Texas doctors say liability costs are driving them away

As frustration mounts, physicians take a day off from seeing patients and make appointments with state lawmakers to talk about soaring insurance premiums.

By Tanya Albert, amednews staff. April 22/29, 2002.

Clad in a white lab coat decorated with a stark black armband reminiscent of Vietnam War protests, Edinburg, Texas, internist Linda Villarreal, MD, walked the mile from her office to the Hidalgo County Courthouse on April 8 to draw attention to an issue she believes has the potential to tear apart the health system.

Once there, she rallied with about 1,000 physicians, support staff and patients who shared her concern. Some of them came from as far away as El Paso, more than 600 miles to the northwest. They carried signs in Spanish and English calling for "Fairness, Yes ... Greed, No!" Other signs informed lawmakers and patients who may have been seeing the rally via extensive media coverage, "You May Be Losing Your Doctor."

More unmerited cases?

Their message: Stop lawsuit abuse before unaffordable medical liability insurance drives physicians out of Texas, particularly the Rio Grande Valley in the southern part of the state.

"It went better than expected," said Dr. Villarreal, who was joined by her office staff and about a half dozen patients. "You were surrounded by a sense of support and pride."

Texas physicians aren't alone in their cry for help.

As a result of insurance companies receiving smaller returns on investments since the economy's downturn, juries awarding larger sums of money and insurance companies pulling out of the medical liability market, physicians across the nation have seen substantial increases in liability insurance premiums.

86% of Texas malpractice suits last year resulted in no award to the plaintiff.

And although physicians are traditionally known for their independence, this has been an issue they're willing to rally around. In the past year, physicians in Pennsylvania, Mississippi, West Virginia, Florida and Nevada have stormed their state capitols in white coats asking for legislative help.

Demonstrations of this magnitude haven't been seen since the medical liability crisis in the mid-1970s. But few states passed meaningful tort reform then, so today's demonstrations are likely to continue.

"The situation is deteriorating all across the country," said Richard F. Corlin, MD, American Medical Association president. "This time the issue needs to be addressed."

Unlike other state efforts, the Texas "Day of Awareness" -- which some called a walkout -- started at a grassroots level. Physicians in the Rio Grande Valley teamed up with the Texas group Citizens Against Lawsuit Abuse to spread the word that they were going to close their practices for a day to go to the courthouse.

Drawing criticism from some lawmakers and trial attorneys who said physicians shouldn't close their offices, physicians posted signs in their offices to let patients know that there would be no office hours or elective surgery on April 8. Physicians did, however, make hospital rounds and take emergency calls. Doctors distributed informational literature to their patients, and some even invited them to join the rally.

By the beginning of April, physicians in Laredo, Corpus Christi, Brownsville, McAllen, San Antonio and El Paso were involved -- many planning rallies or news conferences in their own areas.

"It got a life of its own," said Pam Baggett, spokeswoman for the Texas Medical Assn., which worked behind the scenes with physicians.

What breathed life into the movement were lawsuits that Texas doctors say should never have been filed in the first place. A TMA study found that 86% of medical malpractice lawsuits result in no payment to the plaintiff. Still, insurance companies are forced to defend the lawsuits, and doctors say that is a big contributor to skyrocketing insurance premiums. Some physicians have seen their liability insurance rates double.

Physicians in the Rio Grande Valley have been particularly hard hit. Some insurance company statistics show physicians there are being sued more often than colleagues in other parts of the state. The result: More physicians are considering leaving or taking early retirement.

"Everyone here has been sued," said general surgeon Juan F. Jimenez, MD, Rio Grande Valley Physicians PAC president. "It used to be if you did any aggressive or invasive surgery you got sued. Now people who traditionally didn't get sued are getting sued."

But critics disagree with the physicians' assessment of the magnitude of the problem, as well as their tactics.

Austin-based Texans for Public Justice, a consumer watchdog group, said physicians weren't leaving the valley area and that jury awards and payouts hadn't risen dramatically. And the Texas Trial Lawyers Assn. and Texans for Public Justice said the legal system wasn't to blame.

"Instead of walking out on their patients, Valley doctors should march on the Texas Dept. of Insurance to demand the regulation of a rogue insurance industry," said Craig McDonald, director of Texans for Public Justice.

But Dr. Jimenez said they're not blaming any one group in particular. Instead, they are raising awareness that legislative remedies are needed.

"We've let this go too far," he said. "Hospitals did the same. Politicians did nothing. And insurance companies say they've lost money insuring us for years."

The Texas Legislature is not in session this year. But just days before the physician rally, Texas Gov. Rick Perry outlined how he proposes to address the issue, including capping noneconomic damages at $250,000, improving the Board of Medical Examiners ability to police the medical profession and giving the insurance department the ability to review rates and reduce those it deems unjustified.

"We're going to continue to push and push through the legislative process," said anesthesiologist Judson Somerville, MD, president of the Webb-Zapata-Jim Hogg County Medical Society. "This is just the beginning."

Dr. Villarreal agreed: "We have the community listening."

ADDITIONAL INFORMATION:

More unmerited cases?

The number of medical malpractice complaints filed in Texas has increased 34% since 1992, while the total population of the state has increased only 16%. Meanwhile, the percentage of complaints closed without the plaintiff receiving a settlement has also risen from 70% in 1992 to 86% in 2000. This bolsters the physician claims that more lawsuits without merit are being filed.

1992: 2,916
1993: 3,027
1994: 2,976
1995: 3,534
1996: 2,708
1997: 2,595
1998: 3,015
1999: 3,658
2000: 3,901