New York Medical Malpractice

As medical malpractice premiums for doctors keep skyrocketing, New York doctors are traveling to Albany to talk to governor David Patterson about reform. Malpractice premiums are driving many doctors out of the state to practice in other areas where the premiums aren’t as high.

As overhead and other costs soar, doctors say they need flexibility to negotiate fees with managed health-care organizations. Physicians also want more room for discussion with HMOs on issues of patient treatment and testing.

Doctors also contend colleagues are leaving New York in droves because of sky-high medical malpractice insurance premiums. The typical neurosurgeon in the state pays $300,000 a year, said Dr. Perel. Obstetrician-gynecologists on Staten Island can pay upwards of $200,000 annually.

"It’s important for the Legislature to enact medical liability reform this year," said Assemblyman Lou Tobacco (R-South Shore), who, along with the borough’s elected officials in the Assembly and state Senate, met with the doctors. "We need to lower medical malpractice rates during these tough economic times to ensure that current doctors are able to afford practicing medicine here, while encouraging doctors who graduate from New York medical colleges to remain in the state."

If you are in need of a mammogram, chances are that you may have to wait quite a while to have one. A shortage of radiologists has lead to long wait times for women needing a routine mammogram, sometimes up to a year’s wait. Why so long?

Most radiologists don’t choose mammography as a subspecialty for a number of reasons — the repetitive nature of the job, narrow focus, the stress of missing a diagnosis — but two are cited most often: money loss and malpractice.

"Missed or delayed diagnosis of breast cancer remains the leading cause of medical malpractice litigation in the nation today, while at the same time reimbursement for mammographic examinations remains embarrassingly low,"  explains Dr. Leonard Berlin, chairman of the department of radiology at Rush North Shore Medical Center in Skokie, Ill., and Rush Medical College in Chicago.

Are medical malpractice rates in New York state and elsewhere driving doctors out of practice? Texas has recently implemented limits to medical malpractice lawsuit payouts, and doctors are flocking there seeking lower malpractice premiums.

The state medical board now is backlogged with applications from doctors seeking to practice in the state, with 2,500 applications pending at last count. The number of licenses issued jumped 30% in the last fiscal year, and there has been an overall increase of 18% since 2003, according to Donald Patrick, executive director of the Texas Medical Board, a neurosurgeon and lawyer. "Doctors are coming to Texas because they sense a friendlier malpractice climate," Patrick said.

According to many, the medical malpractice crisis in New York state is reaching fevered pitch. In today’s Staten Island Advance, Dr. Joseph DeSena Richmond writes a letter to the editor on the subject urging citizens of the state to write to their local representatives and ask them to help with with problem.

As with most issues, however, a clear illustration of the facts is often needed to prove a point. Sadly, the latest illustration involves one of our finest young OB/GYN physicians, someone with whom I have worked on countless occasions and who I and many others consider to be one of the best the OB/GYN world has to offer.

Unfortunately, because of the incredibly high malpractice insurance premiums he has been faced with over the last few years, he has made the difficult decision to drastically pare down his practice. As of January, 2009, Dr. Alex Giannakakos will no longer be practicing obstetrics, nor will he perform any more GYN surgeries, limiting his practice to office-based GYN and related procedures.

There is relief coming for doctors who are seeking a respite from the soaring medical malpractice rates in New York state. A press release on the New York state website declares “Governor Patterson announces one-year freeze on medical malpractice rates for physicians in New York state”. To read the full article, visit NY.gov.

Is defensive medicine becoming a real issue in New York state and elsewhere? Doctors across the country are becoming increasingly worried about being sued and therefore are practicing what many are calling “defensive medicine”, meaning they order a myriad of tests that may not even be needed just to rule out issues so that they do not come back down the road, even if that means ordering tests that are unneeded.

Doctors say they are in a difficult position because they want to protect themselves against legal vulnerabilities, and at the same time not over-prescribe expensive medical testing such as MRIs and CAT scans, which insurers monitor for unnecessary usage.

‘Sometimes we end up being in a position where we feel like we have to do things a little more defensively than would be ideal in the best of all possible worlds,’ said

Dr. [Michael] Rosenberg, the president of the Medical Society of the State of New York. ‘Where that comes in is the test that should be ordered every 12 months but is ordered every six months, or the antibiotic [prescribed even though] maybe you’d ideally wait a day and see if it is necessary.

Is there a solution to this problem? Or as our society becomes more and more litigious, will the problem worsen?

Many factors, one of them being medial malpractice insurance rates, are sending new doctors away from primary practice and towards specialties, leaving a shortage of primary physicians in this country. The National Association of Community Health Centers reports on the shortage, especially in rural areas, is leading us towards a medical crisis.

"This is the unfortunate reality of our health care system. It’s an example of how the market triumphs over public policy," said Dan Hawkins, the association’s senior vice president of programs and policy and one of the authors of the report. "Even if universal health care comes into play tomorrow, not everyone would have access to a health care provider."

Although many of these people are insured, 56 million Americans do not have a regular source of health care due to shortages of physicians in their communities, according to the online report. Hawkins said that this translates to poorer health outcomes and less coordinated care for this group.

The study estimates that, in order to provide services to these medically disenfranchised Americans as well as current patients, health centers will need up to 60,000 more primary care professionals, and up to 44,500 additional nurses.

A big issue for many doctors deciding on their field of practice out of medical school is how they are going to pay off their education debts. With primary physicians making far less than those in specialties, and with medical malpractice rates skyrocketing along with other debts, the decision for some is easy. What will it take to have more med students choose primary practice?

Following up last week’s news regarding the shuttering of the obstetrics ward at Long Island College Hospital in Brooklyn, the state of New York has decided to fight back. Wanting to close the ward due to rising medical malpractice premiums regarding obstetrics, the state claims the hospital must provide proof that other hospitals in the area can handle the patient load before they can do so. Will they be able to?

New York Methodist Hospital and Maimonides Medical Center told The Brooklyn Paper that their obstetrics departments are already operating at capacity.

“We are not in a position to accommodate a higher volume of maternity cases,” said Eileen Tynion, a spokeswoman for Maimonides, the Borough Park hospital that delivered 7,207 newborns, more than any other hospital in the state last year.

There’s also no room at the inn at Park Slope’s Methodist Hospital.

“We just expanded to meet demand and we are already at capacity,” said Lyn Hill, a spokeswoman for the hospital, which delivered more than 5,000 babies last year.

Local officials are stepping in to voice their opinions on the matter as well.

State Sen. Marty Connor (D–Brooklyn Heights), whose colleagues could force state hearings over the plan to close the birthing wing, called on Continuum to provide honest numbers.

“The service is too important to the community to allow it to close,” he said.

High medical malpractice premiums have forced a Brooklyn hospital to completely shutter their obstetrics ward, which currently staffs 350 people. Long Island College Hospital in the Cobble Hill section of Brooklyn has taken on roughly $170 million in debt with 33% of that coming from the obstetrics department which has higher malpractice premiums than most others.

In New York, doctors and hospitals pay malpractice insurance premiums that are among the costliest nationwide. Last year, following a 14% rate increase, Governor Spitzer charged a task force with investigating and addressing the state’s high medical malpractice costs. The group did not produce a final report, and earlier this month, instead of raising rates again, the state’s Superintendent of Insurance, Eric Dinallo, announced a delay in the setting of new rates to give lawmakers time to address the situation.

"The bottom line is, I’m not surprised that one major hospital that does a significant number of deliveries is discontinuing their obstetrics service," the executive director of the New York chapter of the American College of Obstetricians and Gynecologists, Donna Montalto, said. "That speaks volumes to the maternity crisis."

Many believe this move will send patients to competitor Beth Israel.

Many physicians, especially those in the field of obstetrics, are having to make huge career changing decisions in the last few months because of skyrocketing medical malpractice premiums. Doctors in the Lower Hudson Valley area of New York is being especially hard hit, and even more say they will change their practice if state lawmakers don’t intervene.

The silent, decades-long battle between doctors and their liability insurers reared its ugly head in recent months because of a proposed $50,000 surcharge on top of the more than $137,000 each OB/GYN must pay yearly.

As doctors wait to hear whether their costs will go up, they are forced to make tough decisions that may cost patients more or compromise safety, advocates say.

The massive proposed surcharge is not only driving a lot of New York doctors out of the practice of obstetrics, but making many flee the state as well. With the numbers rapidly declining, many doctors wonder what will be in store for the next generation.