Doctors facing a dilemma

October 10, 2004|by ANDREW SCHOTZ

HAGERSTOWN - While other local physicians have worried about rising malpractice insurance costs, three obstetrician-gynecologists have wondered: Will they have coverage at all?

On Thursday morning, Dr. Jay B. Greenberg of Mid-Atlantic Women's Health Center in Hagerstown said the threat was real because of a pending claim against a physician in his practice.

It was possible that The Doctors Co. of Napa, Calif., wouldn't renew that physician's coverage and, subsequently, the rest of the practice's coverage because losing one doctor might create too big a burden, Greenberg said.


By Friday afternoon, though, after talking to the company again, he was more optimistic that the current claim wouldn't torpedo the physicians' coverage.

The Doctors Co. spokeswoman Jesmine Hulsey later agreed.

"Our position is one claim is not cause for nonrenewal," Hulsey said. "We recognize that doctors have claims and that's why they need insurance."

Still, Greenberg said he and his two practice colleagues - Dr. Ann M. Tramontana and Dr. Hilary W. Ginter - might not get a guarantee of coverage until Nov. 1, or 60 days before the new year begins.

Hulsey said she couldn't discuss whether the policy will be renewed.

If it is renewed, it will be expensive, Greenberg said.

The combined premium for the three physicians rose from $74,000 two years ago to $80,000 last year to $105,000 this year, he said.

Greenberg said The Doctors Co. recently told him that next year's rate hadn't been set, but the premium would be about $170,000.

Hulsey confirmed those figures.

Limited choices

Greenberg, 54, a founding member of the practice in 1980; Tramontana, 50; and Ginter, 36, appear to have limited choices.

They could switch to Medical Mutual Liability Insurance Society of Maryland, which insures most of the state's doctors.

However, their premium with Med Mutual, as it's known for short, could be two or three times as expensive - an increase they can't afford, Greenberg said.

"The Doctors Co. is giving me a good deal," he said.

The OB-GYNs also could shut down and go elsewhere. But Pennsylvania and West Virginia, which are struggling with their own insurance increases, would not be options, Greenberg said.

Or, the physicians could stop practicing entirely. Greenberg hopes not.

"It's the only thing I've been trained to do," he said.

Spreading the word

Doctors throughout Washington County have been training themselves lately in something new: spreading the word about their plight.

They've agreed to spend up to $100,000 on a public relations firm. They've spoken openly about their five- and six-figure insurance premiums.

Last month, hundreds of doctors agreed to halt the elective or nonemergency parts of their work, starting Nov. 15, as a message that medical malpractice awards and insurance rates are becoming unbearable.

Greenberg said nonemergency procedures for OB-GYNs include sterilization, certain hysterectomies and yearly checkups for new patients.

"I think it's the only way the patients are going to understand it's a problem, how things might get if people start cutting back," Tramontana said. "They won't have access."

Asked if a work stoppage would violate the Hippocratic oath to treat those who need help, Greenberg said it would not. Patients might be inconvenienced, but they won't be hurt, he said.

Now, though, several physicians say the work stoppage might be postponed or canceled if the governor and the Maryland General Assembly find a solution by then.

Gov. Robert Ehrlich, a Republican, said Friday that he has asked House Speaker Michael Busch and Senate President Thomas V. Mike Miller Jr., both Democrats, to meet with him Monday to discuss the issue.

Among the measures that Washington County's physicians have said will help are: caps on malpractice awards, rolling back premiums, certifying witnesses in their specialties if they testify in malpractice cases and having binding arbitration through special "health-care courts."

Miller favors subsidized funds to help pay for malpractice awards, but Ehrlich and Busch want deeper changes.

Poor outlook

Greenberg said OB-GYNs, as a group, suffer as much as any doctors in these times because of their liability risk for both mothers and babies. As a result, many OB-GYNs - including three locally - are cutting the obstetrics parts of their practices, he said.

During an interview at his office Thursday, Greenberg, in a new role of spokesman for a cause, produced a slew of articles, columns and statistics on the poor outlook for his specialty.

He talked about the lack of medical students entering his profession and the high national rate of obstetricians leaving.

He mentioned that medical malpractice is considered a "crisis" in at least 22 states, plus the District of Columbia, according to the American College of Obstetrics and Gynecology. Maryland, Pennsylvania and West Virginia were on the list.

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