This is really scary. I have seen this trend all over. I know PA has had a hard time w coverage for OB/GYN's, now NJ. Also, I have seen several ortho's who won't accept Medicare anymore, it has gotten so bad, they would rather take HMO's!!
Where will we go when we are old for healthcare?? The local shaman? The whole syetm seems to be imploding on itself. If no docs to deliver babies, no need for maternity wards, where will the nurses work??
I wonder why in this case tho, these two docs don't try to become nurse midwives? Coudn't they still "do the work that they love" in that capacity? Or is it really about money?
Doctors face coverage ills
Sunday, December 29, 2002
By MARK PERKISS
Dr. Delores Williams says it's heartbreaking to tell pregnant women she won't be able to deliver their babies.
"I wish I didn't have to, but I'm stopping obstetrics because of the problems with liability and malpractice insurance
," said Williams, a Hamilton physician who has been practicing since 1989.
Williams, the chief of obstetrics and gynecology at Capital Health System at Mercer, the former Mercer Medical Center in Trenton, is one of a growing number of doctors around the state and across the country who are dropping obstetrics and other risky specialties because of the high cost of malpractice insurance and the problems of getting coverage.
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"In the past two weeks, I've told people `no,' that I can't deliver their children," said Williams, 46, who will deliver her last baby at the end of July and then stop taking on new maternity patients.
"It's been heart-wrenching, and some of those conversations have been acrimonious."
In one instance, a pregnant woman whose baby is due in August urged Williams to handle the birth. "She said `You're stopping at the end of July. You can just induce me early and meet your date,' " Williams said. "I told her I couldn't do that and she was very upset."
For Williams, the decision to stop obstetrics is less about the cost of insurance than it is about retaining coverage.
"I have two lawsuits pending against me and my insurance company has told me that if I settle them, they won't cover me anymore."
As many as 3,000 doctors in New Jersey have malpractice policies that expire next month who may be forced to stop practicing if their policies are not renewed or they are offered coverage with premiums so high they cannot afford them.
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For Dr. Alicia Tesoro, the cost of malpractice insurance put her out of work in March.
Tesoro, an obstetrician and gynecologist for 28 years, almost all of them in Trenton, ran into trouble when her carrier, the Phico Insurance Co., failed last year and was liquidated, terminating her $36,000-a-year policy.
"I tried to get other coverage, but no one would take me because I have a settlement on my record," she said.
Unable to find insurance, Tesoro turned to Capital Health System, where she delivered babies, for help. `'They looked at hiring me as an employee and putting me under their malpractice insurance, but the only quote they could get was $200,000. I couldn't afford that, and they couldn't afford it. Without insurance, I couldn't practice and I lost the work I had devoted my life to."
"Delivering children was my challenge and treasure, and not being able to do that and help patients leaves a big gap for me," Tesoro said.
Increasingly, doctors, particularly those in high-risk areas such as obstetrics or neurosurgery, are being quoted premiums in the hundreds of thousands of dollars.
Unlike companies in other businesses that can pass on increased costs to their customers, doctors are unable to raise their fees because of contracts they have with HMOs and health insurance companies.
"We get hit on both ends," Williams said. "We have contracts with HMOs that spell out what we get paid, and we have Medicare, which is lowering what it reimburses to doctors. And most health insurance companies peg their reimbursements to what Medicare does.
"Our costs are going up and our revenue is going down," she said. "I'm making less now than I did in 1991."
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Physicians say the high malpractice insurance rates are a result of trial lawyers seeking excessive damages in lawsuits and juries awarding them. They want the Legislature to impose caps on noneconomic awards, commonly known as "pain and suffering."
Doctors do not have to lose cases to be dropped by their insurance companies or to have dramatic increases in premiums. Settling a lawsuit out of court also prompts carriers to raise rates or deny coverage.
Obstetricians also want major changes in the statute of limitations for filing lawsuits. Currently, OBs can be sued up to 21 years after a child is born.
Lawyers say capping awards is the wrong prescription and insist high malpractice insurance rates are caused by bad doctors and price-gouging insurance companies.
State Banking and Insurance Commissioner Holly Bakke won't get into the debate about caps at this point, but she says her department has no evidence of price gouging by insurance companies.
"Right now, I'm focused on the short-term problem of making sure that doctors whose policies are up for renewal next month have access to insurance," Bakke said. "We can and should have the public policy debate about caps, but that's not going to solve the immediate problem."
Part of that problem is there are fewer companies writing policies for doctors.
Phico went bankrupt last year and the St. Paul Fire & Marine Insurance Co. got out of the malpractice business. Zurich American Insurance Co. dramatically cut back on its New Jersey business because of financial losses, and in May, the MIIX Group of Lawrence, which insured about a third of the state's doctors, stopped writing policies.
MIIX lost money when it expanded into other states and in August was replaced by MIIX Advantage, a new company formed to insure only New Jersey doctors.
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Bakke said that company and the creation of two others, Conventus and NJ PURE of West Windsor, which this month got state approval to begin selling malpractice policies, give her cause for optimism.
"Clearly, we have a troubled marketplace, but there are new companies that want to do business here, and that's a positive," she said. "We are in a better position than other states, such as Pennsylvania, where they are having a great deal of trouble attracting companies to provide malpractice insurance."
Bakke also pointed to programs the state Banking and Insurance Department has developed to help doctors who are rejected by two or more malpractice insurance companies.
"This is an access to health care issue, so we are focused on helping doctors find coverage so they can continue to practice and people in this state can continue to go to the doctors of their choice, and we are working closely with the insurers to do that," she said.
Bakke said she is working with state Sens. Joseph Vitale, D-Woodbridge and John Matheussen, R-Washington Township, Gloucester County, who have introduced legislation to reform the state's malpractice system and help doctors cope with the high cost of insurance.
The Vitale-Matheussen bill and a similar one that passed the Assembly this month would create a subsidy program to help doctors who see dramatic increases in their premiums pay for coverage.
Under the Assembly bill, money for the subsidy would come from state coffers. The Vitale-Matheussen bill calls for doctors, podiatrists, chiropractors and lawyers to be assessed $175 a year for the fund.
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The Medical Society of New Jersey and other doctor groups have objected to that provision, saying it is unfair to make doctors pay into a subsidy fund since they already are receiving high malpractice insurance premiums.
Bakke said the subsidy program is needed and should be passed quickly, but she deferred an answer on how it should be funded. "That's a matter of public policy and debate," she said.
Neither bill includes caps on the amount of money that can be awarded in lawsuits. But both include provisions easing the time limit on when lawsuits must be filed and require discovery before litigation commences to weed out doctors who should not be sued.
Currently, when lawsuits are filed, common practice is to sue all physicians whose names appear on a patient's chart, regardless of whether they had any role in the incident that harmed the patient.
While much of the discussion about malpractice insurance has focused on doctors, hospitals in New Jersey also are feeling the pinch.
Four years ago, the average annual malpractice bill for hospitals was about $300,000, said Ron Czajkowski, a spokesman for the New Jersey Hospital Association. A survey by the organization earlier this year found the average premium has ballooned to more than $1 million.
Hospital executives also are looking at potential ripple effects from the malpractice crisis affecting doctors.
"There's a lot of competition among hospitals for the glamour areas such as child delivery," he said. "If there are a lot of specialists, such as OBs, who go to a particular hospital and they stop doing deliveries, that hospital will lose patient revenue.
"We haven't reached that stage yet, and hopefully we won't, but that's a concern, and it's a legitimate one."