Some Maryland Doctors, Irked by Costs, Consider Going ‘Bare,’ Shifting Liability to Hospitals

Doctors at several Maryland hospitals who are fed up with rising medical malpractice insurance costs are considering doing without the coverage, or “going bare.”

The strategy, used by thousands of Florida physicians, tends to transfer liability risk to hospitals. Hospitals, like the doctors, would prefer a legislative solution.

“I would really characterize this is as a symptom of a problem and a cry for help,” Nancy Fiedler, spokeswoman for the Maryland Hospital Association, said.

Physicians who work at Frederick Memorial Hospital became the latest to raise the prospect of going bare when they voted last week to remove from their bylaws a requirement to carry malpractice insurance, The Frederick News-Post reported. On Nov. 9, the hospital’s directors will consider the doctors’ request to be allowed to work at the hospital without the insurance, according to the report.

Physicians from at least three other hospitals — Washington County Hospital, Prince George’s Hospital Center and Doctors Community Hospital in Lanham — also are considering going bare, said Michael Preston, executive director of MedChi, the state medical society.

“It’s a reflection of the immediacy of the problem the doctors are facing in affording coverage for themselves, with the prospect for many of them, especially in high-risk specialties, of being driven out of business,” Preston said.

In Florida, more than 3,000 of 89,000 licensed physicians have dropped their malpractice coverage, according to health officials there. The doctors typically transfer their assets to another party, such as a spouse, making them paupers on paper and unlikely to be sued.

“It’s recognized that lawyers are opportunistic, and if doctors don’t have coverage and hospitals do, they tend to follow the money,” Preston said.

That increases the risk for hospitals that allow uninsured doctors to practice in their facilities, Preston said. To continue offering certain high-risk specialty services, such as obstetrics, some hospitals have considered either increasing their own malpractice coverage, subsidizing the doctors’ premiums or making the doctors hospital employees, according to Preston and Fiedler.

In addition to the increased medical liability risk, hospitals that let in uninsured doctors jeopardize their ability to borrow money for capital improvements, Fiedler said.

She said hospital operators sympathize with physicians and are working with them to persuade state legislators to hold a special session on medical malpractice reform.

Gov. Robert Ehrlich presented a plan to General Assembly leaders Monday that he said would offer doctors immediate relief from premium increases and hold the line on future rate hikes. Opponents have denounced it as an attempt to strip malpractice victims of the right to be compensated for their losses.

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