liability insurance crisis

[mommax3]

Time Magazine had a series of articles in a recent issue about this topic. I was shocked to read that "30% of positions in ob-gyn and 20% in E.R. medicine went unfilled by this year's U. S. graduates, although most spots were ultimately taken by foreign-school graduates and U.S. students who did not get their first choice." There was also a graphic showing which states are being hit hardest by the crisis, and there were only 6 states that so far have not been affected. The average cost of medical-liability premiums for OBs is $56,546, and has increased almost 20% over the past year alone. Premiums in hard-hit states like FL and TX are $150,000 and $102,000, respectively. My husband is insulated from this by the military right now, but he has talked to local civilian OBs who are being hit hard, and 4 of them in our local community have stopped delivering babies in the past year because their premiums have gotten too high.

Those of you whose S.O.'s are med students -- how has all of this affected their choice of specialty, if at all?

I wonder what is going to happen with this....Family Practitioners deliver a lot of the babies born in more rural areas, and in hard-hit states, they are not able to afford to do this anymore -- west Texas was already pretty desperate for doctors before all of this started....

I am interested to hear everyone's thoughts on this!

Sally

Sally,
This is a timely topic. It didn't really affect choice of specialty for us. Luckily, I think the premiums for derm are pretty reasonable. Eric did consider ob/gyn for a while -- I think the liability insurance issue would probably affect the state we would live in.
I think that a friend of ours doing ob/gyn residency is having this factor into his decisions on where to practice.

I've heard that Pennsylvania is especially bad, too.

[peggyfromwastate]

I thought that family docs who deliver dont' have to carry the same malpractice insurance as OB/GYNs do. In WA state, this is an ongoing crisis and I know many OBs who bag it all and 1) don't deliver any more babies or 2) throw in the towel and either move to a friendlier state or else go on a humanitarian mission or even join the military! Tort reform to control these malpractice rates always seems to fail. There are some states (Cali I believe?) where tort reform did pass and I believe the result has been positive. I can't recall exactly what the settlement was...

My dad was an ER doc for years and says that here the ER malpractice cycle from a high of about $50 K to a low of about $20K. The 80's were an excellent year for ER docs here, and since then they have never made as much net money. But the dollar of course has inflated a bit. So here at least ER malpractice isn't so bad.

From what I've read here locally, malpractice hurts the OB/GYNs the most, and in WA, OR, and Nevada docs are leaving the states or are choosing to not deliver babies...

Malpractice instability and the consistent rise in rates were one major consideration for my husband and me in choosing the military route over civilian--- especially should he choose a primary care specialty, those docs get paid about the same as civilian docs, but the military docs don't have to pay the $20 to $30K a year that primary care docs do in malpractice. That makes a big difference when your salary is probably around $100K.

So Sally where are you guys gonna settle and how does malpractice look in that area?

[mommax3]

Luckily, we are from Indiana and that is a state that passed tort reform laws years ago when we had a governor who was also a doctor. So that is where we are headed in two years, and so far, it looks like there will be plenty of job opportunities there. DH is really going to start looking after he takes oral boards in about six months. It is weird to finally be in charge of where we want to go!

It is nice not to have to worry about liability insurance in the military -- but still, for OB/GYNs (who are considered primary care) the salary in the military is around $100K, depending on rank, and the average outside the military is $200K, so even with really high premiums, civilian OBs still make more. Not to mention deployment and no control over where you live.....can you tell we can't wait to get out?

Sally

[Phoebe]

I have heard Pennsylvania high extremely high costs too. A friend of ours is an OB resident and is choosing a subspecialty, gyn/oncology somewhat to avoid the premiums.

On a side note, our pediatrician said her premium rates for primary care went up 38% in the last year alone.

With all this going on and our recent insurance problems, I am becoming more passionate about issues on health care reform. It makes me ill to think about how much insurance companies benefit.

Jennifer

My best friend in Las Vegas was told she would have to go to St. George, Utah if she got pregnant because there were no available OBs in the area. They were either not taking any new patients or had decided to go strictly GYN. She ended up finding someone in Vegas but she didn't have many options.

It is crazy how expensive the liability insurance is. I am sure this will be somewhat of an issue in anesthesia and will make a different of where we practice. Russ had considered doing Family practice in a rural area and doing OB but was told he would never make any money and would actually probably lose money with the insurance rates he would have to pay. Rural docs usually don't deliver enough babies to make up for the increased insurance rates. Of course, then my hubby decided he didn't really like family practice and there went that idea. :!:

I also know a lot of doctors left California, especially specialty surgeons because their incomes were almost cut in half with the insurance rates. Interesting topic that really affects us.

Robin

I haven't check with AMA...

but as spouse to a DO, I was checking the AOA webpage and have been using their online fax/email system to keep after my state elected officials and came across this information that I thought I would share. Please note that it is slanted to the AOA and their version of PLI reform, as I said I haven't check the AMA to see how their version is different, but it is a start if things are getting changed.....


Three States Pass PLI Reform Legislation
Missouri has passed a tort reform bill addressing two of AOA’s PLI reform principles; Texas has passed PLI reform legislation and placed an initiative on the September ballot concerning caps on damage awards in medical malpractice actions; while Oklahoma has passed noneconomic damage caps for limited circumstances.


Here is the run down on what the AOA would like to see changed with the current system.....

The AOA supports six (6) principles or provisions for inclusion in legislation to address the malpractice crisis.

Allows for Periodic Payment of Future Damages
Money or damages will be paid in installments rather than in a lump sum payment. The court can make a specific finding as to the dollar amount of the periodic payment. Debtors who are not adequately insured to guarantee payment will be asked to post security that these payments will be made.

Places a Limit on Non-economic Damages
These damages are monetary damages awarded to plaintiffs in civil actions when plaintiff has suffered physical pain, mental anguish, or loss of enjoyment of life.

Establishes Mandatory Offsets for Collateral Sources
The collateral source rule prohibits defendants from introducing at trial any evidence that a plaintiff has been or will be reimbursed by another person or company for a portion of their damages. The doctrine was developed based on the theory that defendants who cause injury to other persons should not benefit by having the amount they should pay reduced if the person they injured happened to have insurance or some other source of payment for their injuries. The rule prevents those who have harmed another person from escaping full responsibility for their acts. Mandatory offsets would decrease the amount of money awarded to a plaintiff by limiting the collateral resource rule.

Allows for Proportionate Liability Among Parties
The doctrine of joint and several liability allows an injured plaintiff to recover all their damages from any one or any combination of defendants. It is only used, however, when there is more than one wrongdoer; innocent parties are never held responsible for harm caused by others. Joint and several liability ensures that the plaintiff is fully compensated in cases where one or more defendants are not able to pay their share of the compensation.

Establishes a Uniform Statute of Limitations
A statute of limitations defines the amount of time a plaintiff has to file a claim in a lawsuit. Generally, the statute of limitations is defined from the time injury is discovered until the time a lawsuit is filed.

Limits the Amount of Attorney Contingency Fees
Contingency is a manner in which a lawyer can assess fees. When a case is taken on a contingent basis, the lawyer takes a percentage of the winnings in a suit, instead of charging an hourly rate. Usually the contingency fee is somewhere between 25-33%.


For those that have read this far(!) here is the breakdown of what states are in dire need of change and where physicians (not just DO or MD..but all!) are seeing Insurance trouble....

Priority Issue -- Professional Liability Insurance Reform

Medical liability insurance rates are rising rapidly across the country. The increase in insurance rates has had its greatest impact on the many physicians who can no longer afford to pay the premiums necessary to maintain their practices or cannot find coverage at all. These insurance increases have disproportionately affected specialists, such as obstetricians, neurosurgeons, general surgeons, and emergency physicians, and those practicing in rural areas. Insurance rate increases have caused physicians to move their practices to states with lower rates, especially states with tort reforms. Physicians are also limiting their practices and resorting to practicing defensive medicine. Others who cannot obtain coverage under any circumstances or cannot afford the cost of the coverage due to escalating costs have opted to close their practices altogether.

There are several theories about the rising costs associated with liability insurance, but many people assert that meritless claims and outrageous jury awards for medical malpractice play important roles. Only a small percentage of all medical malpractice claims result in payment to the plaintiffs. A report by Jury Verdict Research has shown that jury awards and verdicts doubled from 1995 to 2000. The median award in 1995 was $500,000. Six years later in 2001 (the latest figure available), the median award was $1 million, after increasing by more than 40 percent in 2000. The average jury award today has increased to about $3.5 million. Tort reform is the most progressive solution to the increasing spiraling of medical liability insurance costs.

Presently, there are eighteen states that are considered to be in medical liability “crisis”: Arkansas, Connecticut, Florida, Georgia, Illinois, Kentucky, Mississippi, Missouri, Nevada, New Jersey, New York, North Carolina, Ohio, Oregon, Pennsylvania, Texas, Washington, and West Virginia.

Of the states deemed to be “in crisis”, many of the states, including Arkansas, Connecticut, Florida, Georgia, Kentucky, Mississippi, Missouri, Nevada, New Jersey, New York, Ohio, Pennsylvania, Texas, Washington, and West Virginia have introduced PLI reform measures during the present legislative session. Some insurance reform bills suggest modeling medical malpractice insurance on the workers’ compensation system, while other states have drafted bills in order to conduct studies to identify and resolve the reasons behind the increasing insurance rates. Many other states have written bills in order to provide state-funded insurance coverage for physicians.

Bills with caps on noneconomic damages have met with mixed success so far during the present legislative session. The Kentucky and Utah bills have been defeated, while the West Virginia bill has passed the legislature and was signed by the governor.

[PrincessFiona]

Great Topic

This is such a great topic, Sally...I remember when we were in PA that increases in liability insurance were causing blood to boil among Trauma Surgeons in particular. Right after we moved, the Trauma guys caused a scandal by pulling out of the major hospitals...I don't know what ended up happening to that, except that there were some big meetings in the state because surgeons were leaving in droves. From what I understand, there are still some major shortages.

I've heard the same thing about delivering babies in Nevada....

It is a really scarey situation. Medicine is like everything else in life...it isn't perfect. It is unfortunate when bad things happen, but too many frivolous law suits have spoiled it for physicians and patients alike.

There was a lawsuit last year in California where a family sued their grandfather's internist for not delivering 'enough' pain medication to him while he was dying....(this is actually a problem in the US because people get so freaky about delivering morphine, etc to the dying....what if they become addicted what if they die a few hours prematurely ) HOWEVER, similar lawsuits had already been won by family members elsewhere where the pain meds delivered had helped cause a decrease in breathing and hence a death a few hours early....for millions..So..the doctors became more cautious and delivered exactly what the legal limit allowed...This patient died in horrible pain as a result..and the doctor was sued for millions and lost. You can't win as a physician in these situations.

I'm not saying that there shouldn't be some kind of a recourse if there is a true case of horrible negligence....but often people in fields like OB are sued when tragedy strikes...even if they really did everything in their power to avoid it. It used to be that women and babies died with increased frequency during childbirth..nowadays we delude ourselves into thinking that since childbirth is a 'natural' process it should be perfect....and it isn't.

I'm reminded right now of an old friend of mine who was diagnosed with breast cancer recently. She found a lump and went to the doctor....they did a mammogram and the mammogram showed no abnormalities. She was still concerned, so she went on her own to another physician (a surgeon) who noted that there were no findings on the mammogram but decided that she would biopsy the tiny lump....and it turned out to be cancer...fortunately in the earliest of stages. Now this individual wants to sue the radiologist and has decided that all doctors are idiots. She says he should have picked it up on the mammogram and didn't..and he had told her to come back in 6 months for a follow-up....she feels that she could have 'died' if she had waited. Thomas tried to explain to her that the radiologist could only go from the x-ray picture and that if there was nothing there to see, the best he could do was offer her to come back in 6 months. So...now she thinks Thomas is a quack and has written it off to him being from Germany

I'm sure she'll find an attorney to take it...and who knows...she may even profit off of this...I just have a moral problem with that.

kris

You really have to wonder about some of these things.

In the case of your friend, doesn't she realize that the surgeon didn't see it on the mammogram either? She certainly is lucky to have trusted her instinct and further pursued it....but is that *really* malpractice? And like you said, I am SURE that someone will take her case.

I can't say much about it, but a friend of ours is an expert witness for a malpractice case. Basically, a person went to the doctor (end of the day) with some unusual symptoms. It was too late to do lab work, etc from the office, so the Dr. said that the patient needed to stay overnight at the hospital for observation. The patient didn't do it and died. The Dr. is being sued for not trying harder to persuade the patient to go to the hospital. (I'm leaving out major details but that is the basic idea). 8O Maybe now Drs. will need to personally escort unwilling patients to the appropriate appointment/treatment/etc.

[PrincessFiona]

ugh

In the case of your friend, doesn't she realize that the surgeon didn't see it on the mammogram either? She certainly is lucky to have trusted her instinct and further pursue it....but is that *really* malpractice? And like you said, I am SURE that someone will take her case.

I have to tell you, Nellie that this really bothers me on many levels...and her arrogance about it to boot...I understand that she has gone through something traumatic and feels like she needs to lash out...but she was also sent to oncologist whose advice she completely ignored. She looked things up on the internet and then angrily confronted the oncologist. Her comment to me last time she called "By the time she finishes seeing me, I'll have her whipped into a 'good' doctor"...I thought...no wonder this doctor is being rude to you! I'm sure though if she has metastasis that she'll sue the woman for not forcefeeding her the drugs that she refused. The first radiologist was a DO, so she decided that all DOs are bad...the oncologist is a foreign medical grad...so that combined with Thomas telling her that the radiologist went by the book caused her to decide that every foreign medical grad is bad... ....it was really appalling...I just don't understand.

In regards to your friend, Nellie...that is shocking as well. People take no responsibility for themselves and their choices anymore......it just reminds me of the lawsuits against McDonalds....

kris

I feel bad....I wanted to acknowledge that your friend's experience does sound very traumatic. I imagine that one would be thinking....what if I waited? Would I have died? Would treatment be more difficult? It seems like malpractice is no longer seen for what it is -- remedy for an sub-standard or not the standard of practice care or the failings of an incompetent doctor. (Maybe it really is more than this?) From what you said, it just doesn't seem that the radiologist gave her poor care or was incompetent. And who, in any professional situation, wants to have themselves whipped into a good doctor/lawyer/teacher/whatever? That is a sad story, indeed.

Of course, there are some crappy doctors out there....people Eric wouldn't want his family or himself to see....but they seem to get by with what they do!

[Cumberland]

Jason decided about six months ago he wants to do Ob. Both of us halfway believe/are hoping that tort reform will happen before he is actually practicing ( he is an MSIV). Everyone he talks to tries to talk him out of it or tells him he is crazy for wanting to go into it.

The thing that i think the 'suers' and the lawyers forget is that medicine is an inexact science. If something goes wrong during the surgery, delivery etc, then it is almost a guaranteed lawsuit. Some mistakes are going to happen but some outcomes are also going to be adverse no matter what. We are visiting our parents in Florida now and the papers are raging about the malpractice reform bill that is on the table now. The trial lawyers are saying things like, any doctor who cuts back on his practice is committing malpractice by not being availbable for their patients. It make no sense and is so greed driven it is infuriating.

[Amiens]

I know that premiums are high for anesthesia (I know-- duh!), and it is affecting our decision as to where we will live after residency. It is safe to say that because premiums are so high in WA state that we will not be staying afterwards. Matt was told that WA state is one of the worse states to practice in for anesthesia.

Crystal

[Michele]

In Florida a lot of OB GYNS are going to GYN only practices or they are "going bare" meaning they carry an account with the 200,000 minimum and put everything in their spouses name....so if a lawsuit came....the suer would only get the 200K and then could waste their own money trying to get the house etc that's in the spouses name (not the Dr's name).

It has affected us. Russ is considering OBGYN but we want to stay in FL and it sucks right now.

Michele

[Cumberland]

I had asked a lawyer friend about going bare- he said they would put a lien or whatever it is called, on your paycheck for the rest of your life or until you pay off the judgement.