The Obstetrics Dilemma by Richard Heck Today malpractice insurance and litigation are changing the face <strong>of</strong> obstetrics. The one big casualty is choice —for patients and doctors alike. illustration by Danette Pratt
WWhen Mary Kruszewski, D.O. (‘88), began her practice in 1993, she paid $6,000 for insurance. This year, her total malpractice insurance premiums exceed $107,000. Money, however, has not been the only cost. Skyrocketing costs <strong>of</strong> medical malpractice insurance spell ominous warnings for the future <strong>of</strong> health care and physicians’ practices. Kruszewski is feeling it firsthand like so many physicians, including other graduates <strong>of</strong> <strong>Ohio</strong> <strong>University</strong>’s <strong>College</strong> <strong>of</strong> <strong>Osteopathic</strong> <strong>Medicine</strong>, who are speaking up. Recent studies, surveys, papers and reports reveal in ever-increasing frequency how the issue is impacting decisions physicians make, not only about how they treat patients but where and even if they practice. The field <strong>of</strong> obstetrics remains especially hard hit. An <strong>Ohio</strong> Department <strong>of</strong> Insurance report issued in February 2005 from a survey <strong>of</strong> <strong>Ohio</strong> physicians concluded that the rising cost <strong>of</strong> malpractice insurance has significantly impacted physician behavior and their future plans in the state. The survey included answers from 1,359 physicians from across <strong>Ohio</strong>, 10 percent <strong>of</strong> whom were osteopathic physicians. Nearly four out <strong>of</strong> 10 respondents surveyed say they have retired or plan to retire by 2008 because <strong>of</strong> rising insurance expenses. “This finding is all the more sobering since just 9 percent <strong>of</strong> the respondents were over the age <strong>of</strong> 64,” the report says. Among osteopathic physicians, 11 percent say they planned to retire during 2005, and 15 percent say they planned to seek employment outside patient care. Kruszewski, who practices in Du Bois, Pa.–a rural town in a state considered in crisis because <strong>of</strong> high premiums–has been affiliated with several insurance companies and named a defendant in lawsuits. “I’ve gone to two trials, both <strong>of</strong> which turned out in my favor,” she says. But her hefty insurance premiums have affected how she practices, including ordering more tests, but as <strong>of</strong> yet, she has not considered moving her practice or leaving patient care. “I’m not ready to give it up because I like what I do,” she says. A paper issued by the <strong>University</strong> <strong>of</strong> Michigan Health System warned that increasing premiums are forcing many physicians to rethink how they practice, from reducing staff to quitting patient care altogether. “The hard cost <strong>of</strong> malpractice premiums is beginning to lead providers to drop or reduce obstetrical services,” says Scott B. Ransom, D.O., senior author <strong>of</strong> a research paper published in the June 2005 issue <strong>of</strong> the journal Obstetrics & Gynecology. “Our study shows that there is legitimate reason for concern about patients’ access to obstetric care and prenatal care in the future,” he warned. “It is frustrating,” says Michelle Wright, D.O. (‘95), who moved her obstetrics practice from Athens in rural <strong>Ohio</strong> to Sharon, Pa., for a variety <strong>of</strong> reasons, not the least <strong>of</strong> which was yearly double-digit rate increases for her malpractice insurance. Before relocating from Athens, Wright saw her premiums jump from $18,000 to $65,000 in just two years. “I can’t work without it; it’s a necessary evil.” The primary breadwinner in her household, Wright took a job at a federally funded clinic in western Pennsylvania mainly for economic reasons. Although Pennsylvania ranks close to <strong>Ohio</strong> for some <strong>of</strong> the highest medical malpractice insurance rates in the country, her clinic is covered under the federal court and tort system, keeping Wright’s insurance rates–and any possible malpractice claims–somewhat moderated. With family ties and roots in western Pennsylvania, the pr<strong>of</strong>essional change made more sense. Did malpractice insurance rates drive her out? Certainly in part. “Leaving Athens was difficult, but I had to find a stable climate and not worry about a paycheck at the end <strong>of</strong> the day,” Wright says. summer 2006 15
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