Jewish World Review Dec. 21, 2001 / 6 Teves, 5762

Drs. Michael A.Glueck & Robert J. Cihak

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Consumer Reports


End of medicine?


http://www.NewsAndOpinion.com -- IT'S an ominous phrase "the point of no return." It means exactly what it says the moment in a journey or a process after which return becomes impossible. Today, American medicine is at the point of no return in its relationship with the predatory medical-malpractice lawsuit industry, and with the horrific insurance premiums they spawn. Unless something changes and soon the cumulating burden will destroy vital parts of American medicine. And all of us, except the trial lawyers, will be the losers.

One headline, from the Dec. 4, USA Today, says it all. "Soaring Malpractice Premiums Stun Many Doctors." Writes Rita Rubin: "Some physicians are seeing their malpractice insurance premiums increasing anywhere from 8 percent to 100 percent. As a result, some are dropping procedures that put them at risk of malpractice suits, moving to areas with lower rates or even retiring early."

In truth, this process has been going on for decades. None of it has, or will, help the patient. Some procedures are indeed risky but these are the ones that may save your life. Imagine that you and your coronary (or your nine months pregnant wife) are enroute to a hospital that stopped doing these procedures because they could no longer afford the coverage but not to worry a state or two over, where the insurance premiums are a bit less, you might still find somebody willing. What do you tell the driver of your ambulance? "Yes, I know we're in Philadelphia. Now let's head for Cleveland."

Notes Rubin: "Executives at the St. Paul Companies, the country's second largest underwriter of medical malpractice insurance, have notified virtually all customers who are obstetricians, general surgeons or emergency medicine doctors the three specialties most likely to be sued that their policies will not be renewed."

Some other items, demonstrating that soon enough you may not even have the option of heading for Cleveland or much of anywhere else:

  • Rates for physicians insured by the company in 27 states have increased an average of 24 percent this year.

  • Tillinghast-Towers Perrin, whose clients include malpractice insurers, says doctors can expect rate hikes of 8 percent to 18 percent this year and next and well above 18 percent in some jurisdictions.

  • One six-member OB-GYB practice in North Carolina, whose insurance had been canceled, found itself paying $277,000 a year for new coverage more than double what it had been paying."

In "Costs Lead Rural Doctors to Drop Obstetrics," John Porretto of the Associated Press, Friday, Nov. 23, 2001, notes: "Physicians who specialize in family medicine and obstetrics/gynecology in Indianola and other rural areas of Mississippi are increasingly dropping obstetrics because of skyrocketing costs for malpractice insurance. Medical liability insurance rates for doctors who deliver babies have risen from 20 percent to 400 percent this year depending on the carrier, according to the Mississippi State Medical Association. Annual premiums range from $40,000 to $110,000."

In parts of Florida, some doctors paid nearly $160,000 last year for professional liability insurance.

And then there's the mercifully not-yet-enacted "Patient's Bill of Rights," which only expands the lawsuit lottery. Earlier this year the Employment Policy Foundation released a study that suggests this kind of legislation could lead to 56,000 new lawsuits per year, $16 billion in higher health care costs and 9 million more Americans without health coverage."

For years, the diamond-dripping trial lawyers have brazenly proclaimed their only goal was to eliminate malpractice. The hundreds of billions of dollars yearly headed for their crocodile wallets had nothing to do with it! Sure, and we have some bridges in Newport Beach, to sell you real cheap.

Yet studies indicate that many patients allegedly harmed by medical malpractice and that many winners in the malpractice lottery weren't injured by malpractice but were awarded damages because of jury sympathy or other reasons extraneous to fact and justice.

So what to do? Some states, such as West Virginia, are considering special insurance options to keep doctors open for business. Many experts advocate comprehensive tort reform, destroying the web of greed by limiting punitive damages, contingent fees, class action lawsuits and overall settlements. But medicine can't wait for this particular miracle.

Fortunately, there are alternatives. One may be to require patients, as a condition of treatment, to submit malpractice claims to arbitration. Where this has been tried in the commercial banking industry, it has been found that plaintiffs win more often than they would in court, but that the settlement amounts are generally lower, reflecting proper compensation and neither punitive damages nor the antics of "runaway juries."

Yet another alternative comes from the general-aviation industry. Over several decades, predatory lawsuits effectively destroyed the producers of single-engine piston planes. It took years, but a coalition of manufacturers, unions, pilots and others got Congress to pass the General Aviation Revitalization Act on Aug. 17, 1994 perhaps the first time in history that people had organized to demand limitations on their right to sue. It worked, and general aviation experienced several years of unprecedented growth.

Maybe what's needed is a "General Medicine Revitalization Act." Ask your doctor about it while you still have one.



Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Aberdeen, Wash., is president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists who write numerous commentaries and articles for newspapers, newsletters, magazines and journals nationally and internationally. Comment by clicking here.

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© 2001, Michael A. Glueck & Robert J. Cihak