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April 25, 1990

Medical Malpractice and the Tort System-Reply

Author Affiliations

The RAND Corporation Santa Monica, Calif

The RAND Corporation Santa Monica, Calif

JAMA. 1990;263(16):2180-2181. doi:10.1001/jama.1990.03440160042029

In Reply.—  I appreciate the concerns expressed by Drs Kalenak and Meyerowitz. These letters raise specific malpractice issues that I did not address in my article, but also suggest the need to consider that medical malpractice litigation is only one aspect of the broader relationship between law and medicine.Both Drs Kalenak and Meyerowitz raise the issue of the contingency fee system as a potential cause of medical malpractice claims and awards. Although I have not conducted the analysis suggested by Dr Kalenak myself, recent work by Sloan et al1 and earlier work by Danzon2 provide some insight. Both studies, using multiple regression techniques on different data sets, concluded that neither attorneys per capita nor limitations on contingency fee arrangements had statistically significant effects on claim frequency or award severity. As to attorney density, Danzon concluded that for every 10% increase in attorney density, malpractice award severity rose