5 Years Later, Ohio Has Falling Insurance Rates; Fewer Obstetricians

When Bobbie Cameron became pregnant with her third child, she reluctantly chose a new doctor to oversee her care. Her longtime physician had dropped out of the birthing business because of soaring malpractice insurance rates.

Cameron’s daughter, Avery, was born in February 2007. The experience just wasn’t the same.

“We had to go to someone we didn’t know, who didn’t know my history, who didn’t know how my last two births went,” said Cameron, 31, a full-time mom in nearby Plain City.

Five years after a law trying to reduce the malpractice rates went into effect, Ohio has fewer doctors who deliver babies than at the height of protests about high costs.

Ohio had 1,327 doctors listing obstetrics and gynecology as their primary specialty at the end of 2007, a 5 percent decrease from 2002, according to an AP analysis of State Medical Board numbers.

The overall number of doctors in Ohio rose during the same time, from about 28,000 to about 30,000. Those figures represent all doctors and not just those in high-risk specialties.

The Republican-sponsored 2003 law caps most jury awards for pain and suffering in medical malpractice cases at $350,000 but allows up to $1 million in cases with multiple victims _ such as injuries to a mother and baby during a delivery _ and injuries considered catastrophic.

Supporters of caps had argued that large jury verdicts and frivolous lawsuits were driving up insurance rates and forcing doctors with high-risk specialties such as obstetrics to leave the profession.

Supporters, such as the Ohio State Medical Association, say malpractice rates are still too high for obstetricians and others in high-risk medical specialties. They also say Ohio has not recovered from losing doctors who quit delivering babies or left the state because of high rates.

Opponents of caps, such as the Ohio Association for Justice, which represents trial lawyers, say if the limits worked the state would have more doctors delivering babies, not fewer. The opponents had said insurance rates were increasing not because of jury awards but because insurance companies were raising prices to make up for stock market losses.

Experts say there could be any number of reasons why Ohio has fewer obstetricians, from rising medical costs of all kinds to the increasingly sophisticated technology used to deliver babies, which may be forcing old-style obstetricians to rethink the specialty.

In the past, “if there was a problem with a delivery, the baby usually didn’t survive very long. Now we have the technology to keep these infants alive,” said Maxwell Mehlman, a professor of law and medicine at Case Western Reserve University.

“That increases the costs to a physician of being ajudged negligent,” he said. “It’s become a high-tech practice with severe consequences for malpractice.”

The astronomic rates by which insurance premiums grew, an average of 31 percent in 2002, began to slow in 2005 and 2006. In 2007 the premiums themselves shrank slightly.

But even with those improvements, doctors in high-risk areas such as obstetrics are still paying tens of thousands of dollars a year in insurance premiums.

On average, obstetricians in Ohio paid about four times the rate of doctors in internal medicine in 2007, according to the 2007 survey by Medical Liability Monitor, a newsletter that analyzes the medical malpractice insurance industry.

In greater Cleveland, the base premium rate for obstetricians insured by American Physicians Assurance Corp. was $194,293, compared with $43,192 for internal medicine physicians, the survey showed.

In 2001, Cleveland-area obstetricians insured by the same company were paying a base rate of $84,029, a figure that jumped to $120,275 by 2003, a 43 percent increase.

Supporters and opponents of caps on jury awards offered wildly varying data on the need for legislative changes, sometimes referred to as tort reform.

Proponents said caps were required to rein in jury verdicts averaging as high as $3.5 million nationally by 2002 and annual insurance increases of 30 percent or more.

Opponents delivered their own data that found no evidence of jury verdicts spiraling out of control. They argued that surgeons in states with caps, for example, paid an average of $26,746 in premiums, compared to $26,144 paid by surgeons in states without caps.

Independent experts said there was little data either way.

It’s difficult to measure the impact of caps, especially since such laws are still relatively recent. In addition, the growth of insurance rates has been leveling off in recent years, including in states that did not pass caps, according to Medical Liability Monitor.

Other states with caps on jury awards have had better luck with maintaining obstetricians.

Florida, which enacted limits in 2003, had 2,182
obstetrician-gynecologists at the end of 2006, an 8 percent
increase from five years earlier. Texas, which enacted some of the
country’s toughest limits in 2003, had 2,871 obstetricians at the
end of 2006, a 10 percent increase from five years earlier,
according to the American Medical Association.

Unlike Ohio, both states also have growing populations.

Proponents point to a backlog of applications at the Texas state medical board as proof the cap is working. Opponents say the picture’s not that clear.

“Anyone would concede there’s some physicians who come to Texas because of the tort reform,” said Paul Waldner, president of the Texas Trial Lawyers Association.

“To make a statement that that’s the primary reason, or that’s the reason most of them are coming, there’s not any data to suggest that,” he said.

The bottom line of all five of Ohio’s biggest medical malpractice insurance companies has been improving, according to an AP analysis of state insurance records.

The companies say that’s because the amount a company pays out in malpractice claims has decreased. That drop could be related in part to caps and other changes to malpractice law across the country, though many factors are involved beyond caps, companies say.

“It’s very hard to quantify and tie the two pieces together,” said Ann Storberg, vice president for investor relations at East Lansing, Mich.-based American Physicians Assurance Corp.

The company’s income rose from a $61 million loss in 2001 to $53 million in the black in 2006. Over the same time its rates went from a 30 percent increase in 2001 to a minus 7 percent cut in 2007.

In the fall of 2002, family practitioner Dr. Sarah Sams rallied at the Statehouse in favor of Ohio’s pain-and-suffering cap and Republican state Supreme Court candidates she believed would be sympathetic to the limits.

Three months later, then-Gov. Bob Taft signed into law the bill that Sams supported. But two years later, her rates still high and before premiums began to fall, Sams was forced to give up delivering babies anyway.

Eventually she went to work for a self-insured hospital that allowed her to deliver babies again. But it was too late for Bobbie Cameron, one of Sams’ favorite patients.

“I was devastated when I gave it up. It was very, very difficult,” said Sams, 43, of suburban Columbus. “Here were people I had a long-standing relationship with who wanted to continue with me but couldn’t. And that’s hard.”