Towson obstetrician Carol Ritter spent two decades delivering babies, earning a reputation as one of Baltimore's top woman doctors.
Then she got sued three times in 10 months.
Now Ritter is one of Maryland's most visible physician activists. Like other physicians, she has testified at hearings and spoken at rallies. But she has also become the producer and central character of a documentary. Today she plans to be in Annapolis at the special legislative session on medical malpractice reform, where she expects the final shots of the documentary to be filmed.
"It took on a life of its own," Ritter said of her new role. "I never woke up one morning and said, 'This is what I'm going to do.' "
Ritter's gradual slide into activism began in October 2003, when the third suit was filed. Along with a 28 percent across-the-board increase in malpractice rates, she said, the loss of her "claims-free" discount meant her premiums would jump from $50,000 a year to $89,000 - a 78 percent increase. (Obstetricians have the highest malpractice premiums in Maryland.)
Ritter was dropped as a defendant from the first suit, which was dismissed. Trials in the other two suits, in which plaintiffs allege they suffered from lingering pain, are scheduled for next year.
In 1998, Ritter settled a fourth case in which the plaintiffs alleged the infant she delivered required some physical therapy; she said she believes she would have won in court. She agreed to settle because her insurance company at the time had just gone bankrupt and she was personally liable, Ritter said.
After the more recent rash of suits, Ritter decided to stop delivering babies, limiting her practice to gynecology. That would reduce her revenue, but cut her annual malpractice premium to $28,000. Her take-home pay would be about the same, meaning in effect that if she delivered babies, she'd be doing it for free, she said. "It was a business decision."
She began breaking the news to her patients. One suggested she attend a breakfast with lawmakers to tell her story, so they would understand the malpractice issue.
"It was the first time I spoke in public without notes," she recalled in a recent interview at her Towson office. "I just spoke from the heart. I talked about how I went through all these tissue boxes with my patients. The big line they liked was, 'Even my fourth-grade son can do the math.' "
She agreed to speak at a January rally at the State House sponsored by MedChi, the state medical society, and to appear in a MedChi commercial.
She spoke again at a press conference when Gov. Robert L. Ehrlich Jr. announced a task force to study malpractice reform. Two Towson legislators conducted a press conference at her office to announce their own proposal for malpractice reform.
She has been interviewed by CNN, appeared on the cover of Ob.Gyn. News and been featured as one of the best local women doctors in Baltimore magazine.
Along the way, as she attracted coverage, she began to cover herself via the documentary.
She decided the Annapolis rally should be documented. She contacted Steve Yeager, a local filmmaker who won the 1998 Filmmaker's Trophy at the Sundance Film Festival for his documentary about John Waters, Divine Trash.
"It was originally intended to be a little film about the rally," Yeager said. "As I got into it, I said, 'I think this is a bigger film, Carol.' "
The documentary is being largely financed by herself and about 200 doctors.
Yeager filmed some 35 hours of interviews with doctors, patients and trial lawyers. Yeager and Ritter color-coded the interview transcripts and constructed a script.
Yeager also shot other doctors delivering babies. He filmed Ritter on rounds at Greater Baltimore Medical Center.
"We're trying to structure this like a feature film," he said of the film, which will be 60 to 90 minutes long.
They hope to have the documentary ready for showing by the end of January, and are planning a showing at the Senator Theater. Then, Ritter hopes to have it shown on television - potentially on Maryland Public Television or one of the cable networks - and to send copies to elected officials.
Her life took another unexpected turn in June. She and her husband, a dentist, joined a church-sponsored medical mission to Honduras. Their 17-year-old daughter was part of a group of teenage helpers. They staffed a clinic in a small town, and she made house calls to homes with dirt floors.
"It was a refreshing, therapeutic experience - no file-keeping, no billing, no lawyers looking over your back," she said. "The helping-people part is what we get the rush out of. That saved me."
That trip, she said, ended her anger and frustration over the failure of malpractice reform efforts in the spring. She had thought that once she and other doctors explained the problem, government would act. "I had this naive sense that politics was rational," she said.
She still feels a sense of solidarity with other doctors working for reform. "I am an obstetrician," she said. "I have a skill to serve women. But I feel very restricted in Maryland."