Sick? Call a lawyer
June 3, 2003
Of the Medical Liability Crisis in the USA
"Sick? Call a lawyer" according to a placard held by a physician in a rally in Pennsylvania a few weeks ago. The malpractice insurance crisis in the United States has now reached an unprecedented scale, threatening not only physicians and their livelihood and families, but also patient’s access to care. I am in no way close to being a lawyer nor do I profess brilliance in the issue, but I know enough of it and it affects me, being a physician practicing in the USA, as it does thousands of other doctors and patients here: Pinoys or otherwise. Never did I imagine, having had years of experience in heading and participating in rallies back home, that I will be doing the same thing here, years later. Why? Just to save our livelihood, that’s all, no big deal.
As many of you probably know, here you will much more likely get sued by a disgruntled patient or family member rather than get stabbed in the streets outside the University Hospital. For many reasons, noble or otherwise, a doctor gets to go to court once every few years to be insulted, interrogated and then possibly stripped of his hard earned assets after all those 12 years or more of medical education. Some of the cases are legitimate, stemming from the fact that we are not gods and not infallible, and sometimes outright negligent and fail to police ourselves. However, most of these cases are frivolous, seeking pure monetary profit, through greedy but very astute lawyers who turn stupid cases into overblown headaches for us who are simply trying to save lives.
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"The projected impact of higher premium costs over the next three years is that about 26% of doctors will just retire, relocate or limit patient care."
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And why have these crocs jumped into the river that turned into a quagmire for medical practitioners? Of course, because it pays. Courts have of late been granting higher and higher rewards to plaintiffs, causing insurance companies billions of dollars of losses. Like a reflex, insurance premiums have been jacked up, in order to compensate for underwriter losses (in addition, stock losses have not helped). In 2001, medical-malpractice insurers paid out $1.53 for every $ 1 in premiums, losing $8 B in the past six years plus $4.6 B more in anticipated losses from current lawsuits. Where then should they get money to stay alive? From the doctors, duh.
If you or I lose a case, there are usually two types of damages we pay for: economic and non-economic. The former refers to actual expenses for medical care, lost earnings, lost jobs, etc. and the latter refers to the “PAIN and SUFFERING” which God or the patient alone can actually quantify. It is the latter that causes the bigger problem, because juries have been awarding ridiculous amounts of money for this real but easily pretended and invisible “loss”. How much? Such as $ 1 M for a little burn from a coffee cup to $5.8 M for paraplegia. Between 1997 and 2001, juries have increased awards from an average of $ 500,000 to $1 M. Some states have a $1 M cap to this, but not all. Moreover, not all states have laws to protect the doctors from at least having their livelihood preserved: if the doc’s coverage is less than the amount, his house, cat, car, even books and stethoscopes can be forfeit and sold to pay the plaintiff. There have been numerous proposals and even bills in the Senate or Congress to get the cap down to $ 250,000, but even Democrats and Republicans can’t agree among themselves, probably because most of them are lawyers too. Well, there are statistics that show such as one done by Weiss Ratings, an independent org, that there is no difference in the states where there is a cap or not. But other studies also say otherwise. Basically, premiums have risen between 36% to 48% from 1991 to 2002. The insurance companies are still losing money despite this, because they pay out only 38% in states with caps, and 71% in those without. Therefore, they will still have to charge doctors more.
How much is this exactly? Well, it depends on which State, City, or Specialty. A Neurosurgeon in Chicago will need to pay a yearly premium of about $ 280,000 per year. An Obstetrician in Miami needs to pay $210,000 and an Orthopedic Surgeon $135,000 in Philadelphia. If you work there, and earn less than 300% of this amount minus taxes (another 30+ %) it would be better to quit medicine or move to another place or specialty.
And that is exactly what is happening. Where I practice now, our Pulmonology group of 5 has split to 3 and are quitting or limiting practice this month if a new carrier does not give them an affordable price (the cheapest offer was $100,000/year/person). Our last Neurosurgeon stopped operating on heads (just laminectomies from now on) last month and a third of our Obstetricians are now just practicing Gynecology. Even a poor Infectious Disease guy like me, got my carrier cancel my coverage by next month, and so far, we are still looking for a new affordable company. Yes, you need insurance here. Period. You can’t just salvage every patient who sues you. You’ll be a serial killer worse than Saddam Hussein. Worse, Medicare and Medicaid payments are shrinking. It feels like everybody thinks that doctors are unreasonably rich and therefore must be robbed, lynched and hung out to dry. Because of this crisis, many practices are closing, limiting practice or moving. Patients have to transfer care, drive farther away for medical care, and many die in emergencies because they have to be airlifted or driven to another hospital far, far away.
Oh hey, and nurses are not spared either. More and more now, lawsuits involve nurses and every medical staff down to the janitor. Any person these drooling lawyers could get their hands on will be involved, as long as there is money to be had. Hospitals tend to protect their staff less so they can save their own behind. Therefore, many nurses now buy their own liability coverage in addition to what the hospital or nursing home offers. Soon too, nurses’ premiums will be commensurate to the ridiculously high salaries of Registry nurses. By the way, the latter earn three times more than medical residents here and work in any shift of their preference.
So what is the prognosis for physicians here? The projected impact of higher premium costs over the next three years is that about 26% of doctors will just retire, relocate or limit patient care. That is so sad. So, if our already crooked justice system in the Philippines even just tries to start acting like it does here, doctors beware. You need to practice better and more defensively, block unjust laws and protect your livelihood before it gets snatched away from you.
That’s why we who practice here, including Pinoy docs who packed up to work here, are again out in the streets demonstrating.
No big deal, just trying to save our livelihood.
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Views expressed on this column and any other by-lined articles on this site are the authors' own and do not necessarily reflect the views of the organization or its members.
