A young woman who did poorly on her law entrance exam attempted to sue her mother's obstetrician for a poor delivery, claiming diminished intellectual ability.

A tubal ligation, a process where a woman's reproductive tubes are tied to prevent pregnancy, is cynically referred to by physicians as a "tubal litigation" because the procedure fails one in a thousand times - inevitably resulting in a wrongful-life suit.The interference of the lawyer into the doctor's office has created a crisis, Dr. John C. Nelson, past president of the Utah Medical Association, reported to the Commission of Justice in the 21st Century.

"I feel like there is a telescopic site aimed at my head with a hair trigger and someone at the other of that trigger who is a member of the legal profession ready to squeeze that trigger - irrespective of which way I decide," he said.

When Nelson, an obstetrician and gynecologist, began practicing in 1975, his professional liability premium was $300 annually. Today he pays $35,000 a year.

He said a substantial amount of the high cost of medical care is due to unnecessary tests ordered by doctors practicing defensive medicine.

For instance, if a child falls off a bicycle on his head, the first thing a doctor will do is order an expensive X-ray called a Magnetic Resonance Imaging scan. "MRI scans are wonderful, but the cost is great. I have grave concerns. In my opinion they are being used inappropriately, not when clinically dictated but because of worry about liability," Nelson told the commission.

Besides inflating medical costs and insurance premiums, fear of malpractice suits keeps older, skilled physicians from giving their services to assist those who can't afford health care. The Utah Medical Association has attempted to offer a comprehensive plan to those in homeless shelters, but physicians in their retired years can't pay the insurance premium.

"We indeed are turning away a valuable asset, but the threat of a lawsuit is a very real concern," he said.

The medical profession is a victim of its own success, Nelson said. "We are so good at doing what we do, if everything is not perfect, the public believes it should have been."

Doctors aren't blameless, he added.

"Physicians need to police physicians. No one else really can. We need some legal ability to get to our doctors."

Nelson, who is also a delegate to the American Medical Association, advocates changes in the way lawyers and doctors address malpractice problems on a national and local level.

"We need to get the lawyer on our side where we can work together. My heart tells me that the lawyer and the physician can work for the good of the patient, but indeed, it doesn't always feel that way."

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Complaints

In a report to the Justice Commission, Leon Sorenson, director of the Utah Medical Association, outlines doctors' complaints about the Utah legal system:

- Complexity of the system discourages small claims; most attorneys won't take cases involving less than $50,000.

- Jury awards are inconsistent, resembling a lottery.

- Juries are not capable of determining fault involving sophisticated medical techniques.

- Some malpractice cases can take up to eight years to resolve; average time from filing to resolution is four years.

- Many patients harmed by poor medical care don't receive fair compensation.

About 300 malpractice cases are filed each year in Utah. One in three plaintiffs receives compensation.