Question Of The Month

Would legal reform protect health care?

February 28, 2004

Will Maryland residents have to get used to not having access to the world-class physicians and hospitals that are part of what makes living here so special? This is the question that underpins the urgency of remedying our state's medical liability insurance crisis.

The facts are clear: Liability insurance is exceedingly expensive for physicians, nurses, nursing homes and hospitals. Physicians are being forced to stop practicing medicine and consider moving to other states or retiring early, and the number of insurance companies willing to offer medical liability coverage is dwindling.

The rights of injured patients must, of course, be protected. But this can be accomplished together within the framework of the medical liability reform measures that are so important for the long-term health of the citizens of Maryland, the medical community and the hospital industry.

Laurence M. Merlis

Baltimore

The writer is president and CEO of the Greater Baltimore Medical Center.

The prognosis is grave and the chance for long-term survival is poor.

The above statements would be shocking enough if I were talking about a patient. However, I am describing the condition of our malpractice insurance system in Maryland.

I am a family medicine physician who has been practicing in Maryland for the past 23 years, and I have never seen the situation as bad as it is now. Total payout of malpractice awards in Maryland rose from $56 million in 2002 to $93.2 million in 2003.

Who pays for this in the end? We all do: doctors and patients alike, in the form of budget-breaking malpractice premiums and skyrocketing out-of-pocket medical expenses.

The malpractice system is bleeding to death, and the Maryland legislature must take emergency action. We must pass malpractice corrections this year.

Dr. J. Michael Niehoff

Baltimore

The writer is associate director of family medicine at Franklin Square Hospital.

If insurance rates are rising for doctors, it is not because victims have hit a payday. Rates are going up because there is too much careless medicine and not enough discipline of dangerous doctors in the state.

I was the victim of medical malpractice by a doctor who had multiple claims filed against him and has had multiple claims filed since. I complained to the Board of Physician Quality Assurance more than two years ago, as did one of the other victims of this doctor's misconduct. The matter is "still under investigation."

The solutions that have been offered by the insurance industry and the governor propose to solve the problem of rising malpractice rates by limiting damages to the victims.

This so-called solution not only won't lower the incidence of malpractice, it could lead to greater danger for health care consumers. For when you lower the penalty for medical negligence, you will surely get more of that behavior.

Linda Croghan

Dundalk

As an obstetrician who practiced in Harford County for nearly 25 years, I was forced to stop delivering babies because of the excessive cost of liability insurance.

Excellent care of pregnant women requires time and effort. With payment for obstetrical services fixed by third-party insurance companies at a low level, only increased volume would produce the income stream needed to pay the liability insurance premium. I chose to stop delivering babies rather than compromise my level of care.

As the cost of liability insurance continues to escalate, I'm certain other obstetricians currently trying to carry the extra workload will realize they can't continue safely. Coupled with the fact that new medical school graduates are not choosing careers in obstetrics, it's only a matter of time before women will be unable find a qualified obstetrician.

Women dying in childbirth, which is currently a rarity, will return as a common event if the present conditions are allowed to remain unchanged.

Yes, the rising cost of liability insurance is a direct threat to our health care system. I should know -- my practice was an early casualty.

I'm certain it will not be the last unless change occurs soon.

Dr. David L. Zisow

Bel Air

A better solution to the malpractice "crisis" would be for legislators to enact reforms that remove the riskiest doctors from practice.

Only 3 percent of the state's doctors are responsible for 51 percent of medical malpractice payouts to injured patients, according to data from the National Practitioners Data Bank. The Maryland Board of Physicians has been dangerously lenient in its punishment of these repeat offenders.

Patient lawsuits aren't the problem. The number of malpractice lawsuits per Maryland physician has declined dramatically in recent years, the total and average amounts of malpractice payouts to victims have declined dramatically, the number of $1 million-plus payouts has plummeted and the number of doctors is increasing, government data show.

Ninety percent of Maryland doctors have never lost or settled a malpractice lawsuit, but they must cover the cost of those who have.

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