COLUMBIA--More than 250 doctors from across the state descended on the Statehouse Tuesday in hopes of persuading lawmakers to make changes in the state's liability system.
The group is hoping that the Senate will strengthen a pair of so-called tort reform bills approved by the House last month.
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LOU KRASKY/AP
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Doctors from across the state took a day away from work Tuesday to stage a rally at the Statehouse.
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Physicians came to Columbia because they're fed up with years of rising malpractice insurance premiums coupled with stagnant insurance reimbursements that have eaten into profits, forced them to see more patients and to practice medicine in constant fear of being sued.
As many as 80 of the doctors were from the Charleston area, and many closed their practices for the day to all but emergency patients.
The House passed two bills last month, one with a $300,000 cap on damages for pain and suffering in medical malpractice cases, the other with a $2 million cap on non-economic damages in all kinds of civil litigation. While the bills include several provisions the physicians favor, they say the malpractice cap has too many exceptions for it to be effective.
"It's a paper tiger," said Dr. Alex Ramsay, a Charleston urologist. "It's virtually useless."
The doctors view the $2 million cap in the other House bill as being too high. They would like to see it reduced to half that amount.
Tuesday's rally, somewhat larger than a similar event last year, underscored the expected battle in the Senate surrounding malpractice and tort reform.The battle pits doctors and business groups against lawyers and consumer advocates who believe that limiting damages would only hurt victims by limiting the amount they can receive when they're injured as a result of a medical mistake.
One point on which all sides agree: Doctors are paying much higher malpractice insurance premiums than they did a few years ago.
This year, the two state-owned malpractice insurers, the Joint Underwriting Agreement and the Patients Compensation Fund, increased premiums 24.1 percent on average. That increase has come on top of big hikes in the past few years. Malpractice insurance rates for some medical specialties are now approaching $50,000 a year.
At the same time, doctors' overhead costs, for items such as employee salaries and their own health insurance costs, also are increasing. And many doctors complain that reimbursements from health insurers have remained stagnant.
Thus, doctors say they must treat more patients, or their practices struggle to stay in business.
One Charleston obstetrician who did not want his name used said he recently moved into a smaller office, and that his malpractice rates are so high now that tort reform may come too late to keep his practice from going bankrupt.
South Carolina is not the only state with this problem. Skyrocketing rates have led to protests in Florida, West Virginia and Nevada, and rates in some states dwarf those paid here. Obstetricians can pay premiums well into the six figures in places like Florida and Pennsylvania.
At issue is what's causing these increases. Doctors, backed by insurers, blame high jury awards and a growing number of lawsuits.
They would like to see South Carolina follow examples set by states like Texas, where insurers dropped premiums 12 percent this year because of newly imposed caps on non-economic damages. They also point to California, where rates have risen only moderately since that state approved caps in 1976.
Tort reform opponents, including lawyers and consumer groups, blame the problem largely on the insurance industry, and in South Carolina they note that despite the recent increases, premiums remain among the lowest in the country.
A Clemson University study last year said the problem was due to mismanagement of the state's two malpractice insurers, which cover most of the state's doctors. The report also said increases in jury awards have only followed the rate of health care inflation, which has gone up considerably in recent years.
Last year, Washington, D.C.-based watchdog group Public Citizen released a report showing that malpractice awards nationally and in South Carolina dropped in 2002.
The group also noted that the amount doctors pay in malpractice premiums is small compared to the cost of preventable medical errors. In 2000, the group says, doctors in South Carolina paid $18.8 million in malpractice premiums. The cost of preventable medical errors ranged between $242 million to $413 million, according to Public Citizen.
State Sen. Robert Ford, D-Charleston, a member of the judiciary subcommittee that will look at the issue, believes there could be some compromise, no matter how far apart the sides may seem.
"We've got to come up with something that favors both sides," Ford said. "Right now, we've got lawyers taking hard positions and doctors taking hard positions. There's got to be some compromise somewhere."
State Sen. Larry Grooms, R-Bonneau, said legislators have been the target of intense lobbying from all sides.
He said his colleagues in the Senate are all over the map on the issue, "but everybody agrees something needs to be done."
Until something is done, doctors say malpractice premiums will keep hammering the health care system.
Dr. James Edwards, the former governor and one-time president of the Medical University of South Carolina, said many of the tests and procedures doctors order these days are done simply because doctors are worried that they may be sued.
Several doctors agreed, noting the "defensive medicine" they practice these days is a big factor in rising health care costs.
"It's not just the financial cost. It's the stress of looking at the patient and seeing them as a potential adversary," said Dr. Don Hurley, a Charleston family practice doctor. "It is an ugly situation when fear of reprisal and attack dominates medicine."
Physicians say that malpractice premiums are forcing doctors to retire early or change their practices. They point out that the Myrtle Beach area now lacks neurosurgeons -- blaming, in part, their average annual premium of $48,697, highest in the state among all specialties.
They also say that the high malpractice insurance costs for obstetricians, the second-highest specialty at $37,597 a year, is forcing many to consider abandoning baby delivery.
In Oconee County, there are only two doctors who can deliver babies.
Two years ago, there were 11. The drop is the result of family practice doctors ending deliveries because of their impact on malpractice premiums.
Rate increases and a fear of lawsuits were among the reasons Dr. Jack Simmons dropped obstetrics from his practice two years ago. The 57-year-old doctor now focuses on gynecology and women's health at his West Ashley office.
"Doctors are being squeezed at both ends," Simmons said. "At some point in every profession, enough is enough."
