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Malpractice insurance crisis hits home
By KRIS HUNDLEY, Times Staff Writer TAMPA -- South Bay Hospital in Hillsborough County has lost the services of three specialists in the past month, including a urologist and vascular surgeon, because of the doctors' inability to find affordable medical malpractice insurance. At Largo Medical Center in Pinellas County, the maternity ward will close by year-end, stung by the loss of two busy obstetricians who could not find insurance coverage. "These doctors found they could no longer afford to practice," said Tom Herron, chief executive of Largo Medical, which saw its deliveries drop 25 percent after the two specialists left. "And with two more obstetricians saying they expect to lose coverage, we can't afford to keep the unit open." More than a dozen local hospital executives gathered Friday morning in Tampa to call for an overhaul of malpractice insurance and alert the public that the crisis is beginning to be felt locally as hospitals curtail services and doctors are forced to leave their staffs. Skyrocketing malpractice rates already have temporarily closed a trauma center in Las Vegas, severely limited obstetrical care in West Virginia and eliminated orthopedic service at a Philadelphia hospital. Dr. Carmen Damiani, one of the Largo obstetricians who lost her malpractice coverage at the beginning of August, said the worst is yet to come in the bay area. "So far the problem has just been individual doctors coming up for renewal," she said. "But in October, some big groups in the area are coming due (for renewal) and it's going to blow up. The bigger crisis is coming." In the past four years, 40 insurance carriers have stopped writing medical malpractice policies in Florida, leaving just a handful of carriers. The remaining insurers have raised their premiums by at least 30 and as much as 300 percent, saying they're being hit with an ever-increasing number of claims and huge jury awards. The upshot is that experienced obstetricians like Damiani, who has not had a claim in her 15-year career, are not being renewed by their insurers. Dr. Carlos Vazquez, the other obstetrician to leave the Largo hospital, was offered renewal but at rates he considered astronomical. Dr. Richard Landrigan, the Brandon urologist who was forced to stop practicing at South Bay, was simply notified this summer that his long-time insurer was leaving the state. Vazquez has since joined an obstetrics group in South Florida, where several hospitals allow doctors to practice without malpractice insurance. To practice in Florida, doctors with hospital privileges must have either commercial insurance; a $250,000 bond or letter of credit; or they must agree to come up with $250,000 per claim (a maximum of $750,000 per year) within 60 days should there be an adverse judgment. The last option is considered self-insurance, commonly known as "going bare." Self-insured doctors also must post a sign in their office notifying patients that they have no malpractice coverage. Hospitals in South Florida, which has the nation's highest medical malpractice rates, have been forced over the past several months to allow doctors to self-insure or post a bond in order to keep their doors open. So far, hospitals in the Tampa Bay area have largely resisted physicians' efforts to move in that direction, continuing to demand that doctors have commercial coverage. The only exception is University Community Hospital in Tampa and Carrollwood, which allows doctors to put $250,000 in an escrow account or bond to handle malpractice claims. Largo Medical Center is considering a similar proposal. But as local hospital executives gathered to bemoan the medical malpractice crisis Friday morning, they avoided endorsing such options. Bill Bell, general counsel with the Florida Hospital Association, said his group has no statistics on the number of hospitals that have allowed doctors to practice without commercial coverage. "Each hospital's board is trying to grapple with that," Bell said. "But hospitals prefer to help their medical staff find some other kind of remedy." Landrigan, the Brandon urologist, thinks hospitals are being warned by their attorneys that they could be forced to pay more out of their malpractice insurance if doctors are uninsured. But he's angered that hospitals are adhering to higher standards than the state. "Since when does an organization such as a hospital decide it's smarter and more powerful than the state?" he asks. Landrigan now operates his office practice on a self-insured basis. He said about 10 of the 100 patients he had scheduled in the past month have canceled appointments after being told he no longer carries malpractice. Those who remain with his practice but need surgery are referred to other local urologists. But Landrigan said the referral system isn't always smooth. "A patient with kidney stones was told he couldn't be seen till mid-October," he said. "It's not life-threatening but it means more pain and suffering for the patient." Shut out of surgical work, Landrigan's income has declined more than 50 percent. He says he has little choice but to keep searching for a malpractice carrier, though he's been told he could end up paying 300 to 400 percent more than the $14,000 per year he paid in the past. Damiani, the obstetrician, is likewise resigned to paying more. "I've never paid more than $43,000 a year," she said. "Now I'm getting quotes of up to $180,000." Even when they find new insurance, both doctors said they'll probably curtail risky procedures. Damiani will likely give up general surgery and Landrigan expects to avoid emergencies like one he handled a couple of years ago involving a pregnant woman with kidney stones. "If an insurer tells me my rate will be lower if I don't treat complicated cases like that, I'll go for the cheaper rate," he said. "Then the next time that happens I won't come in and you'll be talking life and death." -- Kris Hundley can be reached at hundley@sptimes.com or (727) 892-2996.
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From the Times Business report
From the AP
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