West Virginia Surgeons Protest High Malpractice Insurance Rates; Pennsylvania Governor-Elect Offers Proposal

More than two dozen surgeons at four hospitals in northern West Virginia on Jan. 1 began leaves of absence to protest the state government's inaction on the high cost of malpractice insurance, the AP/Pittsburgh Post-Gazette reports. More than 18 general, orthopedic and heart surgeons have requested 30-day leaves of absence beginning at staggered times this week at Wheeling Hospital and Ohio Valley Medical Center in Wheeling and Reynolds Memorial Hospital in Glendale, and 11 others have requested leave from Weirton Medical Center. Although all four hospitals' emergency rooms plan to remain open, many are left with few or no surgeons available, except for plastic surgeons. Most patients at the facilities needing emergency surgery will have to be transferred 90 miles to Morgantown, W.Va., or to hospitals in neighboring Pennsylvania and Ohio. Dr. Gregory Saracco, a general surgeon who began leave yesterday, said he and other surgeons would be available in an emergency, but added, "[I]f I don't get some help to offset my premium costs, I can't operate in this state" (McCormick, AP/Pittsburgh Post-Gazette, 1/2). Saracco said, "We just can't afford to practice in this environment under these conditions. We probably have the most expensive malpractice insurance rates and the worst tort system in the country." According to West Virginia-based orthopedic surgeon Dr. Robert Zaleski, the surgeons hope their leaves of absence will prompt legal reform including caps on damage awards (Miller, Los Angeles Times, 1/2). The AP/Post-Gazette reports that the surgeons want the state to enact legislation that would "make it harder" to file malpractice suits. They also would like the Legislature to seek help from private insurers and others to pick up the cost of a larger percentage of medical costs. State Insurance Director Tom Susman on Jan. 1 met with surgeons at Wheeling Hospital but could not come to an agreement to prevent the surgeons from taking leave (AP/Pittsburgh Post-Gazette, 1/2). The state Legislature is expected to address medical malpractice reform when it convenes next week (Los Angeles Times, 1/2). In addition, Susman said Gov. Bob Wise (D) will present a plan to address rising malpractice insurance costs in his State of the State address on Jan. 8 (AP/Pittsburgh Post-Gazette, 1/2).

Pennsylvania Averts Strike
Meanwhile, a possible strike by "hundreds" of doctors and surgeons in Pennsylvania "appeared" to have been averted after state officials vowed to attempt to reduce physicians' medical malpractice premium costs, the New York Times reports. The Times reports that doctors statewide had been threatening to strike beginning Jan. 1, when malpractice insurance for the majority of the state's doctors came up for renewal (Treaster, New York Times, 1/1). The Philadelphia Inquirer reports that Pennsylvania doctors were "outraged" by a Dec. 20 letter from Secretary of the Commonwealth C. Michael Weaver, whose office is in charge of licensing and disciplining doctors in the state, "remind[ing]" them of their "professional and legal obligations." Weaver wrote, "A stoppage of practice may be detrimental not only to your patients, but also to your practice, your standing amongst colleagues, as well as your license should your conduct be found to constitute abandonment" (Goldstein, Philadelphia Inquirer, 12/29). However, initiatives proposed by Gov.-elect Ed Rendell (D) have "stabilize[d] the situation," according to Andrew Wigglesworth of the Delaware Valley Health Care Council. Rendell on Monday said he would seek legislation to reduce doctors' insurance payments by 25% in 2003 by forgiving the portion of 2003 insurance premiums that goes toward the state-run fund for doctors in high-risk specialties. The approximately $220 million needed to pay for Rendell's plan would come from a one-time fee to the surpluses of health insurers in the state, the Inquirer reports. Rendell also expressed support for a bill by State Rep. Curt Schroeder (R) that would grant a subsidy of between $18 million and $26 million for the state's 26 trauma centers. Rendell also asked insurers in the state to "follow the lead" of Independence Blue Cross, which recently increased its payments to physicians in light of increasing malpractice premium costs. Rendell said he hopes lawmakers will act on his proposal within "five or six weeks," adding that he is "very confident that we will see the plan enacted." Rendell also asked that a medical malpractice task force make final recommendations for long-term solutions by April 1 so that legislators have time to pass any new measures by summer recess (Goldstein, Philadelphia Inquirer, 12/31).

Editorials
Summaries of two newspapers' editorials about Rendell's proposal appear below.

• Philadelphia Inquirer: While Rendell's "smart, fast-track fixes" are "semi-good" news, they will not "permanently cure the state's malpractice headache," according to a Philadelphia Inquirer editorial. The editorial concludes that even if the "pain-relief ideas work short term, that won't excuse state leaders from aggressively seeking a long-term solution. Otherwise, the pain will be back, worse than ever" (Philadelphia Inquirer, 1/2).
  
• Philadelphia Daily News: Rendell's plan is "triage, at best," but it is a proposal "worth supporting if the state doesn't want to see a mass exodus of doctors," a Philadelphia Daily News editorial states. While doctors have said that capping jury awards for pain and suffering in malpractice cases is a "cure-all for the malpractice crisis," the editorial points out that consumer groups do not support such proposals, and concludes, "Whatever solution the state comes up with shouldn't hurt the patient" (Philadelphia Daily News, 1/2).
  

Other States
Several other lawmakers from states around the nation are also under pressure to address the rising costs of malpractice this year.

• Florida: Doctors in Broward, Miami-Dade and Palm Beach counties are using a new survey to lobby state lawmakers to impose a cap of $250,000 on noneconomic damages awarded in medical malpractice cases, the Fort Lauderdale Sun-Sentinel reports. Currently, there is no limit on such damages. The survey of 1,573 doctors in the three counties found that as a result of rising malpractice insurance rates, 44% of doctors stopped performing "high-risk" services, 66% performed more tests to protect themselves from litigation and 33% make patients wait longer for an appointment. The study also found more than 52% of doctors are considering dropping their malpractice coverage altogether (Hollis, Fort Lauderdale Sun-Sentinel, 1/2). However, consumer advocates have said the survey "exaggerate[s]" the impact of high malpractice costs and that imposing caps on malpractice awards would further harm injured patients (Hollis, Orlando Sentinel, 1/2).
  
• Texas: The state Legislature this month is expected to begin debating a bill that would cap jury awards for pain and suffering in malpractices cases at $250,000, half the current limit, the Houston Chronicle reports (Zuniga, Houston Chronicle, 1/1). The bill would apply to only noneconomic awards and would not place limits on damages awarded for medical costs and lost income. The bill also would limit attorney contingency fees, establish a statute of limitations for filing lawsuits, allow damages to be paid over time, require injured patients to disclose any "collateral" payments to prevent duplicative payments and expand immunity for doctors who provide charity care (Yu, Dallas Morning News, 12/23).
  
• Wyoming: Because the state does not cap jury awards for pain and suffering in malpractice litigation, many doctors have dropped their malpractice insurance or stopped practicing in parts of Wyoming, the AP/Denver Rocky Mountain News reports. For example, physicians at Riverton Memorial Hospital voted to investigate dropping their malpractice insurance, and some areas have lost their only practitioners (AP/Denver Rocky Mountain News, 1/2).

Media Coverage
The following broadcast programs reported on rising malpractice insurance premium costs leading to physician shortages and protests in several states:

• CBS "Evening News": CBS reports on Pennsylvania's proposal to reduce physician malpractice payments in the state. A transcript and video of the segment in RealPlayer are available online (Brezinski, "CBS Evening News," CBS, 12/31).
  
• CNN's "Wolf Blitzer Reports": Features an interview with Dr. Charles Bannon, chief of surgery at Mercy Hospital, about the medical malpractice costs in Pennsylvania. The full transcript of the program is available online (O'Brien, "Wolf Blitzer Reports," CNN, 12/30).
  
• NPR's "Morning Edition:" NPR reports on cancelled surgeries in West Virginia and the averted physician walkout in Pennsylvania (Montagne, "Morning Edition," NPR, 1/2). The segment will be available online in RealPlayer after noon ET.