Malpractice muddle

Aside from gasoline, not many commodities have endured a roller-coaster ride in prices like medical malpractice insurance rates. After climbing a breathtaking 28 percent and 33 percent in back-to-back years in 2004 and 2005, the rates for the state’s largest carrier are headed back down (albeit at a somewhat more leisurely pace). Medical Mutual Liability Insurance Society of Maryland is seeking an 8 percent cut in physician premiums for the coming year.The question is, why? The simple answer is that Medical Mutual has been paying out less in damages and legal fees, and that’s primarily because of fewer malpractice claims. That probably speaks more to the cyclical nature of insurance than anything else – not every year produces big payouts. Unfortunately for doctors insured by Medical Mutual, premium bills will barely budge because a reduction in the state’s premium subsidy slated for next year will likely offset the rate reduction.

Clearly, it would be a mistake to assume that the recent malpractice crisis – a cause championed (and ultimately fumbled) by Gov. Robert L. Ehrlich Jr. – is now resolved. The subsidy, and some modest reforms approved by the General Assembly last year, may have been helpful but the system is still fundamentally flawed. It remains too much of an unfair lottery for plaintiffs and defendants, raising medical costs and often hurting the quality of health care.Physicians and other reform advocates have promised to bring the issue back to the legislature next year but they aren’t likely to get far. The necessary sense of urgency no longer exists, and powerful political players, lawyers, insurers and health care providers are predictably at loggerheads. The modest possible changes that have been discussed so far – ensuring that doctors who apologize for adverse outcomes can’t have those words used against them in court, for example – aren’t likely to have a profound effect.

What the downturn in rates truly demonstrates – to put it bluntly – is that nobody seems to know precisely what’s going on in the malpractice field. Experts point to more aggressive legal defenses, various tort reforms and perhaps even better medical outcomes as possible factors. What’s needed is more concrete information and less spin. Might the highs and lows of rates be lessened if insurers carried larger reserve funds?

Lawmakers would be wise to keep an eye on how other states have attempted to tackle the malpractice morass and whether those efforts yield better results. Perhaps there is a way to reduce insurance premiums, ensure more doctors stay in business, promote quality health care and fairly compensate the victims of genuine malpractice that has so far eluded Maryland’s legislature.

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