Lawyers who sue Maryland's elite hospitals for alleged medical mistakes often don't target the physicians involved, a practice that expedites such cases but can shield doctors from government regulators and the public.
The practice involves doctors employed by Johns Hopkins Medicine or the University of Maryland Medical System. When doctors are not defendants, it is easier to reach agreement, Hopkins and lawyers say.
In the process, the identities of doctors associated with malpractice claims can be obscured, an investigation by The Sun has found.
The doctors are not reported to the National Practitioner Data Bank, a federal program that tracks malpractice payments and is used by the health care industry to do background checks on physicians.
Neither are the doctors likely to be scrutinized by the Maryland Board of Physicians. The oversight board says it has little basis for examining the doctors' performance or making the outcomes of the malpractice cases public.
Dr. Habib A. Bhutta, a member and former vice chairman of the Board of Physicians, suggested that the practice is creating a double standard for doctors employed by the two medical teaching institutions.
"Everybody should be treated equally," he said. "We have to get hold of these cases."
About 2,500 doctors are employed by Hopkins or its affiliates, and 1,700 work for the University of Maryland Medical System.
The Sun documented the practice as part of an investigation into breakdowns in the state's system for overseeing the estimated 17,000 doctors practicing in Maryland. Regulators overlook dozens of doctors throughout the state who are the subjects of unusually high numbers of malpractice claims or payouts, the investigation found.
When malpractice lawsuits are filed against Hopkins or the University of Maryland Medical System, doctors can remain anonymous as a byproduct of the process.
"If I have a claim against Hopkins, I know that the chances of settling are better if I don't name the doctor," said Towson lawyer Dennis O'Brien, who acts as a spokesman for the Maryland Trial Lawyers Association. "If you work for Hopkins or Maryland, this gives you protection against adverse publicity."
In some instances, the doctors are dropped because it becomes clear they were not involved in caring for the patient. In other scenarios, doctors' names don't appear because the hospitals prefer it that way. Plaintiffs' lawyers say hospitals encourage them to omit doctors as defendants.
Hopkins officials declined to be interviewed but replied in writing to some questions. They said that eliminating doctors from malpractice claims can result in more rapid settlement of legitimate claims.
"Because Johns Hopkins favors settlements where appropriate, it has tried to bring all sides together early to resolve differences and avoid prolonged litigation," spokesman John Lazarou said in an e-mail. "Dismissing physicians from the case often hastens resolution of the matter and allows prompt payment of a fair amount to claimants in a timely fashion."
The University of Maryland Medical System turned down requests for interviews. In a statement, Edmond F. Notebaert, the medical system's chief executive, responded to a reporter's questions but did not specifically discuss its handling of malpractice claims.
"We would suggest that you ask attorneys for plaintiffs about why they decide who to name as defendants on lawsuits that they file," he said.
Dr. Paul T. Elder, secretary-treasurer of the Board of Physicians and an anesthesiologist at Anne Arundel Medical Center in Annapolis, said lawyers target hospitals because they have "deeper pockets."
"Lawyers don't want to go after the doctor," he said. "They want the money."
Elder is among health industry observers who predict that the practice of omitting defendants will grow. More doctors may forgo the expense of running their own offices to enter into employment contracts with hospitals and other health care providers.
When a physician works for a hospital or other corporate entity that runs its own insurance plan, the employer is legally bound to take responsibility for the doctor's actions.
By contrast, most hospitals grant physicians privileges to practice and require them to have their own insurance. When patients are injured, doctors typically are sued along with the hospitals and use separate attorneys, according to claims records and lawyers.
That is often not the case in claims stemming from care at Hopkins and the University of Maryland Medical System. The Sun examined records at the Health Care Alternative Dispute Resolution Office, the first stop for claims before they can become lawsuits. Doctors were not named as defendants in about half of the 105 claims that named Hopkins from Jan. 1, 2004, through Nov. 30, 2005. During that period, more than one-third of the 53 claims involving the University of Maryland Medical System did not name doctors as defendants.
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