Doctors hope for state help on insurance

JEFFERSON CITY, Mo. -- After obstetrician Jamie Ulbrich's malpractice insurance carrier stopped doing business in Missouri, the best coverage he and three colleagues at their Marshall clinic could find would have cost them double what they paid in 2003.

And they worried they could be in for a similar increase the following year.

The four doctors decided they couldn't each afford the $50,000 malpractice insurance premium, so they decided to stop providing obstetric service and instead work solely as family physicians in 2004.

"We don't have to make a whole lot" to justify doing obstetrics, Ulbrich said, "because we enjoy it so much."

But with malpractice costs rising, "there's no way we can do it ... from a financial standpoint."

State politicians point to physicians such as Ulbrich as evidence that Missouri's medical malpractice insurance market is terribly ill. They want to heal it, but the Republican legislative majority and Democratic Gov. Bob Holden have been unable to agree on the diagnosis, much less the cure.

Last year, the legislature passed a comprehensive overhaul of the way personal injury lawsuits are handled that would have imposed new restrictions on the legal system. Holden vetoed it, saying the bill went too far.

Now lawmakers will try again in their annual session that begins Wednesday.

According to the Department of Insurance, medical malpractice insurance premiums grew almost 50 percent in 2002 -- the latest year for which statistics are available -- while malpractice claims against doctors grew by just 6 percent.

Different views of cause

Republicans claim Missouri's medical malpractice insurance problems stem from a broken legal system that allows frivolous lawsuits that frequently lead to expensive settlements or judgments. The only way to make sure lawsuits are justified and judgments are reasonable is to overhaul how the state deals with all personal-injury lawsuits, Republicans say.

But Democrats point to a 2002 report from the Missouri Hospital Association that claims bad investments by insurance companies as part of the culprit. Those investments caused insurers' revenue to drop. So to increase revenue, the insurers charged doctors more. The best way to stem the tide of rising insurance premiums is to regulate insurance companies so their premiums aren't as high, Democrats say.

One of the main sticking points last year was over where lawsuits can be filed. Republicans allege many lawyers intentionally file lawsuits in counties where juries are more sympathetic to plaintiffs. Democrats agree to a certain point, but caution that plaintiffs should be free to have their cases heard in counties sympathetic to their claims.

For Ulbrich, any legislative action may come too late to reverse his decision to quit providing obstetrics.

"Everybody's blaming each other. From our standpoint what we see is patients are being hurt because we can no longer provide a service," Ulbrich said. "We're not blaming insurance companies, we're not blaming trial attorneys. We're saying this is a problem. All of us have to sit down and come to an agreement on how to get a handle on this."