Gynecologist says insurance premiums put him out of business

June 26, 2005|by HEATHER KEELS

In March, as the Maryland General Assembly wrangled over how to implement a medical malpractice law that would provide subsidized relief to physicians in the face of soaring insurance rates, Hagerstown gynecologist Dr. Chalmers Ensminger was doing some figuring of his own.

His malpractice insurance premium had gone up 33 percent for the second year in a row, Ensminger said. He was going to owe $7,500 for the first three months of the year and reality was sinking in. He said he no longer could afford to stay in business.

"I was hoping we were going to get some relief before the bills came out in April and we didn't," said Ensminger, who had been in practice for almost 30 years, including 17 at his Hagerstown office at 12907 Oak Hill Ave.


"I said, 'gee,' you know, I had to pay the premium out of my own savings ... I was pretty much working for nothing," he said.

In May, Ensminger took out an ad in the paper: "Due to the unresolved medical malpractice crisis in Maryland, Dr. Ensminger announces the closing of his practice on June 23, 2005, at 4 p.m."

It wasn't a political statement, he said, only a necessary notice of a necessary decision.

But for supporters of Gov. Robert Ehrlich, who originally vetoed the malpractice legislation, saying it didn't do enough to reform malpractice laws, Ensminger is a case in point.

"It's a trend that we're going to see continuing, unfortunately, as time goes by," said Donald Hogan, Ehrlich's deputy legislative officer, who called the premium subsidy program a "Band-Aid" on a problem fueled by unchecked malpractice awards.

"The General Assembly has failed to act in the last two sessions on the solutions proposed by Governor Ehrlich and they've adopted a short-term remedy that seems solely designed to get them by the next election."

The program, part of the Maryland Patients' Access to Quality Health Care Act of 2004, was intended as emergency relief to doctors.

It created a stop-loss fund to stabilize malpractice insurance rates through a 2 percent premium tax on health management organizations, but even after the veto was overridden, the measure was delayed by technical issues and debate over whether HMOs would pass the tax on to clients.

When the law went into effect, it wasn't enough to keep Ensminger in practice.

"They'd been talking about it, but I really didn't believe it was going to happen," Ensminger said. This month he got a refund check for $3,800 for his 2005 premium, he said, "but even with the refund ... my financial situation was tentative."

Ensminger said he considers himself lucky that, at 61, he is old enough to retire, and with a house already paid for and a family that consists of two dogs, he can get by on savings and retirement funds. He said he might continue to practice medicine as a missionary or a volunteer, where there is no risk of being sued.

"Fortunately, I don't have many expenses," Ensminger said. "With somebody who had a family, it'd be very difficult."

That's why he said he is among those who believe the future of the field rests on stronger legislation that would limit the amount a jury can award for various malpractice claims.

"I hope it happens because I think there are not going to be too many doctors left in a couple of years," Ensminger said.

John Franklin of Medical Mutual Liability Insurance, the state's largest malpractice insurer and the company Ensminger said he used, could not comment on Ensminger's case specifically and said it was too soon to judge the effects of the most recent malpractice legislation.

Ensminger's decision to close his practice follows the retirement of thoractic and cardiovascular surgeon Dr. Chia-Chuen Su in November after he heard his insurance premium would go up 40 percent for the second year in a row.

"People think they can get rich by fooling the doctors," Su said. "I had enough, so I quit ... We want to help the patients, we don't want to be labeled as a bad guy ... I'm sure everyone who can will quit."

Neurologists, obstetricians and other surgeons face the highest malpractice insurance rates due to the extent of the damages associated with their practices, Franklin said.

"If you deliver a damaged baby, he's going to live for 15, 20, 30 years ... the award is usually in the millions of dollars," said Ensminger, who said he stopped practicing obstetrics because of the high insurance rates after he moved his practice from California to Maryland in 1987. "If the insurance company is going to insure doctors for obstetrics, they need to make sure they're collecting a lot of money."

Hogan said he had heard anecdotally that it's becoming a trend for ob/gyn doctors to drop the "ob" to lower their insurance rates, though many discover they've dodged one financial trap only to run into another when they find they make significantly less money as gynecologists.

"It just shows it's not just the obstetricians," that end up being affected by malpractice insurance rates, Hogan said. "It's the full range of practices."

The records of many of Ensminger's approximately 1,400 active patients were to be transferred to Dr. George Manger at 235 Mill St. in Hagerstown. Other patients chose to transfer elsewhere.

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