Doctor/Lawyer Heads Malpractice Fight

As the incoming president of the AMA, Donald J. Palmisano, MD, JD, is going to have a very tough job ahead of him— trying to persuade Congress to pass federal legislation that would put a cap on malpractice awards. As a lawyer who counsels doctors on how to avoid costly malpractice suits, Dr. Palmisano's background makes him uniquely qualified to head the AMA's lobbying team.

Ironically, it is Dr. Palmisano's qualifications that have some critics concerned. Palmisano, whose consulting firm, Intrepid Resources (www.intrepidresources.com), advises physicians on avoiding malpractice claims and handling those that do get filed, has become a target of the American Trial Lawyers Association (ATLA).

The ATLA claims that Dr. Palmisano is merely a point man for the AMA, and that his legal work puts him in league with insurers. Dr. Palmisano, a lawyer since 1982 and a doctor since 1963, denies the charges and says he has suspended his role in Intrepid Resources while he serves as AMA president.

The New Orleans-based vascular surgeon is out to convince lawmakers that many areas of the country are in a malpractice crisis and needy patients risk being left without medical care, as soaring malpractice premiums force doctors to give up their practices or migrate to more malpractice-friendly states.

"The AMA has identified 18 states in malpractice crisis and another 26 on the verge of a similar breakdown," Dr. Palmisano says. "A crisis is when dedicated professionals, who have trained for years, want to give up the work of a lifetime and retire."

Trial lawyers have another agenda. The ATLA seeks to rally Congressional support by pointing out that patients will not be able to recoup their full losses if Congress passes federal legislation that caps medical malpractice awards.

Dr. Palmisano was a key player in the 1975 passage of Louisiana's Medical Malpractice Act, which limits provider liability to $100,000 and caps total malpractice recovery, with the exception of actual medical expenses, at $500,000. Legislation at the federal level had passed the US House, but was recently rejected in the US Senate—making any reform very unlikely before the November 2004 elections.

"The medical liability litigation system in the United States has evolved into a ‘lawsuit lottery,' where a few patients and their lawyers receive astronomical awards and the rest of society pays the price through less access to health care professionals and services," Dr. Palmisano says.

Like many lobbying wars, this one is being fought with dollar bills as ammunition. According to the Center for Responsive Politics (www.opensecrets.org), the AMA's political action committee pumped $2.7 million into the last election, of which 60% went to Republicans. ATLA's political action committee handed out $3.4 million to candidates during the same period; 90% went to Democrats.