O.T...If you haven't noticed there's a scary shortage of physicians,techs,etc in the health care arena.............Some states facing ob-gyn shortage
Doctors say malpractice insurance rates are forcing them out of business
By Jim Avila
NBC NEWS
May 8 — There is a growing health care crisis for women in this country: obstetrician-gynecologists are going out of business at an alarming rate, which is very bad news for women having families. And for some mothers, getting adequate care can become a major problem when the local doctor disappears.
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THE DELIVERY of Melinda Sallard’s third child, Susanna, began just as the first two did, with five-minute contractions.
“Then all of a sudden they just got down to two,” says Sallard.
And the race was on, down a dark two-lane road through the Southern Arizona desert. This time, however, she continued driving past her hometown hospital, where doctors no longer deliver babies, 50 miles to the closest ward with a working ob-gyn.
“I was scared,” says Sallard.
Less than halfway to the delivery room, Susanna was born — in the car.
“I just pushed her out and just held her against me with the umbilical cord attached until we got there,” says Sallard.
Melinda’s doctor was one of nearly 5,000 thousand ob-gyns who have stopped delivering babies — 10 percent who have gone out of business because they couldn’t afford malpractice insurance.
Alarmed by a recurring medical liability insurance crisis, The American College of Obstetricians and Gynecologists (ACOG) issued a national "Red Alert" on the condition of obstetrical care. ACOG warns that without federal and state reforms, chronic problems in the medical liability system could severely jeopardize the availability of physicians to deliver babies in the U.S.
New Jersey: Three medical liability insurance companies will stop insuring NJ doctors in 2002 for financial reasons. The state's two largest medical liability insurers have stated they cannot pick up all the extra business and are rejecting doctors they deem high risk. The president of the New Jersey Hospital Association says that rising medical liability premiums are a "wake-up call" that the state may lose doctors. Hospital premiums have risen 250 percent over the last three years. Sixty-five percent of facilities report they are losing physicians due to liability insurance costs.
New York: The state is second only to Florida in the cost of the average liability premium for physicians ($144,973 per year), and is renowned for higher jury verdict amounts. (There is no upper limit on non-economic damages in jury verdicts.) Attempts to pass a no-fault compensation program for birth-related injuries have been unsuccessful. Insurance analysts expect the majority of physicians to see at least a 20 percent hike in premium costs next year. The state is presently faced with a shortage of obstetric care in certain rural regions.
Pennsylvania: Eighty percent of medical students who come to the state for a world-class education choose to practice elsewhere. Despite some tort reform measures passed by the state legislature this past winter, ob-gyns were disappointed the measures did not provide more relief. The state abandoned its provision of a catastrophic loss fund. Dr. Owen Montgomery of Philadelphia says, "In the last two weeks alone, South Philadelphia lost its only maternity ward, when Methodist Hospital announced it would soon be closing the ward for liability insurance reasons. It's the tip of the iceberg."
Florida: This state has the highest average premium for Ob-gyns in the nation, at $158,000 per year. But in certain areas, notably Dade County, rates can soar to $208,949. Ob-gyns in this state are more likely than their colleagues in other states not to practice obstetrics. The liability situation has been so chronic in Florida, that during the crisis of the 1980s, the state allowed doctors to "go bare," (not have liability coverage) as long as they could post bond or prove ability to pay a judgment of up to $250,000.
West Virginia: The state is known for high jury verdict awards, and unaffordable insurance rates could fuel an exodus of doctors from the state. A majority of the state is already classified as "medically underserved" and cannot afford to lose physicians. Yet an informal survey found that half of all ob-gyn residents and two-thirds of ob-gyns in private practice plan to leave the state if the crisis is not resolved.
Mississippi: Liability premiums for obstetrical care rose from 20 to 400 percent in 2001. Certain counties are known for being liability "hot spots," notorious for high jury awards: "forum shopping" by plaintiffs' attorneys, to file cases in such counties, is becoming more common. Most serious of all, the state suffers from a chronic shortage of medical care in rural areas. Few cities under 20,000 have physicians delivering babies. Yazoo City, pop. 14,550, has no one practicing obstetrics.
Texas: In parts of the state, premiums have soared to $160,746 a year. There is a wide variation in premiums. Areas like Dallas are not hard-hit, but cities like San Antonio are. According to the Texas Attorney General, John Cornyn, Texas doctors are two times as likely to be sued as their colleagues across the country.
Nevada: St. Paul Insurance, which dropped its medical liability coverage in the last year, had insured 54 percent of Nevada's physicians. Physicians are rushing to find available or affordable insurance. The University of Nevada Medical Center may lose its medical liability coverage as of July 1. The state ranks 5th among states in the highest average physician liability premium (at $94,820 per year) but only 47th out of 50 states in the number of physicians for its population. Las Vegas could lose as many as 10 percent of its physicians in the coming year. An informal survey of ob-gyns found that 42.3 percent were now making plans to leave the state, if the crisis was not resolved in a few months; six out of 10 ob-gyns say they would stop obstetrics.
Washington: In late 2001, the largest insurance carrier in the state announced it was withdrawing from the medical liability market in Washington. The decision impacted 2,600 physicians. In 2001, insurance premiums increased 55 percent from the year before, and range from $34,000-$59,000 per year. Some Tacoma specialists reported 300 percent increases in premiums.
Source: American College of Obstetricians and Gynecologists
Printable version
Nine states are in crisis, from Florida where some ob-gyns now pay $200,000 a year for insurance, a three fold increase, to West Virginia, where two-thirds of all obstetricians are threatening to leave the state.
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“The rate was going to be going to to 150 thousand per year for me,” says Dr. Cheryl Edwards, who left Las Vegas this year, forced, she says to abandon 30 expectant mothers. “I was on the verge of bankruptcy.”
She moved to California, one of 23 states that limit the amount a jury can award a malpractice victim for pain and suffering. The American Medical Association and the insurance industry are now lobbying for nationwide damage award caps.
“We have 27 years of proof in California that it works,” says Richard Corlin of the AMA.
In response, trial lawyers say that bad doctors contribute to higher rates and also cite Consumer Federation of America studies claiming the insurance industry is raising prices because of stock market losses and heavy liability during the September 11 disaster.
States: Highest medical liability insurance rates
Florida-Dade/Broward: $208,949-$108,043
Texas-Dallas, Houston, Galveston: $160,746-$69,918
New York, Nassau, Suffolk: $115,429-$89,317
Michigan-Detroit area: $123,890-$87,444
Illinois-Chicago/Cook Co: $110,091-$88,928
Ohio-Cleveland: $95,310-$58,131
Nevada-Las Vegas area: $94,820-$71,092
West Virginia: $84,551-$63,185
Medical Liability Monitor, effective July 2001
“What’s driving this crisis is the insurance companies are short of money,” says Bob Hunter of the CFA.
Insurance companies say that losses in the markets mean jury awards must come down, or premiums must go up.
All of that is leaving small towns all over the country short of doctors to deliver babies, closing hometown maternity wards and making the drive to the hospital a race against the clock. |
