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 behavior.
"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, 1994.
For radiation therapy, the same databases were searched nationally, and the guidelines developed at Long Beach Community Medical Center were applied.