Loss of malpractice insurance jeopardizes local care

Published 9:00 pm Saturday, December 13, 2003

It should have come as a bigger shock over Thanksgiving when I learned that, after 10 years as an emergency department physician, my group’s malpractice insurance was being canceled, in just 60 days. Don’t take it personally, the insurance company advised, it’s happening to all the doctors we once covered. Unlike home owner insurance coverage, which is often canceled after submitting a claim, emergency doctors are being canceled who have never been named in a malpractice suit and have never had a claim.

In just the past month, every emergency doctor in Providence’s three major hospitals in western Washington received similar news. That’s bigger than just another one-day headline from the modern-day saga of health-care economics.

Providence Everett Medical Center is committed to keeping the emergency room open and is looking for options for insurance coverage, because our community cannot see emergency care just go away. What is needed is a long-term solution. What we have is a health-care tragedy waiting to happen. The malpractice insurance companies are telling physicians that doctors cannot pay them enough to eliminate the risks that they expose themselves to by insuring Washington state doctors.

If unresolved for physicians like me, it means we will have to give up our practices, or move somewhere we can become insured — another state or physician group where things may be better for a while. I know several Emergency Department physicians who work in other states so they will be licensed and ready to move elsewhere in the face of news like we’re just now receiving. It actually costs these physicians less to travel and practice in Nevada or California than to practice in Washington and pay for liability coverage here.

Indeed, many physicians who practice in higher-risk fields of medicine are getting the same notice as I did, such as obstetricians, orthopedic experts and neurosurgeons. As insurance rates have risen, many orthopedic doctors can no longer afford to treat patients with the lowest reimbursements, usually those on Medicare or Medicaid. Many of these patients are then forced into public hospitals like Harborview, which is already stretched very thin. Also, you may be familiar with the fact that 10 neurosurgeons serving Seattle hospitals lost their malpractice coverage in the summer of 2003. This led to several of these doctors leaving Seattle to practice in other areas where malpractice coverage was obtainable.

But this really isn’t about doctors. It’s an even bigger crisis for the community. It’s about access to care.

Our emergency department in Everett is the busiest in the state. We’ll treat approximately 97,000 patients before this year is out. That’s even more than Harborview in Seattle.

Clearly some of these patients shouldn’t be coming through our department for their services, but that’s where many uninsured people end up these days. Many wait too long to make appointments, only to have their conditions worsen, requiring weekend or late-night emergency care. Emergency departments are the safety valve insuring quality care when your doctor is unavailable or when no one will accept you as a patient.

But let’s face it: emergencies don’t play favorites among rich or poor. Anyone driving on I-5 could easily end up in the Providence hospitals in Centralia, Olympia or Everett. We all expect prompt response by paramedics and excellent care in the closest emergency department. This insurance crisis will put this health-care security at risk.

It would be easy to cast blame for this crisis on the insurance company that is withdrawing from the Washington market. The company has decided there’s too much business risk if it continues to write malpractice insurance policies in the state. There are too many malpractice lawsuits that end in judgments and legal fees that are way out of proportion to the loss involved in the case. Washington differs from other states in that Washington has no cap on damages that patients receive as a result of a judgment in a lawsuit.

We’re not talking about restricting the right to sue when something does go wrong, just putting realistic limits on non-economic losses. With no limits on what a jury can rule in Washington, it’s no surprise that medical malpractice insurance companies are racing for the exits.

No, the problem is with the law. It’s time that our Legislature takes a hard look at this. A public policy decision needs to be made as to which has a higher priority in our communities.

Is it massive settlements for the few who are harmed and their lawyers? Or the opportunity for everyone to receive the expert care they deserve from emergency rooms, birthing centers or orthopedic surgery?

Medicine is not perfect and, yes, mistakes are occasionally made. But this malpractice insurance crisis is not about the quality of care. Our emergency physician group provides outstanding care. National insurance data show that our group is actually very desirable and the type of group that medical malpractice companies ideally want to cover. Despite this fact, they will not cover Washington physicians.

There is a decision that the people need to make about what they want from health care. The lines are drawn. My sense is more people want their care provided by nearby, qualified physicians and medical staff that they know and trust.

Dr. Jeff Wajda is medical director for the Emergency Department at Providence Everett Medical Center.