Medical Malpractice Crisis

Hits Connecticut

To the Editor:

Don’t get sick on March 26.

If you do, you may have trouble finding a physician to treat you. As the AMA adds Connecticut to the list of states in malpractice crisis, doctors are planning a rally and a day of meetings with legislators at the Capitol in Hartford. Many offices will be completely closed and elective procedures cancelled as physicians travel to Hartford to present their case to the public and the Legislature.

What is the malpractice crisis all about? It is a complex interplay of many forces, including inflated malpractice awards, insurance company investment losses, lack of competition among insurers, unreasonable patient expectations, defensive medical practices and, yes, medical mistakes. Insurers, physicians, and lawyers are all pointing fingers at each other, but the result is that physicians are leaving practice and patients are suffering in a multitude of ways.

As in other states, Connecticut physicians are asking for a cap of $250,000 on noneconomic jury awards, i.e., pain and suffering. Noneconomic losses are impossible to standardize, and this is where jury awards can be highly unpredictable.  Many people mistakenly believe that a cap would limit the whole jury award to $250,000, which often is inadequate. But noneconomic losses are only part of the equation. Recovery of economic damages would remain unlimited. These include current and future medical expenses, loss of income, home health care, rehabilitation costs, and child care. In states where caps have been successfully applied, such as in California, the malpractice market is now much more stable. In contrast, many Florida physicians are foregoing their malpractice coverage in order to stay in practice.

In Connecticut only three main insurers are left, down from eight in 2002. One company alone left 42,000 physicians without coverage when they pulled out this year. Dozens of smaller companies have gone bankrupt or left Connecticut. This year physicians who had clean records saw their premiums increase as much as 70 percent, with some specialists paying over $150,000 per year. Unlike other businesses that can pass on increasing overhead to their customers, physician fees are set by contracts with the heath insurers. Doctors cannot simply raise their rates to absorb this expense.

How does this crisis impact the patient? Connecticut doctors are already choosing to relocate to other states, limit their practices, or leave practice altogether. Older doctors with years of expertise are retiring early as they are consumed by skyrocketing overhead due to increasing premiums and decreasing reimbursement. Many women physicians who desire to work part-time are leaving practice as their premiums exceed their salaries. Talented young people are bypassing medical school for professions with more financial stability and less hassle.

Physicians often feel pressured to practice “defensive medicine,” ordering expensive and unnecessary tests for fear of missing something and facing an unpredictable lawsuit. We as consumers often have unreasonable expectations about medicine and feel that if there is a bad outcome, someone must pay. It is estimated that defensive medicine comprises seven percent of our health care dollar, between $50 and $180 billion a year. Those costs are passed onto all of us who pay our families’ health insurance premiums every month, and onto employers who may decide to discontinue coverage.

Many physicians are no longer accepting Medicaid and Medicare patients, and this is only going to get worse. Practices actually lose money on many of these visits, and few can afford to do this much longer. In addition, many MDs are dropping high risk patients and high risk procedures from their practices. Dozens of Connecticut obstetricians are expected to stop performing deliveries this year.

Mistakes do occur, and physicians need to be accountable when they are at fault. A cap is only part of the solution. But it is a solid step in the right direction as we work to reform the system.

How can you help resolve this crisis? Contact your legislators, ask your friends and colleagues to do the same, and let your physician know that you support him or her. Our local legislators are State Senator John McKinney (R) 203-254-1639, Rep Julia Wasserman (R) 426-9178, and Rep Debra Lee Hovey (R) 445-0012.

You should also make informed decisions regarding testing and medical care in partnership with your doctor, and take care of your health. And be sure to eat that “apple a day.” If we don’t do something to fix this problem soon, the closed offices of March 26 are sure to be a daily reality.

Julia W. Auerbach, MD, JD

Family Physician

Canterbury Lane, Sandy Hook                                  March 17, 2003