In a recent post, I asked the question whether or not people would favor providing some type of immunity to emergency physicians if doing so would increase the availability of emergency medical care.
So far, about 75% of people answering that question voted “yes.”
Some of the attorneys that read this blog were all over me.
In particular, Max Kennerly, an attorney with a plaintiff’s law firm and someone whose opinions are generally cogent, thought that immunity would do little good in improving access to emergency care since “There’s no evidence malpractice — which is at the very most 1.5% of healthcare costs — is a major contributing to the lack of access to emergency care in this country. You could eliminate malpractice liability entirely and barely dent access to emergency care.”
- A 2005 hospital ED administration survey also lists “malpractice concerns” as the principal factor discouraging specialists from providing ED coverage.
- Furthermore, because liability premiums have outpaced payments for their services, some surgeons have concluded that they simply cannot afford the added liability risk for a largely uninsured patient population.
- In addition, younger surgeons, who often take the on-call shifts at trauma centers, are leaving states with the most severe liability problems.
- For example, according to the Project on Medical Liability in Pennsylvania, funded by the Pew Charitable Trust, “Resident physicians in high-risk fields such as general surgery and emergency medicine named malpractice costs as the reason for leaving the state three times more often than any other factor.”
- Further, an American Hospital Association study found that more than 50 percent of hospitals in medical liability crisis states now have trouble recruiting physicians, and 40 percent say the liability situation has resulted in less physician coverage for their EDs.
- The crisis has even forced the closure of trauma centers in Florida, Mississippi, Nevada, Pennsylvania, and West Virginia at various times in recent years.
- Specialties that have experienced particularly high premium increases—including neurosurgery, orthopaedics, and general surgery—are also among those that provide services emergency patients most frequently require.
- According to a report from the General Accounting Office, soaring medical liability premiums have led specialists to reduce or stop on-call services to hospital EDs, seriously inhibiting patient access to emergency surgical services.
Max then responded to the articles I cited by stating that they were biased “surveys and a summary for a hospital lobbying group.”
After all, some of the data were based on surveys of *gasp* doctors.
Max, you lost me, there. If you want to know about doctors’ liability fears or if you want to know why doctors are leaving one state for another state, who are you going to ask? Grocery clerks? School teachers? Attorneys? Would the surveys have been more persuasive if they asked a bunch of nuns what effect they thought that medical malpractice liability would have upon the access to medical care?
Of course the survey participants were doctors. Those are the people whose opinions everyone is seeking.
So I spent about 45 minutes doing some further research on the internet and on some paid medical web sites. I decided to make this a separate post so that if anyone else was searching the internet looking to find out whether malpractice affects access to medical care, you can pick up on the work I’ve done.
Below the fold are some more “nonexistent” studies that support my assertion. Funny, but I haven’t seen one link to any study that asserts the opposite. Oh, and if you do happen to find something … mind you – no surveys from biased lawyers, now.
In court, I believe the term is “uncontroverted evidence.”
Review of the professional medical liability insurance crisis: lessons from Missouri merit prizeAmerican Journal of Obstetrics and Gynecology – Volume 190, Issue 6 (June 2004) Erol Amon, MD, JD; Hung N. Winn, MD, JD
In 2001-2002, many insurers stopped writing new and existing PLI. A survey found 1 in 7 physicians had their PLI terminated and/or application for new insurance denied. Average premiums increased 22% in 2001 and 60% in 2002. Accordingly, 50% of surveyed obstetricians took salary cuts, 18% secured loans, 9% liquidated assets, and 55% significantly limited their clinical services. An adverse court ruling caused insurers to double reserves. Incomplete data led the Missouri Department of Insurance to erroneously conclude a decrease in claim frequency and severity. In contrast, courthouse records and missing data sources revealed increased malpractice filings. PLI premiums continue to rise.
Many life-saving specialists are being forced out of business. Specialists are less willing to care for emergency and indigent patients for fear of liability exposure. Legislative enactments leading to meaningful tort reform, public support, and judicial restraint must occur to save health care.
EMTALA and the Ethical Delivery of Hospital Emergency Services
Emergency Medicine Clinics of North America – Volume 24, Issue 3 (August 2006)Robert A. Bitterman, MD, JD
The on-call issue is complex highly politically and economically charged, and EMTALA is only one reason driving the diminishing availability of on-call services by US physician specialists. The uncompensated care burden, malpractice liability issues, decreased reimbursement from Medicare and Medicaid, difficulties obtaining payment from managed care entities, and lifestyle issues are more or equally compelling reasons physicians avoid emergency department on-call services.
Medical Malpractice: The Good, the Bad, and the Ugly
Urologic Clinics of North America – Volume 36, Issue 1 (February 2009)
Kevin R. Loughlin, MD, MBA
Over the past several decades, as the malpractice crisis has intensified, there has been increasing focus on the impact of malpractice costs. The first major attempt at limiting caps was the California Medical Injury Compensation Reform Act (MICRA), which was passed in 1975. This legislation was passed in response to skyrocketing judgments in malpractice suits and dramatic increases in malpractice insurance premiums and decreased access to health care. The malpractice environment in California at that time included a 200% increase in the number of malpractice claims in the preceding 10 years and a 1000% increase in the dollar amount of judgment awards in the prior decade. In California, since MICRA was enacted, benefits to the health care system have accrued. Specifically, lower malpractice premiums, improved patient access to care, and earlier and more equitable settlements have occurred since the passage of MICRA. Malpractice caps alone have not proved, however, to be the panacea to the malpractice crisis that they were initially thought to be.***The authors identified two categories of defensive medicine. The first was “assurance behavior,” or ordering more diagnostic tests than were medically indicated. The second was “avoidance behavior,” where high-risk patients are referred to other providers. Urologists are also affected by defensive medicine. A recent survey among urologists reported that 58% are considering referring difficult cases and 60% are considering limiting the scope of their practice.
GOVERNOR RENDELL UNVEILS MEDICAL MALPRACTICE LIABILITY REFORM PLAN PLAN AIMS TO ENSURE PATIENT SAFETY, ACCESS TO QUALITY HEALTH CARE FOR ALL PENNSYLVANIANS
http://www.state.pa.us/papower/cwp/view.asp?A=11&Q=435088The Governor’s proposal is a comprehensive solution to the current crisis developed after months of research and study on this national crisis. Based on recommendations from the Governor’s Task Force on Medical Malpractice, Governor Rendell will work with the state legislature to implement real change in the system by helping physicians with the cost of medical malpractice coverage for the next three years through state payments of Medical Care Availability and Reduction of Error (MCARE) premiums, as well as implementing patient safety initiatives, along with tort reforms and insurance reforms. Governor Rendell said the main purpose of his proposed reforms, along with comprehensive reforms of 2002 and 2003, is greater availability and affordability of medical malpractice insurance.
HARMING PATIENT ACCESS TO CARE: THE IMPACT OF EXCESSIVE LITIGATION
“The United States is facing a crisis that in the end is going to harm patients. One has to look no farther than my home State of Florida where some obstetricians/gynecologists are paying in excess of $200,000 per year for their liability insurance. Or Mississippi, where neurosurgeons have been leaving the State to practice in Louisiana which has significantly lower insurance premiums.
The most disturbing indication of the severity of this crisis, however, might in Las Vegas, where the county-operated trauma center was forced to close because the Center’s trauma surgeons could no longer afford to risk their livelihoods in this climate of runaway litigation. I’m advised that the trauma center recently reopened, which will spare the city from the dubious distinction of being the largest metropolitan area of the United States without a trauma center.
The United States has seen steady increases over the past several years in both jury awards and malpractice suits and the average amount paid by insurance companies for claims merely alleging malpractice. However, California has remained relatively immune to the pressures brought about by these trends, largely thanks to MICRA. It is a time tested system that certainly seems to work and we should not be discarding any consideration of that type of a process.
The point of this, Mr. Chairman, is that doctors have raised valid concerns about medical malpractice insurance premiums, about access to medical malpractice coverage, about the nature of medical malpractice litigation itself. But the current medical malpractice crisis and it is undoubtedly a crisis because of its effect on patients, first and foremost, and on physicians, importantly, the current crisis should not be used as an excuse to decimate a system that protects patients and doctors. We shouldn’t use this hearing as an excuse to beat up on the insurance industry or to demonize lawyers or to trivialize the concerns of providers or dismiss the legitimate rights of patients. The doctors in my District and others around the country whom I know and whom I respect, have no problem with being held accountable as long as the system is fair.
Mr. Chairman, this crisis affects more than just patients and doctors. Recently, the orthopedics practice that was to cover the Doylestown Hospital emergency room on a weekend found that its insurance coverage would lapse. After months of searching, the hospital then had to find other practices to cover the ER. Other orthopedics practices are also having trouble finding insurance in the area. What happens when we can’t find orthopedists to treat the broken bones and dislocated joints in the ER on weekends? Worse, St. Mary’s Medical Center, the only trauma center in Bucks County, faced closing its doors last fall since it could not find insurance. Luckily, the State came through with emergency coverage. However, this is not sustainable in the long run. Las Vegas, for the past few weeks, as we’ve seen in the news has not been so lucky. This is about patients, doctors and health care institutions where care is delivered. This is not merely a crisis. It is more than that. It is beyond a meltdown. It is a full-blown catastrophe that is having a damaging and detrimental impact on the health care of Pennsylvania and millions of Americans. Worse, this catastrophe will result in people dying because trauma centers will continue to close their doors or emergency rooms will be unable to provide care since doctors won’t be available. I am saddened and angered that this catastrophe is having permanent and long term effects, weakening hospitals, debilitating medical schools, reducing the number of doctors who practice and destabilizing health care institutions. The cause, Mr. Chairman, is clear, unfettered litigation. The median malpractice by jury awards rose from $500,000 in 1995 to $800,000 in 1999. We need reforms now.
[There were many more states mentioned with similar examples – these are just some highlights]
- Florida: Double- and triple-digit premium increases have forced some doctors to cut back on staff, while others have left the state or have stopped performing high-risk procedures to avoid the lofty rates. Ob-gyns in this state are more likely than their colleagues in other states to no longer practice obstetrics.
- Mississippi: According to the Mississippi State Medical Association, medical liability insurance rates for doctors who deliver babies have risen 20% to 400% in the past year, depending on the carrier. Annual premiums range from $40,000 to $110,000. In Cleveland, Mississippi, three of the six doctors who deliver babies dropped that part of their practice in October 2001 because of the increase in premiums. In Greenwood, Mississippi, where approximately 1,000 babies are born every year, the number of obstetricians has dropped from four to two. The two remaining obstetricians are each limited to delivering 250 babies per year, leaving approximately 500 pregnant women searching for maternity care, reports the Mississippi Business Journal. In Yazoo City, Mississippi, which has 14,550 residents, there is no one practicing obstetrics.
- Nevada: In December 2001, The St. Paul Companies, Inc., the nation’s second largest medical liability insurer, announced it would no longer renew policies for 42,000 doctors nationwide–including the 60% of Las Vegas doctors who were insured by St. Paul. Replacement policies are costing some Nevada doctors four or five times as much as before: $200,000 or higher annually, more than most doctors’ take-home pay. A February 2002 survey of Clark County ob-gyns, commissioned by their ob-gyn society, revealed: 60% indicated that they are going to drop obstetric care from their practices because they cannot afford the increases in their professional liability insurance. 42.3% are making plans right now to leave the state if there is no resolution in the medical liability situation in the next couple of months. 78% percent indicated that they ultimately will have to leave the state if there is no long-term solution. According to a March article in the Las Vegas Review-Journal, many Las Vegas Valley doctors say they will be forced to quit their practices, relocate, retire early or limit their services if they cannot find more affordable rates of professional liability insurance by early summer.
- Pennsylvania: Philadelphia and the counties surrounding it are hardest hit by the liability crisis. From January 1994 through August 2001, the median jury award in Philadelphia for a medical liability case was $972,900. For the rest of the state, including Pittsburgh, the median was $410,000. One-quarter of respondents to an informal ACOG poll of Pennsylvania ob-gyns say they have stopped or are planning to stop the practice of obstetrics. 80% of medical students who come to the state for a world-class education ultimately choose to practice elsewhere, according to the Pennsylvania State Medical Society.
- Texas: Preliminary results of a recent Texas Medical Association physician survey indicate that more than half of all Texas physicians responding, including those in the prime of their careers, are considering early retirement because of the state’s medical liability insurance crisis and nearly a third of the responding physicians said they are considering reducing the types of services they provide because of recent premium increases for medical liability.
Critical health care services leaving
The cost of medical malpractice insurance is forcing physicians to relocate.