Last night, the NCMS Legislative Cabinet met to discuss the current political landscape and issues facing physicians and physician assistants during the legislative session set to begin next week. The Legislative Cabinet consists of 15 NCMS members from diverse specialty backgrounds with proven experience in the advocacy arena. They meet regularly in order to develop legislative strategy, analyze proposals in light of current NCMS policy and advise the NCMS Board on all matters related to political advocacy.

The Legislative Cabinet approved three key objectives as recommendations for the Society’s 2012 legislative priorities. The following recommendations will go to the NCMS Board for review:

1. Ensure continued access to high-quality care for Medicaid patients by defending against further rate reductions, cuts to essential medical services and further erosions to the mental health care system.
2. Defend the significant improvements to the medical liability reform system achieved in 2011.
3. Continue to protect our patients by opposing proposals by practitioners to be licensed, relax current regulatory safeguards, or expand licensure beyond their training and abilities.

As the NC General Assembly convenes, look for upcoming articles and action alerts to provide resources for you to connect with your legislators about these and other important medical issues being debated.

The Triangle Business Journal (TBJ) recently reported that since the October 1, 2011 effective date of both the Senate Bill 33 – Medical Liability Reform and House Bill 542 – Tort Reform for Citizens and Businesses, lawsuits filed against physicians insured by Medical Mutual Insurance Company of North Carolina has declined. According to Medical Mutual, only 11 new lawsuits have been filed, four of which were filed by patients without legal representation. Read the entire TBJ article here. Having minimal lawsuits within a six-month period is rare and can be credited to medical liability reform.

“We historically average more than 20 new lawsuits filed per month against our North Carolina members,” said David Sousa, Senior Vice President & General Counsel for Medical Mutual. “Having just 11 new suits in six and half months is a phenomenal drop-off.”

TBJ also reported that MAG Mutual has cut physician’s premiums by an average of 7.4 percent for 2012 and refers to three percent of that as a “tort reform credit.” Click here to read the article. The News and Observer also reported on the issue.

Tort reform was a monumental victory for the NCMS and its partners. In addition to reducing the amount of medical lawsuits filed in North Carolina, tort reform also:

• Strengthens the screening mechanism for frivolous cases
• Eliminates inflated jury awards
• Helps juries distinguish between substandard care and bad outcomes
• Ensures doctors have a meaningful right to appeal legal errors made at trial
• Brings predictability to jury awards for noneconomic damages
• Addresses real challenges faced by physicians of all specialties in emergency care situations
• Prohibits “stale” medical malpractice claims against physicians

For more information on the Society’s tort reform efforts, click here.

Due to a high volume of questions coming in through the Member Resource Center, the NCMS features a Frequently-Asked-Question (FAQ) for its members each week to share information about current medical and health care issues that their colleagues are having.

Q: What is the statute of limitations for medical malpractice actions in NC?

A: The statute of limitations for medical malpractice claims generally is three years, beginning on the date of the last act of the physician giving rise to the claim. However, if the injury is not readily apparent, then the patient gets up to one additional year (up to seven additional years for non-therapeutic foreign objects left in the body) to file the claim.

The statute of limitations for claims brought on behalf of children is the longer of three years after the last act of the defendant giving rise to the claim, or when the patient reaches the full age of ten years. Additional time is provided if the child is in the custody of a state agency or if a judge rules that a child is neglected or abused. The statute limiting claims brought on behalf of minors was a major provision of medical liability reform in 2011. The previous statute allowed minors to wait until age 19 to file their claims.

Have a question? Contact the NCMS Member Resource Center at (919) 833-3836 or kfreeman@ncmedsoc.org.

State and national physician organizations, including the NCMS, have urged the Joint Select Committee on Deficit Reduction to include meaningful medical liability reforms in its final legislative package. The call came in a letter sent October 3, 2011, to Co-Chairs Senator Patty Murry (D-WA) and Representative Jeb Hensarling (R-TX).

The organizations say reforms will save taxpayers billions of dollars while protecting access to care. Cited in the letter is a Congressional Budget Office estimate, that when implementing comprehensive medical liability reforms, the federal deficit would be reduced by $62.4 billion over ten years. Also cited is the National Commission on Fiscal Responsibility and Reform recommendation that medical liability reform be part of a solution to reduce the federal budget deficit.

Among the reforms sought are:

• A 250,000 cap on non-economic damages;
• Collateral source rule reform by allowing evidence of outside payments to be submitted in court and a ban on subrogation by certain collateral sources;
• Language from H.R. 816, the “Provider Shield Act of 2011,” that would prohibit new causes of action against physicians and other health care providers based on standards or guidelines specified in the Affordable Care Act (ACA);
• Liability protections for physicians and other health care providers so that evidence of nonpayment or payment adjustments based on the Centers for Medicare and Medicaid Services’ (CMS) policies would be inadmissible as evidence in a liability claim or lawsuit to prove liability or establish a presumption of liability on behalf of a physician or health care provider;
• Liability protections for physicians and other health care providers who provide emergency care or volunteer to treat victims of a disaster by requiring clear and convincing burden of proof; and
• Reforms to require an individual who serves as an expert witness in a liability case to meet standards of expertise and knowledge.

Click here to read a copy of the letter.

Nearly 100 physicians attended the Triangle Indian-American Physicians Society (TIPS) 5^th Annual CME Symposium on September 24, 2011, at the WakeMed Andrews Center in Raleigh.

“We are delighted to see that the organization we started six years ago has grown to a vibrant and thriving organization of over 150,” TIPS President Prashant Patel, MD, said in opening remarks.

Dr. Patel praised the NCMS for successfully addressing medical liability reform during the 2011 legislative session. “As a member of the NCMS Legislative Cabinet, I witnessed the wonderful work the cabinet and our lobbyists, who are second to none, have performed,” he said.

In listing TIPS’ accomplishments thus far, Dr. Patel noted that two members had graduated from the NCMS Leadership College: Pankaj Gupta, MD, Cary; and Vipul Shah, MD, Burlington.

Four physicians made presentations at the symposium:

Sameer Mathur, MD, Emerging Technologies in Spinal Surgery

Sam Chawla, MD, Prostate Cancer Screening & Treatment

Richard Weisler, MD, Mood Disorders: Diagnosis & Treatment

Sonal Arora, MD, Sleepiness in America

Provisions of Senate Bill 33—Medical Liability Reforms will take effect on Saturday, October 1, 2011, in North Carolina. Included is the provision that places a $500,000 cap on non-economic damages like pain and suffering. The cap is subject to periodic adjustment for inflation. Injured patients will be able to recover full medical costs, lost income and other economic damages associated with their injury.

“There may be a flurry of lawsuits right before the new law takes effect, as plaintiff’s lawyers try to protect their fees,” said NCMS Executive Vice President, CEO Robert W. Seligson, responding to a reporter’s question this week. “Most likely people will not see any immediate effect.  However, over time, we do expect a positive impact in the reduction of unnecessary costs associated with medical malpractice litigation. This in turn will help to control health care costs and assure access to care for patients.”

The key provisions of Senate Bill 33 can be viewed at: http://www.ncmedsoc.org/government_affairs/sb_33.html.

The NCMS led a coalition of medical and business interests that fought for medical liability reforms in the 2011 legislative session. The General Assembly enacted Senate Bill 33 on June 9, but Governor Beverly Perdue vetoed the measure on June 24. That sparked an intense, three-week campaign to override the veto. The coalition of supporters worked around the clock lobbying key legislators to support the override.  The Senate voted for the override on July 11, and the House put SB 33 into law when it voted to override the veto on July 25.

When the law takes effect, North Carolina will be among more than 30 states that have adopted medical liability reforms.

Related stories:

SB 33 – Medical Liability Reforms: The Power of Organized Medicine (Bulletin, 8-5-11)

Victory! SB 33 – Medical Liability Reforms Becomes Law in North Carolina (Bulletin, 7-29-11)

The Brunswick County Medical Society held their annual meeting on Thursday, September 22 in Supply, NC.  County Society President Jugta Kahai, MD, organized and hosted a vendor fair and dinner for the local medical community.  Senator Bill Rabon, representing NC District 8 (Brunswick, Columbus and Pender counties) was the evening’s special guest. Sen. Rabon commended the medical community on their involvement in medical liability reform legislation, saying the personal calls and visits he received during the legislation’s passage, subsequent veto and override, truly made a difference in the outcome. He encouraged physicians to have a voice in the legislative process and to stay engaged and active on behalf of their profession and their patients.

Dr. Kahai encouraged her colleagues to support the county medical society, the NCMS and the NCMS PAC. She also reviewed a list of legislative accomplishments achieved this year. “I believe in the power of advocacy and our voices,” said Dr. Kahai.  The NCMS thanks Dr. Kahai and the physicians of Brunswick County for their support!

The AMA and organizations representing Florida physicians, hospitals, small business owners and their insurers filed a friend-of-the-court brief on Thursday asking the Florida Supreme Court to preserve patients’ access to more affordable medical care by upholding the state’s limit on subjective awards for noneconomic damages in medical malpractice cases. Florida has a $1 million cap on noneconomic damages, but patients who have been harmed by true medical negligence can still receive unlimited economic damages for items such as lost wages, medical expenses, and reduced earning potential.

Florida’s cap on noneconomic damages was enacted eight years ago and is being challenged in a case involving a 20-year-old woman who died following the birth of her child. She had been diagnosed with hypertension and preeclampsia. Her family sued and was awarded $3 million, including $2 million in pain and suffering damages. But the cap on noneconomic damages led the court to reduce that pain and suffering award by half. The family appealed the claim, and the Florida Supreme Court will determine whether the cap violates the state constitution.

Similarly, North Carolina General’s Senate Bill 33 – Medical Liability Reforms, enacted in July, contains a $500,000 cap on noneconomic damages, which takes effect October 1, 2011. The cap does not apply if a plaintiff suffers disfigurement, loss of use of part of the body, permanent injury or death; and the defendant’s conduct was in reckless disregard of the rights of others, grossly negligent, fraudulent, intentional or with malice. It has no effect on recovery for economic harm such as medical expenses and lost wages. The cap is indexed to inflation.

Related articles:

2011’s Legislative Successes: Medical Liability Reforms, NCMS Website

SB 33 – Medical Liability Reforms: The Power of Organized Medicine, NCMS Bulletin

Victory! SB 33 – Medical Liability Reforms Becomes Law in North Carolina, NCMS Bulletin

Legislation under the category of Public Safety were among the 88 bills tracked by the NCMS Legislative Team during the 2011 session of the NC General Assembly. This was in addition to the successful initiative that put into law SB 33 Medical Liabiltiy Reforms and HB 542 Tort Reform for Citizens and Business.

Many more hours were spent working on legislation involving the Medicaid budget, scope of practice, mental health, and implementation of federal programs. The soon-to-be-released 2011 Legislative Summary will provide members more details about this year’s legislative activity.

Six public safety measures of interest to physicians were considered during the session:

House Bill 407 – Modify ATV Helmet Use Requirements  (NCMS opposed)

House Bill 392 – Modify Motorcycle Helmet Requirements (NCMS opposed)

House Bill 792 – Gfeller-Waller Concussion Awareness Act (NCMS supported)

See related story: Important Information for Healthcare Professionals Dealing with Student Athletes (Bulletin, 8-19-11)

Senate Bill 757 – Interscholastic Sports/Concussions (NCMS position: amendments needed)

Senate Bill 471 – Youth Skin Cancer Prevention Act (NCMS supported)

Senate Bill 697 – Patient Advocacy and Protection Act (NCMS opposed)

Look for an announcement about the 2011 Legislative Summary in the Bulletin and at http://www.ncmedsoc.org/.

Related articles:

Coming Soon: 2011 Legislative Summary (Bulletin, 8-19-110

2011 Legislative Session: Medical Liability Reforms and Much More (Bulletin, 8-12-11)

Legislative Summary Highlights Major Accomplishments in 2011 (Bulletin, 8-5-11)

The NCMS Legislative Affairs team expects the 2011 NCMS Legislative Summary to be available in just a few days. Look for an official announcement in the Bulletin and online at http://www.ncmedsoc.org/.

Covering bills of interest to physicians, the Summary will include the all-important SB 33 Medical Liability Reforms and HB 542 Tort Reform for Citizens and Business, along with summaries of 86 other pieces of legislation affecting health care and the community of medicine. The team is currently reviewing the final section on the State Budget, which consumed a lot of staff time and media headlines throughout the legislative session.   

The Summary will include a special section on Mental Health:

SB 437 – Enact First Evaluation Program

SB 316 – Add’l Section 1915 Medicaid Waiver Sites

HB 916 – Statewide Expansion of the 1915(b)(c) Waiver

There were two pieces of legislation introduced in the 2010 session that were not heard by the Legislative Oversight Committee on Mental Health this session:

(1) A requirement for the Department of Health and Human Services to evaluate the CABHA Model, Critical Access Behavioral Health Agencies, with the goal of reducing inefficiencies in the mental health system and returning the system to one with medical leadership.

(2) A bill introduced in each chamber by the House and Senate chairs of the Legislative Oversight Committee on Mental Health to require the department to evaluate the efficiency of the model on a semiannual basis and report the results to the Legislative Oversight Committee on Mental Health.

Related stories:

2011 Legislative Session: Medical Liability Reforms and Much More (Bulletin, 8-12-11)

Legislative Summary Highlights Major Accomplishments in 2011 (Bulletin, 8-5-11)

While enactment of SB 33 – Medical Liability Reforms was a major achievement for the NCMS Legislative Affairs team this legislative session, dozens of other bills of interest to physicians will also be included in the soon-to-be released 2011 Legislative Summary. Watch for more details in the Bulletin and at http://www.ncmedsoc.org/.

In last week’s Bulletin, we reported on legislation that falls under the category of Regulation of Medicine. That section includes 12 bills that will be summarized in the 2011 Legislative Summary, including the widely reported HB 854 – A Woman’s Right to Know Act. Like SB 33, HB 854 became law after the General Assembly overrode a gubernatorial veto.

Another major category of legislation falls under the Implement Federal Programs umbrella. Several of these bills deal with issues arising from the Patient Protection and Affordable Care Act (ACA):

HB 2 – Protect Health Care Freedom

SB 496 – PPACA/Required Fraud and Abuse Provisions

HB – 115 North Carolina Health Benefit Exchange Act

SB 375 – Facilitate Statewide Health Information Exchange

SB 607 – Conform Medical Records Law

In addition to the 2011 Legislative Summary, the NCMS offers more information and updates on a variety of provisions contained in the federal health care reform law, including Accountable Care Organizations (ACOs), the NC Health Benefit Exchange, and the NC Health Information Exchange. Physicians are urged to check the NCMS website to learn more about these programs and how they will be affecting your practices.

Related story:

Legislative Summary Highlights Major Accomplishments in 2011, Bulletin, August 5, 2011

July 25, 2011 will be forever one of the most important days in the history of the North Carolina Medical Society. On that day the NC House voted 74-42 to override the Governor’s veto of SB 33—Medical Liability Reforms, allowing North Carolina to join a majority of states where medical liability reforms are already in place. The victory demonstrated the power of organized medicine and our ability to work with the medical and business communities to advance affordable, quality health care for all our citizens.

As the 2011 legislative session got underway in late January, NCMS leaders had named medical liability reforms as the number one priority this session. Even with the challenges of a huge state budget shortfall in the background, NCMS staff and leaders remained steadfast in their determination and effort to gain medical liability reforms to reduce health care costs and create a fairer tort system for physicians and the people of our state.

A brief timeline highlighting some key moments during the 2011 legislative session reveals how this victory evolved:

February

• SB 33 – Medical Liability Reforms is filed in the Senate.
• House Speaker Thom Tillis (R, Mecklenburg) named the House Select Committee on Tort Reform
• Senate Judiciary 1 Committee continued to work on SB 33.

March

• Senate passes and sends to the House SB 33
• North Carolinians for Affordable Healthcare, a coalition led by the NCMS, began airing TV ads across the state calling for public support of SB 33
• House Select Committee on Tort Reform works on draft legislation

April-May

• HB 542—Tort Reform for Citizens and Business, a bill described as “big and bold,” is filed in the House
• House Select Committee on Tort Reform begins hearings on HB 542
• House divides medial liability reforms and tort issues into two bills: SB 33 will contain medical liability reforms; HB 542 will include general tort reforms
• House passes SB 33 and returns it to the Senate
• Conference Committee is named to work out differences over House and Senate versions of SB 33

June

• House passes and sends to Senate HB 542
• General Assembly enacts SB 33 on June 9 and sends it to the Governor for her signature
• HB 542 is enacted on June 17 and is signed by the Governor on June 20
• Governor vetoes SB 33 on June 24
• NCMS and its coalition partners rally members through Town Hall meetings, alerts, phone calls and emails to contact legislators and urge them to override the veto
• General Assembly recesses and agrees to return in July to consider vetos

July

• Senate votes to override the veto on July 13
• House votes to override the veto on July 25

Not shown by the timeline but critical to our success are the countless hours invested by NCMS staff, leaders, members’ grassroots efforts, and partners on behalf of physicians across North Carolina, including component/county and specialty societies, group practices, physician assistants, the medical group managers, hospitals, nursing homes, chambers of commerce and other business organizations. This is the power of organized medicine. Your participation and support do make a difference. Invite your colleagues who aren’t members to join us—the North Carolina Medical Society—Leadership in Medicine.

There’s no question that enactment of Senate Bill 33—Medical Liability Reforms was the biggest achievement of the 2011 legislative session. However, SB 33 was one of 88 bills that were tracked by the NCMS legislative team because of their potential impact on physicians and patients in North Carolina.

The NCMS Legislative Summary, now in its final stages, will offer a comprehensive review of the work done on behalf of physicians this year. One of the sections will highlight legislation involving the Regulation of Medicine, a compilation of twelve bills of importance to doctors:

SB 31 – Clarify Penalty Unauthorized Practice of Medicine

HB 854 – Abortion – A Woman’s Right to Know Act

SB 609 – Facilitate Locum Tenens Physicians

HB 347 – Notification to Treat Minors/12 or Younger

SB 349 – Confidentiality/Investigative Info/Optometry

SB 190 – Allow Electronic Signatures on Death Certificates

HB 331 – Allow PAs and NPs to Sign Death Certificates

SB 718 – Prescription Integrity Act

SB 357 – DNR Form Signatures

SB 743 – Encourage Volunteer Health Care Providers

SB 765 – No Firearms Questions During Medical Exam

HB 795 – Patient Access to Pathological Materials

Be watching for more details about the 2011 Legislative Summary and how you can access this valuable resource from NCMS.

Physicians are savoring a great and hard-fought victory this week. The North Carolina Medical Society’s longtime campaign for medical liability reform achieved a historic milestone on July 25, when the North Carolina House voted 74 to 42 to override Governor Perdue’s veto and place into law Senate Bill 33 – Medical Liability Reforms. Unlike other override votes this week, there were 12 additional votes gained between the House Floor vote to enact SB 33 and the House vote to override the veto. Other veto overrides only gained one or two votes.

Partnering with various groups from the medical and business communities, the NCMS waged a 24/7 initiative targeting members of the NC House, after the Senate voted to override the veto on July 13. Face-to-face meetings with physicians, countless phone calls and emails, media coverage and daily contact with legislators lead to the momentous victory that followed more than a decade of advocating for needed tort reforms.

In a Special Bulletin [ http://www.ncmedsoc.org/blog/index.php/archives/12539 ] sent to NCMS members on Tuesday, NCMS EVP Robert W. Seligson thanked physicians for their extraordinary efforts in urging their legislators to make SB 33 law. “This was a tremendous victory for the people of North Carolina and their physicians,” Seligson said. “This victory was huge and can be attributed to a team effort by the entire medical and business communities.”

The NCMS also thanked the General Assembly for carefully crafting, debating and ultimately passing the most meaningful piece of liability reform in our state’s history, which will benefit the entire state by saving health care dollars, improving access to care and minimizing frivolous lawsuits.

Special appreciation was extended to every organization and individual that contributed to the success of medical liability reform in North Carolina — it was a team effort.  “Please allow us to say ‘thank you’ to all of the individuals and organizations that contributed their time, money and other resources to this effort,” Seligson said. “We are especially grateful for the work of the component and specialty societies, physician assistsants, the medical group managers, hospitals, nursing homes, chambers of commerce and other business organizations, all of whom put forth special efforts to make medical liability reform a reality.”

Enactment of House Bill 542 — Tort Reform for Citizens and Business by the General Assembly in June lead to yet another big accomplishment for physicians and the business community of North Carolina. The new law included the “actual medicals” provision which requires that evidence of past medical expenses be limited to the amounts actually paid to satisfy medical bills. Evidence of outstanding medical bills are limited to the amounts necessary to satisfy those bills.

Other provisions of this law can be reviewed here.

Click here to read HB 542 Tort Reform for Citizens and Business.