Maryland Injury Lawyer Blog

The FDA said yesterday it is looking into a possible association between Merck's allergy and asthma drug Singulair and suicide. The FDA has received reports of mood changes, suicidal ideation and suicide in patients who have taken Singulair. Trying to get out on the front of the curve with its package insert, Merck has previously updated Singular’s drug labeling four times to include potential risks of tremors, anxiousness, depression and suicidal behavior that has been reported in some users of Singulair.

To call Singulair a popular drug is an understatement. Singulair is Merck's biggest selling drug and one of the world's top selling medicines with $4.3 billion in sales. Singulair is also a leukotriene receptor antagonist. These types of drugs have previously been linked to suicidal ideation and suicide. Two similar drugs, AstraZeneca's Accolate and Critical Therapeutics's Zyflo, will also be reviewed by the FDA. Neither of these drugs have suicide warnings.

Singulair/suicide litigation just might be the next big mass tort. But I doubt it. Unfortunately, 40,000 people a year commit suicide and when you have a drug like Singulair that is used by millions, some of those people are going to take Singulair and commit suicide. Some will even take Singulair and commit suicide in close temporal relationship with the initiation of the drug which really leads people to assume that it must be the drug. But it does not automatically follow that Singulair causes suicide. That remains to be seen and my guess is that Singulair does not cause suicidal behavior. Either way, it is nice to see the FDA is trying to get out in front a potential risk (for once). This is probably a byproduct of the errors that the FDA made with Chantix, where the FDA rushed Chantix - a drug that alters mood - onto the market without fully assessing the suicide risk. .

Our lawyers have long believed that professional expert witnesses’ financial information, including their tax returns, may be discoverable and admissible for the purpose of showing potential bias. Yesterday, the Alaska Supreme Court joined the list of jurisdictions that agree with us.

Noffke v. Perez is a car accident case wherein a wife and husband were awarded $54,000 and $24,000, respectively, by an Anchorage, Alaska jury. On appeal to the Alaska Supreme Court, the defendant claimed that it was error for the trial judge to require her expert witness to produce income tax records. Reading between the lines, it seems that after a motion to compel the records was sought and granted, the defendant’s expert did what many hired medical experts do after an order to produce their records: they refuse to testify.

The Alaska Supreme Court found that there might be a “plausible argument that the witness generates such a significant portion of his or her income from a particular side or particularly attorney that the expert’s impartiality can reasonably be questioned” making this information discoverable and admissible (emphasis added with joy).

The problem I have is that there are a number of doctors who are “Med Mutual doctors” or “State Farm doctors,” the folks that these insurance companies turn to when they need a doctor who is willing to go out on a limb to take a tough position. I do not believe I am being a cynic. This is just reality. To be willing to take this quantum leap from objective doctor to advocate doctor, these experts usually want to be well compensated. To be fair, this happens to some plaintiffs’ experts too, but I think this happens to a lesser extent. If for no other reason than the insurance companies have more of a market share than individual plaintiffs’ lawyers, increasing their leverage over experts. Our law firm has never called an expert to testify at trial who was personally financially beholden to us – insurance companies do it all of the time. (If I'm wrong about this, defense lawyers should join hands with me on this issue.)

Accordingly, it is fair game to question how much money they have made from (1) legal related work generally, (2) from a specific lawyer, law firm or company, and (3) how much money the expert makes overall. Why does the expert’s total income matter? Because without that information, it is easy for an expert to claim that, while he might make $200,000 a year doing legal work, it is a small portion of his income. To put that in fair context, the jury should know just what that portion is.

Unfortunately for these plaintiffs and their personal injury lawyer, Alaska Association of Trial Lawyer President, Michaela Kelly Canterbury, this case was reversed, but on other grounds (excluding certain medical exhibits and failure to give a comparative negligence instruction).

You can find the Alaska Supreme Court decision here.

Citizens Against Lawsuit Abuse issued a press release today pointing out that, according to a new national study by the Center for Medicine in the Public Interest, many personal injury lawyer websites disguised as health care websites are jeopardizing the public health.

Two entities have been mentioned above. Like our local baseball teams in Baltimore and Washington these days, you can’ t tell the players without a scorecard.

Citizens Against Lawsuit Abuse sound like a bunch of nice, good folks someplace like Iowa who want to fight abuses that concern our tort system. Using the word “citizens” really helps create that effect. In fact, Citizens Against Lawsuit Abuse is a front for corporate America to limit the rights of product liability, accident and medical malpractice victims (probably in that order for this group). I could write a lot about their funding, but I think this will suffice: it is believed that Philip Morris is one of their biggest contributors. I have not looked at their website but I’m going to guess that’s not mentioned anywhere on there.

Center for Medicine in the Public Interest reportedly conducted the “study.” Now if you are not impressed by the title of this group, nothing will impress you. I’m picturing a bunch of selfless doctor sitting around with a lot of medical books and journals trying to figure out how to help people. Yet, when their director appeared on PBS’s NewsHour with Jim Lehrer, he was described – apparently without objection - as a director of “a group that receives funding from the pharmaceutical industry.”

Do we really need a “study” on this topic? I’m not saying these sites are not out there, I just have never seen any. The Internet is not such a behind the scenes world where we need a study to find out what is on it. Simply tell us the websites and what you believe is misleading about them.

One of their findings is that 65% of search results on two FDA-approved prescription drugs - Crestor and Avandia - were on sites containing biased or unverified, negative information. I can’t speak much about Crestor, but, yes, lawyers do have great discussions regarding Avandia on their websites. Most of them discussing the New England Journal of Medicine study on the problems with Avandia, which appears to indicate that Avandia significantly increases the risk of heart attack. I would be curious as to whether the Citizens Against Lawsuit Abuse find information in the New England Journal of Medicine as “unverified negative information.” I think they would find the health risks of tobacco to be “unverified negative information.” This reminds me of the lawyer that objects to evidence as “unduly prejudicial” because the information is really harmful to the lawyer’s client’s case.

Look, make a list of personal injury lawyer websites that are pretending to be health care websites offering medical advice and opinions. Let’s look at those and evaluate whether they are misleading the public by pretending to be health care websites or if they are providing information that is incorrect.

In any event, the Citizens Against Lawsuit Abuse accusing someone pretending to be something they are not is downright Spitzerlike.

Last week, I received a call from an insurance company (Progressive) asking how many occupants were in our clients’ vehicle in a car accident case our lawyers are handling. Sadly, it appears someone saw our clients get in what was a pretty serious accident, noted the vehicle information, and then pretended that they had been involved in the accident. Progressive called me and asked if I can get an affidavit from my clients stating that this person was not in the vehicle. I appreciated where the adjuster/investigator was coming from because he wanted to close his file, but I did not see how it helped my client to provide an affidavit, and I could conjure up scenarios where it would not be helpful to me to help them.

I felt knocked off balance for a second after denying Progressive’s request, losing my moral high ground. But then I quickly asked the adjuster if Progressive was willing to accept service in a few cases I was getting ready to file or if they were going to require me to spend needless money and jump through the hoops of hiring a process server to serve the defendants individually. Instantly, the order of the moral universe was restored. Wherever you are at this moment, you probably felt a jolt of unknown origin. The lesson, as always: if your game plan is never give a quarter, don't ask for one.

Another needless hoop insurance companies make you jump through in auto accident case in Maryland is obtaining accurate identifying information for the defendant driver. Once settlement negotiations have failed, the next step is to file a Complaint. But to effectuate service of process, you need the defendant’s address. It is not uncommon for our only information regarding the defendant driver to be a name and insurance information. If his name is Joe Brown or Steve Smith, it can be difficult in car accidents where no police report is filed, the defendant has moved since the accident or the defendant gave a false address.

Of course, this could all be made easier if the insurance companies were willing to cooperate. But they will rarely (read: never in auto accident cases) voluntarily provide their insured’s information for service.

Luckily, in Maryland, the Annotated Code of Maryland provides the Maryland accident lawyer a means to obtain this information fairly quickly and cheaply. Maryland Courts & Judicial Proceedings Code Ann. § 6-311 requires a self-insurer or liability carrier to disclose the defendant driver’s “last known home and business addresses, if known” once the Plaintiff files the proper certification. That section requires a Plaintiff to file a certification with the clerk of the court in which the action is filed and serve it on the insurer or self-insurance plan that provides benefits to the defendant driver. The certification must: 1) state that the defendant had applicable insurance coverage at the time the accident occurred; 2) set forth the reasonable efforts made, in good faith, to locate the defendant; and 3) state that the defendant is evading service, or the whereabouts of the defendant are unknown to the plaintiff.

Once a certification conforming to these requirements is filed and served on the insurer or person that has the self-insurance plan, they must disclose to the plaintiff the last known address information for the defendant driver.

You can find here a sample certification for a Maryland auto accident case. Most other jurisdictions have similar statutes.

Metro Verdicts Monthly recently provided data on legal malpractice settlements and verdicts in Virginia, Maryland and Washington, D.C. The median legal malpractice settlement/verdict in Washington D.C. was a whopping $262,500.00. In Virginia and Maryland, the median legal malpractice settlement/verdict was $212,500.00 and $140,211.00 respectively.

What explains the incredible disparity between Washington, D.C. and Maryland and why is Maryland's median so low? I really have no idea. As always, I find this type of data very interesting yet useless.

When I started practicing law, I spent most of my time defending a pharmaceutical company in AIDS/hemophilia cases, litigation involving approximately 10,000 completely innocent people who contracted HIV from the use of Factor VIII and Factor IX blood products. Regardless of how you viewed the liability of the involved drug companies, everyone agreed on the magnitude of the tragedy (which was very underreported in the media). My experience in those cases eventually lead me to becoming a plaintiffs’ lawyer because I quickly realized I would be far more energized by representing innocent victims who needed my help than large pharmaceutical companies. After I became a plaintiffs’ lawyer, I thought I would never be involved in a mass tort lawsuit with facts as tragic as the AIDS/hemophilia cases, but the gadolinium MRI contrast litigation, while on a thankfully smaller scale in terms of number of patients, is in the same league of suffering - a cruel, progressive disease that you contracted through absolutely no fault of your own.

Gadolinium is the contrast given before a MRI (or MRA, magnetic resonance angiograph, although this practice was never FDA approved) to increase the contrast of blood vessels during an MRI procedure so that the reviewing radiologist can better diagnose abnormalities. While gadolinium did improve MRI diagnostics, nephrogenic systemic fibrosis or nephrogenic fibrosing dermopathy (NSF/NFD) resulted for many patients with kidney issues who received a gadolinium contrast MRI. NSF/NFD causes thickening or tightening of the skin and connective tissues, which severely limits a patient’s ability to move, and it also causes pain, muscle weakness, scarring of internal organs and difficulty bending joints. It seems that patients’ lives are potentially at risk because of the damage to their organs, and destroyed by their inability to move. What we can all hope for is that science will move quickly forward to find ways to make this NSF/NDF more manageable.

More than 215 cases of NSF/NFD have been documented in the last decade, but despite ongoing research, the etiology of the disease was originally unknown. Now, it is clear that use of gadolinium contrasting agents in patients with kidney failure is the culprit. In June 2006, the FDA first said that NSF/NFD can be caused by the use of gadolinium contrast MRI. Last year, on May 23, 2007, the FDA asked manufacturers to include a new boxed warning with gadolinium contrast informing health care providers that patients with severe kidney insufficiency who receive gadolinium contrast are at risk for developing NSF/NFD. Additionally, the warning states that patients with liver problems are also at risk for developing NSF/NFD if they are experiencing kidney problems.

The lawsuits against the five manufacturers of Gadolinium have a simple premise: these companies knew that gadolinium is toxic and, if misused, could lead to serious injury. Accordingly, these companies should have properly designed and tested the gadolinium MRI contrast and given more consideration to vulnerabilities of the different types of patients who would be using the contrast, in this case, patients with kidney disease or renal dysfunction.

I met recently with a confirmed NSF/NFD client here in Maryland. These cases are just absolutely heartbreaking. This client I met with is a wonderful woman who was struck down in the prime of her life by NSF/NFD. Thankfully, she is in better spirits than most people you meet.

The gadolinium MRI cases around the country have been consolidated in MDL-1909 in Ohio. Our gadolinium MRI NSF/NFD attorneys are investigating these cases throughout the country. If you or a loved one has been diagnosed with NSF/NFD, call one of our lawyers for a free consultation at 800-553-8082 or click here to discuss your gadolinium MRI case via the Internet.

The Boston Globe published an article on Friday about the concerns surrounding the manufacture of drugs and medical devices in China. Looking at the Baxter Heparin cases and seeking input from the perspective of a plaintiff’s lawyer, the Globe called me for an interview. This is an excerpt from the article:

“But there are also risks, as evidenced by the heparin incident, that could damage a company’s reputation and lead to expensive litigation. Ronald V. Miller, Jr., a Baltimore lawyer who is considering filing a lawsuit on behalf of patients injured by heparin, said it is easier to win damages against a company that sells defective products made in China instead of the United States.”

“Reasonable people understand that there is some level of concern about Chinese manufacturing,” said Miller, a partner in the law firm Miller & Zois, LLC. “Indeed,” he said, “jurors might conclude that companies make products in China to cut costs at the expense of safety.”

I think this is true. In fact, I think it would be difficult to argue with that statement. But that does not mean that any manufacturing defect case against a Chinese made drug is a slam dunk by any stretch. But if you are going to manufacture a drug or medical product, particularly a life saving drug like Baxter’s heparin, in China or anywhere outside of the United States, you are distancing yourself from the product. This is okay, as along as you take the proper precautions. Here’s a quick checklist companies might want to consider:

•Has the FDA inspected the manufacturing site? (heparin:no)

•Has the foreign version of the FDA inspected the manufacturing site? (heparin:no)

•Is there any final means to verify the product is safe after that stage through the manufacturing process? (heparin:no)

•Is the product one where, if there is a mistake in the manufacturing process, it is likely to have serious or fatal repercussions? (heparin: no)

Obviously, for Baxter with Heparin, it failed every element of this list and, as a result, its Heparin product was transformed from lifesaving to fatal for many consumers.

Concerns about the loss of jobs at home notwithstanding, drug companies may be serving their customers well by manufacturing their products abroad to cut costs because they pass along, in whole or part, these savings to their customers. But if that is the plan, they have to realize that the further they ship away the nuts and bolts of the manufacturing process the more they need to make sure there are adequate safeguards in place to keep the product safe.

Alexandra D. Lahav, a law professor and editor of the Mass Tort Litigation Blog, has an interesting blog post on choice of law made by the MDL Panel in cases consolidated for discovery where the applicable law chosen may foretell the outcome of the case.

To receive certification by the MDL Panel, under Rule 23 you must have: (1) plaintiffs so numerous that joinder is impossible (numerosity); (2) class claims which present common questions of law or fact (commonality); (3) plaintiffs' claims that are typical of those of the class (typicality); and (4) plaintiffs who are adequate representatives of the putative class (adequacy).

This blog post addresses the third prong, commonality of law. In some cases, like the Michigan law at issue in Warner-Lambert v. Kent, with different statutes of limitations, the issue can be a case breaker for the plaintiffs. In MDL cases now, the MDL Panel determines which law will be applied by selecting where to send the case - wherever the case is sent, that forum's law applies. As Ms. Lahav's post points out, the MDL Panel is placed in a terrible situation when the outcome of the case is based on transfer and is already known in advance of the transfer.

Ms. Lahav's blog post, which she says will be the subject of an upcoming law review article, says the MDL panel should consider "transferring and centralizing the cases to several regional forums. I suggest two forums. Plaintiffs who filed within the regions covered by the preemption precedent would be consolidated in one court; plaintiffs who filed in the regions covered by the non-preemption precedent would be consolidated in another court. This would not lead to duplicative discovery because all the cases in region 1 would be dismissed, and all the cases in region 2 would proceed."

I do not appreciate the nuances of the law involving the seven judge MDL Panel's decision making process or the possible ramifications of Ms. Lahav's remedy. While this decision might hurt some plaintiffs who might be able to backdoor otherwise barred claims, I have to admit is appears to be a reasonably fair solution in cases where the choice of law is dispositive of the claim.

A Jury Verdict Research report this month found that over the last ten years, the national median award at trial in personal injury cases for a vertebra fracture is $112,537. Almost two-thirds of the cases in the study were motor vehicle accidents, which is the leading cause of spinal injuries in this country. Not surprisingly, the median award for multiple vertebrae fractures is almost double the single vertebra amount, $207,000.

When I first read this report I assumed the numbers were low because they excluded cases where there was a spinal cord or head injury. But apparently, 7.5% of the verdicts were in excess of $2,500,000, which means they have to include vertebrae fractures where the spinal cord was implicated or there was an accompanying head injury. Because of the proximity of the vertebrae to the spinal column, and because of the weight bearing implications of a vertebra injury, I assumed this number would be much higher, but there must be more minor fractures to vertebrae without significant injury than I realized.

The biggest intangible dealt with by personal injury lawyers in settling or trying a personal injury case is noneconomic pain and suffering damages. These damages defy ready conceptualization and the law provides little in the way of assistance to jurors who make the final call in the end.

In many of our personal injury cases we have used per diem reasoning to juries to articulate pain and suffering damages. Per diem arguments give some tangible basis for a pain and suffering award. In psychobabblespeak, per diem arguments are a form of anchoring -- the cognitive phenomenon of the tendency of people to make estimates with a value in mind. After an anchor is established, there is a bias toward that value to the exclusion of other evidence.

Critics of per diem or other mathematical formulas contend that it manipulates jurors, and is designed to implant in the jurors' minds specific figures and amounts, without a solid evidentiary foundation, to influence the jurors to adopt those figures and amounts in evaluating pain and suffering and measuring damages. This argument ignores the fact that there is never an evidentiary foundation for how to value pain and suffering. Moreover, how is it manipulating jurors to suggest a value pain by the hour or day when defense lawyers have full opportunity to argue why such a valuation is unreasonable? Some jurisdictions have bought into these arguments and have prohibited per diem arguments, which I think is completely unfair to victims who should be able to have their lawyers argue their pain and suffering any way the lawyer and the client deem fit.

Interestingly, some plaintiffs’ lawyers disagree with the efficacy of using per diem arguments. Some point to a study that found that only 23% of jurors said they would defer to the pain and suffering award suggested by the trial lawyers and only 40% would even consider the information in determining damages. But I also read somewhere that 92% of the people surveyed think campaign advertisements have no impact on the way they vote. In other words, I don’t think we can be believed when we are asked what influences us. Besides, if 40% of jurors are considering what you are saying, that is still a lot of jurors whom may not only be able to persuade other jurors, but may also be able to argue that position during the jury's deliberations.

In his book, Damages, David Ball suggests a related argument in closing that turns the tangible to intangible: “Total up the number of extra hours your client is forced to spend on the usual daily tasks of living such as dressing, eating, washing, toileting, getting to and from medical and therapy appointments, shopping for special need items, etc. If brushing his teeth used to take him three minutes but now requires six, and he brushes his teeth three times a day, that’s nine extra minutes a day just to brush his teeth. If that was eight weeks with a cast on his arm, that’s nine minutes times seven days times eight weeks, totally more than eight hours – just for brushing his teeth. If the injury is permanent and there’s a 35-year remaining life expectancy, the total is nearly 2000 hours.”

Under Ball’s paradigm, intangible, noneconomic damages are converted to tangible, economic damages by simply giving him his hourly wage for the total extra time he needs to spend, giving jurors larger economic anchor to use as the basis for their award. Ball also notes that this argument gives a personal injury lawyer a decent shot with “tort reform” minded jurors.

This is a great strategy in the right case. But, using David Ball’s words, pain is often the worst harm in the case. The per diem argument I think gives personal injury lawyers a chance to receive a favorable jury verdict for the pain their client endure.

Yamaha “Rhino” All-Terrain-Vehicle (ATV) litigation has drawn the interest of our lawyers. The Yamaha Rhino ATV appears to have design defects that make the Yamaha Rhino ATV unreasonably unsafe for its occupants. The big problem with the Yamaha Rhino ATV roll is that it will rollover during turns on flat surfaces, even at low speeds, because it has a center of gravity that it too high, too top heavy, and the tires are too small for the expected uses of the vehicle.

Recognizing the problem, Yamaha agreed last summer to install doors and additional passenger handholds on all Yamaha Rhino ATVs manufactured in the last 4 years to protect passengers from a rollover, but they stopped short of issuing a recalling, or even ceasing production of the Rhino ATV.

Yamaha has also issued a new product warning label for the Yamaha Rhino ATV that acknowledges the risk of rollover accidents and alerts users that the Rhino can rollover even while being operated over flat, open areas.

I have to assume that Yamaha’s calculus is that the injuries sustained in these cases are such that the sale of the Yamaha Rhino ATVs creates revenues sufficient to sustain the legal costs, settlements and verdicts that Yamaha will undoubtedly endure. Regrettably, as we learned years ago in the Ford Pinto cases, companies with high selling and profitable products make these cost/benefit decisions all of the time, just like this one.

The reports of injuries in these cases are largely similar: slow speed turns where the Yamaha Rhino ATV rolls over and, because there are no doors to protect the passengers, people fall out of the Rhino and are crushed.

If you or someone you love has suffered a serious rollover injury or death in a Yamaha Rhino ATV, we want to help you. Our lawyers are handling Yamaha Rhino ATV rollover cases in serious injury and death cases across the country. Call us for a free consultation at 800-553-8082 or click here for a free Internet consultation.

The FDA performed MRI tests on Baxter's heparin blood thinner that has already caused at least 21 deaths. The MRI found that as much as 20 percent of the drug's active ingredient was made from an undetermined counterfeit material. Although our lawyers did not "rush to judgment," we strongly suspected that there was a manufacturing defect with heparin that originated in China. It now appears virtually certain that this is exactly what has led to these deaths and injuries from the use of Baxter's heparin.

Our Baxter heparin recall lawyers are reviewing both individual and class action defective heparin recall cases throughout the country. Our law firm is handling only serious injury and death cases in the heparin defect cases. If you or a loved one has suffered a serious injury or death from the use of heparin and want to discuss your potential heparin lawsuit with one of our lawyers, call us for a free consultation at 800-553-8082 or click here for a free Internet consultation.

The Maryland Injury Lawyer Blog received today the following comment from an emergency room doctor in southern Maryland regarding my blog post on the alleged shortage of doctors in Maryland:

"You are guilty of not supporting your assumptions with data as well. I practice emergency medicine in St. Mary's County and Southern Maryland DOES have a doctor shortage problem. I know, I work here. I have many patients that cannot get into a primary care physician or a specialist. Talk to any hospital CEO at Civista, St. Marys, or Calvert Hospital and they will all tell you the same thing. While the shortage may not be evenly distributed about the state, the shortage is real and affects real people. You mentioned that you do not know anyone that has not been able to see a doctor. I imagine that in your nice neighborhood, your friends from the club, your colleagues have all been able to find doctors. You are out of touch with the rest of Maryland. If you are waiting for 'one person to tell you they cannot find the medical care they need' come visit me in St. Mary's county and I will introduce you to many. Maybe that will convince you. By the way, I am not a member of MedChi, have not attended any MedChi meetings and have no other motive to respond to your comment other than your gross misstatements that are baseless."

First, I appreciate the comment. I publish every comment I get, even those that, unlike this one, insult me personally. The Maryland Injury Lawyer Blog is obviously slanted towards plaintiffs and victims because I am slanted that way. But I try hard to make this a forum where I am writing as a human being who sees the world as I do, not as a plaintiffs’ lawyer’s manifesto.

As it turns out, this was not the only disparaging comment I received on this blog. I received a couple of emails and a telephone call from my father echoing Dr. Tucker's sentiment. I think my father may have even mentioned southern Maryland as an example.

First, I stand by the premise of the article. Last month, CareFirst BlueCross told the Maryland General Assembly that rather than a shortage of doctors, Maryland enjoys an adequate supply of physicians, fourth best in the United States. Supporting their argument with facts, CareFirst said that, based upon company records, there are approximately 16,500 full-time doctors practicing in Maryland. MedChi's estimation was approximately 10,000. You can drive a Mack truck through the difference in these numbers. Would this article have come out if 16,500 doctors was the number MedChi used in its calculations? As to who is telling the truth, I don't know, but I can tell you I do not trust Med Chi's numbers. They have always shown a willingness to collect and report numbers that are misleading, in an effort to vilify medical malpractice lawyers and/or insurance companies. So, I do continue to believe that Maryland has plenty of doctors even if "fourth best in the nation" is a CareFirst exaggeration.

What got me into trouble with some readers was the flip "find me someone who cannot find a doctor" comment. I felt comfortable saying this because it is true and I felt insulated from Dr. Tucker's "your friends at the club" jab because we have a lot of clients with limited means throughout the state of Maryland, and I do not recall anyone having trouble finding a doctor who would see them (and because the only “club” that I belong to is a health club - good, this segue gives me a chance to plug Club One Fitness).

I saw Doc Hollywood almost twenty years ago, and I get the idea that rural areas do have shortages of doctors, at least in certain specialties. I should have qualified my words more than I did because my experience of patients looking for and finding doctors in rural areas of Maryland is limited to the kinds of doctors patients typically see after trauma caused by negligence, which clearly leaves out many areas of physician specialties.

If the problem exists in rural areas of Maryland where successful medical malpractice lawsuits are as frequent as cicada sightings, Med Chi should focus on presenting ideas that can be used to recruit doctors to areas suffering from a shortage of physicians, such as public subsidies, scholarships and other incentives, instead of continuing to beat the drum that every problem faced by Maryland doctors involves either the insurance companies or medical malpractice lawyers.