A Syracuse hospital is preparing to airlift patients to Canada if local neurosurgeons will not operate. Some Albany obstetricians are turning away expectant mothers, and hundreds of doctors statewide have joined a work slowdown to protest the cost of malpractice insurance.
In Florida, nearly one-third of obstetricians have stopped delivering babies, citing the expense of medical liability coverage. Florida doctors' and lawyers' groups spent more than $6 million last fall battling over a ballot initiative on malpractice insurance.
In Illinois, legislative committees agreed in May on a bill to curb attorneys' fees in malpractice cases after 3,000 doctors demonstrated at the state capitol. Since then, up to 124 malpractice cases a day -- 10 times the average -- have been filed in Cook County Circuit Court as Chicago lawyers rush to register claims before the law takes effect.
The skyrocketing cost of malpractice premiums has touched off a nationwide debate, prompting more than 35 states to consider controversial laws to cut back the number of lawsuits, limit the size of jury awards and reduce attorneys' fees.
Bitter struggles between doctors and trial lawyers, two powerful and moneyed interest groups, are dividing legislatures. Insurance companies that specialize in medical liability are pulling out of many states, including Maryland. Bills are pending in Congress to spur states to take action.
"This is a nationwide crisis," said Dr. James Sammons, executive director of the American Medical Association (AMA). "There is not a state in the country that is not having severe problems, relatively speaking. There is no way doctors and hospitals can afford these premiums. The American public is paying for this."
The number of U.S. malpractice suits has tripled in the last decade, according to the AMA. Million-dollar verdicts have become commonplace, and the average settlement, less than $5,000 in 1979, has jumped to $330,000.
As a result, doctors say they are ordering unnecessary tests and procedures as legal protection. "Estimates are that defensive medicine may add anywhere from $15 billion to $40 billion annually to health-care costs," an AMA report said.
Nationally, the cost of malpractice insurance rose an average of 80 percent from 1975 to 1983. In New York, it quadrupled. Obstetricians and neurosurgeons, the highest-risk specialties, are routinely paying $80,000 and $100,000 a year in premiums on Long Island and in Miami.
What Sammons calls "a brush-fire" movement for reform, however, is fiercely opposed by attorneys. "There is no medical malpractice insurance crisis," the Association of Trial Lawyers of America declared in a study this spring. "The cause of malpractice litigation is medical negligence."
The group said the average doctor spends 2.9 percent of his gross income (estimated at $200,000 a year) for malpractice insurance, while spending 2.3 percent on "professional car upkeep." In 1983, it said, the per capita price of health care was $1,500, of which $6.08 was the cost of malpractice insurance.
Scott Baldwin, president of the group, blamed escalating premiums on "price fixing" and inflated estimates of reserve needs by insurance companies. The insurance companies, many of which are doctor-owned since some commercial companies pulled out of the business, say they must maintain high reserves against future losses.
In New York, where premiums are the highest in the nation, the insurance commissioner this spring granted a 55 percent increase in premiums to the state's largest insurer and said he would allow another 40 percent rise in July.
In April, Gov. Mario M. Cuomo (D), citing the "alarming" rise in insurance costs, proposed a bill to cut attorneys' fees in malpractice cases (which average one-third of settlement awards), promote pretrial arbitration of claims and require hospitals to crack down on careless physicians. Some 5,000 doctors demonstrated in Albany in late April, wearing buttons and holding signs reading "Please Help Support a Lawyer. Send Your Daughter to Medical School."
When the legislature stalled during the last six weeks, doctors in Albany, Syracuse, Troy, Buffalo and Long Island began closing their practices in protest. "We are looking at a crisis situation as of July 1, maybe even sooner," said Robert Vacarelli, vice president of the Upstate Medical Center in Syracuse where a dozen neurosurgeons and several orthopedic surgeons have notified the hospital that they will stop treating emergency patients.
The state health department set up an emergency referral system 10 days ago. More than 40 women from Albany, where some obstetricians have stopped taking new patients, were referred to clinics. The state attorney general said he would investigate doctors for possible violation of federal restraint-of-trade laws.
Syracuse neurosurgeon Donald H. Stewart and his two partners stopped taking new patients May 25. Stewart said their annual premiums will rise to $60,000 each next month. "Come July 1, if the legislature doesn't address the issue, I'll quit," he said.
Stewart, who has been sued six times -- always unsuccessfully -- said his income has dropped 20 percent over the last four years even though his practice is busier than ever. He added that doctors cannot pass rising premium costs on to patients because most fees are fixed by Medicare, Medicaid and workmen's compensation. Moreover, insurers will not give more than $1 million in coverage in New York, so doctors' personal assets can be seized to meet soaring jury awards. (In a recent malpractice case, a 71-year-old woman was awarded $9.2 million by a New York jury.)
Miami obstetrician William O. Davenport, past president of the Florida Medical Association, said he stopped delivering babies six years ago, limiting his practice to gynecology.
"The chronic anxiety, the fear that the next case could bring a lawsuit took the most joyful practice of medicine -- which obstetrics is supposed to be -- and turned it into an adversarial encounter," he said.
Davenport, who surveyed the state's 700 obstetricians, said more than one-third have stopped delivering babies. Premiums for all medical specialties have risen 22.5 percent a year in Florida for the last six years. The legislature passed a bill in May reducing attorneys' fees and setting up nonbinding arbitration procedures.
California, which had a malpractice-premium crunch in 1975, has a $250,000 cap for court awards for noneconomic losses, such as pain and suffering. But in the last two years, premiums have risen 22 percent annually. A recent survey of the state's obstetricians found one-quarter had or were considering discontinuing obstetrics.
In Massachusetts, where premiums have risen 400 percent in five years, the legislature is debating several malpractice bills. "The situation is unbearable," said Dr. Barbara A. Rockett, president of the Massachusetts Medical Society. "It will become economically unfeasible to practice medicine."
Lawyers are fighting proposed legislation. "It ill behooves members of one of the highest-paid professions to seek preferential treatment afforded no other group, because they refuse to bear the cost of their mistakes," said David J. Sargent, dean of Suffolk University Law School.
In the District of Columbia, orthopedic surgeon Robert E. Collins, president of the Medical Society of D.C., said obstetricians, neurosurgeons and orthopedic surgeons pay premiums of $45,000 to $65,000 a year. "We're approaching a crisis here," he said.
Maryland premiums have risen 20 percent a year since 1975, according to John Sargeant, executive director of the Maryland Medical Association.
U.S. Fidelity and Guarantee, which insures all Maryland hospitals, has said it will pull out July 1. The state's hospitals have had to set up a self-insurance program.
Virginia's statutes place a $1 million ceiling on malpractice awards and a two-year deadline after injury for filing suit. Premiums rose 32 percent last year and 15 percent in 1983. "Many physicians are not able to find insurance coverage," said Richard G. Immel, a Medical Society of Virginia official.