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Many local doctors are bowing out as insurance costs, lawsuits soar

In obstetrician Phil Waterman’s Fort Myers office, a sign hangs on his wall that informs patients he no longer carries medical malpractice insurance.

His staff hands each patient a piece of paper that declares his lack of insurance in accordance with Florida law, and requires a patient’s signature.

After 24 years and delivering some 5,000 babies in Lee County, Waterman suffered acute sticker shock when he opened his June insurance renewal notice.

Paying nearly $200,000 in premiums for $250,000 of coverage was out of the question.
So he did what many Florida doctors are doing these days: He went “bare” — practicing without medical insurance. He also doesn’t deliver babies anymore.

“You get to the point where you lose money every time you open the office,” he said. “I got into this business because it’s exciting and fun. I didn’t go through all those years of training to sit back and do Pap smears all day — but that’s what it has come down to.”

Obstetricians are refusing to deliver babies. Physicians are retiring a decade before they planned. Hospitals can’t recruit specialists. And doctors are practicing without insurance.

These problems sound like recent headlines from around the nation that chronicle the results of soaring malpractice insurance rates.

Trouble is, these are real examples from right here in Lee County.

“There is a crisis right now in health care in Florida,” said Fort Myers orthopedic surgeon Bo Kagan, president of the Florida Orthopedic Society. “If we don’t address it right now ... people are going to be harmed, emergency rooms are going to close and people are going to die.

“People are not going to get in to see their doctor because their doctor cannot see them.”

Health care at risk
At the heart of the problem is skyrocketing insurance premiums in Florida, which have doubled and tripled in the last few years as jury awards for malpractice lawsuits dramatically increased.
Particularly hard hit are doctors in high-risk specialities such as obstetrics, orthopedics and radiology.

“I don’t know why there isn’t a sign over the front door of hospitals saying ‘Having people cut holes in you is inherently dangerous — if you don’t want to take the risk, go home,’ ” Waterman said.
“(People) don’t differentiate between malpractice and bad outcomes. If the outcome isn’t absolutely perfect, there’s a good chance you’re going to get sued.”

The problem has become so rampant nationwide, the U.S. Department of Health and Human Services issued a report last month that calls for federal reform of medical liability laws.
In Florida, medical associations and trial attorney groups are vying for legislative reform — and not necessarily for the same purposes.

Officials say the byproduct of high insurance costs — spawned by massive jury awards and expensive settlements in malpractice suits — threatens access to care, jeopardizes patient safety and increases health care costs across the board.

In a medical climate overshadowed by fear of lawsuits and take-all premiums, doctors are forced to practice defensive medicine — providing unnecessary and costly medical treatments to avoid being sued.

That means more doctors are performing tests and providing treatments they otherwise would not, just to cover themselves in the event of litigation.

At the same time, if more doctors retire early or leave town, health care is at risk as patients clamor for remaining services — or can’t find a doctor when they need one most.

Cape Coral mom Nicole Bickelhaupt, 31, said she knows first-hand the effects of the malpractice insurance problem.

When she became pregnant with her third child, her longtime physician, who by choice no longer delivers babies, referred her to another doctor.

“I was very disappointed,” she said. “He’s my physician and he knew me, and I was comfortable with him.”

On top of that, it took Bickelhaupt almost three months to get an appointment to see a dermatologist — another high-risk practice that is hurting for physicians.

“It was frustrating,” she said. “When I finally did find one that took new patients — and took my insurance — I had to wait. I called in April and got in in July.”

‘Everybody’s problem’
The trick will be to curb Florida’s crisis legislatively before the whole system collapses, physicians say.

“We’re hearing and seeing the writing on the wall,” Kagan said. “Somebody’s whispering to us, and we need to pay attention.”

Physicians blame trial lawyers, and attorneys point their fingers at insurance companies.
Either way, a medical crisis is brewing in Florida and in other states that don’t have legislative reforms in place to limit claims and cap pain-and-suffering awards.

“This is not about doctors blaming lawyers and lawyers blaming insurance companies — this is everybody’s problem, and everybody’s got to give a little bit,” said Anne Wilke, executive director of the Lee County Medical Society, which is supporting state tort reform.

“The government has to deal with some of this, as well as the justice system, and the laws on the books have to change.”

Although plaintiffs lose the majority of their cases, jury awards have doubled since 1995, with the median award in 2000 topping $1 million — an increase of 43 percent since 1999, according to Jury Verdict Research.

Since 2000, many of Florida’s 15 medical malpractice carriers have drastically increased their rates each year — some by at least 40 percent — while only about a third are writing new business.
Some carriers have pulled out of the state altogether.

“Certainly we have seen a rapid escalation of rate increase requests from carriers that write this coverage — many well over 50 percent,” said Tami Torres, a spokeswoman for the Florida Department of Insurance.

“We have tempered many of those rate increases, but among the top 10 writers of insurance, they’re losing 35 cents on every dollar they’re taking in premiums. No one’s going to continue writing or operating business if they’re sustaining those losses.”

When Patrick Cullen’s insurance premium went up to $112,000 in May, the longtime Fort Myers orthopedic surgeon packed up his office, gave away his medical equipment and retired more than 10 years early.

His malpractice insurance, which cost $43,000 in 2000 and increased to $63,000 in 2001, nearly doubled this year.

Cullen, 56, who had been practicing at his Broadway location since 1978, said it was one of the hardest decisions he’s ever made.

“I was finished, like someone just shot me in the head,” Cullen said. “You cannot do anything without malpractice insurance — I instantly lost my hospital privileges, which are so critical. I blame it completely on the trial attorneys and the court and tort system. I was there, then all of sudden, I’m just put out of business.”

Cullen said in more than two decades of practice in Lee County, nine lawsuits were filed against him.
He’s among 230 former and current doctors in Lee who were sued a total of 382 times since the 1970s, almost two-thirds of them since 1990.

Physicians say most of their lawsuits happen because patients didn’t like the outcomes rather than doctor malpractice.

“Most of (mine) were by people who had very bad injuries who came through the emergency room,” Cullen said. “Generally, they were people acting irresponsibly who suffered massive injuries and then turned around and said, ‘I got to cash in here any way.’ A lot of them were uninsured.”

Florida among the worst
Hospitals are hard hit by the crisis as well.

A shortage of doctors unable to absorb their increased insurance premiums in Collier County has forced one hospital to consider becoming more lenient with its mandatory malpractice insurance requirements.

In Naples, the NCH Healthcare System board decided last month to keep its policy of requiring physicians to have malpractice insurance — but agreed to consider exceptions on a case-by-case basis.

“It’s the first time in NCH history that we’ve done this,” said Dr. Perry Gotsis, medical director. “There are some physicians that simply cannot get insurance ... and we’re seeing some very, very high rates for certain groups. It’s out of control.”

NCH, along with Lee County’s Southwest Regional Medical Center, Gulf Coast Hospital and Lehigh Regional Medical Center, has always required physicians to carry a minimum of $250,000 in malpractice coverage.

As Lehigh tries to expand its stature and services in the community, officials there are finding it difficult to bring in certain specialists from other states.

Chief Executive Officer John McClellan has been trying to find a qualified pulmonologist to come to Florida for about six months.

He gets close — until the physician gets an estimate on his malpractice premiums.

“When they find their malpractice cost is doubled here than in their existing state, they make the decision to stay where they’re at,” McClellan said. “The problem is, Florida is considered in the top 10 list for worst places to have malpractice insurance.”

In light of the problem, Lee Memorial Health System’s policy of allowing self-insured physicians to practice may soon become the norm.

State law allows a physician to self insure, provided he can cover himself up to $250,000 in the event of a lawsuit.

Most hospitals won’t risk it. As a public entity, however, Lee Memorial is protected under a government cap of $100,000 per incident and $200,000 per case.

“But now you’re seeing hospitals letting go of that rule, simply because they need to have physicians caring for their patients,” said Lee Memorial system President Jim Nathan. “In today’s climate, I don’t think hospitals have any other choice but to free up that rule.”

By Andi Atwater, The Fort Myers News-Press