[Congressional Record (Bound Edition), Volume 149 (2003), Part 13]
[Senate]
[Pages 17075-17077]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           PATIENTS FIRST ACT

  Mr. ENZI. Mr. President, throughout the West, and all over the 
country, more and more physicians are closing up shop and moving their 
practices out of State because they can no longer afford their medical 
liability insurance premiums in States that don't have some kind of a 
control over the amount that can be awarded.
  Whenever I go home for a town meeting or when I visit with 
constituents, I hear story after story about people who are facing the 
loss of the sole option for health care in their towns because of the 
skyrocketing premiums their doctors must pay.

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  One constituent told me about her family physician in Newcastle, WY. 
She had to close her doors because the cost of insurance premiums made 
it impossible for her to provide obstetrical services to the pregnant 
women of the town. She said: Telling a pregnant woman I won't be there 
to deliver her baby was one of the hardest things I had to do as a 
family physician.
  She then joined two other doctors in Newcastle to announce as of July 
1 they would be unable to deliver babies because of a more than 50-
percent increase in their liability insurance premiums. That means 
pregnant women in the Newcastle area will now drive 30 to 90 miles when 
it comes time to deliver their babies. This is a problem for the people 
of Newcastle, but it is one that also faces the people who live in a 
lot of towns throughout my State of Wyoming and many other States.
  Take Jackson, WY, for instance. A surgeon there paid $16,000 for 
liability insurance in his first year in practice. He is now facing an 
increase in his rates that will place his premium at $164,000. That is 
a jump of $148,000 in 1 year. Emergency room and trauma doctors are 
facing similar jumps in the cost of liability insurance. An emergency 
room doctor in Rawlins, WY, nearly closed his practice after his 
insurance company announced it would no longer provide coverage for 
emergency room services. Fortunately, his hospital was able to find him 
coverage at the last minute, but this is merely a temporary solution to 
a critical problem.
  Recruiting physicians to practice in rural States such as Wyoming is 
a difficult job. The high cost of medical liability premiums is making 
it nearly impossible. These examples highlight the problem we are 
facing. This problem is not just about lawsuits and insurance rates, it 
is about people who cannot get the medical attention they need. It is 
about communities without doctors to serve them. It is about a health 
care system in crisis.
  The cost of medical liability insurance and the role of medical 
litigation raise very complex issues, but the focus is not and should 
not be on doctors or trial lawyers or insurance companies fighting 
among themselves. Our focus should be on patients and on ensuring 
accessible and affordable health care for all Americans. In Wyoming, 
ensuring access to affordable health care is a persistent challenge. We 
probably would have a shortage of health care providers even if our 
medical liability system worked perfectly, but the costs of medical 
litigation and of medical liability insurance are taking matters from 
bad to worse for the people of my State.
  In fact, a study released yesterday by the Agency for Health Care 
Research and Quality found that States that limit pain and suffering 
awards in medical lawsuits have more physicians per capita than States 
such as Wyoming that have no such limits.
  Here are some other examples of the impact this crisis is having on 
Wyomingites:
  Two physicians who practice internal medicine in my hometown of 
Gillette have been notified that their medical liability insurance will 
be canceled as of July 31--not increased, canceled. If they are unable 
to find insurance coverage to replace their canceled policy in 2 weeks, 
they will be forced to close their practice in a town that is already 
experiencing a shortage of primary care doctors.
  Another doctor in Casper, WY, was barely able to find insurance 
coverage for this year. The doctor delivers more than 350 babies each 
year. Nearly half of the mothers are covered by Medicaid. He also 
performs nearly one-half of the gynecological surgeries in the Casper 
area. The only insurance he was able to find cost him $140,000 per year 
with an additional $69,000 to purchase ``tail'' coverage in case he is 
sued for something that happened before his new insurance took effect.
  In Wyoming, a physician who delivers a baby can be sued any time 
until the child's eighth birthday. So this ``tail'' is quite long, 
which means the premium could be quite high. In addition, this coverage 
is a short-term policy only good for 1 year, and he expects his cost of 
insurance will increase substantially again next year. Without his 
service, many pregnant mothers will find it difficult to obtain 
important prenatal care, especially expectant mothers in low-income 
families.
  Earlier this year, a doctor in Wheatland, WY, went to a high school 
basketball game between the Wheatland Bulldogs and the nearby Douglas 
Bearcats. At the game, he announced he would not be delivering any more 
babies in Wheatland or Douglas and may be leaving the State because of 
the cost of liability insurance. The irony is that he had delivered 
just about every player on both teams. This was not somebody new in 
practice.
  We also have doctors who are being forced to leave Wyoming to find 
relief from the financial burden of liability insurance. One doctor 
from Riverton, WY, grew up there, married a native of Wyoming, and 
returned to Riverton to raise his family and practice medicine in the 
State he loves. But between paying off student loans from medical 
school and paying expensive premiums on liability insurance, he is 
being forced to move to a State that has limits on pain and suffering 
awards. By moving, he will reduce his premiums by $43,000 a year.
  The threat of lawsuits is enough by itself to raise insurance 
premiums in a State such as Wyoming. Plus, with so few doctors 
purchasing insurance in the pool, one major payout, whether the doctor 
was at fault or not, can really send premiums for every doctor right 
through the roof. As a result, many doctors in Wyoming are moving to 
States with larger risk pools and fairer liability laws, just as their 
colleague from Riverton is doing.
  People who are truly injured by errors made by health care providers 
ought to be compensated fairly for their losses. However, the medical 
justice system today does not achieve this objective. If fair 
compensation is the standard, our medical justice system falls woefully 
short of the mark. Most people who are injured as a result of health 
care errors do not receive any compensation. However, some who are 
injured receive multimillion-dollar judgments as compensation for a bad 
outcome often without regard for whether the physician or hospital was 
even negligent.
  The unpredictability of our medical justice system really does not 
serve patients or providers well. The only people who come out ahead 
are the personal injury lawyers who happen to find the right case. When 
it becomes impossible for insurance companies to predict their losses 
with any certainty, premiums go up. It is a fact of the business, and 
it is no different for property insurers or life insurers than it is 
for medical liability insurers.
  Yes, people are hurt by health care errors, but skyrocketing medical 
liability premiums are hurting people, too. They are hurting physicians 
and hospitals in my home State by forcing them to curtail services or, 
in the case of doctors, to leave their practices entirely. Those 
doctors who continue to practice now look at each patient as a 
potential lawsuit. So they order more tests, whether or not the patient 
needs the tests. They spend less time discussing a course of treatment 
with the patient so they can spend more time writing a report after the 
appointment to justify the treatment decision in case they get sued.
  Ordering more tests and writing more reports costs an already 
overworked doctor time with his or her family and time to catch up on 
his or her sleep. Doctors should not have to make choices between what 
is right for their patients and what is right for themselves, but our 
medical litigation system does not offer them a real alternative.
  Most importantly, the medical liability crisis in my State is hurting 
innocent citizens who are losing their trusted hometown doctors to 
other States that have reformed their medical justice systems.
  What do we know about our overall system of medical justice in 
America today? We know compensation to patients injured by medical 
errors is neither prompt nor fair. We also know verdicts with huge 
awards that do not match the severity of injuries or the

[[Page 17077]]

conduct of the defendants destabilize the insurance markets. This sends 
premiums skyrocketing, which forces many physicians to curtail, move, 
or drop their practices. This leaves patients without access to 
necessary medical care.
  Finally, we know litigation does nothing to improve quality or 
safety. In fact, the constant threat of litigation drives the 
inefficient and costly practice of defensive medicine and also 
discourages the exchange of information about preventable health care 
errors that we could use to improve the quality and safety of patient 
care.
  The current medical liability crisis and the shortcomings of our 
medical litigation system make it clear that this is the time for a 
major change. We need a medical justice system that promotes 
accountability and fairness instead of discouraging them.
  Regardless of how we vote on this legislation before us, we all ought 
to start working toward replacing the current medical tort liability 
scheme with a more reliable and predictable system of medical justice. 
We need a system that restores rationality to the way in which we 
compensate the injured and learn from mistakes. We need a system that 
restores the trust that patients and providers used to have in each 
other. It is incumbent upon all of us to strive for such a system so 
that we may raise the overall standard of health care in this country.
  The legislation we are considering today is an important step in the 
short term toward making the medical justice system work better for 
everyone, not just a fortunate handful of personal injury lawyers. I 
urge my colleagues to join me and vote for this bill.
  I ask unanimous consent that at 2:15, Senator Kyl be recognized to 
speak for up to 15 minutes to be followed by Senator Feinstein for up 
to 25 minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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