By Bob Lamendola, South Florida Sun-Sentinel
Jul. 27–South Florida has become the nation’s capital for doctors without medical malpractice insurance, experts say, leaving patients at risk of getting little financial help for care after a medical error.
Nearly one-quarter of doctors in Broward and Palm Beach counties, more than one-third in the Miami area, and one-eighth statewide opt out of malpractice insurance under a state law that lets them go without coverage, a state physician database shows.
That’s about double the rates in 2003, when uninsured doctors and medical malpractice became a state policy crisis.
Florida has allowed doctors to go without malpractice coverage for decades. Critics of the law that allows it said it raises the chances patients cannot collect enough money in court to cover medical bills from physician mistakes. Also, malpractice victims and lawyers are less likely to sue doctors who don’t carry insurance.
State Sen. Dennis Jones, R-Seminole, a chiropractor who has filed bills to require doctors to buy coverage, said the increase in uninsured doctors strengthens his case.
“You have to have insurance to drive a cab, but you don’t have to have insurance to do brain surgery?” Jones said. “Patients basically are at risk.”
No one tracks the number of U.S. physicians without coverage or who have filed bankruptcy in the face of a negligence case, but insurance officials, malpractice attorneys and doctors in and out of Florida agreed that no other area of the country has a bigger problem with uninsured doctors than South Florida.
“We’re sort of the [uninsured]-doctor capital of the world,” said Matt Gracey Jr., a malpractice insurance broker in Delray Beach. “I go to conferences and people say, ‘What the heck is going on down there?'”
Boynton Beach retiree Rhoda Fruchter fears she has no recourse against an uninsured doctor she said left her in chronic pain and unable to turn her neck.
Fruchter, 68, sued Dr. Douglas Martin in 2005 claiming the neurosurgeon inserted — then removed — screws in the wrong spot in her neck, said her attorney, Kenneth Sobel. She didn’t realize Martin had dropped his coverage.
Martin’s attorney, Roy Watts, denied the doctor did anything wrong and said Martin went uninsured because his premiums would cost more than the coverage offered. “It makes no sense for him to have it,” Watts said.
Complicating matters, Martin had filed for bankruptcy in 2000, which if approved would shield many of his assets. Among them, his 6,000-square-foot home on the Intracoastal Waterway valued by the county at $2.1 million.
“The doctor hurt me,” Fruchter said. “He’s living in his mansion, living the high life. How does this guy get away with this?”
Watts said the bankruptcy was unrelated to the lawsuit. Both cases are pending.
Florida has long required chiropractors, podiatrists, midwives, some nurses, acupuncturists and optometrists be insured, but medical doctors were allowed to go without coverage to help them cope with Florida’s high malpractice premiums. Some family doctors pay more than $50,000 a year; some high-risk specialists such as surgeons pay more than $200,000.
The law says doctors can go uninsured if they post signs in their offices and promise to pay up to $250,000 per malpractice award, with a maximum of $750,000 per year. If a doctor doesn’t pay, the state can revoke his or her license.
In 2003, legislators moved to lower premiums and get more doctors insured by limiting pain-and-suffering awards to $500,000 in cases of injury or $1 million in cases resulting in death. There’s no limit on payments for medical expenses.
Premiums since have gone down yearly by less than 10 percent; insurer profits climbed to an average of 20 percent in 2006.
But Florida premiums are still highest in the nation, a national survey shows. Those high prices, a high number of lawsuits, liberal bankruptcy laws, a squeeze in physician income and other factors have persuaded 5,200 Florida doctors — 3,450 in South Florida — to go without coverage, physicians and insurance officials said
Many physicians argue that malpractice insurance makes them targets for suits when a patient’s health goes bad, even if there’s no fault. Coral Springs cardiologist Alan Rosenbaum said he dropped coverage in December after his insurer paid $1.2 million to settle two suits in which he felt blameless.
“I have a strong feeling I’ll never hear from another attorney again,” Rosenbaum said. “Sure, I’m nervous. But I practice carefully. The first thing lawyers do when they have a case is [check] all the doctors involved to see who has how much coverage.”
Financial advisors now specialize in sheltering doctors’ assets from malpractice verdicts. Marc Singer, a partner at Singer Xenos Wealth Management in Coral Gables, said he advises doctors to drop coverage and, if sued, offer the patient a choice: a small settlement or get nothing when the doctor goes bankrupt.
“The idea here is not to beat the patient, the idea is to lower the expectations of the plaintiff’s attorney,” Singer said.
Bankruptcy has become a growing option for uninsured doctors, experts said. Federal and state laws shield the main home, retirement accounts, annuities and life insurance from malpractice awards.
Uninsured Juno Beach neurosurgeon Jacques Farkas filed for bankruptcy in 2004 after two patients sued. In the more severe case, a paralyzed man said in a lawsuit that his brain was pierced by a back rod Farkas implanted badly. Bankruptcy court records show Farkas sheltered $2.6 million in assets, including a $1.6 million oceanfront home. His payout to creditors: $16,200. The two patients got nothing.
“Fair or not fair… he did what the law allowed,” said Charles Cohen, a Farkas attorney who said the doctor denies wrongdoing in the surgeries.
Attorneys said declaring bankruptcy gives doctors another edge. If a malpractice award does not get paid because of bankruptcy, the state no longer considers a doctor in violation for not paying it, preserving his or her medical license. Only a handful of doctors have lost licenses for not paying.
Still, uninsured doctors risk a lot if they have not properly sheltered their nest eggs, said Bob White, president of First Professionals Insurance, Florida’s largest malpractice carrier. What’s more, the size of malpractice verdicts has been growing.
But White does not favor making doctors buy insurance, saying some doctors may leave the state if forced to take on the cost.
Malpractice attorney Stuart Ratzan and others counter that Florida’s present laws may attract doctors who have been sued in other states and can’t get coverage.
Six states require doctors to be insured, and eight require it in certain circumstances, the American Medical Association said.
In many states, hospitals require doctors be covered to see patients there. But not all in Florida do so. Also, courts have ruled hospitals cannot be held legally liable if doctors drop coverage.
Bob LaMendola can be reached at [email protected] or 954-356-4526 or 561-243-6600, ext. 4526.
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