Posted on 01/03/2003 5:57:11 AM PST by NautiNurse
Hospital survey says Manatee not alone in liability issue
The medical liability insurance crisis is disrupting Floridians' access to health care statewide, a Florida Hospital Association report issued Thursday shows.
From the Panhandle to Miami, skyrocketing medical liability premiums are forcing doctors and hospitals to eliminate or cut back services, the report says.
Seven hospitals, from Doctors Hospital in Sarasota to Parkway Regional Medical Center in North Miami Beach to South Bay Hospital in Sun City Center, have closed their obstetric units. Four other hospitals have reduced or limited obstetric care.
Tallahassee Community Hospital has closed its mammography unit and four other hospitals have reduced mammography services.
Orlando Regional Healthcare System reported wait times for mammograms increased from 20 days to 150 days in 2002.
The Bert Fish Medical Center in New Smyrna Beach reported cutbacks have forced its medical staff to transfer 100 to 200 patients a year to other medical facilities to receive care.
The second half of the report concerns the impact of the medical liability crisis on specialists who are on-call for emergency room duty.
Sarasota Memorial Hospital, a publicly owned medical facility with a national reputation for research and innovative treatment, reported on-call speciality coverage has been eliminated in neurology services and reduced or limited in gastroenterology, neurosurgery, hand surgery and psychology services.
But the lack of on-call specialists for emergency room duty does not translate to limited access of care at Sarasota Memorial, said Dr. Bill Colgate, the hospital's vice president for medical affairs and an emergency room doctor.
"We have the same access to specialists as we had before," Colgate said. "We just have to route the request through the patient's primary care physician."
At the most, Colgate said, the lack of on-call specialists could mean a delay but not a lack of treatment.
The 230-member Florida Hospital Association gathered the information from surveys returned by individual hospitals.
"This is just a snapshot of what's happening, but it clearly shows that the medical liability crisis is forcing hospitals across the state to stop offering or to curtail health care services that Floridians need," said Wayne NeSmith, president of the Florida Hospital Association.
Neither Manatee Memorial Hospital nor Blake Medical Center, the two acute care medical facilities in Manatee County, are listed on the report.
Local impact
Although neither Manatee Memorial Hospital nor Blake Medical Center had to eliminate or cut back services, according to hospital officials, access to health care has been curtailed locally in other areas.
Currently, only one of Manatee County's five kidney specialists, Dr. Stephen L. Berkes, has medical liability coverage to serve more than 300 patients on dialysis.
Like many other kidney specialists across the state, Berkes and his fellow nephrologists lost their coverage when Farmers Insurance Group recently pulled out of Florida.
Dr. Thomas N. Braxtan, the new chief of staff at Manatee Memorial, and his partner, Guruswamy Ramamurthy, hope to receive word today that they have been insured through GE Medical Protective.
The news pleased Rep. Bill Galvano of Bradenton, the newly elected Republican representative for District 68, who made a call to a local insurance agent to help Braxtan get insurance.
"Dr. Braxtan is a reputable physician," Galvano said. "It makes you stop and say, 'Hey, what's going on here?' when someone like him, a hospital chief of staff, can't get insurance."
Manatee County's two other nephrologists, Dr. Celestino Palomino and Dr. A. Daniel Celaya, have submitted requests for leaves of absence from Manatee Memorial, Blake and the four dialysis centers serving Manatee County until their insurance problems are resolved.
A spokeswoman for Palomino and Celaya said they have placed applications with several companies and hope to receive word soon that they will be covered.
Until then, Palomino said Berkes will be hard-pressed to care for more than 50 patients a day.
"Three of us can handle the load," Palomino said, "but it will be very hard for just one nephrologist to keep up."
Several other physicians, such as Dr. Denise Baker, have had to limit their practices because of skyrocketing liability insurance premiums.
When Baker's carrier pulled out of Florida this summer, she said she had no recourse but to stop delivering babies, which meant 97 pregnant patients had to find new doctors to deliver their babies.
When faced with the cancellation of malpractice insurance last summer, Bradenton surgeon John V. Dunne said he was forced to limit his practice because he could not afford the high premiums charged by his new carrier.
Board-certified in chest surgery, general surgery and vascular surgery, Dunne, 66, said his premium would have been $103,000 to continue his surgical practice. Even though his practice is now limited to the treatment of veins and cosmetic laser surgery, Dunne still has to pay $77,000 for medical liability coverage. And because he is with a new insurance company, he has to pay "tail coverage" or a lump sum that will build a reserve in case he gets sued during the first year.
At least six other Manatee physicians have opted for early retirement or decided to leave the state when faced when premium increases ranging from 50 to 350 percent.
One neurosurgeon is now paying $220,000 a year for medical liability insurance.
And as insurance premiums continue to rise, reimbursement rates for doctors and hospitals are declining.
Medicare reimbursement cuts of at least 4 percent are expected this month. The decreases come on top of a 5.4 percent rate decrease in 2002. By 2005, the Medicare cutbacks in reimbursement rates are slated to total 15 percent.
Private insurance companies are following suit, the Florida Hospital Association said.
Baker said her income in the past decade has been reduced by at least 66 percent.
The worsening crisis
As reimbursement rates fall, the cost of business goes up, propelled, the medical community says, by skyrocketing medical liability premiums.
If something isn't done, doctors say, they will be forced out of business, especially those in high-risk specialities such as neurosurgery, obstetrics, emergency care and orthopedics.
"The problem is very real," said Dr. Colgate from Sarasota Memorial. "We may soon be without neurosurgeons if they don't get their medical malpractice problem solved."
And the problem is not just in Florida, but nationwide.
Who is at fault depends upon whom one talks to.
The medical community blames frivolous lawsuits and multimillion dollar awards to settle medical negligence claims.
The answer, says the medical community, is tort reform or caps on judgments similar to those enacted in California.
Trial lawyers say large settlements are not to blame: Patients' right to sue must be protected.
"In Florida, medical malpractice premiums account for less than 1 percent of total health care costs," says a report from the Academy of Florida Trial Lawyers. "Medical costs rose 13 times faster than malpractice premiums from 1988-98. . . . This shows that medical malpractice insurance is truly an amazing value when one considers that medical malpractice is the eighth-leading cause of death in the United States and that medical errors cost the U.S. economy between $17 billion and $29 billion each year."
The trial lawyers lay the blame on the insurance industry. Sensing a lucrative market in the boom years of the past decade, numerous insurance companies jumped into medical malpractice insurance with no experience, the academy says. These companies kept rates artificially low while at the same time investing heavily in a booming stock market. When the market turned soured, those same companies ended up overexposed with no way to cover themselves except by raising premiums.
Fixing the problem, Galvano said, will require addressing problems in all three areas - health care, tort reform and insurance reform.
"When I was just starting out in law, a mediator told me that if at the end of the day, one party is still happy, you have not done a good job. We are going to have to see some commitments from all three entities to fix the problem," Galvano said.
Will do. As soon as I get a chance to do some very basic search engine queries. Don't know why this isn't obvious to you unless you have just run out of anything to argue and don't want to quit. Ever bother to notice that almost all the schools you see around are public shcools? It should be obvious to anyone with eyes taht the public schools dominate. And why do I have to believe any Freepers are liberals? I mentioned the population at large as consisting of liberals and conservatives, not freepers. Don't feel like naming names, but there are a few Freepers that seem liberal. Some even say so on their home pages or in posts.
Ask your riddles of someone else. I'm tired now and don't feel like it. Riddles and jokes aren't my style.
Just make sure you provide numbers of FReepers and other conservatives that like to send their children to public schools. That should be an interesting number.
Oh, come on now! That's getting into subjectivism and relativism and you know that neither you or I could make that judgment! I could assert that the majority of freepers and conservatives that send their children to public school either like or don't like to with equal validity. If you want to set standards with ill defined or undefined meanings, you are doing exactly the thing that most of my liberal aquantainces do. That way they can never lose an argument in thier own mind or have to consider their position's validity: they can just keep changing a meaning so that they never have to be wrong.
My daughter goes to private religious school. It isn't that I like to spend almost 4000 a year doing this, it is that it's the right thing to do. And I don't hae lots of money. You probably have more that I do.
So, where do/did your children go and why?
A long time ago, I decided what was right and wrong. I decided to do what was right whenever within my power whether it felt good or bad, whether I wanted to or not. This is what I call charachter. If I have to make major sacrifices in my life to to what is right, then I do it. I don't always like to do it, I just do it!
IMO, there is no reason for anyone to voluntarily send thier children to public school. Period! The cost of living in a big house, driving new cars, owning a boat, taking vacations is not reason to put your children in Public school! A court order (backed up by the guys with ski masks and machine guns) is about all I would consider a valid involuntary reason.
Ok, so try here
As you can see, the numbers of private schooleed students have dropped since 1965 from 13% to around 11%. Homeschooled students are difficult to number but lets assume that the 2% decline is due to home schooling. That makes 13% privately educated today.
The votes in the last election between a liberal (Gore) and a conservative (G.W. Bush) were roughly 50/50, which is as good an indicator of liberal/conservative ratio in the general population as any. The ratio of children per family is probably about the same, although it could be argued that conservatives may have larger families than liberals; abortion and such are liberal things, you know. Even if the entire 13% of private schooled children were from conservative families, that would leave nearly 75% of conservatives placing their children in public schools.
That's all the education I intend to provide you for now. If you need more education, then go get it yourself and get back to me when you have it. Education isn't my job, and we were talking about lawyers and tort reform to begin with.
Even a three-quarters or two-thirds vote on the basis of 'clear and convincing evidence' would be an improvement.
Two other things we need to do are to make it harder to strike intelligent working and professional people from a jury (the plaintiff's lawyer just loves to pack the jury with ignorant, envious welfare cadgers with nothing better to do), and to institute 'loser pays'. And make sure the lawyer has to pay some too, if it is a frivolous suit!
-ccm
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