Testimony to the Ohio Medical Malpractice Commission  

Lois Margaret Nora, MD, JD
President and Dean
Northeastern Ohio Universities College of Medicine

June 28, 2004

Director Ann Womer Benjamin and members of the Ohio Medical Malpractice Commission, thank you for the opportunity to address you today, as well as for the deliberative way this Commission is addressing the complex issue of the Ohio medical malpractice insurance crisis.

This commission is well aware of the challenges that the current medical malpractice insurance crisis presents to Ohio. Today, I will share with you some of the issues that this situation creates for the Northeastern Ohio Universities College of Medicine (NEOUCOM): our students, staff and faculty; our teaching hospital partners; and most importantly, the patients that our college seeks to serve through our missions of education, research, and service. I will present a few actions our college is taking to address this crisis, and I will conclude by offering our assistance as you continue your important work.

The Northeastern Ohio Universities College of Medicine (NEOUCOM)

NEOUCOM is the public medical college for northeastern Ohio. NEOUCOM’s consortium arrangement with three universities (The University of Akron, Kent State University, and Youngstown State University) is unique among this country’s medical schools. As a community-based medical school, NEOUCOM does not have an owned-academic health center but instead partners with the academic medical centers and teaching hospitals in our region (major teaching affiliates include Akron Children’s Hospital, Akron General Medical Center, Aultman Hospital, Barberton Citizen’s Hospital, Forum Health System, Mercy Medical Center, St. Elizabeth Health Center and Summa Health System), to educate medical students, residents and practicing physicians; to improve patient care outcomes; and to contribute to the health of our communities.

NEOUCOM was created by the Ohio General Assembly in 1973 to address a shortage of physicians and limited access to medical education in northeast Ohio. To date, we have been very successful in responding to these issues. More than 50 percent of our alumni physicians remain in Ohio caring for the health of Ohioans. This past year, the majority of our students opted to remain in Ohio for their graduate medical education.

The Impact of the Medical Malpractice Insurance Crisis

Despite NEOUCOM’s outstanding track record, it is clear that continuing success is at risk because of the current professional liability insurance crisis, particularly in the northeast portion of the state. This crisis is affecting our volunteer clinical faculty, our partner teaching hospitals and our practicing alumni. It is impacting the choices our students make about areas of medical or surgical practice they will pursue, where to enter a residency and where they will spend their careers. Most importantly, the crisis is negatively impacting the patients we all serve.

As a community-based medical school, NEOUCOM relies on more than 1,700 physicians and other healthcare providers throughout northeast Ohio to serve as our clinical faculty members. The great majority of these physicians volunteer their time to train future physicians, and in a recent survey of our faculty members they identified a commitment to continue teaching for reasons that include altruism, the enhanced quality of medical care that occurs in a teaching setting, and a professional commitment to grow the next generation of physicians. However, our physician faculty also note that skyrocketing insurance rates, shrinking Medicaid and Medicare reimbursements, and increases in paperwork, are forcing them to question whether or not they have the time to train and mentor future physicians.

Our physician faculty members are also experiencing dramatic changes in their medical and surgical practices because of the insurance crisis. Many feel constrained to limit their practices to areas that pose less risk and are associated with lower insurance premiums. Due to dramatic increases in professional liability insurance premiums, many family physicians and obstetrician-gynecologists are discontinuing obstetrics as part of their practice. Recently, the largest obstetrics group in the city of Akron stopped delivering babies, and there are rural communities in northeast Ohio that no longer have local obstetric services. This is bad for medicine, bad for Ohio’s heath, and certainly is not good for educating medical students. The consequences of the current climate create access-to-care issues for patients, and also pose access-to-education issues for our medical students and resident trainees.

I could cite many cases of Ohio physicians leaving or altering their practices in response to the current insurance climate, but I will mention only one. Dr. Ross Black, a NEOUCOM clinical professor of family medicine, has been practicing in the Akron area for many years. He is beloved by his patients and a highly respected teacher. Unfortunately, about one year ago, Dr. Black stopped offering obstetric care because of increasing insurance premiums. Previously, Dr. Black taught obstetrics to residents; he no longer does this teaching. Our students and residents also recognize from his experience that their ability to care for patients will be more difficult in Ohio than it will be in other states.

The medical malpractice insurance crisis is not only affecting established physicians but also medical students and young physicians considering where to spend their careers. National data state that the liability crisis is impacting medical students’ career decisions. This past year, we saw a dramatic decrease in the number of NEOUCOM students choosing obstetrics-gynecology as a specialty. While this may just be a feature of that particular class, some students said that the current environment played a role in their decision.

Recently, Dr. Jay Williamson, NEOUCOM’s associate dean for clinical affairs, relayed the situation of a young physician about to begin his surgical practice. This young doctor grew up in Tallmadge, Ohio, graduated from The Ohio State University and the Medical College of Ohio, and planned to return to northeast Ohio after completing his residency. However, he has decided to care for patients in Wisconsin in large part because that state has addressed the malpractice insurance issue in a way that makes sense. Physician recruitment and retention is a concern of every healthcare provider, whether they are located in a neighborhood clinic, a community hospital or a major teaching health center.

There is talk about “brain drain” from Ohio and our state’s failure to attract young people from other states. Let there be no misunderstanding—the insurance crisis contributes to this in a substantial way. I mentioned earlier that the majority of our 2004 graduates opted to remain in Ohio for their residency training. In conversation with these young adults, it is clear they love Ohio; they want to spend their medical careers and raise their children in our state. But, they also report that if the malpractice insurance crisis is not addressed by the time they complete their residency training it is likely that they will go elsewhere. Similarly, if Ohio citizens lack confidence in their ability to access health care for themselves and their loved ones, they will leave the state and others will not take their places.

These examples highlight the tremendous challenge posed to NEOUCOM’s mission of educating Ohioans to care for Ohio. Our college was created to alleviate the shortage of physicians in our region of the state, and we have successfully fulfilled this mission. Today, we may lose these physicians to other parts of Ohio and the nation. Ultimately, fewer physicians mean fewer choices for Ohio’s aging population. Not only does this crisis affect those in the healthcare profession, it affects each of us in our ability to access the care we need, where and when we need it.

Northeast Ohio, in particular, is being hardest hit with significant increases in medical malpractice insurance premiums. In January 2004, the Ohio Department of Insurance reported data that show that a general surgeon in northeast Ohio, in communities as diverse as Cleveland, Medina, the Mahoning Valley, and Portage County, insured through Medical Protective—the company with the largest market share in Ohio—will pay, on average, more than $117,000 a year for coverage. That surgeon’s colleague in Cincinnati, insured through the same company, will pay only $53,500—less than half of his or her northeast Ohio counterpart. This situation creates tremendous burdens on our teaching hospital partners and clinical faculty members.

NEOUCOM Is Addressing the Crisis

When I began my remarks I stated I wanted to share with you a few examples of NEOUCOM’s actions to address the medical malpractice insurance crisis. We are not sitting by idly, but instead meeting this challenge head-on. First and foremost, we continue to educate medical students, residents, and practicing physicians with programs that emphasize the NEOUCOM Four Cs: competence, communication, caring and character. Our Center for the Studies of Clinical Performance receives heavy use as we assess medical students’ and residents’ clinical skills and interactions with patients and families. We are dedicated to graduating physicians who are committed to lifelong learning, reduction of medical error and integrating quality improvement activities into their medical and surgical practices.

NEOUCOM is also taking a leadership role in fostering meaningful dialogue on the complex issues of professional liability insurance and tort reform. Earlier this month, Governor Taft signed Senate Bill 187 and House Bill 215. Although there is no single, simple solution to the current crisis, this legislation is a step in the right direction, and I commend this commission and the Department of Insurance for your key roles in moving this legislation forward. One aspect of the new law requires that insurers report costs of defending claims, judgment payouts, settlements and loss adjustment expenses to the Ohio Department of Insurance. By requiring companies to report this data and by allowing access to it, we can begin to get a clear picture of the root causes of the current crisis. NEOUCOM is working toward getting information, formulating a clear picture of the issues and generating thoughtful solutions.

In partnership with The University of Akron School of Law, NEOUCOM has created the Institute for Community-Based Medicine and the Law. This Institute will bring physicians, attorneys and other interested parties together for constructive dialogue on this crisis—a dialogue based on quantifiable data, rather than anecdotal information. The Institute is gathering data related to the number of physicians leaving this state or retiring early due to the crisis, the number of medical malpractice cases filed in our 17-county service area and in other major metropolitan areas such as Toledo and Cincinnati, and data on the number and amount of jury awards. To date, there is little hard data available in one location, and we aim to change that. An informed and constructive discussion is only improved with factual information and can lead to optimal solutions.

This novel Institute, which brings together doctors and lawyers for the betterment of healthcare, has caught the eye of the national media. The Akron Beacon Journal was first to report on the Institute; the story later was picked up by the wire services and ran in major daily papers throughout the country. The media attention the Institute has received underscores the public’s interest in this crisis. The word is getting out that the malpractice insurance crisis is not just a problem for doctors, but it is one for every person in our state.

Another way NEOUCOM is attempting to improve the healthcare environment for current and future practitioners is through our Professional Leadership Development Program. The goals of this ongoing leadership program include educating academic leaders about various contemporary healthcare issues and increasing their ability to impact those issues. We are currently exploring the medical malpractice insurance issue in depth. This exploration, which has included hearing the perspectives of several plaintiffs’ attorneys, has deepened our knowledge of and commitment to solving this complex issue.

NEOUCOM will continue to work with physicians, legislators, attorneys and other interested parties in an effort to alleviate this crisis and to improve healthcare throughout our state and for all of our citizens. I am confident that by working together, we can reach a positive resolution to the medical malpractice insurance crisis. No one wants to see Ohio suffer a lack of quality healthcare.

Director Ann Womer Benjamin and members of the Commission, I thank you again for this opportunity to speak on behalf of NEOUCOM and northeastern Ohio. I invite you to continue to call upon the expertise of NEOUCOM faculty and staff as you continue your important work.

Questions or comments email: kcruff@neoucom.edu
For technical problems related to this site email to: webmaster@neoucom.edu

Office of the President and Dean
Northeastern Ohio Universities
College of Medicine
P.O. Box 95
4209 St. Rt. 44
Rootstown, Ohio 44272-0095

posted June 29, 2004