The MacNeil/Lehrer NewsHour

erb says are i'm up on july i'm a newsmaker interview with a defeated president of nicaragua daniel ortega the criminal indictment against the exxon corporation and medical malpractice all tonight on the macneil lehrer newshour oh

the pope good evening leading the news this wednesday nicaragua's sandinista government declared a unilateral cease fire in the war against the conference the supreme court issued two rulings expanding police search powers of the space shuttle atlantis were successfully launched after five attempts we'll have details in our new summer in a moment after the news summary kwame holleman interviews the defeated president of nicaragua daniel ortega we have a debate over using criminal charges against corporations such as x on the debaters are lawyers robert adler and richard sat and then through the use of a new report on medical malpractice there those of new york state health

commissioner david axelrod and lawyer dr harvey waxman funding for the newshour has been provided by at and t he at and to connect and equipment working on computers to communications at it like sure and by the john d and catherine t macarthur foundation a catalyst for change and by pepsico and made possible by the financial support of viewers like you and the corporation for public broadcasting nicaragua's sandinista government today declared a unilateral cease fire in the war against the us backed contras president daniel ortega said the decision was made to achieve the immediate demobilization of the country is in an exclusive interview with the newshour mr ortega was asked by

correspondent call a moment what would be the consequences of the countries did not despair as a focus on the city and so in their place that's extremely serious because that threatens all the security of the entire country typically the political appointee of the peninsula physically laws laws on president i'm going to take whatever measures are necessary in order to do ensure the defense us are our country and the security of each and every city is reason impossible because the alternative would be a civil war we will have the full interview with mr attack after the news summary at a news conference president elect electrician morrow joined our data and calling for an end of hostilities she said the causes that started the civil war have now disappeared and appeal to the contras to return home they select a country spokesman in honduras said his fighters are ready to discuss this weakness is tomorrow

spokesman alejandro severe go cautioned that without us here there is no one to insist that ortega step but under the right conditions we would demobilize center there are believed to be ten thousand us backed rebels based in honduras in washington secretary of state baker said today that the united states agrees the country should be disbanded he made his comments before a senate committee in march of nineteen eighty nine we specifically stated that our policy was to encourage the voluntary reintegration of the resistance under safe and democratic conditions those conditions we think are now rapidly being created we think that with goodwill and with the support of the international me at the un the oil as another suit this issue can be resolved and we think it will be resolve the war is over mr chairman in nicaragua president bush called soviet president gorbachev this morning to discuss the nicaragua situation and other matters was divorce at the conversation lasted about forty minutes he described it to reporters aboard air

force one on his way to a political appearance in new york it's morning edition why not he's been in iraq this week the president said he agreed to joplin to continue such one on one consultations in the us supreme court today ruled on two right to search cases the court approve the search of an armed robbery suspect maryland hold they said no search warrant was needed because there was a

reasonable believe a dangerous person was hiding inside in the other case federal agents also without a warrant search they suspected mexican drug dealer's home in mexico the justices again said none was needed because the us constitution's ban against unreasonable searches does not apply to non americans outside us borders also in washington today dc mayor marion barry pleaded innocent to eight counts of cocaine possession possession and lying to a grand jury a us district court judge set a june fourth trial date the nasser corporation has pleaded guilty to falsifying test data on two weapons systems sold to the us military the defense contractor admitted giving the government false information about defective parts with a cruise missile and harrier jet not have agreed to pay us seventeen million dollar fine the company is also under investigation for fraud in its stealth bomber program the space shuttle atlantis began a

secret military mission that day it blasted off from cape canaveral florida just before three am eastern time flight path ahead of the east coast has reportedly seen as far north of washington dc five previous attempts to launch the shuttle more shrub or whether computer problems and mission commander john creighton skolnick the crew's expected to remain in space until sunday primary mission is believed to be the deployment of a spy satellite us government they revised its latest figure on economic growth for the better the commerce department said the gross national product for the last quarter of nineteen eighty nine grew by nine tenths of a percent instead of the initial estimate of five tenths of a percent it's still slowest growth rate in three years it brings the gnp increase for all of nineteen eighty ninety percent compared to four point four percent the previous year sylvia parliament today approved a new law allowing individuals

police farmland farmers will also be able to pass on the leases to their children the law as part of president gorbachev plan to restructure the nation's iconic it over turns the longstanding socialist policy against private land years but the sale or out right ownership of land will still be barred under the new law and that's it for the newshour tonight now it's on to president daniel ortega of nicaragua criminal charges against exxon and a new medical malpractice report we begin tonight with a newsmaker interview with nicaragua's outgoing president daniel ortega <unk> ortega and the woman who defeated him on sunday violeta chamorro have begun negotiations on a peaceful democratic change over of power which would be the first to nicaragua's history a major stumbling block is the fate of the anti sandinista crime shows the rebel group financed by the united states earlier today correspondent

coming home and talk to president ortega in managua the interpreter was alejandra been done yet the secretary general of the nicaraguan foreign ministry thank you for being honest for you surprised by the election results didn't know any time before and the automobile against well this is an image of an election to have to consider the possibility that you know the whale did what i thought we could reach a majority people have been homeless why do you think your party

people have two options before the procedure which was saying that everything was going to get better until the senate and obama basically having the same as they are though that jose rosado and the people of course have been strong pressure on account of american policy or particularly on things in their economic tour and in social causes we'll have there they'll look different but what they what they said was that they would all know a problem that hasn't been able to sell candy so as a book and that what explains why the vote when we did it

thank you that eventually these are now their demands of the opposition of the biggest political party in general is for the record and the demands that have to do with the bases of the revolution i think in like the us about this law similar to have to be a consensus that these fundamental basis of the revolution should not be altered because that would be all time democracy democracy is strong i work for a primary most important moment in the summer

a lot of that in the agrarian reform for example and so having the bank and natural resources enough in state hands is officially it was in early nineteen eighteen people <unk> they live and supposedly they have to respect the professional character and the institution maliki out of the army and the ministry of interior and i know you know that state employees should not get fired whole scale of what these and were made up parts of their platform and today we're is it reasonable for loses tomorrow to call for the ouster of their brothers had a bit

of a legitimate way into well he has the right to speak out and to and to take a position but of the delinquent the boxes you must also take into account the realities that have come about our over the last three years and the changes that have taken place in a lie at the president and the revolution or haven't been able to achieve because it's meaningless so she should take into account those elements of the revolution which paint which different sectors consider vital to feeling secure so in essence you would accept the ouster of military and political down into the army and all

of the visiting reporters to be involved in the wrong position the man the negotiations for the transition are taking place on the unintelligible and this is well into some of his subject matters that have to be covered president and the president accepted the results the reason to do this you

gave them to go and says all this is a legend among the violence in unusual but in addition to that this young innocent but there was that there's no denying reality that the holy cow was under siege by us pressures us sanctions you us policy secular jonathan so alex's did take place but in very extraordinary special conditions and as citizens of the us elections with a gun to the heads of all of the people in that i didn't know it was a gun that took the form of a dnr michael barr are of us policy and of the whole lot of elections that took place under you shut in well below in boston so you're saying to people if you don't and the

economic sanctions are going to continue in this agreement there was a little bit hesitant about what the soviet union's done and it has to be respectful of the sovereign decision of the macau listen to the political ads in london milan and they were respectful are taking up the challenge of realizing undergoing elections under conditions that were extraordinary events in many cities were neither fair nor just conditions for the sandinistas fought on the political scene of the crime and then in that sense that people had not much of the range in which to choose did you believe them when a social thing you know it wasn't a book that this was forty four that the people did have the right to put forth their choice but the act is that the context with these elections took place was one

called having gone to alter the head of every now secretary geithner said that the countries should disband uses virtual happen will respond that that you will not disband inauguration government that's extremely serious because that threatens all the security of the entire country in korea meanwhile your logo on this show today well ok well in the community but it certainly says and that it's a burden that isn't clearly and indeed it's contrary to the decision i just i've just taken to order

a cease fire in order to facilitate the disbanded of this mobilization on the corners so that they can come come home so that indeed we can have these interim quality by april twenty fifth which the transition ms lisa waited until it is that paulson on board when there are the prisoners of a minute there is an agreement by among the central american presidents that has been abided by by nicaragua but that has not inspected by michael that's silly the new abortion we will tell before the incident and then there is the security which we must insure all those people that voted for the fence on the ocean and that's indeed amassed over forty percent of the electorate is a sin and they feel

threatened by the country and we think of the vote you know especially now that the opposition is as the victorious think that we have to ensure security for these people that is a very important issue i think can that be negotiated and it is and if it is not negotiating on your side you will you take the kinds of actions are also says what many with country and government id ing going on local pacific over the political appointee of the peninsula physically laws laws on president i'm going to take whatever measures are necessary in order to do ensure the defence our country initially opposed the security of each and every says it was impossible

because the alternative would be a civil war in yemen there the us and indeed it would be terrible and one we have made so much progress it is feared that this shouldn't really be confronted with at the pinnacle of the forest look at it in those ways because almost all the guy once have to join hands along the honduran government along with him and states but it is a visible an order to peer at this point a matter one simple you have asked for no further offensives against the country's if the content should be involved in and some of the incident sometime tomorrow you saying that you would take action that day this is

a little intimidating about a business as of this morning what we have done has ordered our troops to hold any offensive operations in order to allow the pointers to demobilize peacefully louis simo so it's a political but they are and it but if they choose not to the more was well then i will have to take up the bills because my obligation is to ensure the safety and security of every day and that issue of demobilization and when the only moment where most successful of a totally improper because it under the existing well we feel that has to take place before april twentieth if there is some giuliani supporters lauren the streets from both sides

agree that the protests escalated into something you hear that there's that recent employment and that is a good answer in that you know here in lies the importance indeed all of the talks that are going on between the respective transition teams on our part of general administrative france and on the other part right and yet so when bear the item in addition to the future of the interior ministry of the army are being dealt with because this is something that which on the island's have a stake in because they these institutions private security firm

when will the negotiations begin peace talks well the talks began yesterday it was it was a little seed we we published a statement saying that they have begun to that and that the respective transition teams that have been along and they're trying to continued meeting regularly on the media coverage is to ask us to walk to act was flexibility with realism with maturity now are asking them to ask him to actively lose and flexibility and maturity when some look at the events in eastern europe sunday's election year and it's been said that there's an anti

marxist anti your response but anyway there's been no anti marxist time here this day reaction here too or to the crisis that has been imposed by the united states it includes a minute this is in the book because you have to take into account that the friends and the news that continues to be the strongest and largest single political party which is a far different situation from what you have in eastern europe there's no significance imitating

piano we end our relations with cuba we have party we have already departed relations as we do with the number of parties in london as we do have a room with members of the socialist international now i can i guess they a levy on the attitude that the end that the cuban government is going to assume with respect to the newly confident were you personally sudden and this guy's your results for you for your own relationship with the voting a four month old bbc yes it was a difficult situation and always been convinced that there

was a real risk of losing the election in my book i think you know that and what's really important here is not one of them and part of that is the important thing was that the elections did take place on the island and that those elections should be free fair and clean is a little slivovitz and we sounded nice does manage to accomplish that what is the political future for the withdrawal of the city and i continue to be with the people with the ferguson is that no but i'm not going to be working on the bases and we're going to govern from below six and to defend what we have won the revolutionary conquests to demand that will comply with those programs and said it's going to do on behalf of the people

and the law will impose we will support everything in the government that is geared toward the national interest for the people's interest you said that we leave the scene victorious people have failed again and gives an overview of the flint why kennedy was ill and that at a certain point because the son is the defenders on the news that never sought out to create a one party state and cases and there were elections in nineteen eighty four was a buzz at the moment but these in nineteen ninety where even more power it

is indeed aren't are we were put to the acid tests our commitment to democracy and the best arm and the animals the test that the proof that we've met this test was on was the election and the results are actually went out today to everyone that they will be in the nineteen eighties okay so you see if we have won the elections it would've been those of the offer on that there have been intimidation they're but now as a result of their own these election results what you have is indeed is the case the cancellation marks and to vernon says he's still ahead on the newshour inviting

exxon and medical malpractice now the criminal case against the exxon corporation it was broad yesterday in anchorage alaska and a five count indictment grine out of last year's alaska oil spill it charges exxon with willfully and knowingly allowing and lice and employees and others known to be physically or mentally and capable to operate the tanker exxon boundaries the company said yesterday it will fight the charges in court if convicted it could be fined more than one billion dollars exxon also faces more than one hundred singles it's neither exxon or the justice department accepted our invitation to debate begins tonight in their stead are two lawyers who disagree about the wisdom of filing criminal cases in such matters robert adler is a senior attorney with the

national resources defense council the nrdc filed court papers to oppose any plea bargain for exxon richard samp was chief counsel for the washington legal foundation mr adler is exxon deserve to be treated as a criminal in this matter absolutely our congress has seen fit to provide an hour laws that corporations can be held criminally accountable for environmental pollution and this was one of the major and most damaging pollution pollution incidents in us history and they ought to be held accountable normally a criminal cases based on no malicious intent or whatever do you believe that that is a cave in the case and now in and in the exxon case well i don't think that exxon deliberately intended to spill the lesson million gallons of oil into alaskan waters but it was clearly a highly negligent operation that allowed this to happen and that allowed it to be cleaned up and almost not at all and if you drive a

car negligent way until someone in the eye process you are held accountable and a corporation should be is held as accountable as you arrive sound is exxon a criminal case earlier or not we would certainly agree with mr adler that's important that exxon be held accountable if in fact it's been negligent in this case but the proper way to hold them accountable as to bring civil actions against them where in the context normally used in and matters of negligence their conduct can be judged criminal liability is wholly appropriate in cases where simply negligence discharged why isn't well first fall because we have a and understanding our society that when someone is branded a criminal that they are being branded as somebody who has done something extremely wrong they need to be marked as as someone is highly probable and i don't think that's true in this particular case secondly the implications that any corporation or any corporate official who was convicted of a

criminal charge are very huge in terms of the ability of a corporation to survive after that when we think that the punishment doesn't fit the crime but rather what about this criminal intent business normally when somebody is accused of world burglary is really date on the grounds that they intended to commit the murder and they intended to burglarize anyone you can see in this case the exxon did not intend to this building or what's the difference here well there are many analogies and criminal law where we punish people under criminal statutes for conduct which is not malicious or not deliver and if you negligent we run a red light and you kill a pedestrian in the process then you can be prosecuted for involuntary manslaughter for the criminal law even in one of the volunteer obviously the role of the person of the red light that's right and the point is that we are punishing irresponsible conduct that we're deterring that person and anyone else in

society from engaging in such conduct know exxon was recklessly operating a kangaroo holding fifty million gallons of oil and dangerous waters they should be held accountable just as you or i would for in such conduct driving an automobile there's dissent is that not a good analogy between care was reckless driving of a car versus care was reckless driving a tank i don't think so because for four talking about criminal charges against a corporation and in the case of a corporation you're not an assembly at a corporation to jail was just a matter of how really are going to be fine and in this particular case exxon is certainly going to be deterred from any negligent conduct in the future they've already spent more than two billion dollars in the cleanup effort they have paid compensation of close to two hundred million dollars to residents of alaska including the fishermen there they are the subject of hundreds of civil suits that have been filed against them so i think it's a little bit naive to suggest that there is there is no trends in the case of a precedent for this kind of action the stroller that

david environmental disruption of this kind that could result in criminal charges were there was not a criminal intent to begin with certainly there are when the ashland oil company and spilled well into the ohio river two years ago the federal government brought criminal charges and now successfully settled that case let's talk about that notion of bringing criminal charges against the corporation corporations in this country and argue all the time that they should have the same rights as individuals property rights due process of law if they have the same rights they have the same responsibilities as well and they cannot be held above the law and any more than an individual and yet in this case no individuals know individual executives aren't stories of actual were indicted just the corporation so there is a difference up until now no individuals have been indicted we think on as a matter of fact that the investigation not to proceed and if any individual corporate executives are found to be

individually responsible and it was thought to be brought against them as well well obviously a corporation can only actual individual so for the government to prove its case it's going to have to prove that certain individuals at exxon work were negligent so the anchorman so so that obviously the government by bring an indictment against exxon believes that there are people who are criminally negligent out there i think that if the government realizes that it would be bad public relations to indict the lower echelon exxon employees who would be probably the ones who would have known something about the exxon valdez east and since this case is probably all a local show to begin with they realize that it was better just to leave it at the corporation a political show the gunman twenty min well seems to me that this administration has made it clear that it wants to be top and the perceived to be tough on environmental corridors and they have been pressured by environmental groups to bring

crime mr adams exactly to bring criminal charges in this particular case and they realize that if they fail to do so they would be charged with traveling and why mobile apps you remember the motivations here we did not bring any direct pressure on the justice department to convene a grand jury what you should remember is that it was a grand jury of citizens like you and me they decided that it was appropriate to bring outside the justice that was not true of pressure for invertebrates what does talk about the message that this indictment will allow come out in the wash and the corcoran as to whether or not exxon has finally found guilty because indictment itself a message to listen to american business an industry veteran the message in an appropriate message of that that is that we will not tolerate conduct that causes severe damage to our natural resources and a new message that is a new message in the magnitude again there had been other criminal

indictments and we would encourage the justice department to pursue this indictment aggressively to send that message very forcefully which are due to the message here i would agree that that's the message and i think it's an unfortunate one it seems to me that all the sudden this country it's become fashionable to see environmental preservation as the sole goal of issues that affect the environment i think that that's an admirable goal i think to preserving jobs also an admirable goal if we continue to penalize american business the way that this administration appears to be starting to do we're simply not going to be continue to be competitive in the world market and it seems to me that we are the inevitable result is we're losing jobs in this country let's be realistic here an exelon corporation posted major profits last quarter despite the accident despite the amount of money it spent on the cleanup we're not a texan out of business were not put a single person out of a job but we will send a message to the corporation and its shareholders that it wants to make a profit

it has to do so by embodying the law you agreement to sample only rumors traveled a well this is it is huge and it's a it's a magnitude has still not precedent shattering that there have been similar cases brought some are criminal cases broughton and there have been similar cases most of them have been in recent years and that's what are notoriously i assume that rudeness or another that exxon has not to be put out of business by this particular case but some of the companies who are being charged criminally and in recent years are being driven out of business there's a client of our organization who whose crime was removing rubbish from a dump replacing the holes with that clean filtered and he's now facing a three year jail sentence for this in his auto repair business been closed down and those of the benefits of the particular thing those kinds of cases where you messed around with the sign could get out and what worries me is that despite many years of civil enforcement of environmental laws we still have widespread noncompliance and to give you an example according to the general accounting office a recent study

four out of every ten industries to discharge toxic waste into the nation's sewer systems are violating their discharge permits despite civil compliance obviously we don't have enough deterrence and without that sort of action corporate america is not getting the message that asked to comply with environmental laws you think this sends a message though on those kinds of cases is well i think it does to all corporations who are responsible for complying with pollution laws if pursued aggressively you're concerned this episode they it sounds of almost a mason a message to the bad guys were also sends the wrong message to the good guys as well exactly and that seems to me that as a stable for that that is not a reasonable environment in order to allow businesses thrive in this country that i would certainly agree that there are harbin circumstances under which criminal laws should be enforced for example since neither the company that goes on in the middle of the night and takes drums for toxic waste and johnson

apart and does so knowingly and intentionally that serve corporations ought to be inviting but we're not talking about the kind of case here we're talking about a corporation which had no intention of spilling any oil did so perhaps through its own negligent and now they're finding themselves in a criminal court judge sent the stragglers adler thank you north koreans think i it's denied new facts and the new debate about medical malpractice a major study released today found the thousands of hospital death and tens of thousand as of injuries each year are the result of negligence of the relatively few victims ever file malpractice claims and courts the study conducted by harvard researchers examined one state new york but drew conclusions with implications for malpractice insurance system nationally was that it was based on new york hospital patients in nineteen eighty four it found more than twenty seven thousand patients were treated negligent

negligently in hospital six thousand six hundred and thirteen deaths were due in part to negligence but only one in eight of the patients injured by negligence actually sought compensation and file malpractice claims these figures feel an already heated debate over what can be done two cup malpractice insurance cost and improve medical care president gore spoke last week the doctors at johns hopkins university about the impact of malpractice lawsuits on medical care and i ask you today to avoid the understandable urged to practice defensive back in medicine or doctors fearing litigation too often dictate treatment it is unnecessary or the threat of lawsuits threatens the very research that is so desperately needed to save lives and in return we've got to restore common sense and

fairness to america's medical malpractice system restoring common sense of the system is the subject of a proposal in this week's new england journal of medicine the article calls for implementing a no fault malpractice insurance system the no fault system would take cases out of court rooms and set up expert panels to compensate victims which you're not a reaction to today's study and the debate over the no fault solution proposal dr david axelrod is the new york state commissioner of health e commission the harvard report released today and is one of the leading proponents of the no fault insurance solution ivy waxman is a physician and practicing lawyer is president of the american board of professional liability attorneys is on the faculty of brooklyn law school at the university of south florida college of medicine dr axelrod what is a surprising finding in your in your study the large amount of negligence or the small amount of claims i think is rather the small all of klein's a previous study done in ski at stanford down

probably ten years ago identified roughly the same percentage of adverse events that is injuries to patients that occurred that would lead us to believe at least that the number would be a partially to sign the reserve a concern which i have with the data that are being present and that is that this is an extrapolation from the review of some thirty thousand charts over two point seven million discharges in nineteen eighty four so to say that numbers of thousands of individuals who were identified as having died represents an extrapolation from one thousand one hundred cases in which andrew was identified in the harvard study yes it's like it's like a porno that were just taken a sample and you're saying that represents the reality is correct like what one sample poses or pick up why do you believe there are so few malpractice claims arising out of so many cases of important i think in many instances the patient is not aware of the fact that a nemesis has been committed i think that there are difficulties in accessing what is otherwise so identified as an official system would respect an individual person i don't think that the average

person believes that there's much chance of success an individual who comes from a lower socio economic background may not feel that he has the wherewithal or she has the wherewithal to pursue a malpractice suit there is no clear indication of that our system is geared to one of social responsibility will respect the payment for medical injury and it reads it it leaves more to eight an event and that looks like entering a lottery with respect we return with a medical malpractice suit do you share president bush's believe that fear of malpractice claims fear that doctors hold a malpractice claims is distorting the medical delivery system yes i believe that there is a distortion the ticket which is occurring i think it's occurring in a number of different areas the most important of them made in fact be the unwillingness of physicians to participate in peer review of their own colleagues that fear i think has removed an important element of maintain the quality of health care within our institutions without full participation of physicians it is not going to be possible to have a full

review of what happens and the manifestation of quality that we would like to have i do believe there is a cost impact associate with the practice of defensive medicine i don't know what it is it's been estimated to be five percent or ten percent or fifteen percent in various studies how does that come about doctors because of their concern for their ultra testimony an event that they should be facing a malpractice suit attempt to go to the nth degree with respect to the ruling out of diseases there is a an error of commission in many instances with respect to reaching the ninety nine point nine percentile in terms of likelihood of a given disease by some very expensive test so we have a broad parliamentarian of diagnostic test a valuable procedures that are available to the medical profession and the physician may choose to utilize one or many of them or all of them an effort to assure himself that he is not going to be subject to litigation by virtue of his failure to have done a single test okay we'll come back and in a moment where dr waxman do you dispute the

findings of a survey i think the survey's findings of enormous amount of malpractice country is true i think that there are numbers of physicians or alcoholics drug addicts psychiatric wing thick with him a seven to nine percent with thirty to forty thousand positions in this country and then obviously that would cause enormous amount of malpractice which does car courses country and a huge trap wait those numbers that comes out to about a hundred thousand people a year die because of malpractice and hospitals alone this was a study of hospitals not even doctors offices and hundreds of thousands of people injured the reason for the great disparity between the numbers of lawsuits and the numbers of over halperin now the bell practices clear it's to the deception in for practice by physicians and hospitals in this country misleading patients that they do not know him and misrepresent the true hosts anna wholesale manner by physicians so that they cannot find out what exactly characters also changing

of records forgery that goes on on a national level that's a significant as well but for those patients who do find out and do know are suspect there's been a practice doctor axelrod said they don't play him because they think they're throwing themselves into a lottery it's not so first of all those people who are significantly injured or in fact were injured that's ok when the cases because the meritorious in our office we just heard before from backpacks weren't very few wins by patients not so in our office when the ninety percent of the patients who come to us are we actually bring a lawsuit for what we went and the enviable although we only take about three percent of those patients were actually caught a core contact our office an attempt to embrace it do you agree with dr axelrod and the president that doctors fearing malpractice are practicing defensive medicine and that that is raising the cost of health care that's absolutely untrue that's something that's been propagated by medicine and also obviously missile the president into thinking that there are so much

defensive medicine are there is not an essentially the only defense because at no test that does not help a patient or at least find a diagnosis or help elucidate with the diagnosis for that patient in no way assist the position of defending himself and the truth of the matter is that most malpractice is not true that the ninety nine percentile past but is due to three things as wanda position not showing up to authority not seeing the patient and evaluating rather than over the phone or showing up some other time to his not taking a proper history which takes time to evaluate a patient and eighty percent of diagnose a bit of history and three is not doing a proper diet physical examination seventy percent of war malpractice case across this country due to a physician not showing up navigate taking a proper history exam and if you look at that i think any patients entitled to those things and not due to some test that somehow he didn't do those deer those cases we have wide experience we've written three violins in the area but it's not so do you say it's not so bad but

you wouldn't agree with a cartoon with it with a set of folk wisdom thats in the cartoon in the new yorker recently where doctors saying and the patient well i think it's just a common cold let's run a full battery of tests just to be sure no because that's just not true again that's misrepresentations that a lot of things in history as you're aware of that have occurred and knowledge that's pushed around and really stated when in fact it's not true that the truth is that there is no great defensive medicine on the defensive medicine that does exist which i do agree with is when a physician spends more time with his patients talked to many exams over a longer period of time and therefore can see us through patients per hour and therefore there's a cost to that position because he can make as much money but it's certainly not do the testing quite different points of view on this now you are in favor of replacing the present system with a no fault system can you explain briefly how that would work and why it would improve same well and i think of the first difficulty is that even talking about the harvard study dealing with medical malpractice harvard study did not do with medical malpractice a harvard study dealt with medical injury and the nature of that

injury any extent to which negligence was responsible for that injury only one percent of the cases that were injured that were reviewed by the harvard study demonstrated negligence so that what we have tried to do is to define our terms a little bit better or we are concerned with a social system which provides justice to those who are injured by virtue of their contact with healthcare system our concern is that the medical care system as a hazardous one in terms of your entry into that system because of the nature of the interventions and that there is a distinct possibility for injury the no fault system which we're proposing would have a mechanism by which individuals would be paid on the basis of the nature of that injury if there was causality established rather than for assigned to a given position it would not be necessary for an individual become a plaintiff within an adversarial system in order to be compensated for the injury which occurred who would decide whether nearby regional director alaska region there would be it would presumably be a pal of individuals will be expert with respect to the nature of those injuries it would work somewhere to workers

compensation where those who make decisions with respect occupational health we'll make a judgment that why would that be an improvement services because as it currently stands at harvard study demonstrates that only one in ten of promptly one in ten individuals who have been injured as a result of negligence ever receive any kind of compensation there is nothing to suggest that there's any equity that it's an effective system of respect to compensation for medical injury i think we have to do is to separate what it is we try to do are we simply trying to provide a small number of individuals with compensation that has no relationship to nature the injury big award as opposed to providing everyone who suffers an injury that a significant with a level of compensation that is relevant to the nature of it julie why wouldn't have been improvement on the second thing first of oil while it does is great community that's what they're really interested in the purpose of the study was not to say to him how they can compensate people that are worked again immunity i can point to virginia new zealand which has no fourth in virginia since

january first nineteen eighty eight there were brain damage baby sir jones and they going to compensate all these children the total number of children in two years and two months of uncompensated is your role in new zealand as a no fault system where a patient has to prove their case to wait an official of the government that just doesn't occur because they can do it one little comment about beckstrom mentioned in passing was the work was a show the work was asian means proximate cause under the law that is the most difficult thing for malpractice lawyer who's capable to prove in any case no patient will never be able to prove it by themselves are where you are in other words it's just giving adopters immunity because you'll never pay anybody because you know the doctors will never admit if they review themselves or the committee reviews the men never admit that it was no but we can choose two very different things we confused physician discipline and a terence with an equitable

system for compensation for medical injury of both third dr waxman i would agree that there needs to be a better disciplinary system i do not believe that there is any data that would suggest that the existing the practices that represents an effective deterrent that was one of the elements of the harvard study and i think that there is any presence of the tides it's very limited authorities have this system are proposing representative parents are now hardly any instances know compensation for damaged babies in under the virginia is no fault system and the inability of patients in new zealand under their assistant again india any admission about well there's i don't want to give the other systems because i think that there are complexities about the new zealand system which has been in place for fifteen years that in fact has not had an effect of the current system the virginia system has been in place for one year in which there's been any experience and i don't know that that's an appropriate time frame which to judge the effectiveness of the program what i think you have to do is to identify the fact that we have not yet

as good as we think we have them with respect oversight of positions i think that there needs to be a whole new or renewed in which we evaluate the effectiveness of the oversight of government the failures of the existing physician peer review process the failures of the hospital review process but i think that the most important thing of all that will challenge the effectiveness of an email practices that any no forces to meet will be the new information is emerging one of the major revolutions which has occurred is the availability of information with respect the outcome with respect to procedures within institutions procedures done by positions i am firmly convinced that it is the public it is the advocacy of the public is the public requesting information that is going to change the medical practice in the most imagine to weigh possible and uncertainty and that was the end of her time like uber for joining us light

again the major stories of this wednesday nicaragua's sandinista government declared a unilateral cease fire in the war against the contras on the newshour presenter ortega said at the countries refuse to disband he will do what is needed to defend his nation and after five previous attempts nasa successfully launch the space shuttle atlantis and i run village and that's the newshour tonight and we will be back tomorrow night and robert mcneill good night funding for the newshour has been provided by at and t at and he has supported the newer newshour since nineteen eighty eight to write short and by the john d and catherine t macarthur foundation a catalyst for change and by pepsico and made possible by the financial support of viewers like you and the corporation for public

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