The following statement was developed by the American College of Surgeons (ACS) Legislative
Committee and was approved by the Board of Regents at its October 2014 meeting.
Statement on medical liability reform
The nation’s medical liability system is broken; it fails both patients and physicians. Less than
3 percent of patients who sustain medical injury
sue for monetary compensation, and in 37 percent
of all closed liability claims no error was discovered. 1, 2 In addition, the current liability system
costs the U.S. an estimated $55.6 billion annually
(including $45.6 billion for defensive medicine). 3
The system is costly and inefficient, and the process of compensating injuries related to medical
errors is inaccurate.
The mission of the ACS is to improve the care of
the surgical patient, safeguard standards of care,
and create an ethical practice environment. 4 The
ACS is a proven leader in patient safety through
initiatives such as the ACS National Surgical Quality Improvement Program (ACS NSQIP®) and the
Inspiring Quality campaign. 5, 6 The failing medical
liability process jeopardizes the public’s trust in the
health care system and threatens to undermine the
successes that the ACS has achieved. Therefore, the
ACS must continue to lead the way by advancing
practical reforms that improve patient safety and
provide quality health care.
Traditional liability reforms, such as caps
on noneconomic damages and collateral source
reform, may have market-stabilizing effects. 3 The
ACS has long supported these reforms and will
continue to do so as a means of addressing sky-
rocketing liability insurance premiums. Howev-
er, for decades, attempts to generate bipartisan
political support for new tort reform have prov-
en challenging, particularly at the federal level.
In addition, reforms that focus on alleviating the
financial impact of medical liability on health care
professionals frequently do little to improve patient
safety or to re-establish the trust patients place in
the system. 3
Beyond traditional legislative remedies, the medical liability system is in need of transformative
change that focuses less on monetary reparations
and more on the ACS mission centered on patient
safety, quality health care, and provider accountability. 7, 8 Adverse events should be approached with
open communication and recognition that an unfortunate outcome is not synonymous with negligence.
Compensation for injured patients, monetary or otherwise, should be fair and timely without the unnecessary delay commonly associated with the current
tort process. Hospitals should pursue system-level
changes that assure patients of quality care and that
prevent event recurrences. Ultimately, negligent
providers should be held accountable.
Alternative, patient-centered solutions to liability
reform have received varying degrees of attention. 9, 10
Health courts, enterprise liability, and alternative
dispute resolution can be crafted around patient-centered principles and also provide excellent opportunities for reform. 9, 10 However, on balance, disclosure
and offer programs, otherwise known as communication and resolution programs (CRPs), show the
most promise for promoting a culture of safety,
quality, and accountability; restoring financial stability to the liability system; and requiring the least
political capital for implementation. 11, 12 All of these
alternatives may be improvements over the status
quo for both patients and providers and should be
explored through additional research and advocacy.
Structural barriers to their implementation, however, such as obsolete reporting requirements to
the National Practitioner Data Bank (NPDB) and
inconsistent apology protections, must be addressed.