CHEYENNE - It's likely that Wyoming and the rest of the country are headed for another medical malpractice crisis, said Wyoming Sen. Charlie Scott, R-Casper.

However, he and others in the state are looking for alternatives to the current system to improve patient safety while still controlling insurance premiums.

"It's entirely predictable," Scott said of the coming crisis. "We are looking for something that is different than caps. They are not an effective solution."

In 2004, the Legislature failed to pass a proposed constitutional amendment that would allow it to put caps or limits on the amount of damages patients could collect.

Scott was one of more than 50 people who met in Cheyenne Monday to discuss ways to reduce medical errors by looking at the medical malpractice system.

The Wyoming Healthcare Commission brought in several experts from across the country to talk about what other states and countries are doing and where the nation should be headed in malpractice reform.

Some speakers said the state could look at an administrative approach to malpractice, taking the blame away from doctors and looking at the entire hospital or health care system.

They said this would encourage more reporting of errors and address system breakdowns. In many cases the error is not one person's mistake, they said.

In a study done by the Harvard School of Public Health, researchers looked at more than 1,800 malpractice claims to determined if there was an adverse outcome caused by an error and the factors that led to the error.

Michelle Mello, an associate professor of health policy and law at Harvard, said on average each error had three contributing factors, which could include individual factors, environmental factors or patient-related factors.

Even though insurance premium rates for physicians seem to have stabilized, the current system does not address this complexity nor the issue of preventing these errors from occurring in the first place.

There has been little done with patient safety, said Dr. Larry Kirven, a physician at Buffalo Family Medical Center.

He said the system does not help prevent future errors. It instills fear in physicians and causes them to create adversarial relationships with their patients or practice defensive medicine.

"It's the fear that malpractice is a threat to their credibility, their livelihood," Kirven said.

He said there needs to be a culture shift that puts the trust back in the patient-doctor relationship.

The system needs to remove the stigma from physicians, said Allen Kachalia, an assistant professor at Brigham and Women's Hospital and Harvard Medical School.

"People will make mistakes," Kachalia said. "If we know this, why are we assigning responsibility to someone who is working as hard as they can?"

Proposed solutions

Kachalia suggested the state might look at a system that improves compensation to patients. This gives patients the incentive to report errors instead of waiting for the hospital or physician to.

He also suggested forming a panel of medical experts to assess each case and offer compensation as opposed to the legal system. He said it would be helpful to create a database of all judgments to improve consistency among decisions.

Instead of blaming a specific physician for the mistake, the panel would look at all factors, assess trends and work with the health care institution to prevent similar errors in the future.

"Right now, all the strategies focus on what has already occurred," Kachalia said. "There is no mechanism to prevent errors in the future."

And what to do with those few "bad apples" in the medical community - Kachalia suggested filing a separate case against the doctor by the patient or health care facility.

Reporting errors has been identified as the key to improving patient safety, Kachalia said.

About two years ago, the Legislature passed a statue mandating the reporting of errors, but if a hospital doesn't comply, there is no punishment.

Paul Barringer, general counsel for a national legal reform coalition, said an administrative system approach is "very elegant" but it might not be practical.

"It will have to be incremental changes, if you are lucky to get those," Barringer said.

Sen. Scott said a system like this could work in Wyoming. He said the state already has a similar system in place for the worker's compensation system and he would like to see some kind of pilot project that works with some of these ideas.

"There will be some opposition from the legal system," Scott said. "It would be reducing the income of attorneys."

Kirven said he wants to see patients get more compensation, feedback on every error and better use of technology to prevent errors.

"We definitely need to change the system on both sides of the fence, on the medical side and the legal side," Kirven said. "Medicine is not the same as it was 20 years ago and malpractice law probably hasn't changed in 40 or 50 years."

Contact health reporter Allison Rupp at (307) 266-0534 or allison.rupp@casperstartribune.net.