The Florida Legislature is in the midst of its second special session on the rising cost of medical malpractice insurance, which the governor considers the most important issue facing the state. Here are some questions and answers about this complex debate.
What is the problem with medical malpractice insurance?
In the past couple of years, the premiums doctors pay have skyrocketed and some have begun closing their doors or stopped performing high-risk procedures. The number of companies offering the insurance in Florida has dropped from dozens to just four.
Are all doctors equally affected?
No. High-risk specialists, such as neurosurgeons or obstetricians, have been hit much harder than general practitioners. Robert Cline, a cardiac and thoracic surgeon in Fort Lauderdale who is president of the Florida Medical Association, said in May that his $1-million insurance policy cost more than $100,000 and was set to double this year. Other doctors have said they pay much more.
Is it a crisis?
There's no doubt that some doctors have been forced out of business by astronomical insurance rate hikes. In some parts of the state, trauma victims must be taken to hospitals out of the area and some women wait months for routine mammograms. But trial lawyers, who file malpractice claims, say the number of doctors in Florida is at an all-time high.
Is this a new problem?
No. Florida addressed the issue in the 1970s and again in the '80s. The Florida Supreme Court, however, threw out the law adopted in the 1980s.
Are other states affected?
Yes. The debate is occurring in numerous other state legislatures and in Congress.
Why are insurance rates so high?
That's the big question, and the reason the Senate wants to put insurance executives under oath. Doctors and insurance companies blame frivolous lawsuits, while lawyers say insurance companies are raising rates to recoup stock market losses.
Is the number of lawsuits increasing?
State and federal data suggest that the number of lawsuits and the amount of money awarded have been fairly constant in recent years. Some private studies agree, others disagree.
So why do insurance companies blame lawsuits?
The companies say a big jump in the number of lawsuits is coming.
How do they know that?
They haven't said, but the data could include initial inquiries by patients or reports from doctors about procedures that went awry. Florida lawmakers, especially senators, want to see that internal data.
Can doctors go without insurance?
Yes, but only if they inform their patients. Doctors who do that put their personal assets at risk, and a patient is less likely to see any money. The Legislature is considering requiring doctors to carry insurance.
What's the solution?
Gov. Jeb Bush, insurance companies and doctors favor a $250,000 cap on noneconomic damages in medical malpractice lawsuits. For months the House also supported the cap, but this week agreed to raise it to as much as $1-million.
What are noneconomic damages?
Money to pay for the pain and suffering a patient endured.
Would the cap cover losses such as wages or medical costs?
No. Those are economic damages, which no one has suggested capping. Economic damages are generally based on how much a patient spent and lost wages now and in the future.
Why a $250,000 cap?
That's the figure California chose when it capped medical malpractice lawsuits some 25 years ago, and it was endorsed earlier this year by a task force the governor appointed to investigate the problem. If inflation is factored in since California's cap was imposed, it would now be more than $800,000.
Would that lower insurance rates?
Not for several years at least, all sides agree. Opponents say there is no guarantee rates will fall.
So why the push for a cap?
Advocates say it will bring stability to the insurance market and lure more companies to offer coverage.
What's wrong with a cap?
Senators say $250,000 is not enough to compensate the victim of severe malpractice, such as a baby left severely handicapped and in need of lifelong care. Senators are not likely to agree to any cap unless it can be "pierced" for the most egregious cases of medical malpractice.
Is a cap the only dispute?
No, but it's the biggest. Legislators also can't agree on forcing insurance companies to reduce their rates.
What percentage of medical malpractice cases were won or settled at or below the $250,000 level?
About 70 percent in the past decade, according to federal data. Those figures include economic and noneconomic damages, though, so the percentage of cases in which just noneconomic damages were below $250,000 would be greater.
How many cases in Florida were won or settled for $1-million or more?
Five in 2000, or 0.4 percent of all cases that year. Ten lawsuits, or 0.8 percent, ended with noneconomic awards of more than $2-million.
If the insurance rates go down, will health insurance premiums also drop?
That's hard to say. A reduction in medical malpractice premiums could theoretically trickle down to health insurance premiums, but many factors drive up health care costs, such as expensive new drugs and a nursing shortage that's driving up salaries. And doctors have had to compensate for years for reduced federal payments for Medicare patients.
How much does does it cost to keep bringing lawmakers back for special sessions?
The standard figure cited most often is $40,000 a day, but that varies widely. For example, only key negotiators in the medical malpractice issue have spent much time in Tallahassee, and much of the negotiating has been handled by telephone, so these sessions wouldn't cost nearly that much.
How much do lawyers get of malpractice jury awards or settlements?
The Florida Supreme Court sets those limits, which vary but are about 25 percent, plus costs.
How many doctors are responsible for what percentage of the state's medical malpractice incidents?
Six percent of doctors cause half of all medical malpractice incidents, according to Public Citizen, a consumer rights group.
How do doctors monitor and inform the public about those among them who are most often sued?
The Department of Health keeps a profile on each doctor in the state that includes judgments, settlements and disciplinary actions, but much of that is self-reported. The Legislature is considering strengthening the reporting requirements.
Who wins more often when a case goes to trial - the patient or the doctor?
