Liability crisis ends century of deliveries

Perhaps one day the children of family physicians Jim Schwieterman, MD, and Tom Schwieterman, MD, will pick up where medical liability rates have forced the brothers to leave off.

The duo is scheduled to deliver their last baby in September, stopping a more than 100-year run of their family bringing children into the world in Mercer County, Ohio.

And in an ending that wouldn't have been more perfect if Hollywood had written the script, the brothers' last delivery will be the baby of a woman their father delivered.

Their grandfather delivered the woman's mother. And the doctors' great-grandfather who founded the Maria Stein, Ohio, family practice, delivered the woman's grandmother.

But the Schwietermans -- who their patients call Dr. Jim and Dr. Tom -- don't want people to interpret their fate as a "woe-is-me" story.

They are saddened that they're being forced to give up a part of their practice that they love. But they'll continue to provide the cradle-to-grave primary care that patients in their rural county of 40,924 need.

They're telling their story because they worry that patients who need obstetrical care may not be able to get it in the future.

"Something is wrong when a legal situation is preventing us ... from doing a service for very little income and when we have good outcomes," Dr. Tom said.

The brothers want people to know that even rural doctors in a practice with no lawsuit payouts in more than 100 years can be forced to cut back services to patients because of unaffordable medical liability rates. Only one lawsuit has ever been filed against the practice, and it was dropped a few days later.

"We've fallen victim to another outside force," Dr. Jim said.

The outside forces

Maria Stein's small-town atmosphere hasn't changed much over the years, Dr. Jim's and Dr. Tom's father, Don Schwieterman, MD, said.

Churches still stand in the community of crossroads. And Dr. Don said the town still clings tight to the values of the thrifty, hardworking German farmers who settled it.

"It's still an area where we have a very close relationship with patients," said Dr. Don, who retired in 1997.

But the practice of medicine has changed.

In Ohio, like so many other states, an increasing number of physicians have had to give up "high-risk" aspects of their practice because insurance has become unaffordable.

An Ohio State Medical Assn. survey released April 15 found that 80% of the state's physicians agree that rising premiums have directly impacted their patients.

The survey found that 34% of Ohio doctors expect to close their practices in the next two years if rates continue to climb. When asked to look forward three years, 58% plan to close.

"If only 10% of that happened, that's a huge crisis," said Bill Byers, OSMA's government relations director.

For the Schwietermans, giving up obstetrics was purely a business decision. When the fax for this year's premium came through, the insurance company was asking for $80,000 for the brothers to keep delivering the 60 or so babies a year that they average. That's a premium hike of about 150% over the past six years.

"It was a financial no-brainer," Dr. Jim said.

And given how long their family has been in the community, neither wanted to move 20 miles west to Indiana where tort reform is established and rates would have been 75% less.

"It doesn't make any sense that geography can play such a role," Dr. Tom said. "[Rates] have nothing to do with the medicine you practice."

Savoring every last moment

It's beginning to hit the doctors that they only have five more months of deliveries left, and they find they're soaking up every moment in the delivery room.

"It's giving up one part of a job where there are tears of happiness," Dr. Tom said.

While both brothers would love to be able to offer obstetrics again, they realize that once they are out of it for a couple of years it will be difficult to go back. "I feel like I'm a baseball player stepping up to bat for the last time," Dr. Jim said.

Family physicians have been giving up deliveries for years. In 1978, 46% had hospital privileges to deliver babies, according to the American Academy of Family Physicians. In 2003, only 24% of FPs did deliveries.

While premiums have been an issue in some states, Thomas S. Nesbitt, MD, MPH, said there are a number of reasons for the decline, including the fact that more FPs are joining groups where the scope of practice is already established.

Dr. Nesbitt, associate dean for graduate education, continuing education and outreach at the University of California, Davis, said it's a loss to family medicine. "The real tragedy is that family care is being fragmented."

Dr. Don hopes the climate shifts so that one or more of his grandchildren may be able to enjoy the special experience of helping deliver children into the world.

"I would love that," he said.