Bay State Physicians ‘Rally For Reform’ Medical Liability Overhaul Sought

Charles A. Welch, M.D., president of the Mass. Medical Society, says doctors across the Commonwealth need to make a “loud, clear statement” on the need for reform of the state’s medical liability system.


That statement will be made April 8 at a State House rally expected to draw hundreds of physicians who will speak with one voice in support of filed legislation to overhaul the liability system.

“It is time for the Legislature to take action,” said Welch. “The medical liability system as we know it is highly flawed: it poorly compensates those injured, drives up the cost of health care by forcing physicians to practice defensive medicine for fear of being sued, and it is driving good doctors out of practice.”

Stephen Sweet, M.D., a kidney specialist affiliated with Baystate Medical Center and CEO of the PHO Bay Care Health Partners, will be among about 100 area physicians who will make the trip to Boston.

He told The Healthcare News that the spiraling liability costs are impacting access to care in Massachusetts, and legislators need to hear that.

“This isn’t a matter of rich doctors battling rich lawyers over the issue of medical liability,” he said. “It’s about access to care, which is certainly being affected.”

As The Healthcare News reported in December, many physicians, especially obstetrician-gynecologists, are facing skyrocketing medical liability insurance costs. Some ob/gyns, staring at six-figure premiums, have dropped obstetrics.

Across the state, physicians in this field and many others are faced with leaving the state, retiring early, or dropping portions of their practice in the wake of the increases.

The current medical liability system is severely reducing access to care for patients of all ages and for services of all kinds, said Welch. “And that’s a big threat to a health care system generally regarded as one of the best in the world.”

Sweet said that in the wake of the higher malpractice rates, physicians in a number of fields are practicing more defensive medicine. By that, he meant that they are ordering additional tests and taking other, sometimes extraordinary steps, to essentially cover themselves.

“Their clinical judgment tells them they should do something,” he explained, “but because they want to cover themselves, they’re ordering additional, often very expensive tests to verify what their own judgment indicates.”

This drives up the cost of health care, he continued, and those costs have to be absorbed by everyone.

Meanwhile, the double whammy of sky-high malpractice insurance rates and low reimbursement rates is making it increasingly difficult to recruit specialists in a number of areas, he said.

“The malpractice rates are going up across the country, “ he said, “but in places like New Jersey, higher reimbursement rates offset those increases. So instead of coming here, physicians are looking at states like New Jersey.”

The April 8 rally is an opportunity for physicians to stand behind legislation filed last December to reform the liability system, he said. That measure, filed by eight legislators, includes the elimination of the existing waiver on the $500,000 cap on non-economic damages.

Among other provisions, it would also provide for the elimination of joint and several liability, providing for judgments based on one’s share of responsibility; include a full collateral source rule, ensuring that plaintiffs do not collect economic damages from more than one source; and structure settlements above $50,000, allowing those judgments to be paid over time.

Welch said the need for reform of the system can be seen in recent statistics on increases, as well as in polls of physicians that ask about the impact of those hikes.

According to the state Board of Registration in Medicine, the dollar average of paid claims has been rising since the late 1990s. Average medical liability premiums for physicians over the past three years have risen 9{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, 14{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, and 12{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, respectively, with more increases due for 2003 and beyond if reform is not enacted, he said.
In addition to the skyrocketing rates for ob/gyns, jumps of 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 70{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} are now common for many specialties such as orthopedics, radiology, neurology, and cardiology.

Two recent polls clearly show that liability and reform have a large impact on the practice of medicine, he said. An

Opinion Dynamics poll last summer of Massachusetts adults commissioned by the Mass. Medical Society shows the following:

• 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the state’s residents agree that not reforming the current system will risk the loss of hundreds of doctors from the state’s health care system;

• 83{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} agree that unlimited awards in malpractice lawsuits would result in higher medical costs for everyone;

• and 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of residents view the malpractice-induced flight of medical specialists from the state as a serious problem facing a health care system renowned for its high quality.

Meanwhile, a survey of physicians indicated that 98{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} believe the medical liability crisis is a serious problem. When asked how the crisis affects the practice of medicine:

• 84{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} say they practice more defensive medicine;

• 53{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} said it significantly impacts their willingness to disclose medical errors to colleagues;

• 52{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} are considering retiring early;

• 50{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} are considering switching to a non-clinical position in medicine;

• and 43{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} are considering moving to another state.

Welch said the problem is national in scope, and as a result of soaring premiums, trauma centers and hospital departments have closed in many regions. Patients, in turn, have found themselves dealing with longer waiting times for orthopedic, radiological, and neurosurgical services.

The situation has also affected recruitment of physicians, especially in Massachusetts, he said, as physicians are electing to practice in states that have already enacted reforms.