Besieged by malpractice litigation, some doctors in Natchez, Miss., are making plans to move across the Mississippi River to Louisiana, where they think the climate is better. Eventually, "healthcare is going to die out in Natchez, so give it a fresh start in Louisiana," says Natchez internist Ken Stubbs, M.D., who is developing plans with Louisiana officials for a 150-bed hospital just across the bridge in Vidalia, La.
Though the Natchez doctors' plans may seem extreme, "I would hesitate to say that they are overreacting," says Michael Houpt, CEO of Medical Assurance Company of Mississippi, the state's largest malpractice carrier.
In the first eight months of 2002, more than 1,500 new claims were filed against MACM physicians. To protect against rising payouts, MACM this year raised average reserves for each case to $150,000 from $139,000, Houpt says. MACM will raise premiums 45% next year.
Houpt adds that tort reforms enacted by the state in October will take years to slow rising costs.
But Louisiana is no safe haven for physicians fleeing Mississippi's med mal problems. Louisiana malpractice officials say they also face an increase in lawsuits and rising payoffs, and their premiums are actually higher than the Mississippi carrier's.
In Louisiana, "people are getting more suit-happy," says Lorraine LeBlanc, executive director of the Louisiana Patients' Compensation Fund.
PCF is a state-run medical malpractice back-up fund doctors must pay into on top of their insurance premiums.
Indeed, rates in Louisiana are higher than in Mississippi. While MACM charged internists $4,786 in 2002, a Louisiana internist with the same coverage paid a total of $11,506 to PCF and Louisiana Medical Mutual Insurance Co., LAMMICO reports. Moreover, LeBlanc reports that PCF and LAMMICO plan to raise rates to Louisiana physicians by 42% next year, almost matching the MACM increase.
Yet the AMA says Mississippi is one of 12 states in a malpractice "crisis," while Louisiana is one of six states that is "currently OK," thanks to a $500,000 cap on noneconomic damages and lost wages.
Mississippi just passed a cap of $500,000 on noneconomic damages. But the cap will increase to $1 million by 2017, and the measure lacks Louisiana's cap on lost wages. Also, the Louisiana cap has withstood legal challenges, while many Mississippi physicians expect the state supreme court will overturn the Mississippi cap.
Nonetheless, the Mississippi State Medical Association has fostered the perception that Mississippi rates are much higher than Louisiana's. In a comparison chart it presented to state lawmakers when it successfully lobbied for tort reform, the medical association reported that Mississippi internists actually paid $3,539 more than Louisiana in 2002.
Charmain Thompson, MSMA deputy director, says the association quoted Mississippi rates from an out-of-state carrier that asked not to be identified to the legislators. Though those rates are "at the high range of what many doctors are experiencing," some doctors have to pay them because they can't get MACM coverage, she says.
But the news that rates can be even higher in Louisiana does not seem to deter Mississippi doctors eager to leave the state.
Former Natchez internist Illey Dillon, M.D., who moved to Vidalia in July, acknowledges that once his new Louisiana malpractice coverage matures, which will take five years, it probably won't be any cheaper. But in Mississippi, he says, "I felt that at any moment I could be taken to trial for a frivolous lawsuit and lose."
He points to a recent rash of Mississippi lawsuits against certain drugs that name hundreds of Mississippi doctors, mostly internists. Houpt says these doctors prescribed the drugs correctly, but plaintiffs used them to bring drugmakers to plaintiff-friendly Mississippi courts.
Stubbs, named in four lawsuits this year, says he won't be deterred in planning the new hospital, even with tort reform.
Teresa Dennis, central region representative for the Louisiana Department of Economic Development, says she is lining up millions of dollars in subsidies, as well as Louisiana hospital systems interested in building the Vidalia facility, which would take two years to construct.
Says Dennis: "A problem for the healthcare community in Mississippi is an opportunity for Louisiana."