A tale from the front: The medical liability crisis in Pennsylvania

AMA Leader Commentary. By Donald J. Palmisano, MD, Nov. 17, 2003.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from AMA President Donald J. Palmisano, MD.

If you ever want to see a recipe for a medical liability system disaster, look no further than Pennsylvania. Because if ever a medical liability system had all the ingredients to destroy the practice of medicine -- Pennsylvania's liability system does.

Region: Northeast
Topic: Liability crisis

Fortunately, the Pennsylvania Medical Society and the county medical societies have been fighting the good fight for state medical liability reform. It's a battle with incredibly high stakes for Pennsylvania's health -- and its physicians.

Since January 2001, more than 1,400 Pennsylvania physicians have either closed their practices, limited services or left the state because of unaffordable medical liability insurance, according to the PMS.

Between 1997 and 2002, Pennsylvania lost 600 general surgeons (36% of the state's total), 145 orthopedic surgeons and 35 neurosurgeons (16% of the total in each group). Of 67 counties, 20 are experiencing physician shortages, and nine more are at risk.

The crisis threatens the next generation of Pennsylvania physicians. According to the PMS, Pennsylvania ranks 41st out of 50 states in the percentage of physicians younger than age 35, even though the state has eight medical schools.

What makes Pennsylvania such a hostile environment for doctors? It is an ideal environment for trial lawyers playing the medical liability lottery.

According to a report from the U.S. House Judiciary Committee on the Help Efficient, Accessible, Low-cost, Timely Healthcare Act (HR 5), Pennsylvania has the second highest payout in the nation for medical liability lawsuits, totaling more than $350 million in 2000 alone, or 10% of the national total.

Jumbo awards, including those for pain and suffering, drive up medical liability premiums. That's a fact supported by a number of studies, including a recent report from the General Accounting Office.

Unfortunately, Pennsylvania's constitution prohibits caps on damages. What's more, state law requires doctors to have liability coverage of $1 million. But neither of the state's two remaining medical liability insurers offer more than $500,000 in coverage. The rest of the coverage has to come from Pennsylvania's MCARE fund, which is threatening to dramatically increase rates Jan. 1, 2004.

Like many states, Pennsylvania has no provisions for screening out frivolous suits, nor for holding accountable the attorneys who file such suits. These suits clog Pennsylvania courts, even though seven out of 10 will be dismissed without payment, according to national data.

Sadly, medical liability isn't the only problem Pennsylvania physicians face. They also must cope with price-fixing by managed care companies with overwhelming market power, the threat of another Medicare payment cut and the ever-growing burden -- and cost -- of government paperwork and regulations.

Given these challenges, you might think that medicine in the commonwealth is doomed. But it's not. The physicians of Pennsylvania have incredible leadership, at both the state and county levels of organized medicine. These leaders are committed to achieving reforms that will make their state a haven for physicians.

A few weeks ago, I had the honor of attending the inauguration of the new PMS president. I watched as outgoing president and warrior Edward Dench, MD, handed over the reins to incoming president, Jitentra Desai, MD.

In his inaugural address, Dr. Desai made his mission clear, saying doctors can "change the course of history and our destiny." Already this has begun to happen for PMS, with the upset election of a candidate favored by doctors to Pennsylvania's Supreme Court.

In another address, Dr. Desai challenged the PMS house of delegates to join their political action committee, PaPAC, saying he would match donations dollar for dollar up to $10,000. Just before I left, the announcement was made that the delegates met and exceeded Dr. Desai's challenge, contributing $15,000.

It was an incredible show of unity and commitment on the part of Pennsylvania physicians -- and I was proud to bear witness to it. I will be prouder still when organized medicine in Pennsylvania leads its physicians to victory in the statehouse and ends the physician exodus of the past few years.

Pennsylvania physicians interested in PMS's legislative strategy and grassroots activity should read about it firsthand on the Web (www.pamedsoc.org). As for the rest of us, we need to understand that Pennsylvania's problem is our problem, too. The broken system that is driving physicians in the Keystone State to retire, limit practice or move is the same kind of system operative in many other states.

In short, Pennsylvania's current crisis tells us a lot about what can happen to states without strong medical liability reforms -- i.e., most states. That's why we must tell our state and federal legislators to pass strong medical liability reform legislation -- and pass it now.

The U.S. House of Representatives already has listened to the AMA's call for reform. President Bush wants to sign strong medical liability reform legislation. Senate Majority Leader Bill Frist, MD (R, Tenn.), also supports our cause. Now is the time for the Senate to act for the good of America's patients. Federal reforms would bring common sense to the liability crisis across the nation, including Pennsylvania -- where legislation we support would override the state's prohibition against caps.

Call your senators through the AMA grassroots hotline, 800-833-6354. Ask them to support the Patients First Act (S 11) or the HEALTH Act (HR 5), legislation based on reforms that have worked in California for 25 years. Remind them that similar reforms recently passed in Texas resulted in the announcement that medical liability premiums in that state will go down 12%. This will halt the access crisis.

If you can, contribute to the AMA's Fund for America's Liability Reform. You can do so by calling 202-789-7407. These funds will go directly to developing public awareness and support for federal liability reform legislation. Already, we've won over 50,000 patient activists to our cause.

Most of all, stick together, speak with the same message and stay involved. When it comes to reform, what counts is committed activism and unshakeable conviction. Or as PMS President Dr. Desai put it: "We must be like the North Star, constant, unchanged and permanent."

Dr. Palmisano, a general and vascular surgeon in private practice in New Orleans, as well as an attorney, was president of the AMA during 2003-04.