Tort Reform: Who’s Gouging Whom?





sam fields


The Sun-Sentinel has a Sunday feature called “South Florida 100”. It allows a couple of dozen Broward muckety-mucks to vent on a topic of their choice for a hundred or so words.

Some are thoughtful.  Some are ranting.

Earlier this month, Earl Maucker, the former Sun Sentinel editor and current Lighthouse Point Commissioner, ranted about Broward County’s payments for victims in personal injury cases:  “$55,000 for an injury caused by a collapsed chair…$45,000 for a fall down some stairs…$27,500 for a woman bumped in a sudden bus stop.”

He offered not a single syllable to support the notion that any of these cases was frivolous. He just attacked the litigious nature of America and the County rolling over to personal injury lawyers.

Based on those amounts, in all likelihood the injured party got little more than reimbursement for medical and legal expenses.  If they were insured, their insurance company was repaid between 67% and 100% of what they laid out.  If they were not insured, as a matter of law, the doctors and hospitals had first dibs on any settlement money.  Money is paid for medical care before the lawyer’s fee, which is usually 1/3.

“First dibs” can get very expensive; especially if you are on the hook for the retail charges from hospitals.

You know the myth about the $5 aspirin?  As I recently found out, it’s not a myth.

Following some inexplicable symptoms, in May, I spent one day at Westside Regional Hospital–an HCA/Rick Scott product.  The retail bill was $19,443!

See the bill below.

There was not a single test on that bill that you could not get for 1/4 of what they were charging. There was not a single pill that you can’t purchase for 5% of what they charged.  There was not a single charge that Medicare did not substantially and rightfully knock down.

Yes, I know that they have to deliver it from the hospital pharmacy to me. But, considering they are simultaneously delivering dozens of pills, it’s hard to believe that the best they can do is a 1000%+ markup!  Maybe they need to bring in a delivery consultant from Dominos.

Is it any wonder that HCA was fined $1.5 billion for Medicare fraud?

Is it any wonder that the World Health Organization, which ranks us 37th in healthcare, makes us Numero Uno in healthcare costs by a mile.

Is modern America, as Earl Maucker said, litigious?  Sure.  But it’s the same litigious America that Alexis DeToqueville noted in his seminal 1840’s book Democracy In America.

The difference? Back then, the victim were not gouged by hospitals and took home the lion’s share.


Fields medical billFields Bill #2

23 Responses to “Tort Reform: Who’s Gouging Whom?”

  1. Well said Sam says:

    Sam, have to agree with you on this post 100%.

    Yes, the US is now (and always has been) a litigious country. That has something to do with starting out as a “country of laws, not of men”. It’s how disputes (other than the old west) have typically been resolved.

    I hope that your hospital stay was uneventful and that any issues have been cleared up.

    But I can’t let the opportunity pass without saying that after looking at your bill, I do agree with the one item of the CT/Brain, because for years, I’ve always thought you needed your head examined.

  2. Observer says:

    81 mg aspirin or (baby aspirin) is used for suspected heart attacks. You mean they found you have a heart!?

    I kid. Hope all is well

  3. City Activist Robert Walsh says:

    This brings back an issue that I had w/ an area hospital that my late mother was admitted to. I see you were astounished by your bill and the five(5) dollar aspirin etc. If Medicare, as was my mother’s chief carrier I notified Medicare andinformed them of the gross conds. etc and the hosptial had to reimburse Medicare for the entire stay(almost 20g) for a two day stay. So if you are admitted to a hospital and its a shit hole ,don’t pay and notify the carrier ,in my mom’s case Medicare. I showed alot of you the statement from the hospital(oh yes, had them send me a letter stating that this was going to be taken care of,which it was(I’m no “Grand Wizard but those that knew about this were amazed). The point is don’t stand for this kind of manevers. This man was clearly over-charged and he should demand charge back. I really think that Ft.lau city hall podium,which I have spoken from gets all the credit. Seriously, it has given me oppurtities I never imagined that I would have. And my motto-“refuse to lose” & whatever it takes, it takes”.. Follow these rules and you to will prevail @ anything you encounter….

  4. chacha says:

    I love you.

  5. Chaz Stevens, one-man-blogging-bazooka says:

    Is that the cost one pays for having an erection that lasts longer than four hours?

  6. Sam Fields says:

    They looked in my brain and found nothing.

    Being lawyer, they could not find my heart

  7. Commissioner Angelo Castillo says:


    Tort reform is a huge issue and one that’s never been looked at very seriously in Florida.

    It’s hard to get the trial lawyers to agree. They control a sizable voting block in the Senate that pretty keeps tort reform from becoming a threat to their interests.

    Here’s a separate example along the same lines.

    So, about five or six years ago, when Marco Rubio was Speaker, I met with him to suggest legislation allowing counties to extend their sovereign immunity to non-profits doing social services or related work that government was required by statute to provide. Lowering the cost of insurance to non-profits, I explained, would allow decreasingly available dollars to help more people. I didn’t even mind having that link quantified and put into increased contractual expectations from grantors.

    Liability insurance in the non-profit field is a huge expense. Lots of states offer sovereign immunity to non-profits operating as agents of the government under contract and avoid it altogether or significantly reduce that expense.

    Rubio’s reaction?

    He was polite about it though somewhat unmoved by the suggestion. He thanked me for the idea but said while such a thing would pass in the House, it would never see daylight in the Senate. Why? The Senate is the bastion of the trial lawyers. They control many votes there and such a bill, if it arrived, would be pronounced dead on arrival.

    True story.

    Now you could say on the one hand that someone seriously injured will need a judgment to get them through it all. How much is always the question thus reform. Lawyers fees are calculated on the basis of total judgment so it’s clearly an issue for them.

    On the other hand, non-profits doing government work should at least have the benefit of government’s protections — as in sovereign immunity. There’s a strong public policy argument to be made for that.

    These are debates worth having however that prospect, because of pure political realities seem unlikely to occur anytime soon. Yet there’s always hope. We can never give up on hope.



  8. Sam Fields says:


    Compensation for a hospital cutting off the wrong leg should be based on whether the hospital is money making, government or charitable?

    I doubt the stump, where there was once a leg, will understand that concept.

    Immunity for charities was based on the notion that they were the only ones who would supply services for the poor. They did not get reimbursed except through charitable donations The threat of lawsuits meant no one would help the poor.

    That has not been the case for 75 years. Insurance, Medicare and Medicaid mean that every hospital is going to get paid a reasonable fee for 90%+ of the work they do.

    Your argument for immunity has not made sense since FDR was in the White House.

    If they can pay million dollar plus salaries for running not-for profit hospitals, they can buy liability insurance.


    How did you know?

  9. john Henry is right! says:

    Help fix the problem Angelo…DON’T VOTE FOR LAWYERS!

  10. Commissioner Angelo Castillo says:


    Medical malpractice is not what I’m talking about. The nature and scale of those cases is so different than liability insurance the industry has their own category for it — thus malpractice insurance.

    I am referring to general liability insurance and umbrella coverage. Still, you raise the other side of the coin which should not be ignored. I acknowledge there’s a trade off that should be debated.

    Those injured as a result of negligence need to be compensated. It’s the right thing to do. How much has always been the question, there is insufficient legal guidance on that question, thus the call for tort reform.

    The cost of claims is passed onto, and form a major part in how much premium we all pay for a variety of insurance policies. There’s no such thing as a free claim, we the insureds pay for those claims through our insurance premiums. So the cost of claims is a legitimate concern for everyone.

    Sovereign immunity applies only to government matters and limits how government will pay in such claims. The concept is centuries old that taxpayers would otherwise go broke paying taxes to cover claims. Government having so wide and necessary an array of services where people could get hurt, there would be no end to such litigation or the cost to society. This is all well established.

    There are many states, I used to live in one, that extend their sovereign immunity through their contracts with certain non-profit organizations.

    What kind of cases would be covered? Car accidents in the course of doing business, trips and falls at facilities, etc. I know of a non-profit so poor it had to ask for old furniture to outfit their offices. They did good work.

    So a member of the public came into the office and sat in one of those chairs, the leg broke and they sued the non-profit and were awarded many thousands of dollars. Next year, when the non-profit went to buy insurance, the increase in their premium almost put them out of business.

    Meanwhile, the grants they got don’t pay for such luxuries as making sure their clients have a chair to sit on. Ponder that.

    If sovereign immunity is offered, the organizations getting the coverage should be required to comply with safety regulations and be inspected for same. That’s only reasonable in any case. I’m simply saying that the cost is out of control for an organization trying to do public good.

    I’m not saying that this be done irresponsibly or thoughtlessly.

    I’m saying that when a non-profit is doing work for the good of the community that (a) involves work statutorily required of local government to do, (b) if government did the work themselves, it would cost society more, and (c) if they did the work themselves sovereign immunity would apply, then (d) with reasonable requirements and restrictions, the non-profit doing the work should be treated as an “agent” of the government and sovereign immunity should flow to them through those contracts.

    Non-profits operate at a very thin margin if any. When forced to buy individual liability insurance plans, the cost is very expensive and it reduces their ability to deliver services to the public. So added public benefit does flow, and should be contractually required from the swap.

    Short of that, there should be a consolidated, lower cost insurance pool for non-profits but the insurance companies don’t want to do that either. Similar programs do exist for Worker’s Compensation coverage but not for liability coverage.

    And what I’m really saying is that argument, which deserves debate won’t ever see the light of day because of special interest politics. And that ain’t right.


  11. Charlotte Greenbarg says:

    Angelo, non-profits are the best-kept secrets. So many of them pay CEOs a great deal, and we only have to look at Children’s Svcs. Council that built itself a headquarters with money that could’ve been used for services.

    Not to mention the fact that from the beginning the Children’s Svcs. Board, which still exists, could have done the same work if it collected the same very large amount of money from property taxes. I’m sure we’ll hear from someone out there who will try to justify having both groups, even though reason cries out that both aren’t needed.

    Charity Navigator does a wonderful job of listing in detail the charities that use money wisely and those that don’t.

    Many non-profits, whether they’re charity organizations or hospitals, are big businesses that make sure they stay non-profit, as the inside joke goes.

    I agree that if the law requires the government to do the work that a non-profit is doing, it begs the question of why the government entity doesn’t declare the non-profit an agent and give it the ability to use the government insurance.

    One could make an argument that poor non-profits should get a break on liability insurance.

    The real issue isn’t the insurance, but the rampant fraud that’s so prevalent, especially in South FL. Until powers that be get serious about penalties, even for the politically connected, it’ll continue and the insurance rates will continue to break our banks.

  12. Commissioner Angelo Castillo says:

    Dear Charlotte,

    With utmost respect and regard, please allow me to gently suggest. That not everything in life is a dead, stinking dog.

    My point had nothing to do with salaries but since you brought that up…

    People with talent in any industry need to be paid. Otherwise there would be a financial disincentive to going into those lines of work.

    The assumption smacks elitist that someone helping the poor should be punished with lesser pay, or is somehow less deserving, or should have the vocation of the clergy sans the free housing. That’s all cliche and yesterday, and it has a stench of mothballs.

    In Broward alone, mind you, this is a comparatively forward real estate and income market, the collective budgets of non-profits exceed one billion dollars annually and they employ many thousands of workers. Do you have any idea what talent, how difficult it is to operate a business, make payroll and all your bills on an average margin of less than 10%? Not to mention the clinical professionals employed by non-profits nationwide, some of the very top at their professions.

    Professional charities need professionals running them because the work demands it and the people served are so frailest, most in need, greatest damaged, or the ones that nobody else can or would care to help. I constantly chuckle at business types who look their nose down on non-profit work. As if selling cars or bonds or building K-Marts was even in the slightest bit at par with the level of difficulty involved in non-profits.

    Try helping just one shattered life back into society. Try getting one person addicted to cocaine to stop. Try helping a blind person find work. Try helping a veteran fighting to keep their sanity to reconcile with their family and start again. Selling cars, building K-Marts is child’s play compared to what our non-profits do daily. Yet they should make millions in salaries and bonuses and few bother to care. But if a non-profit executive makes a fraction of that, suddenly that’s news?


    In terms of salaries, society gets exactly what it pays for just as in any other line of work. That kind of thinking is nowhere and, to the point, non-profit salaries relative to comparable responsibilities in government or the private sector are low, if anything, on average.

    I like you and I respect you. But not everything in this world is dark and horrible — Children’s Services Council is a perfect example of a group doing a great job.



  13. Charlotte Greenbarg says:


    Interesting that you would bring up a stinking dog regarding this formerly logical discussion. In the classic Broward Way you put words into my mouth that were neither said nor implied.

    You compare non-profits and the good work many, not all, of them do with someone who has risked everything to start a business, or has the responsibility for one.

    My family put everything they had into starting a business that grew into one of the largest privately owned orthopedic soft goods manufacturer in the country. We took no salary for almost a year. We had to fund the payroll and materials first. Our house was mortgaged and our son was in university on the way to medical school.

    We had no government entity to get more money from; it was crunch time and we worked 18/7 to get it going.

    There’s no comparison, but you’ll never see that so I won’t try to convince you.

    As I said prior, many charities do good work and spend money wisely, but many don’t. I don’t suppose we’ll see you castigate Charity Navigator for telling us that there are charities that only get 1 star, a warning to anyone who can think that donations should be directed to those that are better-ranked.

    The duplication that supporters of CSC won’t admit to does exist in spite of the politically-motivated denials. The building is testament to the unnecessary spending.

  14. Commissioner Angelo Castillo says:


    I wish you and your family well with your business and I hope your son the doctor is doing well.

    I’m glad you consult Charity Navigator and hope you find it helpful. For all that and much more I give you two stars!!

    I also regret that some, but not all, non-profit organizations have disappointed you and that you feel that some pay their people too much. Perhaps we weigh the value and impact of non-profits in our community differently or have different assessments of the particulars you raise. The contributions of non-profits are very undervalued, as are the contributions of their employees, in a community that would struggle mightily without their daily accomplishments. I see it as something akin to bullying the way they are treated by a society that is angry way too often, thus prone to generating more heat than light. I don’t care for that injustice and will continue to speak out against it hoping, someday for a return to rational and levelheaded assessments of things that important.

    As to the CSC, by every metric an objective review might wish to select, they are doing great work. I find nothing whatsoever wrong with their office space, which I have personally visited, and it is modest by any reasonable comparison. In terms of what it does for kids, the work product is impressive. There is clear return on investment for Broward citizens, and the loss would make Broward worse off, not better.

    As to whether CSC and CSB should merge, I myself raised that issue in 1999 and continue to believe that it deserves study. All that said, both organizations partner well and effectively to deliver quality children’s services that are complementary without being redundant.

    My original point was quite narrowly focused on insurance. Which is the subject matter of this article.

    I believe it would be in the public’s interest to allow non-profits, who serve as agents of county government, to benefit from being granted sovereign immunity in the performance of their required tasks. You seem to agree with that concept and I appreciate that.

    Best of luck and thanks for your comments.


  15. Charlotte Greenbarg says:

    Your not-too-clever comment about my “son the doctor” reveals something about yourself that isn’t pleasant, to say the least.

    So does the arrogant “two star” award that exposes how you really feel about data-based, independent evaluation that Charity Navigator does. Good thing it exists to help those who would otherwise have only opinions such as yours.

    It’s not my opinion that some charities pay their CEOs too highly, it’s Charity Navigator’s. I get the facts from CN.

    You’re entitled to your opinions, but not to your own facts. And of course you’re using all the buzzwords, e.g., “bullying” to create your facts.

    The issue of insurance begs the questions about how charities use money, as well as the rampant fraud especially in S. FL.

    Our business was sold in 1993 and we all retired. My son had to retire on disability after a near-fatal illness.

    I hope you and your family are well and I don’t say that with any sarcasm or any other negative meaning.

  16. Floridan says:

    Very few non-profits pay excessive (whatever that is) salaries to their employees; even fewer pay above market rate. (In fact, there is a joke that the first question on a non-profit employment application is “Does your spouse have a good job?”

    Angelo addressed this, but non-profits have responsibilities, assets and resources that have to be managed and the organizational boards have a fiduciary responsibility to see that they are, in fact, well-managed. And while most people who work in non-profits are willing to do so for less than what they might make elsewhere, few are (or should be) willing to impoverish their families to do so.

  17. Sam Fields says:


    You failed to address anything I said challenging why a malpractice victim at Holy Cross should be less compensated then if he had the same screw-up at Plantation General.

    Holy Cross, which according to my doctor friends is a darn good hospital, is hardly a charity in the Biblical ”giving of alms” sense. They get the same government and insurance payments as any for-profit hospital.

    You have infused an IRS charitable designation (501c3) with some sort of moral equivalency of Doctors Without Borders (a real charity).

    Ask me if a doctor risking his life to fight Ebola deserves immunity, and my answer is “yes”. Tummy tucks and boob jobs for insecure housewives…not so much.

    Just look what’s in walking distance of where they built it.

    I’m sure Jesus would be happy to know that Holy Cross can give walk-in care to the “underprivileged” members of The Coral Ridge Country Club.

    [“Oh, please doctor, in the name of The Blessed Mother, help me. I’m getting a shoulder twinge on my backswing. Do I need prayer, surgery or should I just switch to a Callaway Big Bertha?”]

    Angelo: Answer the question in Paragraph One.

  18. Charlotte Greenbarg says:

    Floridan, please take a look at Charity Navigator. I’m not talking about employees’ salaries, but CEOs’ salaries, benefits, bonuses, etc. I’m also talking about the missions of the agencies.

    It also reveals how much they spend on fundraising and how much goes to the stated purpose.

    Too many of them have taken a page from abusive for-profits.

    The non-profits have created a central coalition with an executive director for lobbying purposes.

    The state Auditor General needs to do an inventory of all the non-profits in the large counties, including CSC and United Way in the manner of Charity Navigator. Only then will we be able to get a clear picture of where the money’s going and whether the agencies are fulfilling their stated missions.

    That’s not too much to ask, especially in the difficult economic times we’re living in. I want to see the money go to those in need, not executives and perks and bonuses and buildings. Every non-profit must be able to validate what it’s doing.

  19. Commissioner Angelo Castillo says:


    The question you raise needs to be debated as part of the larger question of tort reform. I could make an argument in furtherance of good public policy either way but responsibly, absent the professional preparation the matter deserves, I’d suggest that the issue of medical malpractice might need a deeper look than the simpler example I raised.

    In Florida, a tort reform debate unlikely to happen and that’s unfortunate given the stakes involved. I believe the issue merits debate. Good politics should encourage, not discourage discussion about issues that are important to the public. Tort reform is one of those issues. It’s my view that our representatives in both the State House and Senate owe the citizens of Florida a substantive look at the matter.

    Back to non-profits (promise, last time, it’s far afield of this post) and what they do with their money, unlike many if not most private companies, non-profits publish their tax returns — known as 990’s for all to see.

    Where government grants are involved, there are mandated monitoring reviews conducted at least annually, sometimes more often, by the grantors of those funds. They come out generally in person and perform a deep scrub of programs, finances, files, how the programs work, what the outcomes are, against contractual and regulatory provisions.

    All of the findings are published in monitoring reports. These are available to any member of the public upon request. Some donors ask for monitoring reports before deciding to make a donation to a non-profit. Curiously, they invest many times more of their money into companies offering them only a fraction of the information non-profits can provide. But that’s a story for another day.

    Non-profits are also required to do an annual audit that under statutory provisions include examination yearly of specific areas prone to weakness. These too are made public because the non-profits have to give copies to government.

    As to authorities like the State Auditor general conducting audits or reviews of non-profits, assuming they had such an interest, I don’t personally know of any non-profit that would care one way or another. Certainly they shouldn’t.

    Additionally, there are contracts with government, budgets, all kinds of public documents about non-profits in the hands of government which the public has the right to inspect.

    So there’s actually more information available for public consumption about non-profits than most could ever get about publicly traded private companies. Nobody needs to question how non-profits spend their money. All they have to do is look. Yet some insist on guessing or imagining or casting a baseless shadow over an industry without which the loss, as measured in added human pain and suffering, would be significant. And yes, that pisses me off. Shit like that gets tiresome.



  20. STHU says:

    Angello nobody cares about your long ass drunken five page bull shit responses. WE DONT CARE WHAT YOU THINK!,,

  21. Charlotte Greenbarg says:

    The audits non-profits do and the 990 reports don’t give the kind of information that Charity Navigator does. The formats are entirely different. Anyone who looks at both knows that.

    The audits that are needed would reveal the kind of information that we need to be able to discern the good from the not-so-good.

    Sam’s spot on re: comparing a 501(c)(3)designation with Doctors Without Borders. Exactly.

  22. Commissioner Angelo Castillo says:


    I typically use GuideStar when looking for general info on non-profits but since you mentioned Charity Navagator I took a look at it.

    It’s comparable to GuideStar in many ways and while I prefer to do my own ratings, I can see why that system would have appeal. While they didn’t offer a rating for the several non-profits I queried, I did find some rated ones and I like how they did it. At least, that rating offers the viewer some insight into how the agency budget breaks down by categories and that’s very helpful. GuideStar doesn’t do that.

    So I agree, Charity Navagator is a good source for non-profits that they’ve actually rated. For the non-rated ones, either system would do if you’re looking for general info.


  23. Lamberti is a Criminal says:

    Jeez…get a room.