Senator: More ER doctors quitting

Cy Ryan and Mary Manning

Wednesday, April 24, 2002 | 11:13 a.m.

Thirty-one Clark County doctors have resigned from working in emergency rooms because they cannot afford medical malpractice insurance, a state lawmaker said Tuesday.

"This is not a bluff," state Sen. Ray Rawson, R-Las Vegas, told the Legislative Committee on Health Tuesday morning.

Rawson said he received resignations letters from 31 specialists who are on contract to work on-call with area emergency rooms.

In addition to 31 physicians in such specialties as orthopedic, pediatric and neurology who have resigned, another 45 said they will resign, Rawson said.

"That's 10 percent of the physicians in the state who are leaving. That's a crisis," Rawson said.

Several doctors in Southern Nevada have said they are leaving the area because of the high price of medical malpractice insurance, but area hospitals reached by the Sun this morning could not confirm Rawson's numbers. Hospital representatives said they had not heard of such a mass exodus.

Ann Lynch, spokeswoman for Sunrise Hospital, said the numbers, while small, predict more crisis to come.

"(Thirty-one) doctors citywide is not a huge number here, but it will grow," she said. "It's a harbinger."

Rawson's comments came as the politics surrounding a statewide medical malpractice crisis heats up. The crisis began in December, when St. Paul Cos., which covered 40 percent of the state's doctors, said it would no longer provide malpractice coverage.

The state last week launched a semi-public insurance plan for doctors, which had received 108 applications by Tuesday morning. Another private mutual insurance company owned by local doctors has received permission to seek financing.

But lawmakers are facing a bigger issue to solve the medical malpractice crisis as doctors want to press the issue. Doctors say the answer is limiting the amount judges and juries can award in medical malpractice cases. Trial lawyers are against so-called tort reform laws, and the issue is expected to be a major battle in next year's Legislature.

Doctors said the resignations Rawson referred to could mean that some special services or emergency surgery may not be available from time to time at particular hospitals.

"We're seeing the definite possibility where a patient in the emergency room may need surgery and we will not have a surgeon available," said Dr. Donald Reisch, director of emergency services at Desert Springs Hospital.

He said in such a case, a patient would be transferred to a hospital that could treat the person.

Reisch said he has heard doctors talking about pulling themselves off the on-call list but hasn't seen that happen yet. He said state law requires a month's notice for doctors to stop giving services.

No letters of resignation have been received at University Medical Center's trauma unit, nor at Valley Health Systems' hospitals, which include Valley, Summerlin and Desert Springs hospitals, spokesmen for those companies said.

Sunrise Hospital and Medical Center has had some specialty doctors, especially OB/GYNs, resign from emergency room duty, Lynch said, but not enough to leave the ER short-handed. Of the hospital's 107 OB/GYNs, five have said they are leaving, she said.

Lynch noted that a large number of doctors will lose their current coverage in June and July.

"The ER call is still strong," she said. "That doesn't guarantee that it will be in the fall."

At a panel discussion before the Clark County Medical Society Tuesday night, Gov. Kenny Guinn said despite requests for a special session of the Legislature, he would not call one to address the issue.

"No, a special session won't do a thing," Guinn told a packed meeting of the group. "We need a long-term solution."

Guinn spoke after a panel of legislators, including Assembly Speaker Richard Perkins, D-Henderson, Senate Minority Leader Dina Titus, D-Las Vegas, Rawson, and Assemblywoman Sandra Tiffany, R-Henderson.

Rawson said he would support a special session, if the parties affected -- doctors, insurers and lawyers -- could reach a consensus. So far no compromise has garnered support of all of the groups.

"Physicians can't wait until the next Legislature convenes," Dr. Raj Chanderraj, president of the medical society, said. The doctor asked the state to help so "physicians can provide comforting care to their patients without the fear of liability."

The next Legislature opens in February 2003.

Perkins and Titus said they were not in a rush to call a special session.

"There are other things that need to be on the table," Titus said, such as reporting physician errors, a nursing shortage and a low reimbursement rate to providers. "I'm not rushing to that conclusion."

"The Legislature needs to take a very prudent and measured response to this," Perkins said.

Despite the creation by Guinn of a state-backed temporary insurance system to cover doctors, Rawson, chairman of the Legislative Committee on Health, said he heard dire predictions earlier Tuesday about physicians leaving Nevada.

Up to 400 doctors are expected to sign up for the state fund, Larry Matheis, executive director of the Nevada Medical Association, said.

While the state will protect doctors who join the fund, the problem facing them is they must pay "tail" coverage to their former insurance companies. The tail provides doctors coverage for mistakes made while they were covered under a previous insurance plan.

Trauma surgeons pay some of the highest tail coverages because of the risk involved in their specialty area.

Rawson said the governor has convinced St. Paul Cos., which is pulling out of Nevada, to allow doctors to pay that in installments over three years.

The state system published its rates and its underwriting guidelines on Monday.

"If nothing happens to stop this, we're right back where we were 15 years ago, before we had a trauma center at UMC. Patients will have to be stabilized and then flown to Los Angeles," he said.

"The Legislature will have to solve the problem," Matheis said.

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