Medical malpractice became a political flashpoint late in 2004 when, after lobbying for months, Gov. Robert Ehrlich thought he had an agreement with Senate President Thomas V. "Mike" Miller and House Speaker Michael E. Busch for broad reforms. He called a special session of the General Assembly in late December to get the reforms approved before the doctors' insurance premiums were due in January.
But Miller, a Democrat, came up with his own bill - which many Republican lawmakers termed "tort light."
The Maryland Patients' Access to Quality Health Care Act of 2004 created a stop-loss fund to stabilize malpractice liability insurance rates for medical professionals, paid for with revenue from a 2 percent premium tax on health management organizations, which for years had enjoyed a tax exemption.
The act also added reporting requirements for malpractice insurers, including claims experiences, the amount of money paid out in malpractice awards and settlements, and on the amount of money kept in reserves. It also singled out the state's largest malpractice insurer, increasing the information Medical Mutual Liability Insurance Society of Maryland must report to the state's insurance commissioner.
But so many reforms were missing that Ehrlich vetoed the bill shortly before the regular General Assembly began last January. In an act that is still a sore subject for Ehrlich, the Democrat-controlled legislature promptly overrode the veto, voting nearly precisely along party lines.
Consequently, Riggle and his colleagues became fixtures in Annapolis as they lobbied for reforms that never came. Now, in addition to their lobbying efforts, some of the physicians have formed a political action group called the Maryland State Surgical Association. Riggle said the group is "focusing on key districts, making our presence known" - a serious strategy in an election year.
But from their perspective, serious strategy is necessary. Soaring premium rates have prompted a number of Maryland physicians to either limit their practices or quit altogether, Riggle said, which translates into access problems for patients.
"We have less doctors practicing out here and we have more trouble caring for patients," Riggle said. "There's been no improvement in rates and no change in the climate; we're still spending millions of dollars on defensive medicine."
"Defensive medicine" is the practice of performing extra, and sometimes unnecessary, procedures - just in case there's a lawsuit. Riggle maintains that those extra tests result in longer wait times for patients in hospital emergency departments. He estimated that at Washington County Hospital 20 CAT scans are performed between 11 p.m. and 7 a.m. on a given night. In fact, so many CAT scans are being done, Riggle said, that outside sources have been hired to read them "because the docs can't stay up all night to read them."
Del. Christopher B. Shank, R-Washington, sponsored a number of malpractice bills last year, and plans to introduce more in the upcoming session.
For his part, Ehrlich told The Herald-Mail he plans to propose malpractice legislation of his own, "but am I optimistic? No."