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The Honolulu Advertiser
Posted on: Thursday, December 11, 2003

Hawai'i faces possible shortage of doctors

By David Butts
Advertiser Staff Writer

Hawai'i could face a shortage of doctors in high-risk specialties unless physicians get relief from the high cost of liability insurance, the American Medical Association said.

The AMA, which held a policy-making meeting at the Hilton Hawaiian Village this week, released the results of a survey that shows medical students are beginning to decide where to live and what specialty to go into based on medical liability issues.

"It's very sad that medical students in Hawai'i and around the nation are being forced to make career decisions based on factors other than their passion for medicine and where they would receive the best training," said AMA Medical Student Trustee David A. Rosman in a statement.

The survey of nearly 4,000 medical students found that 39 percent said medical liability was a factor in their decision about where to live during residency training.

Hawai'i is one of 25 states considered by the AMA to be showing signs of a crisis, meaning medical malpractice insurance is rising rapidly. Medical liability insurance premiums increased 25 percent for Hawai'i physicians this year, the AMA said.

A doctor here specializing in the high-risk field of obstetrics and gynecology pays about $53,644 for medical liability insurance, the AMA said, quoting the Medical Liability Monitor.

Means to an end

Scott Kawamoto, a fourth-year medical student at the University of Hawai'i, said he worries about the high cost of malpractice insurance. Kawamoto, 25, is considering specializing in internal medicine because it is less risky and malpractice premiums are lower. He considers Hawai'i's liability environment better than in Boston, New York, Washington or Oregon. But if it gets worse, he would consider moving away.

"Medical school is a means to an end," Kawamoto said. "We are all in medical school so we can get jobs. We have to make money to support our families and ourselves. If it gets to the point where liability is compromising our ability to make a living, it is going to factor into our decision."

The AMA wants Congress to pass the "Patients First Act of 2003" that would put a cap of $250,000 on noneconomic damages in malpractice suits.

Opponents include the Consumers Union, publisher of Consumer Reports, which says "the act will not be effective in addressing what is a very real problem: skyrocketing medical malpractice premiums."

States that have caps on malpractice damages have not seen a drop in insurance premiums, studies show. "Moreover, it does nothing to address medical errors, while punishing the most vulnerable — women, children and the elderly — who have suffered serious injury because of malpractice and must rely on noneconomic damages most heavily since they often don't earn incomes," the Consumers Union said.

Mark Davis, a Honolulu lawyer specializing in medical malpractice representing plaintiffs, said, "The issue of medical errors is what causes medical malpractice."

Investments to blame

Bob Toyofuku, who represents the Consumer Lawyers of Hawai'i, said much of the blame for high medical malpractice insurance premiums lies with insurance companies. He said they raised rates to compensate for a drop in investment income, not because of higher claims resulting from lawsuits.

"The difference between the premium paid and the claims paid out is staggering," said Toyofuku. "You really need to look at this. Don't blame lawsuits."

Representatives from the HAPI Physician Indemnity Plan in Honolulu, a cooperative malpractice insurer, were not immediately available for comment. However, HAPI's Web site says its "approach to pricing is based on costs. There is no profit motive."

"Each specialty pays an assessment (premium) appropriate to their risk class, which is based upon industry and HAPI claims experience," according to the Web site.

Reach David Butts at 535-2453 or dbutts@honoluluadvertiser.com.