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Letters to the Editor
OB/GYN December 2002
Medical Malpractice Insurance
Reform
I am a board-certified obstetrician and gynecologist in Newport
News, Va, with more than 25 years of experience. My professional
liability insurance premium (malpractice extortion and protection
fee) increased more than 30% this year to $54,000. I see no help
coming in the near future, and I have little faith in any serious
tort reform as long as Democrats control the Senate. I fully expect
my premium to go up to more than $70,000 next year. The insurance
industry can be partly held responsible for this mess, since they
pay me less than $2,000 to care for a pregnant patient for 9 months
and deliver her baby, and care for her for 6 weeks after delivery!
With my office overhead expenses near 50%, I work most of the year
just to pay my liability premium. I have written to my state governor
and to my state senators, all with no response! Next time they
call for political contributions, I will tell them politely where
to go.
I had planned to continue obstetrics for another 5 years and slow
down when I was 55 years of age. Due to the current crisis in professional
liability insurance, I will no longer practice obstetrics after
the end of this year. My liability insurance will drop to below
$20,000; still outrageous, but economically possible to manage.
With more than 25 years of experience, my obstetric career has
been killed by economic extortion. My patients will suffer and
have to find care elsewhere. Dr Nolan’s editorial in The
Female Patient journal was excellent. He mentioned that The Center
for Justice and Democracy is opposed to tort reform. Perhaps because
they are a front organization for trial lawyers, with a board of
advisors including Erin Brockovich and Ralph Nader! Maybe, when
all the obstetricians quit, the trial lawyers will help out and
deliver their own children. Good luck with that….
DENNIS L NAPIER, MD, FACOG
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I sincerely appreciate your editorial on the liability crisis.
My obstetrical insurance has increased from $48,000 annually to
more than $125,000 annually. This is a severe travesty because
I perform less than 40 deliveries per year in an underserved area.
I agree that action should be taken, and we need to have specific
recommendations from our leaders regarding what action to take.
Unless we act in large numbers,
this situation will only continue to get worse.
DAVID OSTMAN, MD
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I read with interest your editorial. What struck me was the fact that in 30%
to 50% of the cases you reviewed, you felt there was some "negligence." I
am in my third year of a 4-year law program at the University of Nevada, Las
Vegas, William S. Boyd School of Law. I am very interested in medical negligence
and health care law. I have had many years of reviewing records, both plaintiff
and defendant, and I agree with you that in at least 50% of the cases I have
seen, I felt there was some negligence. Also, I have read a myriad of cases in
both tort class and in a recent health care quality law class. It seems unbelievable
to me that there is so much negligent care, especially in OB/GYN. I am not talking
about frivolous suit. Also, in several studies over the years, it has been shown
that when incidents in hospitals occur, expert physicians have reviewed them
and determined that in those cases deemed negligent, about 30% were ever litigated.
It is true that a small percentage of physicians are the cause of the majority
of malpractice cases. Although I have no love for the plaintiffs bar, it takes
two to tango and if you add insurance companies, it takes three! For every litigated
case, there is the plaintiff’s expert as well as that of the defendant.
If the plaintiff’s expert has the right credentials, his opinion is as
good as the defendant’s expert.
Here in Nevada, the insurance industry was absent when it came to trying to get
tort reform. They always seem to be absent whenever there is a fight between
attorneys and physicians. The insurance companies are the ones who control medicine.
They are the ones who reimburse physicians for their work. The few who write
malpractice policies are a part of the whole insurance industry that has been
screwing physicians for years. They are a monopoly and most states, especially
Nevada, are afraid of them.
I see no end to the cycle of low reimbursements and increasing malpractice premiums.
I think the only answer is that physicians become employees of the federal government
and come under the umbrella of the Federal Torts Act, get a good pension, and
not worry about reimbursements.
Richard L. Litt. MD, FACOG
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As the retired partner of a large OB/GYN practice, I continue
to watch the agonies and distress of my former associates. They
are six women and two men, talented and caring. On a daily basis
they deal with the threat of suit and the constant effort of the
insurance industry to decrease reimbursement. Medicare now pays
fees similar to those more than 30 years ago when I first went
into practice. So who pays the price? The patient who gets less
care because the doctor is running ragged just trying to keep their
income where it was many years ago. Who profits? Lawyers and big
time insurance executives; the rest of us lose out. An editorial
by John T. Queenan, MD, in the August issue of the Journal of the
American College of Obstetricians and Gynecologists and the presidential
address of Charles B. Hammond, MD, in the same issue summarize
well the problem, and propose some answers well worth considering.
JULIAN FUERST, MD, FACOG
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Blaming the doctors who bought
the least expensive coverage is ridiculous. Whose job was it
to keep companies
from selling us impossibly cheap policies so the taxpayers don’t
get stuck with the bill when insurance companies go bankrupt? Seems
to me it was the insurance commission’s failure to keep them
out of trouble that lead to artificially low rates. Right? Meanwhile,
a bunch of other companies did a quick hit-and-run. The companies
left are cherry-picking. I’d like them to all leave. Then
the nonprofit JUA can charge whatever is the least necessary rate
to everyone to keep the system going, temporarily.
If the insurance commission’s job is to keep insurance companies
from abusing consumers, then whose job is it keep health insurance
companies from abusing providers?
We aren’t allowed to organize and we actually work for no
pay some days. I have been getting paid less and less over the
past 15 years. Some specialties are experiencing lifestyle changes,
but OB/GYNs are actually going months without drawing a salary.
And that’s this year. Next step will be for us to drop out
of managed care plans and start charging cash up front, like they
are beginning to do on the main line. Can you imagine what happens
next? Chaos and catastrophe.
If you say, "Lawyers don’t sue doctors, patients do." you
don’t get it. That ignores the disparity between what’s
going on here versus the rest of the state. Someone said that malpractice
suits and awards are basically a social program. He gets it. Until
a real social system is developed to ease the burden of a permanently
handicapped person and his family, the tort system is all we have.
If you think the legal system is the guardian of the common man
and is the best answer to our social problems, you don’t
get it. Any system at all could distribute money to those who are
in need better than a contingency fee system that wastes 40% to
50% of the money on the plaintiff’s side, and, lest we forget,
hundreds of thousands of dollars on the defense side.
If you think change of venue rules will help, you don’t get
it. This is not a local problem, it is national. You can at least
do something on a statewide basis if you want. First step—uniform
rates across the state, as of January 1.
If you all think that Pennsylvania is so different than other states
you don’t get it. No one has yet to explain why what works
in other states won’t work in Pennsylvania? Yes, our state
constitution is a problem, but it was amended after the crisis
in 1976! Telling an audience of doctors that Pennsylvania has unique
problems is like telling us that aspirin works well in California
and Indiana, but not Pennsylvania. Right. Why does Pennsylvania
have to be the last to get it?
MARK B VIZER, MD
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