Practicing Without a Net

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1 «Back to Article View Databases selected: ProQuest Newspapers, ABI/INFORM Global Practicing Without a Net Susan Warner. New York Times. (Late Edition (East Coast)).New York, N.Y.: Jun 2, pg. 14NJ.1 Subjects: Medical malpractice, Insurance coverage, Business failures, Physicians Companies: MIIX Group Inc (NAICS: ) Author(s): Article types: Section: Publication title: Source Type: Susan Warner News 14NJ New York Times. (Late Edition (East Coast)). New York, N.Y.: Jun 2, pg. 14NJ.1 Newspaper ISSN/ISBN: ProQuest document ID: Text Word Count 3177 Article URL: Abstract (Article Summary) In New Jersey, doctors and patients are not the only ones having to contend with MIIX's collapse. Shareholders who have seen the value of the stock slump from $13 earlier this year to $1.50 last week, an all-time low, are irate. But it was in February that the value of the shares dropped precipitously as MIIX's solvency was questioned by the state as well as by private rating companies. For MIIX, it was too late. The company agreed to wind down its business over the next six or seven years under the supervision of the state Department of Banking and Insurance. Now, MIIX plans to set up a new company based on the old privately held, doctor-financed model. As for the new company, shareholders asked Ms. [Patricia Costante] in a recent conference call whether it should be run by former MIIX management. Some doctors said they were concerned about the role that members of the Medical Society played on the MIIX board. Full Text (3177 words) Copyright New York Times Company Jun 2, 2002 DOCTOR, heal thyself. Again. With the failure of the state's largest medical liability insurer, doctors in New Jersey -- already facing staggering rate increases from 10 percent to more than 50 percent -- must rescue their troubled malpractice insurance market once more if they ever want to pick up another scalpel. Physicians are being asked to help finance several insurance schemes to restore competition and stability to the market in which about half the state's 24,000 doctors have lost coverage in the past year. In the hardest-hit specialties -- neurosurgery, orthopedic surgery and obstetrics -- more and more doctors are planning to move to another state or simply retire early rather than pay rates that in some instances have reached $100,000 a year. And many obstetricians are going so far as to drop obstetrics from their practice to focus solely on gynecology.

2 In truth, not many patients will shed a tear just because doctors are being forced to dig deeper into the pockets of their well-turned trousers -- in some instances, up to their elbows -- to pay for insurance. Starving doctors are hard to find. Yet while the doctors will be the ones to feel the pain first, it is the patients who will do the real suffering, perhaps in the form of higher fees, and in declining health care as more doctors hang up their surgical gowns. ''Patients are not going to be able to go to the doctor of their choice,'' said Dr. Robert Rigolosi, who in May took over as president of the state medical society. ''The doctor is not going to be practicing. Lots of the older ones are very popular with their patients, but their hands are tied. They just can't afford to stay in practice.'' In May, the MIIX Group, which insures 9,000 doctors -- or 37 percent of all the physicians in New Jersey -- announced it would shut down operations after losing $200 million in little more than a year. Founded in 1977 during an earlier malpractice crisis, MIIX was founded with the help of doctors who had stepped up to contribute the initial capital for the insurer, known then as the Medical Inter-Insurance Exchange, with loans that were later paid off. For now, the company has set aside $1.2 billion in assets to satisfy any claims arising from current or old policies. While MIIX's case may be unusual, Larry Smarr, president of the Physician Insurers Association of America, said that many of the underlying issues were affecting medical malpractice insurance all over the country. Mr. Smarr said the size of claims paid out had been increasing for a decade, noting that according to the association's database of 180,000 claims, the average payout increased 6.8 percent a year in the 1990's. Of those, he said, doctors would be likely to prevail in 70 percent of the claims, including those that were settled. ''It's a lottery system for the lawyers,'' said Mr. Smarr. ''They don't win often, but when they do, they win big,'' sharing damage awards with their clients. The cost to defend a case averages $22,967, but that goes up to $85,718 when there is a trial, encouraging many insurers to settle for economic reasons. Yet Dr. Fred Silverberg, an obstetrician-gynecologist in Chatham, said that doctors were somewhat to blame for rising claims payouts because they often asked their insurer to settle rather than risk a huge judgment. ''Once you settle a claim, you almost become uninsurable the following years,'' he said. ''It's a Catch-22. You either gamble and try to win the case and possibly lose everything, or you settle and you have unaffordable premiums in the coming years.'' Malpractice Coverage Required Like death and taxes, malpractice coverage is one more certainty for doctors. According to state law, all doctors licensed to practice medicine in the state must either be covered by a malpractice policy or have at least a $500,000 line of credit. In New Jersey, doctors and patients are not the only ones having to contend with MIIX's collapse. Shareholders who have seen the value of the stock slump from $13 earlier this year to $1.50 last week, an all-time low, are irate. But it was in February that the value of the shares dropped precipitously as MIIX's solvency was questioned by the state as well as by private rating companies. The largest group of shareholders are doctors, who control 45 percent of MIIX stock, said Patricia Costante, the company's chief executive, many of whom received their shares when the company when public in The Medical Society of New Jersey owns an additional 6 percent, and the rest is controlled by outside investors and institutions. The company, which has close ties to the medical society, performed well enough through much of the 1980's and early 90's. But by the end of the decade it was in trouble after it embarked on a rapid national expansion and went public at the height of the stock market boom. At the same time, several strong competitors began grazing on MIIX's home turf -- though Mr. Smarr described MIIX's moves as the most ''extreme'' -- driving down prices when they all grabbed for a share of the lucrative market

3 as judgments in liability cases began to rise. When the stock market soured, several of the newer companies pulled out, allowing MIIX and the others left standing to raise rates -- nearly twice as much in some cases. But for MIIX, it was too late. The company agreed to wind down its business over the next six or seven years under the supervision of the state Department of Banking and Insurance. Now, MIIX plans to set up a new company based on the old privately held, doctor-financed model. ''We believe the formation of a new company supports the interests of New Jersey physicians by maintaining market stability,'' said Ms. Costante. To make it work, the new company needs to raise $30 million in loans from doctors and commercial banks if it is to meet its goal of getting up and running by Aug. 1. But many doctors are dubious, given the demise of the original company. '' 'Good luck' is all I can say,'' said Dr. Silverberg, who is leading a drive to self-insure the state's obstetricians, a specialty that has been particularly hard hit by the rate increases because of the liability risk in delivering babies. ''I think a lot of the doctors put a lot of money into MIIX, and because of what has happened just in the last three years, I don't think they're going to do that again.'' Others -- acknowledging their lack of a very good second choice -- say they will go along. For instance, Dr. Bernard Saccaro, a Rochelle Park rheumatologist who is chairman of the medical society's liability crisis task force, said he and his partners had already decided to lend money to the new company. After all, Dr. Saccaro reasoned, it was one way to guarantee coverage. ''We were happy with them for many years,'' he said. ''It was a really nice company to work with.'' Rather than point to MIIX's ill-timed expansion, Dr. Saccaro said the company should be judged more on its previous 20-year record. ''They really got their heads handed to them,'' he said. ''But we have assurances that will not happen again.'' Costs Can't Be Passed Along His optimism is not entirely misplaced. After all, doctors say the situation is not as dire as it was in 1977, when a similar sharp increase in claims and malpractice awards drove private insurers out of the market, pushing up rates and leaving many of them without coverage. However, these days doctors they are not as able to pass along the rising cost of insurance. ''The difference is that because of the H.M.O.'s and cuts in Medicare, we cannot pass the increases along to consumers,'' said Dr. Saccaro. For many doctors, if passing along the added costs is not an option, relocating to another state may well be. Dr. George Ajjan, president of the Womens' Healthcare Group, in Teaneck, who is director of obstetrics and gynecology at Holy Name Hospital, said premiums for his practice would more than double next month, to $440,000 from $200,000. So far, Dr. Ajjan said, he had let six office workers go this spring. Still, he said he did not expect sympathy from the public. ''People don't care about doctors or their salaries,'' he said. ''The issue is, we can't stay open. It's going to restrict

4 access to care. It's going to change the way OB is delivered to the population, and they're not going to like it.'' Indeed, in Tenafly, Dr. Vladimir Klinsky's six-person obstetrics and gynecology practice broke up earlier this year because of soaring insurance rates. Dr. Klinsky said he had several claims against him and had so far been unable to get new insurance -- at any price -- to replace his current insurer, Zurich Insurance, which plans to pull out of New Jersey later this year. To keep a lid on costs -- particularly in the field of obstetrics and gynecology -- Dr. Klinsky said that many practices would insure only one doctor for obstetrics, and that person would handle all the deliveries while the others in the practice would monitor the pregnancy. Making Up for Fewer Doctors ''People will be working harder and probably making more mistakes,'' said Dr. Klinsky, who now delivers about 100 babies a year. ''The patients will not be able to choose. They will see one doctor, then be delivered by someone they don't know.'' In other instances, he said, practices might begin to rely more on midwives, though a midwife still needs to be backed up by an insured doctor. ''Two of my claims are from backing up midwives,'' Dr. Klinsky said. ''I won both of the cases, but that doesn't matter. I can't get any insurer to talk to me.'' Whether the new MIIX will be able to fill the void is now up to potential lenders and state regulators, who will have to approve the company's business plan. Of its initial $30 million investment, the new company expects to write premiums for 2,400 doctors. It will pay a fee to the managers of the old MIIX to run the new company as well as other fees to the new one -- MIIX Advantage -- for use of the company name. In addition, it hopes to gain renewal rights to MIIX's customers when their current insurance lapses. Doctors will be asked to make loans based on the risk associated with their specialty, ranging from $5,000 up to $25,000 for obstetricians and neurosurgeons. The loan requirement is the same for all doctors within a specialty regardless of past claims against them. Based on market research, said Ms. Costante, MIIX's chief executive, 40 percent of the state's doctors would join MIIX Advantage. ''It's a very difficult market right now for New Jersey physicians,'' she said. ''It's a market where not many companies are eager to write a lot of premiums.'' Before anything happens, however, the plan must be approved by the state Department of Banking and Insurance. And even if approved, the plan will cover only about half of the doctors who had been insured by the old MIIX by virtue of its smaller size, leaving another 4,500 without coverage, said Elizabeth Ryan, general counsel to the 106- member New Jersey Hospital Association. ''Obviously there has been an abundance of concern expressed by providers about availability and affordability,'' said Peter Hartt, a spokesman for the state Department of Banking Insurance. ''As a general proposition, we certainly think that the more healthy players there are in the market, the more those concerns are addressed.'' Mr. Hartt said there currently were 15 companies authorized to write medical liability insurance in the state, including a unit of Berkshire Hathaway, the holding company of Warren Buffett, which came into the market in May. The second-largest medical malpractice insurer in New Jersey, with 36 percent of the market, is the Princeton Insurance Company, which has stepped up its business. Several other companies are also pushing in, and in some cases, doctors are considering self-insurance plans.

5 But there are other dangers lurking. Joseph Roethel, an assistant vice president at A. M. Best, a company that rates insurance companies, warned that established firms could cherry-pick doctors with the least risk, leaving a newly created MIIX with a greater share of high-risk doctors, further complicating its ability to manage successfully. But Ms. Costante said MIIX officials did a review of renewals last fall, leading them to believe that doctors from across the claims spectrum would agree to underwrite the new company, not just those with no other options. Still, Ms. Ryan disagrees. ''MIIX's plan is ambitious, and it will still leave a lot of doctors uninsured,' she said. ''We will have whole groups of doctors unable to practice in the state of New Jersey.'' That is hardly surprising. According to a recent survey by the association, Ms. Ryan said, hospital malpractice insurance, which covers hospital staff, increased 152 percent from 1999 to 2002, for an average of $942,000 a year. As for the new company, shareholders asked Ms. Costante in a recent conference call whether it should be run by former MIIX management. Some doctors said they were concerned about the role that members of the Medical Society played on the MIIX board. ''They're part and parcel of the same thing,'' said Dr. Klinsky of Tenafly. 'It's really pathetic.'' Dr. Silverberg of Chatham, who signed with MIIX as his first medical liability insurer in 1986, echoed that sentiment. ''I felt that any company endorsed by the medical society was a company I wanted to be with,'' he said. ''I've almost felt betrayed when the company was sold to the public because even though there were still doctors on the board, its mission changed.'' But Dr. Rigolosi, the new president of the medical society, defended having society members on the MIIX board, saying they had their hands tied by securities regulations. ''I don't think they could have said to us things that were happening,'' he said. ''More importantly, MIIX had served us well. Up until December or January nobody was complaining. The problem lies with the system all the malpractice insurers were having problems. It wasn't limited only to New Jersey.'' Indeed, about 60 percent of all medical liability insurance in the United States is written by doctor-controlled companies, said Mr. Smarr, of insurers association. Nonetheless, at the medical society's annual meeting last month, a resolution was passed forbidding members of the MIIX board from being trustees of the Medical Society of New Jersey. For now, while much time and energy is going into the formation of a new company, finger-pointing for the demise of the old one is still the focus of many who are trying to sort out what happened to avoid a similar fate in the future. Mr. Roethel said MIIX's problems began with the timing of its rapid expansion into other states. Led by the company's former chief executive, Daniel Goldberg, MIIX entered Pennsylvania in 1991 and Delaware in 1996, eventually writing policies in 25 states. Mr. Goldberg then took the company public in 1999, though he was dismissed in November of that year after the police found marijuana plants growing in the attic of his house in Bucks County, Pa. He subsequently pleaded guilty to the drug charges. Since then, two other chief executive officers resigned, including one who served for a little more than a month last fall, before he was replaced by Ms. Costante. ''In 1999, the new management team quickly recognized there was a problem and began to look carefully at reunderwriting and re-pricing,'' Ms. Costante said. ''We believed going into 2002 that we had successfully completed that initiative. But at the same time we were starting to feel good about the business. We began to see a tremendous amount of claims activity from 1996, 1997 and 1998.''

6 Rather than patch up one bad situation after another, Mr. Smarr said that federal and state legislators needed to address the root causes of the recurring malpractice insurance cycle. Measure Is Aimed at Easing Crisis In April, a bipartisan group introduced federal legislation in the House aimed at easing the current crisis modeled largely on a measure that took effect in California 26 years ago. The proposed legislation includes standard statutes of limitation, limits on lawyers' contingency fees, limits on punitive damages, periodic payments for future medical expenses, and a $250,000 cap on noneconomic damages in states that do not already have one. Currently, 21 states have a cap on noneconomic damages for pain and suffering in medical liability cases. While New York, Pennsylvania and Connecticut do not have caps, New Jersey does. But Bruce Wilson, the director of government relations for the Physician Insurers Association of America, said it was rarely used. As for the Medical Society of New Jersey, Dr. Rigolosi said his group had come up with a set of legislative priorities, including a cap on noneconomic damages, pretrial panels to screen frivolous suits, limits on the time in which a suit can be brought and a proposal -- already before the State Senate -- that would require expert witnesses in a medical injury trial to live in New Jersey and practice in the same field as the doctor being sued. ''A lot of the expert witnesses are doctors from out of state, Texas in particular, who are solely out for the money as professional expert witnesses,'' said Dr. Rigolosi. ''If a doctor is a member of the community, I think it would important to their reputation.'' While the legislation makes it way through the system and doctors scramble to cover their assets, others make their way as best they can. Dr. Osmundo Saguil of Cherry Hill decided to stop delivering babies after his insurance premium increased to $83,000 from $33,000. ''It's a sad time for me,'' said the 66-year-old doctor. ''I wasn't planning to give up OB. I thought it would be another two years. I still like what I'm doing, but not with this premium.'' He put it like this: ''I've delivered babies of babies that I delivered. I'm at that level now. I'm going to miss those. But I'm done. I'm closing shop.'' [Photograph] ''You either gamble and try to win the case and possibly lose everything,'' says Dr. Fred Silverberg, second from right, ''or you settle and you have unaffordable premiums.'' (Nancy Wegard for The New York Times); Dr. Osmundo Saguil's premium for malpractice insurance rose almost $50,000. (pg. 1); Robert S. Rigolosi, seen at Holy Name Hospital in Teaneck, is president of the state medical society, which has called for legislation limiting awards in medical malpractice suits. (Dith Pran/The New York Times); George M. Aijan, an obstetrician in Teaneck, says his premiums will soon double. (Ozier Muhammad/The New York Times); Dr. Fred Silverberg, at Morristown Memorial Hospital, says doctors often settle claims. (Nancy Wegand for The New York Times)(pg. 13) Copyright 2003 ProQuest Information and Learning Company. All rights reserved. Terms and Conditions Text-only interface

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