Rising insurance rates stress health care systemby Heather WoolwinePublic Relations The doctor-patient relationship is based on mutual trust, and physicians are held to a standard of care for their patients that ensures everyone is treated with professionalism, compassion, and expertise. But a few malicious actions and mistakes on behalf of some doctors created a current climate that has some physicians and patients wary of each other, both sides wondering if they may become adversaries. Add to this equation the ambitions of trial lawyers and the caution of insurance companies, and the complicated web that is medical malpractice, rising insurance premiums, and tort reform aggravates an already stressed health care system. “From a clinical point of view, it creates an environment where practitioners are increasingly defensive, perhaps ordering more tests than necessary and thereby driving up the cost of health care,” said Ray Greenberg, M.D., Ph.D., MUSC president. “Since some of the highest risk groups for litigation (such as trauma patients) also come from otherwise underserved populations, it creates an environment that is not conducive to expanding care to those who are in need.” In South Carolina, the House passed two bills in January that would limit pain and suffering (non-economic) damages in medical malpractice cases to $300,000, and $2 million in non-economic damages in other types of civil litigation. Those bills were moved to the Senate, where after numerous amendments, they await a third reading when the next session opens for state legislators. While many physicians feel these bills are a step in the right direction, some believe that the caps are still too high and that, in the end, they will do little to discourage illegitimate malpractice suits. It is this type of lawsuit that many physicians feel is the reason for increasing insurance premiums. “Even though we as physicians at MUSC pay below what physicians in private practices pay for their premiums, we have still seen our premiums increase by 50 percent in the last couple of years,” said Karl Byrne, M.D., Department of Surgery. Two state-owned malpractice insurers increased premiums by 24.1 percent on average already this year, with malpractice rates for some specialties approaching $50,000 per year. Accompanied by these premium hikes is the complaint that overhead costs for physicians are increasing as well, but reimbursements from insurance companies have remained stagnant, or in some cases, decreased. This powder keg, some fear, will lead doctors to practice medicine outside of South Carolina or force them into early retirement. Such has already been the case for several states like Mississippi, and for certain specialties like obstetrics. Physicians see premiums spiraling out of control and blame high jury awards and a growing number of lawsuits. Lawyers and consumer groups, however, believe that tort reform, like that currently in state legislature, would only hurt victims of malpractice by limiting the amount they can receive when they’re injured because of a legitimate medical mistake. Instead, these groups blame the problem on the insurance industry's mismanagement of investments and policies, and are quick to point out that South Carolina is not a crisis state in terms of malpractice insurance. Indeed, the state exhibits problem signs, but rates remain well below the national average. Physicians in the state don’t believe that will last long. The South Carolina Hospital Association reported on its Web site that states with tort reform (caps of $250,000 to $300,000 for non-economic damages) have an average combined increase in premiums of 12-15 percent compared to 44 percent in states without caps. “Rising premiums mean there is less money from the clinical enterprise to pay our physicians and subsidize the university,” Greenberg said. “This issue has discouraged some other teaching and non-teaching centers from accepting our students for clinical electives. It may also discourage some otherwise promising applicants from choosing to apply to medical school, although to my knowledge, there is no data to document that supposition at this time. “As an institution, we support the effort to cap non-monetary damages, which are the big dollar components of most jury awards. We also support a mandated mediation process, rather than sending these cases to jury trials, so experienced mediators can review and decide on the facts of the case. Lastly, the loser in the case should have to pay all of the legal costs, thus eliminating many of the frivolous cases that are filed.” According to Byrne, MUSC physicians are relatively protected from malpractice lawsuits, as under the university and medical center they can not be individually sued. However, “in the last year or two we’ve heard rumblings that some trial lawyers are trying to see to it that our immunity gets removed. This would be a bad thing for those of us in academic practice. As many know, we are the end of the road for many patients who are sent here because of the high risk or complicated problems involved in their cases that the referring physician is often unable or unwilling to handle because of the risk of litigation,” he said. “If we lose our immunity, who will take these patients?” Tort reform enacted in several states exhibits similar provisions, including the following:
The introduction of expert testimony is required in medical malpractice
actions to prove that the defendant failed to conform to the applicable
standard of care. Currently, the state does not impose a cap on the amount
of damages that a plaintiff can recover in a malpractice case. It is up
to the patient/plaintiff to prove that a physician’s duty to act according
to a certain standard of care was breached, an injury occurred and
that there is a connection between that breach and injury.
Friday, July 23, 2004
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