Where I Stand — Brian Greenspun: State’s medical mess

Tuesday, Feb. 19, 2002 | 8:42 a.m.

WHERE DO YOU go in Las Vegas when you need a doctor?

For the longest time the answer to that question was the airport. It was supposed to be a joke but, as we all know, imbedded within even the most superficial bites of humor are always a few bits of truth. And one of those truths was that not until recently did Las Vegas have the kind and quality of medical care that a city of our size needed and deserved.

Growing up in the 1950s and 1960s, I suppose the medical community fell prey to the same sort of prejudice that affected the city at large, which was was that Las Vegas was not the kind of place to raise children, grow families and otherwise put down stakes for the long term. Those of us who have been fortunate enough to live here a long time know how ridiculous that perception was, no matter how real its effect was on our quality of life in this valley.

As the town grew and the negatives were peeled away, however slowly, baring a city of enormous potential and vitality, professionals from all walks of life flocked to this valley to see what the fuss was about and participate in the upside of the fastest growing place on earth. That included doctors who saw in this city an opportunity to practice in a place that would be most appreciative of any professional who was willing and able to provide quality medicine.

Over the past couple of decades it has become readily apparent that Clark County was becoming one of the better places to practice medicine. But, as in all things, success breeds not only more success but also a certain number of failures. Failure in the system and the failure by some to adhere to the standards that promote excellence. And that brings us to the present and what looms as a medical crisis never contemplated and not yet experienced in this 21st century model of a city.

The medical malpractice issue, which has reared not only its ugly head but also most of the rest of the body of the monster, threatens to destroy the good that has been done in the field of medicine here by chasing away the doctors who have done so much to elevate Las Vegas in the eyes of the medical community. It is not a situation uncommon to many cities across the country in which malpractice insurance rates are skyrocketing to the point that doctors are closing up shop but, as is often the case in Southern Nevada, it is just a little bit worse here.

We live at a time when insurance rates are doubling and tripling for almost all businesses just because of the nature of things. It is too easy to say that the lawyers are creating the mess even though they are clogging the courts with lawsuits that stretch the imaginations of even the most creative members of the bar. And it isn't enough to lay the blame at the feet of the judiciary, which seems to have forgotten its role of arbiter of not only truth but also the reasonableness of judgments that bare no semblance to reality. Nor is it quite fair to blame the medical community which, like all members of the human race, makes its share of mistakes, has no trouble owning up to many of them but oftentimes fails to police those amongst its numbers whose egregious conduct gives rise to ballooning insurance rates across the board.

No, we can't blame any one of those groups but we can place the blame squarely in the middle of them. We can also blame ourselves for the quandary that confronts us ... that of doctors willing to pack up their practices and leave rather than work their lives for "relatively nothing." That's because as a community we often fail to act in time to prevent these problems, choosing instead to scapegoat those whose training can save our lives and make them better. Rather than deal with these problems as they become known we just mosey along hoping that something will be done ... by the other guy, at his expense and not our own.

Well, guess what? It seems that the time has come in Las Vegas when we have to decide what kind of life quality we want for ourselves. Are we going to be content letting those who can afford it to go to the airport for quality medical care, go, or are we going to do what is necessary to ensure that all citizens can have access to the finest care because it not only exists but also flourishes in this valley?

Right now there are OB-GYNs who are opting to continue their gynecological practices -- because their malpractice insurance rates are reasonable -- and abandoning their obstetrical efforts because they cannot afford the 300 percent and 400 percent increases. It seems to me that there will be doctors available to help women who get pregnant but too few around to help bring the results of those efforts safely into this world. Talk about a fine mess!

There is a fix to this predicament. It includes some kind of tort reform that doesn't punish patients wrongly served from recovering reasonable and responsible damages; doesn't remove from the courts the ability to punish those who practice medicine in a grossly negligent manner; some way to buck up the judges to support sound verdicts and not simply rubber stamp runaway juries; some state action requiring insurance companies to provide coverage if they want to do business in this state: a business-like approach to increased premiums being passed through to the ultimate users (that's us); and in the end, a realistic approach to providing quality care to all citizens that will necessarily have some governmental component attached to prevent this kind of excess from occurring.

I, of course, am not smart enough to come up with the answers (I am having enough trouble understanding the tax structure of this state). But the governor, the doctors, the lawyers and everyone else interested in growing our quality of medical care, rather than diminishing it, will be working overtime in the next few months to find a responsible solution. And it will be found because there is really no alternative.

If you want to go to the airport for a doctor, that's always your choice. But we shouldn't make going to that same airport the only choice for the doctors who have chosen to make and keep our community well. That is bad business and bad medicine.

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