State lawmakers in Mississippi, Nevada, Pennsylvania and West Virginia hope legislative Band-Aids will help fix medical malpractice systems, which are leading doctors to threaten to relocate or quit because of soaring insurance premiums.
Doctor discontent with medical malpractice issues is a problem nationwide and could limit healthcare accessibility for thousands of patients across the country. At least 11 other states including Arkansas, Delaware, Florida, Massachusetts, Missouri, New Jersey, New York, Ohio, Oregon, Texas and Washington plan to address the issue this year, according to Cheye Calvo, an official at the National Conference of State Legislatures.
"There's no easy, one-size-fits-all answer," Calvo said.
But policy analysts say no doctors, no care.
All states hold healthcare providers liable in the event of medical negligence. But as was the case in the mid-1970s and 80s, insurance premiums are soaring, often double and tripling 2001 rates.
Healthcare providers who say they can't afford coverage are being driven to retire, protest, shut down their practices or move them elsewhere. Clinics and trauma centers are closing and patients are struggling to find doctors to deliver babies or perform high-risk' procedures like neurosurgery.
The crisis started when the St. Paul Insurance Company, a Minnesota-based firm that had been one of the nation's largest underwriters of medical malpractice coverage, left the business in 2001, saying it was no longer profitable. Several other insurance firms followed suit. The dwindling number of remaining carriers, the dawdling economy, stock market losses and rising jury awards have all contributed to soaring premiums. "It's an issue that's hitting states hard and governors are being called on to take action," said Emily Cornell, a program manager at the National Governors Association Center for Best Practices, the organization's research arm.
Governors in at least four states acted in 2002 by promoting measures to stabilize the insurance market and to provide relief to physicians. While circumstances in each state differ, most are responding with comprehensive legislation, not simply by limiting jury awards in malpractice cases under so-called tort reform legislation.
In December 2001, West Virginia Gov. Bob Wise (D) signed a bill that let doctors buy malpractice insurance from the state, overhauled the civil litigation system and put in place several administrative changes.
But the problem hasn't gone away in Wise's state and at least two dozen West Virginia surgeons staged a highly publicized walkout to protest what they said are still-too-steep insurance rates. Some patients have had to get out-of-state medical care .
"(Surgeons) are coming in for life or death situations, patients are not dying or going without, but it's definitely disrupting healthcare services in the state," Cornell said.
In response to the walk-out, Wise on Jan. 8 unveiled a $20 million plan designed to cushion doctors' insurance costs with tax breaks and credits. Some of the money for the plan will come from the state's tobacco settlement fund.
"By the end of this month we will cover 1,000 doctorsdoctors who would have been forced to leave our state if we had not acted," Wise said in his State of the State address.
In Pennsylvania, Gov. Mark Schweiker (R) approved legislation last March that reduced insurance premiums by as much as 20 percent by giving doctors Medical Catastrophe Fund discounts. Keystone State lawmakers also passed tort reforms. And in a political gesture to patient safety, they also required hospitals to report medical errors to a new Patient Safety Authority.
In Nevada, Gov. Kenny Guinn (R) created a state-underwritten insurance fund last April to offset a dearth of private malpractice coverage. But the largest trauma center in the state closed its doors for 10 days in July when all but one of the 58 surgeons resigned, saying they still couldn't meet the high cost of coverage.
Gov. Guinn responded by calling a special session of the legislature, which enacted the most comprehensive reforms in state history.
The sweeping legislation included placing a $350,000 cap on non-economic damages paid to victims, better known as "pain and suffering," and a $50,000 cap on damages for hospitals and doctors treating trauma patients. It also shortened the statute of limitations for filing malpractice cases and strengthened the system of reporting medical errors.
"(The reforms) seemed to have stabilized the situation, but we're optimistic that in the long-term they'll help reduce rates," Greg Bortolin, Gov. Guinn's spokesman, told Stateline.org. He expects the issue to be revisited this year.
In Mississippi, Gov. Ronnie Musgrove (D) also called a special session to address malpractice problems. Lawmakers responded with a measure that among other things placed a $500,000 cap on "pain and suffering" awards by juries. It became effective January 1.
"It's a very divisive issue. It's hard to get doctors and lawyers to agree but the states are coming in to find a solution to make sure that healthcare is available," Cornell, the NGA official said.