When I returned to Boston I had been invited to join the faculty at the Medical School in the Department of Medicine at the Brigham and Women's Hospital. Dick Nesson who had been a... my number two at the Beth Israel Hospital was now President of the Brigham, and Gene Braunwald, a colleague from my earlier days, was chairman of the Department of Medicine. Both offered me an opportunity to... to join the department as a professor without portfolio and that has provided me with, perhaps, a period as, as gratifying as the first chapter in, in my career.

I had been eager for some time to examine issues of quality of medical care and to look at the problem of medical malpractice. There was a great deal of concern with this issue and I had spoken with a colleague, Paul Weiler, a professor at the Harvard Law School, Joe Newhouse, a professor of economics, and we agreed that we would, first of all, attempt to collect data on the problem. Quite fortunately a former student, David Axelrod, was now the... was now the Commissioner of Health in the state of New York. An extraordinary man. He had been a scientist who turned to the problems of the healthcare system in New York at the urging of the Governor, Mario Como at that time. And, when David heard that we planned to do a study, he urged us to do it in New York. He said, the Governor has asked me to propose legislation to deal with this problem of medical injury and the associated court problems and I find only anecdote as I turn to the literature. If you do what you've assured me you propose to do, it'll help us enormously. And David's involvement in this, in this project is one that I think is really to be adopted by anybody doing such research. He made available to us all sources of information, all hospital records, all court records, and all insurance records. We obviously pledged to keep all of this confidential. He also provided the money for the study. The study took a considerable period of time and more than 3,000... more than $3 million, and the New York State legislature provided that money. When I, when I said rather apologetically to Governor Como, I said that we had calculated the costs and apologized for the, the size of the... for the figure we had put forward, three million dollars, he said to me, 'Doctor, the doctors in this state, last year, spent $1 billion in malpractice premiums, that means that the people of New York spend $1 billion in, in premiums. If you do what you propose to do for $3 million, we'll consider that a great bargain'.

We... we did carry out the study. We did a random sample of every hospital in the state. We were able to randomize scientifically because a member of our team was Nan Laird, professor of statistics at Harvard, and we were greatly helped in this. We couldn't have done it without the participation of two of my medical school colleagues, Lucian Leap, a person who had been a paediatric surgeon and turned to health policy later in his career, and Troy Brennan, a young physician who was trained at Yale in both medicine and the law. That team, along with others, did... did a study of all patients, a randomized study of all patients hospitalized in a random sample of all hospitals in the state of New York. They examined all of the court records of the period and all of the insurance records. We found that, of all of... we found that 3.7% of all of the patients hospitalized were injured as a result of some medical intervention in the hospital, unrelated to their illness - 3.7% of people whose hospital stay was prolonged or who were handicapped when they left the hospital. We found that, of the patients who brought suit that year in the courts for malpractice, only one in six had actually been injured. So, we found a... a system that was flawed, but a legal system that was equally flawed.