Two more hospitals have been hit hard by a medical malpractice insurance crisis sweeping the nation.
In Mississippi, the state's only Level I trauma center is being taxed to its limits because there aren't enough neurosurgeons in outlying areas to handle all critically ill patients. A similar scenario is playing out in West Virginia, where a lack of orthopedic specialists has forced one hospital to take the unusual step of downgrading its status from a Level I trauma center to a Level III.
Together, the two high-profile cases illustrate a burgeoning physician-staffing crisis caused by sky-high medical malpractice premiums across the country, with scores of hospitals having to dramatically alter the way they do business, officials said.
The University of Mississippi Medical Center, Jackson, the state's only Level I trauma center, has experienced a sharp increase in referrals from neurosurgeons, causing concerns about the hospital's ability to handle the extra patient load.
Before the current malpractice crisis hit the state, officials said, the 654-bed hospital was admitting five to seven patients referred by neurosurgeons on a typical weekend. It now admits as many as 15 such patients. The hospital's daily census has grown to an average of 518 over the past six months from an average of 480 in 2000. In June, the average census was 534.
"This is creating a tremendous demand on our capability to provide critical care," said Frederick Woodrell, associate vice chancellor and director of hospitals and clinics at the medical center.
Hugh Gamble, M.D., a thoracic surgeon in Greenville, Miss., said the sole neurosurgeons in the Mississippi cities of Greenwood, Columbus and Meridian have all left. The Gulf Coast region, where five neurosurgeons practiced until recently, is down to just one, he said. "When you've lost that many neurosurgeons, all the patients that they used to take care of are now at the university. And the university is now right at the breaking point of running out of resources," he said.
Mississippi Gov. Ronnie Musgrove has called state lawmakers into a special session Sept. 5 to address the issue of malpractice insurance. The state's medical association is lobbying for a $250,000 cap on awards for pain and suffering and a limit on contingency fees for plaintiffs' lawyers. It says only sweeping tort reform will stabilize costs and prevent more doctors from leaving the state.
In West Virginia, 765-bed Charleston Area Medical Center said it plans to drop its status as a Level I trauma center tomorrow because there aren't enough orthopedic surgeons for on-call duty. The hospital is downgrading to Level III trauma status, hospital spokesman Andrew Wessels said.
The two hospitals are not alone. A recent survey by the American Hospital Association found that more than 1,200 hospitals have been affected to some degree by skyrocketing malpractice costs.
"There have been four days during the month of August where we have not been able to have 24-hour coverage (by) orthopedic surgeons," Wessels said. Only five or six surgeons are available now to provide that coverage, half as many as CAMC relied on just a few years ago. When any of those surgeons travels out of town on professional or personal business, "we just can't guarantee that coverage," he said.
The cost of medical malpractice liability insurance is the biggest reason that the hospital has been unable to keep and recruit enough physicians. Recruiting physicians "has been virtually impossible for some time," Wessels said.
Not only has CAMC been losing physicians for insurance coverage reasons, Wessels said, but also smaller hospitals in central and southern West Virginia have had to drop the trauma services they used to offer and send more patients to Charleston. "It's kind of a double-edged sword, with them sending more patients here and our physicians being stretched thinner and thinner," he said.
Other physicians around the state who have remained in practice have allowed their certifications to perform risky procedures to lapse, reducing their malpractice exposure and further restricting the supply of on-call specialists, he said.
The Level I trauma status, which CAMC initiated in 1990 and has maintained since, is not being dropped for economic reasons, Wessels said. The hospital is actively recruiting physicians and hopes to be able to return to the top trauma status, he added. The only other Level I trauma center in the state is at the West Virginia University Hospitals complex in Morgantown.
West Virginia lawmakers made some changes to the state's malpractice tort laws last year and set up a short-term malpractice insurance option for physicians, but physicians continue to clamor for more changes. In a position paper, the West Virginia State Medical Association calls for tort reform modeled on California's landmark medical malpractice law of the 1970s. The West Virginia Hospital Association also supports tort reform measures that would make it more difficult to file such medical malpractice lawsuits and would cap noneconomic damages.
Meanwhile, the American Medical Association is pushing hard for tort reform on a state and national level. The Nevada Legislature, acting during a special session, passed a law earlier this month capping noneconomic damages at $350,000. In July, the state's only Level I trauma center, University Medical Center, Las Vegas, closed for 10 days after 58 orthopedic surgeons walked off the job complaining about insurance costs.