The Clinton administration's proposal to make individual doctors immune from medical liability, allowing patients to sue only the health networks that provide the treatment, is coming under sharp attack from doctors, consumer advocates and Capitol Hill lawmakers.
Known as "enterprise liability," the concept would shift the burden of costly lawsuits from physicians to the corporations that employ or manage them. Under the proposed new system -- announced by Robert Berenson, co-chairman of the health-care task force's medical malpractice working group Thursday -- most consumers would obtain care from a local health network of physicians, hospitals and clinics such as a health maintenance organization.
Notably, the American Medical Association, the 300,000-member doctors' association that has begged for changes in malpractice law, says it is likely to oppose the recommendations.
Such a move would dash White House hopes of using legal reforms to persuade doctors to support its health-care plan.
"From what we've heard, it is unlikely we will support it," said Martin Hatley, director of professional liability and insurance for the AMA. "It's just shifting the cost of liability from one sector to another, with no cost savings."
Even consumer groups, the Clinton administration's staunchest advocates
on health care, are disgruntled. "This is only going to get you halfway there," said Linda Lipsen of Consumer's Union.
White House health advisers are considering three major changes:
Allowing lawsuits against the networks of doctors and providers created as part of the Clinton health plan, not against the doctors as individuals. Advisers say putting the financial burden on the networks would make them set standards for practicing medicine and monitor the doctors to maintain them.
Capping the amount of damages that patients can receive for pain and suffering related to an injury. Doctors argue that some patients use pain-and-suffering claims to file scores of frivolous lawsuits, driving up medical costs.
Steering patients toward alternative dispute resolution, a method of settling disputes out of court.
On Friday, health-care task force spokesman Bob Boorstin said the president's advisers are "aware of the problems" the recommendations have generated.
"Doctors and lawyers don't seem to be too fond of each other, and we seem to be caught in the cross fire," he said.
In fact, the Clinton administration, caught between the doctors it needs to recruit and lawyers whose donations heavily financed Democratic campaigns last year, has sought to walk a middle line on the malpractice issue.
But advisers appear so far to have alienated most -- and pleased none.
Doctors argue that unnecessary lawsuits are the key reason behind soaring medical costs, and want caps on damages.
Lawyers and consumer advocates do not oppose big damage settlements in principle but say the current system too often benefits the greedy while overlooking the truly needy.
The proposal to cap damages has drawn the most fire, with consumer groups arguing that it would be unfair to the most severely injured. "This is such bad public policy, it would lead us to oppose the entire health-reform package," said Gene Kimmelman of Consumer Federation of America.
"Proposals of this type are ill-advised," attorney Walter Beckham Jr. of the American Bar Association's committee on medical liability told a congressional panel this week.
On Capitol Hill, even Democrats who are supportive of health-care reform in general are lukewarm about Clinton's malpractice-reform proposals. "I don't think it's enough," said Sen. Jay Rockefeller, D-W.Va.
Republicans, who are drafting their own health bill, are outright critical. "All this does is pass the costs of malpractice insurance on to the consumer," said Sen. John H. Chafee of Rhode Island. "It doesn't solve the underlying problem."
A Republican health-care reform proposal likely to be introduced before Clinton's would limit attorneys' fees, set medical practice guidelines, and mandate settling most negligence cases out of court.
Although there is much dispute about the actual cost to the health-care system of medical malpractice, public-opinion polls usually rank malpractice as a top contributor to rising health-care costs.
Physicians paid $7 billion in malpractice insurance premiums in 1992, according to the AMA. Estimates of the total cost of malpractice range between $7 billion and $25 billion a year, including estimates of the cost of "defensive medicine" -- the practice of conducting unnecessary tests and procedures to protect against the possibility of lawsuits.
About 25,000 people die each year as the result of medical negligence, according to Lucian L. Leape, a surgeon and lecturer at the Harvard School of Public Health.