The debate over malpractice insurance reform took a dramatic turn in January, as surgeons at four northern West Virginia hospitals canceled nearly all scheduled surgeries and required at least one patient to be transferred to another hospital. The walkout affects four hospitals in the northern panhandle of the state, bordered by Ohio and Pennsylvania.
A similar walkout was averted in Pennsylvania when the incoming governor promised he’d make the issue a high priority. (See sidebar.)
State Fails to Act
According to an Associated Press report, last-minute talks between the surgeons and state officials failed to stop the West Virginia walkout. The orthopedic, general, and heart surgeons say the state has not done enough to address their skyrocketing medical liability insurance costs.
The state passed a bill in December 2001 guaranteeing all health care providers in the Mountain State access to liability insurance. (See “States Take Lead on Medical Malpractice Reform,” Health Care News, January 2002.) The measure appears to have done little to improve the state’s medical malpractice climate. Physicians are ceasing to practice there due to rising medical liability premiums, and trauma centers are closing at a rapid pace.
At least 18 of 19 surgeons at Wheeling Hospital took 30-day leaves of absence beginning in January, and 11 others have asked for leave from Weirton Medical Center. A spokesperson for both Ohio Valley Medical Center (OVMC) in Wheeling and Reynolds Memorial Hospital in Glen Dale said surgeons there were also taking leave. All four hospitals are keeping emergency rooms open.
The surgeons want the state to make it more difficult to file malpractice lawsuits, a move they say would eventually lower their insurance premiums. They also want the state to pressure insurance companies and other third parties to pay a larger share of their overhead costs: not only insurance premiums, but also rent, labor costs, etc.
The West Virginia Hospital Association does not support the walkout. Hospitals say they will begin cutting shifts among nurses and surgical support staff if the surgeons don’t come back.
Dr. Gregory Saracco, a general surgeon who went on leave from Wheeling Hospital and OVMC, said doctors want clear signals from legislative leaders that changes to the insurance system will not simply be offered, but will pass and become state law.
Most of the surgeons are insured through a special program created by lawmakers last year, and the state Board of Risk and Insurance Management recently cut rates for those policies. Nevertheless, yearly premiums remain among the highest in the country, ranging from $10,000 for dermatologists to $150,000 for orthopedic surgeons.
Saracco, 49 years old, said he had to borrow money twice last year to pay $73,000 for coverage–$40,000 for the state plan and $33,000 to a private carrier, Medical Assurance, to cover liability from previous medical cases. He expects it will cost him $100,000 to renew the annual policy.
“This is not a strike–I’m not protesting anything,” Saracco said. “I’m taking time to look at other options. But if I don’t get some help to offset my premium costs, I can’t operate in this state.”
Market Does Not Exist
The doctors in West Virginia say the problem is compounded because nearly every national insurance carrier has left the state market, driving premiums up dramatically.
Robert Zaleski, an orthopedic surgeon in Wheeling, said his annual premium went to $150,000. People have asked him why he doesn’t feel badly about “abandoning” his patients. “The reason,” Zaleski stated at a news conference, “is that we are taking some action is to improve the quality of care. We once had three neurosurgeons in Wheeling. Now we have none. They left because of malpractice insurance costs.”
As insurance premiums have soared, doctors have been unable to pass the cost increases along to their patients, because many physicians are locked into managed-care health programs that limit their fees. A physician cannot stay in practice for very long with escalating overhead and decreasing reimbursement rates, the doctors note.
Conrad F. Meier is managing editor of Health Care News.
