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The Connecticut physicians are now beginning to feels the squeeze of high malpractice rates and a ceiling on fees. Many OB/GYNs have stopped delivering. The doctors will be offered and will have to accept deductibles for the first time. It should be noted that in legal malpractice insurance in California that deductibles are the norm as well as the costs of defending are included in the cap. The state's physicians are finally waking up to the fact that they need tort reform. To date about 11% of the state's OBs have dropped delivering. That should increase dramatically. I hope this is a wake up call to the remainder of states without tort reform to work for President Bush's national tort reform act put on hold by the Democrats.
In Florida, the BayCare Health System has decided to start an in-house self-insurance malpractice program. This will extend the current policy of covering the hospital based physicians to about 100 primary care and specialty physicians. The only requirement is that the physician be affiliated with a BayCare facility, have problems getting traditional insurance and provide a critical service to the community. I have no idea what a critical service means but it is probably a loophole so the system will not have to cover all. This also keeps the physicians from going without insurance, which is legal in Florida. The new policy will be a $250,000 per claim and $750,000 total policy.
Central Florida is also losing mammography services. About 15% of the centers will close soon due to high costs including malpractice insurance. The other side of the equation is that Medicare pays less than the cost to do a mammogram. The remaining units will be able to upgrade equipment.
Florida Governor Jeb Bush believes that malpractice premiums are pushing physicians out of state. He wants tort reform so more insurers will come into the state. The trial lawyers are getting nervous here as they have lost the battle in every other state except Pennsylvania. That battle continues and they may lose the war.
Ohio physicians may finally be winning a battle. It appears that the legislature will pass and the governor will sign a law with tort reform. This happened in 1999 but the Democratic controlled state Supreme Court overruled it. Now since the November elections there is a new Court. This one may allow the law to go through.
After the above was written the Ohio Senate passed a malpractice reform bill. This will cap non-economic damages at $500,000 and $750,000 for loss of limb or permanent disability. The measure passed on party lines with the Republicans for the physicians and the Democrats for the trial lawyers. The bill also puts percentages on attorney's fees and allows the notice of collateral sources of compensation.
In Pennsylvania the malpractice climate has continued to decline. It is so bad that Pennsylvania Medical Society is considering a recommendation that physicians voluntarily suspend their medical licenses under greater tort reform is passed. To date the only thing of significance is that the attorney can not switch venue as easily.
In two articles the same day in different newspapers, Pennsylvania Governor-elect Rendell stated that the malpractice problem in the state was one of his highest priorities. He is looking at four areas; (1) payment to providers (2) insurance business and investment practices (3) legal tort reform and (4) how providers police themselves. In another paper the trial lawyers accuse physicians of spreading misinformation. He states the physicians are not leaving the state and that the problem is with the insurance companies not the legal system. Could both be to blame?
In New Jersey, the Medical Society has been accused to conflict of interest in their push for malpractice reform. This is by a former official of the Society who was dismissed earlier this year. The conflict stems from the society's own malpractice company that is losing money in the current climate and the dual roles of the directors. The former deputy executive director of the state medical society is planning on filing a whistle blower suit stating he was fired in retaliation recommending steps to end the alleged conflict of interest. The trial attorney's love the suit for some reason. Of course, there may be validity to the charges.
North Carolina is beginning to have the malpractice crisis blues. The insurance premiums are up about 50% for neurosurgeons with an additional 20% next year. This translates to between 15%-20% of many physicians net income. The trial lawyers state that malpractice is up since doctors are making more mistakes. Top
The State of California Medicaid program has stopped payments to the two physicians in Redding, California who have been accused of doing unnecessary procedures. The Medical Board attempted to take away their license without due process and the court struck that down. Now, the Medicaid program is stopping payments and giving the doctors three weeks to wrap up existing cases. This is based on hearsay and innuendo without any hard data. The physicians will appeal the decision and hopefully win due to the lack of data or due process. The doctors may or may not be guilty but they do require evidence against them and due process. Top
The FBI has been busy little beavers in the health arena in the last few weeks. Several weeks after raiding a hospital and physician offices in Redding, California, they conducted a raid in Ohio. This time it was the lender National Century. They took away the books and computers. While the FBI hunts, so do creditors for missing millions of dollars. National Century now states it's insolvent and filed for Chapter 11. It owes $3.6 billion to bondholders and stated in its September 30 report that it had assets of the same amount. Wrong! It appears they moved money between accounts so people would think there was more than there was. They also loaned money unsecured which was against the deal with the bondholders. I think you spell this Enron. Top
Ohio has kept alive the hope for physicians to band together to negotiate fees with managed care companies. This is in spite of or because of a FTC warning that the action will be scrutinized. To date three states New Jersey, Texas and Washington have allowed independent physicians to collectively bargain. Top
In Colorado, the number of HMO patients has decreased. The capitated program lost 200,000 members or 12%. This has been replaced by PPO membership. This loss will affect the power of HMOs with providers. The loss of the HMO membership has led to greater profits for the insurers. It will mean greater consumer costs and greater consumer ability to choose their physician.
California Governor Davis has asked the Department of Managed Health Care to pass regulations requiring HMOs to notify subscribers when employers do not pay the premiums and they are dropped from the plan. Under current law the employers are supposed to tell the employees but on occasion "forget". This can lead to huge bills for people who are hospitalized believing they are insured, but are not.
The Sacramento, California physicians are leading the state in complaints to the Medical Board of California. The Board does not know why there is this increase in the area but thinks it may be from an increase in population. The CMA may have hit the reason, managed care requiring faster and more superficial care. Sacramento id the most highly managed area in the state. Top
For all those who recommend computers as the greatest thing since sliced bread, Beth Israel Deaconess Medical Center in Boston is a reminder that maybe it isn't. The system there went down for 3 1/2 days in one week. This led to blocking of patient records, prescriptions and lab test results. They had to revert to all paper and needed an emergency run to Staples to buy copier paper on the COO's credit card. The ED shut down except for life threatening emergencies and lab tests took up to twelve hours instead of minutes. Cisco was called in to help in the emergency and they warn all hospitals to update their systems now and not later. The week following the crash the Harvard affiliated hospital came out with their financial report showing it cut its losses in half over the past year. The hospital is being overseen by the States Attorney General. Most of the loss improvement came from sale of real estate. Maybe they should have invested in a better grade of paper. Top
The city of Sebastopol, California has passed a resolution that requires the Sebastopol police not to inform the DEA of any medical marijuana cases. Under guidelines of thee county, patients or caregivers can grow up to 99 marijuana plants per year in an area less than 100 square feet. The police must adhere to the resolution. Top
Trauma
The Florida trauma system continues in disarray. Several of the Level I centers are in financial trouble. Shands Jacksonville is $200 million in the red and Lee in the southwestern part of the state may close down due to lack of financial support. There are only 20 centers in the state and the closure of Lee would leave a huge mileage gap between units. Most of the centers with no local tax support are floundering. Without the tax support, physicians may not get paid for the uncompensated care and drop off the trauma rosters. This will lead to avoidable deaths. Top
California has nursing ratios but not enough nurses to fulfill the ratio. There is a way to solve the problem and congratulations go to Good Samaritan Hospital of San Jose for solving the problem. They have seen their volume decrease 20% last year and 33% in the women's services. This means there are too many nurses and some can be laid off to start on the low rung on another hospitals staff or take another job description. What will happen next year as the ratios take effect is either the recruitment of more nurses that don't exist or the decrease in services to meet the ratios. Top
DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.