In 2002, 335 medical malpractice lawsuits were filed in the state of Iowa. By 2009, that number had dropped to 171.

This is good news for most—especially for Iowa physicians whose malpractice insurance is a fraction of what doctors in other states pay. (For example, an internal medicine physician in Iowa pays $5,592 a year in insurance premiums compared with $53,000 that the same physician would be paying in Florida).

There is debate, however, as to what accounts for the drop in lawsuits. Doctors, and the Iowa Medical Society, believe that the decline in lawsuits is the result of fewer medical mistakes. Leaders of the Iowa Medical Society attribute this to a safety effort that began as a result of the 1999 Institute of Medicine report showing that 98,000 Americans were dying every year from preventable medical errors.

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Extra safety precautions in operating rooms, electronic medical records, and double-checks of records have all contributed in some way to the decrease in malpractice cases, believe doctors.

Plaintiff’s lawyers, and patients, feel differently. Many lawyers say that are turning down cases simply because the costs of litigating these types of trials is too high. Finding expert physicians who are willing to testify against other physicians is also a barrier, according to attorneys.

Patients are finding that they cannot get an attorney to take on a malpractice case unless it is clear that an error caused death or permanent disability – in other words, cases that are likely to have big payoffs.

Iowa does not have a cap on non-economic damages in medical malpractice cases. The governor vetoed a 2004 bill to limit non-economic damages to $250,000.

A similar bill was introduced early this year but is unlikely to get much discussion because legislators are aware of the decline in malpractice suits. A law passed in 2006, however, may have contributed at least somewhat to the decline in cases.

That law allowed physicians to apologize to patients without fearing that their statements could be used against them at a trial. Apologies have been shown in other places (for example, the University of Michigan Health System) to reduce the numbers of lawsuits filed.