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AAMC Releases Report on Conflict of Interest Guidelines Malpractice Update: States Say Federal Help Needed To Deal With Spiraling Costs Image Guided Surgery: Making "X-Ray Vision" A New Reality Medical Schools Branch Out: Regional Medical Campuses on the Rise Computer-Based MCAT Gets a Test in London "A Day in the Life of a Medical Student" A Word From the President
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Malpractice Update: States Say Federal Help Needed To Deal With Spiraling CostsAs teaching hospitals around the country continue to face steep malpractice insurance increases, patient care in some institutions is in danger of being compromised, and lawmakers and healthcare leaders are struggling to find a solution. The impact of malpractice premium increases on teaching hospitals has caused many of them to curtail services, close high-risk wards, and cut the number of working faculty. So dire is the state of the malpractice crisis that legislators are trying to bring about tort reform at the federal level, and even President Bush has expressed support for federal legislation to remedy the situation. The AAMC supports the Help Efficient, Accessible, Low Cost, Timely Health Care (HEALTH) Act of 2002 (H.R. 4600 and S. 2793), companion tort reform bills introduced in April that attempt to ease the economic burden on physicians and hospitals with provisions such as a $250,000 cap on non-economic damages. A cap on these damages would help curb rising malpractice jury awards, which can often top $1 million and which critics argue have forced medical liability insurance companies to raise rates. In a related effort, the Department of Health and Human Services (HHS) released a report in July highlighting the problems created by rising malpractice insurance costs and calling for national reform as well as a limit on non-economic damages. “California led the way for the nation by establishing statewide limits on malpractice claims 25 years ago, with bipartisan support,” says HHS Secretary Tommy G. Thompson. “We should learn from the successes of California and other states that have successfully reformed their malpractice systems.” In August, the AAMC co-signed a letter to President Bush expressing appreciation for his statements calling for an overhaul of the country’s medical liability system, and supporting the framework for improving the system outlined by the July HHS report. Teaching hospitals feel effectHospitals in Pennsylvania, a state whose constitution prohibits any cap on non-economic jury damages, are feeling the effect of the crisis. At the end of June, the Methodist Hospital Division of Thomas Jefferson University Hospitals (TJUH) in Philadelphia closed its maternity ward because of a dramatic increase in the cost of medical malpractice insurance premiums. Hospitals in other states, including New Jersey, are facing similar potential closures due to malpractice concerns. “This is what the exorbitant rise in malpractice insurance costs looks like in human terms,” says Methodist Chief Administrative Officer James E. Robinson, who explains that his hospital is facing a near doubling in malpractice premiums for the coming fiscal year. “This move will reduce a portion of the high premium from the hospital’s budget and help us continue to serve the healthcare needs of our South Philadelphia community,” he adds. Obstetricians around Pennsylvania are faced with unusually high malpractice premium increases. Effective June 30, TJUH eliminated 270 positions, and Alan L. Brechbill, executive vice president and COO, cited skyrocketing increases in the cost of medical malpractice insurance as a major reason. The hospitals must absorb a doubling of their expense for malpractice premiums, an increase of approximately $16 million in one year. The cost of malpractice insurance for TJUH physicians will total approximately $50 million next year. “While recently enacted legislation has provided minimal relief,” says Thomas J. Lewis, president and CEO, “the burden of malpractice insurance in the Philadelphia market remains substantial. These adjustments are critical to our mission of providing high-quality and cost-effective health-care services to improve the health of our communities.” In Nevada, another state where the medical malpractice crisis hit the state’s only teaching hospital hard, the story has a relatively happy conclusion, for now, though it took a near-disastrous situation for the state legislature to call a special session to solve its malpractice crisis. The only Level 1 trauma center in the state, at the 504-bed University Medical Center (UMC) in Las Vegas, closed in early July after 56 of its 58 orthopedic specialists resigned, citing excessive malpractice liability costs. As a county-operated facility, the university hospital is able to claim sovereign immunity and to limit its liability for on-staff doctors to $50,000, but the orthopedic specialists were not covered under the immunity. Despite pledges by the hospital to extend its immunity to cover the physicians, they feared the extension would not hold up in court. The same physicians ended up returning to the trauma center 10 days later, after promises from the state legislature that insurance reform laws would come out of a special session on the matter. Special session called“The doctors were re-hired as employees of the UMC and were covered under the county’s liability cap for a 45-day period,” says Rick Plummer, a UMC spokesman. “The 45-day period was enough to get us through the state’s special session that was called to address this issue. During the session, lawmakers passed several revisions to the state law regarding liability and compensation for non-economic damages.” Although Nevada’s tort reform was sufficient to address the pressing problems affecting the region’s orthopedic surgeons, it didn't solve problems for the state’s OB-GYNs, according to Plummer. “One thing [that] the state plan left out regards coverage for OB-GYNs, who are now facing caps on how many babies they can deliver,” he explains. “Insurance companies will only cover OB-GYNs here if they do not deliver more than 125 babies a year.” For this reason, Plummer, along with healthcare leaders around the country, sees federal tort reform as the only way to thoroughly address the crisis. “I wholeheartedly support the president’s stance on a nationwide cap,” says Plummer. — Suria Santana, ssantana@aamc.org |
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