LAS VEGAS — Seven years ago, vascular surgeon Eric Chino removed
the severely infected toe of a 65-year-old Michigan man who
wintered in southern Nevada. After the amputation, the toe was
sent for a pathology report that revealed cancer.
Chino says he never saw that report because an assistant filed
it without showing it to him. The man returned to Michigan before
a follow-up visit, where his cancer eventually killed him.
The family sued for medical malpractice. Chino, who had been
practicing since the 1980s without incident, instructed his
insurance company to settle even though he felt this was a clerical,
not a clinical, mistake.
They paid $300,000, the only settlement in an otherwise sterling
career involving tens of thousands of patients.
Yet it is because of that claim that Chino, 48, stopped practicing
two months ago. His malpractice insurance rates remained reasonable
for years after the incident, he says, but then the St. Paul
Companies pulled out of the medical malpractice business nationally
last year. When Chino went shopping, no licensed insurer in
Nevada would cover him, and quotes from unlicensed insurers
hit $230,000 for 2002. He paid $39,000 last year.
He's not alone. The Nevada State Medical Association predicts
250 doctors may face bankruptcy or will leave this year. That
loss is particularly acute for Nevada, already ranked 47th in
the USA for its physician-to-population ratio. But Nevada is
just one example of a national struggle that is seeing doctors
flee medicine or their locales.
St. Paul ended coverage for 42,000 doctors nationwide, citing
nearly $1 billion in losses, attributed primarily to high jury
awards and settlements in malpractice lawsuits. Now those doctors
are shopping for other insurance, but other companies are refusing
to write policies for obstetricians, general surgeons and emergency
room doctors in states with no or ineffective limits to jury
awards. As a result:
Hundreds of medical professionals gathered in Edinburg, Texas,
Monday to protest lawsuit abuse they blame for skyrocketing
malpractice premiums. The doctors, many of whom closed their
offices Monday for the rally, are angry about the region's litigious
climate and record of large jury awards. The maternity ward
of tiny Bisbee, Ariz., has closed. Expecting mothers must drive
more than a half hour to the nearest town to deliver.
All neurosurgeons in Wheeling, W.Va., have stopped practicing,
and 14 of 16 neurosurgeons practicing in Broward County, Fla.,
are uninsured, the American Medical Association says. The trauma
center at Abington Memorial Hospital in suburban Philadelphia
is teetering on the brink of closure because doctors have had
trouble finding affordable insurance.
"There are factors operating, particularly in Nevada, which
make it a prime example of the problems physicians, hospitals,
malpractice insurers and patients are facing nationwide," says
Carol Golin, editor of the Medical Liability Monitor, which
surveys underwriters.
Physicians' groups and insurers point to the lack of tort
reform, meaning a cap on jury awards for pain and suffering
in malpractice lawsuits. In the past two years alone, Nevada
juries have awarded more than $1.5 million each in six different
medical malpractice trials. The number of lawsuits also is hitting
record highs. Most are settled out of court for undisclosed
sums.
The environment in Nevada has insurers scared of backing anyone
with a record or physicians in specialties that are frequent
lawsuit targets. One obstetrician, Cheryl Edwards, left 30 pregnant
patients behind and relocated last year to California, where
a state law caps jury awards at $250,000. Her insurance premium
is $17,000 a year there; it would have been $150,000 a year
in Nevada, she says.
Another obstetrician, Guy Torres, said he'll probably stop
delivering babies this fall when his insurance policy runs out.
He faces a premium of more than $200,000, which is only slightly
less than he'd make in a year for delivering 15 babies a month.
Las Vegas physicians have received two short-term solutions
in recent weeks. The county commission voted to hire doctors
who do shifts in the emergency room of its medical center as
part-time county employees until the end of May rather than
see the only trauma center for 10,000 square miles cut back
on its days and hours. As county employees, they can't be sued
for more than $50,000.
And recently, Gov. Kenny Guinn announced the state would set
up a state insurance association to cover doctors who cannot
get insurance from the licensed market. Yet while Guinn's measure
will resolve the availability of insurance, it won't solve the
price problem. Rates are bound to skyrocket.
Indeed, many insist tort reform by the legislature, not due
to meet until next year, is the only solution. But neither Guinn
nor legislative leaders are publicly pushing for jury award
caps.
Meanwhile, the Nevada Trial Lawyers Association is irate at
being scapegoated for the malpractice insurance crisis, laying
the blame instead on St. Paul for undercharging for years to
snuff out competition.
"They created the problem, they exacerbated the problem by
writing policies for bad doctors, and then, when the consequences
of their actions became known, they leave the market and the
physicians holding the bag," says Bill Bradley, a lawyer who
insists there's no correlation between jury awards and malpractice
insurance rates. "To place the blame on the civil justice system
is not fair or accurate. This is not a war between lawyers and
physicians."
Tell that to AMA President Richard Corlin, who warns that
his group is amassing a fund "of epic proportions" to go into
political battle against the well-funded trial-lawyer lobbies
on local and national tort-reform efforts.
St. Paul, for its part, disputes Bradley's contention, pointing
to its profits in Wisconsin, where some tort reforms exist.
In Nevada, St. Paul paid out $1.88 for every $1 premium it took
in last year.
"Our experience from states where they have some limits on
damages is that their losses are lower and the rates don't have
to go up as high," spokeswoman Andrea Wood says. "Yes, we did
have a large part of the market, but if this was a profitable
business to be in, there would be other companies jumping in
and taking over. Other companies have taken over for us in other
states."
Many in Nevada fear the long-term consequences of the crisis,
noting the exploding population needs doctors to come from other
states because the state's medical school produces just 50 physicians
a year.
"Before, we'd say, 'Las Vegas is one of the most rapidly growing
areas in the country, the future looks good and if you want
to start and grow your practice, you can do that here,' " says
John Ameriks, general vascular surgeon and senior partner in
practice with Chino. "Now doctors will say, 'Look, I'm highly
trained, I've got job offers all over the country, why the hell
should I come to Las Vegas?' "
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