Professional Liability Crisis Jeopardizes Patient Care

"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 today at the American Academy of Orthopaedic Surgeons' (AAOS) 70th Annual Meeting.

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 could spread to other states.

According to the American Medical Association, twelve 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% for general surgeons. An AAOS study found that premiums for orthopaedic surgeons increased by 35% from 2000 to 2002. Physicians facing these premiums are likely to practice defensively, order extra tests and use only procedures that limit risk.

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% of orthopaedic surgeons to avoid at least some procedures due to liability concerns* 39% to avoid performing spine surgery* 21% to eliminate emergency room call* 6% to eliminate all surgery* 5% 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% in California versus 436% 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.

The AAOS position statement on the professional liability issue can be accessed on the Internet at http://www.aaos.org/wordhtml/papers/position/tort.htm.

The 26,047-member American Academy of Orthopaedic Surgeons (www.aaos.org) or (http://orthoinfo.aaos.org ), is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public. An advocate for improved patient care, the Academy is participating in the Bone and Joint Decade (http://www.usbjd.org ), the global initiative in the years 2002-2011 to raise awareness of musculoskeletal health, stimulate research and improve people's quality of life. President Bush has declared the years 2002-2011 National Bone and Joint Decade in support of these objectives. The Academy's Annual Meeting is being held February 5-9, 2003, at the Ernest N. Morial Convention Center in New Orleans, La.