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.

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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