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Lawsuits will drive doctors away

September 05, 2004|by Frank Collins

The malpractice insurance crisis has arrived in Maryland. As surgeons, our malpractice premiums will bloat by more than 74 percent (after last year's 28 percent increase). The local physician community of 300 will pay not 6 million, but $10 million annually.

In December, insurance premium increases requested by Medical Mutual (the state's largest malpractice insurer), will arrive and, to put this in human terms, one small office with three surgeons will be paying $800 in malpractice premiums every business day.

The legislature tabled tort reform and refused to go into special session as the Governor has requested to deal with this crisis. The rationale is simple denial; there can be no crisis since no patient has had a problem with access to care as of yesterday.

Until now, most people have received health care at sharply discounted rates, because most doctors "participate" in insurance and HMO plans.

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These contracts oblige us to accept declining, basement-level reimbursement rates regardless of our upward-trending overhead under threat of seeing our patients sent elsewhere. The patient no longer realizes the initial benefit of this arrangement because the funding of numerous interests, including CEO salaries, shareholder expectations, pharmaceutical companies and equipment suppliers now drives health insurance rate increases.

Trial lawyers describe malpractice insurance as a safety net, but only three cents on every dime paid into the malpractice premium pool actually makes it to the injured patient. With approximately 70 percent going to insurance company bureaucrats and lawyers, who is this safety net really for?

There are many ways the stated goals of malpractice trial attorneys could be reached. But there is no financial incentive for them to be involved in any way other than as adversaries. This is a shame because our colleagues in the legal arena possess the skills needed to help change the medico-legal environment to one that values the type of evidence-based medical practices that society deserves. No human health-care delivery system will ever deliver perfect outcomes in every case, but the current broken system of tort law is ineffective at best, parasitic at worst.

While we await a solution, what are we individual practitioners to do?

We could stop participating in insurance company/HMO pricing schemes and charge more (go out of network).

We could practice without malpractice insurance and hope for the best. But without malpractice coverage we are barred from being on staff at Washington County Hospital. Without the physician staff doing the heavy financial lifting by paying individual premiums, the hospital would be "uninsurable" according to our administration. We are, in other words, the fall guys for the industry.

We could stop certain aspects of our care that are the riskiest - no more baby deliveries, no more trauma care, no more aneurysm repair, no more breast cancer screening...and hope this would someday lead to lower premiums.

We could retire early or move to a state with tort reform.

We could seek state employment and immunity from lawsuits, although the cold war fairly well demonstrated the fallacy of centrally planned economies.

Yesterday we were here to provide care as we were trained to do. But from here, doctors will be forced into retirement, into moving, into closing insolvent practices, into going out of network and into limiting care to low-risk interventions. This means that you, the Washington County resident, will have difficulty seeing the doctor. This loss of access to primary care and specialists has occurred in countless rural areas where malpractice issues have been ignored.

"Health care as usual" has devolved into an unworkable quagmire in dire need of a reformed social contract. Successful reform would reset expectations, alter patient and physician accountability, change the way injured patients are compensated and abolish the dysfunctional malpractice system as it now exists.




Frank Collins signed this with two dozen other physicians in Washington County.

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