Out of Medicine

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Some doctors are practicing without insurance coverage. Mark McCormick and Bradley S. Douglas, obstetricians in Boca Raton, Fla., elected to "go bare" after learning that their insurance, which last year cost each of them $35,000, would rise this year to $100,000. If sued, they will have to pay court costs and any judgments themselves.

Other doctors are forming their own insurance vehicles. Lewis Sharps, former president of the Pennsylvania Orthopedic Society, has applied to start a doctor-owned self-insuring group that will write policies only for orthopedic surgeons, in hopes of better managing risks and keeping court judgments and rates low.

Both doctors and insurers say the crisis will not abate until legislatures enact reforms. President George W. Bush and the American Medical Association have called for federal limits on recovery for pain and suffering in malpractice cases, and two states, Pennsylvania and Nevada, have already enacted similar reforms. In Mississippi the Governor has called for a special legislative session this month to consider the issue.

Reformers point to California, where jury awards for noneconomic damages, such as pain and suffering, are capped at $250,000 and malpractice rates have held relatively steady over the past year. With tort reform, says Ron Neupauer, a vice president of Medical Insurance Exchange of California, "you don't have the emotion-laden blockbuster verdicts." But plaintiffs' lawyers protest that curbing noneconomic damages will disproportionately impact women, children and the elderly, who typically suffer less "economic" harm, such as lost wages, when they are hurt.

Even when tort reforms are put in place, they can take time to bite. In Nevada, where liability caps were passed last month, most insurers have declined to lower rates until they see the change reflected on their balance sheets, which could take years. They may have a point: courts in six states have struck down as unconstitutional limits on a jury's ability to determine damages in malpractice cases, and lawyers in Nevada are readying a case against the new limits.

While the interest groups jockey, access to the courts is less urgent for most people than access to a doctor. After calling every day for weeks, Elizabeth Gromny finally persuaded her obstetrician to handle her delivery, but only because another patient in military service had been transferred out of state. But complications have forced Gromny to visit specialists, and many specialists have also posted signs in their offices warning that the insurance crisis might force them to close their doors. "I'm constantly worried about what could happen," says Gromny. "When you're pregnant, the last thing you want to have to worry about is your doctor."