A TIME FOR A CHANGE PHYSICIANS WILL demonstrate before the state legislature in Annapolis today because the citizens of Maryland are about to experience the most widespread threat to their health care ever seen - the inability to find a doctor when one is needed. This is the result of a medical malpractice liability environment in this state that is forcing physicians to stop practicing medicine here. The current medical malpractice system treats health care as a potential lottery for dissatisfied patients, encouraging outlandish awards by juries who are misinformed, manipulated and frequently unable to understand the complex medical issues in question. It perpetuates a process that does not promote better care of patients but victimizes all physicians and hospitals who each day try their best to help those in need, sometimes under desperate circumstances. It is an environment in which physicians must view all patients as potential litigants. In recent months, escalating medical malpractice awards have forced major insurance carriers out of Maryland and left physicians with only three companies to turn to for malpractice insurance. Premiums charged to doctors for their premiums have skyrocketed. The largest company has just increased its rates by more than 40%, with a substantial increase above that to follow next year. Last year because of malpractice insurance premium increases, dozens of obstetricians were forced to stop delivering babies, and surgeons have retired or left the state for others where premiums were at least affordable. Fewer doctors volunteered to respond to the call for surgical and other specialty care in emergency rooms throughout the state. The result of all this: fewer doctors, longer waits in the ERs and diminishing access to health care for the citizens of Maryland. But why take to the streets? Maryland is not the firs state to face a medical malpractice litigation crisis. Because of this lessons learned elsewhere no doubt apply here. In 1975, physicians in California faced a similar malpractice abuse crisis. Physicians, hospitals and other health related professionals took to the streets to dramatize their concerns. After a week of "emergency only" care, the California legislature passed landmark liability legislation that today has markedly reduced the rate of malpractice premium increases. Physicians there can find affordable malpractice insurance and remain in practice. The legislation has blunted but not eliminated liability abuse, while preserving citizens' rights to be heard and fairly compensated if injured. Though call for similar actions are heard increasingly in hospital staff lounges, operating rooms and emergency departments throughout Maryland, today Rally for a Change will be one day only - an important first step to raise awareness and provide reform. But there is another reason - less obvious but just as important. Physicians as a group are not politically astute. For decades, they have been solely concerned wit the daily challenges of providing care to patients as technology and diseases have changed. Political action committees, lobbying, even organizing - such concepts are known to very few in medicine. A recent liability reform effort in Texas witnessed a trial lawyer lobby spending over $15 million in an effort to defeat it. Only a referendum placed on the ballot and passed by the voters enabled it to become reality. For the first time in years physicians are returning to Texas. Though today rally may be viewed as naive by some, meager by others, even unprofessional by a few, those of us present will share a common conviction that the health care of all the citizens of Maryland warrant this effort. FACSPublished on the Baltimore Sun on January 21, 2004 Scott E. Maizel, MD, President, Maryland Chapter American College of Surgeons 9101 Franklin Square Drive, #110 Baltimore, MD 21237 (410) 574-5720 MALPRACTICE REFORM IS KEY TO GOOD CARE As lawmakers in Annapolis enter their second month of their three-month session, it is encouraging that all parties concerned with health care in Maryland have decided to look objectively at the crisis posed by the skyrocketing malpractice insurance premiums doctors and hospitals are charged. Gone are the pre-session proclamations that the issue is "dead on arrival" and the misconception that physicians and hospitals can just raise their fees to offset insurance premiums that have almost doubled in the last year or two. The January 21 rally demonstrated that all doctors are being affected across the state and that patients' access to care is already suffering. And it is evident that the immediate problem is indeed monetary and must be addressed in this session to prevent more physicians from restricting their practice, retiring early or leaving the state. With continued hard work by lawmakers who are willing to put patients' need first, the prognosis for meaningful malpractice reform is "good". Without it, the condition of Maryland's entire health care system will surely be downgraded to "critical". Published on the Baltimore Sun on February 29, 2004 Scott E. Maizel, MD, FACS President, Maryland Chapter American College of Surgeons 9101 Franklin Square Drive, #110 Baltimore, MD 21237 (410) 574-5720