Friday, September 3, 2004 11:59 AM CDT
Illinois physicians say insurance rates are driving them out of state
By ROB STROUD and HERB MEEKER, Staff Writers
Editor's Note: This is the fourth in a series looking at medical malpractice lawsuits.
Neurologist Henry Nino, who has worked in Coles County since 1991, said he may move his practice out of Illinois or retire if his malpractice insurance costs go up much more.
Nino gets his insurance through the Illinois State Medical Insurance Exchange, operated by the Illinois State Medical Society.
"In the last four years, my malpractice insurance has gone up 400 percent," he said.
His choice of insurance providers is now limited because the number of companies in Illinois that write malpractice insurance has shrunk from more than 20 to four in recent years, Nino added.
Nino said high rates are causing neurosurgeons, obstetricians and other doctors to leave the state.
Illinois patients will become more aware of that problem when they cannot find someone to deliver their babies or when they have to be transferred hundreds of miles away for treatment of head injuries, he said.
"If it has not affected your family yet, it has affected the family of someone you know," Nino said.
Caps on legal awards for pain and suffering seem to have worked well at lowering rates in other states, he said.
Sympathetic juries tend to grant large awards for pain and suffering to malpractice plaintiffs even if the "bad outcome" in the case was not the result of "bad medicine," Nino said. He emphasized caps shouldn't be placed on awards for economic damages.
Nino said other reforms that might help reduce rates include having a panel of medical experts review cases and, on a national level, setting contingency limits on the amount of money lawyers can receive from malpractice cases.
"There is a need to cut down on the number of lawsuits. Many of these are frivolous," Nino said. "There is a tendency for trial lawyers to bring forth lawsuits they think they can win."
Dr. Mark Dettro, a family practice physician with the Sarah Bush Lincoln Family Medical Center, said his problem is not acquiring malpractice insurance, but keeping up with the premium increases.
"The price has gone up so dramatically," said Dettro, a Mattoon native who has worked with patients and their families here for 18 years. "It went up 75 percent in one year. If this keeps up all the doctors are going to have to go to Indiana or Missouri where they have caps on pain and suffering issues."
And those percentage hikes add up in the tens of thousands of dollars, Dettro said. He was reluctant to cite actual dollar figures on insurance he acquires through plan with Sarah Bush Lincoln.
"Pain and suffering is hard to quantify. When the trial lawyers win a judgment in that area it's like winning the Lotto. There has to be some kind of restraint," Dettro said.
Dettro agrees there are cases of medical malpractice where victims should be compensated fairly. However, the risk of malpractice lawsuits, and especially lucrative judgments on "pain and suffering," keep raising the premiums each year for insurance.
"We are losing all these doctors to other states where they have caps on pain and suffering," Dettro said. "There will be no neurosurgeons south of Springfield in Illinois. If you have a car wreck in Southern Illinois then the odds aren't very good for you."
As a primary care physician, Dettro has not cut back on his care procedures to reduce his malpractice risks, but he knows physicians who have, especially with assistance in surgical procedures.
Dettro foresees cuts in medical staff and services for Sarah Bush and smaller hospitals in the specialty areas if the malpractice costs keep rising.
"I could see the surgery and specialty departments getting some cutbacks here. As for primary care, that would be hard to believe," he said.
Dr. Kathleen LeVeck, a doctor of obstetrics and gynecology, wants to keep her roots in Coles County.
She is a third-generation physician. Dr. Joseph Link, her grandfather, was associated with the old Link Clinic at the corner of Wabash and 17th Street in Mattoon, where the Mattoon Police Department is located today. Her father, Stanley Thiel, was a pediatrician who brought many Mattoon residents into the world during his many years of practice.
For 20 years, LeVeck has been carrying on the family tradition with the same dedication as her grandfather and father.
"Most of us do this because we love it," she said during a lunch break in her office at Carle Clinic east of Mattoon. "In this field (OB/GYN), we actually grow old with our patients."
But her confidence was shaken when she went through a pair of malpractice trials even though the cases were eventually settled in her favor.
"I was a wreck," she recalled. "I remember not being able to sleep at night. Most of us are honest doctors and care for our patients. Believe me, most of us don't like it when something goes wrong for a patient. But these malpractice cases have more of a negative effect on you and your family."
LeVeck knows the court cases have caused her to "go overboard" on medical tests for her patients. In addition, extra precautions are taken on recording the decision-making process for treatments.
"It's on your mind constantly. You are practicing defensive medicine with all the lab tests," she said.
LeVeck believes the advances in technology might have interfered with the doctor-patient relationship. In addition, patients might have lost sight that even with technology and "miracle drugs" doctors are human beings.
"Thirty or 40 years ago, the family doctor or pediatrician was always trusted. You didn't have lawsuits then because people understood the doctor was doing the best he could. My dad used to write notes about his patients on filing cards. And there would be all those scribblings. Now you have courses on dictation for electronic filing on patients' cases to make sure every decision is clearly written out."
Those electronic notes might come in handy for medical board reviews or cross-examinations by lawyers.
LeVeck would like to see some common sense brought back into the process.
"There should be chances to get together with the lawyers and the insurance companies to work something out," she said. In addition, she would support settlement caps because the rising cost of doctors' insurance is having an overall effect on health care for patients as well.
"We're all indirectly paying for it. It affects everyone. I've had some women have to change doctors in the middle of their pregnancies. That's because they have lost the choice of doctors due to increased insurance costs. That's not right," she said.
She cited recently published statistics that show one in seven fellows in the American College of Obstetrics and Gynecologists has stopped practicing obstetrics because of the risk of medical liability claims. She also noted severe cutbacks being cited in high-risk birth care and gynecologic surgical procedures being recorded across the country.
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