Some Maryland doctors say they welcome as a good start the hastily negotiated legislation passed by the General Assembly last week to rein in malpractice premiums, but they warned that more far-reaching legal reforms would be required to solve an insurance crisis that threatens some physicians' practices.
The bill would slash doctors' malpractice premiums, which are scheduled to increase 33 percent this year, and impose a tax on HMOs to subsidize premiums.
Even though Democrats promise to override an expected veto by Gov. Robert L. Ehrlich Jr., who opposes the tax, some doctors say they will continue to press for more measures to limit lawyers' fees and lower limits on awards for pain and suffering.
Ehrlich called the special session, which was held last week.
"This is a start, at best. There are many more things that can be done," said Dr. Mark E. Artusio, a surgeon with Foris Surgical Group in Frederick, which had decided to suspend its practice as of yesterday unless malpractice reform was passed.
Artusio said the surgeons would meet soon to decide whether the action taken by the legislature was enough to warrant keeping the office open.
"The last thing we want to do is to go out of practice," said Artusio, who would save $15,000 as a result of the legislation. But he added that "we have to stand by our principles."
Doctors who have been lobbying for malpractice reform say the legislation doesn't sufficiently protect them from lawsuits they see as unjustified. They say it provides a stopgap solution to rate increases that is likely to unravel over the course of several years and leave doctors in the same position they are in now.
"I can't stop until the problem is rectified. It will take a long time. You can't solve a problem overnight when the problem has been brewing for years," said Dr. Carol Ritter, a Towson obstetrician and gynecologist who stopped delivering babies because of lawsuits that sent her malpractice premiums skyrocketing. "It's a first step to me."
The Maryland Hospital Association and MedChi, the state medical society, said they expect to announce their positions on the legislation Tuesday, after they have had time to review the bill with their members and decision-making bodies.
The legislation would limit increases in the malpractice premiums paid by most Maryland doctors to 5 percent this year instead of the scheduled 33 percent.
The stabilization fund, which would be created by imposing a 2 percent tax on health maintenance organizations, would subsidize premiums over the next several years.
The legislation would also freeze the current limit of $650,000 on awards for pain and suffering and eliminate an annual inflation adjustment. In cases of death, the limit would be cut in half, to $812,500.
It would also establish qualifications for expert witnesses in lawsuits against doctors, allow doctors to apologize to patients without having such apologies used against them in lawsuits and create a People's Insurance Counsel that would review malpractice insurance rate increases of 10 percent or more.
Dennis O'Brien, spokesman for the Maryland Trial Lawyers Association, called the bill a good compromise that "solves the problem."
Randall R. Bovbjerg, a researcher at the Urban Institute who follows malpractice issues, said the legislators did their job.
"Doctors got a lot, but they didn't get everything they wanted," Bovbjerg said. "The biggest single thing doctors want is a cap, but doctors want a very low cap."
Doctors say they like the more stringent standards for expert witnesses, which they say would ensure that a witness was qualified to testify in the area of practice in which the doctor was being sued.
They also like the provision that would allow them to freely express regret without fear that an apology would be used against them.
"It's important to be able to express your own emotions to a patient," said Dr. Karl P. Riggle, a Hagerstown surgeon and leader of the Save Our Doctors Protect Our Patients Coalition. "If something goes less than perfect, if somebody unfortunately dies, I feel emotional about it. I want to be able to express how I feel."
Doctors say that they appreciate the help with premiums but that the stabilization fund would pass the cost of premiums on to the public and wouldn't solve the long-term problem. More reforms to limit damage awards and legal fees are needed, they say. And locking in the limit on awards for pain and suffering at $650,000 doesn't go far enough, some said.
'Big bunch of money'
"Any limit that is over $500,000 is ineffective," Ritter said. "It's still a big bunch of money for people to go after."
Others said the legislation doesn't address high contingency fees, which are paid to lawyers only if they win a monetary award or settlement.
"Right now, lawyers gobble up 60 percent to 70 percent," said Dr. Max Wingerd, a surgeon with Foris Surgical.
O'Brien said there is no evidence that limits on damage awards lower insurance rates. He also said that without contingency fees, many people who suffered injuries because of doctors' mistakes could not afford to hire lawyers to pursue their claims.
Wingerd and other doctors say they think they have raised public awareness and won the attention of the state's political leaders. But their future, they say, remains unsettled.
"We are in limbo," said Wingerd, who doesn't know the fate of his practice. "Right now, we don't know what's going to happen."