Testimony to the Illinois House Judiciary Committee
Kenneth J. Printen, M.D.
President, Illinois State Medical Society
February 23, 2005
Good morning and thank you for allowing me to speak with you today about the worsening medical litigation crisis and its impact on access to medical care for Illinois citizens. My name is Dr. Kenneth Printen. I am a board-certified general surgeon and am here as president of the Illinois State Medical Society, representing over 14,000 physician colleagues and their patients statewide.
Over the past year, I have traveled across the state, talking to physicians, patients, hospital administrators and others, and I can tell you this for sure: health care access is on the decline in our state. Doctors are becoming increasingly frustrated about the decisions they are forced to make to balance their desire to care for patients, and their ability to maintain a viable practice. As a result, doctors have no choice but to leave our state or stop doing the procedures for which they trained. The primary reason for this exodus of physicians: the rising costs of medical litigation, and the resultant increase in liability insurance
premiums.
Illinois citizens are finding it harder and harder to get critical medical care when they need it most. According to a new study by Northern Illinois University, 44 percent of patients living in southern Illinois say they have lost a doctor because he or she left a practice or moved out of state to escape high liability premiums. This independent study also reveals that nearly 70 percent of Illinois residents support capping damage awards in medical liability lawsuits.
In the Metro East area alone, over 165 doctors have left in the last two years to escape the wrath of the excesses of our state’s medical litigation system. Most head trauma patients, orthopedic patients and expectant mothers who relied on the availability of care in Madison and St. Clair counties are now forced -- at an increasing rate -- to travel across the river for treatment.
Between 2002 and 2004, the total number of people transported from Illinois to the Emergency Department at St. Louis University Hospital more than doubled (from 471 to 946). And this is only one of the St. Louis hospitals now taking on more transfer patients from our state. It’s not just trauma and emergency care that’s affected: the total number of hospital inpatients with an Illinois home address treated at SLU increased 12 percent over the last two years (from 3463 to 3920).
Primary care doctors have fled the Metro East area as well, making it increasingly difficult for those with chronic medical conditions to get the care they need.
In Alton, Illinois, the River Bend Physicians and Surgeons, now known as Alton Internal Medicine, once had 12 primary care internists in their group, but lost 6 in the last two years. Alton MultiSpecialists has gone from 22 to 12 physicians of varying specialties in the last year. All because the medical litigation crisis in Illinois has spurred doctors to leave the state.
Often, it’s not just the number of doctors who have left an area that matters, but the effect their loss has on the community. In some areas, when even one doctor leaves, a ripple effect is felt throughout the community. For example, St. Anthony’s Hospital in Effingham lost one general surgeon who performed 80 percent of the vascular surgery cases in the area. Patients in need of vascular surgery now must be transferred elsewhere. Other surgeons have left the Effingham area as well. In 2002, Effingham had seven surgeons; it now has four.
In my travels recently, I met with Mr. Bob Moore, the CEO of Red Bud Hospital in Randolph County. I saw a beautiful, high-tech OB ward sitting empty – closed, because of the drastic escalation of the hospital’s liability premiums, and its inability to find and keep OBs willing to deliver babies in Illinois’ litigation environment. Memorial Hospital in Chester – not far from Red Bud – also closed its obstetric ward last year because local OB/GYNs no longer wanted to accept the risk of practicing obstetrics. This leaves Randolph County with only one hospital providing OB care. That is okay if you live in Sparta, but not so good for other parts of the county.
I do not want to leave you with the impression that our state’s crisis is limited to the rural areas, or Madison and St. Clair Counties.
Local health care systems are crumbling in communities all over Illinois. As physicians leave or eliminate important medical services, local treatment referral networks dissolve and patients must seek care greater distances away. Without an adequate medical support system locally, it becomes an impossible challenge to recruit new physicians to a struggling area. Communities without basic medical services suffer economically as well.
In Cook County, 40 of the 45 emergency rooms in community hospitals once had neurosurgical coverage. Today only 20 ERs have on-site neurosurgical services available —a 50 percent decline. Eleven of those community emergency rooms lost neurosurgical coverage in just the last two years.
At Rush University Hospital in Chicago, the number of transfers coming in from hospitals without neurosurgical ER coverage increased 400 percent. Most of these transfers -- 80 percent -- originated at other Cook County hospitals. Transfer times ranged from 3.5 hours to 9 hours – depriving patients of the immediate care so important to a successful outcome in neurosurgical cases. Many of you may have heard the term ”the golden hour” in reference to the extremely time sensitive need for treatment of neurological and other trauma injuries. Even within the Chicago metro area, this golden hour was severely breached due to the lack of on-site neurosurgical resources. Without change to the state’s hostile litigation climate, we can only expect the lag time to deteriorate further. Of note is the fact that most of the emergency department directors responding to the study cited medical liability concerns as the causal factor in the loss of neurosurgery coverage.
Yet another survey of Illinois neurosurgeons conducted in March 2004, showed that 90 percent of respondents had been sued an average of five times. According to the Journal of Neurosurgery, the average neurosurgeon retires at age 61. At 14 of the 20 community hospitals in Cook County that have neurosurgical ER coverage, the average age of neurosurgeons is 61. We are on the cusp of a catastrophe in the Chicago metropolitan area.
Let’s turn our attention to obstetrical care … in northwest suburban Park Ridge, Lutheran General Hospital has reduced its capability to deliver babies by 39 percent due to the loss of doctors providing OB care.
In fact, a 2004 survey conducted for the OB/GYN Crisis Coalition underlines the severity of the situation statewide. In the past two years, more than one in ten OBs has decided to stop delivering babies entirely as a result of liability concerns. Eighty-nine percent would not recommend that new physicians practice in Illinois. Almost half have reduced services in the past two years, and another 72 percent are likely to do so in the next two years, due to liability concerns. The result: many patients are having difficulty finding a doctor for prenatal care and delivery, and it’s not uncommon for pregnant women in certain areas of Illinois to be forced to find a new obstetrician during their course their pregnancies.
At Chicago’s southwest side, four of the eight vascular surgeons departed Christ Hospital last year due to the hostile litigation environment. Patients must now wait four-to-five months for initial consultations. Recruiting new vascular surgeons to the area has been unsuccessful. “The word is out,” said one of the few remaining vascular specialists trying to recruit colleagues to the medical staff. “Illinois is a hostile environment for doctors.”
Medical students and residents, even those who receive scholarships aimed at keeping doctors in Illinois are not staying.
A recent medical graduate involved in such a grant program wrote in a May 2004 letter to the program manager:
“. . . After much deliberation, I have recently decided to join a practice in Watertown, Wisconsin. My decision for doing this was difficult, yet simple. My reason has to do completely with the malignant atmosphere surrounding medical malpractice in the state of Illinois.
“I explored opportunities in Illinois, and they were comparable to the same in Indiana and Wisconsin. With malpractice [premiums] so outrageous in Illinois, I felt it in my best interest to pursue employment in those physician friendly states.
“I realize the victims are the people of Illinois, but the politicians, judges and trial lawyers are the ones to blame. The people must hold them responsible and seek a solution to this mess. Maybe an action like this will be a motivating factor for change.”
Another medical graduate in the same scholarship program wrote:
“Due to the high malpractice premiums and poor legislative support, I believe it would be a grave mistake to invest my future in the State of Illinois. I can live across the state lines in Indiana and make upwards of 50 percent more of an income simply due to better malpractice rates and friendlier government.
“After growing up in Peoria, I attended the U of I Peoria College of Medicine. My roots are in Peoria and nothing would make me happier than to raise my kids in this area; however, until Illinois legislature improves the medical climate for practicing, I shall move across the border and pay taxes to their government.
“I hope that my reasons for not practicing in Illinois are shared with those governing the state because I am not the only one who feels this way. Many of the young talented residents are considering malpractice premiums before signing contracts or moving to a state.
“I . . . hope to some day move back to Illinois where I can take care of the people who took care of me and the state I love so much.”
The fact is that, according to AMA research and analysis, 48 percent of medical students base future career decisions on liability concerns. This does not bode well for the future of medicine here in Illinois unless our legal environment is reformed.
I could go on and on; examples of how are state’s adverse litigation system affects patients accumulate daily. Unless you, our trusted state legislators, act this session, more of our citizens – your constituents – will be transferred farther and farther distances, putting their lives at greater risk, to access critical trauma care. A greater number of our state’s children will be delivered outside of our borders. Our local health networks will crumble, threatening the very survival of our communities.
The first people to suffer from lack of access to care will be the poor, the elderly and the uninsured. As physicians face the economic realities of our litigation system, they will be forced to make tough choices about how, where and to whom to provide medical services. Already, at least 80 Illinois counties, in whole or in part, are designated as Health Manpower Shortage Areas by the federal government. Our notorious litigation environment in this state will prevent recruiting physicians and all health professionals for these areas.
Let me say a word about patient safety … physicians are rigorously trained to always put the patient first. A great deal of effort has been put into patient safety initiatives, and significant improvements have occurred over the last decade. These efforts will continue because we know that medicine will always strive for perfection. But let’s face it. The practice of medicine entails taking acceptable, well documented risk to improve the lives of patients. However, in Illinois’ litigious environment, it is quite clear that many physicians are no longer willing to accept these risks. Our tort system sends a very strong signal: physicians should no longer use their skills to improve the lives of patients who would benefit from those skills. Medical advances hinge on the ability of doctors to take these measured risks. Illinois’ out-of-balance legal climate is jeopardizing not only the medical care of today, but the medical advances of tomorrow.
I sit here today with Dr. Harold Jensen, chairman of ISMIE Mutual Insurance Company. ISMIE was created in 1976 by the physician members of ISMS, at a time when commercial liability insurers fled the state. ISMIE has been a stable source of insurance for Illinois physicians and patients. Public officials should understand that both ISMS and ISMIE have the same view with respect to the cause of the current crisis and its solution. To suggest there is some sort of conflict of interest between our two organizations is simply wrong. ISMS supports reasonable insurance regulation that has been included in House Bill 705. But we stand strongly opposed to any proposed regulation that will discourage insurers from remaining in or returning to the Illinois marketplace. We are unified with ISMIE Mutual in our goal to achieve meaningful medical litigation reform, and keep medical care accessible for Illinois patients. This is our ONLY interest in this issue.
Please help us continue to provide accessible and affordable medical care for the citizens of this state. Please reform our broken litigation system before it destroys the very heart of our health care system. Support the comprehensive, meaningful reforms included in HB 705.
Thank you.
Twenty North Michigan Avenue, Suite 700 Chicago, Illinois 60602 Telephone: 312-782-1654 Toll Free: 800-782-ISMS Fax: 312-782-2028