End-of-year action crucial: Pennsylvania faces liability meltdown
State physicians are calling for meaningful tort reform and insurance
premium relief.
By
Tanya Albert, AMNews staff. Dec. 9, 2002.
Additional information
An estimated 60% of Pennsylvania physicians' medical liability
insurance policies are set to expire at the end of the year, and tension
over the issue is running high.
As Dec. 31 looms, Pennsylvania physicians fear that some areas are on
the brink of access-to-care issues similar to ones experienced this year
in Mississippi, where rural women are still having a hard time finding a
nearby obstetrician, and in Nevada, where Las Vegas' only level 1 trauma
center closed for 10 days.
Some doctors already have announced that they'll close their practices
or -- at the least -- stop offering high-risk procedures after Jan. 1,
2003, because they can't afford six-figure insurance bills.
Those hanging on say they may be able to keep up with the payments for
another six months, but they could be forced to shutter their practices
then if something doesn't give.
The announcements aren't just coming from Philadelphia anymore. Doctors
in every corner of the state -- from Scranton to 60 miles outside of
Pittsburgh -- are being forced to make tough financial decisions. The
impact on patient care will be greater in rural areas that can't afford to
lose a large number of physicians.
Pennsylvania -- one of the first states to see medical liability
insurance rates spike, forcing physicians to move away, retire early or
eliminate high-risk procedures -- has grappled with the medical liability
problem for several years.
Liability insurance premiums jumped almost 200% for one Uniontown,
Pa., ob-gyn group.
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The Legislature passed some tort reform measures this year, including
allowing physicians to pay damages over time. But the measures did little
to alleviate the crisis, which doctors say is now coming to a head.
"It's a very critical time," said Charles J. Bannon, MD, a Scranton,
Pa., general surgeon. "We need this relief, and we need it now."
Dr. Bannon is part of a 14-doctor group that includes seven urologists
and seven surgeons in the Scranton area. The practice is preparing to
close Jan. 1, 2003.
As a result, four hospitals will have no urology coverage, and the
nearest urologist will now be 30 minutes to 90 minutes away for patients
who usually went to Scranton.
The group, Delta Medix, made the decision after its insurance company
said it considered dropping two of the physicians' coverage, but decided
to make an exception and continue insuring them this year. The group --
whose physicians faced rates 50% to 130% higher than last year -- said it
had no guarantee that things were going to change.
At least another 25 physicians in the Scranton and Wilkes-Barre areas
-- likely the hardest-hit area this year -- have made similar
announcements. "I hope we have gotten beyond finger-pointing," Dr. Bannon
said. "If we lose, who wins? We have to get this straightened out for the
sake of the community."
There is a flurry of activity in the state capital now.
At press time, current Gov. Mark Schweiker said he was working on a
six-month suspension for physicians' payments to the state's catastrophic
fund that helps pay for medical malpractice jury awards. A bill that would
have started the process to amend the state constitution to allow caps on
noneconomic damages in medical malpractice cases was still active in the
Legislature at press time.
And on Nov. 20, Gov.-elect Edward G. Rendell announced a task force
whose mission will be to find short-term solutions that address the
problems physicians face as insurance costs rise while Medicare, Medicaid
and managed care income does not. He wants an interim report in 60 days.
The task force also will consider ideas such as suspending physicians'
catastrophic fund payments. Also on tap is looking at requiring a
physician to sign off on the merits of a medical malpractice lawsuit
before it can be filed, authorizing joint negotiation to give physicians
more bargaining power against health plans, and increasing Medicare and
Medicaid payments.
Physicians hope that something meaningful will come out of the efforts.
The Pennsylvania Medical Society "looks forward to working with
Gov.-elect Rendell to preserve the sacred doctor-patient relationship,"
PMS President Edward H. Dench Jr., MD, said in a statement.
Physicians' response
The mood among Pennsylvania physicians contemplating the future ranges
from gloom and doom to cautious optimism.
"The tone is nervous waiting," said Donna Baver Rovito, legislative
chair of the Pennsylvania Medical Society Alliance, who has been closely
tracking physicians who have left the state or reduced services because of
insurance problems.
With only two traditional insurance carriers left writing insurance,
physicians say they want a plan that ensures that liability insurance will
be available, affordable and reliable.
"I'm hopeful, because I can't imagine the Legislature will let this
crisis continue," said Scranton urologist Jerald Gilbert, MD, with Delta
Medix.
But Allentown, Pa., neurosurgeon George Chovanes, MD, isn't optimistic
about the governor-elect's task force accomplishing that goal.
"It's window dressing," said Dr. Chovanes, who at press time was
waiting to see if his insurance carrier would renew his policy. "I would
be happy to be wrong, though."
"We need true tort reform," added Kingston, Pa., surgical oncologist
Gary Verazin, MD, whose four-person surgical group stopped seeing new
patients Nov. 1.
Caps on noneconomic damages and tougher screening of expert witnesses
are among the things that should be discussed, Drs. Chovanes and Verazin
said.
But Uniontown, Pa., obstetrician-gynecologist Lawrence Glad, MD, is
hopeful that something will change so that he can start delivering babies
again.
Dr. Glad and his two colleagues stopped delivering babies this fall
because the physicians, all in their 30s, couldn't afford the insurance:
$400,000 this year compared with $150,000 last year. The decision to offer
only gynecological services was made after accountants said the group
would be bankrupt by February 2003 if they paid the higher insurance rate.
Now, there are just four obstetricians left in the county. Those four
all are approaching retirement age. Some women are driving 60 miles to
Pittsburgh to deliver their babies.
"Physicians don't want to leave," said Dr. Glad, a native
Pennsylvanian. "We've taken the attitude to stay and fight, to get our
voices heard."
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