Contrary to ads, doctors replaced, clinics still open

By Carol M. Ostrom
Seattle Times staff reporter

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Full-page newspaper ads say that high malpractice jury awards — and malpractice-insurance premium increases — have driven hundreds of doctors from the state, thousands from "states like Washington."

"As a sad result," the ads say, emergency rooms are "mothballed," trauma centers "shuttered," maternity wards "shut down" and neighborhood clinics closed.

In fact, Washington's situation is quite different from the picture painted in the ads.

But the campaign intent on limiting malpractice jury awards goes even further. The ads, which ran in several national newspapers earlier this month, including the Wall Street Journal and USA Today, claim that an "escalating scarcity" and a "dangerous vacuum of access" to health care is "sweeping across" Washington state. "Health-care becomes third-world quality, often unavailable at any price," the ads say.

Jason Kemp, spokesman for the doctors group, says much of the ad's information was gleaned from the American Medical Association, the Washington State Medical Association, and anecdotes and interviews of local doctors and patients.

"We didn't go out and do our own research," Kemp said. "We looked at articles from newspapers and television reports, and based a lot of information from that. Our ads were formulated using such information, with 100 percent respect for the truth."

Is this an accurate picture of health care in Washington state?

Here are some facts:

• No emergency rooms or trauma centers in Washington state have been "shuttered" or "mothballed," said Cassie Sauer, spokeswoman for the Washington State Hospital Association.

Rising medical-malpractice premiums have hit ER doctors hard, though, and some hospitals have coped by hiring ER doctors, covering them under the hospital's own malpractice insurance, or contracting with groups that supply ER doctors and handle their own insurance.
 
• A handful of very small hospitals have stopped delivering babies in the past two or three years. In most cases, the reason was not directly related to malpractice insurance, but to broader economic issues, such as doing too few deliveries or nearby competition, administrators said.

In total, the hospitals that stopped obstetrics were doing about 100 deliveries a year, a small fraction of the 79,000 babies born in the state in 2002. For example, Lincoln Hospital, a 25-bed facility in Davenport, Lincoln County, stopped delivering babies more than a year ago. The hospital's 30 deliveries a year weren't enough to afford an on-call obstetrics crew 24 hours a day, seven days a week, or enough to keep their skills current, said Administrator Tom Martin.

Several hospitals, however, did say they've had to make changes to keep obstetrics malpractice coverage. Some have brought obstetricians/gynecologists into paid staff positions, and at least one now subsidizes doctors' malpractice premiums when the costs increase above a certain amount.

• Doctors are leaving the state, but others are coming in. Tom Curry, executive director of the state medical association, the source of a Doctors for Medical Liability Reform claim that 500 doctors have left Washington since 1998, said the association doesn't know how many came into the state during that period, or how that figure compares to doctor-drain in previous five-year periods.

According to a 2003 U.S. General Accounting Office report, "Physician Workforce," there were more doctors per capita in 2001 than there were in 1991 in all of Washington's metropolitan areas and in the aggregate of rural areas, as well.

For example, in 1991, Bellingham had 164 doctors for every 100,000 people. By 2001, that number had grown to 209 doctors per 100,000. Kemp, of Doctors for Medical Liability Reform, said the ad refers to specialists. The GAO report said the number of specialists per capita also increased in both metro and rural areas.

• Six areas in Washington ranked among Modern Physician magazine's 2003 list of top 75 places to run a medical practice. The rankings took into account the cost of malpractice insurance, among other things.

Bellingham, Olympia, Seattle-Bellevue-Everett, Richland-Kennewick-Pasco, Bremerton and Portland-Vancouver were among the top 75, with Bellingham ranking No. 8 behind six Southern cities and Sioux Falls, S.D.

• Community clinics haven't seen closures, said Dr. Bob Crittenden, chief of family medicine service at Harborview Medical Center. In the private sector, some clinics have closed for various reasons.

• Malpractice-insurance premiums have risen in Washington state, but they're still in the "average" ranks of states, not among the highest, according to Medical Liability Monitor, a national organization that tracks malpractice-insurance premium rates.

Malpractice premiums in Washington last year averaged $29,049 annually, a Medical Liability Monitor report said. That compares to an average of $123,769 in Florida, the most expensive state, and $10,899 in South Dakota, the least expensive. Premiums for certain specialties, however, can be much higher.

Copyright © 2004 The Seattle Times Company