Baby docs go on `red alert'; obstetricians issue an alert to colleagues on insurance as rates soar in nine states

0 Comments | Insight on the News, June 10, 2002 | by Ed Susman

Doctors who specialize in delivering babies and treating pregnant women are closing their offices, leaving states such as Nevada and Pennsylvania or abandoning their profession because they can't get liability insurance--even at sky-high rates. Leaders of the American College of Obstetricians and Gynecologists (ACOG) have issued a "Red Alert," a warning that without relief from state and federal legislation many rural areas of the country will be without obstetricians.

"One New Jersey specialist, without a legal blemish on his practice record, was finally able to secure insurance at the cost of $300,000 a year," said ACOG President Thomas Purdon at the group's annual meeting in Los Angeles. "We are in a crisis situation."

Not only are doctors leaving the field, but hospitals are closing their maternity wards. According to Purdon, the "ripple effect" also is reaching into academic institutions, where recruiting experts to teach obstetrics and gynecology could be hamstrung as well.

ACOG leaders cited Florida, Mississippi, Nevada, New Jersey, New York, Pennsylvania, Texas, Washington state and West Virginia as being most in danger of losing obstetric care due to difficulty in getting insurance coverage. In Florida, for example, obstetricians have an average cost that exceeds $200,000 a year for insurance premiums if they practice in populous Dade (Miami) or Broward (Fort Lauderdale) counties, says Purdon, professor of obstetrics and gynecology at the Arizona Health Sciences Center in Tucson. In Nevada, 70 obstetricians in the Las Vegas area are about to leave the state because of the withdrawal from the market of one of Nevada's largest liability insurers.

"In Mississippi, a pregnant woman in Yazoo City, which has a population of 14,000, has to travel 150 miles to get prenatal care," Purdon says. "When a woman has to travel that far to get care, she isn't going to get care."

Purdon proffers one solution: national legislation to establish legal reforms such as those in place in California. Those laws impose a cap on noneconomic--that is, pain-and-suffering or punitive--damages. "Insurance rates in California have remained stable for years there" he says.

ACOG's "Red Alert" was issued to let the public and legislators know there is a crisis that is going to have a severe effect on obstetric care. Similar crises exist for neurosurgeons and orthopedists, leaders say. "Unlike previous crises in the 1970s and 1980s, where cost was the issue, this time around there's the obstacle of finding any insurance coverage at all," says Albert Strunk, an administrative vice president for the ACOG.

Purdon said the New Jersey doctor he cited had left Eastern Pennsylvania because insurance was not available. Re-establishing his office in New Jersey, the doctor searched for 90 days before he could find insurance-liability coverage--at $300,000 a year. That kind of liability insurance means the doctor "has to pay about $1,000 a day before he can even turn on the lights in his office and doesn't reflect what it costs for paying his nurses and rent," Purdon says. "A lot of doctors are finding that these types of expenses make it difficult to stay in business."

Charles Hammond, president-elect of ACOG, notes that 15 years have passed since the Washington-based Institute of Medicine warned that high liability costs were compromising delivery of obstetric care. "We still need reform at the federal and state levels," Hammond says. "Band-Aid solutions won't work."

Chairman of the Department of Obstetrics and Gynecology at Duke University Medical Center in Durham, N.C., Hammond says future specialists in his field will have to have a passion for their work, "because the liability threat will always be there, no matter how outstanding the care you provide."

RELATED ARTICLE: Eradication of polio possible by 2005.

The world health community is on the verge of dealing polio a "knockout blow," but instability in Africa and central Asia remains the largest obstacle to global eradication, say international health experts.

"There are reservoirs of polio in inaccessible parts of the world, but the number of cases is dropping dramatically," says Steven Cochi, global immunization director for the U.S. Centers for Disease Control and Prevention. Cochi was part of a panel of experts from world health organizations that recently briefed the press in Washington.

According to the panel, 537 cases of polio were recorded in the world in 2001, down from 2,979 in 2000, while 575 million children in 94 countries were vaccinated. By the end of this year, the disease will be confined to regions of northern India, Afghanistan, Pakistan, Nigeria and Niger. The disease already has been eliminated in the Western Hemisphere, Europe and East Asia.

The last incidences of polio will be the hardest to eradicate because of the volatile political situations in key areas. "Countries that are at war are countries where it is increasingly difficult to administer vaccines," says Marie-Otelia Costales, a senior health adviser for UNICEF.