A new national analysis conducted by the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), and the Council of State Neurosurgical Societies (CSNS), confirms that the medical liability system is indeed in a state of crisis for neurosurgeons across the country. According to the data, which are based on survey responses from over 700 neurosurgeons from 48 states and the District of Columbia, 25 states are in "severe" crisis and an additional 12 states are facing a "potential" medical liability crisis. During a news conference, held at the Philadelphia Convention Center during the 52nd Annual Meeting of the Congress of Neurological Surgeons, neurosurgery weighs in on the medical liability reform debate. Joining the AANS and CNS to discuss the impact that this crisis is having on doctors and their patients, are the American Medical Association and the Pennsylvania Medical Society.
While all physicians are combating this recent trend in healthcare, neurosurgeons have been particularly devastated by this phenomenon. According to the survey data, neurosurgeons in nearly all 50 states have had increases in their professional liability insurance (PLI) costs. Approximately 50 percent of respondents have had up to a 50 percent increase, 13 percent have had between a 50-100 percent increase and 19 percent have had over a 100 percent increase in their PLI costs from 2000 to 2002, with some neurosurgeons paying $300,000 per year. The most important findings of the survey showed that as a result of neurosurgeons' premium increases: 43 percent plan to, or are considering, restricting their practice; 29 percent plan to, or are considering, retiring from practice; and 19 percent plan to, or are considering, moving their practice.
"The impact that this crisis is having on patients cannot be understated. Many neurosurgeons are no longer performing high-risk neurosurgical procedures in an attempt to lower their professional liability insurance costs and minimize their risk of suit," said Stephen M. Papadopoulos, MD, a practicing neurosurgeon from Phoenix, Arizona, and President of the CNS. "Based on this survey data, it seems that brain surgeons are no longer performing brain surgery."
The survey identified the following states (in alphabetical order) as in a "severe" crisis: Alabama, Arkansas, District of Columbia, Delaware, Florida, Illinois, Kentucky, Mississippi, Missouri, Montana, Nevada, New Hampshire, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Virginia, Washington and West Virginia. States where professional liability insurance costs have remained relatively stable or even decreased over the past three years include: California, Connecticut, Hawaii, Idaho, Indiana, Louisiana, Maine, Maryland, Nebraska, North Carolina, North Dakota, Oklahoma and Wisconsin.
A "severe crisis" state is defined by either having a 50 percent increase in premiums from 2000 to 2002, or average premiums near or over $100,000 in 2002. A "potential crisis" state is identified as having premium increases of between 25 and 50 percent over the same three-year period.
Because of increased liability risk, fewer neurosurgeons are covering hospital emergency rooms, and trauma hospitals are shutting their doors to neurotrauma, and diverting patients with serious head and spinal cord injuries to other locations.
"What this means for the public is that our patients may be denied crucial neurosurgical emergency medical treatment or they will have to travel greater distances, even to other states, to get the care they need," said Roberto C. Heros, MD, President of the AANS and Co-Chair of the Department of Neurosurgery at the University of Miami in Florida. "Critical life-saving time is lost while searching for an available emergency room."
The AANS and CNS believe that federal legislation is necessary to address this national crisis and are actively seeking passage of the "Help, Efficient, Accessible, Low Cost, Timely Health Care (HEALTH) Act of 2002" (H.R. 4600 in the House of Representatives and S. 2793 in the Senate).
"The HEALTH Act is modeled after California's Medical Injury Compensation Reform Act, which, after nearly three decades, has brought stability to the professional liability insurance market, while at the same time fully compensating injured patients for their legitimate injuries," noted David F. Jimenez, MD, a neurosurgeon at the University of Missouri-Columbia and Chair of the Council of State Neurosurgical Societies. "In a similar manner, passage of the HEALTH Act will ensure that patients and doctors nationwide will reap the benefits of this rational approach to solving the liability crisis."
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