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We are now seeking affordable
malpractice insurance. One may not practice medicine in Pennsylvania
without malpractice insurance. |
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PA is one of the worst states for malpractice premiums.
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Malpractice
Problem
Currently, many states in our nation including West
Virginia, Mississippi, Nevada and New Jersey have had significant crises
related to the rising cost of malpractice insurance. However, Pennsylvania ranks as the worst. |
| Supreme Court
of Pa determined that only the Judiciary, not the General Assembly could,
enact this type of reform |
In 1996 tort reform was passed
by the PA General Assembly and signed by the Governor.
Unfortunately, the PA Supreme Court overturned this legislation.
The Supreme Court determined that the General Assembly did not have
the authority to enact this legislation; therefore, it was not enacted.
The Supreme Court did not determine that the legislation itself was
unconstitutional. If that
legislation had been enacted in 1996, the current problem would be significantly less
severe. |
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Insurers have left PA.
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Scope of the problem:
The vast majority of malpractice (professional
liability) insurance carriers have found PA an unfavorable and
unprofitable place to do business and have stopped issuing policies in
Pennsylvania over the past several years |
| Only 2
insurers are left and only one can offer new policies. |
Currently, there are only 2 major commercial insurers
left in the state (PIMSLIC and Medical Protective).
At this time, only Medical Protective can offer new policies.
In addition, there is the JUA (Joint Underwriting Association),
which is the state-run insurance company of last resort for those
physicians who cannot obtain commercial malpractice insurance.
There are a few new companies of a different type known as
"risk retention groups" which require physicians to pay a substantial amount of
cash to the companies' reserves in order to have the company offer them
insurance. In addition to the
premium the physician’s personal estate is at risk for awards – a risk
many physicians find unacceptable. |
| PA
insurers require high premiums
for malpractice insurance but award the lowest payments to physicians for their services. |
For those who have been able to have their
malpractice insurance renewed, the premium has been going up as much as
100%/year. In other
businesses, one can increase the charge for a product or service to
offset this increased overhead. However,
in our region, physicians are locked in to reimbursement based on whatever
the insurer’s fee schedule pays; in that regard, Southeastern PA
has one of the worst payment systems for physicians in the country as well. |
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Because of
high malpractice situation, insurance costs and very low insurance payments, many
physicians are leaving the state, retiring early and/or cutting back on services
such as OB/GYN’s not delivering babies. |
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Facts about physicians leaving, retiring, etc.
High-risk
specialists—Neurosurgeons,
obstetricians, orthopedic surgeons, for example, are leaving the fastest.
Even worse is the fact that the number of young doctors coming to
Pennsylvania—and staying here—is falling even faster.
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Under
age 35
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| 12th to
41st |
Nationally, Pennsylvania has gone from being 12th among all states
in the proportion of young physicians to being 41st.
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Here
at Abington, 2 neurosurgeons have left the state in the past 3 years
because of the cost of malpractice insurance
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| 24 Abington
Memorial Hospital Specialists did not have their insurance renewed. |
While
this previously had been more of a problem for the high-risk specialists, the problem is now become more widespread.
Our group of 10 pulmonologists in addition to 9 cardiologists, and 4 infectious
disease specialists here at Abington were notified 3 weeks ago that our
insurance would not be renewed after 6/30 of this year. We are
currently looking at our options for insurance coverage – options which are few!
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| Even Lloyds
of London will not insure PA. |
A
few other facts:
o
100
physicians are leaving the state per month
o
There
are 3 (soon to be 2) orthopedists in the state under age 35.
o
Lloyds
of London lists 3 places in the world it will not insure:
Slovakia, Bosnia and Pennsylvania. |
| Access to care
will be affected |
What
does this mean to you?
1.
As more physicians leave the state, your access to quality health
care will be affected. We saw
an example of this in December of last year when the trauma center closed
for 13 days because surgeons could not obtain malpractice insurance. |
| Quality of
care will be affected. |
2.
As doctors leave and are not replaced the
quality of care will be affected |
| Money drained
from health care goes mostly to lawyers |
3.
Money that could be used for new equipment and research is going
into the legal system for multimillion-dollar awards.
Surprisingly, much of this money does not go to the plaintiff but
instead goes to the attorneys. |
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We need caps on “non-economic” damages!
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What needs to be done?
- We
need caps on “non-economic” damages! "Non-economic damages" refers to the “pain &
suffering” payments and has no bearing on damages for medical costs
or inability to work, etc. Because
of the “runaway” jury awards (up to $100 million), insurance
companies can’t estimate what their risks will be and are unwilling
to write insurance in Pennsylvania.
Caps will require an amendment to the state constitution, and
legislation is currently coming up for vote.
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| Injured
parties should receive the bulk of the awards |
- Patients
who are injured should receive the majority of the award instead of
the large proportion now that goes towards legal fees. The
lawyer’s contingency fee must be limited.
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| There
must be a scientific
approach to patient safety in a "blame-free" environment. |
- Comprehensive plans for patient safety need to include a “blame free
environment” so near misses, errors, and bad outcomes can be
evaluated scientifically and with the intent of quality improvement.
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These are complex times. There are limited resources. We must
work together to maintain the high standards that we expect for one
another. Please let us work together to improve the future.
