August 5, 2004

Doctors lose insurance

Yearly costs already top $70,000 for some physicians

BY JANET L. METZNER
The Dominion Post

Nineteen doctors at Monongalia General Hospital -- more than 10 percent of the active physicians there -- are scrambling to get medical malpractice liability insurance issues worked out by this fall.

The problem is that their insurance company, NCRIC, has informed them that they have until October or November to find another policy, because the company won't provide coverage after that in West Virginia, said Dr. C. Andrew Heiskell, one of the affected physicians.

Heiskell and his three partners -- Dr. Roger E. King, Dr. William H. Burns and Dr. Todd E. Tallman -- face limited options.

NCRIC is one of only three insurance companies left in the state which offer medical malpractice liability insurance.

Those remaining are Medical Assurance and West Virginia Physicians Mutual Insurance Company. The latter company was created by the state to help resolve a medical malpractice liability insurance crisis that surfaced about four years ago.

Back then, insurance companies increased rates because of the high cost to defend its West Virginia policy holders and because claims increased.

Physicians complained and threatened to leave the state. In response, the Legislature limited the amount of money defendants suing physicians could get in court.

The state began its own insurance program through the Bureau of Risk and Insurance Management.

On July 1, that program became a private company, West Virginia Physicians Mutual Insurance Company, after being run by BRIM II for about 18 months.

Physicians Mutual now covers about 1,400 physicians -- making it the largest carrier in the state, Tolliver said.

Heiskell said he and his partners are trying to get coverage through Physicians Mutual, but there is a snag. That company has only enough money to back up the amount of physicians it has.

Heiskell said hospital officials still have hope. "I've talked at length with David Robertson, CEO with Monongalia Health System," he said. "He is confident that something will be worked out, such as Physicians Mutual could get more funds from the state."

Another option is for NCRIC to renegotiate with the state insurance commission, Heiskell said. He noted that last year, NCRIC asked for a 35 percent increase in the premiums doctors pay, but the insurance commission approved only 9.8 percent.

Monongalia General physicians are not alone in their insurance woes. All totaled, about 270 doctors throughout the state are covered through NCRIC, said Amy Tolliver, government relations specialist with the West Virginia Medical Association.

"As physicians' policies come up for renewal, NCRIC has been nonrenewing some of their policies and it was understood generally that they (NCRIC) were looking to get out of the state," Tolliver said.

Heiskell said he already pays $70,000 per year. With NCRIC's proposed increase he'd be forced to pay $94,000 per year.

Bill Hennessey, the hospital's director of government relations, said he doesn't want to push any panic button.

"It is a serious situation," he said. "Obviously, if we didn't have our surgeons, it would have a significant effect on operations."

However, he said, "We think we will find ways to overcome."

Just in case, though, Heiskell said, he started handing out fliers to patients last week, informing them that he may have to close the practice Oct. 1.

The effort to help the doctors gained a high-profile advocate during Monongalia County Clerk Michael A. Oliverio's most recent visit to his doctor, who happens to be King. Oliverio noted that he was shocked to learn the entire practice might close because of insurance issues.

During his appointment, Oliverio was handed one of the notices that said, "This office may be closing permanently on Oct. 1, 2004."

"I took that very seriously," Oliverio said Wednesday, noting that, as county clerk, he is concerned for his constituents.

The flier urged patients to look for other surgical care after that date, and noted that it affects all general surgeons practicing at Monongalia General Hospital.

In response, Oliverio contacted local and state officials this week. He sent a letter to 17 officials, from gubernatorial candidates, to senators and delegates, and all the way to the top to Gov. Bob Wise.

Sen. Mike Oliverio, D-Monongalia, and Oliverio's son, said he has contacted the governor's office, the state insurance commissioner, hospital officials and doctors regarding the problem. He said the solution could be that the mutual do a "better balancing act."

"They are going to have to underwrite policies in such a way they provide insurance to lots of physicians who need it, but that they don't provide it to physicians who have poor loss records that could jeopardize the viability of the mutual company."

"It is a tough balancing act for them --- they have to be careful who they insure."

One thing is certain, Heiskell said, if the doctors in his practice cannot get their medical malpractice insurance covered, they will no longer be practicing in the state.

He has considered closing the office and moving his practice to the Carolinas, he said, while the other three surgeons in the practice have considered retiring or moving.

He said hospital officials say they are certain to find a solution. Now, "I expect we will be open at least for a year," Heiskell said Wednesday. "But if the doctors are continued to be asked to pay more money, I can't afford to stay."

By the numbers

Where W.Va. doctors get medical malpractice insurance:

* Doctors with W.Va. licenses: 3,500

* Doctors covered by NCRIC Group Inc.: 270

* Doctors covered by W.Va. Physicians Mutual Insurance Company: 1,450

* The 1,000 physicians employed at the state's three medical schools and other state facilities are still covered by the Bureau of Risk Insurance Management.

* The remaining doctors get their medical liability insurance through a company called Medical Assurance or through companies that serve their specialty. Some do not have any medical malpractice insurance at all.

* The West Virginia Medical Association tracks how many state doctors' licenses are held in the state each year, although they do not know why each doctor makes changes.

* In 2003: 190 physicians dropped their W.Va. license; and three changed their license from active to inactive status.

* As of May 2004: 42 physicians dropped their W.Va. license; and 89 changed their license from active to inactive status.