To the Editor
Dr. Moss’s description of the battle to introduce standards of practice in New Jersey (June, 1989) is fascinating. In his article’ he repeats what others have said about the effect of the application of standards of care in Massachusetts: that is, since they went into effect on July 1, 1987 there have been no anesthesia-associated deaths. Unfortunately there is no evidence to support the implication of cause and effect.
There is some indirect evidence of a sharp fall in mortality between 1955 and the end of 1983. Our insurers (the Joint Underwriting Association of Massachusetts or JUA) tell us they have received no claim arising from incidents after July, 1987 in which the standards were applied and the monitors were used. But the period between January 1984 and June 1987 has not yet been studied and no valid before-and-after comparison can be made.
The malpractice premium discount offered to JUA-insured Massachusetts anesthesiologists resulted from two separate occurrences. The first was the leadership displayed by Massachusetts anesthesiologists in developing and applying risk management techniques. 5,6 The second was the early finding of the ASA Closed Claim Study which showed in retrospect that 29% of anesthetic deaths might have been prevented if certain standards of care and monitoring had been in use.
The JUA believes that adoption and enforcement of practice standards for all specialties will reduce the frequency of claims, and they are using the discount for anesthesiologists as a carrot to dangle in front of some reluctant donkeys. The New Jersey insurers may be correct in taking a wait and see position on premium reduction.
Gerald L. Zeitlin, M.D. Lahey Clinic Burlington, MA
- Moss E. New Jersey enacts anesthesia standards. APSF Newsletter 1989;4,2:13-18.
- McGinn PR. Practice standards leading to premium reductions. American Medical News 1988;31,45: 1.
- Brahams D. Anaesthesia and the law; Monitoring. Anaesthesia 1989;44:606-607.
- Zeitlin GL. Possible decrease in mortality associated with anaesthesia. Anaesthesia 1989;44:432A33.
- Eichhorn JH, Cooper IB, Cullen DJ, Maier WR, Philip IH, Seeman RG. Standards for patient monitoring anesthesia at Harvard Medical School. Journal of the American Medical Association 1986;256,8: 1017-1020.
- Zeitlin GL, Cass WA, Gessner JS. Insurance incentives and the use of monitoring devices (Letter). Anesthesiology 1988;69:441.
Editor’s note: Dr. Zeitlin’s letter was received prior to the announcement of the malpractice insurance premium reductions in New Jersey and Texas