Missouri malpractice costs cheaper for some doctors

JEFFERSON CITY, Mo. -- For more than a year, Missouri doctors have been warning of a pending health care crisis because of steep rises in the cost of malpractice insurance. Doctors who cannot afford the coverage in Missouri, they say, will retire or move to some state where premiums are lower.

Illinois legislators are hearing the same dire predictions -- except that the medical society there suggests doctors might flee to Missouri.

"Attracting new physicians to Illinois is next to impossible," the Illinois Medical Society said in a letter circulated last month to Illinois legislators. "By locating in Wisconsin, Indiana, Iowa or Missouri, an OB/GYN can save $75,000 to $100,000 per year on malpractice costs."

In Illinois, medical malpractice premiums are highest in Chicago and the suburban St. Louis areas of Madison and St. Clair counties. The Illinois State Medical Society cited unnamed doctors in those counties moving across the Mississippi River to Missouri, where they can sometimes find lower costs.

Bruce Trickel, an O'Fallon, Ill.-based health care consultant, said he knew of a neurosurgeon who left Belleville, Ill., for Missouri and saw his malpractice premiums fall by about half.

"We pay considerably more (in malpractice premiums) than in St. Louis," said Trickel, whose job consists partly of recruiting doctors to southern Illinois.

Tom Holloway, lobbyist for the Missouri State Medical Association, was surprised at the assertion that doctors moving to Missouri could pay less for malpractice insurance.

"I can't imagine that. I don't know anybody that's come into Missouri," Holloway said. "We're losing (doctors). We're not gaining them."

According to Missouri's state Board of Healing Arts, the number of physicians practicing in the state fluctuates. From 13,889 practicing physicians in July 2003, the number fell by 266 in February 2004. But that is still 553 more than in August 2002.

Holloway said the 2 percent decline between July 2003 and February 2004 shows "we're clearly in a crisis here, and if we don't get relief, it's going to do nothing but get worse."

Missouri doctors are supporting Republican-backed legislation that revises the rules for filing and trying certain lawsuits, including those based on personal-injury claims, in state court. Physicians also are supporting a companion bill that would limit the annual growth in the cost of medical malpractice coverage.

"To the extent we're really bad, Illinois is even worse," said Missouri Rep. Richard Byrd, R-Kirkwood, who sponsored the two bills. "If you had to put it at a grade, we're at a D-minus-minus. They're at an F. Most of the doctors that are leaving are moving to states that are an A or a B."

Byrd said he would award and A or B to about 40 states, all of which have enacted lawsuit restrictions similar to what his bill would do in Missouri. That includes just about every neighboring state except Illinois, he said.

The U.S. Chamber of Commerce, in its recent annual survey of corporate attorneys' assessments of fairness in states' legal systems, ranked Missouri 41st in the nation -- just ahead of Arkansas and three spots ahead of Illinois. Neighboring Nebraska, Iowa and Kansas all ranked in the top 10.

Republican gubernatorial candidate Matt Blunt, who has made tort reform a key part of his standard campaign speech, cited the rankings as an explanation for how doctors could be coming to as well as leaving Missouri.

"I'm not necessarily particularly surprised to hear about that (Illinois letter)," said Blunt, the current secretary of state. "But unfortunately doctors are leaving Missouri to go to states that make it easier for a doctor to practice medicine."

The Republican plan has been approved by the House and now awaits Senate debate. Gov. Bob Holden, a Democrat, vetoed similar legislation last year. Holden said Friday he wants a bill tailored only to doctors, not to the broader issues including personal-injury lawsuits.

"The tort reform bill that came out of the House is far more expansive than just medical liability," Holden said. "If it encompasses all the other business community, I will veto it."

Blunt said he would "most definitely" sign the legislation, were he governor.

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Medical malpractice bills are HB1304-1305.

On the Net:

Missouri Legislature: http://www.moga.state.mo.us

Missouri State Medical Association: http://www.msma.org

Illinois State Medical Society: http://www.isms.org