Put a cap on legal feesAs a practicing pediatrician and a...

the Forum

April 07, 1993

Put a cap on legal fees

As a practicing pediatrician and a primary care provider, I see a feeding frenzy by lawyers at every level of society. Physicians of every type are their current prey and "controlling medical costs" is their caterwaul.

Carefully cloaking greed in pious platitudes about patients' rights to exorbitant awards (translation: lofty contingency fees), attorneys are actively cajoling every branch of the media. Lawyers are adding an estimated 15 to 30 percent to patient costs as physician "defensive medicine" fees, pharmaceutical insurance and "vaccine injury" costs and hospital bureaucratic "risk management" fees.

On the legislative level, some attorneys have positioned themselves as dubious spokesmen for the public at large, suggesting cookbook "practice protocols" as a solution to malpractice costs. Others are reacting in horror to the possibility of such a threat to their income. On the state and federal level, lawyers are suggesting capping physicians' fees (including the more ethereal "cognitive services" rendered by primary care physicians, such as anticipatory care and counseling).

It is time to consider a more cost-effective and timely way of exiting the "health care crisis." Let's cap lawyers' fees! Here's how to do it. Determine a resource-based relative value scale (RBRVS) for attorneys, such as that recently developed for physicians. A lawyer's permissible fee for any given case would be determined by the RBRVS. Overhead costs, "degree of difficulty" and preparatory training would be accounted for in the RBRVS. The source of funding for the attorney would be either a contingency fee up to, but not exceeding, the RBRVS or by direct billing of the client.

If insufficient funds were available to pay for certain legal activities not amenable to contingency billing, a "legal provider tax" could be levied on attorneys, just like that levied on health care providers in certain states.

The immediate consequence of decreasing windfall legal profits would be the departure of lawyers "in it for the money," leaving those attorneys with ethical and moral concerns and a modicum of social conscience to restore their tainted profession. Soon afterward, we could anticipate a significant diminution in "medical" costs.

Alan M. Davick


Baltimore County schools are in crisis

Across Baltimore County citizens sense a growing mood of alarm over what is happening to the county school system, once recognized as one of the best in the United States.

The alarm is fueled by continuing reports of an educational program being gutted by School Superintendent Stuart Berger.

The Gifted and Talented program, which had won national acclaim for the county, is currently being restructured. Requirements for admission to the program are being greatly lowered to allow more students to participate.

Since the program was designed to challenge highly able students, the admission of many students with lesser ability will of necessity reduce the program's effectiveness.

The new superintendent proposes that all Baltimore County students should feel success in their school program. While this in itself is a laudable goal, Dr. Berger's means of achieving this "success" raises considerable concern. He proposes to eliminate letter grades and replace them with teacher narratives on each student's progress.

Teachers will be encouraged to write these narratives in the most positive manner so as to convey to students and parents a feeling of progress and success. Unfortunately, the reports will fail to identify areas of weakness if the student is falling below grade level standards. These facts will be reserved for discovery later, when the student does poorly on state-mandated competency tests or SAT tests.

Dr. Berger has also mandated that schools move toward interdisciplinary studies instead of subject oriented ones.

This is a peculiar decision, since the idea of interdisciplinary studies was tried in the county during the 1950s and early 1960s in what was then called the "core" approach. It was abandoned after the Soviets appeared to lead in the race for space and there was a national call for a stronger emphasis on the various disciplines.

Today the Soviet military challenge has been replaced by an economic challenge from an increasing number of other countries who are credited with having a superior educational program.

Dr. Berger emphasizes that his goal is to bring "site based management" to the school system. This suggests that the faculty in each school will assess the needs of their students and develop an educational program tailored to those needs.

Unfortunately, the concept is hollow under Dr. Berger's leadership. All major educational decisions continue to be made by Dr. Berger. Principals and teachers who challenge the validity of his decisions can expect to be promptly demoted or dismissed. As a result Baltimore County is experiencing an exodus of administrators and teachers.

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