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LAS VEGAS REVIEW-JOURNAL: NEWS: Medical Malpractice Insurance Crisis
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Many Southern Nevada doctors say soaring rate increases in medical malpractice insurance, some to $200,000 annually from $40,000, are forcing them to close their practices, retire early or double their patient load. Health officials are describing this as a medical crisis for the region. Keep up on the issue here.
News in 2002
May 14: LEGISLATIVE REVIEW: Tort reform studied
May 10: Guinn seeks temporary solutions to doctor crisis
May 09: Obstetricians encounter overload
May 08: Pregnant women scramble for options as obstetricians close doors
May 07: Pregnant women turned away
Apr 27: 75 doctors receive reprieve
Apr 24: OB/GYNs shedding ER duties
Apr 24: Lawmakers told crisis to get worse
Apr 20: Nearly 100 have applied to state liability group
Apr 17: Plan to list medical errors modified
Apr 16: Malpractice insurance applications slow to arrive
Apr 13: Doctors to learn their fate quickly
Apr 13: Doctors get new insurance option
Apr 07: Crisis alters lives, livelihoods
Apr 03: Insurance board members named
Mar 26: MEDICAL COVERAGE: State panel approves funding
Mar 26: Malpractice rates could jeopardize medical school
Mar 23: Poll of doctors gauges depth of medical crisis
Mar 22: Easy solution unseen in medical crisis
Mar 21: Trauma center faces new threat
Mar 17: LETTER: Lawyers must be part of the solution to local malpractice crisis
Mar 16: Doctors leaving, hospitals report
Mar 14: Guinn plan aims to stem doctor exodus
Mar 12: Trauma center to remain open
Mar 10: Guinn: State to offer malpractice coverage
Mar 05: MALPRACTICE INSURANCE: Hundreds crowd medical hearing
Mar 05: STEVE SEBELIUS: Malpractice rates have doctors leaving Las Vegas
Mar 04: Las Vegas surgeon subject of multiple lawsuits
Mar 04: Malpractice lawsuits feed insurance debate
Mar 03: Doctors' futures hinge on hearing
Mar 01: HEALTH INSURANCE: Squeezed physicians quit plans
Feb 28: Senators told about lack of specialists in elderly care
Feb 27: Lawmakers seek solution to medical malpractice crisis
Feb 20: MALPRACTICE RATES TAKE TOLL: UMC trauma center at risk
Feb 07: MALPRACTICE CRISIS: Trauma unit faces cuts
Feb 06: Rising malpractice insurance focus of March 4 hearing
Jan 31: Officials seek options to help doctors with insurance
Jan 31: MIDNIGHT DEADLINE: Hospital rate hike looms
Jan 30: Lawmakers seek legislative solutions to rising malpractice insurance
Jan 24: MALPRACTICE LAWSUITS: Guinn eyes cap on jury awards to avert crisis
Jan 24: EDITORIAL: Need for tort reform is critical
Jan 23: MEDICAL MALPRACTICE CRISIS: Insurance costs driving doctors away
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Medical Malpractice Crisis More Information
Las Vegas health care professionals stream into the lobby of the Sawyer Building on Monday. Photo by Clint Karlsen .
Dr. Bernadine Hanna joins hundreds of protesting medical professionals. Photo by Clint Karlsen .
Las Vegans Tim Beal and Lisa DeCarlo show support for Southern Nevada physicians Monday at the Sawyer Building. Photo by Clint Karlsen .
From left to right, Drs. Robert McBeath, John Nowins and Ikram Kahn are sworn in prior to testifying at the Nevada State Insurance Division's medical malpractice hearing Monday morning. Witness after witness testified at the hearing that skyrocketing malpractice rates are prompting some doctors to retire early, double their patient load, cut services or quit. Photo by Clint Karlsen .
Related Story:
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Tuesday, March 05, 2002
Copyright © Las Vegas Review-Journal
MALPRACTICE INSURANCE: Hundreds crowd medical hearing
Doctors, lawyers, insurance company officials plead cases
By JOELLE BABULA
REVIEW-JOURNAL
Hundreds of Las Vegas doctors attended a medical malpractice hearing Monday, the outcome of which could help determine whether many of them remain open or shut down their practices. Area doctors, lawyers and insurance officials packed three rooms at the Sawyer Building, and hundreds of others filled the foyer outside, hoping seats would become available.
Gov. Kenny Guinn called for the hearing to address what many health officials are describing as a medical crisis in Southern Nevada. Many area doctors say soaring rate increases in medical malpractice insurance, some to $200,000 annually from $40,000, are forcing them to close their practices, retire early or double their patient load.
"Yes, there is an unavailability of (malpractice) insurance," said State Insurance Commissioner Alice Molasky-Arman. Her comments came after the hearing, which featured seven hours of testimony from nearly 50 people representing various sides of the issue.
Officials with the 15 medical malpractice insurance carriers licensed in the state said they were either pulling out of Nevada completely or using "extreme caution" when underwriting new doctors.
Some officials said they would no longer insure any new obstetricians, surgeons, emergency room physicians and other high-risk specialties. Others said they would be willing to look at underwriting new doctors in all specialties, but that they would be very particular about who they would insure.
"I'm just not getting this warm, fuzzy feeling that there's this big appetite to underwrite doctors in Nevada," said Cliff King, chief insurance examiner for the state.
More than 80 members of the public did not get a chance to speak. Because so many people were unable to testify, Molasky-Arman set a March 11 deadline for written testimony to be submitted to her office. She promised to propose a remedy by April 10.
Oral testimony during the hearing included comments from doctors, lawyers, insurance company representatives and members of the Division of Insurance.
Doctors presented a bleak picture of their profession.
"Since November, OB/GYNs have been quitting at a rate of one doctor per month because of excessive malpractice rates," testified Dr. John Nowins, president of the Clark County OB/GYN Society. "We had 140 OB/GYNs. Based on our population of 1.5 million in Southern Nevada, we cannot expect to adequately serve the health care needs of women in our community. Who is going to deliver the babies of Southern Nevada?"
Nowins also stressed the four obstetricians who already have stopped practicing in Nevada are just the beginning of what could be a mass exodus of physicians. The majority of the valley's doctors will not face increases until their current contracts expire this summer.
Although Molasky-Arman did not specify what kind of solution she envisions, she emphasized that she would like doctors to come forward and submit an application to create their own medical malpractice insurance company.
"If someone wants to come to me with an application for an insurance company, that would be ideal," she said after the hearing. "I have heard there are people putting together an insurance company, but they have not approached me. They better approach me rapidly."
Nevada doctors formed their own mutual insurance company in the 1970s, but it eventually was bought out by the St. Paul Insurance Cos. St. Paul insured 60 percent of Clark County doctors until it pulled out of the medical malpractice insurance market in December, citing an increase in jury awards to malpractice plaintiffs as the reason.
According to St. Paul spokeswoman Andrea Wood, for every premium dollar the company received from Nevada, it paid $2 in litigation fees.
In a survey issued by the Division of Insurance, many medical malpractice insurance officials said the leading cause of costly claims is noneconomic damages awarded by juries. Officials also said attorney fees and frivolous claims added to their costs.
Many area doctors and insurance officials are clamoring for tort reform similar to California's, where there is a $250,000 cap on jury awards for pain and suffering. Tort reform was not discussed in detail at the hearing, however, because it would take new legislation to implement and is out of the scope of Molasky-Arman's capabilities.
Although doctors and insurance company officials blame jury awards and frivolous lawsuits for skyrocketing malpractice rates, attorneys point the finger at poor management and underwriting skills by St. Paul.
"We're here today to dispel the rumor and myth that the cause is frivolous lawsuits," said attorney Bill Bradley, representing the Nevada Trial Lawyers Association. "We're here now because of the overaggressive tactics of St. Paul."
Bradley said St. Paul artificially kept prices low to lure most of the market share and also agreed to insure bad doctors.
"They waived the underwriting and insured everyone and anyone," Bradley said. "They left good physicians with high rates. We strongly support strict underwriting."
During the next 30 days, Molasky-Arman will review testimony and decide what kind of action to take to help solve the medical malpractice crisis. Solutions might include forming a joint underwriting association with the state, forming a doctors' mutual insurance company or appealing to existing insurance companies to prepare new plans, King said.
The commissioner also could look into changing the role of the state's medical-dental screening panel. Currently, all medical malpractice cases must be presented to the panel prior to being filed in District Court. However, because the panel comprises three volunteer doctors and three volunteer lawyers, it can be difficult to schedule screening time. Currently, there is a backlog of 138 cases in Las Vegas, King said.
King suggested during the hearing that a full-time screening panel of retired doctors and lawyers could be hired to help speed up the process.
Although all medical malpractice cases must be heard by the panel, cases can still go to trial no matter what the panel finds. Even if all six panelists decide there is no probability for malpractice, the plaintiff can still proceed to a jury trial.
"I recommend that the findings of the panel be admissible in court," King said.
At the end of the hearing, Molasky-Arman talked about the importance of the issue to all Southern Nevadans.
"This touches the lives of every one of us," she said. "This affects the availability of doctors in our health plans, and if we can place some controls over the situation, we certainly will."
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RATING - File
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Bulletin 233
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Rule Chapter 630
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Why
You Should Consider Switching From
Occurrence Coverage
To
Claims Made Coverage For Your Malpractice
Insurance
The State of Ohio used to
be, like the state of Indiana is now, an occurrence coverage
state surrounded by claims made states on all sides. I have
tried in vain to find out why Indiana is the only state in
the Midwest that continues to stick with occurrence coverage
versus the more widely used claims made coverage in all of
the surrounding states. From my research I found that Ohio
used to be almost entirely an occurrence coverage state. As
it stands today, I estimate that Ohio is close to a 50%
occurrence coverage and 50% claims made coverage state. The
following material will explain what occurrence and claims
made coverage are and the differences between the two. More
importantly, I will try to explain why I believe doctors
should consider switching from occurrence coverage to claims
made coverage.
Occurrence Coverage :
Simply put, an insurance company promises to cover you for
the time you are insured with that company. An example is
the best way to illustrate Occurrence Coverage:
If you are insured
by Company A with Occurrence Coverage from January 1,
1995, - December 31, 1999, Company A will defend and pay
for any claims that occur during the time you were
insured. If you switch companies January 1, 2000, to
Company B and have a claim filed against you after
January 1, 2000, for malpractice that occurred prior to
January 1, 2000, Company A will defend and pay for any
settlement or verdict. The malpractice occurred during
the time you were insured with Company A and, therefore,
Company A will defend and pay any settlement or
verdict.
Claims Made Coverage :
An insurance company will promise to cover you for a stated
period of time as long as you are insured with that company.
You need to be familiar with a few terms to fully understand
Claims Made Coverage.
Retro
Date : A previous date your carrier promises to go
back and cover you for malpractice that may have
occurred. If you are a new doctor that has never
practiced before, your retro date will be your first date
you practice. If you are not a new doctor, typically your
retro date will go back to the first date you practiced
medicine.
Tail
Coverage :
(Tail Coverage is typically needed when a doctor
retires.) Tail Coverage defends and pays for any claim
filed after a doctor retires. When a doctor retires,
he/she no longer wants to pay annual premiums for
Malpractice Coverage due to the fact that no patients are
being treated. With Claims Made Coverage, if you stop
paying premiums, you stop being covered for any claims
that are filed after the last date of coverage (your last
day of work). Therefore, if you dropped your Claims Made
policy the day you retired and a claim is filed three
weeks after you retire, you would have no coverage due to
the fact that the Claims Made policy only covers you for
claims that are filed while you are covered. Doctors
purchase Tail Coverage to pay for any claims that are
filed after retirement. (Tail Coverage is not an issue
with Occurrence Coverage due to the fact that the
Occurrence carrier will defend and pay for any claims
that arose/occurred while you were insured with that
company.)
Mature
Claims Made Premium Rate :
If your retro date goes back more then five (5) years,
you are given what is called a Mature Claims Made rate.
In essence, it does not matter for the sake of premium if
your retro date goes back five (5) years or twenty (20)
years. The Mature Claims Made rate is usually an issue
when switching between two Claims Made carriers. If you
have been with one company a certain number of years and
find a more competitive company, your new carrier will
give you a retro date usually going back to the same
retro date as the previous carrier. If you have been in
practice for more than five (5) years, you will be give
the Mature Claims Made premium rate from the new
carrier.
Basic difference between
Claims Made Coverage and Occurrence Coverage .
One--when you have Occurrence Coverage and switch carriers,
your old carrier is responsible for any claims that
arose/occurred while you were covered by your old carrier.
With Claims Made Coverage, your new carrier, not your old,
covers you for any claim filed against you while you are
insured with the new carrier no matter when the malpractice
occurred.
Two--when you have Occurrence Coverage and retire, you do
not need to purchase a Tail due to the fact that your last
carrier promises to pay for any claims that arose/occurred
while you were covered by that carrier. When you retire with
Claims Made Coverage, you must obtain Tail Coverage due to
the fact that your last carrier will only cover you for
claims that were filed when you were covered by the old
carrier.
Advantages of Occurrence and Claims Made
Coverage .
Occurrence: One--you never have to worry about buying Tail
Coverage. (Tails usually cost 124%-230% of your normal
annual policy premium). Two--you do not have to worry about
retro dates when you switch insurance carriers.
Claims Made: One--Claims Made is almost always less
expensive then Occurrence Coverage. The mature Claims Made
rate varies with each company but can be between 5-30% less
per year then the Occurrence Coverage rate. (I believe 10%
less per year is a good thumbnail.) Two--doctors who are new
to the practice of medicine get better discounts for a
longer period of time. Typically, a new doctor gets a
significant discount the first year with Occurrence
Coverage, then a smaller discount the second year of
practice, then a smaller discount the third year of
practice, and, finally, no discount the fourth year of
practice. With Claims Made you usually get a larger discount
the first, second, and third years of practice, and with
some companies, the new doctor discount will cover your
fourth year of practice.
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Why should you consider switching from Occurrence to
Claims Made ?
Significant Cost Savings. If you switch this year from an
Occurrence policy to a Claims Made policy, you can
potentially save yourself up to 80% of your annual
Occurrence premium your first year, 50% your second year,
25% your third year, 20% your fourth year and typically 10%
of your annual Occurrence premium for every year there
after. (These numbers vary depending on the company
used)
An example better
illustrates my point:
Assume you normally
pay $6000 for your annual occurrence premium. Your
potential costs per year for the first five years after
switching to a claims made policy are: (1) 20% x $6000 =
$1200; (2) 50% x $6000 = $3000; (3) 75% x $6000 = $4500;
(4) 80% x 6000 = $4800; (5) 90% x $6000 = $5400; total
cost for the five year period = $18,900. Your costs for
the same five year total if you stayed with occurrence
coverage, $6000 x 5 = $30,000. Your potential saving is
$11,100, per doctor over the five year period.
Also, do not forget that the
mature Claims Made rate is typically 10% less per year than
the same Occurrence Coverage. In other words, every year
after your fifth year you could save 10% (or more depending
on the company) a year off what you normally would pay for
Occurrence Coverage.
Why don't more doctors switch from Occurrence to Claims
Made Coverage ? I believe there are four
reasons.
First, doctors do not
like the thought of having to buy a Tail when they
retire.
Second, the insurance
agents who currently have accounts in the state of
Indiana would be forced to take a significant pay cut if
they switched their clients to Claims Made Coverage.
Third, both doctors and
some agents have very little knowledge on this subject
matter and have not had the pros and cons of each type of
coverage explained to them so an informed decision can be
made on the topic.
Fourth, Medical
Protective does not use outside agents and therefore you
will never hear from a MP agent that you should look into
using another carrier or consider switching to Claims
Made coverage.
I would like conclude with a
little discussion about buying Tail Coverage when you
retire. Most companies have in place in their contract a
section stating that if you are insured with their company
for X number of years (usually between two and five) before
retiring, the company will give you a free Tail. Some
companies will discount the Tail up to the fifth year, and
if you are with them for five years, the Tail will be
free.
If doctors are fearful that they might in the future be
forced to purchase a Tail, the savings by making the switch
to Claims Made Coverage over the first five years will pay
for either the entire Tail or a significant portion of the
Tail. If the money saved from switching to Claims Made
Coverage is invested, over time the amount available will be
more than sufficient to pay for any Tail that might be
needed.
With reimbursement going down every year and the internal
costs of running an office going up every year, doctors can
no longer afford to stay with a malpractice carrier that is
not offering a competitive price. Based on the above
information it is easy to understand why doctors with
Occurrence Coverage should seriously look into switching
from Occurrence to Claims Made Coverage.
Conclusion .
Most offices renew their malpractice insurance in June,
July, August or January. You should immediately get your
malpractice information (current premium paid and claims
history) to a consultant who can tell you if he/she thinks
you are paying to much and what your options are at the
present time.
I have copies of each of the major malpractice insurance
companies filings (including Medical Protective and Medical
Assurance) that are on file with the Indiana Department of
Insurance. From those filings I have created spreadsheets so
that I know what each company charges as a base rate for
every doctor specialty. I have relationships with several
major malpractice insurance companies who offer very
competitive prices.
To start reviewing your office's malpractice insurance
rates, please give me a call toll free at
866-387-3431
or e-mail me at roccy@pahcom.com .
I will know very quickly from your information if I can
help.
Roccy DeFrancesco
Director,
PAHCOM Cost Reduction Division
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