Public Citizen issued the following four press releases, Sept. 17, 2002 No Malpractice Crisis Here: Doctor Errors Greatly Exceed Lawsuits, Study Shows

Six Percent of Florida Doctors Responsible for Half of Malpractice; State Medical Board Does Poor Job of Disciplining Repeat Offenders

FORT LAUDERDALE, Fla. - Assertions that Florida is facing a "malpractice litigation crisis" are wrong; in fact, many more medical errors are committed than give rise to lawsuits, and just a small percentage of doctors are responsible for half of the malpractice awards in Florida, according to a report released today by Public Citizen, a national consumer advocacy organization.

Bad business decisions by insurers also are key to rising medical malpractice insurance liability rates, the report said. Public Citizen used Florida hospital injury data and the National Practitioner Data Bank to debunk claims by the president of the American Medical Association (AMA), Florida doctors and business lobbyists that the number of medical malpractice lawsuits is excessive, and that cutting back consumer rights to use the courts could correct the problem.

"Florida already has some of the most Draconian medical malpractice restrictions of any state in the nation," said Public Citizen President Joan Claybrook. "Yet the American Medical Association and the Florida Medical Association want to limit people's rights to be compensated for horrible medical injuries even further. Meanwhile, they offer false allegations and half-truths to divert attention from the real issue, which is poor medical care."

Among the report's findings:

· The number of medical injuries reported by hospitals - where two-thirds of medical

negligence occurs - exceeds by six to one the number of medical malpractice claims. From 1996 through 1999, Florida hospitals reported 19,885 adverse incidents but only 3,177 medical malpractice claims, according to Florida's Agency for Health Care Administration. Adverse incidents are defined by Florida state statute as "events over which health care personnel could exercise control" that result in death or injury. This means that for every six adverse incidents in the hospital, only one malpractice claim is filed - hardly a crisis.

· Stunningly, only 6 percent of Florida doctors are responsible for half the malpractice and its

costs. According to the National Practitioner Data Bank, 2,674 of the state's 44,747 physicians have paid two or more malpractice awards to patients, making them responsible for 51 percent of all payments.

· The Florida Board of Medicine, which is supposed to police the profession, is dangerously lenient with doctors. There are 24 doctors who have paid 10 or more medical malpractice judgments. Of those, only 12 have ever been disciplined by the Florida medical board. In fact, only 36 percent of Florida's disciplinary actions in 2001 were serious - that is requiring license revocation, suspension, surrender or probation. When compared to the rest of the country, only two states were worse in that regard, Wisconsin and North Carolina.

· Rate increases for many other types of insurance also are up in Florida. This is largely the result of insurance industry economics - major stock market losses mean insurers cannot continue to offer artificially low rates in the hopes of attracting more customers. In Florida in 2002, health insurance increased 20 to 28 percent while homeowners insurance increased more than 15 percent. Florida's Department of Insurance has approved 2001-2002 rate increases for medical malpractice insurers ranging from 6 to 40 percent, with the average being 26 percent.

Public Citizen presented the report at a press conference with Floridians for Patient Protection, which discussed how the insurance industry is trying to shut the courthouse doors on victims of medical negligence and showed the devastating effects medical malpractice has on Florida's families, communities and economy.

"There is no medical malpractice insurance crisis," Claybrook said. "Rather, there is excessive doctor malpractice and an insurance industry profits crisis."

According to the Institute of Medicine, medical errors are a leading cause of death in the United States. At least 44,000 and perhaps as many as 98,000 Americans die in hospitals each year as a result of medical errors. Deaths due to preventable adverse events exceed the deaths attributable to motor vehicle crashes (43,458), breast cancer (42,297) or AIDS (16,516). Further, medical errors are estimated to cost the economy between $17 billion and $29 billion. Medical malpractice costs represented just over one half of 1 percent of health care costs during the 1990s.

Claybrook recommended that: 1) all final board disciplinary actions with information about medical malpractice payouts, hospital disciplinary actions and federal disciplinary actions be made public; 2) medical professionals provide full disclosure to patients and families about errors; 3) doctors be rated on performance for malpractice premiums; 4) doctors with numerous claims be subject to higher malpractice premiums; and 5) the number of classifications of doctor specialties for insurance rating purposes be reduced because the risk pools for some are too small and thus overly influenced by a few losses; 6) the National Practitioner Data Bank be opened to the public; and 7) secret settlements of lawsuits involving medical malpractice be eliminated.

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Sham Crisis is Ploy by Insurance, Medical Lobbies

to Strip Medical Victims' Rights

Statement of Public Citizen President Joan Claybrook

I am Joan Claybrook, president of the national consumer group Public Citizen. I am proud to note that Public Citizen has more than 7,300 members in Florida. Many have joined Public Citizen because of our long history of working to improve the delivery, cost and quality of medical care and to educate consumers about unsafe and ineffective prescription drugs. You might have heard recently about Questionable Doctors Online, our Web-based data bank that lists 1,555 Florida physicians who have been disciplined for negligence, incompetence and other offenses.

Tomorrow, the president of the American Medical Association comes to town. He is coming to wage war. He will directly attack the American legal system - our third branch of government that gives citizens the right to seek redress for injuries caused by others. He will particularly attack the lawyers who are a vital part of that system. But he also will be indirectly attacking the many patients who use the legal system to hold doctors, hospitals, nursing homes and others accountable for horrible and unnecessary injuries and deaths caused by negligent actions. Some of those patients are here with us today, and they will speak to you in a few minutes about how important access to the courtroom is for them.

Let me say one thing to the AMA and to its affiliate, the Florida Medical Association: Have you no shame? For years, taking away citizen rights has been the battle cry to rein in high liability insurance rates - yet no insurance company will promise lower rates if such consumer laws are changed, and states that cut out consumer remedies don't have lower rates as a result. This is a cynical political ploy by the insurance and doctor lobbies, driven by greed, and it's a sham. Citizens should not stand for it, because the courts are the only place where average people can stand up to the powerful and the wealthy.

Florida already has some of the most Draconian medical malpractice restrictions of any state in the nation. Because of these restrictions, injured parties often are denied compensation simply because the anticipated recovery is so limited and the expense and risk of bringing such a case is so great. So who pays? Their families, who become overburdened and overwhelmed. Taxpayers and social service agencies, who have to pick up the tab for errors and wrongdoing committed by medical providers.

Yet the AMA and FMA want to limit patients' rights even further. Apparently, the doctor lobbies will stop at nothing to falsely blame the victim and pretend they are doing something to lower insurance rates.

They continue to engage in propaganda - deceiving the public by blaming rising malpractice rates on lawsuits and the legal system. They continue to spread false allegations and half-truths to divert the public's attention from the real problems: too much poor quality medical care in America today, poor business and investment decisions by the insurance industry, and an insurance model in dire need of reform.

Public Citizen has prepared a report, which we are releasing today, to shed some light on the subject. Among the report's findings:

· The number of medical errors reported by Florida hospitals - where two-thirds of medical negligence occurs - exceeds the number of medical malpractice claims by 6-to-1! From 1996 through 1999, Florida hospitals reported 19,885 adverse incidents - but only 3,177 medical malpractice claims. Adverse incidents are defined by Florida statute as "events over which health care personnel could exercise control" that result in death or injury. This means that for every six adverse incidents in the hospital, only one malpractice claim is filed.

· A small number of malpracticing doctors comprise the largest part of the problem. Only 6 percent of Florida doctors are responsible for more than 50 percent of the malpractice. According to information from the National Practitioner Data Bank, 2,674 of the state's 44,747 physicians have paid two or more malpractice awards to patients, making them responsible for 51 percent of all payments.

· The Florida Board of Medicine, which is supposed to police the profession, is dangerously lenient with doctors. There are 24 doctors who have paid 10 or more medical malpractice judgments. Of those, only 12 have ever been disciplined by the Florida medical board. In 2001, only 36 percent of the disciplinary actions taken by the Florida Board of Medicine involved license revocation, suspension, surrender or probation. Only two states had a worse record than that.

· Rates for many other types of insurance have gone up in Florida. This is largely the result of insurance industry economics. Major stock market losses mean insurers cannot continue to offer artificially low rates in the hopes of attracting more customers. In Florida in 2002, health insurance products increased 20 to 28 percent while some homeowners' insurance lines increased more than 15 percent. Malpractice insurance rates increased in Florida by an average of 26 percent - a hefty increase but one that's comparable to other types of insurance.

Rather than stripping medical victims of their rights, the true causes of malpractice insurance rate increases should be addressed. First, consumers should have access to more information about medical providers. Congress should open up the National Practitioner Data Bank so that information about medical malpractice payouts, hospital disciplinary actions and federal disciplinary actions is made public. Medical professionals should provide full disclosure to patients and families about errors. And there should be no more secret settlements that sweep medical errors under the rug.

In addition, the insurance industry should make changes. Doctors, for example, should be rated on performance, just as insurers do for bad drivers. And the number of classifications of doctor specialties for insurance rating purposes should be reduced, because the risk pools for some are too small and thus overly influenced by a few losses.

The reality is, there is no "medical malpractice insurance crisis." Rather, there is too much medical malpractice. And while some doctors may be facing a temporary insurance "crisis" that causes their rates to spike, the public is facing a permanent quality-of-care crisis that jeopardizes our health. I can't imagine that most doctors want to allow a small number of their profession to continue practicing negligently. We have three strikes and you're out for criminals. Why are doctors who cut off the wrong limb, leave foreign objects inside people or commit medical negligence as many as three times allowed to continue practicing without some form of rehabilitation?

The state legislature should investigate the causes of medical malpractice and find out why the state medical board is failing in its role of policing doctors.

Ask the president of the AMA why he is misleading the public and blaming medical victims for the false medical malpractice insurance crisis.

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Groups Urge Senate Action on Nuclear Security

WASHINGTON, D.C. - Congress should enact legislation to address security concerns at nuclear power plants, national environmental and public interest groups said today. Eleven groups circulated a letter to U.S. senators urging immediate action.

"One full year after the tragedies of last September, Congress has not enacted any legislation to mandate improvements in security at commercial nuclear facilities. This appalling situation leaves the public vulnerable," the groups wrote. "We strenuously urge the Senate to address these pressing nuclear security concerns before adjournment."

Nuclear plant owners have known of their vulnerabilities to terrorist attack, and recent news articles have reported that Al Qaeda specifically discussed bombing nuclear facilities. Not only are nuclear power plants not designed to withstand the type of attack experienced on Sept. 11, 2001, but nearly half of the facilities tested under the Nuclear Regulatory Commission's Operational Safeguards Response Evaluations (OSRE) program between 1991 and 2001 had serious vulnerabilities identified. A report released last week by the Project on Government Oversight (POGO) found that since Sept. 11, security forces at nuclear power plants are undermanned, underequipped and undertrained.

Although the U.S. House of Representatives included nuclear security provisions when it reauthorized the Price-Anderson Act last year, and although the Senate Environment and Public Works Committee unanimously approved the Nuclear Security Act in July, energy conferees last week rejected proposals to include security provisions to the nuclear title of the energy bill (H.R. 4). The Homeland Security Act, currently being debated by the Senate, is similarly silent on security at nuclear power plants.

"Given the current focus on national security, how can lawmakers ignore the unacceptable risks posed by nuclear power plants?" asked Joan Claybrook, president of Public Citizen. "Congress must not allow another year to lapse without taking action on this urgent matter."

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Report Highlights Benefits of Public Ownership of Waterworks

Communities Better Served Through Municipal Control;

Receive Lower Rates, Better Service

LEXINGTON, Ky. - Public ownership of water systems provides more stability, better economic development, more reliable service and lower rates than private ownership, according to a report released today by Public Citizen and Bluegrass FLOW, a citizens group based in Lexington. Both groups warned that privatization, despite its promise of efficiency and improved management, often fails to deliver stable rates and good customer service to the city in which it serves.

Six case studies of cities that have either purchased waterworks from a private company or are currently pursuing a buyout are documented in the report. From Lexington and Huber Heights, Ohio, to Peoria, Ill., strong evidence suggests that water utilities should be kept in the public trust and not treated as a commodity by private investors.

Bluegrass FLOW is taking action to persuade the Lexington-Fayette Urban County Government to regain control of the city's water system. The group maintains that a municipal buyout of the privately owned company, Kentucky-American, would stabilize rates and provide more reliable service.

"Now is the time for Lexington to put power back into the hands of the people who live and work in this community, the people whose only vested interest is making this city a better place to live," said Edward T. (Ned) Breathitt, former governor of Kentucky and a member of Bluegrass FLOW. "What we don't need here is an international corporate giant that siphons profits off our water and invests that money into a new overseas venture instead of our city."

In Peoria, the City Council voted in October 1998 to buy back Peoria's water system from Illinois-American Water Company, a subsidiary of American Water Works, the largest water company in the United States. According to Raftelis Financial Consulting, a management consulting firm that specializes in water and wastewater finance, Peoria had the highest water rates in the country in 1998. This revelation prompted action by the city to regain its waterworks.

"All across the country, we're seeing a demand for corporate accountability from citizens who are fed up with being on the losing end of the profit margin when it comes to their basic utilities," said Wenonah Hauter, director of Public Citizen's Critical Mass Energy and Environment Program. "When people see their rates increase repeatedly, they aren't going to be happy, especially when they don't see any of their money being re-invested into their own communities."

Public utilities serve 85 percent of the U.S. population, including most major cities. A vast majority of these systems are operated by municipal employees. In the early 1990s, when corporations realized that water could be profitable, a wave of mergers and acquisitions swept the nation. The 15 percent of communities that had historically been served by small private companies were now being subjected to the whims of large, international corporations. French-owned Vivendi Universal, Suez and the German energy conglomerate RWE AG became the three largest water companies in the world. As local governments dealt with aging water infrastructures, the water giants were eager to offer solutions through privatization.

In Lexington's case, the city was prompted to take action to pursue a buyout when RWE AG purchased American Water Works, the parent company of Kentucky-American, which is currently running Lexington's waterworks. Many residents in Lexington objected to the idea of an international company running their local water system.

"The citizens of Lexington should be financially responsible only for their water system's operations and improvement costs, not overseas expansion efforts or CEO bonuses," said Hauter. "Lexington cannot afford to miss this unique opportunity to reclaim control of its water rates and economic development."

Communities generally face an uphill battle when pursuing a buyout of private utilities. However, the effort is rewarded by many benefits that public ownership brings. Consider:

· In 2000, Indianapolis officials decided to buy the local waterworks after their owner NiSource announced it would sell them to another company. The city feared dramatic rate hikes, which the new owner was expected to implement to recoup its investment. Indianapolis wanted to ensure that operating decisions and customer service and repair functions would remain in Indiana and that rates would remain reasonable. Following several months of dispute, the company agreed to an April 2001 city purchase. Under the terms of the deal, $17 million will be spent to resolve the odor and taste problems inherited from the private operations and another $7 million will be invested in the infrastructure.

· In 1991, Washington Court House in Ohio moved to buy the local waterworks from the Ohio subsidiary of American Water Works because the company continuously raised rates and failed to meet the local development objectives. The city initially pursued the buyout via eminent domain, but after a two-year legal battle, the company settled. Following the buyout, Washington Court House achieved $500,000 in annual surpluses in just two years. As a result, the city gave a three-year, 10 percent rate discount and performed $9 million worth of capital improvements without raising rates.

· In 2001, Duval, Nassau and St. Johns Counties in Florida saw their water rates cut by an average of 25 percent after the Jacksonville Electric Authority, a municipal body, bought those counties' water systems from United Water, a private company, whose earlier rate hikes met significant local opposition. The buyout also brought water service to a development where residents were prevented from moving in for a year because the developer could not reach an agreement with United Water.

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