Malpractice insurance

[yodaman]

Which specialties have the highest and lowest malpractices rates? (I figure EM would have the lowest because the hospital covers it.) Also, can anyone tell which ones will either increase or decrease within the next 5-10 years? This response may be speculation but any comments will be helpful. Thanks.

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[Winged Scapula]

Which specialties have the highest and lowest malpractices rates? (I figure EM would have the lowest because the hospital covers it.) Also, can anyone tell which ones will either increase or decrease within the next 5-10 years? This response may be speculation but any comments will be helpful. Thanks.

Malpractice can also vary wildly by state in addition to specialty. For example:

A large insurer in Minnesota charged base premium rates of $3,803 for the specialty of internal medicine, $10,142 for general surgery, and $17,431 for OB/GYN in 2002 across the entire state.

In contrast, a large insurer in Florida charged base premium rates in Dade County of $56,153 for internal medicine, $174,268 for general surgery, and $201,376 for OB/GYN, and $34,556, $107,242, and $123,924, respectively, for these same specialties in Palm Beach County.

In addition to the wide range in premium rates charged, the extent to which premiums increase over time also varies by specialty and geographic area.

Beginning in the late 1990s, malpractice premiums began to increase at a rapid rate for most, but not all, physicians in some states. For example, between 1999 and 2002, the Minnesota insurer increased its base premium rates by about 2 percent for each of the three specialties, in contrast to the Florida insurer that increased its base premium rates by about 98, 75, and 43 percent, respectively, for the three specialties in Dade County.

The highest malpractice rates tend to be, across all states, for Ob-Gyn and Neurosugery (especially for NeuroSpine), with lower rates for General Surgery, Anesthesiology, and Radiology. FM also gets sued fairly frequently, usually for delay in diagnosis.

 

[gutonc]

Which specialties have the highest and lowest malpractices rates? (I figure EM would have the lowest because the hospital covers it.) Also, can anyone tell which ones will either increase or decrease within the next 5-10 years? This response may be speculation but any comments will be helpful. Thanks.

Also, who pays for the insurance varies between both specialties and locations. There are plenty of non-hospital employed EM docs who have to cover their own malpractice. Conversely, academic neurosurgeons and OBs will usually have their insurance paid for by the hospital. The type of practice you join, rather than the specialty itself will largely determine who pays for your malpractice (hospital vs. physicians group vs. you).

 

[docB]

I figure EM would have the lowest because the hospital covers it.

You could not be more wrong. #1 we are usually in the highest third of malpractice cost, usually just behind neurosurg and OB. #2 the vast majority of us don't work for hospitals. We have contracts with hospitals and work for ourselves, same as rads and path and in some cases gas, hospitalists, critical care, etc. Therefore we pay our own malpractice.

 

[Dr. Wexler]

I figure EM would have the lowest because the hospital covers it.

It's a zero sum game. Even if "the hospital covers it" that money is coming from somewhere...the doc's compensation. If the hospital is paying more for the doctor's insurance, there is less $ to pay that doc, even though the employee might not see any of this math. Goes for malpractice, health insurance, etc.

 

[plainfacts]

What happens if you practice without insurance and get sued for $500 million? Do you lose all your belongings and declared bankrupt or are you forced to pay 90% of your wage until you've payed the debt?

 

[southerndoc]

What happens if you practice without insurance and get sued for $500 million? Do you lose all your belongings and declared bankrupt or are you forced to pay 90% of your wage until you've payed the debt?

Depends on which state you practice in. Many states have such very low homestead exemption laws that you could very easily lose your house if you get sued for that amount and it doesn't cover. Most insurance policies won't cover more than 1-3 million per incident anyhow. Even if you file for bankruptcy, I believe you will still owe the money awarded to the plaintiff, and they will likely garnish any future wages (at least that's what I remember from the new bankruptcy laws that went into effect a few years ago).

It's a moot point anyway because nearly all hospitals will not let you practice without malpractice insurance, and most states also require malpractice insurance to maintain your license.

 

[michaelrack]

What happens if you practice without insurance and get sued for $500 million? Do you lose all your belongings and declared bankrupt or are you forced to pay 90% of your wage until you've payed the debt?

Certain assets are protected, including retirement accts. I believe that in Florida (where OJ Simpson lived) and Texas your house is protected. If you are married, your spouse will have some rights that will protect some of the assets.

 

[yodaman]

Thanks to everyone's responses and obviously clarifying some assumptions I had.

 

[edmadison]

Even if you file for bankruptcy, I believe you will still owe the money awarded to the plaintiff, and they will likely garnish any future wages (at least that's what I remember from the new bankruptcy laws that went into effect a few years ago).

In a chapter 7 Bankruptcy, virtually all debt, including judgments and garnishments is discharged. There are some notable exceptions to this: student loans, IRS debts, awards from INTENTIONAL torts. In one of the most notable oddities in our legal system, state law determines how much you get to keep after the bankruptcy. Some states, such as Florida and Texas, have very generous homestead exemptions. Theoretically, you could own 200 acres of prime Houston real estate worth hundreds of millions and keep it following a bankruptcy. Other states permit you to keep virtually nothing. I seem to recall that Pennsylvania was pretty bad only permitting at most a few thousand dollars or so.

Chapter 13 Bankruptcy is a restructuring plan where a partial repayment plan is created and you attempt to pay down some of your debt. Under this type of bankruptcy, the debts survive, but you may get to keep more assets. Most individuals would rather declare chapter 7 and make a fresh start than be hobbled by strict repayment plans.

The recent "reforms" to the BR code force more people into Chapter 13. Before theses changes, it was relatively easy to go Chapter 7 and dump your debt and liabilities. Many docs in Florida were "going bare" and going without insurance. I've carefully examined the new BR statute, so I'm not sure what the ramifications would be on going bare. I doubt this has been tested yet in court.

Ed

 

[exPCM]

This is a topic of great importance since the results can be disastrous.

On Friday afternoon, Dr. Lawrence Grey listened in a Hillsborough County courtroom as a jury announced its verdict: He should pay a former patient $1-million.
Late Friday night, Grey's wife found him dead in their $2-million Bayshore Boulevard home, hanging in a bedroom closet from a yellow nylon rope.
Timothy Moran, the Jacksonville lawyer who represented the former patient, learned of Grey's death Wednesday from a Times reporter.
"I never intended for something like that to happen," Moran said. "I blame his insurance company for not doing the right thing."
In August 2002, he operated on Thomas Asimos, a Navy criminal investigator based in Jacksonville. Asimos later hired Moran to sue Grey's practice, contending that Grey left two 3-inch squares of gauze inside Asimos' scrotum. They caused pain and infection and eliminated Asimos' ability to enjoy sex, according to court documents.
Moran said he offered to settle the case for $250,000, the limit of Grey's insurance coverage, and later for $175,000, but was turned down.
If the jury's verdict of $1,005,000 stands, Grey's business will be liable for $755,000.
After finding Grey's body, his wife Muriel told a Tampa police detective that her husband "was despondent over having to pay a $750,000 judgment," according to a case summary from the Hillsborough County Medical Examiner's Office.

http://www.sptimes.com/2006/05/04/Hillsborough/Doctor_kills_self_aft.shtml

The case went to trial in November 2001 in Will County, Ill. Dr. Rutkowski said the plaintiff testified that he could not lift a coffee cup. The defense showed the jury a 38-minute surveillance videotape of the plaintiff lifting and moving two- and four-drawer metal cabinets.

The jury awarded the plaintiff $5.6 million, $2.6 million more than the coverage Dr. Rutkowski and the radiologist had between them. In polling the jury, Dr. Rutkowski's attorney learned that at least one juror thought the videotape was an invasion of the plaintiff's privacy.
Dr. Rutkowski appealed the verdict.
For several months, he said, he received very little information about the status of the lawsuit.
Then, in August 2002, his wife went to the bank and found out that all their corporate and personal assets had been frozen, including $100,000 worth of checks for payment of liability insurance, payroll and general bills. He was forced to turn over to the plaintiff's attorney all leases, 1040s for seven years, bank statements and deposit slips for the same time period, investment statements, housing records and accounts receivable, among other things.

A settlement following the judgment had not been reached, and the plaintiff's lawyer wanted the full amount of the verdict.
Dr Rutkowski said he was left with no choice but to file bankruptcy.
On Sept. 5, 2002, with the help of two new lawyers, he filed corporate bankruptcy, which a government lawyer was appointed to oversee. For six weeks, he was unable to pay his staff. His assets were liquidated and his wife was forced to scrounge together funds to buy his office furniture and equipment to keep the practice running. In November of that year, Dr. Rutkowski began receiving a salary determined by the bankruptcy court.
In October 2002, he filed Chapter 11 personal bankruptcy as well, and he had to hire another lawyer to handle that.

http://forums.obgyn.net/ob-gyn-l/OBGYNL.0602/0726.html

 

[edmadison]

In the first case, the doc was taking advantage of Florida's maltractice rules and essentially going bare with just $250,000 of coverage (Florida requires 250K in insurance or bond). That's crazy. I have more than that for my car. If he lived in a 2 million dollar house and was going bare, he should have had the sense to protect his assets. His death is a tragedy. The second case is a great example of how the jury system doesn't work too well (the verdict was overturned on appeal). It is interesting to me that the combined malpractice coverage for a neurosugeon and radiologist on added up to $3 million. That seems pretty light to me. I'm not an expert on Illinois malpractice and don't know how hard it is to get a $3 or $5 million policy.

Ed

 

[financeguru09]

This is a huge benefit to being an Air Force physician. We do not have to carry malpractice insurance. There are many private practice physicians who actually increase there net income due to not having overhead costs, staff costs, malpractice insurance, etc. The good thing is that you still run your own practice, without having to worry about the uninsured or limits on treatment recommendations.

 

[edmadison]

This is a huge benefit to being an Air Force physician. We do not have to carry malpractice insurance. There are many private practice physicians who actually increase there net income due to not having overhead costs, staff costs, malpractice insurance, etc. The good thing is that you still run your own practice, without having to worry about the uninsured or limits on treatment recommendations.

Uh, where in the military do you get to "run" your own practice? I suggest you start a thread in the Military Medicine Forum on this topic and see what response you get. I would say that this is not a common experience (and certainly not mine in the Army).

As for malpractice, yes you don't need malpractice in the military. You can be reported to the NPDB, however. AD service members are not allowed to sue you at all due to the Feres Doctrine. Dependants can sue the government under the FTCA for any acts of malpractice.

Ed