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Sunday, November 25, 2001
Statistics can't hide the need for malpractice tort reform
Aaron Levenstein once observed, "Statistics are like a bikini. What they reveal is suggestive, but what they conceal is vital." In the Nov. 11 article "Insurance Cost Rise Has Little Impact," staff writer Christopher Snowbeck relies on statistics to argue that our region isn't suffering from a lack of doctors, despite the rising cost of malpractice insurance. A closer look indicates otherwise.
The table accompanying the story shows that the number of obstetricians/gynecologists, neurosurgeons and orthopedic surgeons peaked two to three years ago and has been falling since then. What is not shown is the even steeper decline among obstetricians. Many of them have had to stop delivering babies to keep their insurance premiums at reasonable levels.
To argue that obstetricians/gynecologists are not in short supply, Mr. Snowbeck notes that their ranks have risen by about 30 percent since 1987, while the birth rate has declined. His argument is invalid for several reasons.
Fewer babies are now delivered by family doctors and more by obstetricians than in 1987. More pregnant women now seek prenatal care, which has thankfully led to a 30 percent decrease in infant mortality. And women who are not pregnant visit their gynecologists in greater numbers. The increase in obstetricians/gynecologists has therefore been justifiable. Yet, current conditions suggest that this increase has not occurred rapidly enough to keep up with the patients' demands to see their doctors.
The best way to determine whether there are enough doctors is to see how difficult it is to schedule appointments with them. If Mr. Snowbeck had asked the women of Pittsburgh, he would have learned that it has become very difficult to schedule a routine gynecologic exam in a timely fashion. This situation will only get worse unless newly trained physicians decide to stay in or relocate to this region. Unfortunately, the malpractice insurance crisis in Pennsylvania is a major disincentive for them to do so.
What our state needs is meaningful malpractice tort reform that would: 1) discourage the filing of frivolous lawsuits that cost too much just to get them dismissed; 2) prevent doctors from testifying as experts on cases outside their fields of expertise (even as a radiologist, I can testify as an "expert" on brain surgery); 3) mandate holding trials in the counties where the patients reside or were treated, not in a city hundreds of miles away that was requested by the plaintiff's lawyer for its track record of high payouts; and 4) set fair and reasonable caps on awards for "pain and suffering." We also need a better system to weed out truly bad doctors, whose repeated mistakes contribute to higher premiums for the rest of us.
Pennsylvania has the dubious distinction of having the highest average malpractice awards per physician in the nation. Although the doctors of Western Pennsylvania have been a loyal group thus far, if the economics of practicing medicine keep deteriorating, it will only be a matter of time before significant numbers of us are forced to move elsewhere. Sadly, this will mean reduced access to timely, quality medical care for our patients.
THOMAS S. CHANG, M.D.
Doctors are moving on
Christopher Snowbeck's Nov. 11 article "Insurance Cost Rise Has Little Impact" may inspire false hope in the residents of Pennsylvania. The statistics may reflect stability, but they do not demonstrate the type or amount of care rendered.
For example, while an obstetrician/gynecologist may not leave Pittsburgh, he or she may elect not to do deliveries anymore. Some physicians are limiting their hours of practice, cutting back to part-time status to get a break on malpractice premiums. Others may limit the number of hospitals with which they are affiliated. While the numbers remain the same, the amount of physician-patient contact has diminished greatly.
The reason for the malpractice crisis is lack of tort reform in Pennsylvania. The Medical Professional Liability Catastrophic Loss Fund, or CAT Fund, pays out claims from current surcharges imposed on physicians. The fund has been depleted at an exorbitant rate due to high money awards at the hands of Philadelphia juries. There are no caps on damages. Who sets the amounts of the awards? The trial lawyers. Why do they set such ludicrous amounts for damages? So that they can dip into the CAT Fund to enhance their income from the case. Ever wonder why trials for malpractice in Allegheny County and others are moved to Philadelphia? Because the lawyers know the awards will be higher and they will profit immensely from it.
Why hasn't there been tort reform? Because of the makeup of the Pennsylvania Legislature and the Supreme Court. Where did they come from before being lawmakers and judges? Law firms.
As Mr. Snowbeck correctly pointed out, physician reimbursements have declined in Pennsylvania. Adjustments must be made in reimbursements by insurers to offset the malpractice premiums, or financially it just won't make sense to practice medicine in Pennsylvania. Where will the insurers get the additional money to pay out? From the insured. Wait until you see your next premium hike.
The CAT Fund is a disaster. Perhaps the federal government should be called upon for disaster relief. In the meantime, physicians in Pennsylvania know that they have done their best to help the reform effort. When we depart, there will be no regrets. Physicians who have not lost sight of their potential to benefit others in a more favorable legal environment will go on, albeit in another state. It is only by moving on that physicians can restore their hope and confidence. But who will take care of the people of Pennsylvania?
LAURA A. PALLAN, M.D.
About adoptee rights
When I was interviewed by Mackenzie Carpenter for the Nov. 18 article Many Groups Debate Modernizing Adoption, I was impressed by her knowledge of the issues surrounding adoption practice and history, which was reflected in the finished article, but a few things were wrong in the article. I was unhappy to see the second question she posed framed as an "adopted child's" right to know about his past. While it was right in the rest of the article, I want to stress that we are not adopted children and my organization, Bastard Nation, does not advocate opening records to minors.
Adult adoptees have a right to access the original state-held records of their births in the same manner as all other citizens, whether they choose to use them to trace their birth parents or not. They may do so unconditionally now in only four states: Alaska, Kansas, Alabama and Oregon. I was surprised to see Oregon omitted from this list, since it was a hotly debated issue in the national media when Measure 58, which restored this right to Oregon-born adoptees, was on the ballot in 1998 and passed by a large majority.
I was also dismayed to see Delaware and Tennessee included on this list, since adoptees in Delaware may access their original birth certificates only if their birth parents do not object, and in Tennessee they are subject to restraining orders if their birth parents file contact vetoes against them.
Thanks again to Ms. Carpenter for a fair and informed treatment of the issues involved in Senate Bill 859. The article clearly portrays the forces we are up against in the form of the Catholic Conference, the National Council for Adoption and others who would prefer to keep adoption in the Dark Ages and their own practices under a cloak of secrecy.
CYNTHIA BERTRAND HOLUB
Editor's note: The writer is on the executive committee of Bastard Nation: The Adoptee Rights Organization.
Not children forever
In reference to the Nov. 18 article Many Groups Debate Modernizing Adoption: It is increasingly frustrating to me that Post-Gazette articles continue to refer to all people adopted as children, regardless of their current age, as in "adopted children."
No matter our age, adult adoptees in Pennsylvania continue to be treated like eternal children. We are denied records about us that the state holds, such as our original birth certificates, because it is presumed that our biological relatives need some form of protection from us; in effect, we are presumed guilty.
We are told that we are just like any other "children," but once we do something bad or someone does something bad to us, we are differentiated. You don't say "father found guilty of beating his child," but rather, "father found guilty of beating his adopted child." And when we protest for open records? We remain "adopted children."
I am 31 years old. I have not been a "child," adopted or otherwise, for more than a decade. I am an adult adoptee.
HOPE ANNE NATHAN
Voters are tired of mudslinging campaigns
In response to the Nov. 14 letter by Melissah J. Falavolito ("Candidates, Stop Slamming the Opponent and Tell Us About You"), I agree with Ms. Falavolito 100 percent. As the elections arrive again and again, we obviously see everything typical to a political campaign. These things, of course, include campaign stops, town meetings, TV appearances and interviews and the overkill of political posters and signs everywhere you go. I consider all these means of promoting political candidates acceptable.
It is fine to have the candidates tell you what they are all about, and the signs all over the place can be easily removed after the election. What I do not approve of, as with Ms. Falavolito, are ads that we commonly call mudslinging. Why is it that one candidate has to put down the other in the attempt to get votes?
These ads are pounded into viewers over and over again at what seems to be every commercial break. Aren't the debates enough for "crossfire" between the politicians? If these candidates want more of their fellow Americans to be encouraged to vote, they need to stick to ads that say things like, "Hi, I'm Jack Smith, candidate for governor of Iowa; I am for . . . ; I am against . . . ; We need to do . . . ; I'd like to get this accomplished . . . " etc. Even if the candidate ultimately does not keep his or her promises as the worst-case scenario, at least voters would feel that they had received the information from that candidate.
With the "slamming the other candidate" ads, (prospective) voters can become disgusted and not know what to believe and either pick any candidate or just give up voting altogether.
PAUL M. KESSELER
Fox Chapel
Sewickley
Philadelphia
Polish Hill
Dormont