Set against the backdrop of relentless negative publicity directed at all doctors due to an outbreak of hepatitis C at an endoscopy center in southern Nevada, the Nevada Orthopaedic Society (NVOS) has been an integral part of a coalition to save medical malpractice tort reforms.

As reported last year in AAOS Now (“Medical liability reform comes full circle in Nevada,” August 2008), the NVOS, with the assistance of a grant from the AAOS Health Policy Action Fund, retained the services of a well-known lobbying firm, established a political action committee (the NVOS BonePAC), and reinforced its ties with the “Keep Our Doctors in Nevada” (KODIN) initiative. The group began holding strategy meetings in anticipation of an expected attempt by trial lawyers to overturn tort reform (Fig. 1).

Campaign strategies pay off
During the 2008 election campaign, the NVOS BonePAC, the Nevada State Medical Association (NSMA), and KODIN made contributions to the campaigns of several key legislators. In November, both houses of the Nevada legislature came under the control of the Democrats, who achieved a veto-proof majority in the Assembly.

The NVOS BonePAC developed relationships with key leaders in the state Senate, in particular Steven Horsford, Senate majority leader, and Terry Care, chair of the Senate Judiciary Committee. The AAOS was instrumental in helping to forge a relationship with Sen. Horsford through the 2009 playground build (See “NVOS aid key to 2009 playground build,” AAOS Now, February 2009.)

The fight gets underway
As a patient-centered group, KODIN was the most appropriate leader in the fight to keep tort reforms and hired its own lobbying team. Although KODIN and the NVOS were repeatedly assured that “tort reform was not on the radar of the legislature,” a bill was introduced in committee by the chair of the Assembly Judiciary Committee. The bill completely overturned all facets of medical liability reform previously won and attacked provisions of informed consent.

During a committee hearing on the bill, obvious preferential treatment was given to the trial lawyers to present their case as well as patients with bad outcomes. The NVOS countered by organizing a rally attended by more than 150 people (Fig. 2).

At the beginning of the hearing, the trial lawyers presented a surprise amendment to AB 495, deleting the entire content of the bill and limiting the scope of the bill to establishing exceptions to the cap on non-economic damages in cases of “gross negligence” and extending the statute of limitations.

Attorneys alleged that the ability to sue doctors for an unlimited amount of money was necessary not only to help prevent malpractice in the future but also to properly punish physicians. Presentations by the physician coalition were cut off and rescheduled late in the evening (when the media would not be present). The amended billed passed out of the committee on April 15 and passed out of the Assembly just 5 days later.

Targeted research, grassroots efforts
Efforts to support the benefit of tort reforms were reinforced by two studies. A study commissioned by KODIN found that the reforms were working, that more doctors were coming to Nevada, and that reforms had saved the state approximately $380 million per year through decreased insurance premiums and decreased medical costs.

A study by the State of Nevada Division of Insurance also documented that many more medical malpractice insurance companies were doing business in Nevada, that claims and losses were down, and that medical liability insurance premiums had been reduced by an average of 30 percent since the passage of the KODIN initiative in 2004.

To educate the public and the legislature, the coalition began to run television and newspaper ads. The NVOS assumed primary responsibility for the grassroots campaign by identifying doctors willing to discuss the issue with their patients and ask for help. It also orchestrated the participation of the NSMA, the Clark County Medical Society, the Washoe Medical Society, and hospitals throughout the state. NVOS president Fred Redfern, MD, met personally with the chief executive officers of three major hospital systems in southern Nevada.

The campaign, KODIN 1000, centered around asking physicians to talk to 100 patients, requesting each patient to contact the legislature and to circulate 10 “push-cards” to friends and family. Initially, 100,000 cards were printed. The NSMA created a Web page that detailed the need for a grassroots effort and provided easy access to sign-up forms for cards and legislative contact information.

The medical societies’ auxiliary organizations (spouses of physicians) played a strategic role by volunteering to deliver the cards to participating physicians. Special signs for office reception and examination rooms were printed to grab patients’ attention and encourage their participation in protecting health care in Nevada.

An overwhelming—and successful—response
The response of patients was overwhelming. Some patients asked for 100 cards to distribute; others took 20 to 30 cards to pass out. The legislative Web site, which has a public opinion poll function, showed 95 percent of participating respondents opposed the bill.

After the measure passed the Assembly, efforts were directed at stopping the bill in the Senate Judiciary Committee. The relationships that were developed during the campaigns were key in obtaining access to senators so that physicians could explain the benefits of tort reform and refute the unfounded accusations by the trial lawyers. The bill never passed out of committee and, if it is not attached to another bill, will die when the legislative session closes this month.

As the Las Vegas Review-Journal wrote in an editorial on the legislative session, “lawmakers were wise not to meddle with the expressed will of the people.”

Being involved in the legislative process has been a tremendous education for the Nevada Orthopaedic Society. The saying—“two things you don’t want to see being made are sausage and legislation”—has taken on new meaning for the NVOS. The NVOS and other members of the coalition will remain diligent in the battle to protect tort reform. Providing an additional lobbying team has been money well spent. The contributions the NVOS has made have been appreciated by the medical community.

Fred Redfern, MD, is a member of the AAOS Board of Councilors and president of the Nevada Orthopaedic Society. He can be reached at fredred@concentric.net

Kathleen Conaboy is lead lobbyist for the NVOS and a member of the McDonald-Carano-Wilson, Government Affairs Group.