I was disappointed with Bill Broughton’s counter-point article in the January KPBJ. Several months ago I replied to Michael Koch’s statements regarding the liability cost crisis and I had hope that Bill Broughton’s article would shed some new light on the issue from the point of view of the plaintiff’s bar. However, his statements are the same misleading, and in some cases, absolutely false arguments that have been around for years.

He states that insurance companies are not regulated and can raise rates for any or no reason. He should know this is incorrect. All requests for rate increases must be approved by the insurance commissioner. This includes medical malpractice, car, homeowner’s, health, and life. Only what is called surplus lines (about one percent of all insurance) is not rate regulated.

One more time: NO increase in rates is possible without the approval of the insurance commissioner.

Now to bad investments. I cannot speak for other states but investments are also regulated by the insurance commissioner. Physicians Insurance, which insures the vast majority of physicians in Washington, did not lose money in the stock market drop of the last couple of years. Ninety eight percent of investments were in bonds; government, high grade corporate, and mortgage-backed securities. For 2002, unrealized investment loss was less than one percent of their portfolio and this was recovered in 2003. Insurers do not day-trade or speculate in dot-coms. As a member of the state medical association’s board of trustees, I receive a copy of their annual report, as does Brian Wicks. Again: the problem is not the insurance company.

Though there may have been only one jury verdict in Kitsap county in the last seven years, this does not mean that only one case has been brought against a Kitsap physician in that period. Over ninety percent of cases are either dismissed or settled and only a very few go to trial. Insurance rates for Kitsap physicians depend on statewide experience, not Kitsap alone.

Mr. Broughton says that if any of our reform bills pass, we would have carte blanche to act carelessly and avoid responsibility for our actions. Does he really believe that? Our reforms would set a cap on non-economic damages and attorney’s fees.

Perhaps it’s the latter that concerns the plaintiff’s bar.

Injured patients do not give up rights to compensation for injuries. He says that caps have not stopped rising insurance rates. That’s right. But they have risen closer to the rate of inflation where reforms have been passed. In the 27 years (a fairly long track record) since California put a 250K cap on pain and suffering damages, rates have risen 167 percent while the rest of the country has averaged 505 percent, and Washington has seen rate increases between 878 percent and 1,164 percent.

He refers to “the hundreds of thousands of injuries or deaths that occur every year as a result of medical negligence.” I believe he means the Institute of Medicine report of 1999. Here is the actual quote, “At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented, according to estimates from two major studies.”

Even if you accept the higher figure, this is somewhat less than “hundreds of thousands,” and the figures are estimates. All health care personnel consider any error as one too many and every institution continually evaluates their procedures to eliminate errors. Still, health care depends almost entirely on the knowledge and skills of people and people will still be making errors a millennium from now. All we can do is to continue the search for more knowledge and work to reduce errors.

Though I had to address Bill Broughton’s statements, insurance companies and medical errors are not the issue. It is simple Economics 101. If your outgo continues to exceed your income, you eventually go bankrupt. This is already happening in Washington and many other states. I have addressed this in my previous letter. I will be happy to furnish more proof to anyone who wants it.

The plaintiff’s bar and some politicians are trying to shift the debate to insurance companies and to claim that doctors are trying to evade their responsibilities. This is simply not true. They are also trying to band-aid the problem by offering to shift costs and are trying to seduce the hardest hit specialties with premium assistance. If they are successful the day of reckoning may be delayed, but it won’t be avoided.

A medical analogy may help. We humans like to avoid difficult decisions. Will we be like the overweight patient who doesn’t exercise and has high blood pressure, but who refuses to heed his doctor’s advice and change his ways? If he survives his heart attack, a disaster has still occurred. He is out of work, has big bills, a damaged heart, and still has to change his ways if he is going to survive.

Will we wait until Harrison’s emergency room closes, or all babies have to be born elsewhere because the doctors can no longer afford the premiums? The time is now. The hour is late. The runaway train is getting closer.

Richard Ambur, MD
Silverdale