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Liability Concerns Forcing Some Doctors Out of Practice


Doctors around the United States have declared a malpractice insurance crisis. The policies protect physicians from financial ruin if patients sue them for negligence or incompetence, and are awarded large monetary settlements.

But high premiums for this protection are forcing some specialists out of their fields. In West Virginia during the week of January 4-10, surgeons staged walkouts to protest insurance rates. In Massachusetts, the crisis is hitting obstetrics especially hard.

On a recent afternoon, a young woman is going through active labor at Springfield's Bay State Medical Center. Her family watches TV in the room as a nurse checks the baby's heartbeat, heard through a fetal monitor attached to the woman's stomach. When she's ready to deliver, one of the hospital's several on call obstetricians will arrive to guide the baby out. It could be Dr. Howard Trietsch, who's been delivering babies for 20 years.

"I wonder how many scrapbooks and books I must be in, people's baby books. It's just a real intimate part of someone's life that you can have a real impact in," he said.

But there'll be no more deliveries for Dr. Trietsch. As of January 1, he is no longer doing obstetrics and is focusing instead on gynecology. Dr. Trietsch says it was a difficult decision. It's not that's he's tired of being on call nights, weekends, and holidays. It's that his malpractice insurance premium is tripling, from $28,000 to about $90,000 a year. The cost was simply too much for his practice.

"I felt I had another 10 years of obstetrics left in me," Dr. Trietsch said. "I came into this to help women and deliver babies. And this is not going out the way I wanted to."

Dr. Trietsch is not alone. The Massachusetts Medical Society said doctors across the state are giving up obstetrics in what's become a growing trend. In one area alone, up to a dozen doctors have decided to stop delivering babies.

"We're talking about a reduction in the workforce of 20 to 25 percent," said Dr. Burkman.

Dr. Ronald Burkman is Chairman of Obstetrics and Gynecology at Baystate, and president of the Massachusetts chapter of the American College of Obstetricians and Gynecologists.

"This means, women requesting OB care will have reduced options. It'll mean there will be some delays in getting OB care," he added.

Dr. Burkman says rural communities are hardest hit, because there are fewer doctors in those areas to pick up the slack.

"If one or two decide to leave, then essentially the services disappear," he explained.

Although individual obstetricians leave the field for various reasons, Dr. Burkman said the cost of liability insurance is usually a major factor. The specialty has one of the highest premiums of all medical fields, because the likelihood of lawsuits is greatest. And so is the sympathy factor with juries, said Dr. Burkman.

"People have always viewed that having a baby is always a normal process and that any time a baby is not born normal, obviously there had to be some error in the care," he said.

If America's litigiousness is not new, why are premiums so high now?

According to the insurance industry, there are two reasons. The economy plays a part: when interest rates are low, as they are now, insurance companies earn less from their investments and have to make up the difference in premiums. But more significantly: while the number of malpractice cases has been stable over the past decade, insurers and doctors say jury awards have skyrocketed. Dr. Charles Welch, president of the Massachusetts Medical Society, said the average award is now one million dollars or more.

"I'm not debating whether a case is worth two million or four million or 20 million. The basic issue is simply that there isn't money in the system to pay out those kinds of awards," he said.

As a remedy, the Medical Society, which represents physicians, has proposed legislation to limit the amount plaintiffs could win for 'pain and suffering' to $500,000. That's in addition to any reimbursement for the cost of medical care or lost wages. Insurance companies say states with award caps, such as California and Colorado, have lower insurance premiums.

But Valerie Yarayshus, president of the Massachusetts Academy of Trial Attorneys, said although they may seem high, jury payouts have kept pace with inflation in the medical world.

"What gets lost in the whole debate is a sense of patients rights, and the fact that nobody wants to be in the role of somebody who's been injured as a result of medical negligence," Valerie Yarayshus said. "That's really what this legislation is targeted at, which is the victims who've been most seriously injured."

Moreover, a recent study by a nationwide coalition of consumer groups found that rising premiums are more closely tied to insurance company investments than to jury awards. The coalition said that insurers are using scare tactics to limit their own liability.

Whatever the reason, back at Bay State Medical Center, Dr. Ronald Burkman said Americans are facing a difficult choice: between the chance to win high settlements, and the ability to find a doctor.

"The bottom line is, physicians are giving up the practice of obstetrics. I predict if we don't get fixing this, by this time next year, it will be a much grimmer situation," Dr. Burkman said.

An exodus of obstetricians and other high risk specialists in Nevada, Texas, and Pennsylvania has led to legislative battles in those states. Massachusetts doctors are hoping lawmakers will debate their proposed liability legislation this session.