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Nurse midwife Martha Drohobyczer measures Rubi Contreras' pregnant stomach during a checkup at Alternatives for Women clinic on Tuesday. Drohobyczer may have to close her practice Thursday if she cannot negotiate more reasonable medical malpractice insurance rates. Rates are skyrocketing for all Las Vegas health professionals, forcing many to close, leave the state, or see more patients than before. Photo by Jeff Scheid.

Wednesday, January 23, 2002
Copyright © Las Vegas Review-Journal

MEDICAL MALPRACTICE CRISIS: Insurance costs driving doctors away

Skyrocketing premiums as high as $200,000 per year

Rubi Contreras has had a complicated pregnancy. Her baby was too small, and doctors told her early on that the infant would be deformed.

Now, seven months later, Contreras has a healthy fetus and a due date of Feb. 16, thanks to the help of area specialists and the persistence of her nurse midwife, Martha Drohobyczer. Contreras, who has been Drohobyczer's patient for the past three years, said she was delighted that her long-time nurse would be able to deliver her first child next month.

The 22-year-old expectant mother, however, received some startling news during her exam Tuesday: she may have to find another midwife or doctor to deliver the baby because Drohobyczer cannot afford her medical malpractice insurance, which is expected to jump to $50,000 a year from $7,500.

Drohobyczer is just one of hundreds of Southern Nevada health care professionals facing exorbitant rate increases in malpractice insurance.

Doctors, particularly obstetricians and gynecologists, are being forced to either close their practices, cut back on services, or load up on patients to make ends meet.

They plan to meet with Gov. Kenny Guinn today to discuss legislative solutions to what many health professionals call the "medical malpractice crisis of Southern Nevada." The meeting is limited to just a few doctors, who will address issues that affect all health professionals, including nurse midwives.

"My rates usually go up about $1,000 every year, so I was expecting to pay $8,500," Drohobyczer said. In her 20 years of practice, she has had two claims filed against her. One is still active and the other case was dismissed.

As a nurse midwife, Drohobyczer offers annual exams, PAP smears, birth control and other health care services along with prenatal care and delivery.

"The last insurance quote I got was $50,000," she said. "If I can't find anything else by Thursday, I will have to close. I have 15 patients due next month, and I'll be calling them and telling them this week that they might have to (find another midwife or doctor). It will be horrendous."

Contreras was the first patient told.

"I'm upset," Contreras said of the news that her nurse midwife may have to close her practice. "She knows all the complications of my pregnancy. She knows me, she knows my husband. If I have to go to another doctor I've never seen, I just wouldn't be comfortable."

Contreras' plight is one that many patients will soon find themselves in if insurance rates don't soon drop, said Larry Matheis, executive director of the Nevada State Medical Association. The rate increases are affecting most area doctors, especially those who care for high-risk patients, such as obstetricians, neurosurgeons, and emergency room doctors.

Obstetricians are bearing the brunt of the rate jumps -- some increasing to $200,000 from $40,000 annually -- because they are liable for their infant patients for 18 years. Most doctors can only be held responsible for problems for up to two years, said Dennis Coffin, the Nevada representative for American Physician's Assurance, one of the larger medical malpractice insurance carriers in the state. The company insures about 200 Las Vegas doctors.

"A kid may be mentally retarded, it might not show up for six years, and then the parents blame it on the doctor," Coffin said. "The average OB/GYN in our company is going from paying $35,000 to $60,000. And they are going to get hit with another increase, I have already warned them."

One Las Vegas obstetrician who has been practicing in the area for more than 30 years is selling his practice next week because he cannot afford his insurance, which is increasing to $130,000 from $40,000. The doctor spoke on the condition of anonymity because he has yet to tell his "several thousand" patients.

"I just cannot afford it. I would be working for nothing," he said.

Another doctor, Steve Kramer, has stopped doing deliveries and is just practicing gynecology to bring his insurance rates down. His rates were increasing to $225,000 from $46,000.

"My patients have been very understanding. I just said that I could not financially afford to keep delivering babies," Kramer said. "The increases happened right before Christmas. I was scheduled to do a cesarean section on Saturday, but I had to quit delivering the day before."

Insurance rates are rising because there are too many frivolous medical malpractice lawsuits and there is no cap on the amount of money juries can award for damages in Nevada, area health professionals and insurance companies say. California has a jury-award cap of $250,000.

"Our company was granted a 35 percent rate increase due to the frequency and severity of claims in the state," Coffin said. "Nevada is getting a really bad reputation."

There were 133 medical malpractice lawsuits filed in Clark County in 1998, 148 filed in 1999, and 158 filed in 2000, according to District Court records. Of the cases filed in 2000, 17 went to a jury trial and the rest were dismissed or settled out of court. The largest jury award of the 17 cases was for $6 million.

"I'm going to be pleading with Governor Guinn about tort reform," said Dr. John Nowins, president of the Clark County OB/GYN Society. "We're not saying that doctors who have done something terribly wrong shouldn't be held responsible, but we can't handle these personal injury attorneys attacking us and suing us relentlessly."

Nowins and other doctors want Guinn to call a special legislative session to set a cap on malpractice jury awards. They also want laws in place that would financially penalize lawyers and plaintiffs for pursuing frivolous lawsuits.

"We're asking (Guinn) for the moon, but I realize we won't get it," said Dr. Paul Chao, a Las Vegas obstetrician-gynecologist. "If drastic things don't happen, eventually fewer and fewer doctors will come to town and more and more will leave. We'll end up with a population that can't take care of its pregnant women."

Guinn could not be reached for comment Tuesday.

Las Vegas medical malpractice attorney Charles Lybarger said the blame should be put on greedy insurance companies, not on lawyers. He said that less than 1 percent of insurance costs are related to litigation.

"Insurance companies are out to make a huge profit," he said. "Also, if doctors are being sued successfully, then they've obviously done something wrong. We are protecting the public from doctors that make mistakes and hurt people."

Regardless of why insurance rates are skyrocketing, doctors and lawyers do agree on one thing -- that patient care will suffer as doctors leave town, close their practices, or begin seeing more patients. Patients will also find that there are fewer doctors to choose from and that the wait for an appointment may be months instead of weeks or days.

"Our population is increasing yet our doctor population is decreasing," Chao said. "Doctors are going to have to see more patients, and patients will find they'll have to wait three hours to be seen for five minutes. They'll just show up in the emergency room instead of waiting."

The Nevada State Medical Association is gathering data on how many health care professionals are leaving the state, retiring early, closing practices, or limiting their services due to the rate increases. The statistics aren't available yet.

Chao's insurance contract doesn't expire until May, but he fears he'll be forced to pay huge increases like many of his colleagues.

"I must see more patients, but I don't want to do 40 or 50 deliveries a month because the quality of care is going to suffer," he said. "I don't know what I'm going to do. I'm trembling just thinking about this. I may just have to move out of state."