Pa. warns doctors not to quit

[NRSKarenRN, BSN, RN]

Letter irks those facing huge insurance bills.

By Josh Goldstein

Inquirer Staff Writer

Posted on Sat, Dec. 28, 2002

http://www.philly.com/mld/inquirer/4826479.htm

Many Pennsylvania doctors already struggling with skyrocketing medical-malpractice insurance premiums were outraged by a letter they received this week from the head of a state agency warning them not to abandon their patients.

The Dec. 20 letter from Secretary of the Commonwealth C. Michael Weaver was sent to all licensed doctors in the state as a "reminder" of their professional and legal obligations to their patients.

The letter arrived as some doctors say they will, at least temporarily, stop practicing medicine as of Wednesday in response to the state's malpractice crisis.

"A stoppage of practice may be detrimental not only to your patients, but also to your practice, your standing amongst colleagues, as well as your license should your conduct be found to constitute abandonment," Weaver wrote.

Weaver's office oversees the licensing and disciplining of Pennsylvania doctors.

"It is an absolute threat," Nicholas A. DiNubile, a Chester County orthopedic surgeon, said after reading the letter yesterday. "And it is a slap in our faces because we have been paying for a broken [malpractice] system for years."

DiNubile has insurance through February, but last year he and his partners had difficulty obtaining insurance and warned that they would not be able to care for patients. DiNubile said six of his partners had since left Pennsylvania.

Malpractice premiums have increased sharply in each of the last three years, causing many doctors to say they would retire early, scale back their practices, or move to another state.

Pennsylvania law prohibits doctors from practicing medicine without malpractice coverage. That, combined with Weaver's letter, emphasizes the no-win situation doctors are in, DiNubile said.

Gov. Schweiker's office said doctors should not overreact to the letter.

"Our concern here is that while we are working on medical malpractice, looking at short-term options to help doctors, we also want to make sure that patients are taken care of," said Schweiker spokesman David LaTorre. "There are a lot of people out there who are scared and concerned about the availability of their doctors."

LaTorre said, "This letter was simply meant to make sure that all doctors follow the proper protocols to make sure their patients have adequate coverage."

But the letter has generated a firestorm of protest from doctors.

"It is psychologically abusive to have a letter like that come to our homes during the holidays," said Lynette B. Goodstine, a Montgomery County internist.

Yesterday, the Pennsylvania Medical Society was inundated with calls and e-mail from doctors infuriated by Weaver's letter.

"Many physicians found the tone of the letter insulting and threatening," said Roger F. Mecum, executive vice president of the Pennsylvania Medical Society, which represents the state's doctors.

"Physicians of this state would like the representatives of our state government to help us solve this problem as quickly as possible, and not point out the moral and ethical obligations of physicians of which they are well aware," Mecum said.

Gov.-elect Ed Rendell tried yesterday to calm nerves frayed by the fast approaching New Year's Day deadline for about 60 percent of the state's doctors to renew their malpractice coverage.

"It has always been the governor-elect's experience that the vast majority of all physicians are primarily concerned with providing high-quality health care, and he believes that continues to be true," Rendell spokesman Tom Hickey said.

Rendell and his malpractice task force continue to seek short-term and long-term solutions to the state's malpractice crisis.

One proposal is to provide doctors immediate financial relief by eliminating the surcharge doctors pay for the state's malpractice catastrophe loss fund.

That would cut many doctors' malpractice premiums by one-third or more. But it would cost about $300 million at a time when the state budget is already strapped, making it far from certain that it is a viable solution.

"This is a serious problem that should be dealt with a degree of respect and understanding," said State Sen. Connie Williams (D., Montgomery). "This letter treats doctors like children."

The medical society responded quickly with an angry letter to Weaver yesterday that was also sent to Schweiker and Rendell.

"In the midst of near historic efforts to hold our fragile medical delivery system together, you sent to all physicians a perhaps well-intended, but demeaning letter that essentially threatens them with license revocation," wrote medical society president Edward H. Dench Jr.

Adding to the unease of Pennsylvania's doctors is a notice received by about 15,000 of them from the state's Bureau of Professional and Occupational Affairs.

The notification said that due to "unanticipated production problems" the doctors would not get their 2003 license, but rather "temporary" 120-day authorizations to practice medicine.

Some doctors who got the letter saw it as another ill-timed threat.

But Department of State spokesman Brian McDonald said every doctor who got the temporary license would receive their official license. The problem, he said, was caused by a lack of supplies by the vendor who prints the official licenses.

University of Pennsylvania medical ethicist Arthur L. Caplan said patient abandonment was not an issue doctors should casually dismiss.

"Ethically, it is essential that no patient be abandoned and left in the lurch because of a political action by a physician, nurse or other health-care provider," he said.

"I have sympathy for the doctors," Caplan said. "I believe that the state has let the situation get out of control, but [abandoning patients] is not the right answer... no matter how justifiable [doctors'] anger."

Contact staff writer Josh Goldstein at 215-854-4733 or [email protected].

[oramar]

Dear doctor, I feel for you. It is not fun having someone make the abandoment threat. Especially someone in a position of power. Believe me we nurses know something about this. PS We are also perfectly aware that this tactic can backfire. It gets the results the person making the threat wants for a short time period. Then comes the mass exodus.

[renerian, BSN, RN]

If they can't afford to pay the premiums I don't think it should be held against them legally as long as someone covers their clients or they turn their clients over to other physicians.

Good thread.

renerian

[rncountry]

I might feel sorry for the doctors had I not had my license and job threatened when I refused to work a 20 hour mandatory overtime shift. Since I don't hear too many physicians standing up for the nurses in this position, who are taking care of their patients, I don't know that I can feel anything but how's that shoe fit? To me that letter kind of pulled a bit of political power out from underneath the docs. Got their attention right quick too didn't it? Of course oramar is right, with threats come the mass exodus. Wonder how this will turn out?

[NRSKarenRN, BSN, RN]

My family DR of 20 years(age late 40's) decided solo family practice too much effort and time away from his kids and decided on just working at Urgent care center---that was three years ago. It was the beginning of Doc flight in my area.

Five county Philadelphia area has seen an exodus in past year. Two ER's lost Trauma designation for lack 24 hr coverage. Many OB's have split time between NJ and PA as insurance cheaper in NJ. About 20 surgeon's have left my county....it is beginning to get scarry.

[fab4fan]

I'm not saying I feel 100% sorry for the docs, but really, how are they supposed to practice without insurance? It really puts them west of the rock and east of the hard place.

I'd be a whole lot more sympathetic if they'd show some spine and stand up for us...you know, the ones they count on to be their eyes and ears when they aren't with the patients.

We are in danger of losing several OB's, neurosurg., and some surgeons b/c of this; at one point a few months ago there was talk that we might lose our only trauma center...I'm not sure what's up with that issue. But in the local paper, there were several letters to the editor, expressing outrage and sympathy for the docs...wish the public would give us that kind of support.

[dawngloves, BSN, RN]

This is a serious situation in PA, but rather than threaten the docs, why not change the laws so a cap will be put on awards and thus lower the insurance? I hope our incoming Govenor can take care of this ASAP!

Alas, it may be too late as many docs will have no insurance as of 1/1/03. A local trauma center has already closed this week because the surgeons will have no insurance, a requirement for licensure for PA docs. I'm sure many RNs have lost hours due to this closeur. Two hospials I know of have stopped practicing Obstetris because they have no OBs. Many OB and neonatal nurses lost jobs.

This is not just about the doctors.

[oramar]

I am not completely sure the lawyers are the only ones guilty in this situation. I suspect the insurance companies are up to something. Instead of getting in there and seeing what they can do about making medicine safer they just up the premiums or get out of the business. Wasn't there a time when insurance companies got in there and gave advice about risk managment? Oh by the way, you can bet Pa's huge, bloated legislature would allow things to slide to the edge of the abyss before they would act.