It is indisputable that, in numerous states, including Maryland where I hold a license, tort reforms related to medical malpractice constitute a significant portion of the legislative agenda. In Maryland, tort reforms include:

– **Caps:** The limit on noneconomic damages is initially established at $650,000, increasing by $15,000 annually. Medical malpractice follows a different cap structure; however, the cap is set at $905,000. An award exceeding $905,000 for noneconomic damages is necessary for this law to take effect.
– **Alternative disputes:** Prior to a medical malpractice suit advancing in court, the claim must be submitted to the Maryland Health Care Alternative Dispute Resolution Office. This postpones a trial by several months to over a year, during which insurance companies accrue interest.
– **Certificates of merit:** Within 90 days of submitting the claim to the Maryland Health Care Alternative Dispute Resolution Office, the plaintiff’s attorney is required to file a certificate of merit from a qualified medical expert. Why not submit it at the time of the claim?
– **Expert witness rules:** The “20 percent rule” restricts a medical expert from allocating more than 20 percent of their professional time to serving as an expert witness. This rule raises to a 25 percent cap. What’s next, a 30 percent cap?
– **The collateral source rule:** Damages are lowered by the sums the plaintiff receives from alternative sources as compensation for identical injuries.
– **Contributory negligence:** A plaintiff is prevented from recovering damages if they are found to be even marginally at fault for their own injury.

These tort reforms are implemented largely as a reaction to worries about the escalating costs of medical professional liability insurance premiums in Maryland. Nevertheless, although premiums have stabilized, they have risen since 2019 despite the tort reforms. Medical malpractice premiums consistently remain high, ranging from $10,000 to over $100,000 based on specialty. Additionally, the count of cases assessed by the Maryland Health Care Alternative Dispute Resolution Office has stayed at approximately 600-650 annually since 2005. At this ongoing pace, by 2030, every practicing physician in Maryland may face lawsuits. The situation could be worse as Maryland ranks 24th among 50 states in terms of medical malpractice litigation. Notably, the largest plaintiff award in history, totaling $229.6 million, was granted in Maryland.

The Medical Society of Maryland, MedChi, takes great pride in its role in tort reforms. Respectfully, as a physician who has faced lawsuits, I am indifferent to a $905,000 cap, alternative dispute resolutions, certificates of merit, 25 percent regulations, collateral source rules, or contributory negligence. I safeguard myself and innovate CCC+C (collate, compare, calculate, and certify). Each time I apply it, I am dismissed with prejudice shortly thereafter.

Not long ago, I had the opportunity to teleconference with the CEO and selected board members of the Medical Society of Maryland to present CCC+C. One board member remarked that “this is something before its time.” Another stated: “This is a game changer.” CCC+C is neither “before its time” nor is it “a game changer.” CCC+C is a successful approach played according to “their” rules. It becomes clear to me that while everyone recognizes the value of CCC+C, none are sufficiently dedicated to physician advocacy to do more than offer CCC+C superficial acknowledgment. Finally, the CEO interjects: “What evidence, aside from your personal experience, can you provide to demonstrate that CCC+C is effective?” Upon hearing this question, I realize the teleconference is concluding. I initiated this teleconference specifically because I require the medical society’s endorsement for CCC+C to advance.

In light of this, if state legislators and medical societies consider tort reforms the sole solution to the ongoing medical malpractice crisis enduring for five decades, they should regard the following as a blueprint for forthcoming tort reform, rooted in CCC+C.

A qualified medical expert, whether representing the plaintiff or defense attorney, prepares a certified report documenting the decision-making processes behind formed opinions. This report encompasses:

– **The presenting medical condition.**
– **The applicable standard of care (duties):** The report recognizes that the standard of care can, by itself, be subject to errors-of-nature, which may encompass pre-existing medical or psychiatric issues. These may occur independently of any deviation from the standard of care.
– **The medical intervention in question (potential breaches of duty):** The report specifies what is documented in medical records and what is absent when it ought to be included. Pre-existing conditions and their management to prevent or address them if they arise are relevant. The likelihood that a medical intervention might worsen a pre-existing condition, and that failing to undertake the medical intervention could present a greater risk than exacerbating the pre-existing condition, are also pertinent. Whether the patient consents to the medical intervention is important.