PA: For medical malpractice woes, an option 3

  1. For malpractice woes, an option 3
    By Tom Ferrick Jr.
    Inquirer Columnist

    Robert Schiowitz and Ronit Sugar are a husband-and-wife team of physicians who run a mom-and-pop surgical practice in Warminster.
    Run, as of today. The verb could lapse into the past tense after Dec. 31.

    That's the day the couple's current medical-malpractice policy expires.

    You'd think - since they pay $128,000 a year in premiums - someone would be glad to get their business. Think again.

    Their current insurance company will not renew. It is getting out of the business in Pennsylvania.

    There are no other private insurers willing to take on the couple. Nothing personal. Hardly any companies are taking on new customers.

    So here are Sugar's and Schiowitz's options:

    Stop practicing medicine.

    Move to another state, where insurance is available and more affordable.

    Buy a policy from the state-run insurance pool for an eye-popping $270,000 for the year.

    Buy a "risk-retention" policy, essentially a form of self-insurance, that offers less coverage than they currently have, for about $140,000 a year.

    I said to Schiowitz: In medical terms, what's your diagnosis?

    "We're hemorrhaging," he replied. "We're not quite in irreversible shock, but it's close."

    Take this case, multiply it several thousand times, and what have you got? A crisis.

    And it's real

    All of the players - physicians, lawyers, regulators, experts - agree it is for real. Pennsylvania has a severe problem when it comes to cost and availability of malpractice insurance.

    So severe that the effects may soon be felt by you and me, with practices closing, doctors fleeing the state, closed emergency rooms.

    It prompted Gov.-elect Ed Rendell last week to create a committee to study a "cure" for the crisis.

    It won't be easy. It takes about 30 seconds for the opposing sides to array their forces.

    Side One: Physicians, who blame an out-of-control tort-liability system, with juries awarding megabucks in malpractice cases. (Just last week, there was a $15 million award in a Bucks County case.)

    The physicians' solution: Cap jury awards, especially for pain and suffering, like the system in place in California since 1975.

    Side Two: Trial lawyers, who ferociously oppose limits on the right to sue or caps on awards. They argue: How else to protect patients from incompetent doctors?

    Their solution: The medical profession should do a better job of policing itself and drive shoddy practitioners out of the business.

    Both sides have just enough influence in the legislature - (read: They are generous givers to the political parties) - to cancel each other.

    Making it work

    Under normal circumstances, both sides would shout and argue, and then nothing much would happen. (It's fairly easy to make nothing happen in Pennsylvania.) But circumstances are not normal.

    That said, I do not think the physicians will succeed - even in the current climate - in getting the California system installed here.

    Is there a third way? There may be. We already have a system in place in Pennsylvania for nonjury adjudication of claims of injury. It is called workers' compensation.

    Why not set up something like it to handle all but the most egregious malpractice cases?

    The Institute of Medicine, a think tank affiliated with the National Academy of Sciences, has suggested such a system as an alternative to the current one.

    The institute argues that the tort system fails on a number of levels: It tends to overcompensate a small number of patients at the expenses of others; it takes too long to settle cases - an average of five years in Pennsylvania; and it does nothing to weed out bad doctors or shoddy practices.

    It urges that some state try out its idea of what it calls a "patient-centered and safety-focused, nonjudicial compensation system."

    Quite a mouthful. But I don't care whether they call it a kumquat - as long as it works.

    And I know just the state for it.

    Tom Ferrick's column runs Sunday, Wednesday and Friday. Contact him at 216-854-2714 or
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