Status of reform--or lack thereof

By Terrell J. Isselhard, JD * tal to offer express apologies and fair settlements to patients and families who have suffered mis - he Illinois State has once again takes in patient care. The amendment also gives failed to enact any meaningful counties permission to: create risk retention trusts during its latest session. As a result, all T to provide professional liability coverage to med - in the state of Illinois continue to be ical care practitioners within the county, increase vulnerable to excessive judgments far in excess of state over doctors and insurers, and dis - their professional liability insurance coverage. courage unmerited . Many worthwhile pieces of have been proposed to the Illinois legislature relating to Litigation reform tort reform. This article briefly summarizes, and Upon filing a claim against provides a brief history of one such Bill--HB 4847. a , a plaintiff must employ a consulting The history of HB 4847 demonstrates the hard physician to secure an affidavit of reasonableness work and effort that is being expended by your and merit for the action. Under the proposed representatives to attempt to pass meaningful leg - amendment, the affiant would be required to have islation. After being unanimously passed by the a greater level of expertise in the area of health Illinois House of Representatives, House Bill 4847 care or medicine that is at issue in the particular moved to the Senate last spring, where, after sur - action. This section of the proposed amendment is viving six amendments, it retained much of its of value to physicians because it aims to end frivo - original language as Floor Amendment 5. On May lous lawsuits in their infancy, before a point where 31, Floor Amendment 5 to Senate Bill 4847 passed physicians incur costs and feel the effect a through the Senate, thereby sending it back to the pending may have over their practice. House for concurrence. Unfortunately, this bill According to ISMIE Mutual Insurance Company, was never adopted into legislation. a top physician liability provider, 80% of the claims Overview filed against its insureds result in no payment to the Amendment 5 seeks to reform medical mal - plaintiff. While the success rate for physicians is practice legislation on a number of fronts, includ - high, over the last five years ISMIE spent in excess ing affecting all phases through which a plaintiff's of $150M defending those claims. The passage of successful medical malpractice case traverses, Amendment 5 would work to effect two ends at this from the filing of the claim, to the deci - stage of litigation; it would both eliminate millions sion. Included within Amendment 5 are sections of dollars of excess spending and free up insurance that act to enforce stricter standards for merit, in - companies, defense , and courtrooms to ad - crease plaintiff expert qualifications, in - judicate cases of true merit more efficiently. form of the tax exempt status of plaintiff's Following the filing of a proper claim, a case awards, and protect physicians' personal assets next advances to the and phase. At from being seized to satisfy judgments. The pro - this point, expert is often the greatest de - posed amendment also covers a number of other termining factor in the outcome of a case. The pro - issues, including sections that aim to reform hos - posed amendment seeks to even the playing field pital agency relationships, increase the staff of the as it increases the current low standards for quali - Illinois Department of Professional Regulation, ex - fication as an expert witness in medical malpractice tend good faith immunity to free care providers cases. As of today, it is not required that so-called (including retired physicians), and a "Sorry experts even be certified in the same specialty as Works" pilot program, which allows a pilot hospi - the defendant. Upon passage, the amendment will

6 Chicago Medicine Vol. 107, No. 10 require the to apply the following standards nomic damage cap is the issue in which partisan to determine if a witness qualifies for the case at politics has played the largest role. This section hand: (a) whether the witness is board-certified or was eliminated from the amendment in the Senate board-eligible in the same or similar medical spe - and is not up for vote in the House as part of cialty as the defendant; (b) whether the witness has Amendment 5. The idea of the cap is to limit non- devoted a majority or substantial portion of his economic damages (pain and suffering, punitive time or work to the practice of medicine in relation damages, etc.) at a certain dollar amount. Twenty- to the care and type of treatment at issue; (c) six states currently have established caps. whether the witness is licensed in the same profes - Illinois has not been successful in the enactment sion with the same class of license as the defendant; of such caps. Similar capping non-eco - and (d) whether, in the case of a non-specialist, the nomic awards were passed by the general assem - witness can demonstrate a sufficient familiarity bly in both 1975 and 1995 only to be later declared with the standard of care practiced in the state. unconstitutional by the Illinois Supreme Court on Subsequently, plaintiffs' lawyers would not be able the basis that they were "arbitrary" and "not ratio - to call upon their "professional" or "usual" medical nally related to legitimate government interest." So malpractice expert to offer their frank long as many Illinois lawmakers gain funding from criticism and expert medical opinion in cases in plaintiff personal injury lawyers, it does not appear which they have no expertise to testify. that a bill containing an economic cap will see the docket listing of the Illinois Supreme Court any Clarify tax treatment time soon. This is too bad, because faced with a In recent years, it has come to light that some ju - health-care crisis in which high patient costs are ries in medical malpractice cases have returned limiting the availability of care and doctors contin - damages awards of a higher value when they have ue to emigrate from Illinois, it would be hard for mistakenly believed that the plaintiff would lose a the Supreme Court to characterize such a as large portion of the award to taxes. In reality, for the having "no legitimate government interest" this most part, compensatory damages are not taxed time around. As a result of the ' prior deci - under federal or state income tax . Amend - sions rendering non-economic damage caps un - ment 5 aims to end the confusion, as it requires that constitutional, pro-cap organizations are support - juries receive instructions in writing of the relevant ing SJRCA 54, a constitutional amendment that tax treatment to a plaintiff's damage award. presents the question whether there should be non- economic damage caps to the voters of Illinois. Asset protection for physicians The most talked about section of Amendment 5 Summary entails the protection of physicians' personal as - HB 4847 has the ability to begin to ease the crisis sets. The amendment expresses that in all cases in by removing inefficiencies and reforming the way which a plaintiff seeks damages from medical mal - in which cases go through the courts, including en - practice, the amount of the recovery shall be limit - acting stricter standards at the procedural level. ed to an amount covered by the physician's med - The protection of personal assets will be a victory ical malpractice insurance or liability insurance, for physicians, if not a welcome sigh of relief, as provided the physician maintains at least a mini - they no longer will have to fear losing their per - mum of $1M in insurance coverage per occurrence sonal assets to exorbitant damage awards. While and $3M in the aggregate. Corporate assets are the latest inaction by the legislature is disappoint - subject to attachment for satisfaction of a judg - ing, medical societies and physicians must contin - ment. In no event shall physicians be liable in an ue to contact their state representatives to remind amount that would cause them to forfeit any of them of the critical need for tort reform and to en - their personal assets. courage them to support such legislation. n The author is an partner in the Chicago-based No limitation on non-economic awards firm of Chuhak & Tecson, P.C. Inquiries or sug - The removal of the non-economic limitation is gestions should be e-mailed to Mr. Isselhard at the greatest disappointment since it is the linchpin [email protected] to true tort reform. The original bill contained a *The author acknowledges Brian Radek, summer associate cap on non-economic awards. Unfortunately, this for Chuhak & Tecson, P.C. for his extensive assistance with this article. section was removed. The proposal for a non-eco -

Chicago Medicine 7 Summer 2004