Malpractice crunch squeezes area doctors - Insurance company to drop two neurosurgeons

Olympia neurosurgeon Dr. Joseph Arguelles and a colleague are looking for new malpractice insurance after Doctors Insurance Group dropped them and many others in the state. Neurosurgery is one of the high-risk specialties for which some insurance companies are either dropping clients or raising rates.



Olympia, WA - Medical malpractice insurance problems have hit home for two Olympia neurosurgeons who will lose their current liability coverage effective Aug. 15.
Drs. Joseph Arguelles and Darin Smith are members of Neurosurgical Consultants of Washington, a 10-physician group recently notified by The Doctors Group -- a California insurance company founded by physicians -- that their policies would be canceled.

The cancellation notice sent the doctors scrambling to find a new insurance carrier and created a problem for Providence St. Peter Hospital, where Arguelles was on call last weekend.

"Any new work that I do now -- because of technicalities -- might not be covered by current medical malpractice insurance," Arguelles explained.

Hospital administrators made arrangements to cover Arguelles temporarily to protect against any potential future claims growing out of his work at the hospital. Federal regulations prevent that from becoming a long-term solution, but Arguelles is confident he will find another company willing to insure him before his current policy expires.

"In the event we're not able to get insurance, essentially we would be out of business," Arguelles said.

Emergency room physicians, neurosurgeons, obstetricians and orthopedic surgeons are at the top of a growing list of specialties that medical malpractice carriers are reluctant to cover.

"It currently is affecting certain specialties more than others because of the nature of their practice, which is one more proof that it's not just bad doctors out there," said Dr. Cynthia Wolfe, chief of staff and emergency room director at Capital Medical Center, where Dr. Smith is on staff.

Physicians who treat the highest risk, most acutely ill or injured patients pay higher medical malpractice liability rates and have difficulty finding insurance carriers who will cover them, Wolfe said.

The loss of these highly skilled doctors would hurt the quality of health care available locally and endanger the lives of critically ill and injured patients who have to be transferred to out-of-town facilities to be treated, she said.

Chilling effect

The effect of having fewer doctors willing to practice high-risk specialties will begin to be felt even among people for whom access to health care has not been a problem.

Tom Curry, Washington State Medical Association chief executive, said more obstetrics and gynecology specialists are deciding not to deliver babies.

He predicts 25 percent fewer South Sound doctors will be practicing the specialty a year from now.

"The problem is the tort law system and the rapidly sky- rocketing cost of suits and settlements," Curry said.

"You get sued for bad outcomes, even when you do everything right."

The average cost of malpractice insurance this year for each physician in his group was $50,000, Arguelles said. Next year it will be $80,000, he said.

Rising malpractice insurance costs cause some doctors to change their practices or flee the state. The added costs can also reduce the number of Medicaid and Medicare patients doctors can afford to treat, Arguelles explained.

Most physicians went into medicine to help people, and they don't like to worry about the business end of medicine, he said.

But doctors are learning that they have to watch the bottom line to keep their practices afloat, and government reimbursement rates often don't cover treatment costs.

"I think we are indeed experiencing a crisis in the availability of health care," Arguelles said.

Petitioning politicians

The general public is not fully aware of the problem and politicians are unwilling to deal with it, he said.

Arguelles said members of his group tried "rather zealously" to speak with Gov. Gary Locke and U.S. Sen. Maria Cantwell. They couldn't get an audience, he said.

"I think, in many ways, the severity of the situation is just not being dealt with," Arguelles said. "Part of the problem is physicians are working very hard to make sure the problem doesn't result in negative impacts for patients. Between here and Seattle, physicians are working double and triple shifts to keep emergency rooms covered."

Wolfe, Curry and Scott Bond, Providence St. Peter Hospital chief executive, also laid the crisis in health care at the door of politicians.

"The only solution to the current crisis is major overhaul of medical liability," Wolfe said. "All we asked for this year was something that was (a) proven to work and (b) only put caps on pain and suffering (awards)."

Several bills calling for caps on noneconomic damage awards were introduced this session but none passed both chambers of the state Legislature.

"We don't understand why the governor and the speaker of the House won't step up to these issues," Curry said "We will continue to seek a special session on this."

It is unlikely that advocates for tort changes will get lawmakers to act this year, but Bond said the problem with medical malpractice insurance "clearly points to the need for tort reform."

Arguelles said tort changes might not be the whole answer to rising health care costs, but it is a good place to start.

"I know that sticking your head in the sand is not the answer," he said.


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