Iowa patients are suing their doctors for malpractice half as often as they used to, which has helped drive down malpractice-insurance premiums for many physicians. Doctors speculate that malpractice lawsuits are becoming rarer because they have cut down on medical mistakes. But plaintiffs' lawyers say they're filing fewer cases because it's become more expensive to press lawsuits.

Despite the decline in cases, the two sides continue to debate whether malpractice lawsuits help drive up health care costs. Doctors say they still worry about being dragged into court over bogus accusations. Lawsuit fears still lead some doctors to order needless tests and procedures just to prove they've done everything possible for a patient.

Defensive medicine can add pointless costs, which taxpayers and health insurance customers pay. Some cases are difficult to prove Debbie Haus of Des Moines was surprised to find out how hard it can be to press a medical malpractice lawsuit.

Her father, Leroy Brown, 68, came down with a dangerous infection in his left arm in December, a few days after he had an intravenous catheter placed in the arm at a Des Moines hospital. Hospital staff members kept the catheter in his arm for days, even though he didn't receive intravenous treatment through it, his daughter said.

Haus has photos showing how grotesquely swollen, red and blistered her father's arm became after he returned home. The infection caused pain, a high fever and weakness, she said. Brown fell to the floor in his home, and he might have died if her cousin hadn't found him, she said.

He was taken to a different hospital, where doctors managed to fight off the infection with strong antibiotics, but Brown still faces months of rehabilitation to get his strength back, she said. After the family complained, an administrator from the first hospital sent a letter to Brown saying, “I regret that the experience ... was not positive for you.” The hospital offered to cover any out-of-pocket costs Brown faced for his hospitalization, but nothing else.

She asked a lawyer to look into a possible lawsuit. “He said we could probably get a judgment, but it probably wouldn't be as much as the cost of the case,” she said. Her father suffered no permanent damage, and because he's retired, he couldn't seek reimbursement for earning capacity.

The number of medical malpractice lawsuits dropped by nearly half from 2002 to 2009, state court officials say. Just 171 were filed last year, compared with 335 in 2002. Tim Semelroth, a Cedar Rapids lawyer whose specialties include medical malpractice, said he declines cases that he might have taken a decade ago because they've become too expensive. A complicated case could cost $50,000 to $100,000 to bring to trial, not including the lawyers' time, he said. Such costs usually are borne by the plaintiff's lawyer, whose odds of winning are less than even, he said.

The only medical-malpractice cases worth filing are those in which an error clearly caused a death or a permanent disability, he said. Mistakes that caused temporary suffering, even if it was severe and life-threatening, generally don't lead to big enough payouts.

Doctors are glad to see the drop in malpractice suits, but they disagree with plaintiffs' lawyers about the cause. Leaders of the Iowa Medical Society, the state's largest physician group, credit a nationwide effort to improve patient safety. The safety effort gained steam after a 1999 report from the federal Institute of Medicine, which estimated that 98,000 Americans were dying each year from preventable medical errors.

Midwest Medical Insurance Co., which insures nearly half of Iowa's physicians, said it has cut premiums or held them steady for the past six years. It also has refunded more than $25 million in excess Iowa premiums since 1994, and it expects to refund another $2 million this year.

Company Vice President Libby Lincoln said the drop in malpractice lawsuits has contributed to decreases in malpractice insurance premiums. Payouts in successful lawsuits have gotten larger, but the declining number of such cases has significantly lowered the risks for most doctors, she said. In the past five years, she said, Iowa physicians insured by her company have seen their malpractice insurance premiums decline by nearly a third.

Urbandale lawyer Marc Humphrey, who specializes in bringing medical-malpractice cases, said the public has heard for years that such lawsuits inflate everyone's health care costs. He doesn't believe the argument, he said, but many Americans do.

This is part of an article that originally appeared in the Des Moines Register. The entire article can be found here.