Malpractice Mess

Cherished institutions may become shaky and old heroes tarnished, but Americans have always kept their faith in--and looked up to--doctors. Now, however, many people are worried that doctors may refuse to treat them except in direst emergencies. The reason: the soaring cost of malpractice insurance, which the nation's 300,000 physicians must carry in order to stay in practice. The result is that doctors, who feel their incomes jeopardized, have become rebellious. Patients, who see their access to treatment threatened, are increasingly anxious. State legislators, who must satisfy both groups, are bewildered.

Last week the malpractice situation took on the look of crisis. In California, almost all anaesthesiologists have been on strike since May 1--except for emergency surgery--and they have shut down operating rooms in virtually every major city in the state. However, some anaesthesiologists pledged to return to work this week while a special session of the state legislature slowly wades through some 30 bills aimed at guaranteeing reasonably priced malpractice coverage.

Lift License. Elsewhere, protests over malpractice problems have intensified. Doctors at St. Vincent Hospital in Toledo, Ohio, were prevented from operating when anaesthesiologists refused to take nonemergency cases. Patients in New York were apprehensive about a possible halt in medical treatment. Doctors in nine of the state's counties objected to a new state law aimed at solving their insurance problems and picketed in New York City to express their distress. Many physicians threatened to withhold all but emergency services beginning this week, despite the threats by at least one legislator of action to lift the licenses of those who did so.

The causes of the crisis are complex. Malpractice suits, once rare, have become increasingly common. That is because patients, better informed than ever before and expecting flawless care for what many consider exorbitant medical bills, have taken to the courts to protest--and make doctors pay for --botched results. In New York, for example, the number of malpractice suits doubled between 1970 and 1974. Round the nation, awards by judges and juries have also increased. Settlements of $1 million or more are no longer unusual.

Insurance companies have responded by jacking up premium costs, which are passed along to patients in the form of higher doctor bills and hospital charges. By January the Argonaut Insurance Co., one of the nation's largest malpractice insurers, put doctors in a fighting mood by drastically raising rates. For example, the average annual premiums for high-risk specialists in California soared from $5,377 to $22,704. But the worst was still to come. This spring Argonaut and other companies sought yet another round of increases in some states and announced plans to dump malpractice coverage entirely in others.

State Pool. The states are slowly moving to provide help. Indiana, whose Governor Otis Bowen is himself a physician, created a state insurance fund, established a panel to screen malpractice claims and weed out nuisance suits, and set a ceiling on malpractice awards. Legislatures in Idaho and Maryland have enacted similar measures. New York lawmakers, seeking to avoid a doctors' strike, acted to assure malpractice coverage by passing legislation to create a pool made up of companies now writing insurance in New York and enabling the state medical society to form its own insurance fund as an alternative. Unhappy because the state's system will hold increases to 10% to 15% for the first year only, doctors in the most heavily populated counties repeated their threat to treat none but emergency patients.

Such a strike could cost the medical men heavily in public support, since the New York plan is a good one. It will not, to be sure, turn back the clock and reduce the costs of malpractice insurance, but it could help prevent malpractice. The law will make it easier for doctors to discipline colleagues against whom charges of malpractice are proved. This will not only help responsible physicians but will also protect the patients against the real problem of bungled medicine.

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