People entering a nursing home know they must leave behind many cherished things: Their house. Their pets. Their neighborhood. Their independence.

Some Marylanders may soon add another item to this list: Their doctor.

Surging medical malpractice rates, often said to be prompting obstetricians to stop delivering babies, are also a growing concern for doctors who care for the oldest and sickest patients.

"Insurers are becoming increasingly concerned about potential liability risks, as there has been an increase in litigation against nursing homes" and the doctors who care for their residents, said Alva S. Baker, who oversees care at several homes in Maryland.

"One of the companies that has been writing insurance in this state is now declining to renew policies on physicians who do a lot of nursing home work," said Baker, president of the Maryland chapter of the American Medical Directors Association. The insurer he cited, The Doctors Company of Napa, Calif., did not respond to a request for comment.

Baker said the state's largest medical malpractice insurer, Medical Mutual, only recently "backed off from their stated intention of making a surcharge in premiums . . . or dropping policies on physicians who did a very large amount of nursing home care."

"If you had 10 percent of more" of your patients in a nursing home, "they would assess you a surcharge," said Mark Woodard, a vice president of the Health Facilities Association of Maryland, and "if a physician had 30 percent or more of their patients [in a nursing home,] they would not write a policy for them at all."

"Obviously, that would have been disastrous," said Woodard, whose trade group represents most of the state's 260 nursing homes. "We don't know what would have happened."

So why didn't the approaching storm hit Maryland?

"What we were contemplating doing affected too many of our long-time insureds," said Jeffrey M. Poole, executive vice president of Medical Mutual. As a result, he said, the company will continue to offer coverage to those doctors, and there will not be a surcharge for those who spend substantial hours in nursing homes. "This is not a time to create more hardship for our insureds," he said. (Medical Mutual recently won state approval for a 33 percent rate increase.)

"If Medical Mutual had done what it had intended to do, I think nursing homes would have lost a lot of physicians next year," said Baker, who added, "I'm not sure that Medical Mutual is willing to write new policies for physicians" whom it does not already cover.

Asked if his group would offer policies to physicians being dropped by the Doctors firm, Poole was noncommittal: "We take applications one at a time."

-- Tom Graham

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