If the Bough Breaks - Raising Awareness of the Medical Liability Insurance Crisis in Maryland
 

			NEWS	Malpractice Pinch has Md. Doctors Mulling Whether to Wait -- or Leave
By John Wagner From WashingtonPost.com November 30, 2004 Tomorrow is the day that Cary Brown's next medical malpractice insurance bill comes due. It may also be the day he decides whether he can afford to maintain his practice. Like thousands of other doctors across Maryland, Brown, a Rockville general surgeon, faces a steep increase in his premiums -- and no guarantee that state leaders will intervene to help out. Gov. Robert L. Ehrlich Jr. (R) and top Democratic lawmakers have been talking up the prospect of a special session on medical malpractice reforms since summer. But with bills due to the state's largest malpractice insurer this week, negotiations have not yielded consensus and have offered no clear signal as to whether anything will be done to avert an average 33 percent increase in next year's premiums. For many Maryland doctors, the hit could be even steeper. Last year, Brown paid $37,000 to insure his modest-size solo practice. Next year's premiums will be $52,000 -- at least a quarter of which is due tomorrow. "I really don't know what I'm going to do," said Brown, who has had no malpractice claims filed against him in the past decade. "I'm pretty much up against the wall. . . . I think a lot of people are hanging on, hoping there's going to be a big announcement that there'll be a special session." For Brown, who performs about five surgeries a week on gallbladders, appendixes and other areas, the coming days could be crucial. He said he is wrestling with whether to abandon surgery and focus on less risky procedures, such as wound care. That would lower his premiums but also make it harder to earn a living, he said. Brown, 58, the father of a college student, said he has also considered leaving the profession altogether, but "I can't really afford to do that," he said. Moving to another state is an option. Or he may find a way to come up with the first quarter's payment and hope subsequent action from the legislature will allow him to recoup some of it. "This is a bad time of the year to have to come up with a large amount of money for a lot of reasons," Brown said. In seeking help from the state, doctors are battling the perception -- and in some cases, the reality -- that theirs is a relatively comfortable profession. But doctors say that the insurance pinch is real and that many are now weighing whether to leave the profession. "Is it a stampede? No," said T. Michael Preston, executive director of MedChi, the Maryland State Medical Society. "But is it a phenomenon playing out in many places across the state? The answer is certainly yes." State leaders acknowledge that their inaction has made it more difficult for doctors to make decisions regarding their practices. "Doctors absolutely have a right to be frustrated with this process," House Speaker Michael E. Busch (D-Anne Arundel) said last week after closed-door negotiations with Ehrlich and Senate President Thomas V. Mike Miller Jr. (D-Calvert). Their talks focused on the creation of a temporary state fund that would enable malpractice insurers to hold down their rates for several years. Ehrlich, Busch and Miller have voiced support for the fund, but many details -- including how to pay for it -- remain unresolved. Miller and Busch would like to impose a 2 percent premium tax on HMOs and other managed-care organizations. Analysts say that measure would yield about $80 million a year, enough to effectively freeze malpractice premiums at this year's levels. Ehrlich opposes the HMO tax but has not publicly identified another funding source. Donald J. Hogan, an aide, said Ehrlich would support a less costly approach under which premiums would rise somewhat in coming years, but much less than the average 33 percent increase being imposed by the Medical Mutual Liability Insurance Society of Maryland, which covers more than three-quarters of state doctors in private practice. Aside from short-term relief, other issues stand in the way of a special session. Ehrlich has said he will support a reinsurance fund only if lawmakers adopt reforms to the legal system at the same time. Insurance companies blame lawyers for escalating malpractice payouts. Miller has been cool to many of the ideas floated by Ehrlich, which include curbs on awards in malpractice cases and limits on lawyers' fees. No one close to the situation believes a deal is likely to be closed by tomorrow. "I would hope the doctors who have held on this far would go ahead and pay their first-quarter premiums," Hogan said. Med Mutual's policies give doctors some breathing room. The company has said it will issue cancellation notices during December to doctors who do not make their minimum payments by tomorrow. But the cancellation would not take effect until the end of the month. David Bianchi, an ear, nose and throat specialist in Silver Spring, said his four-doctor practice is wrestling with whether it can absorb $40,000 in additional insurance costs next year. "We're praying that we'll get some sort of relief, but it looks to me that the special session may not happen at all," said Bianchi, whose share of the insurance bill is slated to rise from $24,000 to $34,000. The increase comes on top of an average 28 percent increase from Med Mutual last year. Bianchi said there are few places left to cut costs. Most disturbing, he said, has been an effort to squeeze more patients into the calendar to make more money. "I can't see any more than one patient every 10 minutes," Bianchi said. "I'm on the verge of not giving good medicine." Bianchi said he has been sued twice in 11 years. Both cases, he said, were decided by a jury in his favor. Bianchi, 46, said he is considering moving out of state or returning his practice to where it started: the military, where the government assumes malpractice costs. With four children, however, Bianchi said it's difficult to move. "I'm not going to be moving out of Maryland in the next few days, I know that, but it's something that crosses my mind every day." Christine Neto of Salisbury is having similar thoughts. Her rates are high because of the risks that come with her specialty, obstetrics-gynecology. Neto said her bill for the coming year is $106,000 -- and she is "anxiously" waiting to see whether she will get some help from the General Assembly. "Right now, I don't have the money to pay the premiums," she said. Neto said she moved to Maryland years ago to escape high premiums in New York. Now she is considering a move to Virginia, where insurance rates are generally lower. But she said she would do so reluctantly. "You can't just keep running from state to state. . . . I hope the legislators are listening," she said.