As the number of companies willing to sell medical malpractice insurance in Illinois shrinks and insurance premiums skyrocket, doctors are moving out of the state or quitting medicine entirely. In some counties, observers fear the medical system is on the verge of collapse.
More than 30 malpractice insurers have left Illinois or gone bankrupt over the past five years. In neighboring states such as Indiana, Missouri, and Wisconsin, malpractice insurance is readily available at one-third to one-fourth the price. Those states have imposed caps on non-economic damages, which now make up more than 90 percent of the money awarded by Illinois juries in malpractice cases.
In key Illinois counties–including Madison, which has become infamous as perhaps the most plaintiff-friendly venue in the United States–doctors, hospitals, and some local elected officials are warning of a medical system collapse. They are taking their warning and a plea for tort reform to the most powerful voters in the state: the elderly, who are also the biggest health care consumers.
In the East St. Louis area, which includes Madison and St. Clair Counties, local doctors and retired physicians are visiting area nursing homes and retirement communities to explain the malpractice insurance situation and its impact on health care. Letter-writing and petition campaigns have collected more than 7,000 signatures in less than one month. The petitions ask state lawmakers to enact reforms to rein in frivolous lawsuits and outlandish awards to plaintiffs.
At least 60 doctors in the past two years have left or announced plans to leave Madison and St. Clair Counties. Most have cited out-of-control courts and skyrocketing malpractice insurance premiums as the reason.
At United Methodist Village, a Madison County-based residential facility for the elderly, half of the 200 residents recently attended a malpractice insurance forum led by Dr. Leo Green, a retired Alton, Illinois physician.
“Our residents are very concerned,” said Patrick Noonan, United Methodist Village administrator. “That’s why they came to me to ask if Dr. Green could speak to them. We had a full house with residents from outside the community also in attendance. People are starting to look at this, because our seniors are in need of more attention and care, and their doctors are moving away.”
Alton Memorial Hospital has taken out ads in local newspapers and published an information packet on the crisis. The packet includes a list of area doctors willing to address groups concerning the medical malpractice situation, a sample letter to send to lawmakers, and lawmaker contact information.
Rob Shelton, Alton Memorial’s manager of marketing and development, said 18 physicians–15 percent of the active staff–have left the hospital in the past two years.
“Right now the hospital is okay,” Shelton said. “If we lose, in some cases, a single physician, we could be in trouble. If we lose one key surgeon, that would be detrimental to the hospital. We have two anesthesiologists. Losing one would be extremely detrimental.”
Shelton also noted that for the first time in more than 20 years, the hospital has no physicians going through the credentialing process.
“We’ve lost 18 physicians and have no prospects coming in,” Shelton said. “Our number one challenge is recruiting. There is no neurosurgeon in our market. Belleville (Memorial Hospital, about 40 miles south in neighboring St. Clair County) has lost its trauma program, and that’s directly related to neurosurgery.”
System in Turmoil
Metropolitan East St. Louis is by no means the only troubled area of Illinois. Dr. Richard Broderick, a neurosurgeon who practices at three suburban Chicago hospitals, has seen annual malpractice insurance premium increases of 50 percent or more in recent years.
“If they go up another 50 percent, I’m going to have to go somewhere else,” Broderick said. “It gets to where, like any business owner, I have to pay bills. I’ve had to limit my practice to not care for certain high-risk conditions that often have poor outcomes. It’s frightening. I tell people all the time there are certain areas where you don’t want to get in a car crash, because there is no neurosurgeon in that area.”
He said that in Joliet, in suburban Will County, southwest of Chicago, there is no longer a neurosurgeon. The last one lost a large settlement and was bankrupted, he said.
“They took his professional assets and his house,” Broderick said. “In Joliet now, they’re flying patients to Peoria (nearly 120 miles away) because there are no neurosurgeons. Lawyers are writing letters saying, ‘If you don’t settle for the policy limits, we will go after you personally and corporately.’ It’s legalized extortion.”
State Senator Kirk Dillard (R-Westmont) is sympathetic to such complaints. He is lead sponsor of an omnibus tort reform bill backed by the Illinois State Medical Society.
“Our legislature, especially some Democrats for the first time in my memory, is taking the medical malpractice issue seriously,” Dillard said. “I believe Democrats in the Metro East area and Republicans throughout Illinois are wishing to pass a meaningful tort reform bill. Generally, this issue is quite partisan, with Democrats stonewalling on behalf of trial lawyers. Now, a couple of the Metro East Democrats are wanting do something, because they’re seeing a direct impact on medical care.”
Dillard noted that two hospitals near his home–La Grange Memorial Hospital and Hinsdale Hospital–are both owned by Adventist Health Systems and a mere 2 1/2 miles apart, yet markedly different in some respects because of the malpractice situation.
“At La Grange they have spent a couple of million dollars improving a birthing center, but you could shoot a cannon off in there and nobody would care because doctors won’t deliver there,” Dillard said. “At Hinsdale their birthing area is overflowing. La Grange Hospital is in Cook County, where lawsuits are out of control, and Hinsdale Hospital is in DuPage County. That’s the difference.”
Not that DuPage County is a model of restraint either. One of the Chicago metropolitan counties, DuPage is among 10 Illinois counties from which medical malpractice insurer PIC Wisconsin recently announced plans to withdraw. The others are Cook, Jackson, Kane, Lake, Madison, McHenry, St. Clair, Vermillion, and Will.
PIC Wisconsin’s recent announcement follows last year’s decision by ISMIE Mutual Insurance Company, the state’s largest medical malpractice insurer, to stop writing new business throughout Illinois. ISMIE’s moratorium came in the wake of growing underwriting losses and withdrawals by other malpractice insurers. ISMIE wrote 15 percent more policies in 2002 than it had the previous year, as a result of doctors replacing lost coverage. ISMIE officials decided the company could not safely take on more risk.
Democrats in Control
Dr. William Kobler, president of the Illinois State Medical Society, which runs ISMIE, has been stumping the state to generate support for the society’s reform bills. He said he’s hopeful but realistic.
“Whenever you’re talking about anything to do with the legal system, it’s an uphill struggle,” Kobler said. “I do know that some Democrats [who control both chambers of the General Assembly and the governorship] have started to realize we need to do something about this. But it’s one thing to get a bill out of the rules committee and another to get it through the judiciary committee.”
In 1975 and 1995, the state legislature passed caps on non-economic damages, only to have them struck down by the state supreme court both times. So the state medical society is not pursuing caps this time.
Instead, the reform bills call for measures to reduce unmerited lawsuits–more than 80 percent of Illinois malpractice suits result in no payments to plaintiffs–and various measures, such as good-faith immunity, to protect doctors from lawsuits and make the state a more attractive place to work.
“We know caps are poison when it comes to the Illinois Supreme Court,” Kobler said. “We think our best chance there is with the federal government. We’re trying to do things that would be considered more stopgap to keep doctors available. If we can get good-faith immunity for people who see very sick people and who must make very quick decisions in life and death situations, that would be a help. Without that we’ll have trauma centers shutting down.”
Steve Stanek is an Illinois-based freelance writer. His email address is [email protected].