Doctors caught in two-week insurance trap

By Emily Richmond (contact)

Thursday, March 21, 2002 | 11:11 a.m.

Obstetrician Dr. Jeffrey Wrightson thought he would be delivering more than 60 babies during the first two weeks of April, but now he wonders if he'll even be in business.

Wrightson, like hundreds of other Nevada physicians working in high-risk specialties, has been unable to find new medical malpractice insurance coverage for when his existing plan expires April 1.

Emergency insurance coverage under a plan sponsored by Gov. Kenny Guinn in response to Nevada's health care crisis will not take effect until April 15. That means Wrightson would be without the mandatory insurance for two weeks.

Wrightson and other physicians in high-risk fields -- including obstetrics, emergency medicine and surgery -- have been hit hardest by the crisis, which was sparked by the prospect of rapidly rising malpractice coverage costs in the state.

"I can't tell my patients they'll have to wait to give birth until I'm back on the job," said Wrightson, who has practiced in Las Vegas since 1987. "They're counting on me to be there for them."

Just how many other doctors are facing the two-week lag time isn't known, but the number could be significant, said Larry Matheis, executive director of the Nevada State Medical Association. St. Paul Cos. of Minnesota, which covered 40 percent of Nevada's physicians, including Wrightson, announced in December it was getting out of the medical malpractice insurance market worldwide. The company's losses were particularly high in Nevada because of the lack of a cap on jury-awarded damages in malpractice suits.

Other insurance companies either declined to cover the physicians or required increases of up to 500 percent in premium payments. Dozens of doctors have already said they cannot afford the price hikes and will either retire when their existing coverage expires or move to another state.

Two physicians have already had to quit their jobs at University Medical Center's trauma center, and more staff departures could threaten the facility's ability to stay open 24 hours a day.

Wrightson's pregnant patients due early next month include about 30 indigent women who were referred to the doctor as part of a federally funded prenatal care program through the Nevada Health Centers. The women have no way to pay a private obstetrician to deliver their babies and are likely to turn up at local emergency rooms when labor starts, Wrightson said.

"The ERs are already overwhelmed and understaffed," Wrightson said. "Adding potentially complicated deliveries to the mix would be a nightmare."

Wrightson would not be the only one out of work if he can't find emergency coverage -- he would also have to lay off his staff of office assistants, midwives and nurse practitioners.

In a letter to St. Paul Cos. Monday, a representative from the Nevada Division of Insurance tried to intercede on Wrightson's behalf -- without success.

St. Paul Cos., which had $900 million in losses in its medical insurance division last year, announced in December it would be withdrawing from the market. The company covers the majority of Nevada's doctors.

"We sympathize with the doctor if he's having difficulty finding replacement coverage," St. Paul spokesman Patrick Hirigoyen told the Sun Wednesday. "But our company reached a decision that it could no longer sustain such out-of-control losses."

Dee Mallas, who is eight months pregnant with twin boys, said she interviewed several obstetricians before settling on Wrightson. Changing doctors this late in her pregnancy would be difficult, Mallas said.

"We've built a relationship with Dr. Wrightson," said Dee's husband, Nick Mallas. "It would be catastrophic to lose him now."

A newly formed legislative subcommittee on medical malpractice will meet today at the Sawyer State Office Building in Las Vegas to discuss possible solutions to the insurance crisis, including possible civil justice reforms.

Assembly Majority Leader Barbara Buckley, who chairs the committee, said Wednesday she was disappointed that neither St. Paul nor another insurance company had agreed to extend Wrightson's coverage for the two-week period.

"I guess this is when we find out who really cares, and which companies are truly committed to health care in Nevada," Buckley said.