March 2002 • Volume 8 • Number 3 |
•Chapters lobby for change•
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Nationwide, rising medical liability insurance premiums and costlier jury awards in malpractice cases are forcing some family physicians to move their practices or close their doors.
AAFP constituent chapter officers in many states are hearing members' concerns about:
In some states, where medical liability issues have reached crisis levels, chapters have been working for years for tort reform. Other states are just entering the fray by collecting data from physicians and insurers, and a few chapters are using their data to formulate plans to push state lawmakers to introduce liability-related legislation.
MISSISSIPPI
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The Mississippi AFP has been advocating tort reform for several years, "and we will be involved forevermore with this whole issue," said MAFP President Timothy Alford, M.D., of Kosciusko.
"We got involved because we began observing FPs leaving the state for friendlier legal climates," he said. "A well-trained physician in southern Mississippi left after he was sued. The insurance company would not renew his policy, and no other company would write one."
That doctor moved to a nearby state and now teaches at a university and practices, said Alford. "He moved from an underserved area to a relatively adequately served area -- compounding the maldistribution problem."
Working closely with the Mississippi State Medical Association and lobbyists, the chapter has helped get several pieces of legislation introduced in the state legislature. The measures, if passed, would:
Alford said he's hopeful the proposals will see action this session, but "one senator told me, basically, 'You guys are right. The fact is, if I vote for you on this issue, I will not be alive in the next election.'"
NEW YORK
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New York lawmakers are no different, said Vito Grasso, executive vice president of the New York State AFP. The state's physicians pay some of the highest medical liability insurance premiums in the country because of escalating jury awards and a shrinking marketplace for insurance.
However, lobbying efforts by the chapter and other groups have resulted in legislation that limits the annual increase of premiums paid by physicians for the state's Excess Medical Malpractice Program policies. The policies provide coverage beyond the basic "primary" malpractice insurance. Starting in April, premiums for the excess coverage can't exceed the prior year's premiums by more than 9 percent.
The state's required primary liability coverage limits have increased from $1 million/$3 million (economic/noneconomic damages) in 2001 to $1.3 million/$3.9 million in 2002. According to data from Jury Verdict Research, 48 percent of the medical malpractice awards in the state in 1999, combining economic and noneconomic damages each exceeded $1 million. Without tort reform in New York, analysts say some awards could reach nearly $7 million by 2004.
"We're supportive of the excess coverage system," Grasso said. "But the real issue hasn't changed. The cost of exposure has increased, jury awards are increasing, and there's continuing pressure to increase premiums for primary policies.
"The solution is to reform the tort system."
Working with the Medical Society of New York State and other medical organizations, the chapter is lobbying for a reform measure including:
CONNECTICUT
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Citing concerns from members, the Connecticut AFP board has embarked on a fact-finding mission about the state of medical liability insurance, said President Paul Edelen, M.D., of East Hartford.
In December, the state's largest insurer -- Connecticut Medical Insurance Co., a physician-owned company -- notified policyholders that premiums were increasing by an average of 30 percent. Edelen said the board then "moved the issue to the top of the list" for action.
Rates have been climbing steadily, he said. From 1988 to 2001, his CMIC premiums increased 81 percent, for an average increase of 6 percent annually. This year's increase is 58 percent.
"The rate jump this year was an order of magnitude above previous increases!" Edelen said.
In his renewal notice, the insurer stated "higher court settlements" are to blame. "But we want to know why primary care has been hit so hard. Is this going to inhibit some physicians from practicing?" Edelen asked.
Those answers could come when the board meets with company representatives. At press time, a meeting was slated for late February.
"This outcome (increased insurance rates) is something that needs to be more visible," Edelen said, "and the consequences of high jury awards need to be visible to the public."
TENNESSEE
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No one agrees more than Timothy Linder, M.D., of Selmer, Tenn., president-elect of the Tennessee AFP and chair of the chapter's legislative committee.
One thing the public doesn't know, Linder said, is that juries in medical malpractice cases see the plaintiff's total medical bills -- not the ones with health insurance company adjustments. These lower, adjusted costs reflect the plaintiff's "actual" bill. "So they are working off the wrong numbers to begin with," said Linder.
His committee plans to study the issue this year with the intent of seeking some tort reform legislation in 2003.
"We can look to other chapters for some guidelines on how to go about getting legislative reform," said Linder.
FP Report is published by the
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Copyright © 2002 by
American Academy of Family Physicians.