Las Vegas Sun

March 29, 2024

State leaders scramble to find solution

Gov. Kenny Guinn will call a special session of the Legislature within a few weeks to address the medical malpractice crisis regardless of whether the different parties can reach consensus.

"I am prepared to call a special session even if doctors, lawyers and insurers cannot agree in the next 23 days," Guinn said Monday shortly after University Medical Center announced it was closing its trauma center Wednesday because it has no orthopedic surgeons to staff the Level 1 emergency facility.

Previously Guinn said he wanted the three interests to agree to a solution before convening the 63 legislators in Carson City to approve reforms.

Meetings between doctors, lawyers and insurers are continuing, but lawmakers and sources close to the discussions said Monday's announcement -- coming after a group of orthopedic surgeons pulled out of the trauma center -- could hamper any chance at a resolution.

To keep the trauma center open, UMC officials offered to triple the surgeons on-call pay -- from $1,000 a day to $3,000 -- an offer that was accepted and then rejected as doctors asked for a long-term solution: tort reform.

"(The doctors) are not negotiating in good faith," one source familiar with the UMC talks said. "Every time doctors ask for something, they accept it but then cry for tort reform."

Doctors have continued to force the issue for long-term reform -- they want awards on medical malpractice lawsuits capped. For that to happen, the Legislature would have to pass a new law.

Dr. Michael Daubs, president of the Nevada Orthopedic Society, has been an on-call trauma surgeon at UMC for seven years. A spinal specialist, he resigned from UMC on June 14 because of liability issues.

"I'm sure the community is quite frightened by this, and I hope we can go to special session and get this hammered out and solve this for the citizens of Clark County," Daubs said. "I'll be fighting this to the end. I love this community. I grew up here, and I'll probably be one of the last doctors standing.

"But if we don't solve this problem, the quality of our medical care in this community will regress."

Many politicians say the doctors' new-found political clout -- highlighted by media reports of pregnant women without doctors -- could backfire on the profession when lawmakers convene because of the way the doctors have approached the issue.

Marybel Batjer, Guinn's chief of staff, said the governor has been meeting with doctors since January when the first serious insurance troubles began after St. Paul Cos. -- which covered 60 percent of the state's doctors -- left the malpractice insurance market.

"They asked him for help getting insurance," Batjer said. "He created a state insurance company.

"Then they asked for prior-acts coverage and he included that tail coverage for them."

Guinn asked doctors, trial attorneys and insurers to begin a series of earnest talks aimed at coming to a solution with the understanding that all parties would do their best to limit rhetoric and media events while working toward consensus.

But before the group's second meeting Monday, 58 orthopedic surgeons said they would leave the trauma center if they couldn't become covered under a cap. Even when the Clark County commissioners -- acting as the UMC Board of Trustees -- offered such a scenario in a 7-point plan, the doctors balked, saying they wanted long-term solutions. Some questioned the legality of the plan.

"I am disappointed and fearful for the community," UMC Board President and Commissioner Erin Kenny said. "I am very concerned about the health and safety of residents, especially with the Fourth of July holiday and the requisite number of burns and fireworks accidents.

"It scares me to no end," Kenny said, adding that she and UMC executives are willing to renegotiate with any doctor "willing to work with us."

After the county-proffered plan was rejected, UMC officials agreed to the surgeons' request for $3,000-a-day retainers for being on call -- a fee three times what they normally receive. But after winning approval for the new fee, doctors reportedly refused to stay on the job through July, and again began demanding tort reform.

"They are burning every bridge they have leading up to a special session," one lawmaker said.

And other legislators seemed uncertain as to how a special session will bring the parties -- who are reportedly miles apart -- together.

"Even if we're not talking about getting consensus now, I think there's just a lot more information to go through," said Assembly Speaker Richard Perkins, D-Henderson. "I guess part of the frustration I feel is that there's a process we have to do here that involves deliberations and not snap decisions."

Senate Majority Leader Bill Raggio, R-Reno, said he would defer to Guinn on calling a special session. But Raggio seemed unmoved by UMC's announcement Monday.

"What does that even mean that they're closing the trauma center?" Raggio asked. "People can still go to the emergency room."

State Sen. Randolph Townsend, R-Reno, who is serving on the Legislature's Committee to Study Medical Malpractice, said that while the crisis is "as serious as I've seen in my 25 years in the political world," he is not convinced there's a total collapse in the health care system that warrants a knee-jerk reaction.

"The reason this is not an easy solution is that there are a number of issues that are uncontrollable," said Townsend, who chairs the Senate Commerce and Labor Committee. "We can't order insurance companies to alter their rates."

Assemblyman Bernie Anderson, D-Sparks, said he does not know what doctors will even get in a special session.

"Anytime you get a group of 63 people together, anything can happen," said Anderson, who chairs the Assembly Judiciary Committee which has killed past tort reform proposals. "Without having something to start with, we're just going to be standing at the chalk board."

Anderson also warned that it might take two to three years for market conditions to improve as a result of anything lawmakers do enact.

Dr. Ikram Khan, a Las Vegas surgeon and liaison between Guinn and a physicians' task force, is one of the participants seeking to reach compromise in the next 23 days.

During the second meeting of that select negotiating group Monday, participants traded data from their various perspectives, some offering information via telephone. The group plans to meet again next week, now with the added urgency of the governor's decision to call a special session.

"We're making progress, and we'll leave it at that," Khan said. "I'm satisfied with the current level of progress."

Sun reporters Steve Kanigher, Stacy Willis and Adrienne Packer contributed to this report.

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