Scranton Times Tribune

Most Physicians Remain Despite Insurance Increases

BY MARY JO FELDSTEIN THE SUNDAY TIMES

10/05/2003

A year ago last week, hundreds of doctors from across Northeastern Pennsylvania converged on Lackawanna County Courthouse Square to protest rising malpractice premiums.

In the weeks that followed, more than 40 Lackawanna County physicians said they planned to leave their practices or cut back on services by the end of 2002. Their slowdown threatened access to medical care across the region and made Scranton a prominent face in the national debate over tort reform.

Today, nearly all of those physicians are still here and performing the same services they have for decades. In fact, two practices whose doctors were among the most vocal have more physicians now than a year ago.

A recent government study that highlighted Pennsylvania found doctors nationwide exaggerate the effects of rising malpractice costs. The Pennsylvania agencies that license and insure doctors report no evidence of a mass exodus.

That research misses the point, doctors say.

The local doctors who have left were among the most highly specialized in the region and are nearly impossible to replace. In Scranton, surgeons say their colleagues' departures are forcing some patients to wait months for an appointment. And federal labor statistics show young doctors are not choosing to practice in Pennsylvania, which has one of the oldest populations in the country.

"I have not seen any improvement in the situation from the end of last year until now," said Dr. Charles Bannon, a Scranton surgeon and the chief of surgery at Mercy Hospital. "In fact, I think you could argue it's gotten worse. The public doesn't appreciate the extent of it."

When Scranton became the face of the medical malpractice crisis, Dr. Bannon became the face of Scranton.

On Dec. 4, 2002, Dr. Bannon and his 13 associates at Delta Medix -- Scranton's largest surgical practice -- announced they would close Jan. 1. Dr. Bannon served on Gov. Ed Rendell's malpractice task force and sat for interviews with national media. A picture of President Bush shaking his hand is on display in his Mercy Hospital office.

Dr. Bannon described the slowdown as painful for doctors and patients. He thought his practice might close and he'd retire, but, "We decided we had made our point and gotten the attention of the legislators and the governor-elect."

"I don't see a work slowdown in Scranton again," Dr. Bannon said. "There is no way we can use that again."

Janet Brier, practice manager at Professional Orthopaedics, said her office temporarily stopped performing surgeries to "focus and highlight the plight, the situation and how it had disintegrated."

"It was a very difficult decision and a very costly decision," Ms. Brier said.

At the end of last year, about 100 physicians from 13 Pennsylvania counties had told Blue Cross of Northeastern Pennsylvania they would stop performing surgeries or delivering babies. Nearly all have fully resumed services, said Brian Rinker, vice president of health delivery for the insurer.

Most returned to work Dec. 30 after Mr. Rendell, then the governor-elect, promised focus, change and $220 million.

"The governor asked us to work with the system and we decided that we would," orthopedic surgeon Dr. John Doherty said. "We're still waiting for the system to work with us."

David Fallk, a Scranton attorney, said doctors tried to put their patients in a panic to promote their policy agenda.

"What we endured was another attempt by the medical establishment to divert attention from our true needs to reduce medical errors and implement insurance reform," Mr. Fallk said.

Doctors and lawyers generally disagree on the best way to lower malpractice costs. Doctors support limiting lawyers' fees and plaintiffs' damages for pain and suffering. Lawyers say juries, not legislators, should decide plaintiffs' damages and limiting them would eventually make it more difficult for injured patients to sue.

Jimmy Golden, a Scranton cab driver who cannot afford health insurance, sides with the attorneys. He called the doctors' slowdown "a crock."

"It's the insurance companies -- they're robbing everybody," Mr. Golden said.

Delta Medix patient Virginia Levandoski waited for weeks wondering if her physician, Dr. James Roche, would stay. A patient of Dr. Roche's for eight years, Miss Levandoski said she never felt deceived or misled.

Joey Lee's doctor did leave. Mr. Lee gained local notoriety when he and his physician, Dr. Debra DeAngelo, met with President Bush when he spoke about the issue in Scranton on Jan. 16. Dr. DeAngelo, a pain management specialist, left for Hershey Medical Center two weeks later.

Mr. Lee suffers from reflex sympathy disorder, a chronic pain condition. He now travels 35 minutes every 21 days to visit his new physician in Kingston.

"It's being made to look like the doctors are stingy and not getting as rich as they want to be and that's absolutely not correct," Mr. Lee said.

Blue Cross says more patients are traveling farther for specialty services. Hospital administrators say fewer doctors will agree to take emergency and trauma duty.

Orthopedic surgeon Dr. Alan Gillick specializes in treating spines. He says his next appointment for a nonemergency patient is in February. Referrals have been pouring in since neurosurgeon Dr. Carson Thompson announced he was moving to Colorado.

When Dr. Thompson leaves, two neurosurgeons will remain in Lackawanna County, one of whom only performs some procedures. In 2000, Northeastern Pennsylvania had more neurosurgeons than the state average, according to the National Center for Workforce Analysis. Since then, at least three have left Lackawanna County, retired or stopped performing surgery.

In the year since the local Blues started keeping track, 40 doctors from 13 Northeastern Pennsylvania counties have left the area and blamed rising malpractice costs, Mr. Rinker said.

Orthopedic surgeon Shawn Hennigan, 35, was one of those physicians. He now lives in Green Bay, Wis.

In 1989, Pennsylvania ranked 12th in the nation in the percentage of its physicians under age 35. By 2000, the state had dropped to 41st. Only 2 percent of the physicians practicing in Scranton, Wilkes-Barre and Hazleton in 2000 were under 35. It was one of the lowest percentages in the state.

Attorneys say those statistics are an example of a brain drain, not a malpractice crisis. They contend some doctors say they are leaving because of rising premiums but are actually going on to better opportunities at teaching hospitals or retiring.

Pennsylvania Medical Society president Ed Dench agrees the more qualified doctors are offered the better opportunities, but it's the malpractice climate pushing them out the door. And, he says, if this trend continues, states like Pennsylvania will lose their best physicians.

"The reason I left is because of this problem," said Dr. Hennigan, a shoulder specialist, from his Wisconsin home. "I had no other reason to leave."

Two specialists have since joined practices involved in last year's slowdown. Both say family ties brought them here.

Vascular surgeon and Luzerne County native Dr. John Kutz joined Delta Medix to practice with his father-in-law, Dr. Bannon. High malpractice premiums and a litigious climate deterred him from moving home, but in the end he and his wife wanted to live near their relatives.

No state agency has a running count of how many doctors are leaving the state. But the state Department of Insurance tracks how many pay into the state's catastrophic fund, a requirement for practicing here.

Only 31 fewer doctors paid into the fund in 2002 than in 2001. Overall, the number of doctors paying into the fund has increased 2 percent to 35,092 since 1998.

All doctors with at least 50 percent of their business in Pennsylvania were required to pay into the fund during those years. In 2003, the law changed. Now all doctors with 20 percent of their business in the state must pay.

Using numbers provided by several sources, the Federation of State Medical Boards estimates 1,038 or 2.9 percent fewer physicians were practicing in Pennsylvania in 2002 than in 2001. Its numbers show an 8.4 percent increase in Pennsylvania doctors since 1998.

Stephanie Bewick, practice manager at Scranton Orthopaedics, says some changes to the system -- like a state Supreme Court rule forcing attorneys to file malpractice suits in the county where the incident occurred -- appear to be working. She praises the efforts to improve patient safety.

Risk retention groups and other new insurance models are entering the market. The state's largest malpractice insurer, PMSLIC, is asking for an 18 percent increase in premiums this year, compared to 54 percent last year. Spokeswoman Anna Lavertue says the company has no plans to cancel hundreds or thousands of policies this year, as some feared.

"In our state, they've done some things, but when are they going to finish the job?" Ms. Bewick asked.

"The real question is why shouldn't we close again this year," added orthopedic surgeon Dr. John Rich, sitting in Scranton Orthopaedics' Chinchilla office.

Mr. Rendell has made it clear he opposes limiting plaintiffs' damages, a reform many physicians see as a necessary element of any complete package. He has yet to find more than $220 million in bailout money he promised doctors in December. Several other proposed reforms are awaiting Supreme Court approval.

Rosemarie Greco, director of the state's Office of Health Care Reform, said the bailout money is tied up in the governor's stalled education proposal and the administration is "not in a position to negotiate" on the amount.

Since promising doctors $220 million for this year, Mr. Rendell has upped his commitment to $660 million over three years.

Republicans don't see the connection between education and medical malpractice, said Drew Crompton, counsel to state Senate President Pro Tempore Robert Jubelirer, R-Altoona.

Mr. Crompton says he's still waiting for a proposal outlining how the administration wants to pay for the abatement. Cigarette taxes and federal dollars have been discussed, but he said he has yet to see a detailed plan.

"The doctors and the hospitals should be aware the front office does not want to deal with their issue until they deal with education," said Mr. Crompton, who has started his own bipartisan group to work on the issue.

With talking points and buzzwords, physicians are becoming more politically active and media savvy. Locally, doctors started Pennsylvanians for Patient Access, a statewide advocacy group. They're also campaigning and raising funds for state Supreme Court candidate Joan Orie Melvin, who says her own father stopped practicing because of rising premiums.

Some Harrisburg politicos have said Pennsylvania doctors went too far when they cut back on services in the Northeast or rallied at the Capitol holding pictures of legislators on playing cards in the fashion of Iraqi leaders.

Dr. Bannon uses himself and state Senate Democratic Leader Robert Mellow as an example of how dialogue is more productive than sniping. They disagree on the issue of caps, but agree on many other issues, particularly the need for Northeastern Pennsylvanians to have access to good medical care, Dr. Bannon said.

"There is a serious crisis and it's only going to get worse and patients are going to be seriously affected," Dr. Bannon said. "We're not making this up. We're not trying to panic people. We're just saying how it is."