Dr. Raskin is a neuroradiologist in Ft. Lauderdale, FL; Internal Legal Counsel for the Florida Radiological Society; and a Voluntary Associate Professor of Radiology at the University of Miami School of Medicine, Miami, FL. He is also a member of the editorial board of this journal.

We face a crisis in the United States regarding medical malpractice liability insurance. This is especially true in states that do not have a cap on noneconomic damage awards. The frequency of million-dollar awards in noncap states is well above the national average. California passed medical liability reform legislation in 1975 that caps noneconomic damages at $250,000. California's reform preserves the rights of those who have been truly injured. It has stood the test of time and now serves as a model for state and federal reforms. Several other states now have enacted similar reforms. Medical malpractice insurance rates remain relatively stable in these states, while they continue to soar in states without caps. Many medical liability insurers have left high-risk states, and several have stopped underwriting medical malpractice liability insurance entirely. Others set narrow guidelines defining the physicians they are willing to insure. Plaintiff attorneys claim the problem is not the jury system but bad doctors, greedy insurance companies, and a staggering stock market. That is not so.

In reality, the public has become desensitized to large sums, and no longer thinks of a million dollars as a lot of money. Sports figures routinely make several million each year with an increasing number making tens of millions. This is also fueled by the lottery winnings, as well as popular television quiz shows that can make someone an instant millionaire. Jurors seem to have no problem making someone a millionaire, even if they can't become millionaires themselves. The jury awards continue to increase, with the median award in the year 2000 more than $1,000,000. Settlement medians are significantly lower, making it somewhat more attractive for insurers to settle rather than risk greater exposure at a jury trial, not to mention the extra costs of defending a case to a jury verdict.

The probability of a physician being sued for medical malpractice in the United States is approximately one in four. The incidence of lawsuits has increased for all fields of medicine, including radiology. What is most alarming is the increase in the number of million-dollar or higher jury awards. From 1998 to 1999, approximately 45% of jury awards were a million dollars or more, compared with 39% from 1997 to 1998. The average jury award for medical malpractice more than tripled between 1994 and 2000, from $1.1 million to $3.5 million.

Radiology has its own special problem with liability insurance. While the average indemnification has doubled in the last 15 years for all physicians, it has tripled for radiologists. Larger awards for pain and suffering contribute to this amount. There is a growing hue and cry by the American public to limit the amount of jury awards for pain and suffering.

We now have a surgeon as U.S. Senate majority leader and a President who supports tort reforms. Radiologists must actively support the efforts of federal and state politicians at capping noneconomic damages. The time is now!