Rhode Island slides into liability crisis; Texas escapes

The nation's smallest state -- Rhode Island -- replaces the country's second biggest state -- Texas -- on the American Medical Association's list of states in a medical liability insurance crisis.

While there may be a big difference in state size, Rhode Island physicians say that their insurance problems are no smaller than what doctors in Texas experienced in recent years.

Statistics from the Patients First Coalition, a 65-member organization that includes Rhode Island physicians, insurers and businesses, showed that the state's surgeons have experienced a 175% increase in insurance rates since 2002. For physicians in general practice, rates have increased 200%, according to Patients First.

A recent Rhode Island Medical Society survey found that unaffordable insurance rates have led 49% of the state's physicians to discontinue or consider discontinuing some medical services; 48% said medical liability costs have forced them to consider leaving the state or giving up clinical practice.

"It's a dubious distinction, and we're not proud," RIMS executive director Newell E. Warde, PhD, said in reference to Rhode Island's new designation as an AMA crisis state. "Clearly, though, it supports what we've been telling the politicos -- this ain't no joke."

Rhode Island's Legislature is considering a bill that includes reforms the medical society supports, including reducing pre-judgment interest rates and requiring plaintiffs' lawyers to consult with a medical expert who can certify that there is a good faith basis to go forward with a lawsuit.

Texas crisis halted

At the same time that the AMA announced it was adding Rhode Island to its crisis-state list in May, the Association said it would remove Texas from the list because 2003 reforms stopped the crisis there. The AMA created a new map category: Effective reforms halting crisis.

"Lawmakers and voters acted to bring Texas back from a meltdown of their health system," AMA Trustee William G. Plested, MD, said in a statement. "We urge Rhode Island's state and federal lawmakers to consider the example of other states and look to proven remedies when considering medical liability reform."

Texas lawmakers in 2003 passed reforms that included a $250,000 cap on noneconomic damages awarded in medical liability lawsuits. Later that year, Texas voters approved a constitutional amendment that prevents the courts from overturning the law. The result, physicians say, is that insurance companies can make decisions knowing that the law won't face a lengthy court challenge that could ultimately undo the reforms.

Texas Medical Assn. leaders say the result has been that some liability insurers reduced premiums and that new companies have entered the market. In turn, more physicians have been willing to care for high-risk patients. Also, it's been easier to recruit specialists to the state, doctors say.

But Texas physicians are still proceeding with concern and caution.

"The crisis has passed, but Texas medicine is not yet out of the woods," TMA President Robert T. Gunby Jr., MD, said in a statement. "Only a sustained period of financial and legal stability will reveal the true promise of our reform efforts."

The AMA's changes to its liability crisis map means 20 states remain on the crisis list; six states are considered to be OK because of existing tort reforms. With the exception of Texas, the AMA lists the remaining states as showing signs of liability problems.

The Association supports federal legislation that would cap noneconomic damages at $250,000, while not restricting the economic damages that are awarded. The House has passed legislation containing the cap, but companion measures haven't cleared the Senate. Trial lawyers oppose legislation that would limit noneconomic damages.