Medicine on the edge

by

Published: April 8,2002

When a trial lawyer in Mississippi gets sick, where does he go? The choices are definitely slimmer these days.

With escalating insurance premiums from a drying pool of providers, and little hope for tort reform legislation any time soon, Mississippi’s medical community is dwindling as many practitioners seek early retirement or step across state borders.

“Many of us don’t want to treat trial lawyers unless they have an emergency,” said one physician, who requested anonymity. “Otherwise, let them go out-of-state. But that wouldn’t be ethical and we won’t do it.”

Another doctor, who has treated legislators and trial lawyers, said, “It doesn’t give me a good feeling.”

The legal climate in Mississippi has been regarded nationally as a “lawsuit Mecca” because of hefty jury awards in mostly rural counties. After lawmakers voted down even the weakest tort reform legislation earlier in the legislative session, doctors across the state took action.

Relief across muddy waters

Dr. Mal Morgan, a cardiologist in Natchez and a member of a 13-doctor group that formed a partnership to build a $6-million medical complex near the Natchez Regional Medical Center, said the project was brought to a halt after tort reform legislation died in the legislative session.

“We had an architect working on plans and had worked out a lease on the property from the county, but we had to ask ourselves, ‘Is this the smart thing to do business wise?’ We started crunching numbers and decided it would be a bad business decision,” he said. “It would also be sending a bad message to trial lawyers that says, ‘hey, you’re gouging us, but it’s OK.’”

After one of the partner’s wives mentioned locating the facility across the Mississippi River, the group changed course. Louisiana looked inviting, and state officials were receptive.

“Instead of an office building in Mississippi next to the hospital, we’re talking now about building a 200- or 250-bed hospital in Concordia Parish with a medical building attached,” he said. “We don’t want to uproot our lives, but before we let (trial lawyers) take everything we’ve earned for 20 or 25 years, we’ll get out of the state.”

After finding an interested partner in Florida-based Health Management Associates Inc. (NYSE: HMA) to build a hospital in Concordia Parish, a meeting between the parties was arranged. The governor of Louisiana, who was unavailable for comment at press time, sent the state plane to pick up three of the group’s physicians to attend a meeting at HMA’s Florida office. HMA operates Natchez Community Hospital and seven other hospitals in Mississippi.

“When the doctors arrived at HMA in Florida, the man that greeted them said ‘Gov. Musgrove said to tell you hello,’” Morgan said. “We immediately knew that the governor had already been putting pressure on HMA not to work with us.”

On March 28, Musgrove traveled to Natchez to meet with the physicians about possible remedies for the malpractice crisis. Joe Mullany, vice president of HMA’s Mississippi division, who attended the meeting, said the group presented the governor with “a long list of issues.”

“He encouraged us to continue working with the Legislature and to work up some remedies,” Mullany said. “I don’t think the physicians walked away with the sense that this was going to be solved any time soon. We’re going to review it, but at this point, we already have such a commitment in Natchez that we would find it difficult to give that up. At the same time, we’re trying to support our doctors and work with them.”

Morgan remarked, “Gov. Musgrove said it was up to (Lt. Gov.) Amy Tuck and (House Speaker) Tim Ford, and if they pledged a meaningful session on tort reform, he would call a special session. He put the onus on their backs.”

“We were very disappointed with the meeting,” Morgan said. “We had another meeting after the governor left and those who already felt strongly about moving across the river felt even more strongly about it and those who were on the fence said they felt a move was inevitable.”

Musgrove said, “The issue that our physicians are not able to have access to or to obtain reasonable malpractice insurance rates is important to the delivery of quality health care in Mississippi. This is a real issue and one that needs to be addressed.

“That’s why I met with over 50 health care providers from the Natchez area (last month). When asked if I would call a special session to address the issue of providers having reasonable rates and access to liability insurance, I said I would call a special session if the leadership would give me an assurance that they would consider the issue.

“We still have challenges facing us with the rising cost of prescription drugs and health care delivery. Access to quality health care for all Mississippians is a top priority for my administration.”

Morgan replied, “The governor did not offer to help convince the lieutenant governor or the speaker to help. The physicians present thought that he offered us nothing in the way of help or hope concerning tort reform. We are not pleased.”

Morgan’s group isn’t alone in Natchez. When questionnaires were distributed to 50 or so physicians in the area, 35 replied immediately, he said.

“Twenty-four said they would definitely use a first-class, full-care hospital in Louisiana and nine said they probably would,” said Morgan. “We also asked them to estimate their yearly office payroll to get an idea of the economic impact to the county and about 22 responded that theirs combined totaled over $11 million. We’re doing another questionnaire and will present the results to the Louisiana governor, economic developers and a couple of hospitals.”

Physician shortage statewide

Similar stories have rumbled throughout the state.

In Greenwood, where four OB/GYNs delivered approximately 1,000 babies a year, two have quit delivering babies and the other two are limited to delivering 250 babies each per year, leaving approximately 500 patients searching for maternity care.

In Bolivar County, four family practitioners had to stop delivering babies because the cost of liability coverage exceeded possible earnings. Only two obstetricians are left to deliver approximately 750 babies annually.

In Columbus, Greenville, Greenwood and Tupelo, eight neurosurgeons have stopped taking calls. In less than a year, four lawsuits were filed against a general surgeon in Greenwood, who hadn’t been sued in 10 years. He has stopped taking calls.

Even though court dockets are clogged, nationally, the litigation time for medical malpractice lawsuits, from incident date to trial date, has steadily dropped from 61 months in 1994 to 45 months in 2000, according to Jury Verdict Research/LRP Publications.

Dr. John Nelson, president of South Mississippi Emergency Physicians and emergency room medical director for Forrest General Hospital, said the group of 18 emergency physicians and five nurse practitioners was two days away from flat lining on malpractice coverage when a provider agreed to insure them — for premiums four times higher than in 2000 with only a third of the coverage.

“One physician handed in his resignation last (month) and two others are looking to leave the state,” said Nelson, whose wife, Jan Nelson, is also a physician. “I recently talked to a medical director in North Carolina, where they’ve got legitimate caps, expert witness rules, joint and several liability and venue rules and their premiums for triple the coverage cost one-fifth as much.”

Dr. Henry Godek and his wife, Dr. Jo Tr
avis, anesthesiologists in Greenville, are moving home to Massachusetts this month.

“We came to the Delta from Yale University nine years ago because there was a shortage of anesthesiologists and we felt this was an area in desperate need of our services,” he said. “But it’s become prohibit

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