AAOS Gathers in New Orleans, Reports on Med-Mal Crisis

“If doctors can’t obtain insurance, patients can’t get care,” said Michael Daubs, MD at a special press-briefing panel on the professional liability crisis held at the American Academy of Orthopaedic Surgeons’ (AAOS) 70th Annual Meeting in New Orleans.

Daubs is an orthopaedic surgeon in Las Vegas on staff at the University Medical Center’s trauma center. Millions of people in Nevada and three bordering states were unable to use the trauma center for 10 days last summer after surgeons resigned over the escalating cost of protecting themselves in lawsuits.

Physicians across the country are retiring early, moving their practices to a different state or scaling back their practices because they have been unable to get the necessary medical liability coverage. High-risk specialties such as orthopaedic surgery, obstetrics-gynecology, neurosurgery, general surgery and emergency medicine are the hardest hit. Physician walkouts like those that happened in Nevada and most recently West Virginia and Pennsylvania reportedly could spread to other states.

According to the American Medical Association, 12 states are facing a medical liability insurance crisis: Florida, Georgia, Mississippi, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Washington and West Virginia. Thirty-one additional states are showing problem signs. In these states, liability insurance premiums are rising at a high rate and insurance companies are not writing new policies.

According to the Medical Liability Monitor, in 2002, premiums increased 25 percent for general surgeons. An AAOS study found that premiums for orthopaedic surgeons increased by 35 percent from 2000 to 2002.

Paul Collins, MD, another orthopaedic surgeon speaking on the panel said, “Medical advances are hindered by huge awards, thus depriving Americans of improved medical devices or treatments. There are treatment options available in other countries that are not performed in the United States due to liability concerns.”

A recent survey of orthopaedic surgeons conducted by the Academy found that rising liability insurance premiums have caused:

*55 percent of orthopaedic surgeons to avoid at least some procedures due to liability concerns;

*39 percent to avoid performing spine surgery;

*21 percent to eliminate emergency room call;

*6 percent to eliminate all surgery;

*5 percent to retire early

“The key to rectifying the situation is comprehensive tort reform like the Medical Injury and Compensation Reform Act (MICRA) that was passed in California in the mid 1970s,” said Daubs.

MICRA instituted a $250,000 cap on non-economic damages, such as pain and suffering. This has stabilized the rate of growth of medical liability insurance premiums in California. From 1976 to 2000, premiums rose by 167 percent in California versus 436 percent in the nation as a whole.

According to an October 2002 report, the Medical Liability Monitor found that the 19 states with caps on non-economic damages generally had lower premiums than the other states.