ANNAPOLIS – Mark Artusio has performed surgery in Frederick County for 21 years. He loves his work. He feels like he’s in his prime.
But come Jan. 1 — the day his insurance premium is set to rise 40 percent — Artusio and his four partners will suspend their practice until they see “good” medical malpractice reforms in Maryland.
Artusio is one of many state doctors who say they are quitting or leaving the area to practice elsewhere because of growing insurance costs and what physicians say are inadequate liability laws.
Data in the National Practitioner Data Bank provides some support for his and insurance company arguments: Insurers are paying out more on claims. And that, Artusio and others argue, leads directly to higher premium costs.
Artusio declined to reveal his premium cost, but MedChi Executive Director T. Michael Preston said Maryland general surgeons in Frederick County will pay about $65,000 in 2005.
But Artusio doesn’t blame the insurance companies for the increases — he blames trial lawyers, such as Sen. Brian Frosh, D-Montgomery, chairman of the Senate task force on the issue, and Senate President Thomas V. Mike Miller Jr., D-Calvert.
“Why do you rob the banks? That’s where the money is,” said Artusio. “Why do trial lawyers sue doctors? That’s where the money is.
“Why can’t the public make some of these decisions?” Artusio asked. “It says in the first three words of the Constitution, ‘We the people.’ Whoever changed it to, ‘We the trial lawyers’?”
“I’m sorry he thinks it’s unfair,” Frosh said. “We have doctors in the Legislature who participate in this. We have lawyers who participate in this. It’s a citizen legislature. . . . Would it be better if people didn’t have other jobs? Yes it would. But that’s one of the consequences of having a citizen legislature.”
Artusio said he plans to spend his sabbatical lobbying for doctors. He added that he wants to debate the issue with Miller on the radio.
In an Oct. 28 rally outside the governor’s house, Miller said he is working in the interest of patients entitled to compensation for their injuries.
Miller, Gov. Robert Ehrlich, House Speaker Michael Busch, D-Anne Arundel, and their medical malpractice task forces have worked to write new legislation in time for a special session, but hopes for solving the problem before the end of the year are dim, Miller has said.
Artusio said creating a funding source — as the state’s three leaders have discussed — would help pay for the premiums, but it won’t help reduce them. He said imposing a hard cap on pain-and-suffering damages would lessen malpractice payouts, which would, in effect, lower premiums.
“We look at the premium rise as a symptom of a broken system,” Artusio said. “But we’re also mad about the problems that are causing this rise.”
Other experts put the blame elsewhere, however.
The solutions have nothing to do with the legal system, said Joanne Doroshow, executive director of the Center for Justice and Democracy, a public interest organization based in New York City.
“I don’t think it takes a brain surgeon to see that something else is going on here,” Doroshow said. “The solutions lie in the insurance industry. . . . They’re laughing all the way to the bank.”
David L. Murray, president and chief executive officer of Medical Mutual — the company that covers 75 percent of Maryland physicians, including Artusio — said escalating malpractice costs have forced insurers to hike rates by an average of 33 percent next year, after an average increase of 28 percent in 2004.
“We’re not seeing more claims, but we’re paying more on the claims we do see,” Murray said recently.
But trial payouts and tort reforms don’t affect increasing rates, Doroshow said. She blames the weak economy and “anti-competitive behavior” — insurance companies hiking their costs at the same time — for the premium increases, even in states with caps on pain-and-suffering damages, such as Maryland, where the ceiling is now $650,000 and rises each year by $15,000.
Both average awards and the total payout from malpractice lawsuits filed against Maryland doctors in 2003 climbed by about 17 percent from 2002 — the largest increases in seven years, according to analysis of the National Practitioner Data Bank.
Average payouts rose from $236,765 in 2002 to $277,583 in 2003, while the sum of the awards jumped from $80.3 million to $93.5 million.
The number of lawsuits brought against Maryland health care providers has fluctuated from 1991 to 2003, but remained between 270 and 370.
John Franklin, a Medical Mutual spokesman, said the company paid $93.2 million in malpractice costs in 2003, a sum that represents 99.7 percent of the Maryland total reported in the database.
But the database does not include all malpractice cases in the state and misrepresents Medical Mutual’s role, Franklin said.
“The National Practitioner Data Bank is not a comprehensive number,” Franklin said. “It’s not complete.”
Federal regulations exempt some practitioners, such as social workers and nutritionists, from submitting reports.
And while statistics show a 7.6 percent decline in the number of physicians licensed in Maryland from 2002 to 2003, that doesn’t necessarily mean doctors are fleeing practices over high rates.
“There’s not enough data to attribute this drop to any specific cause,” said the medical society’s Preston. “I wouldn’t leap onto this without data.”
That’s exactly why they’re leaving, said Artusio — because of costly insurance rates and insufficient tort provisions. And he won’t return to work until the problems are resolved.
“This whole broken system is driving doctors out of practices,” he said. “We will not come back until we get substantial reforms.”