Medicine has always been a highly demanding profession. But in recent years, a number of factors have combined to make the demands more severe, and they’re putting an unacceptable squeeze on patient access.
Federal Medicare reimbursements for doctors in this state are far below the national average. The situation is worse in Snohomish County, where reimbursements are 7 percent lower than in King County, making it even harder to recruit top physicians here. In fact, Snohomish County has just 1.1 doctors per 1,000 residents, compared with 2.3 for King County and 2.6 nationally.
Making things worse, much worse, is the soaring cost of medical malpractice insurance, which doctors have put on the top of their policy agenda this year. Rates have skyrocketed in higher-risk specialties like obstetrics, neurosurgery and emergency care.
Emergency room physicians at Providence Everett Medical Center saw their rates increase by 70 percent this year, even though their claims history is excellent. They and emergency physicians at Valley General Hospital in Monroe were notified late last year that their insurance will be dropped as of April 1, forcing the hospitals to self-insure.
The Washington State Medical Association insists that runaway jury awards in malpractice cases are at the root of the problem, and wants the Legislature to approve monetary caps for non-economic damages — usually referred to as pain and suffering. Placing caps on claims will make insurance risk more predictable, doctors argue, and help stabilize rates. Doctors have long said that the threat of big-money lawsuits forces wasteful "defensive medicine," where unnecessary tests are ordered.
Doctors say they’ll work to unseat legislators who don’t go along with their tort reform agenda, and the Washington State Trial Lawyers Association is fighting them, arguing that the spike in rates was caused by insurance company losses in the stock market in recent years. It’s part of a regular industry cycle, they say, and will ease as the stock market recovers.
We doubt it’s that simple. If it were only about gouging doctors to recover investment losses, insurers wouldn’t be pulling out of the state altogether. The threat of big jury awards appears to have had some effect on the rate hikes, and putting reasonable limits on payouts should be on the table.
It almost certainly won’t happen this year, though. Capping jury awards requires a constitutional amendment, meaning a two-thirds majority in the Legislature, followed by a public vote. The Republican-controlled Senate, where doctors get a more sympathetic audience, approved a $350,000 cap recently, but only by a 27-22 vote. The Democratic-controlled House isn’t likely to pass caps at all. Legitimate questions linger over the fairness of caps to patients who suffer from the most extreme examples of malpractice. Still, it’s easy to argue that the lack of limits on jury awards is putting the availability of care for everyone at risk.
The threat to patient access is too grave to allow the disagreement over caps to kill any progress. Other ideas could help, from allowing binding arbitration in malpractice cases to setting up a judicial panel to screen malpractice claims, then making plaintiffs responsible for defense costs if they pursue a case despite negative findings and lose.
Physicians, too, must take greater responsibility, making improvements to patient safety and applying firm discipline to doctors who have a pattern of malpractice judgments or settlements.
Twelve obstetrics practices in Everett closed last year because insurance premiums were unaffordable. That’s a frightening trend. And the unavailability of round-the-clock emergency neurosurgery means people will die unnecessarily.
This is a big, multi-faceted problem that can only be fixed one step at a time. It isn’t acceptable for lawmakers simply to throw up their hands and give up because they’re stuck on caps. The health of the community is at stake. Lawmakers must stay at the table until solutions are found.
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