DJP AMA 7-18-2002: More on Medical Liability Reform; LAGNIAPPE
This e-mail contains two items:
ITEM ONE: MEDICAL LIABILTY REFORM; RALLY IN FLORIDA AND MORE
ITEM TWO: LAGNIAPPE: COURAGE
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Best regards,
Donald
Donald J. Palmisano, MD, JD
AMA President-Elect
E-mail: Donald_Palmisano@ama-assn.org
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DJP@donaldpalmisano.com
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ITEM ONE: MEDICAL LIABILTY REFORM; RALLY IN FLORIDA AND MORE
More than 1,000 attend Florida rally for medical liability reform
On July 17, AMA President-elect Donald J. Palmisano, MD, JD, joined more than 700 Florida physicians and hundreds of patients, nurses and physician assistants at the Palm Beach County Courthouse as they protested skyrocketing medical liability premiums. “Without reforms, patients, trauma centers, maternity wards and physician practices are at the mercy of Florida’s out-of-control liability system,” Dr. Palmisano told reporters from Reuters, Palm Beach and Ft. Lauderdale newspapers, and local TV affiliates for ABC, NBC, FOX and PBS.
Read more about the event on the AMA Web site: http://www.ama-assn.org/ama/pub/article/1616-6469.html
Read more about the AMA’s campaign for medical liability reform: http://www.ama-assn.org/ama/pub/category/7259.html
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More Than 1,000 Rally In Florida For Federal Med-Mal Bill
Best Wire
July 16, 2002
By Marie Suszynski
The American Medical Association urged legislators in Florida to reform the state’s medical-liability system and support a federal bill at a rally attended by more than 700 physicians. “The medical liability system is out of control,” Dr. Donald Palmisano, the AMA’s president-elect and a surgeon in New Orleans said.
More than 1,000 people showed up to rally July 16 at the Palm Beach County Courthouse to urge reforms in Florida’s medical malpractice industry, Palmisano said. Among them were more than 700 physicians.
The rallies were in reaction to a report that six trauma center surgeons at Delray Medical Center would lose their medical malpractice insurance on July 31, AMA said. Palmisano has since learned that the surgeons would be covered in the hospital’s policy. “But that’s a band-aid approach,” he said. “We need to have a marketplace where an individual can purchase insurance at a reasonable rate.”
The bipartisan bill, recently introduced in Congress and modeled after the successful MICRA law in California, would keep medical liability rates at a reasonable level. The bill would allow patients to recover medical expenses and lost wages in a med-mal case, but it would limit damages for pain and suffering, Palmisano said. A companion bill is about to be introduced in the Senate, he said.
The Florida legislature is feeling more and more pressure to address medical liability, said Sam Miller, spokesman for the Florida Insurance Council. Ten years ago, 35 carriers actively wrote medical malpractice insurance in Florida, but that number has dwindled to six. Most recently, First Professionals Insurance Co. of Jacksonville said it would renew existing business but wouldn’t issue new med-mal business, he said.
“What’s happening right now is that doctors are blaming lawyers and lawyers are blaming insurance companies,” Miller said. Some trial attorneys have accused insurers of making “blood-sucking” profits, he said, but in reality insurers are leaving the market because of losses.
In June, American Physicians Capital Inc. said it would stop writing medical-liability insurance in Florida, citing an underwriting loss of $18.8 million in the state in 2001 (BestWire, June 24, 2002).
The AMA wants states such as Florida to follow California’s lead when it comes to medical malpractice. In 1975, the state had the highest medical-liability rates, but now it’s in the lower third, Palmisano said. Since the law was passed 25 years ago, malpractice premiums have gone up 167% in California and 505% in the rest of the United States, he said.
Last year in Florida, insurers paid out $1.36 for every dollar of premium they collected, Miller said. And one in five doctors or surgeons will be sued over medical malpractice, compared with one in 12 in the rest of the country. Many physicians told Palmisano that med-mal premiums have tripled over the past two or three years, and one gastroenterologist and internal medicine specialist said his premium tripled at his last renewal. Obstetricians and neurosurgeons pay more than $200,000 a year in premiums, he said.
The AMA released a report in June that said medical liability has reached crisis proportions in 12 states, including Florida, and is in trouble in 30 other states. The medical-malpractice shortage became high profile in late 2001 when St. Paul Cos., the country’s largest writer of that line, said it would exit the business (BestWire, June 17, 2002).
The AMA has also held rallies in Nevada and Mississippi and has provided support for physicians in numerous other states. The top five writers of medical malpractice insurance in Florida by market share, according to A.M. Best Co.’s 2001 state/line data, were FPIC Insurance Group Inc., with 18.8%; Health Care Indemnity Inc., with 13.7%; ProAssurance Group, with 9.3%; Zurich/Farmers Group, with 8.1%, and HDI U.S. Group, with 5.2%.
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Trial lawyers and the terrorist threat — editorial
The Washington Times
July 17, 2002
We reported on this page last week on the crisis situation in Las Vegas, where one of the busiest Level-I trauma centers in the country – and one of the first lines of defense in the event of a terrorist attack – was forced to shut its doors July 3 due to escalating malpractice insurance costs. We recommended an exemption from existing malpractice laws for trauma centers due to the terrorist threat.
The facility, located at the University of Nevada Medical Center [UMC], closed after most of its surgeons resigned, saying they risked bankrupting their families if they continued to practice and were hit with a seven-figure lawsuit by one of the city’s increasingly aggressive malpractice lawyers. Local physicians and emergency rescue personnel said the shutdown left the Las Vegas area, home to roughly 1.5 million people and destination of 36 million tourists a year, unprepared to face a catastrophic terrorist attack. When our editorial was published last Thursday, the trauma center had been closed for more than a week, and officials were pessimistic that negotiations to reopen the facility would bear fruit any time soon. Just 24 hours later, however, local officials and some of the surgeons reached an agreement to temporarily reopen the UMC trauma center on Saturday, 10 days after the liability crisis had forced it to close. The accord limits doctors’ liability in malpractice lawsuits for at least 45 days. Meanwhile, Gov. Kenny Guinn has called on the legislature to convene in a special session July 29 to take up a reform measure that would place permanent caps on jury awards in malpractice cases despite an intense campaign against it by state trial lawyers.
In an interview yesterday with The Washington Times, Nevada Sen. John Ensign warned that seriously injured patients face “potential loss of life” if insurance problems force the facility to close once again. Asked specifically about the possibility that such a closure could hamper the Las Vegas area’s ability to respond to a terrorist attack, he responded: “Let’s hope we don’t have to find out.” Mr. Ensign said he was heartened by the fact that Nevada’s insurance crisis has drawn “national attention,” referring specifically to last Thursday’s editorial in The Times and columnist George Will’s commentary on ABC’s “This Week.”
And Nevada is just the tip of the iceberg. According to the American Medical Association [AMA], 11 other states are “in the throes of a medical liability crisis.” Aside from Nevada, the AMA lists the states in the most precarious condition as being Florida, Georgia, Mississippi, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Washington and West Virginia. In these states, doctors “are leaving . . . retiring early or abandoning high-risk services because they can’t afford or can’t find liability insurance,” the organization says. Another 30 states and the District of Columbia are also “seeing signs of problems,” the AMA adds.
The Level-II trauma center at Brandywine Hospital in Coatesville, Pa., closed June 10, because of rising malpractice insurance rates, the Las Vegas Sun reported last week. Area trauma patients are now being transported more than 30 miles away to hospitals in Philadelphia and Lancaster. “I believe lawyers have a better ability to lobby,” Brandywine spokeswoman Evelyn Walker told the Sun when asked about the state legislature’s failure to enact tort reform, which includes damage caps for pain and suffering. “Hospitals and doctors are not as diligent when it comes to lobbying.”
This is a situation that needs to change right away. Trauma centers are an essential component of America’s defense against terrorist attack. At a minimum, it’s time that the medical community gets serious about carving out some form of war or terrorism-related exemption, at the national, state and local levels, for doctors and other health-care facilities that will be on the front lines when terrorists strike here once again.
July 18, 2002, Thursday, BC cycle
SECTION: Domestic News; Business News
LENGTH: 1335 words
HEADLINE: Soaring malpractice insurance squeezes out doctors, clinics
BYLINE: By THERESA AGOVINO, AP Business Writer
BODY:
The shock from Jim Lawson’s July 4 death in Nevada auto accident was felt well beyond his family and friends.
The two-car crash on a busy street leading to Las Vegas airport came just one day after the nearest trauma clinic, at the University Medical Center, closed down. The 58 orthopedic surgeons who rotate through the hospital had insisted on relief from the soaring cost of medical malpractice insurance.
No one can be sure his death, confirmed at an emergency room an hour away, could have been avoided. Trauma centers generally offer more effective attention for accident victims. But it prompted a quick July 13 reopening of the university center. Some 10 to 15 of the doctors agreed to become temporary employees of the county hospital, limiting their liability to $50,000, while the governor tries to enact legislation that would restrict medical malpractice awards.
On a much broader level, it brought new attention to a national problem that doctors say is obliging many of them to flee certain states or give up certain specialties – or the entire profession – because of skyrocketing insurance premiums linked to soaring jury awards.
The impact of the trauma center’s closure in Las Vegas was summed up by its director, Dr. John Fildes: “The standard of care in our community was set back 25 years.”
The number of communities suffering similar problems is mushrooming.
This summer, two Pennsylvania hospitals, one Arizona hospital and a clinic in Oregon closed their obstetrics units.
Several counties in upstate New York have no obstetricians covering night shifts.
Soon, two counties in Pennsylvania won’t have a neurosurgeon. Seven hospitals on the Mississippi coast share 3 neurosurgeons, one of whom, Terry Smith in Biloxi, is likely to leave next month because he can’t find insurance.
Thirteen insurance companies have refused to cover Dr. Smith, who currently pays $65,000 in annual premiums. One company may agree to cover him, but it is likely to cost $100,000, an amount he says he can’t afford.
Smith said he often puts in seven-day weeks now to meet the community’s needs.
“This is an area with lots of poor and minority people, so you as a doctor feel you doing something important,” Smith said. “I feel guilty about leaving but I just don’t have a choice.
“The two guys I’m leaving behind are friends of mine and they’ll be working even harder,” he said.
Mississippi is one of 12 states where rising premiums, tied to awards by state juries in malpractice cases, are creating a crisis, according to the American Medical Association. The others are New York, Nevada, Florida, Ohio, Texas, Georgia, Pennsylvania, New Jersey, Washington, Oregon and West Virginia.
Because of risks associated with certain medical conditions and forms of treatment, some specialties pay especially high rates, and those rates are compounded by being charged in states where laws place fewer limits on jury awards.
For example, while premium increases this year average about 15 percent nationwide for all practices, rates for obstetricians and gynecologists in Pennsylvania are set to balloon by anywhere from 40 percent to even 81 percent, according to Medical Liability Monitor, a trade publication. In West Viriginia, they are catapulting anywhere from 29 percent to 36 percent.
The average jury award for medical malpractice doubled to $1 million in the six years ending in 2000, according to Jury Verdict Research, a private database used by lawyers, insurers and doctors. Lawyers who handle malpractice cases are critical of the database, pointing out that it is not comprehensive and contending that its findings are inflated.
In any event, verdicts of more than $1 million are common in states like Mississippi and Nevada. In the first six months of this year, there were five jury awards in in Mississippi and the average verdict was $5.6 million, according to the state’s medical association.
“I think juries are just frustrated with managed care and health care in general, so they take it out on doctors,” said Dr. Michael Daubs, an orthopedic surgeon who said he may leave Las Vegas if his rates keep rising.
He says he has never been sued but his insurance jumped $20,000 to $60,000 a year. He has applied for medical licenses in three other states.
Some insurance companies are leaving the medical liability business. St. Paul Cos., the second largest provider of medical malpractice insurance, announced last December it would stop writing policies, leaving 42,000 doctors searching for coverage. St. Paul said it lost close to $1 billion on its medical malpractice line last year.
Smaller insurers are also cutting back or leaving the business. Pennsylvania’s second-largest medical malpractice insurer, Phico Insurance Co., failed earlier this year and was liquidated by the state.
Legislation has been introduced in Congress that would limit the pain and suffering portion of malpractice awards to $250,000. The bill, intended to override state laws, would also curtail lawyers’ fees and allow juries to hear about the plaintiffs’ other sources of income.
“We absolutely need tort reform,” said Dr. Donald Palmisano, president elect of the AMA. “The situation has spiraled out of control.
The AMA lists six states as having their malpractice situations under control: California, Colorado, New Mexico, Wisconsin, Indiana and Louisiana. In Wisconsin, where there is a limit on awards, St. Paul did not suffer a loss.
Trial lawyers are opposed to the caps. They cite surveys showing juries rule in favor of doctors in two thirds of all malpractice lawsuits. They say doctors and hospitals should focus on reducing mistakes, not jury awards.
“If you run over someone over by accident, no one is putting a cap on what you will have to pay them. Why do we want to elevate one group in society above another?” said Leo Boyle, president of the Association of Trial Lawyers of America.
Boyle blames insurance companies for keeping rates artificially low in the 1990s to win business as they expanded wildly, a practice made possible by booming returns in the stock market. “Insurance companies were reckless in their pricing and now patients are supposed to pay for it?” he said.
Joseph Roethel, who follows the medical insurance industry as assistant vice president at A.M. Best Co., an insurance rating agency, parcels out the blame equally: Insurance companies kept rates too low in the 1990s and jury awards have gone too high.
Now, he said, “Insurance companies don’t have the reserves for these types of jury awards.”
Some doctors are resorting to working without insurance, using a credit line or their own money to cover malpractice expenses. The practice isn’t common but is done, especially in Florida. Most hospitals won’t allow that practice.
Two hospitals in West Virginia have begun directly employing more doctors and paying their insurance to alleviate the doctor shortage. Many hospitals consider such an option too expensive.
At Bluefield Regional Medical Center in West Virginia, doctors are more careful now in delivering medicine, according to hospital president Eugene Palowski. But they are also much less willing to care for high-risk patients with multiple conditions, leaving them to find physicians in surrounding states.
Many patients are confused, or just plain angry.
Marine Hawkins, 20, of Boyle, Miss., was shocked to hear from her obstetrician that he was closing his practice – just two weeks before her due date of July 21.
The nearest doctor is 30 minutes away. She doesn’t have a car, and will have to rely on relatives to get there.
“This isn’t what I needed now,” she said.
On the Net:
www.ama-assn.org
www.juryverdictresearch.com
www.MedicalLiabiltyMonitor.com
Association of Trial Lawyers of America: www.atla.org
Lisa Snedeker in Las Vegas and Brian Farkas in Charleston, W.V contributed to this report.
And many more articles; here are four more.
1. AMA to Protest Insurance Costs — Miami Herald
2. Doctors, Lawyers to Air Dispute — Palm Beach Post
3. AMA’s call to arms: $15 million campaign aims to enact tort reform –Modern Healthcare
4. Medical Malpractice Remath — Miami Daily Business Review
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AMA to Congress: Patients need medical liability reforms now
Patient access to care is now seriously threatened in many states, including Florida, Mississippi, Nevada, and Pennsylvania, the AMA told the House Energy and Commerce Health Subcommittee today in a written statement. “Due to large jury awards and the burgeoning costs of defending against lawsuits (including frivolous claims), medical liability insurance premiums are skyrocketing,” the AMA said. “As insurance becomes unaffordable or unavailable, physicians are being forced to leave their practices, stop performing high-risk procedures, or drop vital services — all of which seriously impede patient access to care.”
Read more on the AMA Web site: http://www.ama-assn.org/ama/pub/article/1616-6471.html
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ITEM TWO: SECRETARY THOMPSON AND MEDICAL LIABILITY REFORM
President’s Forum today in Chicago
Secretary Thompson’s remarks were terrific and his comments on the need for medical liability reform THIS YEAR were outstanding.
HHS secretary speaks to specialty society leaders
Health and Human Services Secretary Tommy Thompson today received a standing ovation after emphasizing his support for modernizing Medicare, regulatory relief for physicians and medical liability reform to 130 leaders of organized medicine gathered in Chicago for the AMA Presidents’ Forum. Thompson was the keynote speaker for the meeting, which prepares specialty society presidents, presidents-elect and CEOs to critically address the challenging issues facing their organizations today. After his remarks, Thompson answered questions from the specialty society leaders on a variety of topics, including preventive medicine, bioterrorism preparedness and mental health parity.
Next year the meeting will be in Washington, DC in March and will be held just before Leadership meeting.
In addition to specialty society presidents and president-elect, the county and state medical presidents and president-elect will be among those invited next year.
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LAGNIAPPE
QUOTES ABOUT COURAGE:
http://www.quotationspage.com/subjects/courage
Courage is the price that Life exacts for granting peace.
Amelia Earhart, Courage, 1927
Life shrinks or expands in proportion to one’s courage.
Anais Nin (1903 – 1977), The Diary of Anais Nin, volume 3, 1939-1944
Courage is the ladder on which all the other virtues mount.
Clare Booth Luce, in Reader’s Digest, 1979
The bravest thing you can do when you are not brave is to profess courage and act accordingly.
Corra Harris
I would rather be a coward than brave because people hurt you when you are brave.
E. M. Forsterbb, as a small child
Courage is doing what you’re afraid to do. There can be no courage unless you’re scared.
Eddie Rickenbacker
A coward turns away, but a brave man’s choice is danger.
Euripides (485 BC – 406 BC), Iphigenia in Tauris, circa 412 B.C.
I wanted you to see what real courage is, instead of getting the idea that courage is a man with a gun in his hand. It’s when you know you’re licked before you begin but you begin anyway and you see it through no matter what.
Harper Lee, To Kill a Mockingbird, 1960
A timid person is frightened before a danger, a coward during the time, and a courageous person afterward.
Jean Paul Richter
Courage and perseverance have a magical talisman, before which difficulties disappear and obstacles vanish into air.
John Quincy Adams
Courage is being scared to death – but saddling up anyway.
John Wayne
If courage wasn’t a standard result of aging, it meant that the young could somehow acquire it as well.
Lawana Blackwell, The Courtship of the Vicar’s Daughter, 1998
Live as brave men; and if fortune is adverse, front its blows with brave hearts.
Marcus Tullius Cicero (106 AD – 43 AD)
Courage is resistance to fear, mastery of fear – not absence of fear.
Mark Twain (1835 – 1910)
It is curious that physical courage should be so common in the world and moral courage so rare.
Mark Twain (1835 – 1910)
The only courage that matters is the kind that gets you from one moment to the next.
Mignon McLaughlin, The Second Neurotic’s Notebook, 1966
Fortune helps the brave.
Publius Terentius Afer (190 BC – 159 BC), Phormio
A hero is no braver than an ordinary man, but he is braver five minutes longer.
Ralph Waldo Emerson (1803 – 1882)
When you meet your antagonist, do everything in a mild and agreeable manner. Let your courage be as keen, but at the same time as polished, as your sword.
Richard Brinsley Sheridan (1751 – 1816)
Keep your fears to yourself, but share your courage with others.
Robert Louis Stevenson (1850 – 1895)
Fortune favors the brave.
Virgil (70 BC – 19 BC), Aeneid