AN ACTION PLAN FOR THE DETERIORATING MEDICAL LIABILITY INSURANCE MARKET IN RHODE ISLAND:
In June, 2002 the Rhode Island Medical Society published a Report and Update on medical professional liability in the state describing how it mirrored the rest of the nation and listing the seven carriers lost to Rhode Island in the previous 12 months (St. Paul; AIG; CAN; HUM; Legion; Phico; Zurich).
At that time, there were only six surviving medical malpractice carriers in Rhode Island insuring a total of 3,300 physicians. These included:
(1)one physician-owned mutual (Norcal with 1,700),
(2)two for-profit stock companies (ProSelect with 300 and General Electric MedPro with 200),
(3)one quasi-public state agency (Rhode Island MM-JUA with 200), and
(4)two hospital-owned, off-shore self-insurance companies (RISE with 700 and Women & Infants Indemnity with 200).
These numbers were rough estimates. Also, because many physicians practice in multiple settings and therefore have multiple insurance policies, the total of 3,300 exceeds the number of physicians who are actually present and practicing in Rhode Island.
The structure of the Rhode Island JUA (Medical Malpractice Joint Underwriting Association of Rhode Island)is such that the JUA could virtually never become insolvent. (This positive assessment of the JUA's strength is supported by the Judge Torres decision of February, 1991).
Hospital-owned off-shore "captives" are not domestically regulated carriers. Information on their capitalization, reserves and loss experience is not publicly available.
See: http://www.rimed.org/news02jun.html
In June 2004, General Electric MedPro announced it will be leaving the Rhode Island market and its remaining 130 covered physicians.
This year in the Rhode Island General Assembly, the Rhode Island Medical Society submitted the 2004 Medical Liability Reform Act to the Judiciary Committees in the House (H7850. Representative Robert E. Flaherty, Chairman) and Senate (S2473. Senator Michael J. McCaffrey, Chairman).
This Medical Society bill was intended to accomplish the following:
(1) Reduce the time injured Rhode Islanders would have to wait for a settlement or award (currently 6.4 years, the longest delay in the nation).
(2) Reduce the 12 percent prejudgement interest rate on successful lawsuit payouts.
(3) Require an expert to certify that a case has merit before it can be filed.
(4) Require a statute of limitations (a suit involving a child must be filed within three years of age 8, not by age 18 as now required).
A bill submitted on behalf of Governor Carcieri this year contained similar provisions, plus a cap on malpractice awards for pain and suffering.
Some of the key reasons professional liability rates are rising so fast in Rhode Island are described in a PDF file on the online May/June 2004 issue of the Newsletter of the RI Medical Society at:
http://www.rimed.org/omeganews5_10.pdf.
In my personal opinion, the H7850 and S2473 bills represent important and long overdue incremental reforms which would benefit both truly injured patients with valid medical negligence claims and the majority of Rhode Island's non-negligent physicians.
However, real medical liability market reform demands not only these common sense measures but also a combination of broader initiatives. Both a clear vision for future reform and substantive, not just incremental, changes are necessary. Policy makers must recognize that patchwork policies will not achieve the fundamental restructuring that is so badly needed. These major "beneficially disruptive" innovations in the system must not be based on the status quo. They must be initiated and catalyzed by an unprecedented, physician-led and insurer-supported effort to shift the focus of reform to increasing patient safety. This will require simultaneously overcoming the tyranny of the minority of physicians with the worst performance records and fundamentally changing the state's existing destructive medical malpractice system.
Even more so than with the two prior medical malpractice insurance crises since 1964, time is rapidly running out for both Rhode Island doctors and their patients.
Before it becomes too late to help, creative structural reforms that truly serve the private and public interests of all of the medical liability stakeholders must be proposed, communicated, enacted and implemented.
Although enactment of the needed legislation and regulations cannot occur until the Rhode Island General Assembly reconvenes in January 2005, it may not prove to be too late if Rhode Island seizes the opportunity to lead the nation in meaningful and durable patient-centered reform by carefully considering, discussing and implementing all three of the following measures.
SUMMARY ACTION PLAN FOR RHODE ISLAND:
I. Medical Discipline:
Increase patient safety immediately and for the long term by creating and implementing fair but firm economic sanctions for the small group of most egregious repeat offenders whose performance records combine excess payouts* with serious disciplinary actions.(mirroring the Texas legislature's SB104 in 2003.)
II. Tort System:
Enact measures equivalent to California's Medical Injury Compensation Reform Act (MICRA) of 1975 and the Texas legislature's HB4 and Proposition 12 in 2003.
III.Insurance System:
Enact measures equivalent to California's Proposition 103 of 1988 and the Texas legislature's SB14 in 2003.
*The Percentage of Physicians with Number of Malpractice Reports in the National Practitioners Data Bank (NPDB)between September, 1990 and December, 2002:
One Report = 63.4%
Two Reports = 20.2%
3-5 Reports = 13.4%
6-10 Reports = 2.5%
>10 Reports = 0.5%
The NPDB Public Use Data File does not include any information that identifies individual practitioners or reporting entities. The file is designed to provide data for statistical analysis only. (http://www.npdb-hipdb.com)
At that time, there were only six surviving medical malpractice carriers in Rhode Island insuring a total of 3,300 physicians. These included:
(1)one physician-owned mutual (Norcal with 1,700),
(2)two for-profit stock companies (ProSelect with 300 and General Electric MedPro with 200),
(3)one quasi-public state agency (Rhode Island MM-JUA with 200), and
(4)two hospital-owned, off-shore self-insurance companies (RISE with 700 and Women & Infants Indemnity with 200).
These numbers were rough estimates. Also, because many physicians practice in multiple settings and therefore have multiple insurance policies, the total of 3,300 exceeds the number of physicians who are actually present and practicing in Rhode Island.
The structure of the Rhode Island JUA (Medical Malpractice Joint Underwriting Association of Rhode Island)is such that the JUA could virtually never become insolvent. (This positive assessment of the JUA's strength is supported by the Judge Torres decision of February, 1991).
Hospital-owned off-shore "captives" are not domestically regulated carriers. Information on their capitalization, reserves and loss experience is not publicly available.
See: http://www.rimed.org/news02jun.html
In June 2004, General Electric MedPro announced it will be leaving the Rhode Island market and its remaining 130 covered physicians.
This year in the Rhode Island General Assembly, the Rhode Island Medical Society submitted the 2004 Medical Liability Reform Act to the Judiciary Committees in the House (H7850. Representative Robert E. Flaherty, Chairman) and Senate (S2473. Senator Michael J. McCaffrey, Chairman).
This Medical Society bill was intended to accomplish the following:
(1) Reduce the time injured Rhode Islanders would have to wait for a settlement or award (currently 6.4 years, the longest delay in the nation).
(2) Reduce the 12 percent prejudgement interest rate on successful lawsuit payouts.
(3) Require an expert to certify that a case has merit before it can be filed.
(4) Require a statute of limitations (a suit involving a child must be filed within three years of age 8, not by age 18 as now required).
A bill submitted on behalf of Governor Carcieri this year contained similar provisions, plus a cap on malpractice awards for pain and suffering.
Some of the key reasons professional liability rates are rising so fast in Rhode Island are described in a PDF file on the online May/June 2004 issue of the Newsletter of the RI Medical Society at:
http://www.rimed.org/omeganews5_10.pdf.
In my personal opinion, the H7850 and S2473 bills represent important and long overdue incremental reforms which would benefit both truly injured patients with valid medical negligence claims and the majority of Rhode Island's non-negligent physicians.
However, real medical liability market reform demands not only these common sense measures but also a combination of broader initiatives. Both a clear vision for future reform and substantive, not just incremental, changes are necessary. Policy makers must recognize that patchwork policies will not achieve the fundamental restructuring that is so badly needed. These major "beneficially disruptive" innovations in the system must not be based on the status quo. They must be initiated and catalyzed by an unprecedented, physician-led and insurer-supported effort to shift the focus of reform to increasing patient safety. This will require simultaneously overcoming the tyranny of the minority of physicians with the worst performance records and fundamentally changing the state's existing destructive medical malpractice system.
Even more so than with the two prior medical malpractice insurance crises since 1964, time is rapidly running out for both Rhode Island doctors and their patients.
Before it becomes too late to help, creative structural reforms that truly serve the private and public interests of all of the medical liability stakeholders must be proposed, communicated, enacted and implemented.
Although enactment of the needed legislation and regulations cannot occur until the Rhode Island General Assembly reconvenes in January 2005, it may not prove to be too late if Rhode Island seizes the opportunity to lead the nation in meaningful and durable patient-centered reform by carefully considering, discussing and implementing all three of the following measures.
SUMMARY ACTION PLAN FOR RHODE ISLAND:
I. Medical Discipline:
Increase patient safety immediately and for the long term by creating and implementing fair but firm economic sanctions for the small group of most egregious repeat offenders whose performance records combine excess payouts* with serious disciplinary actions.(mirroring the Texas legislature's SB104 in 2003.)
II. Tort System:
Enact measures equivalent to California's Medical Injury Compensation Reform Act (MICRA) of 1975 and the Texas legislature's HB4 and Proposition 12 in 2003.
III.Insurance System:
Enact measures equivalent to California's Proposition 103 of 1988 and the Texas legislature's SB14 in 2003.
*The Percentage of Physicians with Number of Malpractice Reports in the National Practitioners Data Bank (NPDB)between September, 1990 and December, 2002:
One Report = 63.4%
Two Reports = 20.2%
3-5 Reports = 13.4%
6-10 Reports = 2.5%
>10 Reports = 0.5%
The NPDB Public Use Data File does not include any information that identifies individual practitioners or reporting entities. The file is designed to provide data for statistical analysis only. (http://www.npdb-hipdb.com)
posted by Bob Coli, MD at 3:54 PM
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