Nevada’s failure to track medical data adds to crisis

Stacy J. Willis

Wednesday, May 8, 2002 | 11:07 a.m.

While pregnant women worry about an apparent shortage of obstetric care in Southern Nevada, the state is not keeping tabs on the number of practicing obstetricians, nor of any other physician specialty.

In fact, the state's medical board says that according to its numbers, there is no health crisis, no shortage of doctors and no mass exodus of physicians from Clark County.

And as for a shortage of baby deliverers, "If you've got a shortage, we wouldn't know," says Larry Lessly, executive director of the Board of Medical Examiners.

"We don't keep track of their specialties. We license and discipline, that's it," he said. "No one, to my knowledge, keeps those numbers for the state."

That lack of health information gathering and monitoring, says Larry Matheis, executive director of the Nevada State Medical Association, is a key problem that allowed the state to spiral into its medical malpractice insurance dilemma.

Since December Clark County physicians have seen malpractice insurance rate increases of up to 200 percent, forcing some to consider abandoning their practices or cutting back on services.

"There were forewarnings that this crisis was developing, but none of us had enough information to see the big picture until it was almost right on top of us," Matheis said. In addition to monitoring changes in physician practices, the state needs to better monitor insurance reimbursement and malpractice rate trends, Matheis said.

"We need to honestly know what's happening. Right now the media is serving the function of trying to report what's going on because the state doesn't have the accurate numbers. Whether it's the licensing board, or the insurance division, or the health division, someone needs to be keeping track," Matheis said.

The Nevada State Medical Association, a professional association of some 1,500 physicians, says that more than 70 doctors have left or are "seriously considering" leaving the state as a result of escalating insurance premiums. Physicians are speaking out daily about curtailing parts of their practice in order to reduce liability, but the board doesn't monitor shifts in disciplines nor services offered.

On Monday some of the county's 93 practicing obstetricians stopped accepting new pregnant patients because their insurance providers raised their rates and then offered them a 25 percent discount to deliver fewer than 125 babies per year -- to limit liability. Last year Clark County obstetricians delivered more than 23,000 babies -- a number which is expected to grow this year.

"Do the math," Dr. John Nowins, president of the Clark County OB/GYN Society, said. "We are going to have more babies than available obstetricians."

Matheis said the problem for high-risk specialities has just begun, and in coming months, similar problems will develop for thoracic surgeons and radiologists, among others.

But Lessly said the state's medical status is "stable" and licensure records show that between December 2001 and May 2002 Clark County's total population of active physicians decreased by only one. "I don't think Nevada is rated as a state that is insufficient in medical care," Lessly said.

The American Medical Association ranks Nevada 47th in doctors-per-100,000 people, with 196 licensed physicians per 100,000 residents. By comparison, California ranks 13th with 216.

There are 2,313 licensed and active physicians in Clark County, according to the board. Upon request, board administrators tallied the licensed number of Clark County OB/GYNs, 143, but did not have records to show how many of them are active. The records also don't show increases or decreases in that number.

"When a crisis comes up people want to know, 'Are we over or under the national average?' I think the board should track it -- it doesn't seem to be an unreasonable thing to ask for," Matheis said. "A state agency like the Board of Medical Examiners has a fundamental responsibility to license, but it also has other public policy responsibilities."

Lessly said that monitoring whether residents are adequately served by health professionals is not in the state's purview.

"That's up to market forces, not the state" Lessly said.

But, Matheis argues, "Markets only work when there is good and accurate information for the public -- think about Enron ...

"A state agency is in the best position to give accurate data. Markets do not function in the absence of good public information. Markets can't work if only a few people know what's going on. We need good information and if we don't have it we're going to make bad judgments."

Physicians are pushing for the Legislature to set limits on non-economic damages awarded in medical malpractice lawsuits. Matheis said overhauling the state's medical monitoring procedures must also be a part of solving the insurance problem and preventing it from recurring.

"It may be asking a lot of the state to be aware of patterns that are developing, but we are going to have to find a way to do that and improve our monitoring systems and data reporting systems so that at the very least we are not caught as flat-footed as we are on this one," Matheis said.

Getting accurate statistics may be critical to policymakers, but it is not the most urgent concern to women such as Kim Maugaotega, who is 6-weeks pregnant and can't find an OB/GYN.

"I'm praying that I'll find someone," Maugaotega said. After being turned away from her regular obstetrician on Monday Maugaotega said she called 27 local OB/GYNs. She is insured by United Health Care and said she could not find anyone on her provider list to accept her as a patient.

"My girlfriend wants me to try a midwife and deliver at home, but I just don't feel comfortable with that," Maugaotega said.