The leaders of a project to reform Utah's health-care system are calling for lawyers to join the effort.

Malpractice lawsuits, whether as threat or reality, skew a provider's treatment decisions to the legal safe side, members of the Legislature's Health Care System Reform Task Force were told Tuesday. That approach, in turn, adds to the amount of redundant testing and is a significant but so far unaddressed factor in the reform process.

The cost of malpractice-insurance premiums for providers also is rising rapidly, Rep. Gregory Bell, R-Fruit Heights, and an attorney, told fellow task force members.

"On the one hand, I've concluded that the literal problem of malpractice is not nearly as big as the perception that it is," Bell said. "And the perception out there of tort liability among providers is just huge. It's the 3,000-pound gorilla hovering over providers."

The perception is so deeply entrenched and the issue so complicated and fraught with anecdotal horror stories of gigantic jury awards, not to mention the issue of a patient's right to legal redress if something goes awry, that it's next to impossible to discuss, let alone take any action to address it, Bell said.

That doesn't mean the task force shouldn't try, Bell said, noting that he gets comments from both sides, including fellow attorneys who remind him that lawyers here and nationwide have adopted every responsible tort reform that policymakers have adopted.

"Then doctors ask, 'So why are my rates going up and up?"' Bell said, noting that the number of physicians who deliver babies has decreased in nearly direct proportion to the tenfold rate of insurance premiums they are charged.

Bell, who has been reviewing the issue with task force members and a working group appointed by the task force, said the situation is creating very real ripple effects in the medical delivery system, including more specialists regarding the emergency room as too legally precarious to provide on-call services.

"The willingness of specialists is declining," he said. "They receive poor to no reimbursement and also have the promise of a lawsuit if everything doesn't go perfectly."

He called for a full discussion that includes actual data and reckoning court actions with real facts in Utah, "not horror stories from another state where a jury has teed off at some provider."

A working group should be appointed that over the next year could bring, he said jokingly, "the natural predators around this issue" — the hospitals, the doctors, other practitioners and trial lawyers — to talk seriously about the issue.

That group could also begin developing best-practices guidelines and to what degree those guidelines should become a safe harbor if an unknown anomaly arises in a medical emergency that wasn't divulged by the patient or was unavailable at the time.

Rep. Roger Barrus, R-Centerville, a task force member, suggested the discussion go a step further by changing the standard of proof a claimant must meet to "clear and convincing" evidence. The current standard is showing the "preponderance of the evidence."

"It would bring it to the beyond a reasonable doubt standard for criminal cases, but rachet it up a notch," he said, adding that the special constraints and obligations unique to rural doctors should also be factored into the discussion.

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E-mail: jthalman@desnews.com