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Friday, September 20, 2002 - Page updated at 12:00 AM

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Rising malpractice costs could pare patient care, medical group warns

Seattle Times staff reporter

The state's medical association says rising medical-malpractice premiums are forcing doctors to stop delivering babies and avoid providing care in emergency rooms, and it yesterday vowed to push for legislation to limit insurance costs and jury awards.

Already burdened by low reimbursements and increasing paperwork, doctors have now been hit with hefty premiums, said Tom Curry, executive director of the Washington State Medical Association (WSMA). "If this were the NFL, I'd throw a flag for piling on," said Curry.

Dr. Nancy Auer, vice president of medical affairs at Swedish Medical Center, agreed. The rise in premium costs is the "straw that is breaking the camel's back," she said.

The two spoke yesterday at the headquarters of the WSMA, which released a report on the impact of rising premiums on patient access to care.

At its annual meeting this weekend in Tacoma, the WSMA will consider an emergency resolution directing the group to throw its weight behind tort-reform legislation now in Congress. It will also push for state laws to control premium costs, reduce awards for pain and suffering, and pare lawyers' share of settlements and judgments, Curry said.

In a reprise of a fight that has surfaced off and on for several years, the state trial-lawyers association quickly criticized the doctors for addressing the wrong issues.

They should push for insurance reforms and do more to weed out "bad apples" and reduce medical errors, said Sue Evans of the Washington State Trial Lawyers Association. "You want to stop getting sued? Don't kill people! That's the easiest way to do it," said Evans.

Auer countered that the problem is not "bad doctors," but good doctors being sued when they have a bad outcome despite doing everything right. She said she believes state and hospital review processes now in place work well to control medical errors.

In 2001, according to the WSMA, there were seven verdicts or settlements in the state of more than $1 million — one over $16 million.

Over the past five years, premiums for family doctors not delivering babies and doing no surgery increased 29 percent, according to Physicians Insurance, which insures about 60 percent of the individual physicians in the state.

During the same period, premiums for obstetricians increased 39 percent.

While both sides wield statistics, they often conflict or are hard to verify, because settlements are often confidential and premium rates are proprietary.

Evans said there's no doubt that doctors were "being gouged" by insurance companies, but that's a problem that needs insurance-industry reform, not tort reform. "We have an insurance crisis — in all lines. Doctors are using the medical-malpractice issue to scare the public into trading their legal rights for access to health care," Evans said.

Evans said her group would lobby for insurance-system reform in the next legislative session. With majorities in both state houses up for grabs in the November election, observers say tort or insurance reform could well catch the attention of candidates.

In 1986, Washington passed a tort-reform bill whose most significant feature was a cap on awards for pain and suffering. The state Supreme Court threw out the cap in 1989, and later rulings undermined other provisions.

Now, rising premiums may force a "wholesale dropout" of doctors, Auer warned, of both specialists and family practitioners who deliver babies.

Dr. Preston Phillips, president of the Washington State Orthopedic Association, said specialists and family doctors are becoming increasingly reluctant to see patients in emergency rooms, because frequency of lawsuits has caused higher premiums. "This is just the tip of the iceberg," he said.

Compounding the problem, more and more patients are seeking care in those emergency rooms, said Dr. Cynthia Markus, president of the state chapter of the American College of Emergency Physicians, because family doctors have closed their doors or are not taking patients with state or federal insurance such as Medicaid and Medicare.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com.

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