As malpractice insurance rates climb and Pennsylvania physicians head for the borders, doctors, lawyers and elected officials are debating how to halt what some are calling a malpractice crisis in the state. Faced with skyrocketing malpractice insurance premiums, doctors -- particularly those in fields considered high risk -- say they must find a way to pay the high bills, stop performing high-risk procedures such as delivering babies, retire, or move to a state with lower insurance premiums. "I have seen doctors leave," said Dr. Allen Yeasted, a Tarentum native who now practices at St. Clair Hospital and serves as president of the Allegheny County Medical Society. "We've had doctors leave to go to North Carolina, and I have a colleague who is looking to go to Mississippi. It's happening every day." Insurance companies say premiums are rising because of frivolous malpractice lawsuits and large jury awards in such cases. Lawyers say insurance companies are using malpractice cases as a scapegoat. The real reason insurance companies are raising premiums, lawyers say, is to recover money the companies have lost in the declining stock market. Dan Joseph, a New Kensington attorney who represents plaintiffs in malpractice cases, said attempts in Legislature to cap the amount of damages in such cases are misguided. "It's very, very difficult to convince a jury of medical malpractice even with good cases," Joseph said. "There are so many roadblocks in the path of a plaintiff. When I hear people say, 'frivolous lawsuits' I want to scream." Lawyers like Joseph said the multi-million dollar settlements insurance companies point to as culprits for high premiums are rare. Just how much an average settlement is in Pennsylvania remains unclear. Democratic State Rep. Mike Veon of Beaver County has asked the state's Insurance Department to determine the average jury award. A report by the General Accounting Office, the investigative arm of Congress, earlier this year confirms much of the attorneys' arguments. The report concluded that malpractice insurance rate increases were caused mainly by insurance company losses in their investment portfolios, inadequate reserve funds for claim payments and artificially low premiums during the 1990s. The report also concluded, however, that states with caps on malpractice case damages generally had lower malpractice premiums. The Pennsylvania Medical Society Alliance has said those rates in Pennsylvania have becoming intolerably high, especially for doctors in "high risk" specialties such as obstetrics or orthopedic surgery, where doctors are more likely to be sued. One small hospital, which Yeasted declined to name, is nervous because its entire neurosurgical staff is considering moving to another state. "They'll have no neurosurgery. All those patients will have to be moved to another hospital," Yeasted said. LOCAL DOCTOR LEAVING In the Valley, patients of orthopedic surgeon Dr. John J. McCarthy III, who had offices in Harrison and Fox Chapel, received a letter in June, saying the doctor was moving his practice to Virginia. "It is the rising malpractice costs and decreasing insurance reimbursement that has forced me to seek other opportunities," McCarthy wrote. Figures show there are more than 4,000 fewer active doctors in Pennsylvania this year than there were in 1998. The reasons for the decline could be many, including a drop in the state's overall population and what some criticize as low reimbursement rates from Medicare and insurance carriers. The medical society alliance, however, says doctors are leaving to escape high malpractice premiums. Joseph maintains that the crisis is overblown. "I don't know of anybody who lost a doctor or can't find a doctor in this area," he said. Malpractice insurance rates vary greatly, depending on where a doctor practices, what his or her specialty is and whether he or she has filed claims. Such factors make it almost impossible to pinpoint an average doctor's premium. PREMIUM EXAMPLES However, as examples, the state medical society said a Pittsburgh-area doctor with a clean record who is an obstetrician/gynecologist got a malpractice insurance bill for $78,537 this year. For a general surgeon, the bill is $63,048. For a pediatrician or family doctor the bill is $14,296. That figure includes the doctor's MCARE assessment, which he or she might not have to pay, depending on whether the Legislature abates the payment. The Legislature has not yet passed proposals by Gov. Ed Rendell to let doctors off the hook for at least half of this bill. The MCARE (Medical Care Availability and Reduction of Error) fund is an insurance program the state requires doctors to participate in. Yeasted acknowledges that high medical liability insurance premiums are just one reasons doctors are leaving Pennsylvania. Poor reimbursement rates and other issues also contribute. "Recruiting physicians is very difficult," he said. "Our best way to recruit is to find physicians who grew up here and want to come back. It's very hard to recruit someone who didn't grow up here. We don't have the ocean. We don't have the great weather." But he urged the Legislature to adopt a malpractice reform measure as a first step toward solving the problem. "When it gets so bad that they consider it a crisis, it will be too late to get these doctors back," Yeasted said. "We're not crying wolf. We see our colleagues leaving."

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