Playing Sick 

Tennessee doctors are malingering on the issue of malpractice.

In America today, it is in vogue to call things by wrong names. Hence: "malpractice reform," a Bush-like malapropism served in a sauce of non sequiturs.

Doctors claim that they are the real malpractice victims and that lawyers are the actual culprits. On the contrary, the problem with medical malpractice is -- well, medical malpractice. It is not a stretch to say that it requires a measure of chutzpah to kill one's patient (by accident, of course), then present a petition to the state for relief as the victim. Hippocrates would gag.

The Tennessee Medical Association, a group of 11,000 physicians, seeks to pass a bill capping compensation to victims of bad medicine at $250,000 for non-economic damages, among other things. These and other proposed caps shift the onus of medical mistakes onto the patient. In effect, Tennesseans will be asked to clean up their doctors' messes.

About 5 percent of the doctors are responsible for over 50 percent of the claims. The public-advocacy group Public Citizen estimates the costs of preventable medical errors in Tennessee to be as high as $586 million a year. The proposed caps would remove the deterrent to bad doctors and drive up costs for the rest of us.

In states like California, Texas, and Colorado, where such caps have become law, malpractice premiums actually rose until subsequent legislation mandated rate reductions. Insurance companies, tort reformers, and journals such as Modern Physician have observed that caps like the proposed ones don't reduce physician costs for malpractice coverage and that the real driver for premium increases is the economy and its vicissitudes.

Under Tennessee's present laws, which already favor physicians with a half-dozen privileges enjoyed by no other profession, both rural and urban counties have seen an increase in general-practice physicians and specialists. In fact, Tennessee's physicians outstripped the national average for the reported period, 1991-2000, and also surpassed the growth in numbers of practitioners in seven states with caps on non-economic damages. Bottom line: Caps are not needed to lure or retain doctors. Physicians seek special privileges but do not offer to curb their medical errors in exchange for this dispensation. There are national practice guidelines available on publicly accessible Web sites for physicians to follow, step-by-step, in treating patients. These guidelines, if followed, enhance patient safety and can reduce malpractice rates.

Nonetheless, Tennessee physicians still insist on being judged under their floppy "locality rule" instead of the practice guidelines. They know better and can do better.

Tennessee's dominant malpractice carrier, State Volunteer Mutual Insurance Company [SVMIC], is a doctor-owned mutual company insuring its 10,000 member-physicians. SVMIC has a $730 million surplus. Those reserves equal seven years' worth of verdicts and settlements, using SVMIC's own 2004 statistics as a benchmark.

Another bottom line: If not one dollar in medical malpractice premiums should be collected for the next five years -- none, zero, nada -- SVMIC has sufficient reserve funds on hand to defray all reasonable malpractice verdicts and settlements in Tennessee until 2010.

Each year, SVMIC collects at least $327 million in premiums from its member-insureds. In 2004, they paid off less than 10 final verdicts and some 444 settlements aggregating approximately $109 million, leaving a surplus for that year alone of $212 million, after reductions for costs of defense and administrative overhead. The largest verdict paid in 2004 was $1.6 million, and there were fewer than 10 others paid -- all for less than seven figures.

The economic picture of the Tennessee physician's carrier, SVMIC, is one of health and stability. It enjoys an "A" financial rating from A.M. Best Company, the leading agency concerned with insuror solvency.

Finally, premiums for 2005 for malpractice insurance in Tennessee actually dropped from an 8.5 percent increase in 2004 to a 4.9 percent increase for 2005, a 42 percent decrease in the premium growth rate. Since 1987, SVMIC has refunded $230 million in premiums to its doctor-insureds.

Physician, heal theyself! There is no crisis in Tennessee medical malpractice that a good mirror will not fix.

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