Testimony On Medical Liability Reform Before the House Committee On Small Business

TESTIMONY OF THE AMERICAN ACADEMY OF FAMILY PHYSICIANS SUBMITTED BEFORE THE HOUSE COMMITTEE ON SMALL BUSINESS CONCERNING “ARE SKYROCKETING MEDICAL LIABILITY PREMIUMS DRIVING DOCTORS AWAY FROM
UNDERSERVED AREAS?”

PRESENTED BY

LARRY S. FIELDS, MD, PRESIDENT-ELECT
ASHLAND, KENTUCKY


Chairman Manzullo and Representative Velazquez,

For the 95,000 members of the American Academy of Family Physicians and, more importantly, for the 50 million of your constituents who give us the privilege of taking care of their health every day, I sincerely and, humbly, thank you for your invitation to participate in this hearing.

A few years ago, you invited our then President, my friend, Dr. Warren Jones, of Mississippi, to testify on Medicare payment policies. He remembers that exciting, thoughtful experience as the highlight of his service as leader of our academy.

Like Warren, I am truly honored by your request to testify this morning.

On behalf of the AAFP, I commend you for your persistent and successful efforts to ease the burdens of small businesses in this country.

I am particularly honored to be here before this committee as it includes one of our academy’s outstanding members, Representative Donna Christensen, who is serving as the leader of the Congressional Black Caucus Health Brain Trust.

Family physicians are serving proudly and with distinction in all branches of our military. We practice in all 50 states, here in the District of Columbia, Puerto Rico, Guam, and as Representative Christensen can attest, in the Virgin Islands.

As family physicians, nearly half of Dr. Christensen’s and my patients are Medicare beneficiaries, on Medicaid, or have no insurance at all.

A large percentage of family physicians work in small and medium sized practices of four physicians or fewer. Our practices are typical of small businesses that operate with very tight financial margins.

The average gross revenue for family medicine practices in 2003 was $360,000. From this total, family physicians pay staff salaries, rent, utilities, medical equipment costs and medical liability insurance premiums.

Most of these costs have risen rather steadily and predictably with the single, significant exception of medical liability premiums.

When these premiums increase at the rate of which we have seen for the last several years, my practice has no way to absorb them.

So, among my alternatives are:

Those who suffer the most are our patients.

They are your constituents, who no longer have a medical home, who can no longer find the friendly, familiar faces that humanize medicine and provide a safe haven in the complex world of 21st century medicine, or who can’t find the obstetric services they need.

I practice in Eastern Kentucky, close to where I was born, a beautiful, rural, underserved area.

Last year, the liability carrier we had for 22 years, without a dime ever being paid in claims, dropped our practice and, for a couple of months, there was the very real possibility that 18,000 human beings would not find that friendly face I spoke of earlier.

My heart aches every day when I see the financial hardship created for my patients by the forced, defensive of medicine practiced by emergency physicians, sub-specialists, and by me.

Much like me, my colleague, Dr. Julie Wood, in Missouri was raised in a rural area to which she returned to practice family medicine.

Julie did a full scope of practice including OB. Fifty percent of her patients were Medicaid and that program covered 80% of her OB patients.

Six years after starting her practice, her liability carrier informed Julie that her premium would rise from $19,000 to $71,000. Because she loves mothers and children and the special relationship that forms between physician and expectant mother, she had no alternative she left practice in her hometown and took a position with a large academic health center in, Kansas City, where the hospital pays her insurance.

There is now no OB in a corridor of northern Missouri stretching from Hannibal to St. Joe.

Some people can drive the two hours to see Julie, but what do we tell the people who cannot afford to do that?

What do we tell the 15 year old, intellectually challenged, pregnant girl who rode her bicycle to Dr. Wood’s office because her only other way to get there would have been to walk?

Do we say that because they are poor, or not as smart, or live in the wrong place they do not deserve prenatal care or must risk having their baby born in a car or ambulance on a lonely highway in the middle of the night?

My friend, Dr. Neil Brooks is a family physician in Connecticut, where he was born and raised.

He was part of a four physician group in his hometown of 30,000.

Three years ago, his liability premium had skyrocketed 600% to $31,000, and, at age 59, Dr. Brooks was forced to retire from his practice through which he had served four generations of his friends and neighbors, 50% of whom were by then Medicare beneficiaries.

Neil was followed into retirement by the best surgeon in town and by two ob/gyns, all of who had to leave practice before they drowned in red ink produced by liability premiums.

I am the AAFP’s Member on the AMA’s Commission to end health care disparities.

I assure you that American Medicine can end this problem.

But, I have to tell you now that such disparities will never end unless physicians in this country are freed to do the right thing for our patients, each and every one each and every time.

Free of a system that allows any lawyer who can chase down a victim and dig up an expert to drag a physician through the courts for 5 years, all the while demanding that the physician pay even higher liability premiums, and at the end of the day pay next to nothing to the alleged victim.

The spectrum of medical liability is an equal opportunity employer. It affects everyone, but it does not affect everyone equally.

If you are black, hispanic, or if you are poor, or weak, or innocent. If you live in Eastern Kentucky, or Macon, Missouri, or Vernon, Vermont it robs you of the full opportunity that this country can offer.

What I am really saying, is there is opportunity here. American medicine can be the highest quality, most cost efficient, most accessible, health care system in the world not just for a segment of our people, but for everyone in this country.

Please, for the good of the innocent, continue to try and find ways to free American medicine to be what I know in my heart it can be.

I promise you the full support and assistance of America’s family doctors in your work. And, I promise you a health care system the likes of which the world has never seen.

Thank you, Chairman Manzullo and Rep. Velazquez. I am happy to be here and to be able to answer any questions you may have.


American Academy of Family Physicians
Professional Medical Liability

Academy Goals and Methods

As one of its highest priorities, the Academy will continue to work on the professional medical liability problem through it’s Strike Force on Medical Liability which will have specific recommendations this summer.
No responsible party in the medical profession denies the existence of malpractice and the right of a fair recovery to the negligently injured patient.

The goals of the AAFP in this area are:

a. To be an advocate for the patient and help them obtain relief from costs related to professional medical liability insurance and to support solutions that more equitably and quickly compensate those truly injured in the course of medical care.

b. To be an advocate for family physicians regarding any mechanism for: (1) affordable premiums; (2) differential premiums for beginning and part time physicians; and (3) equitable premium differentials for family physicians who provide obstetrical and surgical services based on sound actuarial evidence and standards of care.

c. To encourage and support in depth study and implementation of non-legislative solutions to the professional liability problem.

d. To encourage and support state and national legislative solutions to aid physicians providing medical care (including obstetrics) in underserved areas. Such relief could be in the form of tax relief, partial reimbursement of professional liability insurance premium and/or loan forgiveness.

e. To support chapters by serving as a resource center to provide information of evolving solutions in other areas.
(1976) (2004)

The American Academy of Family Physicians supports the following federal liability reforms:

Other methods that the Academy believes will be helpful in stabilizing unacceptably high liability premiums and aid in abating the medical liability problem are:

(1975) (2004)