By ANNEMARIE FRANCZYK

Three initiatives by local, state and federal leaders are attempting to address a medical malpractice environment that some say has reached crisis proportions.

The recent reforms are intended to ease some of the pressure points in medical liability, but they are so new that few will speculate as to their potential impact. The reforms appear to be a byproduct of the nation's debate over health-care policy and the associated reduction of factors that contribute to rising health-care costs.

There are several ways to quantify some of the situations that prompted the reforms:

• Malpractice insurance premiums have increased between 5 percent and 14 percent in four of the last seven years.

• Premiums vary widely depending on medical specialty and geography so that doctors practicing on Long Island pay more than three times the premiums charged to doctors in Erie County and most of Upstate New York. The reason? Long Island juries tend to award huge amounts that drive up rates across the entire region, said Richard Peer, M.D., of Buffalo, vice president of Medical Liability Mutual Insurance Co. the state's largest insurer.

• Overall annual medical liability costs reached $56 billion in 2008, or 2.4 percent of total health-care spending, according to a Univera Healthcare study.

• The amount of awards to patients have increased between 2 percent and 5 percent annually, though they have leveled recently.

Or perhaps the problem is that medical malpractice suits cast a wide net among providers and can take more than 10 years from complaint to resolution.  Robert Zielinski, M.D., an oncologist with Buffalo Medical Group, said he is among a large and varied field of medical providers named in a malpractice suit brought on behalf of a deceased patient.

"When the suit was brought, it involved every physician who touched that patient a year before her death. The diagnostic lab was named and the specialty doctor who had nothing to do with her death," Zielinski said. "In the meantime, everyone had to get an attorney and spend time and expense (in defense)."

Erie County Medical Liability Reform Court

State Supreme Court Justice John Curran and four of his colleagues in Erie County have been selected to create a medical malpractice court to help streamline and lower costs of local cases involving hospitals. They initially will handle cases involving Catholic Health and Kaleida Health hospitals and Erie County Medical Center.

The program replicates one that originated in Bronx and Manhattan. In the New York City model, according to the Unified Court System, medical malpractice cases are assigned at the preliminary conference stage to dedicated judges who work with plaintiff and defense attorneys to settle or streamline cases before they reach trial.

The judges are specially trained in negotiation and medical skills, medical terminology and malpractice patterns to familiarize themselves with the parties and the issues at an early stage and, where possible, settle the cases prior to costly discovery proceedings, according to the Unified Court.

The New York City model has reported savings of $50 million annually. The Erie County program began Sept. 1.

Plaintiff's attorney Laraine Kelley, senior partner in Lipsitz Green Scime Cambria LLP, said she would welcome a strategy that brings about "early and just resolution" to cases, but had doubts about the New York City model.

"Defendants and their carriers are rarely interested in resolving these claims early unless the plaintiff is willing to take what amounts to nuisance value. In fact, the defense model has been that no case will resolve unless and until it has been made clear that there is a real risk of imminent loss," Kelley said. "I believe the medical malpractice insurance industry has always acted on the notion that a vigorous and long defense was a disincentive to people filing claims."

New York State Medical Indemnity Fund

The fund was created by the state's Medicaid Redesign Team to pay medical expenses for infants with birth-related neurological injuries, the largest area of malpractice coverage for hospitals. Half of the $1.6 billion in medical malpractice expenses spent by hospitals in 2009 compensated neurologically impaired infants.

Specifically, the fund is intended to pay or reimburse costs necessary to meet the future health-care needs of "qualified plaintiffs," reduce expenses associated with malpractice litigation and reduce the cost of malpractice coverage for providers, according to the Greater New York Hospital Association article published by the state Bar Association.

Between 150 and 200 babies are expected to qualify annually for fund compensation.

By creating the fund, the state has helped to spread the costs of neurological injuries more broadly, according to the hospital association. It requires the fund, not the defendants or insurers, to pay the costs of all future medical expenses related to such injuries.

It became operational Oct. 1. The state will deposit $30 million in the fund during the 2011-12 budget year. The administration appears committed to future funding, according to the hospital association, though no funding amounts have been specified.

Defense attorney Barbara Schifling, a partner in Damon Morey LLP, said lawyers for hospitals may view the fund favorably because it might relieve their clients of a potentially catastrophic settlement or verdict.

"This puts some predictability for the hospitals into the resolution of these very large cases. It will affect the direct costs to the hospitals for the future care of these infants," she said.

H.R. 5

The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act of 2011 aims to improve medical care overall by reducing the liability burdens on health-care delivery, including:

• Setting the statute of limitations to three years after the injury;

• Limiting pain and suffering damages to $250,000;

• Barring punitive damages in cases involving Food and Drug Administration-approved products.

The bill was introduced in the House in January and has the support of 132 Republicans, including four New York City representatives, and two Democrats.

Kelley summed up the bill as the most recent attempt by Republicans to cap non-economic damages.

"What's most striking about the cap on pain and suffering is that it provides for full damages to those with more modest claims, and utterly ignores the most horrendously injured patient's rights to be made whole. If a medical provider's negligence results in a life thwarted by pain and deprivation, then simple fairness demands fair compensation," Kelley said.

She said premiums have not fallen in states where caps have been enacted as a means of protecting doctors from such expense.

"These laws benefit the insurance industry but rarely benefit doctors," she said, "and never serve injured patients."

While these reforms work themselves out, medical malpractice insurers are trying their own initiatives. As of July 1, Medical Liability Mutual and Physicians' Reciprocal Insurers, the state's second-largest insurer, is offering a 7 percent claims-free discount to doctors who have had no new claims filed against them and have had no claims paid out, Peer said.

It offers some help to doctors who continue to practice in New York state, despite the flow of their colleagues to other parts of the nation such as Texas where medical malpractice premiums are a third less than New York's. A high number of new applications for medical licensees there are from New York doctors, he said.