Is Oklahoma Losing Doctors?
By Marie Price
Two arguments sometimes cited in favor of tort reform are that Oklahoma is losing doctors, particularly in high-risk fields such as emergency medicine and obstetrics, and substantial malpractice liability payouts that help fuel high insurance rates for doctors.
Hugh Robert, executive director of the Oklahoma Center for Consumer and Patient Safety, says both contentions are off the mark. The number of doctors in Oklahoma is actually rising, he says, and lawsuit outcomes prove that Oklahoma is hardly a jackpot-jury haven.
Dr. William Oehlert, president of the Oklahoma State Medical Association, says it is becoming more and more difficult to get physicians to go into some fields, and some are either leaving practice or avoiding certain lawsuit-prone procedures.
Dr. Carl Hook is an ear, nose and throat surgeon who says his insurance rates skyrocketed 368 percent between 2001 and 2005.
He is also president and CEO of Physicians Liability Insurance Co., or PLICO, an insurer affiliated with the OSMA that writes well over half of the state’s medical malpractice insurance.
PLICO’s rates were increased 60 percent in 2003, and the company sought an 82.8 percent hike in November 2003.
However, then-insurance Commissioner Carroll Fisher ruled that the increase should be spread over three years, 39.5 percent in 2004, 15 percent in 2005 and 14 percent in 2006.
Although PLICO officials at the time attributed at least part of the need for the rate hike on large jury awards, the insurer was actually in financial trouble for several reasons (See related story).
Hook said that in recent years, juries have been handing down more common-sense decisions, but lawsuit limitations are still needed, particularly now that state courts have overturned portions of Oklahoma’s tort-reform law.
But is Oklahoma losing doctors?
In 1997, according to data from the Oklahoma State Board of Medical Licensure and Supervision, some 4,787 medical doctors were practicing in the state, including 166 emergency physicians and 276 practicing obstetrics, gynecology or both, including ob-gyn surgical specialists.
By 2007, the total had risen by more than 900 to 5,718, including 283 ER doctors and 395 in the ob/gyn fields. However, the number of the latter had dropped from 414 in 2004.
When it comes to osteopathic physicians, data from the Oklahoma Osteopathic Association shows that in 1997 there were a total of 880 doctors licensed to practice in Oklahoma, not including retirees, interns and residents. The total included 72 emergency physicians and 25 ob/gyn doctors, including surgeons.
In 2007, the osteopathic association listed 1,324 licensed doctors in Oklahoma, including 143 ER doctors and 58 in the ob/gyn field. There has been a slight but steady rise in the number of osteopathic ob/gyns since 2002.
Robert said that 2006 data from the Federation of State Medical Boards shows that Oklahoma ranks 43rd per capita for the number of doctors practicing in the state, just above Arkansas. Texas ranked 49th, Kansas 24th, New Mexico 31st.
“In Oklahoma, between 2002 and 2006, population growth in Oklahoma has been 2.54 percent, according to the U.S. Census,” he said.
“Our doctor population, however, has grown at 7.93 percent.”
He said the rise in the number of Oklahoma doctors places the state about in the middle of all 50 states.
“The data basically shows that what they are claiming is just not true,” Robert said. “The numbers of doctors that are becoming licensed and practicing in the state are continuing to increase.”
But not fast enough, says Oehlert.
“The big thing is that our physician numbers haven’t really increased significantly,” he said. “And as our population ages, that’s going to be a major area, in gyn, cardiology, internal medicine, family practice, general surgery, because those type of health problems that would be applicable to those physicians, you’re not going to have the physicians.”
Oehlert said that some doctors are leaving clinical practice, have stopped delivering babies and steer clear of ER room work because of the threat of being sued.
Some rural areas reported difficulty in attracting or retaining physicians, particularly in some specialties, during the period of the back-to-back insurance rate hikes.
“I’ve been told that there are physicians leaving the state or – probably more appropriately – not coming into the state because of the reputation that Oklahoma has in being a lawsuit-friendly state,” he said.
Oehlert said there have been inquiries from Texas seeking OSMA’s mailing list wanting to contact Oklahoma physicians about possibly moving south.
When it comes to malpractice lawsuits, Hook said that 70 percent to 75 percent of them are dismissed.
On average, he said, 25 percent of legal actions against doctors around the country are settled out of court, with maybe 5 percent actually going to trial.
“Doctors win approximately 90 percent of the trials,” Hook said. “We’re doing better than that right now.”
Hook said that PLICO participated in about 35 trials from 2005 into this year. He said the company averages 10 or 11 per year, but has gone to trial four times already this year.
“I think that we’re getting good, sane, logical thought processes out of the juries, and have been the last few years,” he said.
The Oklahoma Insurance Department keeps track of medical malpractice insurance claims.
The form in which the information is published differs somewhat from year to year, making comparison tricky.
It should also be noted, as Hook pointed out, that some hospitals self-insure themselves and their doctors.
In 2006, according to the agency’s annual closed-claim report in this area, out of 805 closed claims against doctors, hospitals and other health care providers, 591 were dismissed at some point, with 181 settled and 20 tried to a jury or judge.
The average claim settlement or award in 2006 was $257,887, the agency reported.
Exclusive of attorney fees and case costs, the amount paid out on behalf of insureds in 2006 was almost $50 million.
In 2005, out of a total of 831 claims, 645 were settled out of court in one way or another.
Of those that went to trial, nine resulted in plaintiff’s verdicts or judgments, 22 for the defendant.
Other cases did not go to trial or had other types of resolutions.
In 2005, medical liability insurers paid out $43.8 million.
That year, the companies made payments for 247 claims, with an average payment of $177,369.
The previous year, 2004, totaled 974 closed claims, with 344 settled out of court.
That year, medical liability insurers paid out a total of $77.4 million. The average claim payment was $301,123.
Out of 83 cases that went to court in 2004 in which verdicts were issued, 69 resulted in judgments for defendants, seven for plaintiffs.
The remainder was resolved by other means.
According to data from the Kaiser Family Foundation, the average medical malpractice payout in Oklahoma in 2007 was $272,294, compared to a national average of $326,637. The foundation’s data for 2007 covers only January-September.
Hook said there have been several million-dollar-plus recoveries by plaintiffs.
He said a 2000 case resulted in a $10.5 million plaintiff’s verdict, and a $5 million PLICO payout.
He said a portion of that case has since been reopened on appeal regarding the other $5.5 million.
However, Robert said that such high damage awards are relatively rare in Oklahoma cases.
Robert said that the reported average payout for Oklahoma is below the $300,000-$350,000 cap on noneconomic damage awards touted by tort reform advocates.
He also said that most sizable awards are in cases involving severe injuries such as paralysis or permanent brain injury.
“I think our juries are smart,” Robert said.
“We trust those juries to send people to death, yet they’re saying juries don’t know what they’re doing when it comes time to compensate somebody for their loss.”
Originally published by Marie Price.
(c) 2008 Journal Record – Oklahoma City. Provided by ProQuest Information and Learning. All rights Reserved.