GAO report calls liability crisis localized

AMA questions the study, noting that it focuses on only five of the 19 states the Association says are in a full-blown crisis.

By Tanya Albert, amednews staff. Sept. 22/29, 2003.

For now, rising medical liability rates have affected health care access on a local scale, not on a "widespread basis," a recent General Accounting Office report found. But the nonpartisan government agency said it was essential to closely monitor how liability insurance premiums are impacting patients' access to care.

The GAO studied nine states, five of which are on the American Medical Association's list of states experiencing a medical liability crisis. It found that while local problems exist, reports of physicians retiring early, discontinuing services or moving out of state couldn't be substantiated or didn't have a big effect on access to care.

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Topic: Liability crisis

"Although some reports have received extensive media coverage, in each of the five [crisis] states, we found that actual numbers of physician departures were sometimes inaccurate or involved relatively few physicians," the GAO stated in its report, "Medical Malpractice: Implications of Rising Premiums on Access to Health Care."

For example, some physicians said they had reduced high-risk spinal surgeries and mammograms. But GAO officials said that when they reviewed Medicare data and talked to doctors who reportedly were affected, they did not find that access to services was widely impacted.

The AMA questioned the report's finding that difficulties aren't widespread. The small number of states studied doesn't give an adequate picture of overall trends, and some of the data are too old to be relied upon, the Association stated.

GAO researchers did not find problems in the four states they studied that had adopted tort reform years ago -- California, Colorado, Minnesota and Montana.

"The GAO report also confirms what the AMA has long held to be true -- tort reform works," AMA President Donald J. Palmisano, MD, said in a statement.

Dr. Palmisano also noted that the report verifies that there are access problems in high-risk medical specialties in each of the five crisis states.

But the Assn. of Trial Lawyers of America said that the study showed that claims of a medical liability crisis had been overblown.

"The government's own objective analysis has now shown that the medical malpractice 'crisis' is a political fabrication," ATLA President David S. Casey Jr. said in a statement.

State by state

Among the GAO's findings:

In Florida, an anecdotal report maintained that liability concerns drove all neurosurgeons out of two counties, but at least five neurosurgeons were practicing in each county as of April 2003.
In Mississippi, physician departures were scattered throughout the state and represented 1% of all licensed physicians.
In Nevada, of the 34 ob-gyns who reported leaving, closing practice or retiring because of liability concerns, eight still practiced and three stopped practicing for reasons other than liability insurance, according to a Nevada State Board of Medical Examiners survey. Also, of 11 surgeons who reportedly moved or discontinued practice, four still practiced.
In Pennsylvania, 24 ob-gyns left the state, but the number of women ages 18 to 40 in the state dropped by 18,000 during the same time. Also, despite reported departures of orthopedic surgeons, the rate of orthopedic surgeries among Medicare enrollees has increased steadily over the past five years.
In West Virginia, despite anecdotal reports of departures, the number of physicians increased slightly to 2.2 doctors per 1,000 residents in 2002, up from two physicians per 1,000 people in 1997.

The GAO asked the AMA and three independent health policy researchers who have published research on malpractice pressure's effects on the health care system to evaluate the report. The researchers, two of whom are physicians, generally agreed with the office's findings.

Problems scattered nationwide

Although the GAO said problems aren't widespread, that doesn't mean that they don't exist in some areas. The study turned up evidence of localized problems in each of the five states it studied that had been identified by the AMA as being in a medical liability insurance crisis.

The GAO confirmed that there was "reduced access to hospital-based services affecting emergency surgery and newborn deliveries in scattered, often rural areas where providers identified other long-standing factors that also affect the availability of services."

For example, one hospital in rural Pennsylvania lost three of its five orthopedic surgeons. That resulted in the emergency department having on-call doctors available only one-third of each month instead of full time.

In Florida, a reduction in ED on-call surgical coverage occurred in Jacksonville after at least 19 general surgeons took leaves of absence starting in May 2003. In rural central Mississippi, pregnant women now travel about 65 miles to the nearest hospital obstetrics ward to deliver because large increases in medical liability premiums forced family physicians at the local hospital to stop providing obstetrics services.

A drop in the number of surgeons on call in the ED has created problems in the Las Vegas area.

In West Virginia, a major medical center lost its Level I trauma designation for about one month in 2002 because fewer orthopedic surgeons were providing on-call coverage, and the state's northern panhandle lost all neurosurgical services for about two years, requiring patients to be transferred 60 miles or more.

"America's patients are the ones who will truly suffer if Congress does not act soon," Dr. Palmisano said. "This is a crisis, and without real reforms, more patients will be unable to find a doctor to deliver a baby or perform life-saving trauma surgery."

The GAO said the situation needs to be followed because the state of affairs can change quickly.

"Continuing to monitor the effect of providers' responses will be essential, given the important and evolving nature of this issue," the GAO said.

ADDITIONAL INFORMATION:

On-call impact

The General Accounting Office contacted 49 hospitals to determine whether losing on-call physicians because of medical liability insurance problems impacted patient care. Here's what it found.

26 reported a drop in surgeons available on call.

11 said the drop didn't impact services.

3 reported that surgeons returned or were replaced.

Source: General Accounting Office

Weblink

General Accounting Office report, "Medical Malpractice: Implications of Rising Premiums on Access to Health Care," August, in pdf (www.gao.gov/cgi-bin/getrpt?GAO-03-836)