Medical Liability Reform: Putting Missouri Patients First

By Senator Jim Talent

Driving to the doctor's office for routine health exams and appointments have become daytrips for many families living in rural Missouri.  Just ask the patients of Dr. Al Elbendary.  Dr. Elbendary, a gynecological oncologist, told the St. Louis Post-Dispatch that skyrocketing medical liability insurance left him no choice but to shut down a group practice and eliminate a rural outreach clinic.  That decision left his patients, primarily women with gynecological cancer, with no alternative but to drive a hundred miles to get the care they need.  

Dr. Elbendary is not alone.  Hundreds of experienced physicians are closing their practices or moving to other states because of out of control medical liability insurance premium increases in Missouri.  These rising costs are affecting access to care for patients, particularly those living in rural areas, and making health care more expensive for everyone.  

Missouri is facing a medical liability crisis.  Our state is one of 19 "crisis" states, where the American Hospital and the American Medical Associations consider the medical malpractice laws unfavorable or the cost of liability insurance at "crisis proportions."  

Last year, many physicians saw their premiums increase by more than 60 percent on average.  For example, the Skaggs Community Health Center in Branson received a 95 percent increase in medical liability insurance this year, a $215,405 increase from last year.  Additionally, nearly half of "crisis state" hospitals have seen liability expenses at least double.  According to the American Hospital Association, liability expenses per staffed bed totaled $11,435 in these states, compared to $4,228 in states such as California, Colorado and Texas that have enacted liability reforms.

The medical liability crisis falls hardest on women in rural areas.  Obstetric providers, for example, when confronted with substantially higher costs for liability 
coverage will stop delivering babies, reduce the number they do deliver and further cut, or eliminate care for high-risk patients, the uninsured and the underinsured. In fact, according to the American College of OB-GYNs, potentially 3,564 pregnant women in Missouri will annually be forced to find new physicians to provide their obstetric care, interrupting continuity of care and disrupting long established physician-patient relationships upon which these patients have come to rely.

Additionally, as premiums increase, women's access to general health care including regular screenings for reproductive cancers, high blood pressure and cholesterol, diabetes and other serious health risks is decreasing. These are screenings routinely provided by community clinics, OB-GYN and family physicians. With experienced doctors scaling back these services in rural areas, recruiting new physicians for high-risk specialties, like obstetrics, is becoming increasingly more difficult.

The crisis is also affecting Missouri seniors.  As the number of doctors caring for Medicare patients decreases, the impact on seniors increases.  Patient loads in offices that provide care to Medicare patients are straining doctors and making it more difficult for patients to get appointments and making seniors travel greater distances for health care.  Specialty doctors, opthomologists, gerontologists, internists and other doctors that seniors rely on are being forced out of practice.

This week, the Senate is taking up medical liability reform as we debate the Patients First Act of 2003 (S. 11).  The measure is designed to help doctors and hospitals stay in business, while reducing the downstream flow of medical liability insurance costs to patients.  The legislation caps non-economic damages and punitive damages at $250,000, permits defendants to be held liable for no more than their share of responsibility for a plaintiff's injuries and limits lawyers' fees.  The U.S. House passed a similar bill in March.

Patients cannot get the care they need if physicians are in short supply or out of reach.  I have heard from hundreds of physicians and patients across Missouri who tell 
me that we need to stop unscrupulous trial lawyers from driving up physicians' insurance costs and putting the lives of patients at risk.  This common sense legislation will both protect physicians and fairly compensate injured patients.

Not surprising, the bill is opposed by the trial lawyers and they have launched an intense lobbying effort on Capitol Hill to defeat the proposal.  It is clear that something needs to be done.  I am hopeful this Senate will put the interests of patients first and pass the Patients First Act. 
	
Sen. Jim Talent (R-Mo.) was elected to serve Missouri in the U.S. Senate in November 2002.  He is a member of the Aging, Agriculture, Energy and Armed Services Committees. Previously, he served in the U.S. House of Representatives (1993-2001) and the Missouri House (1985-1992).