Medical Device Daily Washington Editor

WASHINGTON – With the annual meeting of the American Academy of Orthopaedic Surgeons (AAOS; Rosemont, Illinois) held last week in the nation's capital, a little political talk was probably both inevitable and unavoidable.

The topic: medical liability reform.

Stuart Weinstein, MD, charged that the continuing rise of medical insurance premiums is an "enormous concern" for the medical community. From 1994 to 2000, the median jury award for a medical liability case rose by 176%, according to Weinstein, the newly elected president of AAOS and chairman of a group called Doctors for Medical Liability Reform (Washington).

"Americans can't afford to lose any more doctors," Weinstein said in his presentation at AAOS, arguing that some doctors stop practicing due to the high cost of insurance premiums.

Physicians have already been faced with judgments that have led to an increase in the average jury award to $3.5 million, he said. And he contended that the high cost to defend against lawsuits and the associated, escalating jury awards have driven big increases in medical liability insurance premiums.

"Many states are struggling to find the balance between protecting their citizens from potential medical error and providing means for proper access to care," Weinstein said. "There will be no reform unless it comes from the federal government."

President George Bush made federal tort reform one of his priorities for his re-election and in his second term. In a recent speech on the subject in Collinsville, Illinois, he charged that "junk lawsuits" drive up costs for all doctors, even for those who never have been sued.

"When insurance premiums rise, doctors have no choice but to pass some of the costs on to their patients," Bush said. The president and the many supporters of this policy say that passing a nationwide limit on frivolous malpractice lawsuits would reverse some of the escalating healthcare costs.

On the other hand, critics of this type of reform argue that caps on malpractice claims serve only to shield doctors and companies that provide substandard healthcare or products. The real problem, according to lawyers who represent malpractice victims, is insurers who look to raise premiums, which affects the healthcare spending for individuals and companies.

Currently, California, Colorado, Indiana, Louisiana, New Mexico and Wisconsin are the only states that have instituted some sort of medical liability caps. A bill to adopt liability reform measures is currently being debated by Georgia's House of Representatives. Maryland also is working on legislation to limit payouts in malpractice cases.

Though Weinstein acknowledged that enacting medical liability caps would not be a cure-all for the U.S. healthcare system, he called it "a solid step in the right direction."

In a much less political presentation as the AAOS meeting wound down on Friday, a panel of surgeons discussed advances in the field of computer-assisted orthopedic surgery, which they abbreviated as CAOS.

According to the panel members, CAOS offers an adjunct to current joint replacement procedures, allowing for more feedback, instant information and more accurate decision-making and potentially fewer complications for patients.

Richard Berger, MD, assistant professor of orthopedic surgery at Rush Presbyterian-St. Luke's Medical Center (Chicago), said that CAOS enables better accuracy in the positioning of prosthetic components, but he added that its use is still a little "under the radar."

He added: "As CAOS technology becomes easier to use and receives greater recognition in terms of how it enhances surgical procedures, it will be more widely adopted by the orthopedic community."

The presenters likened CAOS technology in the orthopedic surgery setting to a global-positioning system. CAOS systems use optical sensors, computers and infrared cameras to help map out joints for replacement and provide a guide to position implants with much more precision.

The technology fits right in with the current trend of minimally invasive techniques. Computed tomography scans proved a complete 3-D view of the joint, helping to reduce the incision size and trauma to surrounding bone and tissue.

Cost is one drawback of the technology though. Systems can cost upward of $250,000.

Right now, according to panel members, because the technology is in its infancy, it actually adds time to the surgical procedure, and the longer surgery takes, the more blood is lost and the greater the risk of infection.

Anthony DiGioia, MD, director of The Western Pennsylvania Hospital (Pittsburgh), is considered one of the pioneers of CAOS technology, beginning work in the field in the early 1990s.

He said the time and cost factors will drop as the technology is more widely used. "We are just scratching the surface," he noted. "My predication is that minimally invasive procedures with CAOS will be combined with tissue engineering within about 10 years or less."

This will allow surgeons to perform biologic resurfacing of patients' joint using their own bone and cartilage as implants, instead of the medal, ceramic or plastic versions used today, DiGioia said.

Commenting on this strategy, William Hozack, MD, professor of orthopedic surgery at Thomas Jefferson Medical School (Philadelphia), said: "The only negative I see is when a surgeon thinks a computer is going to perform the operation, forgetting that surgery is an art.

"The surgeon," he emphasized, "still makes the biggest difference."