In the first concerted action by doctors in Maryland to force legislative reforms in the state's malpractice system, physicians in Hagerstown said last night that they will refuse to see patients -- except on an emergency basis -- beginning Nov. 15.
The action comes eight days after state insurance regulators approved a 33 percent increase in malpractice premiums for next year for the insurer that covers most of the state's doctors, adding to the heated debate over how to control insurance rates that doctors say will drive some out of practice or out of state.
On top of a 28 percent increase this year, it will push premiums as high as $150,000 for some doctors.
"I guess 'job action' is the right word for it," said Dr. Karl P. Riggle, a surgeon. "It's an effort on our part to make a statement."
He said "the vast majority of specialists" in the area had agreed to join in the action during the quarterly meeting of the medical staff of Washington County Hospital yesterday afternoon. Riggle said the action would continue until Dec. 1, when malpractice insurance premiums for next year are due; if the legislature doesn't act by then, the doctors would decide how to proceed after that.
"Walking, quitting, resigning, leaving, taking sabbaticals for six months -- we're going to put it all on the line," said Dr. John Caruso, a neurosurgeon.
The doctors' action is the latest salvo in a continuing battle over malpractice. This year's legislative session considered several possible reforms -- ranging from a lower limit on "pain and suffering" awards to mandatory mediation -- but none passed. In addition, the issue has been hotly debated in Congress, which has also been deadlocked, and in legislatures in other states.
The Western Maryland doctors' strategy met with stern disapproval from a key legislative leader. "The General Assembly is not going to respond to that kind of tactic," said Senate President Thomas V. Mike Miller, a Democrat who has opposed malpractice reform.
Call for special session
Miller repeated his call for a special session to create a state fund to freeze malpractice rates at their current level. That, Miller said, could stabilize rates and allow next year's regular session to consider other reforms being studied by a task force of senators and another named by Republican Gov. Robert L. Ehrlich Jr.
"The governor needs to spend some time in Annapolis and meet with me and with the [House] Speaker [Michael E. Busch]," Miller said. "We could solve this in a few hours."
Ehrlich spokesmen could not be reached last night. The governor has said that he is willing to support a stabilization fund, but only as part of a package that would change the way the court system deals with malpractice cases. He has blamed trial lawyers and lawmakers -- Miller, in particular -- for blocking reform.
Dennis O'Brien, a spokesman for the Maryland Trial Lawyers Association, said last night that other factors -- such as the Medical Mutual Liability Insurance Society of Maryland, the major insurer, seeking unnecessarily large reserves -- were contributing to the high premiums. As for the Hagerstown action, he said previous predictions of doctors leaving their practices had been incorrect, and "we'll believe it when we see it."
T. Michael Preston, executive director of MedChi, the state medical society, said last night that he was not aware of other groups of doctors considering actions similar to the one in Hagerstown, which he termed "a cry for help."
While he added that MedChi "cannot encourage actions that might jeopardize patients' interests," Preston said doctors wanted a full package of reforms but would support stabilization if that were "the only thing that can be achieved at this time."
Washington County doctors have a track record of getting action by curtailing their services. In a 2002 dispute over reimbursement rates, doctors declined to be on call for the hospital's trauma center, shutting it for four months. The state created a fund to pay doctors for treating uninsured trauma patients.
Impact on patients
The doctors said they are not putting patients in jeopardy with their planned action.
"We're not going to not see someone and let them put their health at risk," said Dr. Jeffrey Jones, a cardiologist. "It's the elective stuff we're forgoing."
He said his group includes eight of the nine cardiologists in the county, and deciding to participate in the action was "a terrible, hard decision." The group, he said, had just invested in a new building and equipment. But, he said, "We need to take time away from the practice to focus on the crisis."
Caruso, the neurosurgeon, said threats of lawsuits were leading many in his specialty to avoid cases, such as those of trauma patients. He said that pushes some of those cases to academic medical centers, the hospitals tied to medical schools, where the institution pays malpractice premiums.
He said he favored a system of having medical experts review malpractice cases, similar to the one used in Indiana. "You can't expect juries to understand the nuances of a stroke," he said.
"It's not a matter of paying premiums," Caruso said. "It's the onus of having targets on our back."