"One New Jersey specialist -- without a legal blemish on his practice record -- was finally able to secure insurance at the cost of $300,000 a year," Dr. Thomas Purdon, president of the American College of Obstetricians and Gynecologists (ACOG), told United Press International Monday.
"We are in a crisis situation," Purdon said at the annual meeting of ACOG in Los Angeles, Calif., as organization leaders issued a "Red Alert" -- warning that without relief from state and federal legislation many rural areas of the country will be without obstetricians.
Not only are doctors leaving the field, but hospitals are closing their maternity wards, and Purdon said the "ripple effect" is also reaching into academic institutions where recruiting experts to teach obstetrics and gynecology could be hamstrung as well.
ACOG leaders cited the states of Florida, Mississippi, Nevada, New Jersey, New York, Pennsylvania, Texas, Washington and West Virginia as being most in danger of losing obstetric care due to difficulty in getting insurance coverage.
For example, in Florida obstetricians have an average cost that exceeds $200,000 a year for insurance premiums if they practice in populous Dade (Miami) and Broward (Fort Lauderdale) counties, said Purdon, professor of obstetrics and gynecology at the Arizona Health Sciences Center, Tucson.
In Nevada, Purdon said 70 obstetricians in the Las Vegas-area are about to leave the state due to the withdrawal from the market of one of Nevada's largest liability insurers.
"In Mississippi, a pregnant woman in Yazoo City which has a population of 14,000 has to travel 150 miles to get prenatal care," Purdon said. "When a woman has to travel that far to get care, she isn't going to get care."
One solution, Purdon said, would be creation of national legislation to establish legal reforms such as those in place in California. Those laws impose a cap on non-economic -- that is, pain-and-suffering or punitive -- damages. "Insurance rates in California have remained stable for years there," he said.
Purdon said the "Red Alert" was issued to let the public and legislators know there is a crisis that is going to have a severe effect on obstetric care. He said similar crises exist for neurosurgeons and orthopedists and are evidence that "we need to have legal reform. We have to look for better solutions."
"Unlike previous crises in the 1970s and 1980s," said Dr. Albert Strunk, an administrative vice president for Washington, DC-based ACOG, "where cost was the issue, this time around there's the obstacle of finding any insurance coverage at all."
"When you enter the field of obstetrics and gynecology, you have to love what you do with a passion," said Dr. Charles Hammond, president-elect of ACOG and chairman of the department of obstetrics and gynecology at Duke University Medical Center, Durham, N.C., "because the liability threat will always be there, no matter how outstanding the care you provide."
Purdon said the New Jersey doctor he cited had left Eastern Pennsylvania because insurance was not available. Re-establishing his office in New Jersey, the doctor searched for 90 days before he could find insurance liability coverage -- at $300,000 a year.
That kind of liability insurance means the doctor "has to pay about $1,000 a day before he can even turn on the lights in his office and doesn't reflect what it costs for paying his nurses and rent," Purdon said. "A lot of doctors are finding that these types of expenses make it difficult to stay in business."
Hammond noted that 15 years have passed since the Washington-based Institute of Medicine warned that high liability costs were compromising delivery of obstetric care. "We still need reform at the federal and state levels," he said. "Band-Aid solutions won't work."