Fed-up obstetricians look for a way out

By Rita Rubin, USA TODAY

Twice last month, Las Vegas obstetrician/gynecologist Shelby Wilbourn saw patients who'd made an appointment under a false pretense.

They said they were having irregular menstrual periods. But when they met Wilbourn face-to-face, they fessed up. The reason they hadn't had a period in a couple of months was because they were pregnant, not because their cycle was out of whack.

"I had to close the chart and say, 'Ma'am, I can't help you, because I'm not doing OB anymore,' " Wilbourn says. "They just started sobbing in the office."

Such are the lengths that pregnant Las Vegas women are going to, say Wilbourn and his colleagues. Fed up with soaring malpractice-insurance premiums, a growing number of OB-GYNs in that city have stopped caring for pregnant women or are leaving town. The American College of Obstetricians and Gynecologists has named Nevada one of nine "hot states" where rising liability-insurance premiums threaten the availability of doctors to deliver babies. Seven states might soon join them, ACOG warns.

But how is this affecting patients? Even though they might not have trouble finding a new doctor, pregnant women who find they're no longer welcome in their OB-GYN's practice say they dread having to start a new medical relationship.

Their doctors and their doctors' insurers say tort reform, including such measures as caps on pain and suffering damages, is the only way to solve a medical liability insurance crisis. But trial lawyers and at least one consumer group question whether an OB shortage really is imminent and argue that tort reform won't get to the root cause of rising malpractice-insurance premiums. They call for better policing of the medical profession and the insurance industry.

One thing everyone agrees upon is that obstetrics/gynecology is always one of the hardest-hit specialties during times of rising premiums. According to ACOG, OB-GYNs on average can expect to be sued two or three times over their career.

"There are neurologically impaired babies born that have nothing to do with what the physician did in the prenatal state or the delivery," says Carol Golin, editor of a newsletter that has been tracking the malpractice issue for years. Faced with enormous costs in caring for such a child, parents "have no option but to go and sue, even if they like their physician," she says.

'Litigious environment'

In part because of the lengthy statute of limitations in such cases, OB-GYNs had more claims against them and paid out more money to plaintiffs than any other specialists between 1985 and 2000, says the Physician Insurers Association of America, a trade group of doctor-owned malpractice insurance companies.

C. Dale Eubank practices in Texas, one of ACOG's "hot states."

"I have been named in suits, and none of them ever went anywhere," says Eubank, who has delivered 3,000 babies since 1983.

Disgusted with what he calls the "litigious environment" in Corpus Christi, Eubank this year decided to stop delivering babies.

He says he's heard of local OB-GYNs whose malpractice insurance premiums are climbing toward the six-figure mark. "Now that I've decided to do just gynecology, my premium has dropped to $12,000," Eubank says.

Eubank cared for Shannon Gulley when she was pregnant with her first child, who will be 2 in August. Gulley says she knew he was considering getting out of obstetrics, and at her last annual checkup she asked, "But you're still going to deliver my baby, right?"

Gulley recalls that Eubank's answer was kind of vague. Now nearly three months pregnant, Gulley is skeptical about whether the doctor to whom Eubank has referred her could live up to his predecessor. "His bedside manner is wonderful," she says of Eubank. "It's very comfortable, especially when you're having a child."

In Washington, another ACOG "hot state," Jen Fleming of Friday Harbor says she keeps hoping she can persuade Robert and Barbara Pringle, a husband-wife OB-GYN team, to care for her during her next pregnancy. In January 1999, Fleming delivered a stillborn daughter. A few months later, she became pregnant with her son, who is now 2. "Now they'll have to refer me to someone else" when she gets pregnant, Fleming says. "It's a shame, because they're the ones who got us through our second pregnancy."

The Pringles, who practice in Mount Vernon, Wash., stopped taking new OB patients a few weeks ago. "Our insurance company won't announce the rates for 2003 until October," says Robert Pringle. "Our suspicion is the rates are going to rise dramatically."

Wilbourn, who has 8,000 patients in his 12-year-old Las Vegas practice, says he's never been sued, but his rates have been going up along with the worst of OB-GYNs. If Wilbourn continued to deliver 200 babies a year, his malpractice insurance premium was scheduled to jump from $56,000 to $108,000 next year.

Meanwhile, Wilbourn says, reimbursement in Nevada for providing prenatal care and delivering babies hasn't budged from $1,200 a patient in 20 years. "I'd have to borrow money to pay the malpractice," he says. Instead, he stopped taking new pregnant patients May 1.

Leaving Las Vegas

But Wilbourn likes delivering babies, and he likes Las Vegas less and less. So he logged on to a headhunter's Web site to check out options elsewhere. Last month, Wilbourn announced to tearful patients and office staff that he had accepted an offer in Belfast, a small town on the coast of Maine.

Right up front, he had asked the hospital administrator trying to woo him to Maine about his first-year malpractice insurance premiums. "Ninety-eight," the man replied. Coming from Las Vegas, Wilbourn figured $98,000. The man clarified that he meant $9,800. "Obviously, that piqued my interest," Wilbourn says.

Still, he says, the decision to close his practice July 31 was not easy. "I've got a lot of pregnant women I'm not going to be here for," he says. "I'm going to be turning them loose halfway through a pregnancy, and I can't find them a doctor."

One of them is Deanna Rood, who is due in October. Wilbourn cared for Rood when she was pregnant with her firstborn, a son who will turn 2 in August. "I'm in a scary position right now," Rood says. "I'm six months pregnant, and I don't have a doctor."

John Nowins, president of the Clark County (Las Vegas) OB-GYN Society, says that 80% of his members are phasing out obstetrics because of the jump in malpractice insurance premiums. And, he says, no one wants to move to Las Vegas to replace them. (According to the Nevada State Board of Medical Examiners, though, 23 OB-GYNs have opened practices in Clark County since Jan. 1, 2000, it's not known how many of them actually deliver babies.)

Nowins, a Chicago native, says he's considering moving to Indiana. "At least they have good tort reform," he says.

State action urged

Reno attorney Bill Bradley, past president of the Nevada Trial Lawyers Association, blames the "very vile nature of the insurance industry," not a lack of tort reform, for the rise in malpractice premiums in his state. Instead of settling a claim, insurers often prefer to go to court, where even bigger judgments are levied against their clients, he says. The insurers turn around and use these judgments to support higher rates, he says.

Bill Montei, CEO of PIC Wisconsin, a physician-owned liability insurance underwriter in Madison that entered the Nevada market a few years ago, says the industry looked so profitable in the mid-1990s that it attracted inexperienced companies. To compete, Montei says, insurers offered Nevada doctors unrealistically low rates. "What you've seen in the last 18 months is insurance companies trying to recover from that," he says.

Joanne Doroshow, executive director of the Center for Justice & Democracy in New York, a non-profit group that opposes tort reform, says states need to aggressively question insurers' rates.

"If you're just going to look at tort laws, we're going to be in the exact situation we were 15 years ago during the last crisis," says Doroshow, who says her group has no ties to trial lawyers.

She questions ACOG's tort reform campaign. "Women are being exploited here, basically threatened with inaccessible health care unless they give up their rights to sue doctors who commit malpractice on them," Doroshow says.

Yet, she says, she empathizes with the many doctors like Wilbourn who've never been sued or had a successful claim against them but are facing six-figure malpractice premiums. Because insurers charge all members of a specialty the same rates, Doroshow says, "the good doctors are paying for the bad doctors."