The whole Washington area is now on red alert.

We're not talking air pollution or terrorism. We're talking babies.

The American College of Obstetricians and Gynecologists (ACOG) last month added Maryland to its list of "red alert" states experiencing or facing widespread disruptions to obstetric care. The District and Virginia were already on the list, which now totals 23.

The problem, according to ACOG, is a medical malpractice liability crunch that is "threatening the availability of physicians to deliver babies."

Case in point: Jeannette Akhter, who just quit her OB/GYN practice at Prince George's Hospital Center.

Akhter said her departure from the hospital's OB/GYN staff after 14 years was based on "a combination of factors, but I must admit that as you open your mail every day and you don't know when the next letter from the next lawyer will appear," it's tempting to go elsewhere.

Maryland's primary medical malpractice insurer has applied for a rate increase averaging 41 percent for 2005, following a 28 percent hike for 2004.

Thomas Ein, president of Capital Women's Care -- whose doctors deliver about 7,000 babies a year in the Maryland suburbs -- said his group's obstetricians could each be paying as much as $130,000 in insurance premiums next year, up from $75,000 to $85,000 now.

Ein cited this increase as one reason his group decided last month to drop out of United Healthcare's provider networks. While other insurers agreed to give Capital Women's Care modest increases that will help cover malpractice expenses, Ein said, United proposed "about a 6 percent decrease in our current fees" -- a reimbursement rate "significantly lower than the other insurers that we participate with."

ACOG says the typical OB/GYN faces 2.6 claims during his career -- 2.6 reasons why these doctors are retiring early, moving out of high-risk jurisdictions or curtailing their services, the advocacy group says.

"Many people stopped seeing high-risk obstetric cases" in Prince George's County in recent years, Akhter said. How does she know this? "Because our group [at the hospital] was the recipient of those cases."

Akhter said she has been named in five claims since she began practice in 1975, three of them in the past year. She has been dropped from two of the recent cases, "and I hope I'll be dropped from the third one."

"One has to focus so much of one's energy and thought . . . on the malpractice specter," she said. "There's no day, there's no moment when you're away from that."

So where is Akhter going to escape the madness? Not to California or Colorado -- where ACOG says reforms "have put a halt to skyrocketing liability costs" -- but to places such as Afghanistan. "At least I will be able to continue practicing medicine" there as a volunteer, she said.

-- Tom Graham

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