Malpractice crisis: Some surgeons walk off the job
Reform sought at state, national levels
As the liability insurance crisis comes to a head in many states and some surgeons are organizing walkouts, facilities are facing dire financial impact from those walkouts.
For example, when surgeons in the northern panhandle of West Virginia walked off the job due to rising liability insurance rates, Wheeling Hospital lost $210,000 a day in revenues, and about two-thirds of the amount was attributable to cancelled ambulatory surgery procedures. Eighteen surgeons walked off the job at the hospital. In terms of the ambulatory surgery department, "for all intents and purposes, it was shut down," says Donald H. Hofreuter, MD, president and chief executive officer at Wheeling Hospital.
There was a spillover effect to other departments of the hospital, he says. Fewer colonoscopies were performed, and certain gynecological procedures were not scheduled because some specialists feared that patients might encounter difficulties and require immediate surgery by a general surgeon. Also, the cancellations of orthopedic surgeries affected rehabilitation and other areas.
The hospital continued to pay all full-time and part-time employees. The nurses were provided with their annual mandatory education, Hofreuter adds. "Those not involved in direct patient care were assigned other duties: catching up on filing, doing certain medical records, other administrative tasks, so we might have had a $20-a-hour nurse doing filing," he explains.
The physician’s leave of absences were not the responsibility of other staff, Hofreuter says. "We felt we had a responsibility to them to maintain their livelihood the best way we could," he says.
Most surgeons returned after 15 days when the governor presented his plans for a medical liability reform bill and area legislators reassured the surgeons that they were in support of the legislation. The bill, as written at press time, would set litigation award caps, explain how appeals will be conducted, and require that patients reimburse their insurance providers after they receive their settlements.
Many other same-day surgery providers around the country face rising liability insurance rates. Many surgeons are retiring early or moving their practices. One such surgeon is Joseph E. Gutierrez, MD, FACS, former president of the Medical Society of the District of Columbia.
"The high liability insurance premiums in [Washington] DC, led to my closing my DC office and relocating to Virginia, where liability insurance premiums are lower," Gutierrez says. Virginia has a cap on noneconomic losses, but DC does not, he adds.
Consider these other recent developments:
• At press time, surgeons and obstetricians were leading hundreds of doctors in New Jersey on a work action against elective surgery. Physicians were asking for a reduced statute of limitations for filing suits and a $250,000 dollar cap on pain-and-suffering damages.
"This is the line in the sand," says Michael A. Goldfarb, MD, FACS, chairman and program director of the department of surgery at Monmouth Medical Center in Long Branch, NJ. "The patient has to decide that good health care is more important than a chance to win the lottery [with exorbitant liability awards]," he says.
Surgeons have seen their malpractice insurance policies increase severalfold, and some cannot afford it, according to Goldfarb.
The situation is critical: Rising rates are preventing people from entering the surgical field and causing early retirements, he says. "We have only one pediatric surgeon for Monmouth and Ocean counties," which includes a population of 1 million, he says.
The latest twist is that surgeons are being required to pay a "monster" amount of money for tail coverage, he says. For example, surgeons can be required to pay for twice their last year’s insurance rate for that coverage. "Who will go for that?" Goldfarb asks. "That’s like making a deal with the devil."
The New Jersey Department of Banking and Insurance is trying to establish a state subsidy fund to help lower the cost of physicians’ liability premiums.
• In Pennsylvania, a mass walkout by physicians protesting high insurance costs was canceled in January when the governor vowed to fight for $200 million in aid for physicians. Before the governor intervened, some hospitals had cut back on scheduled operations and reportedly cut back on some staff members’ hours to prepare for the walkout.
Insurance costs for Pennsylvania doctors more than doubled in 2002 for thousands of physicians. About 900 physicians have left the state since 2001 to avoid paying malpractice premiums as high as $200,000 annually, according to the Pennsylvania Medical Society.
• In January, a dozen surgeons at four hospitals in southern Mississippi left work to protest that insurance companies dropped their malpractice coverage or severely raised premiums. The surgeons refused to perform emergency surgery as well. Many elective procedures were cancelled, due to concerns over patients who might develop complications and need a general surgeon.
• Also in January, more than 800 Florida doctors stayed away from work in protest of liability insurance rates. A task force appointed by Florida Gov. Jeb Bush recently recommended that jury awards for punitive damages and pain-and-suffering awards in medical liability cases be capped at $250,000.
• On the national level, President Bush has asked Congress again to pass medical liability reform legislation that would cap noneconomic damages, such as pain and suffering, at $250,000 and limit punitive damages.
President Bush also called for joint and several liability reform that would assign blame fairly and protect doctors who share information with patients or other providers.
The president said that "frivolous and junk lawsuits" are the primary cause of the rise in health care costs and doctor shortages. "The problem of those unnecessary costs don’t start in the waiting room or the operating room. They’re in the courtroom," he said. "Everybody’s suing, it seems like. There are too many lawsuits in America, and there are too many lawsuits filed against doctors and hospitals without merit."
According to the president, the answer is capping jury awards in medical malpractice suits. "We need reform all across America, and we need a law coming out of the United States Congress," he said.
Sources
For more information contact:
• Michael A. Goldfarb, MD, FACS, Chairman and Program Director, Department of Surgery, Monmouth Medical Center, Long Branch, NJ. Telephone: (732) 923-6770. E-mail: [email protected].
• Donald H. Hofreuter, MD, President and Chief Executive Officer, Wheeling Hospital, One Medi-cal Park, Wheeling, WV 26003. Telephone: (304) 243-3263. Fax: (304) 243-5045. E-mail: [email protected].
• Joseph E. Gutierrez, MD, FACS, 611 S. Carlin Springs Road, Suite 204, Arlington, VA 22204. Telephone: (703) 933-8757. Fax: (703) 933-8759. E-mail: [email protected].
As the liability insurance crisis comes to a head in many states and some surgeons are organizing walkouts, facilities are facing dire financial impact from those walkouts.
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