PHILADELPHIA--At Long Beach Community Medical Center, the addition,
in 1993, of a new radiation therapy facility and a new cancer
center spurred the development of clinical pathways (or practice
guidelines) for radiation therapy and breast cancer.
A study by Robert H. Goebel, MD, a radiation oncologist at the
Center who is also a law student at Thomas Jefferson School of
Law, San Diego, provided one important rationale: The use of pathways
may reduce malpractice suits by favorably modifying physician
"Our study suggests that the potential savings from malpractice
suits would be significant," Dr. Goebel said in his presentation
of the findings at the American Society of Clinical Oncology meeting.
The study analyzed retrospectively whether malpractice lawsuit
verdicts would have been changed as a result of instituting a
clinical pathway. A plaintiff in a malpractice suit must prove
that the standard of care was not met and also that the breach
of the standard of care caused damages. Therefore, verdicts for
a plaintiff would change if the doctor had merely met the standard
of care as defined in a clinical pathway.
On the other hand, verdicts in favor of the doctor would change
in favor of the plaintiff if the introduction of a clinical pathway
changed the standard of care. However, even in these cases, proof
of causation of damage would still be required. "This causation
proof makes it very difficult for a lawsuit in favor of a doctor
to be changed," Dr. Goebel said.
The methodology used in the study "basically matches the
standard of care as defined by the guideline with the lawsuits,"
he said. For breast cancer, Dr. Goebel and his co-author Michael
Goe-bel, of the University of Nevada, Reno, compared California
verdicts, found by a search of the LEXIS and WESTLAW legal databases,
with the Blue Cross/Blue Shield breast cancer guidelines of March,
For radiation therapy, the same databases were searched nationally,
and the guidelines developed at Long Beach Community Medical Center