Florida bill would triple liability requirement
■ Organized medicine worries that the proposed legislation would result in more physicians giving up medicine because they wouldn't be able to afford to self-insure.
By Mike Norbut — Posted May 2, 2005
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Florida physicians are lobbying to stop legislation that would require the state's doctors to purchase professional liability insurance or prove they can pay $750,000 in judgments.
The bill would dramatically alter the current law, which requires physicians without liability insurance to be able to pay $250,000 in a single case or an aggregate total of $750,000.
A doctor without liability insurance now only needs to prove he or she can cover $250,000 through a letter of credit or escrow account. But if the proposed bill passes, that physician's financial responsibility would triple.
If the state requires doctors to prove they can cover the $750,000 aggregate, physicians will be forced to purchase expensive insurance or find a more affordable place to practice, said Florida Medical Assn. President Dennis Agliano, MD, an otolaryngologist in Tampa.
With bottom lines hurting and liability insurance premiums rising rapidly, the law adds an additional burden that threatens to chase some physicians out of Florida, especially those in high-risk specialties, he said.
Florida already is among the 20 states that the American Medical Association lists as being in the middle of a liability insurance crisis that has physicians retiring early, cutting some high-risk procedures or moving out of state.
"This is a terrible bill," Dr. Agliano said. "It truly is going to knock out access to care."
Doctors say they have preserved access to care to this point by self-insuring to avoid high liability premiums. The practice known as "going bare" makes sense, doctors say, because some physicians in high-risk specialties such as neurosurgery pay $200,000 for $250,000 annually for traditional insurance coverage, Dr. Agliano said.
Physicians have been going bare in Florida for about two decades, and South Florida has one of the highest concentrations of self-insured physicians in the country.
Dr. Agliano estimates between 30% and 50% of physicians in that region are self-insured.
Self-insurance "works fine," he said. "If a doctor is threatened, he handles it himself or has a medical defense attorney handle it. In some ways, it's more preferable, because the attorney works for them and not for the insurance company," Dr. Agliano said.
According to the AMA, at least 13 states require physicians to carry liability insurance, either as a condition of medical licensure or to qualify for state liability reforms such as caps on noneconomic damages. Florida is not one of those states.
Hospitals and health plans also generally require physicians to maintain minimum levels of insurance to be on staff or in a member panel.
AMA policy allows each hospital medical staff to determine for itself whether it will require liability coverage for member physicians.
If the proposed Florida legislation passes, however, discussions of liability coverage requirements would become moot, Dr. Agliano said.
"This is ill-advised, and it's really anti-patient," he said. "In the long run, they'll end up without access to care."
At press time, House and Senate versions of the bill were still in committee. The House version had passed the Health Care Regulation Committee, but needed to pass through three other committees before reaching the House floor. The sponsor of the Senate version, state Sen. Dennis Jones, DC, did not return a phone call seeking comment.