When the Wheatland High Bulldogs hosted arch-rival Douglas for a basketball game the other night, the gym was jammed with fans roaring support for the home team. But one prominent Wheatland citizen watched the game with mixed loyalties. Willard Woods, the local obstetrician, had delivered just about every player on both the Wheatland and Douglas teams.
As the only "baby doctor" serving a three-county swath of the khaki-brown Wyoming prairie for the past quarter-century, Woods has delivered about 2,500 infants, including almost all the high school athletes in Wheatland, Douglas, Chugwater and other rural communities. But this winter, Woods ended his obstetrical practice.
"I love delivering babies," the intense physician, 56, said. "I really love delivering the babies of women I delivered a couple of decades ago. And I know this community needs an obstetrician.
"But you can't practice without [malpractice] insurance. And I can't get coverage for deliveries any more."
The national malpractice insurance crisis that President Bush spoke of in his State of the Union address last week hit home for Wheatland this winter when Woods's insurance company joined a number of national malpractice carriers in declaring bankruptcy.
That left only two firms selling malpractice insurance in Wyoming, and neither one was willing to take on new obstetrical coverage. Woods did get insurance for his gynecological practice -- a branch of medicine that spawns far fewer lawsuits than delivering babies -- but the annual premium costs him $116,000, three times what he paid a year ago.
In this wheat-growing region of eastern Wyoming, where medical services are sparse and scattered -- Platte County, with a population of less than 9,000, has five doctors, equal to the number of veterinarians -- the impact has been acute.
Women with normal pregnancies can still have their babies delivered in the hospital; Woods's two partners, both general practitioners, share the delivery duties.
"But if you have any kind of problem, like I did," said Wheatland mother Kori Wilhelm, who has a genetic blood mutation that makes pregnancy dangerous, "you have to go to Cheyenne now -- and it's a three-hour round trip -- to get the specialized treatment we used to get right down the street at Dr. Woods's clinic."
Woods's problem has turned into a financial problem for Platte County Memorial Hospital, a 43-bed facility that is Wheatland's biggest building. "The economics of a rural hospital are always tight," noted hospital director Mike Matthews. "If I don't have all my physicians providing services here, I'm losing revenue. And if I have to cut back -- well, this hospital is the third-biggest employer in the county."
The two family practitioners who share Woods's practice have found their lives complicated by the insurance problems. Their malpractice premiums have gone up sharply, though neither one has ever been sued. Even worse has been the impact on their daily schedules.
"We're now the only docs delivering babies in the whole area," said Steve Peasley, a Douglas native who returned to the prairie after finishing Georgetown Medical School. "So each one of us has to be on call every other day. That means you can't leave town. You can't have a beer at the barbecue. And after a full day of regular practice, you get a call from the hospital at 3 a.m. saying somebody's in labor."
Wheatland's medical problem is replicated in communities large and small across the country as more and more doctors find malpractice insurance out of reach. Some doctors in New Jersey plan to demonstrate today to protest the high cost of insurance, while doctors have already staged protests in West Virginia, Nevada and Florida. Bush's proposed solution to the growing crisis is to put a limit on the amount of damages an injured patient can win. That would reduce the number of multimillion-dollar jury verdicts, cutting the risk for doctors and their insurance companies. In Woods's view, the president has it just right.
"We love that plan," he said. "It will save medicine in Wyoming." In the neighboring state of Colorado, he notes, which has a limit on pain-and-suffering awards, malpractice premiums tend to be a fraction of the Wyoming rates.
Wyoming's state constitution prohibits any limit on damage claims against a corporation -- a ban that goes back to the 1880s, when the Union Pacific Railroad was the most powerful, and most hated, institution in the state. But a federal law capping damages would presumably override the state constitution.
Still, there are doubts here about the Bush plan. "The cap on damages sounds like a simple solution, but it isn't one," said Dave Freudenthal, a lawyer and Wyoming's newly elected Democratic governor. "We just had hearings in the legislature on this issue. The insurance companies said a cap on damages would not reduce rates, and would not induce any more companies to sell [malpractice insurance] in Wyoming."
The governor said he hopes to appoint a blue-ribbon panel to study "new approaches that would work in a rural, sparsely populated state like this." Wyoming covers a land area bigger than Maryland and Virginia combined but has fewer residents, and fewer doctors, than the District.
While the study is underway, Wheatland has to get by without an obstetrician.
"I can't practice OB anymore, and nobody else will do it, either," Woods said with a grimace. "My daughter wants to be a doctor, and she asked me what kind of medicine she can do so she doesn't have to worry about insurance. And I said, 'Well, you sure don't want to deliver babies.' "