[Congressional Record Volume 152, Number 52 (Thursday, May 4, 2006)]
[Senate]
[Pages S4040-S4042]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
MEDICAL LIABILITY CRISIS
Mr. BURR. Mr. President, some in this institution suggest that there
is no liability crisis in health care in America. I am here today to
say that I don't think anyone in America believes that. They may
believe it in this institution. As a Senator from North Carolina, I can
state no one from North Carolina believes it.
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Not only has the out-of-control litigation in health care over the
last decade inflated the cost for every American, it has now begun to
affect the access we have to health care services.
Doctors across the State in North Carolina report they have been
forced to reduce the coverage of critical medical services, especially
in obstetrics, neurosurgery, orthopedics, plastic surgery, and primary
care because of the sharp increase in the cost of medical malpractice
insurance coverage. It has gotten so high they cannot afford the
coverage.
Hospitals are concerned about the potential reduction in their
services to their communities in the future as a result of the current
crisis in medical liability insurance where premium increases and
declining reimbursements continue. Hospitals report that the insurance
crisis is making it increasingly more difficult for their medical staff
to obtain adequate insurance coverage, and more importantly, at
affordable prices.
The crisis is real. We can no longer in this institution act like an
ostrich, put our head in a hole in the ground, and believe because we
cannot see it, it does not exist.
Some nursing homes in North Carolina this year have no choice but to
operate without liability insurance in order to stay open. The oldest
and the frail in this country would not have the facilities to live in
but for the brave decision of some owners that forego the insurance
they can't afford.
Other long-term care facilities, faced with the huge increase in
premiums, have been forced to reduce staff hours, freeze wages and
reduce residents' activities. Those are things we do not want to see
happen to that population.
North Carolina faces a medical liability insurance crisis. I had a
friend who graduated from Wake Forest with me and was lucky enough to
go to medical school. Today he is a nephrologist. I don't even know
what a nephrologist is. I am not sure that too many people in America
know what a nephrologist is. But I can tell you that he tells me
nephrologists rarely get sued. In the last 3 years, his liability
insurance has increased 300 percent. He has had a 300-percent increase
in his cost to continue to practice medicine in a specialty that rarely
sees lawsuits.
North Carolina hospitals have experienced medical liability insurance
premiums increasing from 400 to 500 percent for the past 3 years, with
small rural hospitals experiencing the greatest increases.
According to two recent studies, North Carolina's nursing homes are
experiencing a tremendous increase in their medical liability premiums.
Premiums for some nursing homes in North Carolina have skyrocketed by
as much as 1,800 percent since 1995. But some in this institution
suggest there is not a liability crisis in health care in America.
The U.S. Department of Health and Human Services has concluded that
the leading cause of the national liability insurance crisis is the
recent explosion in multimillion dollar litigation awards and the
resulting instability this creates in the medical liability insurance
market.
The U.S. Department of Health and Human Services cited that North
Carolina is tied with Nevada for the most mega malpractice awards in
recent years. But some in this institution suggest that there is not a
medical liability crisis in America.
Not only is it a crisis, health care services are out of the realm of
the average American. It is driving doctors out of the profession of
delivering medical services. In medical schools across the country this
year, just as last year and the year before, many students will make a
decision as to the specialties they choose for their entire medical
profession based upon the likelihood of being sued in a court versus
where their interests and their love might exist in health care. But
some suggest there is not a liability crisis in America.
In North Carolina today we have a shortage of OB/GYNs, we have a
shortage of neurosurgeons, we have a shortage of thoracic surgeons.
When you look at the demographic shift that is happening in America,
the Census Bureau projects that in North Carolina alone we will have a
53-percent increase in the State's population over the next 20 years.
We will be the seventh most populated State. The OB/GYNs better move
there because without OB/GYNs we are not going to deliver new babies.
If they move there for retirement, which is probably our largest growth
area, they may find out that they are moving to a State that has a
tremendous health care infrastructure but the state does not have the
specialists in neurology, in neurosurgery, and thoracic surgery
available for their age group, and then they will have not made the
wisest decision. But some suggest there is no crisis.
Lawsuits today are the leading cause of liability insurance
increases. Changes are needed to protect patient access to health care.
States that have enacted comprehensive common sense liability reforms
have experienced much lower increases in medical liability insurance
premiums compared to States such as North Carolina and Nevada because
we have yet to adopt such reforms.
It is imperative this institution accept the national responsibility
to end this crisis in health care, to make sure that the next students
in our medical schools make decisions based upon where they want to
practice and who, in fact, they want to help and not based upon where
their fear exists of where the trial bar is most likely to target for
the next lawsuit.
Over the years, I have heard from a lot of folks in North Carolina. I
received this letter from a doctor in Greensboro, NC, in the month of
April. It says:
As an orthopaedic trauma surgeon, I urge you to pass
medical liability reform this year. Each year, reform
legislation passes the House of Representatives, but stalls
in the Senate. Special interests are standing in the way of
reform.
I can say that special interests are not the patients across this
country, it is not the patient who is looking for the specialist in
North Carolina.
The letter goes on to say:
I can tell you from the point of view of someone on the
front line of medicine that America's (and North Carolina's)
medical liability crisis has to be solved. Medical lawsuit
abuse and unpredictable and huge verdicts are forcing good
doctors out of practice. Fewer young doctors are entering
important, but high risk specialties, including orthopedics,
obstetrics, and emergency medicine. Others are cutting back
on critical, but risky procedures, leaving patients to wonder
where they will get care when they most need it.
The cost of defensive medicine alone is staggering. I see it all the
time: doctors ordering tests and referring patients to specialists more
out of fear of lawsuits than because doctors believe the tests or extra
visits are medically indicated. These costs are dragging down our
health care system and our economy, and they ultimately increase out-
of-pocket patient costs. It is time we fix this broken system.
I am not sure that anyone summed up the crisis in America in a one-
page letter better than this doctor, this doctor who said that he is on
the front line of medicine in America and in North Carolina. He put his
finger on the point that if we don't solve it today, fewer young
doctors will be entering the profession. That means less choice. Fewer
doctors doing high-risk procedures in trauma care, something that
doctors perform because they are trying to save a life.
Others are cutting back on critical but risky procedures, leaving
patients to wonder who will be there to do these procedures.
In this institution, we fight cost and access. In America, we fight
cost and access. Many times the decisions we make as Americans, such as
choosing to move to a particular area because the schools are good,
also includes the big component that there is a major medical facility
available for us and our family.
The realities are, as this goes on, those major medical areas are
going to be more and more important because in rural America there will
not be doctors. And if there are no doctors, we know today, based upon
what doctors tell us, there won't be OB/GYNs. We will have to tell
pregnant women, let us know when you think you are going to go in labor
because it is a 2-hour drive to the nearest facility that delivers
babies. Or, as we have seen in some places, no natural child births,
only Caesarian, because there is a risk of litigation to natural
delivery that does not exist with the procedure of Caesarian birth. But
some suggest in this institution that the liability crisis does not
exist in America.
[[Page S4042]]
We come to the Senate to debate how we change health care policy so
that health care is accessible and affordable for all Americans. We
understand today how many Americans, or we think we do, go without
insurance, without coverage, without the security at night of knowing
that whatever happens to them, they have a policy to take care of.
If we did not solve this problem, it does not matter what the policy
says. If the doctor is not there, where is our level of security? Where
is the level of security of an American today that lives in a rural
market where their hospital is closed? Not just their doctor left, but
because of an 1,800-percent increase in the cost of liability
insurance, they have decided to close the doors.
The burden falls on the payer--us--on insurance companies to try to
raise the reimbursements big enough to make the payments for liability
coverage. Why? Because of mega-awards, because of the influence those
mega-awards have, in fact, had on the insurance product itself.
Dr. Handy was not the only one who wrote me. I had an interesting
note from a doctor in Fayetteville, a member of a four-person neurology
practice that cannot attract physicians to join the practice because of
the inhospitable liability environment that exists. She and her husband
are both neurosurgeons. They want to stay in North Carolina, but they
may need to move and are actively looking elsewhere because they cannot
even attract a neurologist to come into an existing practice.
They realize, as two neurosurgeons, if your practice cannot grow
based on today's reimbursement structure, there is no way they can
survive. Increases in their costs of insurance have limited their
ability to deliver charity care. They have also decreased their
participation in workers' comp. Their practice writes off more than $1
million a year in uncollectible accounts. There are currently only four
neurosurgeons in Fayetteville, NC--the pentagon of the Army, Fort
Bragg, NC, where over 55,000 men and women in the U.S. Army call home.
But some still suggest there is not a crisis. You see, it is easy to
suggest that something does not exist because I think there is a
tendency in our system that until it directly affects us, it really
does not exist.
The reality is that every day we meet in this incredible, historic
institution, there are people across this country who do not have
access to a doctor, who cannot afford the services, who have been
affected by the fact that the liability crisis in America is, in fact,
real and has affected them.
Well, the challenge for this Senate, as we move forward, is to make
sure our voices are louder than those who suggest there is not a
crisis, to make sure the human face of those around America--who are
affected directly and indirectly by the liability crisis that exists in
medicine today--to make sure their voice is heard, their face is seen,
that in this institution, as we talk about solutions, we look around
the country and say: What have others done?
Well, that is what we are getting ready to do next week. We have
looked around the country and seen who has been successful. And we are
going to adopt a model that exists in Texas. It is not one that
tightens as much as California. California, usually not necessarily the
one that looks at Washington and says: Limit something for us--
California woke up and said: There may not be a liabilities crisis in
America, but there is a liability crisis in California, and we are
going to put caps in, we are going to bring some sanity to the system,
we are going to bring in the parameters that drive price's down and
encourage doctors to practice here in, yes, obstetrics, in neurology,
in neurosurgery, and thoracic surgery.
California thrives today. What was California's comment about what we
might do in Washington? It was: My gosh, don't make us raise our caps
to what you are going to establish in all the States. We are below that
today. I never thought I would say: California does something right.
Let's mirror it. But that day has come in the Senate but at a time
where some still suggest there is not a crisis.
What do we want to do? Replicate what, in fact, States have
replicated to address the high cost of health care, the lack of access,
the flight of doctors, the need for specialists. We want to adopt that
nationally. It is as simple as that.
Next week, people will come to the floor of the Senate and they will,
in an incredible way, suggest there is not a crisis in America. I want
those in the Chamber today to remember next week not just the doctors
who say there is a crisis, and it is real, but to remember the patients
out there who are directly affected by our inability to solve this
problem. They are the ones for which the safety net is supposed to be
there to protect them. But the safety net only works if the
infrastructure is there. This is not about cost by itself today. This
is about access. And when access goes away, our ability to address it
with a safety net is gone.
I urge my colleagues to stay engaged. I look forward to next week's
debate.
I thank the Presiding Officer for the time, and I yield back.
The PRESIDING OFFICER (Mr. Burr). The time of the majority has
expired.
The Senator from Texas.
Mr. CORNYN. Mr. President, I ask unanimous consent to speak for up to
20 minutes in morning business.
The PRESIDING OFFICER. Without objection, it is so ordered.
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