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Medical Malpractice Crisis More Information An air ambulance takes off from University Medical Center Wednesday after dropping off a trauma patient. Photo by John Gurzinski. Mercy Air nurse Kathy Chelius, left, and paramedic Paul Valencia bring a trauma patient to the University Medical Centers's Trauma Center. Photo by John Gurzinski. Dr. John Fildes, director of University Medical Center's Trauma Center, stands Wednesday morning inside the center. Photo by Gary Thompson.

Thursday, March 21, 2002
Copyright © Las Vegas Review-Journal

MEDICAL MALPRACTICE CRISIS: Trauma center faces new threat

Surgeons will quit unless Guinn commits to tort reform

More than half of the surgeons working at Southern Nevada's only trauma center are poised to quit if Gov. Kenny Guinn doesn't soon commit to limiting malpractice liability in Nevada, their representative said Wednesday.

The resignation of six of the 11 remaining surgeons at University Medical Center's Trauma Center would force the center to severely limit hours or close completely, said the center's medical director, Dr. John Fildes.

The six surgeons, all in private practice at Desert West Surgery, say they can no longer afford to pay their skyrocketing rates of medical malpractice insurance. They also say they can no longer risk massive lawsuits by performing high-risk trauma surgeries in a state that does not support tort reform.

"Anything short of tort reform is going to force us to limit our exposure and cut out our high-risk activities, which is trauma," said Dr. Darren Soong, one of the six trauma surgeons at Desert West. "If Gov. Guinn called an emergency session, if he made a commitment to tort reform, if he was actively pushing for tort reform, I'd stay and do trauma because I'd see hope."

Tort reform limits an injured person's ability to pursue a lawsuit by making it harder to prove fault, limiting attorneys fees, placing caps on noneconomic jury awards and other means. Defendants often view tort reform as a way to limit lawsuits and jury awards, while plaintiffs often see it as a way to deny them their day in court.

California has the most comprehensive and effective legislation regarding medical malpractice and tort reform, according to the American Medical Association. The association is a longtime supporter of tort reform, especially caps on noneconomic jury awards. California institutes a $250,000 cap on jury awards for pain and suffering.

Soong said he and the five other doctors will make a group decision this spring whether to continue to work at the trauma center. The surgeons all cover shifts at the 24-hour trauma center as well as practice general surgery at Desert West. The surgeons include Drs. Terry Lewis, James Lovett, Wydell Williams, James Atkinson and Craig Iwamoto.

Guinn promised last week to use $250,000 in public money to create an insurance association that would provide doctors with affordable malpractice insurance by mid-April.

In a statement issued by Guinn's press secretary Greg Bortolin on Wednesday, Guinn said: "The Nevada Essential Insurance Association is a short-term solution that gets us to the next legislative session. Everything, including tort reform, will be put on the table so that we can develop a long-term solution. These doctors must understand I am doing everything possible to address the crisis. In return, I would hope they would give consideration to the citizens of Southern Nevada who need medical care."

This latest threat of trauma center closure is the second in recent weeks. The center was supposed to close for several shifts this month after two surgeons quit in February, making it impossible to cover all shifts. The closure was prevented, however, when one doctor returned to work under a temporary policy that allows him to practice without having to pay for medical malpractice insurance.

The policy allows trauma surgeons to have part-time employee status at University Medical Center, giving them coverage under the medical center's self-insured umbrella policy. Doctors who are considered employees of the government-run hospital are exempted from picking up the tab of any malpractice claims, which are capped at $50,000 for both economic and punitive damages, according to Clark County.

But Soong said the Desert West surgeons distrust the validity of the temporary policy.

"I'm not sure I'm willing to risk my whole career and my house and personal finances on a cap that's never been tested in court," Soong said. "A lawyer could challenge that and go after my personal assets, and I'm not willing to risk everything I've worked for."

Even if the six surgeons could find less costly malpractice insurance, they still would stop working at the trauma center without a commitment from Guinn to tort reform. Working at the trauma center brings in the least amount of money, the most amount of lawsuits and poses the greatest risk for increasing malpractice premiums in the future, Soong said.

"Our rates would not be cheaper immediately if we pulled out of trauma and continued in private practice, but this would be a long-term decision," he said. "Most of our group claims and cases revolve around the trauma center and by eliminating that, it would keep our rates lower in the long run."

The six doctors face increasing malpractice rates in June, when their current contract expires. They have yet to find affordable insurance and if they can't do so by June, they will quit their private practice and move elsewhere.

"This trauma center pullout might just be a moot point," Soong said. "If we cannot find an affordable policy by June, then we're not going to do trauma or general surgery. We will be packing up our families and moving."

Soong, who has worked as a trauma surgeon in Las Vegas for 12 years, said he already has put out feelers for jobs in other states with tort reform, including Utah, which has a cap similar to California's.

Trauma center surgeons care for car accident victims, those with gunshot wounds and other critically injured patients 24 hours a day, seven days a week. The center cares for approximately 11,000 patients a year, including patients from Nevada and parts of California, Arizona and Utah.

"If we don't have enough doctors, it's a real possibility that we'll have to close," Fildes said. "If Desert West pulls out, then one-third of our shifts will not be covered and I don't have enough people to make up that deficit. Right now, we have all the trauma shifts covered through April only."

If the trauma center closes or limits hours, patients with life-threatening injuries would be sent to the closest emergency room instead, where doctors often are often not trained to perform surgeries.

Fildes said he is in the process of recruiting trauma surgeons from other states, but the medical malpractice climate in Nevada is making it difficult.

The trauma surgeons are just a handful of hundreds of area doctors who say they may have to quit, retire early, or limit their services because they can no longer afford their exorbitant rates of medical malpractice insurance.

Many of the doctors say Guinn's essential insurance program won't work. Although rates would be reasonable, many would still have to pay approximately $100,000 in tail coverage, a one-time fee a doctor must pay when signing up with a new insurance company. The tail insurance covers any past problems or claims filed while the doctor was with the old insurance company.

Doctors also say that the program is only temporary, and that Nevada needs tort reform, said Larry Matheis, executive director of the Nevada State Medical Association.

Trial lawyers, however, think differently. They say that the insurance crisis has nothing to do with excessive lawsuits or jury awards, and that poor underwriting practices by insurance companies have contributed to the problem. They also say that insurance companies are raising rates to compensate for having lost money on investments and for insuring bad doctors in the past.