I characterize a trivial medical malpractice lawsuit as being the result of an arbitrary natural occurrence. Plaintiffs have the right to feel wronged and to pursue legal representation. Nevertheless, some may have hidden agendas. Plaintiff lawyers are “good Samaritans.” They operate on a contingency fee basis. This invites hidden agendas; however, since these lawyers incur the expenses, intentions are irrelevant. The significance of a case is what truly counts, and there exists artificial intelligence to identify the most profitable ones. Claims that meet this standard are subsequently evaluated by medical professionals, who are essentially “hired guns.” Only at this point is a claim presented as a malpractice lawsuit; the remainder are rejected. In the interim, plaintiff lawyers claim they never take on a frivolous lawsuit. Clearly, some are frivolous as 55,000 are dismissed after being filed, and there are disclaimers outlined in the contingency fee agreement. Contingency fees total $2.5 billion. One thing plaintiff lawyers certainly are not is good Samaritans.

Defense lawyers employ a contrasting approach. Aware that 85,000 medical malpractice lawsuits require defense, they engage medical malpractice insurance companies. They act as “zealous advocates.” Because zealous advocates should discern frivolous lawsuits at first glance, they ought to inform their assigned clients of a possible legal strategy to counter-sue for malicious prosecution. Nonetheless, counter-suits are excluded from the agreement and the annual $1.1 billion is deemed more critical. The one thing defense attorneys fail to be is a zealous advocate.

Next in line are medical professionals. 85,000 work for plaintiff lawyers while an equal number serve defense lawyers. This is referred to as “self-regulation” within the medical field. Many allocate as much as 25 percent of their professional time to self-regulatory practices. While the medical field may self-regulate, they are still simply hired guns.

Malpractice insurance firms claim to be the “cash cow.” They have contracts with defense lawyers, who devise the defense strategy, and every policy includes a clause mandating the insured physician’s cooperation with this strategy. Malpractice insurers prefer to settle a wholly defensible claim rather than risk a ruling in favor of the plaintiff. Notable are 27,000 settlements. Defense lawyers agree to settle to avoid losing contracts. Physicians acquiesce to avoid jeopardizing their insurance coverage. Regarding premiums compared to losses, profits amount to $25 billion annually, with a majority placed into reserves and remaining tax-exempt. Malpractice insurers are not victims.

The healthcare system presents a different scenario. Previously, it was comprised of private hospitals and practices regulated by free-market dynamics. Today, it consists of hospital networks, third-party payers, and physician groups that are poorly regulated due to the Affordable Care Act. Physicians join networks mainly for malpractice protection. Most networks are self-insured against medical malpractice. Networks receive payments from health insurers based on capitation, referring to the number of insured individuals they enroll. As physicians enlist, so do unsuspecting patients. This boosts enrollment numbers. Physicians receive compensation based on outcomes. Outcomes are influenced by resource-based practice guidelines, known as best practices. Occasionally, best practices may diverge from standard care norms. Healthcare costs reach $4.9 trillion per year, generating a $600 billion profit for networks. There are 85,000 medical malpractice lawsuits. This illustrates how connections form.

The reasoning behind these connections is a separate issue. Numerous politicians are attorneys; hence, no lawsuit is considered frivolous. Some, such as Dick Durbin, begin their careers engaged in medical malpractice litigation.

The AMA’s total revenues surpass half a billion dollars annually. Politicians view the AMA as the authoritative voice for the medical field. As such, the AMA is agreeable to best practices. Its 2024 annual report, titled “Why We Fight,” clearly asserts that frivolous lawsuits are not worth opposing. In this report, the term “frivolous lawsuit” is absent. Despite a malpractice crisis persisting since the 1970s, it wasn’t until 2003 and again in 2023 that the AMA recognized the existence of a medical malpractice crisis. In 1995, the AMA established the Litigation Center. However, between then and 2021, it has been involved in 322 medical malpractice cases, averaging only twelve cases per year. The AMA’s board of trustees comprises doctors, executives of networks, consultants for malpractice and health insurance firms, medical experts, and lawyers. If the AMA does not regard frivolous lawsuits as significant, neither do politicians. Nonetheless, 75 percent of doctors do not belong to the AMA, highlighting that its sway over politicians is unjustified.

Additionally, there is the tort system. The most infamous medical malpractice verdict ever recorded is for $229.6 million. Due to the tort system, juries are never informed that the alleged harm is an error of nature. The litigation process takes three years, followed by an additional two years for appeals.

Finally, we have doctors. Because the cost of medical malpractice insurance can be prohibitively high.