June 26, 2002 -- The malpractice crisis isn't just about doctors anymore.
The day before Father's Day, Methodist Hospital, which for 110 years delivered all of south Philadelphia's babies, began sending expectant mothers 20 blocks north to Thomas Jefferson University Hospital to have their babies.
The Methodist maternity ward, which in the early 1900s was the place to be born in Philadelphia, was claimed as another casualty in the 2002 malpractice crisis. The hospital can no longer afford to pay the skyrocketing bills for malpractice insurance, so its board voted to get out of the baby business.
Far away in the south Texas town of McAllen (population 106,414) all head injuries are life threatening because there is only one neurosurgeon still practicing there, and "he has to sleep sometime." Mark Kubala, MD, a Beaumont, Texas neurosurgeon, says that neurosurgeons from Corpus Christi or San Antonio usually provide coverage for McAllen. "But recently, an elderly man had a severe head injury from a fall. The emergency room doctors checked Corpus Christi, San Antonio, and even Austin but couldn't find a neurosurgeon," Kubala tells WebMD. When a neurosurgeon was finally located, "seven hours had passed. By then the patient was in a coma and he eventually died."
Richard Corlin, MD, a Santa Monica, Calif., gastroenterologist who just completed a term as president of the American Medical Association, says that Philadelphia and McAllen, Texas, are just two of hundreds of examples of the effect of the current malpractice crisis.
Rising malpractice insurance costs and fewer insurance companies willing to offer malpractice coverage fuels the crisis. Corlin and the AMA contend that multimillion-dollar awards handed out by juries drive up the premiums. Those spiraling awards drive insurers out of the malpractice insurance market, and the remaining insurers jack up rates to try to cover future awards.
Caught in the middle are the nation's doctors and hospitals that often can no longer afford the insurance bill. For example Sand Reed, MD, a Thomasville, Ga., obstetrician-gynecologist, says that insurers -- including Medicare -- are cutting payments to her so "I'm taking a pay cut." That cut leaves her hard-pressed to pay the higher malpractice rates.
Many physicians caught in a similar squeeze are fleeing states with high malpractice insurance rates and setting up practice in states that have reformed their legal systems. Corlin says that California is a good example of a state where reforms have worked.
The Medical Injury Compensation Reform Act, called MICRA (pronounced mike-ra), limits the amounts that juries can award for pain and suffering to a maximum of $250,000 and also limits the contingency fees paid to attorneys, and it requires that multimillion-dollar awards be paid out over several years rather than in a lump sum.
Corlin says that MICRA has meant money in his pocket: "I pay $7,700 a year for malpractice insurance. But in Miami, a gastroenterologist pays up to $40,000." Similarly, an obstetrician in California pays an average of $60,588 for malpractice insurance, while a physician delivering babies in Miami has to pay more than $200,000.
Corlin says the situation is so bad that it has reached the critical stage in a dozen states -- Florida, Georgia, Mississippi, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Washington, and West Virginia -- and 30 other states are reaching the breaking point.
Thus, the AMA has declared malpractice reform its No. 1 legislative priority. It wants a federal law similar to MICRA to be passed within a year. To bring pressure inside the beltway, the AMA is asking for help from trade groups, unions, employers, farmers, patient advocacy groups -- in short any one who is willing to join their ranks.
Corlin says the AMA's reform campaign will cost $15 million this year, and he is passing the hat to pay for it. At the AMA's annual meeting in Chicago, Corlin asked every one of the more than 550 delegates for a $1,000 donation "to fund our war chest," and he kicked off the campaign with his own check for $1,000. Within minutes more than 20 checks were deposited in campaign donation box.
M.A. Subhan, MD, a family physician from Kingman, Ariz., came to the AMA meeting as guest of some other physicians. Subhan tells WebMD that he came seeking help for his own problem: Even though he has never had a malpractice suit filed against him, his longtime carrier refused to renew his insurance.
As he made his way to Corlin to hand him a check for the malpractice reform campaign, Subhan was talking on a cell phone with his office manager, who was updating him on the latest news about his search for coverage. "We have to do this," he said as he handed Corlin the check.