Medical Malpractice Insurance Reform
MEDICAL MALPRACTICE INSURANCE REFORM -- (House of Representatives - November 19, 2004)
The SPEAKER pro tempore. Under the Speaker's announced policy of January 7, 2003, the gentleman from Georgia (Mr. Gingrey) is recognized for 60 minutes as the designee of the majority leader.
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Mr. BURGESS. Mr. Speaker, I thank the gentleman from Georgia (Dr. PHIL GINGREY) or Dr. PHIL, as we say here in Congress. I need to point out that I am just a simple country doctor, and while the gentleman from Georgia will spend a lot of money on polling, my operation in Texas is far too small for that. But I do talk to a lot of my constituents, and the doctor is right that this is an issue understood by average, everyday Americans. They understand it very well. They understand it is limiting their access to medical care, and they want this situation fixed.
The Subcommittee on Health Policy met this summer and had a hearing on medical liability reform. We wanted to bring the spotlight to what are some of the successes we can point to in this country in this arena, not just simply rehash and recover old territory but what are some of the solutions. We were fortunate to be joined by a doctor from California who was actually practicing medicine in California 1975 when the California Medical Injury Compensation Reform Act of 1975 was passed.
Of course, he talked about the night-and-day difference that it made in his State as far as being able to practice medicine with the noneconomic damages capped at $250,000 and how that held down premiums and allowed doctors to continue in practice and not leave the State because they were in a crisis in 1975.
Let us remember the governor who signed this bill into law from the California legislature was none other than Jerry Brown, not known for his conservative thoughts or principles. It was truly landmark legislation when it was passed in California now some 28 or 29 years ago.
In Texas, we passed legislation this past legislative session that also limited noneconomic damages, put a cap on noneconomic damages. It was a little bit different. We might say it was a 21st century variation of capping noneconomic damages. There is a cap of $250,000 for the physician's component, a cap of $250,000 for the hospital component, and another $250,000 if a nursing home is involved. But altogether, the noneconomic damages in a case would be capped at $750,000. This has had an enormously positive impact on the State of Texas as far as liability reform is concerned.
Consider this: When I was practicing medicine in the late 1990s, there were 17 insurers who would write a liability policy for doctors in the State of Texas. As the medical liability crisis mounted in my State, the number of insurers dropped out and left the State to the point that, by 2002, there were two remaining insurers writing medical policies in Texas.
What did this mean for the average medical practitioner and their patients? When I was campaigning in 2002, when I would do speaking events, I remember a young woman came up to me. She was probably in her early 40s. She said, "I am a radiologist who studied at State schools and I did my residency at a State-supported institution. My insurance carrier left the State 3 months ago, and now I cannot buy liability coverage at any price, and I cannot afford to jeopardize my future, my husband's future, and my children's future by continuing to practice medicine without a liability policy, so I am a stay-at-home mom."
That is an admirable thing for someone to do, but the State of Texas had made a significant investment in her college and medical education. In addition, she did her residency at a publicly funded hospital. Again, a good investment made in this bright individual to practice her craft of radiology, a lot of investment was made by the State of Texas, by the people of Texas, in her medical career, and she was unable to practice her profession because of the unavailability of liability insurance at any cost, let alone liability insurance that might have been quite costly.
One of the people we heard from at that hearing was Texas Insurance Commissioner Jose Montemayor. This hearing was in June. Commissioner Montemayor talked about some of the improvements that had come to Texas as a result of this law that was passed by the Texas State legislature. We had gone down to two liability insurers. We were now up to 13. Of those that had come back into the State in 8 months time, they had done so without an increase in their rates, contrasting with the neighboring States of Oklahoma and Louisiana where those insurers were able to show and justify an increased rate of 50 percent in Oklahoma and 80 percent in Louisiana. So this is a big difference this law has made in Texas.
In addition, Cristus, a Catholic not-for-profit health care system in south Texas that self-insures, has been able to, by June of this year, 6 months into this fiscal year, had posted a $20 million savings in their insurance premiums that they were then able to directly invest in hiring nurses, direct patient care, and capital improvements in their hospitals there.
So this is a tremendous gift or tremendous savings for the people in the State of Texas, and one of the things that we were able to showcase in that hearing is one of the proven successes in the country for medical liability reform.
We also heard from an individual, and I apologize. I am blocking on his name. He was the administrator of the hospital in Uniontown, Pennsylvania, and there the story has not been as benevolent. Pennsylvania has not managed to pass medical liability reform in their last legislature. Because of the peculiarities of their State system, they will have to pass that legislation two times in the form of a constitutional amendment. So 2007 or 2008 is the soonest time they can expect any type of relief from their medical liability crisis.
The administrator at Uniontown Hospital told us he is down to one ear, nose and throat doctor who is now responsible for about 140,000 patients in that area. I did some quick math, that is about 300,000 ears for one doctor. That is a lot of work for one ENT doctor, and they cannot bring in another doctor to help him because of the cost of their liability insurance.
About a year and a half ago, we were at a field hearing up at ANWR, and we came back home through Nome, Alaska. When a group of congressmen come through Nome, Alaska, it is a big deal, and a lot of people turn out for that. They heard that one of the congressional representatives was a physician representative, and the entire medical staff of their hospital came out to lunch with us.
Over lunch, they asked questions. What it was like to serve? And one said we hope Congress gets that medical liability law passed because we cannot afford an anesthesiologist for our hospital here in Nome.
I asked what kind of medicine he practiced. He said I am an OB/GYN, just like you.
Mr. Speaker, what a deal. Practicing OB/GYN in your hospital without an anesthesiologist in Nome, forget pain relief during childbirth. We are talking what do you do if you have to do a c-section. He said, well, we get that patient on an air ambulance as soon as possible and get her to Anchorage for her c-section. Well, Anchorage is an hour and a half a way, and I am given to understand there is poor weather sometimes in Nome, Alaska.
I cannot understand how we feel that we are furthering the cause of patient safety by allowing this system to continue.
People do ask me back in Texas, they say, we have done a good job here in Texas. Why are you worried about medical liability insurance anymore? It is not an issue for us here in Texas. But as Dr. GINGREY has pointed out so clearly, it costs our country billions of dollars every year.
In the Medicare system alone, the cost of defensive medicine from a 1996 Stanford University study was estimated to be between 30 and $50 billion a year in the cost of defensive medicine. Do the math on that. What is the average of 30 to $50 billion? It is $40 billion a year. Dr. GINGREY is quite right. We were criticized last night about increasing the debt limit. We were criticized a year ago for passing a Medicare bill that costs $40 billion a year for prescription drug coverage. We basically would save that amount of money if we would only pass meaningful medical liability reform. That is why it is a national issue, because we are all paying for that. Every taxpayer in the country is paying that freight for this medical liability system. $230 billion a year in direct costs for medical liability and about 20 percent of that actually goes to injured patients.
Do not tell me that by capping noneconomic damages that we are keeping money out of the hands of patients. The system is keeping money out of the hands of patients today under the present system and the only parties that are enriched by today's system are the trial lawyers.
With that, I see my time is about up. I appreciate so much the doctor organizing this Special Order this evening. It is of critical importance that we get this done. We did not manage to do it this year. There has been a little bit of a change across the Capitol rotunda, and I am very optimistic that as we start into the 109th Congress, this will continue to be an issue of pressing concern for it, and we will get this job done for the American people.
Mr. GINGREY. I thank my colleague from Texas for joining us this evening for this discussion, and I appreciate his very accurate remarks. I know one thing he was talking about, physician access and which specialties doctors choose today based on this liability crisis.
I want my colleagues to listen very carefully to this number: 48 percent, the proportion of American medical students in their third or fourth year of medical school who indicated that the liability crisis was a factor in their choice of specialty, threatening patients' future access to critical services. I am sure that Dr. BURGESS would agree with me that when we were in medical school a few years ago, OB-GYN was one of the most popular specialties. It was the one that everybody wanted to go in. It was the compassionate, the feel-good specialty, delivering babies, being with a family, at what usually is the happiest day, the happiest moment of their lives, the birth of a child.
Yet today because of this crisis, as he well knows, we are having fewer and fewer, not only fewer and fewer of our best and brightest students from college wanting to get into medical school and go into the practice of medicine in any specialty but particularly OB-GYN and general surgery and neurosurgery and some of these higher risk specialties.
Mr. BURGESS. If the gentleman will yield, about a year ago I was having a discussion with a woman who was in charge of the residency program at a northeast hospital. I trained at Parkland Hospital, arguably the best residency program in the country, but this one in the northeast has a good reputation as well, and she said that they were at the point now where they were taking people into their OB-GYN residency program that 5 years ago they would not even have asked in for an interview, such has been the dropoff in the quality and caliber of, as you put it, the best and the brightest not going into the specialty. These are children's doctors. These are the doctors that are going to be there for the next generation of Americans. Again, I fail to see how allowing this system to continue is furthering the cause of patient safety or excellent patient care.
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