The inability to get malpractice insurance -- literally at any price -- is driving obstetricians from their practices in eastern Pennsylvania, Nevada, and New Jersey. And in states such as Florida -- when an insurer can be found -- the cost almost pushes doctors to the brink of bankruptcy.
If this sounds like a crisis to you, the American College of Obstetricians and Gynecologists (ACOG) has already achieved one of its goals. The organization has even issued a red alert, seeking legislation that will at least ease access to coverage.
"One New Jersey specialist -- without a legal blemish on his practice record -- was finally able to secure insurance at the cost of $300,000 a year," said ACOG president Dr. Thomas Purdon at the 2002 ACOG meeting in Los Angeles. "We are in a crisis situation."
He warned that without relief in the form of new state and federal legislation, many rural areas of the U.S. will be without prenatal care or specialists in delivering babies. Not only are doctors leaving the field, hospitals are closing their maternity wards. Purdon said the ripple effect is also reaching into academic institutions, where recruiting experts to teach obstetrics and gynecology could be hamstrung.
ACOG leaders cited Florida, Mississippi, Nevada, New Jersey, New York, Pennsylvania, Texas, Washington, and West Virginia as the states most in danger of losing obstetric care due to difficulty in getting insurance coverage.
In Florida, for example, obstetricians are seeing average costs in excess of $200,000 a year for insurance premiums if they practice in populous Dade (Miami) and Broward (Fort Lauderdale) counties, said Purdon. He is a professor of obstetrics and gynecology at the Arizona Health Sciences Center in Tucson.
In Nevada, 70 obstetricians in the Las Vegas area are about to leave the state following after one of Nevada’s largest liability insurers withdrew from the market, he said.
"In Mississippi, a pregnant woman in Yazoo City, which has a population of 14,000, has to travel 150 miles to get prenatal care," Purdon said. "When a woman has to travel that far to get care, she isn't going to get care."
One solution would be national legislation to establish legal reforms such as those in place in California where a cap on noneconomic -- that is, pain-and-suffering or punitive -- damages exists. "Insurance rates in California have remained stable for years there," Purdon said.
"Unlike previous crises in the 1970s and 1980s, where cost was the issue, this time around there's the obstacle of finding any insurance coverage at all," said Dr. Albert Strunk, an administrative vice president for Washington, DC-based ACOG.
Purdon said the New Jersey doctor in his example had left eastern Pennsylvania because insurance was not available. He searched for 90 days before he could find coverage in the Garden State -- at $300,000 a year. That kind of liability insurance means the doctor "has to pay about $1,000 a day before he can even turn on the lights in his office, and (that) doesn't reflect what it costs for paying his nurses and rent," Purdon said. "A lot of doctors are finding that these types of expenses make it difficult to stay in business."
By Edward SusmanAuntMinnie.com contributing writer
July 8, 2002
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