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Medical Ethics |

Medical Malpractice Reform Measures and Their EffectsMedical Malpractice Reform Measures

Robert B Leflar, JD, MPH
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From the School of Law, University of Arkansas, Fayetteville, and College of Medicine and College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR.

Correspondence to: Robert B Leflar, JD, MPH, School of Law, University of Arkansas, 1045 W Maple St, Fayetteville, AR 72701; e-mail: rbleflar@uark.edu


Editor’s note: This essay is the seventh article in the Law and Medicine curriculum of the ongoing “Medical Ethics” series. To view all articles from the core curriculum, visit http://journal.publications.chestnet.org/collection.aspx?categoryid=9186.—Constantine A. Manthous, MD, FCCP, Section Editor, Medical Ethics

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(1):306-318. doi:10.1378/chest.12-2861
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New rules and methods for medical injury dispute resolution have been launched in New Hampshire and New York, and demonstration projects are underway elsewhere. This article describes major medical malpractice reforms undertaken and proposed in recent years. Reforms are classified as (1) liability-limiting initiatives favoring health-care providers; (2) procedural innovations promoted as improving dispute resolution processes, such as patient compensation funds, “sorry” laws, disclosure and early offer laws, health courts, and safe harbor laws; and (3) major conceptual reforms to move liability away from physicians to hospitals or administrative no-fault compensation systems. Empirical evidence about the practical effects of already-implemented reforms, such as damage caps, is reviewed. In light of declining malpractice claim rates, heavier adverse impacts of damage caps on vulnerable groups (people who have severe injuries, who are elderly, and who are unemployed) and repeated findings of state law unconstitutionality, the rationale for nationwide damage caps is questioned. Attention to innovative reform proposals such as patient compensation funds, disclosure and early offer laws, safe harbor laws, enterprise insurance and no-fault compensation systems, is encouraged.


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