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U.S. Medicine cannot be run from Washington any better than the Soviet economy was run from Moscow.
 
Warning To Those Espoused To  Corporate 'Health' Lawyers/Administrators:  IF whoever is your future-spouse defames or destroys doctors, those so harmed will be your family's own physicians.  Recall Brunswick (Georgia, 1984), Pennsylvania (2002) and West Virginia (2003), because the game has run its course--there are no more time-outs, there is to be no overtime play.  The collapse of this profession 'will not be televised.'  If physicians serve the public, and if our 'free' society heckles them with sufficient insult, bureaucracy, and reprisal for pursuing the public good, they will retire early and be replaced by whomever.  If whoever reads this web page is not moved to action, expect to be treated by whomever the next time you are sick, and thank you for placing your family's trust in whoever is running the scam in Corporate America Medical Entity.  American Enron Medical Corporation.  Corporate Enron America Medicine.  Whatever. 
















washingtonpost.com

Increase in Physicians' Insurance Hurts Care
Services Are Being Pared, And Clinics Are Closing

By Rob Stein
Washington Post Staff Writer
Sunday, January 5, 2003; Page A01

Americans are beginning to feel the effects of double-digit increases in medical malpractice insurance premiums, which are prompting doctors to flee states with the highest rates, refuse to perform high-risk procedures, retire early out of frustration or stage protests such as one underway in West Virginia.

Clinics are closing in some places, and hospitals are shuttering trauma centers, maternity wards and other facilities that provide the most lawsuit-prone care. The impact appears to be relatively limited so far. But in far-flung parts of the nation, pregnant women are having a harder time finding doctors to deliver their babies, teenagers may have to travel farther to find a doctor to mend a broken bone and brain cancer patients may have to travel out of state to find a neurosurgeon. Hardest hit are rural areas, which chronically struggle with shortages of physicians.

"My sense is that in past malpractice crises there's been a lot of talk about a lack of availability of care, but that has largely been to serve political and financial agendas. But this time it seems more real," said Troyen Brennan, a professor of medicine at Harvard Medical School in Boston. "There's really no good empirical data, but I'm less suspicious this time. It's pretty widespread and spreading."

Twenty percent of hospitals have had to curtail services in some way because of rising insurance costs, and 6 percent have completely closed or discontinued some service, according to a survey by the American Hospital Association.

In West Virginia's northern panhandle, at least a half-dozen hospital patients have been transferred to nearby states because surgeons went on leave to protest rapidly rising medical malpractice insurance rates.

In Pennsylvania, thousands of patients faced a similar fate until hundreds of doctors called off their own job action last week, after state officials intervened with a plan to help offset their insurance bills.

Around Las Vegas, millions of people in four states were unable to use a nearby high-quality trauma center for 10 days last summer after dozens of surgeons resigned over the escalating cost of protecting themselves against lawsuits.

The issue has prompted state legislators around the nation to consider limiting the amount of money juries can award to victims of medical mistakes, and has set off an intense battle in Washington between two powerful interest groups -- trial lawyers and doctors -- over proposed federal caps.

"We consider it a crisis when a woman can't find a physician to deliver her baby. We consider it a crisis when a . . . trauma center shuts down, and someone who has been seriously injured in an automobile accident has to be transferred to another hospital," said Donald J. Palmisano, president-elect of the American Medical Association. "We think there's a meltdown occurring right now."

Doctors blame multimillion dollar jury awards and say the answer is limiting the amounts that juries can give plaintiffs. Lawyers blame insurance companies, contending they are raising rates -- not because of big jury awards but to make up for money they would be earning if the stock market were doing well.

"Insurers place profits over people and threaten the livelihood of America's doctors," said Mary E. Alexander, president of the Association of Trial Lawyers of America. "It's unfair to ask patients to give up their legal rights so the insurance industry can make higher profits."

One thing is clear: The cost of malpractice insurance is rising rapidly in many parts of the country -- with doctors in some areas seeing their premiums jump 80 percent in one year, according to the Medical Liability Monitor, an independent newsletter. Rates vary widely, and metropolitan areas such as New York, Chicago, Detroit and Miami tend to be hit hardest. But premiums are rising unexpectedly fast elsewhere, including Pennsylvania, West Virginia and Texas.

Premiums in the District, Maryland and Virginia are increasing fast for some specialties, but the local jurisdictions don't appear to be among the hardest hit. Rates in the District rose about 21 percent across the board for the coverage year that began Wednesday, said D.C. Medical Society president John L. Lawson.

Nationwide, surgeons and obstetricians, who tend to get sued more often when something goes wrong, are paying the most and facing the biggest increases. Obstetricians in Miami, for example, may pay more than $200,000 a year.

"The situation in our state has become intolerable," said Dante Marra, an orthopedic surgeon who was one of about 18 surgeons taking a 30-day leave of absence in the West Virginia protest, throwing into turmoil four hospitals with more than 800 beds.

Marra said his premium jumped 20 percent from the $80,000 he paid last year. "I've got the cheapest rate in town. My partner's paying $150,000. Three years ago, we had three neurosurgeons at our hospital. Now we have zero."

More and more states have begun to cap jury awards, including Nevada, Mississippi and Ohio, according to the AMA. As many as 30 states are expected to address the issue somehow this year.

Pennsylvania Gov.-elect Edward Rendell forestalled a job action in his state by promising to ask the legislature to take steps that would cut insurance costs for the hardest-hit doctors. West Virginia Gov. Robert E. Wise Jr. plans to propose a solution there next week.

President Bush has endorsed federal legislation that would limit claims for pain and suffering, and the issue is expected to be the subject of intense debate in the upcoming session of Congress.

Whatever the cause and whatever the outcome, the effects are increasingly filtering down to patients.

Joseph E. Gutierrez, a surgeon, recently closed his District office and converted his Arlington office into his main practice. The move came after his main facility, Columbia Hospital for Women, shut down and Gutierrez was scaling back to half-time anyway. But he said the savings in malpractice premiums were substantial enough to make the decision for him.

Had Gutierrez continued his full-time District practice, his premium would have risen from about $45,000 to $68,000 a year, he said. Instead, this year he will pay about $22,000 for his part-time practice. He figures it would cost him about $30,000 to insure a full-time practice in Virginia.

"I suspect that a few more docs in the city are going to start moving out to the suburbs," Gutierrez said.

In Alabama, the Atmore Community Hospital shut its maternity ward last July, in part because the annual malpractice insurance for its obstetrician jumped from $22,000 to $88,000. Pregnant women in Atmore now must travel a half-hour to nearby communities to deliver their babies. The Largo Medical Center in Largo, Fla., did the same thing last month.

Paoli Memorial Hospital outside Philadelphia discontinued its paramedic service in part because of rising insurance costs, and the Lankenau Hospital in nearby Wynnewood, Pa., has lost a significant number of obstetricians and orthopedic surgeons.

So far, the job action in West Virginia has affected only four hospitals. Most of the half-dozen patients that have had to be transferred were sent across nearby borders to medical centers in Ohio or Pennsylvania.

"General surgeons are the engine of any hospital, and when you have general surgeons not available on a routine basis this curtails other things in the hospital as well," said Donald Hofreuter, chief executive officer at the Wheeling Hospital, one of the affected facilities. "I understand the concerns and frustrations of the physicians. But as a physician and a CEO of a hospital, I'm concerned about patient care."

Patients needing nonemergency surgeries are either waiting until the job action ends or are going to other hospitals.

Joseph Donato, 79, a retired carpenter who lives outside Wheeling, has been trying to get an appointment at a Veterans Administration hospital in Pittsburgh since last week, when a doctor at Wheeling Hospital found that an artery in his neck was 75 percent blocked. His doctor recommended surgery to prevent a stroke. The work stoppage at Wheeling was starting the next day.

"They said they didn't have a doctor they needed to do the operation. They said it was bad, and that if it had been any worse they would have done it right away. But if it gets any worse it could give me a stroke," Donato said.

Surgeons in other parts of West Virginia are threatening to join the job action. And if it continues or spreads, more patients will be transferred or have their surgeries delayed.

"With each passing day, without being able to offer services, we're certainly inconveniencing patients," Hofreuter said.

Staff writers Avram Goldstein and Juliet Eilperin contributed to this report.

© 2003 The Washington Post Company

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