The Rhode Island Medical Society’s drive for tort reforms it hopes would control the cost of medical malpractice insurance got a powerful boost last week with the formation of a large coalition including medical specialty groups, hospitals, insurers and Chambers of commerce.
The Patients First Coalition, which counts 60 members so far, is pushing for passage of a single comprehensive bill that wouldn’t impose caps on jury awards, as President Bush’s plan before Congress would do, but rather would bring Rhode Island in line with other states.
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Rhode Island tacks on 12 percent interest, for example, on jury awards, going back to when the doctor was notified of the plaintiff’s claim. With the average case taking 6.44 years from injury to award, that means a $250,000 award can easily cost over $400,000.
The coalition’s bill, which mirrors Gov. Donald L. Carcieri’s own proposal, would start interest later in the process, at 5 percent, and raise it to 8 percent once the plaintiff has shown the claim has merit. The bill also includes incentives to expedite cases.
The idea is that patients “deserve full, fair and fast compensation when injured,” the coalition says, and “a reasonable, rational adjustment” to the tort system would help ensure they get it.
Without tort reform, the coalition says, malpractice insurance rates are going to drive many doctors out of Rhode Island – there’s already a shortage, for example, of anesthesiologists – and cash-strapped hospitals will be choked by their premiums.
“We must preserve access to care for Rhode Island’s citizens,” said Arthur J. Sampson, president of Newport Hospital and chairman of the Hospital Association of Rhode Island. “The medical liability is not an isolated problem to be addressed solely by the health care industry. It affects everyone, and the time for action is now.”
The message is not new: Doctors have been sounding the alarm for over two years, and hospital officials have testified on their behalf at the General Assembly. But while doctors are quick to speak out about their spiraling premiums, hospitals have been more guarded. Even now it’s unclear how candid the self-insured institutions – the Lifespan family, and Care New England – are willing to be to support the reform drive.
At an event Tuesday to unveil Patients First, the emcee was Dr. Kathleen C. Hittner, president and CEO of Miriam Hospital, which is covered by Lifespan’s insurance captive. But the spokesman for hospitals’ plight was Louis Giancola, president and CEO of South County Hospital, one of the few institutions still relying entirely on a commercial insurer.
When he arrived at South County four years ago, Giancola said, the hospital’s premiums were about $200,000. “This year we’re going to pay close to $1.5 million – same coverage, with lower limits and a deductible,” he said. South County’s annual budget is about $75 million.
“We’ve had losses in three of the last four years, and this has certainly contributed to that,” Giancola said. “It does not give us much latitude.” The hospital has also had to help two ob/gyns get insurance so they could continue working, he said, and it helped start a general surgery practice “because it would probably be impossible” to make it happen otherwise.
Edward J. Quinlan, president of the hospital association, said overall, hospitals’ malpractice coverage costs have risen 286 percent since 2002 – including the self-insured institutions.
That’s actually a bigger hit than doctors have taken: NORCAL, the state’s largest malpractice insurer, offers an average premium for a nonsurgical internal medicine doctor that rose from about $4,700 in 2002 to $13,600 – 189 percent – due to rate hikes and reduced discounts, said Robert A. Anderson Jr., director of the RIMS Insurance Brokerage Corp.
As of Tuesday, neither NORCAL nor ProSelect, the two commercial carriers still doing business in Rhode Island, had signed on to the coalition, though NORCAL has helped the Medical Society all along. The Medical Malpractice Joint Underwriting Association, the state’s malpractice insurer of last resort, had signed on.
More strikingly, both UnitedHealthcare of New England and Blue Cross & Blue Shield of Rhode Island are onboard. Blue Cross spokesman Scott A. Fraser said the insurer has testified before in support of the doctors’ effort, because curbing malpractice insurance costs would help reduce the financial pressures on the health care system.
“It seems to be one way to help deal with the problem of (health) premium increases,” he said.
But can Patients First make a big enough difference to overcome the massive opposition the doctors’ effort has faced in the General Assembly? Last year, the RIMS bill didn’t even make it out of the House Judiciary Committee.
Steven DeToy, head of government affairs for RIMS, is hopeful. The new coalition is the culmination of two years of raising awareness, he said, and now the trial bar and consumer groups, who’d been “in denial for the last two years,” have put in their own bill, ensuring that malpractice reform will be a major topic of discussion.
The climate is also enhanced by President Bush’s focus on tort reform and the extensive press coverage the topic has been getting, DeToy said. And a recent SHAPE Foundation study showing potential doctor shortages, he added, “bolstered our argument tremendously.”
The Patients First Coalition has set up a Web site, www.patientsfirst coalition.org.
