The American Medical Association has designated Rhode Island as medical liability “crisis” state, citing a “deteriorating” legal climate and a “growing threat of patients losing access to care.” Rhode Island joins 19 other states, including Massachusetts and Connecticut.
“Patients bear the brunt of the nation’s broken medical liability system,” said Dr. William G. Plested, an AMA trustee and former president who visited Providence on Monday. “The cost of unrestrained litigation not only jeopardizes patients’ access to physicians, hospitals and clinics, but also inflates the cost of medical services.”
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The AMA classifies states as “OK,” “showing problem signs” or “in crisis” on the basis of three major factors, Plested said: how fast medical malpractice insurance premiums are rising, whether doctors say the costs are pushing them to move or retire, and whether doctors say they are limiting the services they offer to avoid liability.
Since 2002, malpractice insurance costs have risen 286 percent for hospitals, 200 percent for general practitioners, and 175 percent for surgeons, the Rhode Island Medical Society says. And a RIMS survey of local doctors found 47 percent were considering moving or leaving clinical practice, 41 percent were considering no longer performing certain procedures, and 71 percent had found it hard to recruit new doctors.
The numbers make it clear, RIMS president Dr. Fredric V. Christian said: The state’s medical liability system is “in desperate need of reform.”
A RIMS-led group called the Patients First Coalition is promoting a bill – which has yet to be heard at the General Assembly – that it says would “stabilize” the market, which has lost several carriers and is described by those who remain as a difficult place to operate.
The coalition’s proposal and an identical measure sponsored by Governor Donald L. Carcieri would lower the statute of limitations for minors (for injuries at birth, e.g.) from age 18, to 8; require plaintiffs to attach a “certificate of merit” with any suit showing an expert agrees the claim is “reasonable and meritorious”; allow pre-judgment interest to accrue only after a suit is filed – not when a notice of claim is given – and reduce the rate from 12 percent to 5 percent until the plaintiff has disclosed all his experts, then 8 percent thereafter.
But Marti Rosenberg, executive director of Ocean State Action, a consumer and health care advocacy group that is promoting a rival medical malpractice reform package, said the truth is that Rhode Island’s problem is not a broken tort system, but a broken insurance system.
“We need to pass comprehensive reform that holds the insurers accountable for the skyrocketing rates,” Rosenberg said, adding that her group would like to strengthen the state’s ability to hold down rates when insurers’ surpluses “soar,” and to “demand transparency in how the insurers calculate rates.”
As for the AMA’s “crisis” designation, Rosenberg said, “it’s political.” Nothing has changed to warrant an upgrade to “crisis” status, she said, but the AMA is now trying to enlist U.S. Senator Lincoln Chafee’s support for President Bush’s “tort reform” plan.
Ironically, the Patients First package being touted at Monday’s event would only bring Rhode Island roughly in line with Massachusetts, designated as an AMA “crisis” state last year.
Yet more dramatic “tort reforms” are viewed as unsellable with Rhode Island legislators, so Patients First and its individual members always stress that they only want modest, “common-sense” changes that stop well short of MICRA-style caps.
Still, Plested urged local lawmakers to “look to proven remedies” to fix the medical liability system, citing MICRA and a “sweeping” reform in Texas in 2003 as examples. The Texas reforms, which included a $250,000 cap on non-economic damages, have already saved the state’s health care system about $50 million, he said.
Along with adding Rhode Island to the “crisis” list, the AMA on Monday took Texas off that list, reclassifying it as a state where “effective reforms” are “halting” a crisis.
A longer version of this story will appear in the PBN’s May 30 edition. An AMA “backgrounder” on Rhode Island is posted here.
