The Medical Liability Crisis Doesn't Affect Me - Or Does it?
By Donna Baver Rovito (11/26/05)
The terms "medical liability reform" and "malpractice crisis" have become part of the language in recent years - yet many people still aren't quite sure what they mean or how they affect the average person.
The terms "Malpractice crisis" and "medical liability crisis," although used interchangeably by the media and those who support maintaining the dysfunctional status quo, are not the same thing.
"Malpractice crisis" conjures up images of widespread physician and hospital negligence. But the situation which faces many states right now (Pennsylvania and New Jersey being among the hardest hit) is a crisis of availability and affordability of insurance for health care professionals and accessibility to physicians for patients.
The problem isn't that doctors are committing more "malpractice." In fact, studies have shown that medical liability lawsuits have VERY little to do with actual negligence on the part of individual physicians, and everything to do with a jury's compassion for catastrophic injury, regardless of the cause.
The REAL crisis faced by doctors and patients alike is skyrocketing increases in the cost of medical liability insurance and difficulty in obtaining that insurance at ANY price. In Pennsylvania, physicians are mandated by law to buy $1 million of medical liability coverage or they can't practice - $500,000 from a commercial insurer and an additional $500,000 from the state-run MCARE fund. The price of that insurance varies from region to region, but on average, medical liability premiums in Pennsylvania have increased 1,400% since 1975 - compared to about a 500% average increase in the rest of the nation.
It's perfectly reasonable for a patient to ask "Why should I care about how much my doctor has to spend for insurance? Doctors make WAY more than I do, so can't they afford it?"
And if it were simply a matter of lifestyle and job satisfaction, the answer would be "DON'T worry about it." But Pennsylvania is a prime example of what PATIENTS lose when doctorslose the ability to purchase reasonable liability insurance.
In Chester County, PA, there isn't a single fulltime neurosurgeon on staff at any of the county's five hospitals, which serve 450,000 residents. There used to be six fulltime neurosurgeons in the county - before rising premiums drove them to other positions and other states. The last fulltime neurosurgeon to leave would have been forced to pay $283,000 for a single year's coverage.
That neurosurgeon's departure forced the closing of the county's only certified trauma center at Brandywine Hospital - so now, patients who require immediate neurosurgical intervention must be transported elsewhere. While a helicopter can generally get a patient from Point A to Point B within the "golden hour" of optimal care, sometimes weather makes flying impossible. So far, we've heard reports about six patients who've tragically died because a neurosurgeon wasn't immediately available at a Chester County hospital.
It's not that the hospitals in Chester County haven't TRIED to recruit neurosurgeons - they've been trying for years. It's that medical liability premiums in PA are so high in comparison to other states and that the possibility of being sued is so certain that no one (in his or her right mind) wants to practice there.
And the problem isn't unique to Chester County. In 1996, there were 216 neurosurgeons practicing in Pennsylvania. Now, there are only 152 - although some studies indicate the number who are actually performing neurosurgery is only 141, located primarily in urban areas. And the American Association of Medical Colleges reported that not a single neurosurgical resident who trained at one of Pennsylvania's outstanding medical schools or hospitals stayed in PA to practice in 2004. Why would they, when opportunities and the litigation climate are so much better in so many other places?
So how does this affect the 12 million people living in Pennsylvania? Very few people actually require the services of a neurosurgeon in the course of their lives, right?
Of course, if you or a loved one is one of the few, NOTHING affects you more.....
All specialties of medicine are affected by skyrocketing medical liability premiums - but the higher risk specialties, the doctors who do the difficult surgery or take care of the sickest patients, are affected the most. The American College of Obstetricians and Gynecologists, the people who provide women's health care and deliver our babies, report that nationwide one out of every seven obstetricians has stopped delivering babies to reduce premiums. They also report that fewer and fewer medical school graduates are choosing obstetrics as a specialty solely because of the cost of liability insurance and risk of lawsuits.
Again, how does that affect a patient? In Fayette County, the three doctor group which delivered 60% of the county's babies was forced to eliminate obstetrics when the group's medical liability premium hit $450,000. Now, many of the women who live in Fayette County must drive 60 miles or more to have their babies delivered - and anyone who's ever had a child knows that babies sometimes won't wait.....
Independent polls show that 26% of Pennsylvanians report that someone in their family has been forced to change doctors in the past year because of rising medical liability premiums. I don't know what that number is throughout the nation, but the problems which have plagued Pennsylvania and New Jersey in recent years are being repeated in at least 20 other states, all of which have been dubbed "crisis states" by the American Medical Association because of skyrocketing liability premiums and a loss of practicing physicians created by those premiums.
Despite public relations efforts by the trial bar and alleged "consumer groups" which front for them, many Americans realize that the cause of this crisis is runaway litigation. A Gallup poll showed that 60% of Americans believe there are too many lawsuits against doctors, compared to just 13% who think there are too few. 62% of medical liability cases filed are dismissed or dropped for lack of evidence of any negligence on the part of the doctor - but each of those cases costs about $25,000 to defend. In court, doctors "win" 81% of the time - although since defending a doctor in court costs the doctor's insurer about $85,000, which is reflected in the doctor's future premiums, the doctor never really "wins."
What's the difference between "crisis" states and those which have already solved their medical liability issues? States which cap one small portion of medical liability awards, pain and suffering, have lower premiums and more doctors. When the difference between liability premiums is as staggering as $195,000 a year for an obstetrician in Florida and $17,000 a year for the same obstetrician on Oklahoma, it's not hard to understand why physicians are gravitating toward states which DON'T have high premiums and a high number of frivolous lawsuits. New studies published in the Journal of the American Medical Association indicate that states which have passed laws the limit awards for non-economic damages (but NOT economic damages like medical care, lost wages, outpatient care, home services and whatever else a patient needs to be "made whole") and which discourage filing of frivolous lawsuits have a higher number of doctors per capita than states which have not.
What this patchwork of wildly varying state laws concerning medical liability has created is a massive inequity in the ability of Americans to obtain quality health care. If you live in California, where reforms were passed in 1975, you have far greater access to the specialists you need than if you live in Pennsylvania or New Jersey, where special interests have thus far prevented passage of laws to limit awards and increase access to care. If you live in Colorado, you have a far better chance of finding a neurosurgeon when you need one than if you live in Florida, where ALL the neurosurgeons have been sued at least five times. Pregnant women in Louisiana have a far greater choice of obstetricians than pregnant women in Illinois or Ohio.
The medical liability crisis may not directly impact you or a member of your family until the terrifying moment when you need a doctor who isn't there....
The only certainty is that that moment WILL arrive - unless legislative action is taken at both state and national levels to rein in lawsuit abuse and return control of health care to doctors and nurses.
(Printer friendly version) 
