Doctors Are Riskier With Heart Patients In States With Malpractice Damage Caps: Study

In states where legislators have enacted caps or limitations on liability doctors may face from medical malpractice lawsuits, new research suggests that doctors typically recommend riskier treatments for patients with coronary artery disease. 

In a study published on in the medical journal JAMA Cardiology on June 6, researchers from George Washington University found that after stats enacted malpractice damage caps, physicians changed how they test and follow-up on patients with heart problems.

The study looked at physician-specific changes in coronary artery disease testing and treatment in nine states that recently put medical malpractice caps in place, and compared them to practices by doctors in 20 states where there were no such caps. The study involved an analysis of nearly 80,000 physicians’ practices nationwide.

According to the findings, physicians in states with new malpractice caps decreased angiography testing by nearly a quarter as the first diagnostic test, replacing them with stress testing. They also referred fewer patients for angiography following stress testing, and reduced revascularization rates.

“Physicians substantially altered their approach to coronary artery disease testing and follow-up after initial ischemic evaluations following adoption of damage caps,” the researchers determined. “They performed a similar number of ischemic evaluations but conducted fewer initial left heart catheterizations, referred fewer stress-tested patients for left heart catheterizations, and referred fewer patients for revascularization. These findings suggest that physicians tolerate greater clinical uncertainty in coronary artery disease testing and treatment if they face lower malpractice risk.”

Medical malpractice caps are limits on how much plaintiffs can be awarded in non-economic damages. Those limits are generally set by state legislatures, and override the determination of a jury on how much the plaintiff actually deserves to receive for injuries and death caused by careless physicians.

In 2017, for the second time in recent years, the Florida Supreme Court ruled that medical malpractice caps in that state violated the Equal Protection Clause of the Florida Constitution. The first time the issue came before the state’s high court, it ruled that the caps were “offensive to justice.”

About 30 states currently have damage caps of some form, but they have been increasingly challenged in recent years.

State Supreme Courts in Illinois, Missouri and Georgia have thrown out similar damages caps in recent years, saying that the imposition of caps by the state legislatures violated the plaintiffs’ rights to a trial by jury, since the cap overrode the jury’s judgment on what the compensation for those cases should be.

California was the first state to enact a damage cap in 1975, specifically limiting the non-economic damages in medical malpractice lawsuits. According to the National Conference of State Legislatures, as of 2005 ten states capped recoveries specifically on medical malpractice cases and another 22 have caps that are not limited to medical malpractice. About a dozen states also have caps on punitive damages.