Medical malpractice reform is keeping lawmakers at odds

March 13, 2005|by TAMELA BAKER

ANNAPOLIS - With more than two dozen bills to reform Maryland's medical malpractice laws pending in the General Assembly, physicians from across the state continue making weekly treks to the capital to lobby for more reforms.

Soaring premiums for malpractice liability insurance over the past few years prompted growing numbers of Maryland doctors to restrict their practices or abandon them altogether. Carol Ritter, a Towson, Md., obstetrician-gynecologist, told a Senate committee last week that she stopped delivering babies after Dec. 31, 2003, when her malpractice premium was set to consume 80 percent of her revenue.

Many of those who remain have engaged in "defensive" medicine, involving extra, sometimes invasive, tests and procedures performed to avoid lawsuits. A study commissioned by the Maryland Hospital Association last year estimated that nearly $800 million was being spent that year on defensive medicine. The study, prepared by Baltimore-based Sage Policy Group Inc., defined defensive medicine as "the provision of medical services to establish a defense against a potential lawsuit. These services would not be provided in the absence of that concern."


And more doctors are declining to accept Medicaid and other low-income patients because their reimbursement for those services is so much lower than normal charges that in some cases they can actually lose money. That forces low-income patients to use emergency rooms for routine services, and at a greater cost to the government.

What all of that translates into for the general public is loss of services, loss of access to specialty medical treatment and a whole lot of inconvenience.

Help is on the way?

But for all their lobbying, doctors have gotten little relief so far from state legislators, who remain locked in a philosophical, if not politically partisan, stalemate over how much and what kind of relief should be provided. A special session of the General Assembly convened by Gov. Robert Ehrlich in December yielded a stop-gap measure to subsidize doctors for their premium increases that the governor called "tort light" because it didn't contain many of the reforms he sought, that doctors have yet to see any money from and that even some of the bill's own sponsors have been tweaking ever since.

A "corrective" bill they have sponsored is under consideration in both chambers of the legislature, and as an example of how mired the issue has become, voting was stalled on the Senate version Thursday as Republicans offered - and Democrats rejected -10 floor amendments in an attempt to conform the bill to reforms that Ehrlich and Maryland physicians have been seeking.

Those reforms include:

· Strict requirements for expert witnesses in malpractice cases

· Caps on some damage awards

· "Good Samaritan" immunity for medical staff in certain emergency situations

· Structured payments of malpractice damage awards

The various malpractice bills filed during this legislative session include some or all of those provisions, but legislators haven't yet managed to strike the right balance between providing relief to physicians reeling from sticker shock and protecting the interests of patients who haven't been well-served by the health-care community.

Testifying about the experience of his late father, witness Michael Bennett told the Senate Judiciary Committee last week that poor care from five different institutions had led to his father's death. Choking back tears, Bennett said "my father was from the greatest generation, and he received the greatest injustice my father said he would not wish this suffering on Adolf Hitler."

He questioned the basis of the insurance companies' rationalization of raising premium charges because of skyrocketing costs of awards and settlements.

"Where are the runaway awards?" Bennett asked. "No rational person believes that insurance companies give away money for free. Malpractice rates are high because of malpractice."

The Maryland Trial Lawyers Association weighed in as well, delivering what it called "key data" culled from the 2004 annual statement of Medical Mutual Liability Insurance Society of Maryland, the state's largest malpractice insurer. The association suggested Medical Mutual had too much cash on hand to justify the more than 30 percent increase in premium charges approved last year - on top of a nearly 30 percent increase the year before.

Insurers are required to keep a certain level of financial reserves on hand. But MTLA claimed that based on its 2004 statement, Medical Mutual reduced its reserves in 2003 and posted an all-time high surplus of $139.1 million in 2004.

Feeling the impact

The House Judiciary Committee is scheduled to spend all of Tuesday afternoon, and probably much of Tuesday evening, hearing testimony on proposed malpractice legislation - 20 bills in all are scheduled, including bills sponsored by Del. Christopher B. Shank, R-Washington.

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