Tuesday, March 4, 2003 | 11:01 a.m.
CARSON CITY -- Based on his knowledge as a physician, Assemblyman Garn Mabey is disputing the findings of a legislative report that examined the number of doctors who have left the state.
Mabey, R-Las Vegas, told reporters Monday that he can list 32 obstetricians who formerly practiced in Clark County but have either moved out of the state, retired or, like him, quit the obstetric portion of their practice.
The Legislative Counsel Bureau issued a report Feb. 12 that found 35 doctors statewide have closed their offices or are in the process of closing their offices. The bureau found six physicians who have stopped practicing obstetrics.
"The report, to me, didn't emphasize the number of OBs who have left town," Mabey said, handing over a four-page list of Clark County obstetricians. "People are continuing to look at leaving. They just don't have any hope left."
Mabey's report includes eight doctors who have closed their practices, one who died, eight who have stopped delivering babies and 15 who have moved out of state.
"It just shows that there's got to be some more help," Mabey said.
St. Rose de Lima Hospital chief executive Rod Davis also criticized the bureau report, noting that its count may have been off.
"As I understand the results of that study, it's in terms of physicians who are licensed in the state and most of the physicians who have left our staff have asked for a leave of absence of their privileges," Davis said Monday. "So that means they're maintaining some level of staff privileges and they're maintaining their license in the state, so unfortunately that study skews the real numbers.
"There are physicians leaving who have not technically resigned their license to practice in Nevada. That study does not show physicians who have left that still maintain their license here."
The office manager for Dr. Freida Fleischer, the first woman obstetrician in Southern Nevada, also disputed the findings of the legislative report.
"The list was entirely wrong," office manager Donna Meneses said.
Meneses said that Fleischer, who marked her 25th year as a Las Vegas OB last August, gave up that part of her practice due to rising malpractice insurance costs.
"Of course she dropped obstetrics," Meneses said. "When your malpractice (coverage) goes from $25,000 to $126,000 per year how can you practice?"
Fleischer closed her obstetrical practice in November and filed for bankruptcy in December, Meneses said.
Meneses said that a White House spokesman called Fleischer's office on Monday to tell the doctor that President Bush is concerned about the situation in Nevada.
Mabey said he and other physicians thought the law passed in August 2002 during a special session of the Legislature would be enough to reduce medical malpractice insurance rates for doctors and keep them on the job in Nevada.
He said the reality for most OB/GYNs is that it just doesn't make sense to stay in the obstetric business due to the high insurance premiums, reduced reimbursements for patient care and being on call 24 hours a day.
"It's just not successful," Mabey said.
Mabey's report shows 78 doctors practicing obstetrics and gynecology in Clark County, a number he said was insufficient for the county's population.
The counsel bureau report, based on information compiled by the state Board of Medical Examiners, was researched by Allison Combs.
Combs wrote that the Nevada State Medical Association reported 76 medical specialists had closed their practices, while news reports had mentioned "more than 30 obstetricians" who had stopped delivering babies.
Combs said the board contacted each physician listed by the medical association, with the exception of five licensed by the state Board of Osteopathic Medicine and two physicians whose names were not in the database.
The bureau report found 35 doctors had stopped practicing, with 19 of those having left the state. Two of the 35 stated they were continuing to work at local medical facilities and another said he was taking a leave of absence until 2003.
Mabey said he wanted to bring forward his "personal knowledge" of the numbers of obstetricians because the number of OBs in Clark County is "insanguinating," meaning dripping with blood.
Mabey has requested a draft of a bill that would bring back the medical dental screening panel used in malpractice cases. He said he also supports the initiative petition and Senate Bill 97, both of which seek to cap jury awards for non-economic damages in malpractice cases at $250,000.
Both of those measures were the subject of a hearing that began this morning in the Senate Judiciary Committee.
In a meeting Monday with the Las Vegas Sun editorial board, American Bar Association President Alfred P. Carlton Jr. said that it is wrong to address the medical malpractice liability dilemma facing Nevada and other states by placing caps on damages.
"We're not looking at a justice system crisis," Carlton said. "We're looking at an insurance industry crisis. When their investment income goes down they have to make it up somehow. Well, guess what? The market is down and interest rates on bonds are down."
Because the insurance industry relies on investment income to survive, Carlton said, what is needed is for states such as Nevada to take a closer look at insurance regulations.
"The real reform that needs to take place is in the insurance industry," he said.
Carlton said that in some states where there are caps on damages with no exceptions -- California being the notable example with a $250,000 cap -- the cost of medical liability premiums for doctors continues to increase. Nevada last year passed a law that placed a $350,000 cap on damages with exceptions for gross malpractice or unusual circumstances as deemed by the court.
When asked to explain why Las Vegas doctors have to pay at least two to three times the insurance rates charged in California, Carlton said it had nothing to do with the legal environment.
"I'll guarantee you that the legal environment is not much different in Nevada than in California," he said. "Lawyers don't look for people who have been injured. The actuaries will tell you the incidence of malpractice is probably higher in Nevada."
Carlton conceded that the volume of litigation tends to be higher in fast-growing cities such as Las Vegas. But he said it would be ill-advised to place caps on damages, something his 410,000-member organization opposes, because of the limitations those caps place on juries.
"There is a way to fix it other than putting a limit on people's rights," Carlton said. "The (judicial) system in place is pretty good. Responsible doctors will tell you they need to clean up their act."
Sun reporters
Jennifer Shubinski, Steve Kanigher and Mary Manning contributed to this report.
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