Legislature takes another stab at medical issues
TARA WESTREICHER Star-Tribune staff writer | Posted: Sunday, July 11, 2004 12:00 am
Sen. Charlie Scott, a long-time advocate for medical malpractice reform, isn't optimistic about the week ahead.
"I don't think we're gonna get it fixed this time," the Casper Republican says.
Optimistic or not, Scott and his fellow lawmakers will return to Cheyenne this week, in hope of agreeing on what to do about high medical malpractice insurance rates. This week's special session reopens an issue on which the Wyoming State Legislature already has voted this year.
In this winter's budget session, both houses narrowly rejected attempts to put a $250,000 cap on noneconomic - or "pain and suffering" - damages in medical lawsuits. But the situation is a little different this time.
What has changed is that the Ohio Health Insurance Co. (OHIC), which was the state's largest provider of malpractice insurance, has said it will pull out of the state.
Company spokesmen say the reasons are unrelated to Wyoming's lack of tort reform or caps on damages. But doctors and many legislators say OHIC's withdrawal means malpractice coverage may become unaffordable to many health-care providers -- or worse, unattainable.
Without such insurance, a medical practice is an impossibility.
"My insurance will lapse as of December of this year," said Dr. Steven A. Orcutt, an orthopedic surgeon in Casper who is insured by OHIC. "OHIC may even go bankrupt before that … and nobody has guaranteed to insure me after the end of this year. If I can't insure myself, I can't practice in the state - I'm leaving."
Scott says most of the meaningful changes proposed for addressing medical tort reform were voted down during "supercommittee" meetings conducted before the session even begins.
Unless some of those initiatives are revived, Scott cautions that the Legislature merely will be taking another swing at starting the constitutional process that could lead to damage caps.
Scott points out that only Wyoming and Arizona have the constitutional right to recover unlimited damages in cases of injury or death.
"We have this unusual provision in our constitution that forbids any limits on damages," he said. "I've been unable to find any other state that does, so it's not a right that's widely held by Americans - it's a particular thing in Wyoming."
How many doctors the state has lost because of the malpractice insurance situation and how many have come in to replace them can't really be quantified, said Scott.
While groups with a vested economic interest in the issue - doctors, lawyers, insurance companies and consumer groups - don't agree about the factors that have contributed to rising malpractice premiums and what should be done to moderate them, there is more universal accord about this much: Caps on damages alone are unlikely to fix the problem.
Studies suggest states that have enacted packages of tort reforms in addition to caps on "pain and suffering" damages have done better in controlling rising malpractice premiums than those which have not.
But determining which mix of reforms works best is difficult, the Congressional Budget Office stated in a study released in June.
Indeed, officials in states such as Wisconsin and California that have seen lower malpractice rates in recent years credit reform packages for their successes, including such measures as statewide risk pools, prohibitions on unfair insurance increases, limiting attorneys' fees and caps on noneconomic damages.
In Texas, where changes were limited to a $250,000 cap on noneconomic damages, the reduction in malpractice insurance rates has been modest. In May, according to the American Medical Association, the Texas Medical Liability Trust had dropped its rates 12 percent, although other companies had not followed suit. The trust insures one-third of the 39,900 physicians who practice in Texas.
Of course, Wyoming is not Texas, and many physicians would never entertain an offer to practice in Wyoming regardless of tort reform, opting instead for social amenities doctors often find desirable in more urbanized areas.
South Dakota, for example, reports some of the nation's lowest malpractice insurance premiums, but last spring it also reported a moderate shortage of physicians and an acute lack of nursing professionals. Clearly, low rates alone have worked no magic in the Mount Rushmore State.
Even so, the lure of other states with lower premiums can be powerful for Wyoming doctors.
Former Casper surgeon Brook Redd recently moved to Minnesota, in large measure, he explained, because of Minnesota's low malpractice insurance costs.
"I looked at getting out of medicine altogether," he said in an interview last year. Eventually, his thinking shifted to, "'We don't have to stay,'" Redd said.
He went to work for a multi-specialty, 18-physician clinic that paid $4,000 less last year for medical malpractice insurance for all its doctors than he paid here for himself, he said.
According to Scott, Minnesota medicine consists of large managed-care organizations, and there are fewer lawsuits. Those two factors combined are generally credited for the low malpractice insurance rates there.
As for Wyoming, it remains to be seen whether the Legislature's special session will result in legislation that will effectively reverse escalations in malpractice insurance rates.