Mr. Chairman, Representative Velazquez, and Members of the Committee, my name is Chad Rubin, MD, FACS, and I am a general surgeon from Columbia, South Carolina. I am here representing the American College of Surgeons and its more than 65,000 Fellows.
In a growing number of states, surgeons are having difficulty obtaining medical liability insurance and, for those who are able to find coverage, the cost is often prohibitively high. Surgeons in some areas are experiencing double- and even triple-digit premium increases every year. At the same time, reimbursements from Medicare and other insurers are declining, providing no way to offset the continuing escalation in premium costs. We've seen particularly difficult situations develop in Illinois, West Virginia, Pennsylvania, New York, Ohio, Missouri, New York, and Georgia, and in many other states across the country.
Allow me to tell you about my experience in South Carolina. I am in a single specialty group practice of nine surgeons in Columbia. We are the major non-university group in town and cover all the hospitals in the city except the VA. Even though I've never been sued, my liability insurance premiums have increased by 816 percent in the last nine years—and by 117 percent last year alone. These increases, along with those my partners have experienced in their premiums, have forced us to borrow money each year in order to pay these costs. It is appropriate that I present this to the Committee on Small Business, since most physician practices are, in fact, small businesses and we are feeling the "squeeze."
In addition to the economic impact that premium increases have had on our practice finances, they have also affected our ability to care for patients. For example, three of my partners have stopped performing vascular surgery because of the increased liability costs. Two of my partners who perform gastric bypass operations are currently evaluating whether or not they will be able to continue performing this procedure because of liability costs.
The crisis is having a detrimental effect on many South Carolina physicians and their patients. In the last month, an obstetrician-gynecologist in Columbia stopped delivering babies, and many counties in South Carolina have no OB coverage at all. In addition, Myrtle Beach now has only occasional neurosurgical coverage. Imagine being on vacation in Myrtle Beach and getting involved in a bad car crash or water sport accident and not having a neurosurgeon available at the closest hospital. The liability crisis is having a very real impact on the health and safety of South Carolina's citizens, as well as on our visitors from other states across the country.
Unfortunately, this crisis has recently had a profound impact on my own family. My mother lives in Carbondale, IL. As you know very well Mr. Chairman, the medical liability crisis is having a particularly dramatic affect in Illinois. My mother is 74 years old. She has had two disabling strokes and has pulmonary fibrosis requiring around-the-clock care and home oxygen. Her primary doctor and her pulmonologist both left the state because their liability costs made practice there unsustainable. Now, southern Illinois has no pulmonologists. My mother's rehabilitation doctor moved to Saint Louis, and she now must travel to Missouri to see him.
Mr. Chairman and members of the Committee, this hearing is titled "Medical Liability Reform and the Skyrocketing Price of Health Care." There is ample evidence of the financial cost that the liability is having on our health care system, but the challenge many patients now face is receiving needed health care services.
Large premium increases and the declining number of liability insurance carriers are forcing many surgeons to make difficult decisions about limiting the scope of their practice, moving to other states, or retiring early. As a result, we see a growing access problem emerging throughout the country, with some frustrated surgeons leaving practice before turning 60. Considering the fact that surgeons do not complete their training until reaching their early- to mid-30s, such early retirements result in far too few years of service to patients and communities.
For many years, the College has advocated the federal adoption of health care liability reforms like those enacted in California under the Medical Injury Compensation Reform Act (MICRA) of 1975. For over 25 years, MICRA has demonstrated that medical liability costs can be stabilized while patients' rights are protected.
Every year, the House of Representatives has considered and passed strong medical liability reform legislation that follows the MICRA blueprint. One of the most essential elements of these bills has been a limit on non-economic damages to control the continually escalating severity of claims.
A cap on non-economic damages does not prohibit an aggrieved individual from receiving compensation. Economic losses such as lost wages, medical expenses, and rehabilitation costs are fully covered. A reasonable $250,000 cap on non-economic damages would bring more economic stability to the medical liability system and still compensate individuals for pain and suffering.
In addition to the cap on non-economic damages, the following provisions are included in strong medical liability reform bills:
- collateral source payment offsets that prevent duplicate payments for the same expense.
- periodic payment of future damage awards over $50,000.
- encouraging speedy resolution of claims
- fair share rule
- limits on plaintiff attorney contingency fees
- application of punitive damages only when there is clear and convincing evidence that the defendant intended to injure the claimant.
The College hopes that the House and the Senate will pass strong medical liability reform soon. The crisis confronting us continues to grow, and the impact is most severe on our sickest and most vulnerable patients.
I appreciate this opportunity to testify before the committee and I would be happy to take any questions.
Online February 17, 2005
