PROFESSIONTort crisis limits hospital servicesLoved ones whose family members died or suffered because hospitals couldn't provide care say lawmakers need to fix the problem before others are injured.By Tanya Albert, amednews staff. May 26, 2003. For much of this medical liability crisis, the stories about hospitals closing trauma centers or diverting patients to other hospitals because they are experiencing a physician shortage have been mostly anecdotal, making it hard to pinpoint how widespread these problems have become. Now the numbers are in. A majority -- 53.1% to be exact -- of the more than 1,000 hospitals surveyed in the 18 states the American Medical Association has determined are in the middle of a medical liability crisis say it's more difficult for them to recruit physicians. About 45% of the hospitals in those states say high medical liability insurance premiums have forced them to cut emergency department coverage. Nearly 35% of hospitals say insurance woes have caused a negative impact on their ability to provide services, particularly trauma care and obstetrics. And nearly 19% of hospitals say professional liability premiums have had a "significant" impact on their community's access to care.
45% of hospitals in liability crisis states have cut ED coverage.
"I don't see any light at the end of the tunnel," said Curtis Rooney, counsel and senior associate director for the American Hospital Assn., which conducted the survey. Hospitals in Arkansas, Connecticut, Florida, Georgia, Illinois, Kentucky, Mississippi, Missouri, Nevada, New Jersey, New York, North Carolina, Ohio, Oregon, Pennsylvania, Texas, Washington and West Virginia were surveyed. The AMA said those are crisis states because high insurance premiums or an inability to get insurance has caused physicians there to retire early, discontinue high-risk procedures or leave to practice in states with lower insurance rates. To fix the problem, the AHA and AMA support tort reform in crisis states and at the federal level that includes a $250,000 cap on noneconomic damages awarded in medical malpractice lawsuits. A bill including a cap passed the House of Representatives earlier this year, but the narrowly Republican-controlled Senate has not taken up the issue. Physicians, hospitals and patients hope that happens soon, as worry builds that patients will suffer complications or die because medical care is not available. How hospitals have copedPatients seeking obstetrics, emergency or neurosurgery services face the biggest potential for problems because those high-risk specialties have been stretched the thinnest, according to the survey. The AHA study supports findings by specialty societies showing that obstetricians, emergency physicians and neurosurgeons are cutting back services or moving to a different state because they can't afford or can't find insurance.
One Mississippi community hospital's annual liability insurance premium increased $163,000.
Over the past couple of years, at least one West Virginia hospital had been left without neurosurgeons entirely. Other hospitals had times when they couldn't treat certain cases because neurosurgeons or other specialists weren't available to assist in the emergency department. Hospitals had to stabilize the most serious cases and then airlift those patients to another hospital. "To the extent we can tell, no one was truly harmed by this, but it was an inconvenience to the patient and the patient's family," said Steven Summer president and CEO of the West Virginia Hospital Assn. He said things seemed to be turning around in West Virginia since tort reform passed the state Legislature earlier this year. More medical residents are willing to stay, and hospitals are starting to have an easier time recruiting physicians, he said. Mississippi hospitals hope they soon will see similar results. The community hospital in Rolling Fork, Miss., -- Sharkey-Issaquena Community Hospital -- saw its insurance premium jump to $223,000 this year, up from $60,000 last year. In February, the hospital shut down for three weeks while it was looking for a new policy after being discontinued by its previous insurer. The nearest hospital was about 40 minutes away, so Sharkey-Issaquena contracted with paramedics who had an ambulance on site and could treat patients while they were transported to another hospital, said hospital Administrator Jerry Keever. "Our staff was very frustrated," he said. "I hope that the Legislature does something about the situation soon. There is no way a small hospital such as ours can absorb the increases and continue to stay open." Keever said they were able to pay for the insurance without cutting staff this year, but with a $5 million annual operating budget, that could be difficult to accomplish in the future. The human tollA lack of physicians at some hospitals already has changed the lives of some families whose loved ones couldn't get treatment because of the crisis. Two families living states apart had their lives change in an instant in July 2002 because care wasn't available to their loved ones. Now they are publicly supporting tort reform, speaking out so other families will not find themselves in the same situation. Vicksburg, Miss., resident Leanne Dyess got a phone call July 5, 2002, from a hospital in Gulfport, Miss., telling her that her husband, Tony, had been in a serious car accident. He had head injuries that weren't treated for six hours. He had to be airlifted to another hospital to have a shunt put into his brain to drain fluid because a specialist wasn't available in Gulfport. Tony is permanently brain-damaged and no longer can work or care for himself or his family. "My attitude is not to get mad," Dyess said. "Why cry over spilled milk? Let's fix it. Griping isn't going to change it." Mary Rasar has a similar attitude. In Las Vegas on July 4, 2002, her father was in a car accident and needed immediate trauma care. But the state's only Level 1 trauma center at the University of Nevada's Medical Center was closed because high-risk specialists there were having trouble finding insurance. Rasar's 59-year-old father, Jim Lawson, died while waiting to be transported elsewhere. "It's scary," said Rasar. She said she had heard doctors were having insurance problems before her father passed away, but "never realized how many people's lives were at risk." ADDITIONAL INFORMATION:Feeling the painHospitals in liability crisis states are dealing with their own problems related to high insurance rates.
Source: American Hospital Assn.'s Hospitals on Professional Liability Experience Specialty troubleIn the 18 states the AMA says are in a medical liability crisis, hospitals are having trouble recruiting specialists and covering emergency departments. The percentage of hospitals in crisis states reporting difficulties in each specialty is listed.
Source: American Hospital Assn.'s Hospitals on Professional Liability Experience Crisis states18 states the AMA says are in a medical liability crisis: Arkansas, Connecticut, Florida, Georgia, Illinois, Kentucky, Mississippi, Missouri, Nevada, New Jersey, New York, North Carolina, Ohio, Oregon, Pennsylvania, Texas, Washington and West Virginia Copyright 2003 American Medical Association. All rights reserved.
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