>> Sender's name: George Johnson
>> Sender's e-mail address: GeorgeJ780@aol.com
>> Narrative: I'm conducting research regarding the incidences of medical "mishaps"
>> (call it accidents, misdiagnosis, whatever), under managed
>> healthcare (for example, within HMO environments), versus 
>> within traditional or fee for service insurance environments.
>> UNfortunately I'm finding very little! ANy thoughts or ideas
>> for direction, please? Thanks very much.

Dear Mr. Johnson,

     I share your interest in the medicolegal effects
of the transformation of American medicine from fee for service
to managed care.

     Given the circumstance that managed care corporations are
actively soliciting members, it is not surprising that they will
do whatever possible to minimize or to conceal their medical-legal
problems.

     Defense attorneys with whom I have spoken informally tell me
that there is in fact an increase in the number of tort claims
under managed care; but I am uncertain of the extent to which this
is wishful thinking on the part of the lawyers.

     It should certainly be possible to ascertain from public
records the names of physician defendants, and to ascertain in
each case whether the physician was working under managed care
constraints and whether the plaintiff was insured under a managed
care contract. However such research would be very time consuming,
and I have not contemplated undertaking it.

     Although my personal experience suggests that managed care
has resulted in a degradation of the quality of medicine, I do not
think that there will necessarily be a corresponding increase in
the number of malpractice suits, for the reason that plaintiffs
may be less likely to sue corporations than to sue individuals.
The function of both criminal and civil litigation, it seems to
me, is to find a scapegoat; and large powerful, well-connected
corporations to not make good sacrificial victims. To the extent
that managed care is sponsored by employers, employees will be
in a position of having to bring suits against their employers
chosen agents, the threshold for which is likely to be higher than
for suits against individuals. Finally, I expect the courts to be
very sympathetic to corporate defendants, for, the larger the
corporation the more government-like it appears, and the government
itself, as we all know, is above the law. Rex not potest peccare,
as the lawyers used to say.

    You may correctly infer from this letter, that I am very
much interested in the topic of your research, both from a
theoretical and from a practical point of view. I should like
to know the results of your work thus far, and I should certainly
be pleased to pursue with you this interesting and very important
topic in further correspondence.

                                     Sincerely yours,
                                     Ernst J. Meyer, M.D.