Ob/Gyn ‘driven from the valley’

Monday, March 20, 2006 | 7:08 a.m.

Dr. Shelby Wilbourn was shocked when he opened up his mail one morning in 2002.

Wilbourn had been an Ob/Gyn in Las Vegas for 12 years and had never been sued before. The notice said his malpractice insurance rates had almost doubled.

He was told that at his delivery rate of 200 babies a year, his insurance rate would rise from $56,000 to $108,000.

"I told my office manager it had to be a typo," Wilbourn said. "When I got the insurance company on the phone and they said it wasn't a typo, I still could hardly believe it."

Faced with the prospect of taking out a loan to continue to practice, Wilbourn made what he calls "one of the hardest decisions of my life."

"I took out a loan for $109,000 to pay the 'tail' on my insurance and walked away from a practice I had spent 12 years building." Wilbourn said. "I had a good life in Las Vegas, but I was absolutely driven from the valley by malpractice insurance costs."

The tail is the amount a doctor must pay the insurance company when he leaves a state, to cover any subsequent litigation for services he has already performed.

Wilbourn, 45, now works at Waldo County General Hospital in Belfast, Maine. He said the toughest thing was leaving behind the 8,000 patients he had developed rapport and trust with over the course of a decade.

"I still get letters and Christmas cards from former patients and pictures of the kids I've delivered over the years," Wilbourn said. "I miss my friends, and I still worry about my former patients, but I know I made the right choice."

At the time Wilbourn left, malpractice insurance costs caused an exodus from Las Vegas of doctors in some specialties. Malpractice rates are determined largely by the risk factor in a doctor's specialty. The field of obstetrics/gynecology is among the highest risk.

The combination of an increase in litigation and the lack of a cap on damages forced some insurance companies to get out of the malpractice insurance business altogether. Other companies continued to offer coverage but substantially raised their rates.

Wilbourn still keeps in touch with colleagues in the valley and he said some of them can no longer afford to leave.

"I talked to one doctor who considered leaving a year after I did, and his tail would have been more than double what mine was," Wilbourn said. "Sometimes a prospective employer will pay a tail to persuade a doctor to move, but it's hard to imagine anyone would pay that much."

Wilbourn would not reveal his current insurance rates, but he said they were "substantially lower" than what he paid in Nevada. He said he has already managed to pay back the loan he took out to cover his tail in Nevada.

The Maine Department of Professional and Financial Regulation estimates the cost of malpractice insurance in the state is less than half of the national average.

Nevada voters passed a ballot initiative in 2004 to cap damages in malpractice cases, but insurance companies are waiting to see if the measure holds up to the scrutiny of the courts before lowering rates.

Wilbourn said he could not envision returning to Las Vegas to practice because he is very happy in Maine.

He said if the cap on damages remains in place, either through the courts or by constitutional amendment, however, he would encourage other doctors to move to Nevada.

"I have a lot of fond memories of Las Vegas," Wilbourn said. "I hope things work out there for everyone's sake."