Costs Lead Rural Doctors to Drop Obstetrics
By John Porretto
Associated Press
Friday, November 23, 2001; Page A04
JACKSON, Miss. -- When Kim Smith went into labor in Holly Ridge on Sept. 9, 1993, she had every intention of driving two hours south to her doctor in Jackson.
But Smith and her family ended up instead in a hospital in nearby Indianola, where family practice physician Edgar Donahoe Jr. delivered her son.
"We barely got in the car and it was time to have the baby," said the 40-year-old mother of three.
If Smith were in the same predicament today, she may not have found a doctor in time.
Physicians who specialize in family medicine and obstetrics/gynecology in Indianola and other rural areas of Mississippi are increasingly dropping obstetrics because of skyrocketing costs for malpractice insurance.
Medical liability insurance rates for doctors who deliver babies have risen from 20 percent to 400 percent this year depending on the carrier, according to the Mississippi State Medical Association.
Annual premiums range from $40,000 to $110,000, the association said.
"They're passing the load to every physician they cover," said Liz Carroll, the medical association's government affairs representative. "Good doctors are being forced to ante up for the jackpot justice mentality in this state. In the end, patients have fewer options."
The Delta has been particularly hard hit because of the already-limited choices for care in the rural, impoverished region.
Three of the six doctors in Cleveland who deliver babies ended that part of their practice in October because of the increase in premiums. Greenwood soon will go from four to two. Yazoo City, which has 14,550 residents, has no one practicing obstetrics.
Waldemar "Lanny" Prichard, one of Donahoe's partners in Indianola, said he will have to stop delivering babies next year unless he gets a break on his malpractice insurance bill, which he pays himself.
Prichard's premium for the coming year: $70,000. His gross salary last year: $72,000.
"Rural family doctors don't make a lot of money, contrary to popular belief," said Prichard, 57. "My whole raison d'etre is I wanted to be a doctor -- not for the money but for the sheer pleasure and satisfaction of making a difference in people's lives. But you still have bills to pay."
Insurance companies say they've had no choice but to raise rates because of increasing health care costs and the rising number of high-dollar lawsuits and claims in Mississippi and other states.
Mississippi has gained a national reputation for multimillion-dollar verdicts and settlements and attracted high-profile lawsuits involving the tobacco industry, asbestos, health maintenance organizations and drug companies.
"The legal climate is one of several factors that has us where we are," said Mississippi Insurance Commissioner George Dale. "That's what the insurance companies want to talk about. But they've also seen their investments decline in this economic downturn."
The St. Paul Cos., one of Mississippi's largest medical malpractice carriers, earlier this year requested a 75 percent rate increase for doctors in the state. The state approved a 65 percent increase.
Not satisfied, St. Paul responded by dropping a number of ob-gyns and other doctors in high-risk specialties. A spokesman said it was part of the company's nationwide strategy to reduce its coverage of ob-gyns, emergency-room doctors and general surgeons.
Dale said he has threatened to rescind the rate increase approval if St. Paul continues to drop doctors. The issue was still pending late last week.
Mississippi is not alone in dealing with high malpractice insurance rates.
West Virginia Gov. Bob Wise (D) called legislators into special session last week to come up with affordable insurance options for doctors, some of whom are leaving the state.
In parts of Florida, some doctors paid nearly $160,000 last year for professional liability insurance.
Prichard said he and other doctors in the Delta can't simply increase their fees to cover the higher cost of insurance because most of their pregnant patients are on Medicaid, the government program that helps pay health care costs for the needy and aged.
Something has to happen soon or the medical crisis in rural areas will become even worse, he said.
"The Delta is already known as a place not to go to if you want to practice medicine," Prichard said. "It's like our recruiting policy is: Come to us where you can work three times as hard for half the money." |
