Your loved one is seriously injured in a car wreck and needs immediate surgery to relieve swelling to the brain. If this isn't frightening enough, you find out there's only one practicing neurosurgeon left in your town and he's working in a hospital that is a two-hour drive away.

Whopping medical malpractice premiums are forcing many doctors to stop practicing high-risk specialties, such as brain surgery, orthopedic surgery, and delivering babies.

"This is a scary thing," says Kim Ross, vice president of the Texas Medical Association. "What if a patient has a car wreck, needs a neurosurgeon, and there's none available? It's an hour to Houston. That 'golden hour' [when treatment is most beneficial] is lost."

Crisis across the nation

The crisis is not any better in Pennsylvania, where 72 percent of the doctors polled by the Pennsylvania Medical Society say they have deferred purchasing new equipment or hiring new staff due to sudden, steep increases in their medical malpractice insurance premiums. In Connecticut, New Jersey, and New York, medical malpractice premiums in 2002 jumped between 10 and 40 percent. In Florida, obstetricians in south Broward County stopped delivering babies at the Memorial Healthcare System because they can't afford their insurance premiums and the hospitals in the system won't allow them to go "bare" (uninsured).

In 2001, eight states saw two or more liability insurers raise rates by at least 30 percent, according to the American Medical Association, and doctors in more than a dozen states saw one or more insurers charge at least 25 percent more for medical malpractice insurance.

Doctors blame the hefty sums awarded in malpractice lawsuits for driving their medical liability premiums through the roof. From 1996 to 1999, jury awards for medical malpractice claims jumped 76 percent, according to Jury Verdict Research. As a result, many doctors and patient advocates in states that don't have laws to limit the dollar amount of jury awards fear increasingly large verdicts threaten to collapse the health care system by driving up medical malpractice insurance premiums.

To fend off litigation and cope with steep insurance premiums, doctors say they are being forced to take defensive measures, such as:

• Practicing defensive medicine by ordering additional, sometimes unnecessary medical tests that insurers might be reluctant to pay for, but that doctors want to protect themselves from lawsuits. According to the Quarterly Journal of Economics, "defensive medicine" costs the nation $50 billion per year.
• Deferring the hiring of new staff, or even downsizing staff, sparking patient backlogs and making it difficult for patients to get timely appointments.
• Ceasing to practice certain high-risk specialties, such as obstetricians/gynecologists who stop delivering babies because the threat of patient litigation is so high. Former-Pennsylvania Medical Society President Dr. Howard Richter points to one obstetrics/gynecology group in his state where insurance premiums nearly tripled in 2001 to $1 million. When two of their seven physicians stopped delivering babies, their rates were cut in half.
• Moving their practices to regions with lower medical malpractice insurance costs, or stopping the practice of medicine altogether. In addition, regions with high liability costs might have difficulty attracting new doctors, creating a lack of consumer choice of physicians.

Situation critical in Pennsylvania

Although exorbitant malpractice insurance premiums are wreaking havoc in states throughout the country, Pennsylvania has been particularly hard hit. In 2000, Pennsylvania's doctors and other health care practitioners paid $372 million in total lawsuit judgments, according to research conducted by the state's medical society. That figure ranks second only to New York's approximately $633 million in aggregate medical malpractice lawsuit judgments in 2000.

As a result of Pennsylvania's liability crisis, patients are suffering, according to the Pennsylvania Medical Society. A poll of the society's member doctors indicates more than 90 percent of them are practicing defensive medicine to avoid lawsuits.

There seems to be no limit to the skyrocketing jury awards, says Pennsylvania Medical CAT Fund Director John Reed. "There used to be a gentleman's agreement that lawyers wouldn't go after an award larger than a physician's liability coverage," he says. "Now the gloves are off."

Trial lawyers argue frivolous lawsuits and large jury awards are not to blame for Pennsylvania's — or any other state's — health care crisis. The Pennsylvania Trial Lawyers Association claims medical malpractice is a serious problem, and the number of lawsuits simply reflects that.

Pennsylvania Governor Edward Rendell is taking action. Rendell has created the Medical Malpractice Liability Insurance Crisis Task Force. The task force, formed through a partnership between Rendell and Pew Charitable Trusts, will investigate short and long-term solutions to the medical malpractice crisis in Pennsylvania.

The task force will examine the tort reform system. Rendell thinks caps on non-economic damages are not the solution. Rendell cited California's caps system, and claims premiums there went up 40 percent in 2002.

Rendell also spoke with insurers that stopped doing business in Pennsylvania. The governor says when he asked the insurers whether caps would bring them back to Pennsylvania, he was told they would not.

Rendell says the insurance industry's investment practices need to be examined. He says there should be proper oversight of insurers' investments. Another solution proposed by Rendell is to investigate how doctors and hospitals police themselves.

Pennsylvania has a medical malpractice insurance law, which includes:

• Allowing malpractice awards for the future medical costs of the plaintiff to be spread out over time.
• Requiring malpractice claims to be filed within seven years from the date of injury.
• Allowing doctors and hospitals to have jury awards lowered by a judge if it would force a doctor out of business or a hospital to cut services, thereby damaging patient care in the community.
• Requiring hospitals to report medical errors to a patient Safety Authority and the Pennsylvania Department of Health.