with a protracted lawsuit. Neither side wants to engage in that [process], just as nobody wants to pay an attorney 30% [of the settlement] or an insurance company a huge amount of overhead. It is in everybody’s interest to develop more efficient ways of dealing with claims, [most] likely [methods] that rely less on juries than they do currently.

Endocrinology Advisor: What are the largest legal barriers to medical liability reform?

Dr Mello: At the public law level, reform has emerged as a very partisan issue. A possible explanation for this is proposals tend to heavily favor healthcare providers and have an overall lack of balance in their consideration of what patients may need. Moving forward, we need to return to ideas that are win-win, resulting in lower costs to providers while also offering benefits to patients.

Endocrinology Advisor: Why is now the right time to amend medical malpractice litigation?

Dr Mello: If you examine insurance premiums, you [can] see that they cycle and spike every 15 years or so. This, of course, upsets physicians, whose demand is then not for fixing the system, but [for] lowering their costs quickly. And the problems are much more complicated than that. Because of this, the time [for] a thoughtful conversation about malpractice reform is when people are not in a crisis state, which is now.

Endocrinology Advisor: In the current political climate, how should the issue of malpractice reform move forward?

Dr Mello: I continue to favor state-based solutions. Malpractice has always been a state law issue. It has been extraordinarily rare for the federal government to get involved [in malpractice suits]. However, when Congress takes up the issue, it can serve as a lightning rod for states to get things done that Congress cannot. 

If we are to move forward with federal legislation, I favor approaches that facilitate alternative dispute resolutions and other avenues for dealing with incidents that do not rely on adversarial litigation and are not as one-sided as the current Republican proposals. There has to be a willingness to revise the processes outlined in the proposals, so that they more fairly balance the interests of patients and providers.

Disclosures: Dr Mello reports receiving grants from SUMIT Insurance Company Ltd.


Mello MM, Kachalia A, Studdert DM. Medical liability — prospects for federal reformN Engl J Med. 2017. doi: 10.1056/nejmp1701174 [Epub ahead of print]

This article originally appeared on Endocrinology Advisor