On June 14, the House Small Business Committee held a hearing on the impact of the medical liability crisis on small businesses. Chair Donald Manzullo (R-IL) said, “Surging medical malpractice insurance rates have skyrocketed the costs of health insurance in our country. Many doctors are simply choosing to get out of the profession rather than pay the exorbitant increases,” adding, “The problem has been exacerbated in our rural areas and inner cities, where doctors are leaving in droves. Millions of our rural and inner-city residents are in danger of losing the basic ability to see a doctor when they are ill.”
Testifying on behalf of the American Academy of Family Physicians, Dr. Larry S. Fields said, “A large percentage of family physicians work in small and medium sized practices of four physicians or fewer. Our practices are typical of small businesses that operate with very tight financial margins. Most of these costs have risen rather steadily and predictably with the single, significant exception of medical liability premiums. When these premiums increase at the rate of which we have seen for the last several years, my practice has no way to absorb them.” Dr. Fields told the story of a colleague, Dr. Julie Wood, who practiced in rural Missouri. When her insurance carrier increased her malpractice premiums from $19,000 a year to $71,000, she left her rural practice and joined a large academic health center in Kansas City. “There is now no OB in a corridor of northern Missouri stretching from Hannibal to St. Joe. Some people drive the two hours to see Julie, but what do we tell the people who cannot afford to do that? What do we tell the 15-year-old, intellectually challenged, pregnant girl who rode her bicycle to Dr. Wood’s office because her only other way to get there would have been to walk?”
Dr. Winston Price, president of the National Medical Association, testified about the adverse impact of medical liability on minority communities. Stating that his organization is the “largest membership organization for physicians of African descent, representing the vital interests of over 25,000 physicians and the patients they serve,” he told the committee that minority physicians in many states are “either limiting the scope of their practices, closing up shop altogether, or moving to ‘greener pastures.’” Dr. Price cited a doctor in Mississippi whose malpractice insurance policy was cancelled when he refused to share his patients’ records. Subsequently, that doctor has been unable to purchase another policy due to the high cost. “It is notable that Dr. Myers has never had a malpractice lawsuit filed against him, and his approximately 3,000 (mostly African-American) patients now do not have assured access to medical care, but are left to fend for themselves,” he stated. Adding that there “is no magic wand to make these problems go away,” Dr. Price said, “Every one of us in this room is in danger, however, of being in a possibly fatal collision on a federal highway somewhere and there is no trauma surgeon available for over a hundred miles to minister to our need, thanks to this medical liability insurance crisis. Any woman in a red state [states that have been declared by the American Medical Association and the American College of Obstetricians and Gynecologists to be in the midst of a medical liability crisis], and any of the women in this very room of child-bearing age, should be worried if they go into labor in a ‘red’ state, because it could mean having to deliver their baby without the benefit of an obstetrician or midwife, because the closest one is three hours away.”
Speaking about the dearth of minority physicians, President and CEO of the National Hispanic Medical Association (NHMA) Dr. Elena Rios said, “As for Hispanic physicians, we number about 36,000 or 5 percent of the total number of U.S. physicians. Of these, 3,600 or ten percent are full-time faculty of medical schools, according to the Association of American Medical Colleges, and less than half of those make up full-time physician administrators of the public and private sectors in the country. Thus, roughly 23,000 Hispanic physicians are in private practice. We estimate at least one-third or 7,500 of those are foreign medical graduates, many of whom are about to retire…Due to the limited results of the national, mainly federal, recruitment programs of minority students to medical schools over the past three decades, these physicians will not be replaced at the same rate that they leave practice. Currently, only about 5 percent of medical school matriculants are Hispanic — out of 65,000 that is about 3,250 new Hispanic medical students per year. Graduates number about the same.” Noting that the Hispanic population is rapidly increasing, Dr. Rios stated, “The NHMA believes that it is vital to the health of America, with a growing minority population, that we urge Congress and leaders in health care to create an opportunity to increase the number of Hispanic physicians and to protect those in practice. Additionally, we strongly feel that we need to develop a more culturally competent physician workforce through education programs for medical students and residents and licensing requirements for CME [continuing medical education] for non-minority physicians.”
Will Colom, founding senior partner of Colom Law Firm, spoke in opposition to legislation that would place limits on noneconomic damages in medical malpractice lawsuits, saying, “The best form of medical malpractice reform would be to have less malpractice. That could be achieved by implementing well known and established controls.” He added, “I agree wholeheartedly that doctors have a malpractice premium crisis, but it is not caused by lawsuits. In fact, there is no so-called ‘liability crisis’…The growth of medical malpractice payments is far less than previously thought. The average payment amount grew at an annual rate of only 4 percent between 1991 and 2003. Over the most recent four years the annual growth rate slowed to just 1.6 percent. Despite anecdotes of an explosion of multimillion dollar awards, the top ten percent of malpractice payments grew only 2.6 percent annually…We agree that good doctors are paying too much for their malpractice insurance premiums, but we disagree on the cause and the solution. It is my recommendation that we look to the insurance companies’ role in this. The evidence proves that lawsuits are not the case.”
