The American Medical Association has added Massachusetts to its list of states in a "full-blown medical liability crisis," bringing the total to 20.
The AMA said it added Massachusetts after the state's medical society reported that services were being restricted or withdrawn by about 50% of neurosurgeons, 41% of orthopedic surgeons, 36% of obstetricians and 29% of general surgeons in the face of skyrocketing malpractice premiums for high-risk specialties.
Meanwhile, the AMA's 550-member House of Delegates, at its annual policymaking meeting this week in Chicago, is considering several reports and resolutions dealing with doctors' ire over medical malpractice costs.
For example, one motion asks the AMA to create a special Internet list of physicians who testify against other physicians in malpractice cases -- described by one opponent as a "blacklist."
In another example, delegates carried out a long and spirited debate Sunday on a resolution by South Carolina surgeon J. Chris Hawk, M.D., that called for an AMA endorsement of Hawk's effort to encourage doctors to refuse non-emergency care to plaintiffs' lawyers and their spouses.
Hawk revealed that he had "fired" one female patient after learning that her husband was a plaintiff's attorney.
"With trial attorneys and their spouses," he said during floor debate, "I need to excuse myself from their care."
Hawk then voluntarily withdrew his "infamous resolution," saying, "It has served its purpose -- it has brought attention to the problem."
The Massachusetts Medical Society, in a two-page list of citations of newspaper articles, workforce surveys and anecdotes, notes there are just 23 neurosurgeons serving in 39 hospitals outside metro Boston. The state society also says the time to recruit a neurosurgeon has increased from nearly 23 months in 2002 to nearly 30 months in 2004. The society attributes the numbers to the medical malpractice environment.
"Our patients have world-class physicians and health care institutions, but this crisis has been steadily eroding the quality of our health care system for many years," said Alan Woodward, M.D, president of the 18,000-member Massachusetts society, in a prepared statement. "This crisis drives up costs, restricts patients' access to care, and prevents physicians from providing the most optimal and efficient care. For many physicians, it has become the final straw driving them out of medicine."
Arkansas, Connecticut, Florida, Georgia, Illinois, Kentucky, Mississippi, Missouri, New Jersey, Nevada, New York, North Carolina, Ohio, Oregon, Pennsylvania, Texas, Washington, West Virginia and Wyoming are also on the AMA list as crisis states.
Massachusetts has a cap on noneconomic damages in medical malpractice cases, $500,000, which is double the $250,000 cap the AMA is backing in its state campaigns. The AMA also decries the "broad exceptions" in the Massachusetts cap law that render it "woefully inadequate."
Other AMA resolutions to be heard by the House of Delegates this week on medical malpractice include asking the AMA to:
- Advocate for requiring hospitals, health plans and other pertinent health care entities to keep their medical malpractice coverage amounts and state-mandated minimums, which are sometimes lower than the $1 million to $3 million coverage limits often required by these entities.
- Study, support and develop guidelines on the concept of adding a "liability surcharge" to patient visits to make the public more aware of the med mal problem.
- Support broad malpractice reforms, instead of specialty specific reforms like federal tort cap legislation aimed only at OB/GYN physicians.
The agency said greater use of self-insurance, spurred by soaring malpractice premiums in some states, poses "one area where increasing risk may not be visible until a significant problem occurs."
S&P noted that some hospitals have mitigated the risks of substantial losses through reinsurance policies and measures to improve patient safety and satisfaction, including making apologies for errors.
Joseph Conn contributed to this story.