Francis Covelli, MD, believes that Florida’s worsening medical liability crisis is jeopardizing Central Florida residents’ ability to get quality and timely healthcare.

"I’m afraid for my own healthcare," said Dr. Covelli, a Maitland internal medicine specialist. "We are going to have a significant physician shortage here if this trend continues. Who’s going to take care of me in five years?"

Dr. Covelli and his colleagues, even those who have never been sued, have seen their liability insurance rates increase 25% to 350% this year. OB/Gyn physicians are among the hardest hit, paying as much as $175,000 this year compared to $25,000 last year. Neurosurgeons, orthopedists, general and vascular surgeons are facing steep increases as well.

Approximately 350 of Florida Hospital’s 1,800 physicians are due to renew their medical liability policies by the end of 2002, and they expect similar increases. With only a few insurance carriers serving Florida (the others have pulled out), physicians have no choice but to pay the higher rates.

"We are seeing a number of physicians especially neurologists, OB/Gyns, orthopedists and vascular surgeons leaving Florida for other states with lower premiums. Or, they are choosing not to perform high-risk procedures or are retiring early," continued Covelli. "This leaves internists like myself with no one to refer our patients to for specialized care."

Indeed, the days of seeing a specialist within seven to 10 days are a thing of the past. Four to six months is now the norm for many specialty physicians. And if the number of available doctors continues to dwindle patients may also:

• Find certain specialty services unavailable (obstetrics, orthopedic surgery, neurosurgery, trauma services, etc.)
• Find fewer primary care physicians
• Have to travel long distances (possibly out of state) for specialty services
• See increased healthcare costs in health insurance and in physician and hospital charges
• Be unable to collect medical negligence awards if physicians suffering large adverse judgements declare bankruptcy

Locked doors and disappearing doctors

Physicians in Nevada recently gave Floridians a preview of what could lie ahead if the medical liability insurance crisis isn’t addressed. The state’s only high-level trauma center closed for 10 days including the busy Fourth of July weekend after all but one of the hospital’s 58 orthopedic physicians resigned over the high cost of liability insurance. This left a 10,000 square-mile area of southern Nevada, and parts of California, Utah and Arizona, without key trauma services.

Closer to home, a group of surgeons in Sanford quit for nearly a week in late July after they lost their liability insurance when their premiums tripled. This left one local hospital with just one general surgeon to cover all emergency surgeries until the group was able to find coverage.

In August, officials at Largo Medical Center announced they would close their maternity ward on December 1. The hospital lost its two obstetricians to significant increases in medical liability insurance. The physicians left 86 pregnant women for some, the next closest facility is up to an hour away.

And throughout the state, few physicians are taking new patients. Those who take them are being very selective as to whom they’ll accept.

Recruitment woes

Physician groups and hospitals are having trouble recruiting both specialty and primary care physicians to the state. In recent days, two out-of-state specialists who had tentatively accepted positions in Central Florida backed away, citing the medical liability insurance crisis. One was a neurosurgeon and the other a gastroenterologist, both needed in the community.

Additionally, hospitals are seeing a drop in the number of medical staff applications. Florida Hospital’s medical staff office received 136 applications in August this year compared to 191 at the same time last year.

John Saranko, MD, president of the Florida Academy of Family Physicians, knows that the crisis is not limited to specialists.

A letter from a local OB/GYN

August 2002

Dear Sirs/Madams:

I am an OB/Gyn practicing for 15 years in Orlando.

Unfortunately, as of September 1, 2002, I will have to give up my practice due to lack of affordable liability insurance. I deliver 20-30 patients per month. I am being forced to transfer my patients to a physician unknown to them.

In 2000, I paid $20,000 for a standard medical liability insurance policy. In 2001, this same policy cost me $36,500. In 2002, $47,500. My insurance company just stopped providing coverage in Florida, and has advised me that I will no longer be covered as of September 1, 2002.

(If I switch insurance companies, I will need to get)

Extended Reporting Tail coverage in case any suits are filed). For the next year, this is estimated at $95,000. A standard policy will cost another $80,000. In essence, if I want to continue to practice, I will need to pay $175,000 to cover me for the upcoming one-year period.

I think you can see why I’m forced to quit. I believe my patients, and Americans in general, deserve better.

I have always believed in America as a land of opportunity. I grew up a poor boy in New York City, studied hard to make something of myself and get away from the stereotype that "ghetto kid stays in the ghetto." I never thought I would someday have to give up everything I had worked so hard to accomplish, just because this country also allows a group of unscrupulous litigation attorneys to legally extort monies through threats of litigation (even when it is obvious that there has been no negligence).

I am aware of cases where there actually were injuries to patients, not necessarily due to negligence, which would require millions of dollars for lifetime care. Yet the attorneys, who say they want to protect the rights of people to get "adequate" compensation for their injuries, immediately try to settle for limits of liability – even though the full amount of the settlement will not be enough to cover the future costs to the injured. And, of course, from this amount the attorneys take 30 –40% plus fees and expenses!

I am glad that the Secretary of HHS has called for National Malpractice Legislation to protect access to and quality of healthcare. As an American, I am proud to see that something is being done – even if it is too late to keep me practicing.

Sincerely,

(The author of this letter has asked to remain anonymous.)