Palmisano: A Proven Voice for Medicine
And A Trusted, Valued Resource For Physicians Through AMA

Since his election to the American Medical Association’s Board of Trustees in 1996, Donald J. Palmisano, MD, JD has become a much sought-after and well respected source of knowledge on a myriad of topics affecting physicians and organized medicine. From risk management issues, to antitrust concerns, to the vital arena of medical malpractice, Dr. Palmisano has shared his expertise in lectures to medical students, during presentations to fellow physicians, before Congressional committees, and in all realms of national and local media.

Dr. Palmisano first became active in organized medicine in the early 1970s when he was a key advocate for passage of the Louisiana Medical Malpractice Act. Successfully enacted into law in 1975, the measure placed a $500,000 total cap on damages for medical malpractice. That action put Louisiana in the forefront of tort reform nationwide.

President of the Louisiana State Medical Society (LSMS) during 1984-85, Dr. Palmisano has continued to work for fellow physicians on local, state and national levels. He had served as a delegate to the LSMS House of Delegates since 1974, and as an AMA delegate for nearly 10 years before his election to the AMA Board in 1996.

In addition, Dr. Palmisano is a founding member of the Louisiana Medical Mutual Insurance Co. (LAMMICO), a physician-owned liability insurance company developed by the LSMS during a time many national companies were refusing to write professional liability insurance in the state. Subsequently, he founded Intrepid Resources/ The Medical Risk Manager Company, a firm providing professional liability claims handling and risk management consultation to physicians, clinics, and hospitals.

As point person for AMA’s protection of patient privacy and medical record confidentiality, Dr. Palmisano has testified before congressional committees on these issues, and he was featured in over 30 interviews during a 48-hour period in 1998, espousing the AMA’s policy for the potential for unique patient identifiers to breach confidentiality. Shortly after that media blitz, then Vice-President Al Gore announced that our government would put on hold the use of such measures.

Patient safety issues are also dear to Dr. Palmisano, and he has taken a lead role in the National Patient Safety Foundation founded by the AMA. The Foundation is an independent, nonprofit research and educational organization, dedicated to the measurable improvement of patient safety in the delivery of healthcare. As a member of the NPSF Board of Directors, former Chair of their Development Committee, and current Chair of their Communication Program, he is a leader in the quest for innovative research and for a culture of candor and sharing of information affecting patient safety, rather than a culture of shame and blame.

Testifying before Congress, speaking to colleagues, lecturing to medical students, or being interviewed by the media, Dr. Palmisano has a proven track record in championing the issues and working for our AMA.

A tort is a civil wrong, other than a breach of contract, for which the law affords a remedy. Medical malpractice or professional liability claims are negligence claims and these are, by definition, the “unintentional act” subset of tort law. “Malpractice” is a violated duty that results in harm to a patient. For a plaintiff to win, an expert must convince the jury that substandard care was rendered that directly hurt the patient. An exception to the need for an expert would be the legal theory of “res ipsa loquitor”; the thing speaks for itself. This theory allows the case to proceed without an expert and, in some jurisdictions, shifts the burden of proof.

The present tort system for professional liability claims is inefficient, unjust, and expensive. The soon to be realized result of such a system is an access problem for patients resulting from physicians limiting their practice, retiring early, or switching to another endeavor that doesn’t subject them to the litigation lottery.

What are the factors that allow the current tort system to threaten the practice of Medicine?

1- No penalty for filing frivolous suits;
2- A jury system that gives lottery awards;
3- A blame and shame culture that prevents root cause analysis to fix system problems that lead to patient injury;
4- The allowing of unscientific testimony with the belief that the jury will know what is scientific and what is not;
5- Lack of accountability for unscientific and unfair testimony; and
6- A Contingency fee system that encourages attorneys to get into the lottery at minimal expense.

What is the solution?

Implement AMA policy nationwide. Adopt the California MICRA law of 1975 at the national level and protect those alternative state laws that are just as effective such as Louisiana’s Act 817 of 1975. The AMA proposal caps non-economic damages at $250,000, modifies the collateral source rule (no double payments), gives periodic payments, and limits attorney fees. In addition, a certificate of merit (affidavit) should be required documenting that an expert has certified that the standard of care has been breached with resulting direct harm to the patient. Also, testimony by medical experts should be considered the practice of medicine and subject to review by the state board of medical examiners. Finally, judges should prevent unscientific testimony from being entered into evidence. Under the federal rules and also in some states, the judge has the right to bring in an independent expert to review the proposed testimony for scientific validity.

It would be great if attorneys would be held accountable for filing suits without merit. A study of 72,000 closed cases of medical malpractice claims were reviewed from 1975-1978 by the National Association of Insurance Commissioners and it was noted that 62% of the cases were closed with NO payment. Only 18% went to trial and the physician won 89% of the time.

Imagine a surgeon operating for suspected appendicitis and finding appendicitis in such small numbers. That surgeon would lose the privilege to operate! Finally, let’s revisit the administrative system proposed by the AMA/Specialty Society study group over a decade ago as well as the proposal of the PIAA that came from its committee on alternatives to the present tort system. The latter proposal stated that fault could be established by the tort system or by an administrative system but the awards would be on a fixed payment schedule. Crisis abounds in many parts of our Nation. We must act without delay. Failure to win this battle will cause the loss of skilled physicians and create patient access problems.

DJP

From the Pelican Recipe files:
The Original Fried Green The Original Fried Green Tomatoes with Shrimp Remoulade
Compliments of Upperline Restaurant, New Orleans

Per Person:
6-8 peeled medium boiled shrimp
2 slices green tomato
4 tbsp. favorite remoulade sauce

Cook and chill shrimp. Make or buy remoulade sauce and chill.* Can be prepared the day before. Fry green tomatoes according to recipe immediately prior to serving.

Fried Green Tomatoes

• two ½-¾-inch slices green tomato per person (green all the way)
• seasoned corn meal (light salt & pepper)
• egg wash (1 egg mixed with 1 cup milk)
• salad oil or very light olive oil

Heat small amount of oil in heavy sauté pan. Dip tomato slice in egg wash and then coat with corn meal. Cook slowly until golden brown on bottom, then turn and brown other side. Note: If cooked too fast, the inside does not get cooked.

On individual serving plates, place 2 slices fried tomato next to each other over a bed of your favorite greens and top each slice with 3-4 chilled, cooked shrimp and 1½-2 tbsp. remoulade sauce.

* If you would like Upperline Restaurant’s recipe for boiled shrimp or remoulade sauce, go to www.upperline.com.

Visit the LSMS website for more on Palmisano for AMA President-Elect.
www.lsms.org
E-mail: publicaffairs@lsms.org