Grassroots advocacy: Doctors keep up the fight for tort reform

Chicago physicians turned drivers' heads and stopped lunchtime office workers in their tracks March 26 when they took to city streets to rally for an end to the medical liability insurance crisis.

Chanting "tort reform now" and carrying signs with such lines as: "Who is going to deliver your next baby?" and "Sen. Durbin: Prevent the Illinois MD exodus," about 200 physicians were escorted by police down city sidewalks.

Doctors marched about a mile and a half to the Dirksen Federal Building, where they dropped off petitions asking Sen. Dick Durbin (D, Ill.) to help move tort reform through the U.S. Senate. He has opposed previous bills. Marchers then took their rally several blocks north to the James R. Thompson Center, where Illinois Gov. Rod R. Blagojevich keeps an office, to urge him to support tort reform in Illinois.

"I'm fighting for my job right now," said Chicago internist Michael G. Grassi, MD. His rates, without any lawsuits, jumped to $52,000 this year, up from $14,500 in 2003. "We need a rollback, and the governor has the power to do this."

The Chicago rally is one of dozens that have taken place across the country this year. Physicians have joined forces to push lawmakers to enact reforms they believe will help stabilize -- or even reduce -- medical liability insurance rates. Rising prices continue to force physicians to give up their practices, retire early or move to states where rates are still economically feasible.

"Our system is absolutely broken," American Medical Association Secretary-Treasurer Herman I. Abromowitz, MD, told the physicians gathered for the march. "Only six states are safe from tort issues."

At press time, Republican senators planned to call for a vote by April 7 on a congressional bill that would cap at $250,000 noneconomic damages awarded in medical malpractice cases against obstetrician-gynecologists and emergency physicians. If that passes, it could go to conference committee with a House bill passed last year that calls for a $250,000 noneconomic damages cap in all medical malpractice lawsuits.

But success in the Senate has been elusive. The anticipated bill is expected to meet the same short-lived fate as a measure introduced earlier this year targeted at ob-gyns and one introduced in 2003 that included all physicians. The earlier bills failed because there weren't enough Senate votes to block Democratic filibusters.

Although they're hoping for a federal law, physicians in Illinois and elsewhere continue to do what they can to bring about state reforms.

Pressuring the states

Illinois has enacted tort reform in the past, but the state Supreme Court ruled it unconstitutional. The same outcome would be expected today if another bill was passed.

As a result, Illinois doctors are campaigning to change the state Supreme Court's makeup this election year. They also are asking state lawmakers to pass a number of measures other than the $250,000 cap on noneconomic damages. Requiring that an expert witness be board certified or eligible in the same specialty as the defendant and granting good-faith immunity to emergency department and trauma physicians are among the reforms that physicians are seeking.

"We need to take action that is going to help keep access there for patients," said Illinois State Medical Society President William E. Kobler, MD.

Illinois is one of 19 states the American Medical Association lists as being in a medical liability insurance crisis. It's one of many working on legislation this year.

Iowa physicians are moving closer to achieving a $250,000 noneconomic damages cap. The House passed a bill calling for that change. At press time, a Senate companion bill was waiting to be called up for debate. The cap would round out other reforms passed in the 1980s and 1990s.

"We have everything but the cap, and that's the one thing that is demonstrated to help stabilize the market," said Karla Fultz McHenry, vice president of public policy and advocacy for the Iowa Medical Society.

At press time, tort reform in Georgia was going down to the wire. The Legislature was 38 days into its 40-day session. A bill was set to be discussed in the Senate during the final two days of session. If it didn't pass, doctors would have to start the process again next year.

In late March, New Jersey's Senate passed a measure that among other things would create a fund to help physicians pay insurance premiums and implement stricter guidelines for who can testify as an expert witness. The bill next goes to the Assembly, which approved an earlier version. The governor is expected to sign the legislation.

In Maryland, a Senate committee voted down a bill that could have reduced the state's noneconomic damages cap to $350,000. The cap currently stands at $635,000. At press time, the House was still considering legislation that included the cap reduction, structured settlement payouts of large awards and other reforms.

In Pennsylvania, a move is underway to ask voters to approve a state constitutional amendment that would allow caps.

The state Senate in March passed a bill that would permit the question to go to voters. The Pennsylvania House has not yet voted on the legislation. Before the question could go to voters, both chambers would have to pass the measure again next legislative session. If voters then approved the constitutional change, the state Legislature would need to pass legislation creating a specific cap.

In Connecticut, legislators have not been receptive to bills proposing a $250,000 cap on noneconomic damages so far this legislative session. Four committees have considered the idea, and each has shot it down.

The legislative session isn't over until midnight May 4, and doctors and lawmakers continue talking.

"We're still fighting," said Tim Norbeck, the Connecticut State Medical Society executive director. "We're not giving up. I have a commitment from a number of key legislators to do something to reduce rates."

CSMS officials believe the way to do that is through the cap, which they say has been proven in California. But Norbeck said they would listen to other ideas if the reforms could be proven to reduce premiums.