HOW IS IT that Maryland, home of Angelos, Saiontz, Kirk, Miles and 39 members of the Million Dollar Advocates Forum, which calls itself "the most prestigious group of trial lawyers in the United States," has avoided the malpractice-insurance blowup?
Decent government, smart doctors and responsible insurance executives.
To be more precise, Maryland owes its relatively favorable malpractice-insurance outcome to the fact that it has avoided, intentionally or not, imitating New Jersey.
New Jersey is one of a dozen states that the American Medical Association claims is in malpractice-coverage "crisis."
About half of New Jersey's doctors have lost their liability coverage since mid-2001, mainly because insurers have left the state or gotten out of the business altogether. Most obtain new coverage, but only at steep price increases.
In some cases, policies for high-risk specialties such as obstetrics and neurological surgery have reportedly reached $100,000 a year. Some docs are quitting their practices rather than pay the high premiums, although many are older and were close to retirement anyway.
Maryland is not tort utopia. Baltimore-region obstetricians pay as much as $65,000 a year for malpractice policies. But Maryland differs from New Jersey in three important ways.
First, Maryland has an effective cap on noneconomic damages, the payoff for "pain and suffering" that sympathetic juries sometimes inflate into multiple millions.
Compensation for medical bills, lost income and other economic damages is sensible and fine. But if even economists can't agree on the cost of pain and the value of joy, certainly juries shouldn't have unlimited license to bill insurers for these "hedonic" factors.
Second, Maryland courts reject malpractice awards if a patient contributes in any measure to the injury for which the doctor is being sued.
This "contributory negligence" bar is patently unfair and may be scrapped by the General Assembly this year. But it certainly blocks verdicts by turning a patient's failure to take medicine or schedule visits into a trump card for the defense.
The other, and maybe most important, way that Maryland differs from New Jersey in doctor-liability coverage is this: Maryland's doctor-owned malpractice insurer did not lose sight of its mission, did not issue stock to the public, did not peddle cheap policies in two dozen states, did not try to "establish itself as a national leader" and did not hire a president who grew marijuana in his attic.
When former Miix Group Inc. President Daniel Goldberg pleaded guilty to marijuana cultivation early last year, it might have been the low point for the company that started life in 1977 as the Medical Inter-Insurance Exchange of New Jersey. But it was just a pause on the way to the cessation of writing new policies this summer.
Miix was founded during a previous malpractice-coverage crisis as a doctor-controlled risk pool - a service organization, more or less, whose goals were solvency and stability.
But bad judgment, big egos and the lure of stock options worked their magic, and by 1999 Miix was trying to impress Wall Street by doing unprofitable business across the nation. The company lost $158 million last year.
By contrast, the Medical Mutual Liability Insurance Society of Maryland, created like Miix in the 1970s insurance drought, has retained its mutual, doctor-owned status, issues most of its policies in Maryland, has resisted chasing new business by cutting rates and gets an excellent, A-minus rating from A.M. Best.
Everything Miix did wrong, MedMutual did right. A few years ago, when carriers were trying to build market share with cut-rate policies. MedMutual looked expensive. Now, as the supply of malpractice coverage has dried up and prices have jumped, it looks reasonable.
Plenty of blame is flying for the current problems nationally, mostly in symmetrical, mutually exclusive fashion between docs and insurers on one side, and the plaintiffs' bar on the other. In truth, everybody scores points.
There are bad doctors who harm patients, who deserve compensation. There are undeserving plaintiffs. There are runaway juries. There are insurers taking advantage of the crisis to jack up rates, although, if malpractice coverage were such a terrific business, I doubt the St. Paul Cos. and all these other outfits would be bailing out.
The tort situation will shift again. Reform legislation is floating around Congress. States are mulling pain-and-suffering caps. Maryland could cheer trial lawyers by jettisoning the unfair contributory-negligence standard; if so it should even the score by rejecting the equally illogical "joint and several liability" rule, which allows plaintiffs to milk the defendant with the deepest pockets.
But whatever happens, you don't have to be a brain surgeon to know where to buy malpractice insurance in Maryland.