Las Vegas Sun

March 29, 2024

Governor calls for consensus, special session

Gov. Kenny Guinn unveiled the latest emergency solution to the state's medical malpractice crisis Wednesday even as he admitted long-term measures will be both complex and difficult to achieve.

But he urged all affected parties to "sit down at the table" over the next 60 days to find enough common ground so he can call a special session of the Legislature to halt a threatened exodus of doctors.

"I am certainly willing to look at a special session if they come together and bring me a package," Guinn said. "I would certainly be willing to do that."

Doctors applauded Guinn's plan to reduce medical malpractice rates for OB/GYNs by 18 percent and provide "tail" coverage -- insurance for past work -- for all Nevada doctors. Guinn also asked the attorney general to sue an insurer who pulled out of the state, and he asked to ease licensing requirements on doctors from other states to help recruit more doctors to Nevada.

Looking for long-term fixes, lawmakers studying the problem and trial lawyers who oppose caps on noneconomic jury awards don't believe any consensus is possible in the near future.

"They aren't close," said Assembly Majority Leader Barbara Buckley, who chairs a legislative sub-committee studying the issue.

But Buckley, D-Las Vegas, added it is admirable of the governor to try and build consensus.

Bill Bradley, a board member lobbyist for the Nevada Trial Lawyers Association, said his group has not yet been asked to the table, but has been talking with doctors' groups.

"Any compromise will have to involve the participation of the insurance companies," Bradley said. "We do not believe that a cap on noneconomic damages will have any impact on premiums or health care costs. Only insurance companies can control that."

Larry Matheis, executive director of the Nevada State Medical Association, said he is hopeful that the different parties can begin talking about real reform.

"We haven't been talking with each other very much," he said. "We've been talking to and at each other."

Matheis said one key problem is finding consensus within doctors' groups, between plaintiff's and defense attorneys and among the various insurance companies. Only then can the different parties begin to talk fruitfully to each other, he said.

"I think the fear that we would have going in to those negotiations is that the essential things we think need to be done would be glossed over for a public relations job," Matheis said.

He said that while agreement may be possible about the medical screening panel, error reporting and patient compensation funds, there may never be agreement on tort reform.

Assembly Speaker Richard Perkins, D-Henderson, said he does not believe the state is ready for a special session, in part because Buckley's sub-committee has completed only about a third of its fact-finding.

"One side says there's a quick fix here and the other side thinks there isn't," Perkins said. "Then you have the insurance companies that won't even come to the table."

"The worse thing in the world in a crisis is to have a knee-jerk reaction," he added.

Guinn said that while he supports a $250,000 cap on pain and suffering damages, he knows it is "one element" of an overall solution that must also focus on insurance reforms.

On Wednesday Guinn asked the attorney general's office to join in a complaint filed by Insurance Commissioner Alice Molasky-Arman alleging St. Paul Cos. engaged in unfair trade practices. The office did so this morning.

St. Paul's sudden departure from the Nevada market left 60 percent of the state's doctors without malpractice insurance.

The complaint, prepared by Deputy Attorney General Gabrielle Carr, wants executives of St. Paul to appear to show why they should not be disciplined for allegedly violating the state's insurance regulations. Carr said the practices of St. Paul were "unfair and deceptive." The complaint carries fines of more than $30,000.

Andrea Wood, a St. Paul spokeswoman, said the company has not received the complaint. But she contested the allegations. She said the rates charged by St. Paul were "consistent with Nevada law and were reviewed and approved by the staff of the insurance division."

In March, Attorney General Frankie Del Papa's office notified St. Paul of the violations including implementation of unauthorized policy modifications, payment of commissions to unlicensed agents and unlawful policy cancellations and non-renewals.

"They did not deal in good faith," Del Papa said.

Guinn also did his best Wednesday to ease the burden on doctors left looking for insurance.

The Medical Liability Association of Nevada (MLAN) -- an emergency underwriting agency established by Guinn to offer insurance to doctors in high-risk specialties -- will now offer prior acts coverage, or tail coverage, to all Nevada doctors.

Tail coverage covers incidents that occurred prior to obtaining insurance from the state, but were unknown and not reported to the former insurer.

Many doctors faced tail coverage in excess of $100,000 when new insurance companies offered them premiums this year in the wake of St. Paul's departure.

The state will offer a mature rate -- for doctors with four or more years of experience who have not yet purchased tail coverage -- of $88,586. That is down from the $107,994 initially offered by the state.

MLAN's board of directors also reduced its rates for obstetricians and gynecologists by 18 percent as a result of actuarial study of Nevada loss patterns.

Additionally, Guinn announced MLAN would drop tiered rates for obstetricians based on the number of babies delivered in a year. Now doctors can deliver between 125 and 225 babies a year for the same rate.

Guinn also wrote to Dr. Cheryl Hug-English, chairman of the Nevada Board of Medical Examiners, asking that board to designate Clark County an underserved area for OB/GYN physicians.

That designation would, in turn, allow the state board to waive requirements of a state law mandating three years of consecutive residency training. Instead, Guinn asked the board to allow one year of residency, five years of experience and successful completion of other licensing criteria.

Larry Lessly, executive director of the board, said that while the waiver law was originally drafted to address problems in rural areas, it can be applied to Clark County.

"We're not going to let anybody in with horrible malpractice suits," Lessly said.

The board will consider the waiver Tuesday.

Sun reporter Cy Ryan contributed.

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