Congressional watchdog agency finds claims of malpractice insurance "crisis" not substantiated

Congressional watchdog agency finds claims of malpractice insurance "crisis" not substantiated
October 2003

Congress and State Legislatures Should Heed GAO Report, Not AMA Rhetoric; Report Shows AMA Doctored Tales of Physicians Quitting Due to Malpractice Costs

WASHINGTON, D.C.-A General Accounting Office (GAO) study showing that medical groups manufactured a crisis to push their agenda of changing the medical malpractice insurance system is further proof that Congress and state legislatures should abandon efforts to take away patients' legal rights, Public Citizen said stated Sept. 4. Public citizen is a consumer watchdog group.

The GAO study, which was released on the Friday before Labor Day, found that the American Medical Association (AMA) and other medical provider groups manufactured a "crisis" of access to care - a crisis they claimed was caused by malpractice lawsuits.

Eighteen of the GAO report's 41 pages are devoted to debunking claims that doctors in AMA-designated "crisis states" were no longer providing medical care to patients. Most damaging to the AMA's argument was the GAO's finding that the volume of medical care delivered to patients in five states had increased during the period during which the AMA suggested it was decreasing.

Congressional lawmakers earlier this year considered a measure to cap non-economic damages provided to victims of medical malpractice at $250,000. Proponents of the measure cited the AMA's information. Public Citizen offered data showing no crisis existed and explained how the insurance industry was pushing damage caps because it suffered losses as a result of the economic cycle. Now, however, lawmakers are talking about reconsidering the cap this fall.

"The GAO report confirmed what Public Citizen has found in its numerous state studies - that liability laws have a positive effect on doctors' behavior, not the negative effects so often alleged," said Joan Claybrook, Public Citizen president. "The GAO study also shows that Bush administration lies are not limited to foreign policy."

Added Frank Clemente, director of Public Citizen's Congress Watch, "The AMA propaganda machine failed in Congress but succeeded in too many state legislatures. Far too many state lawmakers were hoodwinked by the AMA's false claims. It's unfortunate that the AMA succeeded in pulling the wool over the eyes of so many policymakers and the public."

The GAO compared conditions in five AMA-designated "crisis states" - Pennsylvania, West Virginia, Florida, Mississippi and Nevada - to four states that the GAO determined had no reported problems. Those were California, Colorado, Minnesota and Montana. The report was requested by three Republican House committee chairs who support restricting patients' legal rights.

The GAO also determined that the overall number of doctors in the AMA-designated in "crisis states" had not declined, echoing findings made by Public Citizen in reports on malpractice conditions in a dozen states released earlier this year. (The reports are available at http://www.medicalmalpracticefacts.org.

GAO investigators also determined that the AMA's claims that medical services were unavailable in particular areas were untrue. The investigators found that other factors, such as the rural character or economic circumstances of an area, created conditions that made it hard to attract or keep physicians.

The GAO report indicates that the AMA quarreled with these findings when shown the agency's first draft, but that GAO researchers concluded that the AMA complaints were unfounded. Although the AMA could have offered the GAO access to its own Physician Masterfile, which the AMA calls the most comprehensive source of physician data in existence, the AMA did not provide the data and instead quibbled with other methodological details. Among the findings of the GAO report, available at http://www.gao.gov/new.items/d03836.pdf:

In Florida, where Gov. Jeb Bush just shepherded a damage cap law to passage, "Reports of physician departures were anecdotal, not extensive, and in some cases inaccurate. For example, state medical society officials told us that Collier and Lee counties lost all of their neurosurgeons due to malpractice concerns; however, we found at least five neurosurgeons currently practicing in each county as of April 2003...[O]ver the past 2 years the number of new medical licenses issued has increased and physicians per capita has remained unchanged." (p. 17)
"In Nevada, 34 OB/GYNs reported leaving, closing practices, or retiring due to malpractice concerns; however, confirmatory surveys conducted by the Nevada State Board of Medical Examiners found nearly one-third of these reports were inaccurate...Random calls [GAO] made to 30 OB/GYN practices in Clark County found that 28 were accepting new patients...Similarly, of the 11 surgeons reported to have moved or discontinued practicing, the board found 4 were still practicing." (p.17)
"In Pennsylvania, despite reports of physician departures, the number of physicians per capita in the state has increased slightly during the past 6 years. The Pennsylvania Medical Society reported that between 2002 and 2003, 24 OB/GYNs left the state due to malpractice concerns; however, the state's population of women age 18 to 40 fell by 18,000 during the same time period." (p.18)
AMA "surveys" of doctors were not reliable. "Survey data used [by AMA] to identify service cutbacks in response to physician concerns about malpractice pressures are not likely representative of the actions taken by all physicians.-AMA recently reported that about 24 percent of physicians in high-risk specialties responding to a national survey have stopped providing certain services; however, the response rate for this survey was low (10 percent overall), and AMA did not identify the number of responses associated with any particular service." (p.20)

Public Citizen is a national, nonprofit consumer advocacy organization based in Washington, D.C. For more information, please visit www.citizen.org.