Legal Rash

It was once standard practice for a doctor to say soothingly to the patient with a broken arm: "Don't worry--we'll soon have it as good as new." Such optimistic pleasantries are now out of fashion. Doctors are becoming more & more wary of laying themselves open to malpractice suits. And nowhere are, they warier than in Los Angeles, where such suits are commoner than anywhere else-in the U.S.

This month, the 3,600 doctors who take out malpractice insurance under a plan sponsored by the Los Angeles County Medical Association found their premiums raised again. One of the biggest jumps was for protection against suits over cosmetic surgery. Los Angeles medicine is well populated with face-lifters, and patients are generally satisfied with simple restoration jobs. But, says Doctor-Lawyer Louis J. Regan, author of Doctor and Patient and the Law (a doctors' guide on how to stay out of court): "When we try to improve on nature [e.g., by nose-bobbing], we find the patient doesn't always think we do it."

Face-lifters are not the only targets of Los Angeles' litigious patients. Radiologists (because of the danger of X-ray burns) and general surgeons (tackling serious and often risky operations) are under steady legal fire. So are obstetricians and neuro-psychiatrists.

Search & Seizure. California law aggravates the rash of malpractice suits: one trick provision compels the defendant doctor to serve as an expert witness for the plaintiff. The epidemic in Los Angeles is especially severe because Southern California is full of elderly hypochondriacs. Says Dr. Regan; "We have so many people in the fringe group here--the lunatic fringe, that is." Examples: one woman, accusing her surgeon of having left needles in her arm, stuck 26 sewing needles into herself; another woman, claiming that she had been examined without her consent, sued under the Fourth Amendment guarantee against unlawful search & seizure. Both plaintiffs lost.

Because malpractice suits are costly to defend, even when the doctor wins, Dr. Regan and the County Medical Association are concentrating on trying to prevent them. For example, a doctor must not tell a patient that a broken limb will be "as good as new," for that can be regarded as a verbal contract. He must not promise a cure.

Possible Preventive. As extra insurance, doctors are getting more & more into the habit of calling in specialists as consultants. It costs the patient money, but the consultant makes a fine witness for the defense. Doctors are also ordering more diagnostic procedures, especially X rays. Such devices, along with the higher insurance premiums, force up the cost of medical care to all Angelenos, whether they suffer from lawyer's itch or not.

Last week Dr. Regan and representatives of the law and medicine faculties of the University of California at Los Angeles were plotting a graduate course on the legal aspects of medicine, to be given at U.C.L.A. in June. By making doctors more aware of the dangers they face, the course should help prevent malpractice suits. And Dr. Regan balieves that in forensic as in other types of medicine, prevention is better than cure.

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