Leaving the Delivery Business - Insurance costs drive away baby docs

BILL CRAIG, Skagit Valley Herald

Skagit Valley, WA - 5/21/02 - Half of the area’s obstetricians will stop delivering babies as a result of a sudden spike in malpractice insurance costs.

Five are getting out of the business, leaving six obstetricians to cover Skagit County.

“The deluge is about to hit us,” said Sedro-Woolley family practice physician Vanoy Smith, who Monday saw his first patient turned away by a Mount Vernon obstetrician.

“By July or August there are going to be a very large number of patients seeking care,” he said.

The American College of Obstetricians and Gynecologists last week called Washington one of nine “red alert” states where liability insurance is threatening the availability of physicians to deliver babies.

Malpractice insurance is one of the biggest costs for an obstetrician — ranging from $50,000 a year to $200,000 nationally. The costs took another hit when the second-largest insurance carrier in the state, Washington Casualty Group, pulled out of the medical liability market.

Insurance premiums for obstetricians increased 167 percent between 1982 and 1998, the physicians’ association reported earlier this month.

Premiums are expected to increase another 15 percent this year.

For doctors already squeezed by stable or declining revenues that don’t cover rising costs, the increase in malpractice premiums was the last straw.

“We’re paid less by the insurance companies,” said Dr. Nadine Burrington of the North Cascade Women’s Clinic in Mount Vernon. “It’s sad because it’s something that we’ve enjoyed doing for a number of years.”

She is getting out of the business along with her two partners, Drs. Robert and Barbara Pringle. The three will continue to conduct annual exams, Pap smears and other procedures.

But they won’t be delivering babies. They have delivered about 300 babies annually.

Other doctors may be able to deliver babies. But a lack of specialists, including those who specialize in performing Caesarean sections, puts the burden on other doctors, Smith said.

Smith said he had planned on discontinuing obstetrics altogether before finding out last week of the five doctors’ departure. Smith said he might have to dedicate a portion of his family practice for obstetrics.

Dr. John Knudsen, who practices obstetrics at the Mount Vernon Women’s Clinic, is staying in the business, at least for now.

“I’m not giving up on OB,” he said.

Knudsen is sympathetic to his colleagues who are finding it more cost-effective to stop delivering babies.

“You have to balance the cost of malpractice against income,” he said. “If he or she is a specialist in that field, it’s becoming unfeasible to do it anymore.”

Because the Department of Social and Health Services sets medical fees, consumers will not see doctors raising their prices, even though doctors are paying more in malpractice insurance, Knudsen said.

“This situation is going to worsen,” he said.

The hospitals in Mount Vernon and Sedro-Woolley are trying to recruit more obstetricians to fill the vacancies, said Ann Raish, an assistant administrator with Affiliated Health Services.

On Friday, Raish briefed the boards overseeing the two hospitals on the reduction in obstetricians.

“There is a crisis in Skagit County right now,” Raish said. “We are meeting with all the OB/GYN physicians to see if there are any actions we can take to assist them.”

Both physicians who deliver babies at the Anacortes hospital are remaining in the fields, according to Island Hospital spokesperson Dennis Richards.

For those struggling to get access to malpractice insurance, state regulators are trying to help by streamlining the application process.

State Insurance Commissioner Mike Kreidler announced a Market Assistance Plan that allows doctors, hospitals and clinics to file one application for a pool of insurance companies. The plan does not help pay premiums.

“It’s not a panacea,” said Sandi Peck, a representative of Kreidler’s office.

To truly address malpractice insurance problems will require limits on how much can be paid out through lawsuits, Peck said.

The Legislature addressed the issue in the mid-1980s, but the state Supreme Court ruled that caps on malpractice suit awards were unconstitutional, Peck said.

“We’re certainly concerned about that,” Peck said.

Taya Briley, the director of legal services and health policy with the Washington Association of Public Hospitals, said liability insurance premiums have doubled in some specialties.

“The state is really seeing an emerging crisis with liability and medical malpractice,” Briley said.

Because the state Supreme Court threw out limits on lawsuits, the answer for liability insurance ills could rest with congressional action. A bill before the U.S. House of Representatives called the Health Act of 2002 seeks to place caps on jury awards.

“If there was a federal cap on jury awards, that would help this state as well,” Briley said.


Obstetricians getting out ...
Dr. Nadine Burrington, Mount Vernon
Dr. Daniel Logen, Mount Vernon
Dr. Doug Madsen, Mount Vernon
Dr. Robert Pringle, Mount Vernon
Dr. Barbara Pringle, Mount Vernon


... and staying in
Dr. Daniel Bynum, Mount Vernon
Dr. Jan Delli-Bovi, Mount Vernon
Dr. Kathy Garde, Anacortes
Dr. William Hinderstein, Mount Vernon
Dr. John Knudsen, Mount Vernon
Dr. Robert Prins, Anacortes


Source: Affiliated Health Services list of doctors who specialize in obstetrics, interviews with doctors.


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