Malpractice crisis compromises patient access.

Byline: John LeBow and John Allcott For The Register-Guard

Several recent Register-Guard pieces describe the medical malpractice crisis in Oregon. This crisis affects access - that is, seeing your doctor. We, the Lane Independent Primary Care Physicians, are 70 primary care physicians in the Eugene-Springfield area. Malpractice reform is very important to our ability to care for our patients.

In addition to caring for patients, we also manage our independent medical practices and employ several hundred people. When a prominent expense such as malpractice insurance escalates at a dizzying pace, the viability of our businesses is directly affected.

One explanation of the crisis that has been put forth is that insurance companies are in a financial crunch because they have lost so much money in the stock market in the past two years.

Fact: Northwest Physicians Mutual, one of two major companies still left in Oregon that will write medical malpractice insurance, has a policy dictating that no more than 15 percent of its entire portfolio be invested in stocks; the rest is distributed in very conservative investments.

The ability to pay off settlements is not impaired by the insurance company's business practices.

Premiums have approximately doubled since 1998. This crisis is occurring because settlements, unrestrained by any cap on payments, have outstripped the financial resources that insurance companies obtain from the premiums we pay.

Is it possible that physicians have become extraordinarily incompetent since 1999, when the Oregon Supreme Court (in Lakin vs. Senco Products) struck down the $500,000 cap on noneconomic damages? Two simple comparisons tell the tale.

Until 1998, there were less than 10 medical malpractice verdicts and settlements of $1 million or more in Oregon. From 1999 to today, there have been 25 verdicts and settlements exceeding $1 million. Insurance companies paid out $60.8 million in losses in 2001, compared with $15.1 million in 1998. Obviously, this is no coincidence. It's also quite apparent that insurance companies cannot continue to sustain losses of this magnitude and afford to stay in business.

Are there medical errors? Do patients deserve a method of compensation for these errors? Undeniably, yes. Although we continually strive to improve safe delivery of high-quality health care, the perfect human or the perfect system is not at hand. There will always be a need for a system to deal with the problems that are inherent to the delivery of medical care.

A recent article warned that if the current system is changed a patient could wind up unable to pay for basic medical needs and living expenses. This is simply not true. The caps we advocate are for noneconomic costs - for example, pain and suffering - and not for medical care. The projected costs of care for the injured patient in these settlements are carefully reviewed and protected. Moreover, in a system with caps there is always an appeal mechanism if patients feel that there is a gross discrepancy between the cap limit and their specific situation.

If losses continue at this pace, no company will be willing to write malpractice insurance, the rates will be unaffordable or both. Either development will compromise patient care by limiting the access to some specialties or, if insurance cannot be procured, make it impossible for a doctor to continue practicing.

This is where the crisis directly affects our relationship to patients. Seven of our LIPP doctors who deliver babies have stopped or will stop their obstetrical practice this year because they cannot obtain malpractice insurance at an affordable rate, if at all. Obviously, it will be nearly impossible to recruit high-quality physicians into the state because of the negative malpractice climate. We would wonder why our medical school would continue to train family doctors to deliver babies!

We encourage The Register-Guard to report further on the California Medical Injury Compensation Reform Act