Malpractice costs driving doctors out
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November 11, 2002
BY JIM RITTER HEALTH REPORTER
Soaring malpractice insurance premiums are forcing doctors to scale back their practices, retire early, move to other cities or find new work, physicians groups say.
On the North Shore, an obstetrician-gynecologist who will pay $118,000 in liability insurance next year is studying to obtain a pharmacist license.
"I never thought about doing anything else," said the 43-year-old doctor, who asked not to be named. "Now all I'm thinking about is what else can I do."
In the 12-month period ending last July, liability insurance premiums nationwide increased 24.7 percent for internists, 25 percent for general surgeons and 19.6 percent for obstetrician-gynecologists, the Medical Liability Monitor reports.
In Chicago, annual premiums total about $32,000 for internists, $76,000 for general surgeons and $110,000 for OB-GYNs. By comparison, doctors' average income, after insurance and other expenses, was $160,000 in 1999, the American Medical Association said. One reason rates are so high for OB-GYNs is that doctors get sued after difficult births leave babies with permanent disabilities.
There's anecdotal evidence insurance costs are changing the way doctors practice.
Brain surgeons, for example, may do less brain surgery. According to a survey of 700 neurologists by the American Association of Neurological Surgeons, 43 percent said they are planning to or are considering restricting their practice to get relief from liability premiums as high as $300,000.
Premiums vary widely. General surgeons, for example, pay $66,000 per year in Long Island, N.Y., and $174,000 in Miami. In Las Vegas, more than 75 obstetricians have moved or plan to move to lower-cost cities. And in West Virginia, a shortage of orthopedic surgeons who can afford liability insurance has left the state with only one Level I trauma hospital to treat the most critically injured patients, the AMA's American Medical News reports.
Doctors blame "frivolous" malpractice lawsuits and "jackpot" jury awards. "The dollars that go to pay for legal defense and plaintiffs' attorneys ultimately come from patients," said Dr. John Schneider, president of the Illinois State Medical Society.
But in the last 30 years, jury awards and settlements have gone up no faster than health care costs, a study by Americans for Insurance Reform found.
So far this year, there have been 211 malpractice settlements in Illinois, with an average award of $1.9 million, according to the Jury Verdict Reporter.
Some experts said the insurance industry and the economy are more to blame than trial attorneys and juries. Insurance companies make money by investing premiums in stocks, bonds and other investments. To compensate for the recent drops in stock prices and interest rates, insurance companies are hiking premiums. The same thing happened in the mid-'70s and mid-'80s.
The House has passed a bill that would limit malpractice awards to economic costs such as lost wages and a maximum of $250,000 for pain and suffering. But the bill is expected to die in the Senate.
Copyright © The Sun-Times Company
All rights reserved.State probes neurosurgeon shortage
By Phil Galewitz, Palm Beach Post Staff Writer
Tuesday, March 9, 2004Gov. Jeb Bush directed state health officials Monday to investigate the lack of neurosurgeons available to treat emergency patients in Palm Beach County, a worsening side effect of Florida's medical malpractice insurance crisis.
Bush's action comes in response to Saturday's story in The Palm Beach Post that revealed how emergency neurosurgery patients are increasingly being transported from Palm Beach County to hospitals in Broward and Miami-Dade counties, and sometimes as far as Tampa and Gainesville.
One of those patients, Mildred McRoy, 61, of Lake Worth, died Saturday, six days after being transferred from JFK Medical Center in Atlantis to North Broward Medical Center in Pompano Beach because no neurosurgeon was available to treat her in Palm Beach County. Bobby McRoy thinks his mother still would be alive if she didn't have a more than seven-hour delay in getting care from a neurosurgeon following a stroke.
"The governor is extremely concerned and wants to ensure there is adequate coverage for those in need," Bush spokeswoman Alia Faraj said Monday.
Bush asked the state Agency for Health Care Administration to contact Palm Beach County hospitals to determine the availability of neurosurgeons, agency spokeswoman Kim Reed said.
What the governor will find is that the county has 10 neurosurgeons, roughly the same number it had in 1980, when it had about half of its current 1.3 million residents. More worrisome is that just four of the 10 neurosurgeons treat all the non-trauma emergencies -- patients typically with aneurysms, brain tumors and bleeding in the brain. Two more of the 10 provide emergency coverage -- but for spinal injuries only, not brain injuries, which make up the majority or neurosurgical emergency cases.
With a paucity of neurosurgeons taking emergency room on-call duty, none of the county's hospitals has full-time coverage for non-trauma emergencies. Two of the area's busiest hospitals, JFK Medical Center and Bethesda Memorial Hospital in Boynton Beach, have neurosurgical coverage for just 20 days a month. JFK cut its coverage last spring when a senior neurosurgeon stopped working in the emergency room after gaining enough seniority to no longer have to treat emergencies. Bethesda cut coverage last year after one of its doctors moved to Indiana and another had a heart attack.
Bethesda recently recruited a neurosurgeon from the Cleveland Clinic in Weston. JFK said it has recruited a neurosurgeon who is expected to start in August.
The Palm Beach County Medical Society said Monday that it is hiring a consultant to collect data on the shortage of neurosurgeons and other specialists and hopes to complete a report by mid-May.
The good news for Palm Beach County residents and visitors is that the county's trauma system -- which treats victims of car accidents, serious falls and gun violence -- remains strong. The two trauma hospitals -- St. Mary's Medical Center in West Palm Beach and Delray Medical Center -- both have neurosurgeons on call around the clock every day.
But several of those neurosurgeons who work in the trauma system have quit providing non-trauma emergency care at St. Mary's, Delray and other hospitals, citing the higher risk of being sued by a patient or a patient's family.
One of them is Dr. Philip Levitt, the most senior neurosurgeon in Palm Beach County. About a year ago, he quit treating non-trauma emergencies at St. Mary's. As one of the few remaining neurosurgeons treating emergency patients, Levitt said he was on call up to 21 days a month and treating patients transported from nine hospitals throughout the region.
"I had to resign out of my own personal need," Levitt said. In the past year, Levitt said, his malpractice insurance cost rose from $60,000 a year for $250,000 coverage to $98,000 for the same coverage.
Levitt still works as one of the five trauma neurosurgeons at St. Mary's. Under the trauma system, the Health Care District of Palm Beach County pays him and other doctors to treat patients, and the hospital covers their malpractice insurance cost for seeing trauma patients.
Trauma doctors don't treat non-trauma emergencies because the district requires them to see only trauma patients when on call, and their hospital-paid malpractice insurance covers only trauma cases. Dwight Chenette, the district's chief executive, said his agency wants to help to find solutions for the lack of emergency room neurosurgeons and other specialists in the region.
Levitt said trauma patients are considerably less likely to sue him than other types of emergency patients.
"You'd have to have rocks in your head to see the non-trauma emergencies," the doctor said, regarding the malpractice exposure.
To that end, neurosurgeons in Palm Beach County have quit working in hospital emergency rooms, limited their practice to spine injuries and moved out of state largely because of surging costs of medical malpractice insurance and the desire to reduce their risk of being sued.
Florida is one of the states hardest hit by the medical malpractice insurance crisis, which has doctors in many states limiting their practices to cut liability risk. South Florida, where doctors pay some of the highest malpractice premiums, is one of the epicenters of the problem. But unlike in Broward and Miami-Dade counties, which both have public hospital systems that offer some doctors sovereign immunity from lawsuits, all of Palm Beach County's 13 hospitals are privately owned. Therefore, the doctors here are fully exposed to malpractice liability.
Levitt, 60, said the medical malpractice insurance reform plan that Bush last year guided through the state legislature has done nothing to help him or other neurosurgeons. He wants the state to give neurosurgeons and some other high-risk specialists legal immunity in treating emergency patients.
