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Doctors leaving delivery rooms over malpractice insurance costsFrom: art fougner, md (evsono@pipeline.com)Mon Apr 12 12:12:32 2004
By Carey Hamilton The Salt Lake Tribune ST. GEORGE -- After making the hardest decision of his life, Grant Carter had to break the bad news to his patients: He was no longer delivering babies. Some of his patients were devastated. One woman -- having given birth to eight children with Carter presiding in the delivery room -- didn't want to find another doctor after building such a strong relationship with Carter. "It created a lot of anxiety for some of my patients," said Carter, a gynecologist with Southern Utah Women's Health Center in St. George. "I loved being an O.B. I consider it the grandest of all medical specialties because you can help women deliver healthy babies. But it became economically unfeasible." Like other physicians in Utah and across the country, Carter quit his specialty because of the soaring cost of medical malpractice insurance. Premiums have risen dramatically for all doctors but obstetricians have been the hardest hit because there are so many possibilities for complications. Many family practice physicians and obstetricians in Utah are dropping obstetrics or planning to retire earlier than planned. At the same time, medical students are largely steering clear of obstetrics, which could create a crisis over the next 10 years. The number of OB-GYN residency positions nationwide -- about 1,150 -- has been stable over the past decade, but only 68 percent of the positions were filled by U.S. medical school seniors in 2003, compared with 86 percent a decade ago, according to the 2003 National Resident Matching Program. The rest were filled by non-U.S. students. The University of Utah has seen the number of OB-GYN resident applications decrease from 175 five years ago to 126 this year. The U. selects five new residents each year for that specialty. Considering Utah has the highest birth rate in the nation -- 21.9 per 1,000 residents, translating to 49,182 births in 2002 -- women here could have trouble finding someone to deliver their babies in the future. The situation isn't isolated to Salt Lake City or even Utah. Doctors in the United States are being financially squeezed out of obstetrics and other high-risk specialties, including neurosurgery, because of skyrocketing malpractice rates. The average malpractice insurance rates for obstetricians/gynecologists in Utah jumped 94 percent from 2000 to 2004 from $42,000 a year to $81,628, according to the Utah Medical Association. Many doctors and insurance companies blame the rise on an increase in lawsuits and multimillion-dollar jury awards. Even if they haven't done anything wrong, doctors still must hire lawyers to defend the claims, and that isn't cheap. The debate over how to solve the problem is currently raging in Congress. The Senate tried but failed for the third time last week to limit damages juries can award in malpractice suits against obstetricians and emergency room doctors. Republican Utah Sens. Bob Bennett and Orrin Hatch voted in favor of the caps. "This bill helps to remedy the exploding medical liability and litigation crisis in our country, which is preventing patients from receiving high-quality health care -- or, in some cases, any care at all -- because doctors are being driven out of practice," Hatch said. "In fact, this crisis hits us on two fronts: preventing many Americans from getting the vital health care they need, and raising the overall costs of health care for nearly all Americans." But ask trial lawyers why malpractice insurance has skyrocketed, and they probably will insist the insurers are raising premiums to make up for the loss of millions during the stock slump that started in the late 1990s. Martin Oslowski, president and CEO of the Utah Medical Insurance Association, a doctor-owned malpractice insurer in Salt Lake City, disputes that theory. "That's their myth. Blame it on the big bad insurance company," Oslowski said. "This is an insurance company that is managed by physicians who set the rates. The public is not going to understand the problems physicians are facing until access is a problem." Like Oslowski, Carter doesn't believe much will be done until patients have difficulty getting appointments or finding doctors who accept new patients. He believes lawmakers need to more aggressively come up with reforms. Under Utah's medical reform laws, the state has a $400,000 cap on non-economic damages -- for pain and suffering -- but has no cap for economic damages, mainly medical expenses and lost wages. Aside from tort reform, Carter and others believe arbitration is a good solution and would eventually reduce the rates. Medical arbitration in Utah came to a head at the Legislature earlier this year when patients' rights groups and trial lawyers staged protests on Capitol Hill against Intermountain Health Care, the state's largest health care network. Prior to the session, IHC instituted mandatory arbitration for patients in Salt Lake County and Bountiful. Requiring mandatory medical contracts was made possible under a law passed the previous session that made it legal for health care providers to deny treatment to non-emergency patients who refused to sign arbitration agreements. After the uproar, lawmakers overhauled the arbitration law, giving patients the choice of arbitration, mediation or the courts to settle malpractice claims. Many doctors, the Utah Medical Association and insurers lamented that action, arguing mandatory arbitration would help drive down the rates and potentially curb the access crisis that's occurring in other parts of the country. Access may not be a huge problem in Utah now, but it may well be in the future, said Carol Osbourne, a family medicine practitioner at the University of Utah's Madsen Family Health Clinic. After nearly 20 years, Osbourne figures she only has one year left to deliver babies before the cost of malpractice insurance forces her to drop her obstetrics premium. Since last fall, all but three of the clinic's eight family doctors have stopped treating pregnant women and delivering babies because of costly premiums. "Delivering babies is one of the best parts of my practice," Osbourne said. "Taking care of a woman for nine months and seeing those kids grow up is the real link in family medicine. I get to know the whole family. It would be very disappointing if I had to give it up." In more rural areas, a shortage of obstetricians may occur sooner because, overall, there are fewer physicians. Marla Shelby-Drabner, the chief executive of Allen Memorial Hospital in Moab, said the only reason the hospital can deliver babies is because it helps pay the premiums of the three family practice doctors who deliver there. "This problem is very real," Shelby-Drabner said. "Without some intervention, whether it be mandatory arbitration or a cap on damages, nothing will change. The insurance companies are being asked to insure an unknown. Don't get me wrong, I'm not happy with the insurance companies, either. But they are at the whim of the jury. The system is broken right now." Nowhere is this more pronounced than with the people who are affected most -- expectant mothers. "I've been going to Dr. Carter since I was 12 years old because I have endometriosis," said St. George resident Michelle Belcher, 26, who is pregnant with her second child. "To have to go out and find a new doctor after 14 years, I was really upset," she said. "I cried as soon as I got out of the doctor's office, and called my husband and said, 'He's not delivering babies anymore.' " http://www.sltrib.com/2004/Apr/04112004/utah/utah.asp
-- art fougner, md ich bin ein New Yorker
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