Suing the Doctor

Higher office rents, the mounting costs of equipment and rising wages for office personnel are all contributing to the increasingly steep price that doctors everywhere must pay to practice their profession. In New York State last week, overhead costs grew still more. Premiums for malpractice insurance--which almost every physician carries to protect himself against lawsuits by his patients--rose by a whopping 93.5%. The increase will make the state's doctors pay the highest average malpractice rates in the nation and could have an enormous influence upon the way medicine is practiced.

New York is not the only state in which the cost of malpractice insurance is rising. Premiums in California climbed by more than 400% between 1968 and 1970 and are likely to go up again this year. Insurance rates in Maryland have recently increased by 46.9%, and may soar another 48% if the state's major malpractice insurer is granted its request for a hike. Even in such states as New Hampshire and South Carolina, where patients seem less prone to bring suit against their doctors, costs of coverage have recently moved upward.

There is a legitimate reason for the increases in premiums. Malpractice claims, once relatively rare, have become so common that one out of every four physicians practicing today can expect to be sued before the end of his career. In New York State, for example, courts handled 407 malpractice suits in 1968; by last year, the number of such suits had risen to 773, a 90% increase.

The number of suits has been increasing partly because patients are better informed and less tolerant of physicians' mistakes--which do happen more often than doctors would like to admit. Ever more dependent upon specialists, patients also feel fewer qualms about suing a brain surgeon or dermatologist than they would their old and trusted family physician. At the same time, fat malpractice cases are more and more appealing to lawyers, who stand to keep as much as one-third to one-half of any damages awarded by a court.

Five years ago, successful New York lawsuits brought plaintiffs an average of $9,878; in 1973 the figure stood at $23,426. Juries have already handed out several awards exceeding $1 million in cases in which negligence was proved; a New York court recently awarded Tracy Gamell, 12, a total of $2,110,000 for brain damage suffered shortly after her birth at a Manhattan hospital. Nor, apparently, is negligence the only ground for a successful suit. Juries seem to be taking the attitude that when a patient dies during surgery his family is entitled to compensation, and they are calling upon insurance companies to provide it.

Crippling Costs. The resulting rise in rates is "a disaster," says Dr. Melville Platt, associate director of professional services at New York Hospital. Most doctors agree. A New York City obstetrician has to shell out $9,433 a year to keep himself adequately covered against lawsuits; a specialist in a high-risk field like neurosurgery must pay $14,329 for protection. Doctors elsewhere face similar hikes. Dr. Suzanne

Graham, a San Francisco anesthesiologist, paid $2,100 for insurance when she started in practice three years ago. Now she must pay $5,100 for the same coverage. Says she: "It's a real crippler."

While there is still no evidence that high malpractice premiums have deterred young physicians from entering practice, there are indications that the costs are forcing older physicians out, thus contributing to the medical manpower shortage. Some semiretired doctors attempting to practice part time have found that they cannot afford to pay full premiums, and have had to abandon medicine completely.

But it is the patient who will ultimately bear the burden of increased costs. Many doctors now try to protect themselves against lawsuits by running extra tests and taking additional X rays, the price of which is reflected on the patient's bill. Physicians generally resent the need to practice such "defensive medicine" but feel that it is absolutely necessary. "We are shivering in our boots," says Dr. John Gregory, a Bronxville, N.Y., obstetrician. "We sometimes find that we face almost every patient more as an adversary than a friend." Gregory and his partners in practice protect themselves by ordering a wide range of tests for every surgical patient over 35; these cost their patients up to $150 and an extra day in the hospital. "Years ago, we never would have done all of this unless we thought it was necessary in the particular case," says Gregory. "Today we do this routinely."

Higher bills, however, could be the least serious result of climbing malpractice costs. In 1965 the House Medical Group of Los Angeles was successfully sued by a patient who was partly paralyzed in a risky operation that nonetheless saved her life. Remembering that experience, Dr. William House, an ear surgeon, said he would now hesitate before performing a similar procedure.

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