Malpractice hearing details rising costs

JEFFERSON CITY, Mo. -- The rising cost of medical malpractice insurance could force some physicians to cut back their services or move out of Missouri, doctors said Wednesday.

Several physicians in high-risk specialties testified at a hearing hosted by the state Insurance Department, which is seeking to determine the cause of the increases as well as a potential solution.

Gov. Bob Holden requested the hearing after a recent Insurance Department report showed that malpractice insurance premiums have risen significantly while the number of claims in Missouri has declined.

"We want an explanation of these rate increases," Holden said at the start of the hearing attended by more than 100 people, including many doctors.

"We must get to the bottom of this problem, because in the end, when insurance rates go up for doctors, it hurts their ability to do their job, it hurts our state's health care system," Holden said, "and in the end, those costs are passed on to our patients."

A recent Missouri State Medical Association survey found that premiums often have doubled for doctors, especially for specialists in risky areas such as neurosurgeons, orthopedic surgeons and obstetrician-gynecologists.

Renewals stop

Dr. Gregory Walker, a neurosurgeon from Independence, said his previous medical malpractice insurer is no longer renewing policies. Walker said he paid $90,000 for liability insurance last year. But under a new policy, that could double. His alternatives are to quit performing some types of procedures or move his practice to neighboring Kansas, Walker said.

"Our situation is fairly typical for neurosurgeons," Walker said. "We are losing physicians and their services because medical liability insurance in our area is out of control."

Also testifying was Dr. Al Elbendary of St. Louis, a gynecological oncologist, who said he recently left a group practice because of the rising cost of malpractice insurance.

"Our concern is that with the current crisis, if not rapidly corrected, the entire medical system in Missouri will deteriorate," Elbendary said.

Statistics from the Insurance Department show that the number of settled malpractice claims against Missouri medical care providers fell from around 2,000 in 1988 to less than 1,300 in 2001.

Yet the average insurance payment per claim rose from less than $70,000 in 1998 to nearly $169,000 in 2001.

Brent Kabler, manager of the department's statistics section, said the increase in average claim payments appears to be attributable to three factors -- an increase in the severity of injuries to patients, higher average wages for workers and a general increase in health care costs.

Three companies, which together accounted for almost one-third of Missouri's malpractice insurance market, have either failed or decided to quit offering policies in the past year or so, said department spokesman Randy McConnell. That likely contributed to higher premiums for doctors, he said.

Insurers suggested the situation could be improved by imposing lower caps on damage awards for pain and suffering. In 1986, Missouri adopted a $350,000 limit on such damages, but that was indexed to inflation and has risen to $547,000.

Kathleen Pinkham, president of Healthcare First in Kansas City, suggested the state should adopt a California model with a limit of $250,000 without adjustments for inflation. Healthcare First is a malpractice program manager, working with physicians and insurance companies.