Your readers might appreciate a more balanced view of the facts.

The “news” article relies on a report from Public Citizen that ranks physician disciplinary actions by state, and cites the Washington State Medical Quality Assurance Commission (MQAC), this state’s licensing and disciplinary body as taking 35 actions in 2001 out of a total physician population of 16,154.

In fact, MQAC took 45 actions, and the total number of physicians licensed who actually have a Washington address is 14,538. This figure includes physicians who are retired, in training, in research, and have administrative rolls or who for other reasons are not actively practicing. The actual number is 11,888 according to the 2001-2002 edition of Physician Characteristics and Distribution in the U.S. published by the American Medical Association (AMA).

The report does not take into account different laws and procedures in different states. Washington’s MQAC has the ability to enter into Stipulated Informal Dispositions and Stipulated Agreed Orders that are designed to address the nature of the complaint and correct a physician’s practice or behavior under supervision and monitoring of the MQAC rather than just revoking a license. According to the MQAC, there were 53 such actions taken between July 1, 2000 and June 30, 2001, none of which counted in the Public Citizen report. Additionally, the MQAC was monitoring the compliance of 193 physicians with such dispositions during that time.

MQAC is made up of dedicated public members and physicians who are appointed by the Governor and take their responsibility very seriously. To suggest otherwise without evidence is at the least very misleading.

Mr. Felice, quoted in the article, goes on to imply that Washington physicians support legislation that would strip injured patients of their legal rights to hold physicians responsible for their actions by capping damages at $250,000. This is false.

The Washington State Medical Association (WSMA) does support a cap on non-economic damages at $250,000. It has never supported a cap on damages to cover ongoing care or last wages that result from medical negligence. Thus, if a patient requires 24 hour-a-day lifetime care, this amount would be recoverable. It is interesting to note that Mr. Felice didn’t offer an opinion on the concept of limiting attorney fees to something less than the 40 percent plus expenses that is commonly taken out of awards that would otherwise go to the injured patient.
Mr. Felice ignores the increase in huge jury awards in recent years and the fact that the largest liability carrier in Washington – Physicians Insurance – is owned by its physician insureds and governed by a board that has considerable physician representation. As a mutual company it has no reason to set unjustifiably high premiums.

Mr. Felice and Mr. Boyle attach California’s tort reform laws of 1975 as not being successful in reducing liability premiums. They cite an AMA source claiming that California physicians pay 20 percent more for liability insurance than the national average. This is incorrect; the same source indicates that the median premium is the same in California as the national median. As statisticians know, the average can be skewed up or down by a few outliers, but the median is always the midpoint, where 50 percent are above, and 50 percent are below.

They also ignore the fact that California premiums have been more stable than other states. An AMA report at this year’s June meeting noted that premiums in Nevada (with no tort reforms) are 42 to 93 percent higher for the same specialties insured by the same company. They also imply that California as a limit on damages. Again this is misleading since there is no limit on economic damages, only on the pain and suffering portion.

Issues of patient safety and professional liability are often more complex than meets the eye in a short presentation. Combined with rising costs and decreasing payments – not just freezes, or decreases in raises, but actual decreases in previous payment levels – watching the current health care system in Washington is like watching a slow motion train wreck. As a physician with over 40 years experience and over 25 years organized medicine with the WSMA, AMA, KPS and Physicians Insurance, I can attest to the increasing difficulty of recruiting physicians to practice in this state. At the WSMA we are noticing that the age of retirement of physicians has begun to drop dramatically in just the last few years.

Richard Ambur, MD
Silverdale.