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Politicians Blame Lawyers, Insurance Companies for Maryland Malpractice Mess

Posted on: Sunday, 31 October 2004, 15:00 CST

Oct. 31--On the issue of medical malpractice, Marylanders are as polarized as their politicians.

In a poll for The Sun, respondents who identified themselves as Republicans were three times as likely as Democrats to blame escalating health costs on trial lawyers suing doctors for malpractice. And Democrats were twice as likely as Republicans to blame insurance companies and HMOs.

And as for remedy, Republicans overwhelmingly want to limit jury awards and lawyers' fees, while Democrats are much more likely than Republicans to support efforts to weed out incompetent doctors.

Marylanders, like their elected leaders, are convinced that the zooming costs of medical malpractice are a serious problem. The poll found that 67 percent of Marylanders believe the malpractice system needs "major change," while 30 percent support "minor change." Only 6 percent say the system is fine as it is.

The sharp political split on the issue was potent in Annapolis last week, as Gov. Robert L. Ehrlich Jr., a Republican, offered a proposed remedy heavy on limits to jury awards and lawyer fees that was immediately criticized by Thomas V. Mike Miller, the Democratic president of the state Senate, as anti-victim.

The leaders are struggling to reach consensus on a reform package for a special session in the next month or two. They're rushing to stave off a large increase due in medical malpractice insurance that is being blamed for forcing some doctors to leave their practices or abandon some services deemed higher risk.

The poll findings "are not really surprising because there has been such a concerted political effort to imprint those views on the public," said Brian E. Frosh, a Montgomery County Democrat who chairs the Senate Judicial Proceedings Committee.

"If your hero is George Bush, and George Bush is telling you three times a day that the trial lawyers are responsible, you take it as gospel," said Dennis O'Brien, a spokesman for the Maryland Trial Lawyers Association.

The poll of 725 Marylanders was conducted during the past week by Ipsos-Public Affairs. It has a margin of sampling error of 4 percent.

Apart from malpractice, the poll found higher medical costs impacting Marylanders. Because of rising costs, 21 percent said they sometimes don't get prescriptions refilled and 23 percent said they're less likely to visit a doctor.

Now, Ehrlich, Miller and House Speaker Michael E. Busch, a Democrat, are searching for at least rough agreement on a reform package that could be passed in a special session in the next month or so -- in time to block another 33 percent rate increase for doctors due to take effect Jan. 1. Most Maryland doctors were hit by a 28 percent increase in malpractice premiums this year. Several reform measures died in this spring's legislative session.

While there is disagreement on what mix of reforms would work best, the consensus for action appears solid -- among lawmakers and the public.

"There has been an increasing consensus in the last couple of weeks among legislators, doctors and others that there is a problem, and that it could impact access to care," said Nancy Fiedler, senior vice president of the Maryland Hospital Association, which is pressing for reforms in the court system.

Frosh, whose committee killed several reform bills in the spring, said the seriousness of the problem has become more clear with a second round of premium jumps.

"It's something most people in Maryland agree on -- we've got a problem, and we've got to solve it, and we've got to solve it soon," he said. However, he said, the choice of remedies is still subject to "quite a bit of uncertainty and debate."

Although the questions are framed somewhat differently, the results of the poll for The Sun are consistent with national findings, said Robert Blendon, a professor of health policy and management at Harvard University.

Blendon and the Kaiser Family Foundation conducted polling last year in which 68 percent of respondents (who could give more than one answer) said drug company profits were very important in pushing up health costs. Malpractice costs ranked second among perceived cost drivers, with 60 percent listing it as very important.

While belief is widespread that malpractice costs are a major contributor to health inflation, that's not really true, according to health economists.

Paul Ginsburg, president of the Center for Studying Health System Change in Washington, who has published numerous studies on health costs, said the share of health spending that goes for malpractice premiums is less than 2 percent.

That is consistent with Maryland data. For example, Robert Murray, executive director of the state Health Services Cost Review Commission, told a state Senate hearing last week that hospitals in Maryland spend about $8 billion a year, and that $115 million -- about 1 1/2 percent of that spending -- goes for malpractice coverage.

Those who argue that malpractice cases are responsible for health inflation say the threat of suits adds costs as doctors practice "defensive medicine" -- ordering extra tests, for example, or doing unnecessary Caesarian deliveries.

However, "when it comes to defensive medicine, we don't have much (research) literature to show it is large and growing," Ginsburg said. "It shows how far we have to go to grapple with costs, if the public perceptions are so different from what the facts are."

Poll respondents who agreed to be interviewed by a reporter confessed to some confusion over the fine points of malpractice awards.

But Linda Looney of Elkton, a 53-year-old mother of five, said she believes a trickle-down effect exists from doctors to patients, where "they've got to get paid more for their insurance, you've got to pay more for them. It all comes down to money."

On rising health costs generally, 43 percent of those polled said that their health spending cut into the amount of money they have left for other expenses. Of the one-fifth of Marylanders who said health care costs cause them to see a doctor less often, two-thirds also said it affected the number of medication refills they get.

Of those polled who said their household income was under $50,000, more than a third said they skipped prescriptions or doctor visits, and more than half said they had to stint on other spending to meet medical costs.

Health care costs have become so debilitating for Upperco resident Judith Plunkett, a 47-year-old paralegal, that she has reduced all three -- overall spending, doctor visits and drug refills.

Plunkett's leg still swells up and hurts two years after she fell on her concrete patio. But she cannot afford the follow-up care doctors initially recommended, she said, because she already pays $700 each month for gastric reflux medicine. She has canceled magazine subscriptions and stopped going to movies, she said, which feels "ridiculous, absurd."

After a "long and protracted battle" with her insurance company, Plunkett said she now thinks business interests distract the intimate doctor-patient relationship from what should be its primary focus: health.

"Something has to be done on a national level," said Plunkett, who opposes malpractice lawsuits but so far finds proposed political solutions vague and unpersuasive. "I could go out and find justice for myself, but at the cost of other people like me."

For Joseph Williams, treating high blood pressure and gout has gotten harder because of the rushed and impersonal attention he said he gets from medical providers.

Williams, 47, said doctors at his Baltimore health clinic regularly switch his brands of medication just as he is used to them, and send him to the drug store with multiple refills so he won't come back to the clinic for six months. "They didn't want to hear my problem," Williams said. "All they did was try to throw some medicine at me."

"It's getting worse," Plunkett said about the health care financing system. "I'm never going to live as long as my parents."

By M. William Salganik and Kathleen Cullinan

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(c) 2004, The Baltimore Sun. Distributed by Knight Ridder/Tribune Business News. For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

Source: The Baltimore Sun, Maryland

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