In just 10 years, the cost of screening mammography litigation
in the United States could top $250 million a year, a recent analysis has found.
The analysis, presented at this year’s American Roentgen Ray Society meeting
in Atlanta, is based on a statistical model that reviewed the number of women
likely to be undergoing mammograms, the potential for missed cancers, the average
lawsuit settlement ($200,000 based on 1995 figures), and other similar factors.
"We are looking at a potential medical-legal
meltdown," said Richard Tello, md, msme, mph, professor of radiology,
epidemiology, and biostatistics at Boston University. The baby boomers are
getting older, so the number of women needing mammograms is going up. As more
mammograms are done, the potential for missed cancers increases, leading to an
increased chance of litigation.
"We were conservative in our calculationsassuming
that only 1 in 10 women who are litigation candidates will sue, that half of the
women who sue will have a lesion on a previous mammogram that was missed, and
that half of this subset will actually win their case," Dr. Tello said.
"These litigation costs could potentially go even higher," he added.
"The analysis found that $70 per woman per mammogram
(assuming that about half of eligible women would have 20 mammograms over their
lifetimes) would need to be saved beginning now, to pay these future
costs," Dr. Tello said. "The $70 figure is based on conservative
estimates; using less conservative estimates, we found that the amount needed
could be as high as $200 per woman per mammogram."
This is a major problem, because some insurance reimbursement
for mammograms is just at or near the $70 level, Dr. Tello explained. At this
rate, it is not economically feasible for radiologists to contribute to a
litigation pool. It is unlikely that insurance companies will pay more to
prepare for future litigation costs. Malpractice insurance companies would
likely increase their premiums as litigation costs go up, making it less
attractive for radiologists to even do screening mammgraphy, he noted.
In addition, it is unlikely that the patient will pay
out-of-pocket to support a litigation pool, Dr. Tello said. A solution, however,
could be a federally sponsored litigation pool similar to the one that currently
exists for vaccine lawsuits.
"The study indicates that we need to act now to avoid a
crisis in 10 years, when the costs of litigation force the shutdown of
mammography facilities nationwide," he said.