News in brief - June 30, 2003

House panel hears arguments on organ donation incentives - S.C. doctor took his life 3 months after guilty plea - Liability fees spur more locum tenens - Urologists paying more in liability insurance

House panel hears arguments on organ donation incentives

Almost one year after the AMA House of Delegates endorsed the concept of studying whether modest financial incentives would boost cadaveric organ donations, Robert M. Sade, MD, a member of the AMA Council on Ethical and Judicial Affairs, testified before a U.S. House of Representatives subcommittee and urged that such studies go forward.

"Nearly all the arguments against financial incentives are based on assumptions that can be proven or disproved by objective empirical studies," said Dr. Sade, a professor of surgery at the Medical University of South Carolina in Charleston. "Factual evidence that would determine the presence or absence of harm to individuals, groups of individuals or society as a whole could resolve many of the policy debates." After speakers gave their prepared testimony, they were questioned by the subcommittee members. "That's when the fun started," Dr. Sade said, explaining that representatives used questions to the speakers as a way of debating each other.

Opposition to studying financial incentives seems to be coming mostly from two camps, Dr. Sade said, transplant surgeons and bioethicists who "treat financial incentives as some horrible idea that should never be entertained."

"One thing that was very clear was that the opposition to financial incentives -- at least to my eyes and ears -- was emotionally based, and did not have a coherent rationale behind it," he said.

S.C. doctor took his life 3 months after guilty plea

Benjamin R. Moore, DO, a South Carolina physician featured in an AMNews article on a crackdown on OxyContin abuse, pled guilty to charges of illegally dispensing the drug and later killed himself.

Dr. Moore, 45, was part of an investigation by federal authorities into the Comprehensive Care & Pain Management Center in Myrtle Beach, S.C., where Dr. Moore had worked. Several doctors at the clinic were charged for unlawfully distributing OxyContin and other pain medications, federal officials said.

In a June 25, 2001, AMNews article, Dr. Moore was among physicians who said they feared discipline from state and federal authorities for prescribing OxyContin to patients.

In April 2002, Dr. Moore pled guilty in federal court to conspiracy to commit health care fraud, conspiracy to launder money with intent to promote the unlawful distribution of controlled substances and/or health care fraud and distributing OxyContin for other than legitimate medical purposes, according to the U.S. Attorney's Office.

In July 2002, Dr. Moore committed suicide, federal officials said.

Liability fees spur more locum tenens

Rising medical liability insurance rates are helping fuel growth in the locum tenens market, according to an annual review by Staff Care, a physician staffing firm.

"Most states show a steady increase in spending over the years, but spending and demand in crisis states jumped dramatically," said David Faries, spokesman for Staff Care.

For example, Faries said, West Virginia facilities spent $69.7 million for temporary doctors in 2002, up from $48.8 million in 2001. During the same period, locum tenens spending in Pennsylvania rocketed to $121.7 million from $84.1 million; in Mississippi to $45.8 million from $29.1 million; in Texas to $182.9 million from $123.3 million; in Ohio to $51.7 million from $39.6 million; and in Illinois to $52.8 million from $32.6 million.

Spending on short-term physicians in other crisis states leveled off last year, after a previous jump. For example, North Carolina's spending soared to $112.2 million in 2001 from $61.2 million in 2000, before falling to $102.3 million in 2002. Georgia facilities spent $18.6 million in 1997, $56.9 million in 2001 and $41.8 million in 2002.

"Malpractice concerns are both fueling an exodus of doctors from some states and increasing the need for temporary coverage," Faries said.

While roughly 100 doctors left West Virginia and dozens of ob-gyns left Pennsylvania, it is more common for physicians to scale back their practices and stop performing certain procedures, he said.

In 2002 total spending on locum tenens services was estimated at $2.08 billion, compared with $1.93 billion in 2001, $1.25 billion in 2000 and $899 million in 1999.

Some 23% of administrators said liability coverage was one factor in selecting a locum tenens firm in 2002, compared with 1% in 2001.

Urologists paying more in liability insurance

Liability premiums increased an average of 20% between 2002 and 2003, according to a Gallup Tuesday Briefing poll of 510 urologists. Getting insurance was a major problem for 12% of those surveyed and 26% of respondents said they had trouble obtaining insurance in 2002, according to survey results released in June. About 25% of the urologists have stopped providing some high-risk procedures. Of those who stopped offering procedures such as cystectomies and prostatectomies, 34% said professional liability pressures were "very important" in their decisions, according to the poll.