Health care in crisis.

There is a crisis in American medicine brewing up a perfect storm that could capsize our healthcare system as we know it. The culprits are a health insurance system that leaves more than 41 million Americans without coverage; a fatally flawed payment system that threatens the foundation of Medicare; onerous rules and regulations that are forcing physicians to spend more time on paperwork than with patients; unreasonable (and unfunded) government mandates; and the ongoing attempts by some insurers to delay, deny, or “downcode” the legitimate claims physicians submit for the care and healing they provide. The most threatening component of the healthcare storm, however, is a broken medical liability system that defies common sense and reason. This danger is picking up speed like a tornado sweeping through states, leaving patient access problems in its wake. This broken liability system is forcing talented and gifted physicians out of high-risk specialties, leaving some communities without access to critical healthcare services. An American Medical Association (AMA) analysis shows that medical liability has reached crisis proportions in 19 states, with another 35 states on the brink of crisis. What is a crisis? The AMA considers it a crisis when a pregnant woman is in labor and distress and no obstetrician is available, or when a 9-year-old boy has a head injury but there is no neurosurgeon remaining in his region. This is happening to the patients we care for and care about across the country. Last summer, the only maternity ward in South Philadelphia shut its doors because of medical liability costs. Today, not one hospital in South Philadelphia delivers babies, and 7 of 39 maternity wards have closed or are about to close. An exodus of physicians out of Pennsylvania is also taking place, especially among high-risk specialists and new MDs. One of the physicians who fled the Keystone state compared his decision with fleeing a burning building. Pennsylvania physicians are not alone. Other physicians around the country are pulling up stakes, dropping or reducing high-risk services, or even taking early retirement. In South Texas, a pregnant woman arrived in a physician’s office just 10 minutes from delivery. She was trying to drive 80 miles to her doctor in San Antonio because her long-time physician had stopped delivering babies. In Las Vegas, a man seriously injured in an automobile accident died because the city’s only Level I trauma center had to shut down for 10 days in July 2002—the surgeons who worked there couldn’t afford their liability premiums. For those 10 days, Las Vegas was the only city of its size in the country without such a life-saving medical facility. The nearest similar trauma center was 5 hours away. In New York State, 16% of obstetricians have stopped practicing obstetrics because of the state’s medical liability crisis. Forty percent of the state’s counties have fewer than 5 practicing obstetricians. Seven counties in New York State, with as many as 300 births per year, currently have no obstetrician. In Ohio, rising liability insurance costs had an oncologist eyeing retirement, but his patients raised more than $40 000 to pay the premium and keep him in practice. If liability reform legislation is passed, the oncologist said, maybe other patients won’t have to step in to keep their physician’s practice from closing. Twenty-seven of Mississippi’s 80 counties have fewer physicians today than they did in 1990, and 21 of those 27 counties have 10 or fewer physicians. This loss of physicians is devastating to rural and underserved communities, as pediatric specialist Kurt Kooyer, MD, can attest. He left the