Horizon, Host: Ted Simons

February 23, 2005


Host: Michael Grant

Medical malpractice


  • The debate over malpractice reform is one of the issues facing state lawmakers, a subject also considered by medical students entering the field. Horizon looks at a medical malpractice bill working its way through the state legislature.
Guests:
  • Brad Parker - Arizona Sports and Tourism Authority
  • Senator Robert Cannell - Senate Health Committee, co-sponsor of Senate Bill 1036


View Transcript
>> Michael Grant:
Tonight on "Horizon," despite the wet weather, the Arizona Cardinals' stadium roof construction is moving ahead. We'll have an update. Plus, the debate over malpractice reform is one of the issues facing state lawmakers, a subject also considered by medical students entering the field. We look at a medical malpractice bill working its way through the state legislature. That's next on "Horizon."

>> Announcer:
"Horizon" is made possible by the friends of Channel 8, members who provide financial support to this Arizona PBS station. Thank you.

>> Michael Grant:
Good evening, welcome to "Horizon." I'm Michael Grant. The new Cardinals' football stadium in Glendale is taking shape. A major construction milestone was passed this week. The stadium roof, 56,000 tons of steel, was lifted to its maximum elevation of 156 feet above the stadium floor, then lowered into place. The four-day roof installation is now complete. Here to give us an update is Brad Parker, a spokesman with the Arizona Sports and Tourism Authority. You guys breathing a sigh of relief?

>> Brad Parker:
Well, it all went according to plan. Hunt Construction, a masterful job in coordinating the whole thing. The workers -- it was blustery, rainy and cold but it didn't affect the process at all.

>> Michael Grant:
It was designed this way; right?

>> Brad Parker:
Absolutely. From the start, the design team decided, you know, let's multitask. Let's figure out a way where we can build the stadium around as we're going around on the stadium, we can also start assembling the roof on the floor, and it allowed them to multitask versus building the stadium and then building the roof in place or building the roof and trying to lift it into place. It was interesting the way it was initially conceived and those four super columns were built precisely to perform this lift.

>> Michael Grant:
We have to be real careful about how we describe the relative importance of this lift in overall engineering North American history; right?

>> Brad Parker:
It's very significant any way you look at it. It is described as the single heaviest roof lift in North America.

>> Michael Grant:
But it wasn't the single heaviest lift -- and it was also moved completely as opposed to being moved in pieces.

>> Brad Parker:
That's absolutely correct.

>> Michael Grant:
Rain didn't bother the procedure?

>> Brad Parker:
Absolutely. We went ahead and knew that we could do the lift with some rain. The caveats were torrential rain, we would probably stop and also high winds and lightning. That's more of a safety issue for the workers than it was for the actual process of raising the roof, which is anchored on four points and carefully controlled by computers.

>> Michael Grant:
And is moving it, Brad, through a series of hydraulics? Is that how they lifted it?

>> Brad Parker:
Very interesting. 8 jacks on top of four stands that actually had cables that went down to the ends of the trusses and hoisted up the entire roof assembly in 18-inch strokes, very interesting, very dramatic. If you've seen the difference from the roof from the inside the bowl to the top, very interesting.

>> Michael Grant:
Now where does that put us in the overall stadium construction timetable, progress?

>> Brad Parker:
Past the half way point. It's a significant milestone because now we can start adding the sides of the roof and getting that all closed in. That will be done around July, and then in this time frame this summer, we'll start doing the lower seating bowl, and by the end of the year, you should see the entire exterior complete of the stadium. And then what we'll do next April is we'll actually finish that, the tray, where the field goes and slides out of the stadium. So some exciting things going on in the next 18 months.

>> Michael Grant:
I was going to ask when the removable field fits into this. Is that one -- pretty much one of the final stages of construction?

>> Brad Parker:
Well, as I alluded to before, there is a lot of pieces going on at the same time to make it efficient, for example panels in the roof are being done on the outside as the center portion is being raised up. Now that that's up off the floor, the lower seating bowl can be done. A lot of pieces are going on. There is a lot more to be done, but as you can see, when you drive by, the change in the look from the columns now to be more of a stadium is really, really dramatic.

>> Michael Grant:
You know I know at "BOB" really remarkably small motors that take a remarkably tiny amount of electricity move its roof. When you move the field, is it also balanced in such a way and engineered in such a way that really to move such a big thing, it doesn't take all that much effort?

>> Brad Parker:
Inch by inch, its a cinch. That same kind of process is going to be for the rollout field. 11-million pound tray, and yet with the sets, we'll have about a little bit less than 100 one-horsepower engines that will do the work. A lot of little engines on those wheels doing the movement takes an hour to get in and out. If a couple of those little tiny engines fail, you'll never notice it until they can be repaired. The same kind of process, lots of little engines versus a few large ones.

>> Michael Grant:
All right, stadium construction completion scheduled for -- remind us again?

>> Brad Parker:
August 2006 is the opening of the stadium. So when you look at it, it's next year. You know, it's a year from this August, but we've got the start of the -- that season in august of '06 and then right then, that next January, we've got the Fiesta Bowl with the BCS national championship. It's a dramatic six months. And then the year after that, we've got Super Bowl 42. Some big, big things will be happening.

>> Michael Grant:
Last time you were here, you told me, and I just hadn't locked on it in relation to the Fiesta Bowl, the two event notion because that's the first year that the BCS goes to -- hold the -- Fiesta Bowl and then if you were hosting the national championships you do that, what a week later?

>> Brad Parker:
The next week.

>> Michael Grant:
Absolutely incredible in terms of logistics. It's tough enough to put together a major bowl event but to put two together back to back?

>> Brad Parker:
But who's the best at putting on those bowl games? Fiesta Bowl. They've got a fantastic organization. They do it so smoothly that having the stadium prepared one week there is no changes to have it be prepared the very next week. It should be logistically fairly easy to do.

>> Michael Grant:
I tell you what, the volunteers are going to be exhausted by the time that's through.

>> Brad Parker:
It's a heck of a year.

>> Michael Grant:
Absolutely. Brad Parker, we appreciate the update.

>> Brad Parker:
Thank you.

>> Michael Grant:
Take care of yourself. Should doctors be able to tell their patients, I'm sorry, without having the apology used against them in court? It is a question under consideration at the State legislature. A bill that would change malpractice law has passed the Senate and is on the way to the House of Representatives. A recent amendment on another provision of the bill would only allow a patient's medical records to be reviewed by defense attorneys if the patient gives permission. In a moment, two state lawmakers, one an attorney by profession and one a medical doctor, join me to talk about the legislation. First, producer Christopher Conover has this background report.

>>Christopher Conover:
Imagine going to the doctor's office only to find no one there. Doctors say if something isn't done about the skyrocketing cost of medical malpractice insurance, that image could be closer to a reality.

>> Dr. Fred Fiastro:
Because of this recent inflation in the amount of pay-outs and the amount of insurance premiums, it's putting people out of our service. Physicians can no longer find it favorable to stay in Tucson, in Arizona. My insurance in Arizona has gone up 30\% in the past two years.

>> Christopher Conover:
Climbing malpractice insurance costs are not unique to Arizona. President Bush brought it up in his most recent state of the union address, and state legislatures around the country are looking at medical malpractice insurance reform. In Florida, the issue even made it to the ballot in the form of dueling constitutional amendments.

>> Male Voice on Commercial:
These words, medical liability claims, were put into allow big insurance companies to deny claims and make more money, hurting patients and loved ones.

>> Male Voice on Commercial:
Greedy trial lawyers are spending millions to lie to you about amendment 3. Don't be fooled. Amendment 3 will protect you against bad doctors.

>>Christopher Conover:
The doctors blame attorneys and lawsuits for blaming the cost up, but the lawyers say they didn't cause the increases.

>> John Osborn:
If we could control the bad doctors, and make them leave the state, then that would be a long way towards fixing the problem.

>>Christopher Conover:
So that's where the legislature comes in. Senate Bill 1036 changes the doctor-patient privilege allowing a healthcare provider to give patient information to a defense attorney in a medical malpractice case. Opponents say that part of the proposal is ripe for abuse.

>> Bill Brotherton:
I've had women clients who have been injured and have had in their OB/GYN records, for instance, stuff about being sexually assaulted, having STDs, things that they don't -- are total totally unrelated to the case, but they don't want these things brought up in a public forum or these records released to insurance companies or attorneys where who knows where they could go.

>>Christopher Conover:
The bill also includes what is known as an "I'm sorry" provision, allowing a physician to make an apology or other similar gesture without the statement showing up in a court case. Backers say the idea could stop many medical malpractice suits before they even begin.

>> John Huppenthal:
You have a brain surgeon that's desperately trying to save a life. And sometimes they just can't do it. You know. They just can't do it. The victim has been too badly hurt in the car accident. The situation, the stroke has gone on too long. They didn't get the patient in time. And they want to be able to be just like you and I. They want to able to be human beings. They don't want to have to think about what the trial lawyer is going to do to every word that they say.

>>Christopher Conover:
The president wants a cap on jury awards for pain and suffering. His proposal would limit that amount to $250,000. The Arizona legislature is looking at a proposed constitutional amendment that would allow for such a cap, but doesn't specify the total amount. Senator Huppenthal says jury awards are spinning out of control and that is why he sponsored the cap amendment.

>> John Huppenthal:
What we have to do is just get publicity out to people who are on juries and say, look, you think you are helping somebody, but by doing what you are doing, you are stripping away the medical profession. You are stripping away everybody's protections when they go into an emergency room, when they go to see certain specialists, that type of thing.

>>Christopher Conover:
But attorneys argue that sometimes a punishment of more than just medical costs is needed.

>> John Osborn:
The thought that somebody who is permanently a quadriplegic for the rest of their life should have their damages for the pain of becoming a quadriplegic limited to $250,000 or whatever number you want to pick arbitrarily out of the book is really criminal in and of itself.

>>Christopher Conover:
Doctors disagree saying the injured is not the one who gets the money in the end.

>> Dr. Fred Fiastro:
60\% of all of the costs of medical liability in this country go to courts and attorneys.

>>Christopher Conover:
And questions are arising about whether or not the legislature is really looking at the right question. Some say instead of capping jury awards, lawmakers should force insurance companies to rollback their rates. Currently no bill in the legislature calls for that.

>> Michael Grant:
Here to talk more about the medical malpractice bill, Senator Robert Cannell, member of the Senate Health Committee, co-sponsor of Senate Bill 1036. Senator Cannell is also a medical doctor. Also here is Senator Bill Brotherton, who opposes the measure. Senator Brotherton is an attorney by profession. Gentlemen, good to see both of you again. The package we just saw had mentioned the caps, Robert, on medical malpractice awards. That one is not moving, correct?

>> Robert Cannell:
Right, that was an SCR. That was going to be a referendum for the people. It may come back next year, but it's not moving. It was heard in that committee, not voted on, so it's dead for this year.

>> Michael Grant:
Let's move to some of the live issues. A doctor walks in, says I'm sorry, some things went wrong in there, we'll do our best, but you have my apology. Why shouldn't that statement be able to be used against him?

>> Robert Cannell:
The problem is that if we don't allow that to be used -- if we made that statement such that it could be used against him, then the doctor is not going to make that statement. So from the physician standpoint, there is a barrier now between the doctor and the patient when something goes wrong, and there is a tendency for the patient not to hear the truth. We want to improve the doctor-patient relationship so the patient can hear exactly what the truth is. The doctor can seem caring, which most doctors are, rather than the situation now where physicians, because of fear of lawsuits, are afraid to say anything to their patients when things don't turn out right. And it's not necessarily that something was done wrong by the doctor, but sometimes we get bad results and the patients wants to know what those results are. There is a lot of evidence, I think, that if the patient has the doctor be honest with him and show caring, that they often don't move on to a malpractice suit, even though things didn't work out the way they had wished. And I've actually seen that in a personal sense. I think a lot of times patients when they file a suit, they are looking for the truth, what happened here, and in my opinion, in the current system they usually don't find out the truth.

>> Michael Grant:
Well sounds like some pretty good reasons, Bill. Why is it a bad idea?

>> Bill Brotherton:
It's not a bad idea, actually. I support that part of the bill. I had some issues with some of the wording of it. I still think it could be improved on, some, but that part of the bill actually I support, I talked to Bob about it last year when it came to my attention through a media report on it, that it seemed to me to be a common sense fix to some of this, because I do think that, because of HMOs and just the way the system has gone in healthcare, totally unrelated to the court system, doctors don't in general get the opportunity many times to build up long-term relationships with their patients. More so for Bob because he is in a smaller town in Yuma, but you really have to fight to stay with the same pediatrician or family practitioner. And so I think that has caused, unnecessarily, more suspicion between the patient and the doctor. So I really think the "I'm sorry" provisions are good and could and have been proven to actually cut down on litigation and on claims.

>> Michael Grant:
All right, well, being constantly alert here, let me offer you a problem and you can respond to it. If we're searching for truth in this process, I mean, a lot of evidence comes into court, certainly, including, but not limited to admissions by people that I did wrong, and why wouldn't you want that bit of -- the jury can do with it what it wants, why wouldn't you want that bit of data in front of the fact-finder, the truth finder?

>> Bill Brotherton:
Well, I think again, and the things you are bringing up are things like, for us lawyers, are admission of party opponent or admission against interest, which are…

>> Michael Grant:
Excited utterance.

>> Bill Brotherton:
These hearsay exceptions that we all learn about in law school. And my only concern is the way it was written in the initial bill, it could have kept those types of statements that were made in a deposition or even in trial from being used. I don't think that that would have been appropriate, but I think that Bob is right. There is a lot of times where people are just searching for answers and there may even be a situation where a doctor did make a mistake, but I don't think that -- and I know this in practice and I don't practice medical malpractice but I have people that will say somebody hurt me but I don't want to do anything about it. So I think that the balancing between the two, I think the "I'm sorry" provision actually makes sense when you look at that balance.

>> Michael Grant:
I'm not sure that I understand, Bob, this issue going on on the access to the patient's records. Explain that to me and what it's driving at.

>> Robert Cannell:
There's been a group of us working down there for four years headed up by Bill Jones, who is a malpractice attorney for the defense, looking at ways we can improve the situation short of changing the constitution. Because as you know, Arizona has a constitutional barrier to limiting with caps and that sort of thing. One of the big pieces all along has been the DUKET decision made several years ago, where in a malpractice trial it was determined that, yes, when a patient sued a doctor, they gave up their physician-client privilege, but no, you can't interview any of the treating physicians without the plaintiff's okay, without the plaintiff's attorney there. So the physicians felt we had an unfair playing field, that whereas the prosecuting attorney could interview anyone, the defense attorney could not. It had to go through the process of getting a deposition and having a court reporter there.

>> Michael Grant:
Couldn't talk to him informally without the consent of the plaintiff, which is not likely to be given.

>> Robert Cannell:
And the lawyers that protect doctors or look after our interests felt that by getting this information early, we could settle these cases a lot quicker and save money. Mike estimated that we could save one to two million dollars, which is not a huge amount when you consider, by avoiding expensive depositions by finding out the information. Now this is not the way the bill stands, as you know.

>> Michael Grant:
That provision was killed coming out --

>> Robert Cannell:
There were not enough votes to get it through, quite frankly. And so, Senator Verschoor put it through an amendment that among other things of course addressed Senator Brotherton's concern about the "I'm sorry" provision to make sure you couldn't say "I'm sorry" to the plaintiff's attorney and not have that admitted in court. That was a pretty easy fix on our part, but Verschoor's amendment set up an informal process where both attorneys still had to be present.

>> Michael Grant:
Does seem lopsided. Why shouldn't I be able to talk to people?

>> Bill Brotherton:
I don't think it is lopsided in the sense that again, there is a discovery. There is discovery that exists, as you know, in a court proceeding. The idea of discovery is that -- and I do this, again in, my practice outside of medical malpractice, people ask for certain records, and what's come up with my own practice is, I've had, in particular, female clients who they'll ask for all their medical records, including say their OB/GYN records. Many women have been opposed to giving those over, feeling they don't actually apply to whatever the case may be. And you have the ability through discovery that if you can't agree, that no, that shouldn't be looked into, you go to the judge, impartial arbiter. He or she looks at these things in camera, in their chambers and makes that determination. So, there is basically the ability on both sides to go to someone if there is a dispute, and these disputes are real-life types of disputes, and what Senator Verschoor's amendment did is at the very least it allowed the patient's representative to be there to know if perhaps inappropriate questions or inappropriate areas were being gone into by the defense attorney.

>> Michael Grant:
Okay, stay with us. Medical malpractice not just an issue facing doctors, medical students and residents also concerned about the effects of potential lawsuits on their work with patients, as well as the high cost of malpractice insurance. Again, producer Christopher Conover looks at medical malpractice from the perspective of medical students and educators at the University Medical Center in Tucson.

>>Christopher Conover:
Law students and the faculty at law schools certainly think about liability cases, and so, too, do their counterparts often on the other side of the trial bench, medical students and faculty training the future doctors.

>> Dr. Ken Ryan:
From the time our students will start to see patients and deal with patients and learn how to interview patients from the time they enter medical school, and the most important part of that is building a constructive relationship with the patient.

>>Christopher Conover:
Continued reinforcement of what used to be called bedside manner is not the only part of the curriculum that deals with malpractice.

>> Dr. Ken Ryan:
We do have some formal sessions in the curriculum that are directed by lawyers in which they discuss malpractice as a specific entity from the legal standpoint, even from the Arizona standpoint in terms of Arizona statutes, and then we also have other sessions in which we mix together lawyers and physicians and patients in sort of a panel discussion mode, talking about particular cases and instances of malpractice.

>>Christopher Conover:
Dr. Ryan says the faculty at UMC teaches that communication at all levels can smooth over many problems.

>> Dr. Ken Ryan: Humans and patients in general understand that sometimes mistakes are made. And our -- they understand that. It's the situation where if they don't have a positive relationship with their physician, if the physician is arrogant or hasn't communicated with them, those are the physicians that get sued.

>>Christopher Conover:
Medical students say they certainly don't want to end up here at the courthouse, but medical malpractice is not at the forefront of their minds, however, they do admit they think about it.

>> Charles Schmier:
It definitely figures into what career field you are going to end up choosing. Not so much because of how it's going to affect you in the pocketbook, but more as to how it's going to affect your patient relationship and whether you are going to feel like you have a target on your chest every day.

>> Maura Mahoney:
Right. I agree with Chip on that, too. It's not only are we worried about it as common sense individuals who want to have a good career, but it's kind of leaked into the relationships that we have with our patients. It's almost like this corrupt sort of -- at the beginning, patients are paying too much in insurance to see us. I have six minutes with you, I can remember the meds that I wanted to ask about, the thing I read on the Internet, don't forget the list of questions, there is an urgency on the part of the patients because they are paying a lot of money in insurance, and then again, we're walking in and we're paying a lot of money in insurance as well. When we're dreaming in medical school of the kind of doctor I want to be, "defensive" isn't on our list. Already it's intruded on the relationship, the economic and the legal aspect of medicine, instead of just the spiritual and physical relationship. So the patient comes in with that, and we come in with that and so already we're concerned about, you know, the economics and the legal issues that might face both of us.

>>Charles Schmier:
By the time you finish eight years of college training and three or four years of residency training, and you've seen your friends get their Bachelor's degrees and acquire jobs and start raising families while you are still in school in the library, the last thing you want to do is worry about coming out and losing everything that you've worked so hard for.

>> Maura Mahoney:
In a lot of ways we're taught to leave our fallible humanity at the door, do you know what I mean? And you are a perfectionistic scientist when you walk into the room and a lot of people read that as uncaring. There isn't that intimate relationship of patient and doctor anymore. We don't have extensive relationships any more with continuity of care, so you don't know the physician standing in front of you. So we get very used to being very cold and walking into -- you know, very systematic in approaching patients. We also learn to let our guard down and feel like you know what, this is still a patient-doctor relationship.

>> Michael Grant:
Larger social issue, are we chilling potential doctors with medical malpractice?

>> Robert Cannell:
Yes, we are. Arizona is getting a bad reputation as far as being doctor unfriendly where malpractice is concerned. Obstetricians are leaving the Tucson area, which has a huge rally down there on that issue. We've lost the ability of family physicians in southeast Arizona to get malpractice in order to deliver babies, even though lay mid-wives can deliver babies, general practitioners cannot.

>> Michael Grant:
Are we chilling or should we care?

>> Bill Brotherton:
Well, the evidence we heard in the judiciary here earlier was that we're actually below the national average on the average cost of malpractice suits, and the average number of suits, and I don't think -- and that was from MICA, the insurance company. So I really don't think that that's their chilling effect here. People do have to be accountable.

>> Michael Grant:
Senator Brotherton, thank you for being here.

>> Bill Brotherton:
Thank you.

>> Michael Grant:
Senator Cannell, thank you for being here.

>> Robert Cannell:
My pleasure, Michael.

>> Michael Grant:
For links related to tonight's program, please visit the web site, that address is www.azpbs.org, and click "Horizon." You can see transcripts of "Horizon," and find out about upcoming topics.

>>Mike Sauceda:
A bill that would extend tuition tax credits to corporations is making its way through the legislature. The tuition tax credit is used to fund private school tuitions. Also the legislature has sent to congress a resolution urging it to start the process on a constitutional ban on same sex marriage. We'll discuss those issues Thursday at 7:00 on "Horizon."

>> Michael Grant:
Thanks for being here on a Wednesday. I'm Michael Grant. Have a great one, goodnight.

stadium update


  • Despite the wet weather, the Arizona Cardinals' stadium roof construction is moving ahead. Horizon has an update.
Guests:
  • Brad Parker - Arizona Sports and Tourism Authority
  • Senator Robert Cannell - Senate Health Committee, co-sponsor of Senate Bill 1036


View Transcript
>> Michael Grant:
Tonight on "Horizon," despite the wet weather, the Arizona Cardinals' stadium roof construction is moving ahead. We'll have an update. Plus, the debate over malpractice reform is one of the issues facing state lawmakers, a subject also considered by medical students entering the field. We look at a medical malpractice bill working its way through the state legislature. That's next on "Horizon."

>> Announcer:
"Horizon" is made possible by the friends of Channel 8, members who provide financial support to this Arizona PBS station. Thank you.

>> Michael Grant:
Good evening, welcome to "Horizon." I'm Michael Grant. The new Cardinals' football stadium in Glendale is taking shape. A major construction milestone was passed this week. The stadium roof, 56,000 tons of steel, was lifted to its maximum elevation of 156 feet above the stadium floor, then lowered into place. The four-day roof installation is now complete. Here to give us an update is Brad Parker, a spokesman with the Arizona Sports and Tourism Authority. You guys breathing a sigh of relief?

>> Brad Parker:
Well, it all went according to plan. Hunt Construction, a masterful job in coordinating the whole thing. The workers -- it was blustery, rainy and cold but it didn't affect the process at all.

>> Michael Grant:
It was designed this way; right?

>> Brad Parker:
Absolutely. From the start, the design team decided, you know, let's multitask. Let's figure out a way where we can build the stadium around as we're going around on the stadium, we can also start assembling the roof on the floor, and it allowed them to multitask versus building the stadium and then building the roof in place or building the roof and trying to lift it into place. It was interesting the way it was initially conceived and those four super columns were built precisely to perform this lift.

>> Michael Grant:
We have to be real careful about how we describe the relative importance of this lift in overall engineering North American history; right?

>> Brad Parker:
It's very significant any way you look at it. It is described as the single heaviest roof lift in North America.

>> Michael Grant:
But it wasn't the single heaviest lift -- and it was also moved completely as opposed to being moved in pieces.

>> Brad Parker:
That's absolutely correct.

>> Michael Grant:
Rain didn't bother the procedure?

>> Brad Parker:
Absolutely. We went ahead and knew that we could do the lift with some rain. The caveats were torrential rain, we would probably stop and also high winds and lightning. That's more of a safety issue for the workers than it was for the actual process of raising the roof, which is anchored on four points and carefully controlled by computers.

>> Michael Grant:
And is moving it, Brad, through a series of hydraulics? Is that how they lifted it?

>> Brad Parker:
Very interesting. 8 jacks on top of four stands that actually had cables that went down to the ends of the trusses and hoisted up the entire roof assembly in 18-inch strokes, very interesting, very dramatic. If you've seen the difference from the roof from the inside the bowl to the top, very interesting.

>> Michael Grant:
Now where does that put us in the overall stadium construction timetable, progress?

>> Brad Parker:
Past the half way point. It's a significant milestone because now we can start adding the sides of the roof and getting that all closed in. That will be done around July, and then in this time frame this summer, we'll start doing the lower seating bowl, and by the end of the year, you should see the entire exterior complete of the stadium. And then what we'll do next April is we'll actually finish that, the tray, where the field goes and slides out of the stadium. So some exciting things going on in the next 18 months.

>> Michael Grant:
I was going to ask when the removable field fits into this. Is that one -- pretty much one of the final stages of construction?

>> Brad Parker:
Well, as I alluded to before, there is a lot of pieces going on at the same time to make it efficient, for example panels in the roof are being done on the outside as the center portion is being raised up. Now that that's up off the floor, the lower seating bowl can be done. A lot of pieces are going on. There is a lot more to be done, but as you can see, when you drive by, the change in the look from the columns now to be more of a stadium is really, really dramatic.

>> Michael Grant:
You know I know at "BOB" really remarkably small motors that take a remarkably tiny amount of electricity move its roof. When you move the field, is it also balanced in such a way and engineered in such a way that really to move such a big thing, it doesn't take all that much effort?

>> Brad Parker:
Inch by inch, its a cinch. That same kind of process is going to be for the rollout field. 11-million pound tray, and yet with the sets, we'll have about a little bit less than 100 one-horsepower engines that will do the work. A lot of little engines on those wheels doing the movement takes an hour to get in and out. If a couple of those little tiny engines fail, you'll never notice it until they can be repaired. The same kind of process, lots of little engines versus a few large ones.

>> Michael Grant:
All right, stadium construction completion scheduled for -- remind us again?

>> Brad Parker:
August 2006 is the opening of the stadium. So when you look at it, it's next year. You know, it's a year from this August, but we've got the start of the -- that season in august of '06 and then right then, that next January, we've got the Fiesta Bowl with the BCS national championship. It's a dramatic six months. And then the year after that, we've got Super Bowl 42. Some big, big things will be happening.

>> Michael Grant:
Last time you were here, you told me, and I just hadn't locked on it in relation to the Fiesta Bowl, the two event notion because that's the first year that the BCS goes to -- hold the -- Fiesta Bowl and then if you were hosting the national championships you do that, what a week later?

>> Brad Parker:
The next week.

>> Michael Grant:
Absolutely incredible in terms of logistics. It's tough enough to put together a major bowl event but to put two together back to back?

>> Brad Parker:
But who's the best at putting on those bowl games? Fiesta Bowl. They've got a fantastic organization. They do it so smoothly that having the stadium prepared one week there is no changes to have it be prepared the very next week. It should be logistically fairly easy to do.

>> Michael Grant:
I tell you what, the volunteers are going to be exhausted by the time that's through.

>> Brad Parker:
It's a heck of a year.

>> Michael Grant:
Absolutely. Brad Parker, we appreciate the update.

>> Brad Parker:
Thank you.

>> Michael Grant:
Take care of yourself. Should doctors be able to tell their patients, I'm sorry, without having the apology used against them in court? It is a question under consideration at the State legislature. A bill that would change malpractice law has passed the Senate and is on the way to the House of Representatives. A recent amendment on another provision of the bill would only allow a patient's medical records to be reviewed by defense attorneys if the patient gives permission. In a moment, two state lawmakers, one an attorney by profession and one a medical doctor, join me to talk about the legislation. First, producer Christopher Conover has this background report.

>>Christopher Conover:
Imagine going to the doctor's office only to find no one there. Doctors say if something isn't done about the skyrocketing cost of medical malpractice insurance, that image could be closer to a reality.

>> Dr. Fred Fiastro:
Because of this recent inflation in the amount of pay-outs and the amount of insurance premiums, it's putting people out of our service. Physicians can no longer find it favorable to stay in Tucson, in Arizona. My insurance in Arizona has gone up 30\% in the past two years.

>> Christopher Conover:
Climbing malpractice insurance costs are not unique to Arizona. President Bush brought it up in his most recent state of the union address, and state legislatures around the country are looking at medical malpractice insurance reform. In Florida, the issue even made it to the ballot in the form of dueling constitutional amendments.

>> Male Voice on Commercial:
These words, medical liability claims, were put into allow big insurance companies to deny claims and make more money, hurting patients and loved ones.

>> Male Voice on Commercial:
Greedy trial lawyers are spending millions to lie to you about amendment 3. Don't be fooled. Amendment 3 will protect you against bad doctors.

>>Christopher Conover:
The doctors blame attorneys and lawsuits for blaming the cost up, but the lawyers say they didn't cause the increases.

>> John Osborn:
If we could control the bad doctors, and make them leave the state, then that would be a long way towards fixing the problem.

>>Christopher Conover:
So that's where the legislature comes in. Senate Bill 1036 changes the doctor-patient privilege allowing a healthcare provider to give patient information to a defense attorney in a medical malpractice case. Opponents say that part of the proposal is ripe for abuse.

>> Bill Brotherton:
I've had women clients who have been injured and have had in their OB/GYN records, for instance, stuff about being sexually assaulted, having STDs, things that they don't -- are total totally unrelated to the case, but they don't want these things brought up in a public forum or these records released to insurance companies or attorneys where who knows where they could go.

>>Christopher Conover:
The bill also includes what is known as an "I'm sorry" provision, allowing a physician to make an apology or other similar gesture without the statement showing up in a court case. Backers say the idea could stop many medical malpractice suits before they even begin.

>> John Huppenthal:
You have a brain surgeon that's desperately trying to save a life. And sometimes they just can't do it. You know. They just can't do it. The victim has been too badly hurt in the car accident. The situation, the stroke has gone on too long. They didn't get the patient in time. And they want to be able to be just like you and I. They want to able to be human beings. They don't want to have to think about what the trial lawyer is going to do to every word that they say.

>>Christopher Conover:
The president wants a cap on jury awards for pain and suffering. His proposal would limit that amount to $250,000. The Arizona legislature is looking at a proposed constitutional amendment that would allow for such a cap, but doesn't specify the total amount. Senator Huppenthal says jury awards are spinning out of control and that is why he sponsored the cap amendment.

>> John Huppenthal:
What we have to do is just get publicity out to people who are on juries and say, look, you think you are helping somebody, but by doing what you are doing, you are stripping away the medical profession. You are stripping away everybody's protections when they go into an emergency room, when they go to see certain specialists, that type of thing.

>>Christopher Conover:
But attorneys argue that sometimes a punishment of more than just medical costs is needed.

>> John Osborn:
The thought that somebody who is permanently a quadriplegic for the rest of their life should have their damages for the pain of becoming a quadriplegic limited to $250,000 or whatever number you want to pick arbitrarily out of the book is really criminal in and of itself.

>>Christopher Conover:
Doctors disagree saying the injured is not the one who gets the money in the end.

>> Dr. Fred Fiastro:
60\% of all of the costs of medical liability in this country go to courts and attorneys.

>>Christopher Conover:
And questions are arising about whether or not the legislature is really looking at the right question. Some say instead of capping jury awards, lawmakers should force insurance companies to rollback their rates. Currently no bill in the legislature calls for that.

>> Michael Grant:
Here to talk more about the medical malpractice bill, Senator Robert Cannell, member of the Senate Health Committee, co-sponsor of Senate Bill 1036. Senator Cannell is also a medical doctor. Also here is Senator Bill Brotherton, who opposes the measure. Senator Brotherton is an attorney by profession. Gentlemen, good to see both of you again. The package we just saw had mentioned the caps, Robert, on medical malpractice awards. That one is not moving, correct?

>> Robert Cannell:
Right, that was an SCR. That was going to be a referendum for the people. It may come back next year, but it's not moving. It was heard in that committee, not voted on, so it's dead for this year.

>> Michael Grant:
Let's move to some of the live issues. A doctor walks in, says I'm sorry, some things went wrong in there, we'll do our best, but you have my apology. Why shouldn't that statement be able to be used against him?

>> Robert Cannell:
The problem is that if we don't allow that to be used -- if we made that statement such that it could be used against him, then the doctor is not going to make that statement. So from the physician standpoint, there is a barrier now between the doctor and the patient when something goes wrong, and there is a tendency for the patient not to hear the truth. We want to improve the doctor-patient relationship so the patient can hear exactly what the truth is. The doctor can seem caring, which most doctors are, rather than the situation now where physicians, because of fear of lawsuits, are afraid to say anything to their patients when things don't turn out right. And it's not necessarily that something was done wrong by the doctor, but sometimes we get bad results and the patients wants to know what those results are. There is a lot of evidence, I think, that if the patient has the doctor be honest with him and show caring, that they often don't move on to a malpractice suit, even though things didn't work out the way they had wished. And I've actually seen that in a personal sense. I think a lot of times patients when they file a suit, they are looking for the truth, what happened here, and in my opinion, in the current system they usually don't find out the truth.

>> Michael Grant:
Well sounds like some pretty good reasons, Bill. Why is it a bad idea?

>> Bill Brotherton:
It's not a bad idea, actually. I support that part of the bill. I had some issues with some of the wording of it. I still think it could be improved on, some, but that part of the bill actually I support, I talked to Bob about it last year when it came to my attention through a media report on it, that it seemed to me to be a common sense fix to some of this, because I do think that, because of HMOs and just the way the system has gone in healthcare, totally unrelated to the court system, doctors don't in general get the opportunity many times to build up long-term relationships with their patients. More so for Bob because he is in a smaller town in Yuma, but you really have to fight to stay with the same pediatrician or family practitioner. And so I think that has caused, unnecessarily, more suspicion between the patient and the doctor. So I really think the "I'm sorry" provisions are good and could and have been proven to actually cut down on litigation and on claims.

>> Michael Grant:
All right, well, being constantly alert here, let me offer you a problem and you can respond to it. If we're searching for truth in this process, I mean, a lot of evidence comes into court, certainly, including, but not limited to admissions by people that I did wrong, and why wouldn't you want that bit of -- the jury can do with it what it wants, why wouldn't you want that bit of data in front of the fact-finder, the truth finder?

>> Bill Brotherton:
Well, I think again, and the things you are bringing up are things like, for us lawyers, are admission of party opponent or admission against interest, which are…

>> Michael Grant:
Excited utterance.

>> Bill Brotherton:
These hearsay exceptions that we all learn about in law school. And my only concern is the way it was written in the initial bill, it could have kept those types of statements that were made in a deposition or even in trial from being used. I don't think that that would have been appropriate, but I think that Bob is right. There is a lot of times where people are just searching for answers and there may even be a situation where a doctor did make a mistake, but I don't think that -- and I know this in practice and I don't practice medical malpractice but I have people that will say somebody hurt me but I don't want to do anything about it. So I think that the balancing between the two, I think the "I'm sorry" provision actually makes sense when you look at that balance.

>> Michael Grant:
I'm not sure that I understand, Bob, this issue going on on the access to the patient's records. Explain that to me and what it's driving at.

>> Robert Cannell:
There's been a group of us working down there for four years headed up by Bill Jones, who is a malpractice attorney for the defense, looking at ways we can improve the situation short of changing the constitution. Because as you know, Arizona has a constitutional barrier to limiting with caps and that sort of thing. One of the big pieces all along has been the DUKET decision made several years ago, where in a malpractice trial it was determined that, yes, when a patient sued a doctor, they gave up their physician-client privilege, but no, you can't interview any of the treating physicians without the plaintiff's okay, without the plaintiff's attorney there. So the physicians felt we had an unfair playing field, that whereas the prosecuting attorney could interview anyone, the defense attorney could not. It had to go through the process of getting a deposition and having a court reporter there.

>> Michael Grant:
Couldn't talk to him informally without the consent of the plaintiff, which is not likely to be given.

>> Robert Cannell:
And the lawyers that protect doctors or look after our interests felt that by getting this information early, we could settle these cases a lot quicker and save money. Mike estimated that we could save one to two million dollars, which is not a huge amount when you consider, by avoiding expensive depositions by finding out the information. Now this is not the way the bill stands, as you know.

>> Michael Grant:
That provision was killed coming out --

>> Robert Cannell:
There were not enough votes to get it through, quite frankly. And so, Senator Verschoor put it through an amendment that among other things of course addressed Senator Brotherton's concern about the "I'm sorry" provision to make sure you couldn't say "I'm sorry" to the plaintiff's attorney and not have that admitted in court. That was a pretty easy fix on our part, but Verschoor's amendment set up an informal process where both attorneys still had to be present.

>> Michael Grant:
Does seem lopsided. Why shouldn't I be able to talk to people?

>> Bill Brotherton:
I don't think it is lopsided in the sense that again, there is a discovery. There is discovery that exists, as you know, in a court proceeding. The idea of discovery is that -- and I do this, again in, my practice outside of medical malpractice, people ask for certain records, and what's come up with my own practice is, I've had, in particular, female clients who they'll ask for all their medical records, including say their OB/GYN records. Many women have been opposed to giving those over, feeling they don't actually apply to whatever the case may be. And you have the ability through discovery that if you can't agree, that no, that shouldn't be looked into, you go to the judge, impartial arbiter. He or she looks at these things in camera, in their chambers and makes that determination. So, there is basically the ability on both sides to go to someone if there is a dispute, and these disputes are real-life types of disputes, and what Senator Verschoor's amendment did is at the very least it allowed the patient's representative to be there to know if perhaps inappropriate questions or inappropriate areas were being gone into by the defense attorney.

>> Michael Grant:
Okay, stay with us. Medical malpractice not just an issue facing doctors, medical students and residents also concerned about the effects of potential lawsuits on their work with patients, as well as the high cost of malpractice insurance. Again, producer Christopher Conover looks at medical malpractice from the perspective of medical students and educators at the University Medical Center in Tucson.

>>Christopher Conover:
Law students and the faculty at law schools certainly think about liability cases, and so, too, do their counterparts often on the other side of the trial bench, medical students and faculty training the future doctors.

>> Dr. Ken Ryan:
From the time our students will start to see patients and deal with patients and learn how to interview patients from the time they enter medical school, and the most important part of that is building a constructive relationship with the patient.

>>Christopher Conover:
Continued reinforcement of what used to be called bedside manner is not the only part of the curriculum that deals with malpractice.

>> Dr. Ken Ryan:
We do have some formal sessions in the curriculum that are directed by lawyers in which they discuss malpractice as a specific entity from the legal standpoint, even from the Arizona standpoint in terms of Arizona statutes, and then we also have other sessions in which we mix together lawyers and physicians and patients in sort of a panel discussion mode, talking about particular cases and instances of malpractice.

>>Christopher Conover:
Dr. Ryan says the faculty at UMC teaches that communication at all levels can smooth over many problems.

>> Dr. Ken Ryan: Humans and patients in general understand that sometimes mistakes are made. And our -- they understand that. It's the situation where if they don't have a positive relationship with their physician, if the physician is arrogant or hasn't communicated with them, those are the physicians that get sued.

>>Christopher Conover:
Medical students say they certainly don't want to end up here at the courthouse, but medical malpractice is not at the forefront of their minds, however, they do admit they think about it.

>> Charles Schmier:
It definitely figures into what career field you are going to end up choosing. Not so much because of how it's going to affect you in the pocketbook, but more as to how it's going to affect your patient relationship and whether you are going to feel like you have a target on your chest every day.

>> Maura Mahoney:
Right. I agree with Chip on that, too. It's not only are we worried about it as common sense individuals who want to have a good career, but it's kind of leaked into the relationships that we have with our patients. It's almost like this corrupt sort of -- at the beginning, patients are paying too much in insurance to see us. I have six minutes with you, I can remember the meds that I wanted to ask about, the thing I read on the Internet, don't forget the list of questions, there is an urgency on the part of the patients because they are paying a lot of money in insurance, and then again, we're walking in and we're paying a lot of money in insurance as well. When we're dreaming in medical school of the kind of doctor I want to be, "defensive" isn't on our list. Already it's intruded on the relationship, the economic and the legal aspect of medicine, instead of just the spiritual and physical relationship. So the patient comes in with that, and we come in with that and so already we're concerned about, you know, the economics and the legal issues that might face both of us.

>>Charles Schmier:
By the time you finish eight years of college training and three or four years of residency training, and you've seen your friends get their Bachelor's degrees and acquire jobs and start raising families while you are still in school in the library, the last thing you want to do is worry about coming out and losing everything that you've worked so hard for.

>> Maura Mahoney:
In a lot of ways we're taught to leave our fallible humanity at the door, do you know what I mean? And you are a perfectionistic scientist when you walk into the room and a lot of people read that as uncaring. There isn't that intimate relationship of patient and doctor anymore. We don't have extensive relationships any more with continuity of care, so you don't know the physician standing in front of you. So we get very used to being very cold and walking into -- you know, very systematic in approaching patients. We also learn to let our guard down and feel like you know what, this is still a patient-doctor relationship.

>> Michael Grant:
Larger social issue, are we chilling potential doctors with medical malpractice?

>> Robert Cannell:
Yes, we are. Arizona is getting a bad reputation as far as being doctor unfriendly where malpractice is concerned. Obstetricians are leaving the Tucson area, which has a huge rally down there on that issue. We've lost the ability of family physicians in southeast Arizona to get malpractice in order to deliver babies, even though lay mid-wives can deliver babies, general practitioners cannot.

>> Michael Grant:
Are we chilling or should we care?

>> Bill Brotherton:
Well, the evidence we heard in the judiciary here earlier was that we're actually below the national average on the average cost of malpractice suits, and the average number of suits, and I don't think -- and that was from MICA, the insurance company. So I really don't think that that's their chilling effect here. People do have to be accountable.

>> Michael Grant:
Senator Brotherton, thank you for being here.

>> Bill Brotherton:
Thank you.

>> Michael Grant:
Senator Cannell, thank you for being here.

>> Robert Cannell:
My pleasure, Michael.

>> Michael Grant:
For links related to tonight's program, please visit the web site, that address is www.azpbs.org, and click "Horizon." You can see transcripts of "Horizon," and find out about upcoming topics.

>>Mike Sauceda:
A bill that would extend tuition tax credits to corporations is making its way through the legislature. The tuition tax credit is used to fund private school tuitions. Also the legislature has sent to congress a resolution urging it to start the process on a constitutional ban on same sex marriage. We'll discuss those issues Thursday at 7:00 on "Horizon."

>> Michael Grant:
Thanks for being here on a Wednesday. I'm Michael Grant. Have a great one, goodnight.


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