Insurance puts doctors in dilemma

Published 5:00 am Monday, May 13, 2002

Second in a Series

Worry is creasing the brow of area physicians as highmalpractice insurance premiums threaten to force several to makethe decision of whether to leave the state or stay and pay”astronomical” premiums.

Physicians and hospitals are facing limited insurance coverageoptions because the state’s growing reputation for “jackpotjustice” has insurance agencies nervous, said Semmes Ross, LawrenceCounty Hospital Administrator. This nervousness has caused severalto quit issuing malpractice policies in the state and others toraise rates by a considerable percentage.

“I think it’s very serious. I really do,” Ross said. “I thinksomething’s got to happen. It’s serious and I think some doctorswill go across the state line.”

Dr. F. Lee Neal Jr., a family practice physician with no claimsagainst him, is among those facing a loss of coverage.

“I’m in a position where I cannot get coverage,” he admitted. “Idon’t know what I’m going to do.”

Neal said he has been insured with Mutual Assurance of Alabamasince 1993, but the company recently informed him they would not berenewing his malpractice policy because they are leaving the state.His policy expires July 17.

When he applied for a policy with another insurance company thepremium they quoted him would be “three to four times” the $5,200premium he had been paying. Most physicians contacted werereluctant to give the specific costs of their premiums.

“It was much higher and I can’t afford that,” Neal said of hissituation.

At King’s Daughters Medical Center, anesthesiologist Dr. RobbieNations is among 14 doctors, certified registered nurseanesthetists or nurse practitioners facing the loss of coverage inthe coming months. He said he has some applications for coverage inwith insurance companies.

“I’m waiting to hear back from them,” Nations said.

Nations said his insurance premium rose 60 percent last year andhe is uncertain how much more he will be paying this year with anew company.

“There’s really no telling,” Nations said.

Doctors must have the malpractice coverage or face personalliability exposure. Also, they are contractually required to haveit to practice at hospitals.

Nations said insurance-related concerns, though, are not limitedto Mississippi.

“We just happen to be the poster child right now,” Nationssaid.

On top of the premiums for a new policy, Neal said, doctors mustpurchase “tail coverage” from their previous policy-holder.

Tail policies cover any claims which may be filed against themlater for the time period the former insurance company coveredthem, said Terry Pendley, an agent with Medical Underwriters ofMississippi. Not buying tail coverage would leave a doctorvulnerable to claims made in the future for events which occurredwhen they were with the previous company.

With his policy with St. Paul ending, internist Dr. Ray Montalvois looking at a tail policy costing around $15,000. That would bein addition to $20,000 to $25,000 malpractice policy with a newcompany and rising expenses in general in the health carefield.

“That’s a situation you can’t offset,” Montalvo said, indicatingthat how much doctors receive is often based on Medicaid, Medicareor insurance guidelines.

Dr. Steve Mills, who as an OB/GYN has premiums second only toneurosurgeons, is facing a policy renewal in January.

Mills is expecting the rate to possibly double. If there is ahuge increase, he said that costs could have to be passed onpatients or his staff reduced.

“Neither of those is very pleasant,” Mills said.

The higher overhead has meant longer hours for some doctors.

“I’m working longer hours now than I’ve ever worked,” said Dr.Spencer Mooney, an eye, ear, nose and throat specialist who hasbeen practicing for 14 years.

In dealing with patients, Mooney said the legal climate of thestate makes doctors more cautious about treatments and procedures.Mooney added that he will refer certain types of problems to otherphysicians if the risk of a lawsuit is higher.

Mooney also discussed extra precautions that doctors sometimestake.

“It makes us order more tests to prove what we are alreadypretty much certain of,” he said.

Those tests, he said, then drive up costs to the patients.

“We’ve actually stopped some procedures because of the lawsuitenvironment,” Mooney said.

Mooney said no cosmetic surgeries are being done. Now, he willonly do restructuring because of trauma or cancer.

Mooney said he has heard attorneys say they are protectingpatients when lawsuits are brought. He disputed that assertion.

“Physicians try to take good care of their patients because theywant to do a good job for their patients, not because some fearthey might be sued,” Mooney said.

In seeking tort reform, physicians agree that if a mistake ismade in the treatment or a hospital procedure, the patient shouldbe compensated. However, they also say a cap is needed on awardsfor non-economic damages.

“None of us want patients not to be able to sue,” Mooneysaid.

The concern, though, is the astronomical jury verdicts becausethere is no cap, said Phillip Grady, chief executive officer atKDMC. Also, he said something needed to be done to address “selectareas” of the state where attorneys file big class actionlawsuits.

“There’s got to be some protection of venue,” Grady said.

Montalvo expressed concerns about “frivolous” lawsuits againstdrug companies, of which he has been a part of three. Often, hesaid, doctors are eventually dismissed from those, but that stillcauses their malpractice insurance rates to rise.

Montalvo said there are no checks and balance on attorneys whofile frivolous lawsuits. Some physicians would like to be able torecover from plaintiffs attorneys when lawsuits are ruledfrivolous.

Regarding drug company lawsuits, Montalvo said it was not rightfor people to be awarded large sums in class action when there isno proof they’ve been injured. He indicated specific cases shouldhave to be shown.

“You won’t find it, and if you do, it’s less than 1 percent,”Montalvo said.

Dr. Randy Tillman, a gastroentorologist at Lawrence CountyHospital, said doctors believe in compensating patients for lostwages and reasonable suffering when a mistake is made. They evenagree to reasonable punitive damages, “but the key word isreasonable,” he said.

“None of us are God,” Neal said. “There will be mistakes. But nodoctor wakes up in the morning and says, ‘I think I want to hurtsomeone today.’ It just happens.”

The insurance question coupled with the hectic work schedule ofcaring for Mississippi’s underserved population has manyconsidering the possibility of moving to another state.

“Many physicians are working just to pay bills,” Montalvo said.”Quite frankly, there are other places to go work.”

Tillman, who also works at Natchez Regional Medical Center, saidseveral doctors there are considering crossing the state line andmoving their practices to Louisiana. Patients would not mindcrossing the bridge to Louisiana to see their doctor, he said, andLouisiana has a $500,000 cap on punitive damage awards as well aslower malpractice premiums.

Montalvo said he has two offers now where he could leave thestate to go and make more money with less stress. He said he wasnot leaning toward leaving, but the future was uncertain.

“If things don’t change, I may be forced to,” Montalvo said.

Other physicians said they were not looking to move or did notwant to.

“Brookhaven is my home and I like it here,” Neal said.

There are those, however, who believe forcing the issue with thestate legislature is an option. Local physicians, however, tend toview this as a drastic action and their support isquestionable.

“(A strike) was mentioned as long as three months ago. It mightresort to that,” Neal said, although he admitted he had moralissues to resolve regarding a strike. He said doctors swore an oathto “do no harm” and “by not being there are we doing harm?”

He said he would have to resolve these moral issues before hewould even consider a strike.

Tillman was much more sure of himself.

“Would I strike? Of course I would,” he said, although he wasquick to add that he would not be striking for himself but tosupport his fellow doctors. He said his type of practice isconsidered low risk and it is the high risk physicians, such assurgeons, who are suffering the most.

Neither Neal nor Tillman advocated a strike, but both said itwas a possibility and they had heard doctors discussing it.

Editor’s note: Tuesday’s story will take a look at how theinsurance companies are reacting to the high premiums and the furorover tort reform.