A medical emergency

March 24, 2004|By Andrew B. Wigglesworth

MARYLAND'S GROWING medical malpractice insurance troubles are strikingly similar to what doctors and hospitals in the Philadelphia region started confronting a few years ago.

From my perspective as someone who invested 16 years in Maryland politics and health policy before relocating to Pennsylvania, I would urge legislators in Annapolis to deal with this issue now, during the current General Assembly session -- before the availability and affordability of liability insurance reach crisis proportions, as they have in Pennsylvania.

The situation in southeastern Pennsylvania is so serious that Lloyd's of London informed our hospitals that the region is one of the three most difficult places in the world to write medical liability coverage (along with Australia and the Czech Republic).

Only a few major insurers even offer, albeit selectively, medical liability policies to doctors in the Philadelphia region. Over the past three years, premiums annually have increased at double- or triple-digit rates for hospitals and physicians. One major teaching center saw its liability insurance bills soar from $8 million to $32 million; another hospital's premiums jumped from $25 million to $52 million in one year.

Philadelphia-area hospitals pay well over $300 million in liability coverage costs. Think of the number of nurses that could be hired or life-saving technology purchased with that money.

What's the impact? Seven maternity units closed in the Philadelphia area between 2000 and 2003. Insurance is so costly for obstetricians that most of them now have become hospital employees, covered under hospital liability policies.

Two local trauma centers have closed and two others were temporarily shut.

About 1,500 doctors have stopped practicing or have left the state over the last three years. In Chester County (population 433,000), only one neurosurgeon remains; in Bucks County (population 600,000), there are just two neurosurgeons left.

This shortage of physicians is occurring in a region renowned for medical education, with nearly 20 percent of the nation's physicians receiving some portion of their training at Philadelphia's major teaching hospitals and five medical schools.

Maryland's situation isn't yet as severe as Pennsylvania's. In Harrisburg, the medical liability insurance crisis had gotten to the point where the governor and state legislature stepped in with $600 million in liability insurance relief over the next two years to slow the exodus of doctors.

This is a costly, temporary fix -- a bandage applied to a wound until more permanent medicine has had a chance to work.

Another reason why reforms in Maryland need to happen quickly is that it takes several years before changes in medical liability laws affect premiums. The Pennsylvania legislature enacted far-reaching legislation in 2002 and 2003, but it's still too early to see the results.

Everyone has a stake in the outcome of this debate. We all need a quality health care system in our communities. Yet sky-high liability insurance threatens our entire network of medical care providers.

When you or your family needs treatment, will doctors be available? Will there be sufficient surgeons to perform lifesaving operations? Will there be enough obstetricians to deliver babies? Will hospitals have the money to hire needed staff, purchase new technology and replace or modernize aging buildings?

Maryland has a long tradition of developing innovative and progressive solutions to critical health care issues. A package of sensible steps to preserve access to care and keep the liability system from spinning out of control is what is needed now.

The package should modestly lower the cap on noneconomic damages, base awards for medical bills on the actual amount paid, base future medical payments on inflation-adjusted Medicare rates, require structured, periodic payments instead of large, lump-sum awards and authorize alternative dispute resolution, such as mediation.

None of these actions would prevent injured persons from being fairly compensated. Their needs should and must remain a prime consideration.

All patients and communities lose if doctors are driven from medicine because they no can longer afford six-figure insurance premiums. The situation will not improve if Annapolis lawmakers ignore reforms this session. Instead, liability insurance problems are likely to grow and deepen. That has been Pennsylvania's experience, and Maryland leaders would be wise to learn from it.

Andrew B. Wigglesworth, a former executive assistant to Maryland Gov. Harry R. Hughes, is president of the Delaware Valley Healthcare Council.

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