The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) are pleased that the House Energy and Commerce Committee will be marking-up H.R. 4600 the "Help, Efficient, Accessible, Low Cost, Timely Health Care (HEALTH) Act of 2002" later this week. If enacted, this bipartisan bill, with over 115 co-sponsors, will significantly help alleviate the current professional liability crisis and help stabilize the skyrocketing professional liability insurance (PLI) premiums that are beginning to debilitate the nation's health care delivery system.
According to data from a national survey of neurosurgeons across the country (which will be released next week during a press conference on September 25 in Philadelphia, the day before a special symposium on the medical liability crisis during the 52nd Annual Meeting of the CNS at the Philadelphia Convention Center), 25 states are in "severe" crisis and an additional 12 states are facing a "potential" medical liability crisis. 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 over $300,000 per year.
The most important findings of the survey showed that as a result of neurosurgeons' premium increases patient access to neurosurgical care is in jeopardy. The survey demonstrated that:
- Patients Can't Get Complex Neurosurgical Procedures. 43 percent of survey respondents stated they plan to, or are considering restricting the types of surgical procedures they perform. - Patients Can't Get Emergency Medical Treatment. 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. - Patients Can't Find a Neurosurgeon Close to Home. 19 percent of respondents indicated that they plan to, or are considering moving their practice to states where PLI costs are relatively stable. 29 percent stated that they plan to, or are considering, retiring from practice altogether.
"The impact that this crisis is having on patients is significant and demands attention by our federal legislators. 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."
Roberto C. Heros, MD, President of the AANS and Co-Chair of the Department of Neurosurgery at the University of Miami in Florida, echoed these remarks. "It is a devastating reality when patient care is compromised, as quality physicians are moving, retiring or restricting their practices in reaction to these escalating insurance premiums," said Dr. Heros. "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 to get the care they need. Critical life-saving time will be lost while searching for an available emergency room."
The survey identified the following states (in alphabetical order) as in a "severe" crisis for neurosurgeons: 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.
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.
"Many of the states where professional liability insurance costs have remained stable are a direct reflection of effective tort reform laws passed in those areas," said James R. Bean, MD, a practicing neurosurgeon from Lexington, KY and Chairman of the AANS and CNS Washington Committee. "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. 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."
The AANS and CNS believe that federal legislation is necessary to address this national crisis and are actively seeking passage of the HEALTH Act. They are working with a broad-based coalition that includes other medical societies, hospitals, health plans, and business organizations, to achieve passage of this important legislation.
The AANS, founded in 1931, and the CNS, founded in 1951, are the two largest scientific and educational associations for neurosurgical professionals in the world. These groups represent approximately 5,200 neurosurgeons in the United States, Canada, Mexico, Europe and the Pacific Rim. Neurosurgery is the surgical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spine, brain, nervous system, and peripheral nerves.
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