State Tort Reform vs. Patient Safety

The insurance industry has done an incredible job portraying medical negligence as a potential source of savings to health care costs-what a myth! A close look at the numbers reveals that insurance companies enjoy record profits while physician and patient premiums continue to increase exponentially. The reality of it is that medical negligence lawsuits hardly contribute to America’s insurmountable health care costs. Undisputedly, an analysis of data from the National Association of Insurance Commissioners (NAIC) and company annual statements shows malpractice insurer profits are 24 percent higher in states with malpractice caps. In these cap states, insurers took in 3.5 times more in premiums than they paid out in 2008. In contrast, insurers in states without caps took in just over twice what they paid in claims.

A closer look at the data clearly indicates that no correlation between the cost of malpractice premiums and health insurance premiums. In fact, with more than 30 states enforcing MICRA’s malpractice caps, insurance companies are enjoying extraordinary high levels of profit while approximately 98,000 patients are killed annually by preventable medical errors. (From To Err Is Human: Building a Safer Health System Executive Summary - Committee on Quality of Health Care in America, Institute of Medicine). Its time for America to call the insurance companies on their bluff and expose the facade that medical negligence caps as a source of savings to health care costs. Logically, the true source of any potential savings is the underlying principle of reducing preventable medical errors. It follows that preventing medical errors will lower health care costs, reduce doctors’ insurance premiums, all the while protecting the well-being of the patient. So, lets take it back to the basics. If patient safety becomes the overarching goal by focusing on reducing/preventing medical errors, don't all the related problems seem to go away?
 

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Read Bahar Dejban's KPA Newsletter Article "To know or not to know? For Merck, the answer is both."

In January 1999 Merck began their Vioxx Gastrointestinal Outcomes Research (VIGOR) study which compared Vioxx to naproxen, which is the active ingredient in some brand name pain relievers. At the conclusion of the study it was not only apparent that there was a lower incidence of gastrointestinal events in patients being treated with Vioxx , but more significantly there was a higher risk of cardiovascular events in those same patients. On March 27, 2000 Merck issued a public statement explaining those results:

Among patients treated with Vioxx, there was significantly reduced incidence of serious gastrointestinal events compared to patients treated with naproxen…………In addition, significantly few thromboembolic events were observed in patients taking naproxen in this GI outcomes study, which is consistent with naproxen’s ability to block platelet aggregation. This effect on these events had not been observed previously in any clinical studies for naproxen. Vioxx, like all COX-2 selective medicines, does not block platelet aggregation and therefore would not be expected to have similar effects.

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Read Galorah Keshavarz's Article "Inmates Continue to Endure Constitutional Violations While California Struggles with Prison Reform"

The United States Constitution acts to guarantee fundamental rights concerning conditions of confinement and treatment for all criminal defendants sentenced to U.S. prisons. Pursuant to the Eighth Amendment of the U.S. Constitution, individuals convicted of a crime have the right to be free of cruel and unusual punishment while in prison. While no universal definition exists of what constitutions “cruel and unusual” punishment, it is settled that any punishment that is clearly inhumane or that violates basic human dignity may be deemed “cruel and unusual.” Typically, an inmate’s Eighth Amendment complaint regarding punishment and confinement conditions are brought in connection with federal civil rights laws, including the Prison Litigation Reform Act (PLRA), 18 U.S.C. §3626, and 42 U.S.C. §1983.

Continue reading Galorah's article as published in the January KPA Newsletter here.

Read Robert Drexler's Article "The Fuzzy Line Between Merits and Class Certification Analyses"

An often-stated principle in class certification law is that the class certification motion is not a motion on the merits; the merits of the case are distinct from the analysis of the class certification requirements. However, in practice, the line between a class certification and merits is blurred. Two recent California Court of Appeal cases illustrate this point.

In Ghazaryan v. Diva Limousine, Ltd., 169 Cal. App. 4th 1524 (2009), the employee drivers filed a lawsuit challenging Diva’s policy of paying its drivers an hourly rate for assigned trips but failing to pay for on-call time between assignments, referred to as “gap” time. The trial court denied plaintiffs’ motion to certify two overlapping subclasses, one based on Diva’s alleged failure to pay earned overtime and straight time and a second targeting Diva’s failure to provide mandatory rest breaks. The denial focused on the potential difficulty of assessing the validity of Diva’s compensation policy in light of variations in how drivers spend their gap time. Diva had submitted numerous employee declarations stating that drivers typically used unpaid gap time for their own purposes such as working out at a gym, napping or eating at home or running personal errands. The trial court’s order denying certification, however, suggested that if plaintiffs’ claims are valid, class treatment of those claims is appropriate, but stated that the court must first determine if Diva’s practices are improper and, if so, which drivers fit into the appropriate class.

Read the remainder of Robert's article as published in the January KPA Newsletter here.

Are Manufacturers using Deceptive Advertising to Capitalize on Consumer Concern over H1N1?

Kellogg, the nation’s largest cereal maker, recently slapped a label on its kid-friendly Rice Krispies and Cocoa Krispies cereal brands which tout that the product “Now Helps Support your Child’s Immunity.” While it’s true that Kellogg added some vitamin A, B, C and E to their cereal, health care professionals have been extremely critical of the leap Kellogg has made from the addition of certain vitamins to the claim that the product “helps support immunity.” One vocal critic is Kelly Brownell, director of Yale University’s Rudd Center for Food Policy who was quoted as saying “[b]y their logic, you can spray vitamins on a pile of leaves and it will boost immunity.”

Health care professionals aren’t the only consumer advocates who have taken issue with Kellogg’s claims. Shortly after the “immunity claim” plastered boxes hit shelves, , the city of San Francisco wrote a letter to Kellogg and the FDA asking Kellogg to prove its claim. “I am concerned the prominent use of the immunity claims to advertise sugar-laden chocolate cereal like Cocoa Krispies may mislead and deceive the parents of young children” said Dennis Herrera, San Francisco‘s City Attorney.

Following San Francisco’s efforts to demand substantiation of  Kellogg’s  claim, the Attorney General’s office of Oregon made a similar appeal to the company. Keith Dubanevich of the Oregon’s Attorney General’s office offered the following reasoning for seeking substantiation, “[t]he implied claim that if somebody ate Cocoa Krispies it might help them avoid getting swine flu, and given the season, that’s a pretty important claim to be making.”

It is telling that in response to the public pressure, rather than provide scientific data to support its claims, Kellogg has opted to remove the label from all cereal boxes by January 15, 2010. This response not only offers insight to the validity of Kellogg’s claims, but begs the broader questions:  to what degree should we accept manufacturer’s claims at face value, and how often are we, as consumers, unconsciously manipulated by deceitful advertising?

Can Class Certification Be "Preemptively" Denied?

A recent decision in Vinole v. Countrywide Home Loans, Inc., 571 F.3d 935, (9th Cir. 2009) provides defendants an important tool in the battle for class certification; the ability to set the timeline in class cases and preemptively move to deny class certification. The general scheme in class action lawsuits is well-known: plaintiffs move for class certification, and in doing so, have the right to put the class certification issue before the court. Defendants, in turn, then oppose. The Ninth Circuit in Vinole turned this general practice upside down by deeming a preemptive motion to deny certification proper under Federal Rule of Civil Procedure 23.

Rule 23(c)(1)(A) discusses the time limitations for a court’s determination of class certification. Rule 23 specifically states, “Time to Issue: At an early practicable time after a person sues or is sued as a class representative, the court must determine by order whether to certify the action as a class action.” The Ninth Circuit held that the literal language of Rule 23 does not preclude defendants from seeking resolution of the class certification issue early in the case, and before plaintiffs have the opportunity to confront the issue. In Vinole, the motion to deny class certification was brought ten months after the filing of the lawsuit.

Plaintiffs, in opposing defendant’s tactics, attempted to argue that the preemptive motion to deny class certification was not only per se improper because it preceded the motion for class certification, but also because it was filed prior to discovery and pretrial motion cutoff dates. The court of appeals rejected plaintiffs argument, reasoning that plaintiffs had adequate time to conduct class related discovery and that the district court did not abuse its discretion by considering the issue of certification before the pretrial motion deadline. 

Although the court deemed defendant’s preemptive motion to deny class certification proper in Vinole, there are undoubtedly times when such motions should be denied. For example, and as the Ninth Circuit discusses, had plaintiffs shown the need for additional discovery, defendant’s motion would have been denied as premature. Plaintiffs should not make the mistake of relying on a “per se improper” argument as plaintiffs did in Vinole, and should instead be prepared to make a showing of why additional time is needed when confronting a motion to deny class certification. 

Tort Reform - An Infringement on Rights and a Corporate Handout

In the ongoing debate over health care, Republicans and lobbyists for Big Business continue to clamor for tort reform. To understand tort reform, one must first understand what a tort is. Simply put, a tort is an intentional or negligent act which causes injury (physical, monetary, and/or mental) to another party. When a tort has been committed, the injured party has the right to sue her wrongdoer in civil court. Some common examples of torts include medical malpractice, negligence, and strict products liability. Tort reform refers to legislative measures designed at limiting the amount of damages available to plaintiffs who take legal action for their injuries.

Today’s campaign for tort reform is by no means new or unique. In fact, the tort reform movement was born in the early 90’s by tobacco industries looking to dodge liability in failure to warn and personal injury cases. From its inception, the campaign was designed to appeal to a broad range of corporate interests. It didn’t take long for the pharmaceutical, chemical, insurance, and automobile manufacturing industries to jump onboard the tort reform bandwagon. To date, these industries have collectively poured millions of dollars into public relations campaigns aimed at deceiving the public. The message: Trial attorneys and injured patients file frivolous lawsuits in search of deep pockets and, in turn, drive up health care costs for average, hard-working citizens like you!

These accusations need to be set straight. Before we get into the real motivations behind tort reform, let’s hit the violin music and dim the lights (a little more please…) and consider the real and convincing facts. According to the Institute of Medicine, 98,000 patients die annually as a result of medical error, making medical negligence the sixth leading cause of death in the United States. Remember now, this is the number of patients who die each year, not the number of people who are left scarred and seriously injured for the rest of their lives. While 46 states have enacted some version of tort reform, the cost of health care continues to sky rocket as doctors have begun practicing “defensive medicine” (ordering of unnecessary medical tests and procedures) out of fear of medical liability. 

Medical malpractice insurance companies, the most zealous advocates of reform, are and will forever be the sole victor in the tort reform movement. In the last 10 years alone, the medical malpractice insurance industry has seen a 47% increase in profitability. According to the American Association for Justice, in 2008 the average profit of the 10 largest medical malpractice insurers was higher than 99% of Fortune 500 companies and 35 times higher than the Fortune 500 average. These profits have been pocketed by insurance companies and have never passed savings to doctors or injured patients. So really, tort reform is just another handout to corporations and insurance companies. Moreover, placing caps on victim recovery, suggesting shorter statute of limitations periods, and proposing the creation of special medical courts to try malpractice cases, are nothing more than corporate attempts to restrict victim access to the legal system for redress of harms and wrongs. 

Learn more about the role of our civil justice system in the current health care debate! Visit www.98000reasons.org to find out how you can help put people over profit!

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DID YOU KNOW…

If you are unable to work or maintain a job due to a physical or mental impairment or condition, you may be eligible for Social Security Benefits

If you or someone you know have filed a claim for Social Security Benefits and you are not represented by an attorney, contact us. Even if you have been denied benefits before, we may be able to help you. 

Contact KPA immediately.

 

Anticipating Defenses to UCL Claims

It has become common practice in class action litigation, particularly in cases concerning consumer fraud, to include a cause of action for violation of California Business & Professions Code § 17200, also known as the Unfair Competition Law (“UCL”). Section 17200 states

As used in this chapter, unfair competition shall mean and include any unlawful,unfair or fraudulent business act or practice and unfair, deceptive, untrue or misleading advertising and any act prohibited by Chapter 1 (commencing with Section 17500) of Part 3 of Division 7 of the Business and Professions Code.

In order to successfully assert a cause of action under section 17200, it is important to anticipate the defenses that may be raised against such a claim. One of the most common defense arguments is that the UCL claim is preempted by federal law. Because the preemption issue is so complicated, this issue arises frequently in UCL cases with often unpredictable results. For instance, the California Supreme Court reversed itself on the issue with respect to claims against tobacco companies allegedly targeting minors with their advertising. In 1994, in Mangini v. R.J. Reynolds Tobacco Co., 7 Cal.4th 1057 (1994) the Supreme Court held that such a claim was not preempted by the Federal Cigarette Labeling and Advertising Act. Thirteen years later in In re Tobacco Cases II, 41 Cal.4th 1257 (2007), the court overruled Mangini and held that such claims are preempted by that federal law.

Another defense is that there can be no claim under the UCL if the underlying law specifically bars a claim. For example, in Safeco Ins. Co. v Superior Court, 216 Cal.App.3d 1491 (1990) the court held that an alleged violation of Insurance Code § 790.03(h) cannot be the predicate for a section 17200 claim because that would circumvent the Supreme Court’s holding in Moradi-Shalal v. Fireman’s Fund Insurance. Companies., 46 Cal.3d 287, 250 (1988), which bars direct actions against insurers for such claims.

Additionally, a UCL claim will not succeed if the alleged unlawful conduct is specifically permitted by law. As an example, in Shvarts v. Budget Group, Inc., 81 Cal.App.4th 1153 (2000), the rental car industry’s practice of allegedly charging unfairly high prices for refueling returned cars was held to be expressly permitted by Civil Code § 1936(m)(2) and so a section 17200 claim challenging the practice could not proceed.

Finally, certain types of claims are simply not recognized under the UCL. For example, in People for the Ethical Treatment of Animals, Inc. v. California Milk Producers Advisory Board, 125 Cal.App.4th 871 (2005), PETA alleged that the Board’s “happy cows” campaign constituted false advertising. The court held the Board is not a “person” within the meaning of the UCL and therefore could not be sued under section 17200.

In essence, the UCL is a powerful tool for plaintiffs and in order to succeed under the statute, plaintiffs should anticipate the various defenses that may be asserted.
 

New Antidepressant Pharmaceutical Analysis Reported in the New York Times

This article regarding a new analysis on antidepressant pharmaceuticals such as GlaxoSmithKline's Paxil, appeared in yesterday's New York Times.  According to the analysis, antidepressants effectiveness is directly correlated with the severity of the depression being treated.  Will findings like this slow down doctors from prescribing antidepressants to patients whose "depression" could only be due to something as simple as PMS or one bad day?

We want to hear what you think!  In your opinion, are doctors writing unnecessary prescriptions?